The creation of optimal conditions and the organization of special care are determined by the unstable functioning and, to a certain extent, immaturity of all systems of the child’s body, especially in the first years of his life.
The skin is the most sensitive to adverse effects. The anatomical features of the skin of young children are characterized by the presence of a thin and sensitive stratum corneum of the epidermis, represented by two or three rows of loosely interconnected constantly exfoliating epithelial cells. The basement membrane is very loose and delicate, which determines the weak connection between the epidermis and dermis. The skin has a well-developed capillary network. Sweat glands, formed at the time of birth, do not function sufficiently during the first 3-4 months and have underdeveloped excretory ducts, closed by epithelial cells. Further maturation of the structures of the sweat glands, the autonomic nervous system and the thermoregulatory center of the central nervous system ensures the improvement of sweating.
The functions of the skin are very unique. The protective function of the skin from adverse external influences is significantly reduced. The skin is easily vulnerable due to the poor development of the epidermis and the low activity of local immunity. Thin stratum corneum and well developed vascular system cause increased resorption function of the skin. The danger of generalization of infection in children in the first years of life is much greater than in older age. The thermoregulatory function of the skin is unstable: heat transfer dominates over heat production, sweat glands do not function sufficiently. This makes it difficult to maintain a constant body temperature and leads to the need to create an optimal temperature regime for the child. The respiratory function of the skin is many times stronger than in adults. The peculiar structure of the vessels ensures easy diffusion of gases through the vascular wall. The skin contains a large number of extrareceptors. Excessive skin irritation with poor care has a negative impact on the child’s health.
The basis of care is cleanliness. This applies to the room in which the child is located, items to care for him and the personal hygiene of the caregiver. It is necessary to carry out wet cleaning daily and ventilate the room several times a day. The air temperature in the room is maintained at 20-22 °C, humidity - 40-60%; The child does not tolerate dry air well, as this increases water loss and overheating occurs more easily.
The child should be in his own crib, the side walls of which allow air to pass freely.
A hard mattress is placed in the crib, which is covered with a sheet, and a diaper folded several times under the head.
Child's clothes. It is preferable to use natural, easily washable materials (cotton fabrics, knitwear, wool). Clothing should protect the child from heat loss, but at the same time not cause overheating and not restrict movement. A full-term newborn is swaddled with his hands for the first two to three days, then his hands are left free. Tight swaddling is not used: the child must move freely. At night after bathing, it is better to swaddle your arms and put a cap or scarf on your head. At 3-4 weeks of life, and sometimes before the child wear rompers or overalls.
Morning toilet. The child is turned around on the changing table and undressed completely, the skin is carefully examined, especially the folds. Wash your face and hands with boiled water. The eyes are washed with sterile cotton wool soaked in boiled water from the outer corner of the eye to the inner; A separate swab is used for each eye. It is necessary to ensure that water does not get from one eye to the other, therefore, when washing the left eye, turn the child to the left and vice versa. If signs of conjunctivitis appear, treatment should be started as soon as possible. The oral cavity is not treated, since the mucous membrane is dry and easily injured. However, it must be inspected daily. The appearance of white plaque on the oral mucosa (thrush) requires certain measures. The auricles and external auditory canals are cleaned with a dry cotton swab only within sight. Toilet the nose is done with a cotton swab soaked in oil or a special stick with cotton wool wound on it, which is inserted into the nasal passages with gentle helical movements. Skin folds behind the ears, on the neck, in the armpits, elbows, groin, popliteal areas are treated with a cotton swab soaked in oil. Treatment of the genital organs of girls is carried out with a cotton swab soaked in oil or special sanitary napkins in the direction from front to back. In boys, it is necessary to open the head of the penis as much as possible and treat it with oil.
In a newborn child, during the first 2 weeks of life, the physiological process of healing of the umbilical wound occurs. It must be treated once a day with a 3% solution of hydrogen peroxide, then with a 1% alcohol solution of brilliant green.
Skin care includes removing waste products (urine and feces), cleansing the skin with gentle detergents, and protecting the skin from irritating factors. Children's hygiene products are developed taking into account the characteristics of the skin (pH-balanced, hypoallergenic). They are divided into cleansing (shampoos, bath foams, soaps, lotions), protecting (oils, powders), nourishing (creams).
The delicate and sensitive skin of a child requires gentle but thorough cleansing. For this purpose, gentle detergents are used. Baby skin has a lower irritability threshold than adult skin, so you should not use cleansers in large quantities. Soap can irritate the skin due to alkaline components, and synthetic detergents (bath bubbles, shampoos) due to the degreasing effect they produce. Skin irritation can be caused not only by the composition of the detergent and its high concentration, but also by the duration and frequency of bathing, as well as the temperature of the water, the type of towels and sponges used.
Bathing. After separation of the umbilical cord, if the process of epithelization of the umbilical wound is uncomplicated, the newborn should be bathed daily. The duration of the hygienic bath is 5 minutes, the water temperature is + 36.5...+ 37.0 °C. Until the umbilical wound heals, add a solution of potassium permanganate to the water until it turns slightly pink (the crystals are first dissolved in a separate container). For bathing, you can use unboiled tap water, both hot and cold. You should bathe your child with detergents no more than 2-3 times a week. At the end of bathing, the child is doused with water, the temperature of which is 1-2 degrees lower than the temperature of the water in the bath. You need to wash your child regularly, and after bowel movements, it is mandatory. The skin is dried (but not wiped!) using a towel or diaper made of soft cotton fabric using blotting movements. After 6 months, you can bathe your child every other day (in the hot season - every day at any age), at a water temperature of + 36 ° C, the duration of bathing is up to 10 minutes.
Protecting the skin from irritating factors is carried out by powdering or lubricating with cream or oil. Moderate powdering of the baby's skin prevents it from rubbing with a diaper or clothing. The powder is first applied to the hands, then to the child’s skin for a more even distribution, without lumps. Sometimes children do not tolerate the rubbing of emollients (creams, oils) into the skin, as this can cause delayed sweating and maceration. Excessive use of oils impedes the respiratory function of the skin. Skin care products must be selected individually for each child. The main selection criterion is their good tolerability.
A diaper is an essential item for caring for a young child. A healthy newborn urinates 20-25 times a day and has stool 5-6 times. The following types of diapers are used: reusable cotton diapers (gauze or fabric); disposable, the inner cellulose layer of which contains a gel-forming material with increased moisture absorption capacity. Modern disposable diapers quickly absorb urine, securely hold it in the inner layer, while the child’s skin remains dry. Disposable diapers reliably prevent contamination of children's clothing, are comfortable for the child, practical and easy to use.
In recent years, disposable diapers have undergone further improvement: diapers with reusable fasteners, with an improved inner layer (the new additional layer absorbs moisture faster and in greater quantities), so-called “breathable” diapers, the outer layer of which contains microscopic pores that can allow air to pass through, are being produced. skin and ensuring the release of water vapor from the diaper to the outside.
There are several sizes of diapers; a relative guideline in their selection is the child’s body weight. It is recommended to change a disposable diaper before feeding, after each bowel movement with obligatory toileting (washing), before bedtime and after motivation, before going for a walk. There is no scientific basis for the assumption that disposable diapers may have an adverse effect on the development of the genital organs of boys. When using disposable diapers, the temperature of the skin under them increases by no more than 0.5-1.0 °C, which does not create conditions for a persistent greenhouse effect. Spermatogenesis in boys begins no earlier than 7-8 years, and, therefore, in young children there can be no talk of any process of its suppression.
Pediatricians and physiologists consider the age of 12-18 months to be the optimal period for a child to begin developing toilet skills. In some children, readiness for learning may develop later - at 2-2.5 years. By this time, the child should be able to walk, bend down and pick up small objects from the floor, understand well the speech of an adult addressed to him, speak individual words himself, and try to explain to his parents what he wants.
A child’s readiness to learn can be determined by the presence of one or more signs: the child remains dry for at least 2 hours and wakes up dry after a nap, adheres to a regular “schedule” of bowel movements, makes it clear through words, gestures, facial expressions, and behavior that it is time to urinate or defecation, is able to follow simple verbal instructions from parents, experiences discomfort from soiled diapers and expresses a desire to change them.
Subsequently, caring for a child and raising him are inextricably linked. From an early age, it is necessary to pay the child’s attention to his appearance and teach him to be clean and tidy. During feeding, toileting, and going to bed, you should treat the child gently, showing kindness and calmness. Caring for him should be accompanied by affectionate conversation, which evokes positive emotions and distracts from unpleasant sensations.
Common diseases of the skin and mucous membranes include omphalitis, vesiculopustulosis, prickly heat, conjunctivitis, candidal stomatitis, and diaper dermatitis.
Omphalitis - inflammation of the umbilical region. With catarrhal omphalitis, serous discharge from the umbilical wound, slight hyperemia and infiltration of the umbilical ring are noted. Bloody crusts form, and a small amount of serous-purulent discharge accumulates under them. Epithelization of the umbilical wound is delayed. The child's condition is not impaired.
As the inflammatory process progresses, purulent discharge from the umbilical wound, swelling and hyperemia of the umbilical ring, and infiltration of subcutaneous fat around the navel appear. Umbilical vessels become thickened, well palpated. The umbilical region bulges somewhat, the skin around the navel is hyperemic, and the vessels of the anterior abdominal wall are dilated. The general condition of the child is disturbed: lethargy, regurgitation appears, body weight decreases, body temperature rises, and signs of an inflammatory reaction in the peripheral blood are noted.
In the presence of discharge from the umbilical wound and prolonged detachment of the umbilical cord, mushroom-shaped granulations (umbilical fungus) appear at the bottom of the umbilical wound.
Treatment consists of daily treatment of the umbilical wound with a 3% solution of hydrogen peroxide, then 70% ethyl alcohol, 1-2% alcohol solution of brilliant green or 3-4% solution of potassium permanganate. Zinc hyaluronate (curiosin) has a good effect. For navel fungus, use a silver nitrate solution. If the general condition is disturbed and there is a threat of generalization of the infectious process, antibiotics are prescribed.
Vesiculopustulosis - inflammation in the area of the mouths of the sweat glands. On the skin of the buttocks, thighs, head, and in natural folds, small superficial bubbles appear, filled with first transparent, then cloudy contents. After 2-3 days, the blisters burst, small erosions are found, covered with dry crusts, after which no scars or pigmentation remain.
Hygienic baths with disinfectants are carried out (potassium permanganate solution until the water acquires a slightly pink color, decoctions of celandine, chamomile). The ulcers are first removed with a sterile material moistened with 70% alcohol. Twice a day, the elements are treated with a 1-2% alcohol solution of brilliant green or mupirocin (Bactroban).
Prickly heat - skin damage associated with hyperfunction of the sweat glands, caused by overheating or insufficient skin care. Clinically manifested by an abundance of small red nodules and spots on the neck, lower abdomen, upper chest, and natural folds of the skin. The general condition of the child is not impaired.
Hygienic baths with the addition of a solution of potassium permanganate are recommended until the water acquires a slightly pink color; thoroughly drying the skin with blotting movements; dusting with indifferent powders (“baby”, talc with zinc).
Conjunctivitis may be catarrhal and purulent. The disease occurs mainly as a local process; infection usually occurs when the fetus passes through the birth canal. The disease is characterized by severe swelling and hyperemia of the eyelids, and there may be purulent discharge. In case of abundant purulent discharge and a prolonged course of the process, the etiology of the disease should be determined based on the results of microscopic and bacteriological studies.
Prescribe washing the eyes with a weak solution of potassium permanganate 6-10 times a day, followed by instillation of a 20% sodium sulfacyl solution or a targeted antibiotic solution (if the pathogen is specified).
Candidal stomatitis (thrush) is characterized by the appearance of a slightly raised white plaque on the oral mucosa. When the plaque is removed, a hyperemic, slightly bleeding surface is discovered. Pathogen - Candida albicans. The disease usually occurs due to defects in care.
Treatment involves treating the oral cavity with a 2-4% solution of sodium bicarbonate, aqueous solutions of aniline dyes (diamond green, methylene blue, gentian violet), and oral administration of fluconazole (Diflucan).
Diaper dermatitis - periodically occurring pathological condition baby's skin, provoked by exposure to physical, chemical, enzymatic and microbial factors when using diapers or nappies.
The disease begins with the appearance of moderate redness, a mild rash and peeling of the skin in the genital area, buttocks, lower abdomen and lower back. In the future, if the effect of irritating factors is not eliminated, papules and pustules appear on the skin, and small infiltrates may form in the skin folds; infection occurs Candida albicans and bacteria. With a prolonged course of the disease, drainage infiltrates, weeping, and deep erosions are formed.
For treatment, it is necessary to use hygroscopic disposable diapers; frequent changes are indicated (including at night). Special “diaper” creams are applied to the affected areas of the skin, drapolen cream, desitin ointments, and bepanten are used. For candidiasis, apply cream or powder with antifungal drugs (miconazole, clotrimazole, ketoconazole) to the affected areas of the skin. If the child's condition is complicated by itching, antihistamines are indicated. In case of severe diaper dermatitis or its combination with allergic dermatitis, topical glucocorticosteroids (Advantan, Elokom) are used topically.
Literature
- Zanko N.I. Efficiency of new skin care technologies for young children: abstract. dis. ...cand. honey. Sciences, M., 2000.
- Shabalov N.P. Neonatology. M., 2006. T. 1. P. 593-607.
- Darmstadt G. L., Dinulos J. G. Neonatal skin care // Pediatr Clin North Am. 2000; 47(4): 757-782.
- Madison K. C. Barrier function of the skin: ‘la raison d’etre’ of the epidermis // J Invest Dermatol. 2003; 121: 231-241.
- Odio M., Friedlander S. F., Railan D. et al. Diaper dermatitis and advances in diaper technology // Curr Opin Pediatr. 2000; 12(4): 342-346.
N. A. Belousova, Candidate of Medical Sciences
E. G. Belousova
MMA im. I. M. Sechenova, Moscow
SAOU SPO RK "Evpatoria Medical College"
Cyclic methodological commissionnursing and pediatrics
METHODOLOGICAL DEVELOPMENT
open practical lesson No. 8
on the topic of:
« Carrying out nursing care for young children with acute digestive disorders »
Type of lesson: practical
Academic subject: “Nursing care in pediatrics”
Well: II
Number of hours: 4
Evpatoria, 2018
Prepared by a teacher of the highest qualification category Averyanova L.I.
Reviewed and approved
CMC of nursing
and pediatrics
Protocol No. __________
from "____"___________20___
Chairman __________ Mailyan V.L.
Review
On the methodological development of an open practical lesson on the topic:
“Performing nursing care for young children with
The methodological development was compiled by a teacher of the highest qualification category “Nursing care in pediatrics” Averyanova L.I.
The topic of the practical lesson corresponds to the work program.
This methodological development is intended for conducting practical classes in the discipline MDK 02.01. “Nursing care for various diseases and conditions” Section 02.01.03 “Nursing care in pediatrics”PM 02 and compiled in accordance with the Federal State Educational Standard for the specialty of secondary vocational education 34.02.01 nursing.
The methodological development consists of a lesson plan that defines goals and motivation, as well as materials for extracurricular independent work, questions for frontal surveys, tests with standard answers, a role-playing game scenario, which includes tasks to identify the level of practical training and mastery of the topic with standard answers; situational tasks for final control, algorithms of previously studied and mastered practical skills, homework.
To optimize the assimilation of the material, a multimedia presentation is attached on the topic “Performing nursing care for young children with acute digestive disorders", allowing not only to visualize, but also to consolidate knowledge on the topic.
The methodological development was carried out at a high methodological level and is recommended for conducting an open practical lesson.
Reviewer, teacher of nursing care in pediatrics of the highest category _____________Panchenko L.V.
State autonomous educational institution of secondary vocational education of the Republic of Crimea “Evpatoria Medical College”.
Practical lesson plan No. _8____
Lesson topic: «acute digestive disorders."
MDK. 02.01 Nursing care for various diseases and conditions.
Section 3. Nursing care in pediatrics.
Speciality02/34/01 CNursing Affairs course 2, semester 3.
Lesson objectives:
Educational goal: systematize theoretical knowledge, improve the skills of a nurse in caring for young children with pathologies of the digestive system.
To master the features and basic principles of the nursing process when caring for young children with acute digestive disorders.
Developmental goal - activation of cognitive activity of students, generalization and systematization of knowledge on the occurrence of acute digestive disorders, development of professional thinking.
Educational goal – develop a sense of responsibility for the timeliness and correctness of the nurse’s professional actions, form an understanding of the essence and social significance of their future profession, and develop a sustainable interest in it; education of professional, information culture.
Methodological goal:- formation of general and professional competencies in the process of teaching students,applicationinnovative technologies for developing professionalism in future nurses,
Interdisciplinary connections :
4). Pharmacology with prescription (medicines used for this pathology
Intradisciplinary connections: organization of care for children with infectious diseases of the skin and umbilical wound in newborns,
Location: preclinical practice room.
Type of lesson: practical
Number of hours: 4
Providing classes :
Information : textbook, presentations: “Acute digestive disorders in young children”, “AFO of the digestive organs in children”, “Pylorospasm and pyloric stenosis”.
Methodical: methodological development, instructions, professional algorithms, situational tasks, questions for oral questioning, tests.
Equipment:
Literature:
Main sources:
1.Sokolova N.G., Tulchinskaya V.D. "Nursing in Pediatrics" Rostov-on-Don, "Phoenix" 2015
2. Sokolova N.G., Tulchinskaya V.D. "Nursing in Pediatrics." Workshop" Rostov-on-Don, "Phoenix" 2015
3. Ezhova N.V. Pediatrics, publishing house M.: Onyx, published 2010.
4. Drozdov A. A Propaedeutics of childhood diseases: tutorial, publishing house M.: EXIMO, published 2011.
Additional sources:
1. Shabalov N, P. Pediatrics: a textbook for students, publishing house M.: Spetslit, published 2010.
2. Vertkin A. L. Ambulance: a guide for paramedics and nurses (author, publishing house M.: EKSMO, published 2010.
3. Eliseev Yu.Yu. Directory of a paramedic, publishing house M.: GEOTARMED, published 2012.
The student must be able to:
5. Organize care for patients with functional diarrhea and intestinal toxicosis.
The student must know:
The student must have:
General competencies:
OK 1. Understand the essence and social significance of your future profession, show sustained interest in it.
OK 2. Organize your own activities, choose standard methods and ways of performing professional tasks, evaluate their implementation and quality.
OK 3. Make decisions in standard and non-standard situations and take responsibility for them.
OK 5. Use information and communication technologies in professional activities.
OK 6. Work in a team and team, communicate effectively with colleagues, management, and consumers.
OK 7. Take responsibility for the work of team members (subordinates) and for the result of the task.
OK 12. Organize the workplace in compliance with the requirements of labor protection, industrial sanitation, infection and fire safety.
Professional competencies:
PC 2.1. Present information in a form understandable to the patient, explain to him the essence of the interventions.
PC 2.2. Carry out therapeutic and diagnostic interventions, interacting with participants in the treatment process.
PC 2.5. Comply with the rules for using equipment, equipment and medical products during the diagnostic and treatment process.
PC 2.6. Maintain approved medical records.
Lesson structure:
Organizational moment 2 min.
Assessment of students' knowledge (checking the initial level of knowledge)
Practical part:
4.2. Role-playing game “Performing nursing care for young children with acute digestive disorders.” 50 min.
4.3. Independent work:
5. Final control.
6. Homework _____________________________________________ _1 min.
Summing up the lesson, evaluating students' work ________ 4 min.
Progress of the lesson.
1.Organizational moment : Greeting the teacher, checking absences, student appearance and availability of diaries.
Occupational safety briefing. Compliance with safety precautions when working with medications.
2.Motivation (goals) for the lesson : communication of the topic, goals of the lesson, entry in the practical training diary, mastery of general and professional competencies.
In their practical activities, nurses can daily encounter pathology of the digestive organs in young children, so they must clearly and competently, depending on the impaired needs, identify the child’s problems, draw up a plan of nursing care, implement the goals, differentiate
functional intestinal disorders from acute intestinal infections in order to promptly and correctly organize treatment for children.
Among infectious diseases in children, acute intestinal infections receive special attention. According to WHO, AEs occupy 2nd place (after upper respiratory tract infections) among infectious diseases in children. Every year, AEIs are registered among 500 million of the planet's population, of which 60-70% of cases occur in children of different age groups. As a result of diarrhea, 3 million children die annually (80% of them are children under 2 years of age).
The high prevalence of acute digestive disorders in children of the first year of life is due to the anatomical and physiological characteristics of the digestive organs.
3. Assessment of student knowledge (checking the initial level of knowledge):
3.1. Testing knowledge: questions for an oral frontal survey (Appendix No. 2)
testing (Appendix No. 3).
3.2. Checking extracurricular independent work: checking homework.
3.3. Summing up control results: assessing initial knowledge.
4. Practical part:
4.1. Preparing students for independent work (instructing how to complete tasks, Appendix 1).
Analysis of algorithms for the action of a nurse in caring for children with functional diarrhea and intestinal toxicosis:
"Carrying out oral rehydration"
"Gastric lavage"
"Performing a cleansing enema"
"Emergency help for vomiting"
"Providing emergency care for flatulence"
4.2. Role-playing game "Carrying out nursing care for young children
acute digestive disorders" (Appendix 4).
4.3. Independent work:
Algorithms for practical skills (Appendix 5).
Students practice practical skills on mannequins:
“Gastric lavage”, “Getting a cleansing enema”,
“Inserting a gas outlet pipe.”
4.4. Summing up the results of independent work: individual control of practical skills. 5. Final control
. Solving problem-situational problems, students identify patient problems and draw up nursing care plans. (Tasks appendix 6). :
6. Homework
Chronic digestive disorders in children.
N.G. Sokolova, V.D. Tulchinskaya “Nursing in pediatrics. Workshop"
G. Rostov-on-Don, “Phoenix” 2015, pp. 184-191.
7. Summing up the lesson, evaluating students’ work . A message about the grades received, an explanation of errors.
Teacher L.I. Averyanova.
Annex 1
Instructions for practical lesson No. 8
Topic of the lesson: “ Role-playing game "acute digestive disorders."
MDK: 02.01. Nursing care for various diseases and conditions.
Section 3. Nursing care in pediatrics.
Specialty: 02/34/01 Nursing
Course: 2. Semester 3.
Equipment: manikin doll, medicines, aprons, pears - cans, disinfection solution, gastric tube for gastric lavage, intravenous drip infusion system, sterile gloves, trays, masks, sterile bag, referral forms, nursing history, gas tube, syringes.
I . Learning objectives of the lesson:
1.To consolidate theoretical knowledge about acute digestive disorders in children.
2.Study the stages of the nursing process for acute digestive disorders in children.
The student must be able to:
1.Assess the condition, identify patient problems, and draw up a nursing care plan.
2. Carry out oral rehydration.
3. Give a cleansing enema.
4. Perform gastric lavage.
5. Organize care for patients with functional diarrhea and intestinal toxicosis.
6. Provide emergency care to patients with vomiting, flatulence, and intestinal toxicosis.
The student must know:
1. Etiology, clinical symptoms, diagnosis, treatment, prevention of functional diarrhea and intestinal toxicosis.
2. Features of nursing care for this pathology.
3. The role of the nurse in the treatment and prevention of acute digestive disorders in young children.
11. Lesson structure and plan:
1. Organizational moment 2 min.
Motivation (goals) of the lesson 3 min.
Assessment of students' knowledge (checking the initial level of knowledge).
3.1. Oral frontal survey_______________________30 min.
3.2. Testing_____________________________________________ 10 min.
3.3. Oral discussion of extracurricular independent
work_______________________________________________10 min.
Practical part:
4.1. Preparing students for independent work________30 min.
4.2. Role-playing game “Performing nursing care for young children with acute digestive disorders.” _ 50 min.
4.3. Independent work:
practicing practical skills on mannequins___________ 20 min.
4.4. Individual control of practical skills______ 10 min.
5. Final control.
5.1. Solving situational problems_______________________ 10 min.
6. Homework: Chronic eating disorders in children.
N.G. Sokolova, V.D. Tulchinskaya “Nursing in Pediatrics” Rostov-on-Don, “Phoenix” 2015, pp. 48-54.
111. Literature:
Main:
Sokolova N.G. Nursing in pediatrics: workshop
Rostov n/a Phoenix 2013
Tulchinskaya V.D. Pediatric Nursing
Rostov n/a Phoenix 2014
Additional sources:
1.Lebed V.A. Handbook of pediatrics with nursing process Rostov n/DFenix 2011
2. Golubeva M.V. Diseases of newborns: diagnosis and treatment Rostov n/a
Internet resources
7. Summing up the lesson, evaluating students’ work ________ 4 min.
Teacher Averyanova L.I.
Appendix 2.
Questions for an oral frontal survey.
Classification of acute digestive disorders in children.
Etiology of functional diarrhea.
Functional diarrhea clinic.
Treatment. Prevention.
What is intestinal toxicosis?
Pathogenesis of intestinal infections in young children.
Classification and clinical symptoms of various forms
intestinal toxicosis with exicosis.
Treatment of intestinal toxicosis with exicosis.
Prevention of acute digestive disorders in children.
Criteria for evaluation:
“5” (excellent) - 1) the student fully presents the material, gives correct definition basic concepts;
2) shows an understanding of the material, can justify his judgments, apply knowledge in practice, give the necessary examples not only from the textbook, but also compiled independently;
3) presents the material consistently and correctly from the point of view of the norms of literary language.
“4” (good) – the student gives an answer that satisfies the same requirements as for the mark “5”, but makes 1-2 mistakes, which he himself corrects, and 1-2 shortcomings in the sequence and linguistic design of what is presented.
“3” (satisfactory) – the student demonstrates knowledge and understanding of the main provisions of this topic, but:
1) presents the material incompletely and allows for inaccuracies in the definition of concepts or the formulation of rules;
2) does not know how to substantiate his judgments deeply and convincingly enough and give his examples;
3) presents the material inconsistently and makes mistakes in the language of the presentation.
Grade “2” (unsatisfactory): the student shows ignorance of most of the relevant issue, makes mistakes in the formulation of definitions and rules that distort their meaning, presents the material in a disorderly and uncertain manner. A rating of “2” indicates deficiencies in preparation that are a serious obstacle to the successful mastery of subsequent material.
Appendix 3.
Test control
Option 1.
1. The main causes of intestinal toxicosis with exicosis are:
A) rotavirus infection
b) escherichiosis
c) streptococci
d) klebsiella
d) proteus
2. Stage 2 exicosis is characterized by:
a) fluid loss 5%
b) fluid loss 10%
c) fluid loss 15%
d) fluid loss 20%
e) fluid loss 30%
3. Salt deficiency exicosis is characterized by symptoms:
a) lack of thirst
B) increase in temperature
c) decreased tendon reflexes
d) disturbance of consciousness
e) increased sodium levels in the blood
4. For intravenous rehydration, solutions are used:
a) yells
b) rehydron
c) rheopolyglucin
d) citroglucosolan
D) Ringer's solution
5. The child lost 800 grams of body weight due to vomiting and loose stools. Upon objective examination, the condition is serious: the skin is grayish-bluish in color, dry to the touch, reflexes and tissue turgor are reduced, facial features are sharpened.
What disease can you think about?
A) intestinal toxicosis
B) malnutrition
B) hypervitaminosis
D) functional diarrhea
D) allergic diathesis
6. To prevent intestinal toxicosis, a child who has vomited 2 times and loose stools without pathological impurities 6 times is prescribed:
A) water-tea break 6-12 hours
B) intravenous infusion of 20% glucose solution
B) drip infusions of saline solution
D) smecta
D) antibiotics
7. In what dose is breast milk prescribed on the second day after the water-tea break:
A) 10-15 ml every 2 hours
B) ½ daily milk requirement
C) 1/3 of the daily milk requirement
D) daily requirement for milk
D) 70 ml every 2 hours
8. The child is 6 months old. He is being treated in a hospital with a diagnosis of intestinal toxicosis. Which symptom is not typical?
A) loose yellow stools 4-5 times a day
B) dry wrinkled skin
C) the large fontanel is located below the level of the skull bones
D) loose stools up to 15 times
e) vomiting every 15 minutes
9. Determine the daily dose of fluid for a child who has grade 2 dehydration due to intestinal toxicosis.
B) 150-170 ml per 1 kg of body weight
D) 120-150 ml per 1 kg of body weight
D) 10-60 ml per 1 kg of body weight
10. Select a symptom that is observed with protein overfeeding in children infancy.
A) the stool is alkaline
b) stool is liquid, foamy, green with undigested lumps of food of yellow and white color
c) crumbly stool with a putrid odor
d) yellow stools with a lot of liquid
d) constipation
Option 2.
1. The main causes of functional diarrhea are:
a) proteus
b) violation of rational nutrition
c) improper introduction of complementary foods
d) natural feeding
e) carbohydrate overfeeding
2. For 1st degree of intestinal toxicosis with exicosis it is characteristic:
a) increase in temperature to 39.0-39.5 ° C,
b) increased blood pressure
c) intestinal paresis
d) oliguria
e) exicosis
3. The child has a serious condition, underweight. The skin has a grayish tint, is wrinkled, food tolerance is sharply reduced, and dyspeptic disorders occur. These symptoms indicate:
a) intestinal toxicosis with exicosis
b) 1st degree malnutrition
c) hypotrophy 2nd degree
d) functional diarrhea
e) pylorospasm
4. The child is 5 months old. Complementary feeding of 100 grams of vegetable puree was introduced, after 50 minutes the child became lethargic, vomiting appeared, and loose stools with a large amount of liquid. This condition is observed when:
a) intestinal toxicosis with exicosis
b) malnutrition 1st degree
c) allergic diathesis
d) functional diarrhea
d) pylorospasm
5. After feeding, the child has stool 20 times a day and vomits 10 times. Select the symptoms that may occur with this condition:
A) loss of body weight per day 100-150 g.
B) loss of body weight per day 600-800 g.
B) skin rash
d) “geographical language”
d) crumbly stool
6. Select a symptom that is observed with functional diarrhea and carbohydrate overfeeding.
A) feces are alkaline
B) feces are liquid, foamy, and have an acidic reaction.
c) crumbly stool
d) green stool with mucus and a lot of water
d) uncontrollable vomiting
7. Determine the dose of the daily amount of fluid if the child is diagnosed with intestinal toxicosis with exicosis of the 1st degree.
A) 75-100 ml per 1 kg of body weight
B) 100-120 ml per 1 kg of body weight
B) 120-150 ml per 1 kg of body weight
D) 150-170 ml per 1 kg of body weight
D) 50-75 ml per 1 kg of body weight
8. Select an enzyme preparation that is used in case of digestive disorders:
A) videohall
B) pyridoxine
B) retinol
D) festal
D) smecta
9. With isotonic exicosis, the ratio of glucose-saline solutions for infants is:
a) 1:1
b) 2:1
at 12
d) 2:3
e) 3:1
10. For oral rehydration, solutions are used:
a) yells
b) rehydron
c) rheopolyglucin
d) citroglucosolan
D) acesol 21
Sample answers:
Option 1 1. a, b, d, d Option 2 1. b, c, d
2.b 2.a, d
3. b, c, d 3. a
4. c, d 4. g
5. a 5. b
6. a, d 6. g
7. a 7. c
8. a 8. d, d
9. in 9. a
10.c 10.a, b, d
Appendix 4
Role-playing game scenario on the topic: acute digestive disorders."
Motivation:
In their practical activities, nurses can daily encounter pathology of the digestive organs in young children, therefore they must clearly and competently, depending on the impaired needs, identify the child’s problems, draw up a plan of nursing care, implement the goals, differentiate functional intestinal disorders from acute intestinal disorders infections.
Learning objectives:
1.Develop professional, clinical, interdisciplinary thinking.
2.Be able to establish psychological contact with parents and children, analyze the situation, make thoughtful decisions, and work in a team.
3. Form cognitive interest, apply your knowledge in practice.
Training room: preclinical practice room.
Materials for methodological support of role-playing games : manikin doll, medicines, aprons, pears - cans, disinfection solution, gastric tube for gastric lavage, intravenous drip infusion system, sterile gloves, trays, masks, sterile bag, referral forms, nursing history, gas tube, syringes, manipulation table.
Interdisciplinary connections :
1). Human anatomy and physiology (structure of the digestive organs).
2). A healthy person and his environment (AFO of the digestive organs in children, basic rules of natural feeding, introduction of complementary foods).
3). Performing work in the profession of a junior nurse caring for patients (performing a cleansing enema, gastric lavage, placing a gas tube).
| Scroll stages | Activity teacher | Activity students | Methodical security |
| 1.Preparatory Stage 2.Main stage 3.Final stage. | Announces the topic, relevance, educational goals. Introduces students to tasks and game script. Distributes roles between game participants Determines the task for each participant in the game. Observes, adjusts the stages of the game, monitors the skills of each student participating in the game. Helps students by asking guiding questions. Determines the level of criticality and self-esteem. Summarizes the game with students. Analyzes students' work. Conducts an individual assessment of theoretical knowledge, practical skills and abilities in accordance with the criteria. | They perceive the theme of the game. Think about the assigned tasks. Listening explanations teacher. Get to know the content of the role. Make up your own list of necessary actions to fulfill your role. Each student performs his role, demonstrates the full range of skills and practical skills, modeling problematic situation. Students answer the questions posed. Give self-esteem They draw conclusions. Conduct self-analysis and self-assessment of the role performed. | Literature on the topic main and additional. Individual cards to prepare roles manikin doll, medicines, aprons, pears - cans, disinfection solution, gastric tube for gastric lavage, intravenous drip infusion system, sterile gloves, trays, masks, sterile bag, referral forms, nursing history, gas tube, syringes. Criteria for assessing practical skills, the level of professional skills when performing a role-playing game, the ability to work in a team. |
In the role-playing game Role-playing game "acute digestive disorders» It is expected to involve 6 persons:
Mother of a sick child.
Treatment room nurse.
Guard nurse.
District nurse.
The doctor is the referee.
Actors, their rights and responsibilities.
2.List the typical complaints characteristic of functional diarrhea.
3. Ask the nurse questions about the child’s condition.
4. Know the results of laboratory examinations
Give a detailed medical history and report the symptoms of the disease.
District nurse
1. Call your local pediatrician.
1. Assess the child’s condition.
5. As prescribed by the doctor, give a referral for tests: OBC, coprogram and bacterial research.
Admissions department nurse.
1. Call a pediatrician.
2.Conduct an examination of the sick child.
3. Write down your medical history.
1. Assess the child’s condition, determine body T, heart rate, respiratory rate, palpate the abdomen.
2.Identify problems and perform necessary emergency nursing interventions.
3.Follow the doctor's instructions.
4.Teach the mother the elements of caring for a sick child.
5. Take the tests prescribed by the doctor:
6.Fill out medical documentation.
7. Carry out sanitary treatment of the sick child.
Guard nurse
1. Call a pediatrician.
2.Conduct an examination of the sick child.
3. Write down your medical history.
4.Get the necessary information from your doctor.
1.Tell the mother about the disease and its causes.
2. Monitor a sick child: measure body T, determine heart rate, respiratory rate.
3. Monitor your diet.
4.Count the amount of liquid drunk and excreted.
5. Carry out the treatment prescribed by the doctor.
6. Conduct tests prescribed by the doctor.
7.Fill out medical documentation.
8. Monitor the child’s personal hygiene.
9. Carry out disinfection.
10. Watch the stool.
Treatment room nurse
1.Get the necessary information from your doctor.
2. Call a pediatrician.
3. Examine the sick child.
1. Observe all rules of asepsis and antiseptics.
2.Follow doctor’s orders: intramuscular and intravenous injections, infusion therapy.
3. Conduct blood sampling for various types of tests.
4. Write it down in the journal, make a note on the assignment sheet.
Doctor - referee
1. Monitor the work of nurses.
1. Monitor the work of nurses and make comments.
2.Conduct an examination of the patient.
3. Make a diagnosis.
4. Prescribe examination and treatment for a sick child.
Task No. 1.
M nursein foster care for a child 5 months.
From the anamnesis it is known that p The baby was switched to mixed feeding three weeks ago due to a lack of milk from the mother. The mother supplements with 100 ml Detolact formula. After the introduction of supplementary feeding, stool frequency increased up to 5-7 times a day.
The mother complains of anxiety, weakness, poor appetite.
During nursing examination:the skin is somewhat pale, normal tissue turgor , subcutaneous fat layerdeveloped satisfactorily. T -36.6, respiratory rate 40 per minute, Heart rate - 160 per minute.
The abdomen is moderately distended, rumbling intestinal loops upon palpation, loose stools Green colour up to 5-6 times a day with clear mucus and white lumps.Urination is not impaired.
What needs are violated?
What problems have arisen?
Compose
Standard answer.
Needs violated:
to be healthy;
have a comfortable state;
Healthy food;
It's okay to highlight.
Problems encountered:
1. From the child's side:increased gas formation, loose stools, weakness, poor appetite, anxiety.
2. From the mother's side:lack of knowledge about proper nutrition.
Nursing intervention plan.
Informmother about the cause of the disease.
Tell the mother about the need to follow a diet: exclude foods with increased gas formation from the diet.
Massage the abdomen clockwise.
Install the gas outlet pipe.
Assign oral rehydration for 6 hours.
At the expiration of diet therapy: feed 10-15 ml every 2 hours.
Dependent actions of the nurse- V fulfillment of medical prescriptions: enzyme drugs, smecta, ubiotics, spumizan.
Task No. 2.
The child is 8 months old. Enters the emergency room. From the anamnesis it is known that deer since yesterday, when regurgitation appeared, repeated vomiting, frequent, liquid stool mixed with mucus up to 20 times a day.
Child's condition heavy Temperature 39.0º C, lethargic, adynamic, no vomiting at the moment. Skin is pale, dry, elasticity and turgor are reduced. Visible mucous membranes are dry and bright. Big sunken fontanel, facial features are sharpened. B D 52 per 1 min., heart rate 120 beats. in 1 min, weak filling, muffled heart sounds.Breathing is puerile. The abdomen is moderately swollen, urination is rare. Lost weight 800 grams. Watery yellow stools up to 20 times a day.
At the emergency room, a diagnosis was made: grade 2 intestinal toxicosis.
Tasks
1. Highlight the patient's problems.
2. Define goals and make nursing intervention plan.
Standard answer.
Needs violated:
1.be healthy;
2. have a comfortable state;
3. eat right;
4. it’s normal to highlight.
Patient problems:
1. From the child's side:increased body temperature, loose stools, increased gas formation, weakness, poor appetite, anxiety.
2. From the mother's side:lack of knowledge about proper nutrition and intestinal toxicosis.
Nursing intervention plan.
1. Informmother about the disease and its causes.
2. Instill hope for a favorable outcome.
3. Hospitalize in a hospital.
4. Take a stool sample for bacteriological examination.
5. As prescribed by the doctor, it is necessary to rinse the stomach and give a cleansing enema.
6. Train the mother of a sick child to take a water-tea break for 12-24 hours. A child is prescribed 150 ml of liquid per 1 kg of body weight per day.
at II degree -2/3 of the calculated fluid is given orally (if there is no persistent vomiting), 1/3 is administered intravenously.
7. After the water-tea break, make sure that the baby is fed 10 ml of expressed breast milk every 2 hours (10 times). Every day the feeding volume was increased by 10-15 ml, when reaching 50 ml per 1 feeding, the child was transferred to 8 times feeding, upon reaching 90 ml - for 7 feedings, at 150 ml - to 6 times feeding.
8. As prescribed by the doctor, carry out detoxification therapy, antibiotic therapy, and symptomatic therapy. give probiotics, enzymes, vitamins.
9. Train the mother of a sick child to count the fluid drunk and excreted.
10. Monitor: monitor body temperature, calculate heart rate, respiratory rate, observe stool
The teacher begins the game by describing the situation:
Task No. 1.
A nurse came to patronize a 2-month-old child who had anxiety, decreased appetite, disturbed sleep, and periodically writhing legs. The mother of a sick child talks about the onset of the disease and describes the clinical signs.
The nurse identifies problems, examines the child, determines the condition, decides on further treatment, calls a doctor, and draws up a nursing plan.
Task No. 2.
The teacher reads the medical history of a child who is admitted to the emergency room with intestinal toxicosis.
The mother of a sick child talks about the onset of the disease and describes the clinical signs.
The emergency room nurse examines the sick child, assesses the condition, invites a doctor, administers a cleansing enema as prescribed by the doctor, and carries out sanitary and hygienic treatment.
The treatment room nurse talks about intravenous drip administration of fluid and gives examples of solutions for infusion therapy.
Talks about administering antibiotics. Question for the nurse: how to organize the implementation of medication prescriptions.
The guard nurse identifies the patient's problems and draws up a nursing care plan. Performs oral rehydration, diet therapy, and collection of tests prescribed by the doctor as prescribed by the doctor.
Monitors the condition of the sick child, the amount of fluid drunk and excreted, and carries out doctor’s orders.
Cards for individual tasks in a role-playing game.
Card for preparing the role of the mother of a sick child.
1. Point out changes in the child’s condition that forced him to seek medical help.2. List typical complaints characteristic of functional diarrhea and intestinal toxicosis.
3. Name the characteristic symptoms of the disease.
4.Ask the nurse questions about the child’s condition.
Study literature on the topic
Card for preparing the role of a district nurse
1. Tell the mother about the disease and its causes.2.Identify the patient’s problems and give advice on care.
3.Perform necessary nursing interventions.
4. Call a doctor.
5. As prescribed by the doctor, give a referral for tests: OBC, coprogram and tank.
sowing.
6.Fill out medical documentation.
Study literature on the topic.
2. Learn the clinical symptoms of acute digestive disorders in children.
6. Teach the mother the elements of caring for a sick child.
3. To study the provision of emergency care for acute digestive disorders in infants
1. Assess the child’s condition.
2.Identify the patient’s problems and give advice on care.
3. Resolve the issue of hospitalization.
Card for preparing the role of a treatment room nurse
1. Study the features of care,treatment of acute digestive disorders in infants.
1. Follow all rules of asepsis and antiseptics.
2. Conduct blood sampling for various types of tests.
3. Write in the journal, make a note on the assignment sheet
Study literature on the topic.
Repeat the algorithms for intravenous injection, filling the system for intravenous drips
infusions.
2. Repeat the algorithms for collecting blood for biochemical analysis, intravenous injection, filling the system for intravenous drips
infusions.
Follow doctor's orders: intramuscular and intravenous injections, infusion therapy.
Criteria for assessing students' educational activities
Students are assessed based on the following types of activities:
1. Participation in role-playing game (professional skills):
role fulfilled completely - 5 points
role partially fulfilled - 3 points
role not fulfilled - 0 points
2. Practical skills:
correctly at the optimal pace - 3 points
correctly at a low pace - 2 points
deviations from the algorithm were made - 1 point
3. Ability to cooperate:
Expressed - 2 b
low -1 b
absent - 0 b
4. Activity- 1 b
Evaluation is carried out according to the rating system:
10 points = “5”
6-8 points = “4”
3-5 points = “3”
≤ 3 points = “2”
Appendix 5
Algorithms for practical skills
"Gastric lavage technique."
Target : remove toxic substances from the stomach.
Contraindications : bleeding from the gastrointestinal tract, inflammatory diseases in the oral cavity and pharynx.
Equipment :
gastric tube
rubber apron 2 pieces
container with rinsing solution 20-22 o C
basin for rinsing water
equipment tray
waste tray
gauze wipes
putty knife
sterile container for rinsing water
container with disinfectant solution, rags
latex gloves.
Required condition : The rinsing solution should not be warm (will be absorbed) and should not be cold (may cause stomach cramps)
- Respect for the right to information- Formation of motivation for cooperation
- Prepare the necessary equipment
- Ensuring the accuracy of the procedure
- Put on an apron
- Wash and dry your hands, put on gloves
- Treat the changing table with a disinfectant solution and lay a diaper on it
- Sit down and secure the child in the arms of an assistant:
A). The assistant covers the child’s legs with his feet
b). Fixes hands with one hand
V). Head with the other hand, placing your palms on the child’s forehead.
Note: Younger children can be wrapped in a swaddle or sheet for better support
- put an apron on the child over the restraining hand
- Place a basin for washing water at the child’s feet
- Protecting clothes from getting dirty and getting wet
- Prevention of environmental pollution
Executing the procedure
- Measure the distance to the stomach with a probe (from the earlobe to the tip of the nose and to the end of the xiphoid process)
- Compliance with the conditions for the probe to enter the stomach
- Moisten the “blind” end of the probe in water
- Facilitation of passing the probe into the stomach
- Open the child’s mouth with a spatula (if he doesn’t open it himself). If necessary, use a mouth dilator and tongue depressor.
Note: to open the mouth, take a spatula like a writing pen, insert it into the oral cavity, turn it with its edge and run along the side surface of the gums to the end of the teeth, then turn it flat and sharply press on the root of the tongue
- A condition that allows you to insert a tube into the stomach and carry out the procedure
- Insert the probe along the midline of the tongue to the mark and with the index finger right hand place the probe behind your teeth.
Note: if during insertion of the probe the child begins to choke or cough, remove the probe immediately
- Prevention of vomiting
- Signs of a probe entering the respiratory tract
- Attach a funnel or Enane syringe without a piston to the probe
- Creating conditions for introducing liquid into the probe
- Lower the funnel below the level of the stomach (slightly tilting it) and pour water into it for rinsing
- Water does not go into the stomach through a system of communicating vessels
- Slowly lifting the funnel up, monitor the flow of liquid from it into the stomach (the water should drop to the mouth of the funnel)
- Gastric lavage occurs according to the law of communicating vessels
- Quickly and smoothly lower the funnel below the original level and pour the contents of the stomach into the basin
- Repeat rinsing until you get “clean water”
- Achieving the effectiveness of the procedure
Note:
A). The amount of water for rinsing is taken at the rate of 1 liter per year of life
b). When lavaging the stomach, it is necessary to ensure that the amount of injected and excreted fluid is approximately equal.
- Disconnect the funnel and quickly remove the probe through the napkin
- Prevention of vomiting
- Ensuring infection safety
Completing the procedure
- Rinse the child's mouth
- Ensuring hygienic comfort
Practical skill algorithm: "Technique for installing a gas outlet tube."
Target : removal of gases from the intestines.
Equipment : gas outlet tube, Vaseline oil, tray for equipment, tray with water to control the release of gases, tray for used material, diaper, oilcloth, gloves and rubber apron.
Required condition : absence of rectal fissures, acute inflammatory changes in the area of the large intestine and anus.
- Make a mark on the gas outlet tube for the insertion depth.Note: for children of early and preschool age, a gas outlet tube 15-30 cm long is used, for schoolchildren - 30-50 cm, it is inserted at 7-8 cm in infants, from 1 to 3 years - 8-10 cm, from 3 to 7 years old – 1-15 cm, at school age – 20 cm
- Ensuring that the sigmoid colon is reached
- Age characteristics
- Lay oilcloth, diaper, diaper in the crib
- Prevention of soiling of bed linen
- Lay out 2 more diapers (the end of the gas outlet tube is inserted into one, the other is used to dry the child after washing)
-
- Lubricate the inserted end of the gas outlet tube with Vaseline oil using the pouring method
- Ensuring the insertion of a gas tube into the rectum
- Preventing discomfort in a child
- Unwrap (undress) the child, leaving the undershirts
Executing the procedure
- Place the baby in the crib on his left side with his legs brought to his stomach.
- To improve the removal of gases from the intestines
- Spread the child’s buttocks with fingers 1 and 2 of the left hand and fix the child in this position
- Having squeezed the free end of the gas outlet tube with 4 and 5 fingers, carefully, without effort, insert it with your right hand in a rotational-forward motion into the anus to the mark, directing it first to the navel, and then, overcoming the sphincters, parallel to the coccyx
- Prevention of possible leakage of intestinal contents during insertion of a gas tube
- Check the release of gases by lowering the end of the gas outlet tube into a tray of water.
Note: when gases escape, bubbles will appear in the water, if gases do not escape, change the position of the gas outlet tube by moving it back or forward
- Control of the position of the gas outlet tube
- Place the outer end of the gas outlet tube in a loosely folded diaper
- Liquid stool may also be released along with gases
- Massage the abdomen clockwise
- Stimulation of the passage of gases
- Cover the baby with a diaper
- Prevention of hypothermia
- Record the time (30-60 minutes)
- Prevention of complications (bedsores)
Completing the procedure
- Remove the gas outlet tube from the rectum by passing it through a napkin and immerse it in a disinfectant solution
- Ensuring infection safety
- Treat the perianal area with a cotton ball moistened with petroleum jelly
- Prevention of skin irritation
- Swaddle (dress) the child
- Ensuring a comfortable state
- Remove gloves and apron, placing them in a disinfectant solution
- Ensuring infection safety
- Wash and dry your hands
- Ensuring infection safety
Practical skill algorithm: "Performing a cleansing enema"
Target : achieve the passage of feces and gases.
Equipment : rubber gloves, apron, oilcloth, diaper, rubber spray can No. 1-6 with a soft tip, for young children, container with water at room temperature (20-22 O C), Vaseline oil.
- Fill a bottle with water at a temperature of 20-22 O C, in quantity:Up to 3 months 50-60 ml;
Up to 1 year 100-120 ml;
2 years 200 ml;
3 years 300 ml;
4 years 400 ml;
5-6 years 500 ml
- Lubricate the tip with Vaseline oil using the pouring method
- Facilitation of insertion of the tip into the rectum
- Preventing the occurrence of unpleasant sensations in the child
Executing the procedure
- Lay the child on his left side on an oilcloth covered with a diaper, bend his legs at the knee and hip joints and press him to the stomach.
Note: a child up to 6 months can be placed on his back with his legs raised up
- Taking into account the anatomical features of the location of the rectum and sigmoid colon
- Spread the child’s buttocks with the 1st and 2nd fingers of the left hand and fix the child in this position
- Place the rubber can with the tip up and press it from below thumb right hand
- Removing air from the canister and preventing the introduction of air into the rectum
- Without opening the can, insert the tip carefully, effortlessly into the anus and push it into the rectum, first directing it to the navel 3-4 cm, and then, overcoming the sphincters, parallel to the tailbone. The depth of administration for young children is 3-5 cm, for older children 6-8 cm.
- Taking into account the anatomical bends of the rectum
- Slowly pressing the canister from below, introduce water and, without unclenching it, remove the tip from the rectum (place the canister in the waste material tray)
- Preventing the development of unpleasant sensations in a child
- Prevents water from being sucked back into the can
- Squeeze the child’s buttocks with your left hand for 3-5 minutes
- Allowing time for stool to liquefy and peristalsis to begin
- Place the child on his back, covering the perineum with a diaper (until the appearance of stool or the urge to defecate)
Completing the procedure
- Wash the child after defecation, dry with a towel using blotting movements
- Ensuring a comfortable state after the procedure
- Dress
- Remove apron, gloves, place in disinfectant solution
- Ensuring infection safety
- Wash and dry your hands
Practical skill algorithm: "Emergency help for flatulence."
Goals : eliminate symptoms of increased gas formation
5.If there is no effect, administer the following drugs:Peroscarbolene (activated carbon)
or smecta
Intramuscularly
cerukal (raglan)
or prozerin
Note: each subsequent drug should be administered if the previous one is ineffective
- They are adsorbents
- Normalizes intestinal motility
Up to 1 year – 1 sachet per day,
1-2 years - 2 sachets per day,
> 2 years - 2-3 sachets per day.
1 mg/kg
(1 ml = 5 mg)
0.1 ml/year
6. Eliminate gas-forming foods from your diet:
unleavened milk, carbonated drinks, vegetables, legumes, brown bread and others
- Prevention of increased flatulence or its reoccurrence
Practical skill algorithm: "Emergency treatment for vomiting."
Goals : prevent aspiration of vomit, eliminate vomiting.
STEPS
JUSTIFICATION
DOSES
MEDICINES
1. Lay the patient down with the head end elevated, head turned to the side
- Prevention of aspiration of vomit
2. Unbutton tight clothing
- Providing lung excursions
3. Provide access to fresh air
- Easier breathing
- Elimination of unpleasant odors
4. As prescribed by the doctor, rinse the stomach
- Mechanical removal of toxins, poisons
- Gastric lavage may worsen the condition in some cases
5. Administer the following drugs:
peros0.25% novocaine solution
intramuscularly
cerukal (raglan)
or prozerin
- Reduces the excitability of the peripheral vomiting center
- Normalizes peristalsis
- Normalizes peristalsis
1 tsp. – 1 d.l. – 1 tbsp. l. depending on age
1 mg/kg (1 ml = 5 mg)
0.1 ml/year
0.1 ml/year
Practical skill algorithm: « ZCompletion of a system for intravenous drip administration of drugs.”
I. Preparation for the procedure.
Introduce yourself to your mother/relatives, explain the process and purpose of the procedure. Make sure that you have informed consent for the upcoming procedure of administering the drug.
Empty your bladder, taking into account the duration of the task.
Offer the child to take a comfortable position, which depends on his condition.
Treat hands hygienically and dry.
Fill the device for infusion of single-use infusion solutions and place it on the infusion stand.
Filling the device for infusion of single-use infusion solutions:
Check the expiration date of the device and the seal of the package.
Using non-sterile tweezers, open the central part of the metal cap of the bottle, treat the rubber stopper of the bottle with a cotton ball/napkin moistened with an antiseptic solution.
Open the packaging bag and remove the device (all actions are performed on the desktop).
Remove the cap from the air duct needle (a short needle with a short tube covered with a filter), insert the needle all the way into the stopper of the bottle, secure the free end of the air duct to the bottle (with a band-aid, pharmaceutical rubber band). In some systems, the duct opening is located directly above the dropper. In this case, you only need to open the plug covering this hole.
Close the screw clamp, remove the cap from the needle on the short end of the device, and insert this needle all the way into the stopper of the bottle.
Turn the bottle over and secure it on a tripod.
Turn the dropper to a horizontal position, open the screw clamp: slowly fill the dropper to half the volume. If the device is equipped with a soft dropper, and it is rigidly connected to the needle for the bottle, you must simultaneously squeeze it on both sides with your fingers and the liquid will fill the dropper.
Close the screw clamp and return the dropper to its original position, with the filter completely immersed in the drug intended for infusion.
Open the screw clamp and slowly fill the long tube of the system until the air is completely displaced and drops appear from the injection needle. It is better to pour drops of the drug into the sink under running water to avoid environmental contamination.
You can fill the system without putting on the injection needle, in which case drops should appear from the connecting cannula.
Make sure that there are no air bubbles in the long tube of the device (the device is full).
Place a capped injection needle, napkins/cotton balls with skin antiseptic, and a sterile napkin in a sterile tray or packaging bag.
Prepare 2 strips of narrow adhesive plaster, 1 cm wide and 4-5 cm long.
Deliver to the room a manipulation table with the necessary equipment placed on it.
Appendix 6
Situational tasks.
Task No. 1.
The child was 3 months old and was breastfed. The mother, due to a decrease in the amount of breast milk, decided to supplement the baby with whole milk, giving him 170 ml once. The child developed anxiety, poor sleep, frequent regurgitation, single vomiting, stool became more frequent up to 5 times a day, liquid, yellow-green in color with white lumps and a small amount of mucus. Body weight 5600 g.
1. What disease can you think about?
Task No. 2.
The child is 4 months old. The mother gave 180 ml of semolina porridge once as complementary feeding. After 2 hours, the child began vomiting 3 times a day, restlessness, bloating, stool became more frequent up to 6 times, liquid, yellow-green in color with mucus and white lumps. Breastfed baby. Body weight at birth 3200 g, currently 6000 g. Coprogram: liquid, yellow-green color, neutral fat ++, fatty acids ++, soap - a large amount, L - 2-5 in the subsection, mucus - small quantity.
1. Make a diagnosis.
2. Identify the patient's problems and draw up a nursing care plan.
Task No. 3.
Child 5.5 months. was admitted to the hospital with a diagnosis of:
O. gastroenteritis. Intestinal toxicosis with exicosis II degree.
Life history: child from the first pregnancy and childbirth, which proceeded physiologically. Birth weight 3300 g, length 53 cm. Until now, she is breastfed. In addition to breast milk, he receives apple and carrot juices, fruit puree, and is vaccinated according to age. Stool before illness 2-3 times a day, without impurities. Heredity is not burdened. At the age of 5 months. body weight 7400 g.
I fell ill 4 days ago, when the temperature rose to 37.70C, loose stools appeared 7-8 times a day, and repeated vomiting was noted. On the 2nd day of illness, the child was examined by a local pediatrician; the parents refused hospitalization. It was recommended to give the child small amounts of water up to 500-600 ml per day, and cefotaxime IM 250,000 units 2 times a day was prescribed. On the 3rd day of illness, vomiting became more frequent up to 8 times a day, the boy began to refuse to drink and eat, and drowsiness appeared. On the day of hospitalization, the child experiences uncontrollable vomiting, does not urinate for 8 hours, and has watery, scanty stools. Upon admission to the hospital, the condition is very serious. Consciousness is soporous, adynamic. Body temperature 360C. The skin is cold to the touch. Acrocyanosis and a “marbled” pattern of the skin are evident. The large fontanel is sunken, the facial features are pointed, the eyeballs are sunken. Dyspnea is pronounced. BH 42 in 1 min. Heart sounds are muffled, arrhythmic, heart rate is 88 per minute. The abdomen is distended, painless on palpation in all parts, peristalsis is sluggish. The liver is +3 cm from under the edge of the costal arch, the spleen is not enlarged. Severe muscle hypotension. During examination, there was bile vomiting twice. There was no stool during the examination, and he did not urinate.
1. Do you agree with the referring diagnosis? Justify your answer.
2. Identify the patient's problems and draw up a nursing care plan.
Task No. 4.
The child is 1 year old. She was admitted to the hospital with her mother’s complaints of weakness, fever up to 390C, repeated vomiting, refusal to eat and drink. From the life history it is known that the child is from the 2nd pregnancy, which occurred with nephropathy in the 3rd trimester, 2nd term labor with stimulation. Birth weight 3200 g, length 51 cm. She cried out immediately, was placed at the breast in the delivery room, and suckled well. Breastfed for up to 11 months. Complementary feeding is introduced from 5 months. She gained normal weight; her body weight at 11 months was 9.8 kg. Vaccinated according to age. Until now I have not been sick with anything. Neuropsychic development corresponds to age. Medical history: the child was vacationing in the village with his grandmother; 2 days before admission to the hospital, the girl’s temperature rose to 39.2, vomiting, and frequent watery stools appeared. On the first day of the disease, she drank greedily and was very excited. She was not examined by a doctor and did not receive treatment. On the 2nd day of illness, vomiting became more frequent, she began to refuse to eat and drink, and passed stool up to 12 times a day. The grandmother called the parents, who brought the child to the hospital. Upon examination, the child’s condition was serious, body weight 9.4 kg. Expressed lethargy and drowsiness. “Sunken” eyes, “sharpened” facial features. The skin is clean, pale, dry, gathers in folds and slowly straightens out. Lips are cracked and dry. The tongue is “papillary” and sticks to the spatula. There is viscous mucus in the mouth. Pulse and breathing are increased. The stomach is swollen. Watery stool with mucus and greens. The child did not urinate.
1. Make a diagnosis.
2. Identify the patient's problems and draw up a nursing care plan.
Problem #5
A nurse visited an 8-month-old child at home. Ill since yesterday, regurgitation, repeated vomiting, frequent, watery stool mixed with mucus.
The child's condition is serious. Temperature 38.0 C, lethargic, adynamic. The skin is pale, dry, and elasticity is reduced. Visible mucous membranes are dry and bright. The large fontanelle is sunken, the facial features are sharpened. Respiratory rate 52 per minute, pulse 120 beats/min. weak filling. Heart sounds are muffled. The abdomen is moderately swollen, urination is rare.
Tasks
1. Identify the patient's problems. Set goals.
2. Create an algorithm for the nurse’s actions.
3. Carrying out oral rehydration.
Standard answer to the problem.
1. Symptoms of exicosis: thirst, dry skin and mucous membranes, retraction of the eyeballs, decreased tissue elasticity, decreased diuresis, retraction of the fontanelle, loss of body weight, etc. Symptoms of toxicosis: fever, asthenic syndrome, sleep disturbance, appetite, convulsions, deep toxic breathing of a “hunted animal,” tachycardia.
The symptoms of toxicosis and exicosis in children quickly increase, causing disruption of the central nervous system and cardiovascular system (possible death).
2.Care: oral rehydration, then fractional nutrition, skin care, especially the perineum and buttocks. Treatment: antibiotics by mouth, enzymes, biological products, infusion therapy. Monitor temperature, respiratory rate, heart rate, diuresis, frequency and character of stool, and skin.
3.Isolate the patient, allocate separate dishes, toys, and disinfect.
Criteria for evaluation:
5 “excellent” – comprehensive assessment of the proposed situation; knowledge of theoretical material taking into account interdisciplinary connections, right choice action tactics; consistent, confident execution of practical manipulations;
4 “good” – a comprehensive assessment of the proposed situation, minor difficulties in answering theoretical questions; incomplete disclosure of interdisciplinary connections; the correct choice of action tactics, logical justification of theoretical issues with additional comments from the teacher; consistent, confident execution of practical manipulations;
3 “satisfactory” – difficulties with a comprehensive assessment of the proposed situation; incomplete answer requiring leading questions from the teacher; the choice of tactics of action, in accordance with the situation, is possible with leading questions from the teacher, correct, consistent, but uncertain execution of manipulations;
2 “unsatisfactory” – incorrect assessment of the situation; incorrectly chosen tactics of action, leading to a deterioration in the assessment of the situation; breach of patient safety; incorrect performance of practical manipulations carried out in violation of the safety of the patient and medical staff.
Task No. 6.
You are a nurse. You are examining a 6 month old child. During the nursing examination, you received the following data: The child suffered from a severe form of pneumonia 2 months ago, and three weeks ago was transferred to mixed feeding due to a lack of milk in the mother’s breast. Physical examination: correct physique, low nutrition, weight Currently 5 kg 400 g (birth weight 3 kg 700 g), height 64 cm (height at birth 50 cm), the skin is somewhat pale, dry, visible peeling is noted on the body , the hair is hard and brittle, tissue turgor is reduced, the subcutaneous fat layer is absent on the abdomen, torso and limbs, and thinned on the face. He doesn’t sit, he holds his head unsteadily, he has no teeth, he gurgles. There is puerile breathing in the lungs. RR is 40 per minute, heart sounds are frequent and muffled, heart rate is 160 per minute. The abdomen is moderately swollen, rumbling of intestinal loops upon palpation, loose stools up to 5-6 times a day with clear mucus and white lumps. From a conversation with the mother, you found out that within 3 days after the administration of the “Baby” mixture in a volume of 200 ml, the child’s bowel movements became more frequent up to 5-7 times a day.
Tasks.
What needs are violated?
What problems have arisen?
Standard answer.
Needs violated:
to be healthy;
have a comfortable state;
Healthy food;
It's okay to highlight.
Problems encountered:
From the child's side:
mass deficit
loose stool.
From the mother's side:
Knowledge deficit.
Nursing intervention plan.
Inform the mother about the cause of the disease.
Instill hope for a favorable outcome.
Set a water-tea break according to the standard.
After oral rehydration, diet therapy for grade 2 malnutrition.
Dependent actions of the nurse:
fulfillment of medical prescriptions:
Enzyme preparations
Smecta.
Vitamin therapy.
Eubiotics
Espumisan
Task No. 7.
The child is 8 months old. Ill since yesterday, regurgitation appeared, repeated vomiting, frequent, liquid mixed with mucus. The child's condition is moderate. Temperature 38.0º C, lethargic, adynamic. The skin is pale, dry, elasticity is reduced. Visible mucous membranes are dry and bright. The large fontanelle is sunken, the facial features are sharpened. Respiration rate 52 per minute, pulse 120 beats. min, weak filling, muffled heart sounds. The abdomen is moderately swollen, urination is rare.
Tasks
Task No. 8.
A 5-month-old child is admitted to the infectious diseases hospital. with a diagnosis of intestinal toxicosis, the Mother complains of lethargy, drowsiness, poor sucking, frequent regurgitation, loose stools with mucus up to 5 times a day, “weight loss.”
According to the mother, the child fell ill 2 days ago.
On examination: the child is lethargic, spitting up, the skin is pale and dry. The subcutaneous fat layer is reduced on the arms, chest, thighs, and abdomen. The pharynx is clear, the temperature is 37 "C. In the lungs, breathing is puerile, respiratory rate is 60 per minute, heart sounds are somewhat muffled, heart rate is 160 per minute. The abdomen is distended. The liver is along the edge of the costal arch. When examined, the stool is liquid with mucus.
Tasks.
1. Make a nursing diagnosis.
2.Define goals and plan nursing interventions.
Baby care.
Care – protection, protection, care.
Child care is a set of measures aimed at helping the child adapt to environmental factors.
The result of incorrectly constructed care measures:
1. deviant behavior (crime, drug addiction, substance abuse, fanaticism, sectarianism, homosexuality, lies, fantasies);
2. neurotization (stuttering, hyperkinesis, hysteria);
3. somatization (chronic pathology).
Care includes:
1. organization of sanitary and hygienic regime: personal, hygienic, family members, health workers;
2. organization of rational nutrition;
3. communication with the child, organization of his wakefulness and leisure time;
4. monitoring the child’s condition.
The basis for organizing care is mode- this is a rational distribution in time and the sequence of satisfying basic physiological needs, alternating various types of activities during wakefulness. Basic physiological needs - nutrition, sleep, wakefulness.
The mode includes: rhythm (time distribution), sequence of actions, nature of activity.
Regime activities:
· satisfaction of the child’s physiological needs;
· physical education;
· protection of the nervous system from stress;
· child health protection.
Care may be general– factors for meeting the child’s needs , therapeutic and protective– a set of preventive and therapeutic measures aimed at maximizing the physical and mental peace of patients.
1. ensuring a gentle regime for the child’s psyche (mother lies with the child, children in the ward are of the same age, medical confidentiality);
2. compliance with internal regulations;
3. assignment of a rational motor activity regime (general, ward, bed, strict bed);
4. nutrition: general, therapeutic and prophylactic (treatment is impossible without nutrition), dietary (during the rehabilitation period);
5. mode of performing procedures, taking samples;
6. fulfillment of doctor’s prescriptions (at home, medical and outpatient)
Periods of childhood:
1. period of intrauterine development (280 days - 10 lunar months):
· phase of embryonic development (from the moment of conception to 3 months of pregnancy);
· phase of placental development (3-9 months of pregnancy).
2. intrapartum period (from the onset of labor to ligation of the umbilical cord);
3. neonatal period (first month);
4. infancy (1-12 months);
5. toddler age (1-3 years);
6. before school age(3-7 years);
7. junior school age (7-11) years;
8. puberty or high school age (11-16 years).
Features of the nursing process in pediatrics.
Currently, there are 5 stages of the nursing process:
Stage 1 – medical nursing examination;
2. stage – formulation of patients’ problems;
3. stage – planning nursing intervention;
4. stage - implementation of nursing intervention plans;
5. stage - assessment of the nurse’s performance.
Medical nursing examination consists of collecting information (passport data, complaints, collecting a life history, previous diseases, epidemiological anamnesis), conducting an objective nursing examination, analyzing examination data, analyzing procedures prescribed to the patient, medications,
Statement of patient problems. The problem statement should help the patient meet personal needs, which are based on the 14 “activities of daily living” identified by Virginia Henderson:
1. normal breathing;
3. normal functions of the body;
4. movement and various poses;
5. sleep and rest;
6. choosing appropriate clothing, dressing and undressing;
7. maintaining body temperature at a normal level;
9. the ability to avoid hazardous environmental factors and not harm others;
10. communicating with others, expressing emotions, needs, fears and opinions;
11. preservation of religious opinions;
12. work that brings results;
13. play or other forms of recreation;
14. cognition, satisfaction of curiosity, leading to normal development.
Particular attention is paid to 10 universal needs: breathing, nutrition, physiological functions, sleep, movement, clothing and personal hygiene, normal temperature, environmental safety, communication, work and rest.
Based on the data obtained, problems (explicit and potential) should be formulated and prioritized. Problems may be:
· primary, which require emergency care;
· intermediate, not life-threatening;
Secondary, not related to the disease or prognosis.
Planning nursing interventions, i.e. define goals and make a plan. The goal must be: real and feasible, set separately for each problem that can be assessed. Nursing intervention plans are drawn up: separately for each problem; include all possible activities of the nurse; be drawn up specifically; strictly correspond to the achievement of set goals.
Implementation of nursing intervention plans. Clear documentation of this stage of the nursing process allows for coordinated, consistent work of the entire medical team caring for the patient.
Performance evaluation– achievement of set goals. At this stage, the achieved results are compared with the planned ones. The results are assessed by the patient himself, relatives, the nurse herself, and the doctor.
The patient's problems are identified and addressed daily throughout the entire time of work with the patient, taking into account dynamic changes in his condition.
Nursing assessment plan.
Height_____ (N=) Weight___ (N=)
Temperature______
Pay attention to whether the child is in a forced position.
Pay attention to appearance (looks angry, scared, apathetic, confused, balanced, shows signs of anxiety).
Speech (fast, slow, stuttering, emotional, monotonous, loud, whispering, inaudible);
· attention (distractibility, inability to concentrate, attentive);
Mood (joyful, state of dissatisfaction, sad, complete indifference, indifference);
Orientation (in time: knows what day, month, year, time of day, together: knows where he is in one's own personality: knows where
he who is talking to him).
Determine self-esteem (complete denial of one’s
diseases; admits the fact of the disease, but blames it
someone around you or yourself; correctly assesses the situation).
Assess consciousness (clear, confused, absent).
Determine the color of the skin (normal, pale, oral cyanosis, acrocyanosis).
Assess the condition of the umbilical wound (in a newborn child).
Examine the scalp (gneiss, dandruff, lice...).
Examine the condition of your fingernails and toenails.
Determine the cleanliness of the skin, the presence of pathological changes (carefully examine the natural folds).
Determine skin elasticity and tissue turgor.
Assess skin moisture (in symmetrical areas: on the back of the head, torso, especially on the palms and soles).
Determine the thickness of the subcutaneous fat layer and evaluate the result.
Assess the shape of the head and its circumference.
Palpate the sutures of the skull and occipital bone.
Examine the fontanelles of a young child (size, condition of the edges, their level in relation to the bones of the skull, pulsation).
Conduct an examination of the teeth, assess their number and condition.
Examine the spine, pay attention to posture, possible pathological bends.
Assess the shape of the chest and its circumference.
Carry out a palpation examination of the transition of the bony part of the rib into the cartilaginous part for the presence of rachitic rosary.
Assess the shape of the limbs, examine the joints
(color, shape, size, local temperature, mobility, pain).
Assess muscle development and muscle relief.
Determine muscle tone and strength.
Check the child's passive and active movements.
Assess the development of motor skills.
Inspect and palpate the lymph nodes: occipital, chin, submandibular, axillary, ulnar, inguinal.
Examine your fingertips and nails (“drumsticks”, “watch glasses”).
Assess the nature of the cough (barking, wet, dry).
Listen to breathing (calm, wheezing, distant wheezing).
Examine the patency of the nasal passages, assess the nature of nasal discharge.
Assess the participation of auxiliary muscles in the act of breathing (pay attention to the wings of the nose, intercostal spaces, abdomen, supraclavicular areas, jugular fossa).
Inspect the pharynx.
Rule out the presence of edema.
Determine the frequency and character of the pulse. Evaluate the result.
Measure blood pressure. Evaluate the result.
Look for signs of dehydration.
Assess the shape of the abdomen and its participation in the act of breathing.
Palpate the abdomen.
Check the gallbladder symptoms of Kehr and Ortner.
If necessary, inspect the anus (determine its pliability, pay attention to the skin around the anus).
Determine the frequency and nature of stool.
Check Pasternatsky's symptom.
Determine the frequency of urination per day.
Check meningeal symptoms
Identify the problems of parents (relatives) associated with the child’s illness.
Features of clinical pharmacology in pediatrics;
The complexity of dosing pediatric drugs is determined by the characteristics of pharmacokinetics (absorption, binding to plasma proteins, penetration into tissues, metabolism, excretion) and pharmacodynamics in different age periods.
Doses of different medicinal substances are expressed differently:
· Per kg body weight;
· Per unit surface of the body;
· For a year of a child’s life.
Main symptoms of infectious diseases
Poor general health, increased body temperature, the appearance of rashes on the skin and mucous membranes, dyspeptic (nausea, vomiting, frequent loose stools, flatulence) and catarrhal (runny nose, lacrimation) phenomena. The child's condition may be restless (not sleeping, crying). In severe infectious diseases, depression of the central nervous system (lethargy, lethargy) may occur.
Acute respiratory viral infections
Etiology
The causative agents of the disease are influenza viruses (A, B, C), parainfluenza, respiratory syncytial virus, adenovirus, and rhinoviruses. The highest incidence of acute respiratory viral infections (ARVI) is observed in winter.
The source of infection is a sick person and virus carriers. The main route of transmission is airborne droplets.
Clinical manifestations
Flu. Acute onset, high body temperature (up to 40 °C), lethargy, adynamia, loss of appetite, headache, pain in muscles and joints, redness of the sclera, photophobia, there may be vomiting, meningeal symptoms, nosebleeds. Catarrhal symptoms are mild (slight coughing, mucous discharge from the nose, hyperemia of the posterior pharyngeal wall may be noted). As a rule, the condition improves on the 3rd–4th days. The total duration of an uncomplicated disease is 7–10 days. The period of convalescence is characterized by pronounced asthenia of the patient.
Adenoviral infection. Undulating fever, severe symptoms of intoxication, cough, runny nose, conjunctivitis, diarrhea. The duration of the disease is 10–14 days.
Respiratory syncytial infection. The temperature is low, intoxication is not very pronounced, symptoms of bronchitis and bronchiolitis (severe shortness of breath) are characteristic. The duration of the disease is 10–14 days.
Rhinovirus infection. Catarrhal phenomena (serous or mucous discharge from the nose), minor symptoms of general intoxication of the body, and there may be an increase in body temperature.
Complications
Pneumonia, bronchitis, laryngeal stenosis, urinary tract infection, myocarditis, encephalitis, meningitis.
Diagnostics
3. Serological blood tests (detection of antibodies to viruses).
4. Virological examination (in epidemics).
5. Immunofluorescent rapid method (for detection of virus antigens).
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Drug therapy: antiviral, vitamin, vasoconstrictor, antipyretic, antihistamines, bronchodilators.
4. Treatment of complications.
Prevention
1. Anti-epidemic measures: early isolation of patients, compliance with hygiene rules, systematic ventilation of the premises where the patient stays.
2. Sanitation of foci of infection (primarily in the ENT organs).
3. Hardening and organization correct mode day and nutrition of the child.
4. Instillation of interferon into the nose 4-5 times a day for 2-3 weeks during an outbreak of ARVI in children's groups.
5. Admission of convalescents to children's institutions no earlier than the 7th day from the onset of the disease.
Nursing care
1. Even with a low body temperature and minor catarrhal symptoms, a sick child must be examined by a doctor. In severe cases (high body temperature, convulsions, croup syndrome), hospitalization in a hospital will be required.
2. A sick child must be provided with emotional peace and treated patiently and kindly. With normal and subfebrile body temperature and good general health, the child’s mobility is not limited. In case of severe cough, severe runny nose and other complaints, outdoor games are not recommended. In case of febrile temperature, bed rest is recommended.
3. To restore nasal breathing, drops based on sea salt should be instilled into the nose; vasoconstrictor medications should be prescribed by a doctor.
4. Regularly clean the nasal cavity: in infants - with cotton wicks, a nasal aspirator or the corner of a clean napkin, in older children - by blowing their nose.
5. The room where the child is located should be warm and bright. Regular ventilation of the room and wet cleaning are mandatory. It is necessary to limit the child’s contact with other children and other adults.
6. The child’s nutrition should be appropriate for his age, be fortified, high in calories and easily digestible. Feeding should be done more often than usual, in small portions. Food should be warm, semi-solid or liquid. You cannot force feed a child - this can cause vomiting, and emotional stress associated with a reluctance to eat can provoke stenosis of the larynx when it is inflamed (croup syndrome). It is recommended to drink plenty of fluids: give warm milk, juices, fruit drinks, tea, rosehip decoction, mineral water.
7. At body temperatures up to 38 °C, the use of antipyretics is not recommended. If the body temperature has reached febrile values, antipyretics are prescribed in the form of suppositories, syrups, and suspensions. To speed up the achievement of the antipyretic effect, you can wipe the child’s skin with a napkin soaked in water with the addition of table vinegar or vodka, or put a cold compress or an ice pack on the forehead. At the stage of increased body temperature, accompanied by chills, the child must be covered with a warm blanket and a cap placed on his head. At the stage of lowering the temperature, it is recommended to put the child to bed and get rid of excess clothing. Due to excessive sweating, you should regularly wipe the child with a damp cloth and change underwear and bed linen.
8. If there is excessive vomiting and diarrhea, you need to increase your fluid intake. You should not try to feed your child immediately after vomiting - it may happen again. It is better to let your child drink acidified lemon juice or salted water.
9. After each bowel movement, be sure to wash the child with warm water. With frequent bowel movements, irritation may appear around the anus; in this case, it is recommended to lubricate the irritated areas with Vaseline oil.
10. After stable normalization of body temperature and reduction of the main symptoms of the disease, walks are recommended. fresh air(at the initial stage - short, without outdoor games).
Chicken pox
Chickenpox is an acute infectious disease caused by viruses of the Herpes family and characterized by the formation of a blistering rash on the skin.
Chickenpox is a highly contagious disease. Children under 3 months of age rarely suffer from this disease due to transplacental immunity received from the mother.
Etiology
The infectious disease is caused by viruses of the Herpes family. The source of infection is a sick person. Infection occurs by airborne droplets; the pathogen is unstable in the environment. The incubation period is 11–21 days.
Clinical manifestations
A characteristic manifestation of chickenpox is a rash. The disease begins with the appearance of rashes and worsening general well-being. Body temperature rises to febrile levels, headache appears, and appetite worsens. First, maculopapular elements form on the skin, quickly turning into vesicles with transparent and then cloudy contents.
After 1–2 days, the bubbles dry out and brown crusts appear. After the crusts fall off, there are no traces left on the skin. The rash is localized on the face, scalp, torso, and is accompanied by itching. The rash occurs in separate episodes over 1–2 days. The total duration of the rash is 3–8 days. After the disease, persistent lifelong immunity is developed.
Complications
Encephalitis, meningitis, bacterial infection.
Diagnostics
Recording of epidemiological information (data on contacts with a sick person).
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Treatment of the rash elements with ethyl alcohol or a 1% solution of brilliant green.
4. Drug therapy (according to indications): detoxification, antiviral, antipyretic, antihistamines, vitamin therapy.
Prevention
Early isolation of the patient in an individual box in the infectious diseases department. Isolation of contact children who have not had chickenpox for a period from the 11th to the 21st day from the start of contact.
Nursing care
1. Treatment of chickenpox in most cases is carried out on an outpatient basis (with the exception of severe cases).
2. It is necessary to explain to the parents of a sick child what he should be provided with good care, rest (emotional and physical), during periods of elevated body temperature, bed rest is recommended.
3. The room where the patient is located must be regularly ventilated, and constant wet cleaning is necessary. Frequent changes of underwear and bed linen are indicated.
4. If you have photophobia (pain in the eyes from bright light), the room must be darkened.
5. Food should be high in calories, tasty, varied, warm, liquid or semi-liquid consistency. Feed the child in small portions, more often than usual, and only at will. The patient's diet must include vegetables, fruits and berries as foods with a high content of vitamins. Plenty of warm drinks are recommended: milk, juices, fruit drinks, decoctions, mineral water, tea.
6. It is necessary to carefully monitor the cleanliness of the mucous membranes and skin, cut nails, wash hands regularly and ensure that the child does not scratch the elements of the rash or tear off the scabs.
7. Bubbles and papules should be regularly lubricated with a 1% alcohol solution of brilliant green or a 5% solution of potassium permanganate.
8. In case of fever, antipyretic drugs are prescribed.
Rubella
Rubella is an acute infectious disease manifested by a spotted red rash on the skin and enlarged cervical and occipital lymph nodes.
A special feature of rubella is its danger for pregnant women due to the possible development of deformities in the fetus: heart defects, deafness, cataracts.
Etiology
The causative agent is paramyxovirus. The source of infection is a person with rubella. The main route of transmission is airborne. The incubation period is 15–24 days.
Clinical manifestations
The disease begins with a short-term prodromal period with a slight increase in temperature and mild catarrhal symptoms.
The rash appears within several hours on unchanged skin, mainly on the cheeks, extensor surfaces of the arms and legs, and buttocks. The nature of the rash is spotty, without a tendency to merge, size is up to 5 mm. The rash lasts for 3 days, after which it disappears without a trace. The body temperature during the rash is normal or low-grade. A characteristic symptom is enlargement of the occipital lymph nodes.
After the disease, strong immunity is developed.
Diagnostics
2. Immunofluorescent method.
3. Serological studies.
Treatment
No special therapy is required. If necessary, symptomatic medications are prescribed.
Prevention
Isolate a patient with rubella from the team for 5 days from the onset of the rash. Active immunization of non-ill girls and women in the absence of pregnancy.
Nursing care
Measles
Measles is a highly contagious acute infectious disease.
Etiology
The causative agent is paramyxovirus. The source of infection is a patient with measles throughout the entire period of catarrhal symptoms and in the first 4 days from the moment the rash appears. The route of infection is airborne. The incubation period is 7–21 days.
Clinical manifestations
In the picture of the disease, 3 periods are distinguished: catarrhal, rash period and pigmentation (convalescence) period.
The catarrhal period lasts 5–6 days. As a rule, there is an increase in body temperature, cough, runny nose, conjunctivitis, photophobia (similar to ARVI). After 2-3 days, a small pink rash appears on the palate, and on the mucous membrane of the cheeks - many pinpoint whitish spots (Belsky-Filatov-Koplik spots) - a pathognomonic sign of measles. At the end of the catarrhal period, body temperature decreases.
Rash period. There is a new rise in temperature to 39–40 °C, the patient’s condition worsens, increased catarrhal manifestations, photophobia, and lacrimation are noted. Measles is characterized by staged rashes.
Within 3 days, the rash spreads throughout the body from top to bottom. On the 1st day, the rash appears on the head and neck (first on the forehead and behind the ears), on the 1st–2nd day - a profuse rash on the upper torso and upper limbs, by the 3rd day the rash covers all parts of the body. The measles rash is maculopapular in nature, the size of the elements is up to 5 mm. There is a tendency to merge them. Each element of the rash begins to fade after 3 days.
It is very easy to become infected with the measles virus. Some time after contact with an infected person, the disease occurs in 98% of cases. Children are the most susceptible to the disease. True, under certain conditions, anyone can get measles - both children and adults.
Pigmentation period. Starts 3–4 days after the onset of the rash. During this period, body temperature normalizes, runny nose and lacrimation decrease, and the rash gradually disappears. Pigmented areas remain in place of the brightest elements. Sometimes during this period there is slight peeling of the skin.
During the period of convalescence, asthenia phenomena are observed. The child is characterized by increased fatigue, irritability, loss of appetite, and drowsiness.
After measles, lasting immunity is formed.
Complications
Pneumonia, pleurisy, encephalitis, meningitis.
Diagnostics
1. Accounting for epidemiological data.
2. Serological blood tests.
Treatment
1. Balanced nutrition.
2. Symptomatic therapy: antitussives, antipyretics, antihistamines.
Prevention
1. Active immunization - vaccination with a vaccine containing a live attenuated virus is carried out for children aged 1 year and contact children over 1 year old who have not had measles and have not previously been vaccinated.
2. Human immunoglobulin is administered to contact children under 1 year of age or who have a medical exemption from vaccination.
3. Contact children are subject to quarantine: vaccinated - from the 8th to 17th day from the start of contact, those who received immunoglobulin - from the 8th to 21st day from the start of contact.
Nursing care
Patient care is carried out in accordance with the general principles of care for childhood infections.
Whooping cough
Whooping cough is an acute infectious disease, the main manifestation of which is a paroxysmal cough.
Etiology
The causative agent is the Bordet-Giangu bacterium. The source of infection is a sick person within 25–30 days from the onset of the disease. The route of transmission is airborne. The incubation period is 3–15 days.
Clinical manifestations
During the course of the disease, there are 3 periods: catarrhal, spasmodic and the period of resolution.
Catarrhal period. Duration – 10–14 days. There is a short-term increase in body temperature to subfebrile, a slight runny nose, and an increasing cough.
Spasmodic period. Duration – 2–3 weeks. The main symptom is a typical paroxysmal cough. A coughing attack begins unexpectedly and consists of repeated cough impulses (reprises), which are interrupted by a prolonged wheezing inhalation associated with a narrowing of the glottis. In infants, after a series of coughing impulses, breathing may stop (apnea). During a coughing attack, the skin on the child’s face becomes cyanotic with a purple tint, and swelling of the neck veins is observed. When coughing, the child sticks out his tongue and drools. At the end of the attack, a small amount of viscous sputum may be released. The frequency of attacks is from 10 to 60 times a day, depending on the severity of the disease.
Permission period. Duration – 1–3 weeks. Attacks occur less and less frequently, are shorter in duration, and the cough loses its specificity. All symptoms of the disease gradually disappear. The total duration of the disease is 5–12 weeks.
Complications
Emphysema, atelectasis, pneumonia, bronchitis, encephalopathy.
Diagnostics
1. Accounting for epidemiological data.
3. Bacteriological examination of mucus taken from the back wall of the pharynx.
4. Immunoluminescent rapid diagnostics.
5. Serological study.
Treatment
1. Treatment regimen.
2. Balanced nutrition.
3. Drug therapy: antibiotics, antispasmodics, expectorants, including proteolytic enzymes.
Prevention
1. Active immunization – DTP vaccination (pertussis-diphtheria-tetanus vaccine). The course begins at the age of 3 months. The course consists of 3 injections with an interval of 30–40 days. Revaccination – after 1.5–2 years.
2. Isolation of patients for 25–30 days from the onset of the disease.
3. Contact children under 7 years of age are subject to quarantine for 14 days.
Nursing care
3. If the disease is accompanied by frequent vomiting, then it is necessary after 30 minutes. After vomiting, supplement the baby's feeding.
Parotitis
Mumps is an acute infectious disease that occurs with damage to the salivary glands. In addition, other glandular organs may be involved in the process: pancreas, testes, ovaries. Sometimes, against the background of mumps, damage to the central nervous system occurs.
Etiology
The causative agent is paramyxovirus. The source of infection is a sick person in the first 9 days from the onset of the disease. Infection occurs by airborne droplets within the same room or ward. The incubation period is 11–23 days.
Clinical manifestations
The main symptom of the disease is bilateral enlargement of the parotid salivary glands. There is pain on palpation in the center of the enlarged gland and when chewing. The disease occurs with an increase in body temperature to 39 °C, deterioration in general health, headache, and sometimes with vomiting and abdominal pain. The involvement of new glandular organs in the process is accompanied by another rise in body temperature and a deterioration in well-being. With otitis, swelling and pain appear in the testicle, with pancreatitis - pain in the epigastrium and right hypochondrium, nausea, vomiting. Serous meningitis is manifested by headache, vomiting, fever, and stiff neck.
The duration of the disease is 6–21 days.
Mumps in boys can be complicated by orchitis (inflammation of the testicles) and subsequently lead to infertility.
Complications
Pancreatitis, orchitis, oophoritis, meningitis.
Diagnostics
1. Accounting for epidemiological data.
2. Virological and serological studies (for retrospective purposes).
Treatment
1. Treatment regimen.
2. Balanced nutrition.
3. Drug therapy: painkillers, anti-inflammatory, antihistamines; dehydration, glucocorticosteroid hormones - for meningitis; antispasmodics, proteolysis inhibitors, enzyme preparations - for pancreatitis.
Prevention
1. Active immunization at the age of 15–18 months with a live vaccine.
2. Early isolation of patients.
3. Quarantine for contact children from the 11th to the 21st day from the moment of contact.
Nursing care
1. Patient care is carried out in accordance with the general principles of care for childhood infections.
2. Apply dry heat (wool bandage, irradiation with a Sollux lamp) to the swollen salivary glands.
Diphtheria
Diphtheria is an acute infectious disease caused by Coreynebacterium diphteriae, characterized by the formation of diphtheria plaques on the skin and mucous membranes.
Etiology
The causative agent is diphtheria bacillus or Leffler's bacterium, which produces an exotoxin. Sources of infection are people with diphtheria, convalescents and healthy carriers of diphtheria bacteria. The route of transmission of infection is airborne droplets. The incubation period is 2–10 days.
Clinical manifestations
The following forms of the disease are distinguished: diphtheria of the nose, pharynx, larynx, trachea, bronchi, external genitalia and skin.
Diphtheria of the pharynx is more common. On the first day of the disease, elevated body temperature, malaise, sore throat, hyperemia and swelling of the mucous membrane of the tonsils, and the appearance of a whitish coating on them (fibrinous film) are noted. On the second day, the plaque takes on a characteristic appearance: a smooth surface, clearly defined edges, rises above the mucous membrane of the tonsil, has a grayish-white color, and is tightly fused to the underlying tissue. At the same time, the submandibular lymph nodes enlarge and become sharply painful. Swelling of the subcutaneous tissue of the neck and chest may occur (in severe cases).
With diphtheria of the larynx, the development of croup syndrome is observed: barking cough, change in voice, shortness of breath, cyanosis. In the absence of timely assistance, death may occur.
After an illness, a strong immunity is formed.
Complications
Infectious-toxic shock, toxic nephrosis, myocarditis, polyneuritis, paresis and paralysis of the respiratory muscles, peripheral paralysis of the upper and lower extremities.
Diagnostics
1. Taking into account the epidemiological situation.
2. Bacteriological study of material obtained from fibrinous film.
3. Serological study.
Treatment
1. Treatment regimen.
2. Administration of antitoxic diphtheria serum.
3. Drug therapy: detoxification, glucocorticosteroids, antihistamines, sedatives, protease inhibitors, albumin, antibiotics.
4. If the symptoms of diphtheria croup increase and there is no effect from drug therapy, a tracheotomy is performed.
Prevention
1. Active immunization with weakened diphtheria toxin (anatoxin), which is part of the DTP vaccine. Vaccination begins at the age of 3 months. Primary vaccination consists of 3 injections 45 days apart. The first revaccination is carried out after 1.5–2 years.
2. Hospitalization of all patients with diphtheria. The patient is discharged from the hospital if there are two negative cultures of mucus from the throat, carried out with a 2-day interval.
3. After hospitalization of the patient, final disinfection of the outbreak is carried out.
4. A bacteriological examination for diphtheria is carried out on all patients with tonsillitis.
5. If diphtheria is suspected, hospitalization in a hospital is required.
Nursing care
1. The patient needs to be treated in an infectious diseases hospital. The ward must be isolated. It is necessary to ventilate the room regularly (at least 2 times a day).
2. The patient must be provided with general care: body and oral hygiene.
3. Food should be pureed, semi-liquid, warm, since mechanical, chemical and thermal sparing of the oropharynx is necessary. Food should be fortified; it is recommended to include foods with a high potassium content in the diet. To prevent additional irritation of the oropharynx, you need to slightly limit the amount of table salt. Fluid restriction is necessary for severe swelling of the tissues in the pharynx. These rules must be followed for up to 3 weeks from the onset of the disease.
4. The amount of urine excreted should be monitored for 3 weeks, as toxic damage to the kidneys is possible.
Scarlet fever
Scarlet fever is an acute infectious disease caused by streptococcus and characterized by the presence of sore throat and pinpoint skin rash.
Etiology
The causative agent is group A beta-hemolytic streptococcus, which produces an exotoxin. The source of infection is a patient with scarlet fever from the first hours of the disease for 7–8 days. If the disease occurs with complications, the contagious period lengthens. The incubation period is 7 days.
The main route of transmission of scarlet fever is airborne. Infection occurs through direct contact with a sick person. Infection through clothing, toys, and underwear is possible. Mostly children aged 2–7 years are affected.
Clinical manifestations
The disease begins acutely. Characterized by increased body temperature, malaise, headache, loss of appetite, and possibly vomiting. From the first hours of the disease, the patient complains of a sore throat; upon examination of the pharynx, hyperemia of the tonsils and arches is noted, and sometimes plaque appears on the tonsils. The lips are juicy, bright, the tongue is coated. The nasolabial triangle is pale, almost white.
At the end of the first - beginning of the second day, a rash appears simultaneously throughout the body. It is small-pointed, densely located on the hyperemic general background of the skin, brighter in the area of natural folds. Symptoms reach a maximum by the 2-3rd day, then begin to fade and disappear after a few days. The tongue is cleared of plaque and acquires a crimson color typical for scarlet fever. After the rash disappears, lamellar peeling of the skin occurs, especially pronounced on the palms and fingers.
After an illness, a strong immunity is formed.
Complications
Otitis, inflammation of the paranasal sinuses, lymphadenitis, nephritis, rheumatism.
Diagnostics
1. Accounting for epidemiological data.
2. No specific studies are carried out.
Treatment
1. Treatment regimen.
2. Balanced nutrition.
3. Drug therapy: penicillin antibiotics, anti-inflammatory, antipyretic, antihistamines, multivitamins.
Prevention
1. Isolation of patients for at least 10 days from the onset of the disease. Convalescents are isolated from the children's team for another 12 days.
2. Children who have been in contact with a person with scarlet fever are isolated for 7 days.
3. In case of repeated cases of scarlet fever in children's institutions, they resort to passive immunization with immunoglobulin.
Nursing care
Patient care is carried out in accordance with the general principles of care for childhood infections.
For any course of the disease, bed rest is prescribed for at least 6 days.
Diseases of the cardiovascular system
Main symptoms of diseases of the cardiovascular system
With diseases of the cardiovascular system, patients are concerned about weakness, fatigue, sleep and appetite disturbances, memory loss, shortness of breath, pain in the heart, and a feeling of interruptions in the functioning of the heart. Edema, cyanosis, acrocyanosis, arterial hypo- or hypertension are observed.
Congenital heart defects
Congenital heart defects are abnormalities in the development of the heart and large vessels.
Etiology
Embryogenesis disorders. The causes of disembryogenesis are the presence of the following diseases in the mother: alcoholism, diabetes mellitus, thyrotoxicosis, tuberculosis, syphilis, viral infections in the first months of pregnancy.
Heart defects are divided into 3 groups:
1) with overflow of the pulmonary circulation - open ductus arteriosus, atrial septal defect;
2) with unchanged pulmonary blood flow – coarctation of the aorta;
3) with depletion of the pulmonary circulation - triad and tetralogy of Fallot.
Atrial septal defect
Recognized at birth or in the first year of life.
Clinical manifestations: shortness of breath, fatigue, sometimes heart pain. When examining the area of the heart, a “heart hump” is detected. The borders of the heart are shifted to the right.
Treatment: surgical – suturing or plastic surgery of the defect. Optimal age for surgical treatment – 3–5 years.
Surgical treatment of the defect is carried out only in the stage of compensation of the disease. In this case, conservative treatment before surgery is carried out to maintain the life of the child until the compensation phase is reached and the optimal time for surgery.
Patent ductus arteriosus
Clinical manifestations: intense heart murmur after birth or during the first years of life, shortness of breath, fatigue, pain in the heart, expansion of the borders of the heart to the left and up.
Treatment: surgical - ligation or dissection of the duct after its suturing. The optimal age for surgery is over 6 months.
Tetralogy of Fallot (“blue defect”)
Tetralogy of Fallot (“blue defect”) is a combination of pulmonary artery stenosis, ventricular septal defect, aortic dextraposition, and right ventricular hypertrophy.
Clinical manifestations: observed immediately after birth or in the first month of life, characterized by cyanosis, shortness of breath during exertion (feeding, crying), and then at rest; The following signs are formed early: the fingers take on the appearance of drumsticks, the nails take on the appearance of watch glasses, a “heart hump” is formed, and the favorite position of such a child is squatting.
Treatment: surgical – 1st stage – at an early age, an anastomosis is applied between the vessels of the pulmonary and systemic circulation, 2nd stage, at 6–7 years, – elimination of pulmonary artery stenosis and plastic surgery of the ventricular septal defect.
Coarctation of the aorta
Coarctation of the aorta is a narrowing or complete closure of the aortic lumen in a limited area.
Clinical manifestations: complaints appear late and are associated with cardiac decompensation; headache, dizziness, tinnitus, shortness of breath, fatigue, abdominal and leg pain associated with tissue ischemia are observed; the upper part of the body is more developed than the lower, the borders of the heart are expanded to the left, there is an increase in the apex impulse, high blood pressure in the upper extremities along with reduced blood pressure in the lower extremities.
Treatment: surgical - excision of the narrowed area or, at the age of 4–6 years, aortic replacement.
Complications
Heart failure, infective endocarditis.
Diagnostics
3. X-ray of the chest organs.
4. Echocardiogram.
5. Angioventriculography.
6. Cardiac probing.
Treatment
In the period preceding surgical treatment, cardiac glycosides, diuretics, potassium supplements, and vitamins are prescribed.
Prevention
1. Conversations with future parents on the topic of protecting the health of a pregnant woman and preventing viral infections. Elimination of bad habits and occupational hazards.
Nursing care
1. Systematic monitoring of a sick child, establishing an optimal emotional and motor regime.
2. Carrying out aero-, helio- and oxygen therapy (air, sunbathing and other types of hardening).
3. Monitoring the correct performance of the doctor’s actions, parenteral administration of prescribed drugs, explaining to parents and the child the need for long-term continuous treatment.
4. It is necessary to monitor the child’s regular visits to a cardiologist for medical examinations.
Cardiopsychoneurosis
Neurocirculatory dystonia (NCD) is a complex of functional changes in many organs and systems of a child that arise as a result of a violation of the neurohumoral regulation of their activity.
Etiology
Hereditary (constitutional-genetic), congenital (damaging effects during intrauterine development of the fetus), acquired (chronic foci of infection, hormonal dysfunction, mental and physical stress) factors.
Clinical manifestations
The clinical picture of the disease consists of 3 syndromes.
Somatic syndrome: headaches, dry or excessively moist skin, thermoregulation disorders (temperature "suppositories" or prolonged low-grade fever after an acute respiratory viral infection), shortness of breath, dissatisfaction with breathing, a feeling of suffocation when excited, a feeling of a lump in the throat, loss of appetite, dyspepsia (nausea, vomiting , heartburn), abdominal and chest pain, arterial hypo- or hypertension, tachycardia.
Neurological syndrome: sometimes there are signs of dilatation of the 3rd cerebral ventricle, signs of cerebrospinal fluid hypertension - all these changes are transient. It manifests itself as increased fatigue, weakened memory, dizziness, sleep disturbances, and irritability. After a short rest all complaints disappear. Tremor may occur.
Psychological syndrome: fears, aggression, anxiety, conflict.
With NCD, vascular crises (usually with arterial hypertension) may develop. A crisis is triggered by stress and develops suddenly.
The main symptom of a crisis is a very severe headache that lasts from several hours to a day. The patient complains of a feeling of pulsation in the temples, flashing “spots” before the eyes, ringing in the ears, nausea, blood pressure rises to 180/100 mm Hg. Art., sweating, redness of the facial skin, coldness of the extremities are possible.
Complications
Vegetative crises.
Diagnostics
3. Biochemical blood test.
4. Clinoorthostatic tests.
5. Blood pressure control.
6. Echo and electrocardiography.
7. Bicycle ergometry.
8. Rheoencephalography.
9. In case of thermoregulation disorders, simultaneous measurement of temperature under the tongue and in the armpit.
10. Consultations with an otorhinolaryngologist, psychotherapist, neurologist.
Neurocirculatory dystonia often develops in children from socially disadvantaged families. More often, the disease develops in adolescence: in girls - at 12-14 years old, in boys - at 13-15 years old.
Treatment
1. Normalization of lifestyle, physical activity, rational nutrition.
2. Hardening activities.
3. Sanitation of foci of chronic infection.
4. Drug therapy: antihistamines, sedatives, tranquilizers, vitamin therapy, drugs that improve metabolic processes and blood circulation in the central nervous system.
5. Physiotherapy: showers, electrophoresis with calcium, ultraviolet irradiation, massage, electrosleep.
6. Herbal medicine: preparations of pantocrine, eleutherococcus, lemongrass.
Prevention
Primary – dispensary observation of schoolchildren, blood pressure control, adherence to work and rest regime, fight against physical inactivity and excess body weight, health education work with children and parents. Secondary – dispensary observation of children with NCD at least once every 3 months.
Nursing care
1. It is necessary to create optimal conditions for work and rest for the child, to prevent emotional, physical and mental overload.
3. The patient’s diet must be age-appropriate; food must be tasty, high-calorie and fortified.
Kidney and urinary tract diseases
Main symptoms of kidney and urinary tract diseases
For kidney diseases and urinary tract patients are bothered by pain in the lower back or lower abdomen when urinating, fever, manifestations of intoxication (fatigue, lethargy, weakness, headache, nausea). There may be changes in daily diuresis, edema, urinary syndrome (appearance of protein in the urine - proteinuria, leukocytes - pyuria, casts - cylindruria, red blood cells - hematuria), arterial hypertension of renal origin.
Glomerulonephritis
Glomerulonephritis is an infectious-allergic inflammatory disease of the kidneys with predominant damage to the glomeruli. This disease is characterized by bilateral kidney damage and secondary involvement of tubules, arterioles and renal stroma.
Etiology
The most common cause of the disease is group A beta-hemolytic streptococcus. Factors contributing to the development of the disease: exposure to cold in conditions of high humidity, trauma to the lumbar region, excessive exposure to sunlight, repeated administration of vaccines and serums, drug intolerance, hereditary predisposition.
Clinical manifestations
There are acute, subacute and chronic glomerulonephritis.
Acute glomerulonephritis. General symptoms are deterioration in general condition, weakness, fatigue, headache, nausea, vomiting, decreased appetite, increased body temperature up to 38 °C, decreased diuresis, swelling and pallor of the face.
Syndrome of acute glomerular damage - urinary syndrome (oliguria or anuria, proteinuria, hematuria, cylindruria).
Edema syndrome – on the 3-4th day morning swelling of the face and eyelids appears, then the swelling spreads to other parts of the body, fluid accumulates in the body cavities; the syndrome lasts 10–15 days.
Cardiovascular syndrome - increased blood pressure, expansion of the boundaries of the heart, weakening of heart sounds, irregular heart rhythm, shortness of breath, cyanosis.
Brain syndrome – severe headache, insomnia, lethargy, convulsions.
Subacute glomerulonephritis is the most severe form of the disease with a malignant course. Severe hypertension, hematuria, widespread edema, and swelling of the optic nerve papilla are noted.
Chronic glomerulonephritis develops in the 2nd year after acute glomerulonephritis. There are nephrotic, hematuric and mixed forms of chronic glomerulonephritis.
The nephrotic form is characterized by severe edema, proteinuria (10 g of protein in the urine or more per day), cylindruria, and microhematuria. Blood pressure remains within normal limits.
The hematuric form is characterized by persistent macrohematuria (the urine becomes bloody in color). There is no swelling, blood pressure is normal or increases briefly.
The mixed form is characterized by all of the listed symptoms.
Complications
Acute glomerulonephritis is complicated by acute renal and heart failure, eclampsia; chronic glomerulonephritis – chronic renal failure.
Diagnostics
4. Urinalysis according to Zimnitsky, Nechiporenko.
5. Rehberg's test.
6. Daily measurement of the amount of fluid consumed and urine output.
7. Immunological blood test.
8. Fundus examination.
10. Ultrasound of the kidneys.
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Drug therapy: for acute glomerulonephritis - antibiotics, antihistamines, diuretics, antihypertensives; for subacute and chronic glomerulonephritis - antiplatelet agents, anticoagulants, glucocorticosteroids, cytostatics.
4. For subacute and chronic glomerulonephritis, hemosorption, hemodialysis, plasmapheresis, and kidney transplantation are indicated.
Prevention
Prevention of acute glomerulonephritis:
1) timely diagnosis and treatment of streptococcal infection (scarlet fever, tonsillitis);
2) rehabilitation of foci of chronic infection;
3) rational implementation of preventive vaccinations;
4) improving the health of children's groups.
Prevention of chronic glomerulonephritis:
1) clinical observation of convalescents after acute glomerulonephritis;
2) routine examinations children's contingent;
3) prevention of stressful situations, physical overexertion, hypothermia, infectious diseases, avoidance of preventive vaccinations.
In the first days of exacerbation of chronic glomerulonephritis, it is advisable to carry out a fasting sugar-fruit diet: 5-8 g of sugar per 1 kg of body weight per day in the form of concentrated solutions with the addition of lemon juice, fruits (apples, grapes) - up to 500-800 ml per day. If necessary, this diet can be repeated after 5–6 days.
2. The patient must follow a certain diet. In the first 5–7 days of the disease, a salt-free table with limited animal protein is prescribed (meat and fish are excluded from the diet) - table No. 7a. The high calorie content of the diet is achieved through carbohydrate foods: potatoes, oatmeal and rice porridge, cabbage, watermelons, and milk are recommended. Then they switch to a low-salt diet: food is prepared without salt, but it is added to ready-made dishes at first 0.5 g per day, then gradually increased to 3-4 g per day. To improve the taste of food, you can add garlic, onions, and seasonings. The total amount of fluid consumed per day should be 300–500 ml greater than the volume of urine excreted the day before. From the 7th–10th day, meat and fish are included in the diet.
Every other day they move to table No. 7b. Products that can cause allergies (citrus fruits, eggs, nuts, strawberries, chocolate), spicy, salty foods, extractive substances (strong broths, sausages, canned food) are contraindicated.
After 3–4 weeks from the onset of the disease, the patient is transferred to diet No. 7, in which the protein content corresponds to the age norm. Foods rich in potassium are useful: raisins, dried apricots, prunes, potatoes. During remission, the patient is fed according to his age, with the exception of foods that can cause allergies.
3. Strict monitoring of health status is required (pulse, blood pressure, number of respiratory movements, body temperature are noted, daily diuresis is calculated, visual examination of urine), regular blood and urine tests, and compliance with doctor’s prescriptions.
Pyelonephritis
Pyelonephritis is an infectious and inflammatory disease of the kidneys with damage to the tubules, calyces, pelvis and interstitial tissue of the kidneys.
Etiology
Pathology is caused by various microorganisms and their associations. Most often the causative agent is Escherichia coli.
The routes of infection are ascending, hematogenous and lymphogenous. Factors contributing to the development of pyelonephritis: hereditary predisposition to kidney diseases, maternal illnesses during pregnancy, impaired intrauterine development of the kidneys, abnormalities of the renal structures, immunodeficiency states.
There are acute and chronic pyelonephritis.
Clinical manifestations
Acute pyelonephritis is manifested by the following factors: general intoxication syndrome (hyperthermia up to 40 °C, weakness, lethargy, headache, symptoms of meningism), gastrointestinal syndrome (nausea, vomiting, diarrhea, abdominal pain), urological syndrome (lower back pain and lower abdomen, positive Pasternatsky symptom - increased pain during tapping in the projection of the kidneys is noted), dysuric syndrome (painful frequent urination small portions), urinary syndrome (urine is cloudy, with sediment, bacteriuria, leukocyturia, proteinuria, hematuria are noted).
Chronic pyelonephritis. During the period of exacerbation, increased body temperature, lethargy, headache, lower back pain, dysuric and urinary syndromes are noted. Outside of exacerbation, health status improves. Pallor, weight loss, decreased appetite, dark circles around the eyes, and sweating may be noted.
Complications
Apostematous nephritis (multiple abscesses in the kidney), renal carbuncle, paranephritis; chronic pyelonephritis, chronic renal failure, arterial hypertension.
Diagnostics
3. Urinalysis according to Zimnitsky, according to Nechiporenko.
4. Determination of bacteriuria, examination of urine for sterility, determination of the sensitivity of urine flora to antibiotics.
5. Immunological studies.
6. Biochemical blood test.
7. Rehberg's test.
8. Plain radiography of the kidney area, chromocystoscopy.
9. Thermometry.
10. Intravenous renography.
11. Ultrasound of the kidneys.
12. Examination of the fundus.
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Drug therapy: antibiotics, sulfonamides, vitamin therapy, antihistamines, anti-inflammatory drugs, antipyretic therapy, antioxidants, biostimulants.
4. Sanitation of extrarenal foci of chronic infection.
5. Physiotherapy (in remission) - UHF, laser therapy, paraffin and ozokerite treatment.
6. Drainage position.
Prevention
1. Hygienic care for children.
2. Prevention of acute intestinal diseases, helminthiasis, rehabilitation of foci of chronic infection (carious teeth, chronic sinusitis, otitis media, tonsillitis), strengthening the body's defenses.
3. Control urine tests after any infectious diseases.
Nursing care
1. Bed rest is indicated for the entire period of elevated temperature, dysuria and lower back pain.
3. It is necessary to monitor the cleanliness of the skin and mucous membranes, regularly ventilate the room where the patient is located, and carry out wet cleaning. The room temperature should be maintained at 20–22 °C. It is necessary to ensure a sufficiently long and deep night's sleep, for which all possible irritants are eliminated and fresh air is ensured in the room.
4. A dairy-vegetable diet is prescribed (table No. 5) without limiting salt, but with the complete exclusion of foods rich in extractive substances (strong meat and fish broths, sausages, canned food, garlic, onions, legumes, chocolate, cocoa, citrus fruits, fried, smoked dishes). It is recommended to alternate protein and vegetable days (3-5 days each), as this creates conditions for the destruction of pathogenic flora in the kidneys. You should increase fluid intake to 1.5–2 liters per day, give the child fruit, vegetable and berry juices, rosehip decoction, mineral waters, cranberry and lingonberry fruit drinks, compotes. Children under 1 year of age are prescribed a water-tea break for 6–8 hours, then fed with breast milk or formula.
5. To increase diuresis, herbal medicine is recommended: kidney tea, bearberry, horsetail, centaury, lingonberry. The number of urinations must be increased so that under the age of 7 years, urination occurs every 1.5–2 hours, from 8 to 15 years – every 2–2.5 hours.
To normalize urodynamics, you need to regularly take the drainage knee-elbow position on a hard surface at least 3 times a day for 5-10 minutes.
6. After acute pyelonephritis, the child is on dispensary observation with a pediatrician for 3 years, a patient with chronic pyelonephritis - until he was transferred to a teenage doctor. It is necessary to undergo regular medical examinations.
Cystitis
Cystitis is inflammation of the bladder.
Etiology
The disease is caused by various microorganisms and their associations. The infection enters the body through ascending, hematogenous, and lymphogenous routes.
Factors contributing to the development of cystitis are hypothermia and immune deficiency.
Clinical manifestations
There are acute and chronic cystitis.
Acute cystitis. The main symptoms are frequent painful urination, pain in the lower abdomen, and sometimes urinary incontinence. An increase in body temperature is often noted, more often to a subfebrile level. Laboratory tests of urine reveal pyuria, bacteriuria, and in the hematuric form of cystitis - red blood cells. The duration of the disease is up to 6–8 days.
Chronic cystitis. During the period of exacerbation, symptoms characteristic of acute cystitis appear, but they are somewhat less pronounced. During remission, all signs disappear until the next exacerbation.
Complications
Pyelonephritis.
Diagnostics
3. Tests of Nechiporenko, Addis - Kakovsky.
4. Cystography (for chronic cystitis).
5. Ultrasound of the bladder.
6. Consultation with a urologist.
Treatment
1. Treatment regimen.
2. Balanced nutrition.
3. Drug therapy: antibiotics, antispasmodics, vitamin therapy, sedatives.
4. Herbal medicine.
5. Physiotherapy (UHF, inductothermy, mud therapy).
6. Sanatorium-resort treatment.
Prevention
Compliance with personal hygiene rules. Timely treatment of inflammatory diseases of any location.
Nursing care
1. During dysuric phenomena, patients are prescribed bed rest.
2. It is necessary to ensure physical and emotional peace, ensure that the child’s legs and lower back are warm.
3. Spicy foods, salty foods, seasonings, sauces, and canned food should be excluded from the child’s diet. Dairy products, fruits, vegetables and plenty of fluids are recommended.
4. If there is severe pain in the lower abdomen or if the child is restless, you can apply a warm heating pad to the suprapubic area.
5. To speed up the elimination of the pathogen from the bladder, it is recommended to take infusions and decoctions of herbs with a diuretic effect (as prescribed by a doctor): kidney tea, corn silk.
Diseases of the gastrointestinal tract
Main symptoms for diseases of the gastrointestinal tract
In diseases of the gastrointestinal tract (GIT), symptoms of general intoxication of the body (weakness, lethargy, headache, increased body temperature) may appear. Manifestations of dyspepsia are noted: loss of appetite, belching, heartburn, nausea, vomiting, flatulence, constipation, diarrhea. A characteristic symptom is pain. Often chronic diseases The gastrointestinal tract is accompanied by asthenovegetative syndrome (increased fatigue, dizziness, irritability).
Gastritis
Gastritis is inflammation of the gastric mucosa. There are acute and chronic gastritis.
Etiology
Acute gastritis is provoked by food poisoning, consumption of poor quality food, overeating (especially fatty and spicy foods), frequent consumption of food containing coarse fiber, insufficient chewing of food, long-term treatment with salicylates, sulfonamides, poisoning, allergies.
All of the above factors also play an important role in the development of chronic gastritis. In addition, this disease develops with some endocrine pathology, chronic kidney diseases, and cardiovascular diseases. Heredity and reduced immunity are important.
Clinical manifestations
Acute gastritis. The disease begins with general malaise, loss of appetite, nausea, a feeling of heaviness in the epigastric region; low-grade fever and chills are possible. Subsequently, vomiting, pain in the upper abdomen, and belching appear. The tongue is coated with a yellowish coating. When palpating the abdomen, some swelling and pain in the upper sections are noted. The duration of the disease is 2–5 days.
Chronic gastritis. Relapse of the disease is characterized by pain syndrome (pain in the epigastric region occurs soon after eating and lasts 1–2 hours) and dyspeptic syndrome (nausea, unpleasant taste in the mouth, heartburn, loss of appetite, belching, feeling of heaviness in the epigastric region). When examining the tongue, a white coating is visible. Palpation reveals moderate pain in the epigastric region. Sometimes asthenovegetative disorders are observed: dizziness, emotional instability, irritability. Exacerbations of chronic gastritis are often caused by errors in the diet (too cold or too hot food, dry food, disturbances in the rhythm of nutrition, its imbalance).
Diagnostics
3. Fibrogastroscopy with histological examination of the material taken.
4. Fractional study of gastric contents.
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Gastric lavage (for acute gastritis).
4. Oral rehydration (in severe cases - infusion therapy).
5. Drug therapy: for acute gastritis - antiemetics, laxatives, antibacterial drugs, vitamins, enzymes; for chronic gastritis - antispasmodics, antacids, sedatives, metabolic therapy, vitamins.
6. Physiotherapy (electrosleep, iontophoresis, thermotherapy, ultrasound).
7. Sanatorium-resort treatment (for chronic gastritis).
Prevention
1. Balanced nutrition.
2. Eating only good quality foods.
3. Taking medications that irritate the gastric mucosa after eating.
4. Elimination of bad habits.
Currently, the infectious nature of gastritis is increasingly being revealed. In many patients, the causative agent of the disease, Helicobacter pylori, is found in the gastric contents. Such gastritis requires antibiotic therapy.
Nursing care
1. In case of acute gastritis, bed rest should be observed for 2–3 days. At the very beginning, the stomach is lavaged to free it from stagnant food residues. Then fasting is prescribed for 8–12 hours, during which the patient must drink large quantities of chilled tea, a mixture of saline with 5% glucose solution (in equal proportions), and rehydron. After 12 hours, the patient begins to be given mucous pureed puree soups, low-fat broth, jelly, crackers (chew thoroughly!), and porridge in small portions. Next, the diet is gradually expanded, and by the 5th–7th day the patient is transferred to a normal, age-appropriate diet.
2. Chronic gastritis. During the period of exacerbation, bed rest is prescribed, the duration of which depends on the severity of the exacerbation and can be up to 4 weeks. The child needs to be provided with physical and emotional peace and individual care. The room where the patient is located must be regularly ventilated and wet cleaned.
3. Diet therapy. Food must be mechanically, chemically and thermally gentle. Tables No. 1a (5–10 days), No. 1b (10–20 days), No. 1 (before remission), No. 2 (during remission) are recommended. Included in the diet: milk, cream, liquid milk porridge (semolina, rice), milk or slimy cereal soups, soft-boiled eggs or in the form of an omelet, boiled meat soufflé, jelly and jelly, juices. Salt is limited to 6–8 g per day. When moving to table No. 1, to the listed products you can add dry cookies, noodles, boiled fish, steamed cutlets, fresh cottage cheese, curdled milk, boiled and chopped herbs and vegetables, boiled sweet fruits and berries, compotes. After the onset of remission, they move to table No. 2: they are given low-fat meat and fish, mild cheese, meat broth and fish soup, strong vegetable broths, butter, sour cream, cream, cottage cheese, vegetable oil, eggs and dishes made from them, herbs, pureed vegetables and fruits, tea, cocoa, day-old white and black bread, raw vegetable, fruit and berry juices, rosehip decoction. The amount of salt is not limited.
5. Dispensary observation is carried out by a pediatrician and gastroenterologist according to the following plan: after an exacerbation of the disease during the first six months - once every 2 months, then quarterly for 2-3 years, then - 2 times a year.
6. In spring and autumn, anti-relapse treatment is carried out in courses of 1–2 months.
7. 3-4 months after the end of the exacerbation, during a period of stable remission, sanatorium-resort treatment is recommended: Zheleznovodsk, Essentuki, Truskavets, etc. Treatment with mineral waters as prescribed by a doctor is useful.
Biliary dyskinesia
Biliary dyskinesia is a disease characterized by impaired motor and evacuation functions of the gallbladder and bile ducts.
Etiology
The pathological condition is provoked by a violation of the neurohumoral regulation of the function of the gallbladder and bile ducts as a result of neuroses, allergic diseases, endocrine pathologies, and eating disorders.
Factors contributing to the development of the disease: large intervals between meals, abuse of fried, spicy, fatty foods, acute infectious diseases (especially salmonellosis, dysentery, viral hepatitis), hereditary burden, allergies.
Clinical manifestations
Depending on the tone of the gallbladder, the main forms of dyskinesia are distinguished: hypotonic and hypertonic.
Hypotonic dyskinesia. It manifests itself as general weakness, increased fatigue, dull pain in the right hypochondrium or around the navel, bitterness in the mouth, and normal body temperature. Palpation reveals an enlarged gallbladder, the walls of which are atonic.
Hypertensive dyskinesia. The child complains of short-term paroxysmal pain in the right hypochondrium or around the navel, nausea, and normal body temperature.
Complications
Chronic cholecystitis, cholelithiasis.
Diagnostics
3. Stool analysis.
4. Ultrasound of the liver and gall bladder.
5. Duodenal intubation with biochemical study of bile.
Treatment
1. Medical nutrition.
2. Drug therapy: for hypertensive dyskinesia - antispasmodics, sedatives, choleretics, for hypotonic dyskinesia - cholekinetics, tonics, adaptogens.
3. Physiotherapy.
4. Herbal medicine.
5. Treatment with mineral waters.
Prevention
1. Balanced nutrition.
2. Taking choleretic preparations in the fall and spring to prevent exacerbations of the disease.
3. Fight against physical inactivity.
Nursing care
1. It is necessary to create optimal living conditions for the child: physical and emotional comfort.
3. Establish regular meals at least 4-5 times a day. The diet must correspond to the child’s age in terms of calories, protein, fat, carbohydrates, vitamins and minerals. It is recommended to exclude fatty, smoked, fried, spicy foods, spicy seasonings, fish and meat broths, canned and pickled foods, sweets, baked goods, chocolate and ice cream from the diet. Be sure to include milk, sour cream, vegetable oils, mild cheese, eggs, fresh vegetables(cabbage, beets, carrots), fruits (pears, apples, plums, apricots), greens.
5. For hypotonic dyskinesia, therapy with adaptogens is indicated: ginseng tincture or pantocrine solution, 1 drop per year of life - 3 times a day for a month in the morning.
6. For hypotonic dyskinesia, active general strengthening exercises (bending, turning the body) and abdominal exercises, outdoor games are recommended. For hypertensive dyskinesia, exercises should be performed from a lying position, general strengthening exercises alternate with breathing and relaxation exercises, the pace of exercises should be slow or medium. Sedentary games without a competitive component are shown.
Chronic enterocolitis
Chronic enterocolitis is a chronic inflammatory disease of the large and small intestines.
Chronic enterocolitis often accompanies other diseases of the digestive system, accompanied by disorders of the secretory and motor functions of the intestine. In some cases, isolated forms of enteritis or colitis are diagnosed, but combined pathology is more common.
Etiology
The disease is characterized by alternating relapses and remissions.
Clinical manifestations
When the small intestine is predominantly affected, there is loss of appetite, pain in the navel or diffuse pain throughout the abdomen, a feeling of heaviness, rumbling in the abdomen, increased gas formation in the intestines, possible nausea, vomiting, frequent loose stools with inclusions of undigested food particles. During examination, attention is drawn to the child's insufficient body weight, dry skin, flaking, jamming in the mouth, swelling and bleeding of the gums (signs of vitamin deficiency).
When the colon is predominantly affected, there is a decrease in appetite, pain in the lower abdomen, a tendency to constipation or alternating constipation and diarrhea, flatulence, painful sensations during bowel movements, and mucus in the stool. Lack of body weight is less pronounced.
When both the small and large intestines are affected, a combination of the listed symptoms is simultaneously observed.
Complications
Ulcerative intestinal lesions, hypovitaminosis.
Diagnostics
3. Biochemical blood test.
4. Scatological examination, stool analysis for worm eggs and dysbacteriosis.
5. Study of intestinal absorption capacity.
6. Fibroesophagoduodenoscopy.
7. Ultrasound of the abdominal organs.
8. Colonoscopy, irrigoscopy.
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Drug therapy: antibiotics and sulfonamides, antifungal drugs, antispasmodics, astringents, enveloping agents, adsorbents, immunomodulators, metabolites, enzyme preparations, eubiotics, multivitamins.
4. Physiotherapy.
6. Herbal medicine.
7. Treatment with mineral waters.
8. Sanatorium-resort treatment.
Prevention
Rational nutrition and food hygiene.
Nursing care
1. For the first 2 days, the patient needs a “starvation” diet (the patient drinks 1.5–2 liters of hot tea with lemon or rosehip decoction per day), kefir, acidophilus, apple or carrot diets. In the following days, the patient is transferred to table No. 4. The food is boiled and pureed; the food should not be very cold or very hot. Meals – 6–8 times a day in small portions. Recommended are soups with pureed meat, boiled meat, poultry and fish, steamed cutlets, pureed porridge cooked in water, jelly, jelly from berries and fruits, fresh cottage cheese, butter. Legumes and pasta, sauces, spices, and alcohol are excluded. Outside of an exacerbation, the patient eats according to table No. 4. Dishes are boiled or baked, taken at a moderate temperature, unchopped. Fresh bread, fatty broths and soups based on them, fatty fish, poultry, meat, fried, smoked, canned foods, refractory fats, millet and pearl barley porridge, apricots, plums, sharp cheese, sour cottage cheese, strong coffee and tea are not recommended.
2. For anti-inflammatory purposes, therapeutic enemas are prescribed with a solution of furatsilin, sea buckthorn oil, rose hips, and tocopherol acetate.
3. To reduce intestinal spasms, rectal antispasmodic suppositories are used before bedtime or in the morning.
4. Exercise therapy: breathing exercises, walking, exercises with bending, turning the torso, and abdominal exercises are shown.
Respiratory diseases
Main symptoms of respiratory diseases
Respiratory diseases are manifested by the following factors: increased body temperature, symptoms of intoxication (headache, dizziness, weakness, fatigue, sleep and appetite disturbances), symptoms of respiratory failure (shortness of breath, cyanosis), cough (dry or wet, with sputum), with auscultation – changes in the nature of respiratory sounds (appearance of weakened or hard breathing, dry or moist rales).
Acute bronchitis
Acute bronchitis is an acute inflammation of the bronchial mucosa in the absence of signs of damage to the lung tissue.
Etiology
More often, viruses become the cause of the inflammatory process in the bronchi. They are subsequently joined by bacterial flora.
Clinical manifestations
The main symptoms of acute bronchitis are cough, sputum production, and symptoms of intoxication (the more pronounced the younger the child is). During the first 1–2 weeks of the disease, the cough is dry, paroxysmal, worsens at night, leading to fatigue in the child and disruption of night sleep. Body temperature is often normal, rarely rising to low-grade fever. High body temperature indicates the addition of bacterial flora or the development of complications. From the 2-3rd week, the cough becomes wet and persists until the 3-4th week from the onset of the disease.
Complications
Chronic bronchitis, pneumonia, respiratory failure.
Diagnostics
2. X-ray of the lungs.
Factors that increase the likelihood of bronchitis: hypothermia, reduced immunity, intoxication, allergies, air pollution, parental smoking.
Treatment
1. Treatment regimen.
2. Balanced nutrition.
3. Drug therapy: antiviral, antitussive (for dry cough), expectorants (for wet cough), anti-inflammatory drugs, antibiotics (after confirmation of the bacterial nature of the disease), bronchospasmolytics.
4. After normalization of body temperature - physiotherapy (thermal, electrical procedures).
6. Massage.
Prevention
1. Timely treatment of ARVI.
2. Regular walks in the fresh air.
3. Ventilation and wet cleaning in the room where the child is.
Nursing care
1. Isolate the child, limit contact with other children and strangers.
2. In the room where the child is located, it is necessary to maintain a comfortable climate: the air temperature is daytime– 20–22 °C, at night – 18–20 °C. Regularly ventilate the room and wet clean it.
3. The child’s nutrition should be age-appropriate, fortified, and easily digestible. It is recommended to feed the child often, in small portions, and allow him to choose the menu himself. Drinking plenty of fluids is recommended (tea, fruit drinks, compotes, carbonated water; for a wet cough, milk with carbonated water to facilitate expectoration of sputum).
4. The sick child should be provided with physical and emotional rest.
5. Constant monitoring of the child is mandatory: measuring body temperature, counting respiratory movements, pulse, monitoring general well-being.
6. It is necessary to regularly follow the doctor’s prescriptions: give medications, after a decrease in body temperature, carry out physiotherapeutic procedures (from 3–4 days - mustard foot baths, mustard wraps, warm compresses on the chest), exercise therapy, massage (from the 7th day of the disease) .
Pneumonia
Pneumonia is an acute inflammatory and infectious disease that affects all components of the lung tissue, including the alveoli. Children under 3 years of age are most often affected.
Etiology
The disease is caused by bacteria, viruses, protozoa, fungi, helminths, and foreign bodies. Ways of spread of infection: aerogenic, hematogenous, lymphogenous, aspiration of foreign bodies.
Factors contributing to the development of pneumonia: functional and morphological immaturity of the body of a young child, respiratory defects, fermentopathy, constitutional anomalies, prematurity, the presence of foci of chronic infection in the nasopharynx, hypothermia or overheating, impaired bronchial obstruction.
Depending on the extent of the spread of the inflammatory process, focal, segmental, lobar and interstitial pneumonia are distinguished. Separately, a destructive form of the disease is distinguished.
Clinical manifestations
The disease begins with an increase in body temperature to febrile, deterioration in health, the appearance of a cough (dry, rare) and symptoms of intoxication, such as headache, loss of appetite, irritability, weakness, nausea, tachycardia, pale skin with a grayish tint. Pain in the chest or abdomen is often noted.
The more extensive the inflammation of the lung tissue, the more pronounced the symptoms of general intoxication of the body and respiratory failure. A clear example is lobar pneumonia. With this type of disease, symptoms of respiratory failure (shortness of breath, cyanosis) appear and rapidly increase. On physical examination, shortening of the percussion sound above the infiltration in the lung, hard or weakened breathing, the presence of small moist rales, and crepitus are noted. The disease lasts 7–14 days. In the resolution stage, the body temperature normalizes, the cough becomes frequent, wet, with sputum (sometimes rusty in color). The patient's asthenia persists for a long time.
The destructive form of pneumonia is most often caused by Staphylococcus aureus or gram-negative bacteria. An infiltrate forms in the lung, which undergoes decay with the formation of abscesses. The clinical picture corresponds to a severe septic process. The patient's condition is serious, intoxication and respiratory failure are severe. The course of the disease is rapid, often ending in the death of the patient or transition to chronic pulmonary pathology.
Complications
Acute adrenal insufficiency, anemia, pleurisy, atelectasis and lung abscesses, pyopneumothorax.
Diagnostics
3. X-ray of the lungs in two projections.
4. Bacteriological examination of sputum and determination of pathogen sensitivity to antibiotics.
Treatment
1. Medical and protective regime.
2. Medical nutrition.
3. Drug therapy: antibiotics, bronchodilators, mucolytics, expectorants, detoxification therapy, antipyretics, antihistamines, metabolic, sedatives, vitamins, drugs that improve metabolic processes and blood circulation in the central nervous system. In the destructive form of pneumonia, therapy is supplemented with glucocorticosteroids, diuretics, and plasma transfusions are performed.
4. Oxygen and aerotherapy.
5. Physiotherapy (UHF, inductothermy, electrophoresis, ultraviolet radiation).
6. Breathing exercises.
8. Massage.
Prevention
Primary prevention - hardening from the first months of life, rational feeding, sanitation of foci of chronic infection, treatment of diseases that contribute to the development of pneumonia. Secondary prevention consists of timely and adequate treatment of acute pneumonia until complete recovery; for 2–4 weeks after recovery, the child should not visit childcare facilities to avoid reinfection.
The reasons contributing to the development of pneumonia are often the functional and morphological immaturity of the body of a young child, respiratory defects, fermentopathy, constitutional anomalies, prematurity, the presence of foci of chronic infection in the nasopharynx, hypothermia or overheating of the child, and impaired bronchial obstruction.
Nursing care
1. The patient must be positioned with maximum comfort, since any inconvenience and anxiety increase the body’s need for oxygen. The child should lie on the bed with the head end elevated. It is necessary to frequently change the patient's position in bed. The child's clothing should be loose, comfortable, and not restrict breathing and movement. The room where the patient is located requires regular ventilation (4-5 times a day) and wet cleaning. The air temperature should be maintained at 18–20 °C. Sleeping in the fresh air is recommended.
2. It is necessary to monitor the cleanliness of the patient’s skin: regularly wipe the body with a warm, damp towel (water temperature – 37–38 °C), then with a dry towel. Particular attention should be paid to natural folds. First, wipe the back, chest, belly, arms, then dress and wrap the child, then wipe and wrap the legs.
3. Food must be complete, high-calorie, fortified, appropriate for the child’s age. Food should be liquid or semi-liquid. It is recommended to feed the child in small portions, often, and offer favorite foods. Drinking plenty of fluids (mineral waters, compotes, fruit, vegetable and berry decoctions, juices) is mandatory. After eating and drinking, be sure to let your child rinse his mouth. Infants should be fed with breast milk or formula. Give sucking in small portions with breaks for rest, since respiratory failure may worsen during sucking.
4. It is necessary to ensure the cleanliness of the nasal passages: remove mucus using a rubber spray, clean the nasal passages with cotton wool soaked in warm vegetable oil. Monitor the mucous membranes of the oral cavity for timely detection of stomatitis.
5. Physiological functions and compliance of diuresis with the liquid consumed should be monitored. Avoid constipation and flatulence.
6. Regularly follow the doctor’s orders, trying to ensure that all procedures and manipulations do not cause significant anxiety to the child.
7. In case of severe cough, it is necessary to raise the head of the bed, provide access to fresh air, warm the child’s feet with warm heating pads (50–60 °C), and give antitussives and bronchodilators. When the cough becomes wet, expectorants are given. From the 3rd–4th day of illness at normal body temperature, it is necessary to carry out distracting and absorbable procedures: mustard plasters, warming compresses. In the 2nd week, you should begin to perform physical therapy exercises, massage of the chest and limbs (light rubbing, in which only the massaged part of the body is exposed).
8. If the body temperature is high, you need to open the child, if there is a chill, rub the skin of the torso and limbs until reddened with a 40% solution of ethyl alcohol using a rough towel; if the child has a fever, the same procedure is carried out using a solution of table vinegar in water (vinegar and water in a ratio of 1: 10). Apply an ice pack or a cold compress to the patient’s head for 10–20 minutes, the procedure must be repeated after 30 minutes. Cold compresses can be applied to large vessels of the neck, armpit, elbow and popliteal fossa. Do a cleansing enema with cool water (14–18 °C), then a therapeutic enema with a 50% analgin solution (mix 1 ml of solution with 2–3 teaspoons of water) or insert a suppository with analgin.
9. Carefully monitor the patient, regularly measure body temperature, pulse, respiratory rate, blood pressure.
10. During the year after suffering from pneumonia, the child is under dispensary observation (examinations in the first half of the year - 2 times a month, in the second half of the year - once a month).
Endocrine diseases
Obesity
Obesity is a disease associated with an increase in body weight of 10% or more.
Etiology
The disease can be triggered by factors such as:
1) hypercaloric nutrition, habitual overeating, excessive appetite due to family tradition, the action of psychogenic factors, dysfunction of the hypothalamus, and carbohydrate metabolism;
2) reduced energy consumption due to physical inactivity or constitutional characteristics of metabolism;
3) pathological metabolism, in which there is a shift in metabolic processes towards the formation of fat from proteins and carbohydrates; If both parents are obese, the likelihood of a child developing obesity increases to 80–90%.
Clinical manifestations
On initial stages obesity is marked by a uniform distribution of fat on the body, transient autonomic disorders such as sweating, nausea, thirst, dizziness, fatigue, and palpitations.
At stages III–IV of the disease, excessive fat deposition is observed on the abdomen (hanging folds), hips, back, chest, and limbs. Characteristic changes in the skin are revealed: folliculitis, marbling of the skin, the appearance of a network of small vessels, striae (red-bluish stripes of skin stretching). In some cases, there are disturbances in skin sensitivity and a decrease in the body's defenses.
Patients complain of shortness of breath at the slightest exertion, a feeling of interruptions in the heart area. The load on the musculoskeletal system increases, which can lead to the development of joint diseases. Hereditary-constitutional obesity differs from the nutritional form of the disease in its early onset (from the neonatal period), rapid progression and loss of ability to work, and the onset of disability.
Complications
Diabetes mellitus, dysfunction of the endocrine system, diseases of the heart and respiratory system.
Diagnostics
3. Biochemical blood test.
4. X-ray of the skull.
5. Ultrasound of the adrenal glands, uterus and appendages.
Treatment
1. Lifestyle correction.
2. Treatment of the underlying disease (endocrine obesity).
3. Medical nutrition.
4. Drug therapy: appetite suppressants, stimulating lipolysis (fat breakdown), diuretics.
6. Massage.
7. Physiotherapeutic methods of treatment.
8. Psychotherapy.
9. Surgical treatment.
10. Sanatorium-resort treatment.
It is necessary to carefully calculate the caloric content of foods and ensure that the child’s diet is hypocaloric. Limit the consumption of easily digestible carbohydrates, pasta, and cereals.
Prevention
A balanced diet, outdoor games, and physical exercise are the basis for the prevention of obesity.
Nursing care
1. An obese child is advised to have an active lifestyle. Exercise therapy classes are useful. Morning exercises, therapeutic exercises, dosed walking, running, swimming, dancing, cycling, training on exercise machines, sports games (volleyball, tennis, badminton) are recommended.
2. Hot, spicy, smoked and salty foods, seasonings, pickled and canned foods, meat and fish broths, and ice cream are prohibited. Table salt is not added to food during cooking; adding salt to ready-made dishes is allowed. Sugar is excluded from the diet. It is recommended to increase the content of plant fiber and fortified foods (vegetables, berries, fruits) in food. It is useful to eat 5-6 meals a day with the last meal no later than 3-4 hours before bedtime. Food portions should be small; it is recommended to eat with a small spoon. Every meal should include vegetables and fruits.
3. Staying in the fresh air, sleeping with open windows or on an open veranda, sun and air baths are beneficial.
4. It is necessary to have regular conversations with the patient, explaining the harm of overeating and insufficient exercise.
5. Identification and sanitation of foci of chronic infection are indicated.
6. Severe forms of obesity are treated in an inpatient setting under the supervision of an endocrinologist and nutritionist.
Diabetes
Diabetes mellitus is an endocrine disease, which is based on an absolute or relative deficiency of the pancreatic hormone, insulin.
Etiology
The pathological condition is caused by hereditary predisposition, autoimmune processes during viral infections, exposure to toxic substances, and obesity. In childhood, type I diabetes mellitus develops - insulin-dependent.
Clinical manifestations
The disease develops very quickly (within several weeks). The main complaints are weakness, polydipsia (pronounced thirst - patients can drink up to 5 liters of water per day), polyuria (increased urine output - up to 3-4 liters per day). With severe polyuria, symptoms of dehydration may develop. Polyphagia (increased appetite) is often observed simultaneously with significant weight loss (for a short time the child loses up to 10 kg). In some cases, there is a tendency to develop purulent infections of the skin and mucous membranes (pyoderma, boils, stomatitis occur). In the absence of timely diagnosis and treatment, ketoacidosis develops, which is manifested by severe pain in the abdomen, lower back, poor health, the patient refuses to eat, and the smell of acetone is felt from the mouth. When testing blood and urine for glucose, hyperglycemia and glycosuria are noted.
Complications
Ketoacidosis, hypoglycemic conditions, purulent infection of the skin and mucous membranes, diabetic retinopathy, nephropathy, neuropathy, cardiopathy.
Diagnostics
2. OAM (with determination of glucose, acetone).
3. Blood test for sugar (sugar curve).
4. Biochemical blood test.
5. Study of the acid-base state of the blood.
6. Fundus examination.
8. Consultations with an endocrinologist, neurologist, ophthalmologist.
9. Ultrasound of the abdominal organs.
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Drug therapy: insulin, fatty acid binders, anticoagulants, antiplatelet agents, vitamins.
4. Treatment of complications of diabetes mellitus.
5. Herbal medicine.
6. Physiotherapy.
Prevention
Prevention of overfeeding of children, prevention of obesity, limitation of excessive mental and physical stress on children, prevention and rational treatment of infectious diseases, sanitation of foci of chronic infection, early detection of latent forms of diabetes.
Nursing care
1. At the initial stages, treatment of the disease is carried out in a hospital. After selecting insulin therapy and achieving a state of compensation for the disease, the child is discharged home, further treatment is carried out on an outpatient basis.
2. The main method of treating diabetes mellitus is insulin therapy, which is carried out for life. Insulin is administered several times a day every day, so the child’s daily routine and meals have to be adjusted to the drug administration regimen. Parents must understand that successful treatment requires careful adherence to the rules and timing of insulin administration. It is necessary to ensure that insulin preparations are always available and in sufficient quantities. It is necessary to explain to the child and mother that intense physical activity can cause the development of hypoglycemia, so outdoor games should be moderate.
It is necessary to carefully monitor the child’s condition; at the slightest suspicion of the development of hypoglycemia (weakness, increased appetite, dizziness, sweating, trembling hands), give the child food rich in carbohydrates (porridge, potatoes, white bread, sweet tea, jelly, compote, candy) , and notify the doctor about this.
3. To prevent the occurrence of lipodystrophy (changes in fatty tissue in places where insulin is frequently administered), it is recommended to alternate injection sites - buttocks, thighs, abdominal area, subscapular region. The insulin must be warmed to body temperature. After treating the skin with alcohol, you need to wait until it evaporates. To administer insulin drugs, use special disposable insulin syringes with sharp needles. The drug must be administered very slowly.
4. The calorie content of the diet and the content of essential nutrients must correspond physiological standards, defined for a given age. Sugar and foods containing easily digestible carbohydrates are excluded from the diet: confectionery, bakery products, candies, chocolate, jam, honey. The consumption of bread, potatoes, cereals and pasta should be limited (counting bread units is required). Meals are 5-6 times a day with an even distribution of carbohydrates between meals.
5. It is necessary to carry out preventive measures colds, hardening the child.
6. The child is under lifelong dispensary observation. He must be examined monthly by an endocrinologist (to monitor his condition and, if necessary, correct treatment), and regularly undergo urine and blood tests.
Diffuse toxic goiter
Diffuse toxic goiter is a disease based on hyperfunction and hyperplasia of the thyroid gland. The resulting hyperthyroidism (increased production of hormones) leads to disruption of the functioning of all organs and systems of the body.
In case of diffuse toxic goiter, a study of the level of blood hormones is carried out: an increased concentration in the blood of triiodothyronine, thyroxine and a decreased concentration of thyroid-stimulating hormone are determined.
Etiology
Toxic goiter is an autoimmune disease that is inherited.
Clinical manifestations
Damage to the nervous system: increased excitability, irritability, hasty speech and fussy movements, anxiety, tearfulness, increased fatigue, sleep disturbance, general weakness.
Autonomic disorders: low-grade body temperature, sweating, feeling of heat, trembling of hands, eyelids, tongue, sometimes tremor of the whole body, loss of coordination.
Complaints from the cardiovascular system: a feeling of interruptions in the functioning of the heart, pulsations in the head, abdomen, shortness of breath, tachycardia, a tendency to increase blood pressure.
Gastrointestinal disorders: increased appetite (and despite this, progressive loss of body weight), thirst, diarrhea, enlarged liver.
Eye symptoms: photophobia, lacrimation, exophthalmos (protrusion of the eyes), hyperpigmentation and swelling of the eyelids, infrequent blinking.
Enlargement of the thyroid gland (goiter) can be of 5 degrees of severity:
1) I degree – there is no visible enlargement of the thyroid gland, but its isthmus is palpable;
2) II degree – the thyroid gland contours under the skin of the neck when swallowing;
3) III degree – the thyroid gland is clearly visible, filling the area between the sternocleidomastoid muscles;
4) IV degree – the gland is significantly enlarged;
5) V degree – the thyroid gland is very large.
Symptoms of thyrotoxicosis intensify with the addition of other diseases (infectious).
Complications
Toxic goiter can be complicated by the development of a thyrotoxic crisis, which is manifested by severe tachycardia, hypertension, heart rhythm disturbances, dehydration syndrome, increased body temperature, and the gradual development of symptoms of adrenal insufficiency. In severe cases, thyrotoxic coma develops.
Diagnostics
3. Biochemical blood test.
4. Immunological blood test.
5. Study of thyroid function (hormone levels).
6. Ultrasound of the thyroid gland.
8. Fundus examination.
9. Consultations with an ophthalmologist, neurologist.
Treatment
1. Drug therapy: thyreostatic agents, glucocorticosteroids, immunomodulators, symptomatic therapy (beta-blockers).
2. Surgical treatment (subtotal resection of the thyroid gland).
Prevention
Timely detection and treatment of viral infections. Elimination of the stress factor.
Nursing care
1. The patient should be provided with a calm environment and irritating factors should be eliminated.
2. In severe cases of the disease with the development of thyrotoxic crisis, it is necessary to organize constant monitoring of the patient. For such patients, hospitalization is indicated.
3. With severe exophthalmos, due to incomplete closure of the upper and lower eyelids, drying out of the cornea may occur when blinking, which leads to disruption of the trophism of the eye, the development of keratitis, ulcers, and visual impairment. To prevent such complications, it is recommended to regularly moisten the eyeballs with nutritious plant solutions (vitamin A, vitamin drops).
4. Patients with thyrotoxicosis, due to increased metabolic processes, constantly feel hot and tend to get rid of what they think are unnecessary clothes, even in winter. Therefore, it is necessary to ensure that such a patient is dressed in accordance with weather conditions and does not reveal himself when ventilating the room in the cold season.
5. In cases of severe agitation, irritability, and sleep disturbances, it is recommended to take sedatives of plant origin (tinctures of valerian, peony, motherwort). In severe cases, as prescribed by a doctor, the patient is given tranquilizers and sleeping pills.
6. The diet should be high in calories and include a sufficient amount of proteins, fats, carbohydrates, vitamins and minerals. Particular attention should be paid to balancing the diet with B vitamins and iodine. It is recommended to limit the consumption of foods that have a stimulating effect on the central nervous system (coffee, tea, chocolate).
7. Considering increased sweating patients, careful skin care becomes an important element of treatment. Patients should take a hygienic shower or bath every day, and regularly change their underwear and bed linen.
8. Surgical treatment is performed if there is no effect from conservative therapy for 6–12 months.
9. Children with compensated thyrotoxicosis may return to school activities 1 month after hospital treatment. They are exempt from physical activity (physical education) and must be given an additional day off per week.
Hypothyroidism
Hypothyroidism is a disease characterized by decreased function of the thyroid gland.
Etiology
The disease can be caused by the absence of the thyroid gland, delayed development of the thyroid gland (hypoplasia), a defect in the enzyme systems of the thyroid gland, inflammatory and autoimmune processes in the thyroid gland, surgical removal of the gland due to tumor pathologies, inflammatory or tumor processes in the pituitary gland and hypothalamus.
Clinical manifestations
Congenital hypothyroidism (myxedema) is detected during the neonatal period. Characterized by a large weight of the child at birth (more than 4 kg), lethargy, drowsiness, jaundice of the newborn, rough facial features, wide bridge of the nose, widely spaced eyes, large swollen tongue, difficulty breathing through the nose, low voice, large belly with an umbilical hernia, dry skin , acrocyanosis, long body, short limbs. Subsequently, delays in physical and mental development, dystrophic disorders, and slow maturation of bone tissue are noted.
Acquired hypothyroidism is characterized by the appearance of puffiness of the face, retardation of speech and movements, poor performance at school, memory impairment, hair loss, brittle nails, dry skin, constipation, and chilliness.
A blood test in a hypothyroid state reveals an increased concentration of thyroid-stimulating hormone and a decrease in the levels of thyroxine and triiodothyronine. The concentrations of these hormones are always interdependent, since the neurohumoral regulation of the thyroid gland is based on the feedback principle.
If the thyroid gland produces few hormones, then the synthesis of thyroid-stimulating hormone by the pituitary gland increases.
Complications
Hypothyroid coma.
Diagnostics
3. Biochemical blood test.
4. Determination of thyroid hormone levels.
5. Ultrasound of the thyroid gland.
7. Consultations with an endocrinologist, neurologist.
8. X-ray of the skull and tubular bones.
Treatment
1. Treatment regimen.
2. Medical nutrition.
3. Drug therapy: replacement therapy with thyroid hormones, vitamins, iron supplements, and for autoimmune processes - immunosuppressive therapy.
4. Physiotherapy.
6. Massage.
7. If the disease is of a tumor nature, surgical treatment is required.
Prevention
Including iodine-rich foods in your diet. Increasing the dose of thyroid hormones in pregnant women with thyroid diseases accompanied by hypothyroidism to prevent congenital hypothyroidism in the fetus.
Nursing care
1. Children with hypothyroidism experience chilliness and have cold extremities, so it is recommended to dress them warmly.
2. To prevent constipation, you need to give your child fresh juices, fruits, vegetables, as well as dishes made from them. Of course, nutrition should be appropriate for the child’s age. It is necessary to enrich the diet with foods high in vitamins.
3. Skin changes due to hypothyroidism require special care. It is necessary to moisturize and soften the skin with children's cosmetics (baby creams, skin care oils).
Educational educational institution of secondary vocational education "Kursk Basic Medical College"Specialty: Nursing
PM 02. PARTICIPATION IN TREATMENT AND DIAGNOSTIC
AND REHABILITATION PROCESS
MDK 02.01 Nursing care for various diseases and conditions
Nursing care in pediatrics
Nursing care for functional disorders and diseases
infants, preschool and preschool children
Teacher T. V. Okunskaya Assignments for practical lesson No. 1
Questions to prepare for the seminar “Features of nursing
process (SP) when working with newborns and premature infants
children with borderline conditions, diseases and
emergency conditions"
1. AFO of a newborn child.
2. Organization of care and feeding of a healthy newborn.
3. Features of SP when working with newborns and premature babies
children with borderline conditions, illnesses and emergencies
conditions: conducting an initial nursing assessment
conditions, features of collecting information about the patient,
planning and implementation of the nursing process.
Literature for preparation:
Healthy person (Electronic manual) – topic No. 2.
N.G. Sevostyanova. Nursing in pediatrics. Pages 11-25.
Krasnov A.F. Nursing. T.2. (Electronic abstract).
N.N. Volodin. Neonatology: National Guidelines
(Electronic textbook). Section I-II. Plan:
1. Features of caring for an infant
for diseases.
2. Features of pre-school child care
age for diseases.
3. Features of preschool child care
age for diseases. Caring for a sick child
Caring for a sick child involves, first of all, creating
appropriate regime, environment.
At an early age, a child has a certain age regime.
If the condition is not severe, then the age regime is maintained,
which was before the child’s illness.
Regardless of the nature of the illness, a young child
it is necessary to provide access to fresh air. This is achieved
frequent (every 3 hours) regular ventilation of the rooms.
It is important to organize walks for children. Walks in the open air
or veranda is prescribed taking into account the nature of the disease and
the condition of the child, the time of year.
The hygienic maintenance of children is of great importance: clean
bed, regular washing, clean dry linen,
hygienic baths (taking into account the patient’s condition), skin care
and mucous membranes of the mouth, nose, and eyes. Early Childhood Nurse Assistant - Mother
sick.
An inexperienced mother needs to be taught care techniques.
Staying of a mother at the bedside of a sick child in cases
hospitalization is of great importance for maintaining
emotional tone of the child.
You should be allowed to take your child’s favorite toy into the room.
The nurse should ask about health status on a daily basis.
mothers coming to the department in order to avoid contact
children with sick mothers. In order to create a protective regime for the central nervous system, it is necessary
comply with the following rules:
affectionate and attentive attitude towards the patient (smile, kind
eyes can cause a reciprocal smile, joyful animation);
put the child at ease before giving him any
manipulations, especially those involving pain. For
performing the manipulation requires preparatory
work out of sight of the patient, and perform the manipulation itself
quickly and skillfully. An important factor in shaping the regimen of sick children is
sufficient sleep, night and day. Great value for
organization of daytime sleep has a skillfully designed schedule
manipulation procedures that should not interrupt sleep
patient, you should not allow him to become overtired before going to bed. Regimen for underlying diseases
The regimen is prescribed according to the child’s age with the provision
maximum exposure to fresh air. While walking
the child's face should be open to influence
ultraviolet rays and the formation of vitamin D3 in the skin.
The organization of wakefulness is of great importance in the regime
a child with rickets. Taking into account the age of the child it is necessary
encourage him to engage in physical activity using toys.
Prevention of bone deformities.
Stimulation of psychomotor development and positive emotions with
taking into account the main age lines of development.
The child's clothing should not restrict his movements.
It is necessary to bathe your child daily. Diet and nutrition
This important factors in the treatment and care of young children.
Take into account the diet and nature of nutrition before illness, general
condition, severity of the disease and nature of the course.
Taking into account the frequency of possible or existing reactions with
side of the gastrointestinal tract in the form of functional disorders to the patient
early age during the acute period of the disease with severe
condition, the volume of food is often reduced, and the frequency of feedings
increase by 1–2.
Easily digestible food is prescribed, in a more liquid form.
Sick children should be prescribed fortified foods,
which is achieved by introducing juices, vegetable and fruit.
The patient should be provided with sufficient fluids
in the form of 5% tea, vegetable and fruit decoctions, glucose-salt
solutions. Under no circumstances should you force feed a child. Diet and nutrition
The amount of food eaten and liquid drunk should be
clearly mark on the nursing sheets, and also indicate the nature
appetite, whether or not there was regurgitation and vomiting, if yes, then at what time
time of day, their character and admixtures of bile, blood, mucus.
Regurgitation in young children can also be due to
swallowing air. If there is any suspicion of a connection
regurgitation with swallowing air is necessary after
during feeding, place the patient in a vertical position so that
so that he burps the air that has entered his stomach.
If regurgitation occurs, control feeding should be carried out
and avoid overfeeding.
If the child is hospitalized and his condition allows,
control feedings should be carried out daily, so
This will determine the volume of lactation in the mother. results
feedings should be recorded on the nutrition sheet.
Optimally - breast-feeding: found in breast milk
the best ratio between calcium and phosphorus, contains
all necessary macro- and microelements.
For a child with manifestations of rickets in order to reduce acidosis
prescribe a diet with a predominance of alkaline valences:
mainly vegetable and fruit dishes.
Complementary foods in the form of vegetable puree are introduced from 5 months; porridge is cooked on
vegetable broth or use instant porridge, do not
requiring cooking, containing microelements; vitamins,
enriched with iron. Buckwheat, rice, oatmeal are recommended
porridge. In vegetable puree, use zucchini, cauliflower and
white cabbage, pumpkin, carrots, turnips and in smaller quantities
potato. Feeding for underlying diseases
A special place in nutrition is given to products containing
complete proteins, essential amino acids (meat, fish,
egg yolk, cottage cheese, green peas). Egg yolk for baby
a patient with rickets, can be prescribed from 5 months to 1/4, from 7 months to 1/2,
hard-boiled, mashed.
Complementary feeding with minced meat is prescribed 1-1.5 months earlier than
to a healthy child. When artificial feeding, use
modern adapted mixtures. Feeding for underlying diseases
For anemia, the first complementary foods are introduced for 2-4 weeks ahead of schedule V
in the form of vegetable puree containing iron and copper salts.
In severe anemia, accompanied by a pronounced decrease in
appetite and dystrophy in infants, diet therapy
must be carried out according to the principle of dystrophy, following the stages
minimal, intermediate and optimal nutrition with
gradual introduction of iron-rich foods.
For diathesis - a special hypoallergenic diet. Caring for a sick child
The patient's thermometry is usually carried out 2 times: in the morning and in the evening.
The axillary areas should be wiped dry, thermometer
should be kept for 7–10 minutes. Measurement result
body temperatures are recorded on a special sheet.
In some patients, body temperature measurement may be
prescribed every 3–4 hours, in such cases the nurse must
clearly carry out this assignment and record the measurement time
temperature. Simultaneous measurement can be scheduled
temperatures in the armpits and rectum. At
When measuring the temperature in the rectum, the patient is placed on
side, thermometer, pre-lubricated with Vaseline, mercury
the end is inserted 2–3 cm into the anus. During
rectal temperature measurements of the buttocks are maintained in
closed position 5 min. Rectal temperature by 0.5 °C
above the axilla. Upon completion of temperature measurement
The thermometer must be washed thoroughly and
disinfect. Thermometers are stored in the nurses' closet in
jar with cotton wool at the bottom. Caring for a sick child
When caring, it is important to pay attention to children’s behavior (active,
passive, lethargy, agitation, etc.), monitor the reaction to
environment (does he show interest in toys, other children,
adults, etc.), record the characteristics of the reaction to
manipulations, especially injections.
The nurse should reflect all his observations in the nursing report.
sheet and report at morning conferences.
About a change in behavior or deterioration in the child’s condition,
If new symptoms appear, the nurse must immediately report
ward or duty doctor.
When the patient's behavior and condition changes, the nurse should
measure his body temperature again. Caring for a sick child
When caring for young children, it is important to maintain cleanliness.
their skin, hygienic baths are carried out daily (if not
prohibited by a doctor), in patients in serious condition the skin is wiped
partially, sometimes rubbing with alcohol is used
solution. Caring for a sick child
Medical staff should monitor stool patterns and
urination.
Frequency of stool, its character after personal examination by a nurse
records it on the nurse's sheet.
The number of wet diapers and how wet they are are noted.
If there are no contraindications due to the severity or nature of the
underlying disease, a patient of early age must
weigh daily. Caring for a sick child
When performing intramuscular injections, the nurse must:
Before injecting, check the condition of the tissues
places of previous injections in order to timely detect
possible infiltrates, hemorrhages, etc. About your
she should inform the doctor about her observations.
At the time of injection, it is necessary to monitor the patient's reaction.
After injections, especially antibiotics, it is necessary 20–30
minutes to approach the child and make sure that his condition is not
visible changes have occurred (the possibility of
allergic reactions). It is necessary to have ready for this case
all emergency aid.
Prescribed medications must be used strictly.
The nurse must ensure that she is giving or
administers exactly the medicine prescribed by the doctor, and for what period
The medicine has not expired. Caring for a sick child
In case of active resistance when administering the drug through
mouth, the nurse should administer the medication using the following technique:
press on the side of the cheeks with two fingers, at this moment
The lips open and the medicine can be poured into the mouth. Medicine
can be poured in by pinching the nose, the child opens his mouth to breathe, and
At this point you need to inject the medicine. Caring for a sick child
Subcutaneous injections are made into the outer surfaces of the shoulder and
thighs after thoroughly wiping the skin with alcohol.
Intramuscular injection is carried out in the upper outer
quadrants of the buttocks, thigh muscles. Need to make a quick
puncture. The needle must be removed strictly vertically, place
After removing the needle, hold the injections with a cotton ball,
soaked in alcohol. Caring for a sick child
As the child recovers, the child should be given the opportunity
movements during wakefulness, the ability to communicate with children
older people, if they are on the department, you need
attract the patient's attention to a beautiful toy.
However, it is necessary to protect the child from contact with
patients with acute respiratory viral infection. Caring for a sick child
When caring for preschool children, it is important to consider:
What is the first place among diseases in this age period?
frequency are infectious, determined by wide contacts
children, as well as respiratory diseases. However, diseases in children
during this period, as a rule, have a benign course.
