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Textbook of Pediatric Nursing
Susamma Varghese, Anupama Susmitha
SECTION 1: INTRODUCTION
1:
History of Child Health Nursing
PRINCIPLES OF CHILD HEALTH NURSING
DIFFERENCES BETWEEN ADULT AND CHILD NURSING
Anatomical Differences
Size
Skull
Eyes
Nose
Oral cavity
Stomach
Eustachian Tube
Physiological Differences
Basal Metabolic Rate (BMR)
Regulation of Body Temperature
Fluids and Electrolytes
Cardiovascular System
Hematologic System
Gastrointestinal System
Respiratory System
Integumentary System
Urinary System
Central Nervous System
Psychological Differences
Differences in Illnesses
RIGHTS OF THE CHILD
QUALITIES OF A PEDIATRIC NURSE
ROLES OF THE PEDIATRIC NURSE
Primary Care Giver
Health Educator
Nurse-counselor
Social Worker
Team Cocoordinator and Collaborator
Manager
Child Care Advocacy
Recreationist
Nurse Consultant
Researcher
REACTION OF CHILD AND FAMILY TOWARD ILLNESS AND HOSPITALIZATION
Parental Reactions
Specific Causes of Parental Anxiety
Hospitalized Child
Sources of Stress During Hospitalization
Stressors of Hospitalization
Child's Reactions
Separation Anxiety
Loss of Control
Bodily Injury and Pain
Effects of Hospitalization on the Child
Beneficial Effects
Adverse Effects
Nursing Care of a Hospitalized Child
Prevent/Minimize Separation
Minimize Loss of Control
Preventing or Minimizing Bodily Injury
Provide Developmentally Appropriate Activities
Maximize Potential Benefit of Hospitalization
Supporting Family Members
PEDIATRIC HISTORY AND PHYSICAL EXAMINATION
History
Patient's Name and Address
History of Present Illness
History of Past Illness
Growth and Development
Nutrition
Immunizations and Tests
Family History
Socioeconomic History
Environmental History
Physical Examination
Approaching the Child
Sequence of Examination
General Physical Examination
Equipment
Vital Signs
Measurements
General Appearance
Skin
Lymph Nodes
Head to Foot Examination
PREOPERATIVE AND POSTOPERATIVE NURSING MANAGEMENT OF CHILDREN
Preoperative Nursing Management
Factors Affecting Preoperative Care
Preoperative Preparation
Legal Preparation
Psychological Preparation
Physiological Preparation
Physical Preparation
Preoperative Teaching
Postoperative Nursing Management
Immediate Recovery Period
Intermediate Stage
Normalcy Stage (Care in the Ward)
SECTION 2: HEALTHY CHILD
2:
Growth and Development
CHARACTERISTICS/PRINCIPLES OF GROWTH AND DEVELOPMENT
Pattern for Development
Development is a Continuous Process
Readiness for Certain Tasks: The Critical Periods
Individual Differences Exist in Development
Development is Predictable
Changing Growth Rate Over Years
Individual Differences in the Rate of Development Remain Constant
Every Child Passes through Each Major Stage of Development
Different Parts of the Body Attain Different Rates of Development
Development Proceeds from General to Specific Response
Most Traits are Correlated in Development
Each Development Phase has Traits Characteristic of its Own
Many Forms of “Problem Behavior” are Normal Behavior of the Age in which they occur
Growth and Development are Continuous and Orderly Processes that have Predictable Sequences
Inter-relatedness of Growth and Development
Growth is a Total Process
STAGES OF DEVELOPMENT
FACTORS AFFECTING GROWTH AND DEVELOPMENT
Internal Influences
Heredity (Phenotype)
Characteristics of Parents
Sex
Race
Nationality
Genetic Disorders
Biorhythm and Maturation
Hormonal Influences on Growth
Emotions
External Influences
Environment
Social Factors
Socioeconomic Status of Family
Climate and Season
Natural Resources
Cultural Factors
Age of Parents
Exercise
Ordinal Position in the Family
DEVELOPMENTAL THEORIES
Psychoanalytic Theory
Psychosexual Development Theory
Stages of Development
Psychosocial Development Theory [Erikson, 1963]
Intellectual or Cognitive Development Theory
Stages of Cognitive Development
Moral Development Theory by Piaget and Kohlberg
Behavioral Theory
Process of Learning
ASSESSMENT OF GROWTH
Nutritional Anthropometry
Weight
Body Mass Index (BMI) or RAO Index
Height or Linear Growth or Length
Digital Scale for Checking Weight and Length
Height
Head Circumference
Chest Circumference
Abdominal Circumference
Tissue Growth Assessment
Midarm Circumference and Skinfold Thickness
Skinfold Thickness
Kanawati Index (KI)
Arm Span
Bone Age or Skeletal Maturity
Dental Development
ASSESSMENT OF DEVELOPMENT
Purposes of Developmental Assessment
Assessment of Development
Data Collection
Assessment Tools
Gesell Development Schedule
The Denver Developmental Screening Test (DDST) (Age Range 2 Weeks to 6 Years)
The Brazelton Neonatal Behavioral Assessment Scale
Risk Factors for Developmental Delay that can be Identified in the History and Physical Examination
History
Physical Examination
Disorders of Development
3:
Growth and Development of Infants
INTRODUCTION
PHYSICAL OR BIOLOGICAL DEVELOPMENT
Weight
Length
Head
Chest
CHANGES IN PHYSIOLOGIC SYSTEMS
Integumentary
Respiratory
Cardiovascular
Hematopoietic System
Fluid and Electrolytes
Nervous System
Digestive System
Sensory Experiences
Immunologic System
PSYCHOSOCIAL DEVELOPMENT
COGNITIVE DEVELOPMENT
Substages
PSYCHOSEXUAL DEVELOPMENT
SPIRITUAL DEVELOPMENT
MORAL DEVELOPMENT
SOCIAL AND EMOTIONAL DEVELOPMENT
ADAPTIVE BEHAVIOR
Gross Motor
Head Control
Rolling Over
Sitting
Movement
Fine Motor
Developmental Observation Card (DOC)
ASSESSMENT OF VISION IN EARLY INFANCY
Hearing Assessment
Hearing Development—Milestones
COMMON PLAY BEHAVIOR IN INFANTS
Sensorimotor
Exploratory
Social
Games
EARLY DEVELOPMENTAL STIMULATION
Infant Stimulation Programs
Aims
Remember
INFANT AT A GLANCE
4:
Growth and Development of Toddlers
INTRODUCTION
PHYSICAL/BIOLOGICAL GROWTH
General Characteristics
Weight Changes
Height Changes
Head
Chest
Dentition
PHYSIOLOGICAL DEVELOPMENT
Cardiovascular System
Respiratory System
Gastrointestinal System
Integumentary System
Genitourinary System
Immune System
Nervous System
Sensory Development
Vision
Hearing
Smell, Taste, Touch
Motor Development
Gross Motor Development
Fine Motor Development
PSYCHOSOCIAL DEVELOPMENT OR EMOTIONAL DEVELOPMENT
Psychosocial Moratorium
Negativism
Temper Tantrums
Ritualistic Behavior
Ambivalence
PSYCHOSEXUAL DEVELOPMENT
The Anal Stage
Development of Gender Identity
SIBLING RIVALRY
INTELLECTUAL OR COGNITIVE DEVELOPMENT
Substage V (13–18 Months of Age)
Substage VI (19–24 Months)
Preoperational Stage (2–7 Years)
MORAL DEVELOPMENT
Stage 0 (Birth to 2 Years)
Stage 1 (2–3 Years)
SPIRITUAL DEVELOPMENT
SOCIAL DEVELOPMENT
LANGUAGE AND SPEECH DEVELOPMENT
HEALTH PROTECTION AND PROMOTION OF TODDLERS
Prevention of Injury/Accidents
Sleep
Nutrition
Dental Health
NEEDS OF TODDLERS
Play and Stimulation
Love and Security
Discipline
Control of Bodily Functions
Toilet Training
TODDLER AT A GLANCE
5:
Growth and Development of Preschool Children
PRESCHOOL CHILDREN (3–5 YEARS)
PHYSICAL/BIOLOGICAL DEVELOPMENT
Weight and Height Changes
Weight
Height
Body Proportions
Cardiovascular System
Respiratory System
Gastrointestinal System
Dentition
Integumentary System
Genitourinary System
Immune System
Nervous System
Sleep
Sensory Development
Vision
Hearing
Gross Motor Skills
Fine Motor Skills
PSYCHOSOCIAL DEVELOPMENT
PSYCHOSEXUAL DEVELOPMENT (PHALLIC STAGE)
Oedipal Period
Oedipus Complex
Electra Complex
Masturbation
Remedies
INTELLECTUAL OR COGNITIVE DEVELOPMENT
Preoperational Stage (2–7 Years)
SPIRITUAL DEVELOPMENT
SOCIAL DEVELOPMENT
EMOTIONAL DEVELOPMENT
LANGUAGE
Certain Factors Influence Language Development
ACTIVITIES TO ENCOURAGE GROWTH AND DEVELOPMENT
TEACHING SAFETY RULES TO PRESCHOOLER
NEEDS OF PRESCHOOLERS
Physiologic/Biologic Needs
Control of Bodily Functions
Encopresis
Health Promotion
Nutrition
Sleep and Activity
Sleep Problems
Nightmares
Sleep Walking
Bruxism
Emotional Needs
Love and Security
Feeling of Independence
PRESCHOOL—AT A GLANCE
6:
Growth and Development of School-Age Children
SCHOOL-AGE CHILDREN (6–12 YEARS)
BIOLOGIC DEVELOPMENT
Height and Weight
Body Proportions
Dentition
MATURATION OF SYSTEMS
Cardiovascular System
Gastrointestinal System
Nervous System
Reproductive System
PSYCHOSEXUAL AND PSYCHOSOCIAL DEVELOPMENT
COGNITIVE OR INTELLECTUAL DEVELOPMENT
Preoperational Stage
Concrete Operational Stage (7–11 Years)
MORAL DEVELOPMENT
Movement Skills
Spiritual Development (Fowlers)
LANGUAGE AND SPEECH
NEEDS OF SCHOOL-AGE CHILDREN
Nutrition
Dental Health
Rest and Sleep
Prevention of Accidents
Play Needs
Sex Education
Prevention of Drug Abuse, Tobacco Use
PROBLEMS OF SCHOOL-AGE CHILDREN
Emotional Problems
Lack of Sleep
Learning Difficulties
Poor Nutrition and Lack of Physical Activity
SCHOOL AGE AT A GLANCE
School Age 6-12 Years
7:
Growth and Development of Adolescents
BIOLOGIC DEVELOPMENT
Height and Weight
PUBERTY
Changes in Girls
Development of Breasts
Growth of Bony Pelvis
Growth of Pubic and Axillary Hair
Menarche
Completion of Growth of Uterus and Vagina
Changes in Boys
Increase in the Size of Genitalia
Pubic Hair
Voice Changes
Growth of Axillary, Facial and Chest Hair
Activated Sebaceous Glands
Sexual Maturity Rating Scale (SMR)
Boys (Tanner Staging)
Girls
PHYSIOLOGIC DEVELOPMENT
PSYCHOSOCIAL DEVELOPMENT
Individual Identity
PSYCHOSEXUAL DEVELOPMENT
Sexual Identity
COGNITIVE DEVELOPMENT
LANGUAGE AND SPEECH DEVELOPMENT
SPIRITUAL DEVELOPMENT
NEEDS OF ADOLESCENTS
Adequate Nutrition
Body Mass Index (BMI)
Dental Health
Prevention of Accidents
Sex Education—Adolescent Sexuality
Counseling and Guidance
LIFE SKILL EDUCATION
Advantages of Life Skill Education
PROBLEMS OF ADOLESCENTS
Early or Delayed Puberty
Poor Nutrition
Homosexuality
Low Self-esteem
Anxiety About Beauty, Appearance, Figure, etc.
Problems/Issues Seen in Adolescent Boys
Gynecomastia
Nocturnal Emission
Masturbation
Drug Abuse
Juvenile Delinquency
Sexually Transmitted Diseases
Problems/Issues Seen in Adolescent Girls
Menstrual Disorders
Breast Disorders
Hirsutism
Acne Vulgaris
Pregnancy in Adolescents
GROWTH AND DEVELOPMENT DURING ADOLESCENCE
Early Adolescence 12-13 Years
Middle Adolescence 14-16 Years
Late Adolescence 17 Years and Above
ADOLESCENCE AT A GLANCE
8:
Nutrition in Children
NUTRITION
CLASSIFICATION
WATER
ENERGY
CARBOHYDRATES
PROTEINS
FATS
VITAMINS
Fat-soluble Vitamins
Vitamin A (Retinol)
Vitamin D
Vitamin E (Tocopherol)
Vitamin K
Water-soluble Vitamins
Vitamin B-complex
Vitamin B1 (Thiamine)
Vitamin B2 (Riboflavin)
Vitamin B3 (Niacin, Nicotinic Acid, Nicotinamide)
Vitamin B5 (Pantothenic Acid)
Vitamin B6 (Pyridoxine)
Vitamin B11 (Folic Acid, Folate, Folacin)
Vitamin B12 (Cyanocobalamin)
Choline
Biotin
Avidin
Inositol
Para-aminobenzoic Acid (PABA)
Vitamin C (Ascorbic Acid)
MINERALS
Macrominerals (Major Minerals)
Calcium
Phosphorus
Sodium
Potassium
Magnesium
Trace Elements (Microminerals)
Iron
Iodine
Zinc
Cobalt
Molybdenum
Chromium
Fluorine
Selenium
Manganese
FOOD GUIDE TRIANGLE
ADVANTAGES OF BREASTFEEDING
To the Child
To the Mother
PREPARATION FOR BREASTFEEDING
IMPORTANCE OF FOREMILK AND HINDMILK IN MATURE MILK
DEMAND FEEDING
Cleaning the Breasts
Exclusive Breastfeeding
BREASTFEEDING POSITIONS
BREASTFEEDING PROCEDURE
BREAST MILK STORAGE AND EXPRESSION
MATERNAL ILLNESS AND BREAST PROBLEMS
CONTRAINDICATIONS FOR BREASTFEEDING
Ensuring Good Nutrition for Breastfeeding Mothers
Monitor Baby's Growth
TEN STEPS TO SUCCESSFUL BREASTFEEDING
WEANING FOOD
FEEDING GUIDELINES
Six to Nine Months
Nine to Twelve Months
Weaning and Illness
Formula-feeding Positions/Formula-feeding Assistance
FORMULA-FEEDING
9:
Accidents: Causes and Prevention
INJURIES IN CHILDREN (ACCIDENTS IN CHILDREN)
SCOPE OF THE PROBLEM
RISK FACTORS FOR INJURIES
Age
Sex
Race
PRINCIPLES OF INJURY CONTROL
COMMON CAUSES OF INJURY
Suffocation
Causes
Prevention
Cuts and Scratches
Drowning
Prevention
Poisoning
Prevention
Electrocution
Prevention
Burns and Scalds
Prevention
Insects, Arthropods and Snake Bites
Prevention
Motor Vehicle Accidents
Prevention
Play and Toys
PRECAUTIONS
10:
Play Needs of Children
CHARACTERISTICS OF CHILDREN'S PLAY
Children's Play is Informal
Play Follows a Pattern of Development
Tradition Influences Play
Time Spent to Play Decreases with Age
Play Activities Decrease in Number with Age
Time Spent in a Specific Activity Increases with Age
Younger Children Engage in a More Vigorous Active Play
PURPOSES/VALUES OF PLAY
Physical and Motor Development
Social Development
Emotional Expression
Intellectual Education
Development of Moral Values
FACTORS INFLUENCING PLAY
Health
Motor Development
Intelligence
Sex
Environment
Available Leisure Time
Play Equipment
TYPES OF PLAY
Solitary Play
Onlooker Play
Cooperative Play
Associative Play
SELECTION OF PLAY MATERIALS
PLAY AND PLAY MATERIALS FOR DIFFERENT AGE GROUPS
Infants
Toys for Infants
Toddlers
Toddlers of 2½-3 years
Preschoolers
3–4 years
Toys
4–6 Years
Toys
School Age
Adolescents
11:
Immunization
INTRODUCTION
TYPES OF VACCINES
Live Attenuated Vaccine
Killed Vaccine
Toxoids
Other Antigens
VACCINE FAILURE
Primary Vaccine Failure
Secondary Vaccine Failure
ADMINISTRATION OF MULTIPLE VACCINES
Adjuvants
DOSE OF VACCINE
PREMATURITY AND IMMUNIZATIONS
Cold Chain
COMBINATION VACCINES
Advantages
Drawbacks
COMMON VACCINES
BCG Vaccination
Poliomyelitis Vaccine
Oral Polio Vaccine (OPV)
Inactivated Polio Virus Vaccine (IPV)
Diphtheria, Pertussis, Tetanus Vaccine (DPT)
Pertussis Vaccine
Tetanus Vaccine
Hepatitis B Vaccine
Haemophilus Influenzae Vaccine (Hib)
Measles Vaccine
Rubella Vaccine
Contraindications
Typhoid Vaccine
Side Effects
Contraindication
Cholera Vaccine
Meningococcal Vaccine
Pneumococcal Vaccine
Influenza Vaccine
Varicella Vaccine
Rabies Vaccine
Points to Remember
IMMUNIZATION SCHEDULE
NATIONAL IMMUNIZATION SCHEDULE
12:
Preventive Pediatrics
INTRODUCTION
UNIVERSAL CHILDREN'S DAY
NATIONAL POLICY FOR CHILDREN
LEGISLATIONS IN RELATION TO CHILD HEALTH AND WELFARE
The Child Marriage Restraint Act, 1929
The Children Act, 1960
The Juvenile Justice Act, 1986
The Child Labor (Protection and Regulation) Act, 1986
The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992
LEGISLATIONS RELATED TO THE WELFARE AND REHABILITATION OF THE DISADVANTAGED
The Person with Disabilities (Equal Opportunities, Protection of Rights and Free Participation) Act, 1995
The National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act, 1999
CHILD WELFARE PROGRAMS
Nutritional Supplementation Programs in India
Mid-day Meal Program
Main Recommendations
Supplementary Nutrition Program
Specific Nutrient Supplementation
The Universal Immunization Program (UIP)
The Child Survival and Safe Motherhood Program (CSSM)
The Integrated Child Development Services (ICDS) Scheme
Reproductive and Child Health Program (RCH)
Components
Integrated Management of Neonatal and Childhood Illness (IMNCI)
National Nutrition Mission
Nutrition Program for Adolescent Girls
Sarva Shiksha Abhiyan
National Program for Education of Girls at Elementary Level
Kasturba Gandhi Balika Vidyalaya
Child Helpline
The Shishu Greh Scheme
Elimination of Child Labor
Rajiv Gandhi National Crèche Scheme for Children of Working Mothers
Gramodaya Yojana and Nutrition Program for Adolescent Girls
An Integrated Program for Street Children
Integrated Program for Juvenile Justice
CHILD MORBIDITY AND MORTALITY RATES
Mortality
Fetal Death
Stillbirth Rate
Perinatal Mortality Rate (PMR)
Neonatal Mortality Rate (NMR)
Postneonatal Mortality Rate (PNMR)
Infant Mortality Rate (IMR)
Under Five Mortality Rate (UFMR)
Morbidity
New Morbidity
GENETIC COUNSELING
Genetic Counseling Team
Who Needs Genetic Counseling?
Goals of Genetic Counseling
Principles of Genetic Counseling
Accurate Diagnosis
Nondirective Communication
Confidentiality
Truthfulness
Timing
Follow-up Counseling
Steps in Genetic Counseling
Nurse's Role in Genetic Counseling
Assessment
Nurse's Responsibilities
CHILD GUIDANCE CLINIC
Objectives
Functions
Team Approach
CARE OF UNDER FIVE AND UNDER FIVE CLINICS/WELL BABY CLINICS
Under Five Clinics
Preventive Services
Curative Services
Referral Services
SECTION 3: NEONATAL CARE
13:
Care of a Newborn
INTRODUCTION
ADAPTATIONS
Cardiovascular System Adaptations
Embryofetal Circulation System—Changes at Birth
Heart Rate
Blood Volume
Blood Components
Physiologic Changes in Cardiovascular System
Blood Coagulation
Respiratory System Adaptations
Lungs
Physiologic Changes in Respiratory System
Body Temperature Regulation
Hepatic System Function
Gastrointestinal System Adaptations
Mucosal Barrier Production
Stomach and Digestion
Bowel Elimination
Physiologic Changes in Gastrointestinal System
Urinary System
Physiologic Changes in Renal System
Immune System
Integumentary System
Neurologic System Adaptations
Newborn Behavioral Adaptations
Behavioral Pattern
The Senses
Hearing
Vision
Touch
Taste
Smell
ASSESSMENT OF A NEWBORN
Parameters
Birthweight
Weight
Length
Head Circumference
Chest Circumference
Vital Signs
Skin
Color
Cyanosis
Jaundice
Pallor
Harlequin Sign
BIRTHMARKS
Hemangiomas
Nevus Flammeus (Portwine Stain)
Strawberry Hemangioma
Cavernous Hemangioma
Mongolian Spots
Cutis Marmorata
Café-au-lait Spots
Vernix Caseosa
Lanugo
Desquamation
Milia
Erythema Toxicum
Forceps Marks
Skin Turgor
Head
Fontanelles
Sutures
Molding
Cephalhematoma
Caput Succedaneum
Eyes
Ears
Nose
Mouth
Neck
Chest
Abdomen
Anogenital Area
Male Genitalia
Female Genitalia
Back
Extremities
Musculoskeletal System
ASSESSMENT FOR WELLBEING
Apgar Scoring
Respiratory Evaluation
Physical Examination
Laboratory Studies
Assessment of Gestational Age
Assessment of Behavioral Capacity
IMMEDIATE CARE OF A NEWBORN
Maintaining Airway Patency
Ensuring Proper Identification
Administering Prescribed Medications
Vitamin K
Eye Prophylaxis
Maintaining Thermoregulation
Thermal Management in Newborn Babies
Interventions
Radiant Warmer Beds
Incubators
Heat Shields
Warming Pads
Head Coverings
Plastic Wraps and Coverings
Skin Protectors
Skin-to-Skin Care
General Newborn Care
Bathing and Hygiene
Bathing a Newborn
Elimination and Diaper Area Care
Cord Care
Circumcision Care
Safety
Environmental Safety
General Newborn Safety
Car Safety
Infection Prevention
Sleeping
Enhancing Bonding
Assisting with Screening Tests
Genetic and Inborn Errors of Metabolism Screening
Hearing Screening
Promoting Nutrition
KANGAROO MOTHER CARE (KMC) PRACTICE (TOWARDS MOTHER-BABY FRIENDLY CARE FOR LBW INFANT)
Concept of KMC
Mechanism of KMC
Benefits of KMC
Benefits to the Baby
Benefits to the Mother
Benefits to the Family
Benefits to the Hospital
Kangaroo Position
Feeding Policy
Early Discharge and Follow-up
MINOR DISORDERS OF A NEWBORN
Head and Scalp
Eyes
Ears
Nose
Mouth
Chest
Skin Rash
Genitourinary Tract
Congenital Phimosis
Physiological Jaundice
Constipation
NEWBORN FEEDING
Newborn Nutritional Needs
Feeding Methods
Breastfeeding
Weaning and Introduction of Solid Foods
FETAL DEATH
Early Fetal Death
Intermediate Fetal Death
Late Fetal Death
14:
Birth Asphyxia
CLEARING OF FETAL LUNG FLUID
PREPARATION FOR DELIVERY AND RESUSCITATION OF THE BABY
Resuscitation Corner
The ABC of Resuscitation
Neonatal Resuscitation Program (NRP) Guidelines (See Appendix for 2013 revised Guidelines)
Rapid Assessment
Initial Steps
Clearing the Airway
Suctioning the Airway
Evaluation
Oxygen Administration
‘BAG AND MASK’ VENTILATION
Indication
Parts of an Ambu Bag
Inlet Valve of the Bag
Face Mask
Do not
CHEST COMPRESSIONS
Indication
Technique
Two methods are:
Complications of Chest Compressions
ENDOTRACHEAL INTUBATION
Purposes
Steps for Intubating a Newborn
Special Considerations
RESUSCITATION OF THE PRETERM BABIES
Follow-up Care
For the Baby
For the Mother and Family
15:
Respiratory Distress Syndrome
INTRODUCTION
SURFACTANT AND HYALINE MEMBRANE FORMATION
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS OF RESPIRATORY DISTRESS SYNDROME
Respiratory Signs and Symptoms
Manifestations as the Disease Progresses
Manifestations Associated with Severe Disease
Investigations
ASSESSMENT OF LUNG MATURITY
Interpretation
THERAPEUTIC MANAGEMENT
TREATMENT
MANAGEMENT OF VENTILATION AND OXYGENATION
Assessment of Severity (Score on admission every half hourly using Downe's score)
Mechanical Ventilation
SURFACTANT REPLACEMENT THERAPY
Timing of Administration
Method of Administration
Complications of Surfactant Therapy
NUTRITIONAL MANAGEMENT
PREVENTION OF RDS
COMPLICATIONS OF RDS
NURSING DIAGNOSIS OF AN INFANT WITH RESPIRATORY DISTRESS SYNDROME
TRANSIENT TACHYPNEA OF THE NEWBORN
16:
Prematurity
PREMATURE (PRETERM) INFANTS
Definition
Characteristics
Causes
Maternal Factors
Fetal Factors
Medical Factors
Socioeconomic Factors
Illiteracy
Iatrogenic Factors
Assessment of Prematurity
Prognosis
PREVENTION OF PRETERM BIRTH
ASSESSMENT OF IMMATURE INFANTS
General Appearance and Behavior
Size
Temperature
Integument
Cardiorespiratory System
GI System
Assessment of Signs of Infection
Assessment of Pain
PHYSIOLOGICAL HANDICAPS OF PREMATURE INFANTS
Apnea of Prematurity
Meconium Aspiration
Atelectasis
Idiopathic Respiratory Distress Syndrome
Bronchopulmonary Dysplasia (BPD)
Pulmonary Dysmaturity (Wilson-Mikity Syndrome)
Retinopathy of Prematurity (Retrolental Fibroplasia)
Necrotizing Enterocolits (NEC)
Physiologic Anemia
Hyperbilirubinemia
Intraventricular Hemorrhage
Dental Problems Related to Prematurity
NURSING CARE OF A PREMATURE INFANT
Establishment and Maintenance of Respiration
Provide Neutral Thermal Unit
Provide Adequate Nutrition
Caloric Requirements
Fluid Requirements
Techniques of Feeding in Premature Infants
Prevent Skin Breakdown
Provide Sensory Stimulation
Prevent Infection
Conserve Energy
Assist in Specific Therapies
Encourage Positive Relationship with Parents
Facilitate Parental Infant Attachment Process
Prepare the Parents Ready for Discharge
NURSING CARE OF A PRETERM BABY
17:
Neonatal Sepsis
ETIOLOGY
PREDISPOSING FACTORS
Host Factors
Immune Status of Term Healthy Neonates
Immaturity of Immune System
Risk Factors for Neonatal Sepsis
Agent Factors
Inoculum Size
Bacterial Capsular Antigens
Bacterial Toxin Production
Environmental Factors
Maternal Genital Tract Flora
Environmental Flora
Exposure to Microorganisms
Postnatal
CLASSIFICATION OF NEONATAL SEPSIS
Early Onset Sepsis
Late Onset Sepsis
CLINICAL FEATURES
Early Signs of Neonatal Sepsis
‘Going Off’
Temperature Changes
Jaundice
Apnea
Tachypnea/Recession
Cardiovascular Signs
Gastrointestinal
Irritability
Skin
Late Signs of Infection
Respiratory
Abdominal
CNS
Pseudoparalysis
Serious Manifestations
INVESTIGATIONS
Microbial Investigations
Blood Culture
Collecting Blood for Culture
Surface Swabs
CSF Culture
Gastric aspirate
Urine Culture
Other Microbiology Culture
Indirect Markers of Neonatal Infection
Total Leukocyte Count
Absolute Neutrophil Count (ANC)
Immature to Total Neutrophils (I/T Ratio)
Acridine Orange Test
Platelet Count
Eosinophil Count
Acute Phase Proteins
Micro ESR
CSF Examination
Biochemical Abnormalities
Other Tests
Radiology
Immunological Tests
MANAGEMENT
Antimicrobial Treatment
Monitoring the Response to the Therapy
Duration of Therapy
Adjunctive Therapies
Exchange Transfusion
Granulocyte Transfusion
Supportive Care
Other Therapeutic Modalities
NURSING MANAGEMENT
Nursing Care Plan—Neonatal Sepsis
PREVENTION OF NEONATAL SEPSIS
Prophylaxis
Barrier Techniques in the Nursery
Policy Guidelines
Equipment
Housekeeping Routines
Handwashing
Controlling Admissions and Screening of Admissions
Surveillance of Bacterial Flora
Other Measures for Reducing Infection
18:
Neonatal Hyperbilirubinemia
INTRODUCTION
Bilirubin Metabolism
Transport
Uptake
Conjugation
Excretion
Fetal Bilirubin Metabolism
Physiologic Hyperbilirubinemia
Pathological Jaundice of Neonates
Breast Milk Jaundice
CAUSES OF NEONATAL HYPERBILIRUBINEMIA
Overproduction
Metabolic and Endocrine Conditions
Obstructive Disorders
Mixed Causes
Diagnostic Evaluation
Other Investigations
MANAGEMENT OF HYPERBILIRUBINEMIA
Pharmacologic Management
PHOTOTHERAPY
Indications for Phototherapy
Technique of Phototherapy
Side Effects of Phototherapy
Care of Child in Phototherapy
EXCHANGE TRANSFUSION
Mechanism
Purposes of Exchange Transfusion
Blood for Exchange Transfusion
Blood Volumes
Technique of Exchange Transfusion
HYDROPS
Bilirubin Toxicity
Nursing Diagnoses
19:
Meconium Aspiration Syndrome
MECONIUM PASSAGE
Causes
PATHOPHYSIOLOGY
CLINICAL FEATURES
At Birth
MANAGEMENT
Don'ts in the Management of MSAF and MAS
Complications
Treatment of PPHN
NURSING DIAGNOSES
20:
Infants of Diabetic Mothers
PATHOPHYSIOLOGY
The Pedersen Hypothesis
EFFECT OF MATERNAL DIABETES
Growth
Glucose Metabolism
Fetal Oxygenation
Calcium and Magnesium Metabolism
Hematologic Status
Cardiorespiratory Function
Bilirubin Metabolism
Neurologic Function
Congenital Anomalies Associated with IDM
Central Nervous System Anomalies
Cardiac Anomalies
Skeletal Anomalies
Renal Anomalies
Gastrointestinal Anomalies
DIAGNOSTIC EVALUATION
MANAGEMENT
Managing Hypoglycemia
Managing Electrolyte Abnormalities
Managing Respiratory Distress
Managing Cardiovascular Complications
21:
Neonatal Seizures
ETIOLOGY
Focal Ischemic Injury
Intracranial Hemorrhage
Infections
Metabolic Disturbances
Cerebral Dysgenesis
Pileptic Syndromes
Neonatal Abstinence Syndrome
Others
PATHOPHYSIOLOGY
SEIZURES IN NEONATES VS OLDER CHILDREN/ADULTS
CLINICAL MANIFESTATIONS
Types of Neonatal Seizures
Subtle Seizures
Tonic Seizures
Clonic Seizures
Myoclonic Seizures
DIAGNOSIS
MANAGEMENT
Acute Management of Neonatal Seizures
Anticonvulsant Therapy
Specific Management
NURSING MANAGEMENT
Nursing Diagnosis
22:
Necrotizing Enterocolitis
PATHOLOGY
SIGNS AND SYMPTOMS
INVESTIGATIONS
MANAGEMENT OF NECROTIZING ENTEROCOLITIS
Supportive Care
Antibiotic Therapy
Surgical Management
COMPLICATIONS OF NEC
Acute Complications
Late Complications
Rare Complications
PREVENTION OF NEC
23:
Neonatal ICU
PHYSICAL FACILITIES
Space
Location
Floor Plan
Ventilation
Lighting
Temperature and Humidity
Sound
Handling and Social Contacts
Communication System
Electrical Outlets
PERSONNEL
EQUIPMENT
Resuscitation Equipment
Oxygen and Resuscitation Facilities
Emergency Drugs
Catheters, Syringes and Needles
Feeding Equipment
Laminar Flow System
Weighing Machine
Bassinets
Incubators
Radiant Heat Warmers
Phototherapy Unit
Monitors
MISCELLANEOUS ITEMS
NEONATAL VENTILATORS
LABORATORY
Special Concerns
NIDCAP (NEWBORN INDIVIDUALIZED DEVELOPMENTAL CARE AND ASSESSMENT PROGRAM)
HUMANIZED CARE AND RHYTHMIC STIMULATION OF NEWBORN BABIES
Technology-oriented Newborn Care
Principles of Humanized Care
Baby-friendly Ecology in the NICU
Sound
Light
Gentle Handling and Positioning
Feeding with Human Milk
Physiologic and Autonomic Stability
Rhythmic Gentle Stimulation
Tactile-kinesthetic Stimulation
24:
Preventive Neonatology
PRENATAL CARE
Premarital Health Check-up
Premarital Counseling
CARE OF MOTHER DURING PREGNANCY
HIGH-RISK PREGNANCIES
Causes
IDENTIFICATION OF GENETIC AND DEVELOPMENTAL ANOMALIES
ANTENATAL DIAGNOSTIC MEASURES
Maternal Serum Alpha-fetoprotein (MSAFP)
Beta Human Chorionic Gonadotropin (β-hCG)
Unconjugated Estriol (uE3)
Triple Test
Quadruple Test (Quad Screen)
Acetyl Cholinesterase (AChE)
Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROF Test)
High Resolution Ultrasound Scanning
Prenatal Cytogenetics
COMMONLY USED SAMPLING PROCEDURES FOR ANTENATAL DIAGNOSIS
Preimplantation Genetic Diagnosis (PGD)
Embryoscopy
SECTION 4: SYSTEMIC DISORDERS IN CHILDREN
25:
Nutritional Deficiencies in Children
MALNUTRITION
PROTEIN-ENERGY MALNUTRITION [PEM]
Definition
Etiology of PEM
Sociodemographic Factors
Environmental Factors
Nutritional Factors
Marasmus
Causes
Clinical Features
Kwashiorkor
Clinical Features
Classification of PEM
IAP Classification
Gomez's Classification
Jellife's Classification
Arnold Classification Based on Mid Arm Circumference
Diagnostic Evaluation
Complications
Management
Treatment of Complications
Dietary Management
Prevention of PEM
VITAMIN DEFICIENCY
Vitamin A
Ocular Lesions
Extraocular Lesions
Treatment
Hypervitaminosis A
Vitamin B
Thiamine (Vitamin B1)
Riboflavin (B2)
Niacin (Nicotinic Acid)
Pyridoxine (B6)
Folic Acid
Cyanocobalamin (Vitamin B12)
Vitamin C (Ascorbic Acid)
Treatment
Vitamin D
Treatment
DEFICIENCY OF MACROMINERALS
Calcium
Treatment
Sodium
Manifestations of Hyponatremia
Treatment
Iron
Management
Trace Elements
Iodine
26:
Respiratory Disorders and Infections
RESPIRATORY SOUNDS
CONGENITAL DISORDERS
Choanal Atresia
Unilateral Atresia
Bilateral Atresia
Diagnosis
Associated Anomalies
Treatment
RESPIRATORY ALTERATIONS
Common Cold (Rhinitis, Nasopharyngitis)
Etiology
Pathophysiology
Clinical Manifestations
Diagnosis
Management
Pharyngitis
Etiology
Clinical Manifestations
Diagnosis
Complications
Treatment
Tonsillitis
Etiology
Clinical Manifestations
Treatment
Nursing Care
Laryngitis, Laryngotracheobronchitis
Nursing Care
INFECTIONS OF LOWER RESPIRATORY TRACT
Bronchitis, Tracheobronchitis
Etiology
Clinical Manifestations
Treatment
Bronchiolitis
Etiology
Pathophysiology
Clinical Manifestations
Diagnostic Evaluation
Natural History
Treatment
Croup
Etiology
Clinical Manifestations
Treatment
Pneumonia
Classification based on Etiology
Viral Pneumonia
Bacterial Pneumonia
Clinical Manifestations
Diagnosis
Treatment
Nursing Management
Bronchial Asthma
Risk Factors Associated with Bronchial Asthma
Etiology
Pathophysiology
Clinical Manifestations
Diagnosis
Grading of Asthma Severity
Classification of Asthma Severity
Treatment
Complications
Treatment
Prevention of Asthma
Nursing Management
Long-term Care
Cystic Fibrosis
Etiology
Pathophysiology
Clinical Manifestations
Diagnostic Evaluation
Complications of CF
Management
Prognosis
27:
Gastrointestinal Disorders
CLEFT LIP (CL) AND CLEFT PALATE (CP)
Etiology
Clinical Manifestations
Immediate Consequences
Long-term Consequences
Treatment
Nursing Management
Preoperative Care
Postoperative Nursing Care
TRACHEOESOPHAGEAL FISTULA
Definition
Embryology
Associated Anomalies
Clinical Findings
Triad of Symptoms in TEF
Diagnostic Studies
Management
Surgery
Preoperative Management
Operative Procedure
Postoperative Care
Complications
OBSTRUCTIVE DISORDERS
Infantile Hypertrophic Pyloric Stenosis (IHPS)
Pathophysiology
Etiology
Clinical Manifestations
Diagnosis
Management
Operative Management
Preoperative Care
Postoperative Care
Complications
INTESTINAL OBSTRUCTION
Classification
DUODENAL AND JEJUNAL ATRESIA
Etiology
Pathophysiology
Clinical Features
Before Birth
Neonatal Period
Classification
Diagnosis
Associations
Management
INTUSSUSCEPTION
Etiology
Pathophysiology
Clinical Features
Investigations
Complications
Management
Nonoperative
Operative Management
MALROTATION AND VOLVULUS
Clinical Features
Diagnosis
Management
HIRSCHSPRUNG'S DISEASE
Incidence
Etiology
Pathophysiology
Clinical Presentation
Features in Newborn Period
Infants
Older Infants and Children
Diagnosis
Treatment
Medical Management
Surgical Management
Prognosis
Complications
COLOSTOMY
UMBILICAL HERNIA
EXOMPHALOS (AMNIOCELE, OMPHALOCELE, CELOSOMIA)
Etiology
Embryology
Three Forms of Presentation
Management
Postoperative Complications
GASTROSCHISIS
Management
INGUINAL HERNIA
Clinical Features
Management
Postoperative Complications
CONGENITAL DIAPHRAGMATIC HERNIA (CDH)
Pathophysiology
Varieties of CDH
Clinical Manifestations
Diagnosis
Management
ANORECTAL MALFORMATION
Incidence and Etiology
Embryology and Pathophysiology
Clinical Features
Diagnosis
Treatment
Low Anomaly
High Anomaly
Nursing Care
MALABSORPTION SYNDROME
CELIAC DISEASE (GLUTEN SENSITIVE ENTEROPATHY)
Clinical Features
Diagnosis
Management
LACTOSE INTOLERANCE
Etiology
Pathophysiology
Clinical Features
Management
CYSTIC FIBROSIS
Pathophysiology
Clinical Features
Diagnosis
Management
DIARRHEA
Definition
Types of Diarrhea
Contributing Factors
Etiology
Pathophysiology
Clinical Features
Diagnostic Evaluation
Management
Components of ORS
Management of Severe Diarrhea
Drug Therapy in Acute Diarrhea
CONSTIPATION
Etiology
Pathophysiology
Clinical Manifestation
Management
APPENDICITIS
Etiology
Clinical Manifestations
Diagnosis
Complications
Management
Preoperative Management
Postoperative
HEPATIC ALTERATIONS
Hepatitis
Hepatitis A
Hepatitis B
Indian Childhood Cirrhosis (ICC)
Risk Factors
Etiology
Pathophysiology
Clinical Manifestations
Diagnosis
Treatment
Biliary Atresia
Etiology
Clinical Features
Diagnostic Evaluation
Classification
Management
FAILURE TO THRIVE (FTT)
Etiology and Classification
Organic FTT
Nonorganic FTT
Mixed Type of FTT
Clinical Manifestation
Diagnosis
History
Rule Out Organic Causes
Anthropometric Measurements
Management
Nursing Management
Prognosis
Prevention
28:
Cardiovascular Disorders
ASSESSMENT
History
Physical Examination
Inspection
Palpation and Percussion
Auscultation
DIAGNOSTIC EVALUATION
Radiography of Chest
Electrocardiogram (ECG)
Echocardiography
Purposes
Cardiac Catheterization
Types of Catheterization
Purposes
Complications of Cardiac Catheterization
Nursing Care
Phonocardiography
Ultrasonography
Angiocardiography
Vectorcardiography
FETAL HEART
Key Structures of Fetal Heart
CONGENITAL HEART DISEASES
Etiology
Classification
LEFT TO RIGHT SHUNTS (ACYANOTIC)
Atrial Septal Defect (ASD)
Ventricular Septal Defect (VSD)
Patent Ductus Arteriosus (PDA)
Atrioventricular Canal Defects AVCD (Atrioventricular Septal Defect) (Endocardial Cushion Defect)
Valvular Aortic Stenosis
Pulmonary Stenosis
Coarctation of the Aorta
RIGHT TO LEFT SHUNTS (CYANOTIC)
Tetralogy of Fallot
Tricuspid Atresia
Transposition of Great Arteries (Transposition of Great Vessels)
Truncus Arteriosus
Total Anomalous Pulmonary Venous Connection [Total Anomalous Pulmonary Venous Return (TAPVR), Total Anomalous Pulmonary Venous Drainage TAPVD]
Ebstein's Anomaly
Hypoplastic Left Heart Syndrome (HLHS)
Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA)
CONGESTIVE HEART FAILURE
Etiology and Incidence
Other Causes in Children
Pathophysiology
Signs and Symptoms
Diagnostic Evaluation
History
Management
To Reduce Cardiac Workload
To Increase Myocardial Contractility
To Remove Accumulated Fluid and Sodium from the Body
To Improve Cardiac Performance
To Correct the Underlying Cause
INFECTIVE ENDOCARDITIS (BACTERIAL ENDOCARDITIS)
Organisms Causing Infective Endocarditis
Predisposing Factors
Clinical Manifestations
Diagnosis
Management
Complications
Prognosis
Prevention
ACUTE RHEUMATIC FEVER
Etiopathogenesis
Clinical Manifestations
Major Manifestations
Minor Manifestations
Diagnostic Evaluation
Laboratory
Management
Prevention of Rheumatic Fever
RHEUMATIC HEART DISEASE
Management
29:
Hematological Disorders
ANEMIA
Classification of Anemia
Classification based on Severity
Classification based on Morphology
Iron Deficiency Anemia
Etiology
Clinical Features
Diagnosis
Management
Prevention and Control
Megaloblastic Anemia (Pernicious Anemia)
Etiology
Clinical Features
Diagnosis
Management
Bone Marrow Failure Syndrome
Aplastic Anemia
Etiology
Clinical Features
Diagnostic Evaluation
Management
Definitive Therapy
Hemolytic Anemia
Classification of Hemolytic Anemia
G6PD Deficiency Anemia (Glucose-6-Phosphate Dehydrogenase Deficiency)
Clinical Features
Diagnosis
Management
Hereditary Spherocytosis
Pathogenesis
Clinical Features
Diagnosis
Treatment
Thalassemia
Thalassemia Minor
Thalassemia Intermedia
Thalassemia Major (Cooley's Anemia, Mediterranean Anemia)
Laboratory Investigation
Management of Thalassemia
New Treatment Approaches
Sickle Cell Disease (Sickle Cell Hemoglobinopathies)
Pathogenesis
Clinical Features
Sickle Cell Crisis
Complications
Crises
Diagnostic Evaluation
Management
Immune Hemolytic Anemia
Autoimmune Hemolytic Anemia
Causes
Clinical Features
Management
BLEEDING DISORDERS
Terminologies
Immune Thrombocytopenic Purpura (ITP)
Clinical Features
Classification
Management
Hemophilia
Types
Pathophysiology
Classification
Clinical Features
Diagnostic Evaluation
Management
Prevention and Control
von Willebrand Disease (vWD) (Vascular Hemophilia)
Clinical Features
Management
Disseminated Intravascular Coagulation (DIC)
Pathogenesis
Etiology
Clinical Features
Diagnostic Evaluation
Treatment
Prognosis
LEUKEMIA
Stem Cells
Classification
Etiology
Acute Lymphoblastic Leukemia (ALL)
Classification
Clinical Features
Common Symptoms
Prognosis
Differential Diagnosis
Management
Chemotherapy
Supportive Care
Treatment of Relapse
Bone Marrow Transplantation
Acute Myeloid Leukemia
Clinical Features
Treatment
Chronic Lymphoblastic Leukemia
Chronic Myeloid Leukemia
LYMPHOMA
Hodgkin's Disease
Etiology
Pathophysiology
Histologic Types of Hodgkin's Disease
Hodgkin's Disease Staging Classification
Clinical Manifestations
Diagnosis
Treatment
Non-Hodgkin's Lymphoma
Etiology
Clinical Features
Staging
Diagnosis
Management
Prognosis
NURSING CARE OF PATIENT ON CHEMOTHERAPY
Classification
Nursing Care
Administration of Drugs
Side Effects of Chemotherapeutic Drugs and the Nursing Care
Gastrointestinal Problems
Diarrhea
Hematological Problems
Dermatological Problems
Neurological Problems
Respiratory Problems
Reproductive Problems
NURSING CARE OF CHILDREN UNDERGOING RADIATION THERAPY
External Radiation Therapy
Internal Radiation Therapy
Radiation Safety
Most Common Effects of Radiation Therapy
Skin Reaction
Waiting Room Syndrome
During Radiation
After Radiation
Late Complications
30:
Genitourinary Disorders
COMMON INVESTIGATIONS IN RENAL DISEASES
Urine Examination
Blood Studies
Glomerular Filtration Rate (GFR)
Imaging Studies
Ultrasonography
Intravenous Pyelogram (IVP)
Micturiting Cystourethrogram (MCU) or Direct Voiding Cystourethrogram
Radionuclide Imaging
Cystoscopy
CONGENITAL ABNORMALITIES
Pelviureteric Junction Obstruction (Puj Obstruction)
Etiology
Clinical Presentation
Investigations
Management
Surgical Management
Complications
Posterior Urethral Valves (Amussat's Valvula)
Classification
Pathophysiology
Clinical Features
Diagnosis
Management
Correction
Temporary Urinary Diversion
Prognosis
Vesicoureteral Reflux (VUR)
Risk Factors
Pathophysiology
Etiology
Classification
Diagnosis
Natural History
Management
Hypospadias
Etiology
Clinical Presentation
Management
Epispadias
Meatal Stenosis
Signs and Symptoms
Treatment
Phimosis
Clinical Features
Treatment
Undescended Testis (Cryptorchidism)
Etiology
Clinical Features
Classification
Management
Complications
Exstrophy of the Baldder (Ectopia Vesicae)
Management
ACQUIRED CONDITIONS OF URINARY TRACT
Urinary Tract Infection
Etiology
Clinical Features
Diagnosis
Management
Acute Glomerulonephritis
Etiology
Pathophysiology
Clinical Manifestations
Diagnosis
Management
Complications
Prognosis
Nephrotic Syndrome
Pathophysiology
Clinical Features
Types
Diagnostic Evaluation
Management
Relapse
Treatment of Frequent Relapses and Steroid Dependence
Side Effects of Steroids in Children
Nursing Considerations
Wilms’ Tumor (Nephroblastoma)
Etiology
Pathology
Clinical Features
Diagnosis
Stages of Tumor
Management
Acute Renal Failure (Acute Kidney Injury)
Causes of Acute Renal Failure
Clinical Features
Investigations
Management
Prognosis
Chronic Renal Failure (CRF)
Etiology
Causes of CRF in Various Age Groups
Pathophysiology
Clinical Manifestations
Diagnostic Evaluation
Complications
Management
Renal Transplantation
Four Forms of Rejection are Recognized
31:
Neurological Infections and Disorders
CONGENITAL ANOMALIES
Neural Tube Defects (Dysraphism)
Etiology
Spine Bifida
Spina Bifida Occulta
Spina Bifida Cystica
Anencephaly
Encephalocele
Craniorachischisis
Hydrocephalus
Pathophysiology
Classification
Etiology
Presenting Features
Diagnostic Evaluation
Treatment
Complications
Prognosis
Cranial Deformities
Microcephaly
Etiology
Management
Craniosynostosis
MENTAL RETARDATION (INTELLECTUAL AND DEVELOPMENTAL DISABILITIES)
Etiology
Nutritional Deficiencies
Predisposing Factors
Classification
Presenting Features
Diagnostic Evaluation
Management
Prevention
Primary Prevention
Secondary Prevention
CEREBRAL PALSY (CP)
Etiology
Classification
Signs and Symptoms
Associated Problems
Diagnostic Evaluation
Management
Prognosis
SEIZURE DISORDERS IN CHILDREN
Pathophysiology
Etiology
Classification and Clinical Manifestations
Partial Seizures
Generalized Seizures
Unclassified Seizures
Status Epilepticus (SE)
Diagnostic Evaluation
Management of Epilepsy
Drug Therapy
Surgery
Ketogenic Diet
Alternative Treatments
FEBRILE SEIZURES
Classification
Simple Febrile Seizures
Atypical Febrile Seizures (Complex)
Prognosis
Treatment
Prophylaxis
Nursing Management
Care During Seizures
Care Immediately After Seizure
INCREASED INTRACRANIAL PRESSURE
Clinical Features of Increased Intracranial Pressure
In Infants
In Children
ALTERED LEVEL OF CONSCIOUSNESS
Grades of Coma
Causes of Coma
Assessment of Coma
Glasgow Coma Scale
Vital Signs
Eyes
Motor Function
Posture
Reflexes
Diagnostic Evaluation
Care of Unconscious Child
CRANIOCEREBRAL TRAUMA (HEAD TRAUMA, HEAD INJURY)
Pathophysiology
Clinical Manifestations
Complications
Treatment
Diagnostic Evaluation
Management
Emergency Management
Surgical Therapy
Prevention
MENINGITIS
Bacterial Meningitis
Pathophysiology
Etiology
Clinical Features
Signs and Symptoms in Neonates
Features of Different Types of Meningitis
Meningococcal Meningitis
Pneumococcal Meningitis
Staphylococcal Meningitis
Haemophilus Influenzae B Meningitis
Diagnostic Evaluation
Complications
Treatment
Prognosis
Tuberculous Meningitis
Pathophysiology
Clinical Manifestations
Diagnostic Evaluation
Prognosis
Treatment
Nonbacterial (Aseptic) Meningitis
Manifestations
Diagnosis
Treatment
ENCEPHALITIS
Etiology
Clinical Features
Diagnosis
Management
REYE'S SYNDROME
Incidence and Etiology
Clinical Features
Diagnostic Evaluation
Prognosis
Management
GUILLAIN-BARRÉ SYNDROME (GBS)
Pathophysiology
Clinical Manifestations
Diagnosis
Differential Diagnosis
Prognosis
Treatment
Nursing Care
MYASTHENIA GRAVIS
Neonatal Transient Myasthenia Gravis
Manifestations
Juvenile Myasthenia Gravis
Clinical Manifestations
Diagnosis
Treatment
INTRACRANIAL SPACE OCCUPYING LESIONS (ICSOL)
Etiology
Classification
Infratentorial Tumors
Medulloblastoma
Astrocytoma
Brainstem Gliomas
Ependymoma of Fourth Ventricles
Supratentorial Tumors
Glioma of Cerebral Hemispheres
Ependymoma and Sarcoma of Cerebral Hemispheres
Midline Tumors
Optic Nerve Glioma
Craniopharyngioma
Pathophysiology
Clinical Manifestations
Diagnostic Evaluation
Treatment
Surgery
Radiation Therapy
Chemotherapy
BRAIN ABSCESS
Clinical Features
Diagnosis
Management
NEUROCYSTICERCOSIS
Clinical Features
Diagnostic Evaluation
Treatment
NURSING CARE OF A CHILD WITH BRAIN TUMOR
Preoperative Nursing Management
Nursing Diagnosis
Nursing Interventions
32:
Endocrine Disorders
DISORDERS OF PITUITARY GLAND
Growth Hormone Deficiency (GHD)
Etiology
Pathophysiology
Clinical Features
Diagnosis
Treatment
Growth Hormone Hypersecretion
Gigantism and Acromegaly
Features
Etiology
Diagnosis
Treatment
Diabetes Insipidus
Etiology
Pathophysiology
Clinical Features
Diagnosis
Treatment
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Etiology
Clinical Features
Treatment
DISORDERS OF THYROID GLAND
Hypothyroidism
Congenital Hypothyroidism
Acquired Hypothyroidism
Goiter
Hyperthyroidism (Grave's Disease)
Etiology
Pathophysiology
Clinical Manifestations
Diagnosis
Management
DISORDERS OF ADRENAL GLAND
Congenital Adrenal Hyperplasia
Pathophysiology
Clinical Features
Diagnosis
Management
Pheochromocytoma
Etiology
Clinical Features
Treatment
Complications of Surgery
Addison's Disease
Etiology
Pathophysiology
Clinical Features
Diagnostic Evaluation
Treatment
Nursing Care
Cushing's Syndrome
Etiology
Clinical Features
Diagnostic Evaluation
Management
DISORDERS OF PANCREAS (HORMONE SECRETION)
Diabetes Mellitus
Etiologic Classification
Etiology (Fig. 32.1)
Pathophysiology
Clinical Features
Diagnostic Evaluation
Complications
Hypoglycemia (Insulin Coma)
Hyperglycemia (Diabetic Coma)
Signs and Symptoms
Diabetic Ketoacidosis
Pathophysiology
Clinical Features
Management
Growth Failure
Diabetic Retinopathy
Nephropathy
Neuropathy
Management of DM
Insulin Therapy
Complications of Insulin Administration
Types of Insulins
Blood Glucose Monitoring
Diet Plan
Exercise
33:
Orthopedic Disorders
FRACTURE
Types of Fracture
Bone Healing
Diagnostic Evaluation
Clinical Manifestations
Management of Fracture
Goals
First Aid Following a Fracture
Methods of Fracture Reduction
Methods of Fracture Immobilizations
Cast
Traction
Nursing Diagnosis
Additional Nursing Diagnosis
DEVELOPMENTAL DYSPLASIA OF HIP (DDH)
Pathophysiology
Diagnostic Evaluation
Ortolani's Sign
Barlow's Sign
Allis/Galeazzi Test
Management
Newborns to Age 6 Months
Age 6–18 Months
Older Child
Nursing Management
CONGENITAL CLUBFOOT
Types of Clubfoot (Fig. 33.5)
Classification of Clubfoot
Positional Clubfoot
Syndromic (Teratologic) Clubfoot
Idiopathic
Management
Goals
Techniques
Surgical Management
34:
Disorders of the Skin
SCABIES
Clinical Manifestations
Diagnosis
Treatment
Nursing Care
IMPETIGO
Types
Clinical Manifestations
Treatment
FUNGAL INFECTIONS
Candidiasis (Moniliasis)
Causes
Clinical Manifestations
Candidal Diaper Dermatitis
Intertrigo
Diagnosis
Treatment
Tinea Infections
Tinea capitis
Tinea corporis (Body Ringworm)
Tinea cruris (Jock Itch)
Tinea pedis
Tinea unguium
ACNE VULGARIS
Etiology
Management
35:
Communicable Diseases
CHICKENPOX (VARICELLA)
Clinical Manifestations
Complications
Prevention/Control
Management
Symptomatic Treatment
Prevent Secondary Infection
Maintain Hydration/Nutrition
MEASLES (RUBEOLA)
Clinical Manifestations
Transmission
Complications
Prevention/Control
Management
Symptomatic Treatment
GERMAN MEASLES (RUBELLA)
Clinical Manifestations
Transmission
Complications
Prevention/Control
Treatment
DIPHTHERIA
Clinical Manifestations
Transmission
Prevention/Control
Treatment
PERTUSSIS
Clinical Manifestations
Transmission
Complications
Prevention/Control
Treatment
TETANUS
Mode of Transmission
Pathophysiology
Clinical Manifestations
Complications
Treatment
MUMPS
Clinical Manifestations
Transmission
Complications
Treatment
POLIOMYELITIS
Pathophysiology
Mode of Transmission
Types of Poliomyelitis
Clinical Manifestations
Diagnosis
Complications
Management
Prevention
TUBERCULOSIS
Pathophysiology
Clinical Manifestations
Diagnosis
Management
Prevention
WORM INFECTIONS (HELMINTHIASIS)
Ascariasis (Round Worms)
Mode of Transmission
Incidence
Clinical Manifestations
Diagnosis
Management
Prevention
Enterobiasis (Pinworm Infection) (Oxyuriasis)
Clinical Manifestations
Prevention
Management
Ancylostomiasis (Hookworm Infection)
Clinical Manifestations
Transmission
Diagnosis
Management
Prevention
Trichuriasis (Whipworm)
Teniasis (Tapeworms)
Clinical Manifestations
Diagnosis
Management
Prevention
36:
Child Health Emergencies
POISONING
Ecology
Types of Poisons
Clinical Features
Corrosive Ingestion
Organophosphorus Poisoning
Paracetamol Poisoning
Diagnosis
Management
First-aid Management
In the Hospital
FOREIGN BODIES
Foreign Bodies in the Respiratory Tract
Clinical Features
Management
Foreign Body in the Alimentary Tract
Clinical Features
Management
Foreign Bodies in the Eye
Clinical Features
Management
Foreign Bodies in the Ear
BURNS
Causes of Burns in Children
Pathophysiology
Classification of Burns
According to Depth
Classification Based on Severity
Extent of Burns
Modified Lund and Browder Chart
Clinical Manifestations
Management
First-aid Measures
Management in the Hospital
Promotion of Wound Healing
Nutritional Support
Davies Formula
Herndon Formula
Alexander
Rehabilitation
Complications of Burns
Late Complications
DROWNING
Pathophysiology
Clinical Features
Management
Emergency Care
In the Hospital
Health Education Regarding Prevention
SHOCK
Pathophysiology
Etiological Classification
Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock
Stages of Shock
Early Compensated Shock
Decompensated Shock
Irreversible Shock
Complications of Shock
Management of Shock
Symptomatic Management
Nursing Management
37:
HIV/AIDS in Children (Acquired Immunodeficiency Syndrome)
MODE OF TRANSMISSION
PATHOPHYSIOLOGY
CLASSIFICATION AND CLINICAL MANIFESTATIONS OF HIV
DIAGNOSTIC EVALUATION
TREATMENT
PREVENTION
PREVENTION OF VERTICAL TRANSMISSION FROM MOTHER TO CHILD
NURSING CARE
38:
Disorders of Ear and Eyes
OTITIS MEDIA
Etiology
Risk Factors
Types
Pathophysiology
Clinical Features
Diagnosis
Complications
Treatment
HEARING IMPAIRMENT
Etiology
Congenital Hearing Impairment
Acquired Hearing impairment
Classification and Pathophysiology
Clinical Manifestations
Diagnosis
Degree of Hearing Loss
Treatment
Use of Communication Techniques
Nursing Management (Table 38.1)
Assessment
Nursing Diagnosis
Implementation
IMPAIRMENT OF VISUAL ACUITY
Refractive Disorders
Myopia
Hyperopia
Astigmatism
Testing for Visual Acuity
Child/Parent Education Regarding Care of Glasses
IMPAIRED MUSCULAR EFFICIENCY
STRABISMUS (SQUINT)
Etiology
Manifestations
Classification
Types of Strabismus Deviations
Diagnosis
Hirschberg Corneal Light Reflex Test
Cover Test
Treatment
Medical Treatment
Surgical Treatment
AMBLYOPIA (LAZY EYE)
Causes
Pathophysiology
Clinical Manifestations
Diagnosis
Treatment
ALTERED PHYSICAL INTEGRITY
Cataract
Types
Etiology
Treatment
Glaucoma
Pathophysiology
Classification
Causes of Secondary Glaucoma
Clinical Manifestations
Management
INFECTIONS OF EYE
Conjunctivitis (Pink Eye)
Etiology
Clinical Manifestations
Diagnosis
Treatment
Health Teaching
Keratitis
Causes
Treatment
BLINDNESS
Etiology
Clinical Manifestations
Diagnosis
Management (Table 38.2)
For Blindness
For Children Whose Vision is Impaired
Prevention
EYE TRAUMA
Classification/Etiology
Clinical Manifestations
Treatment
First Aid
In the Hospital
Complications
RETINOBLASTOMA
Pathophysiology
Clinical Manifestations
Diagnosis
Treatment
Prosthesis
Prevention
SECTION 5: BEHAVIORAL AND SOCIAL PROBLEMS
39:
Behavioral and Social Problems in Children and Adolescents
BEHAVIORAL DISORDERS IN CHILDREN
BEHAVIORAL PROBLEMS OF CHILDHOOD
Speech Problems
Causes
Types
Dyslalia
Stuttering/Stammering
Cluttering
Learning Disabilities
Etiology
Classification
Management
Attention Deficit Hyperactivity Disorder (ADHD)
Manifestations
Diagnosis
Management
Autistic Spectrum Disorders (ASD)
Etiology
Clinical Features
Management
BEHAVIORAL DISORDERS IN ADOLESCENTS
Juvenile Delinquency
Contributing Factors
Characteristics of Delinquent Children
Management
Anorexia Nervosa
Etiology
Clinical Features
Management
Drug Abuse
Factors Causing Drug Abuse
Management
MANAGEMENT OF MENTALLY CHALLENGED CHILDREN
Physically Challenged/Handicapped Children
Socially Challenged/Handicapped Children
Causes of Social Handicaps
Prevention
Rights of Handicapped Children
Management
Problems Faced by Handicapped Children (Physically, Mentally and Socially Challenged)
WELFARE SERVICES FOR CHALLENGED CHILDREN IN INDIA
SECTION 6: GENETIC DISORDERS
40:
Genetic Disorders in Children
TERMS USED IN GENETICS
INTRODUCTION
PATTERN OF INHERITANCE
CLASSIFICATION OF GENETIC DISORDERS
Genetic Disorders Due to Traditional Modes of Inheritance
Mendelian Disorders (Monogenic)
Chromosomal Disorders
Multifactorial Disorders
Somatic Cell Mutation
Genetic Disorders Due to Nontraditional Modes of Inheritance
Mosaicism
Genomic Imprinting
Uniparental Disomy
Unstable Mutations
Mitochondrial Inheritance (Maternal Inheritance)
COMMON CHROMOSOMAL DISORDERS
Down's Syndrome
Genetics/Etiology
Clinical Features
Systemic Abnormalities
Diagnosis
Vaccines
Education/Services
Trisomy-18 (Edward Syndrome)
Characteristics
Management
Trisomy-13 (Patau Syndrome)
Manifestations
Management
SEX CHROMOSOMAL ANOMALIES
Turner Syndrome
Genetics
Clinical Features
Diagnosis
Management
Klinefelters Syndrome
Clinical Features
Management
PRENATAL SCREENING
Indications
Antenatal Diagnostic Tests
GENE THERAPY
Approaches to Gene Therapy
Types of Gene Therapy
Approaches for Correcting Faulty Genes
Indications for Gene Therapy
SECTION 7: ADMINISTRATION OF MEDICATIONS TO CHILDREN
41:
Administration of Medications to Children
SAFETY RULES FOR THE ADMINISTRATION OF DRUGS
MEDICATION HISTORY
CALCULATION OF DRUG DOSAGE
ADMINISTRATION OF ORAL MEDICATIONS
RECTAL ADMINISTRATION
ADMINISTRATION OF EYE, EAR AND NOSE DROPS
INTRAMUSCULAR MEDICATIONS
Preparation
Administration
SUBCUTANEOUS INJECTIONS
INTRAVENOUS INJECTIONS
Peripheral Lock (Heparin Lock)
SECTION 8: INTEGRATED MANAGEMENT OF NEONATAL AND CHILDHOOD ILLNESS
42:
Integrated Management of Neonatal and Childhood Illness
AIMS
IMNCI GUIDELINES
COLOR CODE CASE MANAGEMENT STRATEGY
IMNCI CASE MANAGEMENT PROCESS—6 STEPS
Assess, Classify, Identify the Treatment and Treat the Young Infant/Child (Steps One to Four)
Appendices
THE NEW BALLARD SCORE
Neuromuscular Maturity
Posture
Square Window
Arm Recoil
Popliteal Angle
Scarf Sign
Heel to Ear
INDEX
TOC
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