Endocrine disorder
explain Acromegaly
Acromegaly is a word derived from the Greek vada.
Acromegaly Means := “Extremities ” “Enlargement “
Acromegaly is a chronic metabolic disorder in which too much growth hormone is secreted from the pituitary gland.
Acromegaly occurs after epiphyseal plate closure.
Bone thickening and transverse growth occurs in acromegaly.
This is mainly seen in excess during childhood.
Acromegaly is an abnormality of the pituitary gland, caused by the secretion of excessive amounts of growth hormone from the pituitary gland.
And the extremities of the body grow in an excessive amount.
Explain the Etiology of Acromegaly.
Due to tumor in pituitary gland ex:=
Pituitary adenoma
Due to the presence of a tumor in the pituitary gland, the pituitary gland is pressurized due to which the hormone of the gland is secreted in excessive amount.
Due to excessive amount of hormone secretion from pituitary gland.
Genetic
Because of Abnormality.
Explain the clinical manifestation/sign and symptoms of Acromegaly.
(Write the symptoms and signs of acromegaly)
Swelling occurs in the finger.
Suze size increases.
Enlargement of the peripheral parts of the body like hand, fit and mandible,
Special features are Swelling.
If and the prominence of the forehead increases.
Increased head circumference.
Skin pigmentation,
muscle weakness,
The skin of the palms and soles is thickened.
Swallowing occurs in the tongue.
There is pain in the joint.
Swelling occurs in the neck.
Breathing difficulty occurs during sleep time.
Pain, numbness and tingling sensation in the hand and wrist (Carpal Tunnel Syndrome).
Thirst and urination increases.
Body order.
Weakness is seen.
Height is greatly increased.
Sweat profusely.
headache.
Joint pain.
Increase in hand and foot size.
Explain the diagnostic evaluation of Acromegaly.
history taking and physical examination.
X Ray.
CT scan.
MRI.
Echocardiogram.
Growth hormone assessment
Genetic testing.
Visual field testing.
Explain the management of Acromegaly.
surgical management
The main primary cause of acromegaly is a tumor so surgically remove the tumor.
(transsphenoidal hypophysectomy)
In this, the tumor is removed by making an incision through the nasal sinuses.
medical management
When surgery is not impossible, it is treated with medication.
(somatostatin analog) (octreotide)
Somatostatin analogs reduce growth hormone.
(Pegvisoment) Pegvisoment blocks the action of growth hormone.
Radiotherapy :=
Radiotherapy is used to reduce the size of the tumor.
(dopamine agonist)
Dopamine agonist medications prevent the release of growth hormone from tumor cells.
Ex:= carbagoline,
lanreotide
Explain the nursing management of children with Acromegaly
1) Disturbed body image related to enlargement of body part.
Assessing child’s body image.
Providing psychological support to the child.
2) Fluid volume efficiency related to polyuria.
Assess the child’s fluid and electrolyte status.
Provide oral fluids to the child.
Provide fluids intravenously to the child.
3) Disturbed sleeping pattern related to soft tissue swelling.
Assessing the child’s sleeping pattern.
Provide a comfortable position to the patient
Provide work and quiet environment to the child.
4) ineffective coping related to changes in appearance.
Assessing the child’s coping ability.
Providing psychological support to the child.
5) Anxiety related to changes in appearance and treatment.
Assessing the child’s anxiety level.
Diverting the child’s attention.
Assessing the child’s coping ability.
Providing psychological support to the child.
6) Knowledge deficit related to development of disease and treatment.
To assess the knowledge level of the child.
To clarify doubts in the child.
Gigantism is a condition in which the body grows abnormally large before the epiphysial plate (bone growth plate) of the body closes.
It is mainly seen during childhood due to excessive growth hormone secretion.
Explain the Etiology/cause of Gigantism.
Due to benign tumor of pituitary gland.
Due to excessive secretion of growth hormone.
Karni Complex (Karni Complex := This is a hereditary disorder in which pigmentation of the skin is seen.)
(MAS := McCune All Bright Syndrome is a genetic disorder that primarily affects the bones, skin, and endocrine system. Café-au-lait skin pigmentation is seen.)
Multiple Endocrine Neoplastic Type :=1( MEN :=1)
Multiple endocrine neoplasia is an inherited endocrine disorder in which tumor formation occurs in parathyroid gland, pituitary gland, pancreatic islet. Due to exposure to radiation.
Explain the Clinical manifestation/ sign and symptoms of Gigantism.
Children’s muscle organ and its height grow.
Children are seen to be taller than their corresponding height.
Excessive amount of growth is seen in children.
Facial features
Enlarge is seen.
The joint is enlarged.
Enlargement of organs and tissues is seen.
Puberty delay is seen.
Obesity.
Double vision.
Frontal bushing and if it is prominent.
Having a headache.
Sweat profusely.
Menstruation period becomes irregular.
Hand and fit are enlarged and fingers and toes are thickened.
Weakness.
Explain the diagnostic evaluation of Gigantism
history taking and physical examination.
ct scan.
MRI.
Assaying prodectin levels.
Assess the cortisol level.
Assess the estradiol level
(In Girls).
Assess the testosterone level (in boys).
Perform a thyroid function test.
Explain the nursing management of Child with Gigantism
If there is a tumor in the pituitary gland, surgically remove it.
Transsphenoidal hypophysectomy.
(medical management)
Somatostatic analogues
Somatostatic analogues are used to reduce the secretion of growth hormone.
Dopamineagonists Carbagoline, Bromocriptine.
Used to reduce growth hormone.
The growth hormone antagonist pegvisomat
This medicine reduces the effect of growth hormone.
Provide radiation therapy to the child.
Due to the provision of radiation therapy, learning disability, obesity, and emotional changes are seen in children, so radiation therapy is provided only if surgery and medication fail.
Explain the Nursing management of Children with Gigantism
Health Assessment
Taking a comprehensive medical history of the child.
Assessing the child’s physical status, emotional status, and psychological status.
To assess the child’s growth pattern.
Psychological support
To provide psychological support to the child and his family members.
Improving child’s coping ability.
To clear all the doubts of the child and his family members.
Education
To provide complete information about DCs to the child and his family members.
To provide complete information about the disease, its causes and its treatment to the child and his family members.
Medication management
Complete information about medicine and signs and symptoms to the child and his family members.
Monitoring and Documentation.
Continuously monitoring the child’s condition.
Continuously monitor the signs and symptoms of the child’s disease condition.
Nutritional counselling
Continuously monitoring the nutritional status of the child.
Collaborate with dietician to provide education about healthy diet habits of patients.
Joint care
Ask the child to care for the joint continuously.
If the child is in pain, provide medicine to relieve the child’s pain.
Collaborating with other health care personnel for the care of the child and providing adequate treatment to the child.
For Health Promotion
Encourage the child to exercise regularly to promote health.
Encouraging the child to adopt healthy dietary habits.
Ask the child to take a well-balanced diet.
Asking the child to make changes in life style.
explain/define the diabetes insipidus.
Diabetes insipidus is caused by antidiuretic hormone deficiency or inadequate amount of antidiuretic hormone.
Antidiuretic hormone: Regulation of body water is done by antidiuretic hormone. This hormone is produced from the hypothalamus and secreted from the posterior pituitary gland. }
Diabetes insipidus is a condition in which antidiuretic hormone is secreted in inadequate amounts or antidiuretic hormone deficiency.
Due to this, the body water level is impaired and the urine output from the body increases.
Two main symptoms are seen in diabetes insipidus.
1) polyuria (excessive urination due to antidiuretic hormone deficiency),
2) Polydipsia
(Excessive thirst := due to excretion of excess urine from the body.)
Explain the etiology/cause of diabetes insipidus
Due to any lesions in hypothalamus and pituitary gland.
Due to any head injury.
Due to any head surgery.
Due to infection and inflammation of the central nervous system.
Due to any genetic condition.
Due to developmental abnormalities.
Aneurysm in the head
due to happen.
(Aneurysm := Aneurysm is a bulge or balloon-like structure formed from the area due to the wall of the blood vessels being weak, it is called aneurysm).
Due to skull fracture.
Antidiuretic hormone is seen due to deficiency or inadequate amount.
Diabetes insipidus occurs when antidiuretic hormone is in adequate amount in the body but kidney/kidney does not respond to antidiuretic hormone for any reason.
So the water balance in the body is impaired.
Due to any defect in the kidney’s tubules, excess water is excreted from the body.
Due to any impairment in kidney structure.
Having any genetic disorder.
Due to taking certain types of medication like lithium, diuretic.
Due to any kidney disease.
Due to general anesthesia.
Due to any developmental abnormality.
Due to excessive fluid intake for any reason
Being a mental health disorder.
Due to habit of excessive fluid intake.
Explain clinical manifestation / Sign and symptoms of diabetes insipidus
1)Polyuria (Polyuria := passing excess urine)
Passes too much dilute urine.
2) Polydipsia (Polydipsia := excessive thirst)
Passing excessive amount of urine from the body leads to loss of body fluid, so excessive thirst is required to maintain body fluid.
(Fluid intake is 5 to 20 liter/day.)
3) Nocturia (Nocturia) Passes more urine during night time so sleep patterns are altered.
4) Dehydration
Due to excess amount loss from the body, the body becomes dehydrated, hence conditions like dry mouth, dry skin, impaired skin turgor are seen.
5) (hypernatremia)
Hypernatremia means an increase in the amount of sodium in the body and this is mainly seen due to excessive amount of fluid loss from the body.
Due to this, confusion, irritability, and in severe cases many neurological symptoms such as seizure-like conditions are also seen in the body.
6) Hypotension
Hypotension is seen due to excessive amount of fluid loss from the body, due to which conditions like dizziness and fainting are seen.
7) Weight loss
Due to continuous fluid loss from the body, body weight is reduced.
Other symptoms:
feel tired,
Fever,
Tachycardia,
difficulty seeing,
Electrolyte imbalance,
Loss of appetite (anorexia),
Electrolyte imbalance.
diarrhea,
Vomiting.
Bed waiting.
Explain diagnostic evaluation of diabetes insipidus. (Write diagnostic evaluation of diabetes insipidus)
history taking and physical examination.
1) Water deprivation test.
This test is done to assess the cause of diabetes insipidus.
This test involves asking the child to stop drinking fluids for two to three hours.
Then what kind of changes are observed in the body due to lack of fluid intake are assessed such as changes in body weight, urine output,
Urine concentration etc.
This test also assesses the amount of antidiuretic hormone present in the blood.
When this test is done in children and pregnant women, it is done under close observation and keep in mind that the body weight should not be lost more than five percent.
2) Antidiuretic Hormone Test (ADH) Test.
Antidiuretic hormone test is done after water deprivation test.
In this test, antidiuretic hormone (Desmopressin :=synthetic antidiuretic hormone) is provided in small doses by injection. Then it is seen how the body reacts to this hormone.
This test is done to assess which type of diabetes insipidus a patient has. In this test, when antidiuretic hormone is provided to the child and the child’s urine production stops, the patient has a condition of diabetes insipidus due to antidiuretic hormone deficiency.
This primarily detects central diabetes insipidus in children.
Even after providing antidiuretic hormone to the child, if the urine production remains in the same amount, it detects that the antidiuretic hormone is produced in an adequate amount in the body but due to any kidney abnormality, the kidney does not respond to the antidiuretic hormone. Therefore, nephrogenic diabetes insipidus is detected. happens
3)Urine analysis:=
In this test, when the amount of water in the urine is high and salt and waste products are low, it detects the condition of diabetes insipidus.
4)MRI (Magnetic Resonance Imaging)
This test is mainly done to detect any problem in hypothalamus and pituitary gland.
5) Serum osmolarity
This test is mainly done to assess the amount of solutes in the blood.
6) Fluid intake output monitoring
This test is mainly done to assess the amount of fluid intake and urine output by the patient.
7) Genetic testing
This test is mainly done to assess any genetic abnormality.
8) Check the electrolyte level
It is done to detect if there is any electrolyte imbalance in the child’s body.
Explain the management of diabetes incipitus.
medical management
Central diabetes insipidus is caused by inadequate levels of antidiuretic hormone.
Hence providing synthetic antidiuretic hormone (desmopressin) to the child.
Synthetic antidiuretic hormone is taken in the form of nasal spray, oral tablets, and injection.
Providing this synthetic antidiuretic hormone reduces the excessive urine output.
Synthetic desmopressin is not used as a treatment if the cause of diabetes insipidus is due to kidney abnormalities.
If there is condition of diabetes insipidus due to kidney then take low salt diet.
Do not take medicines that damage the kidneys.
Provide Pitresin medicine intramuscularly to the child.
Provide the child with oral chlorpromadine 20 mg/ kg/ 24 hour in 2 divided doses.
Explain the nursing management of Child with diabetes insipidus.
nursing assessment
To monitor the child’s vital signs.
Asking if the child has any history of head injury.
Inquiring about the child’s eating habit.
Assess the child’s urine output and fluid intake.
Assessing the child’s skin turgor.
Asking if the child has signs like polyuria, polydipsia.
nursing management
nursing diagnosis
1) Electrolyte level imbalance related to hypernatremia.
2) Fluid volume deficit related to polyuria.
3) Disturbed sleeping pattern related to disease condition.
4) Altered tissue perfusion related to disease condition.
5) Risk of complications related to disease condition.
nursing interventions
Maintain fluid and electrolyte balance of children
To monitor the child’s vital signs.
To maintain a child’s intake output chart.
Provide intravenous fluid to the child.
Follow aseptic technique while treating the child.
maintain tissues perfusion of children
Assessing the child’s skin integrity.
Providing skin care to the child.
Asking the child to wear clean clothes and knits.
Change the child’s position every two hours.
Ask the child to do active and passive exercises.
relief anxiety level of child
Assessing the child’s anxiety level.
Ask the child to clear all his doubts.
Providing information to the child about the disease and its symptoms.
To involve family members in the child’s care.
Asking the child to maintain his personal hygiene.
maintain hygiene of the child
Ask the child to change his clothes daily.
Asking the child to wear clean cotton cloth.
Assessing the child’s discomfort level.
promote comfort and sleep of child
Assess the child’s sleeping habit.
To provide a conductive environment to the child.
prevent the occurrence of complications to the children
Monitor the child for symptoms like dehydration, metabolic acidosis.
If the child has these symptoms, report them to the physician immediately.
Providing prescribed medicine to the child.
To provide reassurance to the child.
To monitor the child for any complications.
explain the juvenile diabetes malitus.
Juvenile diabetes is a chronic metabolic disorder in which carbohydrate, protein and lipid metabolism is impaired.
Diabetes is a group of metabolic disorders in which high blood sugar levels are seen in the child’s blood. This is mainly due to an impairment in insulin secretion and action of insulin in the body. High blood sugar levels are seen in the body.
The “3 P” syndrome is predominantly seen in diabetes mellitus.
1)P:= polyuria (Frequent urination := passing urine frequently),
2)P:= Polydipsia
3)P:=Polyphagia (Increased Hunger := feeling very hungry).
Juvenile diabetes mellitus is usually a hereditary disorder
This is a type of diabetes mellitus in which there is a total deficiency of insulin due to the destruction of the pancreatic beta cells in the body which are responsible for the production of insulin due to any autoimmune disease or other reasons.
Due to total deficiency of insulin in this, insulin is taken by injection. This type of diabetes is mainly seen before the age of 30 years.
Explain the etiology of juvenile diabetes mellitus. (Give reasons for diabetes mellitus.)
inherited,
Environmental Factors,
certain virus,
Due to insulin deficiency,
Due to obesity,
Due to inadequate insulin production from the pancreas,
Explain Clinical manifestation/sign and symptoms of Juvenile diabetes mellitus.
1) Polyuria (increased urine output.),
2) Polydipsia (increased thirst),
3) Polyphagia (increased appetite)
Other symptoms
feeling tired
Weakness.
Difficulty seeing.
Tingling and numbness on hands and feet.
Dry skin.
Soar that hill slowly.
Frequent infections.
Nozia.
Vomiting.
Decreases wound healing.
Weight loss.
Abdominal pain.
Explain diagnostic evaluation of the Juvenile diabetes malitus (Write Juvenile Diabetes Diagnostic Evaluation).
history taking and physical examination.
1) Fasting Blood Sugar (FBS)
This test is done without eating or drinking anything for at least eight hours.
Its normal value should be less than 110 mg/dl mg of perdesilator.
And if the fasting blood glucose level is more than 125 mg/dl mg perdesh liter then it is diagnosed as diabetes.
2)Random Blood Sugar (RBS)
It does not require any preparation as the sample is taken anytime.
If the random blood glucose is more than 200mg/dl per milliliter, it is indicated as diabetes.
3) PP2bs (Postprandial Blood Sugar)
This test is done after 2 hours after taking a full meal.
3) Glycosylated HB.
This test is done to assess how much glucose is attached to the blood molecule.
4)Glycosylated albumin:=
Glucose is usually attached to albumin, so glycosylated albumin is used to assess average glucose levels.
5) Oral glucose tolerance test.
In this, the patient is provided with 150 mg of carbohydrates for three days.
The patient’s fasting blood glucose level is then checked.
The client is then given 75 grams of glucose to drink after which the patient’s glucose tolerance level is checked.
7)Ketonuria :=
If ketones are present in the urine, it indicates that the body uses fat as a source of energy.
8)Proteinuria:=
If protein is present in the urine, it indicates that the protein is used as a major source of energy.
9) Serum lipid profile.
10)Serum BUN.
11) Serum creatinine.
Explain the management of diabetes malitus.
Overall Principal of Management
To eliminate the symptoms of hyperglycemia.
To reduce microvascular and macrovascular complications of diabetes mellitus.
Reducing blood glucose levels.
Taking measures to enable the child to achieve a normal life style as far as possible.
Blood glucose levels can be reduced using child education, dietary management, exercise and pharmacological therapy.
Child Education
To provide proper health education to the child and his family members.
In which to teach how to do self-monitoring of glucose.
Teach monitoring of urine ketones if juvenile diabetes mellitus.
Teach the child how to administer insulin.
Teaching the management of hypoglycemia.
To provide education to the child about foot and skin care.
Teach management of diabetes before, during, and after exercise.
Providing education about child’s life style modification.
dietary management
Aim of Dietary Management
To reduce the symptoms of hyperglycemia.
If treating hyperglycemia to relieve symptoms of hypoglycemia.
Lowering the body’s overall blood glucose level.
Avoiding diets that increase blood glucose levels.
Ask the child to lose weight if he is obese.
Getting the child to have regular food intake.
Do not ask the child to take sugar.
Ask to eat a diet that contains adequate amounts of protein, carbohydrates and fat.
Dietary management
The main goal of dietary management is to improve metabolic control in the diabetic client.
Improving child’s blood glucose level and lipid level.
Making a daily food intake plan of the child.
Making a plan for weight management of the child.
Providing adequate nutrition to the child.
A child’s lifestyle habits play an important role in controlling and managing the disease.
A balanced nutritional diet is very important in all children.
Asking the child to increase protein intake in his diet Excessive protein intake increases renal function. and glomerular filtration rate increases.
Maintaining the level of fat in the child’s diet, maintaining the daily cholesterol level in the diet and limiting saturated fat and cholesterol.
Provide carbohydrates as per the child’s body requirement.
Asking the child to consume an adequate amount of carbohydrates to maintain the body’s energy requirements.
Breakfast should be taken 1 hour after morning insulin dose.
Then after three hours a small amount of carbohydrate should be taken.
Lunch should be taken four to five hours after taking the morning insulin.
Sugar should not be taken in quantity.
Foods which are sweet and contain sugar should not be taken like cake, ice cream, jam etc.
Checking the child’s blood glucose level regularly.
Carbohydrates should be taken in small amounts before exercise.
The child should be asked to check the amount of glucose, ketones and albumin in the urine and all these substances are observed during fasting.
Caloric restriction for obese children.
Exercise Provide advice to the child on regular exercise to prevent exacerbating his disease condition.
Ask for regular walking.
Ask the child to ride a regular bicycle.
Ask the child to do regular swimming.
Ask for adequate amounts of carbohydrates before and after exercise.
Explain the pharmacological management
Pharmacological management is responsible for maintaining blood glucose levels.
If insulin is given above the abdomen, its absorption is faster. Absorption is slow when given on arm and leg.
Time, course
1)Rapid acting insulin:=
Ex:=Humalog.
Its onset is within 10 to 15 minutes.
2) Short acting insulin:=
It is called regular insulin or R insulin (R insulin) or zink crystalline zinc insulin (czi).
Its onset is 30 minutes.
3) intermediate acting insulin:=
It is also called regular R insulin.
And its onset period is after three to four hours and the patient must take food during this period.
4) Long acting insulin:=
Ultra lente insulin or peakless insulin.
Its onset period is 6-8 hours and its action lasts from 20 to 30 hours.
insulin dosage
The starting dose of insulin is 0.5 unit /kg/day.
Insulin A 2/3rd dose in the morning
and 1/3rd in the evening.
This dose can be increased or decreased depending on food intake, exercise, and illness.
Insulin pump therapy
A small portable pump is used to administer insulin and its needle has to be changed daily.
Combine therapy
Child is provided with oral meditation insulin.
Patient teaching about insulin administration
Proper teaching of the child should be provided for proper administration of insulin because if insulin is not administered properly, tissue damage or conditions like insulin shock may occur.
1)insulin preparation:=
Insulin has to be prepared in the unit. It is present in the vial.
And 100 units of insulin are in milliliters.
2) Insulin syringe:=
There are 0.25, 0.30, 0.50 series of 1ml and 2ml in insulin capacity and long needle and short needle according to the patient’s capacity, if both are obese patients then long needle is used.
3) insulin storage:=
Insulin is stored in a refrigerator at 36°f degrees Fahrenheit to 86°f degrees Fahrenheit and should not be kept longer than 30 days.
4) Insulin preparation and injection.
Before taking the insulin series, the vial should be properly rolled between two hands and brought to room temperature before administration.
5)Route and site of insulin administration:=
Route:=subcutaneous,
Site:= abdomen,
back of arm
Upper part of buttock,
Side of the thighs.
procedure of administration:=
1) Using the left hand to stabilize the skin of the abdomen between thumb and finger.
2) Insert the syringe into the skin keeping the insulin series at 45°.
3) Then push the plunger so that the insulin is injected.
4) Then remove the series from the skin and apply the cotton to the injected site for a few seconds.
5) Then discard the series properly.
nursing management
1) Impaired nutritional status more than body requirement related to intake in excess of activity expenditure.
The primary goal of the diet plan is to control the glucose level, so assess the child’s glucose level, and assess the child’s lifestyle, cultural background, activity level, dietary habits and food preferences.
Ask the child to take food in adequate amount and also ask him to take snacks in between.
Arrange for extra milk before the child does physical activity.
Administer insulin as per prescription.
2) Imbalance fluid volume related to increased stress hormone as evidenced by polyuria.
Assessing child’s intake output chart.
Ask the child to take oral fluids.
Provide intravenous fluids to the child.
Checking the child’s serum electrolyte level.
To check vital sign of child.
3) Activity intolerance related to weakness as evidenced by limited activities.
Assessing the child’s activity level.
To plan the activity of the child.
Provide analgesic medication to the patient before resuming activity.
Ask the patient to rest between child activities.
Provide the child with carbohydrate and protein rich food in small amounts.
Providing prescribed medicine to the child.
4) Knowledge deficit related to cause and disease as evidence by asking questions.
To assess the knowledge level of the child.
Providing education to the child about diabetic diet.
To provide education to the child about foot and nail care.
Provide education to the child by keeping his feet covered with soft shoes.
Provide education to the child about self-administration of insulin.
5) Fear related to insulin injection.
Monitoring the child’s blood glucose level.
Provide education to the child about self-administration of insulin.
Provide education to child about complications of insulin therapy.
Provide education to the child about the signs and symptoms of hyperglycemia and hypoglycemia.
Hypothyroidism is a disorder of the endocrine gland.
Hypothyroidism is an endocrine gland disorder in which the thyroid gland does not produce adequate amounts of thyroid hormone.
Hypothyroidism occurs due to inadequate amount of thyroid hormone, altering the normal body function.
Hypo Means:= Les
Thyroidism:= thyroid hormone.
Hypothyroidism Means Inadequate secretion of thyroid hormone from the thyroid gland Congenital hypothyroidism is called cretinism.
Explain the Etiology of hypothyroidism.
Autoimmune thyroiditis.
If any child has a pre-existing condition of hypothyroidism.
Radiation therapy.
Due to iodine deficiency.
Congenital problem.
Thyroid dysgenesis.
Exposure to Goiterogens.
Explain the Classification of the Hypothyroidism
Primary or thyroidal hypothyroidism
This type is mainly seen due to dysfunction of the thyroid gland.
Central hypothyroidism
This type is seen due to dysfunction of hypothalamus and pituitary gland.
Pituitary or secondary hypothyroidism
This type is seen only due to the dysfunction of the pituitary gland.
Hypothalamic or tertiary hypothalamus.
This type is seen due to the dysfunction of the hypothalamus.
Congenital hypothyroidism
If a child is born with a problem in the thyroid gland, it is called cretinism.
Myxedema
Instead of accumulating in the tissue, my mucopolysaccharide in Mixday. Accumulates subcutaneously.
Explain the clinical manifestation/sign and symptoms of hypothyroidism.
Hair loss.
Brittle nails.
Dry skin.
Numbness and tingling of fingers.
Thickening of the voice.
Disturbance in the menstrual cycle.
Menstrual disturbance.
Subnormal temperature and pulse.
Patient Gain Weight.
Skin thickness.
The face becomes expressionless.
The child becomes irritable and tired.
Child’s speech becomes slow.
Tongue enlarge hand and feet increase in size.
Deafness is observed.
A complaint of constipation is seen.
Inadequate ventilation.
Pleural effusion.
Respiratory muscle weakness.
Serum cholesterol level increases and coronary artery disease is seen.
Myxedema coma.
feeling tired
Explain the diagnostic evaluation of Hypothyroidism (Write the diagnostic evaluation of Hypothyroidism).
history taking and physical examination.
Serum T3,T4 and Tsh level assessment (test is done in fasting).
Radioisotope based thyroid scanning.
Explain the management of hypothyroidism. (Write management of hypothyroidism).
explain the medical management
The missing hormone is replaced to restore normal metabolic function.
synthyroid,
levothyroid.
If there is a condition of severe hypothyroidism, to monitor the vital function, to monitor arterial blood gases, oxygen saturation by pulse oximetry.
Administering the fluid to the child.
Providing hormonal therapy to the child.
Avoid application of external heat as it increases oxygen requirement.
explain the nursing management
Nursing management
Nursing assessment
To monitor the child’s vital signs.
Assess the child’s eating pattern and dietary pattern.
To assess whether the child consumes such as lithium iodine or not.
Assess the child for any symptoms of hypothyroidism.
Nursing diagnosis
1) Activity intolerance related to lethargy and weakness.
2) Disturbance body image related to oedema.
3) Hyperthermia or hypothermia related to decrease metabolism.
4) Impaired nutritional less than body requirement related to disease condition.
5) Impaired bowel elimination constipation related to disease.
6) ineffective therapeutic regimen related to ignorance about disease and treatment.
Nursing management
Asking the child to do daily routine activities in small amounts.
Asking the child to maintain personal hygiene.
Ask the child to do regular physical activity.
Asking the child to maintain personal hygiene.
To monitor the child’s vital signs.
To check the cognitive level of the child.
If the child feels too cold, provide black cat.
Providing emotional support to the child.
Informing the child and his family members about the disease.
Child should be encouraged to take diet in adequate amount.
To clear all the doubts of the child and provide psychological support to him.
Goiter is a disease of the thyroid gland in which the size of the thyroid gland increases. Goiter is seen in a child.
A goiter alters the normal function of the thyroid gland. And of the thyroid gland in it
Explain the Etiology/cause of goiter.
Due to iodine deficiency.
(Iodine helps in the production of thyroid hormone from the thyroid gland, but if the body does not have adequate amount of iodine, the thyroid gland has to work extra hard to produce thyroid hormone, so the size of the thyroid gland increases).
Due to hyperthyroidism,
Graves Disease := Autoantibody that activates TSH receptor,
Hashimoto’s Thyroiditis := Autoimmune Disease Cretinism,
Nodules:= Nodules are solid and filled with fluid. These nodules look like hard structures from the outside but are filled with fluid inside. These are called nodules. These nodules are non-cancerous but they enlarge the thyroid.
Thyroid cancer.
Explain sign and symptoms/clinical manifestation of goiter.
Tachycardia
palpitations,
nervousness,
weight loss,
Blood pressure increases,
Heat intolerance,
In Hypothyroidism
Bradycardia
Weight gain,
Cold intolerance,
constipation,
lethargy,
Other symptoms
hoarseness of voice, dysphagia, difficulty in swallowing,
cuffing,
Dyspnoea: = breathing difficulty,
Swelling in the neck,
Nodules are seen on the neck side.
Dizziness. Describe the risk factors
Hereditary.5
Having a family history of thyroid cancer,
Due to iodine being in inadequate amount,
Due to iodine deficiency,
Women Are High Risk,
If any radiation therapy,
Explain the diagnostic evaluation of the goiter.
history taking and physical examination (Visible enlargement of thyroid gland),
Assess the TSH, T3,T4 hormone levels,
blood test,
thyroid scan,
ultrasound,
Biopsy
Explain the management of goiter.
medical management
1)If Hyperthyroidism:=
Radioactive iodine therapy.
Methymazole,
Propylthiouracil.
2)If hypothyroidism:=
Provide levothyroxine,
3)If iodine deficiency:=
Provide Lugol’s Iodine,
potassium iodine,
Explain the nursing management of children with goiter.
Maintain a proper airway of the child.
Assess the child for any signs of airway obstruction.
Properly instructing the child.
Intubate the child properly.
Provide high favular position to the child while eating and provide high favular position to the patient at least 30 minutes after meal.
To prevent the child from aspirating.
Ask the child to wear loose cloth on the neck side.
Ask the child not to wear tight clothes on the neck side.
Tell the child to take iodized.at list 30 micrograms.
Ask the child to take medicine regularly.
Assess the child for any signs and symptoms of thyrotoxicosis crisis like: neck swelling, weight loss, difficulties in breathing and swallowing.
Disorder of the parathyroid gland
Explain/define hypoparathyroidism.
Hypo parathyroidism is an endocrine disorder of the parathyroid gland.
In hypoparathyroidism, inadequate amount of parathyroid hormone is secreted from the parathyroid gland and is called hypoparathyroidism.
Hypo parathyroidism is a condition in which the amount of phosphate in the blood is elevated and the amount of calcium is decreased.
Explain Etiology/cause of the Hypoparathyroidism. (Describe the cause of hypothyroidism).
Due to gene mutation,
Due to failure of the central nervous system,
Due to thyroid dysfunction,
Due to deficiency of thyroid stimulating hormone,
Due to thyroid drug exposure,
If the parathyroid gland has been removed due to cancer.
Due to excessive amounts of ions.
Due to the amount of aluminum in the diet.
Infraction of parathyroid gland.
Grave diseases.
Hazimoto’s thyroiditis.
Due to magnesium deficiency due to alcoholism.
Explain the clinical manifestation/sign and symptoms of Hypothyroidism. (Write the symptoms and signs of hypoparathyroidism).
Irritability in the neurovascular system.
Numbness and tingling sensation in extremities.
Stiffness in arms and legs.
Broncho spasm.
Difficulty swallowing.
Photo phobia.
to be startled
Tongue thickened and protruding.
Anemia, rough and thick skin,
over slipping,
hypotonia,
bradycardia,
total extremities,
wide posterior fontanel,
Difficulties in feeding,
Decrease appetite,
Dry skin,
Deep tendon reflexes are depressed,
constipation,
Thyroid gland enlargement,
Delayed Bone Age,
bradycardia,
growth retardation,
Shotacture.
Explain the diagnostic evaluation of the Hypoparathyroidism
history taking and physical examination.
Blood test.
X ray study for bone age,
Screening of thyroid hormone,
Examination of T3 and T4 concentrations,
Test for TSH level,
radioisotope scan,
Thyroid Antibody Studies,
Explain the management of Hypoparathyroidism
medical management
Provide calcium gluconate intravenously immediately after thyroidectomy.
Administration of hypothyroid hormone by parenteral route to treat hypoparathyroidism.
Providing anti-conversion drugs to the child.
Environment should be noise free and bright light.
If the child has respiratory distress, provide tracheostomy followed by mechanical ventilation and bronchodilating medicine.
Advise the child to take high calcium and low phosphorus food (milk, milk product, egg yolk).
Explain the nursing management of the Hypoparathyroidism
nursing assessment
To monitor the child’s vital signs.
Assessing the child’s dietary habit.
Assessing the child’s fluid amount.
Perform a neuromuscular examination of the child.
Assessing whether the child has behavioral changes such as anxiety, irritability, etc.
Observing seizure activity.
nursing diagnosis
1) Risk of injury related to tetany, Seizures.
2) Anxiety related to disease, treatment.
3) Impaired nutritional pattern less than body requirement related to dysphagia.
4) Activity intolerance related to weakness, photophobia.
5) Knowledge deficit related to disease condition, treatment, self care, prognosis and discharge needs.
Nursing interventions
To monitor the child’s vital signs.
Assess whether the child has numbness, tingling sensation or not.
Do not restrain the child if he is having seizures.
Keeping the child’s side rails up.
Monitor the child’s serum calcium level.
Administer anticonvulsant medicine to control seizures.
2) relieve anxiety.
Monitoring the child’s anxiety level.
Explaining all the information about the child.
Reducing external stimuli and providing a work environment.
Providing mind diversional therapy to the child.
Provide anti-anxiety drugs to the child.
3) Maintain stable weight by reducing malnutrition.
Monitoring the child’s food intake level.
Asking the child to take an adequate amount of meal.
Ask the child to take high-calorie food that is easily digested.
Provide high calorie high protein and carbohydrate rich food to the child.
Maintaining Child No Intake Output Chart.
4) Improved ability to participate in desired activities.
Monitor the child’s vital signs and assess the client’s activity level.
To assess whether the child has the condition of tachypnea, dyspnea, pallor, cyanosis or not.
To provide a working environment to the child.
Provide bed rest to the child and restrict excessive activity.
Providing an anti-anxiety agent to the child.
To assess the child’s knowledge about the disease and its treatment.
To provide the child with knowledge about drug therapy and its side effects.
Providing nutritional diet to the child.
Planning the child’s nutritional menu.
Ask the parents of the child to take regular follow up.
The parathyroid gland is located at the back of the neck. The parathyroid gland is an oval shape and four.
Parathyroid gland which is four. And the parathyroid gland which secretes parathyroid hormone.
Due to over activity of more than one parathyroid gland, parathyroid hormone is secreted in very high amount into the blood stream due to which the condition of hyperparathyroidism arises in the body.
hyper:= excessive ,
Parathyroidism:=parathyroid hormone
Excessive secretion of parathyroid hormone from the parathyroid gland into the blood stream is called hyperparathyroidism.
Explain the type of hyperparathyroidism
1) Primary hypothyroidism.
Primary parathyroidism is mainly due to any abnormality in one or four parathyroid glands.
2) Secondary hyperthyroidism
Secondary hyperparathyroidism occurs due to any other disease condition.
Explain the Etiology/Cause of hypothyroidism
1) Causes of primary hyperparathyroidism
Due to any non-cancerous growth on the gland.
Due to enlargement of more than one parathyroid gland.
Rare cause is cancerous tumor.
2) Secondary hyperparathyroidism.
Due to severe calcium deficiency.
Due to serum vitamin D deficiency.
Due to chronic kidney failure.
Due to meta bolic abnormality.
Explain the Clinical manifestation/sign and symptoms of Hyperparathyroidism.
feeling tired
Weakness in muscles.
Nausea and vomiting.
Hyper tension.
Cardiac dysrhythmias.
A bone becomes brittle.
Kidney stone formation.
Excessive urination.
Abdominal pain.
Weakness.
Getting depressed.
Bone and joint pain.
The patient makes frequent complaints of illness.
Nausea, vomiting and loss of appetite.
Irritability.
Neurosis or psychosis.
Demineralization of bone.
Skeletal pain.
Tenderness in the back and joints.
Explain the diagnostic evaluation of the Hyperparathyroidism
history taking and physical examination.
blood test,
urine test,
ultrasound,
Bone Mineral Density Test,
Imaging test of kidney,
x ray,
city scan,
like this. RI test.
Explain the management of the Hyperparathyroidism
Treatment.
Surgery.
Parathyroidectomy.
The damaged part of the parathyroid gland is removed.
Explain the medical management of hyperparathyroidism.
Provide adequate diet and medication.
Assessing the nutritional status of the child.
Provide antacid medicine if child has peptic ulcer.
Taking measures to improve the child’s appetite.
Ask the child to drink lotus of fluid.
maintain hydration level.
Ask the child to intake an adequate amount of fluid daily.
Observe the child for signs and symptoms of any renal calculi such as abdominal pain and hematuria.
Avoiding thiazide diuretics in children as these diuretic medicines cause calcium retention in the body, leading to increased serum calcium levels in the body.
If the child has a condition of dehydration, report to the physician immediately.
improve mobility level.
Ask the child to do the activity as much as possible.
Ask the child to walk in small amounts.
Bed rest reduces the level of calcium in the body and reduces the formation of renal calculi.
Providing phosphate orally to the child which reduces the amount of calcium in the body.
provide health education
To bring proper awareness in the child.
To maintain the child’s calcium phosphorus balance.
Closely monitoring the child.
Ask the child’s parents to follow up properly.
Ask the child to take maximum food.
Nursing management
Nursing assessment
To monitor the child’s vital signs.
Assess the child for any symptoms of hyperparathyroidism.
Assessing the child’s dietary habit.
Proper physical examination of the child.
Assess the quality, intensity, duration and aggravating factor of the child’s pain.
pre operative Nursing diagnosis
1) Activity intolerance related to fatigue and weakness.
2) Impaired nutritional status less than body requirement related to nausea and vomiting.
3) Discomfort related to bone pain.
4) Disturbed sleeping pattern related to pain and psychosis.
5) Anxiety related to disease and surgery.
pre operative nursing interventions.
1) Promote activity level.
Assess the child’s activity level.
Planning nursing care for the child.
Asking the child to provide rest between activities.
Ask the child to take a balanced diet.
Ask the child to take the prescribed amount of fluid.
Providing supplementary vitamins to the child.
2) Maintain nutritional status.
Assessing the nutritional status of the child.
Assessing the child’s eating habit.
Provide food to the child in small amounts and frequently.
Ask the child to maintain oral hygiene.
Ask the child to take a balanced diet.
Ask the child to take a soft and balanced diet.
To maintain child intake output chart.
3) Promote comfort level.
Assessing the child’s pain level.
Providing a comfortable position to the child.
Providing diversional therapy to the child.
Ask the child to do range of motion exercises.
Providing comfort devices like pillow, cushion, heat therapy to the child.
4) Promote sleep.
Assessing the child’s sleeping habit.
To provide work and comfortable environment to the child.
Maintain child’s personal hygiene.
Provide analgesic medicine to the child.
Ask the child to read any book before sleeping.
Post operative nursing interventions
1) Ineffective Airway clearance related to post anesthesia effect.
2) ineffective gas changes related to post operative bed rest.
3) Fluid volume deficit related to post operative bed rest.
4) Risk for infection related to post surgery hospitalization.
Nursing interventions
1) Keep airway patent.
To assess the child’s respiratory status, breathing sound.
Providing the child with a fovealer position.
Anchoring the child to do deep breathing exercises.
Ask for oral and endocrine examination of the patient.
Check child’s pulse oximetry.
2) improving breathing pattern.
Assess the child’s respiratory rate.
Providing the child with a fallower position.
Tell the child to do deep breathing exercises.
Provide child steam inhalation, physiotherapy and incentive spirometry.
Tell the child to take plenty of food.
3) Maintain fluid and electrolyte balance.
To monitor the child’s vital signs.
Providing intra-venous fluid to the child.
Ask the child to maintain streak aseptic technique.
Maintaining intake output chart of child.
4) prevent occurrence of infections:=
To monitor the child’s vital signs.
Ask the child to wash hands.
Ask the child to maintain aseptic technique.
To provide neat and clean environment to the child.
Asking the child to wear clean cotton cloth.
Provide plenty of fluids to children.
Giving prescribed medicine to the child.
Monitoring the child for any complications.
disorder of Adrenal gland
Explain/define Addition disease.
Addison’s disease is a rare and chronic disease.
Addison’s disease occurs when the adrenal gland is unable to produce adequate amounts of its own hormones.
So addition diseases are also called adrenal insufficiency and hypocortisolism. Therefore, hormones of the cortex part (outer part) of the adrenal gland such as glucocorticoid
Deficiency of the mineralocorticoid hormone occurs.
This condition is Dr. was given in 1855 after the name of Addition.
Explain the Etiology/cause of addition’s disease. (Write the cause of Addison’s disease)
Primary adrenal insufficiency
This is mainly due to the problem in the adrenal gland itself, the secretion of the hormone does not take place.
Secondary adrenal insufficiency
Due to secretion of inadequate amount of adrenocorticotrophic hormone by pituitary gland.
Other Cause :=
due to infection,
Cancer of Adrenal Gland,
tuberculosis,
Bleeding into adrenal gland,
Anticoagulant
Due to using
Due to any disease of pituitary gland.
Due to taking some kind of medical.
Due to radiation, infection, decreased blood flow,
Any neurosurgery
If it happened, because of that.
Because of stress.
Due to an accident.
Dehydration due to nausea and vomiting.
Because of the industrialized world.
Caused by Cushing’s syndrome. hypopituitarism,
Due to myasthenia gravis.
Due to pernicious anemia.
Explain the clinical manifestation/sign and symptoms of additional diseases. (Write the symptoms and signs of Addiction Disease)
Low blood pressure
Tachycardia,
Muscle weakness,
weight loss,
nozia,
vomiting,
Diarrhea, hyperpigmentation.
feeling very weak,
feel tired,
Hyponatremia (low level of sodium in blood stream)
Hypercalcemia (increase level of calcium in blood)
Hypoglycemia (low blood glucose level)
Hyperkalemia (high level of potassium in blood.)
Slow, sluggish movement, loss of appetite,
Lisions on the Side of Cheek,
extreme weight loss,
Edison Crisis,
Kidney failure,
Loss of consciousness.
Low blood pressure.
Explain the diagnostic evaluation of addition diseases
history taking and physical examination,
Laboratory Investigation
Evaluate the sodium, potassium, and cortisol levels.
x ray
City Scan
MRI test,
CRH Test (Corticotrophin Releasing Hormone),
ACTH stimulating test (adrenocorticotrophin releasing hormone),
Insulin induced hypoglycemia test,
17-hydroxycorticosteroid test,
17-ketosteroids,
Blood eosinophilic count,
24-hour urinary aldosterone excretion rate,
aldosterone test,
explain the management of additions disease
medical management
Providing hormonal replacement therapy to the child
Providing hydrocortisol to the child
Providing prednisolone to the child
Provide glucocorticoid and mineralocorticoid to the child.
Explain the nursing management of children with addition diseases.
nursing assessment
Take a complete history and physical examination of the child.
To check vital sign of child.
To maintain intake output chart of child.
Assess the child’s sleeping pattern.
Monitoring the child’s weight daily.
Assess the child for signs and symptoms of Addison’s disease.
nursing diagnosis
1) Risk for imbalance nutritionally related to decrease gastro intestinal enzyme and decrease gastric acid production.
maintain nutritional needs of children
Assessing the nutritional status of the child.
Monitoring the child’s weight daily.
Monitor the child’s serum glucose level.
Provide high protein, low carbohydrate and low sodium diet to the child.
Ask the child to take food in small and frequent amounts.
Ask the child to rest after eating to increase digestion.
2) Risk for fluid volume deficit related to disease condition.
Maintain fluid and electrolyte balance of patients
Assess the child’s fluid level.
Assessing the child’s skin turgor.
Assessing the child’s mucus membrane.
To monitor the child’s vital signs.
To assess the color, amount of urine of the child.
Ask the child to take an adequate amount of fluid.
Provide parenteral fluid to the child.
Assessing the child’s body for any signs of petechiae.
3) Risk for decreased cardiac output related to disease condition.
maintain adequate cardiac output of children
To monitor the child’s vital signs.
To assess the child’s peripheral pulse.
To maintain intake output chart of child.
Ask the child to take adequate rest.
Provide intravenous fluid to the child.
4) Knowledge deficit related to self administration of steroid medication.
improve the knowledge of children
Providing the child with adequate information about his situation.
Demonstrate the procedure to the child’s parents.
To provide proper psychological support to the parents of the child.
To provide proper work and comfortable environment to the child.
Cushing syndrome is an endocrine disorder. Cushing’s syndrome is mainly seen due to prolonged exposure of body tissues to high levels of cortisol hormone.
Cushing’s syndrome is mainly seen due to excessive secretion of adrenocorticophic hormone (ACTH) from the pituitary gland and cortisol hormone from the cortex of the adrenal gland.
Cushing’s syndrome is also called hypercortisolism.
Hypercortisolism is a condition described by Harvey Cushing in 1922.
Explain the Etiology/cause of Cushing syndrome.
Due to excessive secretion of cortisol hormone from the cortex of adrenal gland.
Due to excessive secretion of adrenocorticotrophin releasing hormone (ACTH) from the pituitary gland.
Due to taking too much corticosteroid medicine (ex:= prednisone and prednisolone).
Due to a tumor in the pituitary gland.
Adrenal hyperplasia.
Due to tumor in another part of the body (ex: = pancreas, lung,
thyroid).
Explain the clinical manifestation/sign and symptoms of Cushing syndrome.
Increase in body weight.
Upper body obesity occurs and arms and legs become thin.
The child’s face is round and red.
Fatty buffalo hump in the neck region.
Its growth is also seen slow in the child.
Look for skin changes
Skin infection is seen.
One is seen in the body.
Striae (white color stretch marks on the abdominal skin) are seen on the skin of the abdomen, thighs, and breasts.
Skin with easy bruising.
Skin is thin, fragile.
Muscle and bone changes.
Stiffness while performing routine activities.
Pain and tenderness in the bone.
Difficulty climbing stairs due to proximal muscle weakness.
Collection of fat between the two shoulders.
Fractures in ribs and spinal cord due to bone thinning.
Muscle weakness.
Other Symptoms of Cushing’s Syndrome
Psychological problems include depression, anxiety and behavioral changes.
Blood pressure increases.
Bon a week.
Sleep disturbances are seen.
Excessive catabolism of proteins occurs.
Muscle wasting is seen.
Retention of sodium and water occurs.
A moon face appearance of the child is seen.
Hyperglycemia in a child
The condition of
Polyuria (increased frequency of urination).
Polydipsia (increased thirst).
Explain the diagnostic evaluation of Cushing syndrome.
history taking and physical examination.
Assay serum sodium level.
Assays blood glucose levels.
Urinary cortisol level is monitoring.
ACTH production is testing.
Assay 24 hour urinary free cortisol levels
In this test, the child’s 24-hour urine is collected and tested for cortisol.
If the cortisol level is more than 50 to 100 microgram, it suggests Cushing’s syndrome.
Overnight 1mg dexamethasone suppression test
In this test, 1 mg of dexamethasone is administered to the child at 11 pm.
In the next morning
Serum cortisol is monitored at 8 am.
If there is a healthy individual then the cortisol level is less than 2-3 mcg/dl but if the child has Cushing syndrome then the cortisol level is greater than 1.8 mcg/dl.
Assay the CRH stimulating test.
ct scan.
MRI.
Explain the management of Cushing syndrome. (Write the management of Cushing syndrome)
medical management
If the cause of Cushing’s syndrome is a tumor in the pituitary gland, removing the tumor.
Providing radiation therapy to remove the tumor in the pituitary gland.
Adrenalectomy (surgical removal of one or both adrenal glands) is performed if there is hyperplasia of the adrenal cortex.
Provide child’s cortisol inhibiting drug.
If Cushing’s syndrome is caused by corticosteroid medication, the dose of the medication should be gradually reduced.
Using drugs that reduce the production of corticosteroids such as
Mitotane,
Ketoconazole,
metyrapone,
Amino glutethimide,
Trilostane and etomidate etc.
Explain the nursing management of children with Cushing syndrome.
nursing assessment
To assess the child’s vital signs.
Monitoring the child’s weight daily.
Maintaining Child No Intake Output Chart.
Assess the child’s abdominal girth.
Inquiring about the dietary habit of the child.
Assessing the child’s sleeping pattern.
Assessing child’s mood and mental activity.
nursing diagnosis
1) Altered nutritional pattern related to disease condition.
meet nutritional need of child
Assessing the nutritional status of the child.
Ask about the child’s food likes and dislikes.
Ask the child to take food in small and frequent amounts.
Serving food to children in an attractive manner.
Ask the child to take high fiber, hypothalamic and calcium rich food.
Maintain Child No Intake Output Chart.
2) Fluid volume excess related to sodium and water retention.
Maintain fluid and electrolyte balance of child
To monitor the child’s vital signs.
Maintaining Child No Intake Output Chart.
Record the child’s body weight daily.
Providing prescribed medicine to the child.
3) Altered sleeping pattern related to disease condition.
improve sleeping pattern of child
Assess the child’s sleeping pattern.
To provide work and comfortable environment to the child.
To involve the child in daily routine activities little by little during the day time.
Maintain child’s hygiene.
Ask the child to read a book.
Ask the child to do prayer and meditation before sleeping time.
4) Anxiety related to disturbed body image.
relieve anxiety of the child
Assessing the child’s anxiety level.
Actively listen to the child.
To clear all the doubts of the child.
Involving family members in child care.
5) Risk for infection related to disease condition.
improve the health of the patient and prevent from the infection
To monitor the child’s vital signs.
Maintaining client’s personal hygiene.
Provide a neat and clean and ventilated room to the child.
Ask the child to wear clean cotton cloth.
Maintain aseptic technique before any invasive procedure.
Proper hand washing before and after child’s meditation.
Ask the child to take a well-balanced diet.
To provide proper psychological support to the child and his parents.