Final 2014

CHILD HEALTH NURSING
UNIT – 1
INTRODUCTION
 Concept of child health care

 Trends in pediatric Nursing
 Roll of nurse in child health care & Pediatric Nursing
 Emerging challenges in pediatric Nursing
 Nursing process related to pediatric Nursing
 Concept of preventive pediatric
 Child health care in India
 Vital Statistics
DIVYESH KANGAD (99987 60909) 1

Child - Human between the stages of birth & puberty

- Age of 0 to 18 years
- A human being below the age of 18 years
CONCEPT OF CHILD HEALTH CARE
Pediatric WORD
Pedia CHILD
Iatrike Treatment
Ics Branch of Science
Pediatric Child Health Care, childhood diseases Treatment Scientific study
Definition :
“Pediatric Medical science Conception to Adolescence
Preventive, Promotive, Curative, Rehabilitative care
”
OR
“Pediatric Medical science Growth & Development of a child
illness Deformities, Prevention , Control, Treatment ”
Pediatric Nursing development

Special Risk Group
Special Health Care & Facilities Provide
Special care
Unequal individual
Special Needs & Family Comprehensive cone
Childhood Socialization process Period Vital Period

Socialization process Family & community attitude, custom, behavior
Health Maintains & Health Promotion Family LivingStandard,
culture, education level religion Belief
Child Health Problem Poorly, Population,Explosions

and environment stress.
Education, Family Planning and health awareness
Poor Social economic condition pregnancy IUGR,

Prematurity, intra uterine infection Obstetrical practice
Pediatric Nurse
Child Health
 Maternal Health.
 Family Health.
 Socio Economic Status.
 Social Support.
 Surrounding environment.
 Available Health care facility.
TRENDS IN PEDIATRIC NURSING (CHILD HEALTH CARE )
History :
460 – 370 BC Child Health Care Creative aspect 850 – 923
AD Child Health Care Development illness
Observation Child health preventive creative aspect Kasltyapa
& Jeevaka world Pediatrician ( Sixth Century B.C.) Child Health Care
Modern Concept
Pediatrics special field ABRAHAM JACOBI (1830-

1919) Father Of Pediatric
Trends :
Nursing Profession Trends Profession
-
- Social Need
- Medical & Technological advancement Pediatrics Nursing field
Social awareness , hospitalization health care
facilities improvement Child Health Care
Modern Child Health Care approach curative care Preventive Care

Child Hood
health care facilities Availability Modern approach
Modern Concept Pediatric Nurse

 Immunization
 Nutrition
 Health Education aspect Pediatrics Nurse
Pediatric Nurse Health Team family health care Deliver

Child Health Care holistic approach Psychological trauma

Child Care Psychological approach, health discipline traditional practice

Include Pediatric Nursing
Role Of Pediatric Nurse :
Medical Science and Nursing Development Child Health Care need

Aspects Pediatric Nurse Role Highly Specialized
Pediatric Nurse Role

1. CARING
2. CURING
Caring Child Wellness & illness observation continuous process

Happening guiding & counseling
Curing ill child complete care & Treatment Disease management

and Rehabilitation process
Pediatric Nurse Hospital, home, clinic, school & Community

Nursing care
Pediatric Nurse Role Basic responsibility
1. Primary care giver

2. Health educator
3. Nurse Counselor
4. Social Worker
5. Team Co-ordinator & Collaborator
6. Manager
7. Child Care Advocate
8. Recreationist
9. Nurse Consultant
10. Researcher
Primary care giver :

o Pediatric Nurse Health service Preventive, promotive, curative &
Rehabilitative care Case finder
o Hospital sick child care Comfort, Feeding, Nutrition, Bathing, Safely &
Hugging Care
o Community health assessment immunization primary health care referral
o Child growth & development & health status implementation

Health educator :
o Healthy lifestyle, health maintenance
health information Planned, incidental health teaching
Pediatric Nurse
o Child care Health teaching health behavior, attitude
health practice develop teacher agent health
educator role
o Nurse positive attitude parents children‘s ideals informal &
teacher
Nurse Counselor :
o Parents health care delivery system pediatric nurse problem solving approach
guidance Health hazards Problem
solve counselor
o parents family member
Counselor
Social Worker :
o Child health Pediatric Nurse
Social service Child welfare agency
Team Co-ordinator & Collaborator

o Better child health care pediatric nurse health team member
team member member IPR
Patient Proper interventions
Co- Ordination communication
Member
Manager :
o Hospital, clinic & community in pediatric care unit Manager role
Better prognosis & good health care system manage
Child Care Advocate:

o Comprehensive family centre care Family support
pediatric nurse Advocate Proper care
Recreationist:
o Hospitalization & illness Crisis
Proper Development interventions pediatric nurse
Play Therapy entertainment emotion
Recreation Role

Nurse Consultant:
o Childhood illness health promotion & Maintenance pediatric nurse
Consultant role
Researcher:
o Professional nursing research integral part pediatric nurse research
nursing health care practice research
researcher
Common role pediatric nurse Hospital, clinic &

community Responsibility
EMERGING CHALLENGES IN PEDIATRIC NURSING
Child care attitude trend Pediatric Nurse

aspect
Pediatric Care medical speciality & super speciality Pediatric Nurse

specialized education & training Neonate unit & ICU
specialized training
HIV infected Pediatric Care Nursing practice

Special approach
Unhealthy competition companion single parents & family conflict

psychological problems Child health care special
attention
Practice Child care consumer protection

negligence poorly illiteracy child health
improve
NURSING PROCESS RELATED TO PEDIATRIC NURSING
Nursing Process patient health care Nursing need patient

health problem solve scientific approach
Nursing Process Related To Pediatric Nursing
individual group problem focus identify solve unique

organized systemic method
Client problem assess solve effective plan orderly &
systemic process Nursing process planned, client-centered,
problem-oriented, goal-directed, dynamic continuous process

STEPS IN THE NURSING PROCESS :
 Assessment
 Nursing Diagnosis
 Planning
 Implementation
 Evaluation
Assessment :
Assessment nursing process phase data collect
subjective data objective data problems
manifestation , developmental needs, emotional need & habits
subjective data : patient relative collect data observable measurable
objective data : Data health personal observation collect

manifestation sign & symptoms measurable observable
Nursing Diagnosis:
Assessment anodizing judgment &
conclusion nursing diagnosis actual or potential or unmet
need unmet need, unrealized expectation, interrupted process Community
crisis
Planning:
Client problem solution Goal establish priority set resources
determine nursing strategy planning
Planning written documentary assessment outcomes
prognosis planning client Participation
Implementation:
Planning care, needs & treatment patient apply process
implementation Care plan action goal Performance
Assistance, observation, communication & accurate recording phase decision
making , observation, co-ordination , IPR Implementation parents
active participation
Evaluation:
interventions achieve
Evaluation intervention s continue terminate
modify Evaluation Planning Implementation

Nursing process child family health problems better outcomes

organized assistance
LIST OF APPROVED NURSING DIAGNOSIS
1. Activity intolerance.
2. Activity intolerance, risk for.
3. Adjustment, impairment.
4. Airway clearance ineffective.
5. Anxiety.
6. Aspiration, risk for.
7. Body temperature, altered, risk for.
8. Bowel incontinence.
9. Breastfeeding, ineffective.
10. Breathing pattern, ineffective.
11. Cardiac output decrease.
12. Communication, impaired, verbal.
13. Comfort, altered, pain.
14. Confusion.
15. Constipation.
16. Coping, ineffective, individual.
17. Coping, ineffective, family.
18. Diarrhea.
19. Divisional activity, deficit.
20. Family process, altered.
21. Fatigue.
22. Fear.
23. Fluid volume, deficit, risk for.
24. Fluid volume, excess, risk for.
25. Fluid volume deficit.
26. Gas exchange, impaired.
27. Growth and development, altered.
28. Hopelessness.
29. Hyperthermia.
30. Hypothermia.
31. Infant feeding pattern, ineffective.
32. Infection, risk for.
33. Injury, risk for.
34. Knowledge deficit.
35. Memory impaired.
36. Mobility, impaired, physical.
37. Noncompliance.
38. Nutrition, altered, less than body requirement.
39. Nutrition, altered, risk for, more than body requirement.

40. Oral mucous membrane, altered.

41. Pain, acute.
42. Pain, chronic.
43. Parenting, altered.
44. Parental role conflict.
45. Poisoning, risk for.
46. Post trauma response.
47. Protection, altered.
48. Self care deficit.
49. Sensory alteration.
50. Skin integrity, impaired.
51. Skin integrity, impaired, risk for.
52. Sleep pattern disturbed.
53. Social interaction, impaired.
54. Suffocation, risk for.
55. Swallowing, risk for.
56. Thermoregulation, ineffective.
57. Thought processes, altered.
58. Tissue integrity, impaired.
59. Tissue perfusion, altered, cerebral, renal, cardio pulmonary, gastrointestinal, peripheral.
60. Urinary elimination, altered pattern of.
CONCEPT OF PREVENTIVE PEDIATRIC
health preventive care health

problem preventive pediatric diseases disability
care child health care
specialized challenge Social Wellness & physical+ mental
health promotion positive health goal preventive pediatric
Preventive pediatric
1. Antenatal preventive pediatric
2. Postnatal preventive pediatric
Antenatal preventive pediatric
 Adequate Nutrition to mother

 Prevention of communicable diseases
 Preparation of mother for Delivery]
 Breast Feeding & mother craft
 Training
 Vaccination & immunization
pregnancy health status

Postnatal preventive pediatric
 Promotion of breast – feeding


 Immunization
 Prevention of infection
 Prevention of accident
 Emotional security with loving care
 Growth monitoring
 Periodic medical supervision & health care check up
 Psychological assessment,
AIMS OF PREVENTIVE PEDIATRICS

1. Prevention of diseases
2. Promotion of physical well being
3. Promotion of mental well being
4. Promotion of social well being
Comprehensive care, community

Local, National & international social welfare measures social
Growth
 Healthy & Happy Parents
 Balanced & Nutritive diet
 Clean helpful house & living environment
 Play, Recreation, Security etc
 Education Provision & Opportunity
PREVENTIVE PEDIATRIC
CHILD HEALTH CARE IN INDIA
Children society most important are group Child health care specific
biological & psychological need healthy development need
Children need proper care special age group divide

E.g. Infancy, preschool, school age & adolescence.
India total population 32% under 5 year age

vulnerable & risk group
The mother & child health (MCH) service special age group healthy
care provide MCH obstetrics, pediatrics, family welfare; nutrition child development
health education preventive, primitive, curative social aspect Life
long health VI MCH ultimate objective MCH specific objective child & mother

morbidity & mortality reduce reproductive health improve

child & family physical & psychological development
MCH services components six sub areas maternal health,
family planning, child health, school health, care of handicapped child & care of child in
specials setting
Mat services RCH (reproductive & child health) program provide

RCH program CSSM (child survival & safe mother hood) , family planning,
prevention of RTI / STD & AIDS deal MCH service community need
client oriented, high quality, target free, participatory decentralized approach
RCH Indian Government child survival health programs

Non governing organization child welfare organization
children better health contribution Other child health services ICDS
(Integrated Child Development Services ) under 5 clinics, school health services, post partum
services, BFHI child guidance
Child health services village level Anganwadi (ICDS) centre deliver

sub centre, PHC, CHC, Hospitals child health care provide
Multiple health worker, field workers, professional worker, voluntary workers
child health care planning services different infrastructure
rural urban areas available specific low cost effective health
care services Indian government provide
SCHOOL HEALTH SERVICE
School health service school age children health promote economic

& powerful health care delivery service
1960 children health & nutrition status government of India

school health committee 1962 school health program service provide
start
School health service health checkup common disorders

local health problems, culture practices problems, malnutrition, PEM, infectious
diseases, dental caries eye & year problem
adolescent reproductive tract infection or STD attention
OBJECTIVES :-
- The promotion of positive health.
- The prevention of disease.
- Early diagnosis, treatment & follow up of defects.
- Increasing health awareness in children about good & bad health
- Provision of healthful environment.
ASPECTS OF SCHOOL HEALTH SERVICES :-

School health service local priority services

important aspects
1. Health appraisal of school children & school personnel.

2. Remedial measures & follow up.
3. Prevention of communicable diseases.
4. Health fall school environment.
5. Nutritional services.
6. First aid & emergency care.
7. Mental health.
8. Dental health.
9. Eye health.
10. Health education.
11. Education of handicapped children.
12. Maintenance & use of school health reads.
SCHOOL HEALTH SERVICES NURSE RESPONSIBILITIES :-

1. Community school visit children health school
Environment information collect
2. School health program organization
3. Home visit School health program child parents teacher
meeting
4. School environment healthful
5. School health services statically records
ACTIVITIES OF NURSE IN SCHOOL HEALTH SERVICES :-

1. Children physical check up

2. Health problem early detection
3. Health problem treatment nursing care
4. Reference & follow up services.
5. Student health parents teacher
6. School environment observe healthful guidance
7. School health programs organization
8. Immunization implementation
9. Children Nutritional status access nutritional program implementation
10. Children, parents teachers health education
11. First aid box maintain teacher first aid demonstration
12. Student mental health promote
13. Health seminar counseling meetings arrangement
14. Handicapped special need children special care
15. Children healthy health habits nutritional problems
16. Students health records school health records maintain yearly statistical
reviews
UNDER FIVE’S CLINIC
Under five‘s clinic concept west India well bally clinic clinic
preventive services [ health supervision, treatment, nutritional surveillance health
education
Under five age group special risk & vulnerable group

mentality rate morbidity rate mentality morbidity ARI,
diarrhea, neonatal & prenatal condition proper health care supervision
prevent
Under five‘s clinics symbol
CARE IN
ILLNESS
FAMILY
PLANNING
GROWTH PREVENTIVE
MONITORING CARE

Figure large triangle apex ―care in illness‖ left triangle

―adequate nutrition‖ Right triangle immunization red triangle
family planning Boarder line triangle ―Health teaching to mother‖
CARE IN ILLNESS :-
children care
1. Diagnosis & treatment of

A. Acute illness
B. Chronic illness
C. Physical, mental, congenital & acquired abnormalities.
2. X-Ray & lab services.
3. Referral services.
care trained medical personnel hospitals health care center
ADEQUATE NUTRITION :-
- Children proper growth & development adequate
nutrition
- Children birth breast feeding, weaning balanced diet
- nutritional disrelish PEM, Anemia, rickets, blindness

disorder age \ common
Nurse growth monitoring malnutrition access nutritional

disorder intervention
FAMILY PLANNING :-
Under five‘s clinic family planning program successfully conduct

Mother counseling family planning practices health practitioner
family planning parents
HEALTH EDUCATION :-
Under five‘s clinic mother education compulsory mother child care,

nutrition, care in disorders education
immunization, health awareness injection prevention

MATERNAL AND CHILD HEALTH (MCH)
MCH mother children promotive, preventive, curative, rehabilitative

health care
MCH components sub areas maternal health, child health, family

planning, school health, handicapped children, adolescence special settings children
care
OBJECTIVES:-
- Reduction in maternal, prenatal, infant & child mentality & morbidity rate.
- Promotion of reproductive health.
- Promotion of physical & psychological development of child & adolescent.
Child mother health problems malnutrition, infection

uncontrolled reproduction India problems prevent
community health improve MCH service fall ―package‖ provide
―MCH package‖ antenatal care intranasal care, prenatal care, intranasal care,
prenatal care, postnatal care, nutritional advice, immunization primary health care rational
family planning
MCH services flexible integrated high risk approach

organized primary health care priority MCH services
mother health special concentration healthy mother healthy
baby
REPRODUCTIVE AND CHILD HEALTH (RCH)
RCH Government of India October 1997 launched
RCH program component:-
- Child survival & safe mother hoed.

- Family welfare.
- Prevention & management of RTI / SID.
- Aelolescent health.
RCH service community need client centered approach planned

implement management strategy target free, decentralized,
participatory bottom up planning program community level, sub centre level,
primary health centre level district hospital level implement

RCH service packages
 For The Children (Child Survival) :-

- Essential new bourn centre.
- Exclusive breast feeding for 6th month and assigning food after 6th month.
- Immunization against six killer diseases.
- Appropriate management of diarrheas & ORT.
- Appropriate management of ARI.
- Vitamin ‗A‘ prophylaxis.
- Treatment of child hood anemia.
 For Mothers (Safe Mother Hood) :-

- Early registration of all antenatal mothers.
- Minimum three antenatal check-up.
- Immunization against tetanus.
- Prevention & treatment of anemia.
- Early identification of maternal.
- Complications & referral.
- Deliveries by trained personnel.
- Promotion of institutional deliveries.
- Management of obstetrical emergencies.
- Minimum three post natal checkup.
- Birth spacing.
 For The Eligible Couples :-

- Promotion of contraception to prevent unwanted pregnancies.
- Safe services for MTP.
 Other New Services :-

- Prevention & management of RTI / STDs.
- Adolescent health & counseling on family life & reproductive health.
RCH package life cycle approach adopt
Healthy
A Healthy Pregnancy
reproductive
age group
RCH
A healthy A healthy
adolesent child

healthy life cycle next generation continue
RCH PHASE – II
RCH Phase – II 1st April 2005 main focus maternal

child morbidity mortality reduce rural health care
concentrate
INTIGRATED CHILD DEVELOPMENT SERVICES (ICDS)
Child welfare field ICDS most important scheme Government of

India ministry of social & women welfare under
national policy for children
ICDS program child welfare human resources development

th
6 year children, pregnant women, nourishing mothers
15 to 45 year women
ICDS scheme rural, urban tribal area work 1975 33 ICDS project
5422 blocks adolescent girl 507 special blocks
sanction 11 18 years 3.51 lacks girls scheme
NGOs 67 ICDS project assist
OBJECTIVES
1. 0 to 6th year health status nutritional status improve
2. Child psychological, physical social development
3. Child mentality, morbidity, malnutrition school dropout rate
4. Child development policy child care deportments Co-ordination
improve
5. Mother capability nutrition needs health education
Objectives achieve categories packages services

provide
 FOR CHILDREN LESS THEN 3 YEARS :-

- Supplementary nutrition.
- Immunization.
- Health check-up.
- Referral services.
 FOR CHILDREN IN AGE GROUP 3 TO 6 YEARS :-

- Immunization.
- Health checks up.
- Referral services.

- Non formal preschool education.
 FOR ADOLESCENT GIRLS 11 to 18 YEARS :-

- Nutrition & health education.
 FOR PREGNANT WOMAN :-

- Healths check up.
- Immunization against tetanus.
 FOR NURSING MOTHERS :-

- Healths check up.
 OTHER WOMAN OF 15 to 45 YEARS AGE GROUP :-

- Nutrition & Health education
DELIVERY OF SERVICES
Anganwadi worker service 1000 population ICDS
centre Anganwadi worker (AWW) work AWW local area
4 month training tanning child
development, nutrition, immunization, personal hygiene, environmental sanitation, antenatal
care, breast feeding care, common illness treatment
Anganwadi worker activities supervision Anganwadi supervisor

mukhya servitor graduate 2 months training
supervisor 20-25 Anganwadi supervision CDPO (Child development project
officer) ICDS project in charge 4 mukhya sevika or anganwadi supervisor
supervision
NATIONAL HEALTH POLICY FOR CHILDREN
Government of India August 1974 National Health Policy For Children adopt
National Policy Children welfare focus team work provide
POLICY DECLARED:-
state children adequate services provide child birth

care provide children physical, mental social development
Policy declaration children ―Nation‘s Supremely Important Asset‖

Nation health, nutrition, handicapped child
welfare destitute children National policy declare Government of

India program ICDS scheme, supplementary feeding programs,

nutritional programs, educational programs, welfare of handicapped children, national
children fund, CSSM programs etc.
 India national policy for children principles
1. children health programs nutritional programs

2. Nursing mother health care , nutrition nutritional
education provide
3. 14 year children free education, compulsory education, pre schooled
informal educational school wastage stagnation
4. formal education out of school education
5. School community centre games, recreation extra curricular activities

program
6. Weak section children special program
7. Distress education, training rehabilitation
8. Child abuse, neglect expiation
9. Child labor
10. Physically handicapped, emotionally dissected mentally retarded children
special treatment, care rehabilitation
11. Distress children care
12. Children special program talented law
13. interest law
14. community & family environment Family
children bonding
CHILD WELFARE SERVICE
Child welfare service preventive, primitive, curative, development,

paviative, rehabilitative child care aspects services high
risk & vulnerable age group childrens need Poor
social group child, working mother‘s child destitute children handicapped children
special attention
Comprehensive child welfare services 2 type provide

a. Community family participate normal child basic need
services.
b. Physically, mentally socially handicapped children special need
services.
Government of India August 1974 national policy for children adopt

rights of child declaration programs introduce
ICDS scheme, programs for supplementary feeding nutrition education,

production of nutrition food child welfare national awards announcement

handicapped child welfare
Welfare services
- Nation policy for children.
- United nation‘s declaration of rights of child.
- The children act.
- Health programs for children.
- Child health services.
- National program on nutrition & nutritional policy
NATIONAL NUTRITIONAL POLICY
 Child welfare important agencies
1. Indian council for child welfare (ICCW)

2. Central social welfare bound.
3. Kusturba Gandhi memorial trust.
4. The Indian red cross society.
health care agencies child welfare services financial aid government

agencies important activities
A. Infant toddler nursery school, balwadies, caches day care centers working
mother children day care services provide
B. 12 to 16 years children holidays homes organization
C. Recreational facilities play center, public parks, children libraries, balbhavans,

children films, national museum, hobby classes arrangement
national agencies non government organization save the

children found, children in need institute (CINI) , sos villages, etc. child welfare active
International agencies child welfare services

- UNISCO
- WHO
- CARE
- FAO
- USAID
- INTERNATIONAL RED CROSS
- UNICEF etc.

PULSE POLIO IMMUNIZATION PROGRAM (PPI)
Poliomyelitis eradicate 1995-96 government of India Pulse

Polio immunization campaign establish 5 years age vaccination
OBJECTIVES:-
1. children immunization
2. Flaccid paralysis cases detect specimen (stool) collect
3. Surveillance high level maintain
4. Polio disappear immunization continue
5. 2005 India Polio free
IMMUNIZATION
Immunization is the process of increasing resistance of a person from

particular infection by artificial mean.
VACCINES
Vaccine is a preparation of disease agent or its toxic product use to inoculate a person
which then simulates specific antibody formation against the pathogen.
Immunization children artificial acquired immunity develop
child mortality morbidity handicapped condition prevent
TYPES OF VACCINES & THEIR CHARACTERISTICS :-
Classification:
A. Live Vaccines: This Vaccine consist of attenuated (weak) micro organisms attenuated
virus vaccines generally provide lifelong immunity.
E.g. BCG, OPU, & MMR
B. Killed Vaccines: They consist of killed becteria and virus.

E.g. Vaccines for Typhoid, Cholera, Whooping Cough, Plague, Rabies
& Influenza.
C. Taxoides : These are inactivated toxins of micro organisms.

E.g. Diphtheria & Tetanus.
D. Mixed or Combined vaccines: They contain mixture of two or more immunity agents.
E.g. DPT, DT, MMR, Typhoid, Paratyphoid.
E. Cellular traction vaccines: Some vaccines are prepared from fractions of the cells,
These are safe & effective but for a limited duration.

E.g. Hepatitis B & Pertussis.
F. Conjugated Vaccines : This is the combination of desired antigen with a protein that
Produced the immune response.
E.g. Diphtheria toxoid.
Influenza type – B.
 Vaccines immuno biological substances Disease specific protection

 Vaccines live attenuated organism, inactive or killed organisms, extracted cellular
traction, toxoids substence combination
 Ideal vaccine permanent immunity provide toxic substance
side effects Administer
Currently vaccines use
 Live Attenuated Vaccines.
Bacterial : - BCG, Typhoid, Plague

Viral : - OPU, MMR, Yellow Fever, Influenza.
Rickeltsial : - Epi, Typhus
 Killed or inactivated Vaccines.
Bacterial: - Pertussis, Typhoid, Cholera, Plague, CS Meningitis.

Viral : - Rabies, Hepatitis – B, Influenza, Salk Polio, Japanese Encephalitis.
Toxoids : - Diphtheria & Tetanus.
Cellular Fraction: - Meningococcal & Pneumococcal
Combinations: - DTP, MMR, DT, Hib, Hep – B
NATIONAL IMMUNIZATION SCHEDULE
Immunization schedule community need plan
WHO 1974 Global Immunization Program expended program on

immunization (EPI) January 1978 lunch
EPI UNICEF Universal immunization program modify

UIP 1985 lunch
National Immunization schedule Govt. of India Recommended

India uniform implementation immunization schedule
table

SCHEDULE:-
Note:-
i) Interval between two doses should not be less than one month.
ii) Minor cough, cold & mild fever or dished are not a contra in dictation to vaccination.
iii) In some states hepatitis ‗B‘ vaccine is given as routine immunization.
iv) Interruption of the schedule with a delay between doses not interferes with the final
immunity aliened. There is no basis for the mistaken belief, that if a second or third
dose in an immunization is delayed, the immunization schedule must be started all
over again. So it the child missed a dose. The whole schedules need to be repeated
again.

NURSING RESPONSIBILITIES FOR CRITICAL IMMUNIZATION:-

Nursing personal immunization administration responsible
Immunization nurse responsibility
 Immunization benefits importance general people awoke

 Non participants immunization drop out children identify
 Immunization problems & queries identify solve
 Immunization session, time, place, available vaccines, immunization
health facilities peoples aware
 Health institute, campus school immunization clinic arrangement
 Immunization center clinic vaccine vaccination equipment
arrangement
 Vaccine transport home visit cold chain maintain
 Vaccine administer nurse main responsibility Administer six
rights vial properly check
 Vaccination children reaction check Parents family member post
immunization care instruction
 Family immunization schedule visit date next dose information
 Immunization could maintain

 Clinic recodes, stock, number of attendance, vaccine used, immunization courage
records maintain
 Immunization research activity participate
 Immunization skills improve advancement knowledge update
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CHILD HEALTH CARE IN INDIA
age group child health care

child health Promotion health facilities
available
Vulnerable & Risk Group
Special Group health service delivery Melt service Preventive,
Promotive, curative care & social aspects, obstetrics, Nutrition child development
Child health care main aim morbidity mortality rate

 MCH Service 6 sub area
 Maternal health
 Family planning
 Child health
 School health
 Care of handicapped children
 Care of children in special settings
NGO‘S Child health care Promotion Participation

Anganvadi center, sub center PHC, CHC, Home visit setting, Camp Hospital indoor &
outdoor child health services

India child health care facilities available

1. Maternal & Child Health (MCH)
2. Reproductive & Child health I & II
3. Baby friendly hospital initiative ( BFHI)
4. Integrated Child Development
5. Under Five Clinic
6. School Health Service
7. Integrated management of Neonates &childhood illness
8. Child labor act
9. Street children
10. Gender bias
11. Child abuse & Neglect
VITAL STATISTICS (STATISTICS RELATED TO CHILD HEALTH)
Vital Statistics Health indicator consider Vital Statistic
Systematically collect Health Planning
Child Health Nursing Vital Statistics Birth rate, Death rate , IMR, MMR,
NMR , Prenatal death & under five mortality rate
Modern Concept Vital Statistics Proper collect

Recording
Use of Vital Statistics / importance of Vital Statistics

- Country , state society health status, health problems health need
- World level health status improve
- Health Programme planning & administration
- Health service
- Health Programme & Health service evaluation
- Child health problem assess planning
- Community health related research
- Health worker Health facilities effectiveness evaluation
Sources of Vital Statistics

o Census
o Registration of Birth , Death & Marriage
o Notification of infectious Disease
o Record of hospital & health centre
o Health services
Important Vital Statistics related to pediatrics

o Birth rate

o Death rate
o IMR
o MMR
o NMR
o Prenatal mentality rate
o Under-five mortality rate
Late fetal and early neonatal deaths

Weighing over 1000 gm at birth
1. Perinatal Mortality Rate x 1000
Total live birth weighing
Over 1000 gm at birth
Number of death of children

Under 28 days of age in a year
2. Neonatal Mortality Rate x 1000
Total live births in a same year
Number of death of children between

28 days & one year of age in a given year
3. Postnatal Mortality Rate x 1000
Number of death of children less

than one year of age in a given year
4. Infant Mortality Rate x 1000
Number of death of children less

than five year of age in a given year
5. Under five Mortality Rate x 1000
CAUSES OF UNDER FIVE

MORTALITY RATE

Selected statistics related to child health in India
Selected statistics related to child health in India
1 Population 1,205,073,612 (July 2012 est.)
2 Age structure 0-14 years: 29.3% (male 187,386,162/female 165,345,284)

15-24 years: 18.2% (male 116,019,042/female
103,660,359)
25-54 years: 40.2% (male 249,017,538/female
235,042,251)
55-64 years: 6.8% (male 41,035,270/female 40,449,880)
65 years and over: 5.6% (male 31,892,823/female
35,225,003) (2012 est.)
3 Population below 15 years of age 32.4 % of total population
4 Birth rate 20.6 births/1,000 population (2012 est.)
5 Death rate 7.43 deaths/1,000 population (July 2012 est.)
6 Infant mortality rate total: 46.07 deaths/1,000 live births

male: 44.71 deaths/1,000 live births
female: 47.59 deaths/1,000 live births (2012 est.)
7 Neonatal mortality rate 37/1000 live birth (2009 est.)
8 Under five mortality rate 85/1000 live birth (2009 est.)
9 Postnatal mortality rate 23/1000 live birth (2009 est.)
10 Prevalence of LBW babies 26% of all live births (2009 est.)

UNIT – 2
The new born
 Characteristics of New Born and Physiological status of the new

born
- Assessment of the new born: head to toe assessment (physical
assessment), neurological assessment.
- Nursing care of the normal/healthy new born including home care.
- Breast feeding-concept of Baby friendly hospital initiative.
 Common health problems –medical and nursing management of:

- Hyperbilirubinaemia, haemolytic disorder neonatal hypoglycaemia,
sepsis, oral thrush, impetigo, erythema toxicum, hypothermia,
neonatal convulsions.
- Birth injuries; injuries of muscles and peripheral nerves, injuries of
bones, sort tissue injury and injury of nervous system.
 High Risk New born

- Definition : small for dates, Low birth weight
- Common health problems of pre-term, post term and low birth
weight infants and their nursing management.
- High risk to new born of HIV +ve mother, diabetic mother, its
medical and nursing care.

New born:
― Life period New natal period week
early neonatal period late neonatal period ‖
THE HEALTHY NEW BORN
 Born at term between 38 to 42 week

 Cry immediately after birth
 Established independent rhythmic respiration
 Quickly adopt with the extra
Uterine environment
 Having an ever age birth weight ( 2.5 to 4 kg)
 No congenital abnormalities presents
Healthy New Born New Born an ever

age birth weight Problem risk
Highly vulnerable New born extra Uterine
environment major physiological adjustment
Factors
 Labor process uterine contraction pressure birth canal
pressure stimulation
 environment stimuli light cold, gravity sound etc.
stimulation
 Breathing
 Fetal circulation, Neo-natal circulation lungs active
 Metabolic process liver activation GI track activation
baby meconium pass
New Born external

CHARACTERISTICS OFenvironment major changes
HEALTHY NEONATE:
Healthy new born characteristics

1. Physical characteristics
2. Physiological characteristics
Physical characteristics:
 Weight: Normal full term Neonate average weight 2.9 kg
 Length: New born Length 50 cm

 Head circumference: New born Head circumference 33-37cm
 Chest circumference: New born Chest circumference Head
circumference 3cm
 Proportion: baby Upper segment Lower segment ratio 1:8:1
 Position: New born baby flexed position

 Skin: New born baby skin soft elastic & pinks red
 Extremities aero cyanosis
 Vernix caseosa: Birth New born baby skin Protective
coverage vernix caseosa Oil, water & sebaceous grand
 Secret fatly substance Protective layer
 Milia: Birth New born face cyst Mongolians spots / birth marker
disappear
 Lanugo hair: Birth New born baby body specially back hair
 ear cartilages firm & fully covered breast nodules palpable
 Testiest palpable Pigmentations girl child labia minora,
labia majora cover deep creases
Physiological characteristics:
 Respiratory system :
 Healthy neonate cry spontaneous & satisfactory respiration

established
 New born respiration normally 30-40 breath/min crying (55-60
breath/min ) baby breathing quite shallow
 Circulatory system :
 Baby heat rate 120-140/min crying 160/min resting &

sleeping 80-100/min
 Blood pressure 60 to 80 mm of Hg systolic 25- 40 of Hg systolic
 Average blood pressure 60/40 mm of Hg
 Blood pressure manually measure
 Blood volume 80 ml/kg/bodyweight
 G.I. system :
 G.I. SYSTEM normal work baby 8-24 Me

conium pass Me conium sticky, greenies, black substance Bile,
mucus, Epithelium , intestinal, secretion, bile salt digestive juices
 Meconium stool pass
 New born gastro colic reflex feeding stool pass
 stool pass milk
regurgitation recap normal common
 hour baby breast feeding breast
feeding

 Genitor Urinary Treat :
 New born baby urine pass 6 -8 times 1 day urine pass

Male baby scrotum pigmentation testis palpable
 Female child labia minor ,labia major cover Maternal
Harmon with drawl vaginal discharge pseudo menstruation
disappear
 New born baby 24 hour urine pass
 Blood Value :
 New born 80 ml /kg/ body wt Blood value

 RBC- 6 – 8 million /cm m
 Hb % - 18 gm
 WBC- 1000 – 17000 / cm m
 Platelets- 35000 / cm m
 ESP elevated Clotting power Vit – K deficiency poor
New born fetal red blood cell breakdown
Billirubin Yellowish discoloration of skin
physiological jaundice
 Head & Skull :
Birth skull bone connective tissue divide

Suture
Skull fontanel
1. Anterior fontanel
2. Posterior fontanel
Delivery baby birth canal pass skull pressure scalp

soft tissue swelling caput succedaneum Disappear
 Nervous system:
Neurological mechanism immature fully developed
New born baby temperature regulation labile poor muscle control

un – co ordinate movement Endocrine glands properly organized

ASSESSMENT OF NEW BORN BABY
New born assessment hospital community vital responsibility new born

assessment initial immediate assessment
post natal period subsequent assessment
New born prenatal & intranatal history family genetic history head to toe
examination
Post natal period minimum 3 times assessment post natal
assessment assessment 2 week age
assessment 4 to 6 week age
New born assessment phase divide

 Initial assessment / immediate assessment (Apgar score)
 The transitional assessment during the period of reactivity
 Periodic assessment
Objective of New born assessment

 New born normal characteristics identify
 Abnormalities identify
 Deviation immediate action
 Future physiological changes base line change
 Data planning intervention
Precaution During New Born Assessment

 Examiner hands clean, dry warm

 expose
 Examination room temperature light
 Examination room bed flat comfort
 baby irritable cry examination breast feeding
 Examination room findings record
Assessment:
Initial assessment / immediate assessment:
 Birth activity assessment baby first cry
respiration, heart rate & skin color mainly check
 immediate assessment baby condition life saving support
determine
 assessment apgar score Dr. Virginia Apgar 1952
respiration, circulatory & neurological status apgar
scoring 5 sign observe 1 min 5 min check

APGAR SCORING :
 Skin color
 Heart rate
 Respiration
 Reflex response
 Muscle tone
Total Score = 10
 No depression: 7 – 10
 Mild depression: 4 – 6
 Severe depression: 0 – 3
SUBSEQUENT OR FOLLOW – UP ASSESSMENT ( head to toe exam )
Neonate condition assessment order baby resting

condition respiration abdominal part assessment , nose & Mouth part
assessment baby active cry
Physical Assessment
General Appearance:
infant extremities flex position stimulation

activity baby Discomfort irritability cry
full term baby generally active movement

Measurement:
 Head circumference - 35 cm average
 Chest circumference - 32 cm average
 Length - 50 cm average
 Body weight - 2.9 kg average
Vital Signs
 Body Temperature –
o Axiliary: 36.5c to 37.5 c
o Rectal: 37 c
 Heart rate normal 120 – 140 / min
o When cry: 160/min
o Sleep: 80 -100 /min
 Respiration
o Normal: 30 – 40 breath / min
o Cry: 30 – 60 breath / min
o Sleep: 40 breath / min
 Blood pressure
o 60 – 80 mm of hg (systolic )
o 25 – 40 mm of hg (diastolic )
o 60 / 40 mm of hg average
Posture: Full term baby flexion position extremities & neck flexed
clarcy flex
Activity: Normal neonate alert & active congenital deformities

neurological problems activity abnormalities
Feeding behavior: Sucking & swallowing reflex, vomiting , regurgitation , chocking

associated problem detect
Skin: Skin cyanosis, jaundice, edema erithema, toxicum, dryness, vermix Petechicle,
hemangiomas, milia, Mongolian spot birth mark present assess
Head : Head abnormalities caput succedaneum cephalohematoma mozuding

forceps, marks, encephalocele, widely, sepated and closed sutures Frontanelles
(enlarged,burging, sunken)
Face: Face symmetry, paralysis, shape, swelling abnormal movements observe
Eyes: Size position note discharge conductivities & congenital cataract

eye observe abnormal placement & abnormal distance between eyes
observe

Nose: Nose patency low nasal bridge , nasal discharge & nasal flaring examine
Ears: Ears size, shape, position cartilage examine
Mouth: Mouth cleft lip , cleft palate , mouth size , oral opening, tongue size Natal teeth,
tongue ties, sucking, callosities infection observe
Neck: Abnormal masses, facture of clavicle, stiffness, rigidity examine
Chest: Abnormal size shape observe breast engagement

respiration rate rhythm examine heart sound auscultation method
and rate rhythm sound examine
Abdomen: Abdomen shape distention observe inguinal hernia

swelling masses observe Ambelical card infection, discharge redness
examine Abdomen auscaltation bowel sound
Genitilia female: Libia majora , libia minara clitoris cover examine

vaginal discharge abnormalities examine
Genitilia male: Full term baby testes scrotal sake scrotam pigment &
wrinkled penis hypospadias , epispadias , phymosis examine
Back: Back abnormal curvature, spin bifida,memingocel ,meningomyocele examine
Extremities: Fracture , paralysis, range of motion position examine

missing digit, extra digit, fused digit examine
hand & foot position structure examine
Orifices counting & their patency: baby birth orifice examine

patency eg. Mouth, eye, ear, nose, anus, urethra, esophagus etc.
NEUROLOGICAL ASSESSMENT
Neurological assessment posture, observation, reflexes, muscle, tone, head control

& movement assessment Newborn baby Neurological immature
tempreture regulation disturbances uncoordinated movement
uncontrolled muscle tone muscle tone , head control & reflexes examination
A. Muscle tone: Posture / attitude of baby

Passive tone
Active tone

B. Joint Mobility: Full term baby – relaxed

Pre term baby – relatively stiff
C. Vision: Neonate light blinking reflex
D. Hearing: Hearing sense develop baby loved music
E. Smell: Birth properly developed
F. Taste: Birth properly developed
G. Touch: touching stimuli response
Neonate reflexes
1. Protective Reflexes : blinking, coughing, sneezing, gagging
2. Primitive Reflexes : Rooting, sucking, mare, tonic neck, stepping & Parmer grasp
Age of
Reflexes Stimulation Response disappearance
Rooting Touching or stroking the Head turns towards the 3-4 months when
cheek near the corner of the stimulation, mainly to find awake and 7-8
mouth food months when
asleep
Sucking Touching the lips with the Sucking movements to take Begins to
nipple of the breast in food diminish at 6
months
Swallowing Accompanies the sucking Food, reaching the Does not

reflex posterior of the mouth is disappear
swallowed

Gagging When the food is taken into Immediate return of Does not
the mouth that can be undigested food disappear
successfully swallowed
Coughing Foreign substance entering Clearing of upper air Does not
& sneezing the upper & lower airway passages by sneezing & disappear
lower air passage by
coughing
Blinking Exposure of eye to bright Protection of eye by rapid Does not
light eyelid closure disappear
Doll‘s eye Turn the neonates head Normally eye do not move When flexion
slowly to right or left side develops
Palmer Object placed in neonate‘s Grasping of object by Disappears in 6

grasp palm closing finger around it weeks to 3
months
Stepping or Hold neonate in a vertical Rapid alternating flexion Disappears

dancing position with feet touching a and extension of the legs as within 3 – 4
flat surface in stepping weeks
Morro Startling the neonate with a Generalize muscular Strong upto 2

(startle) loud nose or apparent loss of activity. Symmetric months
support due to change in abduction & extension of disappear by 3-4
equilibrium. The neonate arms and legs with fanning months
held in supine position of fingers. The baby may
supporting upper back & cry
head with one hand and
lower back with other. the
neonate‘s head is suddenly
allow to drop down backward
for an inch
DAILY OBSERVATION OF NEONATE
Daily Observation of Neonate:

Hospital stay neonate daily observe Daily examination mother
feeding behavior, vomiting, stool & urine, sleep pattern information collect
neonate hypothermia, respiration distress, jaundice infection
conjunctivitis. Umbilical sepsis, oral thrush skin infection observe
Neonate danger signs monitor danger sign present
early evaluation intervention
Danger sign
 Poor feeding , sucking swelling reflex
 High or very low body temperature

 Poor activity & poor response

 Excessive crying & irritability
 Rapid respiration (>60/min )
 Blue discolorations of lips & tongue
 Very slow or absence of respiration
 Jaundice within 24 hours
 No urine within 48 hours & home meconium within 24 hours
 Convulsion or abnormal movement
 Bleeding from any site
 Umbilical discharge
 Infection
 Diarrhea , vomiting , abdominal distension
Examination on Discharge
Discharge baby examine record Mother breast
feeding, essential care & daily care advice follow up
Immunization advice
NURSING CARE OF HEALTHY NEONATES
Nursing personnel supervision neonate care

80% normal healthy neonate minimal care Healthy neonate
temperature maintain
breast feeding established infection
Normal Healthy Neonate Care

1. Immediate basic care of neonate
2. Daily / general routine care of neonate
1. Immediate basic care of neonate :
It includes,
A. Maintenance of Normal baby temperature (warmth ) :
o Neonate heat regulation mechanism mature heat loss
o Delivery room temperature (warmth )

o Birth neonate dry clean
o Baby unnecessary exposure
o Baby radiant warmer
o Baby care clean warm
o Baby mother temperature loss
B. Established of open airway

o Airway passage amniotic fluid & mucus neonate position
nasal suction
o Airway Clear tactile stimulation
o 95 to 98 % neonate resuscitation majority baby cry
respiration established
C. Initiation of breathing & maintenance of circulation

o Baby cry airway clear baby normal respiration
check
o birth ashy assess
o Birth apgurscorin assess heart rate, respiration, color,
muscles, tone, reflexes check
o Baby birth assess baby umbilical cord out
baby dry warm cloth wrapped normal characteristics cognital
abnormalities illness assess baby mother breast feeding
o Neonate birth 1mg vitamin- k IM

o Record : birth date, time, sex, examination finding, presence of any problem,
highly sick & high risk neonate special setting special care
2. Generate care of healthy neonate

Baby generate care major goal health improve physiological status
stable Birth baby continuously care care
mother family member new
born complication Close observation essential
routine care important Daily routine care
Warmth:
o Baby dry warmth cloth wrap mother skin to skin contact
o Hypothermia prevent bathing avoid room temperature warm

o
o Baby transfer warm maintain
o Baby undressing avoid oil massage baby temperature
o maintain helpful
Breast Feeding & Nutrition

o Baby as soon as possible mother breast
o Baby starting 2 to 3 hour interval breast feeding
o breast feeding pattern regular 2 to 3 hour interval
self demand breast feeding
o Mother exclusive breast feeding procedure explain
Skin care / Baby bath:

o Neonate skin soft neonate cephalous –co dual direction clean
o face, scalp body & extremities clean dry warm cloth
fold neck, axils, groin, joint etc. clean & dry
Care of umbilical cord

o Abdomen umbilical cord 5 cm (2 inch ) clamp out

o Cord out examine umbilical stamp artery

vein
o Cord periodically inflammation redness, bleeding & infection
examine
o Cord clean & dry 8 TO 10 days remove
Care of eye:
o Eye birth clean
o sterile cotton swab & water clean
separate swab clean
o Kajal application strictly avoid
o eye discharge , infection, redness, eye disorder examine
early management
Clothing of baby:
o Baby cloth loose, soft, easily, removable cotton
o Cloth clean & dry wet napkin diapers frequently change
o Large button clothes synthetic, plastic, nylon tight cloth avoid
o Winter woolen or flannel clothes
Bounding with mother & care givers:

o Baby continuously mother bed
o Baby well ventilated room comfortable clean & warm bed
o Neonate care person proper hand washing hugging maintain
infected person neonate contact
Observation:
o Neonate daily 2 time observe temperature, pulse, respiration, feeding,
behaviors & stool, urine , sleeping pattern mainly assess
o mouth, eye, cord & skin infection check
o Baby always supine position sudden infant death sydrome prevent
Weight recording:
o Birth weight check neonate daily weight check
o mouth baby 30gm/day weight gain 2nd month 20gm/day
3rd month weight gain
o 4 TO 5 month baby weight weight
o Proper breast feeding , proper bondage of infant & mother & proper daily care baby
weight gain helpful
Immunization:
o Baby national immunization schedule immunized

o parents recommended national immunization schedule explain
o parents complete immunization encourage advice
Follow up four advices:

o Baby follow up
o advice
o Proper growth & development, early detection management of health problems and
prevention of illness follow up
o Mother and care giver immunization breast feeding , hygienic measures, rooming
in clothing advice
o diarrhea , ARI child health problem prevention and home care
advice
Harmful traditional practices for the care of neonate:
Culture customs mother child health related harmful

traditional practice health harmful Common traditional
practice
o Home delivery dirty place dirty things blade cord out

o Harmful resuscitation practice umbilical cord unclean substance apply
o Colostrums discard
o Late breast feeding start feeding interval baby
o Female newborn child emotionally & nutritionally neglect
o New born
o Unhygienic herbal product baby
o Bathing baby herbal drops instillation
o Baby 6 month mother milk orally
 artificial feeding
 cow milk
 nutritional powders
 water of sugar
 feeding bottles
o birth baby
o Baby mother
harmful traditional practice neonate major health

& nutritional problems

CONCEPT OF HOME CARE OF NEONATE
80 % normal healthy neonate minimum care basic health

professionals supervision Mother birth basic care sepsis
maintenance promotion of breast feeding
Neonate mother close contact emotional bonding

breast feeding established infection prevent neonate
body temperature maintain
New born baby health mother health status , education, health

awareness skill Neonate health status maintain
family member roll & support
Family mother emotional support proper breast feeding,

hygienic care, nutrition of mother, minimum disturbance to neonate, promotion of growth
&development & love & affection
BREAST FEEDING & NEONATE NUTRITION
Nutritional Requirement :
Proper growth & development baby nutritional need

Neonate diet protein, carbohydrates, fat, water, vitamins minerals
calories provide
calories 110-120/kg/day
protein 1.9 gm / 100 k cal
fat 30% to 55 % of total calories
carbohydrates 35% to 55 % of total calories
water 140-160 ml /kg/day
calcium 388 mg
phosphate 132 mg
Iron 16 mg
zinc 0.5 mg / 100 k cal
Copper 90 mg / 100 k cal
Florid 0.1 mg
Vitamin A 375 mg
Vitamin B 0.5 mg
Vitamin C 4 mg
Vitamin K 5 mg / day
Vitamin E 30 mg / day
Thiamine 0.4 mg / 100 k cal

Riboflavin 0.3 mg / 100 k cal

Folic acid 65 mg
Vitamin B - 12 0.4 mg
Pantothenic acid 1.7 mg
Biotine 5 mg
Daily requirement of water & Calories:
Age Range Water requirement Calories requirement

(ml / kg ) ( ca / kg )
First 3 days 80 – 100 120
3 to 10 days 125-150 120
15 days 3 month 140-160 120
3 to 12 month 150 105-115
1 to 3 year 125 100
4 to 6 year 100 90
7 to 9 year 75 80
10 to 12 year 50 70
13 to 15 year 50 60
16 to 19 year 50 50
Adult 50 40
Recommended dietary allowance of vitamins :
New born child breast feeding nutrition child nutrition

need nutrient
Child nutritional need proper growth & development
nutrition baby body building proper energy tissue
Function, body function, health maintenance & development improvement
Nurse mother & family mamber nutritional advice benefits
care givers nutrition importance baby health & body
function & growth development improve
BREAST FEEDING :
Child breast feeding best natural feeding breast milk best milk infant
basic food mother breast milk first immunization mother breast
milk Breast feeding nutritional need emotional & psychological need
According to UNISEF breast feeding 1 million infant

inadequate
improper breast feeding practice breast feeding practice
WHO & UNISEF
Breast feeding baby basic need approaches & programme

breast feeding week (1-7 august ) celebration baby

friendly hospital initiative concept exclusive breast
feeding family support baby health
Breast feeding child nutritional need safest, cheapest best

protective way Breast feeding infant protective food baby totalNutritional
Requirement Breast feeding weaning diet
Breast feeding
ADVANTAGES OF BREAST FEEDING:
1. Advantages to Infant :
o Breast feeding nutrients growth &
development breast milk lactose, protein ,fat,
iron, vitamin, minerals, water and enzymes
o Breast milk water soluble vitamin & cow milk vitamin A,B & C
o Breast milk sterile, free from bacteria protective property

o Breast milk preparations need
o Breast milk baby temperature warm hypothermia prevent
o nutrients absorption helpful
o Preterm delivery preterm baby specific nutrition provide
o Easily digestible
o Breast milk protective value baby GT track infection ARI, malaria,
allergy , asthma ,tetany, convulsions disorder
o Exclusive breast feeding nutrition, hypertension, diabetes mellitus, colitis,
inflammatory diseases dental disorder chance
o breast feeding baby mother emotional bondage baby intelligence
improve securities feeling
o breast feeding growth & development proper
2. Advantages to Mother :
o breast feeding PPLT
o uterine involution proper
o mother metabolic efficiency improve
o satisfaction and fulfillment filling
o mother breast & ovarian cancer chance
o exclusive breast feeding 6 month pregnancy prevent
o Lactation amenorrhea iron store
o Mother less time fresh pure readymade clean temperature
milk provide baby health
3. Advantages to Family & Community:

o Breast feeding economical time money & energy

o Exclusive breast feeding baby illness

hospitalization
o community , hospitals , family after all country economical & beneficiary
INITIATION OF BREAST FEEDING :
Newborn child breast feeding

delivery cesarean section 4 hour breast feeding .
Breast feeding baby warmth securities, feeding colostrums first
Immunity Mother breast feeding technical demonstrate rooming
advice mother baby separation prevent
Exclusive breast feeding breast feeding

complimentary food Mother Exclusive breast
feeding Water, glucose, animal milk, gripe water , vitamins &
mineral drops, medication & syrup Mother diet intake
daily extra SSO fluids
INDICATORS OF ADEQUACY OF BREAST FEEDING :
Adequate breast feeding indicators

 Breast feeding swallowing sound
 Mother breast let down sensation
 Feed breast full
 baby urine pass
 3 to 8 time baby soft stool pass
 18 to 30 gm / day average weight gain
 Baby cry
 Baby skin healthy muscle tone
DIFFERENT COMPOSITION OF BREAST MILK :
Baby breast milk composition postnatal period

stages breast milk
1. Colostrum : Delivery secret milk colostrums

Yellowish thick antibodies, proteins & fat-soluble
vitamins (A,D,E,K ) baby immunity provide baby
2. Transitional milk : Colostrums delivery 2 week milk Transitional

milk fat and sugar protein immunoglobulin
3. Mature milk : delivery 2 week ( 10 – 12 days) mature milk secret

Transitional milk Mature milk secret Baby growth

& development
4. Preterm milk : Mother preterm baby deliver milk
protein, sodium, iron, immunoglobulin & calories milk preterm milk
preterm baby
5. Fore milk : Regular breast feeding milk fore milk milk
watery baby thrust proteins , sugar vitamins &
mineral
6. Hind milk : Regular breast feeding fore milk feeding end
milk Hind milk fat & energy Infant optional growth
fore milk & Hind milk milk
TECHNIQUE OF BREAST FEEDING:
Majority mother baby successfully feed mother

help breast feeding Technique Primi mother breast Feeding
problem in previous pregnancy retracted nipple mother
Nurse mother proper breast feeding Technique follow

 Mother breast feeding physically & mentally relaxed & comfortable
 Mother breast feeding hand wash

 Baby clean dry & comfortable
 Baby Mother position correct baby head support
mother sitting or side lying position
 Latching : Proper position baby chin breast touch chick

nipple touch rooting reflex baby mouth quickly
nipple move Sucking reflex breast stimulation
breast milk proper secret Mother swallowing sound nipple
pain favorable signs proper breast feeding latching indication

 Breast feeding 1–2 hour interval baby self demand

baby satisfy feeding
 breast empty breast breast feeding
Opposite breast
 Baby breast attachment latching proper baby mouth air
entry prevent
 Breast feeding usually baby dry right side placed comfortable
position satisfied feeding usually baby
 Baby 6 month continues exclusive breast feeding 6 month breast
feeding 6 month complementary food start 2
month complementary food breast feeding continues
 Breast feeding hygienic masseurs maintain
CONTRA INDICATION OF BREAST FEEDING :
Breast feeding true contraindications galactosemia & phenylketonuria

Maternal condition REAL
R - Radiotherapy
E - Ergot therapy
A - Anti metabolites therapy
L - Lithium therapy
Most of maternal illness breast feeding interruption condition
expressed breast milk
PROBLEM OF BREAST FEEDING :
Breast feeding problems intervention

 The Baby who does not suckle:
- Mother drugs
- Baby artificial food water
- baby Alert , ready hungry Breast feeding
- Nipple baby mouth properly placed
- Breast feeding baby Nose free
- expressed milk feed milk expressed
 The Baby who refused on breast :

- Baby Breast feeding clean, dry ,comfortable position
good attachment
- Lactation maintain breast milk express
- Baby demand feeding
 Inverted Nipple :
- Baby birth treatment start
- Nipple manually stretch
- practice
- Nipple draw out pump

- syringe
 Sore Nipple :
- Baby position correct latching proper
- Breast wash
- Baby sucking
- Feeding breast hind milk apply
- Breast aired heal
 Breast Engorgement :
- Breast Engorgement prevent frequent feeding correct
attachment
- Local warm application mother pain
analgesics
- Latching proper breast milk gently express
 Breast Abscess :
- Mother treatment analysis antibiotics
- Abscess incision & drainage
- Breast feeding continued
 Working Mother :
- Working mother breast milk clean container express mother
absence baby need
- Expressed breast milk cup
- Hand breast milk express easy pump use
ESTABLISHMENT OF LACTATION / PHYSIOLOGY OF LACTATION :
Breast feeding motivation & preparation antenatal period

Successful lactation establish mother willingness & confidence delivery
mother child bonding breastfeeding promote healthy baby
mother mother active support proper
technique use
Lactation mainly malnutrition Malnourished mother milk
fat, minerals & vitamin additional food fluids
advice
Milk production hormones & reflexes interaction Prolectine
Anterior pituitary grand secret hormone breast glandular tissue milk
produce stimulate baby suck nipple nerve ending impulses
anterior pituitary prolectine secret stimulate baby suck
prolectine secret process milk production baby
Demand milk production
Sucking reflex impulses vogues nerve hypothalamus

anterior pituitary prolectine raise
baby nipple sucks sensory impulses posterior pituitary

oxytocin raise oxytocin milk grand Mayo epithelial
cell contract milk lactiferal sinus is & lacteal duck nipple
ejection reflex letdown reflex reflex mother emotion
happiness, love & affection for baby milk secretion
fear, excitement, anger, apprehender, pain & discomfort able Milk flow
effective baby attachment feeding breast empty milk
production
Lactation nutrition breast milk quality quantity

improve Malnourished mother lactation nutritional supplement
Malnourished mother poor quantity milk product fat micronutrients
Oestrogen, bromocryptyne thyazyme pirocloxine etc. lactation suppress

Chlorpromazine and methachloropromide, 10 mg, 3 times / day, 7 – 10 day milk
production
Successful breast feeding anxiety free sucking by baby mother self

confidence

PRINCIPLE OF BREAST FEEDING :
1. breast feeding
2. birth cholostrome feeding
3. feeding breast feeding breast empty
breast feeding
4. feeding alternative breast feeding start
5. breast feeding
6. feeding
7. bre
ast feeding
8. breast feeding continue
9. breast feeding continue
Complimentary food 2 year breast feeding
10. breast feeding treatment
COMPLIMENTARY FEEDING OR WEANING:
breast feeding 6 month infant optimum growth & development

sufficient 6 month baby energy requirement energy reached
nutritional supplements introduce
―Six month infant gradually & progressive breast feeding family routine
diet transfer process weaning ‖
6 month breast feeding gradually family diet
weaning food breast feeding continuous
weaning food baby nutritional need
QUALITY OF COMPLIMENTARY FOOD :
- liquid gradually semi solid solid diet start

- Clean, fresh & hygienic infection

- easily available
- Easily available acceptable & easily digestible
- Energy density bulk viscosity
- baby nutritients
- Cultural practices traditional beliefs & local availability
- nourishing, well balanced infant suitable
PRINCIPLE OF INTRODUCTION COMPLIMENTARY FOOD / WEANING

FOOD :
- weaning food Introduce principle

- food good quality home made
- small amount gradually quantity
- New food baby tongue test at a time
food add
- Additional food
- food hungry force
- Weaning process child problem assess indigestion, abdominal,
pain, diarrhea, skin rash & psychological upset problem
- Problem carefully manage
- Weaning 6 month start breast feeding 2 years continue
- Delayed Weaning baby malnutrition growth failure
COMPLIMENTARY FOOD AT DIFFERENT AGE :
 6 – 7 month
- Weaning process starting water & fruit juices
- 1 – 2 week suiji, vegetable soup, mashed banana, mashed & boil potato
food 2-3 3-6
- 3– 4 week amount ( half cup )
- Food over diluted breast feeding continue
 7– 9 month
- rice & dal soft mixture , khichdi , pulses, mashed & boil
potato, roti socked in dal or milk, mashed fruit banana, mango, papaya,
stewed apple
- 8- month egg yolk
- 8 - month food breast feeding continue
 9 - 12 month
- healthy food fish, meat , chicken add
food soft well
cooked Complimentary food breast feeding continue

 12– 18 month
- home made food baby mother
half food
- baby 4-5 need
- breast feeding continue
Weaning period child development crucial period child health & optimum
growth & development weaning process role
ARTIFICIAL FEEDING
Baby breast milk feeding substitutes process artificial feeding

E.g. Fresh Cow milk, Fresh buffalo milk, Cried Whole milk
INDICATIONS:
 Death or absence of mother

 Prolonged maternal illness
 Complete failure of breast milk production
PRINCIPLES OF ARTIFICIAL FEEDING :
 Artificial feeding decision breast feed effect fail human milk

availability
 Artificial feeding main aim baby nutritional need
 Artificial feeding clean bowl & spoon hospitalized or sick child nasogastric
tube
 Bottle feed avoid mother Bottle feed disadvantages
 Preparation & feeding procedure strict cleanliness
 Artificial feeding always water calories nutrient value calculate prepare
 Feeding correct technique use food warm cold or hot

 Feeding time baby depend generally 15-20 min
 Infant older baby feeding
 Cow milk is best artificial food
 Illness baby energy requirement small quantity food
calories food
FEEDING PROBLEMS
Little feed, frequent feed, large amount of feed, wrong technique of feeding, bottle
feeding, in experiment mother etc. feeding problem
Baby common feeding problem

Regurgitation:
Stomach swallowed air baby feed backward flowing

Regurgitation feeding baby right side place burping
Regurgitation baby cry breast feeding
Vomiting:
Over feeding excessive swallowing of air prolong burping pathological condition

gastroenteritis, congenital pyloric stenosis, intestinal obstruction vomiting
Baby cause defect carefully observe easily treatment
Sucking & swallowing Difficulties :
Sometimes neonate sucking & swallowing problem

problem congenital abnormality mother
nipple abnormality breast engorgement problem condition
carefully assessment easily treatment
Dehydration fever:
First 3 -4 days neonate fever drowsiness, lethargy & feed refusal common
problem feeding refusal baby dehydration early treatment
neonate excessive crying, under feeding, over feeding problem
problem simple intervention prevent & manage
BALANCED DIET FOR CHILDREN

EXPRESSION OF BREAST MILK
mother baby baby suck breast milk

pump
1. Hand method
2. Mechanical method
PRINCIPLE OF EXPRESSION OF BREAST MILK:

- Hand milking breast pump hygienic
- Mother hand washing
- Nipple & areola clean
- container milk container
- Breast full milk express
- milk nipple contact
TECHNIQUE OF MANUAL EXPRESSION:

- position privacy
- mother nipple
- breast pressure
- nipple side areola pressure
milk express
-
CONCEPT OF BABY FRIENDLY HOSPITAL INITIATIVE (BFHI)
BF WHO/ UNISEF policy marker meeting July 30 to 1 august 1990 innocent

Florence Italy BF promotion , protection support, declaration
innocent declaration declaration 1992 breast
friendly hospital, initiative
Exclusive BF promotion & encourage breast friendly hospital, initiative

programme WHO / UNISEF & co-sponcer USAID & SAID
Developing country baby death bottle feeding

programme baby exclusive breast feeding
Baby BF knowledge attitude & practice improve
Health care worker information scientific facts skill provide
training
BF promote & protect 1992 The Infant Milk Substitute -

feeding bottle & infant food act.

infant food manufacture representative low cost free

infant milk substitute, feeding bottle, free sampling, hospital promotion health worker
Baby friendly hospital policy WHO, UNISEF

ten step of successful BF practice code
STEPS:
- BF written policy
- Policy scheme health care staff trained
- BF benefit & management pregnant woman
- BF mother help
- BF
- Medical contraindications breast milk food liquid
- 24 child & mother rooming in practice
- breast food
- BF artificial food
- Hospital , clinic mother discharge BF support group
Baby friendly hospital initiative movement hospital
BF promotion
COMMON HEALTH PROBLEMS:

HYPERBILIRUBINEMIA
Jaundice hyperbilirubinemia visible manifestation skin serum bilirubin

level yellowish discoloration Neonatal jaundice icrterus neonatarum and
neonatal hyperbilirubinemia
Almost 60% term & 80% prectum neonate life first week bilirubine
level 3 mg/dl about 6% term babies bilirubine level 15 mg
/dl
neonate bilirubine level 5 mg /dl face skin nasolabial

folds & tip of nose yellowish discoloration condition Jaundice
TYPES OF NEONATE JAUNDICE:

1. Physiological Jaundice
2. Pathological Jaundice
1. Physiological Jaundice :
Physiological Jaundice factor term preterm
unconjugated bilirubine concentration

Physiological Jaundice mechanism

- Pocthemic condition RBC hepatic cell bilirubine load
- Fetal RBC life span destruction circulization bilirubine
- Defective bilirubine conjugation

- Lever Defective bilirubine uptake
- congenital infection Defective bilirubine excuate
Characteristic of Physiological Jaundice:

- 24 hour appear mostly 30 to 72 hour appear
- Term baby preterm baby maximum intenlity
- Bilirubine level 5 mg /dl to 15 mg /dl 15 mg /dl

- Term baby 7 to 10 preterm baby14 disappear
- subside treatment
- Premotality, asphyxia, hypothermia, & infection
2. Pathological Jaundice :
About 5 % neonate pathological jaundice develop pathological
jaundice cause investigation
CAUSES:
 Hemolytic disease RBC excessive distraction
Ex, ABO incompatibility
G6 EPD deficiency
Neonatal septicemia
 Defective conjugation of bilirubine
Failure to execrate the conjugated bilirubine
Eg. Umbilical sepsis, congenital obstruction of bile duct etc.
 Miscellaneous :
- Viral hepatitis , toxoplasmosis, malania
- Intra uterine infection, hypothyroidism
- Thalassemia, maternal diabetes, anoxia, hemorrhage
TYPE OF PATHOLOGICAL JAUNDICE :

1. Prolonged unconjugated hyper bilirubinemia
2. Prolonged conjugated hyper bilirubinemia
Characteristic of Pathological Jaundice :

- Pathological jaundice 24 hour appear Term baby one
week preterm baby 2 week persist
- bilirubine level 5 mg /dl increase
- total bilirubine level 15 mg /dl
- Direct bilirubine level 2 mg /dl
- palm & soles yellow

- Stool dry or white color excessive urination
KERNICTEUS:
pathological condition un conjugated bilirubine brain
toxicity seizure basal ganglia neurons necrosis
hippocampalceutex cerebellum neurons necrosis renal Tabular
Cell, intestinal mucosa pancreatic cells necrosis bleeding & hematuria
DIAGNOSIS OF NEONATAL JAUNDICE:

 History collection
 Physical Examination
- Eyes
- Skin
- Scalp
 Lab investigation
- Serum bilirubine
- HB %
- Serum albumin
- RBC micro logy %
- Coomb‘ s test
- LFT & RFT
- Stool & urine Examination
TREATMENT:
Treatment depend on cause of Jaundice:

 Phototherapy:
- Neonate blue spectrum light
- Phototherapy baby naked
incubator blue florescent light expose
- baby position change

eye & genital area neonate
- 12 hourly bilirubine level check

bilirubine level 10 mg /dl
Phototherapy discontinued
- Phototherapy baby position vital sign &
complication continues observe
 Exchange Blood Transfusion (EBT) :

Saver hyperbilirubinemia kanicteus prevent EBT effective
Ralibe method
 DRUG METHOD (Phenylbarbitone)
 Use of febroptic blank
 Treatment of under lying condition
 Hyperbilirubinemia treatment
NURSING MANAGEMENT:
- Frequently observation body changes detect
- Monitor vital sign
- Neonate skin color observe
- Neonate urine color observe
- Behavioral changes convulsion of sluggishness
- Body temperature maintain
- Fluid intake maintain input output record
- Personal hygiene daily , routine care
- Baby condition intervention
- Breast feeding continue
- Phototherapy baby observation eye & genital area cover .
HYPOTHERMIA
Hypothermia neonatal morbidity & mortality increase Neonate thermal

protection important essential neonatal care consider
DEFINITION:
―Neonate body temperature 36.5`C (97.7`F) Condition

Hypothermia ‖
Baby normal body temperature 36.5`C to 37.5`C Neonate thermal

regulatory state alteration Hypothermia develop new born
baby effective heat production non severing thermo genesis Baby heat
gain & heat loss mechanism evaporation , conduction convection radiation
heat loss

STAGES:
 Cold stress / mild Hypothermia
36`C to 36.4`C (96.8`F to 97.6`F )
 Modrate Hypothermia
32`C to 35.9`C (89.6`F to 96.6`F )
 Sever Hypothermia
Below 32`C (89.6`F )
FACTOR RESPONSIBLE FOR NEONATAL HYPOTHERMIA/ CAUSES:

- Baby mother separate
- Delivery room & baby care area cold
- Baby transport
- High risk neonate ( BW baby birth asphyxia, congenital, malformation

- Baby wet evaporation, conduction, convection
heat loss
- Neonate characteristics large body surface area, large head heat
regulation centre immature, less subcutaneous fat etc
SIGN & SYMPTOMS:
 Early Signs:
- Skin temperature 36.5 C
- Abdomen touch
- Sucking weak
- Lethargic
- Weak cry
- Peripheral vaso constriction blue

 Late Sign:
- Continuously temperature
- Slow sucking & swallowing reflex.
- Irregular respiration
- Slow heart beats.
- Lethargy & poor response
- Central cyanosis , sometimes
- Weight loss
- Tissue hardness
- Body & face pale
PREVENTION OF NEONATE HYPOTHERMIA:
 At The Time of Birth in Delivery Room

- Delivery Room
- Care giver hand warmth
- Receiving tray & clothes warmth
- warm towel dry head
dry warm & soft cover head
cover
- baby body temperature maintain radiate warmer, room hitter
- zero vault bulb
- skin to skin contact
- Baby cold object contact cold object
- Baby birth bath
- M & G produce baby expose
- Baby room temperature note .
 During Transportation:
- Transport baby hypothermia prevent
- baby body temperature & vital sign normal transport
- Baby Transport kangaroo mother care
- Baby warm & soft cover
- thermal box warm cloth transport
- Baby close & comfortable vehicle transport open vehicle avoid
 At Hospital:
- Baby pre warm cot
- Baby properly cover
- Baby temperature 30 – 32 C
- Humidity 50% maintain
- Hospital stay dip bath avoid
- baby body temperature
- Warmer, heater, heated water, filled mattress
- Convection, conduction & radiation heat loss

 At Home:
-
- KMC KMC
- proper breast feeding rooming in
- Winter baby 3 -4 head foot socks
- Baby bath bath Baby clean & dry
- warm & soft cover
- thermal state check
- Daily essential care oil massage
- Cold stress condition special intervention
NEONATAL HYPOGLYCEMIA
Hypoglycemia common metabolic disorder neonate death

proper breast feeding & effective neonatal care
DEFINITION:
―New born baby blood glucose level 40 mg /dl condition neonatal
Hypoglycemia asymptomatic symptomatic ‖
CAUSES & RISK FACTORS:

- Low birth weight
- Baby of diabetic mother
- Secondary complication in asphyxia, hypothermia, infection, polycythermia &
neurological disturbance
- IUGR
- Incompatibility
- Metabolic dysfunction & adrenal insufficiency
SIGN & SYMPTOMS:

- Refusal feed
- Sweating
- Limpness
- Jitteriness
- Tremors
- Twitching
- Pallar
- Hypothermia
- Lethargy of irritability
- Restlessness
- Convulsions & coma
- Apnea with cyanosis is common in preterm baby
MANAGEMENT:
 New born baby birth breast feeding mother close contact

 Mother & baby close observation hypoxia & hypothermia prevent
 In symptomatic infant :
- Culvusions present 25% dextrose 2 ml / kg IV
- Culvusions present 10% dextrose 2 ml / kg IV
- At the rate of 6 – 8 mg/ kg/ minute
 All ½ hourly blood glucose level check
 blood glucose level normal IV dextrose reduce oral breast feeding
gradually increase
 emergency condition symptomatic treatment
eg. Glucagon, Epinephrine, Diazoxine etc.
PROGNOSIS:
- Prognosis poor
- Sever hyperglycemia case baby mental retandation cerebral paisy &
convulsions complication
- Asymptomatic hyperglycemia initial breast feeding Or treat
NEONATE CONVULSIONS
Neonate convulsion common life threatening emergency cerebral

biochemical abnormality elder child neonate infant common
CAUSES:
 Developmental neurological problems
- Nerve injuries
- Structural cerebral abnormality
- Hydrocephalus
 Perinatal complications
- HLC
- Birth cyphyxia
- Birth injuries
- Intracranial hemorrhage
 Perinatal infection
- Meningitis
- Septicemia
- Intra uterine infection (storch )
 Metabolic Problems
- Hyperglycemia
- Hypo calcemia
- Hypo magnesemia
- Hypo or hyper natremia
- Sevel hyper bilirubinemia with convulsions

 Drugs
- Narcotic addicted mother‘s child
- Theophylline
- Phenothiazine
- Local anesthesia in to fetal scalp
TYPES:
 Subtle :
- Repeated blinking
- Fluttering of eye
- Jerking of eye
- Oral baccul movement
- Apnea & brady Candia
 Tonic Seizures :
- Abnormal eye movement & deviation of eye
- Irregular respiration
- Abnormal extension & flexion of limb
 Focal colonic & myo colonic
- Seizures new born & infant
DIAGNOSIS:
- History
- Clinical manifestation
- CT Scan
- USG
- Radiography
- CSF examination
- EEG
- Blood investigation
MANAGEMENT:
Treatment
- Special care with oxygen
- IV line
- Thermal Protection
- Prevention of Aspiration
- Prevention of Injuiry
- Respiration support
- Anti convulsion therapy
E.g. Phenobarbiton,
Phenytoin
Sodium valparate
- Detection of cause & its management
NURSING CARE
- Normal respiration established
- IV line & Dr. Prescription treatment
- Vital sign check

- Continues observation
- CPR prepare
- Personal hygiene maintain hypothermia prevent
- Complication treat
BIRTH ASPHYXIA
―Birth new born baby normal respiration establishment Birth

Asphyxia ‖
Baby progressive hypoxia, hypercapnia, hypoperfasion & metabolic disorder

multiple system dysfunction Birth gasping, inadequate,
breathing, no breathing , for one minute apgon score of Birth Asphyxia
consider early management
Perinatal Asphyxia: Fetus or neonate oxygen delivery decreased

inadequate tissue perfusion (hypoxia) low apgar score & metabolic acidosis
CAUSES:
 Ante partum factors :

- Placement insufficiency
- Pre eclampsia
- Hypertension
- Anemia
- Pre maturing of mother
- Maternal systemic
- Diseases
- Maternal drug abuse
 Intra partum factors :

- Fetal distress
- Preterm labor
- Premature raptor of membrane
- Prolonged labor
- Birth trauma
- Difficult delivery
- Instrumental or Operative delivery
 Post natal factors :

- Pulmonary , cardiovascular & neurological abnormalities of neonate
- Aspiration
- Arculatory collapse
- Preterm & low birth weight
- Congenital abnormalities
MANAGEMENT:
- Most of baby specialized care
- Baby birth 1 minute 5 minute apgar scaring
- 5 minute baby respiration stable specialized care
- Neonate CPR
o Proper Position
o Bag mask ventilation
o Oxygen
o Tactile stimulation
o Chest Compression
- Neonate reflexes & respiration continuously assess continuous
respiration support
- Baby expose hypothermia prevent
PREVENTIVE MEASURES:
- Antenatal care Risk factor detect
- Fetal hypoxias & Fetal distress management
- Delivery carefully anesthetic drugs carefully
- Complicated & preterm delivery carefully handle
- Birth asphyxia prevention immediate care
- Birth baby proper cry mucus suction Tactile stimulation
- Birth 1 & 5 minute Apgar scaring
- Neonate respiration distress immediately treatment
- Nursing personal antenatal, intra natal & care after birth baby life
save long term problem
HEMOLYTIC DISORDER
Newborn 48-72 hour vitamin-k deficiency hemorrhage problem develop

2 -5 days umbilical cord, nose & GI track
bleeding breast milk vitamin-k poor source breast feed
babies hemolytic disorder
mother and fetus blood group incompatibility Rh,

ABO minor group incompatibility sever hemolysis baby sever
anemia, hepato-splenomegaly generalized anasarca baby
pathological jaundice develop birth asphyxia, hypothermia, hypoglycemia,
acidosis coagulopathy
DIC- Disseminated intravascular coagulation

Thrombocytopenia, tissue hypoxia, anemia, hypovolamia, and
acidosis DIC bleeding tendency oozing

ORAL THRUSH
oral thrush Candida albinus fungus mouth mucous membrane

white patches bleeding
MANIFESTATION
- milky on buccal mucosa, lip, tongue and gums.
- patches easily remove gauze bleeding
- swallowing difficulties
- diarrhea
- lung infection
CAUSES
- Infected birth canal infection
- Infected feeding bottles
- Contaminated feeding articles contaminated breast nipple and mother‘s hands
- Prolonged antibiotic therapy
MANAGEMENT
- oral application of 0.5 % gention violate after each feed
- nystatin and ketoconazole or cotrimazole lotion 4 times per day for 5 to 7 days.
PREVENTION
- prevention and treatment of maternal infection.
- general cleanliness and hygienic measures.
- Cleaning of breast nipples and utensils.
NEONATAL SEPSIS
―Severe infection blood body sepsis

‖
In newborn it is called sepsis neonatorum or neonatal septicemia.‖
CAUSATIVE ORGANISMS:
Prenatal During Delivery After birth
- Rubella - Group is streptococcus - Respiratory

- Cytomegalovirus - E – coli - syncytial virus
- Viricella zoster - herpes simplex - Candida heremophins
- Usteria - influenzac – B
- Monocytogenes - Entervirus

EFFECT OF SEPSIS :
Preterm baby, low immunity baby, low birth weight baby unhealthy baby
sepsis life treating condition
New born child immune system immature micro organisms fight
infection body quickly pneumonia, meningitis
serious problem
PREDISPOSING FACTORS:
- Intrauterine infection
- Premature rapture of membrane
- Me conium stained liquor
- Repeated virginal examination
- Maternal infection
- Lack of aseptic practices
- Birth asphyxia
- Low birth weight or preterm baby
- Invasive procedure
- Needle pricks
- Lack of breast feeding
- Lack of care & rooming In
CLINICAL MANIFESTATION:
- Apnea
- Bradycardia
- Temperature instability
- Weak suck & weak cry
- Jaundice
- Severe cases are come out with Respiratory distress, Pneumonia, Meningitis,
Septicemia & other infection
INVESTIGATION:
- Blood culture
- Culture of umbelicres
- CSF studies
- Chest X- Ray
- Blood sugar
- S. bilirubin
- Blood count & ESR
MANAGEMENT:
- Antibiotic Therapy: Amoxicillin, cloxacillin, ceffriaxone , ceftazidime, ciprofloxacin,
cefotaxime etc.
- Neonate body temperature massure
- IV fluids administer input / output recording
- Respiratory distress apnea O2 therapy
- Sever respiratory problem bag mask ventilation CPR
- VIT – K intramuscularly to prevent bleeding disorders
- Supportive masseuse physical stimulation , nasogastric, aspiration, dose &
constant monitoring of infant & expect nursing care

PREVENTION OF NEONATAL INFECTIONS:

- Neonatal infection prevent health hazards treatment
- Neonatal infection prevent follow

- Institutional delivery strict aseptic management
- Five clean practices in Home Delivery :
Clean surface
Clean hand
Clean cord tie
Clean blade
Clean cord stamp
- Babies handle hand washing
- Baby unit enter sterile gown separate shoes
- Delivery room , neonatal care unit post natal area cleanliness
- baby separate disposable
- Infected person baby baby handling minimum
- Baby cot, incubators, warmer, phototherapy, machine, weighing, machine clean
aseptic technique use
- Invasive procedure aseptic technique use
- Baby & mother general cleanliness mother hygienic massures
education
- Infected babies separate accommodation
- Unnecessary IV fluids, needle pricks & sharing or needle & syringes avoid
- Post natal ward visitors entry restrict
- Antenatal & post natal period maternal infection prevent & treat
- baby infection sign immediately isolate
- Immunization schedule follow
KEY: STORCH
S – Syphilis
T – Toxoplasmosis
O - Other ( gonococcal , tuberculosis, vericell, hepatitis, HIV)
R – Rubella
C – Cytomegalovirus
H - Herpes simplex
MINOR PROBLEMS OF NEONATE
REGURGITATION:
- Regurgitation baby breast feeding milk air swallow
feed backward flowing
- Feeding baby milk & air mouth Regurgitation
- Regurgitation proper feeding technique, burping baby upright
position

CONSTIPATION:
- Artificial feeding baby inadequate breast feeding Constipation
- congenital abnormalities of GI track, hirschprung‘s disease, cretinism
baby
- Constipation relive treatment breast feeding improve
-
DIARRHEA:
- Breast feeding baby 3 – 6 times golden yellow color sticky, semi solid stool
pass diarrhea consider
- Neonate diarrhea main reason unhygienic feeding practice, over feeding,
bottle feeding, serious under feeding septicemia, necrotizing, enter
colitis, hirschsprung‘s disease & phototherapy diarrhea
- Acute diarrhea condition IV fluid diarrhea disease
condition associated treat
- Breast feeding continue
EXCESSIVE CRYING:
- Neonate crying baby help comfort mother
- Crying common cause hunger, discomfort, abdominal colic, unpleasant, sensation,
full of bladder & bowel pain, hot or cold feeding, insect bite, wet nappies, loneliness
lack of mothering
- Cerebral irritability, meningitis, abdominal colic, trauma. Otitis media, & other
painful inflammatory condition, narcotic withdraw syndrome, thyrotoxicosis
condition Excessive Crying
- Excessive Crying condition detailed investigation specific treatment
DEHYDRATION FEVER:
- Summer month neonate infant inadequate breast feeding
fever (38.5 – 39.5 )
- Condition baby proper breast feeding room temperature
- infection assess
HICCUPS :
- Neonate breast feeding Hiccups stomach distention
diaphragm pressure
- Normal
NAPKIN RASH :
- Artificial feeding babies ammonia dermatitis
- prolonged wet nappies cleanliness diarrhea,
fungal, infection, & plastic napkins
- perianal skin red, indurate excoriated

- condition prevent baby cotton soft napkins wet

napkins immediately change perianal area dry
- Treatment application of coconut oil + antifungal cream & powder
MASTITIS NEONATORUM:
- Birth 3rd or 4th day maternal hormone sudden withdrawal
neonate breast bilateral engorgement & swelling sex
babies
- 2 – 3 week spontaneously recover
VAGINAL BLEEDING & MUCOID SECRETIONS (PSEUDO – MENSTRUATION):

- 1/4 female babies 3 to 5 Vaginal bleeding
- 2 to 4 harmless maternal harmless sudden withdrawal
- genital organs septic cleaning
NEONATE CONJUNCTIVITIS:
- Child birth 3 week conjunctiva inflammation 2 – 3 days
common
- Neonate eyes sticky, red without discharge
- Care giver infected hand, infected vaginal canal & lack of essential
care
- Treatment : Specific antibiotic therapy (eye drop)
UMBILICAL SEPSIS (OMPHALITIS):

- Contaminated cord cutting instrument, infected hands of care giver, infected clothing,
umbilical catheterization & unhygienic environment of delivery room
Umbilical staphylococcus E coli organism infection
inflammation omphalitis
S/S:
- Swollen & moist umbilical tissues
- Redness with foul smell
- Fever
- Jaundice
- Delayed falling of cord
Treatment:
- Dressing of umbilical cord with antibiotic powder or lotion
- Systemic antibiotic in complicated cases.

MINOR DEVELOPMENTAL PECULIARITIES
Irregular blue patches baby buttocks sacral area sometimes

back extremities Patches 6 month 1 year age disappear
MILIA:
- Skin sebaceous glands sebum retention baby forehead, nose,
labial folds cheek yellow spots or cysts appear
- spots or cysts 1 – 2 week disappear
ERYTHEMA TOXICUM / URTICARIA NEONATORUM:

- Full term neonates erythmatous rash
face trunk & extremities spread
- Exact cause unknown toilet articles clothing & allergy
EPSTEIN PEARLS:
- Epithelial inclusion baby mouth hard palate midlines whitish spots
- No treatment requires.
SUCKING CALLOSITIES:
- Baby upper lip center button like cornfied plaque
- intra uterine life sucking attempts indicates
- spontaneously disappear
PREDECIDUOUS TEETH (NATAL TEETH)

- Baby mouth teeth present lower incisors position
breast feeding problem
- problem create extract
BIRTH INJURIES:
―Delivery process trauma birth Injury ‖
injuries Adequate
antenatal check up labor skilled management prevent Birth injury
common site head 96% baby cephalic presentation deliver
injury nerve, bone, muscle, superficial tissue etc. Injuries
preventable measure
INJURIES OF HEAD:
It includes:
A. Caput succedaneum
B. Cephalohematoma
C. Intracranial injury
D. Fracture of skull
E. Scalp injury
A. CAPUT SUCCEDANEUM:
- Labor process baby head soft tissue birth canal pressure

swelling swelling develop pressure
venous & lymphatic supply
- area edematous & congested swelling
- 36 hour disappear special treatment
- Reassurance anxiety

B. CEPHALOHEMATOMA:
- Skull periosteum skull bone blood collection
Cephalohematoma
- labor process fetal skull pelvis friction small blood
vessels rupture
- Cephalohematoma forcep or complicated delivery common swelling
unilateral bilateral suture
- Cephalohematoma gradually
size weeks disappear
- condition active treatment infected complicated
treatment
- INJ VIT - K
- Systemic anti-biotic
- Monitor haematocrit
- Mother condition & prognosis
C. INTRA CRANIAL INJURY:

- Perinatal hypoxia & Intra Cranial Injury delivery condition
- Difficult labor, forceps delivery, vacuumed delivery, abnormal presentation

Intra Cranial Injury & hemorrhages
- babies asphyxia CPR respiration establish
i. Traumatic Intra Cranial Hemorrhage:

Fracture of skull bone extra Dural Hemorrhage sub Dural
Hemorrhage skull bone Fracture
ii. Anoxic Intracranial Hemorrhage:
Intra ventricular Hemorrhage, sub arachnoid Hemorrhage intra cerebral
Hemorrhage
SIGN & SYMPTOMS:

Convulsion High pitch cry
Apnic attack in candidate movement
Hypotonia Flaccid Limb
Bulging fontanels Paresis
Vomiting Upgar score below 3
MANAGEMENT & NURSING CARE:

- Symptomatic & supportive management with intensive care unit
- O2 Therapy
- Clear airway
- Ventilator support
- Fluid therapy
- CSF testing
- Systemic antibiotic
- Vit - k
- continuous monitoring of symptoms
- VIT – K
- Vital sign monitoring
- Gentle Handling
- Calm environment
- General Nursing Care
D. FRACTURE OF SKULL:
- Difficult forceps delivery neonate frontal bone parietal bone
fracture common liner skull fracture on depressed fracture
- Cephalohematoma & Intra Cranial Injury & hemorrhages associated
- Depressed fracture neurological problem associated surgical
treatment
- Liner or tissue fracture management
E. SCALP INJURIES:
- Forceps delivery, LSCS, USCS & during episiotomy scalp injuries
- Scalp injury antiseptic lotion dressing hemorrhage infection assess
INJURIES TO NERVES:
A. Facial Palsy
B. Brachial palsy
1. Erb‘s palsy
2. Klumpke‘s palsy
A. Facial Palsy:
- Facial palsy unilateral bilateral bell‘s palsy labor process
TH
facial nerve ( 7 ) direct pressure baby
routing reflex absent eye close cry
side angle
- week recover Complete resolution month
- eye care
B. Brachial Palsy:
- Brachial nerve route, trunk brachial plexus damage
labor process back hyper extension
1. ERB’S PALSY:
-
Cervical 5 & 6 ( C5 & C6 ) nerve injury ERB‘S PALSY
-
- Paralysis baby
- elbow extended
- Moro‘s reflex & biceps jerk absent
- Diaphoretic paralysis respiration distress

2. Klumpke’s palsy :
- C7 & C8 nerve T1 nerve damage
- Wrist drops
- Grass response absent
- Elbow arm flexed
- Flexed Finger
MANAGEMENT OF NERVE INJURY:

- Arm splinting
- Baby hand cotton ball
- Physiotherapy
- Gental massage & passive exercise
- Surgical management in some cases
INJURY TO THE BONE:

- Skull bone humerus, femur, clavicle bone fracture common
- Complicated labor joint dislocation
- spinal cord bone fracture
INJURY TO THE MUSCLES:

- Difficult breech delivery neonates sterno mastoid muscles injury
commonly
- muscles injury muscle fibrous & blood vessels rupture
hematoma formation 7 -10
- disappear
- head turning neck
unaffected side flexing

PREVENTION OF BIRTH INJURIES:

Comprehensive antenatal & intranatal care birth injuries
 Antenatal period
- High risk cases identify
- High risk cases management
- Skilled antenatal examination
- Guidance to mother
 Post natal period

- Spontaneous vaginal delivery head & neck carefully deliver
- Scalp injury prevent episiotomy & forceps use carefully
- Cerebral anoxia prevent continuous fetal monitoring
- Preterm delivery special attention
- Forceps delivery Precautions
- Vaginal breech delivery skilled personal gently & carefully
- Prolonged labor carefully manage
- Preventive measure birth injury permanent disabilities
future handicapped citizen
DIFFERENCE BETWEEN A CAPUT SUCCEDANEUM AND CEPHALHEMATOMA
INDICATORS CAPUT SUCCEDANEUM CEPHALHEMATOMA
Location Presenting part of the head Periosteum of skull bone and bone
Extent of Involvement Both hemispheres; CROSSES the Individual bone; DOES NOT CROSS the
suture lines suture lines
Period of Absorption 3 to 4 days Few weeks to months
Treatment None Support
HIGH RISK NEONATES:
High risk neonate identify care nursing personnel

Careful assessment appropriate management High risk
consider babies special care special supervision
- Birth weight less than 2000 gm

- Gestational age less than 36 weeks

- Sever birth asphyxia

- Gross congenital deformities
- Rh - incompatibility
- Maternal diabetes mellitus
- Systemic problems
- Unwed, Unwell Or Unwilling mother
Baby special care management referral indication
1. Birth weight 1800 gm gestation age 34 week

2. Excessive crying & reduce activity
3. Major Or marked changes in skin
4. Color pale yellow or blue
5. Cold baby or febrile baby
6. Delayed passage of meconium (more than 24 hours) urine (more than 48 hours)
7. Abnormal respiration (more than 60 breath / min), chest retraction
8. Continuous vomiting or watery diarrhea
9. Infections conductivities, oral thrush, umbilical sepsis, pyoderma, abscess
10. Abdominal distension
11. Bleeding or injuries
12. Abnormal movement or convulsions
13. Bulging or depressed fontanel
14. Sudden weight loss
15. Congenital anomalies
16. Circulatory problems
Community health worker & nurses problems aware basic

essential care
LOW BIRTH WEIGHT BABIES (LBW)
Neonate birth weight 2500 gm (< 2.5kg) LBW consider

(WHO)
- Small for dates (SFD) preterm baby

- India 30 to 40 % neonate LBW
- Babies malnutrition, infection & neurological problems
hypertension, DM coronary artery disease
LBW babies weight 3 categories divide

 Low Birth Weight Baby (LBW) - Birth weight < 2500gm
 Very Low Birth Weight Baby (VLBW) - Birth weight < 1500gm
 Extremely Low Birth Weight Baby (ELBW) - Birth weight < 1000gm

Low Birth Weight Baby classified

1. Preterm Baby
2. Small for dates baby
1. PRETERM BABY :
Baby birth 3 > week complete weight gestational age

10 to 90 percentile baby preterm baby consider
India approximately 10 to 12% neonate 3 > completed week

Preterm neonate anatomical & functional immaturity high NMR
physiological handicap condition
CAUSES OF PRETERM
 Spontaneous Causes
- APH & cervical incompetence
- Maternal infection or systemic diseases
- Threatened abortion acute emotional
- Stress, sexual activity & trauma
- Low maternal weight & poor socio economic condition
- Maternal malnutrition & anemia
- Smoking & Drug addiction
- Very young ( < 20 year ) & unmarried Mother
- Frequent child birth
- Past History of Preterm deliver
 Induced Causes :
- Maternal DM & Heart diseases
- Placental abnormalities
- Eclampsia, pre-eclampsia & HTN
- Fetal hypoxia & Fetal distress
- Severe Rh antenatal care & improper diagnosis
Characteristics of Preterm Infants

Physical:
- Preterm baby size small head large
- Poor reflexes, poor cry, inactive extremities
- Large head skull bone soft sutures separated large fontanels‘
- Eyes remains closed soft ear

- Shiny & thin skin, little vernix present
- Plenty of lanugo hair & less sub cuteneous fat
- Nipple areola flate nodules absent or 5 mm
- Round abdomen c prominent veins
- Genitalia
Male - undescended testis
Poorly pigmented scrotam

Female - labia majora proper

Develop
Exposed libia minora
Hypertrophied clitoris
Physiological Problems
- Alteration in respiratory function
- Immature central nervous system
- Disturbed circulatory function
- Impaired thermoregulation
- Impaired GI & hepatic function
- Metabolic Disturbance
- Impaired renal function
Management of Preterm Babies:

1. Delivery of preterm baby :
- Preterm baby delivery expert neonatologist
- Neonate problems & physiological disturbance management expert nursing
care
2. Care Of Birth :
- Hypothermia prevent
- CPR
- Proper cord damping
- VIT – K 0.5 mg
- Baby clean cover NICU transfer
3. Care Of NICU :
- Aseptic technique
- Daily weighting Breast feeding promote
- Care full handling inventive procedures avoid
- Temperature maintain vital sign maintain
- Breathing maintain
- Daily care
- Periodical Assessment
2. SMALL FOR DATES (SFD) BABIES:

Baby weight gestational age 10 percentile baby
Small for dates consider Small for gestational age ( SGA ) light far
dates or intrauterine growth retardation (IUGR )
Common problems:
- Fetal hypoxia
- Me conium aspiration syndrome
- Congenital malformation
- Hypoglycemia & hypocalcaemia
- Hyper bilirubinemia

- Pulmonary hemorrhage, polycythemia

- Poor growth potential
- Increased risk for infection
- Risk for diabetic mellitus , hypertension & coronary artery diseases
- Respiratory distress
Management:
- Resuscitation provide
- Early breast feeding start
- Ventilator support
- Hemorrhage check management
- Temperature maintain
- Infection prevent
- Daily rutine care
DIFFERENCE BETWEEN SYMMETRICAL IUGR & ASYMMETRICAL IUGR
Symmetrical IUGR Asymmetrical IUGR
Symmetrical IUGR Asymmetrical IUGR
1. less common 20.25% 1. most common 50 %
2. Causes 2. Causes
- Early untrue uterino - Chronic high blood
infections such pressure
as cytomegalovirus - Severe malnutrition
rubella or toxoplasmosis - genetic matations
- Chromosomal chaise danlos
abnormalities syndrome
- Anaemia
- Maternal substance
abuse
3. Global growth Retardation 3. Length weight

growth
4. body proportion head 4. Body proportion

growth normal blood growth
5. Complications 5. Complications
- Chances or permanent neurological Sequela - hypoxia
- hypoglycemia

DIFFERENCE BETWEEN PRETERM AND FULL TERM BABY
Characteristics Full term baby preterm baby
Birth between 37 to 41 week < 37 week
Weight 2.5kg to 3.5kg < 2.5kg
Height 50cm < 47 cm
Head 34-35cm < 34cm

circumference
Chest 30-33cm < 30cm

circumference
Skin Pink, glossy Red, thin, gelatinous.
Hair Dark abundant Thin, lanugo
Subcutaneous fat Adequate Inadequate
Breast nodule Areola > 10mm Small, areola > 10mm
Genitalia Testis palpable, scrotal skin dark and Testis palpable, scrotal skin dark and
pigmented pigmented
Ear Pinna well developed not well developed, with poor recoil
Anterior fontanel Wide open, closed by 18-24 month Wide open, closed by 18-24 month
Posterior fontanel Closed by 6-8 week Late Closer
Abdomen Flat and soft Cab be distended
Sole creases Present Deep sole creases
activity Active, keep limb flexed, Moro’s, sucking and Less Active, keep limb flexed, Moro’s, sucking
swallowing reflex normal and swallowing reflex poor

KANGAROO MOTHER CARE (KMC)
LBW & Preterm baby care family babies

babies qualitative management cost day by day
KMC Low Birth Weight baby care low cost method
DEFINITION:
―KMC Low Birth Weight baby special care baby
mother skin to skin contact effective thermal control , breast feeding , bonding
baby health promote ‖
KMC hospital
COMPONENTS OF KMC:
1. Skin to Skin Contact :
baby mother direct skin to skin contact thermal
control promote baby mother bonding baby health
promote
2. Exclusive Breast Feeding :
skin to skin contact lactation & feeding
successfully breast feeding weight gain
PRE - REQUISITES OF KMC:

1. Support to Mother:
- Mother KMC provide family members support
- Mother hospital health personnel counseling & supervision
family members support co- operation
2. Post discharge follow up :

- Hospital discharge KMC continue safe & successful
KMC regular follow up arrange infant problems & health
status evaluate & manage
BENEFITS OF KMC:
1. KMC thermal control & proper metabolism helpful baby & mother
continuous, prolonged & direct skin to skin contact neonate effective thermal
control hypothermia risk
2. KMC breast feeding rate & duration
3. KMC infant 5 - senses satisfied
- baby & mother direct skin to skin contact warmth fill (touch )
- mother voice heart beat (voice)
- feeding breast milk suck (test)
- Mother odor ( affection )
- Mother eye contact ( vision )
4. KMC baby breathing regular apnea

5. KMC nosocromial infection prevent severe illness pneumonia incidence
6. KMC baby weight gain hospitalization duration

7. KMC mother infant bondage incubator care baby low stress
8. KMC small babies transportation best way baby mother family

members skin to skin contact care
9. Mother KMC confidence self, esteem, sense of fullness deep
satisfied Father relaxed comfortable & stress free bondage feel
10. KMC incubator companion staff
REQUIREMENT OF KMC IMPLEMENTATION:
- Nurse doctor staff KMC training baby care involve

train
- Educational material information booklets, posters ,video , films etc
material local language
- Reclining chair or beds adjustable back rest or pillow or ordinary chair provide
- KMC extra staff KMC implement care giver
appreciate
ELIGIBILITY CRITERIA FOR KMC:

 For Baby
- Stable LBW baby KMC eligible particular LBW infant weight
2000gm care use full
- Stable baby KMC start
- Baby haemodynamically stable KMC start
- Sick LBW infant KMC start baby
proper facility ICU transfer

- Baby weight 1200 gm babies serious prematurity

baby KMC
- IV fluid therapy, tube feeding, or O2 therapy baby stable
KMC
 For Mother:
- Age , education , culture & religion KMC provide
- Mother serious illness adequate diet & supplements
- Mother baby KMC willing

- Mother good hygine maintain daily bath, cloth change, hand
washing & other cleanliness.
- Mother KMC family member community support
PREPARATION FOR KMC:

 Counseling :
- mother family members KMC benefits
- patience gently mother KMC procedure
- Question answer family mother anxiety
- Mother mothers KMC experience interact
- Family member KMC mother support advice
 Mother clothing :
- Mother local culture front open light dress mother
etc.
 Baby clothing :
- Baby front open , sleeveless, shirt, cap, socks, nappy, hand glows
KMC PROCEDURE:
 Kangaroo positioning :
- Baby mother breast upright position
- Baby head side turn slightly extend airway open
mother baby eye contact
- Baby hip flexed frog like position abdoated
arms flexed (mother chest )
- Baby abdomen mother epigestric level
- Position apnea occurrence reduce help mother breathing
& heart beat baby stimulate baby sling binder or especially prepared
KMC bag support
 Monitoring During KMC :
- KMC initial stage baby airway, breathing, color & temperature monitor
warmth assess hands & feet examine
- Regular breathing airway clean normal skin color & temperature
- Baby neck position flexed or extended

 Feeding :
- Mother KMC baby BF help baby
breast milk production stimulate kangaroo position BF
easy
- Baby condition paladai, spoon or tube feeding
 Psychological Support to Mother :
- Mother KMC continue motivation
- Mother anxiety question encourage
 Privacy :
- Mother privacy body part unnecessary exposure
mother nervous & demotivate
 Time of initiation Of KMC :
- KMC gradually start (from conventional care to kmc )
- KMC NCU stable start
- Short KMC start medical treatment IV fluid O2 therapy
recovery
- Baby gavage feeding KMC
 Duration of KMC :
- KMC duration 1 hour baby frequent handling avoid
( because which may be stressful to the baby )
- KMC length 24 hour per day Baby diapar change
mother
- KMC postnatal ward home continue
- KMC provide
duration encourage
- mother present father, grandmother, aunty KMC provide
 Can the Mother Continue KMC During Sleep Rest :

- Mother baby sleep realined or semirecombent position mother
back ground 15 – 30
- Adjustable back comfortable chair mother provide
- Adjustable bed or several pillow or ordinary bed position maintain
baby apnea risk
- Supportive garment sleep & rest position mother KMC provide
help
- Mother rest relieve family members or father KMC provide
DISCONTINUATION OF KMC:
- Baby weight 2500gm post – conception age 40 weeks KMC
continue
- baby discomfort wriggling start limbspulls out cry
KMC discontinue
- Mother & baby comfortable KMC continue
- Mother occasionally KMC baby during cold night.

POST TERM BABY:
Normal pregnancy 37 to 41 week baby pregnancy 42 week

(294 days ) post term baby 7% babies post term
EFFECTS OF POST MATURITY:

- Completed & high risk labor
- Risk for me conium aspiration
- Hypoglycemia
- Amniotic fluid Placenta function diminished baby
nutrition
- Risk for pneumonia pneamothorax & fatal cloth
CHARACTERISTICS OF POST TERM BABY:

- Baby skin pale, cracked, dry, wrinkle vernix caseosa
- Dehydration & Lanugo absent
- Thigh buttocks fat wrinkles
- Amniotic fluid baby skin nail umbilical cord meconium staining
- Me conium aspiration hypoglycemia / hypocalcaemia placental

insufficiency asphyxia
- New born baby 2 to 3 week old infant
- Infant nail hair
- Complication pulmonary , hemorrhage , pneumonia, pneumothorax
DIAGNOSIS:
- Assessment of physical appearance, gestational age, complication & problems
- Test – ultrasound , non stress testing, estimation of amniotic fluid volume
MANAGEMENT:
- Gestational age & baby condition check care full labor cesarean
delivery
- Delivery special immediate care
- Respiration distress check
- Adequate calories & fluids provide
- Adequate oxygen provide
- Input & output monitor
- Thermoregulation stable
- Complication treatment
- Parents support baby care education

INFANT OF HIV POSITIVE MOTHER OR HIGH RISK OF NB OF HIV

POSITIVE MOTHER
HIV mother vertical transmission 90% HIV infection

vertical transmission vertical transmission range rate
13.40 Transmission
- in Utero - 30 to 35 %
- During Delivery - 60 to 65 %
- Breast Feeding - 10 to 15 %
DIAGNOSIS :
NB HIV infection diagnosis
HIV infected mother NB transplacently IgG antibody transmit
15 -30 % neonate infected antibody neonate 18
asymptomatic
NB HIV Asis test duration of ,
24
- P antigen
- ELISA TEST
- IgA & IgM
- PCR – To de tect viral nucleus acid in the peripheral blood
PREVENTION & TREATMENT:

- HIV positive mother CD4 cell count 200/ml
vertical transmission Zidovudine profilasa‘s
gestation 14 week delivery
- HIV positive mother infant 6 week age
Zidovudine
- BF infection & nutritional problem
breast milk infeated BF
parents
- infant good nutrition & symptomatic supportive care
- Symptomatic HIV infected infant OPV & BCG vaccine DPT,
MMR & inactivated polio vaccine
- Asymptomatic HIV infected infant BCG vaccine
- Parents emotional support
- Parents guidance & couneding
- Health care provider universal precaution transmission
extra co- ordinary Ioolation procedure
- Disease nature
- healthy life style & infection parents

INFANTS OF DIABETIC MOTHERS
Maternal diabetic infant problems babies heavy,

plump, full freed, pletharic & vermix caseosa cover maternal diabetic
fetal hypoglycemia large –for-dates (LFD) baby
COMPLICATIONS:
- Pregnancy last trimester fetal death

- Preterm delivery
- Macrosomia birth trauma chances
- Hypoglycemia
- Hypocalcemia
- Neonatal respiratory distress Birth asphyxia Hyper bilirubinemia
- Polycythemia
- High risk of congenital anomalies
- Cardiomyopathy & persistent pulmonary hypertension
- Lazy left colon syndrome
- Hyper trichosis & hairy pinna
- Diabetic mother babies later life diabetes incidence 9%
MANAGEMENT:
 Diabetic mother baby preterm baby intensive care
 Possible oral feeding stent
 IV glucose
 Proper respiration maintain asphyxia & respiratory distress syndrome
prevent
 Physical problems & anomalies assess
 management
 Hypothermia infection prevent
 immediate & essential new born care

- Care full monitoring of blood glucose level
- Checking for hypoglycemia administer O2 if needed
- Care for problems & birth injuries
- Monitor intake & output
- Support the mother & family
COMMON NURSING MANAGEMENT OF PRETERM, POS TERM,

LOW BIRTH WEIGHT BABY & HIGH RISK NEONATES.
Preterm labor high risk delivery carefully manage new born baby
systematically assess problems early detection & management Delivery

experienced & expert staff attend skill full nursing care provide
complication & fetal death
CARE OF BABY AT BIRTH :

- Birth resuscitation ready airway clean
resuscitation
- Birth baby clean cover
- APGAR check cord dump out
- VIT – K 0.5 mg administer
- Baby stable NICU transfer
MAINTENANCE OF RESPIRATION:
- Baby neck extended airway clean position
- Gentle section secretion remove O2 administer SaO2 90 to 95 %
PaO2 60 to 80 mm of Hg maintain
- Baby respiration Rate, Rhythm , sign of distress chest retraction, nasal
flaring, apnea, cyanosis , oxygen , saturation monitor
- Maintain body temperature :
- Baby warmth cloth receive
- NICU baby prewarmed incubator receive
- Baby skin temperature 36.5 C to 37.5 C maintain
- Baby stable kangaroo mother
- Baby frock cap socks mittens expose
- Heat loss continuous temperature monitoring
CARE IN NICU:
- NICU warmed silent clean
- Inventive procedure avoid
- Procedure hand washing infection prevent
aseptic technique
- NICU baby special essential care skilled nursing personnel
MAINTENANCE OF NUTRITION & HYDRATION:

- Baby first week 60-80 Kcal / kg / day week
120 – 150 Kcal / kg / day
- Adequate feeding baby nutritional requirement
- Feeding regular
- Feeding baby gavages or nasogastric tube feeding
- 1200gm weight baby IV dextrose start
- Baby stable breast feeding continues
PREVENTION OF INFECTION:
- High risk neonates & premature baby immunity poor infection
chances
- Infection hand washing separate baby article restriction of visitors,

care giver aseptic technique
- Infected person baby contact
- Infected babies separate
- NICU & baby care unit or room clean & warm
CONTINUOUS MONITRING
- Respiration rate, depth & regularity - Oxygen saturation
- Chest retraction - Systemic problems
- Cry (feeble, high- pitched, high) - Bleeding & edema
- Heart rate - Activity
- Temperature - Feeding behavior
- Reflexes - Stool - urine passage
PREVENTION, EARLY DETECTION & MANAGEMENT

- Birth baby physical examination problems early detection
- Problem identity immediately manage
- Mother baby care contact allow
- Baby continuous monitoring systemic problems identify
FAMILY SUPPORT & FOLLOW UP

- Baby condition family member explain
- Family baby care treatment education
- Need for warmth , breast feeding, general cleanliness, hygiene, follow up plan
immunization family members explain
HOME CARE :
- Oral feeding continue
- Child regular follow up
- Baby abnormal sign closely monitoring
- Prescription medication continue
GRADES OF NEONATAL CARE
Baby care level weight gestation age maturing health problems
LEVEL - 1 CARE
- 80-90% neonates minimum care Mother family
members
- 2000gm babies level-1 care ( G.A. > 37 weeks )
- Care home, sub centre, PHC
- Care care at birth , provision of warmth , prevention of infection
essential care

LEVEL - II CARE:
- 10-15% neonates level – II care
- 1500 – 2000 gm birth weight / 32 to 36 week of gestational age babies level – II
care
- Care district hospital & nursing home, nursing staff pediatrician
- Resuscitation maintenance of temperature IV infusion, Gavage feeding , photo

therapy & blood transfution
- Hospital yearly 1000-1500 delivery care arability
LEVEL - III CARE:

- 3 TO 5 % neonates care
- Care NICU skilled nurse & neonatologist special observation
- 1500gm birth weight 32 week gestation age babies

care
- Level – III care apex institutes & special hospital baby equipments,
central oxygen , suction facilities, incubators, ventilators, monitors, infusion pumps
highly equipped operation theaters
- High risk baby c respiratory problems, sever systemic problems , very low birth
weight baby , congenital problems & sever infected child care
TRANSPORTATION OF SICK CHILD
Baby hospital & neonatal care unit condition care Baby

stable discharge stable refer baby
transport care health maintain aspect
PRINCIPAL OF TRANSPORTING NEONATES:

- Transportation baby continuous assessment
- Transportation hyperthermia correct baby condition stable
- Care history referral on need treatment sheet record
- Doctor Nurse or health care provider transportation
- IV infusion air passage & baby condition observe
- Baby temperature maintain aspect warm chain
temperature check
- Mother transportation breast feeding
- Fastest , smoothest & short root
- Mother & family members follow up & home care advice

UNIT – 3
The healthy child
GROWTH & DEVELOPMENT:

 Definition
 Principles
 Factor affecting growth & development
 Techniques of assessment of GROWTH & DEVELOPMENT
 Importance of learning about GROWTH & DEVELOPMENT
THE INFANT:
 GROWTH & DEVELOPMENT DURING INFANCY
 Health promotion during infancy
 Nutrition counseling & weaning
 Immunization
 Safety & securities including prevention of accidents
 Plays & Toys
THE TODDLER:
 GROWTH & DEVELOPMENT of Toddler
 Health promotion during Toddler
 Nutrition counseling
 Immunization
 Toilet Training
 Safety & prevention of accidents
 Guidance to parents on toddler care
 Plays & Toys

THE PRESCHOOLER:
 GROWTH & DEVELOPMENT during pre school years
 Health promotion during pre school years
 Nutrition Guidance
 Safety & securities
 Day care centers / nursery school

 Plays
 Role of parents in sex education of child
THE SCHOOL AGER:

 Physical psychological & moral development during school age
years.
 Health promotion during school years
 Nutrition Guidance
 Sleep & Rest
 Physical exercise & activity
 Dental Health
 Sex Education
 Play
 Role of Parents in reproductive child health
THE ADOLESCENT:
 Physical changes psychological & reproductive changes reaction of
adolescents of probity.
 Health Promotion during adolescence
 Nutritional Guidance
 Personnel Care
 Reproductive child health / sex education
 Role of Parents in Health Promotion during adolescence

GROWTH & DEVELOPMENT
Growth & development process conception , life

time Growth & development interrelated growth & development
pattern child health promotion & care growth & development
DEFINITION OF GROWTH:
―Growth physical maturation process baby
organ size cell multiplication, intracellular, substance
Growth ‖
Growth body quantities inches / cm / pound / kg etc .
DEFINITION OF DEVELOPMENT:
―Development functional & physiological maturation process
skill, functional capacity nervous system maturation & machination
psychological emotional & social changes maturation
Quantitative aspect measure difficult ‖
DEFINITION OF MATURATION:
Maturation genetic inheritance
maturation ‖
IMPORTANCE OF GROWTH AND DEVELOPMENT FOR NURSES:

• Knowing what to expect of a particular child at any given age.
• Gaining better understanding of the reasons behind illnesses.
• Helping in formulating the plan of care.
• Helping in parents‘ education in order to achieve
Optimal growth & development at each stage.
GROWTH PATTERNS:
The child‘s pattern of growth is in a head-to-toe

Direction, or cephalocaudal, and in an inward to
Outward pattern called proximodistal.

PRINCIPLES & GROWTH & DEVELOPMENT:

Growth & development normal growth &
development growth & development regulate
Principles & Characteristic
 Continuous & Orderly process in old child: Growth & development
Process 1st stage
2nd stage
 Growth & development processed by stage : Stage
GROWTH & DEVELOPMENT predictable stage
 Co – Ordination between GROWTH & DEVELOPMENT : Physical & mental

ability GROWTH & DEVELOPMENT sexual
maturation , paternal , interest, behavior Relationship
 Cepalocadual & proximodistal: Cepalocawdual low process head
tail Proximodistal center / midline periphari direction
 Rate of growth & development: Growth & development rate inter – related
Infancy & puberty preschool & school age
 Individual Differences: growth & development pattern
pattern rate develop
inter dependent factor heredity & environment
 Initial mass activity & movement:
STAGE OF GROWTH & DEVELOPMENT:
Intrauterine life prenatal & extra uterine life or post natal period growth
& development stage
Prenatal period:
Stage Time period

Ovum 0 to 14 days after conception
Embryo 14 days to 8 week
Fetus 8 week to birth
Post natal period:
Stage Time period

Neonate / new born from birth to 4 week of life ( 0- 28 days )
Infancy first year of life (1 month – 1 year )
Toddler one to 3 years of life
Preschool child 3 to 6 years (early childhood )
School going child 6 to 10 years ( girls )
6 to 12 years (boys)

Adolescent from puberty to adult hood

Early: 12 – 14 years
Middle: 14 – 16 years
Late: 16 – 20 years
FACTOR INFLUENCING OR AFFECTING GROWTH & DEVELOPMENT
1. Genetic / Heredity:
Genetic pattern factor growth & development
body size shape , height , body, structure , color of skin , color of eye
transmit abnormal gens transmit
family disease growth & development
2. Racial / Race:
physical characteristic
3. Sex :
Female infant male infant
4. Intrauterine Development:
Intrauterine Development GROWTH & DEVELOPMENT
- Maternal malnutrition growth retardations anemia.
- Maternal infection – HIV HPV
- Maternal substance abuse – congenital , deformity , anomalies
- Maternal illness – Anemia , DM , CRF
- Hormones thyroxin
- Radiation expose
- Mantel stress
5. Child illness & Injury:

Injury growth & development
6. Nutrition:
growth & development nutrient balance diet
quality & quantity growth
& development immunity
7. Physical Environment:
Housing, living, condition, safety , measure , clean Environment, sunlight ,Drinking
water etc growth & development
8. Birth order / ordinal position of child:

Family G& D

9. Physiological Environment:
Healthy family, good parents child relationship , family member
teacher, peers group, school Environment GROWTH &
DEVELOPMENT factor emotional, social & intellectual
promotion lack of love affection & securities emotional
maturity & personality
10. Cultural influence:

Cultural Cultural G& food,
habit, health , education level
Growth & development
11. Socio – Economic status:

Poor socio – economic growth & development
parents economic status
growth & development
12. Intelligence:
Intelligency social development
higher Intelligence adjust
13. Play & Exercise :

Play & Exercise physiological activity & muscular development
stimulant Play & Exercise physical, physiological, social, moral, intellectual
& emotional development
14. Hormonal influence :

Internal environment hormone growth & development
some autotrophic, thyroid & adrenocortico tropic hormone GROWTH &
DEVELOPMENT
15. Growth potential:

Growth potential size ,weight etc
growth & development
IMPORTANCE OF LEARNING ABOUT GROWTH & DEVELOPMENT
-
- Growth & development normal
-
-
- total care plan
- Growth & development deviation
- Parents Rx, health promotion

-
TECHNIQUES OF ASSESSMENT OF GROWTH & DEVELOPMENT
Weight:
Birth full term neonate weight 2.5kg to 3.8kg Indian baby first
week 20% weight loss 10 days recover 3 month 25- 30 gm
Weight per day 1 year 40gm per month
5 month infant weight birth double tripled by one year of age, four
Time by two years, six times by five years, seven times by 7 years & 10 times by 10 years
Length or height :
Height improvement skalated growth indicate healthy Indian new born
Baby birth average length 50 cm 3 month 60cm, 9 month 70cm
- 50 cm - birth
- 60 cm - 3 month
- 70 cm – 9 month
- 75 cm – 1 year
- 12 cm increase in 2nd year
- 9 cm increase in 3rd year
- 7 cm increase in 4th year
- 6 cm increase in 5th year
- Double the height - 4 to 5 year of age
- 5 year puberty 5 cm height height measurement infant
meter or simple measure tap use
Body mass index (BMI):

Body mass index (BMI) normal growth deviation malnutrition & obesity
to child assess important base
BMI = weight in (kg)
Height (m)
Head circumference:
Average head circumference of child = 35 cm at birth
- At 3 month it is about 40cm
- At 6 month it is about 43cm
- At 1 year it is about 45cm
Fontanels closer:
Posterior fontanels 6 – 8 week (1.5 to 2 month) close anterior fontanel 12 -18
month (1 to 1.5 year) close
Chest circumference:
Birth chest circumference head circumference 2 - 3 cm
6 -12 month equal 1year 5 year Chest Circumference
2.5 cm head circumference

Mid upper arm circumference:

Mid upper arm circumference children nutritional condition find out
help birth normal new born baby Mid upper arm circumference average 11 to
12 cm
- AT 1 year of age it is about 12 - 16cm
- AT 1to 5 year of age it is about 16 - 17cm
Dentition or eruption of teeth:

Physiological process parents infant difficult period infant
discomfort pain infant first teeth lower central incisors delay
Teeth
1. Temporary Teeth
2. Permanent Teeth
Temporary or milk teeth deciduous teeth teeth
Infant age 2.5 to 3 years full sat of temporary teeth
20
First permanent teeth infant 6 year age total permanent teeth 32
rd
12 year 3 molar 18 year
AGE TYPE Total No. of

Teeth
1. Temporary Teeth
6-12 month Incisors (central & internal) 2-8
12-15 month First molar 8-12
13-24 month Canines 12-16
24-30 month Second molar 16-20
2.Permanent Teeth
6-7 year First permanent molar
7-10 year Replacement of temporary

Incisors & canines
10-12 year Replacement of temporary 26

Molar by premolars
12-15 year Second permanent molars 28
16 year Third permanent molars 32

Osseous (bone) Growth:

Bone growth biological age main indicators x-ray fetus bone connective tissue
cartilage convert

GROWTH CHART

FETAL GROWTH
THE NEWBORN INFANT
― 1 year age infant .‖
GROWTH & DEVELOPMEN OF INFANT
PHYSICAL:
 Weight :
WHO newborn infant weight 2.5kg normal weight
10 days feed digestion
weight 30gm /days 5to 6 month 15gm/day 6 to 12
month weight
- At Birth 2.5 kg
- 6 month 5- 6 kg
- 1 year 7.5 - 9 kg
- 2.5 year 10 – 12 kg

 Length :
New born length 48 – 53 cm 6 month 2.5cm /month
- 6 – 12 month 1.5cm
- 1 year height 75cm
- Birth height year age (100cm ) double
- 13 -16 year age (150cm)
 Head circumference :
Brain growth
- At birth 33 – 35 cm
- Up to 3 month - 40 cm
- Up to 1 year 45 cm
 Chest circumference :
Chest beral shape 31 – 33 cm
- anterior , posterior & transverse diameter
- transverse diameter age
- 1 year age head & chest ( 45cm )
PHYSIOLOGICAL
• Vital signs
- Temperature (36.3 to37.2C ).
- Pulse ( 120 to 160 b/min ).
- Respiration ( 35 to 50C/min) .
• Senses
o Touch
- It is the most highly developed sense.
- It is mostly at lips, tongue, ears, and forehead.
- The newborn is usually comfortable with touch.
o Vision
- Pupils react to light
- Bright lights appear to be unpleasant to newborn infant.
- Follow objects in line of vision
o Hearing
- The newborn infant usually makes some response to sound from birth.
- Ordinary sounds are heard well before 10 days of life.
- The newborn infant responds to sounds with either cry or eye movement,
cessation of activity and / or startle reaction.
o Taste
- Well developed as bitter and sour fluids are resisted while sweet fluids are
accepted.
o Smell
- Only evidence in newborn infant‘s search for the nipple, as he smell breast milk.

DEVELOPMENT:
BIRTH TO 4 WEEK:
 Motor Development:
- Object & adult face
- Bright moving object eye follow
- Back
-
- Response
-
 Socialization & vocalization:

-
-
-
 Emotional Development:
- Reflective
- External stimulation meaningless
- Discomfort & tension response
- Feeding
1 MONTH TO 2 MONTH:
Gross extension reflex disappear
 Motor Development:
- Reflective voluntary movement
- Infant side back turn
- Prone position
- Light & object eye coordination
- Eye vertically & Horizontal
 Socialization & vocalization

- Vocalization ―coo‖
- cry
-
- stimulation touch, talking or singing etc
- Social smile
- object
 Emotional Development
- Familiar face
- Environment aware & interested
- Feeding position feeding
- Sucking enjoy

12 Week (3 month)
- Physical characteristic : -
- Stapling reflex disappear
- Positive support reflex disappear
- Posterior fontanel close
 Motor Development :
- Body
- Prone position for arm rest head middle position
head ( rowing movement )
- Prone supine position
-
- Head control
 Socialization & vocalization

- Smile
- Mother room
- Feeding
- Familiar
 Cognitive & Emotional Development

- Environment interest
- Familiar face & object
- Object focus & follow
- Play activity repetitiveness
- Stoking situation aware
- Sucking
- Rooting sleep establish
16 WEEK (4 MONTH):
Stepping & routing reflex disappear
- Small object focus
-
- Environment
-
-
- Familiar person
- Internal rolling
- Back to side
- Offer
-

 Socialization & vocalization :

- Fully smile
- Social attention demand
- No response
 Cognitive & Emotional Development :

- Environment actively interest
-
- Develop
- Mother
- Trust & security indicate Adult
26 WEEK (5 – 6 MONTH):
- Tonic neck reflex disappear ( 3 – 6 month)
- Palmer grasp reflex disappear ( 6 – 7 month)
- Support
- Balance recover
- Object manipulate
- Supine position
-

- Request
-
-
-
- Excitement
- Kitchen item toys

-
-
- High chair
-
-
40 WEEK (10 month):

- Support
- Balance
- Object manipulate
- Drinking cup lip control
- Bell
- index finger & thumb use

- Response
- Facial expression & sound response
- Mirror image
- Adult toys
-

-
-
- independent
-
1 Year (12 Month):

- Furniture
-
- Book page
- Object
-
- Ball box
- Block tower
- Spoon use
- Bowel movement regular
- Walking support

- Demand
- Activity repeat
- Meaning 2 – 3 word

- Fear , anger , affection, anxiety & sympathy emotion
- Action

MILE STONE OF INFANT
Growth & development changes normal

age growth development
Mile stone
 AT BIRTH :
- Weight 2.5 kg or more
- Length 45 to 50 cm
- Head circumference 33 to 35 cm
- Chest circumference 31 to 33 cm
- Infant posture flexion
-
- lying sitting position
- Grasp reflex strong
- Moro‘s reflex , tonic neck & crossed extensor reflex (routing , sucking,
swallowing ) present
- Papillary reaction present
- Week doll‘s eye
- Baby
 UP TO 3 MONTH :
- 3 mass flexion
- Weight 30 gm
- Prone position baby head 20 lift
- Week walking placing & gross reflex disappear
- Moro‘s & grasp reflex absent
- Moving object 180 follow
-
-
-
-
-
-
- Social smile
- expression cry
-
 3 TO 6 MONTH :
- (symmetrical )
- chest & head extension
- 6 back to side prone to supine position
-
-
- saliva
- 6 weight double
- 6 lower incisor teeth
-
- Family member
- Mirror image smile
- ‖coo‖ words
-
 6 TO 9 MONTH :
- supine to prone & supine
- support
-
-
-
-
-
-
- central incisor
- Da… da.. ma… ma,,,
-
 9 TO 12 MONTH :
-
- support
- request
-
-
- postural adjustment
-
-
-
-
-
-
- 1 year 6 to 8 teeth
RED FLAGS IN INFANT DEVELOPMENT
• Unable to sit alone by age 9 months

• Unable to transfer objects from hand to hand by age 1 year
• Abnormal pincer grip or grasp by age 15 months
• Unable to walk alone by 18 months
• Failure to speak recognizable words by 2 years.

COMPLEMENTARY FEEDING OR WEANING FOR INFANT
G&D Breast Feeding G&D

Breast Feeding Breast Feeding supplementary food
weaning
sudden breast feeding breast
Feeding gradually supplementary food
process weaning
Qualities of Complementary Food:

- Weaning liquid semi solid & solid food
- clean, fresh & hygienic food infection
- weaning
- Baby
- well balanced & nourishing diet food
-
- energy
Principle Of Introduction Of Weaning Food:

- Milk infant weaning baby
-
-
- Food test
-
-
-
-
- Weaning process problem indigestion, abdominal Pain, diarrhea,
breast feed psychological upset
- Weaning 2 years breast feeding
weaning malnutrition & growth failure
COMPLEMENTARY FEEDING AT DIFFERENT AGE:
 6 MONTH:
-
-
- breast feeding
 6 – 12 MONTH:
-
-

-
-
-
-
-
- breast feeding
-
-
 12 MONTH TO 2 YEAR:
- breast feeding
-
-
-
-
-
-
-
 AFTER 2 YEAR :
-
-
-
-
ARTIFICIAL FEEDING :
Artificial Feeding breast feeding feeding breast
milk liquid milk cow‘s milk, buffalo milk.
 INDICATION:
- Death of mother
- Absence of mother
- Prolonged maternal illness
- Failure of Breast Feeding
 FACTOR CONTRIBUTING TO RAISING INCIDENCE OF ARTIFICIAL

FEEDING:
- Health worker mother family Breast Feeding
- Breast Feeding
- Life style
- Working mother
- Western country
- Mother milk
-

 PRINCIPLE OF ARTIFICIAL FEEDING:

Artificial Feeding breast feeding
human milk availability
- Artificial Feeding breast feeding

-
-
-
- Artificial Feeding spoon , bowl, cup, glass
- Bottle Feeding
- Artificial Feeding proportion & feeding procedure cleanliness
- Baby weight Artificial Feeding calculation feed

- Feeding correct technique
-
- feed 15-20 minute
- Infant 6 – 8 time 3 – 5 times
- Artificial Feeding
-
HEALTH PROMOTION DURING INFANCY:
Infancy physical, physiological need & social need

Health Promotion need
- Essential neonatal care

- Breast Feeding
- Immunization
- Weaning
- Prevention of accident care need play
stimulation & regular health check up supervision
- Emotional social need parents infant interaction love, security
& satisfaction trusting relationship develop
- Psychological
development infancy need
parents guidance
- Infant health problems danger sign

- Nutritional requirement
- hygienic need, gentle handling, safety measure
- Immunization & schedule

- Play stimulation & health environment

- Emotional deprivation trauma

- Late infancy self care activity
- Love, affection , safety & securities
NUTRITIONAL COUNSELLING / GUIDANCE:
Children & parents nutrition guidance & counseling pediatric nurse

G&D promotion &
Maintenance prevention of disease prevention of accident & injury guidance
Infancy health promotion & nutrition maintenance

6 breast feeding 6
weaning diet
IMMUNIZATION:
Immunization individual system live / kill / attenuated organism

protect process Immunization
Vaccine Immunobiological substance substance
protection produce vaccine protective antibodies active production
Immune mechanism active
Live attenuated vaccine :

 Bacterial - BCG
Typhoid
 Viral OPV
Measals
Mumps
Rubella
Yellow Fever
Influenza
Recital
Killed / inactivated Vaccine :
 Bacterial : pertusis
Typhoid
Cholera
Meningitis
Plague

 Viral : Rabbis
Hepatitis – B
Influenza
Polio
Japanese encephalitis
 Toocoid : Diphtheria
Tetanus
Mening coccal vaccine
MMR
DT
DPT
Hip , Hib – B
PLAY & TOYS:
Play:
Play natural & easily available
G&D factor Stimulation & support
IMPORTANCE OF PLAY OR FUNCTION OF PLAY:
1. Psychological Development :
- helpless
- environment
- feeling control
-
- negative feelings
2. Intellectual & Educational Development :

- space, color, shape, distance, height, speed
- problem solving technique
- skill develop
- concentration ability
- Communication skill
3. Social & Emotional Development :

-
- Group play skill develop
-
- Language ability
-
-

4. Physical Development :
- muscles , activity & muscles tone encourage
- condition adjust
-
Criteria for selection of Toys :

- Physical , social & mental development
-
- Interest create
- Attractive
- Interest
- Part
- Color
- Clean
-
-
- Music
- Part injury cut Sharp
SELECTION OF TOYS ACCORDING TO AGE:

 2 to 4 month :
 4 to 5 month :
 6 month : plastic ring, plastic ball, bat

 9 month :
interlooking toys, building , fix box toys tower music
 10 month : design fix remove
 1 year : tricycle Games

block doll
 2 year :
 3 year : Tricycles, bat, ball, gun, car

 4 year : fit
 5 year : Motor nerve develop pen pencil

design toys
 6 – 11 year :
- Painting
- Race car
-
- Music Game
- Cycling
 11 - 12 year :
Creative
Material
Outdoor games cycling, painting, music, carom,

chase
SAFETY & SECURITY INCLUDING PREVENTION OF ACCIDENT:
Safety measure accidental hazard

Aspect investigative,
impulsive accident hospital
accident 2 – 3 year & 5 – 6 year accident
Age Wise Accident :

1. Infant :
- Burns
- Choking
- Extremity
- Head injury
- Drowning or Near drowning
- Toxic injection
2. Toddler :
- Burns
- Choking
- Extremity
- Head injury
- Drowning or Near drowning
- Toxic injection
- Bicycle injury
3. Preschooler :
- Burns
- Extremity
- Falls injury
- Motor vehicle accident
- Toxic injection
- Bicycle injury
4. School Going Child :
- Extremity
- Sports injury
5. Adolescent :
- Extremity
- Sports injury

Prevention of Accident & Safety Precaution:

accident
1. Forethought
2. Time
3. Discipline
accident prevention & safety parents role main

family member role safety precaution
parents
- cot , table
-
-
- solid feed
-
-
- Electrical
-
- Cut injury
- suffocation
- movable play pan / hooker
THE TODDLER
GROWTH & DEVELOPMEN OF TODDLER
Toddler stage is between 1 to 3 years of age. During this period, growth slows considerably.
physiological maturity Infection
body temperature maintain & physiological concept
Physical growth
 Weight:
 The toddler's average weight gain is 1.8 to 2.7 kg/year.
 Formula to calculate normal weight of children over 1 year of age is
Age in years X 2+8 = ….. kg.
e.g., The weight of a child aging 4 years
= 4 X 2 + 8 = 16 kg

 Height:
Age in years X 5 + 80 = …..cm.

e.g., the length of 2 years old child
= 2 X 5 + 80 = 90cm
 Head and chest circumference:
- The head increases 10 cm only from the age of 1 year to adult age.
- During toddler years, chest circumference continues to increase in size and exceeds
head circumference.
 Teething:
- By 2 years of age, the toddler has 16 temporary teeth.
- By the age of 30 months (2.5 years), the toddler has 20 teeth
 Physiological growth:
- Pulse: 80–130 beats/min (average 110/min).
- Respiration: 20–30C/min.
 Bowel and bladder control:
- Daytime control of bladder and bowel control by 24–30 months.
DEVELOPMENT
Fine Motor development toddler
- 1 year old: transfer objects from hand to hand

- 2 year old: can hold a crayon and color vertical strokes
o Turn the page of a book
o Build a tower of six blocks
- 3 year old: copy a circle and a cross – build using small blocks
Gross - Motor development of toddler

At 15 months, the toddler can:
- Walk alone.
- Creep upstairs.

- Assume standing position without falling.

- Hold a cup with all fingers grasped around it.
At 18 months:
- Hold cup with both hands.
- Transfer objects hand-to hand at will.
-
At 24 months:
- Go up and down stairs alone with two feet on each step.
- Hold a cup with one hand.
- Remove most of own clothes.
- Drink well from a small glass held in one hand.
At 30 months: the toddler can:

- Jump with both feet.
- Jump from chair or step.
- Walk up and downstairs, one foot on a step.
- Drink without assistance.
Emotional development (Issues in parenting)

- Stranger anxiety – should dissipate by age 2 ½ to 3 years
- Temper tantrums: occur weekly in 50 to 80% of children – peak incidence 18 months
– most disappear by age 3
- Sibling rivalry: aggressive behavior towards new infant: peak between 1 to 2 years
but may be prolonged indefinitely
- Thumb sucking
- Toilet Training
Cognitive development:
- Up to 2 years, the toddler uses his senses and motor development to different self
from objects.
- The toddler from 2 to 3 years will be in the pre-conceptual phase of cognitive
development (2-4 years), where he is still egocentric and cannot take the point of view
of other people.
Social development:
- The toddler is very social being but still egocentric.
- He imitates parents.
- Notice sex differences and know own sex.
- According to Erikson,
- The development of autonomy during this period is centered around toddlers
increasing abilities to control their bodies, themselves and their environment i.e., "I
can do it myself".

HEALTH PROMOTION DURING TODDLER:
Toddler health promotion & maintenances area

- Nutrition council
- Accident prevention
- Toilet training
- Provision of play & health supervision
- Immunization & health supervision
- Love & affection for emotion
- Avoiding separation & anxiety
- Promoting discipline & self esteem development
Parents guiding & assisting pediatric nurse

parents guidance
Parents diet, nutrition supplementation, hygienic major, immunization, play facility,
prevention & safety measures, toilet training, Problem early detection regular health
cheek up
Discipline & temper tantrum control
NUTRITION COUNSELING / GUIDANCE FOR TODDLER
Period
period
parents balance diet & full range
2 year‘s breast feeding

feed assist
behavior time Table
Toddler vitamin–A supplementary vitamin – A

iron, folic parents deficiency
condition etc.
Parents appropriate cooking method, food hygienic , hand washing , sanitation
major & safe water. Regular health check up & growth chart
maintain
-
-
-
-

PREVENTION OF ACCIDENT & SAFETY PRECAUTION:
Toddler & Preschooler:

- Negative sentence use
-
- Accident Prevention supervision
-
- Poisons
substance, oil , electric
- Accident Prevention
- Safe material & soft
- Floor
- Furniture manage
-
-
-
- Electric switch board
- Plastic bag, pillow
-
- Torch battery lead poisoning
- Traffic sense
TOILET TRAINING
Toddler:
- Toddler learning defecation & urination control
sensory & motor control
- Urine feaces excreta
- Toddler 18 -24 anal & urethral sphincter muscles voluntary

control
- Physical & psychological
- 18 age toilet training
- 2 year age bladder control night bladder control
toilet training
- toilet training potty chair selection
Training parents confidence
- force training 10 minute
- training
- confidence training
- excretion process
emotional relationship
- motivate

THE PRE SCHOOLER
GROWTH & DEVELOPMENT OF PRESCHOOLER

It is the stage where child is 3 to 6 years of age. The growth during this period is
relatively slow.
Physical changes :
- Toddler (chhuby toddler )
- 1.5 – 2.5 kg weight
- Height 4 –6 cm
- Height double
Physiological growth
- Pulse: 80–120 beat/min. (average 100/min).
- Respiration: 20–30C/min.
- Blood Pressure: 100/67+24/25.
DEVELOPMENT
Fine Motor development

- 3 year old: copy a circle and a cross – build using small blocks
- 4 year old: use scissors, color within the borders
- 5 year old: write some letters and draw a person with body parts
- Fine motor and cognitive abilities
 Buttoning clothing
 Holding a pencil
 Building with small blocks
 Using scissors
 Playing a board game
 Have child draw picture of himself
Cognitive development
Preschooler up to 4 years of age is in the pre-conceptual phase. He begins to be able
to give reasons for his belief and actions, but not true cause-effect relationship. Development
of Preschooler
- Fears the dark
- Tends to be impatient and selfish
- Expresses aggression through physical and verbal behaviors.
- Shows signs of jealousy of siblings.
Social development in preschoolers

- Egocentric
- Tolerates short separation
- Less dependent on parents

- May have dreams & night-mares

- Attachment to opposite sex parent
- More cooperative in play
Social development
According to Erikson theory:

- The preschooler is in the stage where he develops a sense of initiative, Where he
wants to learn what to do for himself, learn about the world and other people.
Psychosocial Development :
-
-
-
- Social norms
-
-
-
-
-
-
-
- Co operative & sympathetic
- Story
-
Vocational Development :
- 1500 – 2000
-
-
RED FLAGS PRESCHOOL
- Inability to perform self-care tasks, hand washing simple dressing, daytime toileting
- Lack of socialization
- Unable to play with other children
- Unable to follow directions during exam
HEALTH PROMOTION DURING PRESCHOOLER
- Preschooler Health Promotion & maintenance nurses parents

- area Parents guidance
- Nutritional requirement
- Nutrient

- Limitation
- Environmental frustration help
- Self care ability develop
- Accident prevention
- Play & lunch
-
Tour, museum, zoo etc.
- Environment nursery, school
relative
- Health check up
- Immunization record
-
NUTRITIONAL COUNSELING FOR PRESCHOOLER:
- Preschooler
- Socialization, meal time, behavior

meal time parents
- Age nutritive value & quantity
meal time environment
- Up happy atmosphere at meal parents
variety teeth delay , physical illness, fatigue ,
emotional disturbance
- Parents
NOTE: PREVENTION OF ACCIDENT & SAFETY PRECAUTION :
Same as toddler
THE SCHOOL AGER
GROWTH & DEVELOPMENT OF SCHOOL AGE CHILD
School-age period is between the age of 6 to 12 years. The child's growth and development is
characterized by gradual growth.
Physical Growth:
- Height
- Muscle develop
-
- Long bone growth
- The child gains about 5cm/year.
- Body proportion during this period: Both boys and girls are long-legged.

- Weight 1.4 - 2.2 kg

- 6 year age permanent teeth
- School age motor skill & eye , hand co – ordination
Normal school-age child:
- Weight Formula for 7 - 12 yrs

= (age in yrs x 7 )– 5
2
Physiological growth:
- Pulse: 90+15 beats/min (75 to 105).
- Respiration: 21+3 breath/min (18–24).
- Blood Pressure: 100/60+16/10. mm of Hg
DEVELOPMENT
fine motor development
- Writing skills improve
- Fine motor is refined
- Fine motor with more focus
• Building: models – logos
• Sewing
• Musical instrument
• Painting
• Typing skills
• Technology: computers
Motor development
At 6–8 years, the school–age child:
- Rides a bicycle.
- Runs Jumps, climbs and hops.
- Has improved eye-hand coordination.
- Prints word and learn cursive writing.
- Can brush and comb hair.

- Throws balls skillfully.
- Uses to participate in organized sports.
- Uses both hands independently.
- Handles eating utensils (spoon, fork, knife) skillfully.

- Enjoy all physical activities.
- Continues to improve his motor coordination.
Gross motor
- 8 to 10 years: team sports
- Age ten: match sport to the physical and emotional development

School performance
- Ask about favorite subject
- How they are doing in school
- Do they like school
- By parent report: any learning difficulties, attention problems, homework
- Parental expectations
Cognitive development
- he child now is in the concrete operational stage of cognitive development.
- He is able to function on a higher level in his mental ability.
- Greater ability to concentrate and participate in self-initiating quiet activities that
challenge cognitive skills, such as reading, playing computer and board games.
Emotional development
- Fears injury to body and fear of dark.
- Jealous of siblings (especially 6–8 years old child).
- Curious about everything.
- Has short bursts of anger by age of 10 years but able to control anger by 12
years.
Psychosocial Development:
-
- Parents support
- 7 year age operational thinking
-
-
-
-
-
- Co – operation & social skill
Communication Skill :
-
- 6 2500-3000
- 7 Complex & Compound
- 12 adult
- 12 anger, fear, worry , gulty love & affection
control
RED FLAGS SCHOOL CHILD
• School failure
• Lack of friends
• Social isolation
• Autism
• Aggressive behavior: fights, fire setting, animal abuse

HEALTH PROMOTION DURING SCHOOL AGE:
- School age self care parents health promotion

parents
- Parents family member & teachers emotional support & guidance
- School
- Punishment
- Reward
- Behavior problem negative
- Peer activity home responsibility

- Recreational & play activity

- Psychological & physical changes
- Sex education
- Dependence & independence
- Immunization & regular health check up record
- Socialization
NUTRITION GUIDANCE FOR SCHOOL CHILD
- Nutrition education parents behavior
- Slower growth rate food requirement

- Age dependent
Socialization
- Age parents advice
BALANCE DIET :
- Calorie
- Vitamin – k minerals
- Heavy breakfast
- Meal time healthy environment create
- Food hygiene & sanitation advice
-
- Health check up regular record maintain
- nutrition status
PREVENTION OF ACCIDENT & SAFETY PRECAUTION :
- Fire , firework , match box, electricity , sharp instrument safety precaution
- sport injury safe ground supervision
-
-
-
-

THE ADOLESCENT
Adolescent
Behavior period G & D Psychological &
Physical changes
Physiological
- Pulse: Reaches adult value 60–80 beats/min.
- Respiration: 16–20C/minute.
Physical
The sebaceous glands of face, neck and chest become more active. When their
secretion accumulates under the skin in face, acne will appear.
Appearance of secondary sex characteristics

1- Secondary sex characteristics in girls:
- Increase in transverse diameter of the pelvis.
- Development of the breasts.
- Change in the vaginal secretions.
- Growth of pubic and axillary hair.
- Menstruation (first menstruation is called menarche, which occurs between 12 to 13
years).
Body image
2- Secondary sex characteristics in boys:

- Increase in size of genitalia.
- Swelling of the breast.
- Growth of pubic, axillary, facial and chest hair.
- Change in voice.
- Rapid growth of shoulder breadth.
- Production of spermatozoa (which is sign of puberty).

Adolescent
- As teenagers gain independence they begin to challenge values
- Critical of adult authority
- Relies on peer relationship
- Mood swings especially in early adolescents
DEVELOPMENT
Cognitive development: Through formal operational thinking, adolescent can deal with a
problem.
Emotional development: This period is accompanied usually by changes in emotional

control. Adolescent exhibits alternating and recurrent episodes of disturbed behavior with
periods of quite one. He may become hostile or ready to fight, complain or resist everything.
Social development: He needs to know "who he is" in relation to family and society, i.e., he
develops a sense of identity. If the adolescent is unable to formulate a satisfactory identity
from the multi-identifications, sense of self-confusion will be developed according to
Erikson:-
 Adolescent shows interest in other sex.
 He looks for close friendships.
Psychological Development
- Adolescent
-
-
-
-
-
-
-
-
-
-
-
-
-
depression & stress
-
-
- Adolescent knowledge
Adolescent behavioral problems

- Anorexia
- Attention deficit
- Anger issues
- Suicide
HEALTH PROMOTION & teaching:
maturation special need
- Rest , sleep, exercise , hygiene, balance diet, healthy eating, habit self care
- Regular health check up

- Female regular self breast examination
- accident, addictive, behavior, Adolescent problem, STD, unwanted pregnancy
education
Sport, dancing, reading , TV
- Emotion, frustration, depression, antisocial activity, abnormal, sexual behavior
control
- Adolescent
- Norms follow
- Adolescent
- Sex education
Adolescent Teaching
- Relationships
- Sexuality – STD‘s / AIDS
- Substance use and abuse
- Gang activity
- Driving
- Access to weapons
NUTRITION GUIDANCE FOR ADOLESCENT:
Adolescent period puberty rapid growth

energy requirement physical fitness nutritional need
Period iron, calcium, vitamin – D

female Adolescent iron & ED
ADOLESCENT HEALTH
CHALLENGES IN ADOLESCENT DEVELOPMENT AND HEALTH IN INDIA:

 45% of adolescent girls under nourished

 20% of adolescent boys under nourished

 Early marriage 26% < 15yrs – girls, 54% < 18yrs
 20 – 30% adolescent boys sexually active
 10% adolescent girls sexually active
 59% adolescents know about condoms
 49% adolescents know about contraceptives
 4.5% drug abuse
 50% of all HIV positive new infections are in the age group of 10 – 25yrs
 Adolescent abortion 1 – 4.4millions
INDIAN ACADEMY OF PAEDIATRICS PROPOSAL:

1999 = Family Education for adolescents
2000 = Teenage care clinic in the hospitals
2001 – 2003 = Teenage care wards for girls and boys in the hospitals
31st July Every year = Teenage day
25 – 31st July Every year = Teenage week
 Early adolescence(10 -13yrs): Spurt of growth of development of secondary sex.

 Middle adolescence(14-16yrs): Separate identity from parents, new relationship to peer
groups, with opposite sex and desire for experimentation.
 Late adolescence(17-19yrs): Distinct identity, well formed opinion and ideas
THE FOLLOWING CHANGES ARE TAKING PLACE DURING ADOLESCENT

PERIOD:
A. Biological changes – onset of puberty

B. Cognitive changes – emergence of more advanced cognitive abilities
C. Emotional changes – self image, intimacy, relation with adults and peers group
D. Social changes – transition into new roles in the society
SMR (SEXUAL MATURITY RATING)

 Genitalia stage for boys
 Pubic hair stage
 Breast development for girls
IMPACT OF ADOLESCENCE:
 Lack of formal or informal education

 School dropout and childhood labour
 Malnutrition and anemia
 Early marriage, teenage pregnancies
 Habits and behaviors picked up during adolescence period have lifelong impact
 Lot of unmet needs regarding nutrition , reproductive health and mental health
 They require safe and supportive environment
 Desire for experimentation
 Sexual maturity and onset of sexual activity

 Transition from dependence to relative independence
 Ignorance about sex and sexuality
 Lack of understanding
 Sub optimal support at family level
 Social frustration
 Inadequate school syllabus about adolescent health
 Misdirected peer pressure in absence of adequate knowledge
 Lack of recreational, creative, and working opportunity
ADOLESCENT HEALTH PROBLEMS
1. Anorexia nervosa
2. Obesity & overweight
3. Adolescent pregnancy
4. Micronutrient deficiency
5. Emotional problems
6. Behavioural problems
7. Substance abuse & injuries
8. Sexually transmitted infection
9. Thinking and studying problems
10. Identity problems
REASONS FOR ADOLESCENT RELUCTANT TO SEEK HELP
 Fear
 Uncomfortable with opposite health worker
 Poor quality perception
 Lack of privacy
 Confidentiality
 Cumbersome procedure
 Long waiting time
 Parental consent
 Operational barrier
 Lack of information
 Feeling of discomfort
 Health education
 Skill based health education
 Life skill education
 Family life ducation
 Counselling foe emotional stress
 Nutritional counselling
 Early diagnosis & management of medical and behavioural problem

ADOLESCENT FRIENDLY HEALTH SERVICE

ADOLESCENT FRIENDLY HEALTH CENTER SERVICES
 Reproductive Health services

 Sexual & Reproductive health education
 Contraception
 Pregnancy testing and option
 MTP
 STD/HIV Screening counselling and treatment
 Prenatal & postpartum care
 Well baby care
 Nutritional services
 Growth & development monitoring
 Anticipatory guidance about substance abuse and other risk taking behaviour
 Counseling for life skill development
 Screening for various disorders
MENSTRUAL CYCLE
INTRODUCTION
Ovarian hormones (Estrogen & Progesterone) uterus endometrial cyclic changes
produce layer thick ovum implantation degeneration
per vaginal bleeding menstruation Duration 28 days lactation
& pregnancy
Menstrual cycle 3 phases

A. Menstrual Phase
B. Proliferative Phase
C. Secretary Phase
A. Menstrual Phase :Phase 1 to 5 days ovum fertilize corpus

luteum degeneration progesterone Estrogen level
endometrium functional layer Hormones depend degenerate
Vaginal bleeding menstruation
Menstrual flow endometrial glands cells broken capillaries blood
unfertilized ovum Duration 3 to 5 days blood
amount 30 to 35 ml 80 ml blood loss abnormal
B. Proliferative Phase : Menstrual Phase phase Proliferative preovulatory

Phase menstruation 6th day Ovulation
10 day
Phase ovarian follicles estrogen endometrium ovum receive
phase endometrium endometrium thickness 3 to

4 mm
C. Secretary Phase : Secretary Phase luteal phase ovulation 15days

28 days phase endomethium edematous
endometrial gland mucus secret Endometrium vascular spiral
arteries vessels ovum fertilization corpus luteum
degeneration ovulation ovum 24 hormonal
Support phase Endomethium thickness 5 to 6 mm
phase ovum fertilize menstruation
Cycle
NORMAL MENSTURATION
 This begins roughly 2 years after the appearance of first physical signs of puberty.
 Normal duration of cycle varies from 23-39 days, the mean being 28 days.
 There are no clots in the menstrual blood.
 Normal flow varies from 2-7 days, the mean being 5 days. However, duration of more
than eight days is of concern.
 On average one has to change a menstrual pad two to three times a day.
 During the first few years, period is often irregular and flow varies. This is normal
MYTH
 Menstruation is unclean
 It is unhealthy for a girl to bathe during her
 periods
 Once a girl begins to menstruate, she can
 become pregnant
 A girl having periods should not enter kitchen or touch food Myth There is no
scientific reason behind it. However, adequate rest should be taken
MENSTRUAL HYGIENE FOR ADOLESENT GIRLS
 MENSTRUAL CYCLE
MENSTRUAL CYCLE
-
-
-
-
-

-
-
-
-
DEVELOPMENTAL THEORY
 Freud theory (sexual development).
 Piaget theory (cognitive development ).
 Erikson theory (psychosocial development).
Freud theory(sexual development)

 Infancy stage  Oral-sensory stage
 Toddler stage  anal stage
 Preschool stage  Genital stage
 School-age stage  Latency Stage
 Adolescence stage  pubertal stage
Piaget theory(cognitive development )

 Infancy stage  Up to2 years  sensori -motor
 Toddler stage  2-3 years  pre-conceptual phase.
 Preschool stage  Up to 4years  pre-conceptual phase.
 School-age stage  7-12 years  concrete-operational.
 Adolescence stage  12-15 years  preoperational formal operations
15 years - through life  formal operations
Erikson theory(psychosocial development)

 Infancy stage  Trust versus mistrust.
 Toddler stage  Autonomy and self esteem versus shame and doubt.
 Preschool stage  Initiative versus guilt.
 School-age stage  Industry versus inferiority.
 Adolescence stage  Identity and intimacy versus role confusion.

UNIT – 4
The sick child
 Child‘s reaction to hospitalization.

 Effects of hospitalization on the family of the child.
 Role of nurse in helping child and family in coping with stress of
 Hospitalization and illness.
 Nursing interventions adaptations in nursing care of sick child
 Examination, principles of safety observed in pediatric techniques.
 Preparation of child for diagnostic tests, collection of specimens.
 Calculation and administration of oral and parenteral medications.
 Procedures related to feeding: formula preparation, gavages,
 Gastrostomy feeding.
 Procedures related to elimination: enema, colostomy irrigation.
 Use of play as nursing intervention.
 Care of child in incubator.
 Administration and analysis of oxygen concentration.
 Surgical dressing
 Steam tent inhalation.
 Immobilized child

INTRODUCTION
Sick child care pediatric nursing aspect children immunity

pneumonia, diarrhea, appendicitis
common congenital anomalies, prenatal & neonatal Problems. Nutrition‘s,
malignancies emotional disturbance growth & development problem
Child mortality rate health status improve normal
health promote proper medical & nursing interventions
SETTING OF PEDIATRIC ILLNESS CARE DELIVERY:

Home care hospitalization main aim care
health status improve health problems
Pediatric health care facilities home based care, health centers, clinical service, out
– patient services, day care service, school health service, health camp, hospital
General practitioners or pediatrician home care hospital care provide
child health care facilities available pediatric ward, PICU, NICU, baby nursery,
pediatric research center
Hospital pediatric unit baby or child condition special care medical,
surgical, orthopedics, ENT, emergency room semi units
child health care provide hospital & health care unit laboratory,
diagnostic imaging centers, physiotherapy facilities available

CHILDS REACTION TO HOSPITALIZATION
Psychosocial & Physical Development

pain, parents environment disturb
Hospital Growth & Development age
hospital reaction
1. Reaction Of Neonates :
2. Reaction Of Infants :
3. Reaction Of Toddler :
4. Reaction Of Preschool child :
5. Reaction Of School age child :
6. Reaction Of Adolescent :
 Reaction Of Neonates :
 Family healthy relationship development
 Bonding & trusting relationship impair
 Parents love & care
 Parents & family member reaction response
 Reaction Of Infants :
 Separation anxiety
 Hospitalize basic trust develop
need
 Emotional withdrawal and depression
 Growth delayed development
 8 – 13 month infant limited tolerance separation anxiety fear
excessive, crying
 Reaction Of Toddler :

 Nurse attention reject



Reaction
 comfort
 Denial care nurses
 Regression stressful situation control
 Reaction Of Preschool child :

 Preschool child defense mechanism adopt hospitalization
illness stressful experience adjust
 Regression , projection, displacement, identification, aggression, denial,
withdrawal & fantasy exhibiting
 Age toddler reaction aggressive
 Reaction Of School age child :



 Privacy reaction
 Fantasies behavior
 Defense mechanism Regression, suppression, anxiety,
negativism, depression fobia, unrealistic , fear reaction
 Reaction Of Adolescent :
 Adolescent privacy
 Family school education
 Strong environment insecurities
 Anxiety
 Un co-operative staff
 Depression
EFFECT OF HOSPITALIZATION ON THE FAMILY OF THE CHILD:
Hospitalization family unit Hospitalization

family member stress & emotional Reaction parents Hospital
parents nurse, doctor etc.
 Hospitalization Parents anxiety

 Family anger & fear
 Self blame & guilty
 Anxiety
 Hospital Strange environment
 Separation

 Outcome progress

 Parents community
Hospitalization reaction culture &

spiritual belief
ROLE OF NURSE TO COPPING WITH STRESS & HOSPITALIZATION ILLNESS
Family member hospital nurse

stress warm welcome
Environment parents
Pediatric nurse parents
hospital anxiety Care
 NEONATES :
 parents
 Rooming in & sensory motor stimulation active involvement
 INFANT :

 Infant
 Infant need
 Procedure
 Play therapy
 TODDLER :
 Feeling
 Unlimited visiting hours rooming in
 Sleeping, eating, bathing, etc.
 Parents love & trusting relationship environment

 Therapeutic play
 Interest recreation
 PRE SCHOOL CHILD :

 Care planning care parents stress
separation
 Hospital plan

 Feeling
 Procedure privacy level


 Negative feelings
 SCHOOL CHILDREN :
 Parents hospitalization


 Procedure room Procedure
 Child self care encourage
 Play & school work continue encourage
 Parents child reaction
 Child care parents
 Visit
 Parents parents
 ADOLESCENT :
 Adolescent plan hospital admission parents Adolescent prepare
 hospitalization assess misconception
 Admission warm welcome hospital staff hospital routine & hospital
 privacy recreation
 care plan procedure
 recreation peer relationship interaction & feeling expression
 parents hospitalization stress
NURSING INTERVENTION & ADAPTATION IN NURSING CARE OF SICK CHILD
Sick child need action intervention

goal
Adaptation intervention
nursing care adaptation
Strategies
 Nursing Intervention parents

 Intervention

 Parents Feelings

 Intervention
 Parents
 nursing Intervention privacy
Gently handling
 Procedure comfort
 Plan parents child
 Eye level contact
 Diversonal therapy
 Procedure
 Restrain
 Procedure skillful & confidence approach
 Physical injury & infection
 Care

 Negative statement
NICU (NEONATAL INTENSIVE CARE UNIT)
NICU intensive care unit iii premature newborn infant specialized care
NICU staff Neonatologists, Nurses pharmacists, Assistant physician,
Respiratory therapists
NICU Newborn infant care special well equipped unit
facilities Available
ARTICLES AVAILABILITY IN NICU:
1. Cardiopulmonary monitor
2. Blood pressure monitor
3. Ventilator
4. Defibrillator
5. Central line
6. Cardiopulmonary monitor
7. C-PAP (continuous positive airway pressure)
8. Endotracheal tube
9. Incubator
10. I.V. Line, IV pumps,
11. Or Infusion pumps
12. Nasal cannula prongs
13. Oxygen hood
14. Pulse oximeter
15. Radiant warmer
16. Umbilical catheter
17. Bright blue fluorescent lights
18. A scale
LEVEL OF CARE IN NICU:-

India Neonate weight Gestational age level classify
 LEVEL -I CARE:-
 Weight mare than 1800 grams
 Gestational maturity – 34 weeks on mare
 Neonates G[ basic care temperature maintenance, Asepsis
maintenance Breast feeding promote
 care Home, sub center primary health center
 LEVEL -II CARE:

 Weight 1200-1800 grams
 Gestational maturity – 30-34 weeks
 care Nurse + pediatricians resueitation, thermal
environment Regulation, IV infusion garage feeding,
phototherapy Blood transfusion
 care first referral unity district hospital, teaching institutes Nursing
Home Available
 LEVEL -III CARE:

 Weight Less than 1200 grams
 Gestational maturity – Less than 30 weeks
 care Apex institations, perinatal centers centralized oxygen,
suction facilities, incubates, vital signal motor ventilator, inflation pump
emergency care equipments medication Available
 care skilled nurses neonatologists

COMMON PROBLEMS PATHOLOGIES:-

 Apnea Breathing problems
 Bradycardia
 Anemia
 Bronchopulmonary dysplasia (BPD)
 Jaundice
 Hydrocephalus
 Intraventricular hemorrhage (IVH)
 Necrotizing enterocolitis (NEC)
 Patent ductus arteriosus (PDA)
 Periventricular leukomalacia (PVL)
 Sepsis
 Retinopathy of prematurity (ROP)
 Transient tachypnea
LOCATION:-
 NICU labour room obstetric OT
 subnlight well ventilated
 AREA + SPACE
 incubator 6 feet space
 Space distribution 500 to 600 aross square feet per bed patient
care area space fer doctors nurses other staff, affice area, seminal room area
laboratory area availability
 LIGHTING + TEMPERATURE
 Lighting smooth shadow fee illumination 100 foot candle sat
 Unit temperature 2.c + 2.c
 Humidity 50%
Neonatal care best result well equipped unit skilled staff
PICU (PEDIATRIC INTENSIVE CARE UNIT )
PICU paediatric intensive care unit hospital specialized unit ill infants
children teenagers care
PICU paediatric intensive direct PICU staff
doctor, nurse respiratory therapist PICU specially trained
PICU physiotherapies, Social world, child life
specializes

Patient professionals ratio hospital area PICU

accurately life – threatening complications Complex technology
equipment use Particularly
EQUIPMENT TO SYSTEM :
 Mechanical ventilator – ET Tube tracheotomy breathing assist

 Hem filtration equipments – Aleut renal failure
 Monitoring equipments
 I.V. lines
 Nasogastric Tubes
 Drains catheters
 Drugs – Intripes, Sedatives, Analigics, and analgesics
CONDITIONS THAT COMMONLY CAUSE CRITICAL ILLNESS AND INJURY

INCLUDE:
 Severe infections
 Poisoning
 Drug overdose
 Trauma
 Extensive surgery
 Congenital anomalies
 Immunological disorder
PICU ROUTINE CARE ACTIVITIES:
 Admission / Discharge
 Assessment / Monitoring
 Common procedures/Protocols
 Documentation
 Infection control
 IV access and drug administration
 Nutrition
 Pain Management
 Patient Hygiene & Basic care
 Patient Safety
 Transfer / Transport
 Unit Management

Scoring systems in PICU:-
Measure
illness severity
Assess
therapeutic Determine
requirements prognosis
& efficacy
ROLE OF NURSE IN PICU :-

 Patient condition Assess care plan planning
 Physicians procedure
 Wound treat patient Advanced life support
 Patient vital signs observe Record
 Ventilators, monitors medical instrument properly works daily
check
 IV fluid medications Administer
 Diagnostic test order sample collect
 Capital care team member co-ordination
 Life saving situations Response Proper nursing standards
Protocols
 Patient advocate Role
 Patient family education support
 Proper Documentation Record report
 Case manages policy makers administrative duties perform
HISTORY COLLECTION
Obtaining history is an important aspect in child health care, history regarding child
health‘s condition can be collected from the parents or family members. The purpose of
history of a child is to obtain data to help in diagnosis and treatment and to formulate
individualized plan for care.
The following information to be collected and recorded:
 Identification data
 Chief complaints

 History of present illness

 History of past illness
 Birth history
 History of growth and development
 Immunization history
 Dietary history
 Personal history
 Family history
 Socio economic history
PHYSICAL EXAMINATION OF CHILDREN
Hospital & community physical Examination pediatric nurse role

head to toe Examination system
system Exam
Physical Examination:
 Manipulation
 Percussion
 Palpation
 Auscultation
 Inspection
Diagnosis, complication deviation
follow up parents
GENERAL PRINCIPLES:

 Minimum expose gently handling
 Examination friendly approach
 parents co – operation

 procedure
 restrain
 position
 record
 parents
PURPOSE:-
 general condition check
 system normal g & d. find out
 Abnormality early management appropriate action
 Congenital & dirth defect
 Need Rx provide
 g and d systemic examination parend educate

 Diagnosis
 Anthropometric measurement find out
ARTICLES:
 Sterile gloves
 Measuring tape
 Weight machine (spring balance)
 Infanto meter
 Studio meter
 Stethoscope
 T P R tray
 Flash light
 Knee hammer
 Cotton piece
 Rector thermo meter
 Rubber catheter
 Recording articles
TECHNIQUE OF PHYSICAL EXAMINATION
A. General Appearance:
 Nourishment
 Body built
 Health
 Activity
 Height
 Weight
B. Vital Sign:
 Temperature (Oral, Rectal, Axillary )
 Pulse
 Respiration
 Blood pressure
C. Skin Integrity:
 Color
 Texture
 Temperature
 Lesions
 Additional information:- yes /no
If yes specify:-……………………
D. Hair and Scalp:

 Scalp
 Condition of hair

E. Head and face:

 Head circumference
 Face: Pale, fatigue, pain, fear, anxiety etc.
Eye-
 Eye Lashes
 Eye ball
 Eye lids
 Conjunctiva
 Sclera
 Pupils.
 Vision
Ear-
 Size
 Shape.
 Discharge
 Cerumen
 Swelling
 Presence of foreign body:- yes /no
 if yes specify:-……………………….
 Hearing acuity
Nose
 External nares
 Nostrils
Mouth and Pharynx

 Lips
 Odour of mouth
 Teeth
 Mucus membrane and gums
 Tongue
 Throat and Pharynx.
F. Neck
 Lymph nodes
 Thyroid gland
 Range of motion
G. Chest
 Shape
 Chest movement
 Breath sounds
 Breast size and shape
 Heart sounds

H. Abdomen
 Inspection
 Auscultation
 Percussion.
 Palpation
 Peristalsis
 Abdominal sounds
I. Extremities and joint:-

 Shoulders
 Elbow
 Wrist
 Fingers
 Hip
 Knees
 Ankles
 Toes
 Reflexes
J. Back:
 ROM of spine: Flexion, Extension, Rotation, bending
 Deformity:- yes /no
If yes specify:-………………………….
K. Genitals and Rectum:

 Frequency of Urination
 Urine Last Voided
 Colour
 Normal / Anuria / Hematuria / Incontinence / Any Other
 Catheter Present yes /no
 Urethral Discharge
 Any sexually transmitted diseases
 Enlargement of prostate glands
 Descent of the testes
L. Neurological test:
 Co ordination Tests
 Reflexes
 Sensitivity tests
 Equilibrium Tests

SAFETY MEASURE DURING PEDIATRIC TECHNIQUES

OR
PRINCIPLE OF SAFETY MEASURE
Safety, securities &protection

Physiological need Hospitalize child care safety
precaution
nurse accidental, injury, infection & psychological
Trauma
 Child care

 Hospital
 restrain
 Infection transmission aseptic technique
 Feeding aspiration
 Drug administration
 Procedure record
 Psychological trauma
 Supervision
 Hospital accident building , furniture , electric
intervention
PREPARATION OF CHILD FOR DIAGNOSTIC TESTS
Modern health care service advance medical technology & laboratory science
laboratory investigation, X-ray , USG & other diagnosis technique
Adult physical & emotionally diagnosis procedure

special physical & psychological preparation anxiety
approach
Diagnosis procedure setting Laboratories,
Outpatient department, ward, radiology department etc. diagnosis procedure
Parents prepare doctor nurse
nurses diagnostic preparation
Procedure positive outcome importance purpose

Preparation Procedure time
Procedure Visual aid doll
Procedure Procedure Preparation evaluation
Child & parents
Physical Preparation Procedure prepare Position, privacy,
antiseptic technique & restraint
COLLECTION OF SPECIMENS :
Infant young children specimen collection
parents specimen collection
COLLECTION OF URINE SPECIMENS:

 Urine sample collection toilet trained
specimen collection
 Infant urine collection urine bag hand
Wash external genitalia clean collecting bag Apply
Semi fowler position
 Diaper bag
 Nurses observe
 Urine pass bag remove laboratory
Bag sterile container urine collect clean catch
Urine specimen
COLLECTION OF STOOL SPECIMENS:

 Spatula or spoon use fresh stool cover specimen container transfer
 Urine rectal swab gently swab
rectal insert
COLLECTION OF BLOOD SPECIMENS:

 Blood Specimens laboratory technician or doctor nurses
assisting procedure
 Collection sterile tray prepare
 Parents psychologically prepare Collection labeling
laboratory
COLLECTION OF THROAT SPECIMENS:

 Throat swab Collection uncomfortable procedure
 Sterile swab collection
 Swab lip, tongue touch
COLLECTION OF SPUTUM:
 Sputum Collection
 Mucus trap
 Deeply cough container Sputum Collection
 Saliva material early morning collection
COLLECTION OF CSF :
 Neurological diagnosis CSF usable investigative procedure
 CSF Collection puncture

 Lumbar puncture: 3rd & 4th or 4th & 5th lumbar vertebrae space needle introduce
sub arachnoids space CSF drain collect
 Ventricular puncture: Coronal suture or anterior fontanels brain ventricle

CSF collect
 Cisternal puncture: Nape of neck cisternal megna CSF collects
 Sub Dural puncture : Arachnoids & duramater Sub Dural space

remove & collect
Purpose:
 Diagnostic purpose
 Therapeutic
 Prognostic
 Study of electrolyte, protein etc.
Purpose of lumber puncture:

 CSF withdrawal
 To reduce intra cranial pressure
 Diagnostic purpose
 Disease drug
 Spinal anesthesia inject
 Radiology examination
 Enbeph………gram , mylogram , liquid……inject X-ray
Equipment:
 Tray with cover ( Sterile )
 Mackintosh & towel (draping material)
 LP needle - 2
 Syringe c needle
 Bowl (antiseptic solution)

 Cotton swab / gauze swab

 Sponge holding forceps
 Glosses
 Sterile container/test tube
 Solution
 Povidon
 Savlon
 Tincture benzoin
 Xyloacin 2%
 Kidney tray
 For container
 Procedure sheet
Procedure:
1. Patient Preparation:
 Explain Procedure
 Child procedure cover& warm
 Policy procedure consent
2. Position of Patient & procedure:
 Procedure room procedure tray
 Knee & chest flat up right position lateral position use
bed lateral position chest head flex knee
abdomen chin flex position
 doctor skin area painting & draping
 Nurse & helper position hold
condition observe
 Doctor LP needle insert
 CSF drain sterile container collect
 Collect needle remove banzoin ………
3. Care after Lumber Puncture :
 Head low lying flat position
 Fluid diet breast feeding
 Vital sign check
 Headache , nausea, vomiting observe
 LP area linkage bleeding observe
 Specimen label laboratory
 Procedure sheet procedure
 Policy instrument sterilization
Complication:
 Bleeding
 Infection
 Headache / backache

DRUG ADMINISTRATION IN CHILDREN
ROUTES OF DRUG ADMINISTRATION

DEFINITION:
A route of administration is the path by which a drug, fluid, poison or other substance is brought
into contact with the body.
CLASSIFICATION:
Routes of administration can broadly be divided into:
 Topical: Drugs are applied topically to the skin or mucous membranes, mainly for local
action.
 Oral: used for systemic (non-local) effect, substance is given via the digestive tract.
 Parenteral: A drug administered parenterally is one injected via a hollow needle into the
body at various sites and to varying depth.
 Rectal: Drugs given through the rectum by suppositories or enema.
 Inhalation: The lungs provide an excellent surface for absorption when the drug is delivered
in gaseous, aerosol or ultrafine solid particle form.
 Topical route:
I Skin
A-Dermal – cream, ointment (local action)
B- Transdermal- absorption of drug through skin (i.e. systemic action)
I. stable blood levels(controlled drug delivery system)
II. No first pass metabolism
III. Drug must be potent or patch becomes too large
II Mucosal membranes
• eye drops (onto the conjunctiva)
 ear drops
 intranasal route (into the nose)
 2- Oral route:
- By swallowing.
- It is intended for systemic effects resulting from drug absorption through the various
epithelia and mucosa of the gastrointestinal tract.
IMPORTANT NURSING RESPONSIBILITY IN MEDICATION ADMINISTRATION

FOR THE PEDIATRIC PATIENT
 Differences with Pediatric Patients:
 Many variables with infants and children
 In neonates there is an absence of hydrochloric acid, which may interfere with absorption of
some medications.
 If the child is over 2 years old, giving orange juice will provide an acid medium
 Variables with Oral Medications:

 Variable weights and differences in body surface area
 Greater risk for toxic levels which produce untoward effects.
 More rapid intestinal transit time in children under 5.
 Less pancreatic enzymes in infants.
 Immature kidney function in infants

 Variables with Topical Medications

 Topical medications maybe absorbed and have systemic effects
 Larger skin surface area increases amount of absorption
 Plastic diapers can also increase absorption of topical medication applied to the diaper area
 Parental Teaching
 Many times it is the parents who give medications to their children.
 Our responsibility is to adequately teach them to do so safely.
 Must be certain they understand the importance of the safe drug and the correct dose given at
the right time.
 Common measures and Conversions

 Milligrams to grams / grains
 Dram—5 ml
 Ounce—30 ml
 Teaspoon—5 ml
GIVING ORAL MEDICATIONS

 GIVING ORAL MEDICATIONS TO INFANTS
 give with elevated support to head / shoulders.

 Plastic syringes are good to give accurate amount (Calibrated to the one hundredth)
 Depress chin with the thumb
 Give slowly in the side of the mouth
 Allow time for swallowing
 GIVING ORAL MEDICATIONS TO TODDLERS
 Usually helps to have a parent or someone else available

 Letting child handle the equipment helps reduce some fear
 Explain why the medication will help
 Let child hold the medicine cup if he can cooperate
 Don‘t rush the child.
 GIVING ORAL MEDICATIONS TO PRE-SCHOOLERS
 May use chewable as well as suspensions or elixir

 Loose teeth may pose a problem
 Often can cooperate better with parents.
 Letting parents give the medications is acceptable, although nurse is still responsible to
prepare the drug and assist parent in giving it.
 GIVING ORAL MEDICATIONS TO SCHOOL – AGE CHILDREN
 Usually can take pills and capsules

 Need to be encouraged to swallow water immediately
 Ability to cooperate may vary and is often unpredictable—be prepared to allow more time
in giving medications to your pediatric patients
 GIVING ORAL MEDICATIONS TO ADOLESCENTS
 Should be prepared to give explanations to adolescents specific to level of understanding.

 Teach therapeutic effects as well as side effects to report

 Stay with the patient until medications are consumed

 Expect that there may be mood swings
 Consider such adolescent issues as drug addictions or use of contraceptives which may
cause drug interactions.
OTHER ROUTES OF ADMINISTRATION

 Eye drops or ointment
 Instill in lower conjunctival sac
 Ointment from inner to outer canthus
 Nose drops
 With head tilted upward
 Maintain position for 1 minute
 Ear drops—warm first

 Pull pinna down and back < 3 years
 Massage area in front of ear
 Maintain position with affect ear up 5 minutes
 Rectal medications
 Use side lying position
 Insert lubricated suppository up to first knuckle
 Hold buttocks together—1-2 minutes
 Intramuscular Medications
 Fewer medications are given by this route due to potential for pain.
 Medications typically given IM- Vastus Lateralis muscle for newborns, infants and young
children
 Intravenous Medication
Benefits:
 Quick response and effectiveness
 Less traumatic than IM
Concerns:
 Extra caution to watch for irritation to small veins
 Extra caution to check for SDR with direct IV route
Intravenous sites
 Scalp veins best for infants & toddlers
 Other sites—hand, foot antecubital fossa
 Infusion control—fluid overload
o Infusion pumps needed
o Volume control drip chamber needed
SAFE DOSE RANGES

 Important nursing responsibility to determine SDR.
 Most medications are prescribed for each child specifically to his/her weight.
 Body surface area is used to determine SDRs.

 Steps in determining SDR:

 Look up drug reference for recommended pediatric doses.
 Compare to ordered amount for this child
 Evaluation:
 Less than therapeutic
 Safe dose amount
 In excess of safe dose range
 Calculating the safe dose
 Ratio/Proportion
o To make conversions
o To determine amount to give what‘s order
 Desired over Have
o To determine amount to give
 Steps to follow
 Use your nursing drug reference
o By age
o By weight (usually kilograms
 May need to convert pounds to kilograms
o Divide pounds by 2.2 (2.2 lbs / 1 kg)
 Multiply referenced amount of medication by child‘s weight in kilograms
o Reference: 30—50 mg / kg / day
 Compare to Physician‘s order for child
 Example: SDR
 Weight is 22 pounds—10 kgs
 Referenced SDR==30-50 mg/kg/D
 Multiply 10 kg s by 30 and 50
 300—500 mg s / day
 Compare to order: 125 mg po qid
 125 X 4==500 mg per day
 150 mg po daily // 150 mg qid
NOTE:
 Less than therapeutic—give medications and clarify order with physician.
 Within safe dose range---give medication as ordered.
 In excess of safe dose range---withhold medication and clarify order with physician.
TYPES OF ORDER
1. STANDING ORDER
TAB PARACETAMAL 1 TDS
2. P.R.N. ORDER
PT 'S ORDER P.R.N ORDER
TAB PARACETAMAL 1 SOS
3. SINGLE ORDER
ORDER SINGLE ORDER
TAB PHRACETAMAL 1 at 10 A.M
4. STATE ORDER
ORDER
TAB PARACETAMAL 1 STATE
DOSE CALCULATION OF PEDIATRIC MEDICINE
dose formula
formula age surface area
1. Young’s Formula (age) :

Young‘s Formula dose Calculation age
Dose = age of child X adult dose (mg)
age + 12
2. Clerk’s Formula (wt) :

Clerk‘s Formula dose Calculation weight
Dose = weight of child (in pound) X adult dose (mg)
150
3. Percentage Method :
Percentage Method child surface area dose Calculation
Dose = surface area of child X adult dose (mg)
surface area of adult
4. For Fluid :
Drops / min = volume of solution (ml) X Drops Factor
Time of interval
5. Drops :
 10 Drops / ml ( blood set )
 15 Drops / ml ( regular )
 60 Drops / ml ( micro drip )
6. Electrolytes :
 Na+ - 3 mmol / kg / dl
 K+ - 2 mmol / kg / dl
 Ca+ - 3 mmol / kg / dl
7. IV Fluid Therapy :
Neonate ( In 24 hours)
 Age Amount of Fluid (ml)
 Day- 1 60 to 80 ml / kg
 Day- 2 80 to 100 ml / kg
 Day- 3 100 to 150 ml / kg
 Up to 1 month 100 to 150 ml / kg
8. Infant : ( In 24 hours)
Wt (kg) Amount of Fluid

Up to 10 kg 100 ml / kg
10 to 20 kg 100 ml + 50 ml / kg
20 to 30 kg 150 ml + 20 ml / kg
30 to 40 kg 60 ml / kg / day
ABBERAVIATIONS USED IN MEDICINE

COMMON ABRIVATION
NO. ABRIVATION ENGLISH MEANING GUJARATI MENING
1 A.C. BEFORE MEAL

2 P.C. AFTER MEAL
3. A.M. MORNING
4 P.M. AFTERNOOM
5 O.M. EACH MORNING
6 O.D. ONCE A DAY
7 B.D. TWICE A DAY
8 TDS / TID THRICE A DAY
9 Q.D.S. (Q.I.D) FOUR TIME A DAY
10 H.S. AT NIGHT OR AT BED TIME
11 O.N. EACH NIGHT
12 P.RN. WHEN REQUIRE
13 S.OS IF NECESSARY
14 - WATER
15 COMP COMPOUND COMPOUND
16 DIL DILUTE DILUTE
17 ET AND
18 INF INFUSION INFUSION
19 LIN LINIMENT LINIMENT
20 L.Q LIQUID
21 PULV POWDER
22 LOT LOTION LOTION
23 MIST MIXTURE MIXTURE
24 PIL PILLS
25 SP SPIRIT SPIRIT
26 TR OR TICT TINCTURE TINCTURE
27 UNG OINTMENT
28 AA OF ESCH
29 C CENTIGRADE CENTIGRADE
30 C.C. CUBIC CENTEMETER
31 C WITH
32 GM GRAM
33 GR GRAIN

34 GTT DROP
35 MINIM DROP
36 LIBILBS POUND POUND
37 S WITH OUT
38 SS HALF
39 TSP TEA SPOON FULL
40 TBSP TABLE SPOON
41 OZ OUNCE OUNCE
42 I.V. INTREAVENOUS INTREAVENOUS
43 S.C. SUBCUTANEOUS SUBCUTANEOUS
44 PR PER RECTUM PER RECTUM
45 PV PER VAGINA PER VAGINA
46 I.M. INTRA MUSCULAR MUSCULAR
47 CM -
48 STAT AT ONCE
49 CAP. CAPSULE
WEIGHT AND MEASURE MENTS
60 GARIM 1 DRAM
8 DEAM 1 OUNCE
16 OUNCE POUND
1 DRAM 4 GRAIN
1 DRAM 4 M.L.
1 DRAM TEA SPOON FULL
60 MINIMS 1 DRAM
1 TEA SPOONFUL 4 TO 5 ML
1 TABLE SPOONFUL 3 TEA SPOON
1 TABLE SPOONFUL 15 ML
1 TABLE SPOONFUL 1/2 OUNCE
1 GLASS FUL 8 OUNCE OR 22 ML
1 OUNCE 30 GM OR 30 ML
OR 8 TEA SPOONFUL
OR 8 DRAM OR 480 GRAIN
1 LITRE 1000ML OR 2 PINT, 1 QUART
1 K.G OR 40 OUNE 1000 G.M., 2.2 LBS
1CC 1 ML OR 15 MINIMS
60 MICRODROPS
1 MINIM 1 DROP
1 500 ML

CARE OF CHILD IN INCUBATOR

CARE OF CHILD IN INCUBATOR :
Incubator mechanical device new born nsg care stable,
warm, humidify & safe environment baby ideal micro environment
apparatus high risk new born care
PURPOSE / FUNCTION OF INCUBATOR :

 To provide safe isolation
 To provide humidity
 To maintain temperature
 To prevent infection
 To administer of O2
 For easier observation of baby
 Easy to assess baby for all Nursing procedure
TYPE OF INCUBATOR:
1. Open incubator / Radiant warmer :
Radiant warmer baby warm micro environment
infant heat loss baby
assess evaporative heat loss
2. Close incubator :
Isolate incubator enclosed box like environment incubator servo
control maintain skin sensor umbilicus abdomen skin
temperature (36.5 to 37.5 ) incubator set
incubator visual audio alarm system O2 & humidity set
PURPOSE OF CLOSE INCUBATOR:

 Baby complete aseptic precaution care infection prevent
High risk & cut risk new born nurses care

New born adequate rest
Baby incubator warmth & humidity settling
Baby neutral thermal environment baby heat loss & heat production
maintain
PREPARATION OF THE PATIENT & ENVIRONMENT:
 Baby incubator need
 Incubator soap & water clean 20% antiseptic solution disinfect
 Humidity tank sterile distill water & incubator 60% humidity maintain
 Power on temperature 30 c set target

maintain
 O2 inlet O2 supply 35% O2 Concentration maintain

 Baby diaper cloth baby

 Check the temperature of newborn every hour .
EQUIPMENT:
 Humidity tank
 Incubator tray c firm mattress
 Small white sheet
 O2 inlet connected to the central supply of O2
 Port holes for nursing the baby
 Skin sensor problem
 Audio visual signal alarm
 Indication of power supply
PROCEDURE
 Baby handling policy dress
 Baby handling hand wash
 Part holes through nusing care
 Incubator temperature maintain
 Baby flow chart monitor temperature heart rate , respiration & O2
 Saturation record
 Baby basic need proper time planning
 Procedure properly hand wash
DAILY CARE OF INCUBATOR

 Micro organism growth prevent 24 hours humidity tank water change
 Baby clothes regular changes

 Disinfectant daily incubator clean
 Day change
TERMINAL CARE OF INCUBATOR

 Power of Part detach
 Wash the soap & water
 Humidifies Completely Disinfectant
 Basin clean Disinfected
 Incubator baby culture & sensitivity swab
NASOGESTRIC FEEDING
patient Nasal tube inset feed

Nasogestric feeding
PURPOSE:
 Pt
 Pt. swallowing difficulty

 Mouth & throat surgery
 Fracture jaw case
 Patient unconscious
 Premature baby swallowing weak
PRECAUTION:
1. Doctor order noel feeding
2. Patient & relatives procedure
3. Patient denture remove
4. Tube lubricant lubricate
5. Tube force
6. Feeding air stomach
7. Tube remove pinch gently & quickly remove fluid trachea
PURPOSE:
 Nostril moist lotton clean
 Generally 5 to 12 Do tube use
 Tube distance measurement Nose ear lobe ear lobe xiphisteanum
measurement
 Tube 6 to 8 inch tip lubricant lubricate mucus membrane
irritate
 Nose tip thumb upward press tube nostril tube
backward downward direction nose pharynx
tube insert
TUBE STOMACH CHECK TEST :

 Syringe aspirate gastric content tube stomach
 Tube ear water boil bubbles tube trachea
immediately remove

 Mouth & throat check Patient trachea tube patient
FEEDING THOROUGH THE NASOGESTRIC TUBE:

 Requirement feeding
 Tube position check
 Syringe barrel tube attach Feeding stomach content aspirate
Residual food poxes food adjust signal
 Feeding record & report Feeding syringe barrel use Barrel
stomach level 15 to 20 cm food flow slowly
 Air stomach
 Feeding 1 to 3 ml water tube introduce tube clean
tube clamp
AFTER CARE:
 Syringe clamp
 Mouth wash
 Patient comfortable position
 Tray utility room Articles clean 4 feeding
 Hand washing
GASTRONOMY FEEDING
DEFINITION:- Gastronomy Jejunostomy feeding Abdominal well opening

stomach jejunam surgical opening Fluid Administration method
gastrostomy feeding
PURPOSE AND INDICATION:

 Patient nutritional status maintain
 Infant esophageal Artesia Indicates
 trachea – esophageal fistula
 child Artificial feeding
ARTICLES:
 Feeding syringe 60 to 100 ml
 Disposable Gavage bag and tubing
 Iv Stand
 Feeding material
 Administration set
 Gloves pair
 Stethoscope :- Bowel sound
PROCEDURE:
 Doctor instruction order patient confirm

 Feeding bowel sound

 Gastronomy / Jejunostomy GL HuIFV[ skin Breakdown VG[ drainage
check
 Hand wash
 Patient procedure explain
 Bag tube connect bag fill tube feed connect
 Patient fowler‘s position
 Patient Head 30. Elevate
 Gastric tube check
 feeding gastronomy tube proximal end clamp syringe tube end
patient Abdomen 18 Inches Elevate Syringe formula
 Gavage bag use feeding tube end connect bag

patient Abdomen 18-20 Inches Beg slowly
 feeding continuous gastronomy tube proximal end bag end
connect gavage bag Iv stand
 Tube skin clean and dry water proof ointment zinc oxide
skin Hydrocoric acid skin irritation protect
 Skin integrity infection stoma Regular observe

 Waste properly discard Art ides clean
 Procedure Record and Report
GASTROSTOMY CARE
OBJECTIVES
1. Identify gastrostomy tube (GT) .

2. List the indications of gastrostomy tube (GT).
3. Enumerate advantages and disadvantages of gastrostomy tube ( GT ).
4. Apply gastrostomy care to the patient.
5.
DEFINITION OF GT
Placement of feeding tube through the skin and stomach wall directly into the stomach.
INDICATIONS
1. Prematurity.
2. Sever cerebral pulse.
3. Burns.
4. Head trauma.
5. Gastrointestinal disorder.
6. Sever refusal to eat food.
7. Sever food allergy.
8. Sever cleft lip / cleft palate.
9. Cancer.

ADVANTAGES OF GT
 The ability to provide additional food
and calories .
 No nasogastric tube is needed.
 Less time spent giving feeding.
 Feeding can be done at night when child is sleep.
 Dose not interferes with daily activities.
 Less chance of tube coming out.
DISADVANTAGES OF GT
 Infected.
 Lack.
 Irritated.
 Malfunctioning.
GASTROSTOMY CARE
 Purposes :
 Promote healing and prevent skin breakdown.
 Provide comfort.
 Teach child/parent self care.
 Procedure of GT Care
 Introduce yourself.
 Prepare equipment.
 Explain procedure to the child and his parent
 Maintain privacy.
 Put on non sterile gloves.
 Assess the child into comfortable supine position.
 Remove old dressing and discard in appropriate waste container.
 Pour normal saline for newly placed tube into a medicine cup , wash around stoma; use
betadine for healed site.
 If the skin become red, irritated, clean site with hydrogen peroxide.
 Rinse insertion site with sterile solution (saline) and gauze.
 Dry insertion site with gauze.
 Apply skin barrier or antibiotic ointment around site.
 Apply dressing around and secure loosely with tape.
 Secure tube to skin on abdomen at another site with tape.
 Discard used supplies.
 Keep child in comfortable position.
 Wash hand.
 Document the procedures.

ADMINISTRATION OF AN ENEMA
OBJECTIVES
 Define the enema.
 Enumerate the purposes of using an enema.
 Assess the patient conditions before administering enema.
 Ability to administer enema for the patient.
DEFINITION OF ENEMA
An injection of a liquid through the anus to stimulate evacuation; sometimes used for
diagnostic purposes
ASSESSMENT
 Last bowel movement, amount , color and consistency of feces.
 Presence of abdominal distension.
 Use toilet or commode or must remain in bed anduse a bedpan.
 Has sphincter control.
PREPARATIONS
 Lubricate about 5 cm of the rectal tube.
 Run some solution through the connecting tube of a large volume enema set and the
expel any air in the tubing.
PROCEDURE
 Introduce your self
 Identify the patient identity.
 Explain the procedure to the client.
 Wash hand.
 Provide patient privacy.
 Assist adult patient to left lateral position with the right leg acutely flexed as possible.
 Put the disposable linen under the patient buttocks.
 Insert the enema tube.
 Left the upper buttock .
 Insert the tube smoothly and slowly into the rectum, directing toward the
umbilicus.
 Insert the tube 7 to 10 cm.
 Ask the client to take deep breath and run small amount of solution through
the tube.
 Never force tube or solution entry.
 Slowly administer the enema solution.
 Raise the solution container and open clamp.
 Or compress a pliable container by hand.
 Hold or hang solution container no more than 30 cm above the rectum.
 Administer the fluid slowly.
 Close the clamp, and remove the enema tube from the anus.
 Place the enema in a disposable towel as you withdraw it .

 Encourage the patient to return the enema.

 Ask the client to remain lying down.
 Request that the patient return to the solution for appropriate amount of time.
 Assist the patient to defecate.
 If a specimen of feces is required, ask the client to use bedpan or commode
ADMINISTRATION & ANALYSIS OF O2 CONCENTRATION
Inspired air O2 respiratory center depressed lung level gas

exchange O2 therapy drug
O2 Administration illness respiratory disease
Common procedure breathing discomfort
nurse assessment & Observation skill O2 need
trichinae, cyanosis hypoxia suffer O2
PURPOSE OF O2 THERAPY / ADMINISTRATION :

 To correct hypoxia
 To increase O2 tension of blood plasma
 To restore the hemoglobin in RBC
 To maintain the ability of body cells
 To carry on normal metabolic Function
ASSESSMENT OF NEED FOR O2 THERAPY / ADMINISTRATION:

 Respiratory distress & hypoxia symptoms observe
o Inadequate breathing pattern
o Labored respiration
o Cyanosis
o Restlessness
o Lathery
 Arterial blood gas analysis PaO2, Pa CO2, PH value, HCO3 observe .
 Pulse Oxymatory level
 Inspired O2 concentration measuring .
O2 REQUIREMENT :
 Infant - 1lit / min
 Young child - 2 lit / min
 Elder Child - 4 lit / min
METHOD OF ADMINISTRATION OF O2 :
1. Nasal catheter: Method catheter potency check
4 – 6 no catheter Naso pharynx 7.5-10cm catheter
insert catheter insert flow rate adjust 8 catheter change
O2 humidity water bottle nasal
catheter 50% O2

2. O2 by Mask: Size mask O2 nose & mouth cover

size mask mask remove face clean replace
3. method 100% concentration O2 method infant 1-2lit /

min & child 2-3lit /min O2
4. O2 by Tent: O2 Tent plastic material O2 absorption

O2 Tent O2 flow patient face O2 6 - 8 lit
tent O2 circulate 2 – 4 lit / min O2 adjust
O2 concentration 40%
5. O2 by Hood: Infant head fit box transparent & plastic

material 100% O2 neonate 1.5 lit/min & older
child 2 lit/ min O2
6. O2 through Incubator :Incubator humidifier O2 tube
PRECAUTION TO BE TAKEN:
 O2 drug use rate concentration & duration
 humidifier & regulator use

 O2 room temperature
 O2 40% to 50% concentration
 Doctor order baby condition
 O2 therapy gradually
 Fire hazard electric equipment O2 sources
alcohol oil use
EQUIPMENT:
 O2 supply
 Flow meter
 Humidifier
 Method
PROCEDURE:
 Procedure parents
 Comfortable position
 Doctor order flow rate concentration, humidification O2 supply
 Observation skin color, respiration rate, rhythm &
complication watch

COMPLICATION OF O2 THERAPY :
High Concentration
 Irreversible brain Damage
 Retinopathy of Prematurity
 Ratrolental Congestion
 Bronchiolar Edema
 Bronco pulmonary Dysplasia
 Respiratory Depression
Long term complication

 chronic pulmonary Disease
 Seizure Disorder
 Epilepsy
EXCHANGE BLOOD TRANSFUSIONS
Sever hyperbilirubinemia, kernicterus correct anemic prevent Billirubin

level effective method phototherapy fails method Billirubin
toxic level
COMMON INDICATION FOR BLOOD TRANSFUSION:
 Rh – hemolytic disease new born EBT

 cord blood hemoglobin 10 gm/dl
 Cord blood Billirubin level 5 mg/dl
 Unconjugated serum Billirubin level 10 mg/dl 24 hours 15 mg/dl 48 hours 0.5
mg|dl per hours
 High risk neonates prenatal hypoxia, hypothermia, acidosis, hypoglycemia
asepsis
 Lower serum Billirubin level Relatively Exchange Transfusion
 Preterm infant Billirubin 10-18 mg/dl lower Exchange
 ABO incompatibility, severe hyper bilirubinemia , indirect serum Billirubin level 20
mg/dl Billirubin more Neonatal period protein ratio 3.5 EBT
 Reticulocytes
NATURE AND AMOUNT OF BLOOD FOR EBT :
 In Rh- iso immunization Rh negative, ABO compatible blood is used.

 In ABO in – compatibility O group, Rh – compatible blood is used.
 72 hours fresh preferred blood collected

NEEDED ARTICLES:
 Blood exchange transfusion kit containing – bowel, kidney tray, suture scissors,
toothed forceps, curved, mosquito forceps, dressing forceps, surgical towel, suringe
10 and 20 cc, pads and bandages.
 Dressing pack.
 Sterile scalped blade.
 I. V. stand.
 Injection – Heparin & normal saline.
 Resuscitation equipments.
 Oxygen sources
 3 or 4 way stopcock.
 Umbilical vein catheter.
 Gloves and mask.
 Specimen container
 Cord tie
 Scissors to cut the adhesive plaster
 Emergency drugs – Adrenalin, calcium gluconate inj aminophylline.
 Fresh blood for transfusion.
CARE AND PROCEDURE:
 Parents care procedure properly explain
 Parents written consult
 Donor blood properly cross match
 Blood fresh 5 days (old)
 Procedure 4 hours NPO maintain
 Cross splint baby immobilize
 Dressing pack umbilical stump clean
 Sticky bowl saline hearing
 Skin surface 25 cm umbilical cord cut
 Vein catheter insert ligature
 Air embolism procedure donor blood catheter fill
 Adhesive tape catheter fix
 Transfusion start
 Catheter insertion central venous pressure record
 Vital sign baby condition check
 Procedure blood sample blood Hb level Billirubin level check
 Catheter remove umbilicus cord tie tincture benzoic umbilicus

apply Gauze apply Adhesive tape
 Wash report proper
 Recur Report proper

NOTE:
 Blood slowly inject infants body temperature warmer
 Fresh heparin zed blood use
 20 – 30 ml blood with draw 10 – 20 ml blood time replace
 Radiant warmer baby transfer
 Bleeding umbilicus observe
COMPLICATION OF BLOOD TRANSFUSION:

 Umbilicus Vein Perforation
 Cardiac Arrest
 Hypoglycemia, Hypocalcaemia
 Bacterial Sepsis
 Metabolic Acidosis
 Thrombocytopenia
DELAYED COMPLICATION:
 Extra hepatic portal Hypertension
 Portal vein thrombosis
 HIV
 Hepatitis B.
 E infection
 Ulcerative colitis etc.
IMMOBILIZATION OR RESTRAINTS
 Restraints child movement limit protective measure

 Restraints short term & long term
 Restraints examination procedure injury
physical movement limitation
PURPOSE
 child safety
 physical examination diagnosis procedure specimen collection
discomfort facilities
 healing
GENERAL PRINCIPLE FOR USE OF RESTRAINTS OR PRECAUTION

 Restraints use
 appropriate safe comfortable Restraints select
 Restraints
 skin protect adequate pad apply
 Restraints 15- 30 min check hazard

 Restraints child injury observe

 2-3 Restraints relive
 Restraints knot tight
 Restraints tight side rail bed from

 Routine skin care
TYPES OF RESTRAINTS
1. Mummy Restraints: Short term type Restraints infant small child head
& neck procedure Rx Restraints sheet blanket
use side
2. Modify mummy Restraints: Modify mummy Restraints chest abdomen

procedure
3. Elbow Restraints: Restraints elbow flexion elbow

extant face Restraints I / V, S / C infusion ryles
tube feeding, face surgery cleft palate cleft lip repair face
Rx
4. Leg Restraints: Elbow Restraints leg movement limitation
5. Clove hitch Restraints: Restraints arm / leg immobilize pad

apply Restraints Restraints figure of eight
Restraints circulation obstruction
6. Jacket Restraints: Restraints bed supine position flat

Jacket
long tapes cot frame wheel chair frame
7. crib top Restraints: Crib top cot fix bed area

Restraints
8. Abdominal Restraints: Restraints supine position

Restraints abdomen respiratory movement
Restraints abdomen
9. Mitten or Finger Restraints: infant Restraints use

Restraints guess piece bag cover

wrist Restraints self

injury prevent burns, facial injury & operation
HAZARDS OF RESTRAINTS
Restraints
 brachial plexus injury
 sore or gangrene
 Exhaustion & loss of energy
 Dislike for the hospital health team members
 Restraints macular strength & flexibility
 Motor & psychological skill development
PHOTOTHERAPY
Cremer at all (1958) jaundice baby skin (yellow pigmentation)
& serum billirubin baby sunlight blue light use indirect
billirubin skin superficial blood vassels water soluble (direct billirubin)
kidney excrete
PROCEDURE METHOD :
 remove Phototherapy unit
male baby diaper
 baby eyes cover
 baby turn
 light 45 cm – 75cm baby
 baby Phototherapy fluid intake
over heating & exposer & looser stool
Fluid loss
 Baby body temp. monitor normal
 hydration status monitoring maintain

 serum billirubin & HB blood level monitor
 Intermitted breast feeding
 Phototherapy 2 – 3 days
 General Routine care , Hygienic Care
OBSERVATION:
 Body Temperature
 Hydration Status
 Loose motion
 Serum Billirubin & HB blood level
DURATION:
 Duration billirubin blood level

 2 – 3 days
 Therapy billirubin slightly rebound
COMPLICATION:
 Hyperpyrexia
 Dehydration
 Irritability
 Transient skin rash
 Kernicterus
 G.I. Effect
 loose motion
 Retinal Damage
 Bronze Baby Disease
CARE OF BABY IN RADIANT WARMER
 Radiant warmer electronically based devises body temperature maintain
 Radiant warmer baby warm micro environment Infarct

heat loss baby assess
evaporative heat loss
PURPOSE:
 Birth body temperature maintain
 Child proper light source observe
 Any obstruction any synoptic episode case baby resuscitation
suction
 Medication introduce
EX = I/V administration
INSTRUMENTS:
 Mattress and platform = Baby place
 Side rails = Baby
 Light sources = Baby examination
 I / V Stand =
 Side tray = Skin temperature maintain or set alarm and Irradiators
of power and on & off
 Warmer Filaments or rods = Baby warm
Baby radiant warmer care :

 Doctor order Instruction check
 Baby warm doctor prescribe temperature set
 Side rails properly mattress
 Baby observation light observe
 Baby Feed provide dehydration

 Hand washing child
 Time to time diaper charge
 High risk & cut risk New born Nurse care
 New born adequate rest
 Skin sensor umbilicus abdomen skin
temperature (36.5 to 37.5) incubator set
 Check the temperature of new every hour, and records maintain of the 6 hourly
CAUTION:
 manual mode infant left unattended
 Radiant warming water loss fluid balance maintain
 No naked flame and no smoking
FOR DISINFECTION:
 Daily clearing of panel use damp cloth soaked in mild detergent
 Do not use spirit or other chemicals
CARE OF CHILDREN UNDERGOING SURGERY
PREOPERATIVE NURSING CARE

 Admission
 Psychological Support
 Discuss about surgical procedure to parents and child.
 Investigation
 Diet / NBM
 Drugs
 Written Consent
 Physical Care
 Skin Care
 Elimination
 Sedatives
 Financial aids
 Care of the patient on the day of the Operation
 Preoperative Medication
 Charting & Reporting
 Transporting patient to the Operation Theater
CARE OF THE PATIENT IN OT

 Reception
 Anesthesia
 Position
POST-OPERATIVE NURSING CARE

 Transportation

 Bed
 Position
 Maintenance of pulmonary Ventilation
 Observation
 Manage Post operative comfort
 Follow Post operative order
 Manage Post operative Complication
 Continuous observation
 Post operative medication

BABY BATH
 Charting & Reporting
Procedure baby skin Luke warm water clean
PURPOSE:
 Skin clean skin integrity increase.
 To increase and maintain the proper blood circulation.
 To maintain the temperature at normal level.
 Skin infection prevent
 To improve the skin function and fragrance.
ARTICLES:
 A jug with hot water and one jug with cold water.
 Bath tub or bath basin.
 Two bucket
 Bath towel or bland baby
 Mackintosh
 towel baby baby
 Soap
 Baby cloth
 Bath thermometer
 Slab sticks
 Kidney tray and paper bag
 Screen (Baby age )
COMPLICATION:
 Hypothermia
 Convulsion
 Bronchopneumonia
 Congenital cyanotic heart disease
 Critical illness
 Premature intents
TYPE OF BATH:
A. Sponge Bath: - bath child sick bath bed

Soft sponge cloth use normal temperature maintain
B. Tub Bath:- hospital common bath Bath tub basin baby
C. Lap Bath:- Mother Lap Baby bath tub bath possible

Rural area mother bath use
D. Oil Bath:- Baby body Oil apply Vernix caseosa remove

bath Premature baby body temperature maintain oil
temperature increase
PROCEDURE:-
 Mother procedure explain
 articles side .
 Check intent‘s temperature.
 Turn off tan
 Check the temperature of water.
 Baby draw sheet
 2 boiled cotton swab, squeeze, baby eyes clean colon swab
inner surface touch
 Baby mouth water face clean
 Dry towel face clean shop water use
 Swab sticks nostrils clean single stick use nostrils
stick use
 First TM arm 5Z gently shop apply long strokes
 gently shop clean Sponge cloth use
 Bath towel arm dry
 clean
 Apper half body baby G[ cloth
 water change temperature maintain
 distant lag clean nearest leg clean
 Lastly princel clean groins skin folds special attention
 Baby Dry clothes
 Articles replace
 Time infant condition check
 Restricted bath mother baby feed
IMNCI
IMNCI is an integrated approach to child health
DEFINITION:
It is focuses on the well being of the whole child. It focused primarily on the most
common causes of child mortality (diarrhea, pneumonia, measles, malaria, and malnutrition,

illness) affecting children aged 1 week – 2 months, 2 months -5 year including both
preventive and curative elements to be implemented by families.
BENEFICIARIES OF IMNCI
 care of young infants for new borns(under 2months)
 young children(2months-5yrs)
GOAL
To assess current statues of child survival indicators and process indicators for
existing programmed activities in intervention and compassion districts.
OBJECTIVES
 To determine baseline mortality among children under 5yrs of age (NMR,IMR,)
 To determine prevalence of fever, loose stools, cough and any other illness (morbidity
density) in two weeks prior to day of field survey among children under 5yrs of age.
 To assess effective programme coverage for specified disease condition (cough with
fast breathing ) occurring in two weeks prior to day of field survey
 Causes of under 5 mortality and path way analysis of events prior to death and
recovery of sick under 5children
 Sickness management practices at household, community level and health facility
level.
 Sickness and care providing competence is of health care providers (doctors, health
workers and other community level non convectional service providers)
 Health system support for man power, logistics, referral mechanism, inter sectoral
coordination, Social mobilization and monitoring and supervision.
COMPONENTS
 Case management skills
 Improvement in overall health
 Improvements in family and community health care practices
IMPLEMENTATION OF IMNCI
- Adopting an integrated approach to child health and development in the national
health policy.
- Adapting the IMNCI clinical guidelines to countries needs, available drugs, policies
and to the local foods and language used by the population.
- Upgrading care in local clinics by training health workers in new method examine
and treat children and to effectively council parents.
- Making up grade care possible by insuring that enough of the right low-cost
medicines and simple equipment are available.
- strengthening care in hospitals for those children too sick to be treated in an
outpatient clinic developing support mechanism within communities for preventing
disease, for helping families to care for sick children and for getting children to
clinics or hospitals when needed.
PRINCIPLES
 All sick young infants up to two months must be assessed for bacterial
infection/jaundice and major symptoms of diarrhea

 all sick children 2months to 5yrs must examine for general danger signs which
indicate the need for referral or admission to a hospital
 all young infants and child 2months-5yrs of age must be routinely assessed for
nutritional and immunization status, feeding problems and other potential problems
 Only a limited number of carefully selected clinical signs are used based on evidence
of drugs sensitivity and specificity to detect disease.
 A combination of individual signs leads to an infant or Child classification rather than
diagnosis.
CLASSIFICATION ACCORDING TO COLORCODECOLOR

 Pink
 Yellow
 Green
TRAINING IN IMNCI
 Training is at 2 levels
 In-service training for the existing staff
 Pre service training
CARE OF CHILDREN ACCORDINGTO IMNCI

 0-2 MONTHS
- Keeping the child warm
- Initiation of breast feeding.
- Counseling for exclusive breast feeding.
- Cord, skin and eye care.
- Recognition of illness in newborn and management and/referral.
- Immunization
- Home visit in the post natal period.
 2MONTHS-5YRS
- Management of diarrhea, ARI, malaria, measels, acute ear infection, mal nutrition
and anemia.
- Recognition of illness and risk.
- Prevention and management of iron and vitaminA deficiency
- Counseling on feeding for all children below 2yrs.
- Counseling on feeding for malnourished.
- Immunization
CONCLUSION
 IMNCI strategy has emerged as a promising approach to deal with children‘s health
 Major strength is it use evidence with issues related to child survival.
 This approach could help country to based management decisions to achieve
millennium goal.















UNIT – 5
Behavioral disorder and
Common health problems
 INFANCY :
 Nutritional Disturbances
 Allergies
 Dermatitis
 Vomiting
 Diarrhea
 Failure to Thrive
 Resistance to Feeding Colic
 Anxiety
 EARLY CHILDHOOD :
 Communicable Disease
 Poisoning
 Tonsillitis
 Otits Media
 Urinary Tract Infection
 Diarrhea
 Child Abuse
 Breath Holding Spells
 Bed Wetting
 Thumbs Sucking
 Nail Biting
 Temper Tantrums
 Masturbation
 MIDDLE CHILDHOOD
 Helminthes infestations
 Common skin Infection
 Animal & insect Bites
 Stuttering
 Pica
 Tics
 Antisocial Behavior
 Enuresis
 LATER CHILDHOOD :
 Problems of pubertal Development
 Precocious Puberty
 Tall Stature
 Gynaecomastia
 Acne
 Amenorrhea
 Dysmenorrheal
 Sexually Transmitted Disease
 Accident
 Sports Injury
 Juvenile Delinquency
 Anorexia Nervosa
 Obesity

INFANCY
Behavioral disorder and common health problems of infant
RESISTANCE TO FEEDING OR IMPAIRED APPETITE
Infancy weaning feeding problem

anxiety, weaning food test food refuse
force indigestion colic problem
condition anxious reassurance advice
weaning reschedule taste
separation
ABDOMINAL COLIC
cause colic infant problem

birth first week 4–6week 3–4
colic parents over

stimulation & infant over active hunger improper feeding
technique intestine immaturity cow‘s milk allergy food
carbohydrate gas formation
mother anxiety tension baby upright
position baby burping psychological bonding rule out
doctor advice
Antispasmodic drug feeding
STRANGER ANXIETY / SEPARATION ANXIETY
Infancy satisfaction of need, feeling of comfort , pleasure & securities

mother mother infant mother
trust relationship develop
Mother infant approach infant

anxiety infant
Relationship develop infant stranger anxiety

NUTRITIONAL DISTURBANCE
PEM (PROTEIN ENERGY MALNUTRITION)
PEM common nutritional problem lack of Proteins & Energy

(calories) result PCM (Protein Calories Malnutrition )
PEM Clinical Condition group
CLASSIFICATION:
PEM Classification
 Syndrome Classification:
- Kwashiorkor
- Nutrition Marasmus
- Pre Kwashiorkor
- Nutrition Dwarfing
 Classification by Indian Academy Of Pediatrics (IAP):

- Normal :- 80% of expected weight
- Grade – I :- 80 - 70 % of expected weight
- Grade – II :- 70- 60 % of expected weight
- Grade – III :- 60 - 50 % of expected weight
- Grade – IV :- less than 50 % of expected weight
 Gomez Classification :
- First Degree :- weight between 90 -75 % of expected
- Second Degree :- weight between 75 -60 % of expected
- Third Degree:- weight blow 60 % of expected
CAUSES:
- Low Socio Economic Status
- Maternal Malnutrition
- Infection
- Poor Hygiene – Warm Infestation
- Ignorence
- Wrong Child Feeding Practice
S / S:
 NUTRITIONAL MARASMUS:
 infant toddler
 body weight 60%
Causes:
- Inadequate Diet
- Congenital anomalies – cleft lip & palate
- Starvation
- Vomiting & Diarrhea
- Food Allergy
- Anorexia due to infection
- Emotional Problems child mother relationship disturbance
- Artificial Feeding & Formula Feeding
Classification:
Grade - I or + :- Axilla & groin fat loss
Grade - II or ++ :- Axilla & groin, abdomen & gluteus region fat loss
Grade - III or +++ :- Grade –I + II + chest & spine fat loss
Grade - IV or ++++ :- I + II + III + buccul mucosa fat loss
S / S:
- Muscle Wasting & S/c Tissue wasting
- Failure To Thrive
- Less growth & progress
- child irritable & weak
- weak cry
- Growth Failure :
- Normal child 50%
- watery Diarrhea & Dehydration
General S / S:
- Tooth Less
- Old men Shape Face
- Hand & Leg Thin , abdomen big
- Abnormal Vital Sign
- Grade I & II active
- Severe grades infection less active
- Anorexia
- Plasma Protein reduce
 Pre - Kwashiorkor :
Poor nutritional status & features of Kwashiorkor but no edema Present
 Kwashiorkor :
1933 British physician Dr. Cicely Williams‘s
1935 Kwashiorkor Red Haired Boy
Nutritional Deficiency Condition Mostly preschool &
school child Protein level sever S / S
weaning complimentary food proper Diarrhea & GI track
problems, uneducated parents, ARI etc
S / S:
- Pitting Edema : Intra cellular fluid accumulation hypoalbuminia,
Capillary permeability cell membrane damage pitting edema

Lower limb face
- Growth Failure
- Muscles Wasting
- Psychomotor changes
- Mental Capacity
- environment interest
- Lethargy
- Dullness
- Loss & appetite
- Irritability
Skin Changes:
- Skin thick & Glossy
- Easily break & sore
- Dermatitis
- Blisters
- Flunky Paint
Hair Changes:
- Light color / Red / Brown
- Thin Dry
- Alopecia
- Puffy Face
PREVENTION OF PEM:
PEM problem prevention different approaches
1. Health Promotion
- Health improve
- Healthy Pregnant & Lactating mother
- Promotion of Exclusive breast feeding
- Proper Weaning practice & necessary nutrition supplement
- Balance Diet for mother & child
- Nutritional education & counseling
- Supplementary Nutrition
- Healthy Environment of Family
2. Specific Protection
- Age Diet
- Immunization
- Treatment of Disease
- Promotion of Hygiene
3. Early sis & Rx :

- Periodic Health Check Up
- Growth Chart maintain
- Detection Of Failure to Thrive
- Implementation of Nutrition Program me
4. Rehabilitation :
- Nutrition Rehabilitation services
- Hospital management Of PEM cases
- Follow Up Care
MANAGEMENT OF PEM:
- Nutrition Rehabilitation
- Hospitalization according to severity
- Continuous Observation, Weighting, Growth chart maintenance
1. Calories
daily 100 Kcal / kg / day 150 Kcal / kg / day
(Normal 1.5
2. Protein
Normal protein double protein 2 – 3 g / kg / day to
4 – 5 g / kg / day Fluid intake 100 – 125 ml / kg / day
3. Electrolyte
Potassium chloride ( KCL) 2-4 gm, Magnesium chloride 0.5gm, regular
2 week
4. Vitamins
vitamin mainly vitamin – A 5000 IU single dose daily
5000 IU
5. Anemia
Ferrous ammonium citrate (0.6gm) syrup form 3 time / day. FA 1gm 1
week 100mg 1 month
- Iron Vitamin – B Complex
- Intensive Feeding
- Emotional & psychological Support
- Home care training for patients
- Regular Medical Check up
- Can Recover within 6 – 8 week but depends on grade
COMPLICATION OF PEM:
1. Acute:
- Local systemic Infection
- Severe Dehydration
- Shock
- Hypoglycemia
- Hypothermia
- Bleeding Disorder
- Hepatic Disfunction
- Convulsion
2. Long Term:
- Cachexia
- Growth Retardation

- Mental Retardation
- Visual & Learning Disabilities
DIET PLAN FOR CHILD PEM:

According to age & weight it should be calculated.
- Body weight - 12 kg
- Calorie - 17 Kcal
- Protein - 50 -60gm
Food Diet 1 – 10 day Diet 11– 30 day

Milk 1000ml 2000ml
Sugar 100gm 100gm
Dextrimeltose 50gm 50gm
Banana 150gm 150gm
Bread & biscuit 25gm 10-100gm
Vitamin - C & milk according to need & Other Supplementary if prescribed
NURSING RESPONSIBILITIES FOR THE MANAGEMENT OF PEM PATIENT:

- Assess Nutritional Status
- Diagnosis & investigation
- Proper management
- Diet Plan
- Growth Chart Maintain & Observation
- Follow up
- Education
- counseling
- Preventive Measures
- explanation Nutritional Programmes
VITAMINS & THEIR DEFICIENCY DISORDER
1. VITAMIN - A DEFICIENCY (XEROPHTHALMIA):

S / S:
- Night Blindness: Dim light
- conjunctively Xerosis: Conjunctiva dry
- Bitots Spot: Conjunctiva spot laterally
color black
- Corneal Xerosis: Corneal bright , dull & ground glass
- Keratomalacia: Xerophthatmia primary & dangerous sign cornea very
soft & raw easily infection complete blindness
CAUSATIVE FACTORS:
- Dietary inadequacy of Vitamin - A
- Maternal Malnutrition

TREATMENT:
- In severe case: Vitamin – A 2 lakh IU 1 lakh IU
- In mild case: Capsule Vitamin – A 1 Od for 30 day
PREVENTION:
- immunization schedule 9 month to 12 month Vitamin – A first
dose 2 lakh IU 6 month 1 lakh IU dose 5 year age 9
dose
- Green leafy vegetable, Fruits ( yellow color) liver, Fish live, oil, Milk , Butter Ghee ,
Egg Yolk , Cheese & Roots ( carrot )
- Vitamin – A health Education
2. VITAMIN - D (Eargocalciferol / D2, D3) DEFICIENCY: (RICKETS)

CAUSES:
- lack of vitamin – D in the diet
- lack of exposure of sunlight
- Disease calcium & vitamin –D absorption & metabolism
S / S:
- Teeth
- Body weight bone
- Knee (knock – knee )
- Spine ( Kyphosis - scoliosis)
- Pigeon Chest
- Anterior fontanels close
- Calcium & Phosphorus metabolism disturbance bone ossification
disturbance
- Late Mental Development
- Recurrent Cuttack‘s of Respiratory infection
TREATMENT:
- Vitamin – D Preparation ( 4 week )
- Tab. Calcium
PREVENTION:
- sunlight expose
- Vitamin – D Diet & cod liver oil
3. VITAMIN - E DEFICIENCY (TOCOPHEROL) :

S / S:
- RBC easily rupture
- Body muscles degeneration
TREATMENT & PREVENTION:

- Vit.– E Diet Yellow part of egg , green leafy vegetables

4. VITAMIN - K DEFICIENCY :
S / S:
- Blood clotting process
- Blood clotting
- Liver Function disturb bile secretion disturb
PREVENTION:
- Vitamin - K diet, dark green color vegetable
5. VITAMIN - B DEFICIENCY ( THIAMINE ) :

- Vitamin dry & wet beri beri
S / S:
DRY BERI-BERI:
- leg weakness
-
-
-
- weight loss
- muscles wasting
- complete bed ridden
- Peripheral neuritis
- constipation
- Hoarseness
-
WET BERI-BERI:
- Cardiac involvement
- CCF
- Dyspnea
- Cyanosis
- Tachycardia
- Edema
- Hepatomegaly
TREATMENT:
- inj. thiamine 25mg I/M
- Mild cose tab. thiamine 25mg orally
PREVENTION:
- vitamin – B diet cereals , pulses, dry nut , oil seeds
6. VITAMIN - B2 DEFICIENCY ( RIBOFLAVIN ) :

S / S:
- Angular Stomatitis
- Cheilosis (fissuring of lips )
- Glossitis
- Magenta Tongue (red , purple color spot in tongue )
- Nasolabial Seborrhea
- Seborheic Dermatitis

- Keratitis
- Photophobia
- Watery Eye
- Blurring of vision
- Burning & itching of eyes
- Peripheral neuropathy
- Pain Sensation
TREATMENT:
- Tab. riboflavin 5 to 10 mg orally, daily for 7 days
PREVENTION:
- B2 diet
7. VITAMIN - B5 DEFICIENCY ( NICOTINIC ACID NIACIN ) :
- Vitamin Pellagra characteristic 3 – D

D – Diarrhea, Dermatitis, Dementias
S / S:
- Glossitis
- Stomatitis
- Dyphagia
- Nausea
- Vomiting
- Loss of AppetiteAnemia
- Mental Changes like depression, irritability, delirium
TREATMENT:
- Nicotinic acid diet
- Tab. Nicotinic acid 50 -300 mg daily orally
8. VITAMIN - B6 DEFICIENCY ( PYRIDOXINE ) :
S / S:
- Peripheral Neuritis
- Irritability
- Microcytic hypochromic Anemia
- Seborrheic Dermatitis nose eye
- Gastro – intestinal upset
- Abdominal Discomfort & Diarrhea
- Convulsion

- Vitamin – B supplementary
- Liver, egg, meat, wheat, germ, soybean, peas, pulses, cereals, etc.

9. VITAMIN - B12 DEFICIENCY ( CYANOCOBALAMINE ):

- Vitamin – B12 juvenile pernicious anemia & megaloblastic
anemia
S / S:
- Numbness
- Tingling sensation of finger & toes
- Lesion of spinal cord
- Spoon Shape Nail
- Skin pallor
- Failure to Thrive
- Apathy
- Hyper pigmentation of the skin
INVESTIGATION:
- Blood Examination
- HB
- RBC Count
- Assess pack cell Volume
- Vitamin – B12 serum level check
- protein serum level check
TREATMENT:
- Injection Vitamin – B12 15 – 30 mg I /M tds / week for 4 week
PREVENTION:
- Vitamin – B12 diet
- Liver, milk, egg, meat, fish, cheese etc.
10. VITAMIN - C DEFICIENCY ( ASCORBIC ACID ) :

- Vitamin - C Deficiency Scurvy
S / S:
- Swollen & bleeding gum
- delayed wound healing
- infection
- Anemia
- Irritability
INVESTIGATION:
- X- ray of the limbs show ground glass appearance
TREATMENT:
- severe cases injection Vitamin – C
- Mild Cases
- Tablet Vitamin – C 300 to 1000 mg orally daily for one week
PREVENTION:
- Vitamin – C diet
- Amla. guava and other fresh fruits like tomato , orange, lemon

MINERALS DEFICIENCY
1. CALCIUM DEFICIENCY
- Calcium Deficiency rickets & Hypocalcaemia & Tatary
S/S:
- Muscles Cramps
- Numbness
- Tingling Sensation of limbs
- Growth retardation
- Dental Caries
- Osteoporosis
- Insomnia
- Skin Problems
- Joint Pain
- Palpitation
TREATMENT & PREVENTION :

- calcium diet
- Tab, Calcium
2. IODINE DEFICIENCY :
- Iodine goiter, Hypothyroidism, Cretinism, Dwarfism, Deaf autism etc.
S / S:
- Thyroid gland swelling
-
- subnormal intelligence
- muscular weakness
- Dwarfism
- Hypothyroidism
TREATMENT:
- Iodised Salt
- Iodine
3. DEFICIENCY OF IRON & FA :

- Iron Deficiency Nutritional Anemia
- Cell mediated immunity
- Infection
- Fatigue
- Giddiness
- Loss of appetite
- Eye , tongue, Nail & Skin
- Spoon shape bittle nail

- Tab. FA & iron & vitamin B12

- FA iron diet
- worms TREATMENT
- Personal Hygienic advice
4. COBALT DEFICIENCY :
- anorexia , weakness, anemia & RBC Vitamin B12 diet
cobalt Deficiency
5. EXCESSIVE INTAKE OF KESHARI DAL :

- Keshari Dal Excessive intake lathyrism develop Keshari
Dal nervous system dal use MP, VP, Bihar
S/S :
STAGE 1ST lower limb weakness Ankle & knee joint pain
STAGE 2ND Knee flex Toes Tendency
STAGE 3RD
Last stage knee completely fix
Thigh & Leg muscles atrophy
TREATMENT :
- condition TREATMENT
- Prevention
6. EXCESSIVE INTAKE OF FLUORINE :

- Fluorine intake Dental Fluor sis & skeletal Fluor sis
Dental Fluor sis Skeletal Fluor sis

Mottling of Teeth Difficulty in Movement
Eurosion of enamel Complete immobility
Pitting of Teeth Skeletal Deformity
ALLERGIES
―Foreign substance abnormal acquired immune response

allergy ‖
Allergen contact host reactivity human antibody
cellular immune response interaction sensitization
allergy expose allergen contact broad range reaction
allergy allergy early detection &

management prompt complication & recurrence
common allergen
- Food item
- Drugs
- Animal Hair
- Feathers
- Dust
- Pollens
- Insect Bites
- Cosmetics
Allergy mechanism condition factor
1. Hereditary Predisposition : 60% cases allergy positive history

2. Exposure to Sensitizing Factors : allergen expose immune
response
3. Psychological Factor :Psychological disturbance histamine release
4. Infection: allergen allergic child allergic reaction
5. Drugs : Antibiotic , Aspirin drug symptoms produce
TYPE OF ALLERGIC REACTION :

1. Type - I (Immediate ) :
- IgE rapid & immediate reaction local systemic
- Local reaction urticaria , asthma etc.
- systemic reaction anaphylactic shock
2. Type - II (Cytotoxic ) :
- reaction IgG IgM antigen & antibody reaction cell
damage reaction B.T. drug
3. Type - III (Immune complex ) :

- reaction sensitized people antibody ( IgG
IgM) antigen immune complex Blood vassals
basement membrane local inflammation serum sickness
allergy
4. Type - IV ( Cell mediated ) :

- reaction T- lymphocyte contact dermatitis reaction
rubber, nickel chemical
TREATMENT :
- Careful history & skin test allergy avoid
- Drug therapy – Antihistamine, corticosteroid , adrenergic,(epinephrine ,salbutanal &
theophylline group )
- Immunotherapy desensitization of allergen patient tolerance level
repeat injection allergic extract procedure
health center

NURSING INTERVENTION:
- Allergen careful history
- common allergen allergic reaction health education
- drug skin test B.T. mismatched preventive
- Emergency drug
- desensitization therapy refer
- Child parents & family members support
DERMATITIS
It is superficial inflammation of skin redness , swelling, Itching, Warmth in acute

Dermatitis
chronic dermatitis thickening increased pigmentation & prominent skin
marking
ATOPIC DERMATITIS OF INFANT:

1. INFANTILE ECZEMA :
- Eczema first 3 month age
- Itching bilaterally
- papilla vesicular lesions check extremities trunk
infected secondary lesions scratching
disease 2 year cure
2. ACTOPIC DERLATITIES OF CHILDHOOD :

- 4 – 5 year
- lesion firm develop
- Itchly popular lesion
- Elbow & Knee
- Loss of Skin Sometimes
TREATMENT:
- Systemic antihistamine drug
- Cream aluminum acetate
- Silver nitrate
- Corticosteroid
- Isolate patient
- improve personal hygiene
- daily bath
- daily change clothes & bed sheets
- surrounding area clean
- inflamated part & blisters cover
- antibiotics
3. CONTACT DERMATITIS :
- Infant & Children
CAUSES:
- Irritant skin area contact Urine / saliva chemical agent
- Child irritant dermatitis main cause Napkin Dermatitis
- buttocks , thigh side & geniteria erythema, vesicles & small ulcer
MANAGEMENT:
- Affected part clear & clean
- Napkin & diaper regular change
- Skin & clothes clean
- Antibiotic cream & drugs according to Dr.‘s Order
VOMITING
―Vomiting ― mouth force full stomach conten
CAUSES:
1. Non – organic causes :

 Neonates :-
- swallowed amniotic fluid or blood
- Faulty feeding techniques
- swallowed air due to erratic feeding
- side effects of drugs.
 Early Infancy :-
- excessive cry
- faulty feeding
- over feeding
- rumination
- loneliness
 Late Infancy & Childhood :-
- Forced Feeding
- Motion Sickness
- Repetitive Swinging Movement
- Poor parents child relation
- Sudden Excitement
- Fear
- Anxiety
- Unpleasant sight OR odour
2. Organic causes :
 Infection :
- Intrauterine Infection
- Septicemia
- Meningitis
- Encephalitis

- Acute Gastroenteritis etc
 Mechanical Condition :
- Congenital Hypertrophic
- Esophageal Atresia
- Duodenal Atresia
- Malrotation of gut
- volvulas
- intussusceptions
- Gastro Esophageal reflex etc
 Neurological :
- Birth Asphyxia
- Birth Injuries
- Intracranial Sol
- Hydrocephalus
- Intracranial Hemorrhage
- Se Intracranial pressure
- Subdural Hematoma etc
 Metabolic :
- Diabetes Mellitus
- Uremia
- Galuatosemia
- Hypoglycemia
- Cholemia
- Hyper Calcemia
- Inborn error of metabolism
 Toxic
- Food Poisoning
- Allergic Food Intake
- Postnatal Discharge
- Dripping
 Emotional :
- Anorexia nervosa
- Migraine
- Psychogenic Habit Vomiting etc.
TREATMENT:
- TREATMENT vomiting
sips of water parents reassurance
- TREATMENT
- Food & Electrolyte balance
- Nasogastric aspiration
- Continuous Observation
- Fluid & Electrolyte balance
- Maintenance of I / O chart
- Dr. order medication

- Plan Investigation management

- Oral feed / breast feeding
- Oral hygiene care
- vomiting aspiration
- head side turn
- General cleanliness & hygienic measure
- care parents
- Emotion Support
- Health Teaching
- Record & Report
- Routine Nursing Care
DIARRHEA
Diarrhea means to frequent passing of watery , loos or liquid stool 4–5

watery stool pass condition Diarrhea
ETIOLOGY:
 Over Feeding
 Indigestion
 Imbalance diet
 Infection :
- Bacteria
- E coli, Shebelle , salmonella
- Viral- entcroviruss
- Parasites- Protozoa
- Fungal- Candida albancans
 Parenteral :
- Infection in G.I. track
- Otitis Media
- UTI
- URTI
PREDISPOSING FACTORS:
- Infant
- Low Socio economic status
- Malnutrition
- Unhygienic Feeding Habit
- Contamination of Feeding
- Low Immunity
- Un Hygienic Condition
S/S :
- S/S age, cause, Immunity diarrhea severity
- Anorexia
- Watery & loose Stool
- Sometimes mucus, pos, blood

- Stool color yellowish Greenish

- Low grade to high grade fever
- Weakness
- Irritability
- Restlessness
- Lethargy
- Pale Body
- Respiration deep & rapid
- Severe Headache
- No tear
CLASSIFICATION OF DIARRHEA :
 Diarrhea - 3-5 days check for Dehydration
 Persistent - Diarrhea for 14 days or more
 Dysentery- Blood in stool
DIAGNOSTIC EVALUATION:
- History Taking from mother
- Other Investigation
- Stool exam for cs
- PH of blood for acidosis
ASSESSMENT OF DEHYDRATION :
A B C
1 Ask About Diarrhea < 4 liquid 4- 10 > - 10
Stool / day liquid stool liquid stool
Vomiting None or small Some Very frequent
Amount
Thirst Normal Normal Unable to
drink
Urine Normal Small Amount No urine
& dark For 6 hour
2. Look Out Condition Well alert Restless Lethargic &
unwell unconscious
Eyes Normal Sunken Very sunken
&dry
Tears Present Absent Absent
Mouth & Moist Dry Very dry
Tongue
Breathing Normal Faster than Very fast
Normal & deep
3. Feel Skin Goes back Goes back Goes back
pinch Quickly Slowly Very Slowly

pulse Normal Faster than Very fast,

Normal Weak or
4. Degree of No sign Some Severe
Dehydration Dehydration Dehydration
CLASSIFICATION OF DEHYDRATION:
No. Dehydration Sign TREATMENT
1 Severe - Sleep lessness - Hospitalization

Dehydration - Weak or - IV Fluid
- Sunken eyes - ORS
- loose skin - Dextrose
- No tear - Glucose
- 7-10 time stool pass
- No urine
2. some / moderate - Thrush - ORS

Dehydration - Weakness - Water
- No sweet - Simple Diet
- Loose skin
- 5-6 time stool
-
-
3. No / mild 2-4 time stool pass treatment
Dehydration
MEDICAL MANAGEMENT:
Clotrimaxazole
Tab. trimithoprime (20mg)
sulfamathoxalone (100mg)
2 – 12 month (4 – 10 kg) - 2 tab.

12 month to 5 years (10 – 20 kg) - 3 tab
NURSING MANAGEMENT:
 Isolation :
- infection isolated stool
 Maintain Fluid Intake :
- coconut water
- butter milk
- skimmed milk
- IV Fluid
- Fruit Juices etc.
 Recording of I /O chart :
- Stool frequency check / assess

- Intake of fluid calculation
MANAGEMENT OF SEVERE DEHYDRATION:
 RL 100 ml / kg
 ORS 5ml/ kg/ hours
 Increase Rate Of RL
 Anti diarrheal + antibiotics drug
 Symptomatic TREATMENT.
ORS
Age weight ORS ml
4 month < 6 kg 200 - 400 ml
4-12 month 6-10kg 400 - 700 ml
12-24month 10-12 kg 700 – 900 ml
2 – 5 years 12 -19 kg 900 – 1400ml
- age ORS
- ORS
- 6 month exclusive breast feeding pure water or 100
– 200 ml ORS
- vomit continuous ORS
TREATMENT OF DEHYDRATION:
 Severity fluid
 Continuous I / V Fluid, Oral Fluid ORS
 Diarrhea Complication Observe
- vital sign , skin change , behavior change
 Care of Perineum & Rectum & buttocks Area :
- change diaper ,
- check for Redness , Irritability & Other Symptoms
 Provide Comfort :
- Clean, dry position , food, liquid & rest
 Nutrition :
- I / V Fluid
- After diarrhea proper diet plan
- Prevent Malnutrition
- Soft & easily digestible food
- High Protein + High calorie food
- No milk & milk item
- fibrous diet
 Health Education :
- For parents about diarrhea
 ORS :
- 1 Glass of water ( 200 ml )
- 2 TSP of Sugar
- a Pinch ( ) of salt & a TSP of lemon Juice
 Diet :
- No tea milk fibrous fruits & vegetable

- Khichdi, Rice & curd, boiled vegetable soup & bananas butter milk
 CELL DOCTOR (emergancy ) :
- No urination lethargy , Unconsciousness , No Tear , Blood in stool, severe
headache, high Fever incontinency of stool
 ORS WHO :
20.5 gm of ORS Powder contain
Nacl 2.5 gm
Kal 1.5 gm
Sodium citrate 3 gm
Dextrose 13.5 gm
FAILURE TO THRIVE (FTT)
- Poor socio-economic group common problem

- FIT infant children chronic potential life threatening disorder
weight gain fail
- cases weight lose
concept
- Psychosomatic Growth Failure
- Physiological Growth Failure
CAUSES:
1. Organic FTT :
serious pediatric illness like …..
- Congenital Heart Disease
- Malabsorption syndrome
- Intestinal Parasitoids
- TB
- Congenital Pyloric Stenos is
- Gastro esophageal Reflex
2. Non - Organic FTT :

Psychosocial problems like ……….
- Disturbed parent – child relationship
- Poverty
- Illiteracy
- Ignorance
- Faulty Food Habit
- Poor Nutritional Intake
- Failure of Growth
3. Mixed FTT :
- combined effects of both organic & Non – Organic causes

MANAGEMENT:
Physical social & emotional approach home & immediate Hospital management
It includes:
 Assessment of child
- Physical
- Mental
 Assessment of Family
- Condition
- Health Status
- Socio – Cultural influence
- Relationship
 Nutritional Status of Child
- Laboratory Investigation
- Growth Chart
- Hospitalization
- Confirm diagnosis & treat cause & complication
- Immunization
NURSING MANAGEMENT:
- supervision
- Optimum food intake
- Emotional Care
- Psychological Stimulation
- Improvement of child parents relationship
- Resolution of emotional conflict
- Social Support & community assistance
- Improve Socio – economic Status
- Regular home visit & follow up
- Improving life style
COMPLICATION:
- Anemia
- Fatigue
- Infection
- Delay Healing
- Behavior Problem
- Speech & Language delay development

EARLY CHILDHOOD
Behavioral disorder and common health problems of early childhood
TUBERCULOSIS
Mycobacterium Tuberculosis bacteria Bovine type milk
CAUSES :
- Inhalation
- Ingestion
- Inoculation
S / S:
Asymptomatic in some child
 General
- Low grade Fever
- Anorexia
- Weight loose
- Fatigue
- Pallor
- Anemia
- Weakness
- Low immunity
 Specific :
- body site infection lung brain kidneys child mainly
lung & respiratory track Fever pallor weakness cough
INVESTIGATION :
 Monteux Test :
- 2 to 10 week infection PPD (Protein purified derivatieg )
- PPD solution insert

- Mark
- 48 to 72 after result
- Diameters
o 5 mm –ve
o 5mm to up +ve
o 10 mm to up more +ve
 x- ray
 sputum
 CSF examination
 TB of meanings

TREATMENT :
- Streptomycin
- Pyrezinamide
- Ethambutol
- Isoniazid
- Rifampicin
- cortico steroid in TB of meanings
- DOTS :
o Isoniazid, Rifampicin , Pyrazinamide & Ethambutol for 2 month
o Isoniazid, Rifampicin for next 4 month
o Isoniazid, Culone for next 9 month
NURSING MANAGEMENT:
- Isolation
- Drugs & Dots
- Nutrition
- Assessment of Symptoms & TREATMENT
- Health Education
- Vaccination (BCG) Prevention
CHICKEN POX
Viral infection Herpes virus verticals Zoster ( VZ ) winter spring

5 – 10 years age group
TYPES:
 Mild
 Moderate
 Severe- in winter,
MODE OF TRANSMISSION :
- Direct or Indirect Contact
- Infected articles & clothes
- Airborne Infection
INCUBATION PERIOD :
- 14 -21 days
S / S:
Prodromal Phase:
- Fever
- Headache
- Malaise
- Rash after 24 hours
Eruptive Phase:
- Rapid Evolution of lesion c a superficial Polymorphic, Having tear or lesion
filled c clean Fluids Vesicles
- Macules
- Pastules
- Cruster Blister
- Raised Spot less than 1 cm lesion back forearm , hand , lower
extremities & face
- Chicken Pox scare
INVESTIGATION:
- History
- Measles serology viral cutter
- Complication :
- Infection of skin
- Respiratory infection
- Septicemia
- Encephalitis
TREATMENT :
- Antihistamine for itching
- Antibiotics to treat secondary infection
MANAGEMENT:
- Isolation
- Skin Care (KMno4 )potassium permanganate
- Warmth
- Position
- Fluids ( Most important )
- Antipyretic
- High Protein & High calorie diet
- Easily digest able & well cooked light diet
- Cloth daily Change
- Oral hygiene maintain
- Eye Care
- Condy‘s lotion
- Humidified Air
PREVANTION:
- Gamma Globulin 0.4ml / kg
- Avoid contact c infected cases
- Personal hygiene Maintain
- Hygienic Clothing
- Chicken Pox vaccine - varicalla
- Zoster virus Vaccine (vervivax)
HEALTH EDUCATION:
- Avoid Scratching & Rubbing
- Keep finger nail short
- Hand Restraints
- Cool light & cotton clothes
- Warm bath

- Avoid oily food & spicy food

- Moisturizer
- Avoid exposure to skin
MEASLES
Rubeola virus acute & highly infectious disease Droplet infection

Preschool & Toddler Vitamin – A deficiency
INCUBATOR PERIOD
- 7 – 14 days
S/S:
stage
 Catarrhal (prodromal ) or Pre cruptive stage :
- Enanthema
- Cold Fever
- Anoresea
- Watery Red Eyes
- Sneezing
- Running Nose
- Spots
- White papules mouth
- Photo Phobia
 Eruptive Stage :
- Exanthema
- Popular rash 3 – 5 days
- Skin, face , neck & Gradually body rashes
- Fever
- Pruritis
 Convalescent OR Post measles Stage :
- Decline
- rash disappear
- Fever subside
INVESTIGATION :
- History Collection
- Serological Tests
- Viral isolation
- ELISA Test
- Blood Examination
COMPLICATION:
- Otis Media
- Bronchopneumonia
- Atelectasis
- Stomatitis
- Enteritis
- Encephalitis
- Corneal Ulcers
TREATMENT:
- Isolation
- Bed sheet
- Oral hygiene
- Care of eyes
- Fluid Balance
- Maintain Nutrition
o Protein
o Calories
o RT feeding if needed
- Humidified Air
- Away from Cold Environment
PREVENTION:
- Immunization at 9 month ( MMR vaccine )
- Gamma globulin
MUMPS
Acute infection disease paramyxo virus One or bath parotid

glands swelling & tenderness Preschool & school age infant
Winter Spread by fomites & droplets infection
INCUBATION PERIOD:
- 14 – 21 days
S / S:
- Fever
- Sore throat
- Pain in ear
- Swelling Of Parotid Gland
- Pain while chewing
- tenderness at angle of Jaw
COMPLICATION :
- Orchitis ( after poverty )
- Meningo Encephalitis
- Pancreatitis
- In some cases , neuritis & myocarditis
- Hepatitis
MANAGEMENT :
- Aspirin to relive pain
- Bed rest
- Hot Application
- Liquid Diet
- Warm salt water gargles
- Extra Fluids
- Soft food
- Acetaminophen
PREVENTION :
- Active Immunization
- Passive of Immunization Gamma
- Globulin ( MMR Vaccine )
POLIOMYELITIS
Poliomyelitis acute viral disease nerve affect partial or full

paralysis Poliovirus
INCUBATION PERIOD :
- 7 – 14 days
CAUSES & RISK FACTOR :

 Virus Spread by
- Direct Contact
- Contact c infection mucus
- Contact c infection mucus feces
 Lack of immunization against Polio
 Travel For long time in area while the disease is very common
 Virus mouth & nose throat intestine absorp blood
& lymph system S/S develop
S/S:
 Malaise
 Headache
 Red throat ( inflammation )
 Slight or mild fever
 Sore throat
 Vomiting
 case symptoms
Chronic infection central nervous system effect partial or full

paralysis
 Abnormal Reflexes
 Back Stiffness
 Difficulty in lifting head or leg when lying flat
 Stiff neck

 Trouble in bending the neck

 Other problems of mother activities
INVESTIGATION :
- Cultures of Throat , stool , CSF
- Test for levels of antibodies
- General Examination of Joint & Reflexes
TREATMENT : Antibiotics
- Painkillers
- No, use of Narcotis
NURSING MANAGEMENT :
- Isolation
- Assessment of S/s & condition
- Control Symptoms
- Severe cases life threatening measures
o Breathing support
o Intensive care
- Moist heat provide
o heating pad
o warm towel
o hot water bag
- Physical therapy
o braces
o corrective shoes
o Orthopedic surgery
o support
- Checking the vital signs
- personal hygiene
- follow up
- psychological support
- Nutrition & diet
- Physiotherapy
PROGNOSIS :
- outcomes disease condition symptoms
- patient recover some cases permanent paralysis of affected
organ
- Brain & Spinal cord effected respiration problems death
- Disability is more common then Death
COMPLICATION :
- Aspiration Pneumonia
- Lack of movement
- Complete Paralysis
- Lung Problems
- Myocarditis
- Shock
- UTI
PREVENTION :
- Immunization ( Polio Vaccine )
DIPTHERIA
Acute infection bacterial disease corynebacterium Diphtheria
CAUSES:
- Direct Contact
- Respiratory Droplets
- Via contaminated object or food
- infection nose & throat Respiratory mucus membrane black
cover bacteria poison respiratory problem
- Cases skin affected skin lesion ( common )
RISK FACTORS INCLUDES:

- Crowded environment
- Poor hygiene
- Lack of Immunization
S/S:
- 2 – 5 days S / S appear
- Bluish discoloration of skin
- Bloody watery drainage from nose
- Breathing Problems
o Difficulty in Breathing
o Rapid Breathing
o Strider
- Chills
- Barking Cough
- Airway Obstruction
- Fever
- Horseness
- Painful swallowing
- Skin Lesion
- Sometimes ….lesion & symptoms
- Pseudo membrane in Throat
- Swelling of neck & larynx
INVESTIGATION :
- Gram stain or throat culture
- ECG
- Physical Examination
TREATMENT :
- TREATMENT is stunted immediately

- Diphtheria antitoxin drugs
- Antibiotics
o Erythromycin
o Penicillin
- Other Symptomatic treatment
MANAGEMENT:
- Assessment
- Hospitalization
- IV Fluid or Oral
- Oxygen & breathing support
- Bed rest
- Heat Monitoring & vital Sign
- Correction Of airway blockage
- Person who comes in to contact with patient must be immunized
PROGNOSIS :
- mild or severe
- Death rate is 10%
- Recovery is very slow
COMPLICATION :
- Heart Problems
- Mycarditis
- Damage Kidneys
- Some times paralysis
PREVENTION :
- DPT vaccine
- Vaccine is effective for 10 year only
- So an adult person should be immunized every to 10 year
PERTUSIS (WHOOPING COUGH)
highly contagious bacterial disease uncontrollable violent coughing

Coughing breath hard Patient breath try
deep whooping sound Bordetella pertuis bacteria
CAUSES & RISK FACTOR:

- Droplets infection
- Infection spread during sneezing & coughing via air
- Direct Contact
S/S:
- Similar to common cold
- 10 to 12 days coughing severe episodes
- coughing whooping noise

- coughing vomiting short coss of contagiousness

- Pertusis age people infant toddler age
- severe condition permanent disabilities and death

- Other signs are
o Runny nose
o Slight Fever
o Diarrhea
o Vomiting
o Chest Pain
o Malaise
INVESTIGATION :
- Based on Symptoms
- Physical Examination
- Sample test of mucus
- CBC
TREATMENT :
- Antibiotics
- Erythromycin
- Sedatives & antipyretic
- Bronchodilators
- Cough suppressants should not be given
- Other symptomatic treatment
PROGNOSIS :
- Infant death highest risk
- Need careful monitoring
MANAGEMENT :
- Monitoring Vitals
- Breathing Support
- Give O2
- Hospitalization
- IV Fluids
- Rest
- personal Hygiene
- Position
- Physical & Psychological support
COMPLICATION :
- Pneumonia
- Convulsions
- Nose Bleed
- Ear infection
- Brain Damage
- Cerebral Hemorrhage
- mental Retardation
- Death
PREVENTION :
- DPT vaccine according to schedule
- age vaccine
- Patient isolation care & procedure aseptic technique maintain
- Un immunized children under age of 7 years should not attend school pr public
gathering
TETANUS
acute infection bacterial disease clostridium tetani Bacterial spore

soil (inactive ) Spores injury or wound body enter spores body acteria
release Bacteria multiplies poison poison nerve enter spinal
cord nerve signal block severe muscles spasm Jaw muscles
spasm chest, back & abdominal muscles affect
S / S:
- Jaw muscles spasm chest, back & abdominal muscles affect
- Opisthotomos appear
- Sudden , Powerful& painful muscles contraction prolonged muscular action
- Other symptoms Includes :

o Drooling , Excessive salivation
o Fever
o Hand or Foot spasm
o Irritability
o Swallowing Difficulty
o Uncontrolled urination or defection
INVESTIGATION :
- Physical examination
- Medical History
- No specific test
- CBC
- CSF examination
TREATMENT :
- Antibiotics
o Clindamycin
o Erythromycin
o Metronidazole
- Antitoxic
o Immune globulin
- muscles relaxant

o Diazepam
- Sedatives
- Surgery to clean the wound & remove source of poison
MANAGEMENT:
- Bed Rest
- Assessment
- Non stimulating Environment
o Dim light
o Reduce noise
o Stable temperature
- Breathing support O2
- Dressing of wound
- Physical support
- Vitals check
- Follow up
PROGNOSIS :
- One die out of four infected people
- Death rate in infant is high
- c proper TREATMENT less than 10% person die
COMPLICATION :
- Airway Obstruction
- Respiratory arrest
- Heart Failure
- Pneumonia
- Fractures
- Brain Damage
PREVENTION :
- completely preventable
- active tetanus immunization
- open wound injury immunization booster dose
- last two booster dose 10 year immunization
- injury pure water wound clean
- short nail
- Prevent injuries.
POISONING
Poisoning important accidental hazard condition

Poisons substance body Inhalation ingestion skin contact injection enter
Poisoning 5 year age 3 year poisoning
supervision carelessness
poisons agent cleansing agent, detergent, sleeping, pills, paint, solvent,
Kerosene cosmetic

S / S:
 G.I. Disturbances :
- Anorexia
- Vomiting
- Diarrhea
- Abdominal Pain
 Respiratory Problem :
- Breathlessness
- cyanosis
- chest in drawing
- Granting
 Circulating Problem :
- Shock
- Collapse
convulsion or unconsciousness smell ingested poison

color poison S/S
TREATMENT & MANAGEMENT:
 Basic Principles of Management :

- Emergency stabilization measures
- Identification of Poison
- Removal of poisonous substance & toxin
- Specific antidote therapy
- Promotion of Excretion of toxin
- Supportive therapy
- Consoling to parents & children
 Step of Management :
- TREATMENT poison identification
- poison removal vomiting poison absorption
- Gastric lavug stomach poison substance
- Patient severe shock, coma , poisoning gag reflex aspiration
prevent vomiting gastric lavug
- mineral oil poison vomiting aspiration chemical
pneumonitis poison acid alkaline pharynx esophageal injured
tissue damage
- Activated charcoal stomach de contaminated compound absorb
help use first hour vomiting
- Dilution of poison poison dilute agent use
- Patient aspiration prevent secretion drainage patient
semi fowlers position
- patient airway patterns
- O2 inhalation
- record


- Parents & patient emotional support
- Poison type patient NBM
- Fluid intake & serum electrolyte maintain
- SOS antibiotic therapy
- Patient comfort measure
- Patient hygienic need
- Poison MLC case
- related document accurate
- Poisoning parents education
URINARY TRACT INFECTION (UTI)
DEFINITION:
UTI Urinary system infection lower urinary tract (Urethra, bladder,

lower part of urethra ) & upper urinary tract (upper portion of urethra & kidney ) infection
CAUSES:
- Bacterial infection E.coli , streptococcus, staphylococcus , pseudomonas etc.
- poor personal hygiene
o male phimosis
- short female urethra
- Urinary Catheterization
- Urinary obstruction
- poor perinea hygiene
- chronic constipation
- Inherent defect in the bladder ( natural inborn )
S/S:
- s /s age & severity of infection
- body asymptomatic
- moderate to high fever chills & rigor
- anorexia
- Malaise
- Irritability
- Vomiting
- Dysuria ( painful micturation )
- Burning micturation, urgency & frequency of micturation
- Abdomen suprapubic pain
- Neonate poor weight gain
- Lethargy
- Diarrhea
- Facture of sepsis
- Urine may be foul smelling
- Jaundice

INVESTIGATION:
- Urine culture
- Blood Examination
o TLC
o ESR
o HB%
- USG
- IVP
- MCU
- renal scan
MANAGEMENT:
- Culture & sensitivity report antibiotic therapy
- Combination of ampicillin & gentamicin or amikacin for 7 to 10 days
- ceftriaxone , cefotaxime
- Plenty of food orally
- Dr. order febril period analgesic /antipyretic
- bed rest
- vital sign check
- Behavior changes
- Acurate I /O chart
- Frequency of urination , pain during urination, enuresis & Retention of urine
observation
- Patient Fluid encourage fever & urine
concentration dilute
CHILD ABUSE / BUFFERED CHILD SYNDROME
Child abuse society

property parents
child abuse national & international level
Child abuse parents care taker, employer, government non - government
temporary permanent physical,
mental psychosocial development changes death condition
Child abuse
CAUSES:
-
-
- unwanted child
- activity
- activity involve
- Family
- Family poorly
- parents

- parents care
- parents alcohol
TYPES :
India culture child abuse
1. Social Abuse :
a) Infanticide
b) Child Marriage
c) Child Prostitution
d) Child Beggary
e) Child Labour
2. Family Abuse :
A. Physical Mal TREATMENT :
a) Physical Abuse – 75%
b) Physical Neglect
c) Beginning Neglect
d) Sexual Abuse 20%
B. Non Physical Mal TREATMENT :
a) Emotional abuse / Neglect 5%
b) Verbal Abuse
c) Educational Neglect
d) Fostering Delinquency
e) Alcohol / Drug Abuse
1. Social Abuse :
a) Infanticide ( fetus sex female
abortion
b) Child Marriage :Child Marriage birth

age marriage
health
c) Child Prostitution :
teenage
d) Child Beggary : parents

parents
e) Child Labour : Hotel, restarant etc

school
family
family

2. Family Abuse :
A. Physical mal treatment :

a) Physical Abuse – 75% : Parents , brother, sister family
school teacher
physical abuse
b) Physical Neglect :
Health care
c) Beginning Neglect :
Family
d) Sexual Abuse : Sexual Abuse
B. Non physical mal treatment :

mal adjustment
a) Emotional abuse / Neglect :
b) Verbal Abuse :
Verbal Abuse
c) Educational Neglect :
d) Fostering Delinquency :Parents direct indirect

Parents parents extra marital relationship, prostitution
e) Alcohol / Drug abuse : parents Alcohol / Drug abuse

Normal
IDENTIFICATION OF ABUSE CHILD:
 Injury : injury, injuries, injury, injuries
 Nutritional Status :Abuse child weight dehydration etc.

 Disease Condition: Venereal disease sign of trauma, private part injuries etc.
 Sign Of abuse in care giver :
- condition
- Injury information
- Available medical TREATMENT
-

- stress
- etc
- care giver
-
ROLE OF NURSE IN PREVENTION OF CHILD ABUSE:

Child abuse prevention three main role
1) Primary Prevention
2) Secondary Prevention
3) Tertiary Prevention
Primary Prevention:
- main aim abuse /
- abuse feeling
- abuse care guidance
- abuse need care refer
- Anganwadi , Balwadi , school
- Parents , family, care giver
- abuse
- abuse child
- abuse child care
-
- STD Unwanted pregnancy
- parents
Secondary Prevention :
- Abuse
- Child abuse
- help

- Child abuse love

- Parents care
- Child abuse severe parents
- foster home
Tertiary Prevention :
- Rehabilitation
- Parents
- counseling
- Biological parents
- Future abuse
BREATH HOLDING SPELLS
DEFINITION :
6 month 5 year disciplinary conflict
Frustration anger response
S/S:
- Violet Cry
- Hyperventilation
- Expiration breathing stop
- cyanosis & Rigidity
- Twitching
- tonic clonic movement
- limp pallor & lifeless
- Heart Rate Slow
- laryngeal muscles spasm
attack 1 – 2 min glottis relaxed & breathing
resumed
MANAGEMENT:
- attack parents & family member
attack harmless attack
- parents emotional environment
- disciplinary conflict
- punishment punishment
attack
- repeated attack history carefully evaluate
investigation

ENURESIS OR BED WETTING
Enuresis 4 – 5 year age bed involuntary

urine pass school children 3 –10 % 4 – 12 year
abnormal
4-12 year group primary & secondary enuresis
Primary / Persistence enuresis:

4 year age urinary bladder delayed neurological maturation
control organic cause normal bladder control
Secondary enuresis:
bladder control develop 1 year
Night bed wetting illness, hospitalization
Emotional deprivation
CAUSES:
- Small bladder Capacity
- Improper toilet training
- Deep sleep distended bladder signal receive inability
- Emotional factor like
- Hostile or dependent parents child relationship
- Dominant parents
- Punishment
- Emotional Deprivation
- Insecurity
- Parental Death
- Emotional Conflict & tension
-
- Scratching & irritation
- Perineal part inflammation UTI neurological deficient diabetes insipid as
- Thread Warm infection

- Environmental Factor like
- Toilet
- Toilet bed room
- Toilet
MANAGEMENT :
- specific cause Management
- child parents reassurance
- child self confidence
- child parents relationship child parents interview

- Emotional Factor
- Parents punishment
- evening meal fluid bladder
- urine pass
- bladder capacity toilet training
- personal hygiene nail
- Infection daily change wash
- psychotherapy
THUMB SUCKING / NAIL BITING
Thumb Sucking, finger Sucking habit disorder insecurity feeling, tension,

reducing activity tired, bored, lonely, sleeping habit
Thumb Sucking behavior normal 7 - 8 year Thumb
sucking habit develop stress
4 year age Thumb Sucking habit complication develop
- deformity of thumb
- Difficulty in mastication & Swallowing
- GI tract infection
- Facial distortion
- Speech Difficulty
MANAGEMENT:
-
- parents & family members support
- habit breast bottle feeding
- habit encourage
- finger thumb activity activity
- habit
-
- hygienic care
- dentist & speech therapist help complication correct
TEMPER TANTRUMS
toddler behavior problem

biting, kicking, throwing objects, hitting, crying, rolling
on floor, etc.

MANAGEMENT:
- parents Temper Tantrums normal Frustration
- behavior & play therapy

- parents behavior injury behavior let
go punishment
- Recover
time & space
- parents attitude
- securities & support
MASTURBATION
Masturbation or genital stimulation

genital organ handling Infant & toddler
sexual feeling anxiety
Masturbation teenage boys & girls practice
girls privacy adolescent Sexual
Excitement erection of penis or clitoris relief
Prepubescent pubescent stage Masturbation normal response

parent & child physical & emotional development
Sexual experience tension release, sexual fantasies & future sexual behavior
development
parents Masturbation
Conflict Physical
Symptoms express Masturbation
sex , education, counseling, recreation, diversion therapy, love & affection
care

MIDDLE CHILDHOOD
Behavioral disorder and common health problems of middle childhood
HELMINTHES INFESTATION (worms infestation)
Common problem tropical country defecation &

disposal of excreta method worm group health
status intestine worm
1. Round worms (Ascaris lumbricoides ) :

2. Hook Worms (Ancylostomiasis) :
3. Thread Worms (Enterobius Vermacularis )
4. Tape Worm (Taenia saginata of taenia solum )
1. HOOK WORMS:
Rural area common problem
effective larva
skin hair follicles larva body
enter larva skin blood vessels & blood lungs pulmonary
capillary alveoli respiratory tract migrate epiglottis
alimentary canal small intestine villi blood
Female hook worm egg worm blood (0.6ml) suck
gradually mild severe anemia develop

S / S:
- Epigastric Pain
- Factigue & weakness
- Pica & black colored stool
- Anorexia
- Loss of weight
- Paleness
- Abdomen & limb & eye lead
- Nausea / Vomiting
- Diarrhea c blood stool
INVESTIGSTION:
- Stool examination for Ova cyst & occult blood
- Blood examination
MANAGEMENT:
- Tab. Albendazole 400 mg single dose
- 10kg 200mg single dose
PREVENTION:
- infected person detection & early TREATMENT soil contamination
- sanitary latrine hore holl latrine use
- contaminated soil contact

- Personal hygiene
- Infected soil contamination food, vegetable etc
clean running water use
- Safe water supply & water source contamination
- Infected child isolate & TREATMENT
2. ROUND WORMS :
common 1 -5 year, poor hygienic condition, socio – economic status poor, small
intestine lumen adult female round worm length 20-40cm & male 12-30 cm female round
worm per day 240000 eggs produce
S / S:
- Fever
- Easinophilia (excessive numbers of eosinophils present in the blood )
- Blood serum lung larva liver cell necrosis
- Ascuriasis pneumonia
- Abdomen pain
- Intestinal Obstruction
- General Pertonitis
- Extra Peritoneal excess
- Irritability
- Loss of weight
- Anorexia
- General symptoms :
- Diarrhea
- Abd. distention
- Dehydration
- Vomiting
TREATMENT :
- Tab. Albendazole 400 mg single dose
- 10kg 200mg single dose
PREVENTION :
- Good hygienic condition
- Good health habit create
- Excreta & refuse
- Drinking boil water
- Fly control
- Toilet
- Slipper advice
-
-
- Use
3. THREAD WORMS OR PINWORMS (OXYURISIS ) :
Finger, fly sanitary canal

worm white thread length 0.5 - 1 cm Egg 30 – 60
cm larva 6 hours mature 20 days survive
Worm large intestine cesium & appendix Female worm anus
5 -10 eggs eggs anus opening skin itching
Area scratching oral route swallowing
duodenum & cesium worm young Etc
infection Worm 10 days dry condition
room
S/S :
- Asymptomatic child symptoms
- Anorexia
- Loss of weight
- Abd. Pain
- Parietal itching
- Enuresis (natural)
- Scratching secondary
- Appendicitis
- Diarrhea & vomiting
- Rest lessens

TREATMENT:-
- Tab. Albendazole - 400mg
- 10 years -200mg
- All family member at time give
PREVENTION:-
- Hygienic eating habit
- Child bed & cloths disinfect
- Child scratching
- Nail regular cut
- Nutritive diet
-
- anus antilarvi Cream itching & scratching
-
4. TAPE WORMS / TENIASIS (CESTODES) :

Infected animals mass infestation direct contact
Type
A. Taenia saginata catal
B. Taenia solium pork (PIG)
A. Taenia saginata :
Catal matam living larva infection larva color
white & semi transparent
Worm complete egg head stool
contaminated egg animal
layer intestine
hard tissue tissue
infected animal mass gastric juice tissue
worm jejunum mucus membrane 3month
Growth & development
S / S:
- Weight loss ,
- Abdomen Pain
- Constipation
- Headache
- Stool worm part
B. Taenia solium :
Pig living larva infection
Vegetable larva color white yellow
Larva stomach intestine intestine mucosa
penetrate body skin & muscles

Nodule palpate brain epileptic fit cyst 3 year
S / S:
- Skin small lump
- Epileptic fit
TREATMENT:
- Same as previous
PREVENTION:
- Hand washing
- Personal hygiene nail cutting health education
- Stool contamination
- License mat am
- Infected person stool
- Taenia solium infection cooking
COMMON SKIN INFECTION, ANIMAL & INSECTS BITE:
SCABIES
School children skin contagious disease itch mite

scabies (sarcastic scabies) parasite skin to skin contact transmit
Indirect contact scabies cloth, towel, book,
spread
S / S:
- Irritation
- Formation of burrow
- Vesicles
- Pustules finger wrist & axillaries part
- worm, moist & fold
- Male genitalia female breast
- Scabies complication acute nephritis
MANAGEMENT
- Local Application benzyl benzoate lotion
- Secondary infection prevent broad spectrum antibiotic
- Scabies contagious disease child & family member
-
- Family Treatment
- Boil water
- Local application

- Itching doctor order antihistaminic drug

- Local application gloves
- Personal hygiene
RABIES
Rabies dog bite result viral disease Rabies hydrophobia disease

cat, monkey, horse etc. animal bite Rabies incubation period
clinically sign hydro-phobia outcome threatened rabies dog
form
1. Furious Rabies
2. Dumb Rabies
Dog rabies clinical sign one week

Infected animal saliva virus ( Lyssavirus type – 1 ) bite host subcutaneous
&muscular tissue contact viral encephalitis picture
rabies transmit
INCUBATION PERIOD:
- 90% case 20 – 90 days
- 10 days to 1 year
S/S:
- First 1 – 4 day patient fever myalgia, headache , easy fatigability sore throat
& change in mood
- Bite parenthesis or fasciculation rabies suggestion
- Prodromal stage excitation & nervous system stimulation
- Patient noise, bright, light & cold
- Aerophobia
- Exam pupil dilate muscles spasm & reflex
- Perspiration, Salivation & lacrimation
- Mental changes fear of death, anger, irritability & depression
- Symptoms progress liquid swallowing difficulty
- Patient convulsion paralysis coma stage
INVESTIGATION:
- History of dog bite
- Site parenthesis
- Post mortem ante mortem tests diagnosis
MANAGEMENT / NURSING INTERVENTION:

Antirabies TREATMENT aspect
1. Management of wound
2. Rabies Prophylaxis
Management of wound:
- Wound Management wound shop running water clean & wash
- Alcohol tincture iodine iodine aqueous solution

- 24 hour bite wound antirabies serum
infiltrate
- Tetanus toxoid & wound unhealthy antibiotics
- wound open
- Antirabies serum (passive immunity )
- Rabies Injection
- Single or multiple transdermal bite Scratches
- Contaminated mucous membrane dog saliva
- Rabies long incubation exposure active immunization
- Nervous tissue & tissue culture vaccine available
- I /M injection anterolateral aspect of thigh
Rabies Prophylaxis: -
- Rabies patient rabies TREATMENT ICU respiratory &
cardiac support strictly isolated technique intensive therapy
- Rabies result fatal
- Animal immunization rabies prevention help
SNAKE BITE
Health problem snake bite 216

52 3 family member
1. Elapidae ( cobra , krait )
2. Viperidae ( viper )
3. Hydrophidae ( sea snake )
Cobra & krait & sea snake venom neurotoxin neuromuscular junction
neuronal transmission block respiratory depression death
Viper venom primary cytolytic cellular necrosis, vascular leak, hemilysis
& coagulopathy hemorrhage , shock orrenal failure death
Snake bite total cases 7–15 % cases 10 year age
rural & semi rural area bite bite bite
2/3 (two- third) bite lower limb 40% bite upper limb
S/S:
- S/S snake type local effect & system effect
Cobra & krait S / S:

- Local pain swelling
- Rapid necrosis & wet gangrene

- Symptomatic S / S 15 min to 10 hour neurotoxic cardiotoxic features
Neurotoxic Cardiotoxic
Paralysis Hypotension
Ptosis Tachycardia
Gag reflex absent ECG changes
Respiratory depression hemilysis
Larynx absent
Deglutition
Viper bites S / S:
 Local S / S
- Severe burning
- Edema
- Cellulites
- Swelling
- Continuous oozing or bleeding
- Local necrosis & dry gangrene
- Ecchymoses ( Local hemorrhagic spot )
- Blister
 Systemic S / S :
- 15 min or
- Hemolytic effect main
- Bleeding from puncture sites
- Purpura
- Hematemesis
- Melena
- Epistaxis
- Hematuria
- Gum bleeding
- Intra craninal hemorrhage
- Circulatory collapse
- Rencul failure
- Delirium
MANAGEMENT OR TREATMENT:
First aid Management:
- Snake bite reassure
- Rest & moral support
- Horizontal position patient & bite immobilize
- Bitten part manipulation
- Exertion & exercise avoid
- Patient alcohol stimulate
- Bitten part immediately incision & suction
-

- Tourniquet crepe bondage bite side proximal apply

- Tourniquet apply swelling lose proximal apply
- Patient medical treatment refer
Hospital Management:
- Immediate hospital management shock management & respiratory
failure ventilator
- Antivonum therapy
- Elapids venom neostigmine + atropine
- Supportive care fresh whole BT
- Secondary infection prevention policy centibiotie
- Wound care
- Renal failure hemodialysis
- Effect patient continuous, observation
neurotoxic , cardiotoxic & hemolytic S /S observe
- General hygienic care
INSECT STINGS
Rural & coastal area snake bite fatal condition

stings scorpion sting red scorpion
Insect sting (bees), (ants), (wasps), (beetle)
Scorpion sting fatal scorpion venum neurotoxic,cardiotoxic,

hemototoxic & mytoxic local systemic
S/S:
- Intense local pain
- Swelling
- Ecchymosis
- Profuse Perspiration
- Tachypnea
- Vomiting
- Hyper salivation
- Lacrimation
- Frequent passage of urine or stool
- Convulsion, hemiplegia, shock, respiratory distress, acute renal failure,
coagulapathy & coadiomyopathy
MANAGEMENT :
- Scorpion bite Management first aid
- Tourniquet precaution apply
- Wound plain water wash & part immobilize

- Pain local anesthetic agent

- Shock manage O2 therapy, drug & I/V infusion start
- Symptomatic TREATMENT diuretics, bronchodiladen etc.
- Prophylaxis TT
- General hygienic care
- Parents reassurance
-
STUTTERING
Stammering speech fluency interpret 3–5 year

age
Stuttering emotional & social development
Neuromuscular factor perfect co-ordination stressful
situation disturb condition
Parents class Stammering
Stuttering anxiety child disturb parents
competition avoid treatment speech therapy
TICS OR HABIT SPASM
Tics habit spasm muscular movement

Habit spasm abnormal involuntary movement purposeless & rapid
stereo type muscles movement
face, neck, eye, shoulder & school children (5 – 10
year)
Tics s emotional disturbed mal adjustment &
outlet anxiety tension discharge tic
Motor Tics:
- Eye blinking
- Grimacing
- Shrugging shoulder
- Toungue protrusion
- Facial gesture
Vocal Tics:
- Throat cleaning
- Coughing
- Barking
- Sniffing
Nurse & mother

- pressure, tension
- improper attention avoid
- anxiety, emotional disturbance
- action movement
PICA / GEOPHAGIA / EATING DISORDER
Condition non-edible substance (non -food material)

paints, chalk, pencil, scalp hair plaster, etc.
CAUSES:
Poor mal nourish supervision
condition 2 year normal
abnormal
Low socio economic status & Lack of Food can cause:
- Nutritional Deficiency
- GI trunk problem
- Infections diarrhea
- Warm infestation
MANAGEMENT:
- Continuous observation
- Meal time proper
- Supplementary food
- Health education
- Treatment of S / S
ANTISOCIAL BEHAVIOR / JUVENILE DELINQUENCY
Antisocial Behavior child activity

running away from homes, lying, Ragging
Etc Behavior society individual
1960 ―children act ―
Broken family, emotionally disturb family,
unhealthy family environment financial & legal problem family
CAUSES & CONTRIBUTING FACTOR:
- Poverty
- Low socio economic status
- Lack of toys & play facility
- Bad group & gangs
- Broken family
- Child abuse
- Lack of love & affection
- Lack of securities
- Alcoholism & drug addiction
- Lack of discipline

MANAGEMENT:
1960 care & welfare training, rehabilitation &
- Stress
- Toys & need fulfill
- Education & counseling
- Child guidance clinic
- Encourage parents to love & security of child
- Good grouping & environment
- Rules, regulation , policy
LATER CHILDHOOD
BEHAVIORAL DISORDER AND COMMON HEALTH PROBLEMS OF LATER

CHILDHOOD
PRECOCIOUS PUBERTY
Girls age 8 year & boys age 9 year sexual maturation & secondary sexual
characteristic development Precocious puberty
ACNE
Acne inflammatory skin disease face, trunk leg, arms &

buttocks adolescent infancy childhood
Whitehead blackhead lesion 2 – 3 year classical acne
sign popules and pastules infected
lesion deep cyst & scar Children greasy scalp, dandruff, Seborrhea
& hormonal refuse sebum acne
Acne varieties Acne vulgarism, Infantile acne, steroid acne, halogen
acne, topical acne, acne conglobates , pomade acne etc.
MANAGEMENT :
- Child adolescent
- Psychologically prepare
- Cosmetics, hair preparations, facial manipulation cleansing etc
-
- Commercially advertised medicine
-

- Acne TREATMENT clindamycine & cryhromycine week

topical application result
- Systemic antibiotic vitamin – A result
- Hygienic & nutrient care
ANOREXIA NERVOSA
Anorexia Nervosa adolescent girl eating disorder normal

body weight maintain food intake reduce refusal of food problem
Food fat & CHO girls slim exercise
vomiting body
adolescent under weight
control age anorexia nervosa organic cause
Anorexia Nervosa adolescent associated condition

disease of liver , kidney, heart etc.
S/S:
- Under nutrition
- Marked weight loss
- Bizarre food intake pattern
- Dryness of skin
- Hypothermia
- Hypotension
- Bradycardia
- Amenorrhea
- Constipation
MANAGEMENT:
- Psychotherapy
- Anti depression drug
- Behavior modification
- Nutritional rehabilitation
- Parents child relationship counseling
- Complicated case hospitalization
OBESITY
Indian child obesity nutritional deficiency

life style practice obesity
― Obesity S/C tissue fat ‖
Children & adolescent obesity assess BMI

BMI = weight in (kg)

Height (m)
BMI value 30 obesity 5 year age BMI

constant
CAUSES:
- Endogencous obesity
- Genetic cause
- Endocrenical cause
- Hypothalamic obesity
- Constitutions
- Excessive dietary conguction
- Poor energy expenditure
- Fat cell hyperplasia
S / S:
- Fatty
- Average weight 20 %
- Fast deposition all over the body
- Neck fat deposition double chin
- Thigh, abdomen & breast fat deposit external genitenia hand & feet
MANAGEMENT:
Weight reduction programmers
Dietary regulation & reduce calorie intake
Physical exercise & sport activity
Emotional problem handle
- Weight constant observation

- Dietary restriction meal snake avoid chocolate, candy, sweet &
ice-cream (between meal )
- Regular weight recording & follow up appetite drug
o amphetamines
- Psychogenic over eating counseling
- Complete investigation TREATMENT
parents

NURSING RESPONSIBILITY IN BEHAVIORAL DISORDER IN

CHILDREN
- Behavioral disorder prevention, early identification &

management nurse nurse
- Specific problem assessment history responsible factor
detect
- Behavioral problem parents
- Parents, teacher & family member at home, school & community environment
- Behavioral modification
- Physical, psychological & social support health emotional
development
- Development stage psychosocial disturbance
Behavioral disorder awareness
- Parents counseling
- Problem management health team
child guidance clinic organized
- SOS refer higher hospital child guidance social welfare
service & support agency

UNIT – 6
CHILD WITH CONGENITAL
DEFECT/MALFORMATION
ETIOLOGY, SIGN, SYMPTOMS, COMPLICATION, MEDICAL,

SURGICAL & NURSING MANAGEMENT OF:
 MALFORMATION OF THE CNS
- Cranial Deformities
- Defect of Spinabifida
- Meningocele
- Hydro cephalus
- Cerebral palsy
- Neural tube closer
 SKELETAL DEFECTS
- Cleft lip & Palate
 DEFECT OF GI TRACT
- Esophageal Artesia & fistula
- Ano rectal Malformation
- Hernia
- Congenital hypertrophied pyloric stenosis
-
 DEFECT OF GENITOURINARY TRACT
- Hypospadiasis
- Epispadiasis
- Extrophy of bladder
- Phimosis
- Cryptrochidism
- Polycystic kidney
 SEXUAL ABNORMALITY
- Ambiguous genitalia
- Hermaphroditism
 DEFECT OF CARDIO VASCULAR SYSTEM :

- Conjenital heart disease
- Major acyanotic & cyanotic defect
 ORTHOPEDIC ABNORMALITIES :
- Club foot
- Developmental abnormalities of extremities

MALFORMATION OF THE CNS
CNS congenital malformation main cause genetic factor maternal infection

prenatal period radiation anoxia Main defect
DEFECT OF NEURAL TUBE CLOSER
Neural Tube defect CNS congenital malformation early embryogenesis (intra

uterine life 3-4 week neural tube closer defect
Defect skill vertebral column spinal cord CNS 1000 live
birth 1- 5 risk
ETIOLOGY:
 Main cause unknown
 Factors
- Maternal radiation exposures
- Drugs (valproic acid )
- Exposure to Chemicals
- Malnutrition folic acid main
- Genetic Determinant
TYPE OF NEURAL TUBE DEFECT: Spina Bifida and Encephalocele
1. SPINA BIFIDA:
CNS most common developmental defect spinal column structure
developmental defect vertebrae posterior portion / vertebral arch fusion
defect meninges & spinal cord
Defect spinal column vertebrae arch fusion vertebrae
posterior portion lamina close fail lamina complete
Absent
Spina Bifida group divide

A. Spina Bifida Occulta
B. Spina Bifida Cystica
i. Meningocele
ii. Meningomyclocele
A. Spina Bifida Occulta :

Neural tube defect benign defect vertebrae posterior arch
lamina closure L5&S1
Defect meninges spinal cord dysplasia
Spina Bifida Occulta cases asymptomatic 6-8 year age
 Progressive deformity of Leg

 Changes in micturation pattern
 Gait
 Toes & Feet trophic ulcers
Spina Bifida occulta components

1. Vertebral – arches fusion defect (tuff hair )
2. Cutaneous – Cutaneous components Cutaneous lesion & hemangioma
3. Neural – Intra spinal lesion ( lipoma dermal sinus )
B. Spina Bifida Cystica :

Spina Bifida Cystica meningocale & meningomyclocele Commonly
i. Meningocale :
Posterior vertebral arch midline defect hernia meaninges
lumbo sacral region sac meninges & CSF sac
transparent membrane cover skin cover
ii. Meningomyclocele ( myclomeningocele ) :

Posterior vertebral arch defect meninges spinal tissue & CSF sac
herniated lumbo sacral region Back midline
90-95% lesion
Defect spinal cord dysplasia neurological defect defect
weakness complete flaccid paralysis area sensory loss
bowell bladder disfunction
2. ENCEPHALOCELE :
Cranial malformation
Encephalocele meninges, CSF & brain
Substance (cerebral, cortex, cerebellum or
part of brainstem) skull bony
Congenital defect sac
protrusion Herniated sac
meninges & CSF cranial
meningocele
TREATMENT & NURSING MANAGEMENT:

 Prevent local trauma :
- Infant carefully handle prone position
- Lesion protective cover sac pad
- Routing care neonate injury & comfort
 Prevention of local infection :

- Doctor order aseptic technique sterile saline lesion clean abrasion
tear infection sign observe
- Urine stool contaminated
- doctor order antibiotic
- totally hygienic care
 General Observation :
- Head circumstance observe
- Bulging fontanels observe
- High pitch cry
- Irritability
- Difficulty in taking food
 Prevent Skin Breakdown :

- Abdomen & lateral side carefully position change
- Bed sore prevent skin care
 Prevention of Urinary Tract infection :

- Stool contamination
- Buttocks & perinea part clean
- Bladder periodically empty
- Urine dilute fluid intake
 Prevention of Deformity :
- Position body alignment maintain
- Body turn body support turn
- Soft pad pillow
- Affected muscles & Joints passive exercise
- Hip abduction line
- Limb proper position
 General Care :
- Neonate body temperature
- Fluid & electrolyte balance
- Nutritional status breast feeding
- Neonate hygienic care

- Child tender & loving care close contact & eye to eye
contact
- Comprehensive care
 Guidance to the Parents :

- Anxiety parents genetic counseling
- Long term care parents prepare
Care planning
- Development
SURGICAL MANAGEMENT
Defect management surgical treatment surgeon
12 - 18 repair surgeon delayed Surgery
 Pre – Operative Care :

- General Care
- Investigation
- Explanation of surgery
- Pre – Operative teaching for post Operative Care
- Written consent
- Spiritual Care
- Skin Preparation
- Case Preparation
- Removal of prosthesis
- medication
- bowel & bladder Preparation
- Dresser
- Child & case paper hand over to OT nurse
 Intra Operative Care :

- Cord expose reposition durameter repair skin suturing
- Gape skin flap cover cases drainage tube
skin
 Post Operative Care :

- General neonate post Operative Care
- Doctor order operation orally feeding
- Wound suction drainage amount patency, negative, pressure
- Drainage tube drain 2–3 drainage tube remove
- Lower extremity & joint deformity full range passive exercise

HYDROCEPHALUS
Intracranial cavity normal CSF Hydrocephalus

CSF production flow & absorption alteration Imbalance
Condition Hydrocephalus condition intracranial cavity abnormality
Infancy head enlarge, cerebral ventricles dilatation 1000 3–4
condition
CAUSES:
Hydrocephalus congenital acquired
 Congenital cause :
- Intra uterine infection like rubella, toxo plasmosis, cytomegalovirus,etc
- Congenital brain tumor
- Intracranial hemorrhage
- Congenital Malformation
- Malformation of archnoid villi
 Acquired Cause :
- Inf & inflammation meningities encephality
- Trauma forceps delivery
- Neoplasm tuberculoma
- Hyper vitaminosis ( vitamin – A overdose )
- Degenarative atrophy of birth
TYPES:
1. Communicating Hydrocephalus
2. Non communicating
Communicating Hydrocephalus:
Hydrocephalus ventricular system blockage CSF
absorption failure choroidplexus papilloma tumor
CSF excessive production
None communicating:
Ventricular system level obstruction Partial
Intermittent complete
cases inflammation and Obstructive lesion
SIGNS/SYMPTOMS
S/S cause & type rapid, slowly, staidly, advancing &
remittent age, fontanels close duration
 In Neonate & Infant :

- Excessive head Growth
- Anterior fontanel closure delay
- Anterior fontanel tense, bulging, enlarge & non pulse

- Scalp vein prominent dilate

- ICP increase
- Vomiting
- Restlessness
- High Pitch Cry
- Head circumference
- Change in vital sign ( BP , Temperature, Pulse, Respiration )
- Difficulty in sucking & Feeding
- Papillary changes ( dilate )
- Edema
- Lethargy
 In Older Child :
- Headache
- Lethargy
- Fatigue
- Apathy
- Personality changes
- Skull suture separation
- Visual changes
- Extremity muscles tone changes spastic paralysis
- Fore head prominent
- Neomoencephalography dilated ventricle, brain damage & obstruction lacation
MEDICAL MANAGEMENT:
- Intracranial pressure reduce drug Diuretic, Diamox, liq. Glycerol
- Complication watch
- Progressive hydrophilic fetal condition
SURGICAL MANAGEMENT:
Ventriculostomy, choroid plexectomy surgical shunt operation
1) Ventriculo Paritoneal shunt
2) Ventriculo atrical shunt
3) Ventriculo pleural shunt

4) Ventriculo gallbladder shunt
Ventriculo Peritoneal shunt:

VP shunt lateral ventricle / sub arachnoids space CSF peritoneal cavity
divert lateral ventricle tube S / C ocipital burchole neck
peritoneal cavity paraspinous region incision tube
peritoneum
Ventricular atriecal shunt:

Lateral ventricle silicon catheter skull parietal region borehole
skull behind Internal jugular
vein catheter Right atrium superior venacava tube one
way pressure sensitive blood ventrical (brain) Brain
ventricle pressure
 Pre Operative Care :

- ICP daily head circumference measure
- ICP tension detect vital sign check
- Fontanels palpate
- Comfortable position head support & semi sitting position
- ICP S / S observe
- Baby turn head & body rotate
 Post Operative Care :

- CSF proper drainage shunt & child position doctor order
- Peritoneal shunt constiposition

- Observation potential depress repair
- Child non – operative side
- Shunt mal function

- Temperature continuous 4 day report

- Routine post – OP Care
COMPLICATION:
- Shunt mal formation ICP
- Dehydration
- Cross infection
- right heart failure
CEREBRAL PALSY
Cerebral palsy motor centers & brain pathway mal function Non
progressive disorder Brain injury upper motor neurone injury
muscles control muscular activity condition birth
birth post natal period birth brain damage
non cerebral & non fatal condition
CAUSES:
 Brain substance development disorder
 Trauma brain injury
 Brain anoxia
 Hypoglycemia metabolic disturbance
 Intra uterine
 Prenatal factor
- Genetic
- Metabolic
- Meaternal anemia
- Maternal exposure to radition
- Maternal bleeding
- Toxemia
- Trauma
- Use of drug
 Perinatal Factor :
- Immaturity at Birth
- Trauma at birth
- Anesthesia during labor
- New born cardio pulmonary problem
 Postnatal Factor:
- Intra cranial injury
- Meningities
- Encephalitis
- Carabraw vascular accident

CLASSIFICATION:
1. Spastic cerebral palsy ( pyramidal CP )
2. Dyskinetic cerebral palsy ( extra pyramidal CP )
3. Atonic cerebral palsy ( cerebral CP )
4. Mixed type cerebral palsy
SIGNS/SYMPTOMS
 PYRAMIDAL CP :
- Abnormal reflex
- Mainly firm grasp reflex
- Quadriplegia
- Secondary paraplegia
- Hemiplegia
- Triplegia
- Monoplegia
- Atonia
- Brisk reflex
- Severe retardation
 EXTRA PYRAMIDAL CP :
- Athetosis
- Choreiform movements
- Dystonia
- Tremors
- Rigidity
- Inability to grasp an object
- Mental retardation
- Deafness may be
 CEREBRAL CP :
- Hyporeflexia
- Hypotonia
- Ataxia & tremors
 MIXED CP :
- Diffuse neurological involvement

Cerebral palsy Symptoms

- Strabismus
- Cataract
- Restrolental fibroplasias
- Hearing losss
- asphyxia
- Dysrhythemia
- Dyslalia
- Focal or generalize scissor
- borderline intelligence
INVESTIGATION
- Detail History – G & D neurological limitation posture & involuntary movement
- CT Scan , MRI
- EEG
- Psychometric test
- Blood & urine test
- Hearing ability test
- Vision test
- EMG Elactro myogram
NURSING CARE :
- Promote Physical & Psychological Health
- Assist in Physical & speech therapy
- Provide Education & Counseling
- Assist in feeding & toilet training
 PROMOTE PHYSICAL & PSYCHOLOGICAL HEALTH:

- Health status continuous assess
- Immunization
- Balance diet vitamin & extra calories muscles activity
energy use

- Parents balance diet health education

- Provide sleep & rest
- Plan for daily activities
- Play physical therapy special interest comfortable
Environment independence & self help
- Child inf injury prevent clean skin care
- Injury measure safe furniture & safe bed rest
- Child care child involve self image promote
 ASSIST IN PHYSICAL & SPEECH THERAPY:

- Physiotherapy posture skeletal deformity &
contracture prevent
- Independent motor activity improve
- Speech therapy child child communication
- Nurse speech therapist speech evaluation showing lip, tongue &

teeth appropriate feeding technique
 PROVIDE EDUCATION & COUNSELING:

- Parents child handicapped child
etc nurse parents politely answer
- Family IPR develop
- Parents reading material provide child care
- Educational opportunity
- Games, Special training and schooling
 ASSIST IN FEEDING & TOILET TRAINING:

- Food nurse feeding help
- Child behavior parents
- Child need urination & defecation
- Meal 15 – 20 minute toilet
- Toilet training instruction nurse parents
- Urination & defecation observation

Training
- Child Rx tranquilizer & muscles relax ion drug Convulsion &
muscles improving function
- Child occupational, orthopedic, educational, social & vocational support

SKELETAL DEFECTS
CLEFT LIP (HARE LIP)
Cleft lip face congenital malformation cleft lip upper lip

opening unilateral bilateral fissure nose
strill
Cleft lip embryonic life (fetus) face structural union lateral &
middle nasal process fusion defect
Condition cleft palate deformity absent teeth Cleft lip
cases 1000 : 1 male female
ASSESSMENT:
A. Defective Look
B. Difficulty in sucking & swallowing
C. Defective Dentition
D. Difficulty in Speech
TREATMENT & NURSING MANAGEMENT:
Cleft lip surgically repair surgery age surgeon 2–

3 month repair infant health (at 10 week of age, 10
lb weight & 10gm HB% ) Operation Cheloplasty
NURSING MANAGEMENT OF CLEFT LIP & PALATE :
AT BIRTH:
- Associated congenital anomalies & life threatening problem Menagement
- Stressful environment mother baby condition explain emotional support
- Mother family member encourage

- Feeding demonstration feeding aspiration
nutrition G&D
- Baby breast suck handle spoon & bowl expressed
artificial feeding
- Diarrhea GI disturbance strictly hygienic measures

- Mouth side feeding

- Feeding upright position
- Feed ―burping ―
- Essential care warmth, immunization, prevention of infection hygienic care &
follow up surgical correction
GENERAL MANAGEMENT:
- Prevention of inf
- Provision of adequate nutrition feeding ( cup, spoon, dropper asepto syringe)
- Prevention of aspiration
- Child home care parents education
PROVIDE PRE OPERATIVE & POST OPERATIVE CARE
 Pre – Operative Care :

- baby admit ( before, day of early )
- cleft lip repair baby sucking ability
- Child complete examination & blood test
- child inf
- routine Pre- operative care
- immobilize (sos)
- surgery baby rubber tip syringe feeding
- sucking motion prevent suture line tension
 Post – Operative Care :

- Baby proper position abdomen
- Baby restrain operative site injury
- Baby sucking & crying
- Wound clean dropper feeding
- Suture line properly clean crust formation scar
- Child hygienic & general care
- Child emotional need
- Parents prognosis

CLEFT PALATE
Cleft palate palate fissure palate tissue

soft palate defect palatine bone hard palate affected
most severe case maxilla anterior portion deform
Child feeding problem speech difficulty respiratory ear infection
defect male female common
TREATMENT:
Surgically palate reconstruction palatoplasty
defective speech develop
NUIRSING CARE:
Nurse child parents

emotional status
Parents defect child irregular teeth Eruption
Delayed speech child & parents frustration
develop Condition parents available opportunity & appropriate
treatment guide any anxiety
POST OPERATIVE NURSING CARE:
1. Close observation & monitoring vital sign: Operation site bleeding, oral
secretion, vomiting, crying, comfortable position, vital sign
2. Applied Restrain: Elbow restrain restrain periodically remove

child movement blood circulation normal
stasis prevent Finger object tongue
Sore part

3. Maintain Oral Hygiene: Suture line inf prevent feed oral care hygiene
Dr. order NS H2 O2 mild antiseptic solution use mouth clean
4. Provide Nutrition: Aseptosyringe rubber tip free clear fluid

Operation week soft diet regular diet
Hot Food child strow suck
Spoon feeding spoon oral cavity ruffe touch
5. Provide Diversion Therapy: Child cry Child environment

play Story drawing, color picture
6. Promote Speech: Child speech problem child

encourage speech therapist
7. Prevent Complication: Child earche dental deccy complication

regular Dr. (ENT/Dentist) contact

DEFECT OF GI TRACT
ESOPHAGEAL ARTESIA & TRACHEA ESOPHAGEAL FISTULA
Esophageal artesian embryonic development pharynx stomach

Esophagus passage failure
EA esophagus natural opening congenital
malformation TEF trachea esophagus abnormal passage trachea
esophagus development defect defect premature LBW
infant EA & TEF
CLASSIFICATION / TYPE OF EA & TEF :
A. Type - 1:
Esophagus blind trachea connection
EA total cases 8% EA ( EA without fistula 8 % )
B. Type - 2:
Esophagus upper segment trachea fistula esophagus
distal and blind (TEF upper C EA C 1 % )
C. Type - 3:
Condition Esophagus proximal upper segment blind distal
lower segment trachea fistula most common
Condition (TEF lower C EA C 80 – 95 % )
D. Type - 4:
Esophagus proximal distal lower part trachea EA & fistula
( TEF both upper & lower )
E. Type - 5:
Condition EA Esophagus upper & lower segment trachea
fistula H type fistula total case 5% cases
(H type TEF 4%)

SIGNS/SYMPTOMS
- Excessive salivation ( blowing bubbles)
- Constant drooling
- Nose secretion
- Coughing
- Gagging
- Chiking & cyanosis
- Saliva aspiration intermittent cyanosis
- Feeding infant cough, chokes feed retain mouth & nose
- Stomach air abdominal distension
DIAGNOSIS:
- Gathered / RT nose mouth pass passage continuous
check pass blind pouch atresia
- Antenatal diagnosis USG
- Postnatal diagnosis x-ray USG barium meal
- Radio opaque RT catheter insert
- Bronchoscopy
TREATMENT
Immediate Management:
- Secretion aspirate infant semi upright position
- Infant I /V fluid therapy
- Frequent & careful suction pharynx & upper esophageal mouth catheter
suction
Supportive care
- Nutrition
- Warmth
- Prevention of inf
- Antibiotic therapy
- Respiration support
- Continuous pallor & cyanosis observe O2 therapy
- Infant refer suction head & chest 45 angle alleviate
Surgical Management:
- Surgical correction child proximal & distal part type of defect condition
of neonate
- Weight 2 kg baby pneumonia & clinically stable Defect end
to end Anastomosis excision of fistula
- Neonate premative congenital anomalis very sick
surgical correction stages
- Initial stage gastrostomy & 1 year esophaged anastomosis or colonic transplant

NUIRSING CARE:
1. Pharynx & esophagus suction
2. SOS continuous drainage
POST OPERATIVE CARE:
Gastrostomy post operative care
HYPERCHILD PYLORIC STENOSIS
HPS stomach pylorus circular muscles fibers progressive

overgrowth stomach outlet partial total obstruct HPS
incidence first child male
SIGNS/SYMPTOMS
- 3 to 12 week clinical symptoms
- Regurgitation vomiting feeding
30min projectile vomiting non bilious
-
- Irritability
- FTT with loss of weight
- Constipation
- Urine output & stool quantity
- Lethargic with shallow respiration
- Greenish stool starvation diarrhea
- Jaundice & gastric hemorrhage, Dehydration
- Epigastric fullness upper abdomen left to right visible peristalsis
- Epigastrium or right hypochondrium mass ( 2-3cm ) palpate (firm olive shape )

DIAGNOSIS:
- History & clinical examination
- Plain x – ray abdomen
- USG
- Barium
MANAGEMENT:
Surgical treatment defect correct Initial conservative Mgmt
dehydration & electrolyte Mgmt 4-5 week surgical procedure
―Ramstedts Pyloromyotomy‖ operation Operation pyloric muscles bundle
insize
NURSING MANAGEMENT:
Pre – Operative Care:

- Dehydration I/V fluid correct electrolyte saline & soda bi carb
- V/O vomiting & no. of stool observe record

- Daily weight
- Lungs complication position change
- Operation 6 stomach NS clean
- General routine care
Post – Operation Care :

- Naso Gastric tube order aspiration care
- Abdomen distention watch
- Parents feeding technique type of food, position & nutritional requirement
- General post care
ANORECTAL MALFORMATIONS (ARMS)
ARMs alimentary tract lower end development deformities i.e. anoreatal

canal. Deformities minor cases genitourinary & skeletal structure
perineum surface
Anoreatal canal / perineum anus location anoreatal canal congenital
abnormality imporforate anus use
CAUSES
- Main cause unknown
- Ambryonic life 8 week development
CLASSIFICATION
A. Normal anus infant ARMs 3 group classify
1. With a visible abnormal opening of the bowel
a) Anal stenosis
b) Ano – perineal fistula
c) Ano – vestibular fistula in female
2. With an invisible but manifested opening of the bowel :
a) Recto vaginal fistula in female
b) Recto urethral fistula in male
c) Recto vesicular fistula in male
3. No manifested opening of the bowel
a) Persistent anal membrane
b) Rectal atresia
B. Levator ani muscles ARMs 2 group classified

1. Supralevator or high ano – rectal Malformations
Rectom levator ani muscle terminate
- Rectal atresia
- Rectoprostatic fistula ( male )
- Recto vaginal fistula ( female )
2. Translevator of low ano – rectal mal Fromation
Rectom levator ani muscle terminate
- Ano cutaneous fistula
- Ano vestibular fistula
SIGNS/SYMPTOMS
ARMs diagnosis delivery conduct
care giver
ARMs features
- No anal opening
- Absence of meconium
- Fistula stool passage stool
- Female baby rectum & vagina perineum
- Male baby fistula rectal & urinary tract or perineum
- Baby urine meconium
- Feed abdominal distention (progressive )
- vomiting
- Examination rectal tube rectum insert
Specific anomalities specific features
 Imperforate anal membrane: Anal canal opening greenish bulging

membrane baby meconium pass
 Anal Stenosis: Anal opening very small baby difficulty ribbon like stool pass
 Anal Agenesis: Anus opening anal dimple male

perineum/urethra fistula female baby perineum/ vulva
fistula intestinal obstruction develop

 Rectal Agenesis: ARMs 75% condition male baby

fistula posterior urethra communication female baby upper
vagina communication
 Recto perinea Fistula: Perineum small orifice male baby scrotum
& female baby vulva
 Recto vaginal Fistula: Rectum & vagina fistula stool vagina pass
MANAGEMENT :
Congenital anomalies surgical repair
NURSING MANAGEMENT:
Abdominal surgery basic Pre & Post Operative care
Pre Operative care:

1. Maintenance of thermal level ( warm )
2. Maintenance of Fluid & electrolyte
3. Abdominal Girth ( AG)
Post Operative care:

1. Colostomy care
2. Fluid & Electrolyte balance maintain
POST OPERATIVE COMPLICATION:

- UTI
- Recurrence of fistula
- Anal stenosis
- Sphincter muscles control loss
HERNIA
Hernia internal organ abnormal opening

protrusion projection
CAUSE:
- Hernia congenital acquired
- Hernia common cause
- Development normal opening close failure
- Illness injury weakness
- Tumor obesity distention
- Straining & Coughing intra abdominal pressure
TYPES:
1. Inguinal Hernia
2. Congenital Diaphragmatic Hernia (CDH)

3. Hiatal / Hitus Hernia

4. Umbelical Hernia
5. Strangulated Hernia
6. Femoral Hernia
1. INGUINAL HERNIA :
IH inguinal canal intestinal contain protrusion Condition male & pre term
infant 60% right side inguinal hernia & 30% left side IH & 10 %
bilateral IH IH direct indirect
SIGNS/SYMPTOMS
Painless inguinal swelling baby strain cry
baby rest gently compression
Obstruction symptoms develop
- Irritability
- Herniated side tenderness
- Stool Pass difficulty
- Anorexia
TREATMENT:
- Hernia truss belt
- Majority cases hernioraphy & hernioplasty
POST OPERATIVE ADVICE:

- Strain activity
- Cycling avoid
- Sport injury
2. CONGENITAL DIAPHRAGMATIC HERNIA (CDH) :

Hernia congenital malformation hernia abdominal organ diaphragmatic
defect thoracic cavity slight herniation abdominal contain extremely
protrusion Condition left side lung & heart position
Affected side lung compress & hypostatic
SIGNS/SYMPTOMS
- Severe resopiratory distress
- Trachypnea
- Dyspnea
- Cyanosis
- Chest wall retraction
- Broad chest
- Scaphoid abdomen
- Chest affected side expand
- Apical heart beat
- Thorax affected part large & auscultation dull absent breath sound

DIAGNOSIS:
- Chest X – ray mediastenum sift
- Air intestine thoracis cavity
NURSING MANAGEMENT:
Pre Operative care:

- Birth resuscitation
- Baby head affected side non affected side lung
expand baby semi fowler position
- Respiration secretion suction remove O2 level maintain
- Sodium bi carbonate acidosis correct
Post Operative care:

- Respiratory distress watch
- Endotrachel tube maintain respiration
- General Post care
3. HIATAL / HITUS HERNIA:

Hiatal hernia stomach cardiac and diaphragm abnormal white
esophageal opening pass
CAUSES
- Diaphragm muscles formation deformities
SIGNS/SYMPTOMS
- Esophagus irritation vomiting salivation & regurgitation
- Vomiting mucus blood
- Dehydration
- Aspiration pneumonia
- FTT
- Anemia
- Rector sterna pain & burning sesation
- Chronic case stenosis
DIAGNOSIS
- USG & barium meal test
MANAGEMENT:
Persitant vomiting esophagitis, malma, frequent, aspiration
surgical measure ― Niaaen type of Fundoplication ― operation
- Child upright position
- Thickened feed
- Antacids
- Post Operative Care

4. UMBILICAL HERNIA:
Intestine Umbilical ring protrusion Hernia
soft swelling skin cover infant strain
Umbilical Hernia 1 year age disappear hernia 9 year age
Disappear surgical repair
5. STRANGULATED HERNIA :
Intestine loop obstruction edema & loop venus
Circulation blood supply necrosis bowel loop
Death
SIGNS / SYMPTOMS :
- Inflammation & swelling severe pain
- Intestine obstruction S/ S
MANAGEMENT :
- Immediate seduction
- Emergency surgery
- Pre & Post operative Care
COMPLICATION :
- Post operative inflammation
- Hemorrhage
- Peritonitis
- Painful swelling on scrotum ( male )
DEFECTS OF GENITOURINARY TRACT
HYPOSPADIASIS
Common congenital anomalies penis ventral aspect ( under surface )

abnormal urethral opening Condition undescended testis,
inguinal hernia upper urinary tract abnormal urethral opening vagina
CLASSIFICATION:
Urethra meatus hypospadiasis classified

1. Anterior Hypospadiasis (60-70% ) :
AH opening glands distal penil shaft
2. Middle penile Shaft Hypospadiasis (10-15% ) :
3. Posterior Hypospadiasis (20% ) :

Opening proximal penile shaft penoscrotal scrotal perineal part

Hypospasiasis development testis cell prematurity endrogen (sex hormone )

production external ganitalia formation obstruction
condition
SIGNS/SYMPTOMS
- Birth observation
- Hypospadialis baby urine pass condition defect
MANAGEMENT & NSG CARE :

- Surgical reconstruction two stage
- Birth meatomy operation age
- Penis straight 2-3 year cherdee correction
- Chordee correction 3 to 4 urethroplasty
Surgical process school age social & emotional
problem
- Catheter care & restrain
- Urine flow operation observe
EPISPADIASIS
Congenital condition condition urethral opening penis dorsal

(mild case glands Urethra dorsally displace
intraumbelical wall & urethra upper wall abnormal development condition
exstrophy of bladder & ambiguous genitalia
CLASSIFICATION:
IN MALE:
Anterior Epispadiasis normal continence
1. Glandular
2. Balanitic or penile
Posterior Epispadiasis associated incomplete bladder neck & incontinence of urine
1. Penopubic
2. Subsymphyseal
The male infants Epispadiasis are having short & broad penis c dorsal curvature

IN FEMALE:
Urethra is short & patulous
1. Bifid clitoris with no incontinence of urine
2. Subsymohyseal with incontinence of urine
MANAGEMANT: 3 stage surgical correcting

 1 stage : 1.5 to 2 year
st
penile lengthening urethral strip &
chordee correction
 2nd stage : 1st stage 6 month urethral reconstruction
 3 stage : 3 to 4 year
rd
operation bladder neck reconstruction
Bladder capacity enhance 3rd stage operation 2-3 cystoplasty
NURSING CARE:
- Long term mgmt schedule emotional support
- Prevention of infection in body
- Routine pre post operation care
- Infant normal bladder capacity 200-300ml
EXTROPHY OF BLADDER (ECTOPIU VESICAE)
Congenital malformation abdominal wall lower portion &bladder

anterior wall missing bladder opening everted lower abdomen symphysis
pubis urine condition ectopia vesicae
SIGNS/SYMPTOMS
- Defect urine dribbling
- Skin excoriation
- Bladder infection & ulcerations
- Urinary tract infection
- Growth Failure
DIAGNOSIS:
- Inspection at Birth
- Associated problem x-ray, USG, IVP

- Condition 48 hour surgical repair
- Cases urinary diversion
- Stage malformation surgical correct
- Complete correction school age
Pre operative care :

- Bladder infn trauma protect irritating clothing & linen
avoid baby back or side position
- Expose bladder humidified aseptic technique wet gauze

cover
- Child & Parents planned reconstruction surgery prepare
Post operative care:
- Child close monitoring
- Care of urinary catheter
- I/ O chart
- Home based care parents demonstrate care
PHIMOSIS
Phimosis prepuce narrow opening glands penis Foreskin

3 year age prepuce retract true phimosis
Forcible retraction avoids Skin tear

Scaring & persistent phimosis phimosis congenital & acquired
Acquired glans prepuce inflammation Paraphimosis
Paraphimosis phimotic foreskin restaction spontaneously reduce
edematous severe pain
TREATMENT & NURSING CARE::

Condition circumcision glans penis foreskin excision cut
mgmt narrow preputical skin betamethasone cream 2 time 4 week
apply skin soft & elastic foreskin retract
UNDESCENDED TESTIS / CRYPTORCHIDISM:
Scrotum bottom testis condition Undescended Testis

premature infant inguinal canal / abdominal wall pubic
tubercal
TYPES :
1. Ectopic cryptorchidism: Testis size normal spermatic cord
diversion scrotum
2. True crytorchidism: Testis normal pathway True
crytorchidism condition testis size spermatic cord & artery
short testis descent
SIGNS/SYMPTOMS
- Cases testis inguinal canal easily feel
- Affected side scrotum side & empty
- Undercending testis temperature scrotal temperature
sperm forming cell damage

- Testis undescended sterility

- Endrogenic activity secondary sexual characteristic develop

- 1 year age surgery surgeon school age surgery
prefer
- Orchidopexy operation spermatic cord hernia & adhetion remove
testis mobilize scrotum
Post Operative Care:

- Scrotum & thigh traction
- Rest
- Stress exercise
- 3 month cycle
- Sterility & sexual behavior parents reassure
- Hormonal Rx ( gonadotrophin - 200 – 500 unit week 2-3
time )
POLYCYSTIC KIDNEY:
Polycystic Kidney complex syndrome nephron development

Development nerphon progressive development adverse
hereditary metabolic environment
Polycystic Kidney
a. Infantile type (autosomal recessive inheritance )
b. Adult type (autosomal dominant inheritance )
Infantile type palpable bilateral nodular cystic mass hyper tension & progressive
renal failure condition liver, CNS, CVS anomalies
Adult type anemia, polyuria, hyper tension, bilateral palpable nodular renal mass
sign 40 year
SEXUAL ABNORMALITY
AMBIGUOUS GENITALIA
―Ambiguous ―means being difficult to classify

Congenital adrenal hyperplasia (CAH) common adrino cortical
insufficiency
Aldosteron, cortisone or endrogen production steroid pathway
enzyme deficiency block adreno cortical insufficiency condition
condition life threatening

diagnosis & Treatment etiology

Ambiguous Genitalia normal sexual form male
& female characteristic intersex or hermaphrodite
congenital abnormality
PATHOPHISIOLOGY & ETIOLOGY

Enzyme deficiency steroid pathway block adrenal insufficiency
Due to lack of feedback suppression
TYPE OF HERMAPHRODITISM
1. True Hermaphroditism : Ovarian & testicular glands

side condition rare
2. Pseudo Hermaphroditism Sex gland one sex & genitalia opposite

sex male & female
3. Mixed Pseudo Hermaphroditism
SIGNS/SYMPTOMS:
A. Ambiguous female genitalia / female pseudo Hermaphroditism ( FPH )

A. Large clitoris / resembling the penis
B. Hypertrophied labia majora resembling the scrotum
B. Ambiguous male genitalia
A. Small penis
B. Perineal hypospadiasis
C. Scrotum without testis vulva
DIAGNOSIS:
- Clinical suspicion
- Detail history
- Through head to feet examination
- Radiological examination
- Pelvic USG
- Lab investigation
- Peripheral blood
- Bone marrow study
- Chromosomal study
- Serum testerone or estrogen
MANAGEMENT
- Cause & associated condition
- Early diagnosis
- Hormonal therapy
- Steroid therapy surgical reconstruction of genitalia

- Family & parents situation support

- Health education for continuous management.
ORTHOPEDIC ABNORMALITY
CLUB FOOT
Congenital club foot talipes nontraumatic deformity

foot normal position shape twisted planter flexion (talips equines)
dorsiflexion (talipes calcan-eus ) deform
95% planterflexion club foot foot planter flexion middle
deviated heel elevated twisted
CAUSE :
- Contributing factor
- Fetal life development
- Fetal foot malposition
- Defective neuromuscular development
MANAGEMENT
- Standard foot wear
- Plaster cast, adhesive tape, strapping splinting manipulation
- 2 to 6 month
- Bebax shoe or weaton brace shoe
- 4 to 7 month age surgical mgmt ( tenotomy )

DEFECTS OF CARDIO – VASCULAR SYSTEM
CONGENITAL HEART DISEASE
Congenital Heart Disease heart great vassals

structural malformation (8: 1000)]
CAUSES:
- 90% cases exact cause unknown
- Heredity & consanguineous marriage (blood related)
- Genetic disorder & chromosomal aberrations
- Fetal & maternal teratogenic infection rubbella
- Alcohol intake
- 1st trimester exposure & radiation
- Maternal IDDM (insulin dependent DM)
- Fetal hypoxia
- Birth asphyxia
CLASSIFICATION:
1. A cyanotic CHD:
a. Atrial Septal Defect ( ASD)

b. Ventricular Septal Defect ( VSD )
c. Atrio Ventricular Canal ( AVC )
d. Patent Ductus Arteriosus ( PDA )
2. Cyanotic CHD:
a. Tatralogy of Fallot ( TOF)

b. Tricuspid Atresia ( TA)
c. Transposition of Great Arteries (TGA)
d. Truncus Artriosus
e. Hypoplastic left heart syndrome
f. Total anomalous pulmonary venous return
g. Eisenmenger syndrome or complex
3. Obstructive Lesions :
a. Coarctation Of Aorta ( COA)

b. Artic Valve Stenosis
c. Pulmonary Valve Stenosis
d. Congenital Mitral Stenosis

ACYANOTIC DEFECTS:
Defect cyanosis blood flow
Deoxygenated blood circulatory or systemic circulation mix cyanosis develop
VENTRICULAR SEPTAL DEFECT (VSD):

Right & Left ventricle ventricular septum abnormal opening VSD
Defect size small or large VSD Per membranous muscular
Septum defect Incidence total 20 – 25 %
Pathophysiology:
Defect oxygenated blood Right & Left side shunt systole
Left side high pressure Right ventricle &
pulmonary arterial pressure & pulmonary over circulation Left heart
venous return and Left heart (atrium) dilatation
condition pulmonary vascular resistance pulmonary HT &
reserve shunting cyanosis
Sign / Symptoms:
- Depend on VSD size
- Small VSD child asymptomatic soft murmur
- Large defect 1 to 2 month age defect develop
- Recurrent Chest infection
- Feeding difficulties
- Tachycardia
- Excessive sweating
- Poor weight gain
- FTT
- Hepatomegaly
- Frequent URTI
- Biventricular Hypertrophy
- CCF
- Lower sterna border systolic murmur (hollow systolic murmur)
Investigations:
- History
- Auscultation
- Chest X – Ray ( show cardiomegaly )
- ECG
- Echocardiogram Doppler Study
- Cardio Catheterization
Management:
- Small VSD Rx
- 30 to 50 % cases 1 to 2 year age close
- Large VSD associated problems
- CCF endocarditis mgmt
- Complication manage surgical plan
- Surgical Rx open heart Rx cardiac pulmonary bypass
- Surgery expert Nsg mgmt
- Long term follow up & monitoring ventricular function
Complication:
- Infective endocardiitis
- Eisenmengers syndrome ( bilateral ventricle dilate )
ATRIAL SEPTAL DEFECT (ASD)

Right & Left atrium septum abnormal opening blood shunting
Left & Right total CHD cases 9% case male & female ratio (1: 2)

Pathophysiology:
Pressure Left atrium blood pressure Right atrium ASD
Left & Right shunt pulmonary flow Right ventricular
volume overload and ventricular dilate lung flow pulmonary artery
pressure
Types:
1. Ostium secundum ASD : abnormal opening septum middle or foramen oval
2. Ostium Primum ASD : Abnormal opening septum bottom
3. Sinus venosus ASD : Abnormal opening septum top
Signs / Symptoms:
- Small ASD asymptomatic
- Dyspnea
- Easy fatigability
- Chest bulging
- Cardiac Enlargement
- Poor weight gain & FTT
- Long term CCF
- Recurrent URTI
Investigations:
- Chest x – ray (show Right atrial & ventricular megaly)
- ECG
- Echocardiogram Doppler
Management:
- Condition 5 year age spontanecusly close
- Defect close early childhood plan surgically repair
- Open heart surgery
- Complication or Associated condition SOS treatment
Complication:
- Infective endocarditis
- Pulmonary arterial hypertension
- CCF
PATENT DUCTUS ARTORIOSUS (PDA):
PDA aorta & pulmonary artery continuous vascular connection

ductus arteriosus opening birth functionally close birth duatus
arterisus open & common aorta pressure blood flow artery
recirculation PDA

Preterm baby < 1.5 kg female baby more common
Pathophysiology :
PDA blood flow Left to Right aorta to pulmonary artery
& pulmonary artery over load & systemic circulation O2 blood circulation
pulmonary artery vascular pressure Left heart volume load
Sign / Symptoms:
- Depend on ductus size & patency
- Small & moderate PDA asymptomatic
- Bounding pulse
- Dyspnea
- Recurrent URTI
- Systolic pressure
- Diastolic pressure
- Precordial pain
- Slow weight gain
- Growth failure
- Preterm respiratory distress
- Tachypnea
- Retraction
- Hypoxia
- CCF
- Left & Right ventricular enlargement
Management:
Medical :
- Prostaglandin ( indomethacin ) drug 0.1 to 0.25 mg/ kg/ dose / IV over 30
minutes very slowly is administered every 12 to 24 hours for 3 doses
- Small PDA close

Surgical :
- 3 to 10 year age correct defect
- Transection or ligation
CYANOTIC DEFECTS:
TETRA LOGY OF FALLOUT ( TOF ) :
Cyanotic CHD most common 6 to 10 % condition

defect
1. Pulmonary stenosis
2. Ventricular Septal Defect
3. Overriding or Dextroposition of the Aorta
4. Right ventricular Hypertrophy
Pathophysiology :
TOF structural defect Rt to Lt shunt cyanosis develop Right
ventricle constriction pulmonary valve stenosis blood flow obstruct
and VSD CO2 blood Left Ventricle aorta
Pulmonary stenos is against blood pumping Rt ventricular hypertrophy
develop
Signs /Symptoms:
- VSD size & Rt. ventricular outflow obstruction
- Baby blue or lips & nail beds blue
- Baby crying exhaustion dyspnea
- Age lying down Squatting posture more comfort

- Hypoxic anoxic or blue spell tat spell cerebral anoxia

spell
 Irritability
 Dyspnea
 Cyanosis
 Conscious or unconscious flaccidity
 Right ventricular enlargement
 Slow weight gain & mental slowness
 2 year age fingers & toes clubbing develop
 Soft or harsh systolic murmur
Investigation:
- History
- Auscultation
- X – ray
- ECG
- Echo cardio gram
- Cardiac catheter
Management:
 Medical:
- Cyanosis hypoxic spell O2 therapy
- Spell knee chest position
- Correction of dehydration
- Treatment for anemia
- Supportive Nursing Care
- Continuous Monitoring
 Surgical:
- Defect surgery through technique correct modified blalock
Taussim (BT) shunt
- Pots operation or waterson‘s operation
TRANSPOSITION OF GREAT ARTRIES (TGA):
Condition aorta Right ventricle & pulmonary artery Left

ventricle aorta Co2 pulmonary artery O2 Blood circulation
independent circuits circulate
Malformation communication systemic & pulmonary circuits
child survive
Signs/ Symptoms:
- Severe cyanosis soon after birth
- Dyspnea
- Metabolic acidosis
- Severe hypoxia

- CCF ( if severe )
- Growth failure
Investigation:
- Examination main auscultation

- Radiology exam
- ECG
- Cardiac catheter
- Angiocardiography
Management:
Medical:
- Digoxin prostaglandin inhibitor
- Diuretics
- Iron therapy
- Supportive Nursing Care
Surgical :
- Defect operation
- Arterial switch operation
- Restelli‘s operation
- Beffe‘s operation
TRICUSPID ATRESIA (TA):
Congenital defect tricuspid valve absent Right atrium & ventricle

communication small Right ventricle & large Left ventricle & pulmonary
circulation diminished

OBSTRUCTIVE LESIONS:
AORTIC STENOSIS (AS):
Aortic Stenosis Obstructive Cardiac Lesions aorta blood flow

Left ventricle aorta Aortic Stenosis valvular, sub valvular supra
valvular
Signs/ Symptoms:
- cynosis
- Dizziness
- Easy fatigability
- Exercise intolerance
 In Neonate
- Severe CCF
- Tachypnea
- Faint peripheral pulse
- Poor capillary refill
- Cold skin
- Metabolic acidosis
 In Older
- Exertion chest pain
- Exercise tolerance
- Dyspnea
- Pulmonary edema
- Shortness of breath light headache
- Fatigue
- Dizziness
- Palpitation
- Srrythliass
- Syncope
- Sudden death

Investigation:
- Chest x- ray
- ECG
- Echo CG
- Angiography
- Cardiac catheter
Management:
- PGE prostaglandin E influsion
- Ventilator support ( SOS)
- Surgical correction aortic
- Balloon or valvuloplasty or valvotomy
- Older child valvotomy
Complication:
- Post – operative aortic regurgitation
- Replacent valve work failure
- Pulmonary edema
- Arrhythmias
COARCTATION OF AORTA (CA):
Condition aorta clean narrowing or aortic arch long segment

hypolasia sub clavian artery
Aorta narrow blood flow obstruct & Left ventricle pressure &
work load male VSD or PDA

Signs/ Symptoms:
 In Neonate :
- Severe CCF
- Poor perfusion
- Tachypnea
- Acidosis
- Absent femoral pulse
 In Older :
- Asymptomatic (may be )
- May be normal G & D
- Weak femoral pulse
- Upper & Lower extremity hypertension
- Headache
- Cramps
 General :
- Fatigue
- Headache
- Weakness
- Exertional dysponea
- Cramp
- Intermittemt claudication
Investigation:
- Auscultation ( non specific systolic murmur)
- History
- X – Ray
- Echo cardio gram
- Cardiac catheter
Management:
- PGE
- Antibiotic
- treatment as per complication
- Surgical mgmt at 3 to 5 year age
TRUNCUS ARTERIOSUS: (CYANOTIC CHD):
Trauncus arteriosus fetal life division ventricle single great

vessels

NURSING MENEGEMENT OF CHILD CHDs
Nursing management aim early diagnosis, mgmt of problem,

complication Prevent and genetic counseling
NURSING ASSESSMENT:
Detail History
- Present complain
- History of illness
- Birth history
- Family history
- Development history
Anthropometric measurements:
- Problems severity & growth failure weight length / height
HC CC & AC measure record
Assessment of followings:
- Vital sign
- Oxygen saturation
- Skin color (pink, cyanotic, mottled )
- Mucous membrane ( dry or cyanotic)
- Peripheral pulse ( rate, symmetry, quality )
- Edema
- Capillary refill
- Cool in touch
- Clubbing
- Chest wall deformity
- Level of activity & consciousness
- Respiratory pattern
- Heart Sound
- Feeding Behavior
- Intake & output
- Sleep Pattern
Required Investigation :
NURSING DIAGNOSIS :
 Impaired gas exchange related to disturbed pulmonary blood flow
 Decreased cardiac output related to reduce myocardial function
 Activity intolerance related to hypoxia
 Altered nutrition less than body requirements related to excessive energy demands
required by increase cardiac workload
 Risk for infection related to chronic illness
 Fear & anxiety related to life threatening illness
 Knowledge deficit related to long term problems and prevention of complication

NURSING INTERVENTIONS:
Child respiratory distress
- Semi up right position
- Cleaning oral & nasal secretion
- O2 therapy
- Medication as per Dr. Order
- Continuous monitoring to prevention aspiration
Child cardiac output improve
- Uninterrupted rest
- Minimum exercise
- Maintain normal body temperature
- Provide comfortable enviorment
- Medical as per Dr. order
Digoxine
Antihypertensive
Anti arrythmatic
Monitoring vital sign & heart sound
Child oxygenation & activity tolerance improve
- Physical rest
- Calm enviorment
- Emotional support
- O2 therapy
- Continuous monitoring through pulse oxymeter
Providing adequate nutrition :
- Small frequent feeding
- Oral feeding 15 to 20 min
- Extra calories through NG tube
- Daily weight record
- I / O chart
To prevent infection
- Avoiding infn exposure
- Good hand washing practice
- General clininess
- Hygienic measures
- Provide immunization
- Early detection of infection
Fear & anxiety reduce
- Provide knowledge & information
- Reassurance
- Child parents & family members
- Child problems
Health maintenance & follow up teaching
- Health adequate diet rest immunization prevention of
infection regular medicine & regular follow up
Parents & family members
- Child problems
- Complication
- Dangerous sign

UNIT – 7
Children with various
Disorder and diseases
ETIOLOGY, SIGN, SYMPTOMS, COMPLICATION, PREVENTION,

MEDICAL, SURGICAL & NURSING MANAGEMENT OF:
 Disturbances of fluid and electrolyte balance: burns, disturbances of renal function,
acute and chronic glomerulonephritis, acute and chronic renal failure.
 Disturbed respiratory functions: Acute infections of upper and lower respiratory tract,
acute inflammation of lungs.
 Gastro-intestinal disorders: Malabsorption syndromes (celiac diseases) and obstructive

disorders (intestinal obstruction, Hirschsprugn‘sdisease) inflammatory conditions
(appendicitis, Meckel‘s diverticulum‘s, ulcerative colitis), worm infestations.
 Problems related to production and circulation of blood: Acquiredheart diseases,

congestive cardiac failure, infective endicarditis,rheumatic fever.
 Problems related to the elements of blood: Anaemias, sickle cellanaemia, thalassemia,

defects of haemostasis, haemophilia, Immunedeficiency diseases, HIV infection (AIDS)
leukemias,thrombocytopaenia, purpura.
 Disturbances of regulatory mechanism: disturbances of cerebralfunctions – altered

state of consciousness, craniocerebral trauma.
 Intracranial infections: Meningitis, encephalitis, convulsive disorders.
 Endocrine dysfunctions: Disorder of pituitary functions, disorders ofthyroid and

parathyroid function, disorders of adrenal cortex, disordersof pancreatic hormone
secretion.
 Problems that interfere with locomotion: Poliomyelitis, osteomyelitis,kyphosis,

lordosis and scoliosil, rheumatoid arthritis.
 Children with development problems: Handicapped children, multiplehandicapped

children, mental retardation.
 Communication disorders – hearing, vision impairment, deaf and blindchildren.

DISTURBANCE OF FLUID & ELECTROLYTE BALANCE
BODY FLUID
Balanced body water & electrolyte stable internal environment

Fluid & electrolyte balance disturbance
Problems Fluid & electrolyte maintain
Distribution of total body water:
Fluid Component Infant Older Child
Intra cellular fluid 40% 35 to 40%

Extra cellular Fluid 35 to 40 % 20 to 25 %
Intestinal - 15%
Transvasular (plasma) - 5%
Trans Cellular - 1.3%
Total Body Water 75 to 80% 60%
 Full term neonate body weight 75 to 80 %

60%
 Electrolyte Composition of body Fluid :Body fluid water electrolyte
solution electric current conducting
 Substance positively change actions negatively change anions
 Cation – sodium (Na ) Potassium (K ) calcium (Ca ) Magnesium (Mg++)
+ + ++
Anion chloride (CL) bicarbonate salt anamic acid protein phosphate etc.
FLUID IMBALANCE
Urinary insensible lasers metabolic activity Water

Normal physiological requirement maintain fluid imbalance
Fluid body weight body surface area metabolic rate

fluid imbalance
 Dehydration
 Over hydration or water intoxication
DEHYDRATION

Dehydration body water loss fluid imbalance

infant children
CAUSES:
 Diarrhea
 Vomiting
 Diabetic insipid us
 Hyperglycemia
 Renal looser
SIGNS AND SYMPTOMS
- dry or sticky mouth

- few or no tears when crying
- eyes sunken
- soft fontanelle
- lack of urine or wet diapers for 6 to 8 hours in an infant (or only a very small amount
of dark yellow urine)
- lack of urine for 12 hours in an older child (or only a very small amount of dark
yellow urine)
- dry, cool skin
- lethargy or irritability
- fatigue or dizziness in an older child
ASSESSMENT OF DEHYDRATION :
(See in the unit: 5 of Diarrhea)
MANAGEMENT OF DEHYDRATION:
1. ORT
2. Intravenous Dehydration
(See in the unit: 5 of Diarrhea)
OVER HYDRATION OR WATER INTOXICATION
SIGNS & SYMPTOMS

- Excessive urination
- Vomiting
- Muscle cramps
- Blurred vision
- Drowsy or irritable
- Facial swelling
- Nausea
- Seizures
TREATMENT
 Mild intoxication, asymptomatic .and require only fluid restriction
 severe cases, treatment consists of:

- Urination Diuretics effective

- Vasopressin receptor antagonists
ELECTROLYTE IMBALANCE:
Sick children electrolyte disturbance or dyselectroycemia

A. Hyponatremia
B. Hypernatremia
C. Hypokalemia
D. Hyperkalemia
A. HYPONATREMIA :
Hyponatremia (130 mg / lit) serum sodium level 130 mg / lit
Water retention sodium loss
Acute, diarrhea, pneumonia, meningitis,
sepsis, heart failure, hepatic failure renal disease
Sign / Symptoms:
- severity
- Asymptomatic 120 to 130 mg/ Lit Sodium level
- Restlessness
- Confusion
- Convulsion
- Hypotension
- Heart Failure
- Unconsciousness
Management:
- Intravenously - 3% sodium chloride 10ml kg rate of fluid 1 ml /minute.
- 24 TO 48 hour
- CCF fluid restrict frusemide
B. HYPERNATREMIA :
Serum sodium level 150 mg / Lt Hypernatremia
diarrhea, vomiting, dieresis, burns excessive sodium intake
condition
Signs / Symptoms:
- Irritation
- Confusion
- Twitching
- Seizures
- Tough & doughy skin and subcutaneous
- Intracranial Hemorrhages
- Coma
- Metabolic acidosis deep rapid breathing

- Hypotension
- Dehydration
Management:
- Hypovolemia treat ringer lected or normal saline
intravenous
-
- Conscious free water ORS breast feeding
- Condition frequently monitoring
- CNS symptoms convulsion anticonvulsive therapy mannitol
therapy
- Sodium level 180 mg / Lt dialysis (peritoneal )
- General Hygienic Care.
C. HYPOKALEMIA :
Serum potassium level 3.5 mg/lit hypokalemia
Age, septicemia, diuretic therapy, hepatic failure, potassium intake, renal losses, extra
renal losses, main causes
Signs / Symptoms:
- Muscles contraction
- Nerve Conduction
- Myocardial pacing
- Hypotonia
- Diminished Reflex
- Abdominal Distension
- Poor Peristalsis Movement
- Paralytic ileus
- Paralysis
- Cardiac Problems
Management :
- Slow administration of potassium ( over 24 to 48 hour )
- Treatment
- hypokalemia ECG change 0.3 to 0.35 mEg/ kg / hour
ECG changes normal
- I / O chart
- Continuous observation cardiac features
- General care
D. HYPERKALEMIA :
Serum potassium level 5.5 mg / Lt Hyperkalemia
Causes:
- I /V infusion potassium

- Acute or chronic renal failure

- Potassium – sparing diuretic
- Acidosis hemorrhage burns hemolysis sepsis injuries necrosis insulin defidency crush
injury potassium tissue ECF release
Signs / Symptoms:
- Mild hyperkalemia Signs / Symptoms
- Cardiac skeletae muscles
- Muscular weakness
- Paresthesias
- Shock
- Bradycardia or cardiac arrhythmias
- ECG changes
Management:
- Potassium intake mild hyperkalemia treat
- Moderate hyperkalemia glucose insulin infusion sodium bi-carbonate infusion
- Severe hyperkalemia calcium glucose I /V sodium , bicarbonate, glucose insulin
therapy
- Continuous monitoring child condition
- Supportive nursing measures
BURNS
Heat, Flame, chemicals, Electricity & radiation Injury burns
Burns tissue injury body surface 45 Expose
CAUSES:
- Thermal
- Chemical
- electrical or radioactive agent
CLASSIFICATION:
1. According to depth of Burn therapy

 Superficial partial thickness burns : Dermis epidermis superficial layer
burns
 Superficial deep dermal burns : papillary dermis deep burns
 Full thickness burns : Skin tissue burn

2. According to extent of burns injury

 First degree burns - superficial burn
 Second degree burns – partial thick skin burns
 Third degree burns - full thick skin, subcutaneous
- Fat & muscles bone ending burn OR
- Minor burn below 15% partial or 2% full thick skin
- Moderate burns : Thick burn
- Major burns : 30% or more partial thick OR 10% critical area involved
ESTIMATION OF EXTENT OF BURNS SURFACE AREA :

Burnt area calculate method
1. Rule of Hand : Closed finger 1%
2. Rule of line: adult or > 10 years
Head upper limb trunk front back private part lower limb
19% 18% 18% 18 1% 13+13 =26%
3. Rule of five :
Pediatric burns calculation method
Area Age 0-5 yrs Age 5 -10 yrs Age10 yrs onwards
Head & Neck 20% 15% 10%
Trunk front 20% 20% 20%
Trunk back 20% 20% 20%
Upper limbs 10x2= 20% 10x2= 20% 10x2 = 20%
Lower limbs 10x2= 20% 15x2= 30% 15x2 = 30%

NB: 5% ducted from trunk

CLINICAL MANIFESTATION:
Burns degree common Signs / Symptoms
- Pink red skin
- Pain
- Blister formation
- Edemas & pain moist area
- Third degree burns epithelial cell, fat muscles bone burn
- Symptoms of Shock
- Pallor, cyanosis, poor muscles cone
- Rapid pulse, low blood pressure
- abnormal Temperature
- Inhalation injury inflammation
- Edema, airway obstruction, dyspnea, tachypnea, boorishness, etc..
- Toxemia symptoms week develop
MANAGEMENT:
- First aid measure
- Assessment of extent of burns
- Fluid replacement
- Care of wound
- Use of topical antibiotic & Systemic antibiotic
- Prevention of infection
- Nutritional need
- Psychological support
- Prevention of complication
- Rehabilitation
- Promoting & supporting cardiac output by followings…
 Shock observation
 Vital sign check
 Level of consciousness
 Electrolyte check
 I / V fluid therapy
 Oxygen therapy
 Humid environment
 I / O chart
- Pain & discomfort bed angle & analgesic drugs
- Fear anxiety
- Infection aseptic technique wound care antibiotics position
change bed sheets sterile general cleanliness
- Airway patency maintain
- Severe care catheterization care
- Nutrient

- Exercises early ambulation

- Complication splint therapeutic play
- Negative body image skin grafting cosmetic surgery
- Health education post burn period rehabilitation
ACUTE GLOMERULONEPHRITIS (AGN)
AGN renal glomerular capillary loop immune medical inflammatory disease

2 to 10 year age common female male child
Streptococcal infection glomerular loop antigen antibody complex
endothelium cell proliferation &swelling blood flow obstruct
glomerular filtrate rate Blood cell protein filtrate sodium
water retained
SIGN/SYMPTOMS:
- Periorbital oedema
- Urine output
- High color urine black tea or cola
- Hematuria
- Fever
- Headache
- Nausea
- Vomiting
- Anorexia
- Abdominal pain
- Malaise
- Hypertension
- Pale lethargic irritable
INVESTIGATION:
 Urine examination for
- Hematuria
- Specific gravity
- Albumin
- WBC & epithalial cell
 Blood examination for :
- Serum albumin
- Serum creatinine
- Serum urea
MANAGEMENT & NURSING INTERVENTION :

- No specific treatment
- Supportive treatment
 Antibiotics ( penicillin )
 Symptomatic management
 Anti hypertensive drugs
 Sedatives
 Dialysis
- facilities bed playing
- Bed rest week
- Vital sign check complication early sign
- Intake output chart
- Diet protein salt fluid intake restrict
- Daily weight record oedema
- Skin care & general hygiene care
- Emotional support
- Parents continuous care and follow up
CHRONIC GLOMERULONEPHRITIS
Renal function advanced irreversible impairment symptomatic

asymptomatic primary glomerular disease
CAUSES
 Exact cause of glomerulonephritis is unknown.
 Problems with the body's immune system.
 Risk factors:
- Blood or lymphatic system disorders
- Exposure to hydrocarbon solvents
- History of cancer
- Infections such as strep infections, viruses, heart infections, or abscesses
- Heavy use of pain relievers, especially NSAIDs
- Blood vessel diseases, such as vasculitis or polyarteritis
- Amyloidosis
SIGN/SYMPTOMS:
Asymptomatic patient routine urine exam symptomatic
- Severe hyper tension
- Hematuria
- Nocturia
- Persistent anemia
- Bone Pain
- Bony deformities
- FTT ( Failure to Thrives )
- Foamy urine (due to excess protein in the urine)
- Swelling (edema) of the face, eyes, ankles, feet, legs, or abdomen
- Abdominal pain
- Blood in the vomit or stools
- Cough and shortness of breath
- Diarrhea

- Excessive urination
- Fever
- General ill feeling, fatigue, and loss of appetite
- Joint or muscle aches
- Nosebleed
DIAGNOSIS:
- Anemia
- High blood pressure
- Signs of reduced kidney function
- Abdominal CT scan
- Kidney ultrasound
- Chest x-ray
- Intravenous pyelogram (IVP)
- Anti-neutrophil cytoplasmic antibodies (ANCAs)
- BUN and creatinine
MANAGEMENT
- No specific treatment
- Steroid, Immune suppressive drugs, Anti hypertensive drugs
- Medicines:
 Blood pressure medications to control high blood pressure, most commonly
angiotensin-converting enzyme inhibitors and angiotensin receptor blockers
 Corticosteroids
 Medications that suppress the immune system
NURSING CARE
 Renal chart is very important including :

- Daily weighing of child.
- Blood pressure 6 hourly.
- Urine output 24 hours is collected.
- Diet: high blood urea condition Protein intake decrease
high blood pressure and edema condition Salt restriction
 Bed rest.
- Facilities bed playing
- Bed rest week.
 Prevent infection
- Skin care & general hygiene care
 Emotional support
 Parents continuous care and follow up
 Vital sign check complication early sign

NEPHROTIC SYNDROME
Clinical disorder condition characteristics
- Proteinurea. High albumin level in the urine

- Hypo albuminimia, Low albumin in the blood
- Edema or general anasarca, whole body edema
- Hyper lipidemia, excessive fat / lipid in the blood
CAUSE
- Acute or chronic nephritis
- Diabetes mellitus
- Renal vein thromobosis
- Allergy
- Metabolic disorder
- Toxemia or Pregnancy
- Secondary infection
- Older adult malignancy
SIGN & SYMPTOMS
General system GI system
Pitting oedema Anorexia

Protein urea++ Severe malnutrition
Pale skin due oedema Diarrhea
Swelling of face and abdomen in the child Nausea & vomiting
Asclies Lethargic condition
Adult leg swelling Dyspnea
Anasarca Oligurea
Weight double Body bacterial infection
Oedema male scrotum female

valve
Moon shape face
Hydro torax develops
Oedema discomfort
Body protein loss
serum protein low

INVESTIGATION
- Needle biopsy kidney hysto pathological study
- Serum electrolyte evaluation protein and albumin
- Hyper lipidemia profile test
- Urine microscopic examination protein RBC,WBC, cast
- Renal function test
MEDICAL MANAGEMENT
- Oedema reduce sodium restricted diet
- Renal insufficiency sever diuretics
- Oedema and protteinurea reduce corticosteroid prednisolone
- Auto immune disease nephritic syndrome associated immune
suppressive agent
NURSING MANAGEMENT
- I/O chart strictly maintain
- Bed rest oedema mobilize
- Protein loss dietary management high protein diet body
protein restore
- Mild and moderate sodium restrict sever oedema control
- High calories diet carbohydrate 20 to 50 calories per Kg body weight
- Patient protein loss over all immunity infection protect
- Patient renal thrombosis evaluation

- Patient Protein urea and infection symptoms
- Accurate weight chart maintain
- IV plasma Dr. order
COMPLICATION
- Renal failure
- Heart failure
RENAL FAILURE
ACUTE RENAL FAILURE
ARF renal function deterioration urine excretion (1 ml / kg/ hr

Oliguria anuria fluid & electrolyte
imbalance
CAUSES:
ARF
1) Prerenal cause
2) Renal cause
3) Post renal cause
 Pre renal cause: Kidney blood supply problems systemic

hyporolemia renal hypoperfusion diarrhea dehydration
shock burns diabetic acidosis etc
 Renal cause: Kidney problems glomerulonephritis renal

ischemia tubular damage etc
 Post Renal Causes: Urine flow obstruct bladder neck obstruction

congenital anomalies mass blood clots calculus inflammation & edema
SIGN/SYMPTOMS:
- Causes duration
- Severe oliguria anuria
- Extremely sick
- Nausea
- Vomiting
- Lethargy
- Dehydration
- Acidotic breathing
- Conciousness level
- Cardiac rate 7 rytham
- Oedema
DIAGNOSIS
- Blood tests
- BUN & creatinine
Glomerular filtration rate (GFR)
MEDICAL MANAGEMENT:
- Treatment of underlying causes
- Renal failure complication management
- Supportive therapy
- Fluid & Electrolyte balance
- Diuretic therapy
- Early recognition management complication
NURSING CARE:
- I /V fluid fluid & electrolyte balance
- Maintain intake / output chart
- Heart failure sign
- Electrolyte check
- Medication
- High carbohydrate, low potassium low sodium
Small amount

- Rest, comfortable position

- Skin care urine drainage care
- Hygienic care
- Infection
- Confusion injury & neurotically status
- Emotional support
- Diet infection prevention follow up teaching
- Dialysis care
CHRONIC RENAL FAILURE
CRF nephron permanent irreversible destruction renal function

deterioration
CAUSES:
Congenital renal anomalies urinary tract
malformation causes
- Glomerular disease
- Congenital anomalies
- Obstructive uropathy
- Bilateral wilm‘s tumor
- Renal vein thrombosis
- Renal cortical necrosis
- Renal tuber culosis
- Reflex nephropathy
- Long term treatments:
 Antibiotics, such as gentamicin and streptomycin.
 Pain medicines, such as aspirin and ibuprofen.
PHATHOPHYSIOLOGY:
Nephron damage nephron
hypertrophy & hyperplasia renal function metabolic endocrinal
hematological internal blood circulation homeostatic balance disturb
disturbance hyperphosphatemia urine urea calcium
absorption disturbance disturbance vitamin–D synthesis
anemia develops mild hemolytis
SIGN & SYMPTOMS:

- Polyuria
- Frequent passage of urine
- Oliguria or anuria
- Increase thirst
- Decreased Appetite
- Weakness low energy level
- Bone pain or joint pain

- Dryness & itching of skin

- Progressive anemia, hypertension growth retardation
Late stage
- Acidic breathing
- Hiccough
- Nausea
- Vomiting
- Diarrhea
- Neuropathy
- Convulsion
- Complication CCF Pulmonary oedema hypernatremia etc.
DIAGNOSIS:
- Blood exam: HB% , Na , Ca , HCO3
K+, phosphorus
- Clinical examination
MANAGEMENT:
 Stage CRF Rest, diet, supportive care
symptomatic relief manage
 Medicines: antibiotics and diuretics
 Later stage
- Treatment of complication
- Dialysis
- Renal Transplantation
NURSING MANAGEMENT:
- CRF multi system physiologic crisis system assessment
need care plan
- Dialysis renal transplant special care
- Maintain fluid & electrolyte balance
- Intake / output chart
- Skin care
- Nutrias diet: Calorie high carbohydrates and low protein, salt,
and potassium diet
- Injury, infection protect
- Long term illness cope up
- Continuous care teaching
WILM’S TUMORS
Wilm‘s tumors kidney embryonic malignant tumour
Wilm‘s tumour exact cause unknown unilateral bilateral

case tumors vascular soft mushy gelatinous
SIGNS/SYMPTOMS:
- A firm abdominal mass
- Abdominal pain
- Hypertension
- Fever
- Haematuria
- anuria
DIAGNOSIS:
- Abdominal X – ray
- Pyelography
- Urinalysis
- SGOT
- BUN
TREATMENT:
Tumors stage treatment
 Radiation : Post operative radiation
 Chemotherapy : Actinomycine or outological drugs
 Surgery: Surgical Treatment excision tumors kidney adjacent organ & Para aortic
lymphomas remove
NURSING MANAGEMENT:
Surgery, Radiation, Chemotherapy Treatment care
- Problems
- Abdominal palpation
- Both & handling care
- Diversion therapy
POLYCYSTIC KIDNEY DISEASES
Polycystic kidney diseases inherited kidney disorder kidney fluid

cysts
CAUSES:-
 POLYCYSTIC KIDNEY DISEASES inherited less common desease
types
1. AUTOSOMAL POMINANT PKD (ADPKD) :-

 90 % pkd patients
 parent Affected chances 50%
 generally Aduit (Ahe – 30 to 40 yr)
2. AUTOSOMAL RECESSIVE PKD(ARPKD) :-

 less common
 inherited parents Disease affected gene
 symptoms
3. AEQUIRED CYSTIC KIDNEY DISEASE(AEKD) :-

 inherited
 patient kidney diseases
 Generally Renal failure patients
CLINICAL MANIFESTATION
 Main Symptoms
 Pain an tenderness in abdomen
 blood in urine
 frequent urination
 pain in the both side
 vti
 kidney stones
 Other Syntoms
 Pain an heaviness in basic
 pale skin
 fatigue
 joint pain
 hail abnormalities
Autosomal recessive pkd an Affected high blood pressure, UTI Frequent

urination
OTHER CHILDREN ILLNESS ASSOCIATED WITH PKD :

 Aortic or brain Aneurysm
 Liver cysts, puncuatic cysts
 Cataracts or blindness
 Liver diseases
 Mitral valve prolapsed
DIAGNOSIS :
 CBC Anemia sigrs Assess
 Unine analysis
 USG Abdomen
 CT Scan
 Abdominal MRI
 Intra venous pyelogram (IVP)
TREATMENT :
 symptoms manage blood preslure manage
 Pain killers (analgesics)

 calcium channel blockers

 Antibiotics Low sodium diet Recommended
 Diuretics
 Surgery
 Dialysis
 Kidney transplant
 Removal at kidney
 Urine analysis
 USG Abdomen
COMLICATIONS:
 Anemia
 Bleeding or bursting cysts
 High blood pressed
 Liver failure
 Kidney stones + renal failure
 Cardio vascular diseases
NURSING MANAGEMENT
 Assessment
 Regularly vital signal cheek
 Unine output Assess
 Skin integrity cheek
 Vital organs functions Assess
 Daily Activity observe
 Interventions
 Child complete bed rest
 Liquids Renal function maintain . eg lemon water, Barley water,
Tea, Fruit juices
 Fever hydrotherapy
 Oral ugalive maintain
 Bed sore prevent Complete skin care
 Daily bath twice week hair bath
 One a week nail cut
 Doctors order medication preside Adverse effect Assess
 Diet- patient low sodium light diet
 Fluid intake
 Complications observe interventions

DISTURBED RESPIRATORY FUNCTION
ACUTE RESPIRATORY INFECTION (ARI)
1. Acute Upper Respiratory Tract Infection

 Common cold
 Acute pharyngitis / sore throat
 Acute & chronic tonsillitis
 Acute Loryngoloracheo bronchitis / infection croup
 Otitis media
2. Lower Respiratory Tract Infection

 Bronchiolitis
 Acute bronchitis
 Pneumonia
- Bronchopneumonia
- Lobar Pneumonia
- Pneumonia or interstitional Pneumonia
COMMON COLD
Infant children infection virus

nasophoryngitis cough, sore throat, nasal congestion,
runny nose
CAUSES:
Viruses, Adenovirus rhinovirus, Influenza virus etc, droplet infection
PREDISPOSING FACTOR:
- Chilling temperature
- Overcrowding
- Poor sanitation
- Malnutrition
SIGN / SYMPTOMS:
- Fever
- Malaise & irritability
- Anorexia
- Sneezing
- Watery nasal discharge
MANAGEMENT
- No Antibiotics unless secondary infection
- Symptomatic Treatment: Analgesic, decongestant, antihistamines, etc.

NURSING CARE
 Relieve Nasal Congestion
- Nasal passage clear
- Blow (nose)
- Nasal drops (saliva)
- Nasal obstruction Dr. order
- Decongestants Antihistamine
- Steam inhalation
 Control Fever :
- Temperature check
- High temperature tepid sponge paracetamol (10mg /kg body wt)
 Promote Rest & Isolation :
- Infection isolate
- Articles
- Rest Fever subside 24 hours
 Maintain Fluid And Nutrition :
- Small Frequent feeds & fluids water, glucose, juice
 Give Proper Position :
- Prone Position
- Position change
- Respiratory distress observe
 Observe For Complication :
- Ear pain , cough, purulent secretion Recurrent temperature raise
ACUTE PHARYNGITIS / SORE THROAT:
Acute pharyngitis acute inflammation of pharynx throat infection

Inflammation of the
pharynx that causes a sore throat.
CAUSATIVE ORGANISMS
- Viruses, bacteria, rubella.
- Irritant fames & smoke
- Group A β-hemolytic streptococcal infections are considered a potentially serious
cause because of the risk of rheumatic fever and glomerulonephritis
- Other:
 Chemical irritation
 Gastroesophageal reflux disease
 Postnasal drainage from chronic allergies
 Neoplasms
 pneumonia
SIGNS & SYMPTOMS

- Sore throat
- Enlarged tonsils; tonsillar exudates

- Pharyngeal erythema
- Soft palate petechiae
- Painful swallowing
- Fever greater than 38°C (100°F), erythematous rash, or abdominal pain suggests
streptococcal infection
- Absence of cough, rhinorrhea,
- Headache
- Skin rashes
- Swollen lymph nodes (glands) in the neck
MEDICAL MANAGEMENT
- Antibiotic (Azythromycin , penicillin, Erythrogy
- Symptomatic Treatment
NURSING INTERVENTION
 Relive pain and pyrexia
- Check & record temperature
- Cold Sponging
- Analgestic & Antipyretic Drugs
 Maintain Nutrition & Hydration :
- Small & Frequent feed fluid
 Provide comfort to sore throat & relieve irritating cough
- Warm saline gorgels
- Hot & cold compress applied neck
- Drink warm liquids such as lemon tea or tea with honey.
- Drink cold liquids or suck on frozen fruit-flavored ice pops.
 Drugs :
- Dr. Order antibiotics antihistamine, decongestant
- Rest
ACUTE LARYNGOTRACHEO BRONCHITIS
Croup syndrome / symptoms complex condition hoarseness

aspiratory strider respiratory distress sign laryngeal obstruction
CAUSES:
- Viruses
- Diphtheria
- Pertusis
- Acute inflammation of epiglottis
SIGN & SYMPTOMS:
- Brassy cough & strider

- Fever
- Respiratory Difficulty
- Bilateral Diminished Breath Sound

- Irritability & Restlessness
- Pallor or oynosis
TREATMENT:
 Treat bacterial infection with antibiotics

 Monitor and Facilitate Respiration: Respiratory rate, rhythm , depth type monitor
distress sign observe cyanosis pallor humid hot
steam cool vapor
 O2 inhalation: Airway obstruction artificial airway or trachiostomy
Older children deep breath chest physiotherapy
 Administration of Medication :
 Bacterial croup Antibiotics
- Corticosteroids ( 50mg to 75 mg/kg )
- Symptomatic drugs like antipyretics
 Maintain Hydration :
- I / V Fluid
- High calories liquid
 Promote Rest :
- Fowlers position
 Support and Educate The Parents :
- Parents progress & treatment
- Feeling
- Nutrition
- Fluid
- Rest & Humidity
OTITIS MEDIA
Middle ear infection media acute chronic Condition middle

ear ear drump pus collection bacteria virus
CAUSES
- Bacteria and viruses
- Purulent otitis media pneumococcal influenza or streptococcal ischecian tube
disfunction
SIGN & SYMPTOMS
 ACUTE OTITIS MEDIA

- Pain in Ear
- Discomfort & irritability
- Pyrexia & Malaise
- Ear Discharge
- 20% cases drum rupture purulent fluid
 CHRONIC OTITIS MEDIA

- Persistent inflammation of the middle ear, typically for a minimum of a month.
- Fluid (an effusion) may remain behind the ear drum (tympanic membrane) for up
to three Months before resolving.
- Chronic otitis media can cause ongoing damage to the middle ear and eardrum,
- Chronic otitis media often starts painlessly without fever.
- Ear opping for months.
- Sometimes a subtle loss of hearing can be
TREATMENT:
 Assessment
- Assess Pain behaviors (verbal and non-verbal.)
- Temperature Assess (an indication of the infection process).
- Neck area enlarged lymph nodes
- Nutritional status and fluid intake assess
- Assess the possibility of deafness.
 Interventions
- Dr. order Antibiotics, Analgesic, Antipyretic
- Medical Treatment response myringotomy
- Liquid diet pain
- Parents & child
- URTI
- Reduce noise in the client environment.
- If the client wants, the client can use hearing aids.
LOWER RESPIRATORY TRACT INFECTION
BRONCHIOLITIS
Bronchiolitis Inflammation of bronchioles,

virus adenovirus, influenza virus Para influenza
RISK FACTORS
- Cold season
- Child cigarette smoking
- Age younger than 6 months old
- Living in crowded conditions
- breastfeeding
- Prematurity ( born before 37 weeks gestation)

SIGNS / SYMPTOMS
- Breathing difficulty including wheezing and shortness of breath
- Sudden severe dyspnea
- Fever
- Air hunger
- Cyanosis: Bluish skin due to lack of oxygen (cyanosis) - emergency treatment is needed
- Respiratory acidosis
- Dehydration
- Persistent dry cough
- Restlessness
- Cough
- Fatigue
- Nasal flaring in infants
- Rapid breathing (tachypnea)
INVESTIGATION
- X – Ray
- Sputum examination
TREATMENT:
- Antibiotics
- Symptomatic management
- Dyspnea relive intervention
- Proper position
- clear airway maintain O2 inhalation provide
- Moist breathing sticky mucus relieve
- proper diet hydration maintain
- Administer drugs: hospital child oxygen therapy
- Sever cases Vein (IV) fluids administer
- extremely ill children antiviral medications, such as ribavirin
- Anxiety relieve Proper information
- Antipyretic medicine and Steam inhalation
PNEUMONIA
Pneumonia lungs inflammation lungs parenchyma consolidation

Pneumonia infant young children
CAUSES:
Bacterial Fungal Viruses Others
Pneumococcal Cryptococcosis Influenza Aspiration

Streptococcus Histo plasmosis Chiken pox Fluids , foods
Staphyloeoccus Measles vomitus

H. influenza Chemical
Tuberculosis
CLINICALLY CLASSIFICATION ON PNEUMONIA:
1) Lobar Pneumonia :
2) Bronchopneumonia
 Lobar Pneumonia: Pneumococcus age

acute It affects one or more lobes
 Bronchopneumonia: Datchy area lung

aspiration Pneumonia amniotic fluid water drowning foreign bodies
vomitus chemical vopcurs material aspiration
SIGN & SYMPTOMS:
- High Fever ( 39 – 40 or above )

- Chills
- Cough
- Rapid respiratory rate : 1 to 5 yrs 40
2 to 12 month 50
Less than 2 month 60
- Chest in drawing
- Wheezing
- Strider
- Chest pain
- Convulsion
- Very severe inability to drink hypothermia
- nasal congestion
- vomiting
- abdominal pain
- decreased activity
- loss of appetite (in older kids) or poor feeding (in infants), which may lead to
dehydration
- Cyanosis: in extreme cases, bluish or gray color of the lips and fingernails
MEDICAL MANAGEMENT
- Specific antibiotics
- Bronchodilators
- Oxygen inhalation
- Chest physiotherapy
NURSING DIAGNOSIS FOR PNEUMONIA

- Ineffective Airway Clearance
- Impaired Gas Exchange
- Risk for Deficient Fluid Volume
- Imbalanced Nutrition
- Acute Pain
- Activity Intolerance
- Risk for Infection
- Monitoring Childs respiratory rate pattern

- Monitoring Breath sound rhonchi wheezing
- Respiratory distress sign observe
- High humid warm well ventilated
- Head up position bed rest
- Secretion removing air passage clean
- O2 therapy
- Fever control tepid sponge paracitamol
- Breast feeding dietary intake adequate nutrition
- Nasogastric tube feeding
- Accident and infection prevention
- Child continuous monitoring record
- Position change
- Personal hygiene
- Child parents care plan prognosis care involve
- Rest & sleep
- Diversional therapy
- Discharge follow up home care teaching
COMPLICATION:

 Pleural effusion
 collapse lungs
 emphysema
 lungs observe bronchioctasis
TONSILLITIS
Tonsils infection inflammation

infection group – A beta stepto coccus hemolyticus & H. influenza organism
SIGN & SYMPTOMS

 Acute tonsillitis
- Pain in throat & ear
- Fever shivering and convulsions
- Tonsils enlarged congested red
 Chronic tonsillitis
- Condition signs poor food intake, bad smell breath, abdominal
pain swallowing & breathing difficulties, dryness irritation in throat
pulmonary hyper tension
- Tonsillitis complication peritonsilliar abscess, retrotonsillar abscess, failure to
thrive lymphnodes inflammation
MANAGEMENT
- Acute tonsillitis child bed rest, isolation soft or liquid diet, analgesic
Antipyretics drug patient systemic antibiotics doctors
Order
- patient encourage
- Patient chronic tonsillitis year 6 tonsillitis symptoms
medical treatment condition tonsillectomy
- Surgery patient proper post operative care week patient

liquid diet

GASTRO – INTESTINAL DISORDERS
MALABSORPTION SYNDROME
Malabsorption syndrome disorder group dietary subnormal

absorption stools nutrient loss digestion defect
mucosal abnormality lymphatic obstruction Chronic diarrhea abdominal
distension FTT characteristic
CAUSES:
- Gall bladder & pancreatic disease
- Lymphatic obstruction
- Vascular impairment
- Intestinal parasitosis
Malabsorption & child diarrhea

Three major categories
1. Impaired Digestion
2. Intestinal Malabsorption
3. Carbohydrate
SIGN & SYMPTOMS:

- Chronic Diarrhea
- Abdominal distension
- Failure to thrive
- Flatulence
- Anorexia
- Fatigue
- Loss of weight
- Malabsorption & growth Failure
TREATMENT AND NURSING INTERVENTION:
Cause treatment Detect dietary intake

Nursing Management assessment finding Daily intake-output
daily weight, vital sign, electrolyte function nursing intervention
- Nutritional status improve appropriate diet planning diet

- Condition fluid electrolyte restoration
- Condition continuous monitoring record
- Dr. order medication
- Pain relief drugs fowlers position
- Analgesic, antiflatutents & antidiarrhea drugs Dr. order
- Perianal area skin care area dry locally ointment apply
- Hospitalization long term illness anxiety or fear

- Parents general cleanness nutrition, hydration, danger sign, home care & follow up
health education
INTESTINAL OBSTRUCTION
Intestinal tract intestinal content normal flow interruption

intestinal obstruction
TYPE OF OBSTRUCTION:
1. Mechanical Obstruction :
 Congenital alresia or stenosis of intestine
 Malrotation of the colon volvulus of midga
 Peritoneal band hernia, intussusceptions tumors etc
2. Paralytic illness: Autonomic nervous system toxic traumatic disturbance
3. Strangulation : Obstruction blood supply obstruct intestine

gangrene
CAUSES OF INTESTINAL OBSTRUCTION
1. Congenital intestinal obstruction

2. Acquired intestinal obstruction
Congenital intestinal obstruction :

 Intestinal atresia
 Malrotation of gut
 Meconium plug syndrome
 Meconium pancreas
 Mickel‘s diverticulum
 Hirschsprung‘s disease or congenital mega colon
Acquired intestinal obstruction :

 Intussusceptions
 Volvulas or twisted loop of intestine
 Tumor or hematoma
 Hernia & strangulation
 Stricture stenosis of intestine
 Inflammatory disease ulcerative colitis appendicitis
 Foreign body
 Warm mass (commouly round worms )
 Paralytic ileus
SIGN & SYMPTOMS

- Abdominal swelling (distention)
- Abdominal fullness, gas
- Abdominal pain and cramping
- Breath odor
- Constipation
- Diarrhea
- Inability to pass gas
- Vomiting
-
DIAGNOSIS
 Physical exam bloating, tenderness, or hernias in the abdomen.
 Tests that show obstruction include:
- Abdominal CT scan
- Abdominal x-ray
- Barium enema
- Upper GI and small bowel series
TREATMENT
 Treatment involves placing a tube through the nose into the stomach or intestine to help
relieve abdominal swelling (distention) and vomiting. Volvulus of the large bowel may
be treated by passing a tube into the rectum.
 Surgery may be needed to relieve the obstruction if the tube does not relieve the
symptoms, or if there are signs of tissue death.
NURSING INTERVENTONS
- Main symptom treatment Focus .
- Symptoms change treatment regularly Review
- Good and regular oral hygiene maintain
- Patient and family psychological support & information provide
- Nausea and vomiting, constipation treat
- Abdominal distension (ascites), intestinal colic treat
- obstruction present laxatives stop bowel phosphate enema clear .
- hydration, electrolyte balance and comfort IV fluids administer

POSSIBLE COMPLICATIONS
- Electrolyte (blood chemical and mineral) imbalances
- Dehydration
- Hole (perforation) in the intestine
- Infection
- Jaundice (yellowing of the skin and eyes)
MEGACOLON
Mega colon colon enlargement dilation
CAUSE:
 Chronic constipation
 Due to narrowing of the rectum
 Absence of parasympathetic ganglion of the rectum eg. hirschsprung‘s disease
1) Swenson‘s operation
2) Duhamel‘s
3) Soave‘s
DIAGNOSIS:
- X- ray abdomen or USG abdomen
- Barium study
MANAGEMENT
Initial Management
- Correct fluid & electrolyte imbalance I /V fluid
- Nasogastric suctioning bowel
- Pain reduce analgesic & sedatives
- Infection treat antibiotics
- Causes
- Round worm hypertonic saline enema
SURGICAL MANAGEMENT
Laprotomy obstruction cause specific surgery
 pre – operative care

- Daily rectal wash normal saline enema
- Bacterial flora treat antibiotics
- Frequency types of stool
- Rectal temperature avoid
- Nutritional balance maintain
- General Pre – Operative preparation
 post – operative care

- General Post – Operative Care
- Specific precautions surgical site infection
- Changing of dressing with aseptic precaution
- Preventing contamination
- Using careful hand washing technique
- Care of the colostomy should be giver
- Function of the colostomy observe drainage abdominal distension
colostomy fluid loss measure
- Sign of complication observe peritonitis paralytic ilies or swelling
- Colostomy output absent tenderness irritability vomiting temperature
- Skin care colostomy breakdown prevent changing soiled

dressing frequently washing the skin with clear water and drying it applying zinc
paste or other medication as prescribed
- General pre – post operative care
- Vomiting content, amount, peristalsis, abdominal girth observation checked
record
- Vital sign & behavioral change record
- Rest & comfort
- Analgesic antibiotics medication doctor order
- Fluid & electrolyte balance I /V fluid maintain
- Intake output chart maintain
- Parents prognosis fear
- Normal bowel elimination maintaining

- General hygienic Care
- Diversional therapy
- Explained home base care
HIRSCHSPRUNG’S DISEASE
Disease congenital aganglionic megacolon Distal colon & rectum

parasympathetic ganalionic nerve cell absent condition colon
extreme dilatation
ETIOLOGY
- Unknown
SIGN & SYMPTOMS
- Abdominal distension
- Neonate meconium pass
- Stool not passed
- Vomiting may contain bile faecal matter
- Chronic constipation
- Anorexia
- Abdominal wall superficial veins paristalsis
INVESTIGATION
- Rectal examination faecal matter absent

- Barium enema dilated intestine
- Rectal biopsy ganglionic nerve cells presents absents
TREATMENT
- Surgical intervention colon aganglionic , nonfunctioning & dilated segment

remove
- Colostomy ileostomy intestine decompress normal
colon rest
- Reconstructive surgery technique
HERNIA
Hernia internal organ abnormal opening

protrusion projection
CAUSE
- Hernia congenital acquired
- Hernia common cause
- Development normal opening close failure
- Illness injury weakness
- Tumor obesity distention

- Straining & Coughing intra abdominal pressure
TYPES
- Inguinal Hernia
- Congenital Diaphragmatic Hernia (CDH)
- Hiatal / Hiatus Hernia
- Strangulated Hernia
- Femoral Hernia
Inguinal Hernia :
Inguinal Hernia means inguinal canal intestinal contain protrusion

Condition male & pre term infant 60% right side inguinal hernia &
30% left side IH & 10 % bilateral IH IH direct indirect
SIGNS/SYMPTOMS
Painless inguinal swelling baby strain cry
baby rest gently compression Obstruction
symptoms develop
- Irritability
- Herniated side tenderness
- Stool Pass difficulty
- Anorexia
MANAGEMENT
- Hernia truss belt
- Majority cases hernioraphy & hernioplasty
Post Operative Advice

- Strain activity
- Cycling avoid
- Sport injury
Congenital Diaphragmatic Hernia (CDH) :

Hernia congenital malformation hernia abdominal organ diaphragmatic
defect thoracic cavity slight herniation abdominal contain extremely
protrusion Condition left side lung & heart position
affected side lung compress & hypostatic
SIGNS/SYMPTOMS
Severe resopiratory distress
- Trachypnea
- Dyspnea
- Cyanosis

- Chest wall retraction

- Broad chest
- Scaphoid abdomen
- Chest affected side expand
- Apical heart beat
- Thorax affected part large & auscultation dull absent breath sound
Other
- Chest X – ray mediastenum sift
- Air intestine thoracis cavity
NURSING MANAGEMENT
Pre Operative care :

- Birth resuscitation
- Baby head affected side non affected side lung
expand baby semi fowler position
- Respiration secretion suction remove O2 level maintain
- Sodium bi carbonate acidosis correct
Post Operative care :
- Respiratory distress watch
- Endotrachel tube maintain respiration
- General Post care
Hiatal / Hitus Hernia :

Hiatal hernia stomach cardiac and diaphragm abnormal white
esophageal opening pass
CAUSES
Diaphragm muscles formation deformities
SIGNS/SYMPTOMS
- Esophagus irritation vomiting salivation & regurgitation
- Vomiting mucus blood
- Dehydration
- Aspiration pneumonia
- FTT
- Anemia
- Rector sterna pain & burning sesation
- Chronic case stenosis
INVESTIGATIONS
- USG & barium meal test

MANAGEMENT
- Persitant vomiting esophagitis, malma, frequent, aspiration
surgical measure ― Niaaen type of Fundoplication ― operation
- Child upright position

- Thickened feed
- Antacids
- Post Operative Care
UMBILICAL HERNIA
Intestine Umbilical ring protrusion

Hernia soft swelling skin cover infant strain
Umbilical Hernia 1 year age disappear hernia 9
year age disappear surgical repair
Strangulated Hernia:
Intestine loop obstruction edema & loop venus

circulation blood supply Necrosis bowel loop death
SIGNS/SYMPTOMS
- Inflammation & swelling severe pain
- Intestine obstruction signs/symptoms
MANAGEMENT
- Immediate seduction
- Emergency surgery
- Pre & Post operative Care
COMPLICATION
- Post operative inflammation
- Hemorrhage
- Peritonitis
- Painful swelling on scrotum ( male )
DIVERTICULUM
Esophageal diverticulum mucus membrane saclke pouch food

diverticulum regurgitate
ETIOLOGY
Esophageal weakness, coma, congenital defect, formation of scar inflammation

PATHOLOGY
- Muscles weakened area divericula develop
- Muscles weakness esophageal trauma congenital chronic inflammation etc.
- develop
- Diverticulum collect
- Local abscess develop
- Esophagus develop protective layer
SIGN & SYMPTOMS

- Stage Patient difficulty in swelling complain
- Regurgitation of food undigested
- Sore taste in the mouth
- Tracheal irritation coughing
DIAGNOSIS
- Barium swallow , MRI .
- Endoscope diverticula endoscope
perforation
MANAGEMENT
- Dietary management small and frequent liquid and semi solid diet
- food regurgitation fowler‘s shoulder or head raise
position
- Sign and symptoms duration check
- Regurgitation respiratory distress maa to watch
- Diet pattern observe
 Surgical Management
- Operation risky Co. Jomama diverticulum nao locate excise unit
pre & post operative care
- Naso gastric tube management aspiration amount color mark
- Drainage bleeding doctor inform
- chest pain fever apprehension complain esophageal perforation
doctor inform
- Discharge written and verbal instruction
COLITIS
Inflammatory condition colon means intestine large intestine

sigmoid colon
Colon inflammatory condition spread colon mucosa and sub mucosa
Rectum and ileum distal part involve inflammatory process
Chronic colon epithelium ulcer (Patches) ulcer formation
ulcerative colitis

CAUSE
- Main cause unknown factors
- Psychosomatic Disease emotional disturbance disease
means mental stress colon blood supply condition
- Condition unidentified pathogenic organism condition positive
factor complication infection dycentry (antamoeba hytolica
organism ) or allergic reaction stress auto immune deficiency
- Young adulthood and middle age disease common sex equal
female
SIGN & SYMPTOMS

- Diarrhea, loose stool with pus and blood
- Abdominal cramps and urgency in defection
- Fever, weight loss, anorexia, iron deficiency depression, abdominal distention and
bowel sound increase. (hypocalcaemia, calcium deficiency hypocalcaemia deficiency
of potassium )
COMPLICATION
- Serious condition mortality rate high Colon cancer
- Disease co replication skin arthritis anemia absence perforation stricture

of colon and fistula toxic mega colon
- Diarrhea and vomiting sever electrolyte imbalance and hypocalcaemia
develop
DIAGNOSIS
- History of physical examination
- Lab study blood exam stool exam for ova cyst and occult blood fecal analysis
- X – ray, barium meal enema, sigmoid scope, proctoscopy, biopsy.
- USG
MANAGEMENT
- Acute colitis complete bed rest
- Sedative drugs colon peristalsis reduce
- Soft and liquid diet
- Disease attack severe NBM or (NPO) IV fluid
supportive drugs vitamins
 Medication :
- Anti diarrhea drugs Ex sulphonamide bactom septran
-Intesline movement reduce lomotil or loparamide tablet

-Ante spasmodic belladonna and alropine
symptomatic treatment
 Psychological support :
- Chronic condition adjust accept
- Occupation family environment and socially adjustment
- Family member adjust
APPENDICITIS
Intestinal lumen obstruction appendix inflammation condition

Appendicitis 5 to 15 year age group
CAUSES
- Health, infection, structure, foreign body or tamer.
PATHOPHYSIOLOGY
Intestinal lumen obstruction edema, infection ischemia

Lumen secretion collection intra mural blood vessels
pressure distended inflammation ulceration gangrene
intra luminal tension necrosis perforation appendix inflammation
rupture peritonitis
- Periumbillical pain with fever & vomiting

- Colic pain Mc burney‘s poin in right iliac fosse
- Anorexia, nausea, constipation
- Abdominal examination rigidity
DIAGNOSIS & INVESTIGATION

- USG X- ray
- Blood examination
- Urine & stool examination
COMPLICATION
- Ruptured appendix
- Intestinal perforation
- Paralytic illus
- Peritonitis
- Pelvic abscess
MANAGEMENT
- Acute appendicitis condition appendectomy symptomatic treatment
- IV antibiotic fluid therapy analgesic

- Proper Preoprerative post operative care
- Pain management infection control main aspect
- Parents emotional support follow up

PROBLEMS RELATED TO THE PRODUCTION AND CIRCULATION OF BLOOD
CONGESTIVE CARDIAC FAILURE (CCF)
CCF pediatric common emergency congeative hear failure

cardiac out put
Rest or stress metabolic need Heart blood supply
ventricular cavities venous return receive pulmonary
systemic venous blood volume CCF
CAUSES
- Congenital Heart Disease
- Acute rheumatic fever
- Rheumatic heart disease
- Myocarditis
- Hypertension
- Cardiomyopathy
- Non cardiovascular disease
- Chronic pulmonary nephrotics syndrome acute glomerlonephritis
- Acidaemia low level of potassium calcium glucose or magnesium
PATHOPHYSIOLOGY
Decreased cardiac output

↓
Inadequate supply of O2 nutrition to the tissue
↓
To meet metabolic demand of the body the heart rate increase to raise cardiac out put
↓
Which result to increase stroke volume cardiac output = H.Race * stroke volume )
↓
The systemic vascular resistance increase to maintain blood pressure
↓
Reduced blood flow to the kidney decrease glomerular filtration rate
↓
Tubular reabsorption increase
↓
Causing sodium water retention load oedema and diminished urine output
↓
Thus cardiac output decrease further
↓
Increase venous pressure due to poor contraction of failing heart result in venous congestion
and oedema
↓
Pulmonary system becomes congested in chronic long term illness myocardial hypertrophy
and chambers dilation
↓
Lead to Progressive heart failure
SIGN & SYMPTOMS

- Myocardial function poor
- Tachy cardiac
- Poor peripheral perfusion week peripheral pulse
- Cool extremities
- Pallor
- Easy fatigability
- Excessive perspiration
- Restlessness
- Exercise activity tolerate
 Pulmonary congestion
- Tachypnea
- Cyanosis
- Chest retraction
- Nasal flaring
- Grunting
- Non – Productive persistent cough
- Pulmonary oedema
- Dyspnea at rest on exertion
 Systemic Venous Congestion
- Hepatomegaly
- Peripheral oedema
- Scrotal & orbital oedema
- Oliguria
- Water weight gain
- Neck vein distension
- Abdominal discomfort
- Anorexia & Feeding difficulties
DIAGNOSIS
- History
- Auscultation of Heart
- Systolic murmur
- X-ray chart cardiology pulmonary congestion
MANAGEMENT
CCF management cardiac output improve
- Reducing cardiac work

- Myocardial contractility
- Heart size cardiac performance
- Heart Failure correct
- CCF propped up position
- Activities restricting complete bed rest
- Tissue oxygenation improve oxygen therapy
- Restlessness anxiety sedative
- Myocardial efficiency improve heart force of pumping heart rate
urine output increase digitalis drugs

- Diuretics drugs (0.5 – 1.5 mg/kg )

- Diagnosis therapy potassium supplement
- Anemia correction iron
- infection control antibiotics
- Cardiac work vasodilator ACE inhibitors
- Sodium restriction low salt diet small amount frequently
- Anemia control iron reach diet
- Supportive nursing care skin care hygienic care
- Infection prevention measures
- Medicine administration
- Condition continuous monitoring
- Intake / output chart maintain
- Parents emotional support
- Diet activities restriction complication prevention daily hygienic care regular
follow up health education
RHEUMATIC FEVER
Acute or chronic autoimmune collagen disease beta hemolytic streptococcal

infection hypersensitivity reaction connective tissue & endothelial tissues
inflammatory lesion lesion heart, joint, blood vessels connective
tissue acquired heart disease disease 4 to 15
ratio 5 / 1000
ETIOLOGY
1) Rheumatic Fever etiology clear beta hemolytic streptococcal infection

reaction disease
2) Upper respiratory tract Group – A infection condition develop
3) Beta hemolytic streptococcal protein body protein

react immune system
antibiotics blood body tissue myocardial, pericardium,
cardiac valve
4) Striated muscles, vascular smooth muscles & tissue also affected.
Rheumatic fever group symptoms major minor
essential manifestation
 Major Manifestation :
- CARDIAC : pericarditis, myocarditis, endocarditis, significant murmur cordiom egaly
CCF

- Polyarthritis :
Joint inflammation with pain decrease active movement warm tenderness redness
swelling joint ankle elbows knee
- Chorea :
Purposeless involuntary rapid movement muscles weakness in co-ordination
involuntary facial grimace speech disturbance awkwogait & emotional disturbances
- Erythema Marginatum :
Pink macular non itching rash trunk Extremities
- Subcutaneous Nodules :
Joint surface firm painter nodules knee elbow wrist
occiput & vertebral column
 Minor Manifestation :
- Fever
- Arthralgia
- Previous attack of rheumatic fever of rheumatic heart disease
- Prolonged P – R internal
- Elevated ESR
 Essential Criteria :
- Elevated antistreptolysin – O (ASO) titer (normal 200I/V )
- Positive throat swab
 Other Manifestation :
- Pericardial pain
- Abdominal pain headache easy fatigability
- General weakness tachycardia malaise sweating
- Vomiting epistaxis anemia
- Weight loss
MANAGEMENT
- 6 to 8 week bed rest rheumatic activity disappear
- Nutrias diet CCF salt restoration rich spicy food
- Dr. order infection control antibiotics
- Aspirin drugs joint pain & inflammation control
(90 to 120 mg/kg/day –divided 4 dose)
- Steroid therapy (prednisolone )
- Chorea management diazapam or phenobarbitone
- Complication treatment symptoms care
NURSING MANAGEMENT & INTERVENTION

- Child rest heart strain rheumatic activity
mild care indoor activity allow
- Rest & activities nursing care plan
- Temperature maintain
- Provide adequate nutrition & fluid intake
- Dr. order drugs

- Cardiac function monitoring

- Intake / output chart maintain
- Pain Relive Anti inflammatory drugs, comfortable position, support to join
diversional therapy
- Injury hard & sharp object feeding ambulation
fine motor activities
- Health maintain complication prevention health education
- Rheumatic Fever comfort OR prevention health education
- Emotional support
COMPLICATION
- Mitral stenosis
- Aortic incompetence
- Heart Failure
- Infective endocarditis
PROBLEM RELATED TO THE ELEMENT OF BLOOD
ANEMIA
Anemia circulating Red blood cell number quality reduction

hemoglobin content Anemia oxygen carrying
capacity
Iron deficiency anemia India common blood disorder
WHO Grading of Anemia
 Cut off point of HB level

- Children 6 month to 6 years = 11 gm / dl
- Children 6 years to 14 years = 12 gm / dl
- Above 14 years Male = 13 gm / dl
- Above 14 years Female = 12 gm / dl
 Grading :
- Mild Anemia = HB level between 10 gm / dl and cut of level
- Moderate Anemia = HB level between 7 gm / dl To 10 gm / dl
- Severe anemia = HB level below 7 gm / dl
CAUSES OF ANEMIA
1. Impaired of RBC production: Nutritional iron deficiency folic acid Vit-
B12, Vitamin- B6 & vitamin – E deficiency
2. Increased destruction of RBC (hemolytic )
 Hemolysis due to intrinsic Factor
 Hemolysis due to extrinsic Factor
3. Increase blood loss (hemorrhagic )
4. Decrease RBC production ( bone marrow depression )

CLASSIFICATION OF ANEMIA
RBC morphology classification
1. Microcytic Hypochromic Anemia

Iron deficiency anemia ineffective RBC production (thalassemia lead
poisoning )
2. Normocytic Normochromic Anemia

Impaired cell production hemolysis
3. Microcytic Anemia
Anemia Vitamin – B12 drugs toxicity malabsoption
megaloblastic erythropoisis Non – megalobastic
erythropoisis liver abscess hypothyroidism
- Fatigue
- restlessness
- Anorexia
- Pallor
- Weakness
- Vertigo
- Headache
- Malaise
- Drowsiness
- Sore tongue
- Gastro – intestinal problems
- Tachypnea
- Exertion shortness of breath
- Tachyeardia
- Palpitations
IRON DEFICIENCY ANEMIA:
Infancy childhood common nutritional & haematologic disorder

haemoglobin synthesis iron
CAUSE
- Inadequate iron intake: Iron milk delayed
wearing or only cereal
- Inadequate storage of iron at Birth : Prematurity anemia mother fetal blood loss
during before delivery
- Lack of absorption of iron
- Blood loss due to bleeding
- Intestinal parasites hook worm
- Inability to form hemoglobin ( deficiency of B12 folic acid & protein )

SIGN & SYMPTOMS
- Skin & conjunctiva pale

- Weak feel fatigue )
- Infection
- Oedema tendency
- Retardation of Growth
INVESTIGATION
- RBC count / HB% level

- Peripheral smear
- Stool examination for worms & occult blood
TREATMENT & NURSING INTERVENTION
- Causes
- Dietary intake improve iron & protein
- Iron therapy oral I/V or I /M
- Severe cases (HB%, 4gm /dl or less) blood transfusion
- Symptomatic care
-
- Oral iron therapy side effect nausea vomiting gastric discomfort diarrhea
constipation
- Iron tea
- Worm infestation early detection & treatment
- IDA prevention health education
SICKLE CELL ANEMIA:

Sickle cell anemia autosomal recessive disorder abnormal hemoglobin
(HBS) chronic hemolytic anemia HBS low-oxygen tension cresent
crystal
sickle shaped RBC capillaries Hemolysis
local anoxemia sickling Capillaries blockage tissue /
organ infarction
SIGN & SYMPTOMS
- Progressive anemia
- Mild Jaundice
- Fever headache
- Bacterial Infection
- Enlarged Heart
- Non Healing
- Severe cases hemolytic crisis

DIAGNOSIS
- Peripheral blood smear
- Electrophoresis
- Genetic counseling & history
MANAGEMENT
- Anemic condition blood transfusion, parentral fluid therapy, antibiotic therapy
analgesics manage
- Acidosis correct supportive care
- Folic acid vitamin supplementation
- Sever cases bone marrow transplantation
- Blood transfusion
- Parentral Fluid therapy
- Analgesic
- Correction of acidosis
- Symptomatic & supportive care
- Folic acid & other vitamin supplementation
- General hygienic Nursing Care
THALASSEMIA ( COOLEY’S ANAEMIA ) :

Thalassemia chronic congenital anemia RBC abnormal hemoglobin
condition globin polypeptide chair (alpha or beta ) synthesis congenital
inability immature & short life spot thin RBC
CLASSIFICATION
 Thalassemia Major : Homogeneous Trait
 Thalassemia Minor : Heterogeneous Trait –
No symptoms of anemia spleen enlarge
SIGN & SYMPTOMS
- Anemia
- Fever
- Poor Feeding
- Enlarged Spleen
- Haemosiderosis ( Bronze Skin)
- Haemochromation ( fibrosis causing destruction of tissue )
- Cardiac Enlargement
- Spleenomegaly, destruction of panorama
INVESTIGATION
- Blood examination smear
- HB% level
- X-ray of bone to detect widening
TREATMENT
- Blood transfusion HB% 6gm/100ml

- Iron chelating agent (deforocmine) kidney excessive iron excrete
- Discomfort normal growth promote spleenectory
- Folic acid supplementation

- Supportive management
- Bone marrow transplantation
- New Approaches: New Approaches Gene therapy & gene manipulation
management Gene therapy stem cell normal gene insertion
defect correct Gene manipulation gama chain increase
excess alpha chain
NURSING MANAGEMENT OF ANEMIC CHILD

- Complication prevent child assessment base hospital
communit intervention
- Hospitalization complication child & parents
- Diagnosis
- Blood transfusion & iron chelating agent therapy precaution
- Supportive care
o Rest comfort hygienic care
o Restriction of iron containing food
o Vitamin supplementation
- Infection aseptic technique general cleanliness
- Splenectory Pre & post operative care
- Parents family treatment plan prognosis complication
health education
- Illness & stress effective coping parents & family members emotional
support
- Parents & family members teaching
- Importance of Follow up
- Investigation
- Blood Transfusion
- Sign of Complication
- Dietary restriction
- Activity Modification
- Recreation Diversion therapy
- Available treatment facilities
- Support services
- Referral
- Community
NURSING DIAGNOSIS AND INTERVENTIONS FOR ANEMIA
1. Nursing Diagnosis: Ineffective Tissue Perfusion

 Goal: Adequate tissue perfusion
Interventions

- Monitoring of vital signs, capillary refill, color of skin, mucous membranes.

- Raising the head position in bed
- Check and document the presence of pain.
- Observation of a delay in verbal response, confusion, or restlessness
- Observing and documenting the existence of the cold.
- Maintain the ambient temperature to keep warm the body needs.
- Provide oxygen as needed.
2. Nursing Diagnosis: Activity Intolerance
 Goal: Support the child remain tolerant of the activity

Nursing Interventions for Anemia:
- Assess children‘s ability to perform activities in accordance with physical and
developmental tasks of children.
- Monitoring vital signs during and after activity, and noted a physiological
response to activity (increased heart rate increased blood pressure, or rapid
breathing).
- Provide information to the patient or family to stop doing activities if teladi
symptoms of increased heart rate, increased blood pressure, rapid breathing,
dizziness or fatigue).
- Provide support to children to perform daily activities in accordance with the
child‘s ability.
- Teach parents techniques provide reinforcement to the participation of children at
home.
- Create a schedule of activities with the children and families by involving other
health care team.
- Describe and provide recommendations to the school about the child‘s ability to
perform the activity, the ability to monitor activity on a regular basis and explain
to parents and schools.
3. Nursing Diagnosis: Imbalanced Nutrition Less Than Body Requirements
 Goal: Meet the needs of adequate nutrition

Nursing Interventions for Anemia:
- Allow the child to eat foods that can be tolerated child, plan to improve the
nutritional quality at the child‘s appetite increases.
- Provide food that is accompanied by a nutritional supplement to improve the
quality of nutritional intake.
- Allow the child to engage in food preparation and selection
- Evaluate the child‘s weight every day.

PROBLEMS OF CENTRAL NERVOUS SYSTEM
CRANIOCEREBRAL TRAUMA
External force scalp skull meanings brain injury head

injury or Croniocerebral injury
CAUSES OF HEAD INJURY:

 Neonates :
- Birth injury instrumental delivery
 Toddler & preschooler:

- Fall from height, head hard object head
 Older children :
- Automobile & road traffic accidents sports recreational injury heavy object head
object head
TYPES OF HEAD INJURY

 Fracture of skull
 Intracranial hemorrhage
 Concussion of the brain
 Cerebral contusion
 Extradural Hematoma
 Acute Subdural Hematoma (SDH)
 Brain Swelling ( Cerebral oedema )
SIGN & SYMPTOMS

- Head injury types & severity
- Consciousness level
- Hemiparesis monoporesis hemiplegia
- Drowsy irritable lethargic
- Shock
- Vital sign
- Intracranial pressure increased
- Severe headache visual disturbance
- Vomiting
- Convulsion
- Bleeding form ear or nose
- Loss of memory
- Bladder bowel dysfunction
- Examination fracture skull
- Hearing loss
- Injury severity unilateral bilateral pupil fixed or dilated or pinpoint pupil
- Neurological sign types

MANAGEMENT
- Maintenance of Airway
- Establishment of Breathing
- Maintenance of Circulation
- Neurological assessment
- Antipyretic drugs
- Slight head up position
- Other drugs as per doctor order
- Surgical management if required
NURSING DIAGNOSIS
 Ineffective airway clearance and impaired gas exchange related to brain injury
 Ineffective cerebral tissue perfusion related to increased ICP, decreased CPP, and
possible seizures
 Deficient fluid volume related to decreased LOC and hormonal dysfunction
 Imbalanced nutrition, less than body requirements, related to increased metabolic
demands, fluid restriction, and inadequate intake
 Risk for injury (self-directed and directed at others) related to seizures, disorientation,
restlessness, or brain damage
 Risk for imbalanced body temperature related to damaged temperature-regulating
mechanisms in the brain
 Risk for impaired skin integrity related to bed rest, hemiparesis, hemiplegia, immobility,
or restlessness
 Deficient knowledge about brain injury, recovery, and the rehabilitation process
- Comfortable position
- Clearing air passage & maintain respirator
- Cerebral perfusion maintain
- Life saving measure Emergency organizing
- Monitoring Neurological status
- Monitoring Vital sign
- Provide appropriate care
- Convulsion fever fluid electrolyte hemorrhage wound care etc
- Maintain nutrition & hydration status
- Unconscious care of eye & hygienic care change position etc
- Infection prevent measure
- Parents & family support
- Surgical intervention Pre – Post Operative Care
- Parents routine care long term care regular follow up accident prevent health
education

MENINGITIS
Brain spinal cord meaning (covering layer) inflammation Meningitis
TYPE / CLASSIFICATION OF MENINGITIS
1. Pyogenic or bacterial meningitis

2. Tuberalosis
3. Aseptic meningitis by virus fungus or protozo
PYOGENIC OR BACTERIAL MENINGITIS:

Bacterial infection pyogenic meningitis Meningitis neonate &
infant immature immune mechanism poor phagocytic
function
SIGN & SYMPTOMS :
- High Fever
- Headache
- Malaise
- Vomiting
- Restlessness
- Irritability
- Convulsion
- Refusal of feeds
- High pitched shrill cry
- Hypothermia
- Lethargy
- Bulging Fontanel
- Mental confusion
- Alteration of level of consciousness
- Examination neck rigidity kernig‘s sign positive Brudzinski‘s sign‘s papilledema
INVESTIGATION
- Detail history & physical examination

- CSF examination
- Blood cell count
MANAGEMENT & NURSING INTERVENTION
Meningitis medical emergency measures

- Specofoc antibiotics penicillin cetotaxime afriaxone amikacin etc
- Corticosteroid dexamethaoone as per prescribed
- Osmotic diuretic therapy (manitol 20%)
- Anticonvulsive drugs (phenytoin )

- Hypotension vasopressors (dopamine )

- Maintainance of fluid electrolyte balance
- Antipyretics
- Vitamin supplementary
- Parents emotional support disease
- Rail cot rest
-
- Oropharyngel suction airway clearing
- Position change
- Oxygen therapy precaution
- Fever tepid sponge temperature
- I / V fluid therapy maintain
- Dietary support prescribed medicine
- Personal hygienic maintain skin care, mouth care eye care bladder bowel Care
- Injury & accident prevention care

- Convulsion care
- Observe & monitoring – vital sign level of consciousness pupilary reaction
respiration behavior secretion of air passage blood pressure sudden bleeding visual
changes
- Physiolotherapy body aligment
- Emotional support health education
TUBERCULOUS MENINGITIS (TBM)

Mycobacterium tuberculosis meninges inflammation TBM
Infection hematogenous intracremial lymphatics cervical lymphnode
SIGN & SYMPTOMS

Illness stage devide stage clinical manifestation
 Prodromal Stage :
Illness stage stage of invasion
- Anorexia
- Apathy
- Constipation
- Convulsion
- Headache
- Irritability
- Low grade fever
- Photophobia

- Restlessness
 Trausitional Stage :
Illness stage stage of meningitis stage
- Increase ICP
- Meningeal irritation
- Positive kernig‘s sign
- Neck rigidity fever
- Brady cardia
- Drowsiness delirium headache vomiting
- Respiratory Disturbness
- Unconscious
- Increase muscles tone & convulsion
- Monoplegia hemiplegia sphinecter control loss
- Infant anterior foneanel bulging
- Papilledema
 Terminal OR third Stage :
Stage coma stage paralysis coma stage
- Fever irregular respiration
- Bradycardiac
- Pupil dilated & fixed mystagmus & squint eye
- Ptosis
- Hydrocephalus in small children
- 4 week fetal
MANAGEMENT
- Antitubercular drugs for 12 Month
- INH rifapicin pyrozinomide ethambutol streptomycine
-
- Corticomatic therapy
- Symptomatic management
- Manitol pr glycerol or hypertonic glucose therapy
- Anticonvulsant drugs
- I /V Fluid & Electrolyte
- INH side effect prevent pyridoxine
- Maintain Nutrition requirement
- Daily head circumference measurement hydrocephalus
- AT drugs adverse effect auditory vestibular nerve toxicity
instruction
- Nursing management bacterial meningitis
-
ENCEPHALITIS
Encephalitis inflammation of brain tissue brain function altered

CAUSES
- Viruse measles, mumps, rubella, enterovirus herpes simplex, chiken pox virus,
HIV virus.
- Bacterial Infection tuberculosis, typhoid.
- Other Non viral infectious agent fungi. Protozoa, malaria, amebiasis etc.
SIGN & SYMPTOMS

Mild severe
- Malaise
- Fever
- Altered
- Stupor
- Convulsion
- Mental confusion
- Spasticity
DIAGNOSIS
- CSF examination
- Blood smear for malaria
- Blood for culture
MANAGEMENT
- Only symptomatic treatment is given
- General supportive measures
- Administrative of I / V fluid
- Anti convulsive drugs
- Maintaining airway
NURSING CARE
- Parents emotional support disease
- Rail cot rest
-
- Oropharyngel suction airway clearing
- Position change
- Oxygen therapy precaution
- Fever tepid sponge temperature
- I / V fluid therapy maintain
- Dietary support prescribed medicine
- Personal hygienic maintain skin care, mouth care eye care bladder bowel Care
- Injury & accident prevention care

- Convulsion care

- Observe & monitoring – vital sign level of consciousness pupilary reaction

respiration behavior secretion of air passage blood pressure sudden bleeding visual
changes
- Physiolotherapy body aligment
- Emotional support health education
COMA / ALTERED CONSCIOUSNESS
Coma central nervous system directory or indirectly affect life threatening

emergency condition Coma exact cause management life save
Coma is the condition indicates prolonged state of unrousable sleep and alteration of
consciousness usually resulting from lesions involving reticular formation of the brain stem,
the hypothalamus and connection with the cerebral hemispheres there is decreased
responsiveness to visual auditory and tuck tile stimulations with no spontaneous movement
GRADE OF ALTERED CONSCIOUSNESS :

- Stage 1 or stupor
- Stage 2 or light coma
- Stage 3 or deep coma
- Stage 4 or brain death
CAUSES OF COMA :
 Infection: meningitis, encephalitis, brain abscess, emphysema, cerebral malaria,
septicemia, shigella encephalopathy.
 Metabolic disorder: hypoglycemia, hyperglycemia, diabetic ketoaccidosis, acid base

imbalance. uremia, hepatic failure Roeye‘s syndrome, fluid and electrolyte
imbalance.
 Drug & Poisoning: opioides, barbiturates, sedatives, aspirin, organophosphate,

snake bite, insect sting, lead poisoning.
 Miscellaneous: head injury, intracranial hemorrhage, poetical coma, post cardiac

arrest, disorder of CNS, hyper tension, encephalopathy, brain tumor,
hydrocephalous, hypoxia, water intoxication, & sock.
DIAGNOSIS & INVESTIGATION :

- History taking
- Physical & neurological assessment
- Detection of causes
- History of illness event type symptoms intensity
- Glasgow coma scale
- Laboratory investigational
- Blood Urine CSF

- CT scan MRI PET scan x- ray
MANAGEMENT
Altered conscious condition patient emergency management coma
Management exact cause
- Patient clear airway maintain tracheotomy end tracheal
intubation
- Breathing pattern check O2 administration
- Circulatory status hydration status acid base balance & electrolyte balance check
- Fever convulsion drug administer

- ICP check maintain
- Administer dire tics (menitol, trusemido )
- PaCO2 25 to 30 mm Hg maintain
- Hydrocephalus CSF drainage
- NG tube insert
- Child condition check
NURSING MANAGEMENT
 Nursing Diagnosis
- Ineffective airway clearance related to altered level of consciousness

- Risk for injury related to decreased level of consciousness.
- Risk for impaired skin integrity related to immobility
- Impaired urinary elimination related to impairment in sensing and control.
- Disturbed sensory perception related to neurologic impairment.
- Interrupted family process related to health crisis.
- Risk for impaired nutritional status.

Child special care setting (NICU, PICU) intensive care
 Maintaining patent airway

- Head 30 degree elevate ,to prevents aspiration.
- Positioning-lateral or semi prone position.
- Suctioning
- Chest physiotherapy.
- every 8 hours Auscultation .
- mechanical ventilation, tracheotomy endotrachial Intubation
- O2 therapy
 Minimize secondary brain injury

- respiratory pattern monitor
- vital sign check
- GCS check level of consciousness assess
- basic life support provide ICP reduce
- prescribed drugs administer
 Protecting the client

- Padded side rails
- Restrains.
- Take care to avoid any injury.
- In-between the procedures
 Maintaining fluid balance and managing nutritional needs

- Assess the hydration status.
- vital signs infection sign monitor
- More amount of liquid.
- Start IV line.
- Liquid diet.
- NG tube.
 Maintaining skin integrity and daily routine care

- Pressure sore, back care prevent
- Position change
- Bad clean
- Skin condition monitor
- Passive exercises
- Back massage
- Use splints or foam boots to prevent foot drop.
- Aseptic precautions eye care provide
- Mouth care healthy oral mucosa maintain
- NG tube adequate nutrition provide
- Catheterization urine elimination promote

- Constipation relieve GI track obstruction assess normal bowel

function promote
- Anti convulsive drug restrains continuous observation injury prevent
- Emotional support family coping conditions promote home care
follow up
 Preventing urinary retention

- full bladder Palpate
- indwelling catheter insert
- Condom catheter for male and absorbent pads for females
- Urine pass stimulation
 Providing sensory stimulation

- schedule Maintain
- client the day, date, time and person Orient
- Touch and talk.
- Proper communication.
- Always address the client by name, and explain the procedure each time.
 Family needs
- Family support.
- Educate the needs of client.
- Care to be provided.
 Potential complications
- Pneumonia
- Aspiration
- Pressure ulcer
ENDOCRINE DYSFUNCTION
DIABETES INSIPIDUS
Diabetes Insipidus posterior pituitary gland disorder pituitary gland

secrete anti diuretic hormone deficiency nephrogenic disturbance
Normally thirst control ADH synthesis control hypothdamus

centre water intake output water intake thirst
kidney water loss ADH prevent DI
ADH level polyuria plasma osmolarity thirst increase
SIGN & SYMPTOMS

- Polydypsia (

- Polyuria ( urine output

- Low specific gravity urine output
- Fever, constipation, dehydration weight loss
DIAGNOSIS
- History of Illness
- 24 hours intake output
- Water deprivation test diluted urine & low specific gravity
- CT scan hypothalamic pituitary region
MANAGEMENT
- ADH daily replacement
- Desmopressin I /m Sc route nasal spray or oral or sublingual route
- Nephrogenic DI thaizide diuretics
 Supportive Care :
- Sufficient Water intake
- Maintain intake / output
- Fluid & electrolyte imbalance
- Low sodium intake
- Body weight record
- Skin care
- Safety measure
- Oral care
- Discharge care
HYPOTHYROIDISM
Thyroid Glands Disorder Thyroxin level decreased

hypothyroidism congenital acquired
CAUSES
1. Congenital hypothyroidism gene mutation, CNS failure iodine
Deficiency
2. Acquired hypothyroidism anti immune thyroiditis, thyroid dysfunction,
thyroid stimulating hormone etc
SIGN & SYMPTOMS

- Neonate large heavy
- Posterior fontanel open sutures wide
- Thick lips
- Lethargy

- Sluggishness
- Hoarse cry
- Feeding difficulties
- Hypotonia
- Over sleeping
- Cool extremities dry rough skin
- Umbilical hernia anemia
- Muscles weakness delayed bone age
- Delayed puberty
INVESTIGATION
- Screening of thyroxin level
- TSH level
TREATMENT
- Normal thyroid function maintain synthetic levothy roxine therapy
through out life
- Child monitoring
- clinical symptoms
- biochemical Tecting
- normal activity
- improvement mental performance
- bone age
- Parents long term treatment blood testing follow up overdose & features
explanation
DISORDER OF ADRENAL GLANDS
Adrenal glands disorder present

1. Adrenal insufficiency
2. Adrenal hyper activity
3. Adrenal medullar disorder
Adrenal insufficiency develop prolonged steroid therapy Adrenal

hemorrhage
JUVENILE DIABETES MELLITUS
Childhood adolescence endocrine metabolic disorder child physical &

psychological growth long term effect child juvenile diabetes mellitus
CLASSIFICATION
Type I: juvenile onset diabetes IDDM

Type II: NIDDM

JUVENILE DIABETES MELLITUS

diabetes mellitus hereditary disorder carbohydrate protein fat
metabolism derangement serum glucose level high urine
glucose
ETIOLOGY
- Idiopathic
- Destruction of beta cell insulin deficiency
- Heredity
- Obesity
- Genetic defect of beta cell function
- Diseare of exocrine panorease
- Glucose oxidation
- Protein fat oxidation abnormal rate
MANIFESTATION OR S / S
Condition rapid onset
 Major symptoms:
- Polyuria, polypsia, polyphagia, loss of weight, tiredness.
 Minor Symptoms:
- Skin & Urinary infection, dry skin
- Diabetes acidosis
 Precomatose Stall
- Drowsiness, dry skin, red lips, tachypnoea, Nausea, abdominal pain.
 Comatose stall :
- Extreme hyperapnoea (kussumal breathing )
- Rapid & weak pulse
- Decrease blood pressure
- Body temperature
- Sunken eye
- Rigid abdomen
- Acidosis, dehydration circulatory collapse renal failure
DIAGNOSIS FEATURE
- DKA hyperlycemia (250 to 300 mg / dl )
- Ketonemia & acidosis
COMPLICATION
- Stunting of growth
- Gangrene
- Cataract
- Diabetic Nephropathy
- Diabetic Neuropathy
MANAGEMENT
Combination of:
- Insulin therapy
- Dietary management
- Physical exercise
- Prevention of complication
- Promotion of Growth
- Promotion of Emotional social development
-
Management of DKA
- Fluid therapy
- Administration of insulin therapy
- Meals tolerate potassium supplementation
- Urination bicarbonates replacement
- Antibiotics therapy
- Blood glucose level check
- Blood electrolyte level check
- Level of consciousness
- Vital SIGN
- Patient coma unconscious stage unconscious Patient general care
- Patient DKA aspect proper precaution care

- Complication prevent growth promote nutritional requirement
- Insulin therapy knowledge skill information demonstration
- Urine sugar & blood sugar check record Patient
- Glucometer or reagent strip blood test insinuation self monitoring
- Hypo / hyper glycemia symptoms control
- Infection & trauma prevent Aseptic measure for infection routine

immunization general cleanliness hygienic care skin feet legs hands on care
- Fear & anxiety emotional support
ORTHOPEDIC ABNORMALITIES
DEFORMITIES OF THE SPINE
1. KYPHOSIS
Thoracic vertebra curvature kyphosis

Kyphosis. Kyphosis is characterized by an abnormally rounded upper back (more than 50

degrees of curvature).
CAUSES
- Congenital deformity of vertebral body
- Inflammatory disease of the spine
- Tumor
- Spinal cord muscle develop
- Malnutrition
- Abnormal vertebrae development in utero (congenital kyphosis)
- Poor posture or slouching (postural kyphosis)
- Scheuermann's disease
- Arthritis
- Osteoporosis
- Spina bifida,
- Spine infection
- Spine tumors
SIGN/ SYMPTOMS
- Pain
- Loss of function
- Lethargy
- Bending forward of the head compared to the rest of the body
- Hump or curve to the upper back
- Fatigue in back or legs

2. LORDOSIS
Lumbar carve normal lordosis
Lordosis: Also called swayback, the spine of a person with lordosis curves significantly
inward at the lower back.
CAUSES :
- Bed posture
- Secondary deformity
- Congenital dislocation of the hip bone
- Abdominal muscles paralysis or weakness
- Pregnancy
- Rheumatic Arthritis malignancy
- Achondroplasia
- dwarfism
- Osteoporosis
- Obesity
SIGN AND SYMPTOMS

- Appearing swayback
- with the buttocks being more pronounced
- Back pain and discomfort
- Problems moving certain ways
- Pain
- Loss of function
- Lethargy
3. SCOLIOSIS
Spinal cord laterally scoliosis
Scoliosis: A person with scoliosis has a sideways curve to their spine. The curve is often S-
shaped or C-shaped.
CAUSES
- Congenital Deformity
- Paralysis abdomen or back muscles
- Intra thoracic disease
- Sciatica
SIGNS / SYMPTOMS
Uneven shoulder blades with one being higher than the other
- An uneven waist or hip
- Leaning toward one side

MANAGEMENT OF DEFORMITIES OF THE SPINE

- General Treatment : Malnutrition disease general health
improve high calorie health protein vitamin, mineral diet
- Special Treatment
- Physiotherapy
- Spinal belt
- Posture maintain advice
- Disease primary deformity correct
- Physiotherapy
- Plaster Support
- Medication to relieve pain and swelling
- Exercise and physical therapy to increase muscle strength and flexibility
- Wearing a back brace
- Weight loss
- Surgery
- Exercise
- Observation. If there is a slight curve your doctor may choose to check your back
every four to six months to see if the curve gets worse.
- Nutritional status maintain
SURGICAL MANAGEMENT
- Spinal instrumentation.
- Artificial disc replacement. Degenerated discs in the spine are replaced with artificial
devices.
- Kyphoplasty. A balloon is inserted inside the spine to straighten and stabilize the
affected area and relieve pain.
TORTICOLLIS (WRY NECK)
Sterno mastoid muscles twisting contracture head rotted

head fix contract torticollis
TYPES
 Primary Torticollis: Congenital
 Secondary Torticollis: Bone abnormality cervical vertebra

deformity Torticollis Secondary Torticollis
CAUSES :
- Cervical spine or muscles problem
- Cervical spine develop
- Neck inflammation contracture
- Forceps delivery stern mastoid muscles injury

SIGN & SYMPTOMS :

-
- Swelling
- Contracture
- Face normal
- inability to move the head in a normal fashion
- neck pain or stiffness
- headache
- one shoulder higher than the other
- swollen neck muscles
MANAGEMENT
- Passive exercise
- Daily routine work
- Cases operation deformity correct
OSTEOMYELITIS
Pyogenic infection bone localized or generalized inflammation

Osteomyelitis
ETIOLOGY:
Organisms like staphylococcus, group B- streptococcus, E coli and pseudomonas
aeruginosa etc.
- Wound surgical or penetrating

- Decubitus ulcer
- Septicemia
- chronic infection
- Risk factors
- External fixation devices
- Catheters ( IV & Urinary )
TYPE :
1. Acute osteomyelitis :
Hematogenous infection metaphysic most susceptible site
2. Chronic osteomyelitis :
Acute osteomyelitis treatment
SIGNS / SYMPTOMS
- Fever and chills
- Localized Pain
- Swelling
- Tenderness

- Warmth affected part

- Limited motion range
Chronic osteomyelitis
- joint stiffning secondary arthritis
- Bone pain
- Excessive sweating
- General discomfort, uneasiness, or ill-feeling (malaise)
- Local swelling, redness, and warmth
- Pain at the site of infection
- Swelling of the ankles, feet, and legs
DIAGNOSIS
- History of trauma or infection
- Blood cultures
- Bone biopsy (the sample is cultured and examined under a microscope)
- Bone scan
- Bone x-ray
- Complete blood count (CBC)
- C-reactive protein (CRP)
- Erythrocyte sedimentation rate (ESR)
- MRI of the bone
- Needle aspiration of the area of the affected bones
MANAGEMENT
- IV broad spectrum antibiotic therapy, coloxacillin, gentamicine for 4 to 8 week
- Analgesics & Antipyretic drug symptoms
- Supportive care adequate rest nutrition diet wound care maintain hydration
immobilization of part
- Exercise ambulation
- Surgical management abscess incision drainage
chronic cases bone grafting
- Orthopedic devices rehabilitation
CLUB FOOT
Congenital club foot talipes nontraumatic deformity

foot normal position shape twisted planter flexion (talips equines)
dorsiflexion (talipes calcan-eus ) deform
95% planterflexion club foot foot planter flexion middle
deviated heel elevated Twisted
CAUSE

- Contributing factor
- Fetal life development
- Fetal foot malposition
- Defective neuromuscular development
MANAGEMENT
- Standard foot wear
- Plaster cast, adhesive tape, strapping splinting manipulation
- 2 to 6 month
- Bebax shoe or weaton brace shoe
- 4 to 7 month age surgical management ( tenotomy )
RHEUMETIC ARTHERITIS
Chronic systemic inflammatory disease joint affect onset 20 to 40
ASSESSMENT
1. Bilateral joint evaluation erythema warmness tenderness pain
2. Early morning pain & stiffness moderate activity subsite
3. Insidious onset of malaise weight loss paresthesia stiffness
4. Subculaneous nodules
5. Low grade temperature
6. Fatigue and weakness
NURSING MANAGEMENT / IMPLEMENTATION :

 Patient medication and side effect
- Salicylates :
i. Aspirin most common drugs
ii. Sideteffect tinnitus GI upset gastric bleeding prolongs bleeding time
- Anti inflammatory drugs :
i. Phenylbutazone indomethisine motrine
ii. Side effect GI disturbance CNS manifestations skin rashes
- Gold salts :
i. 3 to 4 months continue effect
ii. Expensive drugs sever toxicity
- Corticosteroids :
i. Adjunct therapy
ii. Sever condition
iii. Low dose toxicity prevent
 Patient joint mobility / function maintain encourage
 Complete bed rest
 Diet control
 Body image alter psychological support
life long condition

 Flexion contracture prevent range & motion exercise

 Sever condition surgical management
FRACTURE
Bone Continuty Break Fracture 

Stress Fracture
 Fracture # 
CAUSES OF FRACTURE:
 Direct Violence (  ):
 Indirect Violence   :
 orce Transmute
F
Fracture  racture
F
 Muscular Contraction    :  Fracture
Fracture 
 Pathological Causes : Old Age Bone Bone  Diseases

 Induce fracture : Baby
TYPES OF FRACTURE
 Simple or Closed : Fracture

Skin
 Compound or Open facture :-    
 Complicated fracture:- fracture

 Brain, Spinal cord, lungs   Spleen
 Closed Open

 Comminuted # :  Bone
 Green Stick # :  
 reen Stick #
G 
 Impacted #:
 Depressed # :Scalp
 Compression # Bone
SIGN & SYMPTOMS

Fracture Fracture
 Pain
 Loss of Function
 Shorting of Limb
 Crepitus
 Swelling & Discoloration    
 Bleeding:-
 open Fracture
 Sign Symptoms of Shock:- # Skull, # Thigh Bone, # Pelvis
Shock

TREATMENT # Fracture   
Fracture # Splint Bandage

 Bandage
 Spilt splint
FRACTURE OF SKULL
SIGNS AND SYMPTOMS




 Internal Hamrej

 Orbital Cavity Black Eye 
TREATMENT









FRACTURE OF LOWER JAW
SIGNS AND SYMPTOMS






 Crepitus
TREATMENT


 Chin
FRACTURE OF SPINE
Spine SpinalCord
TREATMENT



 Hospital Refer 
FRACTURE OF LIMB
Simple Communized Simple

Communized # #
TREATMENT
 # Splint 
 Wound Dressing Bandage 
 Splint
 # Sling 
 Refer 
DISLOCATION
 Dislocation   Hip
 Dislocation 

SIGNS AND SYMPTOMS







TREATMENT



SPRAIN
Sprain
SIGNS AND SYMPTOMS




TREATMENT


 Cold Compress
 Thick Cotton Wool  andage
B 
  prain
S Figure Of
"8"Bandage 
 Refer
SENSORY IMPAIMENTS (Communication disorders)
VISUAL DISORDERS
India visual impairment blindness important diseases, cataract refraction

Error, corneal opacity, glaucoma, trachoma infection
Malnutrition, systemic disease, eye injury, congenital disorder retinal
detachment, tamors leprosy
Visual disorder problems associated

- Amblyopia or dimness or subnormal vision vision
impaired
- Amqurosis partial or complicate loss of vision patient

vision loss
- Night blindness (Nyctalupia) condition vision problem
retinitis, chroidortinitis, vitamin- A deficiency, retinotoxic drug
- Double vision ( diplopia ) ptosis squint on condition object
double myasthenia gravis, brain tumor lop
- Color blindness genetic abnormality impairment defective color
perception 5 to 6 defect
CAUSE
- Trachoma
- Conjunctivitis, vitamin – A deficiency eye injury tuberculosis &
STD s
- Squint glaucoma myopia, sever measles, leprosy, congenital anomalies like cataract,
opticatrophy, neurodegenerative disorder, malignancy etc.
PREVENTION OF VISUAL IMPAIRMENT

Blindness simple intervention prevent
- Breast feeding promote
- Diet Vitamin – A containing food improve
- Ocular hygiene maintain
- Harmful practices avoid
- Proper lighting safety measures immunization
- School child eye check up regularly
- Eye health eye hygiene health education
- TV visual aid avoid
- Ocular disease early detection appropriate treatment
- Healthy habits visual
NURSING MANAGEMENT OF VISUAL IMPAIRMENT
Assessment
- History
- Ocular assessment
- Laboratorial & Radiological investigations
Diagnosis : impaired visual perception
Interventions
- Eye proper care cleaning or infection prevent , eye care, hand washing
antibiotic drop medications, eye irrigation, ointment eye shield use
- Cold warm compression pain photophobia patient bright light
- analgesics administer
- dim light provide

- diversion therapy
- Hospital home school community safety measures injury prevent
, proper use of eye glasses avoid hurryness, dirt & damage follow traffic
rules, personal safety, proper toileting, use of side rails on bed etc
- Eating bathing toileting dressing hygiene care activity maintain
- Normal growth & development promote man puling object hearing sound
noting smell tasting eatables valuable opportunities sensory
Stimulation
- Emotion support fear anxiety reduce explanation reassurance
encouragement
- Family member mother baby care activity medical help follow up surgery
rehabilitative facilities schooling
HEARING IMPAIRMENT (DEAFNESS)
Hearing Impairment congenital acquired temporary

Permanent common Handicapped condition
9 – 15 % Indian school child Speech verbal
communication development hearing important aspect
CAUSE OF HEARING IMPAIRMENT

- Genetic familiar deafness: chromosomal abnormalities like trisomy 21, pierrerubin
syndrome, alport‘s syndrome, hunter – hurler syndrome & congenital abnormalities.
- Intra uterine infections : Rubella, CMV, syphilis, toxoplasma, chickenpox.
- Teratogenic exposure during pregnancy drug therapy with quinine streptonyins,
thalidomide & irradiation.
- Post natal infection meningitis, encephalitis, mumps, measuls, chickenpox Recurrent
& supportive otitis media.
- Mechanical obstruction of external auditory canal by wax & foreign body
- Brain damage, cerebral palsy, mental retardation, LBW baby asphyxia, prolonged
mechanical ventilation, birth injury.
- Toxic neonatal hyper bilirubinemia
- Toxic drug therapy streptomycin, gentamicin, neomycin, choroquine loop diuretics .
- Injury: direct injury of ear head injury indirect injury by explosion, constant exposure
to loud noise.
- Nutritional: mal nutrition vitamin – B complex deficiency
CLASSIFICATION OF HEARING IMPAIRMENT
 Slight hearing impairment 15 TO 25 decibels

 Mild hearing impairment 25 TO 40 decibels
 Moderate hearing impairment 40 TO 65 decibels
 Severe hearing impairment 65 TO 95 decibels
 Profound hearing impairment > 95 decibels
TYPE OF DEAFNESS
 Conductive Hearing Deficit : Sound transmission conduction disjunction

ear canal ear drum ossides Hearing loss
deafness common type
 Sensor neural Hearing Deficit:Condition cochled lesions auditory nerve pr central

auditory pathways damage acquired problems meningitis, CNS
infections birth asphyxia Jaundice, drug effect genetic congenital anomalities
 Mixed Type: Conductive sensorineural deficiet
CONSEQUENCE OF HEARING IMPAIRMENT

Children hearing impairment complain 6% profound
hearing loss hearing ability mild unilateral
Condition delayed or poor speech development poor academic

performance poor attention behavior problems children TV & Radio
loud voice loudly voice inadequate social & emotional
development
DIAGNOSIS & EVALUATION

- Assessment of development milestone
- Hearing Tests
o Using tanic fark
o Using wrist watch
- Audiometric
- Tymphanometry
- Labyrinthine test
- ABR – Auditory brainstem response
MANAGEMENT
- Defect early detection medical surgical intervention management
- Antibiotic therapy infection treatment

- Surgical procegers myringotomy
- Typanoplasty insertion of graft or prosthesis adenotonsilectomy cochlear implant etc
- Hearing aids speech therapy lip reading sign language deaf education etc
supportive rehabilitative care provide
- Parentral involvement counseling management important aspects deaf child care
hearing aids care instruction
- Parents child emotional support
Accident prevention referral special facilities

HANDICAPPED CHILDREN
Classification:-
Handicapped children classified
A. PHYSICALLY HANDICAPPED CHILDREN :-

Physically handicapped blindness, deaf & dumb, congenital, malformation,
like deft lip, deft palate, dub foot, congenital heart diseases etc. post polio residual paralysis,
leprosy, accidents, burns injuries, etc
CAUSES
- Birth defect.
- Malnutrition
- Infection &
- Accidents
Physically handicapped children body affected part classify
 Orthopedically handicapped children: club foot, bony defects, amputation, bony

defect, following ricked, fracture, arthritis, leprosy etc.
 Sensory Handicapped Children :-

- Visual problems – partial or complete blindness.
- Auditory problems – partial hearing loss deaf & dumb.
- Speech problems – Stammering, dysphasia.
 Neurologically Handicapped Children :- cerebral palsy, mental retardation,

convulsive disagrees, hydro cephalous, spine bifida, post meningitis sequel, post polio
paralysis, degenerative diseases of CMS, learning disabilities, etc.
 Handicapped condition due to chronic systemic diseases heart disease, bronchial

asthma, diabetes mellitus, muscular dystrophy etc.
 Multi physically handicapped :- handicapped children orthopedic, sensory &

neuron logical handicapped condition combination
B. MENTALLY HANDICAPPED :-
Mentally handicapped mentally retarded child, India 2-3%
population mentally handicapped
Mentally retarded child IQ children learning disabilities,
poor maturation & social maladjustment
I.Q 100 100 I.Q I.Q

- 100 IQ
- 70 84
- 55 69
- 40 54
- 25 93
C. SOCIALLY HANDICAPPED CHILDREN:-

Social factor children personality development disturb
socially handicapped children factors broken family, parental inadequacy, loss
of parents, poverty, lack of educational opportunities, environmental deprivation & emotional
disturbances luck of love & care
children orphan child, abused child, addicted child, street children,
child labor, maternal deprivation, emotional deprivation neglected or destitute child,
exploited or victimized & delinquent child children environment
adjust
CAUSES HANDICAP CONDITION

- Congenital anomalies.
- Genetic disorders.
- Poliomyelitis
- Communicable diseases.
- Parental conditions,
- Malnutrition
- Accidental injuries &
- Socio cultural factors.
PREVENTION OF HANDICAPPED CONDITIONAL IN CHILDREN :-
Preconception, Prenatal and intranasal period maternal health improve

adequate care children infancy, childhood adolescent
period care
handicap condition prevent
- Genetic counseling age 20-30 pregnancy care

couple
- High risk patient genetic screening chromosomal sex congenital
anomalies
- Universal immunization schedule follow specially poliomyelitis & MMR.
- Children mother nutritional status improve
- Pre conception period iodine folic acid deficiency prevent
- Antenatal, intranasal neonatal period essential care provide maternal &
neural infection, birth injuries, birth asphyxia prevent
- High risk mother children special care
- Malformed fetus pregnancy medical termination
- Health awareness health status improve

MANAGEMENT OF HANDICAPPED CHILDREN :-

Handicapped children management multi disciplinary approach
condition early diagnosis treatment rehabilitation
promotion
Management approaches aspects
- Handicapped condition early detection carefull history, through physical

examination investigation
- MCH school health services regular medical supervision developmental
assessment abnormal condition early stage identify
- Medical surgical management particular handicapped condition
treatment e.g. cataract, obits media, leprosy, accidental injuries congenital
abnormalities etc.
- Deformities correction e.g. visual & hearing problems.
- Physical condition improve physiotherapy [ exersice
- Child ability occupation therapy e.g. pottery, wood work, music,
painting etc.
- Communication skills improve speech therapy
- Prosthetics handicapped child artificial limb provide
- Love, warmth, patience, tolerance & discipline mentally handicapped child
special care
- Parents family members guidance counseling provide
- Parents family members guidance counseling provide
- Welfare services, special training, rehabilation & support services, referral
REHABILITATION OF HANDICAPPED CHILDREN :-

Rehabilitation process
- Prosthesis artificial limbs children function restore
- Social rehabilitation family & social relationship improve
- Specialized training & educational facilities educational rehabilitation Braille
for blind & sign language for deaf & dumb.
- Growth & development process personal dignity confidence [ restore
psychological rehabilitation
- Handicapped children healthy life special training care

UNIT – 8
Welfare of Children &
preventive pediatrics
Unit – VIII
 WELFARE OF CHILDREN AND PREVENTIVE PEDIATRIC

- Child welfare services, agencies, balwadi, anganwadi, day care centers, midday meal
programme.
- Welfare of delinquent and destitute children.
- Programme and policies for welfare of working children.
- National child labour policy.
- Child Act, Juvenile Justice Act.
- Internationally accepted rights of the child.
 PREVENTIVE PEDIATRICS
- School health service
- Under five‘s clinic
- Maternal and child health (mch)
- Reproductive and child health (rch)
- Intigrated child development services (icds)
- National health policy for children
- Child welfare service
- National nutritional policy
- Pulse polio immunization program (ppi)
- Immunization

WELFARE OF CHILDREN
RIGHTS OF CHILD
1.
2. Medical care, housing, nutrition social security enjoy

3. Name Nationality
4. Free education
5. Play recreation
6. Handicapped child special treatment, education
7. Disaster
8. Freedom dignity society useful
member
9.
10. Color, sex, religion, national, social origin
United Nation 20th November, 1959 ―Right of child‖

declaration India rights child need promote
THE ―BALWADI‖ PROGRAMME
Balwadi is an Indian pre-school run in rural areas and for economically weaker
sections of the society, either by government or NGOs. It has been defined by Grewal who is
quoted by R. P. Shukla as "A rural pre-primary school run economically but scientifically and
using as many educational aids as possible, prepared from locally available material". It was
developed by Tarabai Modak, the first balwadi was started in Bordi a coastal village in Thane
district of Maharashtra by Nutan Bal Shikshan Sangh in 1945.
OBJECTIVES OF THE PROGRAMME:

The ―Balwadi‖ programme has been started for scheduled caste children of the age of
three to five years so that they can learn cleanliness, prayers, how to stand up and talk etc and
also learn about the basic morals and good virtues. They also become to accusatorial to
school life.
INFORMATION:
Children between the age of three to five years are given free education. The woman
managing the ‗Balwadi‘ is given a salary of Rs.1200/- to Rs.1500/- depending on
qualifications. While the woman escorting the child get Rs.600 per month, Rs.100/- transport
allow once and Rs.600/- annually for miscellaneous expenses.
BENEFICIARIES OF THE PROGRAMME AND WHOM TO CONTACT

Children of the age group of three to five years and belonging to scheduled caste can
get the benefit.
ELIGIBILITY FOR AVAILING BENEFIT

The scheduled caste child should be between three to five years.
THE CHILDREN ACT (1960)
The children act 1960 1977 act

children care protection, welfare rehabilitation provide
act neglected, destitute, socially handicapped delinquent children
welfare children act work

- (begging)
- (without home)
- (orphan child)
- (prostitution)
- (exposed to moral danger)
- Neglected children
WELFARE OF DELINQUENT CHILDREN
‗The children act 1960 in India‘ children (offence)

delinquent
―Juvenile‖ means 18 years age girl 16 years age
children.
Juvenile delinquent behavior lying, theft burglary, truancy from school, run away from
school & home, habitual disobedience, fights, ungovernable behavior, mixing with anti social
gang, cruelty to animals, destructive altitude, murder, sexual assault
age offence, antisocial, ungovernable,
Juvenile delinquency
India cultural pattern change urbanization industrialization
juvenile delinquency 15 years
girl boys
CAUSES:-
 Biological Causes:-Here litany defects feeble mindedness, physical defects, glandular
disturbances and chromosomal anomaly.
 Social Causes :-Broken homes, death of parents, separation of parents, step mother,
disturbed home, alcoholism, neglect, child abuse, battered baby, too many children.

 Miscellaneous:-Absence of recreation facilities, cheap reactions, sex thrillers,

violence, slum dwelling, urbanization, industrialization, social disintegration, change
in moral standards & value system etc.
PREVENTIVE MEASURES :-
- Family life improve Loving care system
- Appropriate schooling.
- Recreational facilities, parents counseling, child guidance, educational facilities
provide
- Adequate
JUVENILE health service
JUSTICE – 1986provide
New act October 1987 comprehensive scheme

delinquent, juvenile care, protection, treatment development rehabilitation
provide
SPECIAL FEATURES OF JUVENILE JUSTICE ACT :-

- uniform legal framework provide children jail
lock up
- Deliquency prevent child development need
- Children delinquency investigation, care, treatment rehabilitation
standard administration
- voluntary organization formal system co-ordination juvenile
justice linkage
1992 609 institute juvenile justice act 269

observation homes, 249 juvenile homes, 40 special homes 51 after care institute
-
CHILD GUIDANCE CLINIC (CGC)
Child guidance clinic 1909 Chicago Juvenile

delinquency problems deal
OBJECTIVES:-
- Children later life psychotic neurotic

- Children external environment adjust
- Child security feeling provide psychotherapy
- Mental health improvement.
- Play therapy, counseling, guidance suggestions

WELFARE OF DESTITUTE CHILDREN
Destitute children need food, clothes shelter parents

children parents care
(orphans home)
children psycho socially handicapped maternal derivate neglected
special setting placement
CHILD PLACEMENT :-
1. Orphanages :- Orphanages government or voluntary organization
institute children placement emotional security develop
warmth family life environment provide orphanages
children citizen
2. Foster Homes :- destitute children care children

facilities love, affection
security provide
3. Borstal homes :- institutes (attendees) training

Children 3 year training India
boys 6 borstal homes girls
4. Remand home :- Juvenile affiances place child

physician, psychiatrist trained personnel under care & training child
physical mental well being child healthy development
priority schooling, various art crafts, games reputational activities
arrangement
5. Adoption:- Destitute child (adopt) care

legal procedure Adoption law children Care
legal parents child adopt information & support
WELFARE OF WORKING CHILD (CHILD LABOR)
1975 the international labor organization age

15 years sector work light work children
age 13 years work child health, safety school attendance
Child labor poverty, unemployment education

age labor child physical & mental health status growth problems
child labor child labor India
status work eg. Domestic servant, helpers in shops,
dhabas, restaurants, as vendars, as agriculture workers, as shoeshine boys, rag pickers etc.
sari, embroidery, stone polishing, bidi making, industrial business work
CAUSES:-
- Poverty.
- Lack of education.
- Unemployment.
- Exploitation by selfish.
- Lazy parents.
- Bad company.
- Beggar gang.
- School dropout.
- Maladjustment in family.
- Broker family.
- Death of parents etc.
Child labor :-
- Hygiene problems.
- Drug addiction.
- Smoking.
- STDs.
- Accidents & injuries.
- Malnutrition.
- Juvenile delinquency.
- Prostitution.
Child labor special problem special attention level

child labor causes problem treatment care
society awareness
India child labor act
THE CHILD LABOR (Prohibition & regulation act - 1986) :-

Child labor (Prohibition & regulation act - 1986) most important
main
1. children 12 years age adolescent plantation
2. institute industries children work permission

3. period fixed 6
break interval
4. Children work able work overtime permission
5. Children occupation good mail transport, railway, carpet, weaving,

cement, building construction, cloth printing, matches
Permission

Health & social legislation child labor Child

labor child labor problems
PROHIBITION OF CHILD MARRIAGE
The child marriage restriction act 1978 marriage

minimum age boys 21 years girls 18 years
 Early marriage health problem social problem

 Early marriage girls school dropout, sexual hazards, obstetrical problems
poor physical & mental health
 mother baby care early marriage
teenage pregnancy problems
 Early marriage India
early marriage awake responsibility nurse
Children future cilium children health problems prevent
UNICEF (United Nations Children’s Emergency Fund)
UNICEF December 1946 United Nation‘s General Assembly

UNICEF future children health
WHO, UNESCO NGO children mother welfare
UNICEF children health programs
A. Child survival, protection & development.

B. Interventions like immunization, improve infant feeding practices, child growth
monitoring.
C. Home basis diarrhea management drinking water.
D. Education formal & informal.
UNESCO teaching improvement

1. Science laboratories.
2. Equipments.
3. Workshop tools.
4. Library books.
5. Audiovisual aids.
UNICEF newborn & children welfare main area

- Growth monitoring.
- Oral rehydration to treat mild & moderate dehydration.
- Breast feeding.
- Immunization.
- Family welfare.
- Food & Nutrition.
children health services upgrade health &

nutrition, water supply, sanitation & education for parents.
CHILDREN WELFARE LEGISLATIONS
1. The child marriage restraint act – 1929.

2. The child labor (prohibition & regulation) act, 1986.
3. The juvenile justice act, 1986.
4. The infant milk substitutes feeding bolides & infant foods (regulation of production,
supply & distribution) act, 1992.
5. The pre conception & pre natal diagnostic technique (Prohibition of sex selection) act,
1994.
6. The persons with disabilities (equal opportunities, protection of right & full
participation) act, 1995.
7. The immoral traffic (subvention) act, 1956.
8. The guardians & words act, 1890.
9. The young persons (harmful publication) act, 1956.
10. The commissions for protection of child right act, 2005.
GENDER BIAS
developing countries
girls
female feticide, in feticide

sex identification
birth Girl child care
low social economics
family prostitution
SAARC 1990 year ―The year of girl child‖

1991-200 AD decade ―Decade of girl child‖ decade
aloneness gender gap
Indian government gender gap

girl child special services

Girl child status Mumbai national conference

girl child welfare 10 recommended practical action plan
1. Girl child welfare girls boys

2. Country state female feticide
3. Girl child care awareness
4. Girl child nutritional status improve nutritional program
5. Secondary school education school dropout rate
6. Girl child compulsory immunization
7. Girl child health status information
8. Girl children child labor girl
awake sexual exploitation
9. Girl child adopt people organization motivate
10. Government Non government agencies handicapped socially deprived
girls job opportunities
action plan implement gender bias Girl child

status & health
CHILD LAWS IN INDIA
DER BIAS
Children are the future of a country. They bring the development & prosperity to the
country. But as we all know that the children are the most vulnerable part of the society &
can be easily targeted. In India we have enacted many laws & Acts related to Children in
order to protect them & to give them a better & sound development
CONSTITUTIONAL PROVISIONS
Preamble Commitment: Justice, liberty, equality, & fraternity for all the citizens including
children are the main purpose of the Constitution
 Article 14: Equality before law & equal protection of laws. It is available to every
person including children.
 Article 15 (3): empowers the State to make special legal provision for children. It
makes mandate to the government to ensure children‘s welfare constitutionally.
 Article 21: it mandates free & compulsory education for all the children in the age
group of 6- 14 yrs.
 Article 23: puts total ban on forced labour & is punishable under the Act.
 Article 24: prohibits employment of children in hazardous factories below the age of
14yrs.; e.g.: mine, match industries etc.
 Article 51 A clause (k) & (j): the parent or the guardian to provide opportunities for
education to his child or as case may be ward between the age of 6- 14 yrs.
Directive principles in Constitution of India also provide protection for the children
such as, Article 39 (e), Article 39 (f), Article 41, Article 42, Article 45, & Article 47.
There are many Acts enacted in India for the protection children rights:
- The Factories Act, 1948.
- The Probation of Offenders Act, 1959.
- The Child Labour Act, 1986.
- The Child Marriage Restraint Act, 1986.
- The Juvenile Justice Act, 2000.
- The Pre- Conception & Pre- Natal Diagnostic Techniques (Prohibition of Sex
Selection) Act, 2002 and many others
The increased crime rate against the children, even after enacting so many
National Policy for Children (NCP), National Institute of public Co-operation & Child
Development (NIPCCD), The Integrated Child Development Services are polices made by
Government. Even NHRC & UNICEF are also organization, takes special efforts to protect
children rights.

Genetics related to pediatrics
INTRODUCTION
1% of all newborn infants possess a gross chromosomal abnormality, 5% of

individuals under age 25 develop serious disease with significant genetic component.
Genetics is the study of single or a few genes and with phenotypic effects. Genomics
is the study of all the genes in the genome and their interactions.
Any two individual share 99.9% of their DNA sequences. Only 0.1% show
remarkable diversity which represents about 3 million base pairs. The most common
variations in DNA are called single nucleotide polymorphism (SNP). And only 1% SNPs
occurs in coding regions. Proteomics concerns itself with the measurement of all proteins
expressed in a cell tor tissue.
MENDELIAN LAWS
 Law of Dominance
 Law of Segregation
 Law of Independent Assortment
 LAW OF DOMINANCE
 Mendel‘s first law of inheritance
 If two alleles are different i.e. heterozygous ,the trait associated with only one of
these will be visible (dominant) while the other will be hidden(recessive)
 LAW OF SEGREGATION
 The separation of allele into separate gametes is law of segregation.
 It states that every individual possesses a pair of alleles (assuming diploid) for any
particular trait and that each parent passes a randomly selected copy (allele) of only
one of these to its offspring.
 LAW OF ASSORTMENT
 Also known as "Inheritance Law‖
 It states that separate genes for separate traits are passed independently of one another
from parents to offspring

GENETIC DISEASE
Is an abnormal condition that a person inherits through genes or chromosomes
MULTIFACTORIAL DISORDERS
Also known as complex disorders. Associated with the effects of multiple genes in
combination with life styles and environmental factors.
e.g.
 Asthma
 Cancers
 Cleft palate
 Diabetes
 Heart disease
 Hypertension
MENDELIAN DISEASES
Mendelian diseases are inherited according to the Mendelian Laws.

 Dominant
 Recessive
 Sex linked diseases
AUTOSOMAL DOMINANT
 Individual with an autosomal dominant trait will produce two kinds of gametes with
respect to the mutant gene.
 Half with the mutant gene and half with the normal allele.
 Offspring of such individual has a 50:50 chances of being affected, provided the other
parent is normal.
DOMINANT DISEASES
 Polycystic kidney
 Neurofibromatosis
 Retinoblastoma
 Marfan syndrome
AUTOSOMAL RECESSIVE
 Abnormalities occur when both the parents are heterozygous.
 Offspring of such parents has a chance of 1:4 being affected.
RECESSIVE DISEASES
 Cystic fibrosis
 Sickle cell anemia
 Galactosemia
 Phenylketonuria

SEX LINKED
A mutant gene on X chromosome in males will express itself readily as there is no
normal allele. A mutant gene on X chromosome in females will not express itself in the
presence of normal allele.
SEX LINKED DISEASES

 Hemophilia
 Color Blindness
 G6PD Deficiency
CHROMOSOMAL ABNORMALITIES
 Incorrect number of chromosomes.

 Non disjunction: chromosomes do not separate properly. Eg trisomy monosomy
 Breakage of chromosomes:
 Deletion
 Duplication
 Inversion
 Translocation
CHROMOSOMAL DISORDER
 Down syndrome: trisomy 21
 XXY :klinefelter syndrome male
 XXX :trisomy female
 XYY: Jacobs syndrome male
 XO: Turner syndrome.
DOWN SYNDROME
Down syndrome Genetic condition person 46 chromosome

chromosome 21 extra copy
CAUSES:
 chromosome 21 extra copy trysomy 21
 extra chromosome body + brain normal development
SYMPTOMS:
 Down syndrome symptoms
affected person range
(mild to moderate)
COMMON PHYSICAL SIGNS INCLUDE:

 Decreased muscle tone at birth
 Head may be smaller than normal
 Separated skull sutures

 Absence of arrases in pain

 Flat nose
 Small ear
 Upward eyes slanting
 Short + Wide hands
 Physical development normal slow affected person Height adult age
5 feet
MENTAL + SOCIAL DEVELOPMENTAL SIGNS:

 Impulsive behaviour
 Poor judgment
 Short attention span
 Frustration + anger
 Lock at attention
DOWN SYNDROME Associated medical conditions :
 Birth defects eg ASD, USD, etc.
 Dementia
 Bone problems + risk at dislocation
 Hearing impairment
 Eye problems eg cataract
 GI problems eg vomiting TEA + deodenalatresia
 Sleep apnea
 Hypothyroidism + endocrine problem
DIAGNOSTIC TESTS:
 Blood test
 Echocardiogram
 Chest + GI tract on Radio study
 Check the symptoms
 Eye examination
 Hearing test
 Dental examination
 Thyroid testing
 X-ray of affected bone + jovial
TREATMENT:
 Down syndrome specific treatment track blockage Birth
major sugary
 heart defect sugary
 Breast feeding poor toung control problems support

 Older children‘s Adult obesity Activity calorie

manage
 Frustration anger compulsive behavior psychological problems behavioral
therapy
 Infections informatory conditions specific antibiotic therapy
 Down syndrome special education, communication skills training,
speech therapy, physical therapy mental development intervention
 Adolescent female + male sexual abuse pregnancy

prevent
TURNER’S SYNDROME
Generally human females Genetical abnormality ―X‖ monosomy

(absence at entire sex chromosome) condition body cells x
chromosome absent ―Turner mosaicism‖
CAUSES :-
 Turner syndrome body cells sex chromosome ‗X‘ Absence
 Inheritance
 Majority cases monosomy mother ‗X‘ chromosome
 Mitotic errors X chromosome produetion problem
SIGNS / SYMPTOMS
 Short stature
 Lymphedema (swelling) of the hands and feet
 Broad chest (shield chest) and widely spaced nipples
 Low hairline Low-set ears
 Reproductive sterility
 Rudimentary ovaries gonadal streak (underdeveloped gonadal structures that later
become fibrosed)
 Amenorrhoea, or the absence of a menstrual period
 Increased weight, obesity
 Shield shaped thorax of heart
 Shortened metacarpal IV
 Small fingernails
 Webbed neck from cystic hygroma in infancy
 Aortic valve stenosis
 Coarctation of the aorta
 Bicuspid aortic valve
 Horseshoe kidney
 Visual impairments sclera, cornea, glaucoma, etc.
 Ear infections and hearing loss
 High waist-to-hip ratio (the hips are not much bigger than the waist)
 Attention Deficit/Hyperactivity Disorder or ADHD (problems with concentration,
memory, attention with hyperactivity seen mostly in childhood and adolescence)
 Nonverbal Learning Disability (problems with math, social skills and spatial
relations)
 Other features may include a small lower jaw (micrognathia), cubitus valgus, soft
upturned nails, palmar crease, and drooping eyelids. Less common are pigmented
moles, hearing loss, and a high-arch palate (narrow maxilla). Turner syndrome
manifests itself differently in each female affected by the condition, therefore, no two
individuals will share the same features.
DIAGNOSTIC TEST :-
 Prenatal
 Blood Gene testing
 Amniocentesis
 Chorionic villas sampling
 Ultra sound findings
 Maternal serum screening
 Postnatal
 Physical Assessment
 Blood Gene testing
 Cerotype chromosome test
 Chromosomal composition Analysis
TREATMENT :-
 Abnormal chromosomal condition specific treatment

symptomatic management
 Growth retardation condition Genotropin (Growth hormone) use
 Congenital abnormalities Repair surgical management
 Endogen therapy
 Pregnancy avoid reproductive techniques
 Genetic counseling

TRISOMY 18
Trisomy 18 chromosomal abnormality Edward syndrome

Chromosome thread like structure Gene Gene body
organ size shape characteristics Human body total ht
chromosome 23 mother 23 father
chromosome defective Abnormal combine mistake
body Abnormalities Trisomy 18 ‗chromosome 18‘ B (pair)
body Abnormally develop .
Types :-
 Full Trisomy 18 - Body cell 18 chromosome 3 copy
 Partial Trisomy 18 – Partial Trisomy 18 18 chromosome extra
copy pout 3 complete copy
 Mosaic Trisomy 18 – condition extra chromosome body
cells cells Affected
 Small for dates / preterm
 Severe developmental delay
 Weak cry
 Small jaw
 Small head
 Chest deformity
 Sever lungs, kidney, heart defects
 Deformed feet with Abnormal fingers
 Slowed growth
 Low-set ears
 Heart defects
TREATMENT
 Simply condition specific treatment
 Symptoms treatment
 Life traf tening defects immediate surgery
 Genetic conceding + family members health education

KILINEFELTER SYNDROME
Kilinefelter syndrome symptoms male additional X Genetic

material Kilinefelter syndrome 47, XXY VYJF XXY
DEFINITION : syndrome human male Genetic

chromosome chromosome 47 Female XX chromosome
male XY chromosome Kilinefelter syndrome male

chromosome Y chromosome male ―XXY male‖

―47,XXY male‖
Genetic 1:500 1:1000 live male birth
symptoms puberty
Symptoms:
 Hypocorism
 Infertility
 Physical status, language social development
 Smaller testis & penis
 Breast growth
 Face body hair
 Muscle tone reduce
 Shoulders narrow hips wider
 Bones weak
 Energy
 Sexual interest
TREATMENT :
 Male testosterone hormone sexual development
 Rx puberty body development normal
 Testosterone injection skin parch gel Male live Rx
interfiling help
 man Kilinefelter syndrome child semen examinational
in vitro fertilization

TRISOMY - 13
Trisomy 13 patau syndrome Genetic disorder

chromosome 13 Genes
CAUSES
 Trisomy 13 chromosome 13 extra DNA
cells
 Trisomy 13 sperm female egg
TYPES
1. Trisomy 13: cells chromosome 13 pair extra gene
2. Trisomy 13 Mosaicism: cells chromosome 13 pair extra gene
3. Partial trisomy: cells chromosome 13 part
INCIDENCE:
 T-13, 10000 newborn
SYMPTOMS:
 Cleft lip or palate
 Clenched hands (with outer fingers on top of the inner fingers)
 Close-set eyes -- eyes may actually fuse together into one
 Decreased muscle tone
 Extra fingers or toes (polydactyly)
 Hernias: umbilical hernia, inguinal hernia
 Hole, split, or cleft in the iris (coloboma)
 Low-set ears
 Intellectual disability, severe
 Scalp defects (missing skin)
 Seizures
 Single palmar crease
 Skeletal (limb) abnormalities
 Small eyes
 Small head (microcephaly)
 Small lower jaw (micrognathia)
 Undescended testicle (cryptorchidism)
EXAMS AND TESTS:
 Infant single umbilical artery

 Congenital heart diseases signs

 Right side heart
 Atrial septal defect
 Patent ductus arteriosus
 Ventricular septal defect
 Gastrointestinal x-rays ultrasound internal organs relation
 MRI CT scans brain structure problem problem
holoprosencephaly brain side
 Chromosome studies Trisomy 13, Trisomy 13 Mosaicism partial Trisomy
TREATMENT:
 Rx child specific symptoms
PROGNOSIS:
 80 % child 
COMPLICATIONS:
 Congenital heart disease
 Breathing difficulty
 Deafness
 Feeding problems
 Heart failure
 Seizures
 Vision problems
PREVENTION:
 Birth amniocentesis amniotic cells chromosome study
 Parents genetic counseling child condition
GENETIC TESTING
 Genetic test Genetic disorder diagnose blood tissues

 2000 Genetic test available Doctor ainical manifestation test
Recommended
 New born baby Genetic disorder find
 people find defective Gene children pads chances
 Disease embryos screening

 Adults disease symptoms devlop Genetic testing
 peoples disease symptoms diagnosis
 Age Genetic problem on type diagnose medicine dose
 Peoples disease causes test
 Genetic tests Result person life decisions help
GENETIC COUNSELING
 Genetic disorders Genetic disorder risk

Genetic counseling
 Genetic councilor Health care team Genestical risk
discussion
 counseling affected person family members
 counseling Genetic disorder baby plan
 Genetic counseling condition

 Genetic disorder birth defect
 Genetic condition birth history, family history birth defect condition
 Pregnant mother couple baby plan

 pregnancy lose still birth
 Genetic testing signs
Education & Support During counselling :

 Mental period Abnormality tests, investigations,
signs, danger signs treatment
 possible outcome complication
 Hospital + community Support services Available
 Family disable child stress + Anxiety griving process
implementation

 information + support patient family members helpful
UNIT QUESTION MARKS/

YEAR
IMPORTED QUESTIONS
LONG QUESTIONS

Unit :1 1 4
Jan -8
Unit :2 1 6
2 4
3 8
June -7
4 5
5 5
6 3 July -11
7 4 Jan-8,
June -9
8 6 Jan-8,
9 5 June-8,
10 4 Jan-10
11 6 Jan-13
Unit :3 1 12
1.
2.
3.
2 4
June -9
3 12 Jan -13
4 12 June -9
1.
2.
3.
5 4
6 4
7 4 Jan - 10
Unit :4 1 4 June 11
2 4

3 4
4 4 June 07
5 4
6 4
7 4
8 2 June 09
9 3 Jan 10
Unit :5 1 4 Jan 13
2 5 June 12
3 WHO ORS 4 Jan 08
4 7 June 08
1.
2.
5 4 Jan 10
Unit: 6 1 4 Jan 13
2 12 June 13
1.
2.
3 4 June 12
4 4
5 4 June 07
6 9 Jan 08
7 10
1.
2.
8 8 June 08
1.

2.
9 8 June 10
1.
2.
10 8 June 10
1.
2.
Unit: 7 1 10 Jan 13
1.
2.
2 3 June 12
3 7 June 11
1.
2.
4 6 June 07
5 10 Jan 08
1.
2.
6 8 June 09
1.
2.
7 4
8 4 Jan 10
9 1 June 10
2
1.
2.
3.

SHORT NOTES
Unit - 1 1 (Under five clinic) Jan - 12
2
3 (PICU)
4 June - 12
5
6 June - 11
7 June - 07
Unit - 2 1 ( LBW)
2
3 (BFHI)
4 Jan - 13
5 June -12
6 June - 08
7 (APGAR Scoring) June - 11
8
9 (supplementary feeding)
10 (exclusive feeding)
11 (warm chain)
12 Rh-negative June - 08
13
14 (KMC) Jan - 10
Unit - 3 1
2 Adolescence June - 07
Unit - 4 1 Jan - 13
2 (restraints) June – 12
3 June – 08
Unit - 5 1 (Mumps) Jan – 13
2 (ORS) June – 12
3 (pica)
4 June – 11
5
6
7 June – 09
8 June – 10
Unit - 6 1 Jan – 13
2 June – 11
3
4 Jan – 10
5 June – 10
Unit - 7 1
2 June – 09
Unit - 8 1

2 June – 12
3
4 June – 11
5 June – 07
6 June – 08
7
8 June – 10
DIFFERENCE
1
2
3
4
1
DEFINITIONS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26

27
FILL IN THE BLANKS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

32
33
34
35
36
37
38
39
40
FULL NAME:
1. I.A.P.
2. W.B.W.
3. N.A.B.H.
4. ASHA
5. N.R.H.M.
6. I.Y.C.F.
7. B.F.H.I.
8. N.M.S.K.

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CHILD HEALTH NURSING

 Concept of child health care

DIVYESH KANGAD (99987 60909) 1

Child - Human between the stages of birth & puberty

CONCEPT OF CHILD HEALTH CARE

Pediatric Child Health Care, childhood diseases Treatment Scientific study

Pediatric Nursing development

Childhood Socialization process Period Vital Period

Child Health Problem Poorly, Population,Explosions

Education, Family Planning and health awareness

Poor Social economic condition pregnancy IUGR,

TRENDS IN PEDIATRIC NURSING (CHILD HEALTH CARE )

Pediatrics special field ABRAHAM JACOBI (1830-

Modern Child Health Care approach curative care Preventive Care

Modern Concept Pediatric Nurse

Pediatric Nurse Health Team family health care Deliver

DIVYESH KANGAD (99987 60909) 3

Child Care Psychological approach, health discipline traditional practice

Role Of Pediatric Nurse :

Medical Science and Nursing Development Child Health Care need

Pediatric Nurse Role

Caring Child Wellness & illness observation continuous process

Curing ill child complete care & Treatment Disease management

Pediatric Nurse Hospital, home, clinic, school & Community

Pediatric Nurse Role Basic responsibility

1. Primary care giver

Primary care giver :

o Child growth & development & health status implementation

DIVYESH KANGAD (99987 60909) 4

Team Co-ordinator & Collaborator

Child Care Advocate:

DIVYESH KANGAD (99987 60909) 5

Common role pediatric nurse Hospital, clinic &

EMERGING CHALLENGES IN PEDIATRIC NURSING

Child care attitude trend Pediatric Nurse

Pediatric Care medical speciality & super speciality Pediatric Nurse

HIV infected Pediatric Care Nursing practice

Unhealthy competition companion single parents & family conflict

Practice Child care consumer protection

NURSING PROCESS RELATED TO PEDIATRIC NURSING

Nursing Process patient health care Nursing need patient

individual group problem focus identify solve unique

DIVYESH KANGAD (99987 60909) 6

STEPS IN THE NURSING PROCESS :

objective data : Data health personal observation collect

DIVYESH KANGAD (99987 60909) 7

Nursing process child family health problems better outcomes

LIST OF APPROVED NURSING DIAGNOSIS

DIVYESH KANGAD (99987 60909) 8

40. Oral mucous membrane, altered.

CONCEPT OF PREVENTIVE PEDIATRIC

health preventive care health

Antenatal preventive pediatric

 Adequate Nutrition to mother

DIVYESH KANGAD (99987 60909) 9

Postnatal preventive pediatric

 Promotion of breast – feeding

AIMS OF PREVENTIVE PEDIATRICS

Comprehensive care, community

CHILD HEALTH CARE IN INDIA

Children need proper care special age group divide

India total population 32% under 5 year age

DIVYESH KANGAD (99987 60909) 10

morbidity & mortality reduce reproductive health improve