I APPROVED

Deputy Director for SD of the State Budgetary Educational Institution "Paramedic College"

N.P. Belokoneva

"___" _____________ 2014

Methodological development of a practical lesson

For 3rd year nursing students

Topic: “Nursing care for rickets”

Compiled by: teacher

Pediatrics SchisterT. AND . Considered at a meeting of the pediatric central medical committee

protocol no.

Chairman of the Central Committee

Saint Petersburg

year 2014

/ /

1. Place of the lesson, equipment

The lesson is held in a preclinical office, in a children's clinic

Equipment: equipment for a preclinical office, an office in a clinic

Chalk, board

- Phantom dolls “Child with signs of rickets”

Folders with didactic material for 9 workstations (scheme tables, algorithms, analysis forms, selections of medicinal substances) -

Offices in a children's clinic

Situational tasks (see below)

Manipulation equipment (see appendix)

Video equipment and video materials

Presentations:

Videos: “Care for infant", "General massage for children 1-2 years of age", "Breastfeeding"

2. Duration of studying the topic

Duration of topic study: 6 academic hours

Duration of this lesson: 6 academic hours (270 minutes)

3. Relevance of the topic

In recent decades, diseases that arise as a result of a deficiency of certain vitamins, macro- and microelements remain relevant. Deficiency conditions represent an important problem in pediatrics. Among them, special attention is paid to rickets. Infant rickets is not only a pediatric problem, but also a medical and social one. has serious consequences causing high morbidity in children. Severe forms of rickets are relatively rare in our country due to the improvement in the material well-being and culture of the population, stricter compliance with sanitary and hygienic standards,preventive measures.

Studying the topic “Nursing care for rickets” contributes to the formation of the following competencies:

OK 2. Organize your own activities, choose standard methods and ways of performing professional tasks, evaluate their effectiveness and quality.

OK 6. Work in a team and team, communicate effectively with colleagues, management, and patients.

OK 12. Organize the workplace in compliance with the requirements of labor protection, industrial sanitation, infection and fire safety.

PC 2.3. Perform therapeutic interventions

PC 2.1. Implement a treatment program for patients with rickets.

• MAIN OBJECTIVE OF THE CLASS:on the basis of theoretical knowledge, form practical skills, perform manipulations, form elements of competencies, form (professional skills necessary for mastering subsequent academic disciplines etc.)..

1. OBJECTIVES OF THE LESSON:

• Educational: introduce the features of nursing care (this is a PC implementation) PC 2.2 – PC2.6
• Developmental ( this is the implementation of OK) - the ability to compose and analyze
• (develop independent skillswork, promote the development of memory, the ability to highlight the main thing, logic, the ability to search, transfer knowledge to new conditions, thought processes: analysis, synthesis, comparison, mental activity, observation, accuracy of actions, the ability to analyze one’s mistakes, establish cause-and-effect relationships, express your thoughts. promote motivation…. )

Forming the ability to organize your own

Activities to evaluate their implementation and quality. OK 2.

Formation of the ability to search, analyze and

Assessing the information needed to set up and

Solutions to professional problems, professional and

Personal development. OK 4.

Educational ( this is the implementation of OK): OK.1 - OK.14 and

(PC):

PC 2.8.

Formation of professionally significant personality qualities through the subject

4. Lesson objectives

Forming the ability to organize one’s own activities, choose standard methods and methods of performing professional tasks, evaluate their implementation and quality. OK 2.

Forming the ability to search, analyze and evaluate information necessary for setting and solving professional problems, professional and personal development. OK 4.

Organize the workplace in compliance with the requirements of labor protection, industrial sanitation, infection and fire safety OK 12

OK 6. Work in a team and team, communicate effectively with colleagues, management, patients.

Educational – implementation OK, PC

	Professional quality	Possibilities of their formation through
	Organization	when organizing a work place, preparing for manipulation
	attentiveness, tact, responsibility, patience, self-confidence.	when performing a procedure, examining a patient, communicating with each other
	Perseverance, accuracy, respect for the workplace and tools

PC 2.1. Determine a prevention program for patients with rickets.

PC 2.2. Determine patient management tactics.

PC 2.3. Perform therapeutic interventions.

PC 2.5. Monitor the patient's condition.

lesson objectives		student should know	the student must be able to	the student must own
	Organize your own activities, choose standard methods and methods of performing professional tasks, evaluate their effectiveness in case of rickets	Causes, mechanism of development and risk factors for the development of rickets. Basic methods prevention, diagnosis and treatment of rickets. spasmophilia, hypervitaminosis D	Determine tactics for managing a patient with rickets, hypervitaminosis D and carry out the nursing process and prescribe treatment within the limits of professional competence
	Work in a team and team, communicate effectively with colleagues and patients (in the context of this topic). With rickets		Provide advisory assistance to the patient’s environment and family. Collaborate as part of the treatment team.
	Organize the workplace in compliance with the requirements of industrial sanitation and infection safety		Ensure infection safety of patients and staff.
	Determine tactics for managing a patient with rickets.	Clinical manifestations of rickets (main complaints, medical history that may indicate the development of rickets)	Determine patient management tactics and prescribe treatment within professional competence.
	Carry out medical interventions as prescribed by a doctor.	Principles of treatment and prevention of rickets		perform the necessary manipulations
	Monitor the patient's condition with rickets.	Complications and principles of emergency care for spasmophilia, hypervitaminosis D	Complications and principles of emergency care for spasmophilia, hypervitaminosis D, laryngospasm
	Prepare medical documentation	Prepare medical documentation	Prepare medical documentation

5. Motivation

The knowledge and skills acquired in the lesson are necessary when studying other topics, as well as in the future when working with patientspediatricprofile with symptoms similar to those

6. Intersubject and intrasubject connections

7. Self-study assignments

Review covered topics:

AFO of the bone, nervous, muscular, endocrine systems

Mandatory:

Basic literature for students.

Svyatkina K., Belogorskaya E. Childhood diseases. - M.: Medicine, 1987.

Bisyarina V. Diseases of childhood. - M.: Medicine, 1974.

Lecture notes.

1. Your family doctor. - M., 1992.

2. Children's diseases, ed. A.M. Zaprudnova. - M., 1997.

3. Dynamic monitoring of the condition of a healthy child first

3 years of life, ed. V.N. Artemyeva. - Omsk, 1993.

4. General medical practice. Volume 1. - St. Petersburg, 1996.

Additional literature.

Ezhova N., Rusakova E. Pediatrics. - Minsk: Higher School, 2003.

Questions for self-study:

1 . Name the main causes and predisposing factors for the development of rickets.

2. Describe the main clinical symptoms of rickets depending

3. What

What is antenatal and postnatal prevention of rickets?

7. Define hypervitaminosis D.

8. Reasons, mechanism of development of hypervitaminosis D.

9.Describe the clinical manifestations of hypervitaminosis D.

10.What is the prevention of hypervitaminosis D?

11. How assistance is provided in case of emergency conditions

12. Name the basic principles of treatment of hypervitaminosis D.

13.Nursing process in the prevention and treatment of rickets.

Stages of planning and course of the lesson.

	Lesson stages	The goal of the activity is methodological logical justification)	Summary activities teacher	Summary activities students	Time (min.)	Equipment
	Organizational Stage	Mobilization of students to work, activation attention.	Checking appearance, presence of notebooks, readiness for classes	Preparation to class. The foreman reports to the teacher about those present.		Brigade magazine. Notebook mani- populations, tests
	Formulation And justification of the topic, the purpose of the lesson. Lesson plan.	Formation of a hollow residential motivational activities	Explanation of relevance Topics, goals and lesson objectives. Formulation of final results - activities Lesson plan	Beginning of the summary on the topic being studied		See appendix Nie
	Preliminary knowledge control	Identification of the initial level of knowledge to prepare for the lesson.	Carrying out testing - According to the studied theoretical material	Answer test questions		See appendix Nie
	Formation of new skills and abilities. Unlearning practical manipulations. Repetition of already known skills from the topic “Healthy Child”	Practical training skills and abilities in accordance goals of the lesson. Consolidation of known practical skills	Providing handouts. Demonstration practical manipulation. Teacher briefing. Corrective control.	Independent student work: work with distribution precise material, practicing practical manipulations after explanations feeder		See appendix tion
	Application of acquired knowledge and skills in practice. Consolidation acquired practical skills.	Checking the degree student mastery practical man- populations	Learning manipulations by students under the supervision of a teacher. Working in small groups	Practicing manipulations for assessment		See appendix Nie
	Independent work of students	Helps to understand the significance of the topic for further work on providing preventive and therapeutic care to children	Organization of the solution situational students Tasks and role-playing, business games	Solving situational Tasks, role-playing. business games. All stages of the nursing process are practiced		See appendix Nie
	Final control	Generalization and consolidation of what has been learned material control mastering knowledge	Conducting a final test work with grading	Demonstration of acquired in class knowledge in the test work		See appendix Nie
	Summarizing Classes	Conclusions of the practical lesson	Evaluation of student work, summing up, grading, homework	Completing the outline recording homework nia		See Attachment

Business games : after training in practical skills

students begin the final stage of practicing practical skills and solving problems, business games. The essence of the business games offered to students is as follows:. Students are asked to break into groups of 3 people and role-play the following situations:

1. Nurse Natalya provides patronage to a pregnant woman, Lena, who is very happy about her pregnancy and carefully monitors her health. The pregnancy is 36 weeks. Lena asks to tell and teach her about antenatal prevention of rickets in an unborn child because she heard about the serious consequences of rickets….

Lena’s mother joins the conversation and recalls that her daughter had rickets when she was 1 year old (lists the symptoms) and that she developed worse than her peers

2. June 25 Nurse Natalya provides patronage to a 4-month-old child. Grandparents are at home with the child. Mom is away. Complaints of decreased appetite, regurgitation, drowsiness. The skin is dry, with a grayish tint. After a detailed questioning of the grandparents about the daily routine, nutrition, care, preventive measures carried out for the child, the nurse has an assumption about the cause

symptoms that have arisen. She transmits the information to the local doctor and waits for the doctor to arrive.

Extracurricular independent work of students:

1. Write an essay on the topic “Anomalies of the constitution.” Features of nursing care

2. Create an expert map of the nursing process for exudative-catarrhal diathesis

6. Questions for self-preparation of students on this topic for a practical lesson.

Define "rickets".

Name the main reasons, predisposing factors

The mechanism of development of rickets.

Describe the main clinical symptoms of rickets in

Depends on the period of the disease and severity.

Specify laboratory methods, confirming the diagnosis of rickets.

What are antenatal and postnatal, specific and

Nonspecific prevention of rickets.

How is rickets treated?

What are the features of nursing care for rickets?

Name the violated needs, problems with rickets

Indicate the essence and reasons for the development of spasmophilia.

Describe the clinical forms of spasmophilia (latent and

Explicit).

Name the violated needs, problems with spasmophilia

How is emergency first aid provided?

For laryngospasm, convulsions.

What are the features of nursing care?

For spasmophilia.

Define hypervitaminosis D.

Causes, mechanism of development of hypervitaminosis D.

Describe the clinical manifestations of hypervitaminosis D.

What is the prevention of hypervitaminosis D?

What are the basic principles of treatment of hypervitaminosis D?

Name the impaired needs, problems with hypervitaminosis D

What are the features of nursing care for hypervitaminosis?

7. Educational card independent work

Stages of independent work	Working methods	Questions for self-control
1.Organization of the workplace for manipulation No. 1	Prepare everything necessary for manipulation No. 1	What needs to be prepared to perform manipulation No. 1.
2.Perform manipulation No. 1	See manipulation algorithm No. 1 Pine-salt bath	1What underlies the development of rickets. 2.What are the characteristics of changes in the nervous system during rickets? 3.What effect does a salt-pine bath have?
3.Organization of the workplace for manipulation No. 2	Prepare everything necessary for manipulation No. 2	What you need to prepare to perform manipulation No. 2
4. Performing manipulation No. 2	See manipulation algorithm No. 2 Sulkowicz test	1 What are the characteristics of changes in the skeletal and muscular systems during rickets? 2.How to properly dose and store vitamin D 3.Complications of an overdose of vitamin D
5. Organization of the workplace for manipulation No. 3	Prepare everything necessary to perform manipulation No. 3	1.What needs to be prepared to perform manipulation No. 3
6. Performing manipulation No. 3	See manipulation algorithm No. 3 Emergency care for laryngospasm	1.What is the reason for the development of spasmophilia? 2.What is laryngospasm 3. Complications of laryngospasm
7. Organization of the workplace for manipulation No. 4	Prepare everything necessary to perform manipulation No. 4	What you need to prepare to perform manipulation No. 4
8. Performing manipulation No. 4 9. Organization of the workplace For manipulation No. 5 10. Performing manipulation No. 5	See manipulation algorithm No. 4 Providing emergency Help with seizures Prepare everything necessary to perform manipulation No. 5 See manipulation algorithm No. 5 Installation of the gas outlet tube	1. What are cramps? 2. Complications of a seizure 3.How anticonvulsants are administered drugs? What you need to prepare to perform manipulation No. 5 1.What is flatulence? 2. Clinical signs of flatulence 3.Help with flatulence
11. Role-playing games, solving situational problems, tests	See handout	What needs to be taught to the child’s relatives

Independent work is performed in small groups (2-3 people each)

Type of control:

Self-control

mutual control

Teacher control

Preliminary control: testing, Final control:solving situational problems, role playing games, testing

8 . CM. application

Control program

to identify the baseline

to identify final control

9 (Basic literature for students.

Tulchinskaya V., Sokolova N. Nursing case in pediatrics.-

Rostov-on-Don: Phoenix, 2011.

Ezhova N.V. Pediatrics, Textbook N.V., Ezhova, E.M. Rusakova.-: Onyx,

2010.-592pp.

Kosyrev V.P. General and clinical pharmacology: textbook

For medical schools and colleges….-Rostov on

/D PHOENIX, 2010.- 477 p.

Sevastyanova N.G. Nursing in pediatrics: Textbook-M. FGOU;

"VUNMC" of Roszdrav, 2008..

Lecture notes.

Additional literature.

Nurse's reference book for care. - M.: Medicine, 1974

Sokolova N., Tulchinskaya V. Nursing in pediatrics. Workshop-R-n-D: Phoenix

Ezhova N., Rusakova E. Pediatrics. - Minsk: Higher School, 2003

Literature for teachers:

1L.V Erman. Directory of a local pediatrician. - St. Petersburg 2010 167 p. 2.Ivaneev M.D. Primary care and neonatal resuscitation. Practical guide. - St. Petersburg.. 2000

3. Children's diseases, ed. A.M. Zaprudnova. - M., 1997.

4. Shabalov N.P. Childhood diseases. - M., 2000

5. Congenital infections: Tutorial. Golubeva M.V. Barycheva L.Yu. Stavropol 2013 .288с

6. Emergency conditions in internal diseases. Shaytor V.M. 2010.

7. Pharmateka. Peer reviewed journal

8.Emergencies in children.Training manual under

Edited by Prof. L.F. Kaznacheeva. Novosibirsk. 2009.77 p.

9.Doskin V.A.. Kosenkova T.V. Polyclinic pediatrics. - M., 2002.

10. Tulchinskaya Z.V. Sokolova N.G. Nursing in

Pediatrics. Rostov-on-Don: Phoenix2001.

10.Applications

Annex 1

Entrance test

RICKETS. SPASMOPHILIA

Task: Choose the correct answer

1) D

2) C, B, RR, K

3) B1, RR, A, K, B

3. Children suffer from rickets:

3) full-term from 3 months. up to 2 years, premature babies from 1 month.

hypochromic anemia, decreased calcium and phosphorus levels

2) leukocytosis, accelerated ESR, eosinophilia

6. To treat and prevent rickets, you must enter into the menu (for a child):

7. The initial period of rickets lasts from:

1) 3-5 days to 1 month.

2) 2-3 weeks to 2-3 months

3) 1-2 months to 1 year

1) rickets.

2) omphalitis

3) sepsis

9. Laryngospasm is:

10. Spasmophilia happens:

1) explicit and hidden

2) acute and chronic

"3" - 3 errors

“2” - 4 errors or more

Appendix No. 2

Final control

PROGRAMMED CONTROL ON THE TOPIC. "RICKETS

IN CHILDREN"

1) in early childhood,

2) in preschool age,

3) at school age.

1) protein

2) fat

3) mineral

4) carbohydrate

1) vitamin D deficiency,

2) the nature of feeding,

3) gastrointestinal diseases,

4) infectious diseases,

5) time of year,

6) climate,

7) blood type,

8) heredity.

1) nervous system,

2) musculoskeletal system,

3) lymphatic system,

4) hematopoietic system,

5) ligamentous apparatus.

1)excessive sweating,

2)vomiting

3) timidity,

4) anxious, restless sleep,

5) loss of body weight.

1) craniotabes,

2) habitual bone fractures,

3) head deformation,

4) late and incorrect teething,

5) chest deformation,

6) dwarf growth.

7. Symptoms of damage to the muscular system and ligamentous apparatus

For rickets:

1) muscle pain,

2) loose joints;

3) muscle hypotonia,

5) muscle hypertonicity.

1) incubation,

2) initial,

3) prodromal,

4) the height of the disease,

5) convalescence

6) residual effects.

A. Nonspecific:

2) hardening procedures,

3) giving vitamin D,

4)massage and gymnastics,

5)compliance with hygiene rules,

6)protecting the child from contact with

Infectious diseases.

B.Specific:

1) giving vitamin D supplements,

2)UV irradiation,

3) antibiotics,

4) sulfonamides.

10. Treatment of rickets

1) rational feeding,

2) giving vitamin D preparations,

3)hormone therapy,

4) multivitamins,

5) salty, pine baths,

6)massage, gymnastics,

7) antipyretics.

Answers: Evaluation criteria:

"5" - -1 error

1- 1 “4”-2 errors

3-1 2 3 4 5 6 “3”-3errors

5-1 3 4

6-1 3 4 5

7-2 3 4

8-2 4 5 6

9-A-1 2 4 5 6

B-1 2

10-1 2 4 5 6

Appendix No. 3

Manipulation algorithm

1. Algorithm for salt-pine bath

2. Sulkowicz test algorithm

3. Algorithm for providing emergency care for laryngospasm

4. Algorithm for providing emergency care for seizures

5. Algorithm for installing a gas outlet tube

Manipulation No. 1

Algorithm carrying out pine-salt baths on a phantom

Target:

Indications: increased nervous excitability

Contraindications: violation of the integrity of the skin

Equipment:

Possible patient problems:Negative attitude towards manipulation.

Subsequence actions

Salt baths are used for treatment of rickets in children older than 6 months. To prepare a salt bath, 50-100 g sea ortable salt dissolve in 10 liters of water. Duration of baths is 3-10 minutes. at t° 36-37°. After the bath, the child is doused with fresh water. The course of treatment is 15-20 baths, 2-3 times a week. Contraindicated for malnourished and weakened children, as well as for skin diseases.

Pine baths used for increased excitability,insomnia , rickets and malnutrition. Prepare at the rate of 1 tablespoon of pine extract per 2 buckets of water. Duration of baths is 5-10 minutes. at t° 35-36°. Baths are carried out every other day, the course of treatment is 20 baths. For rickets, pine-salt baths are often used (for 2 buckets of water, 200 g of salt and 1 tablespoon of pine extract

Manipulation No. 2

Sulkowicz test algorithm.

Target: detect hypercalciuria

Indications: taking therapeutic doses of vitamin D

Contraindications: no

Equipment: Sulkowicz's reagent, test tube, patient's urine

Urine analysis according to Sulkovich (Sulkovich's test) - qualitative content analysiscalcium V urine (level calciuria ). Used inpediatrics as a preliminary test for calcium excretion in urine, or to monitor the correct selection of the therapeutic dosevitamin D in order to avoid overdose. Proposed by an American endocrinologist. For the Sulkovich analysis, a sample of the child’s morning urine collected on an empty stomach (before the first morning feeding) is needed.

Evaluation of the results obtained: a negative result ("-") may indicate a deficiencyvitamin D in children, or whenhypoparathyroidism (with a parallel blood test it is determinedhypocalcemia An indicator from “+” to “++” is considered normal. The result “+++” or “++++” indicates excessive excretion of calcium in the urine, for example whenhyperparathyroidism urinary calcium excretion can reach 200 mg/day

Manipulation No. 3

Algorithm for providing emergency care for laryngospasm

Goal: restore breathing

Inform

relatives about the disease, about its connection with rickets

Calm mother and child

unbutton tight clothes

It is mandatory to administer intravenous calcium gluconate 1.0 per year of life.

In case of cardiac arrest, perform indirect cardiac massage

After restoring breathing, drink tea, fruit juices

5-10% calcium chloride solution orally

Manipulation No. 4

Algorithm for providing emergency care for seizures.

Goal: relieve cramps

Equipment:

- drugs: seduxen 0.5% solution, droperidol 0.25% solution,

GHB 20% solution. Alcohol70%

Syringe, needles

Gloves

Barrel tray, cotton balls

Gag

Place the child on a flat, soft surface

Free yourself from restrictive clothing

Provide access to fresh air

Administer anticonvulsants:

Seduxen 0.5% r – r. 0.1 ml/year of life or

Droperidol 0.25% solution – 0.1-0.2 ml/year of life or

GHB 20% solution –0.5 ml/kg

If intravenous injections are not possible, use

As an emergency measure for administering medications to muscles

Bottom of the cavity bottom. Algorithm:

Tilt the patient's head back

In the subgenital area on the midline they look for

the middle of the distance between the edge of the lower jaw and

hyoid bone

Seduxen is injected intramuscularly into this place (total volume

No more than 3 ml

Nursing care for rickets

Goal: to prevent the development of a pronounced clinical picture of the disease and the addition of concomitant diseases.

	Rationale
1.Inform relatives about the disease and its possible consequences
2. Provide the child with a complete balanced diet with the obligatory inclusion in the diet of foods rich in vitamins (especially vitamin D), calcium	Rickets is a polyhypovitaminosis with a predominant deficiency of vitamin D, resulting in a tendency to decrease calcium in the child’s body
3. Ensure that the child stays for a long time fresh air in the “lace shade of the trees.”	Ensures the production of vitamin D in the child’s skin under the influence of UV rays The “lace shade of trees” blocks infrared rays and prevents the child from overheating.
4. Organize daily gymnastics massage for the child.	With rickets, muscle hypotonia is noted.
5. Take measures to prevent the addition of concomitant diseases.	Rickets is an unfavorable premorbid condition.

Nursing care for spasmophilia.

Goal: to prevent the development of seizures in children

Nursing intervention plan	Rationale
1. Inform relatives about the disease and its connection with rickets	The right of relatives to information is ensured Relatives understand the advisability of carrying out all care activities
2. Provide the child with a diet high in calcium	The development of spasmophilia is based on calcium deficiency
3. Eliminate cow's milk from your diet	When drinking cow's milk, the absorption of calcium in the intestine is disrupted.
4. Organize a protective regime for the child	Any irritant can cause an attack of convulsions in a patient with spasmophilia
5. Provide measures to eliminate rickets	Spasmophilia - rickets tetany, that is, “there is no spasmophilia without rickets”

Situational tasks

1. While caring for a 2.5 month old child who had recently arrived from the North, it turned out that the boy was restless, during sleep, feeding, crying, he sweated, rubbed his head on the pillow, the hair on his head was frayed, in other words

baldness of the back of the head. Shudder at the slightest sounds. The child is bottle-fed and receives unadapted formulas.

Medical diagnosis: Rickets, initial period.

Exercise:

1.Identify problems (real and potential).

2.Define goals.

3.Draw up a care and observation plan.

2. A 6-month-old child is being observed for rickets.

Artificial feeding from birth, living conditions are poor, and the mother does not follow the doctor’s recommendations. He does not give vitamin D regularly, he practically does not take the child for walks,

Complementary food in the form of porridge. The child suddenly began to have convulsions and lost consciousness. The face is pale with a cyanotic tint. Convulsive twitching of the facial muscles, sometimes spasms of the whole body with stretching of the limbs, especially the hands and feet. The child is pasty, overnourished, with pronounced manifestations of rickets.

Exercise:

1. Explain what is causing the child’s condition.

3.Define goals

3. The child is 3 months old. She is bottle-fed, does not walk much, does not receive massages or gymnastics. The boy became restless, often wakes up and shudders. There is baldness on the back of the head, the edges of the large fontanelle are pliable, the sweat has a “sour” smell.

Exercise:

2.Identify problems (real and potential).

3.Define goals.

4. On July 15, while visiting a 6-month-old child, the nurse found out that the child had recently become irritable and restless. Appetite has decreased and vomiting occurs frequently. I haven’t gained any weight. There was a tendency to constipation, low-grade fever. The big spring has closed. According to the mother, the daily routine is observed, the child walks in the fresh air a lot.

She is artificially fed and receives adapted formulas. A week ago, a course of ultraviolet radiation was completed, and now the child is taking a vitamin D alcohol solution, and when examining the bottle with vitamin D, it turned out to be open and exposed to the light.

Exercise:

1. Explain what is causing the child’s condition.

2.Identify problems (real and potential).

3.Define goals.

4.Draw up a care and observation plan.

5. An 11-month-old child was admitted to the hospital with a diagnosis of obvious spasmophilia, laryngospasm. Rickets II subacute course, repair period. It turned out that while crying, the child suddenly turned blue and lost consciousness, stretching out his legs and arms. His mother brought him to the open window. Breathing was restored. He regained consciousness, cyanosis, and the convulsions disappeared after 2-3 minutes.

From the anamnesis it is known: a child from 1 month. is on artificial feeding, receives unadapted formulas, complementary feeding mainly with cereals, juices, fruits and vegetables extremely rarely. Walks are irregular. On examination, pronounced symptoms of rickets, a period of reparation, increased neuromuscular excitability

Exercise:

1. Explain what is causing the child’s condition.

3.Define goals.

6. A district nurse is caring for a 3.5 month old child. A nursing examination revealed that the child was born at term, pregnancy and childbirth proceeded without any special features. Heredity is not burdened. Breastfed for up to 2 months, then artificially fed with whole cow's milk and formula. In the last 2 weeks, the child became restless, capricious, had trouble sleeping, and began to sweat. On examination, the skin is pale, moist, the edges of the large fontanelle are pliable, the back of the head is bald.

Exercise:

1. Explain what is causing the child’s condition.

2.Identify problems (real, potential, priority).

3.Define goals.

4.Draw up a care and observation plan.

7. A 1-year-old child receives vitamin D through vitamin supplements. Yesterday I started vomiting. I didn't sleep well at night. In the morning, short-term cramps were noted. The emergency doctor diagnosed hypervitaminosis D.

Exercise:

1. Explain what is causing the child’s condition.

2.Identify problems (real, potential, priority).

3.Define goals.

4.Draw up a care and observation plan.

8. A nurse is actively visiting a 1-year-old child after an emergency call. According to the mother, an unusual tense position of the hands appeared in the evening, the child screamed and turned blue. An emergency physician diagnosed spasmophilia. On examination, pronounced manifestations of rickets: “rosary beads”, “bracelets”, “square” skull. It turned out that the doctor’s recommendations regarding the treatment of rickets were carried out carelessly, the child did not receive vitamin D regularly, and there was little vitamin D on the street.

Exercise:

1. Explain what is causing the child’s condition.

2.Identify problems (real, potential, priority).

3.Define goals.

4.Draw up a care and observation plan

9. A 10-month-old girl suffering from rickets began to cry while playing, then let out a loud, moaning breath like a “cock’s crow”, after which her breathing stopped and the girl fell. The nurse came running and saw small convulsive twitching of the girl’s limbs.

Exercise:

1. Explain what is causing the child’s condition.

2.Identify problems (real, potential, priority).

3.Define goals.

4.Draw up a care and observation plan.

10. At a preventive appointment, a grandmother with her one-year-old grandson, whom she took from his drunken parents. Complains that the child is lethargic, adynamic, eats poorly, sleep is disturbed, and lags behind his peers in development. He is fed mainly with unadapted formulas and cereals, randomly. Doesn’t go for walks, didn’t receive massage or gymnastics.

On examination: Current body weight is 8 kg (3 kg at birth). The child is lethargic, the cry is weak. Skin pale, tissue turgor is reduced. Severe sweating, sweat has a sour smell. The muscles are hypotonic. Noteworthy are baldness and flattening of the back of the head, protruding frontal and parietal tubercles, a deformed chest (the “shoemaker’s chest”), the “rosary” symptom, the “bracelet” symptom. Zubov-2. Legs are O-shaped. Breathing is puerile, no wheezing, RR 35/min. Heart sounds are rhythmic, systolic murmur at the apex, heart rate 120 per minute. The belly is large, “frog-like”. Flatulence. Liver +2.5 cm from under the edge of the costal arch. The spleen is not palpable. There is no stool during examination, urination is not impaired.

Psychomotor development: stands with support, but does not step over. Doesn't sit up on his own. Mostly lying down. Pronounces individual syllables.

Exercise:

1. Explain what is causing the child’s condition.

2.Identify problems (real, potential, priority).

3.Define goals.

4.Draw up a care and observation plan.

11. Visiting the local nurse to a 10-month-old child suffering from rickets. During the examination, the girl began to cry, then emitted a loud, moaning breath like a “cock crow”, after which cyanosis and cold sweat appeared.

Exercise:

1. Explain what is causing the child’s condition.

2. Identify problems (real, potential)

3.Define goals.

4.Draw up a care and observation plan.

Sample solution to the problem:

The child's condition is associated with the development of laryngospasm (an obvious form of spasmophilia). The provocation was the child’s crying during examination.

The real problems:

breathing problems (laryngospasm)

Potential problems:

Recurrence of the attack

Death

Providing emergency care for laryngospasm

Goal: restore breathing

1. Reassure mother and child

- place the child on a flat surface

-unfasten tight clothing

- provide access to fresh air

-create a calm environment

-sprinkle the child’s face and body with cold water

- cause irritation of the nasal mucosa (tickle with a cotton swab, blow into the nose, bring ammonia,

-apply a reflex effect on the root of the tongue and

the back wall of the pharynx (press the root of the tongue with a spatula)

- if necessary, perform artificial respiration until the first breath is taken

-It is obligatory to administer intravenous calcium gluconate 1.0 per year of life

-In case of cardiac arrest, perform indirect cardiac massage

-.After breathing has been restored, drink tea or fruit juices

- after breathing has been restored, administer oxygen therapy

-5-10% calcium chloride solution orally

-In the diet, fermented milk mixtures, increase the amount of vegetable puree,

- 3-4 days after taking calcium supplements and the disappearance of signs of spasmophilia, carry out antirachitic treatment

12. A local nurse caring for a 4-month-old child who is receiving specific treatment with vitamin D for rickets found out that the child last days became restless, often wakes up, refuses to eat, spits up, and has unstable stools. When monitoring the administration of the drug, it turned out that the mother gives the child a 0.5% alcohol solution of ergocalciferol, 2 drops daily, instead of an oil solution of vitamin D.

Exercise:

1. Explain what is causing the child’s condition.

2.Identify problems (real and potential).

3.Define goals.

4.Draw up a care and observation plan.

Sample solution to a problem

1. The deterioration of the child’s condition is associated with an overdose of vitamin D, since 1 drop of an alcohol solution of vitamin D is 4000 IU

2.real problems

anxiety

loss of appetite

regurgitation

stool instability

3.Potential problems

delay in physical and psychomotor development, risk of developing calcification, pyelonephritis

• 13. The child is 10 months old, birth weight 3,200 g. Now the weight is 9,200g. From 3 months on artificial feeding. Receives unadapted mixtures. Upon examination, the child is lethargic, appetite is reduced, and sleep is disturbed. The child has anxiety, severe sweating with sour smell. The head is square in shape, the back of the head is sloping. Large fontanel 3.0 x 3.0 cm, soft edges. Craniotabes.Teeth 2. “Beads” on the ribs, “bracelets” in the area of ​​the wrist joints, “strings of pearls” on the phalanges of the fingers. Severe muscle hypotonia, “loose” joints, X-shaped shins. The liver is 3 cm below the costal arch. The abdomen is swollen, gases pass poorly. The child practically does not sit down on his own, does not sit confidently, gets up with support, does not walk. Upon questioning, it turned out that the doctor’s orders for rickets were not being followed. Medical diagnosis: rickets III, peak period, subacute course.

1. Identify violated needs.

2.Identify problems (real, potential, priority).

3.Define goals.

4.Draw up a care and observation plan

Sample solution to a problem

Violated needs

-There is

- highlight

-sleep

-be clean

-move

-to be healthy

The problems are real

sweating

anxiety

sleep disturbance

flatulence

loss of appetite

teething disorder

delay in psychomotor development

Priority problems

anxiety

loss of appetite

flatulence, sleep disturbance

sweating

Potential problems

progression of rickets

progression of psychomotor and physical development delays

association of intercurrent diseases

Problem	Target	Monitoring and care plan	Grade
1.Sweating	Reduce sweating	1. Organize a daily routine (walks, massage, gymnastics, protect the child from drafts and hypothermia). 2. Regular change of linen. 3. Diet - use only adapted mixtures containing vitamin D 4. Carry out pine-salt baths	Sweating has decreased
2. Anxiety, sleep disturbance	Normalization of sleep	1. Organize a daily routine with frequent walks and sleep in the air. Protect the child's sleep (exclude noise). Make the bed and change linen more often 2. Before going to bed, take hygienic and soothing baths.	The child falls asleep quickly. Sleep restful, normal duration.
3. Flatulence	Reducing bloating and passing gas. Regular stool	1. Before feeding, place the baby on his stomach for 5-7 minutes. Perform a light abdominal massage in a clockwise direction. 2Carry out gymnastics 3.If gases accumulate, use a gas outlet pipe. 4. Use carminatives (herbal infusions) as prescribed by a doctor.	Gas and stool pass regularly, no bloating is observed
4.Impaired teething	Normalize the timing of order and teething	1. Diet - the diet requires vegetable puree, juices, yolk, meat puree 2.Long stay in the air, 3.Teach the mother and monitor vitamin D intake (frequency, dosage) 4.Give a referral for the Sulkovich test. Explain to the mother the need to monitor calcium in the urine.	The timing and order of teething are normalized
5. Delay in psychomotor development	Psychomotor development will correspond to the child’s age	1. Carefully assess the child’s psychomotor development 2. Organize a daily routine (massage, gymnastics, walks, lying on the stomach, more often induce a revitalization complex, take the child in your arms, sing, talk to him) 3. Carefully protect the child’s sleep (ventilate the room before bedtime, exclude noisy games before bedtime). 4.Teach parents how to conduct massage, gymnastics, therapeutic baths (pine, salt), which normalize the nervous system. 5.If necessary, arrange a consultation with a neurologist.	Psychomotor development of the child age appropriate

Applications.

I - option

Entrance test

RICKETS. SPASMOPHILIA

Task: Choose the right oneone or more

correct answers:

1. Symptoms of the initial period of rickets are:

1) anxiety, fever

2) anxiety, sweating, fever

3) restlessness, sweating, fearfulness, shuddering in sleep

4) deformation of the lower extremities

2.The cause of rickets is a deficiency of vitamins:

1) D

2) C, B, RR, K

3)В1,РР,К,В

4)A, E

3. Children suffer from rickets:

1) full-term from 1st month. life

2) premature babies from 3 months. up to 2 years

3) full-term from 3 months. up to 2 years,

4) premature babies from 1 month. life

4. The period at the height of rickets is characterized by:

1) sweating, “balding of the back of the head”

2) enlargement of the parietal and frontal tubercles, “O” and “X”-shaped

bowed legs, cobbler's chest, craniotabes

3) dwarfism, laryngospasm, eclampsia

4) pliability of the edges of the fontanelles

5. During the height of rickets, the patient’s blood shows:

1) hypochromic anemia, decreased levels of calcium and phosphorus

2) leukocytosis, accelerated ESR

3) increased levels of sugar and bilirubin

4) eosinophilia

6. For the treatment and prevention of rickets in the child’s menu

you must enter:

1) meat broth, black caviar, iwasi herring, egg yolk

2) breast milk, vegetable puree, egg yolk, cottage cheese

3) breast milk, sour formulas, vegetable and

fruit puree, egg yolk, cod fat

4) rice, semolina porridge

7. The initial period of rickets lasts:

1) from 3-5 days to 1 month.

2) from 2-3 weeks to 2-3 months

3)from 1-2 months to 7 MONTHS

4 ) FROM 1-2 MONTHSBEFORE1 year

8. Spasmophilia manifests itself against the background of:

1) rickets.

2) omphalitis

3) sepsis

4 ) asphyxia

9. Laryngospasm is:

2) contraction of facial muscles, convulsions

10. Spasmophilia happens:

1) explicit and hidden

2) acute and chronic

3) subacute and recurrent

4) congenital and acquired

Answer standards: Assessment criteria:

1-3 2-1 3-3 4-2 5-1 “5”-1 error

6-2 7-2 8-1 9-1 10-1" "4" -2 errors

"3" - 3 errors

“2” - 4 errors or more

Subject

II - option

8.2.2 Frontal survey

The teacher surveys students on the questions presented, corrects and supplements the answers.

Control questions:

1. Name the main causes and predisposing factors for the development of rickets.

2. Describe the main clinical symptoms of rickets depending on

on the severity of the disease.

3. What is the antenatal and postnatal prevention of rickets?

4. How is rickets treated?

5. Specify the reasons for the development of spasmophilia.

6. Name the clinical forms of spasmophilia, describe their manifestations.

7. How is first aid provided in case of emergency conditions?

with laryngospasm, hypervitaminosis D, convulsions?

8. Name the basic principles of treatment of hypervitaminosis D.

8.3.1 Working on concepts (implementation of specific tasks)

Independent work: filling out tables on the differential diagnosis of spasmophilia (laryngospasm), PTSD. Rickets, rickets-like diseases

8.3.2 Solving situational problems (implementation of specific tasks)

8.3.3 Practicing manipulations (implementation of specific tasks

8.4.1 Summing up the lesson

The teacher sums up the work of each student and answers questions. Draws students' attention to the main shortcomings in students' activities, and recommendations are given.

Final control

PROGRAMMED CONTROL ON THE TOPIC.

"RICHITIS IN CHILDREN"

1. Rickets is a disease that begins:

1) in early childhood,

2) in preschool age,

3) at school age.

2.Rachitis is characterized by metabolic disorders:

1) protein

2) fat

3) mineral

4) carbohydrate

3. Factors predisposing to the development of rickets:

1) vitamin D deficiency,

2) the nature of feeding,

3) gastrointestinal diseases,

4) infectious diseases,

5) time of year,

6) climate,

7) blood type,

8) heredity.

4. Systems and organs undergoing changes during rickets:

1) nervous system,

2) musculoskeletal system,

3) lymphatic system,

4) hematopoietic system,

5) ligamentous apparatus.

5. Symptoms of damage to the nervous system due to rickets:

1) excessive sweating,

2) vomiting,

3) timidity,

4) anxious, restless sleep,

5) loss of body weight.

6. Symptoms of damage to the skeletal system with rickets:

1) craniotabes,

2) habitual bone fractures,

3) head deformation,

4) late and incorrect teething,

5) chest deformation,

6) dwarf stature.

7. Symptoms of damage to the muscular system and ligamentous apparatus during rickets:

1) muscle pain,

2) loose joints;

3) muscle hypotonia,

4) delay in motor skills,

5) muscle hypertonicity.

8.What periods of rickets do you know?

1) incubation,

2) initial,

3) prodromal,

4) the height of the disease,

5) convalescence

6) residual effects.

9.Prevention of rickets in children:

A. Nonspecific:

2) hardening procedures,

3) giving vitamin D,

4) massage and gymnastics,

5) compliance with hygiene rules,

6) protecting the child from contact with infectious diseases
diseases.

B. Specific:

1) giving vitamin D preparations,

2) UV irradiation,

3) antibiotics,

4) sulfonamides

10. Treatment of rickets:

1) rational feeding,

2) giving vitamin D preparations,

3) hormone therapy,

4) multivitamins,

5) salty, pine baths,

6) massage, gymnastics,

7) antipyretics

Answers: Evaluation criteria:

"5" - -1 error

1- 1 “4”-2 errors

3-1 2 3 4 5 6 “3”-3errors

4-1 2 4 5 “2” - 4 errors or more

5-1 3 4

6-1 3 4 5

7-2 3 4

8- 2 4 5 6

9 -А-1 2 4 5 6 B-21

10-1 2 4 5 6

.

)

State budgetary professional educational institution

Moscow City Health Department

"Medical College No. 5"

Branch No. 2

GRADUATE QUALIFYING WORK

ROLE OF THE NURSE

IN THE PREVENTION OF RICKETS IN INFANTS

specialty Nursing

Completed the work Allow for protection

StudentA.V. Afonasova "___"______________20__

(I.O. Last name)

Deputy Director of the State Budgetary Educational Institution

(signature)DZM "MK No. 5" - manager

Well III Group 5 Branch No. 2 L.S. Spirina

Head of the Research and Development Committee ________________

E.A. Spevakova (signature)

(I.O. Last name)

__________________ Job protected

(signature)

«___»____________ 20____

Grade_____________

Chairman of the State Examination Committee_____________

(signature)

Moscow

2016

TABLE OF CONTENTS

INTRODUCTION…………………………………………………………….

CHAPTER 1 THEORETICAL PART

1. 1 Characteristics of the disease rickets………………………………

1.2 Vitamin Dand its role in the human body……………………

1.3 Features of nursing activities for rickets in infants…………………………………………………………………………………

1.4 Nursing care for rickets…………………………………….

CHAPTER 2 PRACTICAL PART

2.1. Problem analysis……………………………………………………………………

2.2. Research methods………………………………………………………

2.3. Analysis of the research results………………………………

CONCLUSION………………………………………………………….

BIBLIOGRAPHY……………………………………………….

APPENDIX A Questionnaire for parents………………………………………………………

APPENDIX B Rickets – what you need to know about it……………………….

APPENDIX B First manifestations of Rickets…………………………

APPENDIX D Prevention of Rickets………………………………

APPENDIX D Rules for taking vitaminsD……………………….

APPENDIX E Products containing vitaminD and calcium......

APPENDIX G Preparing a child for the Sulkovich test………….

APPENDIX AND BENEFITS OF Breastfeeding…………………...

APPENDIX K Scheme for introducing complementary foods to healthy children of the first year of life……………………………………………………..

APPENDIX L Child’s daily routine………………………………...

APPENDIX M Standard for dispensary preventive observation of children in the first year of life……………………………….

APPENDIX H Calendar of preventive vaccinations……….

APPENDIX O Personal website of a nurse………

INTRODUCTION

Rickets, as a disease, has been known for a very long time; the first mentions of rickets are found in the works of Soranus of Ephesus (98-138 AD) and Galen (131-211 AD). A complete clinical and pathological description of the disease rickets was made by the English orthopedist Francis Glisson back in 1650.

For some time, rickets was called the “English disease”, since its prevalence was high in England. English name rickets comes from the Old English wrickken, which means “to bend,” and F. Glisson changed it to the Greek rhachitis (spine), since in rickets it is significantly deformed. At the beginning of the twentieth century, our compatriot I. Shabad discovered that cod fish oil is quite effective in the prevention and treatment of rickets, and the American researcher Mellanby in 1920 established that the active principle in fish oil is a fat-soluble vitamin. Vitamin D was discovered and obtained by McCollum in 1922, after which it became possible to study its specific effect on bones, muscles, intestines and renal tubules.

Rickets is found in all countries, both in the northern regions and in hot climates. Children born in autumn and winter suffer from rickets more often and more severely. In the first half of the twentieth century in Russia, rickets was detected in 46-68% of children in the first two years of life. In recent years in Russia, the incidence of rickets among children early age ranges from 54 to 66%. Currently, the incidence of rickets among infants in Moscow, according to reports from local pediatricians, does not exceed 30%. However, this figure is underestimated, since the diagnosis of “rickets” is registered in the case of moderate and severe forms of the disease, and its mild forms are not statistically taken into account.

Back in 1891, N. F. Filatov emphasized that rickets is a general disease of the body. There is no doubt that infantile rickets is not only a pediatric, but also a medical and social problem, as it has serious consequences. It has been proven that rickets suffered at an early age predisposes in the future to impaired formation of peak bone mass, the development of osteoporosis and other disorders of bone mineralization in older age. For example, pelvic deformities are fraught with the forced need for delivery by cesarean section in the future, flat feet - long-term pain syndrome and indirect damage to the spine and joints throughout life. A variety of orthopedic pathologies require lengthy, traumatic, expensive correction; severe deformities of the lower extremities, chest, and skull bones serve as significant cosmetic defect, leading to psychological discomfort for the patient (especially a teenager), can disrupt the functioning of internal organs (located in the chest cavity). These disorders can remain throughout life and even lead to disability.Therefore, prevention of the development of rickets in children in the antenatal and postnatal period is so important.

High quality and competent organized activity rickets prevention nurse includes the following:

carry out in a timely mannerpreventive conversation with parents about the causes of the disease and possible consequences, as a result of which parents will be able to effectively and reliably protect their baby from a whole range of problems, many of which, having arisen at an early age, will continue into adulthood;

timely identify the child’s disrupted needs and the ability to prevent the development of this disease.

The purpose of the final qualifying work: defineThe role of the nurse in the prevention of rickets in infants.

To achieve this goal, the following were identifiedtasks :

assess the level of knowledge of parents on the prevention of rickets in infants;

to establish the reasons for the lack of awareness among parents regarding the prevention of rickets in infants;

propose ways to increase parents' awareness of the issue of preventing rickets in infants.

Object of study : level of parental knowledge about the prevention of rickets in infants.

Subject of study: the influence of the professional role of the nurse on increasing the level of knowledge of parents in the prevention of rickets in infants.

Hypothesis: subject to quality organized work The nurse will increase the level of knowledge of parents on the prevention of rickets in infants.

Chapter 1 THEORETICAL PART

1. Characteristics of the disease rickets

Rickets is a disease caused by vitamin deficiencyD, accompanied by disturbances in phosphorus-calcium metabolism, the processes of formation and mineralization of bones, the formation of the skeleton and the functions of internal organs and systems.

Etiology of the disease

The causes and predisposing factors to the occurrence of rickets are:

1) deficiency of solar radiation and exposure to fresh air, since 90% of endogenously formed vitamin D in the body is synthesized in the skin under the influence of solar radiation.

Vitamin D is the only vitamin that can be formed in the human body from provitamin D without being administered through food. But this requires the presence of sterols in the skin, which serve to form vitamin D, and exposure to light rays of a certain length. In the epidermis, in the capillaries of the skin, there are provitamins - unsaturated sterols (namely 7-dehydrocholesterol), which, under the influence of ultraviolet sunlight, are converted into vitamin D 3 .

2) nutritional factors:

a) artificial feeding;

b) untimely introduction of complementary foods;

c) one-way feeding (carbohydrate, vegetarian).

Children who are bottle-fed suffer from rickets more often and more severely. This is due to the fact that the amount of vitamin D required depends on the ratio of calcium to phosphorus in food. In human milk, the ratio of calcium and phosphorus is more favorable for the absorption of these substances than in cow's milk, since the ratio of calcium and phosphorus does not correspond to the needs of the child's body. Human milk also differs from cow's milk in the composition and quality of protein, fat, and the content of B vitamins A and C, which is also of no small importance.

Irrational complementary feeding to children in the form of an abundance of cereals and flour dishes is one of the factors predisposing to severe forms of rickets, although children give the impression of being plump and quickly gaining weight. This is explained by the fact that phytic acid contained in grain products in combination with calcium forms practically insoluble salts that contribute to metabolic disorders. It is also important that insufficient amounts of proteins and vitamin B are introduced with flour foods 1 . Gastrointestinal and infectious diseases contribute to the development of rickets, since with them mineral metabolism is always disrupted to one degree or another and acidosis develops.

3) perinatal factors. Prematurity predisposes to rickets due to the fact that the most intense supply of calcium and phosphorus from mother to fetus occurs in the last months of pregnancy. At the same time, with more intensive growth than in full-term children, they require more phosphorus and calcium in their food.

4) poor nutrition and daily routine of a pregnant woman can lead to relatively lower reserves of minerals in the body of a full-term baby.

5) unsatisfactory living conditions.

Rickets most often affects children who are in a damp, dark room, deprived of fresh air and sunlight, as well as children living in good, but poorly ventilated apartments, who spend little time in the fresh air.

Pathogenesis of the disease

In the development of the disease, a violation of phosphorus-calcium metabolism is of particular importance, in the regulation of which vitamin plays a major roleD.

By the time a child is born, most of the skeleton consists of cartilage tissue, and in the process of growth and development of the body, cartilage tissue is gradually replaced by bone tissue.

For the correct formation of the bone skeleton, the appropriate content of calcium and phosphorus salts in the blood serum is necessary. A healthy infant's blood serum contains 0.05 g/l phosphorus and 0.1 g/l calcium, their ratio is 1:2. If the concentration of these salts decreases for one reason or another, then changes occur in the bones and in other systems and organs.

Vitamin deficiencyDcauses a decrease in the level of ionized calcium in the blood, reducing the synthesis of calcium-binding protein, which ensures the transport of calcium ions through the intestinal wall. Hypocalcemia stimulates the activity of the parathyroid glands, resulting in increased production of parathyroid hormone. Parathyroid hormone, the main function of which is to maintain a constant level of calcium in the blood, promotes increased excretion of inorganic calcium from the bones. Under the influence of increased secretion of parathyroid hormone, the reabsorption of phosphorus in the renal tubules decreases, which leads to increased excretion of phosphates in the urine. In other words, phosphate release prevails over absorption. As a result, the phosphorus content in the blood decreases to 0.01 - 0.03 g/l, and the calcium level may remain normal or decrease slightly (to 0.09 g/l). The ratio of phosphorus and calcium instead of 1:2 with rickets becomes 1:3, 1:4.

Hypophosphatemia leads to a decrease in oxidative processes in the child’s body, which is accompanied by the accumulation of under-oxidized products of interstitial metabolism and acidosis develops. Under conditions of acidosis, phosphorus-calcium salts are not deposited in osteoid tissue. As a result of the leaching of calcium salts from the bones and disruption of the calcification processes, the bones become soft and easily deformed. Developed acidosis leads to dysfunction of the central nervous system and internal organs. Immunological protection decreases, which contributes to frequent diseases and their protracted course.

The main clinical manifestations of rickets in infants

The first clinical manifestations of rickets are detected in a child at the age of 4-5 weeks, especially in premature infants, but more often rickets develops from 2-3 months. The risk of developing rickets remains throughout the first year of a child’s life.

According to severity, the following degrees of rickets are distinguished:

Idegree (mild) – minor changes in the nervous and muscular systems; does not produce residual effects;

IIdegree (moderate) - accompanied by moderate but distinct deformations of the skull, chest and limbs, changes in the bone, muscle, nervous and hematopoietic systems, moderate dysfunction of internal organs, a slight increase in the size of the liver and spleen, anemia;

IIIdegree (severe) – pronounced changes in the central nervous, skeletal and muscular systems, internal organs.

In the clinic of the disease, characteristic periods are distinguished.

Initial period. The period is characterized by changes in the nervous system. The child develops mild excitability, restlessness, and flinching at a loud sound or sudden flash of light. Sleep becomes shallow. Noted increased sweating, especially when crying, feeding. Sweat has an unpleasant sour smell and irritates the skin, causing itching. The child rubs his head on the pillow, and baldness of the back of the head appears. Muscle hypotension develops.

High period. This period is characterized by the progression of bone changes, dysfunction of the nervous and muscular systems.

Changes in the skeletal system:

Skull: the edges of the large fontanelle become soft, softening of the bones of the skull (craniotabes) leads to flattening of the occiput, its asymmetry; Parietal and frontal tubercles appear, giving the head a square shape.

Teeth: appear late, the order of their eruption is disrupted, and there is a tendency to caries.

Chest: at the junction of the bone and cartilaginous parts of the ribs, thickenings are formed - “rosaries”, the curvature of the collarbones increases; at the site of attachment of the diaphragm, a recess is determined (Harrison's groove), the front part of the chest, together with the sternum, can protrude forward in the form of a “chicken breast” or recess “shoemaker’s chest”.

Spine: a posterior curvature appears - kyphosis or a lateral curvature - scoliosis.

Pelvic bones: the entrance to the pelvic cavity narrows, a flat-rachitic pelvis is formed.

Extremities: the epiphyses of the bones of the forearm thicken (rachitic “bracelets”), phalanges of the fingers (“strings of pearls”); deformation of the diaphysis of the femur and tibia leads to an O-shaped curvature, and when children begin to walk - an X-shaped curvature of the limbs.

Changes in the muscular system:

Hypotonicity of all muscles.

Weakness of the abdominal wall muscles leads to an increase in the size of the abdomen (“frog belly”).

Weakness of the ligamentous apparatus, loose joints, increased range of motion.

Changes in internal organs:

Respiratory organs: respiratory efficiency is impaired due to chest deformation (shortness of breath, hypoxia).

Cordially - vascular system: weakening of heart sounds, tachycardia, hypotension.

Digestive organs: intestinal atony, dyspeptic disorders, liver dysfunction.

Hematopoietic organs: anemia, hypocalcemia.

The period of convalescence. The general condition of the child improves, neurological and autonomic symptoms gradually disappear, normalization of muscle tone and restoration of statistical skills occurs more slowly; calcium levels remain reduced.

Period of residual effects. The consequences of rickets remain in the form of deformations of the bones of the skull, chest, muscle hypotension, and sometimes anemia.

Basic principles of treatment of rickets

Purpose therapeutic measures with rickets is the normalization of phosphorus-calcium metabolism, the elimination of metabolic acidosis, vitamin deficiencyD.

The best effect in the treatment of children with rickets is achieved through complex therapy. It should be long-term and aimed both at eliminating the causes that led to the development of rickets and at eliminating hypovitaminosisD.

Treatment is carried out against the background of nonspecific measures and specific treatment. Nonspecific measures are aimed at normalizing metabolic processes in the child’s body and increasing its resistance. Correction of nutrition is of primary importance. The first complementary food should be vegetable; it is introduced 1 month earlier than usual (from 4 months). For the second feeding, buckwheat or oatmeal porridge prepared with vegetable broth is recommended. The yolk and cottage cheese are introduced earlier than usual. The diet should contain a sufficient amount of complete proteins; therefore, liver and meat purees are included in it earlier. Instead of drinking, they give vegetable and fruit decoctions and juices.

It is necessary to organize the correct daily routine for the child with sufficient rest in accordance with his age and eliminate various factors that contribute to irritation (bright light, noise). Sufficient exposure to fresh air and regular ventilation of the room are recommended.

An effective treatment method is irradiation with ultraviolet rays. Ultraviolet irradiation is recommended to be carried out in a course of 15-25 sessions every other day with a gradual increase in exposure. In the initial period of rickets, you can limit yourself to one course of treatment in 15-20 sessions. During the peak period, irradiation is repeated at intervals of 2-3 months. In the intervals between courses of radiation, treatment with vitaminD.

For the specific treatment of rickets, vitamin is usedD. It is prescribed in the following dosage forms:

Videchol – 0.125% oil solution of cholecalciferol (D 3 ), 1 drop – 500 IU;

Videin is a tableted water-soluble vitamin.D 2 in combination with protein (casein); dragees and tablets of 500, 1000, 5000, 10000 IU;

VitaminD 2 – ergocalciferol – 0.125% oil solution, 1 drop – 1000 IU; 0.5% alcohol solution, 1 drop – 5000 IU.

With the initial manifestations of rickets in a full-term baby who is in favorable living and nutritional conditions, it is enough to prescribe a vitaminDin a daily dose of 1300-2000 IU per day up to a course dose of 100,000 - 120,000 IU. During the peak period for rickets of moderate severity and severe rickets, 3000 - 4000 IU per day is prescribed up to a course dose of 200,000 - 400,000 IU.

After achieving a therapeutic effect, a therapeutic dose of vitaminDare replaced with prophylactic (400-500 IU), which the child receives daily for the first two years.

Vitamin treatmentDcarried out under the control of the Sulkovich test (urine test for calcium content).

Vitamin treatmentDcombined with the use of calcium and phosphorus preparations (glycerophosphate and calcium gluconate). Vitamins of the group are included in the complex therapy of ricketsB, C, citrate mixture or lemon juice, which help reduce acidosis and its consequences.

Special meaning in complex therapy for the treatment of rickets are massage and gymnastics, which are indicated for almost all children with rickets, with the exception of its acute course during the height of the disease. Massage and gymnastics, influencing many systems and organs, contribute to a significant improvement in the general condition of patients, restoration and rapid development of motor functions.

Salt and pine baths are also auxiliary methods for the treatment of rickets, especially when it is persistent in children with severe pastiness. Salt baths are given to children over 6 months old. The water temperature from 36°C gradually decreases for children under 1 year of age to 32°C, for children older than one year - 30°C. The duration of the bath is from 3 to 5 minutes. Baths are recommended every other day, no more than 10-15 per course of treatment. Coniferous baths are made using the same method. Take half a tablespoon of pine extract per bucket of water. Bath duration is 5-10 minutes; for a course of treatment 15-20 baths. Water temperature 35-36°C.

Prevention of rickets

Prevention of rickets begins in the antenatal period and continues in the postnatal period. Prevention consists of nonspecific and specific measures.

Nonspecific prenatal (antenatal) prophylaxis:

a pregnant woman's daily routine and sufficient exposure to fresh air;

balanced diet enriched with vitamins;

taking a daily multivitamin;

prevention and treatment of diseases;

prevention of gestosis and premature birth.

Nonspecific prevention (postnatal):

compliance with the daily routine and child care rules;

organization of daily walks;

rational nutrition of a nursing mother with daily multivitamins;

maintaining breastfeeding;

proper organization of mixed and artificial feeding in case of insufficient quantity or absence of breast milk;

Regularly performing hardening procedures, gymnastics, and massage for the child.

Specific prevention start at 2 weeks of age. Prescribed vitaminD500 IU per day during the first two years of life (autumn, winter and spring periods). Purpose of the vitaminDshould alternate with a course of ultraviolet irradiation (15-20 sessions 2 times a year). After a course of UV irradiation, vitaminDYou can not prescribe it for 3-4 weeks. When feeding with adapted milk formulas, a prophylactic dose is prescribed taking into account the vitamin contained in the formulasD .

Dispensary observation

A child with manifestations of rickets is observed by a local pediatrician for at least 2 years. Examination by a pediatrician is carried out at the height of the disease 2 times a month, then - once a month until the end of 1 year, in the 2nd year of life - once a quarter.

Additional examination methods include:

general analysis blood, general urine test - once a month during the height of the disease, then once every 6 months;

Sulkovich's test is examined when prescribing therapeutic doses of vitaminD 1 time every 7-10 days, preventive 1 time every 2 weeks;

definitionCa, P, alkaline phosphatase activity during the height of the disease once a month.

1. Vitamin D and its role in the human body

It has been established that vitaminD has the ability not only to support mineral and bone metabolism, but also has other very important functions. For vitamin deficiencyDthe risk of developing many pathological conditions increases. The problem of insufficient vitamin supplyDchildren is one of the most relevant today.

The appearance of the first information about the origin and biological functions of the vitaminDin the human body is closely related to the development of the doctrine of rickets.

It is known that vitaminDhas two routes of entry into the human body: with food and as a result of synthesis in the skin under the influence of ultraviolet radiation.

Richest sources of vitaminDare cod liver, tuna, fish oil, and to a lesser extent – ​​butter, egg yolk, milk. Products of plant origin contain its analogue, ergocalciferol (vitaminD 2 ).

Vitamin absorptionDoccurs mainly in the duodenum and jejunum with the help of bile acids. It is subsequently transported by the intestinal lymphatic system in the form of chylomicrons, formed by the interaction of cholecalciferol with taurocholic acid.

Vitamin photosynthesisDin the skin is carried out in several stages. When UVR reaches the surface of the skin, about 90% of it penetrates the epidermis and ensures the conversion of 7-dehydrocholesterol into previtaminD 3 , which is subsequently converted to cholecalciferol. However, it should be taken into account that the efficiency of vitamin synthesisDIn human skin, climatic conditions, geographic latitude, the level of air pollution, as well as the degree of skin pigmentation, and age have a significant influence.

VitaminDis excreted from the body by excretion with bile into the intestines (15-30% of the dose received during the day). The remaining part (70%) is excreted in the feces.

VitaminD, being the most important regulator of phosphorus-calcium metabolism, provides the necessary level of these elements for adequate osteogenesis.

In conditions of sufficient supply of cholecalciferol to the body, calcium supplied with food can be absorbed by 30-40%, while in case of a lack of vitaminDits absorption is only 10 - 15%.

In recent years, a number of studies have shown that cholecalciferol is capable of regulating not only phosphorus-calcium metabolism and bone tissue mineralization processes, but also influencing the function of many organs and systems of the body. Specific receptors for calcitriol are found in more than 30 different organs and tissues. The action of the hormone is aimed at regulating the processes of proliferation and differentiation of cells, the synthesis of hormones, mediators of inflammatory and immune reactions.

In general, there are 5 groups of processes that are regulated by vitaminD:

Skeletal system: the main function of the vitaminDis the absorption of magnesium and calcium, which are required for the formation and development of teeth and bones. It also stimulates the absorption of calcium in the kidneys and intestines. Regulates the content of phosphorus and calcium in the blood, vitaminDrepresents the main link in the hormonal regulation of phosphorus and calcium metabolism. In addition, it increases the flow of calcium to bones and teeth, helping to strengthen them.

Cell growth: vitaminDtakes part in the process of cell growth and development. According to studies, the hormonecalcitriolprotects the body from malignant diseases, slowing down the growth of cancer cells in the breast, colon, and skin.

Immune system: amount of vitaminDin the body it affects the area of ​​the bone marrow responsible for the synthesis of immune cells - monocytes, that is, it increases immunity.

Hormones: vitaminDcoordinates the production of insulin by the pancreas, that is, it affects the level of glucose in the blood.

Nervous system: helps maintain an optimal level of calcium in the blood, which ensures the full transmission of nerve impulses and the process of muscle contraction, that is, the normal functioning of nerves and muscles. According to some reports, by enhancing the absorption of magnesium and calcium, vitaminDhelps restore the protective sheaths surrounding the nerve.

1.3 Features of nursing activities for rickets in infants

Rickets develops when a child does not take enough vitaminsDwith food or if the natural formation of this vitamin in the body is disrupted (insufficient ultraviolet radiation).

More often, rickets occurs in children born in the winter season, those who are bottle-fed and premature.

When performing antenatal care for a pregnant woman, the nurse is obliged to conduct a conversation about rational nutrition and daily routine in order to prevent rickets in the child. A pregnant woman should receive the following foods: meat, fish, cheese, milk, dairy products, eggs, butter, vegetables and fruits. Also, a pregnant woman should spend enough time in the fresh air, follow a daily routine, and exclude heavy physical activity and stressful situations.

The main goal of the nurse when caring for infants who are at risk of developing rickets is the timely identification of the first clinical signs of rickets.

The nurse should:

in children in the first 3 months of life, pay special attention to examination, palpation of the large and small fontanelles and sutures of the skull;

In children 4-6 months old, conduct a chest examination: along the ribs, thickening is revealed at the junction of cartilaginous tissue and bone tissue. In childrenIIfor half a year of life, monitor the curvature of the bones, thickening of the epiphyses of the bones of the forearms and legs;

observe behavior, motor activity and muscle tone;

control the condition of the hair on the back of the head (sweating causes a rickety “bald spot”).

The nurse also conducts a conversation with the child’s mother, identifying:

whether the baby is full-term;

baby's sleep;

are there functional changes in the nervous system: anxiety, frequent crying, irritability, flinching at a loud sound or sudden flash of light;

did the mother notice excessive sweating at night, as well as when crying and feeding;

how and what the child eats, what kind of feeding;

does the mother follow the child’s daily routine and the rules of caring for him;

How often does a mother walk with her child in the fresh air?

However, when caring for a child, you should pay attention to social and living conditions, as they are one of the factors in the development of rickets.

The main goal of caring for children with rickets is to prevent the development of a pronounced clinical picture of the disease and the addition of concomitant diseases.

If signs of rickets are detected, the mother and child should be referred to a pediatrician to clarify the diagnosis. If the diagnosis is confirmed, the doctor will prescribe treatment, in which the main task is to fully implement all the doctor’s instructions, since the best effect in the treatment of children with rickets is achieved through complex therapy.

At the beginning of treatment, you should have a conversation with the mother and relatives about this disease, the need for treatment and the consequences of rickets. This will allow relatives to understand the advisability of carrying out all care measures.

It is important to organize proper nutrition for the child - breastfeeding is the best, provided that the nursing woman has proper nutrition. If natural feeding is not possible, artificial feeding should be carried out only with adapted formulas - breast milk substitutes containing high-quality food ingredients, vitamins and microelements in an optimal ratio. It should be noted that children fed with adapted formulas do not need additional multivitamin preparations. Instead of drinking, a 3-4 month old breastfed baby is given vegetable and fruit decoctions and juices; yolk and cottage cheese are introduced earlier. With mixed and artificial feeding, the first complementary foods are introduced 1 month earlier. For the second complementary feeding, buckwheat/oatmeal porridge prepared with vegetable broth is recommended. The nurse plays a huge role in organizing the nutrition of infants suffering from rickets.

Periodically, the nurse monitors the calcium content in the urine using the Sulkowicz test.

At the height of the disease and in acute cases of rickets, vitamin preparations are prescribedD. Since taking vitaminDhas its own peculiarities, you should tell your mother about the specifics of taking the vitamin.

When providing patronage, the nurse is obliged to pay attention to the creation of favorable environmental conditions for the child, monitor regular massage and exercise therapy, since rickets causes muscle hypotension.

The child should be provided with walks in the fresh air. Under the influence of UV rays, vitamin is produced in the skinD. In winter, walk at least 3 hours a day, in summer 5-6 hours. In the summer, it is recommended to take walks in the “lace shade of trees” (it blocks infrared rays, which prevents the child from overheating).

During the entire period of treatment, the nurse needs to assess the child’s condition in order to assess the effectiveness of treatment.

1.4 Nursing care for rickets

Table 1. Nursing intervention plan

Nursing intervention plan

Rationale

Inform relatives about the disease and its possible consequences

The right of relatives to information is ensured

Relatives understand the advisability of carrying out all care activities

Provide the child with a complete balanced diet with the obligatory inclusion in the diet of foods rich in vitamins (vitaminD, calcium)

Rickets is a polyhypovitaminosis with a predominant vitamin deficiencyD, resulting in a tendency to decrease calcium in the child’s body

Ensure that the child spends a long time outdoors in the “lace shade of trees”

Ensures vitamin productionDin the skin of a child under the influence of UV rays

“Lacy shade of trees” delays infrared raysprevents overheating of the child

Organize daily massage and gymnastics for the child

With rickets, muscle hypotonia is observed

Carry out measures to prevent the addition of concomitant diseases

Rickets is an unfavorable premorbid condition

Chapter 2 PRACTICAL PART

2.1 Problem analysis

An important section of the preventive work of a local pediatrician and nurse is monitoring young children and carrying out a set of preventive measures aimed at preventing diseases.

Prevention of rickets is especially important, since this disease easily occurs in children and, not so rarely, is difficult to treat and leaves severe residual effects that negatively affect the course of their entire subsequent lives.

2.2 Research methods

To achieve this goal, we used the following research methods:

1) theoretical analysis of literature data on the prevention of rickets in infants;

2) we surveyed 30 parents of children under 1 year of age using a self-developed questionnaire. The questionnaire is presented in Appendix A;

3) mathematical processing of data obtained as a result of the survey;

4) qualitative and quantitative analysis of data obtained as a result of the study.

Based on the results of qualitative and quantitative analysis of survey data, instructions were compiled to inform parents about the prevention of rickets, methods of diagnosing it, and risk factors for the occurrence of rickets.

2.3 Analysis of research results

The study was conducted on the basis of the State Budgetary Institution “Scientific and Practical Center for SMPD named after V.F. Voino-Yasenetsky DZM" Clinical Diagnostic Center. We selected 30 outpatient records of children at risk for developing rickets. The risk group for the development of rickets includes children born prematurely, or with a high birth weight (more than 4 kg), who are early artificially fed with unadapted formulas. Predisposing factors in the development of rickets on the maternal side are: maternal age under 22 years or over 35 years, gestosis of pregnancy, extragenital pathology, nutritional defects during pregnancy and lactation.

The survey was conducted during an appointment with a pediatrician using a self-developed questionnaire. The questionnaire is presented in Appendix A.

Figure 1. Structure of respondents by age

Figure 1 chart shows that 30% of mothers are between 18 and 20 years old, and 13% are 26-35 years old. Mother's age under 22 years or over 35 years is one of the predisposing factors in the development of rickets.

Antenatal nonspecific prevention of rickets includes compliance by the pregnant woman with a daily routine. We asked mothers: “Did you follow a daily routine during pregnancy?” The results are presented in Figure 2.

Figure 2 – Pregnant women’s daily routine

Figure 2 shows from the chart that 30% did not follow a daily routine during pregnancy. A pregnant woman should spend at least 2-4 hours a day in the fresh air.

Antenna prevention of the development of rickets in a child also includes daily intake of multivitamins by a pregnant woman. Therefore, we asked the question: “Did you take a vitamin complex during pregnancy?”

Figure 3 – Mothers taking a vitamin complex during pregnancy

The chart shows that 60% of the mothers surveyed did not take vitamins.

Specific prevention includes the prescription of the multivitamin preparation Gendevita, 1-2 tablets per day (1 tablet contains 250 IU of vitaminD). Specific prophylaxis is not carried out if the mother is over 35 years old or with diseases of the cardiovascular system, since taking vitaminDpromotes the deposition of calcium in the placenta and can lead to fetal hypoxia, decreased compliance of the skull bones when passing through the birth canal, premature closure of the large fontanelle, as well as the development of atherosclerosis in the mother.

Poor nutrition of a pregnant woman, and after birth of a child, are predisposing factors in the development of rickets. It has been established that in case of improper nutrition, the child develops a deficiency of vitamins and mineral salts. The main food sources of fat-soluble vitamins (A, D, E, K) are: yolk chicken egg, butter, cod and other fish liver, black caviar; sources of water-soluble vitamins are juices, fruit and vegetable purees. The best food sources of calcium are dairy products: cottage cheese, cheeses, milk, kefir. It is important to note that the causal significance in the development of rickets is not so much vitamin deficiency.Din food, how much food does not provide optimal conditions for the entry of calcium and phosphorus from food into the body. In particular, an excess of cereals in a child’s diet inhibits the absorption of calcium in the intestines.

In order to identify the level of mothers' knowledge about vitamin-rich foodsD, and foods that are the best dietary sources of calcium, we asked parents to list these foods. The analysis of the survey results is presented in Figures 4 and 5.

Figure 4 – Parents’ awareness of foods rich in vitamin D

Figure 5 – Parents’ awareness of foods that are the best dietary sources of calcium

From the diagrams in Figures 4 and 5 we see that the yolk of a chicken egg (46%) - according to parents, is a product rich in vitaminsD, and 44% of parents answered that the best food source of calcium is cottage cheese. To increase parents' knowledge about products containing vitaminDand calcium, we have developed a leaflet “Products containing vitaminDand calcium" (Appendix E).

Antenatal nonspecific prevention of rickets - a balanced diet with a sufficient amount of vitamins, micro- and macroelements, complete proteins (the diet should contain 180-200 g of meat, 100 g of fish, 150 g of cottage cheese, 30 g of cheese, 0.5 l of milk or fermented milk products in a day). Taking into account the identified level of parental awareness of foods rich in vitaminDand foods that are the best food sources of calcium, we asked the question: “During pregnancy, did you consume foods rich in the vitaminDand calcium?

Figure 6 – Structure of consumption of foods rich in calcium and vitamins by pregnant womenD

The chart in Figure 6 shows that 63% of respondents knew about foods rich in calcium and vitaminD, but did not consume them in sufficient quantities during pregnancy.

Prematurity predisposes to rickets due to the fact that the most intense supply of calcium and phosphorus from mother to fetus occurs in the last months of pregnancy and a child less than 30 weeks of gestation often has osteopenia at birth, that is, a lower salt content in the bone.

The next question in our questionnaire is: “At what stage of pregnancy was your child born?”

Figure 7 – Structure of children by date of birth

Prematurity is one of the main risk factors for a child developing rickets. In Figure 7, the diagram shows that 30% are full-term children, and 70% of premature children are likely to develop rickets.

Rickets primarily affects the human skeletal system, although this disease is caused by metabolic disorders. The highest risk group is children under 24 months of age, but children in the first 6 months of life are most often affected. Children living in the northern regions suffer from rickets much more often than children living in sunny, warm areas. Children born in late autumn or winter have a higher risk of getting sick. Rickets affects both boys and girls with approximately equal frequency.

An analysis of the survey results for the following question is presented in the diagram in Figure 8.

Figure 8 – Structure of patients by date of birth, depending on the time of year

Figure 8 shows from the diagram that 36% are children born in winter. According to statistics, such children are most at risk of developing rickets, as a result, they require special monitoring from parents and medical personnel. It is also necessary to pay special attention to children born in autumn and spring (20% and 27%, respectively).

“Type of feeding of your child” - mothers’ answers to this question are presented in the diagram in Figure 9.

Figure 9 – Type of feeding a child

Important looks like feeding a child. Since breast milk contains a sufficient amount of essential vitamins and minerals for the correct and complete development of a child in the first year of life, breastfeeding is an integral part in the prevention of rickets. However, based on the results of the survey, we can conclude that out of 100% of parents surveyed, only 37% of respondents support breastfeeding. Accordingly, in 63% of children the likelihood of developing rickets increases.

To increase mothers' awareness of breastfeeding, we have developed a leaflet “The Benefits of Breastfeeding”, presented in Appendix I.

Figure 10 – Introduction of complementary feeding to a child of the first year of life

As the child grows, so does the body. In this regard, he needs more vitamins and minerals, which are scarce in breast milk. Therefore, it is necessary to introduce complementary foods that fill the missing amount of microelements in the body. But it is also important to follow the rules for introducing complementary foods, since neglecting them can worsen the child’s health. The scheme for introducing complementary foods to healthy children in the first year of life is presented in Appendix K.

Figure 10 shows that 30% of parents do not introduce complementary foods in a timely manner, and therefore we can assume that the child may be predisposed to the development of rickets.

With rickets, vitamin metabolism disorders (in addition to vitamin D) are often observed, especially pronounced in relation to B vitamins and ascorbic acid. Therefore, it is very important to promptly introduce vegetable and fruit juices, as well as purees, into children’s diets. For children with rickets, vegetable puree is recommended as the first complementary food (from 3.5-4 months). To vegetable puree it is necessary to add a hard-boiled egg yolk, rich in fat-soluble vitamins and B vitamins, as well as phosphorus, calcium, and microelements. The second complementary food (in the form of milk porridge - buckwheat, oatmeal, rice, semolina) is introduced after 7-10 days. Cottage cheese is given from 4 months, and meat puree - from 5-6 months. The vitamin D content of breast milk substitutes should be taken into account when prescribing prophylactic doses of the vitamin.

These factors contribute to the development of rickets, since 90% of the endogenously formed vitaminDsynthesized in the body under the influence of ultraviolet rays(UFL). Rickets, as a rule, occurs in children living in regions with insufficient insolation, frequent fog, cloudiness, or in regions of environmental distress.

You should know that the sun is a “source” of vitaminDonly in combination with clean morning air and when the child and he are walking “in the lacy shade of trees” (plant foliage blocks infrared rays, but allows ultraviolet rays to pass through).

When taking sunbathing, it is necessary to remember about the moderation of solar procedures, since the sun's rays with prolonged exposure can have adverse effects.

We asked parents the question: “How often do you go for walks with your child?”

Figure 11 – Mode of walking with a child in the fresh air

VitaminDenters the body not only with food, but also as a result of synthesis in the skin under the influence of ultraviolet radiation. In winter, it is recommended to walk with your child for at least 3 hours a day, and in summer – at least 4-5 hours. According to the survey results, it is clear that 57% of parents comply with the temporary norms for their child’s stay in the fresh air. The rules for observing the child’s daily routine are presented in Appendix L.

From the diagram in Figure 12 we see that 83% of respondents follow the child’s daily routine.

Figure 12 – Child’s daily routine

Figure 13 – Level of awareness of parents about the disease rickets

In order to find out the level of awareness of parents about the disease rickets, the following questions were asked in the questionnaire: “Do you know about the disease Rickets?”; “List the risk factors for the development of rickets that you know”; “List the early and main manifestations of rickets known to you.”

Analyzing the answers received to these questions (Figure 13, Figure 14, Figure 15), we concluded that 37% of the parents surveyed have a lack of knowledge about this disease.

Figure 14 – Level of parental awareness of risk factors for the development of rickets

Prematurity, according to parents in 64%, is the main risk factor for the development of rickets.

For timely diagnosis rickets and contacting a pediatrician for qualified help, parents should know the early and main manifestations of the disease rickets. To do this, we have developed a memo “What you need to know about Rickets” (Appendix B), a memo “First manifestations of Rickets” (Appendix C) and a memo “Prevention of Rickets” (Appendix D). The results of the survey analysis showed that when a child rubs his head on the pillow, as a result, the hair on the back of the head is wiped off, and the most striking sign of the initial period of rickets appears - baldness of the back of the head.

This early manifestation of rickets was named by 54% of parents. The data is presented in Figure 15.

Figure 15 - Level of awareness of parents about the early and main manifestations of rickets

Figure 16 - Parents' sources of information about rickets

The most reliable source of information is a conversation with a pediatrician and a nurse at a children's clinic. The doctor will give the necessary recommendations for the prevention of rickets, the nurse will explain the features of care aimed at preventing this disease.

Specific prevention in full-term babies is carried out from 3-4 weeks of age with vitamin preparationsD. VitaminDis prescribed in a dose of 400-500 IU daily in the autumn - winter - spring periods during the 1st and 2nd year of life. Due to sufficient insolation in the summer, specific prevention is not carried out. If the child was born in May or summer, it begins in September and continues until summer period. When feeding with adapted milk formulas containing vitaminD, the prophylactic dose of the drug is prescribed taking into account the amount of vitaminDcontained in the milk formula. It is adjusted to a total dose of 400-500 IU per day. Rules for taking vitaminsDin prophylactic doses are presented in Appendix D.

Figure 17 – Vitamin D intake by a child for preventive purposes

From the chart in Figure 17 we see that 73% of respondents answered negatively. From the figure it follows that 56% need to take vitaminD, since these children were born in autumn and winter.

Figure 18 – Level of awareness of parents about the Sulkovich test

Children receiving a prophylactic dose of vitaminD, it is necessary to conduct a Sulkovich test once every 2-4 weeks.Vitamin overdoseDcan have consequences no less dire than the disease itself(development of renal failure, dehydration, disorders of the cardiovascular system, convulsions, severe pain in the joints). Therefore, when treating and preventing rickets with vitamin D, it is necessary to monitor urine analysis using the Sulkovich test, since the first signs of overdose appear in the urine. For parents, we have developed a memo “Preparing a child patient for the Sulkovich test,” which is presented in Appendix G. Figure 18 from the diagram shows that only 30% of surveyed parents know about this method of monitoring vitamin contentDin organism.

Figure 19 – Visiting a pediatrician

It has been established that children under 1 year of age need to visit a pediatrician once a month in order to prevent and prevent the development of many diseases, in particular rickets. Therefore, in the questionnaire we asked parents the question: “How often do you and your child visit a pediatrician?” Analyzing the responses received, we came to the conclusion that 30% of parents do not comply with the schedule of preventive examinations of their children by the pediatrician.

Figure 20 – Compliance with an approximate plan for dispensary observation of a child of the first year of life

The first year is a very important period in a baby’s life, since it is at this time that the formation of all organs and systems of the body occurs.Physical and neuropsychic development occurs at a rapid pace, which largely determines the child’s health in the future. That is why mother and baby need to visit the children's clinic regularly during the first year of life, even if the baby is absolutely healthy.

The purpose of visits to the clinic in the first months after birth is to exclude various congenital diseases in the child, identify early forms of diseases, determine predisposition to them, and also prevent the risk of developing pathologies in the future. In the following months, the main tasks of medical examination are: dynamic monitoring of the baby’s development, timely implementation of preventive and health measures.

The first visit of mother and baby to the clinic should take place 1 month after the birth of the baby. It is very important that in the first month the child is examined not only by the pediatrician, but also by other specialists. To ensure that parents visit the necessary specialists in a timely manner in accordance with the age of the child, we have developed a leaflet “Standard of dispensary preventive observation of children in the 1st year of life” (Appendix M).

From Figure 20 it can be seen that 37% of parents do not comply with the plan for dispensary observation of the child in the first year of life.

Figure 21 – Information on childhood vaccinations

Preventive vaccination - this is the introduction of a drug that helps create immunity in the baby against a particular disease. Vaccination does not provide complete protection of a child from infectious diseases, but it significantly reduces the risk of disease in children in the first year of life, who have a very weak immune system and are therefore more likely to get sick. If the baby does get sick, then vaccination done in advance will contribute to a milder course of the disease, without complications. The calendar of preventive vaccinations is presented in Appendix N.

Therefore, in the questionnaire for parents, we asked the question: “Is your child vaccinated according to age?” Analyzing the responses received, we see that 27% of children are not vaccinated by age.

Figure 22 – Parents’ desire to receive the necessary information about the disease using the nurse’s personal website

A fairly large number of fears among parents is due to lack of awareness. In recent years, it has become increasingly clear that the achievements of modern medicine may remain unrealized in practice if partnerships and true cooperation are not formed between the medical professional and the patient. One of the ways to form a “medical-patient” relationship is to educate parents, providing them with complete and reliable information about both preventive measures and the disease itself.

Due to the young age of parents and the popularity of using the media (in particular the Internet), 100% of survey participants would like to receive the necessary information about the disease Rickets from the personal website of the local nurse. Therefore, we developed a Personal Nurse Website (Appendix O).

CONCLUSION

Doctors have always paid great attention rickets disease in children. Thus, in 1650, the English anatomist and orthopedist Glisson described with exhaustive completeness clinical picture and pathological anatomy of rickets.

The founder of Russian pediatrics, N.F. Filatov, 80 years ago, very clearly defined the role of rickets in the pathology of a young child. Rickets is not one of the dangerous diseases of childhood, but nevertheless, it plays a very large part in increasing the mortality rate of children, since, on the one hand, it directly predisposes the child’s body to the disease more or less dangerous diseases, and, on the other hand, generally reduces its endurance and power to counteract harmful influences. Our country has achieved great success in reducing the incidence of rickets. Currently, severe forms of rickets are rare, but the prevalence of this disease in mild form is still high. But even mild forms of rickets lead to children getting sick more often, especially bronchitis, pneumonia, and gastrointestinal disorders. In these children, the diseases, as a rule, take a protracted, chronic course and are much more often accompanied by certain complications. The fight against rickets is an important task in pediatrics.

In the first twelve months of life, the foundations for the child’s future health are laid. Therefore, it is very important for parents to make every effort to lay the foundation for the baby’s health. During this period of a child’s life, special attention should be paid to the prevention of rickets.

The problem of rickets remains relevant today, as there is a high incidence in young children. In most cases, the disease can lead to decreased immunity and delayed neuropsychic and physical development.

A pediatrician is almost always assisted in his professional activities by a nurse, whose specific work and professional skills are largely determined by modern principles training of mid-level medical specialists in medical schools and colleges. The nurse’s knowledge of the early manifestations of rickets and their timely identification will allow the future doctor to correctly organize the treatment process and will ensure the necessary continuity during the transition to more high level work .

We have formulatedconclusions final qualifying work:

revealed the level of knowledge of parents on the issues of antenatal nonspecific prevention of rickets, it was: 30% of respondents did not visit a gynecologist during pregnancy, 60% did not take vitamin D during pregnancy and did not consume foods rich in calcium and vitamin D 63% of mothers; 64% of parents named prematurity as one of the risk factors for the development of rickets, 54% of mothers consider balding of the back of the head to be an early manifestation of rickets, 73% of children do not take vitamin D for preventive purposes, and 83% of children need to take vitamin D for preventive purposes, since they were born in spring, autumn and winter;

the reasons for the lack of parental knowledge about the prevention of rickets are as follows: 70% of parents aged 18-23 years; 45% of respondents learn information from friends and online sources; 30% of parents visit a pediatrician once every six months and 37% do not comply with the approximate plan for clinical observation of the child;

to increase parents' awareness of the prevention of rickets disease,we have developed reminders: “What do you need to know about rickets?”, “First manifestations of rickets”, “Prevention of rickets during pregnancy and after childbirth”, “Benefits of breastfeeding”, “Rules for taking vitaminDfor preventive purposes”, “Child’s daily routine”, “Products containing vitaminD" We have also developed a personal website for a nurse, where young parents can, without leaving home, provide themselves with all the necessary information about the prevention of this disease.

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I.N. Zakharova, Yu.A. Dmitrieva, S.V. Vasilyeva, E.A. Evseeva; Pediatrics Vol. 94 No. 5 2015 – p. 111

Remote access electronic resource: Prevention of rickets in infants (date of access: 04/21/2016)

Remote access electronic resource: Nursing process for rickets (date of access: 04/21/2016)

Remote access electronic resource: Study of the incidence of rickets in young children and the role of the paramedic in the prevention and treatment of rickets (date of access: 04/26/2016)

Remote access electronic resource: Nursing in pediatrics (date of access: 04/30/2016)

Remote access electronic resource: Prevention of rickets in children (date of access: 05/01/2016)

Remote access electronic resource: Modern approaches to the prevention and treatment of rickets (date of access: 05/11/2016)

PEDIATRICS No. 4, 2003

© Demin V.F., 2003

V. F. Demin

ON THE QUESTION ABOUT RICKETS

(regarding the article by E. V. Neudakhin and V. A. Ageikin “Controversial theoretical and practical issues of rickets in children at the present stage”)

RGMU, Moscow

The problem of rickets as the most frequent illness(or condition) associated with disturbances of phosphorus-calcium metabolism in early childhood (mainly in the 1st year of life), has again acquired relevance. Despite the specific prevention of rickets carried out almost universally, its frequency has not decreased significantly. In Russia, the prevalence of rickets is 54-66%. It should be taken into account that in this case quite pronounced (II and III degrees of severity according to the 1947 classification) clinical manifestations are recorded. An experienced pediatrician will find 2-3 mildly expressed symptoms of rickets in almost every 3-4-month-old baby, classified as its I (mild) degree. In this regard, it should be recognized that either rickets as a disease occurs in 100% of cases, or its mild forms are paraphysiological conditions, which are based on individual, genetically determined characteristics of phosphorus-calcium metabolism and bone mineralization. Such conditions, as a rule, disappear on their own as the body grows and matures. The influence of genetic factors on phosphorus-calcium metabolism, ossification processes and the formation of rickets in children is presented in the candidate's thesis of 3. A. Stankevich. The author has shown that concordance in the level of calcium, inorganic phosphorus, alkaline phosphatase, the number of ossification nuclei and clinical manifestations of rickets in monozygotic twins significantly exceeds similar indicators in dizygotic twins under identical living conditions.

The authors of the article “Controversial theoretical and practical issues of rickets in children at the present stage,” Professor E. V. Neudakhin and Professor V. A. Ageikin quite rightly put at the center of this problem the need to agree on the interpretation of the term “rickets.” What is this - a disease or a syndrome? There is no doubt that rickets can be both a disease, sui generis, and a syndrome of many other diseases (various enteropathies, hereditary and acquired liver and kidney diseases, metabolic diseases, some ecopathological conditions, etc.). Disorders of phosphorus-calcium metabolism and vitamin D metabolism associated with these diseases are manifested by the clinical picture of rickets. However, these changes cannot be interpreted as true rickets, but should be considered as a symptom complex of a particular disease. From this point of view, the diagnosis of “rickets-like diseases” requires mandatory interpretation, just like the diagnoses of vitamin D-dependent and vitamin D-resistant rickets.

At the same time, the definition proposed by the authors raises doubts and requires further discussion:

“Infantile classic rickets” is a vitamin D deficiency disease of an intensively growing organism...”

Firstly. The concept of rickets as a vitamin B-deficient disease, unfortunately, has played a significant role in practice negative role, since most pediatricians have a stereotype of thinking according to which the lack of rapid effect from prescribing vitamin O is associated with its insufficient dose. This led to the introduction of increasingly large quantities of vitamin O and often to severe consequences for the child (even death). It is known that in the 60s and 70s of the 20th century, our country experienced a surge in the incidence of hypervitaminosis O.

Undoubtedly, vitamin D is one of the most important regulators of phosphorus-calcium metabolism, but its physiological effect is manifested in a fairly narrow dose range (about 500 IU per day). Increasing the dosage leads to an increase in the blood content of its active metabolites (hydroxy- and dihydroxychole-calciferol), which exhibit their calcium-sparing effect not only by increasing the absorption of calcium in the intestine, but also by activating the resorption of bone tissue and the reabsorption of calcium in the kidneys. This leads to hypercalcemia and possible (at a certain level in the blood) calcification of the walls of blood vessels, calcification of tissues and organs. It is also known that vitamin O in large dosages has a direct toxic effect. Cases of vitamin D poisoning are described not only in the medical literature. Thus, the Izvestia newspaper reported on the mass poisoning of the population of one of the districts of the Moscow region in the early 90s with an oil solution of vitamin O, which was sold by businessmen under the guise of ordinary vegetable oil.

Based on the above, the thesis: “infant rickets is a vitamin O deficiency disease...” reinforces the existing stereotype, if not among medical workers, then, in any case, among the general population.

Secondly. In many children, especially those who developed in utero in unfavorable conditions, the maturation of systems and organs is delayed. In such infants, enzymatic immaturity can manifest itself as disturbances in phosphorus-calcium metabolism, vitamin O metabolism, bone mineralization processes and the development of clinical rickets, even with the administration of sufficient (or increased) doses of vitamin O. In this case, one cannot speak of hypovitaminosis O as the cause of the development of rickets, but such a condition cannot also be interpreted as a syndrome of any other disease. Maturation of enzyme systems leads to the elimination clinical manifestations rickets.

V. D. Demin

Third. It is known that in the development of rickets a huge (if not decisive) role is played social factors. For many centuries and even millennia, rickets was recorded mainly in infants living in unfavorable living conditions. Vitamin B, as a medicine, appeared only in the 20s of the last century. However, even in the distant past, children from good social and living conditions, who naturally did not receive vitamin D, nevertheless did not suffer from rickets. Proper nutrition (with an emphasis on natural feeding), sufficient exposure to fresh air (natural ultraviolet radiation), and physical activity prevented its development. Pediatricians know that if a child is in unfavorable living conditions, he will develop rickets even with the introduction of adequate doses of vitamin B.

Of the listed factors, I would like to draw attention to motor activity as an important stimulus for the development and maturation of the musculoskeletal system. Long-term absence or reduction of load on the bones due to restriction of muscle activity, even in adults, leads to the development of osteoporosis, the leaching of calcium from the bones into the blood (cosmonauts; patients immobilized for a long period of time).

In infants with limited motor activity (tight swaddling), the processes of bone mineralization are disrupted while matrix growth continues. This is clinically manifested by rachitic bone changes.

Can these variants of rickets be attributed to hypovitaminosis B? From our point of view - no.

Fourthly. The fact that has long been established and passed from textbook to textbook, from manual to manual, requires revision and rethinking: “women’s milk is poor in vitamin B.” 1 liter of milk contains 40-70 IU. With all due respect to the luminaries of pediatrics who established this fact, and without disputing the truth of this figure, I would like to comment on the situation as follows:

a) it is difficult (almost impossible) to imagine that nature, having created optimal (even ideal) nutrition in all respects for an infant in the form of human milk, somehow “missed” in providing it with one of the most essential vitamins for growth and development. Nature does not make such mistakes on a large scale;

b) the study of the metabolism of vitamin B, the discovery of its active metabolites naturally suggests that with human milk infant receives an adequate amount of vitamin D in the form of ready-made compounds that have undergone transformation in the mother’s body - hydroxy- and dihydroxycholesterols. 40-70 IU of vitamin B is, apparently, the remaining, unmetabolized part.

From this position, it is impossible to talk about insufficient supply of vitamin B to the child through mother’s milk. The solution to this issue is quite simple and consists in developing a methodology and conducting research on the content of active metabolites of vitamin D in human milk with the establishment of appropriate standards. Unfortunately, no similar works have been found in the literature available to us.

Our position on some controversial issues of the classification of rickets (congenital rickets, late rickets, relapsing course, calcium- and phosphorus-variants, nutrition-dependent and hypoxic-

rickets) was expressed earlier and it largely coincides with the opinion of prof. E. V. Neudakhina and prof. V. L. Ageikina. The classification of S. O. Dulitsky, which the authors intend to preserve for the diagnosis of infantile rickets, undoubtedly requires adjustment. This concerns mainly the relationship between the period (initial, convalescence) and the severity of rickets.

I would like to support the opinion of the authors on the prevention and treatment of rickets. All the above data indicate the inadmissibility of using excessive doses of vitamin B. Our clinical experience, including the observation in the 60-70s of a large number of children suffering from hypervitaminosis B with very severe (even fatal) outcomes, forces us to categorically oppose large course doses (600,000 - 800,000 - 1,000,000 IU), as well as against shock, semi-shock, and push methods of administering vitamin B. Prevention of rickets should be carried out with physiological (500 IU) doses, taking into account the nature of the diet (all artificial mixtures currently contain vitamin B) and time of year. Treatment (if necessary) should be carried out in small doses - from 1500 to 4000 IU per day (maximum). In this case, special attention should be paid to monitoring the effectiveness of treatment. Since vitamin B is one of the main calcium-saving substances, its long-term use, even in minimal therapeutic doses, leads to an increase in the level of calcium in the blood, which is regulated by the excretion of excess calcium in the urine. Calciuria, determined by the Sulkowicz test, is evidence of a sufficient supply of the body with both calcium and vitamin D. It is currently hardly possible or advisable to use existing methods for determining vitamin D metabolites in the blood. At the same time, a method for judging the degree of saturation of the body with vitamin D may be the determination of its active metabolites in the urine. We are not aware of any work in this direction. I would like to draw the attention of biochemists and specialists in the field of vitaminology to this issue. The development of appropriate methods and the establishment of standards will help pediatric clinicians in solving this important issue.

Particular attention should be paid to nonspecific prevention and treatment of rickets. Without normalizing social and living conditions, diet, physical activity, etc., one cannot expect an effect from prescribing vitamin D.

The complexity of the problem under discussion, the huge variety of points of view, and difficult-to-eliminate stereotypes of thinking lead to the idea of ​​the need for a more radical approach to solving it. By transferring rickets to MKV X from the section of hypovitaminosis to the section of diseases of the endocrine system and metabolism (code B55.0), a significant, but not decisive step was taken. It seems to us that the decisive step would be to exclude the term “rickets” and replace it with another(ies), more consistent with the essence of the changes occurring in the body during these processes.

The term "rickets" - curvature of the spine - absolutely does not correspond to the essence. Known variants of spinal curvature (pathological lordosis, kyphosis, scoliosis) are much more common in older children and have other causes of development. In young children (mainly the 1st year of life), this condition (disease, syndrome) affects the entire skeletal system (both tubular and flat bones).

PEDIATRICS No. 4, 2003

Project classification of infant osteopathies

Date of occurrence

Etiopathogenetic factors

Primary osteopathies

Secondary (syndrome) osteopathy

Severity (degree)

Congenital

Postnatal

Endogenous

Exogenous

Mixed

Immaturity of enzyme systems for vitamin D metabolism (liver, kidneys)

Immaturity of bone formation systems

Vitamin D deficiency

Nutritional and household errors

Hereditary disorders of bone mineralization (osteo-genesis imperfecta) Ecopathological conditions (Cd, Sr intoxication, etc.) Hypophosphatasia Chondrodystrophy

Hereditary and acquired nephropathies (tubulopathies: phosphate diabetes, renal tubular acidosis, de Toni-Debreu-Fan-coni syndrome, pseudohypoparathyroidism - Albright's disease; chronic renal failure

Hereditary and acquired enteropathies (malabsorption syndromes, dysbiosis, gastrointestinal infections)

Endocrinopathies (hypothyroidism, hyperparathyroidism, etc.)

Iatrogenic (taking glucocorticoids, phenobarbital, tetracycline, etc.)

I (light)

II (moderate severity)

III (severity)

Chronic

Changes in the spine are currently rare and, as a rule, mildly expressed.

As an alternative, the term “osteopathy of infants”, “infant osteo(chondro)pathy” can be proposed. Refusal of the term rickets will make it possible in the near future to destroy the stereotype of the rigid connection between bone changes in infants with vitamin D deficiency. At the same time, it is the uncertainty of the term “osteopathy” that will direct medical thought to search and clarify the causes of the appearance of this condition and will inevitably lead to a differentiated approach to their prevention and treatment.

As an example of such an approach, we can refer to the problem of jaundice in newborns. This is a generally accepted diagnosis, which, however, requires clarification (conjugation, parenchymal, hemolytic, etc.) and further decoding.

We propose a draft classification of infant osteopathy (see table). We understand the imperfection of the proposed classification and ask that this project be considered as an invitation to discussion on this issue.

Undoubtedly, the initiative of the editors of the journal Pediatrics to conduct a discussion on this very important issue should be welcomed.

P.S. A remark that is not related to the issue under discussion. In the article by Prof. E. V. Neudakhina and prof. V. A. Ageikin in discussing the definition of the concept of “disease”, in our opinion, made an inaccuracy. They write: “disease -

“This is a pathological condition that arose as a result of the action of a certain etiological (pathogenic) factor and the development of specific and nonspecific reactions of the body, qualitatively different from physiological ones.” In our opinion, all reactions of the body are physiological, and their quantitative changes (exceeding a certain measure) lead to a new qualitative state (disease). This interpretation corresponds to one of the basic laws of philosophy.

LITERATURE

1.A. M. Zaprudnov, K. I. Grigoriev. Rickets in children. - M., 1998.

2.H.A. Korovina, A. V. Cheburkin, I. Ya. Zakharova. Prevention and treatment of rickets in children. - M., 1998.

3. Prevention and treatment of rickets in young children. Methodical recommendations / Ed. E. M. Lukyanova and others - M., 1990.

4. 3. A. Stankevich. The content of calcium, inorganic phosphorus, the activity of alkaline phosphatase in the blood serum and the processes of ossification in twin children (on the issue of the pathogenesis of rickets): Abstract of thesis. diss. ...cand. honey. Sci. - Minsk, 1972.

5. V. I. Strukov. Rickets in premature babies. - Penza, 1999.

6. Ya. F. Filatov. Semiotics and diagnosis of childhood diseases. M., 1949.

7. Ya. Ya. Shabalov. Childhood diseases. - St. Petersburg, 1997.

V. D. Demin

8. V. V. Shitskova. Clinical picture, diagnosis, prevention and treatment of hylervitaminosis B in young children. - M., 1972.

9. V. F. Demin. // Lectures on pediatrics. - Volume I. Pathology of newborns and young children. / Ed. V. F. Demina and S. O. Klyuchnikova. - M., 2001. - P. 39-53.

© Samsygina G. A., 2003

Thesis on the topic: “Rachitis as a medical and social problem.” St. Petersburg State Budgetary Educational Institute
institution of secondary vocational education
"Medical College named after. V.M. Bekhterev"
Completed by: student of group 34,
Vinogradova Ksenia Alexandrovna.
Head: Velikaya Nina Anatolyevna.
Saint Petersburg
2015

Rickets

Disease of young children
caused by a lack of vitamin D;
characterized by a disorder of phosphorus-calcium metabolism, a disorder
bone formation, nervous function
systems and internal organs.

Relevance of the topic

Rickets is one of the most
common
diseases among children first
years of life. Infant rickets
is not only
pediatric, but also a medical and social problem.

Goal of the work:

TARGET
WORKS:
Based
research
draw up
medical and social
portrait of a child with
manifestations
rickets.

:
1.Study the theoretical foundations of the problem.
2. Investigate the flow features
rickets in children.
3. Identify the main risk factors
development of rickets in children.
4.Analyze preventive measures
measures used to prevent rickets.
5. Analyze the work of the nurse.

Working hypothesis:

Rickets occurs more often in children who are
bottle-fed; more often
mild forms of rickets are observed;
mothers are not sufficiently informed
the problem of rickets.

Research bases:

Children's clinic
department No. 3.
Children's city
hospital No. 1.

Objects of study:

Mothers with children
up to a year.
Medical
patient cards.

Research methodology included several stages

First stage:
survey
mothers and work
with medical cards
infants,
having a diagnosis
rickets.
Second phase:
analysis and
generalization
received
data.
Third stage:
wording
conclusions,
planning
recommendations
to mothers.

10.

Results of a survey of mothers.
30%
70%
They know enough about Rickets
a lot of
21%
Source of information
is a nurse
58%
75%
75%
This problem
discussed at patronage
Most used
drug - aquadetrim
Perform a massage every
day
Use of UFO

11.

RESULTS OF WORKING WITH MEDICAL CARDS
1. Manifestations of rickets.
Restlessness, flinching, disturbance
sleep
2%
45%
Sweating
Development of hypotension (major
flat belly)
97%.
20%
15%
Tendency to constipation
Infectious diseases of the upper
respiratory tract
35%
50%
Delayed motor development
Change in appearance due to
bone deformations.

12.

2.Identified risk factors as a result of working with medical
cards.
3,30%
8,30%
11,60%
Born premature
Are present from birth on
artificial feeding
Born in the autumn-winter period
17%
45%
77%
There was no antenatal
prevention in mother
Twin baby
No obvious risk factors

13.

MEDICAL AND SOCIAL PORTRAIT OF A CHILD WHO IS SICK
RICKHS.
Premature baby
Artificially fed
With initial manifestations of rickets (prevail
autonomic disorders and muscle hypotension)
Without bone deformities, suffered from acute respiratory viral infection in the first year
life.
Born at any time of the year.
Somewhat lagging behind in the development of motor skills.
Receiving vitamin D preparation - aquadetrim, as
specific prevention of rickets, as well as massage, if not
specific prevention.
The parents of such a child experience some kind of deficiency
information about rickets, but still conscientiously carry out
doctor's prescriptions.
During visits, nurses pay attention
problem. Inform mothers as much as possible
on this issue.
Carry out work aimed at
maintaining breastfeeding.
In conversations with parents, pay special attention
Pay attention to the rules for taking vitamin D.
Teach parents gymnastics techniques and
massage.
Monitor implementation of recommendations
on prevention.

15.

CONCLUSIONS
Health care workers spend time informing parents about
the problem of rickets in the antenatal and postnatal period, although the level
awareness on different issues varies. In general, you should
recognize the work of doctors as satisfactory.
The most common method of preventing rickets is taking 100% vitamin D and performing a massage. UFO is used much less frequently,
only in 30% of cases.
Most mothers follow classic recommendations
for the prevention of rickets. Based on research
a medical and social portrait of the child was compiled with
manifestations of rickets.

Conclusion

Prevention of rickets is an important measure that must be carried out in the first years of a child’s life.

The process of studying rickets in childhood is one of the most important problems. Based on the literature studied, I have identified predisposing risk factors and causes of rickets in children.

The activities of the nurse are of key importance in the prevention of rickets. With proper organization of nursing care, the child’s recovery occurs.

Work on this course work helped me to understand the material deeper and became the next stage in improving my skills and knowledge.

Bibliography

• 1. Bazhenova L.K. Childhood diseases / ed. L. A. Isaeva. M.: Medicine, 1994. P. 173-91. Bessonova M. N. Rakhit. M.: Medgiz, 1960.
• 2. Bozhkov L.K. Physiology and pathology of the premature baby. M.: Medicine, 1983.
• 3. Vorontsov I. M. Some aspects of modern teaching about rickets // Pediatric science and practice. M., 1981. P. 27.
• 4. Ginzburg E. Ya., Sorochek R. G. Therapeutic gymnastics and massage for rickets and malnutrition. M., 1952.
• 5. Zabludovskaya E. D. Morphological changes in muscles in children with rickets // Pediatrics. 1961. No. 12. P. 37-43.
• 6. Korovina N. A., Cheburkin A. V., Zakharova I. N. Prevention and treatment of rickets in children (lecture for doctors). M., 1998.
• 7. Lasfargue J. Vitamin D is necessary // Report at the conference “Rachitis in children”. Moscow Department of Health. April 10, 1996. 7 p.
• 8. Maslov M. S. Rickets // Textbook of childhood diseases. L., 1952. S. 134-144.
• 9. Novikov P.V. Rickets and rickets-like diseases in children: prevention, preventive therapy. M., 1998. 60 p.
• 10. Novikov P.V., Kazi-Akhmetov E.A. A new (water-soluble) form of vitamin D3 for the treatment of children with vitamin D deficiency and hereditary vitamin D-resistant rickets // Russian Bulletin of Perinatology and Pediatrics. 1997. No. 6.
• 11. Radchenko L. G. Rickets in newborn children: abstract. dis. ...cand. medical sciences M. 1993. 21 p.
• 12. Svyatkina K. A., Khvul A. M., Rassolova M. A. Rakhit. M.: Medicine, 1964. 223 p.
• 13. Spirichev V. B. Pathogenesis and prevention of rickets in the light of modern ideas about the metabolism and mechanism of action of vitamin D // Pediatrics. 1978. No. 1. P. 70-71.
• 14. Strukov V.I. Rickets in premature infants. Penza, 1999. 29 p.
• 15. Filatov N. F. Semiotics and diagnosis of childhood diseases. M., 1949. S. 438-442.