NURSING IN PEDIATRICS Chapter 5

Evaluation: the patient will note a significant improvement in the condition, reduction of itching, reduction of rash. The goal will be reached.

Problem #35

A child at the age of 4 days is in the ward of joint stay of the child and mother.

During the feeding of the child, the nurse revealed the following data: during several feedings, the child is very worried at the breast, with difficulty grasping the nipple. The mother notes that there is a lot of milk, the mammary glands have become dense, effective pumping is not obtained. Childbirth 1 urgent b / features.

Objectively: the child’s condition is satisfactory. Skin and mucous membranes are clean. Transitional chair. Reflexes of newborns are well expressed.

From the bottle greedily sucks expressed breast milk. The mammary glands of the mother are dense, hot to the touch, the vascular network is well expressed.

Tasks

1. Find out what needs are being violated.

2. Identify current and potential problems. Select priorities.

3. Make a nursing intervention plan with motivation.

4. Talk about preparing mother and baby for feeding.

5. Demonstrate the technique of washing and swaddling a newborn.

Sample answers

1. Satisfaction of needs is disturbed: eat (drink), excrete, sleep (rest), be clean, maintain a state

Child problems:

– inefficient feeding

– lack of mother’s knowledge of preparing for feeding

– dyspepsia (physiological)

– restlessness and sleep disturbance due to inefficient feeding

– high risk of dehydration

– high risk of weight loss

Potential problems: high risk of diaper rash, dehydration and weight loss.

Priority issues:

– lack of mother’s knowledge of preparing for feeding,

– inefficient feeding.

2. Short term goal: Teach the mother how to pump properly and breastfeeding

Long-term goal: Feeding the baby will be effective.

Plan Motivation
1. The nurse will teach the mother how to express milk. 1. For the purpose of timely emptying of the breast
2. The nurse will recommend that the mother express 2-3 drops of milk before feeding. 2. For effective latch on of the nipple
3. The nurse will help you properly place the nipple in your baby’s mouth. 3. For effective sucking
4. The nurse will advise the mother to express milk after feeding. 4. In order to prevent milk stagnation
5. The nurse will recommend frequent swaddling to the mother. 5. To prevent diaper rash
6. The nurse will monitor the baby’s suckling activity and the mother’s lactation status 6. In order to prevent dehydration and weight loss
The nurse will warn the mother to control before feeding: free nasal breathing no signs of cooling or overheating clean and dry linen

Evaluation: The nurse will check the effectiveness of the baby’s suckling, assess the condition of the mammary glands and lactation.

1. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her the causes and prevention of hypogalactia in an accessible, competent and reasoned manner.

2. The student will demonstrate the correctly chosen method of preparing the mother and child for feeding.

3. The student will demonstrate the manipulation on the model in accordance with the algorithm adopted in this educational institution.

Problem #36

A mother with a 4-year-old child turned to the district pediatrician for an appointment. After examination, the diagnosis was made: enterobiasis. During a nursing examination, the following data were obtained: complaints of itching in the perianal region, abdominal pain, loss of appetite, nausea, sleep disturbance, and bedwetting is also noted. The girl, according to her mother, became capricious, irritable. These symptoms appeared about 2 weeks ago. Objectively: the girl is active, the skin is pale, the abdomen is soft, slightly painful on palpation around the navel, traces of scratching around the anus.

Appointments:

1. A smear for enterobiasis.

2. Pyrantel 10 mg/kg after taking the analysis once.

3. Recommendations for the treatment of all family members.

Tasks

1. Identify what needs are met and the problems of a sick child.

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

3. Explain to the mother the need to comply with the sanitary and epidemiological regime.

4. Teach the mother how to prevent enrobiasis.

5. Demonstrate taking a smear for enterobiasis.

Sample answers

1. Satisfaction of needs is disturbed: eat, sleep, excrete, maintain condition, communicate.

Patient problems:

real:

– loss of appetite

– sleep disturbance,

– urinary incontinence,

– abdominal pain,

– itching in the perianal area,

– violation of the integrity of the skin in the perineum,

– irritability.

potential:

– anemia,

– pyoderma in the anus,

– weight loss.

Priority problem: itching in the perianal area.

2. Short-term goal: the child will not complain of itching after taking anthelmintic drugs and treating pyoderma.

Long-term goal: The child will be free of all symptoms of the disease within 10 days.

Plan Motivation
1. The nurse will talk with the mother about the disease, ways of infection. 1. Eliminate the risk of re-infection.
2. The nurse will talk to the mother about the hygiene of bed linen (the need to change it every day or iron it) and daily wet cleaning of the room. 2. Eliminate the risk of infecting others
3. The nurse will prepare the child for the smear. In the morning, without washing the child, before the act of defecation. 3. For diagnostics, taking into account the method of oviposition by the helminth.
4. The nurse will recommend cutting the child’s nails, washing him every day in the evening and in the morning, changing his underwear daily 4. To reduce itching and scratching
5. The nurse will tell you the rules for taking the prescribed drug. 5. For the right treatment

Evaluation: itching in the perianal region will not bother the child from the next day after taking the anthelmintic. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to comply with the sanitary and epidemiological regime.

4. The student will demonstrate to the mother the correct method and rules for the prevention of enterobiasis.

5. The student will demonstrate the manipulation on the model in accordance with the algorithm adopted in this educational institution.

Problem #37

A 6-year-old child is hospitalized with a diagnosis of ascariasis. During the nursing examination, the nurse received the following data: complaints of nausea, vomiting, pain in the navel, loss of appetite, weight loss, fatigue, restless sleep, night terrors. Sick for several weeks. Objectively: the skin is pale, the subcutaneous fat layer is not sufficiently developed, there is pain on palpation in the umbilical region. Chair according to the boy without pathology.

Appointments:

1. Feces on i/worm.

2. General blood test.

3. Decaris 5 mg/kg, once, repeat after 7 days.

4. Diet N 5.

Tasks

1. Identify what needs are being violated and the patient’s problems.

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

3. Explain to the mother the need to comply with the sanitary and epidemiological regime.

4. Teach the mother how to prevent ascariasis.

5. Demonstrate the rules for taking feces for I / worms.

Sample answers

1. Needs are violated: eat, sleep, excrete, maintain condition,

communicate.

Patient problems:

real:

– loss of appetite

– restless sleep

– vomit,

– irritability

– abdominal pain,

– loss of body weight.

potential:

– worsening condition associated with the development of complications (intestinal obstruction, mechanical asphyxia, anemia, etc.).

Priority problem: abdominal pain.

2. Short term goal: Pain will be gone in 5-7 days.

Long-term goal: all symptoms of the disease will disappear by the time of discharge.

Plan Motivation
1. The nurse will ensure the collection of feces for I / worms. 1. To confirm the diagnosis.
2. The nurse will talk to the mother and child about limiting sweets in the child’s diet. 2. To improve appetite.
3. The nurse will teach the child the rules of hygiene, talk about the mechanism of infection with roundworms (wash hands, fruits, etc.). 3. To prevent re-infection.
4. The nurse will follow the doctor’s orders.

Evaluation: by the end of the week, the patient will notice an improvement in the condition, the pain will not bother. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to comply with the sanitary and epidemiological regime.

4. The student will demonstrate the correctly chosen method of teaching the rules of ascariasis prevention from the mother.

5. The student will demonstrate the manipulation on the model in accordance with the algorithm adopted in this educational institution.

Problem #38

A kindergarten nurse, during a daily examination of children in a 2-year-old girl, found several easily opening vesicles and erosions on the oral mucosa, covered with a yellow-gray coating, surrounded by a bright red rim. The child has increased salivation, the lips are swollen. Submandibular lymph nodes are enlarged and painful. The child refuses food, is naughty, does not play with children, body temperature is 38º C. The nurse suggested that the child has herpetic stomatitis.

Tasks

1. Identify the satisfaction of what needs are violated and the patient’s problems.

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

3. Explain to the mother the peculiarities of the child’s nutrition with stomatitis.

4. Educate the mother on oral hygiene.

5. Demonstrate oral treatment.

Sample answers

1. Violated needs to eat, drink, play, communicate, maintain condition, maintain body temperature.

Patient problems:

real:

– loss of appetite

– anxiety,

– pain in the mouth,

– violation of the integrity of the oral mucosa,

– increased salivation,

– fever.

potential:

– accession of a bacterial infection.

Priority problem: pain in the mouth.

2. Short term goal: Pain will be gone within 3-5 days.

Long-term goal: All symptoms of the disease will disappear in 7-10 days.

Plan Motivation
1. The nurse isolates the child until the mother arrives. 1. To reduce the risk of infecting other children.
2. The nurse will talk to the mother about the child’s nutrition (exclude hot, salty, sour). Give food in liquid form. 2. To reduce pain.
3. The nurse will teach the mother to treat the oral cavity before meals with a 0.5% solution of novocaine with beaten egg white or 5% anesthesin suspension. 3. To relieve pain before eating.
4. The nurse will treat the oral mucosa with a rubber spray with a solution of potassium permanganate or 3% hydrogen peroxide, then 0.25% oxolinic ointment (as prescribed by a doctor). 4. To clean the oral mucosa.
5. The nurse will refer the mother to see a doctor.

Evaluation: The pain will stop after 3-5 days. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her the features of the child’s nutrition with stomatitis in an accessible, competent and reasoned manner.

4. The student will demonstrate the correctly chosen method of teaching the mother the rules of oral treatment for stomatitis.

5. The student will demonstrate the manipulation on the model in accordance with the algorithm adopted in this educational institution.

Problem #39

A 9-year-old girl is hospitalized in the gastroenterology department with a diagnosis of gastric ulcer. During a nursing examination, the following data were obtained: complaints of abdominal pain of a cutting nature, paroxysmal, decrease after eating, loss of appetite, belching, nausea, heartburn, constipation. The girl is touchy, according to her mother, capricious, she does not contact her neighbors in the ward. Objectively: the skin and mucous membranes are pale, the subcutaneous fat layer is not sufficiently expressed. On palpation, pain in the epigastric region. Sick for about 2 years. Eats randomly, often dry. He has a negative attitude towards examination and treatment. He does not believe in his recovery.

Appointments:

1. FGS.

2. Diet N1.

3. Bed rest.

4. Drug therapy.

Tasks

1. Identify what needs are being violated and the patient’s problems.

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

3. Explain to the patient the need for a diet.

4. Teach your child how to prepare for fibrogastroscopy.

5. Demonstrate stool sampling for scatology.

Sample answers

1. Violated needs: eat, drink, communicate, learn, support

state, highlight.

Patient problems:

real:

– loss of appetite,

– belching

– nausea,

– heartburn,

– negativism

– abdominal pain,

– loss of body weight,

– constipation.

potential:

– bleeding

– perforation.

Priority problem: abdominal pain. .

2. Short term goal: Pain will decrease in a week.

Long-term goal: to achieve a positive effect of the therapy

to the extract.

Plan Motivation
1. Bed rest. 1. Reduce the risk of complications. Increasing the body’s defenses.
2. The nurse will organize the implementation of the diet, tell about the importance of nutrition in case of peptic ulcer disease, the nurse will control the transmission. 2. To reduce pain.
3. Nurse organizes a calm environment for the child 3. To reduce irritability, anxiety
4. The nurse will introduce the patient to the same patient, but already in the recovery period, will tell about the disease itself. 4. To improve the results of therapy, increase the desire to recover.
5. The nurse organizes the child’s leisure time. 5. To improve overall tone.
6. The nurse will follow the doctor’s orders.

Evaluation: The patient will believe in her recovery, will feel better about the treatment, the pain will decrease by the end of the week. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the patient, the ability to explain to her the features of nutrition in case of peptic ulcer in an accessible, competent and reasoned manner.

4. The student will demonstrate to the mother the correct method of communication with the child and the rules for preparing for fibrogastroscopy.

5. The student will demonstrate the manipulation on the model in accordance with the algorithm adopted in this educational institution.

Task #40

A 10-year-old boy addressed a school nurse after a physical education lesson with complaints of pain in the right hypochondrium. The child is in the dispensary with a diagnosis of “Biliary dyskinesia in hypotonic form.” During a nursing examination, the nurse received the following data: complaints of constant aching pain in the right hypochondrium, which intensify after physical exertion, after fatty foods, weakness, fatigue, nausea, bitterness in the mouth. The child has been sick for two years. He does not follow the diet, he also often violates the motor regime. Objectively: the boy is active. The skin is pale, clean. Breathing through the nose is free, the respiratory rate is 18 per minute, the heart rate is 85 per minute. The abdomen is soft, painful in the right hypochondrium, the liver along the edge of the costal arch.

Tasks

1. Identify what needs are being violated and the patient’s problems.

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

3. Explain the need for a diet.

4. Teach mother and baby how to perform closed probing.

5. Demonstrate gastric lavage to a 10 year old child.

Sample answers

1. Needs are violated: eat, drink, move, maintain condition, study, communicate.

Patient problems:

real:

– nausea,

– bitter taste in the mouth

– abdominal pain,

– weakness,

– fast fatiguability.

potential:

– complications (diarrhea, cholecystitis disease).

2. Short term goal: Pain will decrease by the end of the week.

Long-term goal: remission in 3-4 weeks.

Plan Motivation
1. The nurse will explain to the patient the importance of observing the motor and food regimen. 1. To reduce pain.
2. The nurse will recommend frequent meals with the introduction of foods rich in fats (meat, cream, etc.). 2. For a better discharge of bile.
3. The nurse will recommend a “blind probing” to the child, tell the mother about his technique. 3. For a better separation of bile.
4. The nurse will tell the mother and child about the use of mineral water in remission. 4. For better continuous emptying of the gallbladder.
5. The nurse will explain the need to use choleretic drugs as prescribed by the doctor (magnesium sulfate). 5. To increase the tone of the walls of the gallbladder.
6. The nurse will recommend that you use analgesics only as directed by your doctor. 6. To reduce pain.
7. The nurse will refer the child to see a doctor for treatment.

Evaluation: the pain will decrease by the end of the week, the child will follow a diet, exercise. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the child, the ability to explain to him the need for a diet in an accessible, competent and reasoned manner.

4. The student will demonstrate the correct method of communication with the mother and child in teaching them the rules for conducting closed probing.

5. The student will demonstrate the manipulation on the model in accordance with the algorithm adopted in this educational institution.

Task #41

Child 5 months Sick on the 5th day, the disease began with an increase in body temperature to 38º C, cough, runny nose, loss of appetite. On the 4th day of illness, shortness of breath appeared with the participation of auxiliary muscles (tensions of the wings of the nose). On examination, the skin, mucous membranes are pale, cyanosis of the nasolabial triangle is noted. The number of breaths is 46 per minute, the pulse rate is 154 per minute. Heart sounds are somewhat muffled. Both halves of the chest are equally involved in the act of breathing. Percussion above the lungs sound with a box shade. Auscultatory – hard breathing, fine bubbling wet rales and crepitus on the right in the subscapular region. The abdomen is soft, painless, the liver protrudes from under the costal arch by 0.5 cm.

Diagnosis: Bronchopneumonia.

Tasks

1. Find out what needs the child is unable to meet. Formulate the patient’s problems, priorities.

2. Set goals and plan nursing interventions with motivation.

3. Explain to the mother the need to enrich the air with oxygen.

4. Teach the mother to count the baby’s pulse and respiration.

5. Demonstrate the setting of circular mustard plasters.

Sample answers

1. Needs are violated: breathe, maintain temperature

body.

Patient problems:

real:

– fever,

– labored breathing.

potential:

– the development of complications that worsen the condition of the child.

The primary problem is difficulty breathing.

2. Short term goal: Difficulty breathing will decrease within a week.

Long-term goal: the child will not experience difficulty breathing

by the time of release.

Plan Motivation
1. The nurse will provide the child with an elevated position in bed. 1. To facilitate breathing.
2. The nurse will follow the doctor’s orders.
3. The nurse will observe the appearance and condition of the patient, calculate the respiratory rate, heart rate. 3. To detect deterioration in the condition and timely provision of emergency care.
4. The nurse will provide access to fresh air, airing the ward for 15-30 minutes. 4. To enrich the air with oxygen.
5. The nurse will talk to the mother about pneumonia. 5. To prevent the recurrence of the disease.
6. The nurse will provide oxygen inhalations. 6. For relief of hypoxia.

Evaluation: the child’s breathing is normal. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to enrich the air with oxygen.

4. The student will demonstrate to the mother the correct method of counting the pulse and respiration.

5. The student will demonstrate the manipulation of oxygen supply to the child on a dummy in accordance with the algorithm adopted in this educational institution.

Task #42

Child 8 months He was admitted to the clinic with a disease duration of 5 days. The illness began with a cough and runny nose. On the 4th day of illness, the body temperature rose to 38.1º C and difficulty breathing appeared. The condition at admission is severe. Body temperature – 38.2º C. The child is lethargic, adynamic. The skin is pale with a grayish tint. Breathing with retraction of the intercostal spaces. The number of breaths is 82 per minute. Percussion above the lungs is determined by the sound with a tympanic shade, in the lungs auscultated hard breathing, abundant crepitus on both sides. Pulse rate – 182 per minute. Heart sounds are muffled. The abdomen is soft, the liver protrudes 3.5 cm from under the edge of the costal arch. The spleen is enlarged by 1 cm. Pastosity of the lower extremities is noted. Little urination, mushy stools.

Diagnosis: bilateral focal pneumonia, severe form.

Tasks

1. Find out what needs the child is unable to meet. State the patient’s concerns. Set your priorities.

2. Set a goal and plan nursing interventions with motivation.

3. Explain to the mother the need to enrich the air with oxygen.

4. Teach the mother to count the baby’s pulse and respiration.

5. Demonstrate giving oxygen from a pillow.

Sample answers

1. Violated needs: to breathe, maintain body temperature, communicate.

Patient problems:

real:

– shortness of breath – (shortness of breath),

– lethargy.

potential:

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

The primary problem is difficulty breathing.

2. Short-term goal: The child will not have difficulty breathing by the end of the week.

Long-term goal: Breathing returns to normal by the time of discharge.

Plan Motivation
1. The nurse will give the child an elevated position in bed. 1. To facilitate breathing.
2. The nurse will observe the appearance, calculate the respiratory rate, heart rate. 2. For the early diagnosis of complications and the provision of emergency care for the relief of hypoxia ..
3. The nurse will provide oxygen inhalations. 3. For relief of hypoxia.
4. The nurse will weigh the child. 4. For status monitoring.
5. The nurse will follow the doctor’s orders.
6. The nurse will take your temperature. 6. Body temperature control.

Evaluation: shortness of breath will decrease, by the time of discharge, breathing will return to normal. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to enrich the air with oxygen.

4. The student will demonstrate to the mother the correct method for counting the pulse and respiration.

5. The student will demonstrate the manipulation on the model in accordance with the algorithm adopted in this educational institution.

Task #43

A 14-day-old child was hospitalized in the thoracic department with a diagnosis of rhinitis.

Examination: the child was born at term with a body weight of 3.5 kg, a length of 55 cm, cried immediately, was attached to the breast on the 2nd day. Body temperature 36.8º C, the child has nasal congestion, mucous discharge from the nasal passages. The child is worried. The mother notes that the child has become worse at breastfeeding.

Tasks

1. Find out what needs the child is unable to meet. Identify the patient’s concerns and justify them.

2. Set goals and plan nursing interventions with motivation.

3. Explain to the mother the need for inpatient treatment of the child.

4. Teach the mother how to care for the child’s nasal cavity.

5. Demonstrate eye and nose drops to a child.

Sample answers

1. Violated satisfaction of needs: breathe, sleep, rest, eat.

Patient problems:

real:

– ineffective airway clearance,

– poor sucking

– anxiety.

potential:

– deterioration of the child’s condition associated with the development of complications, lack of body weight due to poor sucking.

The priority problem is ineffective airway clearance.

2. Short term goal: improved airway clearance after one week.

Long-term goal: normalization of nasal breathing.

Plan Motivation
1. The nurse will clean the nasal passages before each feeding. 1. To facilitate breathing.
2. The nurse will follow the doctor’s orders.
3. The nurse will talk to the mother about the prevention of this disease. 3. For the prevention of colds.
4. The nurse will provide access to fresh air, ventilating the ward, apply UVR. 4. To enrich the air with oxygen.
5. The nurse will calculate the respiratory rate, heart rate, measure the body temperature. 5. Condition control.
6. The nurse will take a throat and nose swab. 6. Condition control.

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