Patient problems:
- prickly heat;
Skin changes in the area of natural folds;
Anxiety;
Disruption of comfort due to improperly selected clothing.
Short term goal: reduction of skin rashes within 1-2 days.
Long term goal: skin rashes will disappear or decrease significantly within 1 week.
| Plan | Motivation |
| 1. Ensure the hygiene of the patient's skin (rubdown, hygienic bath with a solution of a string, chamomile, etc.) | To reduce skin breakouts |
| 2. Ensure that the child is dressed according to the ambient temperature (do not entangle) | |
| 3. Ensure hygienically correct sleep for the child (only in your bed, not in a stroller, not with your parents) | To reduce skin breakouts and prevent recurrence |
| 4. Conduct a conversation with relatives about the correct washing of underwear (wash only with baby soap, rinse twice, iron on both sides) | To reduce skin breakouts and prevent recurrence |
| 5. Carry out hygienic cleaning of the room 2 times a day, ventilate 3 times a day for 30 minutes (temperature in the room 20-22 о С) | To maintain a hygienic regime and enrich the air with oxygen |
Grade: Skin rashes will be significantly reduced. The goal will be achieved.
The student conducts a conversation with the mother about the rules of childcare.
The student demonstrates the technique of conducting a hygienic bath to a child.
Patronage for a child of 5 months. The mother said that the child is restless, sleep and appetite are disturbed, the child has itchy skin and rashes on the head. The child from the 1st pregnancy, 1st birth, was born full-term. From birth to breastfeeding.The child is restless, the skin of the cheeks is hyperemic, there are scratching on the limbs, on the scalp there are extensive seborrheic crusts. NPV 38 per minute, pulse 132 per minute.
Mom associates the disease with the introduction of milk porridge. My mother (as a child) had persistent skin rashes.
Tasks
Have a conversation with the mom about nutrition for the baby.
^
Sample answer
Patient problems
The real ones:
- itching of the skin;
Decreased appetite
Bad sleep.
- high risk infections associated with a violation of the integrity of the skin.
Short term goal: the patient will notice a decrease in itching by the end of the week.
Long term goal: itching will be significantly reduced or disappear by the time of discharge.
| Plan | Motivation |
| 1. Ensure the hygiene of the patient's skin (rubdown, shower, bath) | To reduce breakouts |
| 2. Ensure that the patient's skin is wiped with a solution of antiseptics as prescribed by the doctor | To reduce itching |
| 3. Ensure strict adherence to the prescribed diet | To reduce itching and skin rashes |
| 4. Conduct a conversation with the patient and his relatives about strict adherence to the diet | For the prevention of skin rashes |
| 5. Convince the patient to change the underwear and bedding | To comply with the rules of personal hygiene |
Grade: Skin itching is significantly reduced. The goal has been achieved.
The student conducts a conversation with the mother about good nutrition.
feeding volume 150ml
1.6 hour gr milk
2.9hrs. 30min-gr milk
3.13hours of puree with 3ml vegetable oil 150ml
4.16 hrs 30 min-gr milk
5.20hours-g milk
6.23hrs30min-gr milk
40-50 ml of juice and grated apple of green varieties
Active visit to a child of 3 months of life. Weight 6000g. Artificially fed from 1.5 months. age, constipation. For two days there was no stool, the child is restless, screams, presses his legs to his stomach, twists his legs, the skin is clean. The abdomen is moderately distended, gas does not leave, the body temperature is 36.7 º C, the pulse is 132 beats / min., The respiratory rate is 44 per minute.Tasks
Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
Make a menu for 1 day
^
Sample answer
Patient problems:
- violation of bowel movement (constipation);
Eating disorder;
Anxiety.
Short term goal: the patient will have stools at least once a day (individual time).
^
Long term goal:
relatives know methods of preventing constipation.
| Plan | Motivation |
| 1. Provide rational feeding | To normalize intestinal motility |
| 4. Provide massage, gymnastics, air baths | To improve the general condition of the patient |
| 5. Provide the setting of a cleansing enema, a gas outlet tube, as prescribed by a doctor | For bowel movement |
| 6. Register daily stool frequency in medical records | To monitor bowel movements |
Grade: the patient has a normal stool (once a day). The goal will be achieved.
Student talks to mother about rational feeding
Menu: \ feeding mode-6 times a day after 3, 5 hours
feeding volume: 6000 .1.6 = 1000
The main food is a mixture of fermented milk "nan"
1.6 hour mix
2.9h.30min-mix
3.13h-mix
4.16 hour 30min-mix
5.20h-mix
6.23hrs30min-mix
30 ml of juice and grated green apples
A 6-year-old girl is being hospitalized. Diagnosis: acute pyelonephritis. Complains of general weakness, decreased appetite, body temperature 38.6 C. The girl is lethargic, capricious. Disturbed by abdominal pain, painful and frequent urination. From the anamnesis: sick for the last 3 days. On the eve of the disease, she fell into cold water... The skin is pale, clean. Tongue dry, coated with white bloom. The abdomen is soft. NPV 26 per minute, pulse 102 per minute.Turbid urine, little urine, frequent urination.
Tasks
Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
Conduct a conversation about the prevention of complications of pyelonephritis.
Demonstrate the technique of collecting urine analysis according to Zimnitsky.
Newborn care is the observation of a child in the first month of his life by a doctor and a nurse. It is provided free of charge to all children, without exception. Such observation is carried out at the place of residence of the mother with the child. It doesn't matter where they are registered, the pediatric nurse or pediatrician comes to the mother's place of residence.
The first patronage is carried out before delivery. The purpose of the visits is to take anamnesis and educate the expectant mother.
At antenatal care, the nurse pays attention to the factors of perinatal risk, a child is desirable, the moral and psychological climate in the family and material and living conditions.
Future mom must attend school for young parents, make her meals right and lead healthy image life.
At 31-38 weeks of pregnancy, a second patronage is carried out. Medical workers check how the recommendations are being followed and prepare the mother for the postpartum period: there is a conversation about breastfeeding babies only in the required period of time, about preparing the breast for feeding and preparing a place to care for the baby and the necessary medicines that should be in the home first aid kit.
What is newborn nursing care: legislation
Newborn patronage is carried out during the first month of a baby's life. This is spelled out in the legislation of the Russian Federation.All young mothers are wondering what is the nursing patronage of a newborn, and why should a nurse or doctor come home? After all, parents can call the clinic and report the child's health status.
A newborn needs constant care and protection.
A nurse and a doctor who come home to a mother with a child assess whether the baby is feeding correctly, whether the situation in the family is normal.
The health worker can notice the deterioration of the child's health in time and take action. Young parents with no experience in raising small children may not pay attention, for example, to an increase in body temperature, or complications after childbirth.
Important: Only through the efforts of a mother who maintains a healthy lifestyle, the baby will grow up healthy and strong. Good care and breastfeeding will help him quickly adapt to living conditions, build immunity, and the acquired potential will help develop all vital functions and intelligence.
The compulsory patronage of a newborn is specified in the Order of the Ministry of Health and social development RF dated June 1, 2010. This Order was issued on the basis of Article 37.1 of the RF Law on the Protection of Citizens' Health, adopted on July 22, 1993.
Goals and terms of the first patronage to the newborn
The local pediatrician and nurse, when visiting mother and child, perform their duties professionally and correctly. In a word, care is taken for the person who was born. The goals of patronage include the following:Assessment of the health of the baby. The muscle tone is checked, the fontanelle is felt, the color and condition of the skin are assessed. Also, a visual examination of the child's body is carried out and the symmetry of the location of all organs, the work of the limbs, the development of the genitals, the correct shape of the head, and more are revealed.
Assessment of the health and psychological state of the mother. The pediatrician can examine the woman's breasts for the occurrence of mastopathy, and hold a conversation about how to attach the baby to the breast.
Assessment of social and economic conditions in the family. The conditions must be favorable, and the child must be provided with everything that the child needs at this age. If the family is dysfunctional, the pediatrician evaluates the situation in writing and also determines the psychology of the parents' behavior towards the baby.
Teaching mother to care for the baby, conduct proper care, hygiene procedures
Terms of the first patronage for a newborn:
In the first three days after discharge, a pediatrician and a nurse visit. After the health workers receive information about the child, they are obliged to visit him.
On the first day after discharge, a health worker comes in if the child has health abnormalities or was injured during childbirth.
The nurse visits the newborn every day for 10 days. Then she will come only on the 14th and 21st days of the child's life.
If development is proceeding normally, there is no need for further visits.
A young mother should remember that she should tell the nurse about all the problems that the baby has. If you do everything right and quickly, it will be easier to deal with problems. Colic in the stomach, regurgitation and constant crying of the baby will disappear.
How many times a week is newborn patronage carried out?
Many young parents do not understand the importance of newborn patronage. When they are discharged from the hospital, they ask themselves the question: "How many times a week is a newborn's patronage carried out, and is it needed?" But as described above, the patronage nurse will come every day during the first 10 days of the baby's life. Then on 14, 21 days and the last visit on the 28th day.Newborn patronage scheme
There is an accepted scheme for visiting a newborn health workers... It is as follows:1, 3, 10, 14th day - a pediatrician visits the newborn.
Day 2, 4, 5, 6, 7, 8, 9, 21 and 28 - a nurse visits.
By the end of the first month of life with the child, you can come to the clinic for an appointment for weighing and consultation.
Important: After visiting on the 14th or on another day, if you notice a deterioration in the baby's health, call the children's consultation office and call the doctor at home.
Based on the examination, the nurse talks about caring for the baby, feeding. Teaches parents to swaddle, treat skin, mucous membranes, umbilical wound and conduct a hygienic bath.
If everything is ok, the nurse leaves. If there are any deviations in the child's health or development, she informs the pediatrician about it.
Paid newborn care
Many parents are not satisfied with the free patronage of the newborn. Therefore, they go to private clinics. Paid nursing of a newborn is carried out by pediatricians and nurses of these clinics according to certain schemes.Therefore, when choosing a clinic (public or private), you should evaluate all the benefits and risks for the child, especially if your first child was born.
Patronage of a premature newborn
The pediatrician and nurse must visit the premature newborn on the day he is discharged from the hospital. Patronage of a premature newborn is carried out daily in the first 10 days of life and at least 5 times a week thereafter until the child reaches one month of age. The pediatrician visits the child 3 times a week.Patronage of a newborn with hereditary diseases
The birth of a child with hereditary diseases requires urgent medical intervention. The newborn may need hospital treatment.After discharge from the hospital, a newborn with hereditary diseases is patronized. The nurse visits the baby every day for the first 10 days after discharge, then every other day. The pediatrician comes home to the mother with the child 3 times a week.
How to refuse patronage of a newborn?
Every mother needs help with caring for a newborn, especially if she has a first child. But many parents do not want to receive patronage help in a district medical institution, they get registered with their child in paid centers. Therefore, the question arises, how to abandon the patronage of a newborn?Advice: It is enough to write a written refusal. This can be done on the day of the first visit, or you can specially go to the medical institution to the local pediatrician, but without the child, and fill out the necessary forms there.
Newborn patronage - every family goes through this important stage. Visiting a pediatrician and nurse can help you cope with many problems. Medical workers will teach everything necessary for the care and development of the child, and teach you how to properly take care of the baby from the first days of life.
A health worker under patronage carries out, on the basis of a protocol, the prevention, diagnosis and treatment of major diseases in children under 5 years of age in accordance with the principles of integrated disease management childhood recommended by WHO (hereinafter - IMCI) the following measures:
1) a correct assessment of the health status of a newborn and an infant up to 2 months (early detection of dangerous signs, visible malformations, etc.);
2) assessment of the state of care of a newborn and an infant up to 2 months (baby bed, care items, clothes, toys);
3) assessment of the mother's health status (lactostasis / mastitis, postpartum depression, nutritional pyramid of a nursing mother);
4) checking the state of lactation and teaching the technique of breastfeeding (correct position and attachment to the breast "4-3-4), teaching the benefits of breastfeeding;
5) training in caring for a child, including the period "infant up to 2 months";
6) assessment of psychomotor and social development (sufficient attention to the child through play and communication);
7) the introduction of complementary foods in accordance with the recommendations of the IMCI "Caring for children early age»;
8) prevention of rickets and micronutrient deficiency (iron, vitamin A, zinc);
9) assessment of the sanitary state and safety of the child's environment: hygiene of the home (bed, bedding, playground), clothes, toys, dishes and care items;
10) training in gymnastics and massage complexes, drainage massage with illness;
11) teaching parents or other persons directly caring for the child, the rules of care during a child's illness, the concepts and skills of "general signs of danger", "how to feed, how to water a sick child", "when to return immediately";
12) prevention of injuries, violence and neglect of the child in the family, the formation of family responsibility for the health of the child;
13) monitoring the implementation by the mother or other persons directly caring for the child, previously prescribed recommendations;
14) control over the timely vaccination of the child in accordance with the National calendar of preventive vaccinations of the Republic of Kazakhstan. (Appendix 19)
Patronage supervision of children at risk is carried out by PHC medical workers according to an individual plan in accordance with the risk group, determined by them according to the following criteria:
· Social history: mother's age less than 18 years (teenage mothers); living below the poverty line, refugees; attitude towards parental responsibilities (neglect of the child or unwanted child, hyperprotection); families where parents and / or family members are sick with alcoholism, drug addiction and substance abuse and mental illness; adopted children;
· Medical history: low birth weight children (before the period of normalization of body weight); artificial feeding; HIV positive mothers; mothers with tuberculosis; the condition of the child, which makes it difficult to feed (non-closure of the hard and soft palate).
A health worker during patronage detects the presence of signs indicating cruelty or violence against young children:
· Repetitive injuries;
· Injuries not typical for this age (for example, a bruise on the head of a child who cannot stand or walk);
· Evidence of beatings.
During patronage, a medical worker identifies possible evidence of beatings on the following grounds:
Linear bruising after blows with a stick or twig;
Bruising in the form of a loop - as traces of blows with a wire, belt, rope;
· Traces of tying, pulling with a rope or belt; traces of cauterization by a cigarette;
· Hemorrhages in the retina of the eyes when the child is shaken;
· Hematomas in the head area.
In the event that children in a difficult life situation are identified and traces of harm to the child's health are found, the medical worker must:
1) hospitalize the child according to indications for carrying out medical and diagnostic measures;
2) ensure the provision of assistance in accordance with the standards for the provision of special social services in the field of health care;
3) inform law enforcement agencies and territorial bodies for the protection of children's rights. (Table 8)
Table 8. Scheme of patronage supervision of healthy children in the first three years of life
| Visit time | Main tasks | Recommendations |
| The first 3 days from the moment of discharge from the maternity hospital, joint examination at home by a doctor and a nurse | 1. Assessment of the health status of the newborn, identification of congenital malformations. 2. Teaching the signs of danger of threatening conditions (cannot drink or suckle the breast, vomiting after eating any food or drink, the presence of seizures) 3. Assessment of the mother's health (lactostasis / mastitis, postpartum depression). 4. Testing and training in breastfeeding techniques (lactation state, exclusive breastfeeding). 5. Evaluation of newborn care, the state of the newborn's corner (baby bed, toys, care items, clothing). | 1. Benefits and practice of breastfeeding. 2. Providing exclusive breastfeeding. 3. Technique for expressing breast milk. 4. Optimal maternal nutrition. 5. Personal hygiene of the mother 6. Requirements for the premises and items of care for the newborn. 7. Safe environment (requirements for the choice of clothing, newborn care items and toys) and parenting behavior to prevent injuries and accidents). 8. Care of the newborn, walking regimen and hygienic baths. 9. Rules of conduct and care in case of illness of a child (danger signs). 10. Informing the mother about the doctor's work schedule and the coordinates of the medical organization. 11. Involvement of the father to care (for example: while bathing, changing clothes). |
| Symptoms of postpartum depression (pay attention at every visit): 1. Deep anxiety and anxiety 2. Deep sadness 3. Frequent tears 4. Feeling unable to take care of the baby 5. Feelings of guilt 6. Panic attacks 7. Stress and irritability 8. Fatigue and lack energy 9. Inability to concentrate 10. Disturbed sleep 11. Problems with appetite 12. Loss of interest in sex 13. Feelings of helplessness and hopelessness 14. Antipathy towards the child | Tips for managing postpartum depression: 1. Take care of the baby by postponing other activities 2. Tell family members what is happening to her 3. Create an atmosphere in which the baby will be the center of attention 4. Touch the baby more often 5. Think about your child 6. Go outside and move more often 7. Eat well 8. Take care of yourself 9. Keep a diary If these measures do not help, contact the appropriate specialist | |
| Nurse home patronage (7th, 21st and 28th days). | 1. Examination of the newborn, identification of dangerous signs. 2. Evaluation of feeding: lactation status, breastfeeding technique and regimen. 3. Assessment of psychosocial development. 4. Evaluation of newborn care. 5. Evaluation of nutrition and sleep / rest of the nursing mother. 6. Identifying signs of child abuse (physical abuse, neglect, physical and emotional abandonment). 7. Teaching the mother to identify possible dangerous signs in the child, when it is necessary to urgently contact a medical professional. | 1. Rules of conduct and care in case of illness of the child (danger signs, feeding and drinking regimen). 2. Exclusive breastfeeding. 3. Stimulation of psychosocial development. 4. Caring for the newborn, walking regimen. 5. Safe environment (requirements for the choice of clothing, newborn care items and toys) and parenting behavior to prevent injuries and accidents. 6. Prevention of micronutrient deficiency (iron, vitamin A, iodine, zinc) 7. Personal hygiene of the mother. An invitation to see a doctor at the age of 1 month. |
| 15th day - doctor at home | 1. Assessment of the health status of the newborn. 2. Assessment of the state of health of the mother. 3. Evaluation of breastfeeding technique (lactation state, exclusive breastfeeding). 4. Assessment of psychosocial development. 5. Evaluation of newborn care. 6. Identifying signs of child abuse. 7. Testing the mother's knowledge of the dangerous signs of the child's illness. | 1. Encourage exclusive breastfeeding 2. Optimal nutrition and sleep / rest patterns for a nursing mother. 3. Care of the newborn. 4. Stimulation of psychosocial development 5. Safe environment (requirements for the choice of clothing, newborn care items and toys) and parenting behavior to prevent injuries and accidents. 6. Rules of conduct and care in case of illness of the child 7. Dangerous signs in the child, in which the mother should immediately consult a doctor: - cannot drink or suckle; - vomiting after any food or drink; - the presence of seizures; - lethargic or unconscious. |
| Warning signs that require specialized care: 1. The baby refuses or weakly sucks at the breast. 2. Absence or weak movement of arms and legs. 3. Absence or reduced response to loud sounds or bright light. 4. Prolonged crying for no apparent reason. 5. Vomiting and loose stools which can lead to dehydration. | Tactics of a medical professional in identifying warning signs: Consultation of a pediatrician to select and provide the necessary specialized care | |
| 1 - 5 months, monthly at the doctor's and nurse's appointments. | 1. Assessment of the child's health. 2. Verification of the implementation of recommendations and assessment of: 1) nutrition; 2) physical and psychosocial development; 3) child care. 3. Vaccination of the child according to the National Calendar of Preventive Vaccinations and informing parents about possible post-vaccination reactions and complications. 4. Assessment of the dynamics of the development of the BCG scar, the state of peripheral lymph nodes at 1 and 3 months. 5. Prevention of rickets: nonspecific (sufficient insolation during walks) and, according to indications, specific with vitamin D. 6. Appointment of consultations of narrow specialists and laboratory studies according to indications. 7. Teaching complexes of gymnastics and general massage. 8. Teaching the rules of behavior and care in case of illness of the child (danger signs, feeding and drinking regimen). 9. Identifying signs of child abuse (physical abuse, neglect, physical and emotional abandonment). 10. Counseling on family planning (lactational amenorrhea, condoms, IUD ...). | 1. Practice of exclusive breastfeeding. 2. Optimal nutrition for the mother. 3. Psychosocial and motor development according to age. 4. Massage and gymnastics according to age. 5. Daily walks, sufficient sun exposure. 6. Rules of conduct and care in case of illness of the child (danger signs, when it is necessary to seek help, feeding and drinking regimen). 7. Vaccination (timeliness, possible reactions to the vaccine and the behavior of the parents, which infections protect the vaccinations) 8. Safe environment and parental behavior to prevent injuries and accidents. 9. Active involvement of the father in care for the development of the child. 10. Monthly check-up at the doctor's appointment |
| 6 months Examination by a doctor in the Ministry of Defense, nurses 1 time at home. | 1. Assessment of the child's health. 2. Assessment: 1) nutrition; 2) physical and psychosocial development; 3) child care. 3. Assessment of the dynamics of the development of the BCG scar, the state of the peripheral lymph nodes. 4. Introduction of complementary foods in accordance with the methodological recommendations "Nutrition of young children", approved by the Ministry of Health of the Republic of Kazakhstan dated September 25, 2006. 5. Prevention of rickets: nonspecific (sufficient insolation) and, according to indications, specific with vitamin D. 6. Training in gymnastics and general massage complexes. 7. Teaching the rules of behavior and care in case of illness of the child (danger signs, feeding and drinking regimen). 8. Identifying signs of child abuse (physical abuse, neglect, physical and emotional abandonment). 9. Counseling on family planning issues. | 1. Continuation of breastfeeding 2. Complementary feeding: rules for successful introduction of complementary foods, preparation and selection of a food set, hygienic rules for preparing and storing food, frequency and quantity, nutritional value. 3. Optimal nutrition for the mother. 4. Psychosocial development according to age. 5. Massage and gymnastics according to age 6. Daily walks, sufficient sun exposure. 7. Rules of behavior and care in case of illness of the child (danger signs, when it is necessary to seek help, feeding and drinking regimen) 8. Safe environment and behavior of parents to prevent injuries and accidents. 9. Active involvement of the father in care for the development of the child. 10. Monthly examination at the doctor's appointment. |
| Alarming signs requiring specialized care: 1. Hypertonicity of the muscles of the extremities and / or limitation of movement; 2. Frequent head movements (as a result of ear diseases), which can lead to deafness if not treated in time; 3. Absence or decreased response to sounds, familiar faces, or suggested breasts. 4. Refusal of breast or other food. | Tactics of a medical professional in identifying warning signs: Consultation of a pediatrician for the selection and provision of specialized care | |
| 7-11 months Examination by a doctor in the Ministry of Defense, nurses 1 time at home. | 1. Evaluation of the child's health 2. Evaluation: 1. Nutrition: the practice of feeding and the introduction of complementary foods; 2. physical and psychosocial development 3. child care. 3. Prevention of rickets: nonspecific (sufficient insolation) and, according to indications, specific with vitamin D. 4. Consulting on family planning. 5. Teaching the rules of behavior and care in case of illness of the child (danger signs, feeding and drinking regimen). 6. Identifying signs of child abuse (physical abuse, neglect, physical and emotional abandonment). | 1. Optimal nutrition of the child (continuation of breastfeeding and complementary feeding: expansion of the food set, hygienic rules for the preparation and storage of food). 2. Optimal nutrition for the mother. 3. Psychosocial development according to age. 4. Massage and gymnastics according to age 5. Daily walks, sufficient sun exposure. 6. Rules of behavior and care in case of illness of the child (danger signs, when it is necessary to seek help, feeding and drinking regimen) 7. Safe environment and behavior of parents to prevent injuries and accidents. 8. Active involvement of the father in care for the development of the child. 9. Monthly examination at the doctor's appointment. |
| 12 months Medical examination at the Moscow Region, nurses once at home | 1. Assessment of the child's health. 2. Assessment: 1) Nutrition: Feeding and complementary feeding practices; 2) physical and psychosocial development; 3) child care. 3. Vaccination of the child according to the National Vaccination Schedule and informing parents about possible post-vaccination reactions and complications. 4. Assessment of the development of the BCG scar, the state of the peripheral lymph nodes. 5. Prevention of rickets: nonspecific (sufficient insolation) and, according to indications, specific with vitamin D. 6. Identification of signs of child abuse (physical abuse, neglect, physical and emotional abandonment). 7. Teaching the rules of behavior and care in case of illness of the child (danger signs, feeding and drinking regimen). 8. UAC, OAM. Feces for helminth eggs. 9. Consultation of specialists - surgeon, ENT, neurologist, ophthalmologist. | 1. Optimal nutrition of the child (continuation of breastfeeding and complementary feeding: expansion of the food set, hygienic rules for the preparation and storage of food). 2. Optimal nutrition for the mother. 3. Psychosocial and motor development according to age. 4. Massage and gymnastics according to age 5. Daily walks, sufficient sun exposure. 6. Rules of behavior and care in case of illness of a child (danger signs, when it is necessary to seek help, feeding and drinking regimen) 7. Safe environment and behavior of parents to prevent injuries and accidents. 8. Active involvement of the father in care for the development of the child. Examination at the doctor's appointment 1 time per quarter up to 24 months. |
| by 12 months | Alarming signs requiring specialized assistance: 1) does not come into contact and does not react in any way to treatment; 2) does not look at moving objects; 3) lethargic, indifferent and does not respond to those caring for him; 4) no appetite, refuses food. | |
| 13-36 months Medical examination in the Moscow region 1 time per quarter up to 24 months, 1 time per six months up to 36 months. Examination by a nurse up to 24 months 1 time per six months at home, 1 time per year at home for up to 36 months. | 1. Assessment of the child's health. 2. Assessment: 1) nutrition; 2) psychosocial and physical development; 3) child care. 3. Vaccination of a child according to the National Calendar of Preventive Vaccinations and informing parents about possible post-vaccination reactions and complications. 4. Identifying signs of child abuse (physical abuse, neglect, physical and emotional abandonment). 5. Laboratory tests at 24 and 36 months. 6. Consultation of specialists at 24, 36 months. | 1. Optimal nutrition of the child (five meals a day from the family table, continuation of breastfeeding). 2. Optimal nutrition for the mother. 3. Psychosocial development according to age. 4. Massage and gymnastics according to age 5. Daily walks, sufficient sun exposure. 6. Rules of behavior and care in case of illness of a child (danger signs, when it is necessary to seek help, feeding and drinking regimen) 7. Safe environment and behavior of parents to prevent injuries and accidents. 8. Active involvement of the father in care for the development of the child. 9. Examination at the doctor's appointment 1 time per quarter up to 24 months and 1 time per half year from 24 to 36 months. |
| By the age of 2 | Warning signs requiring specialized care: 1. The child does not come into contact. 2. Difficulty maintaining balance while walking. 3. Incomprehensible changes in the child's behavior, the presence of traces of physical abuse (especially if the child is under the supervision of others) 4. Poor appetite. | The tactics of a medical professional in identifying warning signs: Consultation of a pediatrician for the selection and provision of specialized care (psychologist, speech therapist, etc.) |
| By the age of 3 | Warning signs requiring specialized help: 1. No interest in the game. 2. Falls frequently. 3. Difficulty handling small objects. 4. Problems understanding simple calls. 5. Inability to formulate simple sentences. 6. Lack or negligible interest in food. | The tactics of a medical professional in identifying warning signs: Consultation of a pediatrician for the selection and provision of specialized care (psychologist, speech therapist, etc.) |
2.6 Algorithm of actions of the district pediatrician when
conducting primary care of a newborn child
1. Greet the parents and the child.
2. Introduce yourself, tell your own and the district nurse's surname, first name and patronymic.
3. Establish a relationship of trust with the parents and the child.
4. Get to know the parents of the child, write down the passport details of the parents and the child, the number of the birth certificate.
5. Verify the data of the identity cards of the parents, the birth certificate of the child with the apartment card. If there is no registration at this address, explain to the parents the rules for attaching to the Polyclinic.
6. Introduce, let the parent or guardian complete and sign model contract for the provision of medical services for adults and children in 2 copies, one copy should be pasted into the patient's outpatient card, the second copy should be handed over to the patient.
7. To acquaint, give the parents or guardian to fill out and sign the informed voluntary consent of the patient to perform medical services in 2 copies, one copy should be pasted into the patient's outpatient card, the second copy should be handed over to the patient.
8. Identify problems in the child - signs of danger, main symptoms (local bacterial infection, diarrhea, feeding problems or low weight, jaundice, eye infection), assess the child's vaccination status, feeding the child and care for harmonious development child.
9. Collect anamnesis (how the mother's pregnancy proceeded, how the childbirth went, whether there were complications during childbirth, whether the child received resuscitation measures, whether the child had convulsions, and an epidemiological anamnesis for infectious diseases). Read the certificate for the child from the hospital.
10. Immediately before examining the child, wash your hands according to the hand washing technique, if necessary, put on a mask.
11. Conduct an objective examination of the child.
12. Determine the presence or absence of signs of danger.
13. Assess the condition and well-being of the child, measure the temperature of the child's body.
14. Examine for visible congenital malformations in the child.
Congenital-hereditary dysplastic developmental traits are extremely common and usually do not require medical and genetic recommendations, since they usually do not affect the pace of psychophysical development and the processes of social adaptation. They attract attention only as constitutional features. In cases where a child has an excessive accumulation of them, this gives rise to such syndromological diagnoses as dysplastic status.
Constitutional dysplastic features of development in infant are often called dysembryogenetic stigmas or small developmental anomalies(micro-anomalies). They are a kind of microgenetic background of the family. (table 9)
Dysplastic developmental traits are often hereditary and have dominant inheritance. The assessment of the stigma of a child should be carried out in a comparative aspect with the stigma of his parents.
The conditional threshold of stigmatization is the presence of no more than 5-6 stigmas in a child. Exceeding this threshold should be regarded as a deviation of constitutional development towards the dysplastic variant is an indicator of an increased risk of delayed psychomotor development.
Table 9. Major dysembryogenetic stigmas
| № | Localization | The nature of the anomaly |
| Leather | Deligmented and hyperpigmented spots, large birthmarks with hair growth, excessive local hair growth, hemangiomas, areas of aplasia of the scalp. | |
| Scull | The shape of the skull is microcephalic, hydrocephalic, brachycephalic, dolichocephalic, asymmetric; low forehead, pronounced superciliary arches, overhanging occipital bone, flattened occiput, mastoid hypoplasia. | |
| Face | Straight line of sloping forehead and nose. Mongoloid and anti-Mongoloid eyes. Hypo- and hypertelorism. Saddle nose, flattened nasal bridge, crooked nose. Facial asymmetry. Macrognathia, micrognathia, progeny, microgenia, split chin, wedge-shaped chin. | |
| Eyes | Epicanthus, Indian eyelid fold, low eyelid standing, asymmetry of the palpebral fissures, absence of the lacrimal meatus, enlargement of the lacrimal meatus (third eyelid), distichiasis (double eyelash growth), coloboma, iris heterochromia, irregular pupil shape. | |
| Ears | Large protruding ears, small deformed ears, ears of different sizes, different levels of ears, low-set ears. Anomaly in the development of curl and antihelix, accrete earlobes. Additional tragus. | |
| Mouth | Microstomy, macrostomy, "carp mouth", high narrow palate, high flattened palate, arched palate, short frenum of the tongue, folded tongue, forked tongue. | |
| Neck | Short, long, torticollis, pterygoid folds, excess folds. | |
| Torso | Long, short, depressed chest, chicken, barrel-shaped, asymmetric, large distance between the nipples, accessory nipples, agenesis of the xiphoid process, diastasis of the rectus abdominis muscles, low standing of the navel, hernias. | |
| Brushes | Brachydactyly, arachnodactyly, syndactyly, transverse groove of the palm, flexion contracture of the fingers, short curved V finger, curvature of all fingers. | |
| Feet | Brachydactyly, arachnodactyly, syndactyly, sandal fissure, bidentate, trident, hollow foot, finding fingers on top of each other. | |
| Genitals | Cryptorchidism, phimosis, underdevelopment of the penis, underdevelopment of the labia, enlargement of the clitoris. |
Therefore, conducting a sequential external examination of the head, face, neck, skin, trunk, limbs and genitals of the newborn, it should be borne in mind that in the process it is necessary to establish the symmetry of the development of the child as a whole and its individual parameters, especially appearance and individual parts of the torso, limbs and the level of stigmatization. This will help, without even starting an organ study, to relate the child to one or another health group.
Problem number 1
An 11-year-old girl diagnosed with influenza is being hospitalized. Complains of severe headache, dizziness, repeated vomiting, sleep disturbance, general weakness. Considers himself ill for two days, when the temperature first rose to 39.8 º C and weakness, weakness, delirium appeared.
Objectively: the position in bed is passive. In consciousness, but inhibited, the skin is pale, dry, respiratory rate 30 per minute, pulse 160 beats per minute, blood pressure 140/60 mm Hg. Art. Slight hyperemia of the pharynx, temperature on examination is 39.6 ° C.
Tasks
2. Conduct a conversation about influenza prevention.
3. Demonstrate the technique of oxygen therapy with a nasal catheter.
Problem number 2
Active visit to the nurse of a 4-year-old boy. Diagnosis: ARVI.
The child began to eat poorly, the cough worries, which intensified and has the character of dry, painful. According to my mother, the second day is sick. First, there was a runny nose, cough, then the temperature rose to 38.2 ° C.
Objectively: the child is active, temperature 37.3 ° C, nasal breathing is difficult, mucous discharge from the nasal passages. Frequent dry cough, NPV 28 per minute, heart rate 112 per minute, pharynx: moderate hyperemia, no raids.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation about the rules for conducting distraction therapy.
3. Demonstrate the technique of placing mustard plasters on the chest.
Problem number 3
A 10-year-old boy is being hospitalized. Diagnosis: rheumatism, active phase, polyarthritis.
The child complains of pain in the left knee joint, does not get up because of the pain, tries not to change the position of the leg. Before that (3-4 days ago), pains in the right ankle joint were troubling. Anamnesis: three weeks ago I had a sore throat.
Objectively: the temperature is 37.8 º C. The skin is pale, clear, blue shadows under the eyes, the position in bed is passive. The left knee joint is hot to the touch. round shape, increased in size, painful movements. Pulse 100 beats per minute, NPV 22 per minute.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation about the prevention of complications of rheumatism.
3. Demonstrate the application of a cold compress to the affected joint area.
Problem number 4
A 12-year-old girl is in hospital. Diagnosis: acute glomerulonephritis, edematous form. Complaints of general weakness, poor appetite, headache, swelling on the face and legs. Considers himself sick for 2 weeks. History: frequent acute respiratory viral infections, tonsillitis, dental caries.
Objectively: the skin is pale, clean, pasty face and legs. Pulse 104 per minute, BP 130/80 mm Hg. Art., NPV 20 per minute. The abdomen is of the correct shape, soft, painless.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation about the need for adherence to personal hygiene measures.
3. Instruct the patient on the rules for determining the water balance.
Problem number 5
A 10-year-old boy is being hospitalized. Diagnosis: thrombocytopenic purpura. Complaints about nosebleeds, which appeared a few minutes ago (during the game). Ill for 2 years, deterioration occurred during the last week (suffered from acute respiratory viral infections), hemorrhages appeared on the skin and oral mucosa. Anxious.
Objectively: conscious, oriented, contact. The skin is pale, multiple hemorrhages in the form of spots of various sizes, shapes, randomly located, of various colors (purple, blue, green, yellow), NPV 22 per minute, pulse 112 per minute, BP 100/60 mm Hg. Art.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Talk with parents about the care of patients with thrombocytopenic purpura.
3. Demonstrate the technique of anterior nasal tamponade.
Problem number 6
Patronage, the child's age is 1 month.
The child is wrapped in a fleece blanket, a scarf on his head. The room is stuffy, the air temperature is 28 ° C, the window is closed. The child is restless, screams, the skin is moist to the touch, the skin is hyperemic, a small-dot rash, especially a lot of rashes in the axillary and inguinal folds. Good appetite, active sucking.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation about the rules of child care.
3. Demonstrate the technique of performing a hygienic bath.
Problem number 7
Patronage for a child of 5 months. The mother said that the child is restless, sleep and appetite are disturbed, the child has itchy skin and rashes on the head. The child from the 1st pregnancy, 1st birth, was born full-term. From birth, breastfed.
The child is restless, the skin of the cheeks is hyperemic, there are scratching on the limbs, on the scalp there are extensive seborrheic crusts. NPV 38 per minute, pulse 132 per minute.
Mom associates the disease with the introduction of milk porridge. My mother (as a child) had persistent skin rashes.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation with the mother about the rational nutrition of the child.
3. Demonstrate a healing bath technique.
Problem number 8
Active visit to a child of 3 months of life. Artificially fed from 1.5 months. age, constipation. For two days there was no stool, the child is restless, screams, presses his legs to his stomach, twists his legs, the skin is clean. The abdomen is moderately distended, gas does not leave, the body temperature is 36.7 º C, the pulse is 132 beats / min., The respiratory rate is 44 per minute.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Talk to your mom about nutritional management.
3. Demonstrate a cleansing enema technique.
Problem number 9
A 6-year-old girl is being hospitalized. Diagnosis: acute pyelonephritis. Complains of general weakness, decreased appetite, body temperature 38.6 C. The girl is lethargic, capricious. Disturbed by abdominal pain, painful and frequent urination. From the anamnesis: sick for the last 3 days. On the eve of the disease, she fell into cold water. The skin is pale, clean. Tongue dry, coated with white bloom. The abdomen is soft. NPV 26 per minute, pulse 102 per minute.
Turbid urine, little urine, frequent urination.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation about the prevention of complications of pyelonephritis.
3. Demonstrate the technique of collecting urine analysis according to Zimnitsky.
Problem number 10
A 13-year-old boy is observed in the children's department. Diagnosis: diabetes mellitus, insulin-dependent severe, ketoacidosis. Complaints of general weakness, thirst, headache, polyuria, pruritus, increased appetite. There is a smell of acetone from the mouth when talking. He comes into contact reluctantly, does not believe in the success of treatment, expresses fear for his future.
From the anamnesis: 1.5 months ago there was a head injury (fell, hit his head), was not hospitalized. Then, for a month, I felt bad - general weakness, headache, thirst, and the secretion of large amounts of urine. The reason for hospitalization was loss of consciousness. Is in the department for the 4th day. The boy's grandmother, according to his mother, has type 2 diabetes.
Objectively: conscious, oriented in time and space. The skin is pale, dry to the touch. Blush on the cheeks. The mucous membranes of the mouth are bright. Multiple scratches on the skin of the limbs, trunk. The pupils are constricted and react to light. The abdomen is soft and painless. NPV 20-22 per minute, pulse 96 beats / min., BP 90/50 mm Hg. Art.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Talk to mom about diabetes diet.
3. Demonstrate the technique of subcutaneous administration of insulin.
Problem number 11
A 12-month-old baby is in hospital. Diagnosis: iron deficiency anemia, rickets.
The child gets tired quickly, is not active, the appetite is poor. The child's diet is monotonous - dairy food; they prefer not to give fruits and vegetables to the child, because they are afraid of indigestion.
Child from 1st pregnancy, 1st birth, from young parents. The father does not live with his family. A child on the street is rare, since he is in the care of his grandmother. Mom has chronic tonsillitis, works as a technologist.
Objectively: pale, cracks in the corners of the mouth ("seizures"). The head is slightly enlarged with protrusion of the frontal tubercles, the large fontanelle is still open by 2x2 cm. Rosary beads are determined on the chest. NPV 32 per minute, pulse 120 beats / min. The abdomen is soft. Stool with a tendency to constipation.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation with the mother about rational feeding and the child's day regimen.
3. Demonstrate the technique for examining heart rate and NPV.
Problem number 12
A 9-year-old child is in hospital. Diagnosis: ARVI, right-sided lower lobe pneumonia. Disturbed by a frequent wet cough, general malaise, sleep and appetite disturbances, temperature up to 38.7 ° C, painful, hacking cough. NPV 54 per minute. Was hospitalized, undergoing treatment.
Objectively: the skin is pale, blue under the eyes, perioral cyanosis (mild). NPV 30 per minute, pulse 100 beats / min., BP 100/60, the abdomen is soft, painless, participates in the act of breathing. Frequent wet cough.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Lead a conversation about the importance of exercise therapy for respiratory diseases.
3. Demonstrate a complex of breathing exercises.
Problem number 13
The child is 1 month old, was admitted for examination and treatment. Diagnosis: pyloric stenosis? pylorospasm?
The child is restless. The real weight of the child is 3200.0. The skin is pale, clean, the subcutaneous fat layer is insufficiently developed (thinned on the abdomen and thighs). Dystonia. The abdomen is slightly distended, soft, painless on palpation, no visible peristalsis is observed. Stool 3 times a day, yellow, sour smell. Control feeding 100.0.
From the anamnesis: from the first pregnancy, delivery of the 1st in breech presentation, birth weight 3000.0, height 49 cm. Regurgitation began in the hospital, were rare 1-2 times a day, then became more frequent and from 3 weeks of age were noted After almost every feeding, over the last week there was a "fountain" vomiting.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Talk to your mother about the need for an X-ray examination of the gastrointestinal tract.
Problem number 14
A 9-year-old girl is in hospital.
Diagnosis: chronic gastroduodenitis.
The girl complains of abdominal pain of a cutting nature, the pains appear paroxysmal a few minutes after eating and last 30-40 minutes. The localization of pain is the upper abdomen. Periodically accompanied by nausea, vomiting. The girl is stubborn and capricious by nature. Girl from 1st pregnancy, full-term. She studies well. For the last 3 years, she has been eating randomly, often in dry water, since the parents work and there is no one to serve the girl. The girl lives in a family with her stepfather, there are frequent quarrels in the family.
Objectively: a girl with low nutritional status. Pale, blue shadows under the eyes. Pulse 88 beats / min., NPV 20 per minute, BP 100/60. The abdomen is soft on palpation, painful in the epigastric region.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation about dietary nutrition.
3. Demonstrate the technique of fractional study of gastric juice.
Problem number 15
The girl is 8 years old. Diagnosis: biliary dyskinesia.
Complaints about stupid aching pains in the area of the right hypochondrium, nausea, belching, periodic vomiting. The pain is worse after eating fatty foods. Stool with a tendency to constipation. The girl has a bad appetite.
Mom considers her daughter to be sick for the last 2 years.
Objectively: the skin is pale, dry to the touch. Girl of undernutrition. Tongue moist, densely coated at the root with a white bloom. Pulse 88 beats / min., NPV 22 per minute, BP 100/50. The abdomen is soft on palpation, painful in the right hypochondrium; when tapping along the costal arch on the right, pain occurs.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Lead a conversation about nutrition for school-age children.
3. Demonstrate the technique of duodenal intubation.
Problem number 16
A 4-year-old girl is in hospital. Diagnosis: acute aphthous stomatitis.
The girl is naughty, complains of pain in the mouth, refuses to eat. Lips are bright, swollen, increased salivation. On the mucous membrane of the cheeks, soft and hard palate, rashes in the form of erosions, covered with a bloom of yellowish-gray color. Mucous membranes are bright, edematous. The body temperature is increased. Submandibular lymph nodes are enlarged and painful. From the anamnesis: the girl is sick on the 2nd day, the disease began with a rise in temperature to 37.5-38.2 º С, general weakness, sleep and appetite disturbances.
Objectively: restless, refuses to open her mouth. Temperature 38º С, sleeps badly. He makes contact reluctantly. NPV 28 per minute, pulse 112 beats / min.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Have a conversation about oral hygiene.
3. Demonstrate the oral irrigation technique.
Problem number 17
An 8-year-old child is in hospital. Diagnosis: right-sided lower lobe croupous pneumonia, respiratory failure of the II degree. Complaints of a hacking, painful cough, pain in the right side of the chest and abdominal pain, especially when coughing. General weakness, headache, sleep disturbance, fever, no appetite.
Anamnesis: 2nd day of illness. The disease began acutely with a rise in temperature to 39 ° C, general malaise, abdominal pain, vomiting, then pain in the right side when coughing.
Objectively: the condition is serious. Very pale, blue under the eyes, pronounced cyanosis of the nasolabial triangle. NPV 60 per minute, moaning breathing, pulse 160 beats / min. Heart sounds are significantly muffled. The position in bed is passive, the body temperature is 38.5 ° C.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Lead a conversation about the importance of oxygen therapy.
3. Demonstrate the technique of intramuscular injection of cefomezin 500 thousand units.
Problem number 18
Child 9 months. Was admitted to the hospital with a diagnosis of iron deficiency anemia, moderate form.
Complaints about pallor of the skin, decreased appetite, sleep disturbance. A child from 2 months of age on artificial feeding with a mixture "Malysh", from 4 months receives semolina 3-4 times a day. Vegetable puree was introduced at 5 months of age, but eats it reluctantly, therefore it is received irregularly. He also drinks juices (grape and carrot) sporadically. The child receives meat broth, minced chicken, cottage cheese every day. In the analysis of blood: er. 3.6x1012 / l, HB 80 g / l, c. p. 0.7.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Teach the mother how to take iron supplements.
3. Demonstrate bottle feeding.
Problem number 19
A 6-month-old child is admitted to the clinic on the day of a healthy child.
Diagnosis: exudative-catarrhal diathesis.
A child from 3 months on artificial feeding. Birth weight 3200, in the following months weight gain gr. From 2 months of age, the child often has diaper rash despite good care... The skin on the cheeks is dry, hyperemic. On the scalp, seborrhea. The mother notes an increase in skin rashes after the child eats egg yolk, grape juice. Diaper rash I-II Art. in the groin folds, in the armpits, on the folds of the neck. Mucous discharge from the nose.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother about the diet and teach the mother how to keep a Food Diary.
3. Demonstrate the treatment of the child's skin and mucous membranes.
Problem number 20
Child 1 month. The mother complains about the child's anxiety, poor sleep. The child from the first pregnancy, which proceeded normally. Weight at birth 3400 g, length 51 cm. It is breastfed, but feedings are carried out randomly. Restless after feeding. Stool once a day, mushy, without impurities.
The temperature is normal, the weight is 3500, the length is 54 cm, the skin is pale, the tissue turgor is reduced. With control weighing, it was found that the child sucks 60-80 ml for feeding. There is no milk left in the mother's mammary gland after feeding. The child was diagnosed with dystrophy of the type of hypotrophy of the 1st degree.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention. Explain to your parents the importance of following the diet.
2. Explain to the mother the need for adherence to the diet and teach her how to introduce supplements.
3. Demonstrate the checkweighing technique.
Problem number 21
Child 3 months. The mother complains about the anxiety of the baby between feedings, poor appetite. Child from III pregnancy, 2 births. Birth weight 3200, length 50 cm. She is breastfed. The feeding regimen does not comply. Mom thinks that there is not enough milk. The child suffered an intestinal infection at 1 month. The weight gains were: for the 1st month. 300 g, 2nd month 400 g. Body length is currently 56 cm.
The child is lethargic, inactive, the skin is pale, dry, folds on the thighs. The subcutaneous tissue on the abdomen and thighs, on the shoulder girdle is thinned, preserved on the face, tissue turgor is reduced. The muscle tone is reduced, the mucous membranes are dry, the large fontanelle is slightly sunken. Heart sounds are muffled. The chair is scanty (1-2 times a day), without pathology.
Diagnosis: dystrophy of the type of hypotrophy of the 2nd degree.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention. Explain to the mother the importance of observing security regulations.
2. Teach the mother in additional ways to keep the baby warm.
3. Demonstrate warming the baby by using heating pads.
Problem number 22
Precinct m / s on the patronage of a child of 7 months. The mother complains of the child's anxiety, poor sleep, sweating of the scalp. The child is not sitting yet. Receives cow's milk from birth, juices, did not enter the yolk. Mother and child walk a little. Didn't get vitamin D. The general condition of the child is of moderate severity. The skin is clean, pale. A large fontanelle measuring 2x2 cm, the edges are soft, the bones of the skull are soft. There is an increase in the frontal and parietal tubercles. No teeth. The abdomen is soft, increased in volume, flattened, the liver is enlarged by 1 cm. Stool and urine output are normal. Diagnosis: rickets of the II degree, high period, subacute course.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Train the mother to keep a record of vitamin D intake.
3. Demonstrate the collection of urine for the Sulkovich test.
Problem number 23
The district m / s provides patronage for a child of 3.5 months. The baby is bottle-fed.
The baby was born in October with a weight of 3450 g and a length of 52 cm. Pregnancy and childbirth were uneventful. Breast milk was fed up to 2 months. Vitamin D was prescribed from 1 month, but the mother gave it in bad faith. I prepared the mixtures myself. From 2.5 months started giving whole cow's milk. There is little in the open air with a child.
The mother notes that the child has become restless, capricious, often flinches in a dream, sleep is disturbing, short-lived, appetite is reduced, sweating has appeared. The skin is pale, moist, there is baldness in the occiput, a large fontanel 2.5 x 2.5 cm, the edges of the fontanel are pliable.
The child was diagnosed with rickets grade I, initial period, acute course.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother the need to prevent rickets and teach the mother how to take vitamin D.
3. Demonstrate the child's anthropometry (measuring weight, height, head and chest circumference).
Problem number 24
The woman went to the children's clinic with a 4.5-month-old child. with a diagnosis of exudative-catarrhal diathesis.
The child is breastfed, receives orange juice, semolina porridge in whole milk, 1/2 part of egg yolk daily.
On examination: seborrhea, significant weeping behind the ears, redness, itching.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Teach the mother to do the healing bath.
3. Demonstrate skin care.
Problem number 25
Child 6 months. enters inpatient treatment in the children's department with a diagnosis of iron deficiency anemia, moderate form; dystrophy by the type of hypotrophy of the 1st stage.
Complaints about restless sleep, stools with a tendency to constipation, underweight, pallor of the skin and mucous membranes.
The child was born with a weight of 3200 g. From 1 month. the child is fed with unadapted mixtures, receives complementary foods in the form of porridge 2-3 times a day. Eats juices and fruit purees irregularly.
The child is lethargic, capricious. The skin and mucous membranes are pale. For feeding, he eats 100 ml of food. Has a body weight deficit of 16%, NPV 46 beats. per min., pulse 140 beats. in minutes. The subcutaneous fat layer is thinned on the abdomen, chest, and extremities.
In the study of blood: er. 3.2 x 10 12 / l, HB = 84 g / l, c. p. - 0.65.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Teach mom how to administer iron supplements.
3. Demonstrate the checkweighing technique.
Problem number 26
A child at the age of 4 days is in the ward of the joint stay of the child and the mother.
During several feedings, the baby is very anxious at the breast, with difficulty grasping the nipple. The mother notes that there is a lot of milk, the breasts are dense. Expression is not effective. First childbirth, urgent, no peculiarities.
The child's condition is satisfactory. The skin and mucous membranes are clean. The chair is transitional. Newborn reflexes are well expressed. From the bottle greedily sucks the expressed breast milk... The mother's mammary glands are dense, hot to the touch, the vascular part is well expressed.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Talk about preparing the mother and baby for feeding.
3. Demonstrate the technique of washing and swaddling a newborn.
Problem number 27
A mother with a 4-year-old child turned to the local pediatrician for an appointment.
After examination, the diagnosis was made: enterobiasis.
Complaints of itching in the perianal region, abdominal pain, decreased appetite, nausea, sleep disturbance, and bedwetting is also noted. The girl, according to her mother, became capricious, irritable. She got sick about 2 weeks ago.
The girl is active, the skin is pale, the abdomen is soft, slightly painful on palpation around the navel, around the anus there are traces of scratching.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother the need to comply with the sanitary and epidemiological regime and teach her how to prevent enterobiasis.
3. Demonstrate taking a smear for enterobiasis.
Problem number 28
M / s kindergarten during a daily examination of children in a 2-year-old girl, on the mucous membrane of the mouth, she found several easily opening bubbles and erosions, covered with a yellow-gray coating, surrounded by a bright red rim. The child has increased salivation, the lips are swollen. Submandibular lymph nodes are enlarged and painful. The child refuses food, is capricious, does not play with children, body temperature is 37.3 ° C. M / s suggested that the child has herpetic stomatitis.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother the nutritional characteristics of the child with stomatitis.
3. Demonstrate the manipulation of the child's oral cavity.
Problem number 29
Child 8 months. Was admitted to the hospital with a diagnosis of bilateral focal pneumonia. A state of moderate severity. The body temperature is 38.0 ° C. The child is lethargic, the skin is pale, with anxiety, cyanosis of the nasolabial triangle appears. Breathing heavy, puffing, NPV 64 per minute. Pulse rate 152 / min. Heart sounds are muffled. Percussion over the lungs with a tympanic tone, in the lungs crepitus on both sides.
The child eats very badly. The room is stuffy. The mother does not ventilate the room, as she is afraid of catching a cold to the child. The child does not sleep well. Physiological functions are normal.
Exercise
Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention. Reassure the mother to frequently change the position of the baby in bed and to pick him up frequently. Prepare your child for a general blood test.
Problem number 30
A 14-day-old child was admitted to the chest department with a diagnosis of rhinitis.
The child was born at term, weighing 3.5 kg, 55 cm long, screamed immediately, attached to the breast on the 2nd day. Body temperature 36.8 ° C. The child has nasal congestion, mucous discharge from the nasal passages. The mother does not know how to conduct the toilet of the nasal passages of the child. The child is worried, does not sleep well. The mother notes that the baby quickly stops sucking because it cannot breathe through the nose. The mother is worried that the child is hungry and does not know how to feed him.
Tasks
Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention. Train the mother to toilet the nasal passages. Explain to the mother how the baby can be fed if the baby is not sucking enough milk from the breast.
Problem number 31
A 1 year old child was admitted to the infectious diseases department with a diagnosis of ARVI, stenosing laryngitis.
Body temperature 36.4 ° C, pulse 130 per minute, respiratory rate 40 per minute. The skin is pale, clean. Respiration at rest is noisy with labored inhalation. During inhalation, the intercostal spaces, supraclavicular regions, and the jugular fossa are drawn in. The child has a dry barking cough. In the lungs, puerile breathing. Heart sounds are muffled. The child sleeps on a small pillow, sleep is restless. Physiological functions are normal.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother the need for hospitalization.
Problem number 32
The department was hospitalized for 8 years with a diagnosis of rheumatic chorea.
Marina is irritable and often cries. The girls in the ward make a remark to Marina, as she is unkempt, while eating she spills soup on her clothes, often the spoon falls out of her hands. On the remarks made, the girl intensifies uncoordinated violent movements, grimacing. Restless sleep, decreased appetite.
The skin is clean, pale. Pulse 100 / min., NPV 20 / min. Heart sounds are somewhat muffled, systolic murmur is heard at the apex and in t. Botkin. Vesicular respiration in the lungs. Physiological functions are normal.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother the need for a protective regime and train her to communicate with the girl.
3. Prepare your child for a biochemical blood test.
Problem number 33
Child 9 months. is in the clinic with a diagnosis of overt spasmophilia (eclampsia).
Rickets II degree, subacute course, period of convalescence.
The child's convulsions appeared suddenly while crying, while the child turned blue. The mother brought the child to the open window. Breathing was restored, the child regained consciousness, cyanosis and convulsions disappeared in 2-3 minutes. Mother called " ambulance”And the child was taken to the hospital. The child was born at term with a weight of 3300 g, a length of 52 cm. He was artificially fed from 1 month. I have been receiving fruit juices since 3 months. irregularly, porridge 3 times a day, vegetable puree rarely. At the age of 3 months. the child was diagnosed with rickets, but no treatment was carried out. On examination, the m / s revealed in the child the symptoms of rickets during the period of convalescence, increased neuromuscular excitability, and disturbed sleep. The mother asks the nurse to replace the vegetable puree with semolina porridge, since the child does not eat it well.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother the need for dietary nutrition for this disease and teach her how to cook soda curd.
3. Perform an intramuscular injection on the dummy at an age-appropriate dose.
Problem number 34
You are the m / s of the children's hospital. A 5-year-old child has been admitted to your post with a diagnosis of acute glomerulonephritis with nephrotic syndrome.
Body temperature 38˚C, marked edema on the face and limbs. The child is lethargic, capricious. The skin is pale. Reduced appetite. Pulse 116 / min., NPV 24 / min., BP 105/70 mm Hg. Art. Urine rarely, in small portions. Complains of back pain. Pasternatsky's symptom is positive on both sides. In the analysis of urine: protein - 3.3%, dense, leukp / sp., Erv p / sp., Cylv p / sp. The child refuses to eat because it is unsalted. The mother does not restrict fluid to the baby.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother what diet should be followed by the child.
3. Explain to the mother how to collect the child's urine according to Zimnitsky.
Problem number 35
M / s on the patronage of a 5-year-old child with measles. The child is ill on the 6th day, the second day of the rash. Temperature 37.8 ° С, pulse 120 / min., NPV 28 / min. On the skin of the face, the upper half of the body, there is a maculopapular rash, located on a non-hyperemic background. The rash merges in places. The child has purulent conjunctivitis, photophobia, serous discharge from the nose. The child complains that it hurts him to look at the light. The mother does not know how to wash her eyes, to bury drops. Physiological functions are normal.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Teach the mother how to care for skin and mucous membranes.
3. Demonstrate the procedure for administering the measles vaccine.
Problem number 36
You are a clinic nurse. Carrying out patronage for a 2-year-old child with measles rubella, the 2nd day of the disease. T 37.2˚ С. Troubled by a runny nose, coughing. All over the body, more on the buttocks, limbs, itchy, small-spotted rash. Enlarged lymph nodes up to 1.0 cm in diameter are palpated, painless, mobile.
The girl drinks a little liquid, although the doctor prescribed an abundant drink. Reduced appetite. Sleeps poorly due to runny nose, heat and stuffiness. Physiological functions are normal.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother why it is necessary to isolate the child from the children. What is the term of isolation?
3. Demonstrate the technique of nasal cavity toilet on a dummy.
Problem number 37
6 years old was admitted to the hospital with a diagnosis of scarlet fever, moderate course.
General condition of moderate severity, body temperature 37.6 ° C. The girl complains of sore throat, headache. Eats or drinks almost nothing, as the pain in the throat increases when swallowing. The mother is trying to force-feed the child. On a hyperemic background of the skin, a profuse, small-point rash. Pulse 130 beats in 1 min., Muffled heart sounds. The tip of the tongue is papillary. The tongue is coated with a thick white coating. In the pharynx there is a bright limited hyperemia, loose tonsils, purulent deposits on them. Submandibular lymph nodes are enlarged, painful on palpation. The girl is prescribed to rinse her throat with a solution of furacilin, but she refuses to rinse, because she cannot.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Explain to the mother how to properly feed the baby with scarlet fever
3. Prepare your child for a pharyngeal and nasal swab.
Problem number 38
M / s on the patronage of a child with chickenpox.
The girl is sick for the 2nd day. Body temperature 37 ° C. On the skin all over the body polymorphic rash: papules, vesicles. The rash is present on the scalp, oral mucosa. The girl eats almost nothing because of rashes on the oral mucosa. He sleeps poorly, as the rash is accompanied by itching. The mother does not know how and how to treat the elements of the rash, how to care for the skin. From the side of internal organs - no visible pathology. Physiological functions are normal.
Tasks
Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention. Convince the mother that the child should be isolated from healthy children, indicate the period of isolation. Demonstrate on a dummy the rules for processing elements of a skin rash.
Problem number 39
Patronage for a one month old baby. Mom said that the child is restless, sleep and appetite are disturbed, the child has rashes on his head and arms. The child from the first pregnancy, the first birth, was born full-term. From birth, breastfed.
During nursing examination nurse received the following data: the child is restless, on the skin of the fingers there are vesicles filled with serous contents, a crust, single pustules. NPV 38 / min, pulse 132 / min. Body temperature 37.2˚C. Medical diagnosis: vesiculopustulosis.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation with mom about skin care and hygiene practices.
3. Demonstrate the technique of taking the contents of the rash element for sowing on microflora.
Problem number 40
A child aged 1 year 2 months was hospitalized with delayed physical and neuropsychic development, constipation, general weakness. The boy was born from young healthy parents, heredity is not burdened. Since the transfer to artificial feeding, the mother has noted constipation. He began to sit at the age of 9 months, he does not walk.
Tasks
1. Identify the patient's problems; Formulate goals and plan for priority nursing care with motivation for each nursing intervention.
2. Conduct a conversation with the mother about the need for dispensary observation and substitution therapy.
3. Demonstrate the technique of carrying out a cleansing enema.
Tasks for the provision of first aid at
emergency conditions in Pediatrics with response standards
Problem number 1
A 9-year-old girl suffers from diabetes mellitus. Receives 20 PIECES in the morning. insulin. After receiving insulin, I was late for school and did not eat breakfast. In the first lesson, convulsions suddenly appeared, she lost consciousness. The skin is moist, breathing is shallow, the pupils are dilated, clonic-tonic convulsions.
Tasks
Demonstrate the technique of 3. subcutaneous injection to your child.
Problem number 2
Mom with a child of 7 years old came to the dacha. We washed in a homemade bathhouse, there was no fire in the stove, the chimney damper remained closed. Soon they, mostly a child, developed: headache, dizziness, vomiting. The child has lost consciousness. On examination, the child had difficulty breathing, hoarseness, coughing up phlegm, and tachycardia when listening to the heart. HELL 80/40.
Tasks
Determine the patient's condition. one.
Make an algorithm for the nurse's actions.
Demonstrate the technique for delivering oxygen to your child through the mask.
Problem number 3
A 4-month-old child was given the second DPT vaccine in the treatment room of the children's polyclinic. Suddenly the child became restless, turned pale sharply, shortness of breath appeared, rashes on the skin such as urticaria, lost consciousness.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. DTP vaccination.
Problem number 4
A child of 8 years old, who is in hospital, developed an attack of suffocation in the morning with difficulty in exhaling, frequent dry cough; breathing is noisy, wheezing rales are heard in the distance.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of using a 3. pocket inhaler.
Problem number 5
A 2-year-old child with epistaxis that has not stopped for about 1 hour has been delivered to the emergency department. The mother reported that a similar condition was observed 6 months ago. Then the boy was treated in a hospital with a diagnosis of hemophilia A.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. performing an anterior nose tamponade on a phantom.
Problem number 6
A 5-year-old child was exposed to the sun for a long time. In the evening, he had a headache and nosebleeds.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. cold application to control bleeding.
Problem number 7
When visiting a 9-month-old child, a patronage nurse discovered that his body temperature increased to 39.2 ° C. The skin was hyperemic, the hands and feet were hot to the touch.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. physical cooling to young children.
Problem number 9
Mother 9- month old baby told the visiting nurse that since yesterday he had a runny nose, a rise in body temperature to 37.2º C. At night, the child woke up, was restless, crying.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique for 3. measuring body temperature in young children.
Problem number 10
A 13-year-old child suffers from duodenal ulcer disease, has been repeatedly treated in a hospital. In the morning, going to school, I noticed a dark tarry stool. Weakness, dizziness, tinnitus appeared.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. blood pressure measurement.
Problem number 11
A neighbor turned to you for help. A 10-year-old child hit his chest while playing. Complains of chest pain, coughing up bloody sputum.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. measurement of body temperature in children of different ages, graphical registration.
Problem number 12
A 4-year-old girl was brought to the clinic by her parents because she had drunk kerosene accidentally left in a glass. At the time of examination, the condition is satisfactory, the smell of kerosene from the mouth is determined, the vomit is colored yellow with a characteristic odor. The girl did not lose consciousness; 10 minutes passed after the poisoning.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate gastric lavage technique.
Problem number 13
A 7-year-old girl is being treated for exacerbation of chronic tonsillitis. Receives Biseptol. The doctor prescribed intramuscular injection of penicillin 500 thousand 2 times a day. A minute after the introduction of penicillin to the girl in the clinic, she developed a sharp pallor of the face, cyanosis of the mucous membrane of the lips, vomiting, shortness of breath, convulsions, and a threadlike pulse. The limbs are cold.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate 3. the technique of dilution and intramuscular administration of penicillin.
Problem number 14
A 7-year-old child is being examined by a neurologist for epilepsy. Took daily phenobarbital tablets. On vacation I went to the village to visit my relatives, forgot to take my pills with me. In the evening after playing football, clonic-tonic convulsions appeared.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. mouth-to-mouth respiration.
Problem number 15
A 5-year-old girl suffers from food allergies, under New Year she ate a whole bar of chocolate without asking. After 30 minutes, the temperature rose to 39.0ºC, a profuse papular rash appeared on the skin, severe itching worries.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique to 3. skin treatment to a young child.
Problem number 16
The patronage nurse visited the child at home for 8 months. Sick since yesterday, regurgitation, repeated vomiting, frequent, watery stools mixed with mucus. The child's condition is grave. Temperature 38.0 ° C, sluggish, adynamic. The skin is pale, dry, elasticity is reduced. Visible mucous membranes are dry, bright. Large fontanelle sunken, facial features sharpened. Respiratory rate 52 in 1 min., Pulse 120 beats / min. weak filling, deaf heart sounds. The abdomen is moderately distended, rarely urinates.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Calculate the amount of 3. fluid to be administered to the child?
Problem number 17
A 12-year-old girl, while taking blood from a vein for biochemical analysis, suddenly developed weakness, dizziness, nausea, she turned pale, her skin became covered with cold sticky sweat. The child slowly sank to the floor, lost consciousness. Pulse threadlike, 60 beats / min., BP 60/30 mm Hg. Art. Shallow breathing, 20 in 1 min. The pupils are dilated, the reaction to light is weakened.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. measuring blood pressure, counting the pulse in children.
Problem number 18
You are present during childbirth. At birth, the child had a short-term breath holding, and therefore did not cry immediately, mild cyanosis of the skin, an Apgar score at 1 minute. 6 points.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. suctioning mucus from the airways of newborns.
Problem number 19
You are a health visitor. A 2.5-year-old child became acutely ill. Against the background of an increase in body temperature to 38.2 º C, disorders of the general condition appeared, a rough "barking" cough, hoarseness, difficulty in breathing appeared.
Objectively: breathing is noisy, there is a slight retraction of the compliant parts of the chest, which increases with anxiety. NPV 28 per minute. In the pharynx there is a bright hyperemia of the posterior pharyngeal wall. Above the lungs - hard breathing. On the part of other internal organs - no peculiarities.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. performing distracting procedures on a phantom to a child.
Problem number 20
The mother of a 1.5-year-old child turned to the children's clinic. About an hour ago, while crying, he had a difficult breath, then breathing stopped, the child turned blue, and he lost consciousness. A few seconds later, a noisy sigh appeared, reminiscent of a "cock crow", breathing was restored. On examination, a similar attack was repeated.
From the anamnesis, you found out that the baby was born prematurely, from a month - on artificial feeding, received mainly cow's milk. He began to sit at 8 months, walk at 1 year 4 months, teeth erupted at 12 months. The baby has pronounced parietal and frontal tubercles, there is an O-shaped curvature of the lower extremities.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the introduction of a 3. phantom airway.
Problem number 21
A 2-year-old boy attends a preschool educational institution for the first 3 days, cries a lot. The teacher gave an apple to comfort the child. The child ate an apple, sobbed, suddenly coughed, began to choke, his face turned red. You were there in 3 minutes.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate your actions 3. on a phantom doll.
Problem number 22
The patronage nurse visited the child at home for 8 months. Sick 2nd day. Disturbed by a dry cough, profuse nasal discharge of a mucous nature. The temperature was 37.8 ° C yesterday afternoon, 38.8 ° C in the evening.
On examination: temperature 39.2 º C. Lethargic, capricious. The skin is dry, pink, hot to the touch, with a bright blush on the cheeks. Respiration rate 40 / min., Pulse 150 beats / min. In organs: bright hyperemia in the pharynx, hard breathing, muffled heart sounds.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Phantom 3. Demonstrate the methods of physically cooling the child.
Problem number 23
A mother with a 4-year-old child came to the clinic. According to his mother, the boy, playing alone in the room, took "grandmother's pills" and ate some. From the moment of poisoning, no more than 20 minutes have passed, how many pills there were and how many "ate" the child does not know. Diazolin turned out to be “grandma's pills”.
Objectively: a state of moderate severity, excitement, motor restlessness is noted. There was a single vomiting. Pulse 110 beats / min, respiratory rate 24 times in 1 min., In organs without features.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. phantom gastric lavage.
Problem number 24
A neighbor came running, crying. When bathing, she could not keep a month-old baby, he slipped off her hands and went under the water. She took him out of the water, but he turned blue and did not breathe.
On examination: the skin and mucous membranes are cyanotic, a frothy liquid is released from the mouth and nose. There is no breath.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of performing cardiopulmonary resuscitation 3. on a phantom doll.
Problem number 25
A 11-year-old child, who is inpatient treatment for obstructive bronchitis, showed signs of suffocation in the morning with difficulty breathing out, frequent dry cough; breathing is noisy, wheezing rales are heard in the distance.
Objectively: restless, frightened eyes. Sits on the edge of the bed. Pale, cyanosis of the nasolabial triangle. Tension and distension of the wings of the nose, the ribcage is barrel-shaped, with retraction of the yielding places. NPV - 30 per minute, pulse 100 beats. per minute, BP 130/70 mm Hg. Art. Disturbed by an obsessive dry cough, breathing is noisy.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of using an 3. inhaler.
Problem number 26
The patronage nurse visited the child at home for 2 months. For two days there was no chair, the child is restless, screams incessantly for an hour, his legs are drawn to his stomach. Artificially fed from 1 month, the mixture "Baby".
Objectively: the temperature is 36.7 ° C, the child is restless, screams, the skin is hyperemic, clean, the stomach is moderately swollen, gases do not leave. NPV 44 per minute, pulse 148 per minute, rhythmic.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. introducing a gas tube or performing a cleansing enema.
Problem number 27
A 14-year-old boy ate salted mushrooms. After 30 min. nausea, vomiting, watery stools, profuse sweating and salivation, dizziness, hallucinations appeared.
Objectively: the child's condition is serious, delirious, pupils are constricted, cough with profuse sputum production, spasm of accommodation.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. ventilating your child in a variety of ways.
Problem number 28
A 1 month old child is admitted to the hospital of the infectious diseases hospital. with a diagnosis of intestinal infection, toxicosis with exicosis. The mother complains of lethargy, drowsiness, poor sucking, frequent regurgitation, loose stools with mucus and greens up to 10 times a day, “weight loss”.
The child, according to the mother, fell ill two days ago.
On examination: the child is lethargic, spits up, the skin is pale, dry. The subcutaneous fat layer is reduced on the arms, chest, thighs, abdomen. The throat is clear, the temperature is 37˚ С. In the lungs, the breathing is puerile, the respiratory rate is 60 per minute, the heart sounds are somewhat muffled, the heart rate is 160 per minute. The belly is swollen. Liver - along the edge of the costal arch. On examination, the stool is liquid with mucus and greens.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. nipple feeding, spoon feeding.
Problem number 29
A school nurse was called in to help an 11-year-old child who became ill in an art lesson.
According to the teacher, during the lesson, the boy stood for a long time, posing for the students (was in the same position). Suddenly the boy felt bad, he fell, lost consciousness.
Objectively: the face is pale, the limbs are cold. At the time of examination, the child began to regain consciousness. Breathing is rare, shallow. NPV 14 per minute, blood pressure 80/40 mm Hg. Art., pulse 80 per minute, weak filling. Vesicular respiration in the lungs. Heart sounds are muffled. The abdomen is soft and painless. Physiological functions are normal. In the classroom, the child felt good, was active. Last days did not get sick. Does not suffer from chronic diseases. Not registered at the dispensary.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique for giving oxygen to your child 3. with an oxygen bag.
Problem number 30
The school nurse was asked to provide medical assistance the boy is 10 years old.
According to the teacher, the child suddenly turned pale, became agitated, began to complain of weakness, headache. Suffering from diabetes mellitus. I had a poor breakfast this morning after my insulin injection.
Objectively: the skin is pale, covered with sweat. Trembling of hands and feet is noted. The child is excited, but gradually the excitement changes to lethargy, apathy.
BP 100/55 mm Hg. Art., pulse 90 per minute, NPV 20 per minute. Resonant heart sounds. Vesicular respiration in the lungs. The abdomen is soft and painless.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. administering 12 U of simple insulin.
Problem number 31
The teacher brought a 4-year-old child to the medical office of the kindergarten.
The child does not make complaints, is not contact, calls his mother, cries, the teacher noticed changes in the child's condition half an hour ago, the temperature is 39.5˚ С.
Objectively: the child's consciousness is clear. The skin is pale, free from rashes, the limbs are cold. The tongue is slightly coated with a white coating. In the pharynx, slight hyperemia of the tonsils, NPV 30 per minute. Breathing is calm, through the nose, free, pulse - 140 beats. in a minute. The abdomen is of a normal shape and participates in the act of breathing. There was no chair. Was urinating.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the technique of 3. intramuscular injection of 2% papaverine hydrochloride in a dose of 0.8 ml.
Problem number 32
While on duty, the guard nurse of the children's department was summoned to the ward to a 2-year-old child. According to the mother, the child became worried after taking blood from him for research, and there were convulsions.
Nursing examination revealed a serious condition of the child: lack of consciousness and the presence of clonic-tonic seizures. The skin is pale. The lips are cyanotic. Breathing is noisy. The abdomen participates in the act of breathing.
Tasks
Determine the patient's condition. one.
Make an algorithm for the actions of the 2. nurse.
Demonstrate the i / m technique for 3. seduxene injection.
3.1 Anamnes vitae
Child (girl) 9 months from the first pregnancy, from a socially prosperous family from young healthy parents (dad - 24 years old, mom - 20 years old) without bad habits. Parents have no chronic diseases. There are no occupational hazards.
Pregnancy proceeded without toxicosis. All recommendations given during antenatal care were followed. The regimen, day, diet, personal hygiene, etc. were observed. Delivery on time, independently. The child screamed at once. Apgar score - 9 points. Attached to the breast immediately after delivery. Actively grabbed the nipple.
At birth : Weight - 3600 Length - 52 cm Head circumference - 36 cm Chest circumference - 34 cm
Currently : Weight - 9750 Length - Head circumference -45cm Chest circumference - 46.5cm
All parameters are within the required norm.
Newborn period : Baby care was satisfactory. But due to the illness of the mother, the child from two weeks of age was transferred to artificial feeding - the mixture of NAS is hypoallergenic. The rules of personal hygiene of the child were observed - daily bathing. The umbilical wound was completely epithelized by 1 month.
Dynamics of physical and nervous -mental development .
Physical development corresponded to epicrisis ages: in 2 months when the child held his head on his own, at 6 months sat alone. At 7 months, a problem arose after they began to plant the baby on a pot, she refused it. The child got up on his legs at 8 months. At this time, the girl is confidently standing and moving, holding onto objects. The first teeth (medial incisors) appeared at 5 months, then lateral incisors at 7 months, and now there are 6 teeth.
Neuropsychic development - in 1 month- the first smile in response to an adult's conversation, attempts to raise and hold the head while lying on the stomach; 2 month- smiles at the conversation of an adult with him, examines the toys hanging above him and follows with his gaze a toy moving in front of his eyes; at 3 months- a complex of revitalization in response to an adult's conversation with him (a smile, brisk movements of arms and legs, sounds), lies on his stomach for several minutes, resting on his forearms, and holds his head well, with support under the armpits, rests firmly with his legs bent at the hip joints ; at 4 months- during waking he laughs loudly, often smiles, makes loud sounds, moves, straightens and bends his arms and legs, looks for an object by sound, turns his head to the source of the sound, examines, feels and grabs toys hanging over his chest, holds a bottle with his hands during feeding ; at 5 months- distinguishes the tone with which he is addressed, distinguishes close people from strangers, walks for a long time, turns from back to stomach, stands evenly, steadily with support; 6 months- pronounces individual syllables, takes a toy well from different positions and works with it for a long time, turns from stomach to back, eats well from a spoon; 7 months- babbles for a long time, when asked ("Where is the clock?" or "Where is the bear?" 8 months- loudly and repeatedly pronounces various syllables, at the request of an adult, performs learned movements ("okay", "goodbye", etc.), takes a long time with toys (examines them, knocks a toy on a toy, etc.), sits down on his own and lies down, gets up and stands, holding onto the barrier with his hands, steps along the barrier, drinks from a cup held by an adult.
Currently at 9 months old girl - imitates audible syllables, to the question "Where is the bear?" finds an object with his gaze regardless of its location, knows his name - turns to the call, acts differently with objects depending on their properties (rolls a ball, takes one object out of another, etc.), walks, slightly holding on to objects with his hands , drinks well from a cup, holding it on his own.
Formula for neuropsychic development
Ace - dance movements to the melody.
E - catches up with the child, crawls towards him, imitates the actions
another child.
Dr - acts with objects in different ways, depending on their
properties (rolls, presses, takes out).
Do - moves from one object to another, lightly holding on to them with his hands.
Рп - to the question "where?" finds several objects, knows his name, turns around at the call.
Ra - imitates an adult, repeating syllables after him.
N - drinks well from a cup, slightly holding it with his hands.
3.2 Status presens
The condition of the child: satisfactory.
Skin integument: Clean, pale pink color, moderately moist to the touch, elastic. Visible mucous membranes: color, purity, moisture Subcutaneous fat layer: moderately developed, evenly distributed, the thickness of the fold at the level of the navel is 2 cm.
Peripheral lymph nodes: not palpable
Muscle tone: satisfactory.
Turgor of tissues: satisfactory.
Osteoarticular system: round head, dimensions
large fontanel - 0.5x0.5; movements in the joints are not limited;
there are 6 teeth: medial incisors-2, lateral incisors-4, the order of eruption corresponds to the norm.
Respiratory system: nasal breathing is free.
NPV - 30 per min., Character - mixed.
The cardiovascular system: Heart rate - 120 min., Heart sounds are clear, rhythmic.
Digestive system: Appetite is satisfactory, the oral mucosa is clean, Pink colour, shiny, abundantly moist . The abdomen is accessible to superficial palpation, not tense, soft, no swelling.
The liver protrudes from under the edge of the costal arch along the midclavicular line by 1-1.5 cm, there is no pain on palpation.
The stool is regular, 1-2 times a day, thick, dark yellow in color.
urinary system: urination is painless, the volume of one portion is about 50-60 ml, the frequency of urination is up to 10-15 times a day.
3.3 Additional data
Complete blood count - indicators correspond to age
General urine analysis is normal
Stool analysis is normal
Taking into account the data of the anamnesis of life, examination by systems, antrometric data, it can be concluded that the physical and neuropsychic development corresponds to the epicrisis age of 9 months.
3.4 Nutrition
A girl from two weeks of age on artificial feeding, received a hypoallergenic mixture of NAS. At 5 months introduced I complementary foods - vegetable puree from cabbage, zucchini, carrots, potatoes. Complementary feeding was introduced according to the rules - gradually. At 6 months introduced milk porridge, starting with rice, then oatmeal and buckwheat. At 6.5 months- egg yolk ... At 7 months- meat puree to expand the menu and shape the lunch. At 8 months- introduced whole kefir, according to the same principles as the rest of the dishes. In the second half of the year, crackers and biscuits are added.
Menu currently (9 months):
Feeding frequency - 5 times The volume of a single feeding - 210-220
Milk 220
Fruit puree 180 gr
Vegetables (vegetable oil) 140 gr.
Porridge (butter) 170 gr
Curd 40 gr
Egg yolk (2/3)
Meat 40 gr.
Cookies 20 gr
First feeding Milk 220
Second feeding Oatmeal porridge 170g + butter + juice (currant) 50g
Third feeding Vegetable puree (pumpkin) 140g + meat 40g
Fourth feeding Fruit puree (apple, banana) 180g + cottage cheese 40g
Fifth feeding Kefir 180+ cookies 20g
