NURSING IN PEDIATRICS Chapter 1

Requirements of the state educational standard for the level of training of specialists in the field of nursing in pediatrics
for the specialty “Nursing”

The nurse must:

– know the system of organization of medical care for children;

– know the causes, clinical manifestations, diagnostic methods, complications, principles of treatment and prevention of diseases in children;

– be able to prepare the patient for special diagnostic methods;

– be able to implement and document the individual stages of the nursing process in caring for children;

– be able to provide first aid in emergency conditions in children.

Problem-situational tasks

Task #1

Hospital treatment. Girl 11 years old. Diagnosis: influenza. During a nursing examination, the nurse received the following data: complaints of severe headache, dizziness, repeated vomiting, sleep disturbance, general weakness. He considers himself ill for two days, when for the first time the temperature rose to 39.8º C and the phenomena of weakness, weakness, delirium appeared. Objectively: position in bed is passive. In consciousness, but inhibited, the skin is pale, dry, the respiratory rate is 30 per minute, the pulse is 160 beats per minute, blood pressure is 140/60 mm. rt. Art. Slight hyperemia of the pharynx, temperature during examination 39.6º C.

Appointed:

S. Analgini 50% – 1.0 – intramuscularly.

S. Dimedroli 1% – 1.0 – intramuscularly.

S. Dibazoli 1% – 1.0 – intramuscularly.

Paracetamol 0.5×4 times a day.

Plentiful alkaline drink.

Askorutin 1 tablet x 3 times a day

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and draw up a nursing intervention plan with motivation.

3. Demonstrate oxygen therapy using a nasal catheter.

4. Rules for the use of an ice pack.

Sample answers

1. Violated needs: maintain normal body temperature, eat, sleep, communicate, move, excrete, study, be healthy.

Patient problems:

Real:

– fever,

– headache,

– vomit,

– sleep disturbance,

– anxiety about the outcome of the disease;

Potential:

– asphyxia with vomit,

– deterioration of the condition associated with the development of complications.

2. The patient’s priority problem is fever.

Short-term goal: reduce fever over the next five days to subfebrile numbers.

Long-term goal: normalization of temperature by the time of discharge.

Plan Motivation
Nurse:
1. Provide the patient with physical and psychological peace. 1. To improve the patient’s condition.
2. Organizes an individual nursing post for the care of the patient. 2. To monitor the patient’s condition.
3. Provides abundant fluid intake (plentiful alkaline drink for 2 days). 3. To prevent dehydration
4. Talk to relatives about providing additional food. 4. To compensate for the loss of protein and increase the protective forces.
5. Measure body temperature every 2 hours. 5. To monitor the patient’s condition
6. Apply physical cooling methods: – cover with a sheet or light blanket. – Uses a cold compress or ice pack 6. To reduce body temperature
7. Lubricate lips with vaseline oil 3 times a day. 7. To moisturize the skin of the lips
8. will ensure the intake of liquid or semi-liquid food 6-7 times a day 8. For better absorption of food.
9. Provides thorough care for the patient’s skin and mucous membranes. 9. For the prevention of inflammatory processes of the skin and mucous membranes
10. Provide change of underwear and bed linen as needed. 10. To ensure patient comfort.
11. Will observe the appearance and condition of the patient. 11. For early diagnosis and timely provision of emergency care in case of complications.
12. will carry out doctor’s orders. 12. To treat a patient.

Evaluation: the patient will note a significant improvement in health, body temperature 37.4º C. The goal will be achieved.

Task #2

Active visit to a nurse for a 4-year-old boy. Diagnosis: SARS.

During a nursing examination, the sister received the following data: the child began to eat poorly, the cough bothered, which intensified and was dry, painful. According to my mother, the second day is sick. First there was a runny nose, cough, then the temperature rose to 38.2º C.

Objectively: the child is active, the temperature is 37.3º C, nasal breathing is difficult, mucous discharge from the nasal passages. Frequent dry cough, respiratory rate 28 per minute, heart rate – 112 per minute, pharynx – moderate hyperemia, no raids.

Medical appointments:

– at a temperature above 38.3º C paracetamol 0.2

– complex drops in the nose, 3 drops 5-6 times a day, in both nasal passages.

– distraction therapy.

– cough medicine

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and create a nursing intervention plan with motivation.

3. Teach mom the technique of oil inhalation.

4. Demonstrate the technique of placing mustard plasters on the chest.

Sample answers

1. Violated needs: eat, breathe, sleep, rest, communicate, maintain normal body temperature, be healthy.

Patient problems:

Real:

– dry cough

– ineffective airway clearance

– fever

– loss of appetite

Potential:

– deterioration of the patient’s condition associated with the development of complications.

2. The patient’s priority problem is dry cough.

Short-term goal: The patient will report a decrease in the frequency and duration of coughing by the end of the week.

Long-term goal: no cough at discharge.

Plan Motivation
Nurse:
1. Provides a warm drink that does not irritate the mucous membranes.
2. Place the patient in Fowler’s position.
3. Provides the implementation of the simplest physiotherapy procedures (mustard plasters, warming compresses, mustard foot baths) as prescribed by the doctor. In order to change the nature of the cough and facilitate breathing.
4. Provide the patient with inhalations (oil, eucalyptus and others) as prescribed by the doctor.
5. Talk to relatives about providing additional food to the patient. To compensate for the loss of protein and increase the protective forces.
6. Ensure that you take antitussive drugs as prescribed by your doctor To reduce cough.

Evaluation: the patient’s condition will improve significantly, the frequency and duration of cough will decrease. The goal will be reached.

Task #3

A 10-year-old boy is in hospital. Diagnosis: rheumatism, active phase, polyarthritis.

During a nursing examination, the nurse received the following data: the boy complains of pain in the left knee joint, because of the pain he does not get up, he cannot change the position of his leg in bed. Prior to that (3-4 days ago) I was worried about pain in the right ankle joint. In history, three weeks ago he had a sore throat.

Objectively: the temperature is 37.8º C. The skin is pale, clean, blue shadows under the eyes, the position in bed is passive. The left knee joint is hot to the touch, round in shape, enlarged in size, painful movements. Pulse – 100 beats per minute, NPV – 22 per minute.

Medical appointments:

– aspirin 0.5 x 4 times a day after meals,

– ampioks intramuscularly 500 thousand units. x 4 times a day,

– strict bed rest.

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and create a nursing intervention plan with motivation.

3. Demonstrate applying a cold compress to the area of the affected joint.

4. Teach the patient how to take aspirin.

Sample answers

1. Violated needs: to move, dress and undress, maintain body temperature, sleep, rest, be healthy.

Patient problems:

real:

– limitation of physical activity

– joint pain

– fever

potential:

– risk of bed sores

– risk of constipation

– the risk of disruption of life associated with a lack of rest.

2. The patient’s priority problem is joint pain

Short term goal: relieve pain within 1-2 days.

Long-term goal: the patient will be adjusted to his condition and life in society by the time of discharge.

Plan Motivation
Nurse:
1. Provide the patient with physical and mental peace; 2. Will provide a forced position for the patient in bed; 3. Carry out a set of measures for patient care; 4. Ensure the application of a cold compress to the joint area (as prescribed by a doctor); 5. Will carry out the simplest complex of exercise therapy and massage (as prescribed by a doctor); 6. Conduct a conversation with relatives about the psychological support of the patient, about the sparing mode of his physical activity; 7. Conduct a conversation with the patient about physical inactivity and its consequences; 8. Ensure the fulfillment of doctor’s prescriptions. 1. To improve the patient’s condition. 2. To reduce pain. 3. To comply with the rules of personal hygiene. 4. To reduce pain. 5. For the prevention of hypodynamia and bedsores. 6. To facilitate the patient’s adaptation to his condition. 7. For the prevention of hypodynamia. 8. To treat a patient.

Evaluation: the patient’s condition will improve significantly, pain in the joint will decrease. The goal will be reached.

Task #4

A 12-year-old girl is hospitalized. Diagnosis: acute glomerulonephritis, edematous form. During a nursing examination, the nurse received the following data: complaints of general weakness, poor appetite, headache, swelling of the face and legs. He considers himself ill for 2 weeks, when these complaints first appeared. History: frequent SARS, tonsillitis, dental caries. Objectively: the skin is pale, clean, the face and legs are pasty. Pulse – 104 per minute, blood pressure – 130/80 mm. rt. Art., NPV – 20 per minute. Abdomen of the correct form, soft, painless.

Medical appointments: strict bed rest, table number 7, taking into account diuresis.

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and create a nursing intervention plan with motivation.

3. Teach the patient the rules of personal hygiene.

4. Control of diuresis. The concept of “water balance”.

Sample answers

1. Violated needs: eat, drink, excrete, be healthy.

Patient problems:

real:

– swelling on the face and legs

– loss of appetite

– headache

– weakness

potential:

– the risk of deterioration of the patient’s condition associated with the development of complications.

Priority problem: swelling on the face and legs.

2. Short term goal: reduce swelling in the face and legs by the end of the week.

Long-term goal: Relatives will demonstrate knowledge of nutritional and drinking habits by the time of discharge.

Plan Motivation
Nurse:
1. Explain to relatives and the patient about the need to follow a diet with salt restriction, enriched with proteins and potassium salts (table No. 7); 2. Provide verification of transmissions; 3. Provides care for the skin and mucous membranes; 4. Will determine the patient’s water balance daily; 5. Provides control over the patient’s physiological regimen; 6. Provide the patient with a warm vessel; 7. Provide heating pads to warm the bed; 8. Will weigh the patient once every 3 days; 9. Ensure the intake of medicines as prescribed by the doctor. 1. For the prevention of complications. 2. To monitor compliance with the diet. 3. To comply with the rules of personal hygiene. 4. To control the dynamics of edema. 5. To control the dynamics of edema. 6. To improve microcirculation. 7. To improve microcirculation. 8. To control the dynamics of edema. 9. To treat a patient.

Evaluation: the patient’s condition will improve, swelling will decrease. The goal will be reached.

Task #5

A 10-year-old boy is in hospital. Diagnosis: thrombocytopenic purpura. During the nursing examination, the nurse received the following data: complaints of nosebleeds, which appeared a few minutes ago (during the game). The skin is pale, multiple hemorrhages in the form of spots of various sizes, shapes, randomly located, of various colors (purple, blue, green, yellow). Sick for 2 years, deterioration occurred during the last week (suffered SARS), hemorrhages appeared on the skin and oral mucosa. Anxious.

Objectively: conscious, oriented, contact. The skin is pale, respiratory rate is 22 per minute, pulse is 112 per minute, blood pressure is 100/60 mm Hg.

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and draw up a nursing intervention plan with motivation.

3. Teach the patient how to stop nosebleeds.

4. Demonstrate the technique of anterior nasal packing.

Sample answers

1. Violated needs: eat, drink, breathe, be healthy.

Patient problems:

real:

– nose bleed,

– anxiety,

– hemorrhages on the skin.

potential:

– the risk of complications.

2. The patient’s priority problem is nosebleeds.

Short term goal: stop nosebleeds within 3 minutes.

Long-term goal: Relatives will demonstrate knowledge of how to stop nosebleeds at home.

Plan Motivation
Nurse:
1. Provide the patient with a horizontal position with a raised head (do not tilt the head back); 2. Provide the patient with a cold compress on the bridge of the nose and the back of the head; 3. Provide the patient with cotton swabs soaked in 3% hydrogen peroxide solution into the nasal passages; 4. Provides the patient with physical and psychological peace 5. Ensures the fulfillment of doctor’s prescriptions 6. Holds a conversation with relatives 1. To prevent aspiration of blood. 2. To constrict blood vessels. 3. To stop bleeding. 4. To improve the patient’s condition 5. To treat the patient 6. To teach medical care for nosebleeds.

Evaluation: Nosebleed stopped. The goal will be reached.

Task #6

Patronage, the age of the child is 1 month.

During a nursing examination, the nurse received the following data: the child is wrapped in a flannel blanket, a scarf is on his head. The room is stuffy, the air temperature is 28º C, the window is closed. The child is restless, screaming, the skin is moist to the touch, the skin is hyperemic, small punctate rash, especially a lot of rash in the axillary and inguinal folds. Appetite is good, sucks actively.

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and draw up a nursing intervention plan with motivation.

3. Explain to the mother the rules of child care.

4. Demonstrate the technique of conducting a hygienic bath.

Sample answers

1. Violated needs: to dress and undress, to be clean, to be healthy.

Patient problems:

real:

– prickly heat,

– changes in the skin in the area of natural folds,

– Anxiety, skin rashes.

potential:

– violation of a comfortable state due to improperly selected clothing.

2. The priority problem is prickly heat.

Short-term goal: reduction of skin rashes within 1-2 days.

Long-term goal: Skin rashes will disappear or significantly decrease within 1 week.

Plan Motivation
Nurse:
1. Provide hygiene for the patient’s skin (rubbing, hygienic bath with a solution of string, chamomile, etc.); 2. Ensure that the child is dressed according to the ambient temperature (do not overwrap); 3. Provides a hygienically correct sleep for the child (only in his own bed, not in a stroller, not with his parents); 4. Hold a conversation with relatives about the proper washing of underwear (wash only with baby soap, rinse twice, iron on both sides); 5. Conducts hygienic cleaning of the room 2 times a day, 3 times a day to air for 30 minutes (temperature in the room 20-22 ° C); 6. Will follow the doctor’s orders. 1. To reduce skin rashes. 2. To reduce skin rashes and prevent recurrence. 3. To reduce skin rashes and prevent recurrence. 4.. To reduce skin rashes and prevent recurrence. 5. To comply with the hygienic regime and enrich the air with oxygen 6. For the health of the child.

Evaluation: skin rashes will be significantly reduced. The goal will be reached.

Task #7

Patronage for a 5 month old baby. Mom reported that the child is restless, sleep and appetite are disturbed, the child has itchy skin and rashes on the head. The child from the 1st pregnancy, the 1st birth, was born full-term. Breastfed since birth.

During a nursing examination, the nurse received the following data: the child is restless, the skin of the cheeks is hyperemic, there are scratches on the limbs, extensive seborrheic crusts on the scalp. Respiratory rate 38 per minute, pulse 132 per minute.

Mom connects the disease with the introduction of milk porridge. Mom (as a child) had persistent skin rashes.

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and create a nursing intervention plan with motivation.

3. Have a conversation with mom about rational feeding.

4. Demonstrate the technique of conducting a therapeutic bath.

Sample answers

1. Violated needs: eat, drink, sleep, rest, be clean, be healthy.

Patient problems:

real:

itching of the skin,

decreased appetite,

bad dream.

potential:

high risk of infection associated with a violation of the integrity of the skin.

2. The priority problem is itching of the skin.

Short-term goal: Patient will experience less itching by the end of the week.

Long-term goal: pruritus will be significantly reduced or gone by the time of discharge.

Plan Motivation
Nurse:
1. ensure the hygiene of the patient’s skin (rubbing, shower, bath); 2. ensure that the patient’s skin is wiped with an antiseptic solution as prescribed by the doctor; 3. ensure strict adherence to the prescribed diet; 4. hold conversations with the patient and his relatives about strict adherence to the diet; 5. convince the patient of the need to change the patient’s underwear and bed linen. 6 Will follow doctor’s orders. 1. To reduce rashes. 2. To reduce itching. 3. To reduce itching and skin rashes. 4. For the prevention of skin rashes. 5. To comply with the rules of personal hygiene. 6. To improve the patient’s condition.

Evaluation: pruritus will be significantly reduced. The goal will be reached.

Task #8

Active visiting of the child of 3 months of life. On artificial feeding from 1.5 months. age, suffers from constipation. During a nursing examination, the nurse received the following data: there was no stool for two days, the child is restless, screaming, he presses his legs to his stomach, twists his legs, the skin is clean. The abdomen is moderately swollen, the gases do not go away, the body temperature is 36.7º C, the pulse is 132 bpm, the respiratory rate is 44 per minute.

Examined by a pediatrician, diagnosis: constipation.

Assigned: cleansing enema or gas tube.

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and draw up a nursing intervention plan with motivation.

3. Conversation with mom about rational feeding.

4. Demonstrate the cleansing enema technique.

Sample answers

1. Violated needs: eat, drink, excrete, sleep, rest, be healthy.

Patient problems:

real:

– violations of bowel movements (constipation),

– eating disorders, anxiety.

potential:

– life risk associated with impaired bowel movements,

– the risk of complications.

2. The priority problem is a violation of bowel movement (constipation).

Short-term goal: the patient will have a chair at least 1 time per day (time is individual).

Long-term goal: Relatives will demonstrate knowledge of how to deal with constipation.

Plan Motivation
Nurse:
1. provide a sour-milk-vegetarian diet (cottage cheese, kefir, vegetable broth, fruit juices and puree); 2. will provide sufficient fluid intake (sour-milk products, juices) depending on appetite; 3. will try to develop a conditioned reflex in the patient to defecate at a certain time of the day (for example, in the morning after eating); 4. provide massage, gymnastics, air baths; 5. provide the setting of a cleansing enema, a gas outlet tube, as prescribed by a doctor; 6. will record the daily frequency of stools in the medical records; 7. will teach relatives the peculiarities of nutrition in case of constipation; 8. Recommends the expansion of the mode of physical activity. 1. To normalize intestinal motility. 2. To normalize intestinal motility. 3. For regular bowel movements. 4. To improve the general condition of the patient. 5. For bowel movements. 6. To monitor bowel movements. 7. For the prevention of constipation. 8. To normalize intestinal motility.

Evaluation: the patient’s stool is normal (1 time per day). The goal will be reached.

Task #9

A 6-year-old girl is hospitalized. Diagnosis: acute pyelonephritis. During a nursing examination, the nurse received the following data: general weakness, loss of appetite, body temperature 38.6º C. The girl is lethargic, capricious. Complains of abdominal pain and painful and frequent urination. The skin is pale, clean. Tongue dry, covered with white coating. The abdomen is soft. Respiratory rate 26 per minute, pulse 102 per minute.

From the anamnesis: sick for the last 3 days. On the eve of the illness, she fell into cold water.

Urine cloudy, little urine, frequent urination.

Appointed: washing away, collecting urine for general analysis, urine analysis according to Nechiporenko.

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and create a nursing intervention plan with motivation.

3. Teach mom the rules for collecting urine for tests.

4. Demonstrate the Zimnitsky urinalysis technique.

Sample answers

1. Violated needs: excrete, eat, drink, maintain normal body temperature, be healthy.

Patient problems:

real:

– frequent urination,

– fever,

– loss of appetite,

– Pain when urinating.

potential:

– the risk of violation of the integrity of the skin in the folds of the perineum.

2. The patient’s priority problem is frequent urination.

Short-term goal: reduce urinary frequency by the end of the week.

Long-term goal: Relatives demonstrate knowledge of risk factors (hypothermia, personal hygiene, nutrition) by the time of discharge.

Plan Motivation
The nurse will provide:
1. dietary nutrition (avoid spicy and fatty foods, the amount of liquid should be in accordance with the doctor’s recommendations). 2. change of the patient’s underwear and bed linen as it gets dirty. 3. regular washing of the patient and lubrication of the perineum 2-3 times a day with vaseline oil. 5. Patient’s urinal. 5. disinfection of the urinal. 6. regular ventilation of the room 3-4 times a day for 30 minutes. 7. psychological support for relatives and the patient. 8. ensure the intake of medicines as prescribed by the doctor. 9. hold conversations with relatives about the need for diet, personal hygiene, the need to avoid hypothermia. 1. To normalize the water balance. 2. To comply with the rules of personal hygiene of the patient. 3. To maintain hygiene of the perineum. 4. To empty the bladder. 5. To comply with the rules of infectious safety. 6. To enrich the air with oxygen. 7. To relieve suffering. 8. To treat a patient. 9. For the prevention of complications.

Evaluation: The frequency of urination will decrease. The goal will be reached.

Task #10

A 13-year-old boy is observed in the children’s department. Diagnosis: diabetes mellitus, severe insulin-dependent, ketoacidosis. During a nursing examination, the nurse received the following data: general weakness, thirst, headache, polyuria, pruritus, increased appetite, acetone breath odor.

From the anamnesis: 1.5 months ago there was a head injury (fell, hit his head), he was not hospitalized. Then, for a month, he felt bad – general weakness, headache, thirst, excretion of large amounts of urine. The reason for hospitalization was the loss of consciousness. Stayed in the department for the 4th day. My grandmother, according to my mother, has type II diabetes.

Objectively: conscious, oriented in time and space. Complains of fatigue, sleeps a lot. He is reluctant to make contact, does not believe in the success of the treatment, expresses fear for his future. The skin is pale, dry to the touch. Blush on the lips. Multiple scratches on the skin of the limbs, torso. Thirst, smell of acetone in exhaled air. The mucous membranes of the mouth are bright. The pupils are constricted, react to light. The belly is soft b/b. Respiratory rate 20-22 per minute, pulse 96 bpm, BP 90/50 mm Hg.

Tasks

1. Identify which needs are violated, the patient’s problems, their rationale.

2. Define goals and create a nursing intervention plan with motivation

3. Conversation with mom about diet for diabetes.

4. Demonstrate the technique of subcutaneous injection of insulin.

Sample answers

1. Violated needs: eat, drink, be healthy.

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