GNC CHILD HEALTH NURSING

01/02/2024

Q-1🔸 a) What is Bronchial Asthma? What is bronchial asthma?

• Bronchial asthma is a chronic inflammatory respiratory disorder. In which the respiratory tract becomes hyperresponsive to certain stimuli, the airway becomes inflamed and narrowing, and the airway constricts and becomes obstructed due to mucus production.

• Asthma is reversible. Certain etiological factors cause airway hyperresponsiveness.

• This leads to inflammation in the airways, resulting in hypersecretion of mucus, contraction of the airway muscles and swelling of the bronchial membrane.

• This causes narrowing of the airways. So cough, chest tightness, shortness of breath and wheezing sound are seen.

🔸b) Write down causes and clinical manifestations of Bronchial Asthma.

State the cause of bronchial asthma

• genetic factor,
• family history,
• Respiratory infection
• Environmental Factors: Exposure to Allergens, Air Pollutants (Dust, Chemicals)
• occupational factor,
• Hyperreactive airways
• Due to inhalation of certain types of irritating materials, such as cigarette smoking, shops, and strong orders of perfumes.
• Due to respiratory tract infection.

State the symptoms and signs of bronchial asthma

• dyspnea,
• whizzing,
• Coughing with or without expectoration of sputum,
• Chronic cuffing,
• Shortness of breath,
• Tightness filling in chest,
• Increases respiratory rate,
• Child a pale, irritable, hard to see,
• chest pain,
• A diminished breath sound,
• headache,
• muscle twitching,
• confusion,
• Coma.

🔸c) Write down Nursing management of 4 year old child, who is suffering with Bronchial Asthma.

Nursing Management of Bronchial Asthma,

• 1) Impaired gas exchange related to altered oxygen supply, obstruction of airway
• To monitor the child’s vital signs.
• Assess the child’s respiratory rate, rhythm and breathing pattern.
• Assessing child’s breath sound and chest movement.
• Monitor pulse oximetry and arterial blood gas values.
• Providing the child with a fowler position and restricting his activities.
• Explain and anchor the child about deepbreathing and cuffing exercises.
• To provide knowledge about pursed leap breathing and diaphragmatic breathing to the child.
• Anchor the child to cough expectorate if secretions are present.
• Provide oxygen therapy if spo2 level is low.
• Providing nebulization to the child.
• Administer the medicine (bronchodilator) prescribed by the doctor.
• To maintain records and reports.

• 2) Ineffective airway clearance related to obstruction from narrowed lumen
• To monitor the child’s vital signs.
• Assess the child’s respiratory rate, rhythm and breathing pattern.
• Assessing breath sound and chest movement.
• Monitor pulse oximetry and arterial blood gas values.
• Providing the child with a fowler position and restricting his activities.
• Explain and anchor the child about deep breathing and cuffing exercises.
• To provide knowledge about pursed leap breathing and diaphragmatic breathing to the child.
• Anchor the child to cough expectorate if secretions are present.
• Provide oxygen therapy if spo2 level is low.
• Providing nebulization to the child.
• Administer the medicine (bronchodilator) prescribed by the doctor.
• To maintain records and reports.

• 3) Ineffective breathing pattern related to bronchospasm
• To monitor the child’s vital signs.
• Assess the child’s respiratory rate, rhythm and breathing pattern.
• Assessing breath sound and chest movement.
• Monitor pulse oximetry and arterial blood gas values.
• Providing the child with a fowler position and restricting his activities.
• Explain and anchor the child about deepbreathing and cuffing exercises.
• To provide knowledge about pursed leap breathing and diaphragmatic breathing to the child.
• Anchor the child to cough expectorate if secretions are present.
• Provide oxygen therapy if spo2 level is low.
• Providing nebulization to the child.
• Administer the medicine (bronchodilator) prescribed by the doctor.
• To maintain records and reports.

• 4) Anxiety related to disease condition, hospitalization
• Assessing the child’s condition.
• Paying attention to the child’s psychological needs and listening carefully to the child’s parents.
• Encouraging the child to express his feelings, discomfort and anxiety.
• To solve all the doubts and queries of the child.
• Providing knowledge to the child about his condition and treatment so that his anxiety is removed and the child becomes confident.
• Providing psychological support to the child.
• Providing mind diversional therapy and recreational therapy to the child.

• 5) Activity intolerance related to fatigue, dyspnea
• Assessing the child’s condition.
• Checking the child’s activity level.
• Provide bed rest to the child initially.
• Then gradually anchor the child for range of motion exercises.
• Assisting the child with his activities.
• Provide rest to the child between activities.
• To check if the child has any type of breathing difficulty during the activity.
• If breathing difficulty is found, stop the child’s activity and provide rest.

🔸OR🔸

🔸A) What is Nephrotic Syndrome?

Nephrotic syndrome is a combination of two words.

Nephron Meaning Basic Structure of Kidney.

Syndrome meaning group of symptoms.

Nephrotic syndrome in children is a kidney disorder in which protein is excreted from the body through urine, mainly albumin, due to damage to the glomeruli, which are the filtering units of the kidney, or due to increased permeability of the glomeruli.

Due to the excretion of protein from the body through this urine, the amount of protein in the blood decreases, due to which the condition of edema occurs in the heel (swelling) particularly around the ice, ankle and abdomen. Due to which the lipid and cholesterol levels in the blood also increase.

Nephrotic symptoms are a collection of symptoms that occur primarily due to damage to the glomeruli in the kidney.

Four symptoms are mainly seen in nephrotic syndrome.

• 1) Body excretion of high levels of protein in urine (proteinuria).
• 2) Decreasing amount of protein in blood. (Hypoalbuminemia).
• 3) Increased amount of lipids in the blood (hyperlipidemia).
• 4) Swelling in body part (in heels).

These four main symptoms are seen in nephrotic syndrome.

Nephrotic syndrome affects people of all ages.
In children, it is mainly seen in children of 1 to 7 years.

🔸B) Write down causes and clinical manifestations of Nephrotic Syndrome.

Causes of nephrotic syndrome

• Due to glomerular disease,
• Due to a hereditary condition,
• Certain diseases such as collagen vascular disorder, due to damage to the small blood vessels of the kidney,
• It is mainly seen in children due to certain disease conditions
• Due to abnormal kidney function,
• Due to diabetic kidney disease,
• Due to certain types of infection,
• Due to medication,
• Focal Segmental Glomerulo Sclerosis (FSGS),
• Scattered scarring of glomeruli,
• Membranous nephropathy,
• Due to heart failure, due to certain types of diseases like Hepatitis B, Hepatitis C, Malaria etc.

Symptoms and signs in children with nephrotic syndrome

• Swelling.
• Weight gain in the child.
• Swelling is mainly seen on the lining of the eye socket and around the eye (in the periorbital AD).
• Swelling is mainly seen in feet and ankles due to prolonged sitting or standing.
• The face is puffy.
• Proteinuria.
• Hypoalbuminemia.
• Hypercholesterolemia.
• Diarrhea.
• Vomiting.
• Anorexia.
• Liver enlargement.
• Blood pressure increases.
• Anemia.
• Infection of respiratory tract, peritoneum and skin.
• Skin is pale.
• Skeletal muscle wasting.
• Sometimes swelling is also seen in the wall body which is called Anasarka.
• ascites,
• pitting edema,
• Oliguria (decrease in urine output).
• Weight gain.
• Hematuria (blood in urine)
• Respiratory distress.
• Blood pressure increases.
• Kidney failure.
• Cholesterol level increases in the body.
• feel tired
• Accumulation in the body
• Getting infected immediately.
• Loss of appetite.
• feel tired

🔸c) Write down Nursing management of 6 year old child, who is suffering with Nephrotic Syndrome.

Nursing management of the child with nephrotic syndrome

• Proper assessment of the child.
• To monitor the child’s vital signs.
• Monitoring the child’s fluid balance.
• Monitor the child’s weight regularly.
• Monitoring child’s intake output chart.
• Elevate the extremities if the child has a condition of edema.
• If the child has a condition of edema, then diuretic medicine and fluid level monitoring.
• Continuous maintenance of nutritional status of child.
• Advise the child to avoid protein, salt.
• Provide proper medication to the child.
• To provide complete information to the child’s parents about the disease condition, its causes, symptoms and signs and diagnostic evaluation.
• Advise the child’s parents to maintain personal hygiene to prevent infection.
• Providing emotional support to the child’s parents.
• To maintain a proper interpersonal relationship (IPR) with the child’s parents.
• To provide complete education to the child’s family members.
• To clear all the doubts of the child and his family members.
• Encouraging the child to participate in different play activities.
• To monitor the child’s vital signs frequently.
• Providing properly prescribed medication to the child.
• Continuous monitoring of the amount of fluid intake by the child or the amount of intravenous fluid provided to the child.
• Providing a nutritious diet to the child.
• Advise the child to take small frequent feedings.
• Provide education to parents to provide sodium restricted diet to child.
• Provide supplementary vitamins and iron to the child properly.
• Giving advice to the parents of the child or taking regular follow up.

🔸Q-2🔸

🔸A) Define Hydrocephalus. Write down post-operative nursing management of the child who has undergone for the ventricular peritoneal shunt surgery.

Hydrocephalus is a Greek word with hydro meaning “water” and cephalus meaning “head”. Hydrocephalus is an abnormal condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricular system and subarachnoid space. The pressure increases.

This condition of hydrocephalus usually results from an imbalance in the production and absorption of cerebrospinal fluid due to obstruction in the SCF pathway. Due to this, dilatation of the cerebral ventricles, enlargement of the head, cognitive impairment, seizures and other neurological problems are seen.

Ventriculoperitoneal shunt
In this procedure, one part of the shunt catheter is inserted into the anterior border of the lateral ventricles in the brain while the other end of the shunt is inserted into the skin of the peritoneal cavity. and pathways of cerebrospinal fluid are diverted from the ventricles into the peritoneal cavity.

Post operative management

• Monitoring the child continuously and closely after the surgery.
• To monitor the child’s vital signs frequently every fifteen to twenty minutes.
• Properly monitoring the neurological status of the child.
• Monitoring the child frequently if there is an alteration in body temperature.
• Position the child at the non-operative site to prevent pressure on the shunt.
• After surgery, the child is usually provided with a flat position on the bed for 24 hours.
• Assess the child’s photoreceptors to immediately notice if depressed.
• If the child is in pain, provide analgesic medication to relieve it.
• Do this if the child has any complications after the surgery or not.
• Provide proper fluid to the child and maintain his hydration status. To continuously monitor the intake output chart of the child. And continuously maintain the child’s electrolyte level.
• Provide dressing to the child by maintaining proper aseptic technique on the surgical side.
• To provide proper support and education to the child and his family members.

🔸b) Explain the principles of growth and development.

• Growth and development are closely linked. Growth and development in a child are parallel and continuous.

• We use both the terms growth and development interchangeably. But both words are not same. Both have different meanings. Both cannot be used interchangeably We use both terms together for the sake of simplicity.

• It is very important to understand the characteristics and principles of growth and development in children, which are given below.
• Growth and development is a continuous process. Each child is seen as unique. It also follows patterns of individual differences.

• The pattern of growth and development in every child is seen according to its stage. It can be predicted. Stage-wise looks the same for all children but the time to achieve that stage may vary. D. T. Every child learns to sit, learn to speak but the time to achieve this function is different in all children.

• In growth, there is an increase in the size and shape of each organ and coordination is seen in it.
• Growth and development are observed from Cephalo-caudal i.e. head to tail and Proximo-distal i.e. midline and center to periphery according to these principles.
• Growth and development is simple to complex. In the beginning mass movement and activity is seen in a simple pattern. Over time it is observed as specific action and response i.e. complex function.

• Development is primarily due to stimulation. As stimulation is given to this child, its development is seen to be better.
• Growth and development are interdependent on many factors like heredity and environment.
• The influence of society is particularly visible on the growth and development of a child. Development also depends on the cultural aspect.
• In growth and development, physical, mental, social, emotional activity is seen in a positive correlation and all those factors are connected with each other.
• Growth and development is sometimes fast, sometimes slow and sometimes stable.

🔸OR🔸

🔸a) Define Tracheoesophageal fistula and esophageal atresia. Write down post-operative nursing management of child who has undergone for tracheo esophageal fistula ligation.

Esophageal atresia

• Esophageal atresia is a congenital anomaly of the esophagus. In which the esophagus does not develop properly.

• Esophageal atresia is a condition of the esophagus in which there is a failure of the formation of a continuous passage from the pharynx of the esophagus to the stomach during embryonic development. That is, the esophagus is closed at one or more places or a part of the esophagus is absent. It causes discontinuity of esophagus and formation of gap between it and due to which food and liquid cannot reach from mouth to stomach.

Tracheoesophageal Fistula (TEF)

A tracheoesophageal fistula is an abnormal communication between the esophagus (the tube that is responsible for passing food from the mouth to the stomach) and the trachea (the tube that carries air to the lungs and works to take air from the lungs).

Tracheoesophageal fistula is a congenital anomaly in which there is an abnormal communication/connection between the esophagus and the trachea.

This is a type of congenital disorder that is usually seen in premature children, low birth weight and in children whose mother has the condition of polyhydroamnios.

Congenital heart disease and gastro-intestinal (GI) anomalies are also seen in children with this tracheoesophageal fistula condition.

Surgical management of tracheoesophageal fistula

Surgical correction of a child with tracheoesophageal fistula by anastomosis usually depends on the distance between the upper blind pouch and the lower blind pouch, the type of defect, the condition of the neonate, its weight and the severity of the defect.

First perform a gastrostomy to prevent aspiration.

If the distance between upper blind pouch and lower blind pouch is less than 2.5 cm then tracheostomy is performed and tracheoesophageal fistula is divided and ligation is done and then anastomosis is performed between upper segment and lower segment of esophagus.

If the distance between the two pouches is greater and the condition of the child is poor, the procedure is performed in two stages.

Stage 1 := In this stage esophageal fistula is ligated and gastrostomy is performed.

Stage 2 := In this stage at the same time of 18 months the distance is completed using the colon segment after which the esophagostomy and gastrostomy are closed.

Postoperative nursing management

• Keeping the child’s airway properly patent.
• Performing a proper examination.
• Monitoring thoracic drainage.
• Provide proper oxygen support to the child.
• To monitor the child’s vital signs properly.
• Provide proper intravenous fluids to the child.
• Provide proper elbow restraint to the child.
• If the child is in pain, provide proper analgesic medication.
• To provide proper comfort measures to the child.

Chest tube drainage should be monitored continuously with necessary precautions.

To prevent the child from infection, maintain aseptic technique, provide proper dressing and maintain the child’s hygienic and cleanliness properly.

Administering proper antibiotic medication to prevent the child from infection.

Continuously monitoring the child’s condition.

To provide education to the child’s parents and their family members to take proper care of the child.

🔸b) Explain the role of child health nurse for hospitalized child.

Whenever a child is hospitalized, the stress level of the child and his family increases. So the nurse plays an important role to relieve the stress of the child and its parents.

A nurse works as a helping people for parents and their children
Because, a nurse is a source of comfort, strength and knowledge
works as

A nurse has to develop enough confidence to form a positive relationship with children and their parents.

As a pediatric nurse, the nurse is aware of the feelings of children and their parents to handle their problems. The nurse patiently listens to the child’s complaints to find out the reason for the anxiety of the child and his parents.

Nurses provide sympathy and guidance to parents who are caring for a child.

A nurse helps children and their parents feel less anxious and more secure and calm in the hospital.

A nurse provides the following care:

1) Family :=

The nurse provides permission for family members to stay with the child during hospital procedures and provides family center care to the child.

2) In Neonate (child of 28 days from birth)

• While taking care of the neonate, the nurse also actively involves the parents in the care of the child by applying the rooming-in concept. And provides continuous contact of the child with its parents.

3) in infants (28 days to one year old child)

• Encourages the mother to balance her responsibilities and reduce separation with confidence and competence.
• An attempt is made to fulfill the infant’s basic needs by providing proper attention to the infant and handling the infant properly by the limited person.
• Whenever the nurse is doing any medical procedure on the child, she allows her parents to take care of the child so that the child does not feel separation anxiety.
• To relieve the tension and loneliness of the infants, the nurse provides them with toys.

4) in toddler (one to three year old child)

• The nurse provides a rooming in for the toddler.
• The nurse provides unlimited visiting hours to express the child’s feelings.
• If the child gets angry with the nurse while hospitalized, the nurse does not provide any kind of punishment to the child.
• The nurse tries to continue the child’s home routine like sleeping, eating, bathing etc.
• The nurse provides the child’s choice whenever possible and also provides the child’s familiar toys.
• Provides an adequate environment to the child for recreation and play.
• The nurse maintains an understanding and relationship with the child’s parents.
• Based on the child’s condition, the nurse allows the child for play and physical activity.

5) for preschool child (three to six years old child)

• In the preschool child, the nurse minimizes separation anxiety in children by allowing the child’s parents to be present during any of the child’s medical procedures.
• The nurse maintains a rooming-in approach.
• The nurse tries to make the child’s hospital stay as short as possible.
• A nurse tries to relieve a child from a stressful situation by providing love and care.
• The nurse properly explains the procedure according to the child’s level of understanding and also maintains his privacy.
• Provides opportunities for the child to verbalize his feelings.
• The nurse provides love to the child due to which the child can accept the separation caused by hospitalization.
• The nurse anchors the child to self-care and personal hygiene.
• The nurse tries to allay the child’s fear by providing an adequate explanation.
• The nurse does not do negative reinforcement in the child.

6) For School children (6 to 12 years old child.)

• A nurse assists parents for elective hospitalization of a child.
• The nurse respects the child’s right of privacy during any medical procedure.
• The nurse helps to solve the child’s problem.
• A nurse uses treatment rooms when performing any painful and invasive procedure.
• The nurse explains the procedure and its benefits to the child so that the child can cooperate properly during the procedure.
• When the child’s condition improves, the nurse encourages him to self-care, play and continue schoolwork.
• The nurse encourages the child to maintain personal hygiene.
• The nurse asks the child’s parents to cop up in anxious situations.
• The nurse encourages the parents to properly participate in the child’s care.
• The nurse allows the child to visit his siblings and friends.

7) for Adolescence (12 to 18 years)

• The nurse helps the parents prepare the adolescent for a planned hospitalization.
• Impact of nurse illness and hospitalization
  Assesses what type of misconception is present.
• The nurse provides orientation to the hospital staff, hospital routines, and facilities available at the hospital when the adult is admitted to the hospital.
• Nurses take a complete history of the adult’s illness such as habits, recreation, and hobbies.
• The nurse respects the adolescent’s privacy. And those who have food preferences are involved in the diet plan.
• Before performing any medical procedure, the nurse properly explains the procedure and gains the corporation of the adolescent and his parents.
• The nurse provides the adult with opportunities for proper recreation and interaction with family members and friends.
• The nurse guides the adolescent to promote his health and restore his daily routine activities.

Thus the nurse is a hospitalized child
in health promotion and its activities
Guides to be able to restore. thus,
It is important for the nurse to admit to the hospital
of the born child, his parents, and his family members
Identify the need and respond to it properly
provides.

Q-3 Write short answer (any two) 6+6-12

🔸a) Define the term pediatrics and write the role of pediatric nurse in child care.

PEDIATRIC.
It is a Greek word in which Pedia means child, Itrike means treatment and Ics means a branch of science.
Thus pediatrics is a branch of medical science. Pediatrics is the branch of medical science that provides preventive, promotive, curative and rehabilitative care for children from conception to adolescence age in health or illness.

PEDIATRIC NURSING.
Pediatric nursing is a branch of nursing. Which provides holistic nursing care to children from CONCEPTION to Adolescence age. The main goal of which is for proper growth and development of children and physical, mental and social well-being development of the child. In pediatric nursing, preventive, promotive, curative and rehabilitative nursing care is given to every child in this group.

ROLE OF PEDIATRIC NURSE.

• Due to changes in the field of medicine and technical advancements, the role of the pediatric nurse has also seen many changes to meet the new demands in child health care.
• The role of the pediatric nurse has become specialized in every aspect of care. All care is provided through a comprehensive approach by nurses at every stage of the child whether healthy or sick.

• The role of a nurse changes in different institutes, but its basic responsibilities and roles are the same everywhere.
• A pediatric nurse has specialized training in pediatrics. Its detailed roles are classified as follows.

CARE GIVER.
Preventive, promotive, curative and rehabilitative care is given to the child in every set up by the pediatric nurse. This care is planned based on the needs of the child. It includes all needs related to therapeutic needs, comfort, safety and personal hygiene.

HEALTH EDUCATOR.
Pediatric nurses provide incidental and planned health teaching to the child’s parents and family members on all matters related to child care. So that the child can be given proper care.

ADVOCATIVE ROLE.
A pediatric nurse uses scientific principles of child health care to ensure that children receive quality care. Works to give the child maximum benefit of its karma.

MANAGER.
A nurse acts as a manager of a pediatric care unit to fill every care of a child and helps to organize every care properly.

TEAM LEADER.
A pediatric nurse acts as a team leader in her unit and leads to provide better care by maintaining proper communication between all staff and subordinates. Distributes responsibility among everyone.

NURSE AS A RECREATIONIST.
Plan different types of recreational activities to modify the child’s stress during hospital adjustment procedures and hospitalization and help modify the child’s behavior.

NURSE AS A COUNSELOR.
Counsels and provides guidance to the child during critical care decisions and any problem solving approach to the parents.

SOCIAL WORKER.
For social problems and adjustment related to the child and his family members, it works with special welfare agencies and to provide necessary social support.

NURSE AS A RESEARCHER.
The nurse conducts different types of research during her clinical practice in the pediatric unit and tries to come up with new concepts. Finds new ways to deal with health problems. Nursing plays a role as continuous research to provide better health care facilities.

🔸b) What is measles disease? Write down etiology, mode of transmission, clinical features and management of measles.

• Measles (measles) is a highly contagious and viral infectious disease mainly caused by the measles virus that is mainly seen in children.

• Measles usually presents with body fever, catarrhal symptoms in the upper respiratory tract, and maculopapular rashes on the body’s neck, face, trunk, neck, and legs.

• Thus, measles is commonly seen in children under three years of age and mainly in malnourished children.

Causes of Measles

Mussels virus-a RNA Virous (Paramyxo virus group),
Due to contact with droplets from an infected person,
A child who has not been vaccinated against measles.

Mode of transmission of missiles

• Incubation period:= 4-10 days.
• Due to direct and indirect contact.
• Due to droplet infection.
• Due to respiratory droplets.

Symptoms and signs of measles

Symptoms and signs of measles are divided into three parts.

• 1) Prodomal (catarrhal) or preeruptive stage,
• 2) Eruptive Stage,
• 3) Convulsant stage or postmeasles stage.

1) Prodomal stage (catarrhal) or pre-eruptive stage,

• The prodomal stage (catarrhal) or pre-eruptive stage starts 10 days after infection and lasts for 3 to 5 days.
• common cold,
• coryza,
• Ice is red,
• lacrimation, and photophobia,
• lymphadenopathy,
• Vomiting and diarrhoea,
• sneezing,
• nasal discharge,
• fever,
• Bracey cough,
• to be nosed,
• feel tired,
• sneezing,
• nasal discharge,
• Koplik Sports
• (This sports a bluish white center with small white spots and is usually found in the inside of the mouth and inner lining of the cheeks).

2) Eruptive stage

Maculopapularresis is seen in the wall body. The race usually starts from the mouth and then moves down the body to the trunk, mouth, and legs.
anorexia,
malays,
Cervical lymphadenopathy,
fever,

3) Convulsant stage or postmeasles stage.

• fever,
• to race,
• fever,

Diagnostic evaluation of measles

History tacking and physical examination,
serological test,
ELISA test,
Leukocyte count assessment,
Routine blood examination,
blood culture,
Complement fixator antibody titer,
vaccination history,

Management of measles

To provide properly supportive and comprehensive care to the child.

1) Isolation
Measles is a highly infectious and contagious disease. Therefore, to prevent it from spreading, the child who has measles should be properly isolated. Isolation is usually done up to 4 days after rash appears.

2) Rest and hydration
Advise the child to take adequate rest.
Advise for adequate fluid intake to maintain hydration status and prevent dehydration.

3) Fever management
Provide antipyretic medication to the child to relieve the child’s fever.
Ex:= Acetaminophen,
Ibuprofen.

4) Symptomatic management
If the child has the condition of runny nose, cough, and conjunctivitis, then provide proper medication to the child.
If the child has nasal congestion, instill the child with nasal drops.

5) Nutrition
Provide adequate nutritional support to the child

6) Monitoring for complications
Closely monitor the child for any complications such as pneumonia and encephalitis.
Child has breathing difficulty, chest pain,
Get immediate medical treatment if you have conditions like severe headache, confusion, seizures.

7) Vitamin A Supplement
Provide vitamin A supplement if the child has vitamin A deficiency.

8). Preventive measures
Provide measles vaccine 0.5 ml as immunization to the child.
1st dose:=9-12month,
subcutaneously, right upper arm 0.5 ml
2nd dose:= 16-24 months
subcutaneously, right upper arm 0.5 ml. To provide proper work and comfortable environment to the child.

🔸C) What is Marasmus? Write down etiology, classification and management of Marasmus.

Marasmus

Marasmus word comes from the Greek word “marasmos” meaning wasting.

Marasmus in PEM (Protien Energy Malnutrition) is caused by severe calorie deficiency, resulting in weakness, loss of muscle mass and wasting in body tissues and loss of subcutaneous fat.

Children with marasmus usually appear very thin and have an appearance of a
“Starved”.
In marasmus, the child loses more than 50% of the expected weight for age.

Causes of marasmus

• Due to the innate diet,
• Due to inadequate amount of calories in the diet,
• Due to poor feeding,
• Due to certain medical conditions,
• As due to chronic vomiting,
• Due to chronic infection,
• Ex := Syphilis, Tuberculosis, Upper Respiratory Infection,
• Due to certain environmental factors,
• Due to poverty,
• Marasmus is most commonly seen in infants,
• Due to congenital diseases like cleft palate hydrocephalus, Hisprung’s disease etc.
• Due to certain metabolic disorders such as galactosemia.

Classification of Marasmus

There are total 4 classifications according to the grade of marasmus.

1) Grade-1 := In this grade, there is no loss of fat from the axilla and groin area.

2) Grade-2 := In this grade, there is no loss of fat from the axilla and groin area. Also, fat is lost from the abdominal and gluteal regions.

3) Grade-3 := In this grade, there is no loss of fat from the axilla and groin area. Also, fat is lost from the abdominal and gluteal regions. Along with this, the fat of the chest and spine is also involved.

4) Grade-4 := In this grade there is involvement of first three grades along with fat loss of bucklepad.

Symptoms and signs of marasmus

• Severe wasting in body tissues,
• Subcutaneous fat loss,
• Child becomes very thin,
• Facial features become suspicious,
• Child has growth retardation,
• Developmental delay of the child,
• Subcutaneous fat loss from a child’s buttock abdomen, Thai.
• The face looks like an aged one.
• Loss of fat from the child’s cheeks.
• Child becomes irritable.
• Finding severe malnutrition in the child.
• Electrolyte imbalance in the child.
• Neurological in Child
• Symptoms are observed,
• Child becomes less active,
• Child’s spleen, gonads,
• And reducing the size of the liver,
• The child feels weak, tired, and tired.
• To observe changes in the child’s behavior,
• Decreased physical activity,
• Child’s extreme weight loss,

Diagnostic evaluation of Marasmus Wada child

• History taking and physical examination,
• x ray,
• Taking anthropometric measurements of the child,
• Carrying out laboratory investigation of the child,
• Complete blood count,
• Assay serum electrolyte and serum albumin test,
• Performing imaging testing of the child properly,

Management of the child with marasmus

• Providing adequate nutritional supplements to the child,
• Providing adequate high calorie feeding to the child.
• Advising the child on nutritious food intake.
• Maintaining adequate fluid and electrolyte levels of the child.
• Provide adequate ion supplementation to the child.
• Giving advice to gradually increase the child’s diet.
• If the child has any infection, provide adequate antibiotic medicine.
• To provide adequate psychological support to the child.
• Daily recording of child no weight.
• Advising the child to provide adequate breastfeeding.
• Provide nutritious food like green leafy vegetables, soup, banana, pulse, cereals milk etc.
• Provide diet to the child in small and quantifiable amounts.
• To provide adequate work and comfortable environment to the child.

Q-4 Write short notes. (Any three) 12

🔸a) WIFS program –

• The Minister of Health and Family Welfare of the Government of India has launched a program of weekly iron and folic acid supplementation.
• This program was implemented to reduce the prevalence and severity of nutritional anemia in the adult population (10-19 years).
• A weekly iron and folic acid supplementation program also involves adolescent girls, married adolescent girls with school going children.
• This program was started in 2012.

Silent Features of Weekly Iron and Folic Acid Supplementation Program

objective
A main objective is to reduce the prevalence and severity of anemia in the adult population through iron and folic acid supplementation.

Target group
In this,
school going girls,
Boys who are in 6th to 12th standard and
Including those who are married adolescent girls.

intervention
Weekly iron folic acid supplementation is given in which 100 mg of iron and 500 mg of folic acid are given on a specific day of the week.

Thus, the target group is school going adolescent girls, boys who are in 6th to 12th standard and married adolescent girls to prevent anemia condition.

If there is a condition of mild anemia then iron folic acid supplement is provided but if there is a condition of moderate and severe anemia then such child is referred to appropriate health facilities.

Under this program, worm infestations like round worms, hook worms are prevented in the child by providing deworming medication twice a year.

Current status

• This program is implemented in all the states.
• 11.2 crore beneficiaries are covered under this program out of which 8.4 crore beneficiaries are school going children while 2.8 crore beneficiaries are out of school going beneficiaries.

🔸b) Round warm infestation –

• Roundworms are also known as “Ascaris lumbricoides/nematodes”.
• They are a group of cylindrical worms that belong to the phylum Nematoda. They are found in a variety of habitats around the world, including soil, water, and as parasites of plants and animals.

• Ascaris lumbricoides is one of the most common infestations in children. In children, it mainly affects the small intestine, the adult female roundworms are 20 to 40 centimeters. And mail worms are 12 to 30 centimeters.

• These roundworm infections are mainly found in tropical and subtropical climates where environmental sanitation and hygienic conditions are poor.

• A female roundworm produces 2,40,000 eggs a day.
• These roundworms in the child include the intestine, liver, lungs, trachea, alveoli,
• Affects bronchioles etc.

• Roundworms mature in 60 to 80 days. And its life span is between 6 to 12 months and maximum life span is 1.5 to 2 years.
• Round worm infestation is mainly transmitted by the phyco-oral route i.e. in areas where sanitary facilities are scarce. It is caused by ingestion of contaminated fruits, vegetables and food.

Causes of Roundworms Infestation in Child

Several factors are involved in the etiology of roundworm infestation:

Transmission:

• Roundworms can be transmitted through different routes, including
• Contaminated food and
• Ingestion of contaminated water,
• Due to direct contact with infected soil,
• Bite of an infected insect or animal,
• Due to poor sanitation,
• over crowding,
• Due to compromised immune system,
• Due to environmental conditions,
• Due to inadequate hygiene practices,
• Due to close contact with infected animals,
• Due to children ingesting mud while playing outside,
• Due to malnutrition,
• Food is not properly cooked
• due to happen.

Symptoms and signs of roundworms

Symptoms and signs of roundworms include:

• Abdominal pain,
• Abdominal distension,
• Nausea and vomiting
• Diarrhea and constipation,
• Malnutrition,
• feel tired,
• weakness,
• Visible worms in the stool,
• Coughing, wheezing and other respiratory symptoms,
• Loeffler syndrome such as fever,
• dyspnoea, cough,
• Vision, Urticaria
• Irritability,
• abdominal discomfort,
• nutritional deficiency,
• Poor growth,
• to see anemia,
• peritonitis,
• Pancreatitis,

Diagnostic evaluation of roundworms

• History taking and physical examination,
• stool examination,
• sputum examination,
• Vomit Examination,
• Serological test,
• imaging test,
• ultrasound,
• Abdominal x-ray,
• blood eosinophilia test,
• A contrast study of the gastroenteric tract.

Medical management of a child with roundworms

• Provide proper antiparasitic medication to the child.
• Ex:=
• Albendazole (15mg/ kg) 400 mg or
• Mebendazole 100 mg twice a day for three days.
• Levamisole 2.5 mg/ kg single dose.
• Pyrantel pamoate 10mg/kg single dose.

The ideal drug for eradication of roundworm infestation is Piperazine citrate 100 to 150 mg/kg provided in the form of syrup, tablets, and granules at night time before sleep for one or two days. This drug paralyzes the worms so the child passes stool within 12 hours after ingesting the peperazine medicine.

• If the child has any gastrointestinal symptoms such as abdominal pain, diarrhoea, constipation, nosia, vomiting, treat it properly by providing medication.
• If the child has a condition of nutritional deficiency and malnutrition due to roundworms infestation, provide adequate nutritious diet to the child.
• Advising the child’s parents to properly maintain the child’s hygienic condition.
• Giving advice to the child and his parents that after going to the toilet, wash hands properly with soap and water.
• Advise the child not to ingest any contaminated food and water.
• Advise parents of child to maintain proper sanitation like proper disposal of human and animal waste.

• Advise the parents to provide properly clean and safe water to the child to drink.
• Advising the child’s parents to provide proper medication to the child.
• Advising parents to take regular follow up.

Nursing management of the child with roundworms

• To provide properly comprehensive care and support to the child.
• Proper assessment of the child.
• Provide complete education to the child and his parents about roundworm infestation, its causes, symptoms and signs, and its treatment.
• Properly administer antiparasitic medication to the child and properly assess whether it has any kind of side effect or not.
• If the child has any other type of gastrointestinal system related and other symptoms, it should be properly managed.
• Provide properly nutritional food and properly cooked food to the child.
• Advising the child and his parents to maintain proper good hygienic practices.
• Giving advice to the child and his parents for proper hand hygiene.
• Giving advice to child and parents to wash hands properly before and after eating.
• Advise parents not to provide their child with any contaminated food and drinking contaminated water.
• Advise the parent to provide clean drinking water to his child and maintain proper hygienic condition and prepared food to the child.
• To provide proper emotional support to the child and his family members.
• Advising parents to avoid open defecation.
• Advise parents to wash any raw vegetables and fruits properly with water.
• Advising parents to keep their child’s nails short.

🔸c) Day Care Centre

A day care center is a place where a child whose both parents are working is kept in a day care center during the day for the care of the child and for the proper growth and development of the child. These day care centers are mostly useful for working mothers.

A day care center is a service that provides care to a child during the day while the child’s parents are at work or on business. It generally provides care to children of infant to preschool age.

Services

• Supervision and Care of Children.
• Age appropriate educational activities and play time are provided.
• Meal and snack time.
• Time to relax.
• Basic health care (some centers may have nurses or medical personnel on staff).
• Socialization with another child.

Staff of the day care center

• Director/Manager,
• Teachers/Caregivers,
• Assistant Teachers,
• Administrative staff,
• cook,
• Maintenance and cleaning staff,
• Security personnel.

Types of Day Care Centers:

In-Home Day Care:
Run out of someone’s home, usually in-home day care by a caregiver who cares for a small group of children.

Group Day Care:
Larger facilities with multiple caregivers and serving a larger number of children.

Preschool Program:
Often associated with day care centers, these primarily focus on child education activities and preparing children for school.

Benefits:

• Allows parents to attend to work or other responsibilities.
• Provides socialization and learning opportunities for children.
• Provides a structured environment with trained caregivers.
• Day care centers have achieved a lot of popularity as they are very necessary for working parents.
• For growth and development of children of working parents in a safe environment.
• A day care center provides proper facilities to the child in which the parents of the child can stay stress free.

activities

• Social skills are built up in the child.
• A child is also taught how to behave in school.
• A child is made to learn through games and fun.
• In a day care center, the child is made independent and also self-raised.

Staff to child ratio

• Care is provided to four infants in one caregiver and only eight infants are provided in a group in center based care.
• Care is provided for up to four toddlers (12 to 24 months) under one caregiver. There should not be more than 12 young toddlers in a group and there should be three caregivers in each group.
• Older toddlers (24-36 months) have six children with one caregiver and a maximum of 12 older toddlers and two caregivers per group.

🔸D) Breast feeding techniques.

• Maternal preparations for breastfeeding should begin during the antenatal period. In which improving the nutritional status of the mother, examination of the mother’s breast, etc. If the nipple of the mother’s breast is inverted or flat, to correct it. Breast feeding training should be started in the antenatal period itself.

• A mother’s willingness to breastfeed a child is very important. She should be psychologically prepared to feed the baby.
• Explain to the mother that she should have milk, juice or adequate fluids before breastfeeding.
• He should clean his hands, breast and nipple area before feeding.
• The mother should be physically and emotionally relaxed and in a comfortable position.
• Breast feeding can be given in any position. Mother and baby need to be comfortable.

• Breastfeeding is usually best done in the sitting position. In which the mother should give complete support to the child and should be placed on her lap. The child’s body should get complete support. The baby’s head should be positioned in such a way that it faces the mother’s breast. The mother can fold part of the baby’s leg with part of her axilla.

• Keep the baby’s head against the mother’s breast. Positioning the baby in such a way that the head should be supported by one hand of the mother.

• The baby’s cheek (cheek) and lip part should be touched with the nipple part of the mother’s breast to stimulate the routine reflex and encourage the baby for breast feeding.
• If the breast is full or to arrange the nipple in the baby’s mouth properly, with the help of thumb and first finger, the areola part is held in a U shape and placed on the baby’s mother’s nipple so that the baby can attach well.

• Breast feeding is given until one breast is empty of complete milk. Alternative best no is then used during feeding.
• During the early stages of best feeding, the baby may fall asleep during feedings. So the mother should wake up the child by gently touching the back of the child’s ear and the sole of the foot.

• Breast feeding should be given according to the baby’s demand. Generally best feeding should be given six to eight times during the day and two to three times during the night.

• During best feeding, baby swallows air along with milk. So after feeding, the baby should be kept in an upright position on the side of the mother’s solder, so that the extra air due to the pressure on the baby’s abdomen is removed through the mouth and nose. It is called belching. By doing this, the baby can be prevented from getting abdominal colic pain.

• After breastfeeding, the mother should place the baby on the right side of the abdomen.

Technique for proper latch on

• Baby’s mouth should be wide open.
• His chin (beard) part should be touching the lower part of mother’s breast.
• The baby’s lower lip should curve outwards towards the lower areola and the upper lip should cover the nipple completely.
• A small part of the areola in the upper part of the breast should be visible while the lower part of the areola is not visible. In this way, the baby should cover part of the complete areola with the mouth, not just the nipple.

🔸Q-5 Define following (any six) 12

🔸A) Development

Development means the process of physiological maturation of the body and maturation in functional capacity.

That progressive increase in the child’s skill and capacity to do any work is called development.

The main reason for development is the maturation of the nervous system. This is the qualitative aspect of the body.

Measuring development is a bit difficult but it can definitely be measured in a child.
In it, development is measured according to different activities through physiological, psychological, social, intellectual and emotional changes.

A child learns to speak, learn to walk etc. shows development.

🔸C) Breath holding spell –

A breath holding spell is a common situational disorder.
A breath holding spell is also called “infantile syncope”.

Breath holding spells are involuntary reflexive episodes and psychosomatic disorders that are mainly seen in young children i.e. children between the ages of six months and six years.

In a breath holding spell, the child involuntarily holds his/her breathing for a while while crying. Breathing is temporarily held and the child loses consciousness due to this. This breath holding spell is seen during anger, festeration.

During a breath holding spell, the child’s consciousness is lost, cyanosis is seen and the child also has twitching and tonic-clonic movements, the child becomes limp, lifeless and very pale. And the heart rate becomes slow and laryngeal spasm is seen and this type of attack is seen for one to two minutes.

🔸B) Omphalocele –

An omphalocele, also known as an exomphalus, is a congenital abdominal wall defect that occurs during fetal development.

In an omphalocele, organs of the abdomen, such as the intestines, liver, and other abdominal organs protrude (herniate) outside the body from the base of the umbilical cord. The omphalocele forms a sac covered by a layer of peritoneum and a layer of amniotic membrane that herniates from the umbilicus into a sac-like structure outside the body.

🔸F) Failure to thrive –

Failure to thrive is a chronic potentially life-threatening disorder in which infants and children do not gain adequate weight for their age and lose weight.

In a child who has the condition of failure to thrive, the child does not grow adequately and the well-being of the child is also impaired.

🔸C) Immunization – Vaccination

Immunization is a very important service in preventive pediatric services. By giving vaccine, specific protection is developed against specific diseases.

Immunization provides specific protection against diseases seen as dangerous infections in children such as poliomyelitis, diphtheria, pertussis, measles, rubella, hepatitis B, pneumonia, viral diarrhea etc., which are particularly responsible for mortality and morbidity in children.

Immunization in children produces immunity to specific diseases, and protects children from specific diseases or infections.

The following immunization schedule is followed under Universal Immunization Program.

🔸g) Pica–

Pica is an eating disorder primarily derived from the Latin word magpie.
“Magpie” means that it feeds on substances other than food (non-edible things) such as dust, clay, sand, paint chips, plaster from walls, cloth, snow, etc.
Pica is the most common eating disorder in children.

Children in this condition consume a non-nutritive non-eating substance such as,
Dust, mud, sand, paint chips, plaster from the wall, chalk, hair, peppersoap, ice, plastic, thread, metal objects, etc. These non-eatable things are said to be normal till the child is two years old but after two years they convert into an abnormal habit.

🔸d) Neonatal mortality rate –

Neonatal Mortality Rate (NMR) is the number of deaths of children from birth to 28 days as compared to 1000 live births in a year. Congenital defects, respiratory complications and preterm are the main causes of her death.

🔸Q-6 (A) Fill in the blanks

1.Negri bodies are found in ——- disease, Rabies

2.Full name of PEM is———- Protein Energy Malnutrition

3.An average head circumference is measured about———cm at birth. 33 to 35 cm.

4.Child is placed in —— position in management of drowning.. Supine with head

5.Bluish discoloration of the skin is called Cyanosis.

🔸(B) True or False – State true or false.

1.Mid-day meal program is also known as school lunch program. True.

2.Mid upper arm circumference helps to find out the nutritional condition of the children. True.

3.Whooping cough is a disease caused by Bordetella Pertussis. True.

4.Clotting time decreased in hemophilia. True.

5.Patient cannot be aroused in stupor even with painful stimuli. . False.

🔸(C) Multiple Choice Questions Saso option Lakh from Nicena

1 Growth chart is also known as.

A) Road to Health Chart –

c) GCS Score –

b) Ballard Score –

d) APGAR Score

2.Which of the following is not a component of KMC?

a) Skin to skin contact

c) Exclusive breast feeding

b) Supplementary nutrition

d) Early discharge and follow up –

3.Projectile vomiting is a clinical manifestation of which of the following conditions?

a) Pyloric stenosis –

c) Imperforated anus –

b) Hernia –

d) Appendicitis –

4.Which of the following statement is most appropriate to convince a mother for – immunization of child?

a) Immunization is okay for your baby-

b) Vaccines are expensive and you are getting free.

C) Vaccine will prevent the occurrence of that disease in future for which it is meant.

d) Government will take care of all past immunization complications –

5.Which of the following is preferred site of intramuscular injections in infants?

a) Tricep muscles –

c) Deltoid muscles –

B) Vastus lateralis muscles –

d) Gluteal muscles –