Pediatric Nursing-Sample Paper Solution

Points to keep in mind before appearing for Gujarat Nursing Council Exam :-

• After getting the paper first read the paper once so that one can know about every questions.
• Blue pen should be used as far as possible in the paper, black ball pen can be used where necessary, no other pen should be used.
• Do not use any pattern like line, box, circle etc. which leaves any impression or shows identity in the paper.
• Showing accurate figures as required in the paper.
• Do not write anything other than the seat number in the question paper.
• Before answering the questions asked in the question, read carefully twice and give the same answer as intended.

(Sample Answer only-Full paper inside)

Q-1 a. What is Tracheo Esophageal Fistula? 02

• TEF is a congenital anomaly of the gastrointestinal system. In which there is abnormal communication between trachea and esophagus.

• Mainly this problem is seen in low birth weight or premature baby.
• The trachea and esophagus are fused by incomplete folds during the gestation period of the fourth-fifth week of intrauterine life of the baby. Due to which this abnormal connection is seen between the two structures.

• It is also classified into several types based on the communication between the trachea and the esophagus. After the birth of the child, due to this problem, its nutritional needs are mainly compromised and complications related to the respiratory tract are seen.

b. Write down etiology and clinical manifestation of Tracheo Esophageal Fistula. 05 Marks.

• Reasons for developing TEF.
• The main reason why TEF develops is not known but some contributory factors are as follows. In which genetic factor has a very important role.

• This problem can also be seen due to intrauterine growth failure of the baby.
• Due to the teratogenic effect during fetal life, there are possibilities of this type of problem in the child.
• In TEF, the structure between the esophagus and the trachea fails to grow. Due to which this problem is seen..

• Additional factors for the development of TEF include the fact that the antenatal mother did not receive proper care during the antenatal period and she has an infection or she is abusing any substance.

Clinical Manifestation of TEF.

• The clinical manifestation of TEF varies depending on the type of TEF developed, with different types of signs and symptoms.
  Clinical features are usually seen soon after birth in this disorder.
• Excessive salivation is seen in the child and bubbles are seen forming in his mouth.
  A large amount of secretion is released from the oral cavity.

• Nasal secretions are also sometimes seen and cuffing and choking sensations are also seen in the child.
  Nausea and gagging are also seen in the child.
• Spasm of the child’s larynx is observed due to saliva moving into the trachea. So sometimes cyanosis is also seen.
  When a baby is breastfed, the baby experiences a gagging sensation and choking reflex at the very beginning of feeding, and fluid escapes from the nasal cavity and oral cavity through cuffing.

• Due to cough, cyanosis is seen in the child and breathing of the child is also temporarily abnormal.
  Abdominal distention is also seen in many children.
• Feeding in the baby can also lead to respiratory tract infection due to frequent aspiration in trachea.

c. Write down nursing management of it. 05 marks.

• Nursing management of TEF is done very carefully. Because if this condition is diagnosed as early as possible after birth, additional complications caused by it can be prevented.

• Airway is kept clear by suctioning the child from time to time. Due to which the breathing pattern remains normal and cyanosis is not seen.
• Oxygen therapy is also given when the child needs it, especially in case of cyanosis.

• Vital signs of the child should be closely monitored.
• The child is placed on Neil by Mouth (NBM) and intravenous fluid therapy is administered to maintain the child’s hydration level and nutritional status.

• It is necessary to rule out the child’s abdomen for distension.
• After the surgery, if the child has a chest tube placed, then taking proper care of this tube is very important. Monitoring and recording whether drainage is adequate.

• It is necessary to dress the chest tube with aseptic technique and take all precautions to prevent infection.
• Special care is taken of the anastomosed part of the child and care of the nasogastric tube is also very important.

• After the surgery, the child’s elbow is restrained. So proper care of drainage tube and nasogastric tube can be maintained.
• Oxygen therapy is also given as needed. The child’s vital signs are also specially monitored for early identification of any complications. If any complication develops, immediate management is undertaken.

• All equipment for emergency and critical care of the child is kept on stand by.
• After the operation the baby’s condition stabilizes, the baby is gradually started feeding and the baby’s condition is monitored.

• At the time of discharge of the child, it is necessary to explain to the mother and father about all the care to be taken at home, to explain to take precautions for infection prevention, to explain to maintain the nutritional needs of the child, and also to explain to the mother and father for any complications and for regular follow-up.

Psychological support is also very important to reduce the anxiety of mother and father.

Q-5 Define ANY SIX of the following terms. 12 marks.

1. Croup

This is a type of upper respiratory tract and laryngeal infection. Because of that absolutely
A loud and hoarse cough, hoarseness of voice, stridor and fever are seen.
This is mainly seen in laryngitis. Due to which sometimes breathlessness, restlessness and cyanosis are also seen due to blocking of respiratory passages.
Croup is also known as laryngo tracheobronchitis.

2. Convulsion-

• Convulsion occurs due to involuntary movement of voluntary muscles. Due to disturbances in the function of the brain, more electrical impulses are sent by the brain to the skeletal muscles and involuntary rapid movement of these muscles is seen.
• Convulsions are accompanied by changes in the level of consciousness. Convulsions are also called seizures.
• Convulsions are common in young children. Convulsions can occur in young children for many reasons such as febrile convulsions due to fever.
• Motor movements in convulsions are seen in different ways and are also classified differently according to their patterns.

Q.4 Write Short notes on ANY THREE of the following:- 12 marks.

1.Marasmus–

Marasmus…
Marasmus is a severe form of protein energy malnutrition. In which, especially in children, due to deficiency of protein and energy i.e. calories, severe muscle wasting and fat loss are seen in the body.
50% weight loss is seen according to the age of this child.

Causes of Marasmus

• This condition develops when the child does not get enough protein and calories because its nutritional requirements are not met.
• This child does not get enough food in terms of quality and quantity.

• This type of condition can be seen if the child is taking artificial feeding or is given diluted feeding.
• This condition can develop in the long run if the child is exclusively breastfed even after six months.
• This condition can arise when a child has an inflammatory disease or serious disease condition involving a gastrointestinal tract.

• This condition can also develop due to the child having prolonged vomiting and diarrhoea.
• This condition can also develop when the child has any chronic diseases or diseases related to structural mal formation or mal absorption syndrome.
• This condition is more commonly seen in infants than in older children. During this time, the child has a high requirement of energy i.e. carbohydrates. Due to lack of which, this condition is seen developing especially in infants.

Classification of Marasmus..

According to the degree of fat and muscle loss from the body in this condition, it is classified into different grades.

• Grade 1. Fat loss occurs from the axilla and groin area.
• Grade 2. In addition to the axilla and groin, there is fat loss from the abdomen and gluteal areas.
• Grade 3. In addition to Grades 1 and 2, fat loss occurs from the chest and spine.
• Grade 4. In this last grade, all fat is lost from around the mouth.

Clinical Manifestations of Marasmus.

• In this condition, fat loss occurs gradually from every part of the body and the weight of the child decreases continuously.
• The child looks aged. The child’s face looks like a monkey. The child is constantly irritable.

• Constipation and diarrhea alternate in the child.
• Signs and symptoms of severe electrolyte imbalance are seen in the child. Due to which many neurological and cardiological complications also develop.

• The child is less active.
• Due to loss of weight and not getting enough nutritional food in the child, many diseases and many infections are also caused. Due to some complications, the child may also die.

Diagnosis..

• History Collection
• Physical Examination
• X-ray (to detect systemic diseases and disorders)

management..

• In this condition, children are given high calorie diet. A diet with double calories than its requirement can also be given to the child if it is tolerated. It is necessary to gradually increase the quality and content of the diet.

• Gradually increase the amount of carbohydrates in the food. If there is diarrhoea, the sugar intake is gradually increased.
• Concentrated thick formula feeding should be given to the baby.
• Antibiotics or medicine can be given as per doctor order for infection.

• If any surgical condition is identified, surgical correction can be done.
• The psychological condition of the child is also taken care of.
• Continuous monitoring of baby’s abdomen and growth chart is kept for weight if needed.

• It is very important to maintain the temperature of the child’s body.
• After the baby starts gaining weight, the baby can be gradually shifted to a home made all balance diet.

• Give the child exclusive best feeding for six months. After that, the child is shifted to compulsory weaning diet and breast feeding is given as and when required.

Q-6 A. Fill in the blanks :- Fill in the blanks :- 10 marks.

1.NICU temperature should be _and humidity is,_ (Temp. 22 to 26’C, and humidity 30 to 60%)

2. Beri-Beri occurs due to deficiency.
   Berri Berri is caused by a deficiency of . (Vitamin B1)

3.Acute tonsilities is caused by__________
Acute tonsillitis is caused by_________. (Beta Haemolytic Streptococcal)

4.Surgical operation for undescended testes is called_____
Surgical operation for undescended testis is called _. (Orchiopexy)

B. State whether following statements are ‘True’ or ‘False’s 05 marks.

1. Gestational assessment can be done by Bellard scale. (correct)
2. There is no tear formation in the neonate. (false)