Child Health Nursing–August 2017–

SECTION – 1

1 Long Essay (any one) 1×15=15

(1) Master Nayan, 10 years old boy got admitted in the paediatric ward with the diagnosis of rheumatic fever. Answer the following:

💗 (a) Define rheumatic fever-02

Rheumatic fever is an inflammatory disease that can develop as a complication of untreated strep throat caused by Group A Streptococcus bacteria. It mainly affects children between the ages of 5 and 15.

💗 (b) List the clinical features of rheumatic fever-03

Clinical features of rheumatic fever include:

1. Fever
2. Joint pain and swelling (arthritis), often migratory
3. Carditis (inflammation of the heart), which can lead to complications like heart murmurs, chest pain, and heart failure
4. Skin rash, typically a non-itchy rash with a characteristic pattern called erythema marginatum
5. Subcutaneous nodules, small lumps under the skin, usually over bony prominences
6. Chorea (Sydenham’s chorea), a nervous system disorder characterized by rapid, jerky movements

💗 (c) Explain the medical management of rheumatic fever-04

1. Antibiotics: To treat the underlying strep throat infection and prevent further complications. Penicillin or other antibiotics are commonly prescribed.
2. Anti-inflammatory medications: To reduce inflammation and relieve symptoms, such as aspirin or corticosteroids.
3. Bed rest: To reduce strain on the heart and joints during the acute phase of the illness.
4. Management of complications: Treatment may be needed for specific complications such as carditis or chorea.
5. Long-term prophylaxis: To prevent recurrence of rheumatic fever, individuals are often prescribed continuous or periodic antibiotics for several years.

💗 (d) Describe the nursing care of Master Nayan using nursing process steps-06

nursing process to the care of Master Navya, who is diagnosed with rheumatic fever:

Assessment:

1. Assess Master Navya’s vital signs, paying particular attention to temperature, heart rate, and blood pressure.
2. Perform a thorough physical examination to assess for joint pain, swelling, skin rash, heart murmurs, and other signs of rheumatic fever.
3. Obtain a detailed medical history, including any recent episodes of sore throat or other symptoms suggestive of strep throat.

Diagnosis:

1. Identify nursing diagnoses based on the assessment findings, such as:

• Acute pain related to joint inflammation
• Risk for impaired cardiac function related to carditis
• Impaired mobility related to joint pain and inflammation

1. Collaborate with the healthcare team to confirm medical diagnoses and develop a comprehensive care plan.

Planning:

1. Establish goals and outcomes for Master Navya’s care, such as:

• Relief of joint pain and inflammation
• Prevention of cardiac complications
• Restoration of mobility

1. Develop a nursing care plan outlining interventions to achieve these goals.

Interventions:

1. Administer prescribed medications as ordered, such as antibiotics and anti-inflammatory drugs, ensuring correct dosages and monitoring for side effects.
2. Provide comfort measures for joint pain, such as applying ice packs or assisting with positioning for comfort.
3. Monitor Master Navya’s cardiac status closely, including heart rate and rhythm, and report any abnormalities to the healthcare team.
4. Encourage rest and limit physical activity during the acute phase of the illness to prevent exacerbation of symptoms.
5. Educate Master Navya and their family about the importance of completing the full course of antibiotics and adhering to long-term prophylactic treatment to prevent recurrence.
6. Provide emotional support and reassurance to Master Navya and their family, addressing any concerns or fears related to the illness.

Evaluation:

1. Regularly assess Master Navya’s response to treatment and progress toward goals and outcomes.
2. Modify the care plan as needed based on Master Navya’s changing needs and responses to interventions.
3. Collaborate with the healthcare team to ensure continuity of care and promote Master Navya’s recovery and well-being.

(2) Master Jaisal got admitted to the medical ward with the diagnosis of bronchopneumonin. Answer the following:

💗 (a) Define bronchopneumonia-02

Bronchopneumonia, also known as lobular pneumonia or focal pneumonia, is a type of pneumonia characterized by inflammatory changes in the bronchi and surrounding lung tissue, resulting in localized patches of consolidation.

💗 (b) List down the causes of bronchopneumonia- 03

1. Bacterial infections: Most commonly caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, and Klebsiella pneumoniae.
2. Viral infections: Can be caused by influenza virus, respiratory syncytial virus (RSV), adenovirus, and others.
3. Fungal infections: Less common but can occur in immunocompromised individuals, caused by fungi such as Pneumocystis jirovecii and Aspergillus species.
4. Aspiration: Inhaling food, liquids, or other foreign substances into the lungs, leading to inflammation and infection.
5. Chemical inhalation: Exposure to irritants or toxic substances can damage the lung tissue and predispose individuals to infection.

💗 (c) Describe the pathophysiology of bronchopneumonia -04

athophysiology of Bronchopneumonia:

1. Infection: The condition typically begins with the inhalation or aspiration of infectious agents into the bronchi and bronchioles.
2. Inflammation: The infectious agents trigger an inflammatory response, leading to swelling and increased production of mucus in the airways.
3. Consolidation: Inflammatory exudates and cellular debris accumulate in the affected areas, leading to consolidation of lung tissue.
4. Impaired gas exchange: Consolidation reduces the ability of the affected lung tissue to oxygenate blood, resulting in respiratory compromise.
5. Spread: In severe cases, the infection can spread to adjacent lung lobes or even become disseminated, leading to systemic complications.

💗 (d) Explain the medical and nursing management of bronchopneumonia – 06

Medical Management of Bronchopneumonia:

1. Antibiotic therapy: Treatment typically involves empiric antibiotic therapy targeting the most likely bacterial pathogens, adjusted based on culture and sensitivity results.
2. Antiviral therapy: In cases of viral bronchopneumonia, antiviral medications may be prescribed, though supportive care is often the mainstay of treatment.
3. Antifungal therapy: In immunocompromised patients with fungal bronchopneumonia, antifungal medications such as fluconazole or voriconazole may be indicated.
4. Supportive care: Oxygen therapy, bronchodilators, and hydration are essential to maintain respiratory function and support the body’s immune response.
5. Monitoring: Regular assessment of vital signs, oxygen saturation, and clinical status is crucial to monitor disease progression and response to treatment.

Nursing Management of Bronchopneumonia:

1. Airway management: Ensuring patent airways through frequent suctioning, positioning, and monitoring for signs of respiratory distress.
2. Oxygen therapy: Administering supplemental oxygen as prescribed to maintain adequate oxygenation.
3. Hydration and nutrition: Encouraging adequate fluid intake and providing nutrition support to meet metabolic demands and promote healing.
4. Medication administration: Administering prescribed medications on time and monitoring for adverse reactions or complications.
5. Patient education: Providing education to patients and their families about the importance of adherence to treatment, infection control measures, and signs of worsening symptoms requiring medical attention.

2 Short Essay: (any three)3×5=15

💗 (1) Universal Immunization Programme

Universal Immunization Program (UIP) is a comprehensive initiative aimed at providing vaccines to all eligible individuals, regardless of their socio-economic status. Here’s a breakdown of its key points:

1. Scope: UIP covers a wide range of vaccines targeting various diseases such as polio, measles, diphtheria, pertussis, tetanus, tuberculosis, hepatitis B, and others.
2. Target Population: The program typically focuses on infants, children, adolescents, pregnant women, and sometimes adults at risk.
3. Vaccine Selection: Vaccines included in the program are selected based on factors like disease burden, effectiveness, safety, and cost-effectiveness.
4. Vaccine Procurement: Government agencies procure vaccines from manufacturers through tenders or negotiations to ensure an uninterrupted supply.
5. Cold Chain Management: Vaccines are stored and transported under specific temperature conditions to maintain their potency and effectiveness.
6. Health Infrastructure: The program relies on an extensive network of health facilities, including primary health centers, sub-centers, hospitals, and outreach sessions to deliver vaccines.
7. Monitoring and Surveillance: Regular monitoring and surveillance systems are in place to track vaccine coverage, adverse events following immunization (AEFI), and disease outbreaks.
8. Awareness and Education: Public awareness campaigns and educational programs are conducted to inform the community about the importance of immunization, vaccine schedules, and safety.
9. Routine Immunization Sessions: Vaccines are administered through routine immunization sessions held at fixed locations or during outreach activities in communities.
10. Supplementary Immunization Activities (SIAs): In addition to routine immunization, SIAs are conducted to reach underserved populations or in response to outbreaks, often involving mass vaccination campaigns.
11. Integration with Other Health Services: UIP is often integrated with other maternal and child health services to maximize coverage and efficiency.
12. Equity and Access: Efforts are made to ensure equitable access to vaccines, particularly for marginalized and hard-to-reach populations, through outreach services and mobile vaccination teams.
13. Quality Assurance: Strict quality control measures are implemented throughout the vaccine supply chain, from manufacturing to administration, to ensure the safety and efficacy of vaccines.
14. Evaluation and Research: Continuous evaluation and research help improve the program’s effectiveness, identify gaps, and inform policy decisions for better outcomes.
15. Global Collaboration: UIP often collaborates with international organizations, such as WHO and UNICEF, as well as donor agencies and partners, to strengthen immunization efforts and access to vaccines.

💗 (2) Nursing care of neonates receiving phototherapy

nursing care for a neonate receiving phototherapy:

Assessment Before Phototherapy:

• Assess the newborn’s gestational age, birth weight, and overall health status.
• Check for any signs of jaundice and measure serum bilirubin levels if necessary.
• Evaluate the baby’s skin condition, hydration status, vital signs, and nutritional intake.

Preparation for Phototherapy:

• Explain the procedure and its purpose to the parents, addressing any concerns or questions they may have.
• Ensure proper eye protection for the infant and caregivers during phototherapy to prevent retinal damage.
• Dress the baby in minimal clothing to maximize skin exposure to the phototherapy lights.
• Position the baby under the phototherapy lights, ensuring even distribution of light exposure to all parts of the body.

Monitoring During Phototherapy:

• Continuously monitor the baby’s vital signs, including temperature, heart rate, respiratory rate, and oxygen saturation.
• Assess the infant’s skin integrity regularly for signs of erythema, rash, or skin breakdown.
• Measure serum bilirubin levels as ordered to monitor the effectiveness of phototherapy and adjust the treatment duration or intensity if needed.

Maintaining Hydration and Nutrition:

• Ensure adequate fluid intake for the neonate through breastfeeding or formula feeding to prevent dehydration, which can exacerbate jaundice.
• Monitor the baby’s intake and output closely, including urine output and frequency of stools.
• Encourage frequent breastfeeding sessions to promote hydration and elimination of bilirubin through stool.

Skin Care:

• Keep the infant’s skin clean and dry, avoiding the use of lotions or oils that may interfere with phototherapy or increase the risk of skin irritation.
• Change the baby’s diaper frequently to prevent prolonged exposure to urine and feces, which can exacerbate diaper dermatitis.

Promoting Parent-Infant Bonding:

• Encourage parents to stay close to their baby during phototherapy, providing opportunities for skin-to-skin contact and bonding.
• Educate parents on how to interact with their baby while under the phototherapy lights, such as talking to them or gently stroking their skin.

Assessment for Complications:

• Monitor the infant for signs of complications related to phototherapy, such as hypothermia, dehydration, or electrolyte imbalances.
• Educate parents on the signs and symptoms to watch for and when to seek medical attention.

Documentation and Communication:

• Document all nursing interventions, assessments, and the baby’s response to phototherapy accurately and promptly.
• Communicate effectively with other members of the healthcare team, including physicians, neonatologists, and other nurses, to ensure coordinated care for the neonate.

💗 (3) Tetralogy of fallot

Tetralogy of Fallot:

1. Ventricular Septal Defect (VSD): This is a hole in the wall (septum) between the heart’s lower chambers (ventricles), allowing oxygen-rich blood from the left ventricle to mix with oxygen-poor blood in the right ventricle.
2. Pulmonary Stenosis: This refers to a narrowing of the pulmonary valve and the passage from the right ventricle to the pulmonary artery. It restricts the blood flow from the right ventricle to the lungs, causing the right ventricle to work harder to pump blood through the narrowed valve.
3. Overriding Aorta: The aorta, the main artery carrying oxygen-rich blood from the heart to the body, is positioned directly above the VSD, straddling both ventricles. This allows oxygen-poor blood from the right ventricle to flow into the aorta and mix with oxygen-rich blood.
4. Right Ventricular Hypertrophy: Due to the increased workload of pumping blood through the narrowed pulmonary valve, the right ventricle becomes thickened and enlarged over time.

These four defects together result in Tetralogy of Fallot, a congenital heart condition that causes oxygen-poor blood to be pumped out of the heart and into the body, leading to cyanosis (blue-tinted skin) and other symptoms like shortness of breath and fainting spells. Treatment often involves surgical correction to improve blood flow and oxygenation.

💗 (4) Factors affecting growth and development

factors affecting growth and development in detail:

1. Genetics: Genetic factors play a significant role in determining an individual’s growth and development. Traits inherited from parents influence physical characteristics such as height, weight, and body proportions. Genetic disorders or abnormalities can also impact growth patterns.
2. Nutrition: Adequate nutrition is essential for proper growth and development. Malnutrition, whether due to insufficient intake of nutrients or poor absorption, can lead to stunted growth, delayed development, and various health problems. Essential nutrients like proteins, carbohydrates, fats, vitamins, and minerals are crucial for supporting growth processes.
3. Environment: Environmental factors, including socio-economic status, living conditions, access to healthcare, sanitation, and exposure to pollutants, can significantly influence growth and development. Children raised in supportive, stimulating environments tend to thrive, while those exposed to adverse conditions may experience developmental delays or health issues.
4. Healthcare: Access to quality healthcare services, including prenatal care, vaccinations, and regular check-ups, is vital for promoting healthy growth and development. Timely medical interventions can prevent and treat conditions that may hinder growth, such as infections, chronic illnesses, and developmental disorders.
5. Parenting and Caregiving: The quality of caregiving and parenting practices profoundly impacts a child’s development. Nurturing, responsive caregiving fosters emotional security, cognitive development, and social skills. Conversely, neglect, abuse, or inconsistent parenting can lead to emotional, behavioral, and developmental challenges.
6. Physical Activity and Exercise: Regular physical activity and exercise are crucial for supporting healthy growth and development, strengthening muscles and bones, improving cardiovascular health, and promoting overall well-being. Lack of physical activity or excessive sedentary behavior can impede growth and increase the risk of obesity and related health problems.
7. Social and Cultural Factors: Cultural beliefs, norms, and values influence parenting practices, dietary habits, and lifestyle choices, which, in turn, impact growth and development. Social interactions, peer relationships, and societal expectations also play roles in shaping cognitive, emotional, and behavioral development.
8. Psychological Factors: Psychological factors, such as temperament, personality, self-esteem, and resilience, influence how individuals perceive and respond to experiences, stressors, and challenges. Positive psychological traits and coping strategies contribute to adaptive functioning and healthy development.
9. Hormonal Influences: Hormones produced by the endocrine system regulate various aspects of growth and development, including puberty, sexual maturation, and metabolic processes. Hormonal imbalances or disorders can disrupt growth patterns and lead to developmental abnormalities.
10. Education and Stimulation: Access to quality education, cognitive stimulation, and opportunities for learning and exploration are essential for intellectual, academic, and socio-emotional development. Early childhood education programs and enrichment activities support cognitive skills, language development, and socialization.

💗 (5) Measles

measles:

1. Overview: Measles, also known as rubeola, is a highly contagious viral infection caused by the measles virus (MeV). It primarily affects the respiratory system but can also lead to systemic complications.
2. Transmission: Measles is transmitted through respiratory droplets from coughing and sneezing of infected individuals. It is one of the most contagious infectious diseases, with a high transmission rate among unvaccinated populations.
3. Incubation Period: The incubation period for measles is typically around 10 to 14 days, during which infected individuals may not show symptoms but can still spread the virus to others.
4. Symptoms: Common symptoms of measles include:

• High fever
• Rash: Characteristic red, blotchy rash that starts on the face and spreads to the rest of the body
• Cough
• Runny nose
• Red, watery eyes (conjunctivitis)
• Koplik’s spots: Small white spots with bluish-white centers inside the mouth

1. Complications: Measles can lead to serious complications, especially in young children, pregnant women, and immunocompromised individuals. Complications may include:

• Pneumonia
• Encephalitis (brain inflammation)
• Ear infections
• Severe diarrhea
• Blindness
• Death (particularly in developing countries with limited access to healthcare)

1. Prevention: The measles vaccine, usually given as part of the measles-mumps-rubella (MMR) or measles-mumps-rubella-varicella (MMRV) vaccine, is highly effective in preventing measles. Vaccination programs have significantly reduced the incidence of measles globally.
2. Diagnosis: Measles is typically diagnosed based on clinical symptoms, such as the characteristic rash and fever, along with a history of exposure to the virus. Laboratory tests, such as serology (measuring antibodies) or PCR (detecting viral RNA), can confirm the diagnosis.
3. Treatment: There is no specific antiviral treatment for measles. Supportive care aims to alleviate symptoms and prevent complications. This may include rest, fluids, fever-reducing medications, and treatment of secondary bacterial infections if present.
4. Isolation and Quarantine: Infected individuals should be isolated to prevent the spread of the virus to others, especially those who are unvaccinated or at high risk of complications. Quarantine measures may be implemented to control outbreaks in communities.
5. Global Impact: Measles remains a significant public health concern, particularly in areas with low vaccination coverage or where healthcare infrastructure is limited. Efforts to improve vaccine access and coverage, along with surveillance and outbreak response measures, are essential for measles control and elimination initiatives.

3 Very Short Essay: (any four) 4×2=8

💗 (1) Iron suppliments are administered in two divided doses between meals.

Iron supplements are often administered in two divided doses between meals to enhance absorption. Taking iron supplements on an empty stomach helps the body absorb the iron more effectively, as certain substances in food can inhibit iron absorption. Additionally, splitting the dose helps prevent gastrointestinal side effects such as stomach upset or constipation that can occur when taking a large amount of iron at once.

💗 (2)During chest compression head of the small infants

During chest compressions on a small infant, it’s important not to extend the head because this can obstruct the airway, making it difficult for the infant to breathe. Keeping the head in a neutral position helps maintain proper alignment of the airway for effective ventilation.

💗 (3) should not be over extended Corticosteroids are used in the treatment of bronchial

Corticosteroids are used in the treatment of bronchial asthma because they help reduce inflammation in the airways, making it easier to breathe and decreasing the frequency and severity of asthma attacks. They also help to prevent airway narrowing and reduce mucus production, improving overall lung function.

💗 (4) Weaning should be done gradually

Gradual weaning is recommended to allow both the mother and the baby to adjust to the change in breastfeeding patterns. Abrupt weaning can be emotionally and physically challenging for both.

To wean gradually, start by substituting one breastfeeding session per day with a bottle feeding or alternative feeding method, gradually reducing the number of breastfeeding sessions over time. This allows the baby to gradually adapt to taking less breast milk while still receiving nutrition from other sources. Additionally, it gives the mother’s body time to adjust and reduce milk production gradually, reducing the risk of engorgement or mastitis. Emotional support and comfort for both the mother and the baby during this transition period are also important.

💗 (5) Hepatitis B vaccine is giving in vastus lateralis muscles.

The hepatitis B vaccine is sometimes administered in the vastus lateralis muscle of the thigh in infants because it’s a large muscle with fewer nerves, making the injection less painful. This method is also used for infants who may have inadequate deltoid muscle mass. The vaccine is given using a standard injection technique, ensuring proper dosage and delivery into the muscle tissue.

💗 (6) Vitamin K should be administered to the newborn shortly after birth

administering vitamin K shortly after birth is a standard practice in newborn care. Vitamin K is essential for blood clotting, and newborns have lower levels of this vitamin compared to adults. Administering vitamin K injection to newborns helps prevent a rare but serious bleeding disorder called vitamin K deficiency bleeding (VKDB), which can occur within the first weeks of life. This prophylactic measure is recommended by healthcare professionals to ensure the newborn’s health and well-being.

                             SECTION II

1 Long Essay (any one) 1×10=10

1) Baby Deepa, 3 years old got admitted in the surgical ( ward with the diagnosis of tracheoesophageal fistula. Answer the following:

💗 (a) Explain the types of oesophageal atresia and tracheoesophageal fistula -03

1. Esophageal Atresia (EA):

• In EA, the upper part of the esophagus ends in a blind pouch and doesn’t connect to the lower part of the esophagus or stomach.
• There are several types of EA, including:
  • Type A: Esophagus ends in a blind pouch with no fistula.
  • Type B: Esophagus ends in a blind pouch with a tracheoesophageal fistula (TEF) connecting to the trachea.
  • Type C: Esophagus separates into two segments, with one segment connecting to the trachea.

Tracheoesophageal Fistula (TEF):

• TEF is an abnormal connection between the esophagus and the trachea.
• Types of TEF include:
  • Proximal TEF: The upper part of the esophagus connects to the trachea.
  • Distal TEF: The lower part of the esophagus connects to the trachea.
  • H-Type TEF: There is a fistula between the esophagus and trachea without esophageal atresia.

💗 (b) Explain the surgical management of tracheoesophageal fistula- 02

The surgery aims to close the fistula and connect the esophagus segments.

• The surgeon may approach the repair through a thoracotomy (incision in the chest) or a minimally invasive procedure.

💗 (c) Describe the pre and post operative nursing management of child with tracheoesophageal fistula -05

Pre-operative Preparation:

• Stabilization of the infant’s condition, ensuring adequate respiratory support.
• NPO status (nothing by mouth) to prevent aspiration of gastric contents into the lungs.
• Intravenous fluids for hydration and maintenance of electrolyte balance.

Surgical Repair:

• The surgery aims to close the fistula and connect the esophagus segments.
• The surgeon may approach the repair through a thoracotomy (incision in the chest) or a minimally invasive procedure.

Post-operative Care:

• Respiratory Management:
  • Monitor respiratory status closely for signs of respiratory distress or compromise.
  • Maintain proper positioning to prevent aspiration.
  • Suctioning of secretions to keep the airway clear.
• Nutritional Support:
  • Gradual introduction of enteral feeds post-operatively.
  • Feeding may start with parenteral nutrition and advance to nasogastric or gastrostomy tube feeding as tolerated.
• Pain Management:
  • Administer appropriate analgesics to manage post-operative pain.
  • Monitor for signs of discomfort or distress.
• Monitoring and Assessment:
  • Continuous monitoring of vital signs, oxygen saturation, and respiratory effort.
  • Assess for signs of infection, such as fever or increased secretions.
• Parent Education:
  • Provide education on post-operative care, including feeding techniques, signs of complications, and follow-up appointments.
  • Support parents emotionally, as they may be anxious about their child’s condition and recovery.
• Early Mobilization:
  • Encourage early mobilization and gentle handling to promote recovery and prevent complications such as atelectasis or pneumonia.
• Follow-up Care:
  • Schedule regular follow-up appointments with the surgical team to monitor the child’s progress and address any concerns.

By providing comprehensive pre- and post-operative nursing care, nurses play a crucial role in ensuring the successful management and recovery of infants with TEF.

(2 )

💗 (a) Define Juvenile diabetes -01

Juvenile diabetes, also known as Type 1 diabetes mellitus (T1DM), is a chronic autoimmune condition in which the pancreas produces little to no insulin. Insulin is a hormone essential for regulating blood sugar (glucose) levels and allowing glucose to enter cells for energy. Without enough insulin, glucose accumulates in the bloodstream, leading to high blood sugar levels.

💗 (b) Mention the causes and clinical manifestations.- 04

Causes:

1. Autoimmune Destruction: In T1DM, the body’s immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. The exact cause of this autoimmune response is not fully understood but likely involves a combination of genetic and environmental factors.
2. Genetic Predisposition: Certain genetic factors increase the risk of developing T1DM, although not everyone with these genetic markers will develop the condition.
3. Environmental Triggers: Environmental factors such as viral infections or exposure to certain toxins may trigger the autoimmune response in individuals with a genetic predisposition to T1DM.

Clinical Manifestations:

1. Polyuria (Frequent Urination): High blood sugar levels lead to increased urine production as the kidneys work to eliminate excess glucose from the bloodstream.
2. Polydipsia (Excessive Thirst): Dehydration resulting from frequent urination leads to increased thirst.
3. Polyphagia (Excessive Hunger): Despite high blood sugar levels, cells are unable to access glucose for energy, leading to increased hunger.
4. Weight Loss: Inadequate insulin levels prevent cells from using glucose for energy, causing the body to break down fat and muscle tissue for fuel, resulting in unintentional weight loss.
5. Fatigue: Without sufficient glucose for energy production, individuals with T1DM may experience fatigue and weakness.
6. Blurry Vision: High blood sugar levels can cause temporary changes in the shape of the lens of the eye, leading to blurry vision.
7. Slow Healing: Poorly controlled diabetes can impair the body’s ability to heal wounds and fight infections.

💗 (c) Explain the treatment and nursing management for juvenile diabetes 05

Treatment:

1. Insulin Therapy: Since the pancreas does not produce insulin in T1DM, insulin replacement therapy is essential for managing blood sugar levels. Insulin may be administered via injections or an insulin pump, and the dosage and timing are tailored to individual needs.
2. Blood Sugar Monitoring: Regular monitoring of blood glucose levels using a glucose meter helps individuals with T1DM manage their condition and adjust insulin doses as needed.
3. Carbohydrate Counting: Keeping track of carbohydrate intake and matching it with insulin doses helps maintain stable blood sugar levels.
4. Healthy Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins, with limited sugary and processed foods, supports blood sugar control and overall health.
5. Regular Exercise: Physical activity helps lower blood sugar levels and improves insulin sensitivity. Individuals with T1DM should engage in regular exercise as part of their diabetes management plan.
6. Continuous Glucose Monitoring (CGM): CGM systems provide real-time monitoring of glucose levels and can alert individuals to high or low blood sugar levels, helping prevent complications.
7. Education and Support: Diabetes education programs provide information on managing the condition, including insulin administration, blood sugar monitoring, nutrition, and exercise. Support groups offer emotional support and practical tips for coping with diabetes.

Nursing Management:

1. Education: Provide comprehensive education to individuals with T1DM and their families on insulin therapy, blood sugar monitoring, meal planning, and lifestyle modifications.
2. Support Self-Management: Encourage individuals with T1DM to take an active role in managing their condition, including monitoring blood sugar levels, administering insulin, and making healthy lifestyle choices.
3. Monitor for Complications: Regularly assess for signs and symptoms of diabetes-related complications such as hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA), and long-term complications affecting the eyes, kidneys, nerves, and cardiovascular system.
4. Promote Adherence: Support adherence to medication regimens, dietary guidelines, and exercise recommendations by addressing barriers, providing resources, and offering ongoing support and encouragement.
5. Collaborate with Healthcare Team: Work collaboratively with other members of the healthcare team, including physicians, dietitians, and diabetes educators, to ensure coordinated and comprehensive care for individuals with T1DM.
6. Provide Emotional Support: Acknowledge the emotional impact of living with a chronic condition and offer emotional support, counseling, and referrals to mental health professionals as needed.

2 Short Essay (any three)3×5=15

💗 (1) Importance of play and play materials

importance of play and play materials:

Promotes Physical Development:

• Play encourages children to engage in physical activities like running, jumping, and climbing, which support the development of gross motor skills.
• Play materials such as balls, climbing structures, and ride-on toys provide opportunities for children to develop coordination, balance, and strength.

Enhances Cognitive Development:

• Play stimulates imagination and creativity, allowing children to explore new ideas and problem-solving strategies.
• Play materials like puzzles, building blocks, and pretend play props promote cognitive skills such as planning, spatial awareness, and critical thinking.

Supports Social and Emotional Development:

• Play offers opportunities for children to interact with peers, negotiate roles, and practice social skills like sharing, cooperation, and empathy.
• Play materials such as board games, role-playing props, and puppets facilitate social interactions and emotional expression, fostering positive relationships and self-awareness.

Encourages Language Development:

• Play provides a context for language-rich interactions, including storytelling, conversations, and role-playing scenarios.
• Play materials like books, dolls, and toys with sound effects promote vocabulary development, language comprehension, and communication skills.

Fosters Imagination and Creativity:

• Play allows children to explore imaginary worlds, experiment with different roles, and express themselves freely.
• Play materials such as art supplies, dress-up costumes, and open-ended toys encourage imaginative play, fostering creativity and innovation.

Promotes Sensorimotor Exploration:

• Play materials with different textures, shapes, and sensory features stimulate children’s senses and promote sensory exploration.
• Sensory play activities like sand and water play, playdough, and sensory bins support sensory integration and fine motor development.

Facilitates Learning and Mastery:

• Play provides a natural context for learning, where children can engage in hands-on exploration and experimentation.
• Play materials that are age-appropriate and developmentally stimulating support children in mastering new skills and concepts through play-based experiences.

Reduces Stress and Anxiety:

• Play serves as a natural outlet for stress relief and emotional regulation, allowing children to unwind and relax.
• Engaging in playful activities and using play materials can help children manage feelings of stress, anxiety, or frustration in a safe and supportive environment.

Strengthens Parent-Child Relationships:

• Play promotes bonding and attachment between children and caregivers, fostering positive parent-child interactions and communication.
• Joining in play activities with children provides opportunities for caregivers to connect with their child, build trust, and create lasting memories together.

Encourages Lifelong Learning:

• Through play, children develop a love for learning and exploration that can last a lifetime.
• Exposure to a variety of play materials and experiences during childhood lays the foundation for continued curiosity, adaptability, and lifelong learning skills.

Overall, play and play materials play a crucial role in supporting children’s holistic development across physical, cognitive, social, emotional, and linguistic domains. They provide rich opportunities for exploration, learning, and growth in a fun and engaging manner.

💗 (2)Rehabilitation of a borderly mentally retarded child

rehabilitation of a child with borderline intellectual functioning:

Assessment and Diagnosis:

• Conduct comprehensive assessments to understand the child’s cognitive abilities, strengths, and challenges.
• Obtain medical history and conduct psychological evaluations to diagnose borderline intellectual functioning (BIF).

Individualized Education Plan (IEP):

• Develop an IEP tailored to the child’s specific needs and abilities.
• Include goals and objectives focused on improving academic, social, and adaptive skills.

Educational Interventions:

• Provide specialized instruction in academic subjects, focusing on areas of difficulty.
• Utilize evidence-based teaching strategies and accommodations to support learning.
• Offer small group or one-on-one instruction to address individual learning needs.

Therapeutic Interventions:

• Offer cognitive behavioral therapy (CBT) or other appropriate therapies to address emotional and behavioral challenges.
• Provide speech and language therapy to improve communication skills.
• Occupational therapy can help develop fine motor skills and improve independence in daily activities.

Social Skills Development:

• Implement social skills training to enhance interpersonal relationships and peer interactions.
• Encourage participation in group activities and cooperative learning experiences.
• Foster opportunities for positive social interactions and friendship development.

Family Involvement:

• Engage parents/guardians in the child’s rehabilitation process.
• Provide education and support to families on how to best support their child’s development.
• Collaborate with families to set goals and reinforce interventions at home.

Community Support:

• Connect the child and family with community resources and support services.
• Advocate for inclusion in community activities and programs.
• Facilitate partnerships with local organizations to provide additional support and opportunities for the child.

Progress Monitoring and Adjustment:

• Regularly assess the child’s progress towards IEP goals and objectives.
• Modify interventions as needed based on ongoing assessment data and feedback.
• Collaborate with interdisciplinary team members to ensure a holistic approach to rehabilitation.

Transition Planning:

• Develop a transition plan to support the child’s transition to adulthood.
• Include vocational training, independent living skills, and post-secondary education options.
• Involve the child, family, and relevant stakeholders in the transition planning process.

Advocacy and Support:

• Advocate for the child’s rights and inclusion in all aspects of society.
• Provide ongoing support and encouragement to the child and family.
• Collaborate with community agencies and organizations to promote awareness and acceptance of individuals with intellectual disabilities.

💗 (3) Thalassemia

thalassemia:

1. Definition: Thalassemia is a genetic blood disorder characterized by abnormal hemoglobin production, leading to anemia.
2. Types: There are two main types: alpha thalassemia and beta thalassemia, each with different subtypes.
3. Genetics: Thalassemia is inherited through autosomal recessive genes, meaning both parents must carry the mutated gene for a child to inherit the disorder.
4. Symptoms: Symptoms vary depending on the type and severity but often include fatigue, weakness, pale skin, jaundice, and growth delay in children.
5. Diagnosis: Diagnosis involves blood tests to measure hemoglobin levels and identify abnormal red blood cells. Genetic testing may also be done to confirm the type of thalassemia.
6. Treatment: Treatment depends on the type and severity of thalassemia. Options include blood transfusions, iron chelation therapy to remove excess iron, folic acid supplements, and in severe cases, bone marrow or stem cell transplantation.
7. Complications: Complications can arise from untreated or poorly managed thalassemia, including iron overload leading to organ damage, bone deformities, infections, and heart problems.
8. Prevention: Since thalassemia is genetic, prevention involves genetic counseling and testing for carriers before conception. Prenatal testing can also be done to diagnose thalassemia in utero.
9. Global Impact: Thalassemia is most common in Mediterranean, Middle Eastern, and Southeast Asian populations but can occur in any ethnic group. It presents a significant public health burden in affected regions.
10. Research and Awareness: Ongoing research aims to improve treatment options, including gene therapy and new drug developments. Increasing awareness about thalassemia and the importance of carrier screening is crucial for prevention and early intervention.

💗 (4) Psychosocial and cognitive development of toddler

psychological and cognitive development of toddlers:

Sensorimotor Stage (Birth to 2 years):

• Reflexes (0-1 month): Newborns primarily rely on reflexes like sucking, grasping, and rooting.
• Primary Circular Reactions (1-4 months): Infants start to repeat actions that bring pleasure, like sucking their thumb.
• Secondary Circular Reactions (4-8 months): Infants become more interested in the environment, exploring objects and their properties.
• Coordination of Secondary Reactions (8-12 months): They begin to understand cause and effect, like dropping a toy to see it fall.
• Tertiary Circular Reactions (12-18 months): Toddlers start experimenting with different actions to see the outcomes, like banging objects.
• Beginning of Symbolic Thought (18-24 months): They engage in pretend play and understand symbols, like using a block as a phone.

Language Development:

• Babbling (6-12 months): Babies start producing repetitive consonant-vowel sounds.
• First Words (12-18 months): They begin to say simple words, usually nouns like “mama” or “dada.”
• Vocabulary Expansion (18-24 months): They rapidly acquire new words and may start combining words to form simple sentences.

Social and Emotional Development:

Attachment (0-6 months): Babies form strong bonds with primary caregivers.

• Stranger Anxiety (6-12 months): They may become wary of unfamiliar people.
• Temperament (12-18 months): Individual differences in behavior become more apparent.
• Self-Awareness (18-24 months): Toddlers start to recognize themselves in the mirror and understand basic emotions.

Cognitive Development:

• Object Permanence (4-8 months): Infants begin to understand that objects continue to exist even when they are out of sight.
• Symbolic Play (18-24 months): They engage in pretend play, using objects to represent other things.
• Problem-Solving (18-24 months): Toddlers start to solve simple problems, like figuring out how to stack blocks or fit shapes into a sorter.
• Imitation (12-18 months): They mimic the actions of others, which helps in learning new skills and behaviors.

Motor Development:

• Gross Motor Skills: Toddlers learn to crawl, walk, run, jump, and climb.
• Fine Motor Skills: They develop the ability to pick up small objects, feed themselves, and eventually scribble with crayons.

💗 (5) Pyloric Stenosis

Pyloric stenosis is a condition characterized by narrowing or obstruction of the pylorus, the muscular valve between the stomach and the small intestine. This narrowing prevents food from passing into the intestine, leading to symptoms such as vomiting, poor feeding, and dehydration. Here’s a detailed breakdown of pyloric stenosis, including its clinical manifestations, surgical management, and nursing care for a two-year-old male child:

Definition: Pyloric stenosis is a narrowing or obstruction of the pylorus, the opening between the stomach and the small intestine, usually due to hypertrophy or thickening of the muscle surrounding the pylorus.

Clinical Manifestations:

1. Projectile Vomiting: Forceful vomiting that typically occurs shortly after feeding, often described as “projectile” due to its distance and intensity.
2. Hunger and Poor Feeding: Despite frequent vomiting, infants may continue to appear hungry and may feed eagerly, only to vomit shortly afterward.
3. Palpable Olive-Shaped Mass: A firm, olive-shaped mass may be palpable in the upper abdomen, representing the hypertrophied pyloric muscle.
4. Dehydration and Weight Loss: Prolonged vomiting can lead to dehydration, electrolyte imbalances, and weight loss, resulting in lethargy, decreased urine output, and dry mucous membranes.
5. Hypochloremic Metabolic Alkalosis: Loss of hydrochloric acid and chloride ions through vomiting can lead to metabolic alkalosis, characterized by elevated serum bicarbonate levels and low serum chloride levels.

Surgical Management:

1. Pyloromyotomy: The primary treatment for pyloric stenosis is a surgical procedure called pyloromyotomy. During this procedure, the hypertrophied muscle of the pylorus is incised longitudinally to relieve the obstruction while preserving the mucosa and surrounding structures.
2. Laparoscopic Approach: In some cases, pyloromyotomy may be performed laparoscopically, using minimally invasive techniques with smaller incisions and specialized instruments.
3. Preoperative Preparation: Prior to surgery, the child may undergo preoperative assessment, including laboratory tests, hydration status evaluation, and correction of electrolyte imbalances if present.

Nursing Management:

Preoperative Nursing Care:

• Assess the child’s hydration status, vital signs, and electrolyte levels.
• Administer intravenous fluids as needed to correct dehydration and electrolyte imbalances.
• Provide comfort measures, such as swaddling and positioning to reduce distress.

Postoperative Nursing Care:

• Monitor vital signs, intake and output, and signs of dehydration or electrolyte imbalances closely.
• Assess the surgical incision site for signs of infection, bleeding, or dehiscence.
• Initiate oral feedings gradually, starting with clear fluids and advancing to formula or breast milk as tolerated.
• Educate caregivers on signs of complications, such as fever, vomiting, or refusal to eat, and when to seek medical attention.

Pain Management:

• Administer pain medication as prescribed to relieve discomfort and promote comfort.
• Use non-pharmacological pain management techniques, such as distraction or comforting measures.

Parental Education:

• Provide education to parents on the child’s condition, surgical procedure, and postoperative care requirements.
• Instruct parents on feeding techniques, including burping the child frequently and feeding in an upright position to reduce the risk of vomiting.
• Review signs of surgical site infection, wound care instructions, and follow-up care.

3 Very Short Essay: (Write All) 6×2=12

💗 (1) Convulsion

A convulsion is a sudden, uncontrolled contraction of muscles, often accompanied by rigidity and jerking movements. It can be caused by various factors such as epilepsy, fever, or neurological disorders.

💗 (2) Rickets

Rickets is a condition primarily affecting children, characterized by softening and weakening of the bones. It’s usually caused by a lack of vitamin D, calcium, or phosphate, leading to impaired bone mineralization. Common symptoms include bone pain, skeletal deformities, and delayed growth. Treatment typically involves supplementation with vitamin D and calcium, along with adequate exposure to sunlight.

💗 (3) Hypospadiasis

Hypospadias is a congenital condition where the urethral opening is located on the underside of the penis, rather than at the tip. It occurs during fetal development when the urethral folds fail to fully close, resulting in a misplacement of the urethral opening. The severity can vary, with some cases only affecting the location of the opening, while others involve curvature of the penis. Surgical correction is usually necessary to reposition the opening to the tip of the penis and improve urinary and sexual function.

💗 (4) Spina bifida

Spina bifida is a congenital condition characterized by incomplete closure of the spinal column during fetal development. This can result in varying degrees of spinal cord and nerve damage. There are three main types of spina bifida:

1. Spina Bifida Occulta: This is the mildest form, where there’s a small gap in one or more of the vertebrae, but the spinal cord and nerves are usually unaffected. It might not cause any symptoms or might cause minor issues like a dimple, birthmark, or tuft of hair on the skin over the affected area.
2. Meningocele: In this type, the protective covering around the spinal cord (meninges) pushes out through the opening in the vertebrae to form a sac filled with cerebrospinal fluid. Usually, the spinal cord remains intact, but there might be some nerve damage.
3. Myelomeningocele (or Spina Bifida Cystica): This is the most severe type, where the spinal cord and nerves protrude through the gap in the spine, forming a sac outside the body. This can cause varying degrees of nerve damage, leading to paralysis, bowel and bladder problems, orthopedic issues, and sometimes hydrocephalus (excess fluid in the brain).

💗 (5) Autism

Autism in children is a developmental disorder that affects communication, social interaction, and behavior. It’s characterized by repetitive behaviors, difficulty with verbal and nonverbal communication, and challenges with social interactions. Early diagnosis and intervention can greatly improve outcomes.

💗 (6) Asthma

Asthma is a chronic respiratory condition where the airways become inflamed and narrowed, leading to difficulty breathing, wheezing, coughing, and chest tightness. It’s often triggered by allergens, exercise, cold air, or stress. Treatment includes medication to control symptoms and prevent attacks, along with avoiding triggers when possible.