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Terms in this set (28)

Toilet Training

Toilet training: 2-3 years
voluntary control of the anal and urethral sphincters occurs at age 18-24 months.
Bowel training is less complex than bladder training; bladder training requires more self-awareness and self-discipline from the child and is usually achieved at age 2½-3½ years.

In addition to physiological factors, developmental milestones rather than the child's chronological age signal a child's readiness for toilet training. These include the ability to:
Ambulate to and sit on the toilet
Remain dry for several hours or through a nap
Pull clothes up and down
Understand a two-step command
Express the need to use the toilet (urge to defecate or urinate)
Imitate the toilet habits of adults or older siblings
Express an interest in toilet training
(Option 1) In order to achieve toilet training, the child will need to be able to pull clothing up and down but not necessarily dress and undress autonomously.
(Option 2) Having the child sit on the toilet until urination occurs is not appropriate and will not facilitate bladder control; any urination that occurs is accidental and not due to sphincter control. However, the child should have the ability to remain on the toilet for about 5 - 8 minutes without getting off or crying.
(Option 4) Age 15 months is too early to begin toilet training; voluntary control of the anal and urethral sphincters does not occur until age 18-24 months.
Educational objective:Readiness for toilet training is dependent on the child's ability to voluntarily control the anal and urethral sphincters, which usually occurs at age 18-24 months. Other developmental and behavioral indicators of toilet training readiness include the child's ability to express the urge to defecate or urinate, understand simple commands, pull clothing up and down, and walk to and sit on the toilet.
Some of the first stressors faced by children from infancy through the preschool years are related to illness and hospitalization. Separation anxiety, also known as anaclitic depression, particularly affects children age 6-30 months. There are 3 stages of separation anxiety: protest, when the child refuses attention from others, screams for the parent to return, and cries inconsolably; despair, when the child is withdrawn, quiet, uninterested in activities or meals, and displays younger behavior (eg, use of pacifier, wetting the bed); and detachment, when the child suddenly appears happy and interested in building relationships.
Nursing care of hospitalized clients experiencing separation anxiety focuses on maintaining a calm environment and a supportive demeanor to build trust between the nurse and the child, and encouraging connection with family and familiar environments, even when they are absent. Key interventions include:
Encouraging the parents to leave favorite toys, books, and pictures from home
Establishing a daily schedule that is similar to the child's home routine
Maintaining a close, calming presence when the child is visibly upset
Facilitating phone or video calls when parents are available
Providing opportunities for the child to play and participate in activities
(Option 3) When the child is visibly upset, it is important to provide a calming presence and implement strategies to reduce the child's anxiety. Leaving the child alone at such times can further increase stress.
(Option 5) Providing pictures of the child's family is actually beneficial, as it reminds the child of something familiar and safe.
Educational objective:Toddlers and preschool-age children experience separation anxiety in response to the stress of illness and hospitalization. Key nursing interventions to alleviate separation anxiety include encouraging the presence of favorite items, establishing a daily routine, providing opportunities for play, facilitating phone calls with the parents, and providing support when the child is upset.
FTT, or growth failure, is a state of undernutrition and inadequate growth in infants and young children. Most cases of FTT are related to an inadequate intake of calories, which can be tied to many different etiologies. Physiologic risk factors for FTT include preterm birth, breastfeeding difficulties, gastroesophageal reflux, and cleft palate. Socioeconomic risk factors include:
Poverty - most common
Social or emotional isolation - parents may lack the support system needed to assist them with the problems of child rearing
Cognitive disability or mental health disorder
Lack of nutritional education - parents may not have knowledge of proper feeding techniques or appropriate calorie intake based on age and size of the child
(Option 1) There is no known relationship between caregivers working outside the home and FTT. Caregivers who are fully employed may be more able to provide adequate food resources.
(Option 5) There is no indication that unmarried parents pose a higher risk for an infant to develop FTT. More important protective factors include having a stable environment and living with 2 parents.
Educational objective:FTT is a state of undernutrition and inadequate growth found in infants and young children. Physiologic risk factors for FTT include preterm birth, breastfeeding difficulties, gastroesophageal reflux, and cleft palate. Socioeconomic risk factors include poverty, social or emotional isolation, caregivers with cognitive disabilities or mental health disorders, and lack of nutritional education.
Play is an important developmental task of childhood and reflects the child's physical, social, and emotional health. Parallel play is independent play near other children with minimal group interaction and is typical of toddlers (age 12-36 months) (Option 1). Toddlers engaging in parallel play may share toys and verbalize thoughts, but they primarily focus on doing their own activities rather than directly interacting with others in organized play.
(Option 2) Toddlers engaging in parallel play may play with similar toys but are not directly influenced by the choices of other children. Preschoolers (age 3-5 years) are more likely to interact with each other and borrow each other's toys in associative play.
(Option 3) During solitary play, children play alone while focusing on their own activities but also enjoy interactions with familiar people (eg, parents) or objects (eg, favorite toy). This type of play is typical of infants (age <12 months).
(Option 4) During cooperative play, one or two children direct the activity and assign roles while others follow. This type of play is typical of school-age children (age 6-12 years) and may involve a formal game or task (eg, building a castle from blocks).
Educational objective:Toddlers typically engage in parallel play, which is characterized by independent play alongside other children. Minimal interaction is observed between children during parallel play because toddlers focus on their own activities rather than interact with others in organized play.
The sequence of examination steps for infants requires a different approach than the typical head-to-toe order used for older clients. The steps are altered to accommodate the developmental needs of the infant, minimize the infant's stress, and increase assessment accuracy.
The correct order of assessment in infants is:
Before handling the infant, the nurse first observes the infant for activity level, skin color, and respiratory rate and pattern to obtain findings during a calm state (Option 4).
Auscultation is performed next while the infant is still quiet, allowing the nurse to hear sounds clearly (Option 2).
Palpation and percussion are then performed while the infant remains relatively still. This allows the nurse to accurately assess the abdomen while the abdominal muscles are relaxed. The fontanelles are also palpated while the infant is calm, as crying can cause temporary bulging (Option 5).
Traumatic procedures (eg, examine eyes, ears, mouth) are performed near the end of the assessment after completing any procedures that require accurate observation or counting (Option 1).
Elicitation of the Moro reflex (ie, reflexive startle and cry to a sudden dropping or jarring motion) is performed last because the infant is usually awake and moving around by this point (Option 3).
Educational objective:When assessing an infant, the nurse should observe, auscultate, palpate, and then perform traumatic procedures (eg, examine eyes, ears, mouth). Elicitation of the Moro reflex should be performed last.