Main symptoms of infectious diseases

Poor general health, increased body temperature, the appearance of rashes on the skin and mucous membranes, dyspeptic (nausea, vomiting, frequent loose stools, flatulence) and catarrhal (runny nose, lacrimation) phenomena. The child's condition may be restless (not sleeping, crying). In severe infectious diseases, depression of the central nervous system (lethargy, lethargy) may occur.

Acute respiratory viral infections

Etiology

The causative agents of the disease are influenza viruses (A, B, C), parainfluenza, respiratory syncytial virus, adenovirus, and rhinoviruses. The highest incidence of acute respiratory viral infections (ARVI) is observed in winter.

The source of infection is a sick person and virus carriers. The main route of transmission is airborne droplets.

Clinical manifestations

Flu. Acute onset, high body temperature (up to 40 °C), lethargy, adynamia, loss of appetite, headache, pain in muscles and joints, redness of the sclera, photophobia, there may be vomiting, meningeal symptoms, nosebleeds. Catarrhal symptoms are mild (slight coughing, mucous discharge from the nose, hyperemia of the posterior pharyngeal wall may be noted). As a rule, the condition improves on the 3rd–4th days. The total duration of an uncomplicated disease is 7–10 days. The period of convalescence is characterized by pronounced asthenia of the patient.

Adenoviral infection. Undulating fever, severe symptoms of intoxication, cough, runny nose, conjunctivitis, diarrhea. The duration of the disease is 10–14 days.

Respiratory syncytial infection. The temperature is low, intoxication is not very pronounced, symptoms of bronchitis and bronchiolitis (severe shortness of breath) are characteristic. The duration of the disease is 10–14 days.

Rhinovirus infection. Catarrhal phenomena (serous or mucous discharge from the nose), minor symptoms of general intoxication of the body, and there may be an increase in body temperature.

Complications

Pneumonia, bronchitis, laryngeal stenosis, urinary tract infection, myocarditis, encephalitis, meningitis.

Diagnostics

3. Serological blood tests (detection of antibodies to viruses).

4. Virological examination (in epidemics).

5. Immunofluorescent rapid method (for detection of virus antigens).

Treatment

1. Treatment regimen.

2. Medical nutrition.

3. Drug therapy: antiviral, vitamin, vasoconstrictor, antipyretic, antihistamines, bronchodilators.

4. Treatment of complications.

Prevention

1. Anti-epidemic measures: early isolation of patients, compliance with hygiene rules, systematic ventilation of the premises where the patient stays.

2. Sanitation of foci of infection (primarily in the ENT organs).

3. Hardening and organizing the correct daily routine and nutrition of the child.

4. Instillation of interferon into the nose 4-5 times a day for 2-3 weeks during an outbreak of ARVI in children's groups.

5. Admission of convalescents to children's institutions no earlier than the 7th day from the onset of the disease.

Nursing care

1. Even with a low body temperature and minor catarrhal symptoms, a sick child must be examined by a doctor. In severe cases (high body temperature, convulsions, croup syndrome), hospitalization will be required.

2. A sick child must be provided with emotional peace and treated patiently and kindly. With normal and subfebrile body temperature and good general health, the child’s mobility is not limited. In case of severe cough, severe runny nose and other complaints, outdoor games are not recommended. In case of febrile temperature, bed rest is recommended.

3. To restore nasal breathing, drops based on sea salt should be instilled into the nose; vasoconstrictor medications should be prescribed by a doctor.

4. Regularly clean the nasal cavity: in infants - with cotton wicks, a nasal aspirator or the corner of a clean napkin, in older children - by blowing their nose.

5. The room where the child is located should be warm and bright. Regular ventilation of the room and wet cleaning are mandatory. It is necessary to limit the child’s contact with other children and other adults.

6. The child’s nutrition should be appropriate for his age, be fortified, high in calories and easily digestible. Feeding should be done more often than usual, in small portions. Food should be warm, semi-solid or liquid. You cannot force feed a child - this can cause vomiting, and emotional stress associated with a reluctance to eat can provoke stenosis of the larynx when it is inflamed (croup syndrome). It is recommended to drink plenty of fluids: give warm milk, juices, fruit drinks, tea, rosehip decoction, mineral water.

7. At body temperatures up to 38 °C, the use of antipyretics is not recommended. If the body temperature has reached febrile values, antipyretics are prescribed in the form of suppositories, syrups, and suspensions. To speed up the achievement of the antipyretic effect, you can wipe the child’s skin with a napkin soaked in water with the addition of table vinegar or vodka, or put a cold compress or an ice pack on the forehead. At the stage of increased body temperature, accompanied by chills, the child must be covered with a warm blanket and a cap placed on his head. At the stage of lowering the temperature, it is recommended to put the child in bed and get rid of excess clothing. Due to profuse sweating, you should regularly wipe the child with a damp cloth and change underwear and bed linen.

8. If there is excessive vomiting and diarrhea, you need to increase your fluid intake. You should not try to feed your child immediately after vomiting - it may happen again. It is better to let your child drink acidified lemon juice or salted water.

9. After each bowel movement, be sure to wash the child with warm water. With frequent bowel movements, irritation may appear around the anus; in this case, it is recommended to lubricate the irritated areas with Vaseline oil.

10. After stable normalization of body temperature and reduction of the main symptoms of the disease, walks in the fresh air are recommended (at the initial stage - short, without outdoor games).

Chicken pox

Chickenpox is an acute infectious disease caused by viruses of the Herpes family and characterized by the formation of a blistering rash on the skin.

Chickenpox is a highly contagious disease. Children under 3 months of age rarely suffer from this disease due to transplacental immunity received from the mother.

Etiology

The infectious disease is caused by viruses of the Herpes family. The source of infection is a sick person. Infection occurs by airborne droplets; the pathogen is unstable in the environment. The incubation period is 11–21 days.

Clinical manifestations

A characteristic manifestation of chickenpox is a rash. The disease begins with the appearance of rashes and deterioration in general health. Body temperature rises to febrile levels, headache appears, and appetite worsens. First, maculopapular elements form on the skin, quickly turning into vesicles with transparent and then cloudy contents.

After 1–2 days, the bubbles dry out and brown crusts appear. After the crusts fall off, there are no traces left on the skin. The rash is localized on the face, scalp, torso, and is accompanied by itching. The rash occurs in separate episodes over 1–2 days. The total duration of the rash is 3–8 days. After the disease, persistent lifelong immunity is developed.

Complications

Encephalitis, meningitis, bacterial infection.

Diagnostics

Recording of epidemiological information (data on contacts with a sick person).

Treatment

1. Treatment regimen.

2. Medical nutrition.

3. Treatment of the rash elements with ethyl alcohol or a 1% solution of brilliant green.

4. Drug therapy (according to indications): detoxification, antiviral, antipyretic, antihistamines, vitamin therapy.

Prevention

Early isolation of the patient in an individual box in the infectious diseases department. Isolation of contact children who have not had chickenpox for a period from the 11th to the 21st day from the start of contact.

Nursing care

1. Treatment of chickenpox in most cases is carried out on an outpatient basis (with the exception of severe cases).

2. It is necessary to explain to the parents of a sick child that he should be provided with good care and peace (emotional and physical); during periods of elevated body temperature, bed rest is recommended.

3. The room where the patient is located must be regularly ventilated, and constant wet cleaning is necessary. Frequent changes of underwear and bed linen are indicated.

4. If you have photophobia (pain in the eyes from bright light), the room must be darkened.

5. Food should be high in calories, tasty, varied, warm, liquid or semi-liquid consistency. Feed the child in small portions, more often than usual, and only at will. The patient's diet must include vegetables, fruits and berries as foods with a high content of vitamins. Plenty of warm drinks are recommended: milk, juices, fruit drinks, decoctions, mineral waters, tea.

6. It is necessary to carefully monitor the cleanliness of the mucous membranes and skin, cut nails, wash hands regularly and ensure that the child does not scratch the elements of the rash or tear off the scabs.

7. Bubbles and papules should be regularly lubricated with a 1% alcohol solution of brilliant green or a 5% solution of potassium permanganate.

8. In case of fever, antipyretic drugs are prescribed.

Rubella

Rubella is an acute infectious disease manifested by a spotted red rash on the skin and enlarged cervical and occipital lymph nodes.

A special feature of rubella is its danger for pregnant women due to the possible development of deformities in the fetus: heart defects, deafness, cataracts.

Etiology

The causative agent is paramyxovirus. The source of infection is a person with rubella. The main route of transmission is airborne. The incubation period is 15–24 days.

Clinical manifestations

The disease begins with a short-term prodromal period with a slight increase in temperature and mild catarrhal symptoms.

The rash appears within several hours on unchanged skin, mainly on the cheeks, extensor surfaces of the arms and legs, and buttocks. The nature of the rash is spotty, without a tendency to merge, size is up to 5 mm. The rash lasts for 3 days, after which it disappears without a trace. The body temperature during the rash is normal or low-grade. A characteristic symptom is enlargement of the occipital lymph nodes.

After the disease, strong immunity is developed.

Diagnostics

2. Immunofluorescence method.

3. Serological studies.

Treatment

No special therapy is required. If necessary, symptomatic medications are prescribed.

Prevention

Isolate a patient with rubella from the team for 5 days from the onset of the rash. Active immunization of non-ill girls and women in the absence of pregnancy.

Nursing care

Measles

Measles is a highly contagious acute infectious disease.

Etiology

The causative agent is paramyxovirus. The source of infection is a patient with measles throughout the entire period of catarrhal symptoms and in the first 4 days from the moment the rash appears. The route of infection is airborne. The incubation period is 7–21 days.

Clinical manifestations

In the picture of the disease, 3 periods are distinguished: catarrhal, rash period and pigmentation (convalescence) period.

The catarrhal period lasts 5–6 days. As a rule, there is an increase in body temperature, cough, runny nose, conjunctivitis, photophobia (similar to ARVI). After 2-3 days, a small pink rash appears on the palate, and on the mucous membrane of the cheeks there are many pinpoint whitish spots (Belsky-Filatov-Koplik spots) - a pathognomonic sign of measles. At the end of the catarrhal period, body temperature decreases.

Rash period. There is a new rise in temperature to 39–40 °C, the patient’s condition worsens, increased catarrhal manifestations, photophobia, and lacrimation are noted. Measles is characterized by staged rashes.

Within 3 days, the rash spreads throughout the body from top to bottom. On the 1st day, the rash appears on the head and neck (first on the forehead and behind the ears), on the 1st–2nd day - a profuse rash on the upper torso and upper limbs, by the 3rd day the rash covers all parts of the body. The measles rash is maculopapular in nature, the size of the elements is up to 5 mm. There is a tendency to merge them. Each element of the rash begins to fade after 3 days.

It is very easy to become infected with the measles virus. Some time after contact with an infected person, the disease occurs in 98% of cases. Children are the most susceptible to the disease. True, under certain conditions, anyone can get measles - both children and adults.

Pigmentation period. Starts 3–4 days after the onset of the rash. During this period, body temperature normalizes, runny nose and lacrimation decrease, and the rash gradually disappears. Pigmented areas remain in place of the brightest elements. Sometimes during this period there is slight peeling of the skin.

During the period of convalescence, asthenia phenomena are observed. The child is characterized by increased fatigue, irritability, loss of appetite, and drowsiness.

After measles, lasting immunity is formed.

Complications

Pneumonia, pleurisy, encephalitis, meningitis.

Diagnostics

1. Accounting for epidemiological data.

2. Serological blood tests.

Treatment

1. Balanced nutrition.

2. Symptomatic therapy: antitussives, antipyretics, antihistamines.

Prevention

1. Active immunization - vaccination with a vaccine containing a live attenuated virus is carried out for children aged 1 year and contact children over 1 year old who have not had measles and have not previously been vaccinated.

2. Human immunoglobulin is administered to contact children under 1 year of age or who have a medical exemption from vaccination.

3. Contact children are subject to quarantine: vaccinated - from the 8th to 17th day from the start of contact, those who received immunoglobulin - from the 8th to 21st day from the start of contact.

Nursing care

Patient care is carried out in accordance with the general principles of care for childhood infections.

Whooping cough

Whooping cough is an acute infectious disease, the main manifestation of which is a paroxysmal cough.

Etiology

The causative agent is the Bordet-Giangu bacterium. The source of infection is a sick person within 25–30 days from the onset of the disease. The route of transmission is airborne. The incubation period is 3–15 days.

Clinical manifestations

During the course of the disease, there are 3 periods: catarrhal, spasmodic and resolution period.

Catarrhal period. Duration – 10–14 days. There is a short-term increase in body temperature to subfebrile, a slight runny nose, and an increasing cough.

Spasmodic period. Duration – 2–3 weeks. The main symptom is a typical paroxysmal cough. A coughing attack begins unexpectedly and consists of repeated cough impulses (reprises), which are interrupted by a prolonged wheezing inhalation associated with a narrowing of the glottis. In infants, after a series of coughing impulses, breathing may stop (apnea). During a coughing attack, the skin on the child’s face becomes cyanotic with a purple tint, and swelling of the neck veins is observed. When coughing, the child sticks out his tongue and drools. At the end of the attack, a small amount of viscous sputum may be released. The frequency of attacks is from 10 to 60 times a day, depending on the severity of the disease.

Permission period. Duration – 1–3 weeks. Attacks occur less frequently, are shorter in duration, and the cough loses its specificity. All symptoms of the disease gradually disappear. The total duration of the disease is 5–12 weeks.

Complications

Emphysema, atelectasis, pneumonia, bronchitis, encephalopathy.

Diagnostics

1. Accounting for epidemiological data.

3. Bacteriological examination of mucus taken from the back wall of the pharynx.

4. Immunoluminescent express diagnostics.

5. Serological study.

Treatment

1. Treatment regimen.

2. Balanced nutrition.

3. Drug therapy: antibiotics, antispasmodics, expectorants, including proteolytic enzymes.

Prevention

1. Active immunization – vaccination with DTP (pertussis-diphtheria-tetanus vaccine). The course begins at the age of 3 months. The course consists of 3 injections with an interval of 30–40 days. Revaccination – after 1.5–2 years.

2. Isolation of patients for 25–30 days from the onset of the disease.

3. Contact children under 7 years of age are subject to quarantine for 14 days.

Nursing care

3. If the disease is accompanied by frequent vomiting, then it is necessary after 30 minutes. After vomiting, supplement the baby's feeding.

Parotitis

Mumps is an acute infectious disease that occurs with damage to the salivary glands. In addition, other glandular organs may be involved in the process: pancreas, testes, ovaries. Sometimes, against the background of mumps, damage to the central nervous system occurs.

Etiology

The causative agent is paramyxovirus. The source of infection is a sick person in the first 9 days from the onset of the disease. Infection occurs by airborne droplets within the same room or ward. The incubation period is 11–23 days.

Clinical manifestations

The main symptom of the disease is bilateral enlargement of the parotid salivary glands. There is pain on palpation in the center of the enlarged gland and when chewing. The disease occurs with an increase in body temperature to 39 °C, deterioration in general health, headache, and sometimes with vomiting and abdominal pain. The involvement of new glandular organs in the process is accompanied by another rise in body temperature and a deterioration in well-being. With otitis, swelling and pain appear in the testicle, with pancreatitis - pain in the epigastrium and right hypochondrium, nausea, vomiting. Serous meningitis is manifested by headache, vomiting, fever, and stiff neck.

The duration of the disease is 6–21 days.

Mumps in boys can be complicated by orchitis (inflammation of the testicles) and subsequently lead to infertility.

Complications

Pancreatitis, orchitis, oophoritis, meningitis.

Diagnostics

1. Accounting for epidemiological data.

2. Virological and serological studies (for retrospective purposes).

Treatment

1. Treatment regimen.

2. Balanced nutrition.

3. Drug therapy: painkillers, anti-inflammatory, antihistamines; dehydration, glucocorticosteroid hormones - for meningitis; antispasmodics, proteolysis inhibitors, enzyme preparations - for pancreatitis.

Prevention

1. Active immunization at the age of 15–18 months with a live vaccine.

2. Early isolation of patients.

3. Quarantine for contact children from the 11th to the 21st day from the moment of contact.

Nursing care

1. Patient care is carried out in accordance with the general principles of care for childhood infections.

2. Apply dry heat (wool bandage, irradiation with a Sollux lamp) to the swollen salivary glands.

Diphtheria

Diphtheria is an acute infectious disease caused by Coreynebacterium diphteriae, characterized by the formation of diphtheria plaques on the skin and mucous membranes.

Etiology

The causative agent is diphtheria bacillus or Leffler's bacterium, which produces an exotoxin. Sources of infection are people with diphtheria, convalescents and healthy carriers of diphtheria bacteria. The route of transmission of infection is airborne droplets. The incubation period is 2–10 days.

Clinical manifestations

The following forms of the disease are distinguished: diphtheria of the nose, pharynx, larynx, trachea, bronchi, external genitalia and skin.

Diphtheria of the pharynx is more common. On the first day of the disease, elevated body temperature, malaise, sore throat, hyperemia and swelling of the mucous membrane of the tonsils, and the appearance of a whitish coating on them (fibrinous film) are noted. On the second day, the plaque takes on a characteristic appearance: a smooth surface, clearly defined edges, rises above the mucous membrane of the tonsil, has a grayish-white color, and is tightly fused to the underlying tissue. At the same time, the submandibular lymph nodes enlarge and become sharply painful. Swelling of the subcutaneous tissue of the neck and chest may occur (in severe cases).

With diphtheria of the larynx, the development of croup syndrome is observed: barking cough, change in voice, shortness of breath, cyanosis. In the absence of timely assistance, death may occur.

After an illness, a strong immunity is formed.

Complications

Infectious-toxic shock, toxic nephrosis, myocarditis, polyneuritis, paresis and paralysis of the respiratory muscles, peripheral paralysis of the upper and lower extremities.

Diagnostics

1. Taking into account the epidemiological situation.

2. Bacteriological study of material obtained from fibrinous film.

3. Serological study.

Treatment

1. Treatment regimen.

2. Administration of antitoxic diphtheria serum.

3. Drug therapy: detoxification, glucocorticosteroids, antihistamines, sedatives, protease inhibitors, albumin, antibiotics.

4. If the symptoms of diphtheria croup increase and there is no effect from drug therapy, a tracheotomy is performed.

Prevention

1. Active immunization with weakened diphtheria toxin (anatoxin), which is part of the DTP vaccine. Vaccination begins at the age of 3 months. Primary vaccination consists of 3 injections 45 days apart. The first revaccination is carried out after 1.5–2 years.

2. Hospitalization of all patients with diphtheria. The patient is discharged from the hospital if there are two negative cultures of mucus from the throat, carried out with a 2-day interval.

3. After hospitalization of the patient, final disinfection of the outbreak is carried out.

4. A bacteriological examination for diphtheria is carried out on all patients with tonsillitis.

5. If diphtheria is suspected, hospitalization in a hospital is required.

Nursing care

1. The patient needs to be treated in an infectious diseases hospital. The ward must be isolated. It is necessary to ventilate the room regularly (at least 2 times a day).

2. The patient must be provided with general care: body and oral hygiene.

3. Food should be pureed, semi-liquid, warm, since mechanical, chemical and thermal sparing of the oropharynx is necessary. Food should be fortified; it is recommended to include foods with a high potassium content in the diet. To prevent additional irritation of the oropharynx, you need to slightly limit the amount of table salt. Fluid restriction is necessary for severe swelling of the tissues in the pharynx. These rules must be followed until 3 weeks from the onset of the disease.

4. The amount of urine excreted should be monitored for 3 weeks, as toxic damage to the kidneys is possible.

Scarlet fever

Scarlet fever is an acute infectious disease caused by streptococcus and characterized by the presence of sore throat and pinpoint skin rash.

Etiology

The causative agent is group A beta-hemolytic streptococcus, which produces an exotoxin. The source of infection is a patient with scarlet fever from the first hours of the disease for 7–8 days. If the disease occurs with complications, the contagious period lengthens. The incubation period is 7 days.

The main route of transmission of scarlet fever is airborne. Infection occurs through direct contact with a sick person. Infection through clothing, toys, and underwear is possible. Mostly children aged 2–7 years are affected.

Clinical manifestations

The disease begins acutely. Characterized by increased body temperature, malaise, headache, loss of appetite, and possibly vomiting. From the first hours of the disease, the patient complains of a sore throat; upon examination of the pharynx, hyperemia of the tonsils and arches is noted, and sometimes plaque appears on the tonsils. The lips are juicy, bright, the tongue is coated. The nasolabial triangle is pale, almost white.

At the end of the first - beginning of the second day, a rash appears simultaneously throughout the body. It is small-pointed, densely located on the hyperemic general background of the skin, brighter in the area of ​​natural folds. Symptoms reach a maximum by the 2-3rd day, then begin to fade and disappear after a few days. The tongue is cleared of plaque and acquires a crimson color typical for scarlet fever. After the rash disappears, lamellar peeling of the skin occurs, especially pronounced on the palms and fingers.

After an illness, a strong immunity is formed.

Complications

Otitis, inflammation of the paranasal sinuses, lymphadenitis, nephritis, rheumatism.

Diagnostics

1. Accounting for epidemiological data.

2. No specific studies are carried out.

Treatment

1. Treatment regimen.

2. Balanced nutrition.

3. Drug therapy: penicillin antibiotics, anti-inflammatory, antipyretic, antihistamines, multivitamins.

Prevention

1. Isolation of patients for at least 10 days from the onset of the disease. Convalescents are isolated from the children's team for another 12 days.

2. Children who have been in contact with a person with scarlet fever are isolated for 7 days.

3. In case of repeated cases of scarlet fever in children's institutions, they resort to passive immunization with immunoglobulin.

Nursing care

Patient care is carried out in accordance with the general principles of care for childhood infections.

For any course of the disease, bed rest is prescribed for at least 6 days.

Diseases of the cardiovascular system

Main symptoms of diseases of the cardiovascular system

With diseases of the cardiovascular system, patients are concerned about weakness, fatigue, sleep and appetite disturbances, memory loss, shortness of breath, pain in the heart, and a feeling of interruptions in the functioning of the heart. Edema, cyanosis, acrocyanosis, arterial hypo- or hypertension are observed.

Congenital heart defects

Congenital heart defects are abnormalities in the development of the heart and large vessels.

Etiology

Embryogenesis disorders. The causes of disembryogenesis are the presence of the following diseases in the mother: alcoholism, diabetes mellitus, thyrotoxicosis, tuberculosis, syphilis, viral infections in the first months of pregnancy.

Heart defects are divided into 3 groups:

1) with overflow of the pulmonary circulation - open ductus arteriosus, atrial septal defect;

2) with unchanged pulmonary blood flow – coarctation of the aorta;

3) with depletion of the pulmonary circulation - triad and tetralogy of Fallot.

Atrial septal defect

Recognized at birth or in the first year of life.

Clinical manifestations: shortness of breath, fatigue, sometimes heart pain. When examining the area of ​​the heart, a “heart hump” is detected. The borders of the heart are shifted to the right.

Treatment: surgical – suturing or plastic surgery of the defect. The optimal age for surgical treatment is 3–5 years.

Surgical treatment of the defect is performed only in the stage of compensation of the disease. In this case, conservative treatment before surgery is carried out to maintain the life of the child until the compensation phase is reached and the optimal time for surgery.

Patent ductus arteriosus

Clinical manifestations: intense heart murmur after birth or during the first years of life, shortness of breath, fatigue, pain in the heart, expansion of the borders of the heart to the left and up.

Treatment: surgical - ligation or dissection of the duct after its suturing. The optimal age for surgery is over 6 months.

Tetralogy of Fallot (“blue defect”)

Tetralogy of Fallot (“blue defect”) is a combination of pulmonary artery stenosis, ventricular septal defect, aortic dextraposition, and right ventricular hypertrophy.

Clinical manifestations: observed immediately after birth or in the first month of life, characterized by cyanosis, shortness of breath during exertion (feeding, crying), and then at rest; The following signs form early: the fingers take on the appearance of drumsticks, the nails take on the appearance of watch glasses, a “heart hump” is formed, and the favorite position of such a child is squatting.

Treatment: surgical – 1st stage – at an early age, an anastomosis is applied between the vessels of the pulmonary and systemic circulation, 2nd stage, at 6–7 years, – elimination of pulmonary artery stenosis and plastic surgery of the ventricular septal defect.

Coarctation of the aorta

Coarctation of the aorta is a narrowing or complete closure of the aortic lumen in a limited area.

Clinical manifestations: complaints appear late and are associated with cardiac decompensation; headache, dizziness, tinnitus, shortness of breath, fatigue, abdominal and leg pain associated with tissue ischemia are observed; the upper part of the body is more developed than the lower, the borders of the heart are expanded to the left, there is an increase in the apical impulse, high blood pressure in the upper extremities along with reduced blood pressure in the lower extremities.

Treatment: surgical - excision of the narrowed area or, at the age of 4–6 years, aortic replacement.

Complications

Heart failure, infective endocarditis.

Diagnostics

3. X-ray of the chest organs.

4. Echocardiogram.

5. Angioventriculography.

6. Cardiac probing.

Treatment

In the period preceding surgical treatment, cardiac glycosides, diuretics, potassium supplements, and vitamins are prescribed.

Prevention

1. Conversations with future parents on the topic of protecting the health of a pregnant woman and preventing viral infections. Elimination of bad habits and occupational hazards.

Nursing care

1. Systematic monitoring of a sick child, establishing an optimal emotional and motor regime.

2. Carrying out aero-, helio- and oxygen therapy (air, sunbathing and other types of hardening).

3. Monitoring the correct performance of the doctor’s actions, parenteral administration of prescribed drugs, explaining to parents and the child the need for long-term continuous treatment.

4. It is necessary to monitor the child’s regular visits to a cardiologist for medical examinations.

Cardiopsychoneurosis

Neurocirculatory dystonia (NCD) is a complex of functional changes in many organs and systems of a child that arise as a result of a violation of the neurohumoral regulation of their activity.

Etiology

Hereditary (constitutional-genetic), congenital (damaging effects during intrauterine development of the fetus), acquired (chronic foci of infection, hormonal dysfunction, mental and physical stress) factors.

Clinical manifestations

The clinical picture of the disease consists of 3 syndromes.

Somatic syndrome: headaches, dry or excessively moist skin, thermoregulation disorders (temperature “suppositories” or prolonged low-grade fever after an acute respiratory viral infection), shortness of breath, dissatisfaction with breathing, a feeling of suffocation when excited, a feeling of a lump in the throat, loss of appetite, dyspepsia (nausea, vomiting , heartburn), abdominal and chest pain, arterial hypo- or hypertension, tachycardia.

Neurological syndrome: sometimes there are signs of dilatation of the 3rd cerebral ventricle, signs of cerebrospinal fluid hypertension - all these changes are transient. It manifests itself as increased fatigue, weakened memory, dizziness, sleep disturbances, and irritability. After a short rest all complaints disappear. Tremor may occur.

Psychological syndrome: fears, aggression, anxiety, conflict.

With NCD, vascular crises (usually with arterial hypertension) may develop. A crisis is triggered by stress and develops suddenly.

The main symptom of a crisis is a very severe headache that lasts from several hours to a day. The patient complains of a feeling of pulsation in the temples, flashing “spots” before the eyes, ringing in the ears, nausea, blood pressure rises to 180/100 mm Hg. Art., sweating, redness of the facial skin, coldness of the extremities are possible.

Complications

Vegetative crises.

Diagnostics

3. Biochemical blood test.

4. Clinoorthostatic tests.

5. Blood pressure control.

6. Echo and electrocardiography.

7. Bicycle ergometry.

8. Rheoencephalography.

9. In case of thermoregulation disorders, simultaneous measurement of temperature under the tongue and in the armpit.

10. Consultations with an otorhinolaryngologist, psychotherapist, neurologist.

Neurocirculatory dystonia often develops in children from socially disadvantaged families. More often, the disease develops in adolescence: in girls – at 12–14 years, in boys – at 13–15 years.

Treatment

1. Normalization of lifestyle, physical activity, rational nutrition.

2. Hardening activities.

3. Sanitation of foci of chronic infection.

4. Drug therapy: antihistamines, sedatives, tranquilizers, vitamin therapy, drugs that improve metabolic processes and blood circulation in the central nervous system.

5. Physiotherapy: showers, electrophoresis with calcium, ultraviolet irradiation, massage, electrosleep.

6. Herbal medicine: preparations of pantocrine, eleutherococcus, lemongrass.

Prevention

Primary – dispensary observation of schoolchildren, blood pressure control, compliance with work and rest schedules, combating physical inactivity and excess body weight, health education work with children and parents. Secondary – dispensary observation of children with NCD at least once every 3 months.

Nursing care

1. It is necessary to create optimal conditions for work and rest for the child, to prevent emotional, physical and mental overload.

3. The patient’s diet must be age-appropriate; food must be tasty, high-calorie and fortified.

Kidney and urinary tract diseases

Main symptoms of kidney and urinary tract diseases

With diseases of the kidneys and urinary tract, patients are bothered by pain in the lower back or lower abdomen when urinating, fever, and manifestations of intoxication (fatigue, lethargy, weakness, headache, nausea). There may be changes in daily diuresis, edema, urinary syndrome (appearance of protein in the urine - proteinuria, leukocytes - pyuria, casts - cylindruria, red blood cells - hematuria), arterial hypertension of renal origin.

Glomerulonephritis

Glomerulonephritis is an infectious-allergic inflammatory disease of the kidneys with predominant damage to the glomeruli. This disease is characterized by bilateral kidney damage and secondary involvement of tubules, arterioles and renal stroma.

Etiology

The most common cause of the disease is group A beta-hemolytic streptococcus. Factors contributing to the development of the disease: exposure to cold in conditions of high humidity, trauma to the lumbar region, excessive exposure to sunlight, repeated administration of vaccines and serums, drug intolerance, hereditary predisposition.

Clinical manifestations

There are acute, subacute and chronic glomerulonephritis.

Acute glomerulonephritis. General symptoms are deterioration in general condition, weakness, fatigue, headache, nausea, vomiting, decreased appetite, increased body temperature up to 38 °C, decreased diuresis, swelling and pallor of the face.

Syndrome of acute glomerular damage - urinary syndrome (oliguria or anuria, proteinuria, hematuria, cylindruria).

Edema syndrome – on the 3-4th day morning swelling of the face and eyelids appears, then the swelling spreads to other parts of the body, fluid accumulates in the body cavities; the syndrome lasts 10–15 days.

Cardiovascular syndrome - increased blood pressure, expansion of the boundaries of the heart, weakening of heart sounds, irregular heart rhythm, shortness of breath, cyanosis.

Brain syndrome – severe headache, insomnia, lethargy, convulsions.

Subacute glomerulonephritis is the most severe form of the disease with a malignant course. Severe hypertension, hematuria, widespread edema, and swelling of the optic nerve papilla are noted.

Chronic glomerulonephritis develops in the 2nd year after acute glomerulonephritis. There are nephrotic, hematuric and mixed forms of chronic glomerulonephritis.

The nephrotic form is characterized by severe edema, proteinuria (10 g of protein in the urine or more per day), cylindruria, and microhematuria. Blood pressure remains within normal limits.

The hematuric form is characterized by persistent macrohematuria (urine becomes bloody in color). There is no swelling, blood pressure is normal or increases briefly.

The mixed form is characterized by all of the listed symptoms.

Complications

Acute glomerulonephritis is complicated by acute renal and heart failure, eclampsia; chronic glomerulonephritis – chronic renal failure.

Diagnostics

4. Urinalysis according to Zimnitsky, Nechiporenko.

5. Rehberg's test.

6. Daily measurement of the amount of fluid consumed and urine output.

7. Immunological blood test.

8. Fundus examination.

10. Ultrasound of the kidneys.

Treatment

1. Treatment regimen.

2. Medical nutrition.

3. Drug therapy: for acute glomerulonephritis - antibiotics, antihistamines, diuretics, antihypertensives; for subacute and chronic glomerulonephritis - antiplatelet agents, anticoagulants, glucocorticosteroids, cytostatics.

4. For subacute and chronic glomerulonephritis, hemosorption, hemodialysis, plasmapheresis, and kidney transplantation are indicated.

Prevention

Prevention of acute glomerulonephritis:

1) timely diagnosis and treatment of streptococcal infection (scarlet fever, tonsillitis);

2) rehabilitation of foci of chronic infection;

3) rational implementation of preventive vaccinations;

4) improving the health of children's groups.

Prevention of chronic glomerulonephritis:

1) clinical observation of convalescents after acute glomerulonephritis;

2) routine examinations of children;

3) prevention of stressful situations, physical overexertion, hypothermia, infectious diseases, avoidance of preventive vaccinations.

In the first days of exacerbation of chronic glomerulonephritis, it is advisable to carry out a fasting sugar-fruit diet: 5-8 g of sugar per 1 kg of body weight per day in the form of concentrated solutions with the addition of lemon juice, fruits (apples, grapes) - up to 500-800 ml per day. If necessary, this diet can be repeated after 5–6 days.

2. The patient must follow a certain diet. In the first 5–7 days of the disease, a salt-free table with limited animal protein is prescribed (meat and fish are excluded from the diet) - table No. 7a. A high calorie diet is achieved through carbohydrate foods: potatoes, oatmeal and rice porridge, cabbage, watermelons, and milk are recommended. Then they switch to a low-salt diet: food is prepared without salt, but it is added to ready-made dishes at first 0.5 g per day, then gradually increased to 3-4 g per day. To improve the taste of food, you can add garlic, onions, and seasonings. The total amount of fluid consumed per day should be 300–500 ml greater than the volume of urine excreted the day before. From the 7th–10th day, meat and fish are included in the diet.

Every other day they move to table No. 7b. Products that can cause allergies (citrus fruits, eggs, nuts, strawberries, chocolate), spicy, salty foods, extractive substances (strong broths, sausages, canned food) are contraindicated.

After 3–4 weeks from the onset of the disease, the patient is transferred to diet No. 7, in which the protein content corresponds to the age norm. Potassium-rich foods are useful: raisins, dried apricots, prunes, potatoes. During remission, the patient is fed according to his age, with the exception of foods that can cause allergies.

3. Strict monitoring of health status is required (pulse, blood pressure, number of respiratory movements, body temperature are noted, daily diuresis is calculated, visual examination of urine), regular blood and urine tests, and compliance with doctor’s prescriptions.

Pyelonephritis

Pyelonephritis is an infectious and inflammatory disease of the kidneys with damage to the tubules, calyces, pelvis and interstitial tissue of the kidneys.

Etiology

Pathology is caused by various microorganisms and their associations. Most often the causative agent is Escherichia coli.

The routes of infection are ascending, hematogenous and lymphogenous. Factors contributing to the development of pyelonephritis: hereditary predisposition to kidney diseases, maternal illnesses during pregnancy, impaired intrauterine development of the kidneys, abnormalities of the renal structures, immunodeficiency states.

There are acute and chronic pyelonephritis.

Clinical manifestations

Acute pyelonephritis is manifested by the following factors: general intoxication syndrome (hyperthermia up to 40 °C, weakness, lethargy, headache, symptoms of meningism), gastrointestinal syndrome (nausea, vomiting, diarrhea, abdominal pain), urological syndrome (lower back pain and lower abdomen, a positive Pasternatsky symptom - there is increased pain during tapping in the projection of the kidneys), dysuric syndrome (painful frequent urination in small portions), urinary syndrome (cloudy urine, with sediment, bacteriuria, leukocyturia, proteinuria, hematuria are noted).

Chronic pyelonephritis. During the period of exacerbation, increased body temperature, lethargy, headache, lower back pain, dysuric and urinary syndromes are noted. Outside of exacerbation, health status improves. Pallor, weight loss, decreased appetite, dark circles around the eyes, and sweating may be noted.

Complications

Apostematous nephritis (multiple abscesses in the kidney), renal carbuncle, paranephritis; chronic pyelonephritis, chronic renal failure, arterial hypertension.

Diagnostics

3. Urinalysis according to Zimnitsky, according to Nechiporenko.

4. Determination of bacteriuria, examination of urine for sterility, determination of the sensitivity of urine flora to antibiotics.

5. Immunological studies.

6. Biochemical blood test.

7. Reberg's test.

8. Plain radiography of the kidney area, chromocystoscopy.

9. Thermometry.

10. Intravenous renography.

11. Ultrasound of the kidneys.

12. Examination of the fundus.

Treatment

1. Treatment regimen.

2. Medical nutrition.

3. Drug therapy: antibiotics, sulfonamides, vitamin therapy, antihistamines, anti-inflammatory drugs, antipyretic therapy, antioxidants, biostimulants.

4. Sanitation of extrarenal foci of chronic infection.

5. Physiotherapy (in remission) - UHF, laser therapy, paraffin and ozokerite treatment.

6. Drainage position.

Prevention

1. Hygienic care for children.

2. Prevention of acute intestinal diseases, helminthiasis, rehabilitation of foci of chronic infection (carious teeth, chronic sinusitis, otitis, tonsillitis), strengthening the body's defenses.

3. Control urine tests after any infectious diseases.

Nursing care

1. Bed rest is indicated for the entire period of elevated temperature, dysuria and lower back pain.

3. It is necessary to monitor the cleanliness of the skin and mucous membranes, regularly ventilate the room where the patient is located, and carry out wet cleaning. The room temperature should be maintained at 20–22 °C. It is necessary to ensure a sufficiently long and deep night's sleep, for which all possible irritants are eliminated and fresh air is ensured in the room.

4. A dairy-vegetable diet is prescribed (table No. 5) without limiting salt, but with the complete exclusion of foods rich in extractive substances (strong meat and fish broths, sausages, canned food, garlic, onions, legumes, chocolate, cocoa, citrus fruits, fried, smoked dishes). It is recommended to alternate protein and vegetable days (3-5 days each), as this creates conditions for the destruction of pathogenic flora in the kidneys. You should increase fluid intake to 1.5–2 liters per day, give the child fruit, vegetable and berry juices, rosehip decoction, mineral waters, cranberry and lingonberry fruit drinks, compotes. Children under 1 year of age are prescribed a water-tea break for 6–8 hours, then fed with breast milk or formula.

5. To increase diuresis, herbal medicine is recommended: kidney tea, bearberry, horsetail, centaury, lingonberry. The number of urinations must be increased so that under the age of 7 years, urination occurs every 1.5–2 hours, from 8 to 15 years – every 2–2.5 hours.

To normalize urodynamics, you need to regularly take a drainage knee-elbow position on a hard surface at least 3 times a day for 5-10 minutes.

6. After suffering from acute pyelonephritis, the child is under clinical observation with a pediatrician for 3 years, a patient with chronic pyelonephritis - until he is transferred to a teenage doctor. It is necessary to undergo regular medical examinations.

Cystitis

Cystitis is inflammation of the bladder.

Etiology

The disease is caused by various microorganisms and their associations. The infection enters the body through ascending, hematogenous, and lymphogenous routes.

Factors contributing to the development of cystitis are hypothermia and immune deficiency.

Clinical manifestations

There are acute and chronic cystitis.

Acute cystitis. The main symptoms are frequent painful urination, pain in the lower abdomen, and sometimes urinary incontinence. An increase in body temperature is often noted, more often to a subfebrile level. Laboratory tests of urine reveal pyuria, bacteriuria, and in the hematuric form of cystitis - red blood cells. The duration of the disease is up to 6–8 days.

Chronic cystitis. During the period of exacerbation, symptoms characteristic of acute cystitis appear, but they are somewhat less pronounced. During remission, all signs disappear until the next exacerbation.

Complications

Pyelonephritis.

Diagnostics

3. Tests of Nechiporenko, Addis - Kakovsky.

4. Cystography (for chronic cystitis).

5. Ultrasound of the bladder.

6. Consultation with a urologist.

Treatment

1. Treatment regimen.

2. Balanced nutrition.

3. Drug therapy: antibiotics, antispasmodics, vitamin therapy, sedatives.

4. Herbal medicine.

5. Physiotherapy (UHF, inductothermy, mud therapy).

6. Sanatorium-resort treatment.

Prevention

Compliance with personal hygiene rules. Timely treatment of inflammatory diseases of any location.

Nursing care

1. During dysuric phenomena, patients are prescribed bed rest.

2. It is necessary to ensure physical and emotional peace, to ensure that the child’s legs and lower back are warm.

3. Spicy foods, salty foods, seasonings, sauces, and canned food should be excluded from the child’s diet. Dairy products, fruits, vegetables and plenty of fluids are recommended.

4. If there is severe pain in the lower abdomen or if the child is restless, you can apply a warm heating pad to the suprapubic area.

5. To speed up the elimination of the pathogen from the bladder, it is recommended to take infusions and decoctions of herbs with a diuretic effect (as prescribed by a doctor): kidney tea, corn silk.

Diseases of the gastrointestinal tract

Main symptoms for diseases of the gastrointestinal tract

In diseases of the gastrointestinal tract (GIT), symptoms of general intoxication of the body (weakness, lethargy, headache, increased body temperature) may appear. Manifestations of dyspepsia are noted: loss of appetite, belching, heartburn, nausea, vomiting, flatulence, constipation, diarrhea. A characteristic symptom is pain. Often chronic gastrointestinal diseases are accompanied by asthenovegetative syndrome (increased fatigue, dizziness, irritability).

Gastritis

Gastritis is inflammation of the gastric mucosa. There are acute and chronic gastritis.

Etiology

Acute gastritis is provoked by food poisoning, consumption of poor quality food, overeating (especially fatty and spicy foods), frequent consumption of food containing coarse fiber, insufficient chewing of food, long-term treatment with salicylates, sulfonamides, poisoning, allergies.

All of the above factors also play an important role in the development of chronic gastritis. In addition, this disease develops with some endocrine pathology, chronic kidney diseases, and cardiovascular diseases. Heredity and reduced immunity are important.

Clinical manifestations

Acute gastritis. The disease begins with general malaise, loss of appetite, nausea, a feeling of heaviness in the epigastric region; low-grade fever and chills are possible. Subsequently, vomiting, pain in the upper abdomen, and belching appear. The tongue is coated with a yellowish coating. When palpating the abdomen, some swelling and pain in the upper sections are noted. The duration of the disease is 2–5 days.

Chronic gastritis. Relapse of the disease is characterized by pain syndrome (pain in the epigastric region occurs soon after eating and lasts 1–2 hours) and dyspeptic syndrome (nausea, unpleasant taste in the mouth, heartburn, loss of appetite, belching, feeling of heaviness in the epigastric region). When examining the tongue, a white coating is visible. Palpation reveals moderate pain in the epigastric region. Sometimes asthenovegetative disorders are observed: dizziness, emotional instability, irritability. Exacerbations of chronic gastritis are often caused by errors in the diet (too cold or too hot food, dry food, disturbances in the rhythm of nutrition, its imbalance).

Diagnostics

3. Fibrogastroscopy with histological examination of the material taken.

4. Fractional study of gastric contents.

Treatment

1. Treatment regimen.

2. Medical nutrition.

3. Gastric lavage (for acute gastritis).

4. Oral rehydration (in severe cases - infusion therapy).

5. Drug therapy: for acute gastritis - antiemetics, laxatives, antibacterial drugs, vitamins, enzymes; for chronic gastritis - antispasmodics, antacids, sedatives, metabolic therapy, vitamins.

6. Physiotherapy (electrosleep, iontophoresis, thermotherapy, ultrasound).

7. Sanatorium-resort treatment (for chronic gastritis).

Prevention

1. Balanced nutrition.

2. Eating only good quality foods.

3. Taking medications that irritate the gastric mucosa after eating.

4. Elimination of bad habits.

Currently, the infectious nature of gastritis is increasingly being revealed. In many patients, the causative agent of the disease, Helicobacter pylori, is found in the gastric contents. Such gastritis requires antibacterial therapy.

Nursing care

1. In case of acute gastritis, bed rest should be observed for 2–3 days. At the very beginning, the stomach is lavaged to free it from stagnant food residues. Then fasting is prescribed for 8–12 hours, during which the patient must drink large quantities of chilled tea, a mixture of saline with 5% glucose solution (in equal proportions), and rehydron. After 12 hours, the patient begins to be given mucous pureed puree soups, low-fat broth, jelly, crackers (chew thoroughly!), and porridge in small portions. Next, the diet is gradually expanded, and by the 5th–7th day the patient is transferred to a normal, age-appropriate diet.

2. Chronic gastritis. During the period of exacerbation, bed rest is prescribed, the duration of which depends on the severity of the exacerbation and can be up to 4 weeks. The child needs to be provided with physical and emotional peace and individual care. The room where the patient is located must be regularly ventilated and wet cleaned.

3. Diet therapy. Food must be mechanically, chemically and thermally gentle. Tables No. 1a (5–10 days), No. 1b (10–20 days), No. 1 (before remission), No. 2 (during remission) are recommended. Included in the diet: milk, cream, liquid milk porridge (semolina, rice), milk or slimy cereal soups, soft-boiled eggs or in the form of an omelet, boiled meat soufflé, jelly and jelly, juices. Salt is limited to 6–8 g per day. When moving to table No. 1, to the listed products you can add dry cookies, noodles, boiled fish, steamed cutlets, fresh cottage cheese, curdled milk, boiled and chopped herbs and vegetables, boiled sweet fruits and berries, compotes. After the onset of remission, they move to table No. 2: they are given low-fat meat and fish, mild cheese, meat broth and fish soup, strong vegetable broths, butter, sour cream, cream, cottage cheese, vegetable oil, eggs and dishes made from them, herbs, pureed vegetables and fruits, tea, cocoa, day-old white and black bread, raw vegetable, fruit and berry juices, rosehip decoction. The amount of salt is not limited.

5. Clinical observation is carried out by a pediatrician and gastroenterologist according to the following plan: after an exacerbation of the disease during the first six months - once every 2 months, then quarterly for 2-3 years, then - 2 times a year.

6. In spring and autumn, anti-relapse treatment is carried out in courses of 1–2 months.

7. 3-4 months after the end of the exacerbation, during a period of stable remission, sanatorium-resort treatment is recommended: Zheleznovodsk, Essentuki, Truskavets, etc. Treatment with mineral waters as prescribed by a doctor is useful.

Biliary dyskinesia

Biliary dyskinesia is a disease characterized by impaired motor and evacuation functions of the gallbladder and bile ducts.

Etiology

The pathological condition is provoked by a violation of the neurohumoral regulation of the function of the gallbladder and bile ducts as a result of neuroses, allergic diseases, endocrine pathologies, and eating disorders.

Factors contributing to the development of the disease: large intervals between meals, abuse of fried, spicy, fatty foods, acute infectious diseases (especially salmonellosis, dysentery, viral hepatitis), hereditary burden, allergies.

Clinical manifestations

Depending on the tone of the gallbladder, the main forms of dyskinesia are distinguished: hypotonic and hypertonic.

Hypotonic dyskinesia. It manifests itself as general weakness, increased fatigue, dull pain in the right hypochondrium or around the navel, bitterness in the mouth, and normal body temperature. Palpation reveals an enlarged gallbladder, the walls of which are atonic.

Hypertensive dyskinesia. The child complains of short-term paroxysmal pain in the right hypochondrium or around the navel, nausea, and normal body temperature.

Complications

Chronic cholecystitis, cholelithiasis.

Diagnostics

3. Stool analysis.

4. Ultrasound of the liver and gall bladder.

5. Duodenal intubation with biochemical study of bile.

Treatment

1. Medical nutrition.

2. Drug therapy: for hypertensive dyskinesia - antispasmodics, sedatives, choleretics, for hypotonic dyskinesia - cholekinetics, tonics, adaptogens.

3. Physiotherapy.

4. Herbal medicine.

5. Treatment with mineral waters.

Prevention

1. Balanced nutrition.

2. Taking choleretic preparations in the fall and spring to prevent exacerbations of the disease.

3. Fight against physical inactivity.

Nursing care

1. It is necessary to create optimal living conditions for the child: physical and emotional comfort.

3. Establish regular meals at least 4-5 times a day. The diet must correspond to the child’s age in terms of calories, protein, fat, carbohydrates, vitamins and minerals. It is recommended to exclude fatty, smoked, fried, spicy foods, spicy seasonings, fish and meat broths, canned and pickled foods, sweets, baked goods, chocolate and ice cream from the diet. Be sure to include milk, sour cream, vegetable oils, mild cheese, eggs, fresh vegetables (cabbage, beets, carrots), fruits (pears, apples, plums, apricots), and herbs in your diet.

5. For hypotonic dyskinesia, therapy with adaptogens is indicated: ginseng tincture or pantocrine solution, 1 drop per year of life - 3 times a day for a month in the morning.

6. For hypotonic dyskinesia, active general strengthening exercises (bending, turning the body) and abdominal exercises, outdoor games are recommended. For hypertensive dyskinesia, exercises should be performed from a lying position, general strengthening exercises alternate with breathing and relaxation exercises, the pace of exercises should be slow or medium. Sedentary games without a competitive component are shown.

Chronic enterocolitis

Chronic enterocolitis is a chronic inflammatory disease of the large and small intestines.

Chronic enterocolitis often accompanies other diseases of the digestive system, accompanied by disorders of the secretory and motor functions of the intestine. In some cases, isolated forms of enteritis or colitis are diagnosed, but combined pathology is more common.

Etiology

The disease is characterized by alternating relapses and remissions.

Clinical manifestations

When the small intestine is predominantly affected, there is loss of appetite, pain in the navel or diffuse pain throughout the abdomen, a feeling of heaviness, rumbling in the abdomen, increased gas formation in the intestines, possible nausea, vomiting, frequent loose stools with inclusions of undigested food particles. During examination, attention is drawn to the child's insufficient body weight, dry skin, flaking, jamming in the mouth, swelling and bleeding of the gums (signs of vitamin deficiency).

When the colon is predominantly affected, there is a decrease in appetite, pain in the lower abdomen, a tendency to constipation or alternating constipation and diarrhea, flatulence, pain during bowel movements, and mucus in the stool. Lack of body weight is less pronounced.

When both the small and large intestines are affected, a combination of the listed symptoms is simultaneously observed.

Complications

Ulcerative intestinal lesions, hypovitaminosis.

Diagnostics

3. Biochemical blood test.

4. Scatological examination, stool analysis for worm eggs and dysbacteriosis.

5. Study of intestinal absorption capacity.

6. Fibroesophagoduodenoscopy.

7. Ultrasound of the abdominal organs.

8. Colonoscopy, irrigoscopy.

Treatment

1. Treatment regimen.

2. Medical nutrition.

3. Drug therapy: antibiotics and sulfonamides, antifungal drugs, antispasmodics, astringents, enveloping agents, adsorbents, immunomodulators, metabolites, enzyme preparations, eubiotics, multivitamins.

4. Physiotherapy.

6. Herbal medicine.

7. Treatment with mineral waters.

8. Sanatorium-resort treatment.

Prevention

Rational nutrition and food hygiene.

Nursing care

1. For the first 2 days, the patient needs a “starvation” diet (the patient drinks 1.5–2 liters of hot tea with lemon or rosehip decoction per day), kefir, acidophilus, apple or carrot diets. In the following days, the patient is transferred to table No. 4. The food is boiled and pureed; the food should not be very cold or very hot. Meals – 6–8 times a day in small portions. Recommended are soups with pureed meat, boiled meat, poultry and fish, steamed cutlets, pureed porridge cooked in water, jelly, jelly from berries and fruits, fresh cottage cheese, butter. Legumes and pasta, sauces, spices, and alcohol are excluded. Outside of an exacerbation, the patient eats according to table No. 4. Dishes are boiled or baked, taken at moderate temperature, unchopped. Fresh bread, fatty broths and soups based on them, fatty fish, poultry, meat, fried, smoked, canned foods, refractory fats, millet and pearl barley porridge, apricots, plums, sharp cheese, sour cottage cheese, strong coffee and tea are not recommended.

2. For anti-inflammatory purposes, therapeutic enemas are prescribed with a solution of furatsilin, sea buckthorn oil, rose hips, and tocopherol acetate.

3. To reduce intestinal spasms, rectal antispasmodic suppositories are used before bedtime or in the morning.

4. Exercise therapy: breathing exercises, walking, exercises with bending, turning the torso, and abdominal exercises are shown.

Respiratory diseases

Main symptoms of respiratory diseases

Respiratory diseases are manifested by the following factors: increased body temperature, symptoms of intoxication (headache, dizziness, weakness, fatigue, sleep and appetite disturbances), symptoms of respiratory failure (shortness of breath, cyanosis), cough (dry or wet, with sputum), with auscultation – changes in the nature of respiratory sounds (appearance of weakened or hard breathing, dry or moist rales).

Acute bronchitis

Acute bronchitis is an acute inflammation of the bronchial mucosa in the absence of signs of damage to the lung tissue.

Etiology

More often, viruses become the cause of the inflammatory process in the bronchi. They are subsequently joined by bacterial flora.

Clinical manifestations

The main symptoms of acute bronchitis are cough, sputum production, and symptoms of intoxication (the more pronounced the younger the child is). During the first 1–2 weeks of the disease, the cough is dry, paroxysmal, worsens at night, leading to fatigue in the child and disruption of night sleep. Body temperature is often normal, rarely rising to low-grade fever. High body temperature indicates the addition of bacterial flora or the development of complications. From the 2-3rd week, the cough becomes wet and persists until the 3-4th week from the onset of the disease.

Complications

Chronic bronchitis, pneumonia, respiratory failure.

Diagnostics

2. X-ray of the lungs.

Factors that increase the likelihood of bronchitis: hypothermia, reduced immunity, intoxication, allergies, air pollution, parental smoking.

Treatment

1. Treatment regimen.

2. Balanced nutrition.

3. Drug therapy: antiviral, antitussive (for dry cough), expectorants (for wet cough), anti-inflammatory drugs, antibiotics (after confirmation of the bacterial nature of the disease), bronchospasmolytics.

4. After normalization of body temperature - physiotherapy (thermal, electrical procedures).

6. Massage.

Prevention

1. Timely treatment of ARVI.

2. Regular walks in the fresh air.

3. Ventilation and wet cleaning in the room where the child is.

Nursing care

1. Isolate the child, limit contact with other children and strangers.

2. In the room where the child is located, it is necessary to maintain a comfortable climate: the air temperature during the day is 20–22 °C, at night – 18–20 °C. Regularly ventilate the room and wet clean it.

3. The child’s nutrition should be age-appropriate, fortified, and easily digestible. It is recommended to feed the child often, in small portions, and allow him to choose the menu himself. Drinking plenty of fluids is recommended (tea, fruit drinks, compotes, carbonated water; for a wet cough, milk with carbonated water to facilitate expectoration of sputum).

4. The sick child should be provided with physical and emotional rest.

5. Constant monitoring of the child is mandatory: measuring body temperature, counting respiratory movements, pulse, monitoring general well-being.

6. It is necessary to regularly follow the doctor’s prescriptions: give medications, after a decrease in body temperature, carry out physiotherapeutic procedures (from 3–4 days - mustard foot baths, mustard wraps, warm compresses on the chest), exercise therapy, massage (from the 7th day of the disease) .

Pneumonia

Pneumonia is an acute inflammatory and infectious disease that affects all components of the lung tissue, including the alveoli. Children under 3 years of age are most often affected.

Etiology

The disease is caused by bacteria, viruses, protozoa, fungi, helminths, and foreign bodies. Ways of spread of infection: aerogenic, hematogenous, lymphogenous, aspiration of foreign bodies.

Factors contributing to the development of pneumonia: functional and morphological immaturity of the body of a young child, respiratory defects, fermentopathy, constitutional anomalies, prematurity, the presence of foci of chronic infection in the nasopharynx, hypothermia or overheating, impaired bronchial obstruction.

Depending on the extent of the spread of the inflammatory process, focal, segmental, lobar and interstitial pneumonia are distinguished. Separately, a destructive form of the disease is distinguished.

Clinical manifestations

The disease begins with an increase in body temperature to febrile, deterioration of health, the appearance of a cough (dry, rare) and symptoms of intoxication, such as headache, loss of appetite, irritability, weakness, nausea, tachycardia, pale skin with a grayish tint. Pain in the chest or abdomen is often noted.

The more extensive the inflammation of the lung tissue, the more pronounced the symptoms of general intoxication of the body and respiratory failure. A good example is lobar pneumonia. With this type of disease, symptoms of respiratory failure (shortness of breath, cyanosis) appear and rapidly increase. On physical examination, shortening of the percussion sound above the infiltration in the lung, hard or weakened breathing, the presence of small moist rales, and crepitus are noted. The disease lasts 7–14 days. In the resolution stage, the body temperature normalizes, the cough becomes frequent, wet, with sputum (sometimes rusty in color). The patient's asthenia persists for a long time.

The destructive form of pneumonia is most often caused by Staphylococcus aureus or gram-negative bacteria. An infiltrate forms in the lung, which undergoes decay with the formation of abscesses. The clinical picture corresponds to a severe septic process. The patient's condition is severe, intoxication and respiratory failure are severe. The course of the disease is rapid, often ending in the death of the patient or transition to chronic pulmonary pathology.

Complications

Acute adrenal insufficiency, anemia, pleurisy, atelectasis and lung abscesses, pyopneumothorax.

Diagnostics

3. X-ray of the lungs in two projections.

4. Bacteriological examination of sputum and determination of pathogen sensitivity to antibiotics.

Treatment

1. Medical and protective regime.

2. Medical nutrition.

3. Drug therapy: antibiotics, bronchodilators, mucolytics, expectorants, detoxification therapy, antipyretics, antihistamines, metabolic, sedatives, vitamins, drugs that improve metabolic processes and blood circulation in the central nervous system. In the destructive form of pneumonia, therapy is supplemented with glucocorticosteroids, diuretics, and plasma transfusions are performed.

4. Oxygen and aerotherapy.

5. Physiotherapy (UHF, inductothermy, electrophoresis, ultraviolet radiation).

6. Breathing exercises.

8. Massage.

Prevention

Primary prevention - hardening from the first months of life, rational feeding, sanitation of foci of chronic infection, treatment of diseases that contribute to the development of pneumonia. Secondary prevention consists of timely and adequate treatment of acute pneumonia until complete recovery; for 2–4 weeks after recovery, the child should not visit childcare facilities to avoid reinfection.

The reasons contributing to the development of pneumonia are often the functional and morphological immaturity of the body of a young child, respiratory defects, fermentopathy, constitutional anomalies, prematurity, the presence of foci of chronic infection in the nasopharynx, hypothermia or overheating of the child, and impaired bronchial obstruction.

Nursing care

1. The patient must be positioned with maximum comfort, since any inconvenience and anxiety increase the body’s need for oxygen. The child should lie on the bed with the head end elevated. It is necessary to frequently change the patient's position in bed. The child's clothing should be loose, comfortable, and not restrict breathing and movement. The room where the patient is located requires regular ventilation (4-5 times a day) and wet cleaning. The air temperature should be maintained at 18–20 °C. Sleeping in the fresh air is recommended.

2. It is necessary to monitor the cleanliness of the patient’s skin: regularly wipe the body with a warm, damp towel (water temperature – 37–38 °C), then with a dry towel. Particular attention should be paid to natural folds. First, wipe the back, chest, belly, arms, then dress and wrap the child, then wipe and wrap the legs.

3. Food must be complete, high-calorie, fortified, appropriate for the child’s age. Food should be liquid or semi-liquid. It is recommended to feed the child in small portions, often, and offer favorite foods. Drinking plenty of fluids (mineral waters, compotes, fruit, vegetable and berry decoctions, juices) is mandatory. After eating and drinking, be sure to let your child rinse his mouth. Infants should be fed breast milk or formula. Give sucking in small portions with breaks for rest, since respiratory failure may worsen during sucking.

4. It is necessary to ensure the cleanliness of the nasal passages: remove mucus using a rubber spray, clean the nasal passages with cotton wool soaked in warm vegetable oil. Monitor the mucous membranes of the oral cavity for timely detection of stomatitis.

5. Physiological functions and compliance of diuresis with the liquid consumed should be monitored. Avoid constipation and flatulence.

6. Regularly follow the doctor’s orders, trying to ensure that all procedures and manipulations do not cause significant anxiety to the child.

7. In case of severe cough, it is necessary to raise the head of the bed, provide access to fresh air, warm the child’s feet with warm heating pads (50–60 °C), and give antitussives and bronchodilators. When the cough becomes wet, expectorants are given. From the 3rd–4th day of illness at normal body temperature, it is necessary to carry out distracting and absorbable procedures: mustard plasters, warming compresses. In the 2nd week, you should begin to perform physical therapy exercises, massage of the chest and limbs (light rubbing, in which only the massaged part of the body is exposed).

8. If the body temperature is high, it is necessary to uncover the child; if there is a chill, rub the skin of the torso and limbs until reddened with a 40% solution of ethyl alcohol using a rough towel; if the child has a fever, the same procedure is carried out using a solution of table vinegar in water (vinegar and water in a ratio of 1: 10). Apply an ice pack or a cold compress to the patient’s head for 10–20 minutes, the procedure must be repeated after 30 minutes. Cold compresses can be applied to large vessels in the neck, in the armpit, on the elbow and popliteal fossae. Do a cleansing enema with cool water (14–18 °C), then a therapeutic enema with a 50% analgin solution (mix 1 ml of solution with 2–3 teaspoons of water) or insert a suppository with analgin.

9. Carefully monitor the patient, regularly measure body temperature, pulse, respiratory rate, blood pressure.

10. During the year after suffering from pneumonia, the child is under dispensary observation (examinations in the first half of the year - 2 times a month, in the second half of the year - once a month).

Endocrine diseases

Obesity

Obesity is a disease associated with an increase in body weight of 10% or more.

Etiology

The disease can be triggered by factors such as:

1) hypercaloric nutrition, habitual overeating, excessive appetite due to family tradition, the action of psychogenic factors, dysfunction of the hypothalamus, and carbohydrate metabolism;

2) reduced energy consumption due to physical inactivity or constitutional features of metabolism;

3) pathological metabolism, in which there is a shift in metabolic processes towards the formation of fat from proteins and carbohydrates; If both parents are obese, the likelihood of a child developing obesity increases to 80–90%.

Clinical manifestations

In the initial stages of obesity, there is an even distribution of fat on the body, transient autonomic disorders such as sweating, nausea, thirst, dizziness, fatigue, and palpitations.

At stages III–IV of the disease, excessive fat deposition is observed on the abdomen (hanging folds), hips, back, chest, and limbs. Characteristic changes in the skin are revealed: folliculitis, marbling of the skin, the appearance of a network of small vessels, striae (red-bluish stripes of skin stretching). In some cases, there are disturbances in skin sensitivity and a decrease in the body's defenses.

Patients complain of shortness of breath at the slightest exertion, a feeling of interruptions in the heart area. The load on the musculoskeletal system increases, which can lead to the development of joint diseases. Hereditary-constitutional obesity differs from the nutritional form of the disease in its early onset (from the neonatal period), rapid progression and loss of ability to work, and the onset of disability.

Complications

Diabetes mellitus, dysfunction of the endocrine system, diseases of the heart and respiratory system.

Diagnostics

3. Biochemical blood test.

4. X-ray of the skull.

5. Ultrasound of the adrenal glands, uterus and appendages.

Treatment

1. Lifestyle correction.

2. Treatment of the underlying disease (endocrine obesity).

3. Medical nutrition.

4. Drug therapy: appetite suppressants, stimulating lipolysis (fat breakdown), diuretics.

6. Massage.

7. Physiotherapeutic methods of treatment.

8. Psychotherapy.

9. Surgical treatment.

10. Sanatorium-resort treatment.

It is necessary to carefully calculate the calorie content of foods and ensure that the child’s diet is hypocaloric. Limit the consumption of easily digestible carbohydrates, pasta, and cereals.

Prevention

A balanced diet, outdoor games, and physical exercise are the basis for the prevention of obesity.

Nursing care

1. An obese child is advised to have an active lifestyle. Exercise therapy classes are useful. Morning exercises, therapeutic exercises, dosed walking, running, swimming, dancing, cycling, training on exercise machines, sports games (volleyball, tennis, badminton) are recommended.

2. Hot, spicy, smoked and salty foods, seasonings, pickled and canned foods, meat and fish broths, and ice cream are prohibited. Table salt is not added to food during cooking; adding salt to ready-made dishes is allowed. Sugar is excluded from the diet. It is recommended to increase the content of plant fiber and fortified foods (vegetables, berries, fruits) in food. It is useful to eat 5-6 meals a day with the last meal no later than 3-4 hours before bedtime. Food portions should be small; it is recommended to eat with a small spoon. Every meal should include vegetables and fruits.

3. Staying in the fresh air, sleeping with open windows or on an open veranda, sun and air baths are beneficial.

4. It is necessary to have regular conversations with the patient, explaining the harm of overeating and insufficient exercise.

5. Identification and sanitation of foci of chronic infection are indicated.

6. Severe forms of obesity are treated in an inpatient setting under the supervision of an endocrinologist and nutritionist.

Diabetes

Diabetes mellitus is an endocrine disease, which is based on an absolute or relative deficiency of the pancreatic hormone, insulin.

Etiology

The pathological condition is caused by hereditary predisposition, autoimmune processes during viral infections, exposure to toxic substances, and obesity. In childhood, type I diabetes mellitus develops - insulin-dependent.

Clinical manifestations

The disease develops very quickly (within several weeks). The main complaints are weakness, polydipsia (pronounced thirst - patients can drink up to 5 liters of water per day), polyuria (increased urine output - up to 3-4 liters per day). With severe polyuria, symptoms of dehydration may develop. Polyphagia (increased appetite) is often observed simultaneously with significant weight loss (in a short time the child loses up to 10 kg). In some cases, there is a tendency to develop purulent infections of the skin and mucous membranes (pyoderma, boils, stomatitis occur). In the absence of timely diagnosis and treatment, ketoacidosis develops, which is manifested by severe pain in the abdomen, lower back, poor health, the patient refuses to eat, and the smell of acetone is felt from the mouth. When testing blood and urine for glucose, hyperglycemia and glycosuria are noted.

Complications

Ketoacidosis, hypoglycemic conditions, purulent infection of the skin and mucous membranes, diabetic retinopathy, nephropathy, neuropathy, cardiopathy.

Diagnostics

2. OAM (with determination of glucose, acetone).

3. Blood test for sugar (sugar curve).

4. Biochemical blood test.

5. Study of the acid-base state of the blood.

6. Fundus examination.

8. Consultations with an endocrinologist, neurologist, ophthalmologist.

9. Ultrasound of the abdominal organs.

Treatment

1. Treatment regimen.

2. Medical nutrition.

3. Drug therapy: insulin, fatty acid binders, anticoagulants, antiplatelet agents, vitamins.

4. Treatment of complications of diabetes mellitus.

5. Herbal medicine.

6. Physiotherapy.

Prevention

Prevention of overfeeding of children, prevention of obesity, limitation of excessive mental and physical stress on children, prevention and rational treatment of infectious diseases, sanitation of foci of chronic infection, early detection of latent forms of diabetes.

Nursing care

1. At the initial stages, treatment of the disease is carried out in a hospital. After selecting insulin therapy and achieving a state of compensation for the disease, the child is discharged home, further treatment is carried out on an outpatient basis.

2. The main method of treating diabetes mellitus is insulin therapy, which is carried out for life. Insulin is administered several times a day every day, so the child’s daily routine and meals have to be adjusted to the drug administration regimen. Parents must understand that successful treatment requires careful adherence to the rules and timing of insulin administration. It is necessary to ensure that insulin preparations are always available and in sufficient quantity. The child and mother need to be explained that intense physical activity can cause the development of hypoglycemia, so outdoor games should be moderate.

It is necessary to carefully monitor the child’s condition; at the slightest suspicion of the development of hypoglycemia (weakness, increased appetite, dizziness, sweating, trembling hands), give the child food rich in carbohydrates (porridge, potatoes, white bread, sweet tea, jelly, compote, candy) , and notify the doctor about this.

3. To prevent the occurrence of lipodystrophy (changes in fatty tissue in places where insulin is frequently administered), it is recommended to alternate injection sites - buttocks, thighs, abdominal area, subscapular region. The insulin must be warmed to body temperature. After treating the skin with alcohol, you need to wait until it evaporates. To administer insulin medications, use special disposable insulin syringes with sharp needles. The drug must be administered very slowly.

4. The calorie content of the diet and the content of essential nutrients must correspond to physiological standards determined for a given age. Sugar and foods containing easily digestible carbohydrates are excluded from the diet: confectionery, baked goods, sweets, chocolate, jam, honey. The consumption of bread, potatoes, cereals and pasta should be limited (counting bread units is required). Meals are 5-6 times a day with an even distribution of carbohydrates between meals.

5. It is necessary to take measures to prevent colds and harden the child.

6. The child is under lifelong dispensary observation. He must be examined monthly by an endocrinologist (to monitor his condition and, if necessary, correct treatment), and regularly undergo urine and blood tests.

Diffuse toxic goiter

Diffuse toxic goiter is a disease based on hyperfunction and hyperplasia of the thyroid gland. The resulting hyperthyroidism (increased production of hormones) leads to disruption of the functioning of all organs and systems of the body.

In case of diffuse toxic goiter, a study of the level of blood hormones is carried out: an increased concentration in the blood of triiodothyronine, thyroxine and a decreased concentration of thyroid-stimulating hormone are determined.

Etiology

Toxic goiter is an autoimmune disease that is inherited.

Clinical manifestations

Damage to the nervous system: increased excitability, irritability, hasty speech and fussy movements, anxiety, tearfulness, increased fatigue, sleep disturbance, general weakness.

Autonomic disorders: low-grade body temperature, sweating, feeling of heat, trembling of hands, eyelids, tongue, sometimes tremor of the whole body, loss of coordination.

Complaints from the cardiovascular system: a feeling of interruptions in the functioning of the heart, pulsations in the head, abdomen, shortness of breath, tachycardia, a tendency to increase blood pressure.

Gastrointestinal disorders: increased appetite (and despite this, progressive loss of body weight), thirst, diarrhea, enlarged liver.

Eye symptoms: photophobia, lacrimation, exophthalmos (protrusion of the eyes), hyperpigmentation and swelling of the eyelids, infrequent blinking.

Enlargement of the thyroid gland (goiter) can be of 5 degrees of severity:

1) I degree – there is no visible enlargement of the thyroid gland, but its isthmus is palpable;

2) II degree – the thyroid gland contours under the skin of the neck when swallowing;

3) III degree – the thyroid gland is clearly visible, filling the area between the sternocleidomastoid muscles;

4) IV degree – the gland is significantly enlarged;

5) V degree – the thyroid gland is very large.

Symptoms of thyrotoxicosis intensify with the addition of other diseases (infectious).

Complications

Toxic goiter can be complicated by the development of a thyrotoxic crisis, which is manifested by severe tachycardia, hypertension, heart rhythm disturbances, dehydration syndrome, increased body temperature, and the gradual development of symptoms of adrenal insufficiency. In severe cases, thyrotoxic coma develops.

Diagnostics

3. Biochemical blood test.

4. Immunological blood test.

5. Study of thyroid function (hormone levels).

6. Ultrasound of the thyroid gland.

8. Fundus examination.

9. Consultations with an ophthalmologist, neurologist.

Treatment

1. Drug therapy: thyreostatic agents, glucocorticosteroids, immunomodulators, symptomatic therapy (beta-blockers).

2. Surgical treatment (subtotal resection of the thyroid gland).

Prevention

Timely detection and treatment of viral infections. Elimination of the stress factor.

Nursing care

1. The patient should be provided with a calm environment and irritating factors should be eliminated.

2. In severe cases of the disease with the development of thyrotoxic crisis, it is necessary to organize constant monitoring of the patient. For such patients, hospitalization is indicated.

3. With severe exophthalmos, due to incomplete closure of the upper and lower eyelids, drying out of the cornea may occur when blinking, which leads to disruption of the trophism of the eye, the development of keratitis, ulcers, and visual impairment. To prevent such complications, it is recommended to regularly moisten the eyeballs with nutritious plant solutions (vitamin A, vitamin drops).

4. Patients with thyrotoxicosis, due to increased metabolic processes, constantly feel hot and tend to get rid of what they think are unnecessary clothes, even in winter. Therefore, it is necessary to ensure that such a patient is dressed in accordance with weather conditions and does not reveal himself when ventilating the room in the cold season.

5. In cases of severe agitation, irritability, and sleep disturbances, it is recommended to take sedatives of plant origin (tinctures of valerian, peony, motherwort). In severe cases, as prescribed by a doctor, the patient is given tranquilizers and sleeping pills.

6. The diet should be high in calories and include a sufficient amount of proteins, fats, carbohydrates, vitamins and minerals. Particular attention should be paid to balancing the diet with B vitamins and iodine. It is recommended to limit the consumption of foods that have a stimulating effect on the central nervous system (coffee, tea, chocolate).

7. Considering the increased sweating of patients, careful skin care becomes an important element of treatment. Patients should take a hygienic shower or bath every day, and regularly change their underwear and bed linen.

8. Surgical treatment is performed if there is no effect from conservative therapy for 6–12 months.

9. Children with compensated thyrotoxicosis can return to school 1 month after hospital treatment. They are exempt from physical activity (physical education) and must be given an additional day off per week.

Hypothyroidism

Hypothyroidism is a disease characterized by decreased function of the thyroid gland.

Etiology

The disease can be caused by the absence of the thyroid gland, delayed development of the thyroid gland (hypoplasia), a defect in the enzyme systems of the thyroid gland, inflammatory and autoimmune processes in the thyroid gland, surgical removal of the gland due to tumor pathologies, inflammatory or tumor processes in the pituitary gland and hypothalamus.

Clinical manifestations

Congenital hypothyroidism (myxedema) is detected during the neonatal period. Characterized by a large weight of the child at birth (more than 4 kg), lethargy, drowsiness, jaundice of the newborn, rough facial features, wide bridge of the nose, widely spaced eyes, large swollen tongue, difficulty breathing through the nose, low voice, large belly with an umbilical hernia, dry skin , acrocyanosis, long body, short limbs. Subsequently, delays in physical and mental development, dystrophic disorders, and slow maturation of bone tissue are noted.

Acquired hypothyroidism is characterized by the appearance of puffiness of the face, retardation of speech and movements, poor performance at school, memory impairment, hair loss, brittle nails, dry skin, constipation, and chilliness.

A blood test in a hypothyroid state reveals an increased concentration of thyroid-stimulating hormone and a decrease in the levels of thyroxine and triiodothyronine. The concentrations of these hormones are always interdependent, since the neurohumoral regulation of the thyroid gland is based on the feedback principle.

If the thyroid gland produces few hormones, then the synthesis of thyroid-stimulating hormone by the pituitary gland increases.

Complications

Hypothyroid coma.

Diagnostics

3. Biochemical blood test.

4. Determination of thyroid hormone levels.

5. Ultrasound of the thyroid gland.

7. Consultations with an endocrinologist, neurologist.

8. X-ray of the skull and tubular bones.

Treatment

1. Treatment regimen.

2. Medical nutrition.

3. Drug therapy: replacement therapy with thyroid hormones, vitamins, iron supplements, and for autoimmune processes - immunosuppressive therapy.

4. Physiotherapy.

6. Massage.

7. If the disease is of a tumor nature, surgical treatment is required.

Prevention

Including iodine-rich foods in your diet. Increasing the dose of thyroid hormones in pregnant women with thyroid diseases accompanied by hypothyroidism to prevent congenital hypothyroidism in the fetus.

Nursing care

1. Children with hypothyroidism experience chilliness and have cold extremities, so it is recommended to dress them warmly.

2. To prevent constipation, you need to give your child fresh juices, fruits, vegetables, as well as dishes made from them. Of course, nutrition should be appropriate for the child’s age. It is necessary to enrich the diet with foods high in vitamins.

3. Skin changes due to hypothyroidism require special care. It is necessary to moisturize and soften the skin with children's cosmetics (baby creams, skin care oils).

I .The main problems of the patient against the background of asphyxia

P/ P

Real

Potential

Priority

Breathing rhythm disturbance

Single breaths;

Apnea;

Difficulty breathing;

Rare

superficial

breath

Breathing rhythm disturbance

Heartbeat disturbance

Lack of pulse;

Bradycardia;

Tachycardia;

Arrhythmia

Change

muscle tone

Muscle atony;

Decreased muscle tone;

Tremor of the chin, limbs;

Convulsions

Change in color of the skin and mucous membranes

Pale skin;

Cyanosis;

Acrocyanosis;

Earthy skin tone;

- “marbling”

II

priority problem “Respiratory rhythm disturbances”

The rhythm will be restored if:

Carry out resuscitation measures for asphyxia according to the action algorithm;

Create maximum peace;

Carry out the prescribed manipulations sparingly;

Warm the newborn;

Provide constant oxygen supply;

Carry out a thorough toilet of the skin, mucous membranes and umbilical wound in compliance with asepsis and antiseptics;

Monitor body weight;

Carry out regular nutrition calculations;

Feed the child in a gentle way (as prescribed by the doctor);

Increase the frequency of feeding to 7-10 times a day;

Calculate pulse, respiratory rate, evaluate their characteristics;

Have a conversation with your mother and relatives about the disease and tactics in the post-asphyxial period.

I . The main problems of the patient in acute

period of intracranial birth injury

P/ P

Real

Potential

Priority

Hypo- and adynamia

Muscular hypotonia;

Suppression or absence of physiological reflexes;

Coma

Motor restlessness

Motor restlessness

Increased muscle tone;

Tremor of hands and chin;

Convulsive readiness, convulsions;

Stiff neck

Regurgitation

Vomit;

Anorexia;

Aspiration

II . Nursing Intervention Plan

priority problem “Motor restlessness”

Motor restlessness will decrease if:

Inform your doctor and follow his instructions;

Provide the child with complete rest (daily toilet and necessary manipulations should be carried out in the crib where he lies);

Create a position for the child in bed with the head end elevated;

Provide skin care, mucous membranes, change linen;

Apply cold to the head;

Monitor your general condition, measure pulse, respiratory rate,tbodies;

Early and long-term use of oxygen;

Feed the child (depending on the severity of the condition) in the first days through a tube, then from a bottle, and only when the general condition improves can one begin to put it to the breast under the control of m/s;

Provide comfortable conditions in the ward, incubator;

Extend deep sleep time;

Limit painful manipulations to a minimum;

It is better to administer medications through a tube during feeding or give orally from a spoon;

Administer phenobarbital, bromides, diphenhydramine as prescribed by a doctor;

During an attack of convulsions, administer intramuscularly 25% magnesium sulfate solution, droperidol solution, GHB;

Inform relatives about the disease and its consequences.

I . Main patient problems

against the background of HDN

P/ P

Real

Potential

Priority

Increased muscle tone

Neck stiffness;

Hands clenched into fists;

Tension of the large fontanel;

Convulsions

Increased muscle tone, cramps

Edema

Accumulation of transudate in cavities;

Anasarca (skin swelling);

Violation of a comfortable state

Lethargy

Drowsiness;

Suppression of reflexes;

Refusal to eat

II . Nursing Intervention Plan

priority problem “Seizures”

Convulsions in a child are stopped if:

Inform your doctor and follow his instructions;

Restore breathing (suck out mucus from the mouth and nose);

Place the child on a flat surface (protect from mechanical injuries);

Free the child from restrictive clothing;

Provide a flow of fresh air;

Make sure that the child does not bite his tongue; to do this, place a spatula or the handle of a spoon, wrapped in a thick layer of bandage, between the molars, or place a knot of a napkin (handkerchief);

- as prescribed by a doctor, administer anticonvulsants intravenously or intramuscularly:

Seduxen, or

Droperidol, or

25% solution of magnesium sulfate, or

GHB;

Feed carefully, in small portions (after the cramps end);

Provide the child with breast milk or fermented milk formulas;

Create a protective regime for the child;

Create comfortable conditions (fresh air, ventilation, wet cleaning);

Monitor pulse rate, respiratory rate, measure blood pressure;

Maintain physical and mental peace;

Provide skin care, mucous membranes, change of underwear and bed linen;

Drink frequently, in small doses.

I

localized purulent infection

P/ P

Real

Potential

Priority

Promotiontbodies up to 38C

Poor appetite, breast refusal;

Weakness, lethargy;

Poor sleep;

Irritability;

Tearfulness

Decreased appetite

Poor weight gain;

Regurgitation, vomiting;

Breast refusal

The presence of a purulent focus on the skin and mucous membranes

Violation of the integrity of the skin and mucous membranes (erosions, ulcers, weeping, necrosis);

Infiltration;

Infection of healthy skin areas;

Transition of local inflammatory process into generalized infection

II . Nursing Intervention Plan

priority problem “The presence of a purulent focus on the skin and mucous membranes”

A localized purulent lesion will decrease if:

Inform your doctor and follow his instructions;

Isolate the patient and his mother from healthy children, in a separate box, and examine;

Allocate special personnel to service them;

Provide individual care using gloves, masks, separate gowns, and safety glasses;

Provide the patient with physical and mental rest, protective regime;

Maintain sanitary and hygienic conditions in the ward;

Use personal care items, medical equipment, instruments, and disinfect them;

- influence the etiological factor, prevent further spread of infection:

Carry out external treatment from the first days;

Treat the surrounding apparently healthy skin with disinfectant. solutions;

Use external antibacterial agents, administer antibiotics as prescribed by a doctor;

Treat pyogenic elements and erosions with a 1% solution of aniline dyes (diamond green, methylene blue) or disinfectant ointments;

Treat healthy areas of the skin with alcohol and irradiate them with ultraviolet radiation;

Give newborns and infants baths with a weak solution of potassium permanganate;

- increase the body's defenses:

Prescribe a nutritious diet with limited carbohydrates, increased protein, and vitamins;

Prescribe immunotherapy drugs;

Prohibit older children from washing in baths or saunas;

Cut your hair and nails short;

Use sterile diapers and linen, soak them in a chloramine solution, and deliver them to the laundry separately;

Conduct regular examinations of service personnel;

Do not allow employees with purulent diseases of the skin and mucous membranes to work;

Ensure comfortable conditions in the room (ventilation, fresh air, wet cleaning);

Conduct a conversation with parents and relatives about behavioral tactics and elements of care.

I . The main problems of the patient in the background

sepsis

P/ P

Real

Potential

Priority

The presence of a purulent focus (usually in the area of ​​the umbilical wound)

Promotiontbodies;

Decreased appetite;

Generalization of the infectious process

The presence of a purulent focus - omphalitis

Weight loss

Emaciation;

Weakness, lethargy;

Exhaustion;

Decreased physical activity

Promotiontbodies up to 39C

Refusal to eat;

Weakness, lethargy;

Restless sleep;

Irritability;

Tearfulness

Regurgitation

Vomit

Loose stools;

Dehydration;

Breast refusal;

Weight loss;

Dry skin and mucous membranes

II . Nursing Intervention Plan

priority problem “Presence of a purulent focus - omphalitis”

The symptoms of omphalitis will decrease if:

Inform your doctor and follow his instructions;

Isolate the child in a box, open incubator;

Highlight individual care items;

Provide the child with rational feeding with mother's milk (feed from a bottle or apply to the breast);

Ventilate the box frequently;

Irradiate the box daily with a bactericidal lamp and thoroughly disinfect it;

- toilet the umbilical wound several times a day (2-3 times):

Stretch the edges of the wound;

Rinse with 3% hydrogen peroxide solution and dry;

Treat the wound with a 1% solution of brilliant green;

Leave the umbilical wound open so as not to injure it with diapers or clothes;

Swaddle the baby separately: the upper half of the belly with arms, and the lower half with legs;

Inform mother and close relatives about the disease and possible complications;

Provide the child with individual care items, sterile diapers, linen;

I . The main problems of the patient in the background

malnutrition

P/ P

Real

Potential

Priority

Lack or decreased appetite

Impaired motor activity;

Weakness, lethargy;

Emaciation, weight loss

Regurgitation, vomiting

Poor weight gain

Emaciation;

Retarded physical development;

Exhaustion

Unstable chair

Stomach ache;

Maceration of the skin around the anus;

Anxiety, flatulence

Regurgitation, vomiting

Violation of a comfortable state;

Dehydration;

Weight loss

II . Nursing Intervention Plan

priority problem “Spitting up, vomiting”

Urging frequencyvomiting will decrease and stop if:

Tell your doctor;

Raise the head of the child's bed;

Turn the child's head to the side, provide a tray, basin;

Rinse the child’s stomach as prescribed by the doctor;

Rinse the child’s mouth and give a small amount of boiled water to drink;

Give a drink (as prescribed by a doctor) a solution of novocaine 0.25% in an age-appropriate dosage:

up to 3 years – 1 teaspoon;

from 3 to 7 years – 1 day. spoon4

over 7 years – 1 tbsp. spoon.

Do not feed the child if there is repeated vomiting;

Provide the child with fractional drinks (as prescribed by the doctor): a solution of glucosalan, rehydron, smecta, 5% glucose solution, saline, sweet tea, boiled water (at the rate of 100-150 ml per 1 kg of weight per day);

Administer antiemetic drugs (as prescribed by a doctor);

Provide the child with skin care, mucous membranes, a change of linen, weigh the child daily;

Create comfortable conditions for the child:tplus 24-27C, room ventilation – 3 times a day for 20 minutes; wet cleaning - 2 times a day with disinfectant. means; disinfection of vomit;

Provide physical, psychological peace, psychological support (screen, separate room, box);

Observe and record the frequency, quantity, nature, color of vomit and stool, inform the doctor;

Calculate pulse, respiratory rate;

Have a conversation with the mother about the prevention of aspiration of vomit, about the elements of care;

Follow doctor's orders.

I . The main problems of the patient in the background

exudative-catarrhal diathesis

P/ P

Real

Potential

Priority

Itchy skin

Attachment of a secondary infection;

Poor sleep;

Anxiety;

Irritability;

Tearfulness;

Skin scratches, scratches

Itchy skin

Hyperemia of the skin in the area of ​​the cheeks and natural folds

Itchy skin;

Wetting of the skin;

Violation of skin integrity;

Poor sleep;

Peeling skin

Gneiss on eyebrows and scalp

Anxiety;

Poor sleep;

Itchy skin;

Dry and weeping eczema

II . Nursing Intervention Plan

priority problem “Itchy skin”

Itching of the skin will decrease if:

Inform your doctor and follow his instructions;

Inform the mother and relatives of the child about the disease, possible progression of the disease and consequences;

Teach mom how to keep a “food diary”;

Ensure strict adherence to the cleanliness of the child’s skin and mucous membranes;

Train mother and close relatives to treat the skin, cheeks, natural folds, and scalp;

Organize a protective regime for the child;

Support tair in the room where the child is located is within +20-22C;

Carry out daily wet cleaning of the premises and ventilation;

Use underwear and bedding for the child made from cotton fabrics;

Wash clothes with baby soap;

Put cloth mittens on the child’s hands or place cardboard splints on the elbows (to prevent scratching);

Exclude from the diet foods that cause an exacerbation of the disease in the child;

Use fermented milk mixtures and Biolact kefir in the first year of life;

Limit salt and liquid in your diet;

Maintain a careful daily routine, ensure long stays in the fresh air, help improve and lengthen sleep;

Carry out hardening procedures carefully;

Use ointments, mash, medicinal baths, sedatives (as prescribed by a doctor);

Prevent intercurrent (additional) diseases and eliminate contact with animals.

State autonomous educational institution

Kaluga region of secondary vocational education

"Kaluga Basic Medical College"

Lecture

"Nursing process in care

for a premature baby"

2014

Lecture plan.

The concept of the perinatal period and perinatal mortality.

Definition of prematurity and causes of miscarriage.

Signs of prematurity. Degrees of prematurity.

a) external signs

b) functional signs

Features of transition states in premature infants.

Nursing problems and nursing interventions in caring for premature infants.
a) special medical training. personnel

b) warming the premature baby

c) feeding premature babies

d) transportation

e) prevention of breathing disorders

f) criteria for discharge home

g) general care of the premature baby

Subsequent physical and neuropsychic development of premature infants.

Periodnewborns begins at birth and lasts 28 days. This period is critical for the child and very responsible for the medical staff. From the first hours of extrauterine existence, a newborn child is subjected to serious tests in connection with new living conditions. In the periods of intrauterine development, the perinatal period is distinguished - according to WHO, this is the period from the 28th week of intrauterine life of the fetus to the 7th day of the life of the newborn.

Stillbirths and deaths during this period are defined as perinatal mortality. The first days after birth are especially important. Newborn diseases occupy 1st place in the structure of child mortality

The outcome of childbirth and the health of the newborn depends on a number of factors:

the mother's health status, her age and the number of previous births (optimal for 1 birth - 20-24 years, for 2 births - 25-29 years);

the course of pregnancy;

maternal nutrition during pregnancy;

presence of bad habits;

negative effects of chemicals, radiation, medications;

correct management of childbirth.

Premature baby is a child born prematurely (before 38 weeks).
Causes of miscarriage (% of premature births ≈ 5 - 6%);

Pathology of pregnancy, gestosis in pregnant women, multiple pregnancies, abnormal position of the fetus, fetal diseases, incompatibility of the blood of the fetus and mother;

Women's diseases:

a) severe extrogenital diseases (CVS, endocrine, anemia, etc.)

b) genital pathology: ovarian dysfunction, isthmic-pervical insufficiency, previous abortions

c) chronic infections: cytomegaly, toxoplasmosis, etc.

d) acute infectious diseases: influenza and other acute respiratory viral infections, epidemic hepatitis, etc.

Physical and mental trauma of pregnant women

Abuse of alcohol, smoking, drugs

Occupational hazards, taking medications

Poor nutrition (fasting)

Mother's age (under 18 years old and over 30 years old /relatively/)

Height> 150 cm, weight – 45 kg
Signs of prematurity.

Gestation period 28-38 weeks

Weight less than 2500

Height less than 45 cm

Based on weight, there are 3 degrees of prematurity:

1. weight 2500-2001

2. weight 2000-1501

3. weight 1500-1001

External signs of premature birth:

disproportionate physique (large head and torso)

small fontanel and sutures are open

the bones of the skull are movable and can overlap each other

The ears are soft and easy to wrinkle

on the shoulders, back, cheeks, forehead - thick fluff

There is no subcutaneous fat layer, the skin is flabby

sexual characteristics: in boys the testicles are not descended into the scrotum, in girls the labia majora do not cover the labia minora

the navel is located closer to the womb.

reliefs on the palms of the soles are less pronounced
Functional characteristics:

weak cry (squeak)

lethargy, drowsiness

decreased and absent sucking and swallowing reflexes

imperfection of thermoregulation: do not maintain body temperature, are easily cooled and easily overheated

the breathing of premature infants is irregular, shallow, with a higher frequency than that of full-term infants (marked by lability (external stimuli cause increased or decreased breathing). Premature infants often develop apnea before the development of attacks of asphyxia, especially during meals

cough reflex is weak or absent

pulse rate in premature infants is 100-180 per 1 ,. The pulse is very labile, increases during feeding, when crying, during examination, blood pressure is lower than in full-term newborns

the digestive system is immature, flatulence is often observed, they are able to digest and absorb only breast milk

reduced immunity levels and low resistance to disease

Features of physiological (transitional) states of newborns

The physiological loss of body weight in premature infants is greater than in full-term infants and amounts to 6-14% (Nto 10%). Recovers later (by 2-3 weeks).

Physiological erythema lasts a long time.

Physiological jaundice is protracted.

Sexual crisis is less common and mildly expressed

Transient fever occurs easily, especially when overheated.

Nursing of premature newborns.

Special training of medical staff.

In our country, we have a two-stage system for caring for premature babies.

Stage 1. They give birth during premature birth in special maternity hospitals or departments.

Stage 2. At the age of 9-14 days, premature babies are transferred to a specialized department for premature babies (in Kaluga - the neonatal pathology department).

Nursing problem: warming preterm infants.

Already in the delivery room: the treatment of the premature baby is carried out under radiant heat, the baby is received in warmed sterile diapers.

Then the children are placed in incubators (air temperature 31-35 0 , air humidity 90-95%).

From the incubator the child is transferred to a crib-hot water bottle (Baby-therm).

If there is no incubator or crib-hot water bottle, the child can be warmed in heating pads: 3 heating pads - 2 on the sides (on top of the blanket) and one under the feet (under the blanket). Water temperature in heating pads – 60 0 . The heating pad is placed next to the child at a distance of the width of the palm. The water in the heating pads is changed one at a time.

Air temperature in the wards – 24-26 0 . Don't overheat!

Nursing problem: Feeding premature infants.

Solving this problem is fraught with certain difficulties. A premature baby can only absorb breast milk. Milk during premature birth contains more protein, which is very necessary for the premature baby. In the absence of sucking reflexes, premature infants are fed expressed breast milk through a tube.

If there is a swallowing reflex and the child does not suck, you can feed from a spoon or from a cup or even from a pipette (drip into the mouth). If there are sucking and swallowing reflexes and the baby is in good condition, he can be attached to the breast. A nurse must be present during feeding and help the mother.

Usually, if born prematurely before 30 weeks, the child is fed through a tube, from 30 to 32 weeks - through a tube and 1-2 cup feedings, over 32 weeks - can be put to the breast. A premature baby needs to be fed more often than a full-term baby. The amount of milk per day on day 1 is 60 ml/kg/day, in subsequent days we add 20 ml/kg/day until we reach 200 ml/kg/day.

The nurse should provide psychological support to the mother: instill hope that the mother has breast milk and give advice on preventing hypogalactia, teach pumping at least every 3 hours and always at night, allow (encourage) the presence of the mother when feeding the child through a tube. If there is little breast milk and you have to feed with adapted formulas, then you need to give at least a little breast milk to protect against infections.

A nursing problem is the transportation of premature babies.

Dangers: cooling, asphyxia, vomiting followed by aspiration.

Solution to the problem:

Warming in an incubator, if there are no such machines, then in heating pads.

On the arms (fewer intracranial injuries).

Not earlier than 1-1.5 hours after feeding.

As prescribed by the doctor, before transportation, subcutaneous administration of etimizol, cordiamine.
Transportation is carried out by a specially trained nurse (paramedic). The car must have an oxygen bag.
Nursing problem prevention of respiratory disorders.

Position in an incubator with an elevated head end.

After feeding, lie on your side or stomach. Do not move for 40-60 minutes. after feeding.

Oxygen before and after feeding for 2-3 weeks.

As prescribed by a doctor - 0.5% caffeine, 1 tsp. 2-3 times a day for 1 month.

Nursing problem: discharge of a premature baby.

Weight 1800-2000 and even 1500 if the child meets the following conditions:

Good health and normal physiological parameters, no pathological symptoms.

Steady weight gain.

Good sucking reflex.

Good thermoregulation (maintains body temperature).

The mother is able to care for the child at home.

Nursing problem: mother's lack of knowledge and skills when caring for a premature baby.

Purpose: The nurse will teach and demonstrate skills and knowledge to the mother.

You can bathe your child after the umbilical cord has fallen off (12-14 days) every day, water temperature 37.5-38 0 WITH.

Walking – children over 3 weeks – 1 month, air temperature not lower than -5 0 C, body weight not less than 2 kg. Walk in your arms at the beginning and the first walks are 10-15-20 minutes.

Swaddling: in the incubator the child is naked; when transferred to a hot-water bed, he is swaddled with arms; care must be taken to ensure that there is no tight swaddling (prevention of asphyxia). Swaddle under radiant heat. Loose swaddling is used only when the baby maintains body temperature.

Nursing problems: maternal anxiety and maternal knowledge deficit regarding the subsequent physical and neuropsychological development of children.

Physical development.

Premature babies grow very quickly:

weight

doubles by 3 months, triples by 6 months, by one year it can catch up with peers (≈7500 to 9500), but in very premature infants the weight may lag behind in the first 2-3 years.

height

per year the child grows by 27-38 cm, by the year the height is ≈ 70-77 cm (very premature babies grow especially quickly)

Head circumference

per year - by 15-19 cm, by year ≈44-46 cm

For good development, breastfeeding, proper introduction of complementary foods, and disease prevention are necessary.

Neuropsychic development in premature infants is delayed; all skills may be delayed by 2-3 months. The nurse should explain to the mother that for the child to develop well, he needs to do the following:

massage

from 1 month (weight 1700-1800)

gymnastics

from 3 months

toy show

hanging toys from 1.5-2.5 months. - when the gaze begins to fixate

conversation with a child

It should be noted that most children develop normally. Darwin, Newton, Voltaire, Hugo were premature.

The concept of fetal immaturity and intrauterine malnutrition.

Immaturity of the fetus – a child born at term has external signs of premature birth and functional signs: immature respiratory center, lack of reflexes, low immunity.

Intrauterine malnutrition – at the birth of children, body weight does not correspond to the period of intrauterine development. When children are born at term, their weight is below 2500.

Causes: gestosis in pregnant women, bad habits, severe illnesses in the mother, poor nutrition of the pregnant woman, multiple births.

Admission to care for infants.

The basis of care is adherence to the strictest cleanliness, and for a newborn child, sterility (asepsis). Care for infants is carried out by nursing staff with mandatory supervision and participation of a doctor. Persons with infectious diseases and purulent processes, malaise or elevated body temperature are not allowed to work with children. Medical workers in the infant department are not allowed to wear woolen items, jewelry, rings, use perfume, bright cosmetics, etc.

Medical staff of the department where infants are located must wear disposable or white, carefully ironed gowns (replace them with others when leaving the department), caps, four-layer marked masks and removable shoes. Strict personal hygiene is mandatory.

Care of skin and mucous membranes in newborns and infants. Hygiene.

Daily care for the newborn is carried out by a nurse in the children's ward of the maternity hospital or in the ward where mother and child stay together. After discharge from the maternity hospital, care is provided by the mother in a specially designated corner of the children's room, on a changing table, which should be covered with a blanket, oilcloth, and a clean diaper on top. Good lighting is necessary, air temperature is 20–22 o C.

Before using the toilet for an infant, be sure to wash your hands with warm water, a brush and soap for 2 minutes. After placing the undressed child on a pre-treated changing table, he is carefully examined, paying special attention to the umbilical wound, as well as the places most dangerous for diaper rash (behind the ears, neck, axillary, inguinal folds). Eyes washed with boiled water, in the direction from the outer corner to the inner. Use separate sterile cotton swabs for each eye, first wet, then dry.

In the presence of conjunctivitis, the eyes are treated repeatedly during the day with a solution of furacillin at a dilution of 1:5000 or a solution of KMnO 4 at a dilution of 1:8000 (0.8% solution).

Toilet nasal passages is carried out to remove dry crusts, mucus, and milk that may get there during regurgitation. The nose is cleaned with cotton swabs soaked in sterile petroleum jelly, which are inserted into the nasal passage one to one and a half centimeters with rotational movements. To remove the crusts that form in the baby’s nose, first instill warm Vaseline oil into each nostril, and after 15 minutes, clean the nose with cotton wool. Cleansing of the nasal passages is carried out alternately, using different flagella. Using matches, sticks and other objects with cotton wool wrapped around them to toilet the nasal passages is strictly prohibited. Ears wipe with a well-wrung out damp cotton wool soaked in boiled water. Once every two to three weeks, clean the external auditory canals with wet and then dry cotton wool.

Oral toilet Children are performed only if there are special indications (thrush, aphthous stomatitis).

Thrush (candidiasis of the mucous membranes) appears on the mucous membrane of the oral cavity (cheeks, palate, gums, tongue) in the form of multiple pinpoint plaques, reminiscent of semolina or curdled milk, located on a hyperemic background. The plaque is easily removed with a gauze swab, revealing a moist, erosive, painful surface, which makes it difficult to move the mouth when sucking and swallowing. To treat thrush, the following solutions are used: 1% gentian violet solution, 2% soda solution, 20% borax solution with glycerin, nystatin, irrigation with ascorbic acid. Treatment of affected mucous membranes is carried out 3-4 times a day, before feeding. Using a sterile stick with cotton wool soaked in one of the solutions, carefully rotate the elements of the thrush without pressing.

The face, neck, and hands are washed with boiled water using a cotton ball. The skin of infants is very delicate and thin. It is easily damaged by the slightest impacts. Microbes freely penetrate through damaged skin, and the child’s body is not yet able to actively counteract them. Therefore, even isolated pustules, redness and damage to the skin can lead to generalization of infection in a short time. In this regard, any skin diseases in young children require medical consultation. The child's skin is carefully examined and wiped with sterile cotton wool soaked in sterile Vaseline or boiled vegetable oil. You can also use baby cream to wipe the skin. Particular attention is paid to natural folds, which are wiped in the following order: behind the ear, cervical, axillary, elbow, wrist, popliteal, inguinal, buttock.

Diaper rash- limited inflammatory changes in the skin, in areas easily subject to friction and maceration (natural folds). Diaper rash occurs when care for a newborn is not taken care of: infrequent washing, excessive wrapping, trauma to the skin with rough diapers, etc. Treatment of diaper rash comes down to eliminating defects in care. The child should be washed after each urination and bowel movement, the underwear should be changed frequently, and diapers should be changed at least every hour. General baths with KMnO 4 are prescribed (water temperature 36–38 o C), local air baths for 5–10 minutes. The affected areas are powdered with talc powder and dermatol (3–5%) and lubricated with sterile vegetable oil. When prickly heat(small red spots that merge into general redness), it is recommended to wipe the skin with vodka diluted half with water. Since prickly heat occurs when overheated, it is necessary to switch to loose swaddling. Daily baths with potassium permanganate or potassium permanganate are required. Air baths are also useful.

They wash the children with warm running water at a temperature of 36-38 o C. While washing, the child is held suspended in the left hand, and washed with the right. In case of heavy contamination, washing is carried out with a soapy hand. When washing, girls are held face up and must be washed from front to back; this is done to prevent infection of the urinary tract with fecal matter. Then the child is dried with careful blotting movements. They wash the child at the end of the morning toilet and after each act of defecation. For children with sensitive skin and a tendency to diaper rash, it is recommended to wash them after each urination.

Toilet genitals in girls it is carried out in the presence of vaginal discharge. The cotton wool is moistened in a solution of furacillin 1:5000 or KMnO 4 1:8000, and the genital slit is carefully wiped. The accumulation of smegma between the foreskin and the head of the penis in boys should not be removed, as the mucous membrane can be damaged. For diaper rash and maceration of the penis, local baths with a solution of KMnO 4 1:8000 are recommended.

Nails The child is cut with small scissors at least once a week. Scissors are pre-treated with cologne or alcohol. To make the procedure less unpleasant, you can liken it to a game - tell something about each finger. On the hands, nails are cut in an arched manner, on the feet - with a straight cut (to prevent ingrown toenails). Nails are cut over an unfolded sheet of paper so as not to scatter them; the trimmings should not get into the child’s face or onto the bed. Hair cutting is a very unpleasant procedure for children, so it must be done carefully, using a clipper or sharp scissors; after cutting, you should wash your hair with baby soap or shampoo.

Bathing a child. Daily bathing of the newborn begins 2-3 days after the umbilical cord falls off, after the umbilical wound has healed. Bathing is recommended before the penultimate feeding. A hygienic bath is carried out daily up to 6 months of age, in the second half of the year - every other day, from one year to two - twice a week, after two years - once a week. In the first month, it is preferable to use boiled water for a hygienic bath. For children with an unhealed umbilical wound, a solution of potassium permanganate is added to boiled water (the color of the water is light purple). The child is bathed with soap no more than once or twice a week. Using soap more frequently may cause skin irritation. The duration of the bath for children of the first year is usually 5–7 minutes, the air temperature in the room is 20–22 o C, the water temperature for children in the first half of the year is 36.5–37.0 o C, for the rest - 36 o C.

The baby bath is washed with hot water, soap and a brush (if bathing is carried out in a child care facility, the bath is additionally treated with a disinfectant solution) and rinsed with hot water. Before bathing, prepare underwear for the child. It must be folded in the order in which it will be used after the bath. It is recommended to warm up the laundry, for which you can place it on a rubber or electric heating pad. The bath is filled with water so that the child can be immersed up to the shoulders. One diaper, folded in four, is placed on the bottom of the bath. Carefully immerse the child in the bath, supporting the buttocks with the left hand, and the head and back with the right hand (top left picture), with the child’s head on the bather’s forearm and the back on the palm. You can hold the child in another way with your right hand: the bather uses his hand to cover the child’s right shoulder, so that the child’s neck and head rest on his forearm. After this, the left hand is released. The child is washed with his free left hand (upper right and lower left pictures), with a special terry or flannel mitten or sponge. The scalp (lower right picture) is washed last, soaped in the direction from the forehead to the back of the head. Do not wash your face with bath water. After finishing bathing, the child is taken out of the bath with his back up and doused with water 1–2 0 C lower than the water in the bath. The bathed child is placed on an unfolded towel or sheet, wiped with blotting movements, while only the part that is being wiped remains open, the rest of the body remains closed to prevent cooling.

Clothing for children in the first months of life and the second half of the year.

The child's clothing should protect him from large heat loss, but at the same time not cause overheating and not restrict movement. In this regard, for infants, underwear made of hygroscopic cotton fabrics is used, outerwear is made of flannel or woolen fabrics.

A daily set of linen for swaddling a baby of the first 3–4 months includes a thin undershirt (8–12 pieces), a warm undershirt or blouse (4–6 pieces), a diaper (24 pieces), a thin diaper 80x80 cm (24 pieces), a diaper flannel 100x100 cm (12 pcs), flannel blanket (2 pcs), wadded blanket (1 pc), oilcloth (1–2 pcs), thin cap, hat or scarf (1–2 pcs).

After three months of age, the child is not swaddled, but dressed in vests with buttons, or with open tassels or rompers. A child is allowed up to 15 onesies per day; the calculation for the rest of the linen, with the exception of diapers, remains the same. The number of diapers after 3 months decreases almost threefold. For walks, the child is dressed in accordance with the time of year and the air temperature outside. The last quarter of the year is marked by increased motor activity of the child, in connection with this, rompers can be partially replaced with tights, knitted woolen socks can be used, and by the year, booties.

Rules for breastfeeding a child.

The ideal food for a child is his mother's breast milk, as it is closely related to his tissues. Breast milk contains all the substances and microelements necessary to nourish the baby in the optimal ratio and form, adapted to the characteristics of the baby’s digestive system. Milk is species-specific, its composition changes as the child grows, in accordance with changes in his needs.

Breastfeeding rules:

· The child is fed immediately after birth on demand, and not according to a schedule with a gradual formation of a regimen - with sufficient, established lactation in the mother.

· The duration of feeding is not limited, but no more than 15-20 minutes; if the child wishes, he is fed at night.

· It is not advisable to give a child a pacifier or pacifier.

· You can’t give your baby extra food in between feedings.

· It is necessary to observe the rules of personal hygiene and strictly follow the technology of proper feeding.

Breastfeeding technique:

· The mother should wash her hands with soap, wash her breasts with boiled water, and dry them without rubbing the area of ​​the nipple and areola.

· When feeding, the position of mother and child should be comfortable.

· The baby should not twist or stretch his neck to reach the breast. Do not hold the child's head. The baby's face is turned towards the breast, the nose is at the level of the nipple, and the belly is towards the mother's belly.

· The breast must be placed in the child’s open mouth, so that the grip is full and deep, so that the nipple and part of the areola are in the depths of the mouth, touching the hard palate.

Control of breastfeeding.

Signs on the basis of which hypogalactia can be suspected: a small increase in the child’s weight per month (on average, the monthly increase in the first half of the year is 800 g), the child does not swallow milk after a large number of sucking movements, a rare (less than 6 times) number of urinations per day, and restlessness and crying after feeding.

Hypogalactia can be objectively confirmed by carrying out control feeding (dynamics of changes in body weight before and after feeding the child). Control feeding must be carried out at least three times a day.

Procedure for storing and drinking expressed breast milk.

At home, when taking milk from one perfectly healthy woman, expressing it correctly and hygienically, and storing it correctly, you can feed milk that has not been heat-treated. The duration of milk storage in a dark place at a temperature of 18–20 0 C is up to 24 hours, in a refrigerator at a temperature of +4 0 C - 72 hours, in a freezer at a temperature of -18 0 C - up to 4 months

Features of feeding a baby from a bottle with a nipple .

· Formula or milk should be given to the child heated to a temperature of 37-40 ° C. To do this, before feeding, place the bottle in a water bath for 5-7 minutes. The water bath (pan) must be labeled “For heating milk.” Each time you need to check whether the mixture is warm enough or not too hot.

· When feeding, the bottle should be held so that its neck is always filled with milk (prevention of aerophagia - swallowing air).

· The position of the child is as when breastfeeding, or in a position on its side with a small pillow placed under the head.

· During feeding, you should not leave the baby; you need to support the bottle and monitor how the baby sucks. You can't feed a sleeping baby .

· After feeding, you need to thoroughly dry the skin around the baby’s mouth; Carefully lift the baby and place it in an upright position to remove air swallowed during feeding.

Stool in infants .

Age characteristics of feces in children are presented in Table 1.

Age-related features of feces in children of the first year of life

Age	Name	External features
Color	Consistency	Smell
1-3 day	Meconium	Dark green	Thick, homogeneous	-
3-5 day	Transitional	Areas of different colors - white, yellow, green	Liquid, watery, with lumps, clot, mucus	Gradually becomes sour
From 5-6 days to 6 months.	Normal Natural feeding Artificial feeding	Golden yellow Light yellow	Type of liquid sour cream: Pasty	Sour Putrefactive, pungent
After 6 months	Regular (decorated)	Brown	Dense (shaped)	Normal (natural, natural)

Development and prevention of skeletal deformities in infants.

Skeletal deformities occur if the child lies in the crib for a long time in one position, with tight swaddling, with a soft bed, a high pillow, or with an incorrect posture of the child in his arms.

Prevention of skeletal deformities:

· A thick mattress stuffed with cotton wool or horsehair.

· For children in the first months of life, the pillow is not used.

· The baby must be placed in a crib in different positions and periodically picked up.

· When swaddling, it is necessary to ensure that the diapers and vests fit tightly around the chest. Tight swaddling and constriction of the chest can lead to deformation of the chest and disruption of lung aeration.

· Given the weakness of the muscular-ligamentous system, children under 5 months of age should not be seated. If the child is picked up, then the buttocks should be supported with the forearm of the left hand, and the head and back with the other hand.

Practical skills on the topic

1. Admission of a sick child to the hospital, examination of the skin and hair to exclude infectious diseases and lice.

2. Treatment of a child with pediculosis.

3. Monitoring the appearance and condition of the sick child.

4. Weighing, measuring height, head and chest circumference in children.

5. Change of underwear and bed linen for the child.

6. Swaddling children, selecting clothes and dressing children of different ages depending on the season.

7. Daily toilet for newborns.

8. Distributing food and feeding children of different ages, including infants.

9. Physiological and therapeutic tables for children of different ages, rules for feeding children and methods for processing dishes.

10. Feeding young children. Warming formulas for feeding. Processing bottles, nipples and utensils.

11. Assess and note in the medical history stool in young children, place them on the potty.

12. Toilet of the umbilical wound.

13. Treatment of the oral cavity for children of the first year with thrush.

Lesson equipment

1. Educational tables, computer presentations.

2. Phantom of an infant.

3. Diapers, blankets.

4. Gauze napkins, cotton balls, cotton swabs.

5. Scales, height meter, measuring tape.

The class is held on the basis of the pediatric department.

Literature to prepare for the lesson

1. General child care. Educational and methodological manual, ed. V. V. Yuryeva, N. N. Voronovich. -SPb:GPMA. -Part I. -2007. -53 s.

2. General child care. Educational and methodological manual, ed. V. V. Yuryeva, N. N. Voronovich. -SPb:GPMA. -Part II. -2007. -69s.

3. Mazurin A.V., Zaprudnov A.M., Grigoriev K.I. General child care. -M. -1998 -292 p.

4. Zaprudnov A. M., Grigoriev K. I. General child care: textbook. allowance. - 4th ed., revised. and additional -M. : GEOTAR-Media, 2009. – 416 p.

5. Shamsiev F. S., Erenkova N. V. Ethics and deontology in pediatrics. -M: University book. -1999. -184 pp.

State budgetary educational institution of higher professional education

"St. Petersburg State Pediatric Medical Academy"

Ministry of Health and Social Development of the Russian Federation

Dispensary observation.

Prevention.

Forecast.

In recent years, due to the emergence of new technologies for caring for premature babies, their mortality rates have decreased.

Children with I – II degrees of prematurity have a favorable prognosis. With a birth weight below 1500g, the prognosis is less favorable. These children have a higher mortality rate from secondary infections; pathologies of the visual organs (myopia, astigmatism, strabismus - 25%) and hearing organs (hearing loss - 4%) are more common. They are often diagnosed with neurological changes of varying severity (vegetative-vascular disorders, convulsive, hypertensive-hydrocephalic syndromes, cerebral palsy). The formation of persistent psychopathological syndromes is possible.

· Protecting the health of the expectant mother, starting from early childhood.

· Timely sanitation of chronic foci of infection of a girl - an expectant mother.

· Planning pregnancy.

· Creating favorable conditions for pregnancy.

· Regular monitoring of the pregnant woman in the antenatal clinic, timely detection and treatment of diseases and toxicoses.

· Refusal of a pregnant woman from bad habits.

· If there is a threat of miscarriage, mandatory hospital treatment for a pregnant woman is required.

A premature baby must be registered at a dispensary in health group II (risk group) for 2 years. Once every 3 months, and more often if indicated, the child is examined by a neurologist, ophthalmologist, and once every 6 months by an otolaryngologist. At the age of 1 and 3 months - an orthopedist. In the second and third years, consultations with a child psychiatrist, speech therapist, endocrinologist, and gastroenterologist are necessary.

Possible problems for parents:

• Stress and worries in connection with premature birth.
• Worry and concern for the child.
• Feeling helpless.
• Lack of knowledge and skills in child care.
• High risk of developing hypogalactia.
• Lack of breast milk from the mother.
• Lack of family support.
• The search for those responsible for the premature birth of a child.
• Situational crisis in the family.

Nursing interventions:

1. Give recommendations to a nursing mother on daily routine and nutrition:

• To maintain lactation, a nursing woman must adhere to a correct daily routine, which includes adequate sleep, exposure to fresh air, balanced nutrition, psycho-emotional comfort in the family, and moderate physical activity.
• Complete nutrition for a lactating woman can be provided with a daily set of products: 150-200g of meat or fish, 50g of butter, 20-30g of cheese, one egg, 0.5 liters of milk, 800g of vegetables and fruits, 300-500g of bread. In addition, the diet should include fermented milk products, juices, various cereals, and nuts. Eliminate garlic, onions, hot seasonings (they worsen the taste of milk), strong coffee, and alcoholic drinks from your diet.
• The amount of liquid consumed should not exceed 2.5 liters per day (with 0.5-1 liters for milk and fermented milk products).

Recommend that the mother stop taking medications if possible.

Give recommendations for feeding a premature baby:

· If breast milk is available, use a free feeding mode, convince the mother of the need to put the baby to the breast frequently, because this stimulates lactation and develops the sucking reflex in the baby.

· The duration of feeding should not be limited; it can fluctuate at different times of the day.

· The baby needs night feeding until he can suck the volume of milk he needs during the day.

· After the establishment of lactation and active sucking, with positive dynamics of body weight gain, the child can be transferred to a 6-time feeding regimen.

· If there is a lack of breast milk, use a mixed feeding regimen. Supplementary feeding is carried out with specialized adapted formulas for premature babies during the first 2-3 months, then they switch to feeding with adapted formulas for children in the first half of the year, and after 6 months - on formulas for children in the second half of the year. It is necessary to explain to the mother that supplementary feeding is introduced after breastfeeding, given with a spoon or from a bottle, the nipple must be soft, imitate the shape of a breast nipple, and have an opening adequate to the sucking efforts of the child.

· In the absence of breast milk, use an artificial feeding regimen - feeding 6 times a day with formula recommended by a doctor.

· With mixed and artificial feeding, it is necessary to teach parents the technology of preparing and storing formula and the rules of feeding. If individual tolerance is good, it is advisable to use formulas from the same manufacturer, which reduces the risk of developing food allergies and increases the efficiency of feeding.

· Juices and complementary foods are introduced from 4 months. All types of complementary foods are introduced carefully, using the training method, starting with drops and bringing to the desired volume over 8-10 days.

· It is necessary to monitor the child’s absorption of food (regurgitation, bloating, change in stool character).

1. It is necessary to train parents on the features of caring for a premature baby:

· The temperature of the room where the child is located must first be maintained within 24-26 o C, and gradually reduced to 22-20 o C.

· Train parents in the technique of performing a hygienic bath (room temperature not lower than 25 o C, water temperature 38-38.5 o C, then the water temperature is gradually reduced to 37-36 o C, and from the second half of the year - to 34-32 o C ), Hygienic baths are carried out daily, at first their duration is 5-7 minutes, gradually it increases.

· For irritated skin, teach parents how to conduct medicinal baths with infusions of string, sage, chamomile, and St. John's wort.

· Clothing for a premature baby should be made of soft, thin natural hygroscopic fabrics, without rough seams, scars, or buttons. Clothing should be multi-layered, and swaddling should be loose.

· Placement on the stomach must be carried out from the first day of the child’s stay at home. It is recommended to place it on a hard surface 3-4 times a day before feeding.

· Training methods of hardening (lowering water temperature, contrast dousing after bathing, air baths) begin to be used depending on the degree of maturity, individual characteristics and health status of the child. Air baths begin from 1.5-3 months for 1-3 minutes 3-4 times a day, gradually increasing the time to 10-15 minutes in combination with a stroking massage. From 4 months you can introduce other hardening elements.

· Stroking massage begins from 1-1.5 months, from 2-3 months other massage techniques are gradually introduced - rubbing, kneading, passive hand movements. To improve psychomotor development, hand massage and gymnastics are performed daily, and from 8-9 months, to stimulate the development of speech centers and coordination of small movements, the child is offered games with small objects. It is necessary to train parents in performing all massage techniques and playing games.

1. Train parents in the technology of psycho-emotional communication with their child:

· In the early stages, nursing a premature baby directly on the mother’s chest (“kangaroo method”), only for a short time the baby is placed in a crib.

· Subsequently, it is necessary to convince the mother to pick up the child more often, touch him using the language of bodily communication, constantly communicate and talk to him in a gentle voice, quietly sing songs to him

1. Help parents realistically assess the child’s physical and mental development, accept him as he is, see his achievements and prospects.
2. Advise parents to maintain an atmosphere of emotional comfort in the family, avoid tension in a timely manner, avoid violent manifestations of emotions, actively interact with each other, pay as much attention to the child as possible, select toys and games according to age, and constantly engage with him.
3. To acquaint parents with the features of the physical and neuropsychic development of a premature baby:

· Large loss of initial body weight (9-14%).

· Low weight gain in the first month of life. Subsequent monthly weight gain up to one year on average should be greater than in full-term infants.

· The monthly increase in height in premature babies is greater than in full-term babies (on average it is 2.5-3 cm).

· Head circumference in the first 2 months is 3-4 cm greater than chest circumference; by the end of the 1st year of life, head circumference is 43-46 cm, chest circumference is 41-46 cm.

· Teething begins later than in full-term babies (on average at 8-10 months).

· The appearance of psychomotor skills in the first year of life may be delayed (visual and auditory concentration, purposeful hand movements, the ability to sit, stand, walk, speak), especially in children with a birth weight of 1000 to 1500 g (for 2-3 months), from 1500 to 2000g (for 1.5 months).

· Most children with a birth weight of 2500 g catch up with their full-term peers by one year, and very premature children are compared with them by 2-3 years.

Control questions:

1. What risk factors for having a premature baby do you know?

2. What determines the degree of maturity of a premature baby?

3. List the degrees of prematurity and their main criteria.

4. What morphological signs of a premature baby do you know?

5. What are the manifestations of immaturity of functional systems in a premature baby?

6. What are the principles of feeding premature babies?

7. What is the purpose of the first stage of nursing premature babies and where is it carried out?

8. What is the purpose of the second stage of nursing and where is it carried out?

9. What are the requirements for the microclimate when nursing premature babies at the second stage?

10. What are the principles of drug therapy for a premature baby?

11. What are the criteria for discharging a premature baby home?

12. What is the individual rehabilitation and follow-up program for a premature baby?

13. What is the prevention of premature birth of children?

14. What is the prognosis for a premature birth?

15. What are the features of the physical and neuropsychic development of premature babies?

Information sources:

· Textbook by Svyatkina K.A., pp. 25-27.

· Textbook of Ezhova N.V., pp. 148-160.

· Textbook by Sevostyanova N.G., pp. 171-191.

Basic lecture notes