During the next visit. What will happen if a patient fails to show up for an appointment on time? Tasks for providing first aid in emergency conditions

Assessment: the patient will note improvement in condition, elimination of suffocation, and demonstrate knowledge about the prevention of suffocation attacks. The goals will be achieved.

Problem No. 59

Calling a paramedic to a 4-year-old child. Complaints of repeated vomiting and loose stool within 2 days. According to the mother, the vomiting began after the child drank the milk. Vomiting is observed up to 3 times a day. After each act of defecation there is increasing weakness. Objectively: consciousness is clear, the child is adynamic, the skin is pale and dry, facial features are pointed. Subfebrile body temperature = 37.1º C, C, PS = 52 beats per minute. weak filling, A/D 78/40.

Medical diagnosis: CINE ( intestinal infection unclear form).

Tasks

Sample answers

1. The needs are violated: to be healthy, to eat, to drink, to excrete, to maintain body temperature.

Patient problems:

real:

Repeated vomiting

Dehydration,

Weakness,

Body temperature is low-grade;

potential:

The risk of deterioration of the condition associated with the development of complications, heart failure, dehydration.

2. Priority problems: diarrhea, dehydration.

Short-term goals: prevent the child from aspiration of vomit and further dehydration, stop diarrhea. Protect contacts from infection.

Long-term goals: The baby will be healthy at the time of discharge.

Plan	Motivation
Nurse: will provide
1. Correct position: child (lying on his back, head turned to the side), use a functional bed.	1. To avoid aspiration of vomit.
2. Control the volume of excrement and vomit.	2. To prevent exicosis.
3. Hygienic child care. Frequent change of linen.	3. To prevent diaper rash, skin irritation, and purulent complications.
4. Constant monitoring of the child’s condition (A/D, PS, t).	4. For early diagnosis and timely provision of emergency care in case of complications.
5. Following the doctor’s medication prescriptions.	5. To ensure the effectiveness of treatment.
6. At the outbreak, he will provide isolation of contacts, monitoring of contacts for 7 days, and a biological examination. Preventative treatment contact.	6. To avoid the spread of infections.
7. Sanitary clearance. work on the prevention of intestinal and especially dangerous infections.	7. To avoid the spread of infections.
8. Giving an emergency notification to the SES.	8. To avoid the spread of infections.

Assessment: the patient will note an improvement in condition, absence of diarrhea and vomiting. The goals will be achieved.

Problem No. 60

During a regular visit to the clinic by a 1-year-old child weighing 10,700 grams, the nurse noticed a sharp pallor of the skin and mucous membranes. The mother reported that the child gets tired quickly, is irritable, inactive, and noted a loss of appetite. When questioning the mother, it was possible to establish that the child’s diet was monotonous: dairy foods, dairy products. The mother prefers not to give fruits and vegetables for fear of digestive problems. A child under 1 year old had ARVI 3 times. Blood history: Hb-100 g/l, Er-3.0x10 12, c.p. - 0.8

Medical diagnosis: Iron deficiency anemia.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.

Sample answers

1. Violation of the need: - to eat, to be healthy, to rest, to play.

Patient problems:

real:

Anorexia errors in diet,

Fast fatiguability,

Irritability,

Weakness,

Paleness of the skin and mucous membranes.

potential:

Risk of developing moderate to severe anemia

The priority problem is anorexia.

1) short-term - the child’s appetite will improve by the end of the first week

2) long-term - the child’s parents will note an improvement in the child’s condition at the time of discharge, and will not complain about the child’s lack of appetite or increased irritability of the child.

Plan	Motivation
Nurse:
1. Provides mental and physical peace.
2. Organizes the correct daily routine and nutrition (iron-containing foods).	2. To ensure the necessary content of protein, vitamins and microelements in the body.
3. The baby will be fed warm, small portions 5 times a day every 4 hours.	3. For better absorption of nutrients in the body.
4. Provide walks in the fresh air (in winter at least 3 times a day, in summer all day long), ventilation of the home (in winter - 5-10 minutes, in summer the whole day).	4. For the prevention of secondary infectious diseases. For better aeration of the lungs, enriching the air with oxygen.
5. Have a conversation with parents about the need for adequate nutrition.	5. To compensate for the loss of protein, Fe, vitamins and increase the body’s defenses.
6. Will watch appearance and: the patient's condition.	6. For early diagnosis and timely provision of emergency care.
7. Carry out a set of hygiene measures.	7. To maintain cleanliness of the skin and mucous membranes to prevent bedsores.
	8. For the effectiveness of treatment.

Assessment: the patient will feel satisfactory, become active and sociable. Parents will demonstrate knowledge about proper nutrition for their child. The goals will be achieved.

Problem No. 61

A 9-month-old boy was visited by a local doctor at home, on call. Parents complain of an increase in T to 39.2º C, convulsive twitching. I have been sick for 2 days, I have a runny nose and a dry cough. A child from the first pregnancy, which occurred with gestosis in the second half. Childbirth is urgent, physiological. Weight at birth - 2900 g, length - 49 cm. Breastfeeding up to 1 month. Rickets was diagnosed at 2 months, acute respiratory infections at the age of 5 months. Parents are healthy, there are no occupational hazards, higher education. Housing and living conditions are satisfactory.

Objectively: the condition is of moderate severity. Consciousness is clear. The skin is clean and pale. Extremities are cold. The pharynx mucosa is hyperemic. Nasal breathing is difficult, serous discharge from the nasal passages. Micropolyadenia. Muscle tone is diffusely reduced. A large fontanel 2.0x1.5 cm, the edges are dense, there is no craniotabes. 2 teeth. Rib cage compressed from the sides, deployed in the lower aperture, “rosary”. “Bracelets” are palpated. Percussion and auscultation of the lungs without pathology. The boundaries of the heart are not expanded. The tones are loud, clear, rhythmic. The abdomen is soft and painless. The liver and spleen are not enlarged. Stool and urination are not impaired. No meningeal symptoms were detected.

In the presence of a doctor, an attack of convulsions occurred. The child had twitching of the limbs and bending of the body. The duration of the attack was 7 seconds, it stopped on its own. The body temperature at this moment was 39.5º C. After the attack, consciousness was restored.

Medical diagnosis: Rickets. ARVI.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.

Sample answers

1. The needs are violated: to be healthy, to breathe, to eat, to drink, to be clean, to play, to rest, to maintain body temperature.

Patient problems:

real:

Runny nose,

Dry cough,

Fever;

Cramps,

weakness;

potential:

Development threat fatal outcome due to hyperthermia.

2. The patient’s priority problem is fever, convulsions.

Short-term - the patient will note a decrease in body temperature, absence of cramps, absence of runny nose and cough after 2 days;

Long-term - the patient will note the absence of all symptoms of the disease at the time of discharge.

Plan	Motivation
The nurse will provide:
1. Mental and physical peace.	1. To ensure and correct rhythm processes of higher nervous activity.
2. Drink plenty of warm drinks.	2. In order to reduce intoxication and dehydration.
3. Strict bed rest.	3. To prevent complications;
4. Care for skin and mucous membranes.	4. For the prevention of purulent complications.
5. Monitoring the patient’s condition (t, PS, AD, respiratory rate).	5. For early diagnosis and timely assistance in case of complications.
6. Following doctor’s orders.
7. Taking vitamins.	7. To enhance immunity.
8. Application physical methods cooling the baby.	. To reduce a child's temperature.
9. Have a conversation with parents about the prevention of hyperthermia.	9. For the prevention of hyperthermia and seizures.

Assessment: the patient will note a significant improvement in his condition, the temperature will drop, and the seizures will stop. Parents will demonstrate knowledge of hyperthermia prevention. The goal will be achieved.

Problem No. 62

Tolya Ch., 5 months. The mother went to the doctor with complaints about the child’s anxiety, poor sleep, itchy skin. These complaints appeared 4 days ago. A child from the 1st pregnancy, which occurred with toxicosis in the first half. Urgent birth, birth weight 3450 g, height 52 cm. He screamed immediately. IN maternity hospital toxic erythema was noted. He was discharged on the 6th day in satisfactory condition. The late neonatal period proceeded without changes. He was breastfed for up to 3 months. From this age he was transferred to mixed feeding due to maternal hypogalactia. From 4 months transferred to artificial feeding, receives the “Baby” mixture. Five days ago, 5% semolina porridge with cow's milk was introduced into the diet. From 2 months he receives freshly prepared apple juice, currently in an amount of 50 ml. Suffered from ARVI in 3 one month old, and therefore not vaccinated. Parents consider themselves healthy. Mother works in the chemical laboratory of the Tasma plant. My maternal grandfather suffers from bronchial asthma. My grandmother on my father's side - erosive gastritis. Father smokes.

Objectively: the child is in moderate condition, excited, scratches his skin during examination. There are greasy crusts on the scalp and eyebrows. The skin of the cheeks is dry, flaky, and brightly hyperemic. On the skin of the trunk and limbs there are a small number of smooth, shiny papules and scratch marks. In the groin areas the skin is eroded, moderate hyperemia. Micropolyadenia. In the lungs there is a percussion sound of pulmonary, puerile breathing. The boundaries of the heart are not expanded, the tones are clear, the abdomen is painless. The spleen is not enlarged. The stool is unstable up to 4-5 times a day, semi-liquid, without pathological impurities.

Blood test: Er-4.0x10 12/l, Hb-120 g/l, leuk-10.2x10 9/l, p-4%, s-26%, e-9%, l-56:, m- 5%, ESR-16 mm/h. Urinalysis - specific weight - 1012, leukemia - 3-4 in the field of view, squamous epithelium - 1-3 in the field of view.

Medical diagnosis: Exudative diathesis.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.

Sample answers

1. Needs are violated: to be healthy, to be clean, to sleep, to rest. Patient's problem: play, communicate, allocate.

real:

Skin itching;

Sleep disturbance;

Unstable stool;

Poor sleep;

The skin of the cheeks is dry, flaky, brightly hyperemic, papular rash on the body and limbs, eosinophilia in the blood, micropolyadenia.

potential:

Threat of developing chronic diseases (eczema, bronchial asthma)

2. The patient’s priority problems are skin itching, sleep disturbances.

Short-term: the child will notice a decrease in itching, improved sleep by the end of the first week;

Long-term: the child will note the absence of itching, rash, sleep will become restful by the time of discharge.

Plan	Motivation
Nurse:
1. Provide the child with complete mental and physical peace.	1. To ensure the correct rhythm of the processes of higher nervous activity.
2. Apply hygienic baths with: chamomile infusion, furatsilin solution or ointment dressings.	2. To reduce and treat itching.
3. Provides care for the skin and mucous membranes;	3. For the prevention of purulent complications.
4. Ensure compliance with the daily routine, long stay in the fresh air.	4. To improve the child’s condition, to prevent complications, and better aeration.
5. Provide ventilation of the premises.	5. To improve lung aeration.
6. Fulfill doctor’s orders.	6. For the effectiveness of treatment.
7. Have a conversation with parents about allergy prevention and the need hypoallergenic diet.	7. For the prevention of allergic conditions.

Assessment: the child will notice an improvement in his condition, the itching will go away, there will be no rash, the parents will demonstrate knowledge about preventing allergies in the child. The goals will be achieved.

Problem No. 63

A 13-year-old boy was admitted to the hospital with complaints of pain in the epigastric region. Before admission to the hospital, there was vomiting “coffee grounds”, after which the pain subsided, but weakness, palpitations, dizziness, and tinnitus appeared.

On examination: pallor of the skin, reduced A/D, PS 110 per minute, upon palpation muscle tension in the epigastric region.

Medical diagnosis: Gastric ulcer.

Stomach bleeding.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.

Sample answers

1. The needs are violated: to be healthy, to eat, to excrete, to move, to be clean, to communicate, to study.

Patient problems:

real:

Vomiting coffee grounds

Decrease in A/D,

Decrease in circulating blood volume,

Pain in the epigastric region,

Weakness,

Heartbeat

Dizziness,

Noise in ears,

Paleness of the skin;

potential:

The risk of developing an acute decrease in circulating blood volume and hemorrhagic shock.

2. The patient's priority problem: vomiting coffee grounds.

Short-term: the patient will note a decrease in weakness by the end of the day, there will be no vomiting on the 2nd day;

Long-term: the patient will note the disappearance of weakness and palpitations after 7 days, pain in the epigastric region will disappear by 9-10 days.

Plan	Motivation
Nurse:
1. Provide an urgent call to a doctor.	1. To provide emergency medical care
2. Puts the patient in a horizontal position.	2. To prevent further complications.
3. Place a rubber balloon with ice on the epigastric region, first place a towel on the body	3. To reduce bleeding.
4. Will monitor PS, A/D, skin.	4. For early diagnosis possible complications
5. Will strictly follow the doctor’s orders	5. To ensure effective treatment.
6. Conduct a conversation about the prevention of peptic ulcers, intestinal bleeding.	6. To prevent possible complications.

Assessment: The patient will note a significant improvement in his condition, vomiting coffee grounds will not be. The patient will demonstrate knowledge about the prevention of peptic ulcer disease and complications. The goal will be achieved.

Problem No. 64

Seryozha, 3 years old, became acutely ill, his temperature rose to 38.8º C. There was a single vomiting, headache, pain when swallowing. By the end of the day a rash appeared. On examination: condition of moderate severity, temperature 39.3º C. Excessive pinpoint rash against a hyperemic background. White dermographism, tongue coated with white coating. The pharynx is clearly hyperemic, the tonsils are hypertrophied and swollen. Cardiac tachycardia. The tones are loud, the abdomen is painless. Stool and urine output are normal.

Medical diagnosis: scarlet fever.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.

Sample answers

1. The needs are violated: to eat, drink, be healthy, be clean, maintain body temperature, sleep, rest, play.

Patient problem:

real:

Headache,

Fever,

A sore throat;

potential:

The risk of developing lymphadenitis, otitis,

Risk of developing nephritis, rheumatic carditis.

2. Priority problems: fever, headache, sore throat.

Short-term - the child will notice a decrease in itching, sore throat, improved sleep, by the 3rd day of the disease;

Long-term - the patient will note the disappearance of all symptoms of the disease.

By the 10th day, itching and sore throat will disappear, sleep will normalize.

Plan	Motivation
Nurse:
1. Isolates the child in a separate room.	1. To prevent scarlet fever from infecting other family members.
2. Provide bed rest for at least 7 days	2. To avoid complications from the heart and kidneys.
3. Teach the child to gargle with furatsilin solution and soda solution after eating.	3. To eliminate a sore throat and prevent a secondary infection.
4. Provide the child with plenty of fluids.	4. To eliminate intoxication.
5. Repeat urine and blood tests.	5. For early diagnosis of complications.
6. After recovery, he will give the mother: a referral to a rheumatologist, an ENT doctor, and an ECG.	6. For early diagnosis of complications.
7. Will monitor the appearance and: condition of the patient, PS, respiratory rate.	7. For early diagnosis and timely provision of: emergency care in case of complications.
8. Will follow doctor’s orders.	8. For effective treatment.
9. Have a conversation with the child’s parents about the prevention of infectious diseases.	9. For the prevention of infectious diseases.

Assessment: disappearance of all symptoms of the disease. Parents will demonstrate knowledge about the prevention of infectious diseases.

The goals will be achieved.

Collection

Clinical tasks

Specializing in General Medicine

PEDIATRICS WITH CHILDHOOD INFECTIONS

Problem-situational tasks

Task No. 1.

The boy is 8 months old. Complaints about the child's lethargy, loss of appetite, unstable stool. A child from the 5th pregnancy, which proceeded favorably, 2 term births (weight - 3700 g, length - 50 cm). The neonatal period is without any peculiarities. Breastfeeding up to 2 months, from 3 months. semolina porridge was introduced without the advice of a doctor; unadapted mixtures were used. The child did not take vitamin D and rarely received juices. There were not walks every day. The weight gain was uneven. I suffered from acute respiratory infections 2 times. Material and living conditions are satisfactory.

Objectively: general state satisfactory, but the child is lethargic, pale, and sweating. Sits with support on his hands, his back is round. Muscle tone is diffusely reduced. The head is square in shape, with prominent frontal and occipital protuberances. Large fontanel 2.5x3.0 cm, pliable edges. The back of the head is flattened and bald. No teeth. The chest is compressed from the sides, the lower edges are unfolded, there are small “rosary beads” on the ribs, and pronounced “bracelets” on the arms. There is kyphosis in lumbar region spine, which disappears when the child is positioned on his stomach. Palpation, percussion and auscultation did not reveal any changes in the respiratory and cardiac organs. The liver protrudes 2 cm from under the edge of the costal arch. The spleen is not enlarged. The stool is unstable, urination is not impaired.

Blood test: HB 102 g/l, Er-3.98x10 12 /l, L-4x10 9 /l, ESR 5 mm / hour. Urinalysis is unremarkable. Biochemical data: serum phosphorus 0:034 g/l, calcium 0.09 g/l.

Tasks

3. Write a prescription for vitamin D

4. Demonstrate a technique for measuring the height of children of various ages.

Sample answers

1. The child has rickets of the second degree, the peak stage. Iron deficiency anemia, mild degree. The conclusion is based on medical history: breastfeeding only up to 2 months, early introduction of complementary foods, lack of vegetables and fruit juices in the diet, did not receive vitamin D for preventive purposes.

Objective examination: sweating, pale skin, decreased muscle tone, severe deformation of the bones of the skull, chest, spine, and limbs.

Laboratory tests: a slight decrease in hemoglobin in the blood, a decrease in phosphorus and calcium in the blood serum.

2. An additional symptom of this form of the disease is craniotabes softening of individual areas of the occipital bone, which is determined by palpation. At the level of attachment of the diaphragm, a retraction occurs, a “Harrison’s groove,” and the timing and order of teeth eruption are disrupted.

3. B in this case the child does not need urgent hospitalization in a hospital, and if the material and living conditions are satisfactory, treatment can be carried out at home.

4. In a hospital setting, to confirm the diagnosis, it is necessary to take an x-ray of the distal bones of the forearm and determine the level of the enzyme alkaline phosphatase in the blood serum that plays important role in the processes of bone calcification. First of all, it is necessary to prescribe proper nutrition with the daily inclusion in the diet of vegetable puree, cow's milk, kefir, grated apple, yolk, cottage cheese, low-fat meat broth, meatballs, and liver. For 30-45 days, the child should receive specific treatment for rickets with vitamin D in the form of calciferol 1600 IU per day. Considering the presence of anemia in the child, iron supplements (aloe syrup with iron) should be prescribed. ascorbic acid, vitamin B 1. Massage, daily therapeutic exercises, pine baths, walks in the fresh air are necessary.

5. Technique for measuring height in children of different ages according to the algorithm for performing manipulations.

Task No. 2.

A mother with a 2.5-year-old girl consulted a local doctor about frequent and painful urination in the child, abdominal pain and an increase in temperature to 37.5º C. She was examined by a surgeon, surgical pathology was excluded. These symptoms were observed twice during the year, and after examination a diagnosis of cystitis was made. Treatment was carried out on an outpatient basis. History of frequent colds (7 times acute respiratory infections in the last year). The parents are healthy, but the grandmother on my mother’s side has kidney disease.

Objectively: weight 11.5 kg, length 85 cm. Condition is satisfactory. Asthenic physique. The skin and visible mucous membranes are clean. Lymph nodes: tonsillar, painless, up to 0.8 cm in size, not fused with the surrounding tissue. The subcutaneous fat layer is developed satisfactorily. Above the lungs there is a percussion sound of pulmonary, puerile breathing is heard. The boundaries of the heart correspond to age. The tones are clear and rhythmic. The abdomen is soft, painful above the womb. The liver and spleen are not enlarged. Pasternatsky's symptom is positive on both sides. Urination is painful, 15 times a day.

In general urine analysis, the reaction is alkaline, relative density of urine is 1012, turbid, leukocytes 20-25, squamous epithelium 3-5 in the field of view. Blood test: ESR-25 mm per hour, L-12x10 9 /l, Hb-108 g/l. Zimnitsky test: daytime diuresis 300 ml, nighttime diuresis 500 ml, fluctuations in specific gravity 1005-1012.

Ultrasound of the kidneys: the size corresponds to age, the position and mobility are normal, there is compaction of the pyelocaliceal system on both sides, doubling of the kidney on the right.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Name additional symptoms to clarify the diagnosis, tell us about the method for identifying them.

3. Tell me about the volume first aid and rules of transportation to destination.

4. Make a plan for diagnostic tests in a hospital, tell us about the patient’s preparation for them and the principles of treatment.

5. Demonstrate the technique for collecting a general urine test in children infancy.

Sample answers

1. The patient has a disease of the urinary system - chronic pyelonephritis on the background congenital pathology kidney

The conclusion is based on the history and complaints typical of of this disease:

Frequent and painful urination;

Abdominal pain, increased body temperature;

Symptoms continued for a year.

She has a life history of frequent colds, and her maternal grandmother has kidney disease.

Objective examination data: the child has an asthenic build, his weight is below the norm, the abdomen is painful on palpation above the womb, positive Pasternatsky’s sign on both sides; increased frequency of urination up to 15 times;

Laboratory data in urine tests: (general, Zimnitsky test), low specific gravity, leukocyturia; nocturia. In the blood, the ESR is increased to 25 mm/hour, there is slight leukocytosis, and hemoglobin is decreased.

An ultrasound examination reveals thickening of the pyelocaliceal system on both sides and doubling of the kidney on the right.

2. To clarify the diagnosis, it is necessary to check for the presence of edema (swelling of the eyelids, legs), and monitor A/D.

3. If a child has kidney disease, he or she must be hospitalized in a hospital.

4. In the hospital it is necessary to carry out: urine tests according to Nechiporenko, Addis-Kakovsky to study urine sediment and count shaped elements; functional test according to Zimnitsky, reflecting the reduced ability of the kidneys to concentrate urine. X-ray urological examination methods are informative - excretory urography, voiding cystourography, which reveal the size, contours and location of the kidneys, uneven damage to their parenchyma, reflux and other obstacles to the outflow of urine. It is necessary to conduct a bacteriological examination of urine, sensitivity to antibiotics; Constantly monitor your blood pressure and the amount of fluid you drink and excrete.

Treatment program in hospital:

Bed rest throughout the febrile period;

Diet during the acute period, table No. 7, then table No. 5 (dairy-vegetable) with a limitation of spicy and salty foods. Additional amount of liquid from watermelon, juices, cranberry and lingonberry fruit drinks, alkaline mineral waters;

Antibacterial therapy for 10-15 days: semisynthetic penicillins, aminoglycosides, cephalosporins, nitrofuran drugs (furadonin, furazolidone; nevigramon, 5-NOK);

Vitamins C, group B

When remission is achieved after hospital treatment, herbal medicine (medicinal herbal infusions) is prescribed according to the scheme.

5. Technique for collecting a general urine test in infants according to the manipulation algorithm.

Task No. 3.

During the next patronage visit to a 1-year-old child, the paramedic drew attention to the sharp pallor of the skin and mucous membranes. The mother reported that the child gets tired quickly, is irritable, inactive, and noted a loss of appetite. When questioning the mother, it was possible to establish that the child’s diet was monotonous, milk porridge twice a day. He prefers not to give fruits and vegetables for fear of indigestion. On this diet, the child gains weight, which makes the mother happy. They live in a hostel and rarely go out.

Upon examination: the baby's condition is satisfactory. Pronounced pallor of the skin and secretion of mucous membranes, peripheral lymph nodes are not enlarged. From the side of the heart: a systolic murmur is heard. The abdomen is soft, the liver protrudes 2 cm from the hypochondrium. From the anamnesis it was revealed that the child was born full-term, on mixed feeding from 1 month, and often suffered from ARVI.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Name additional symptoms to clarify the diagnosis, tell us about the method for identifying them.

4. How to prepare vegetable puree.

Sample answers

1. The child may have iron deficiency anemia. The main symptoms of the disease are: pale skin, fatigue, irritability, loss of appetite, lethargy. A systolic murmur is heard in the child's heart, and the liver is enlarged. Reasons: one-sided milk nutrition, frequent illnesses, poor care and poor living conditions.

2. To clarify the diagnosis, it is necessary to conduct a general blood test, where you can detect a decrease in the amount of Er less than 3.5x10 12 l, hemoglobin below 100 g/l, color index below 0.8. Er smears are pale in color, decrease in size, and exhibit moderate leukocytosis and reticulocytosis.

Patients may have additional symptoms of the disease: seizures in the corners of the mouth, wax color ears, dry skin, dull brittle hair, muscle hypotension.

3. Treatment of the child should be comprehensive; with moderate and severe forms of anemia, children are hospitalized, with mild degree treated at home. It is necessary to organize the correct diet. Give foods containing iron and other microelements: meat products, liver, cottage cheese, yolk, fruits, vegetables. You need to be in the fresh air more.

A child of the first year is prescribed aloe syrup with iron, ferrocal 0.3 gx3 times a day after meals, feramide, ferospan, vitamin C, B vitamins. It is necessary to establish the correct daily routine for the child. The child should walk in the fresh air, he needs massage and gymnastics, daily bathing.

When hardening, children are less likely to suffer from colds and anemia.

4. To prepare vegetable puree, take a combination of 2-3 vegetables, wash, cut and then boil them for 20 minutes, then cool and rub through a sieve, add a decoction of vegetables and a salt solution, butter, mix everything.

Task No. 4.

A 13-year-old boy was admitted to the hospital with complaints of pain in the epigastric region. Before admission to the hospital, there was vomiting of “coffee grounds”, after which the pain subsided, but weakness, palpitations, dizziness, and tinnitus appeared.

On examination: pallor of the skin, decreased A/D, PS 110 per minute, palpation of the abdomen - muscle tension in the epigastric region.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Tell us about the scope of first aid and the rules of transportation to the destination.

3. Draw up a plan for diagnostic tests in the hospital, tell us about the principles of treatment.

4. Tell us about further medical examination.

5. Demonstrate the technique of intravenous administration of 10% calcium chloride solution.

Sample answers

1. Diagnosis: gastric ulcer, complicated by bleeding. The conclusion was given on the basis of complaints and an objective examination: vomiting “coffee grounds”, dizziness, weakness, pale skin, tachycardia, decreased A/D, pain, muscle tension in the epigastric region.

2. First aid – lay the patient down, apply cold to the stomach area, swallow pieces of ice, urgent hospitalization, consultation with a surgeon.

3. Plan of diagnostic examination in the hospital:

a) general blood and urine analysis;

b) fibrogastroscopy of the stomach - to determine the nature of the ulcerative defect of the gastric mucosa.

Treatment: diet - table No. 1a, No. 1b, No. 1. Medicines that are needed are drugs that suppress Helicobacter pylori infection: denol, de-nol + oxacillin, de-nol + trichopolum. Antisecretory agents: pepsin, cholinomimetics, atropine, platiphylline, selective M1-cholinomimetics-gastrocetin, antacids and adsorbents, almagel. Maolox, Vikalin. Gastrocytoprotectors: cytotec, smecta, agents that normalize gastric motility: cerucal, No-shpa, papaverine. Sedatives: elenium, diazepam, valerian. Remedies: sea buckthorn oil, rosehip oil.

4. After discharge from the hospital, patients are registered with a gastroenterologist and surgeon. The course of anti-relapse treatment includes diet therapy, drug treatment and physiotherapeutic procedures. The diet is mechanically and chemically gentle: foods with coarse fiber, such as mushrooms, are excluded from the diet. To ensure chemical sparing, foods that increase juice secretion (meat broth, fried foods) are excluded from the diet.

5. Technique intravenous administration calcium chloride solution according to the manipulation algorithm.

Task No. 5.

A mother with a 5-year-old girl came to the children's clinic for an appointment. The child has weakness, abdominal pain, decreased appetite, and in the evenings the temperature rises to 37.9º C. The mother noticed that the girl urinates often and her urine is cloudy. The tongue is dry, covered with a white coating. In the lungs, breathing is vesicular, heart sounds are muffled. The abdomen is soft and painless. The liver and spleen are not enlarged.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Name additional symptoms to clarify the diagnosis and methods for studying this disease.

3. Tell us about the principles of treating the disease.

4. Demonstrate the technique of collecting urine samples according to Zimnitsky.

Sample answers

1. Acute pyelonephritis.

The diagnosis is based on medical history and complaints: the child has weakness, abdominal pain, fever in the evenings, frequent urination, cloudy urine.

2. Additional symptoms of the disease are symptoms of intoxication: fatigue, loss of appetite, pallor of the skin, pain in the lumbar region, the presence of edema.

3. Treatment of pyelonephritis is complex. The child is prescribed a regimen and diet appropriate to his condition, as well as antibacterial and stimulant medications. Strict bed rest during the acute period of the disease until the condition and well-being improve, body temperature normalizes, urine and blood tests.

A sick child must urinate frequently. To do this, you should strictly follow the eating and drinking regime.

Antibiotics are prescribed. Phytotherapy is carried out. Lysozyme, prodigiosan, methyluracil, pentoxyl, and sodium nucleinate are used as immunocorrective agents.

If blood pressure rises, antihypertensive drugs are prescribed.

Medical nutrition is based on the principles of a dairy-vegetable diet with a moderate amount of protein and salt. Fried foods and meat broths are not allowed. As the manifestations of pyelonephritis subside, the child is transferred to table No. 5. In the presence of metabolic disorders, limit the use of fish and meat to 2 times a week, mainly in boiled, stewed form using a potato and cabbage diet. Drinking plenty of fluids is recommended.

4. Urine analysis according to Zimnitsky should be collected according to the manipulation algorithm.

Task No. 6.

A 4-year-old girl has been sick for 2 days. Complains of weakness, lethargy, minor sore throat. On examination: temperature 37.9º С, condition of moderate severity, child is lethargic. Hyperemia of the pharynx is noted. On enlarged tonsils there are shiny grayish-white plaques (not removed with tampons). Sickly sweetish odor from the mouth. In the lungs there is vesicular breathing, no wheezing. Cardiovascular system without pathological changes. Stool and urination are normal. Not vaccinated for medical reasons.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Is hospitalization necessary in this case?

3. List possible complications.

4. Tell us about the principles of treatment.

5. Demonstrate the technique of taking a throat swab using a Loeffler stick.

Sample answers

1. A 4-year-old girl has a localized form of diphtheria of the pharynx. The diagnosis was made according to the anamnesis, complaints, objective examination: weakness, slight sore throat, t-37.9º C, hyperemia of the pharynx, grayish-white plaques on the enlarged tonsils (cannot be removed with tampons). Epidemic history: lack of vaccination for medical reasons.

2. The child is isolated in an infectious diseases hospital; to clarify the diagnosis, swabs are taken from the throat for Loeffler’s diphtheria bacillus. Bed rest, treatment with antitoxic diphtheria serum.

3. Possible complications: infectious-toxic shock, myocarditis, polyradiculoneuritis, acute glomerulonephritis.

4. Bed rest, nutritious, fortified diet.

The main thing in the treatment of all forms of diphtheria is the neutralization of diphtheria toxin with antitoxic diphtheria serum. The dose of serum depends on the form and severity of the disease. Before insertion therapeutic dose carry out a test according to the Bezredka method using 0.1 ml of serum diluted 1:100, injected intradermally; in 30 min. 0.2 ml of undiluted serum is administered subcutaneously and after 1.5 hours the remaining amount of serum is administered intramuscularly. For localized forms of diphtheria, serum is usually administered once.

5. The technique of taking a smear from the throat and nose on the BL is carried out according to the algorithm for performing the manipulations.

Task No. 7.

A paramedic was asked for help with a one-year-old child. I've been sick for three days, complaining of a cough, severe runny nose, poor sleep, decreased appetite, lethargy.

Objectively: the child’s condition is moderate, t - 38.9º C, restless, catarrhal symptoms are expressed, profuse serous discharge from the nose, conjunctivitis, hemorrhage in the sclera, diffuse hyperemia in the pharynx, granularity of the posterior pharyngeal wall, enlarged submandibular lymph nodes. The skin is clean. In the lungs, breathing is puerile, wheezing is not heard. Heart sounds are sonorous, tachycardia. The stool is normal.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. List the methods for diagnosing the disease.

3. Tell us about the principles of treatment.

4. Demonstrate the Nechiporenko urine collection technique.

Sample answers

1. Clinical diagnosis: " Adenovirus infection" is placed on the basis of:

History: complaints of cough, severe runny nose, poor sleep, decreased appetite, lethargy;

Objective examination: condition of moderate severity, temperature 38.9º C, catarrhal phenomena are expressed: profuse serous discharge from the nose, conjunctivitis, hemorrhages in the sclera, diffuse hyperemia in the pharynx, granularity of the posterior pharyngeal wall, enlargement of the submandibular lymph nodes.

2. Laboratory diagnostics:

a) serological testing for viruses of paired blood sera is carried out at intervals of
7-14 days;

b) culture of mucus from the nasopharynx for viruses 2 times;

c) immunofluorescent rapid method for detecting respiratory viruses in the columnar epithelium of the nasal passages. The answer can be obtained 3-4 hours after taking mucus from the nose.

Clarification of the epidemiological situation helps in making the correct diagnosis.

3. Children with ARVI can be treated at home, but the child must be isolated and kept in bed during the febrile period. A high-calorie diet with limited fat, meat products, and a predominance of fermented milk and fruit and vegetable dishes is necessary. Drinking plenty of fluids and symptomatic treatment are necessary.

Prescribe desensitizing drugs (diphenhydramine, suprastin, tavegil), antipyretics (paracetamol, panadol), multivitamins, alkaline inhalations, gargling (decoctions of chamomile, sage, eucalyptus, calendula), mustard plasters. The nasal mucosa is lubricated with oxaline ointment (0.25%).

When treating conjunctivitis, instill 6-8 times a day antiviral drugs– interferon, 0.25% oxolinic or florenal ointment is placed in the nose 1-2 times a day.

The conjunctival sac is often washed with solutions of furatsilin (1:5000), rivanol (1:5000).

For severe forms, placental immunoglobulin is used. For bacterial complications, antibiotics are prescribed.

If there is heavy discharge from the nose, the mucus is sucked out using a rubber bulb. The nose is cleaned with turunda, vasoconstrictor drops are used (galazolin, sanorin, naphthyzin).

Specific prevention: Influenza vaccines, but they are ineffective.

4. Urine collection technique according to Nechiporenko according to the manipulation algorithm.

Task No. 8.

A 3-year-old child lives with his parents in a dormitory and attends kindergarten. I fell acutely ill: temperature - 38.5º C, abdominal pain, vomiting once, frequent loose stools mixed with mucus, streaks of blood, the child is straining, restless. On examination: the child is pale, lethargic, muffled heart sounds, tachycardia, the abdomen is soft, the sigmoid is contracted, painful, the anus is pliable.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Name additional symptoms to clarify the diagnosis,

3. Make a plan for diagnostic tests in the hospital.

4. List possible complications.

5. Tell us about treatment methods.

6. Prevention of dysentery.

7. Demonstrate gastric lavage techniques.

Sample answers

1. Dysentery. The diagnosis is based on the history and complaints typical for this disease: t - 38.5º C, abdominal pain, vomiting once, frequent loose stools mixed with mucus, streaks of blood, the child is straining, restless; as well as objective examination data: the boy is pale, lethargic, heart sounds are muffled, tachycardia, the abdomen is soft, the sigmoid is contracted, painful, the anus is pliable.

2. Additionally, there may be symptoms of intoxication (headaches, weakness, decreased or lack of appetite). Symptoms of distal colitis develop: spasm and soreness of the lower part of the colon, excruciating nagging pain, false urges(tenesmus).

3. A child with any intestinal infection should be hospitalized in a children's infectious diseases hospital.

Diagnostic program in the hospital:

Laboratory and instrumental research methods;

Bacterial culture on the intestinal group;

Coprogram;

Sigmoidoscopy;

Reaction indirect hemagglutination. Bacterial culture for dysentery group.

4. Complications are possible with dysentery, especially in children early age: pneumonia, gingivitis, stomatitis, otitis, anemia, dysbacteriosis. In severe dysentery, rectal prolapse is sometimes observed.

5. Treatment should be carried out taking into account the patient’s age, the severity of the infectious process and the period of the disease. On the first day, reduce the amount of food by 25%, prescribe fermented milk mixtures, liquid porridge, slimy soups, cottage cheese.

Etiotropic therapy: antibiotics, chemotherapy drugs and specific dysentery bacteriophage. Furazolidone, polymyxin, chloramphenicol are prescribed. In severe cases, prescribe gentamicin. The course of treatment with etiotropic drugs is 5-7 days. Along with etiotropic treatment in the acute period, it is advisable to prescribe vitamin C, groups B, A, E, and nonspecific immune stimulants: methyluracil, pentoxyl, sodium nucleinate.

To relieve intoxication, administer intravenous drips of saline and colloidal solutions; 10% albumin solution, concentrated plasma, rheopolyglucin, 10% glucose solution. Infusion therapy is prescribed at the rate of 130-150 ml/kg body weight per day. For hyperthermia, prescribe the following medications: 50% analgin solution intramuscularly, paracetamol, aspirin.

6. Prevention. An important role in the fight against dysentery is played by: sanitary education of the population, universal implementation of sanitary and hygienic requirements, strict sanitary supervision of food enterprises and water supply. Hospitalization of patients with dysentery who work in the food industry is mandatory.

Current disinfection is carried out at the patient's bedside, and final disinfection is carried out after hospitalization. At the same time, a bacteriological examination of contact persons in the outbreak is prescribed. The child communicating with the patient is monitored for 7 days. When cases of the disease appear in the children's team, a one-time bacteriological examination of children and staff is carried out.

7. Gastric lavage technique according to the manipulation algorithm.

Task No. 9.

While providing patronage to a newborn child, the mother turned to a paramedic for advice due to the fact that her eldest daughter, 5 years old, had become capricious, irritable, her sleep and appetite had worsened, and she was complaining of periodic abdominal pain, itching in the anus, and nausea. The girl began to experience bedwetting.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Name additional symptoms to clarify the diagnosis.

3. Tell us about the treatment of this disease.

4. List methods of prevention.

5. Demonstrate the technique of scraping pinworm eggs.

Sample answers

1. Enterobiosis. The diagnosis is made on the basis of anamnesis, complaints typical for this disease: the child is capricious, irritable, sleep and appetite have worsened, complains of periodic abdominal pain, itching in the anus, nausea, and bedwetting is noted.

2. Pinworms can be detected on the surface of feces, and their eggs can also be removed from the perianal area with sticky, transparent plastic film, followed by microscopy.

3. Treatment. Pyrantel is effective in a single dose of 10 mg/kg, or piperazine adipate in an age-specific dosage for 5 days. If necessary, the course of treatment is repeated after 5 days. When treating enterobiasis, strict adherence to a hygienic regime is necessary. The prognosis is favorable. Control analysis - scraping for pinworm eggs is carried out after 1 month.

4. Prevention. Maintaining hygiene of the body, clothing, home, simultaneous treatment all family members. Parents are advised to monitor the child’s hygiene, wash vegetables, fruits, toys and household items, boil and iron and change bedding frequently. Carry out wet cleaning and ventilation of the room daily.

5. Technique for taking scrapings for enterobiasis according to the algorithm for performing the manipulation.

Task No. 10.

IN medical office Kindergarten treated a 5-year-old child. Today the mother discovered rashes all over the child’s body at normal temperatures. Almost all the children in the group got sick; no quarantine was announced.

Objectively: the girl’s condition is satisfactory, she is playing. Small papular rash on the skin of the face, trunk and limbs Pink colour against a normal skin background. The pharynx is hyperemic. The occipital lymph nodes are palpated to the size of a bean, elastic, painless. The heart and lungs are normal, the abdomen is soft, stool and urination are normal.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Name additional symptoms to clarify the diagnosis, tell us about the method for identifying them.

1. In a child 5 months of CINE with symptoms of toxicosis and exicosis.

2. Prescribe a water-tea diet for 4-6 hours with oral rehydration (rehydron, glucosolan) 1-2 teaspoons
after 3-4 minutes and intravenous administration of plasma, rheopolyglucin, 5% glucose solution, vitamins. After

water-tea diet can be given breast milk or acidic mixtures: acidophilus milk or kefir, antibacterial drugs - polymyxin, etc.

Problem No. 36

Calling an ambulance to a 9 month old child's home. The day before I had a runny nose and a temperature of 37.2° C. At night I suddenly woke up and became restless. A barking cough appeared and he began to choke. The temperature became 38° C.

Tasks

2. What urgent measures should be taken?

Sample answers

1. A 9-month-old child developed false croup due to ARVI.

2. Provide emergency assistance:

distraction therapy (hot bath, soda inhalation), - drug treatment: hormones (prednisolone); desensitizing agents (suprastin, diazolin, pipolfen).

Problem No. 37

The child is 7 years old and attends school. The teacher notes that over the past week the child has become whiny, grimaces in class, and his handwriting has changed.

Tasks

1. Formulate a presumptive diagnosis.

2. What disease can cause similar symptoms and which specialist should be referred to?
child for consultation? Tell us about the principles of treatment of this disease.

Sample answers

1. A 7-year-old child has an active rheumatic attack and minor chorea.

2. It is necessary to consult a rheumatologist. Treat in a hospital. Antirheumatic treatment:
penicillin, aspirin, prednisolone, vitamins, suprastin, phenobarbital.

Problem No. 38

A 2.5-year-old child suffering from congenital heart disease was admitted to the hospital with complaints of shortness of breath at rest and swelling in the legs.

Tasks

1. Formulate a presumptive diagnosis.

2. What diet does the child need?

Sample answers

1. A 2.5-year-old child suffering from a heart defect developed symptoms of heart failure.

2. The child should be hospitalized in a hospital, prescribed bed rest, a dairy-vegetable diet with
restriction of salt, liquid (up to 1 liter), from medications - cardiac glycosides, vitamins.

Problem No. 39

A 10-year-old child was admitted to a children's hospital with complaints of headache and pain in the lumbar region. Upon examination, the boy is pale, the face is puffy, and there is swelling under the eyes. Daily diuresis is 600 ml.

Tasks

1. Formulate a presumptive diagnosis.

2. What examinations need to be carried out for the child?

Sample answers

1. A 10-year-old child admitted to the hospital may have glomerulonephritis.

2. In a hospital setting, it is necessary to conduct an examination (test according to Zimnitsky, Nechiporenko, general blood and urine analysis,
biochemical blood test, kidney ultrasound, excretory urography).

Problem No. 40

The child had bloody discharge from the umbilical wound. Within one day, the child’s condition changed: he became lethargic, lethargic, and his skin acquired a gray-sallow hue. T=37.3°C. There is a zone of hyperemia around the umbilical wound. The vessels of the anterior and abdominal wall sharply contoured. Purulent discharge appeared from the umbilical wound.

Tasks

1. Formulate a presumptive diagnosis.

2. What can such a condition lead to?

Sample answers

1. The child may have omphalitis, complicated by phlebitis.

2. It can lead to umbilical sepsis.

Problem No. 41

A 4-month-old child suffers from rickets. She is being treated on an outpatient basis. Receives vitamin O and calcium gluconate. Suddenly in the morning, while eating, twitching of the limbs appeared, the child screamed, but the voice suddenly stopped, the child turned blue. After 30 sec. the skin turned pink, the convulsions stopped.

Tasks

1. Formulate a presumptive diagnosis.

2. What needs to be done?

Sample answers

1. The child may have spasmophilia (laryngospasm).

2. The child must be provided with urgent assistance: in case of laryngospasm, give access to fresh air, irritate the root of the tongue,
spray the skin cold water, perform cardiac massage, artificial respiration. During an attack of convulsions intramuscularly
introduce a 25% solution of magnesium sulfate or a 0.5% solution of seduxen, a 20% solution of Tomk.

Problem No. 42

In a 15-day-old child, staphyloderma suddenly appeared heat 38.9° C, grayish-cyanotic skin color, weak pulse and tension, bloating. Breathing is frequent, with fluttering of the wings of the nose. Examination of the lungs revealed no pathology. On the 5th day of illness, a clear shortening of the percussion sound appeared over the lungs, diffusely over the entire surface, moist, fine-bubbly rales. On the radiograph, there is an infiltrate on the right in the middle lobe of the lung and the parietal pleura is constructed. Leukocytosis in the blood is 12,000 per ml, ESR is 22 ml/hour.

Tasks

1. Formulate a presumptive diagnosis.

2. What could be the nature of this disease?

Sample answers

1. A 15-day-old child has pneumonia.

2. Possibly staphylococcal in nature.

Problem No. 43

During the next visit to the clinic by a 1-year-old child, the doctor noticed a sharp pallor of the skin and mucous membranes. The mother reported that the child gets tired quickly, is irritable, inactive, and has lost his appetite. When questioning the mother, it was possible to establish that the child’s diet was monotonous - dairy food (the mother breastfeeds the child twice a day), and the mother prefers not to give fruits and vegetables, for fear of digestive disorders. On this diet, the child gained weight well, which pleased the mother.

Tasks

1. Formulate a presumptive diagnosis.

2. Which additional examination Can you clarify the diagnosis?

Sample answers

1. A 1-year-old child developed symptoms of anemia due to poor nutrition.

2. A blood test (decrease in hemoglobin and red blood cells) will help clarify the diagnosis.

Problem No. 44

Sasha M., 15 years old, became acutely ill: his temperature rose to 38° C, pain when chewing, radiating to the left ear. There is swelling in the left parotid area, the skin over it is of normal color.

Tasks

1. Formulate a presumptive diagnosis.

2. Tactics in relation to the patient.

Sample answers

1. A 15-year-old child has mumps.

2. Isolate the child for periods of severe clinical manifestations, to the area of ​​the parotid gland on the left
put dry heat.

Problem No. 45

Seryozha K., 3 years old, fell ill acutely with a rise in temperature to 38.8°C, single vomiting, headache, pain when swallowing were noted, and by the end of the day a rash appeared. On examination: the condition is moderate, temperature 39.9° C. There is an abundant pinpoint rash on the skin on a hyperemic background. White dermographism, tongue coated. The pharynx is clearly hyperemic.

Tasks

1. Formulate a presumptive diagnosis.

2. What complications are possible from this infection?

Sample answers

1. A 3-year-old child has scarlet fever.

2. Possible complications - synovitis, purulent lymphadenitis, glomerulonephritis.

Problem No. 46

On the 3rd day of stay, an 11-month-old child in the hospital with a diagnosis of acute respiratory viral infection developed changes in the color of urine and stool: urine became dark, stool (stool) became light.

Tasks

1. Formulate a presumptive diagnosis.

2. What is your tactics in relation to the patient?

Sample answers

1. The child is 11 months old. phenomena of epidemic hepatitis, obviously "B".

2. Isolate the patient in the infectious diseases department. Prescribe bed rest, physiological nutrition
fortified, 5% glucose, vitamins, methionine, lipocaine. In severe cases, hormonal treatment.

Sample answers

1. The needs are violated: to breathe, sleep, rest, play, be healthy, communicate.

Patient problems

real:

Ineffective cleansing respiratory tract;

Sleep disturbance;

Concern about the outcome of the disease;

potential:

High risk of suffocation;

Deterioration of the patient's condition associated with the development of complications

2. The patient’s priority problem is ineffective airway clearance.

Short-term goal: The patient will notice improvement in sputum production by the end of the week.

Long-term goal: The patient will have no complaints of difficulty breathing by the time of discharge.

Plan	Motivation
Nurse:
1. Call a doctor immediately.	1. To provide emergency medical care.
2. Provide the patient with bronchodilators as prescribed by the doctor.	2. To dilate the bronchi
3.  Provides monitoring of the patient’s condition (RR, PS, BP).	3. For early diagnosis and timely provision of emergency care in case of complications.
4. Gives the patient a semi-sitting position.	4. To make breathing easier.
5. Use a pocket inhaler.	5. To relieve and prevent asthma attacks.
6. Complete the doctor’s orders.	6. For effective treatment.
7. Conduct a conversation about the prevention of asthma attacks.	7. To prevent asthma attacks.

Assessment: the patient will note improvement in condition, elimination of suffocation, and demonstrate knowledge about the prevention of suffocation attacks. The goals will be achieved.

Problem No. 59

Calling a paramedic to a 4-year-old child. Complaints of repeated vomiting and loose stools for 2 days. According to the mother, the vomiting began after the child drank the milk. Vomiting is observed up to 3 times a day. After each act of defecation there is increasing weakness. Objectively: consciousness is clear, the child is adynamic, the skin is pale and dry, facial features are pointed. Subfebrile body temperature = 37.1º C, C, PS = 52 beats per minute. weak filling, A/D 78/40.

Medical diagnosis: CINE (intestinal infection of unknown form).

Tasks

1. The needs are violated: to be healthy, to eat, to drink, to excrete, to maintain body temperature.

Patient problems:

real:

Repeated vomiting

Dehydration,

Weakness,

Body temperature is low-grade;

potential:

The risk of deterioration of the condition associated with the development of complications, heart failure, dehydration.

2. Priority problems: diarrhea, dehydration.

Short-term goals: prevent the child from aspiration of vomit and further dehydration, stop diarrhea. Protect contacts from infection.

Long-term goals: The baby will be healthy at the time of discharge.

Plan	Motivation
Nurse: will provide
1. Correct position: child (lying on his back, head turned to the side), use a functional bed.	1. To avoid aspiration of vomit.
2. Control the volume of excrement and vomit.	2. To prevent exicosis.
3. Hygienic child care. Frequent change of linen.	3. To prevent diaper rash, skin irritation, and purulent complications.
4. Constant monitoring of the child’s condition (A/D, PS, t).	4. For early diagnosis and timely provision of emergency care in case of complications.
5. Following the doctor’s medication prescriptions.	5. To ensure the effectiveness of treatment.
6. At the outbreak, he will provide isolation of contacts, monitoring of contacts for 7 days, and a biological examination. Preventive treatment of contacts.	6. To avoid the spread of infections.
7. Sanitary clearance. work on the prevention of intestinal and especially dangerous infections.	7. To avoid the spread of infections.
8. Giving an emergency notification to the SES.	8. To avoid the spread of infections.

Assessment: the patient will note an improvement in condition, absence of diarrhea and vomiting. The goals will be achieved.

Problem No. 60

During a regular visit to the clinic by a 1-year-old child weighing 10,700 grams, the nurse noticed a sharp pallor of the skin and mucous membranes. The mother reported that the child gets tired quickly, is irritable, inactive, and noted a loss of appetite. When questioning the mother, it was possible to establish that the child’s diet was monotonous: dairy foods, dairy products. The mother prefers not to give fruits and vegetables for fear of digestive problems. A child under 1 year old had ARVI 3 times. Blood history: Hb-100 g/l, Er-3.0x10 12, c.p. - 0.8

Medical diagnosis: Iron deficiency anemia.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.

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

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

Tasks

1. Identify which needs are not satisfied in the child. Identify the patient's concerns and their rationale.

3. Explain to the mother the need for hospital treatment for the child.

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

5. Demonstrate putting drops into your child's eyes and nose.
^

Sample answers

1. Satisfaction of the needs: to breathe, sleep, rest, eat is impaired.

Patient problems:

real:

Ineffective airway clearance

Bad sucking

Anxiety.

potential:

Deterioration of the child’s condition associated with the development of complications, body weight deficiency due to poor sucking.

The priority problem is ineffective airway clearance.

2. Short-term goal: improved airway clearance in a week.

Long-term goal: normalization of nasal breathing.

Plan	Motivation
1. The nurse will cleanse the nasal passages before each feeding.	1. To make breathing easier.
2. The nurse will carry out the doctor’s orders.
3. The nurse will talk to the mother about preventing this disease.	3. For the prevention of colds.
4. The nurse will provide access to fresh air, ventilate the room, and apply ultraviolet radiation.
5. The nurse will calculate respiratory rate, heart rate, and measure body temperature.	5. Condition monitoring.
6. The nurse will take a swab from your throat and nose.	6. Condition monitoring.

Assessment: the child sucks actively due to the normalization of nasal breathing. The goal will be achieved.

4. The student will demonstrate to the mother the correct method of caring for the nasal cavity.

A 1-year-old child was hospitalized in the infectious diseases department with a diagnosis of ARVI, stenosing laryngitis.

Examination: body temperature - 36.4º C, Ps - 130 per minute, respiratory rate 40 per minute. The skin is pale and clean. Breathing is noisy, with difficulty inhaling. During inhalation, the intercostal spaces, supraclavicular areas, and jugular fossa are retracted. The child has a dry barking cough. There is hard breathing in the lungs. Heart sounds are muffled. Physiological functions are normal.

Tasks

1. Identify which needs are not satisfied in the child. Determine the patient's problems and priorities.

2. Identify goals and create a motivational nursing intervention plan.

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

4. Teach the mother how to calculate respiratory rate and heart rate.

5. Demonstrate a hot foot bath for a 1 year old child.
^

Sample answers

1. Satisfaction of the need: to breathe is impaired.

Patient problems

real:

Ineffective airway clearance (cough),

Labored breathing.

potential:

High risk of suffocation

Deterioration of the child's condition associated with complications.

The priority problem is difficulty breathing.

2. Short-term goal: the child will not experience difficulty breathing

In 1-2 days.

Long-term goal: the mother will have no complaints of difficulty breathing in the baby by the time of discharge.

Plan	Motivation
1. The nurse will provide the child with a calm environment and a comfortable elevated position in bed.	1. To make breathing easier.
2. The nurse will ensure that the doctor’s orders are followed.
3. The nurse will provide oxygen inhalation.	3. To relieve hypoxia.
4. The nurse will observe externally. Based on the type of child, calculate the respiratory rate and heart rate.	4. For the purpose of monitoring the condition
5. The nurse will conduct a conversation with the child’s mother (technique for performing a hot foot bath, prevention of ARVI.)	5. Providing emergency care at home.

Assessment: the child’s breathing is normalizing. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the need for inpatient treatment.

4. The student will demonstrate to the mother the correctly chosen method for calculating the respiratory rate and heart rate.

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

Marina K., 8 years old, was hospitalized in the department with a diagnosis of rheumatic chorea. During a nursing examination, the nurse received the following data: objects began to fall out of the child’s hands. Marina is irritable, often cries for no reason, gets tired from school, and complains of a headache.

Upon examination, the girl's movements are uncoordinated and violent. Grimaces appear on the face almost constantly. The girl starts crying for no reason, then suddenly starts laughing. Anxious sleep, decreased appetite. The skin is clean and pale. Pulse 100 per minute, respiratory rate 20 per minute. Heart sounds are sonorous, systolic murmur is heard at the apex and Botkin's point. Vesicular breathing in the lungs. Physiological functions are normal.

Tasks

3. Explain to the mother the need to comply protective regime.

4. Teach the mother to communicate with the girl.

5. Demonstrate the technique of administering 500 thousand penicillin.
^

Sample answers

1. The child’s needs are impaired: to move, sleep, rest, eat, drink.

Child problems

real:

Inability to independently eat, dress, undress, or use the toilet due to uncoordinated violent movements.

potential:

Increased neuromuscular excitability.

Of these problems, the priority is the inability to eat,

Dressing, undressing, using the toilet.

2. Short-term goal: Uncoordinated violent movements will decrease by the end of the week. The girl will become calmer.

Long-term goal: by the time of discharge, uncoordinated violent movements will disappear and the girl will become calmer.

Plan	Motivation
1. The nurse will place the child in a separate room.	1. To ensure a calm environment.
2. The nurse will feed the baby, Dress, undress.	2. To meet the child’s needs.
3. The nurse will ensure regular ventilation of the room.	3. To enrich the air with oxygen.
4. The nurse will talk to the girl in a calm, quiet voice.	4. To reduce the child’s excitability.
5. The nurse will carry out all the doctor’s prescriptions: she will give the child Voltaren orally, sedatives, intramuscular penicillin for the first 2 weeks, then bicillin.	5. To treat the underlying disease.

Assessment: by the end of the week the girl will become calmer, uncoordinated violent movements will decrease. The goal will be achieved.

3. The student will demonstrate the correct level of communication with his mother, the ability to clearly, competently and reasonably explain to her the need to comply with the protective regime.

4. The student will demonstrate to the mother the correctly chosen method of teaching communication with her daughter.

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

An 8-year-old child was hospitalized in the department with a diagnosis of rheumatism I, active phase, endomyocarditis, polyarthritis. During the nursing examination, the nurse received the following data: complaints of pain in the right knee joint, weakness, shortness of breath and palpitations during physical activity. Decreased appetite. On examination: T - 37.6 o C, Ps 120 per minute, respiratory rate 20 per minute. The boy is pale, shadows under his eyes. The right knee joint is enlarged in volume, hot to the touch, and pain appears in it at the slightest movement. Heart sounds are muffled, systolic murmur is heard at the apex and at Botkin's point. There is vesicular breathing in the lungs, physiological functions are normal.

Tasks

1. Identify which needs are not satisfied in the child. Identify problems with their rationale.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain the need for bed rest.

4. Teach the mother how to organize the leisure time of a child on bed rest.

5. Demonstrate the technique of administering bicillin 750 thousand.
^

Sample answers

1. The child’s needs are violated: to move, maintain body temperature, eat, drink, be healthy.

Patient problems

real:

Pain in the right knee joint due to symptoms of polyarthritis,

Exercise intolerance due to endomyocarditis,

Fever,

Decreased appetite.

potential:

Acquired heart defect

Repeated attacks of rheumatism.

2. Short-term goal: by the end of the week, body temperature will normalize, and the symptoms of polyarthritis will decrease.

Long-term goal: by the time of discharge, the child will not be bothered by joint pain, and there will be no shortness of breath or palpitations during physical activity.

Plan	Motivation
1. The nurse will provide the child with strict bed rest.	1. To reduce the risk of developing acquired heart disease.
2. The nurse will place the right lower extremity in physiological position.	2. To reduce joint pain.
3. The nurse will provide the child with a bedpan.	3. To maintain strict bed rest.
4. The nurse will recommend foods rich in potassium for the child.	4. To improve the conductivity and contractility of the myocardium.
5. The nurse will ensure that the child limits salt and water in his diet.	5. To reduce inflammatory phenomena in the myocardium, reducing the load on the heart.
6. The nurse will ensure regular ventilation of the room (every 2 hours for 15-20 minutes).	6. To enrich the air with oxygen.
7. The nurse organizes the child’s leisure time in bed.	7. To increase positive emotions.
8. The nurse, as prescribed by the doctor, will administer: penicillin after 2 weeks, bicillin, prednisolone. Voltaren and Panangin will be given orally.	8. For specific treatment of a disease.

Assessment: after 7 days the child’s condition will improve: pain in the right knee joint will disappear, body temperature will normalize. Shortness of breath during physical activity will decrease. The goal will be achieved.

3. The student will demonstrate the correct level of communication with his mother, the ability to explain to her the need for bed rest in an accessible, competent and reasoned manner.

4. The student will demonstrate to the mother the correctly chosen method of organizing leisure time for a child on bed rest.

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

Child 9 months is in the clinic with a diagnosis of obvious spasmophilia (eclampsia). Rickets II, subacute course, period of convalescence. During a nursing examination, the nurse received the following data: the child’s convulsions appeared suddenly while crying, and the child turned blue. The mother brought the child to the open window. Breathing was restored, the child regained consciousness, cyanosis and convulsions took place within 2-3 minutes. disappeared. The mother called an ambulance and the child was taken to the hospital. The child was born at term with a weight of 3300 g and a length of 52 cm. He was bottle-fed from 1 month. Received fruit juices from 3 months. irregularly, porridge 3 times a day, vegetable puree rarely. At the age of 3 months. The child was diagnosed with rickets, but no treatment was provided. During the examination, the nurse revealed symptoms of rickets, a period of convalescence, increased neuromuscular excitability, and restless sleep in the child. The level of calcium in the child's blood is reduced and phosphorus is increased.

Tasks

1. Identify which needs are not satisfied in the child. Identify problems with their rationale.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother the feeding habits of a child with spasmophilia.

4. Teach the mother how to prepare calcined cottage cheese.

5. Demonstrate the technique of intravenous administration of calcium gluconate to an infant.
^

Sample answers

1. The child’s needs are violated: sleep, rest, eat.

Patient problems

real:

Increased neuromuscular excitability,

Anxious dream

Irrational feeding.

potential:

Possible occurrence of repeated seizures.

Delayed neuropsychic development during prolonged seizures.

Of these problems, the priority is increased neuromuscular excitability.

2. Short-term goal: by the end of the week, neuromuscular excitability will decrease, and seizures will not recur.

Long-term goal: By the time of discharge, the child will have no symptoms of spasmophilia.

Plan	Motivation
1. The nurse will ensure that the child has a calm environment in the room.	1. To prevent repeated seizures.
2. The nurse will provide constant monitoring of the child.	2. Because of the threat of recurrent seizures.
3. The nurse will limit procedures that are unpleasant for the child (injections, etc.) as much as possible.	3. To prevent recurrent seizures.
4. The nurse will ensure that cow's milk in the child's diet is limited as much as possible and the amount increased vegetable complementary foods.	4. To reduce the phosphate content in the diet.
5. The nurse will make sure that during the first days A mother and child were walking in the shade.	5. To prevent recurrent seizures
6. The nurse, as prescribed by the doctor, will Give your child calcium gluconate. body. After 3-4 days it will give vitamin D..	6. To replenish calcium deficiency in the body. For the treatment of rickets
7. In case of seizures, the nurse will administer Seduxen 0.5% solution 0.1 ml/kg.	7. To relieve seizures

Assessment: the mother will note that by the end of the week the child has become calmer and the seizures have stopped reoccurring. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the peculiarities of the child’s nutrition with spasmophilia.

4. The student will demonstrate to his mother the rules for preparing calcined cottage cheese.

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

A 3-year-old child was admitted to the infectious diseases department with a diagnosis of a generalized form of meningococcal infection. Meningitis. During the nursing examination, the nurse received the following data: the child was sick for the first few hours. The disease began with an increase in body temperature to 39.5 o C, headache, and vomiting.

On examination: temperature 39.5 o C, the skin is pale and clean. At the time of examination, the child is worried, he has increased sensitivity to all types of stimuli. The child has severe neck muscle rigidity, positive Brudzinski's upper and lower signs, and Kernig's sign. Heart sounds are muffled, vesicular breathing in the lungs. The abdomen was soft, there was no stool.

Tasks

1. Identify which needs are not satisfied in the child. Identify problems with their rationale.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother the need for a lumbar puncture.

4. Teach the mother how to care for her baby after a lumbar puncture.

5. Demonstrate the technique of administering 400 thousand penicillin.
^

Sample answers

1. The child’s needs are violated: to maintain body temperature, eat, excrete, be healthy, communicate.

Patient problems

real:

Fever,

Increased sensitivity to all types of irritants,

Headache,

Vomiting due to cerebral edema.

potential:

Delayed neuropsychic development, headaches due to late diagnosis and inadequate therapy.

Of these problems, the priority is headache.

2. Short-term goal: by the end of the week, headaches will become less of a problem, the child will no longer have a high fever.

Long-term goal: by the time of discharge, body temperature will normalize, increased sensitivity to all types of irritants will disappear, and headaches will not bother you.

Plan	Motivation
1. The nurse will place the child in a separate room.	1. For the purpose of isolation.
2. The nurse will ensure a calm environment in the room.	2. To reduce external stimuli.
3. The nurse will assist the child in vomiting.	3. To prevent aspiration of vomit.
4. The nurse will regularly ventilate the room.	4. To enrich the air with oxygen.
5. The nurse will carry out all the doctor’s orders: Inject IM 50% analgin solution 0.3 ml. Will give it to the child infusion therapy Penicillin will be administered regularly (every 3 hours) Will administer Lasix Give a cleansing enema to the child.	to reduce body temperature To reduce symptoms of intoxication To treat the underlying disease To reduce brain swelling To cleanse the intestines of feces.

Assessment: by the end of the week, the child’s headaches will decrease and the fever will drop to low-grade levels. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the need for a lumbar puncture.

4. The student will demonstrate to the mother how to care for a child after a lumbar puncture.

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

Tanya A., 8 years old, was admitted to the infectious diseases department with a diagnosis of diphtheria of the pharynx. During a nursing examination, the nurse received the following data: the girl has been sick for 2 days. The disease began with a headache and sore throat when swallowing. On examination: the condition is moderate, body temperature is 38.5 o C, the skin is clean and pale. The pharynx is hyperemic, the tonsils are swollen, covered with a dirty gray coating. The submandibular lymph nodes are enlarged to the size of a bean, painful on palpation. There is slight swelling of the neck. Heart sounds are muffled, pulse 110 per minute. There is vesicular breathing in the lungs, the abdomen is soft and painless. Physiological functions are normal. Medical diagnosis: Diphtheria of the pharynx, subtoxic form.

Tasks

1. Identify which needs are not satisfied in the child. Identify problems with their rationale.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother the need to isolate the patient.

4. Teach your child to rinse the mouth.

5. Demonstrate the technique of administering DPT vaccine.
^

Sample answers

1. The child’s needs are violated: to maintain body temperature, eat, drink, communicate, and be healthy.

Patient problems

real:

Fever,

Sore throat when swallowing due to inflammation,

Headache.

potential:

Swallowing problems, speech and vision problems.

Of these problems, the priority is pain in the throat when swallowing.

2. Short-term goal: by the end of the week, the child’s sore throat when swallowing will decrease, and body temperature will normalize.

Long-term goal: The child will be clinically recovered by the time of discharge.

Plan	Motivation
The nurse will place the child in a separate room.	1. For the purpose of isolation.
2. The nurse will provide the child with strict bed rest.	2. To prevent complications.
3. The nurse will serve the child wearing a mask and will change into a different gown in the box.	3. For strict compliance with sanitary and epidemiological regulations.
4. The nurse will ensure that the child receives semi-liquid, easily digestible food and plenty of fluids.	4. To reduce sore throat when swallowing. To reduce symptoms of intoxication.
5. The nurse will administer as prescribed by the doctor. Antidiphtheria serum according to the Bezredki method.	5. For specific treatment.
6. Carry out infusion therapy as prescribed by the doctor: administer intravenous hemodez, 5% glucose solution.	6. To reduce symptoms of intoxication.
7. The nurse will administer as prescribed by the doctor. Prednisolone, ampicillin IM.	7. To treat an infection.
8. The nurse will ensure that the child's ECG is taken regularly.	8. For the purpose of early diagnosis of possible heart complications.
9. The nurse will regularly collect urine samples for testing.	9. Because possible development jade.
10.The nurse will regularly take from. Child swab from throat and nose.	10.To control bacterial excretion.
11.The nurse organizes the child’s leisure time.	11.To mitigate the negative impact of the isolation regime.

Assessment: by the end of the week, the child’s condition will improve: body temperature will normalize, symptoms of intoxication and sore throat when swallowing will decrease. The goal will be achieved.

4. The student will demonstrate to the mother how to rinse the mouth.

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

A 3-year-old child was admitted to the chest department for inpatient treatment with the diagnosis: “Congenital heart disease, tetralogy of Fallot, stage I-II.” Attack of shortness of breath.

During a nursing examination, the nurse received the following data: while crying, the child's shortness of breath increased, and cyanosis of the whole body appeared. After emergency assistance, the child was taken to hospital. A congenital heart defect was detected in a child at birth. With physical exertion, the child experiences increased shortness of breath and cyanosis. The child has a decreased appetite and does not gain weight well.

On examination: respiratory rate is 60/min., pulse is 160 beats/min., the child is lagging behind. physical development, the skin is pale, acrocyanosis is pronounced. Heart sounds are sonorous, a rough systolic murmur is heard over the entire heart area. There is puerile breathing in the lungs, the stomach is soft. Physiological functions are normal.

Tasks

1. Identify which needs are not satisfied in the child. Identify problems with their rationale.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother the need to limit physical activity.

4. Teach the mother to calculate the respiratory rate and assess the color of the skin.

5. Demonstrate giving oxygen to a child from an oxygen bag.
^

Sample answers

1. The child’s needs are disrupted: to breathe, move, play, eat.

Patient problems

real:

Dyspnea,

Exercise intolerance due to heart failure,

Decreased appetite

O-dyspnea-cyanotic attacks.

potential:

Decompensated heart failure,

High risk of death during dyspnea-cyanotic attacks, severe retardation in physical development.

Of these problems, the priority is exercise intolerance.

2. Short-term goal: The child's shortness of breath and cyanosis should decrease throughout the day.

Long-term goal: By the time of discharge, the child should be able to tolerate exercise better and have an improved appetite.

Plan	Motivation
1. The nurse will place the child in a large, bright room.	1. To provide fresh air.
2. The nurse will be there every 2 hours for 20. Min. ventilate the room.	2. To enrich the air with oxygen.
3. The nurse will lift head part beds.	3. To increase the efficiency of cardiac activity.
4. The nurse organizes care so that the child has a long rest.	4. To reduce energy demands.
5. The nurse will recommend potassium-rich foods to the child.	5. To improve cardiac conduction and myocardial contractility.
6. The nurse will administer and stop Administer digoxin only as prescribed by a doctor.	6. To prevent drug overdose.
7. The nurse will administer potassium strictly. As prescribed by the doctor, following all the rules for administering potassium: When administered orally, it will be mixed with juice to relieve irritation of the intestinal mucosa When administered intravenously, dilute to prevent cardiac arrest.	7. To treat an infection. to relieve irritation of the intestinal mucosa to prevent cardiac arrest
8. The nurse will increase the child's fluids.	8. To prevent blood clotting.
9. The nurse will evaluate regularly. Child's activity, breathing, pulse, arterial pressure.	9. To monitor the child’s condition.
10. The nurse will monitor the presence of edema and diuresis. body	10. To identify fluid retention in the body.
11.The nurse organizes warm time years, the maximum time the child spends in the fresh air.	11. To reduce the phenomena of hypoxia. Improved appetite.
12. The nurse will feed the baby strictly by the hour. Prohibits the intake of sweets between feedings.	12. To improve appetite.

Assessment: The child's shortness of breath and cyanosis will decrease as the day progresses. He will be able to tolerate physical activity better and his appetite will improve. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the need to limit physical activity for the child.

4. The student will demonstrate the correctly chosen methodology for teaching the mother and the rules for counting breath and assessing the color of the skin.

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

You are a nurse at a children's hospital. A 5-year-old child with a diagnosis of “Acute glomerulonephritis with nephrotic syndrome” was admitted to your post.

During a nursing examination, the nurse received the following data: Body temperature - 38 o C, pronounced swelling on the face, torso, and limbs. The child is lethargic and capricious. The skin is pale. Appetite is reduced. Pulse - 116 per minute, respiratory rate - 24 per minute, blood pressure - 105/70 mmHg. Urinates rarely, in small portions. Complains of pain in the lower back. Pasternatsky's symptom is positive on both sides. In urine analysis: protein - 3.3%, density - 1012, leuk. - 2-3 n/z., er.-2-3 in n/z., cylinders - 5-6 in n/z.

Tasks

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother how and why urine collection according to Zimnitsky is carried out.

4. Teach the mother to count the fluid she drinks and excretes.

5. Demonstrate the manipulation “Urine collection in infant boys.”
^

Sample answers

1. The child’s needs are impaired: to excrete, maintain body temperature,

Maintain condition.

Patient problems

real:

Oliguria,

Fever,

Lower back pain.

potential:

Deterioration of the child’s condition associated with the development of complications.

Of these problems, the priority ones are edema and oliguria.

2. Short-term goal: swelling will decrease and the amount of urination will increase in 2-3 days.

Long-term goal: swelling is eliminated and will not occur again during hospitalization.

Plan	Motivation
1. The nurse will ensure bed rest.	1. To improve blood circulation in the kidneys.
2. The nurse will ensure compliance with a salt-free diet with limited animal protein and fluids.	2. In order to improve water-salt metabolism.
3. The nurse will keep a “Diuresis Sheet.”	3. To record the liquid drunk and excreted.
4. The nurse will provide warmth to the lower back and lower extremities.	4. To reduce pain.
5. The nurse will palpate for swelling and assess the child's condition daily.	5. For early diagnosis and timely provision of emergency care and complications.
6. The nurse will weigh the child daily.	6. To identify hidden edema.
7. The nurse will promptly change underwear and bed linen.	7. To ensure the child’s comfort.
8. The nurse will ventilate the room for 10-15 minutes. every 3 hours.	8. To improve aeration.
9. The nurse will carry out the doctor’s orders.

Assessment: swelling will decrease, urination will become more frequent. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the essence of the prescribed examination.

4. The student will demonstrate the correctly chosen methodology for teaching a mother to count the fluid she drinks and excretes. Provides training in accordance with manipulative standards.

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

A nurse is caring for a 5-year-old child with measles. The child has been sick for 6 days, rash for 2 days.

Complains of an increase in body temperature to 37.8-38 o C.; purulent discharge from the eyes, photophobia, dry cough, runny nose, rashes all over the body.

On examination: T-37.8 o C, heart rate - 120 per minute, respiratory rate - 28 per minute. On the skin of the face and upper half of the body there is a maculopapular rash located on a non-hyperemic background. The rash merges in places. The child has purulent conjunctivitis, photophobia, and serous discharge from the nose. Internal organs without pathology. Physiological functions are normal.

Tasks

1. Identify what needs are met in the child and the patient’s problems with justifying them.

2. Identify goals and create a motivational nursing intervention plan.

4. Teach the mother how to care for her skin and mucous membranes.

5. Demonstrate the administration of the measles vaccination.
^

Sample answers

1. The child’s needs are violated: to be clean, to maintain body temperature, to breathe, to be healthy, to play, to communicate.

Patient problems

real:

Purulent conjunctivitis,

Dry cough, serous discharge from the nose,

Photophobia,

Maculopapular rash,

Tachycardia,

Tachypnea,

Insulation.

potential:

Risk of developing pneumonia

Blepharitis.

Of these problems, the priority ones are photophobia and dry cough.

2. Short-term goal: the child's fever and catarrhal symptoms will decrease in 2-3 days.

Long-term goal: catarrhal symptoms and rashes stop within a week.

Plan	Motivation
1. The nurse will explain to the mother the need for isolation in a separate room for 5-10 days, explain to the mother the need for wet cleaning 2-3 times a day, frequent ventilation (fresh air), darkening the windows with curtains.	1. To prevent the spread of infection for epidemic reasons. To reduce photophobia
2. The nurse will ensure frequent, abundant drinking of juices, fruit drinks, and compotes. Easily digestible food in semi-liquid warm form (porridge, slimy soups), vegetable puree.	2. For the purpose of detoxification.
3. The nurse will teach the mother daily toilet skin, mucous membranes (washing, wiping, treating the oral mucosa, rinsing with a decoction of herbs, washing the eyes with a solution of furacillin, tea, chamomile decoction, instilling drops as prescribed by a doctor), will teach the mother how to use the toilet in the nasal cavity. Instill drops into the nose as prescribed by a doctor.	3. To satisfy the need to be clean. To reduce inflammation in the nasal cavity and free nasal breathing.
4. The nurse will provide a decoction of expectorant herbs (violet, mint, thyme, marshmallow) as prescribed by the doctor, apply mustard plasters to the chest, and hot foot baths.	4. To soften and moisturize cough.
5. The nurse organizes the child’s leisure time (reading books, Board games).	5. To satisfy the need to play and communicate
6. The nurse will talk with the mother about preventing complications.	6. To prevent the emergence of new cases of the disease
7. The nurse will conduct an urgent count of all contacts (in the apartment, in neighboring apartments) and monitor the outbreak for 21 days; immunization of those who have not been vaccinated and have not had measles, and children with medical supplies and children under one year old - the introduction of anti-measles gamma globulin.	7. To stop the spread of infection.

Assessment: catarrhal symptoms are stopped, the rash will disappear, the child will be safe in 9 days. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the need to isolate the child.

4. The student will demonstrate the correctly chosen method of teaching the mother the rules of skin and mucous membrane care.

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

You are a nurse at a clinic. You are providing patronage to a 10-year-old child with rubella measles, on the 2nd day of illness.

When collecting data, it was revealed: T-37.2 o C. The condition is satisfactory. I'm worried about a slight runny nose and cough. There is an itchy, small-spotted rash all over the body, especially on the buttocks and limbs. Enlarged lymph nodes up to 1.0 cm in diameter are palpated, soft and mobile. Physiological functions are normal.

Tasks

1. Identify what needs are met in the child and the patient’s problems with justifying them.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother the need to isolate the child.

4. Teach the mother how to care for mucous membranes

5. Demonstrate putting drops into the eyes.
^

Sample answers

1. The child’s needs are violated: to be clean, to maintain body temperature, to breathe, to be healthy, to study.

Patient problems

real:

Runny nose,

Coughing

Pinpoint rash,

Insulation.

Of these problems, the priority is itching.

2. Short-term goal: itching will decrease within 1-2 days.

Long term goal: baby will be healthy in 3 days.

Plan	Motivation
1. The nurse will order the child to be isolated for 5 days. Submit an emergency notification to the SES	1. To prevent the spread of infection for epidemic reasons.
2. The nurse will monitor wet cleaning 2 times a day and frequent ventilation.	2. To prevent the spread of infection for epidemic reasons.
3. The nurse will provide nutritious food rich in vitamins. Warm drink.	To enhance immunity. To relieve coughing.
4. The nurse will ensure that the mother gives, as prescribed by the doctor: Antihistamines (diphenhydramine, suprastin, etc.); Nasal drops	4. To reduce itching, to relieve a runny nose.
5. The nurse will find out if there are any pregnant women among the contacts in the first half (consultation with an obstetrician-gynecologist).	5. To prevent disease and the development of various deformities in the fetus.

Assessment: the rash will disappear in 2-3 days, the child will be healthy after 5 days. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the need to isolate the child.

4. The student will demonstrate the correctly chosen method of teaching the mother the rules of caring for mucous membranes.

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

A 4-year-old child attends kindergarten. I got sick a week ago, when I had a temperature of up to 37.5 o C, a runny nose, and a dry cough. We treated ourselves, but there was no improvement. The cough became paroxysmal, leading to vomiting, and sometimes during an attack - urinary incontinence.

From the anamnesis: there is no quarantine in the kindergarten. The child was vaccinated according to age, but was vaccinated with ADS toxoid.

On examination: the child’s condition is satisfactory, active, plays. During examination of the pharynx, a coughing attack developed, a series of coughing impulses accompanied by deep wheezing breaths. The child's face is hyperemic, with a cyanotic tint, the neck veins are swollen, the tongue is protruding from the mouth. The attack ended with the discharge of a small amount of viscous sputum. Temperature is normal. The skin is clean. For organs and systems without pathology. Diagnosis: whooping cough, period of spasmodic cough.

Tasks

1. What needs are met in the child and the patient’s problems with justifying them.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother the need to create a calm environment in the family.

4. Teach the mother how to place mustard plasters.

5. Demonstrate the placement of mustard plasters.
^

Sample answers

1. The child’s needs are impaired: to breathe, excrete, play, communicate.

Patient problems

real:

Paroxysmal cough

Urinary incontinence,

potential:

Risk of complications: bronchitis, pneumonia, rectal prolapse, hernia, hemorrhages in the sclera, brain.

Of these problems, the priority is paroxysmal cough.

2. Short-term goal: cough will become softer, attacks shorter and less frequent within a week.

Long-term goal: the child will be healthy within 1 month. without complications.

Plan	Motivation
Nurse:
1. Provide isolation of the child for 30 days.	1. To prevent the spread of infection
2. Explain to the mother the need to maintain a protective regime (calm environment, distract the child with games, reading).	2. To reduce the provocation of attacks.
3. Explain the need for frequent ventilation, sleeping in the fresh air, walking in the fresh air away from children.	3. To reduce hypoxia.
4. Provide nutritious nutrition in small portions after a coughing attack. In case of vomiting, additional feeding will be provided.	4. For proper development child.
5. Will ensure that the mother gives, as prescribed by the doctor: antibiotics, sedative therapy, expectorants - herbs, etc.	5. As an anti-inflammatory agent to reduce the frequency of attacks to alleviate cough.
6. Provide collection of sputum for bacterial examination (using the “cough strip” method or nasopharyngeal swab for the causative agent of whooping cough.	6. To confirm the diagnosis and isolate the pathogen.
7. Ensure that contacts are quarantined for 14 days.	7. To prevent the spread of the disease.

Assessment: Coughing attacks will decrease in a week, the child will be healthy after 30 days without complications. The goal will be achieved.

3. The student will demonstrate the correct level of communication with his mother, the ability to clearly, competently and reasonably explain to her the need for a calm environment in the family.

4. The student will demonstrate the correctly chosen method of teaching the mother the rules for placing mustard plasters.

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

Natasha R., 6 years old, became acutely ill, developed chills, repeated vomiting, and the temperature rose to 39 o C. A local doctor was called, who, after examining the girl, gave a referral to the hospital.

Complaints upon admission: sore throat, headache, joint and muscle pain.

Objectively: the general condition is closer to severe. Correct physique, satisfactory nutrition. On a hyperemic background of the skin there is an abundant, pinpoint rash. Pulse 130 beats per minute, heart sounds are muffled. The tip of the tongue is papillary. The tongue is covered with a thick white coating. In the pharynx there is bright limited hyperemia, loose tonsils, purulent deposits on them. The submandibular lymph nodes are enlarged and painful on palpation.

Diagnosis: scarlet fever, severe course.

Tasks

1. Identify what needs are met in the child and the patient’s problems with justifying them.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother the need to use antibiotics for treatment.

4. Teach the mother how to collect urine from girls for general analysis.

5. Demonstrate throat and nasal swab collection on BL.
^

Sample answers

1. The child’s needs are violated: to be healthy, to maintain body temperature, to excrete, to be clean, to play, to communicate.

Patient problems

real:

A sore throat,

Headache,

Joint and muscle pain,

Fever,

Purulent plaque on the tonsils,

Isolation of the child.

potential:

Risk of developing myocarditis, nephritis.

Of these problems, the priority is fever, pain (throat,

Joints, muscles, head).

2. Short-term goal: fever and pain will decrease within 2 days, and vomiting will stop.

Long-term goal: the baby will be healthy in 10 days without complications.

Plan	Motivation
Nurse:
1. Ensure that the child is isolated in a separate box for 10 days + 12 days at home. Will submit an emergency notification to the SES.	1. To prevent the spread of the disease (according to epidemic indications).
2. Provide bed rest until the temperature disappears, severe symptoms intoxication.
3. Provides complete fortified nutrition in warm, liquid, semi-liquid form.	3. To reduce pain when eating.
4. Provide plenty of fluids (fruit drinks, juices) in the absence of vomiting.	4. For detoxification.
5. Provide rinsing of the throat with an antiseptic solution, herbs: furacillin, chamomile, calendula, etc.	5. To reduce sore throat and remove plaque.
6.  Will provide a change of underwear, bed linen, and skin treatment.	6.  To satisfy the need to be clean.
7.  Provides wet cleaning in the disinfection box. means, ventilation, processing of the patient’s dishes using Disinfectants, washing toys.	7. To prevent the spread of disease.
8.  Provide drip administration of hemodez, rheopolyglucin, glucose-saline solutions - parenterally as prescribed by the doctor.	8. For detoxification.
9.  Will provide symptomatic medications: antipyretic, cardiac, vitamins.	9.  To reduce temperature, improve myocardial contractility
10. Will keep track of urine output and pulse count. NPV, collection of urine tests.	10. To prevent complications.
11.  Will follow the doctor’s orders: Will introduce penicillin antibiotics, desensitizing.	11. For action on streptococcus, destruction of the pathogen.

Assessment: symptoms of intoxication will decrease after 3-4 days, after 10 days the child will be discharged to home regimen without complications. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the need to take antibiotics.

4. The student will demonstrate the correctly chosen method of teaching the mother the rules for collecting urine from girls for general analysis.

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

Nurse caring for a sick child chicken pox. Nastya A., 3 years old, attends kindergarten “Ogonyok”. Complains of a rise in temperature to 38 o C, a rash. She got sick a day ago, when she began to complain of a headache and refused to eat. In the evening a rash appeared.

Objectively: the condition is not serious, temperature is 38.0 o C. A polymorphic rash is noted on the skin throughout the body: papules, vesicles. The rash is also present on the scalp, mucous membranes of the mouth and genitals. The rash is accompanied by itching. From the internal organs without visible pathology. Physiological functions are normal.

Tasks

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother the need for skin treatment.

4. Teach the mother how to wash her baby.

5. Demonstrate washing the child.
^

Sample answers

1. Satisfaction of needs is impaired: maintaining body temperature, eating, being clean, being healthy, playing,

Real problems:

Fever,

Polymorphic rash,

Headache,

Refusal to eat

^ Potential problem:

Risk of developing stomatitis, chickenpox croup, pyoderma.

Priority problems: fever, polymorphic rash.

2. Short-term goal: temperature returns to normal in 3 days.

3. Long-term goal: the child will recover in 9 days without complications.

Plan	Motivation
Nurse:
1. Explain the need to isolate the child for 10 days (until the crusts fall off) in a separate room.
2. Submit an emergency message to the SES.
3. Will monitor wet cleaning and ventilation 2-3 times a day.
4. Provide plenty of fluids (fruit drinks, juices, compotes). Food should be complete, easily digestible, avoid spicy, salty, and sour foods.	.
5. Explain to the mother how to care for the skin and mucous membranes: treating the elements of the rash with a 1-2% solution, rinsing the mouth with a 2% soda solution, a decoction of herbs (chamomile, sage, etc.), washing with a weak solution, a solution of herbs (chamomile, sage)	4. To reduce pain due to rashes on the mucous membranes
6. Will ensure that the mother gives, as prescribed by the doctor: a/histamines (diphenhydramine, suprastin, tavegil, etc.) antipyretics (paracetamol, analgin)	To reduce itching. To reduce fever.
7. Ensure that contacts are quarantined for 21 days	According to epidemic indications

Assessment: The child will be healthy in 9 days without complications. The goal will be achieved.

4. The student will demonstrate the correct level of communication with his mother, the ability to clearly, competently and reasonably explain to her the need for skin treatment.

5. The student will demonstrate the correctly chosen method of teaching the mother the rules of washing.

6. The student will demonstrate manipulation on a dummy in accordance with the algorithm adopted in this educational institution.

A 4-year-old child attends kindergarten. He became acutely ill, upon returning from kindergarten he began to be capricious and complained of pain in the area of ​​his right ear. The next day the pain intensified, swelling appeared in the area right cheek.

Objectively: the child’s general condition is satisfactory, temperature - 38 o C, correct physique, satisfactory nutrition, clean skin, without rash. There is asymmetry of the face, swelling in the area of ​​the right cheek of a pasty consistency, slightly painful on palpation.

There is slight hyperemia in the pharynx. No visible pathology was identified from other organs and systems. The diagnosis is mumps.

Tasks

1. Identify what needs are met in the child and the child’s problems.

2. Identify goals and create a motivational nursing intervention plan.

3. Explain to the mother what it means to “isolate the child” during an infectious disease.

4. Teach the mother how to perform thermometry.

5. Demonstrate placing a warm compress on the child’s ear.
^

Sample answers

1. Satisfaction of needs is impaired: maintaining body temperature, being healthy, being clean, playing, communicating.

Real problems:

Fever,

Pain and swelling in the parotid region on the right,

Hyperemia of the pharynx,

Child's capriciousness.

potential:

Risk of developing serous meningitis, pancreatitis, purulent mumps.

Priority problem: parotid pain and fever.

2. Short-term goal: pain in the right cheek area and fever will decrease in 2-3 days.

The long-term goal is that the child will be healthy without complications in 9 days.

Plan	Motivation
Nurse:
1. Explain the need to isolate the patient in a separate room for 9 days. Will submit an emergency notification to the SES.	1. To prevent the spread of infection (according to epidemiological indications).
2. Will ensure that wet cleaning is carried out 2-3 times a day, frequent ventilation, and washing toys with soda solution daily; providing separate dishes for the child.	2. To prevent the spread of infection (according to epidemiological indications).
3. Provide plenty of fluids (fruit drinks, juices, compotes). Food is taken in liquid or semi-liquid form. Eliminate fatty foods and flour products (rolls, pasta, white bread).	3. For the purpose of detoxification. To reduce pain when chewing To reduce the load on the pancreas.
4. Teach the mother the technique of applying dry heat to the area of ​​the affected gland.	4. To reduce pain and rashes.
5. Explain to the mother the need to provide leisure time for the child: games, books.	5. To satisfy the need to play and communicate due to isolation.
6. Will ensure that the mother follows the doctor’s orders: symptomatic medications; antipyretics, painkillers: analgin, paracetamol, etc.	6. To relieve fever, reduce pain.
7. Have a conversation with the mother about the disease and prevention of complications.	7. To satisfy the need to avoid danger
8. It will ensure the imposition of quarantine on contacts for 21 days (strict separation from 11 to 21 days), urgent immunization of those who have not been vaccinated and have not had an epidemic. mumps of the gastrointestinal tract, and for children with honey. bends and up to 1 year - administration of immunoglobulin.	8. To prevent the occurrence of disease

Assessment: The child will be healthy without complications in 9 days. The goal will be achieved.

3. The student will demonstrate the correct level of communication with the mother, the ability to clearly, competently and reasonably explain to her the need to isolate the child.

4. The student will demonstrate the correctly chosen method of teaching the mother the rules of thermometry.

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

A 5-year-old child was resting in the forest with his parents. There were many flowering trees around. Suddenly the child developed a cough, a feeling of tightness in the chest, and difficulty breathing. The temperature is normal, the skin is pale, and the nasolabial triangle is cyanotic. Medical diagnosis: attack of bronchial asthma.

Exercise

2. Identify goals and create a motivational nursing intervention plan.
^

Sample answers

1. The needs are violated: to breathe, sleep, rest, play, be healthy, communicate.

Patient problems

real:

Ineffective airway clearance;

Sleep disturbance;

Concern about the outcome of the disease;

potential:

High risk of suffocation;

Deterioration of the patient's condition associated with the development of complications

2. The patient’s priority problem is ineffective airway clearance.

Short-term goal: The patient will notice improvement in sputum production by the end of the week.

Long-term goal: The patient will have no complaints of difficulty breathing by the time of discharge.

Plan	Motivation
Nurse:
1. Call a doctor immediately.	1. To provide emergency medical care.
2. Provide the patient with bronchodilators as prescribed by the doctor.	2. To dilate the bronchi
3.  Provides monitoring of the patient’s condition (RR, PS, BP).	3. For early diagnosis and timely provision of emergency care in case of complications.
4. Gives the patient a semi-sitting position.	4. To make breathing easier.
5. Use a pocket inhaler.	5. To relieve and prevent asthma attacks.
6. Complete the doctor’s orders.	6. For effective treatment.
7. Conduct a conversation about the prevention of asthma attacks.	7. To prevent asthma attacks.

Assessment: the patient will note improvement in condition, elimination of suffocation, and demonstrate knowledge about the prevention of suffocation attacks. The goals will be achieved.

Calling a paramedic to a 4-year-old child. Complaints of repeated vomiting and loose stools for 2 days. According to the mother, the vomiting began after the child drank the milk. Vomiting is observed up to 3 times a day. After each act of defecation there is increasing weakness. Objectively: consciousness is clear, the child is adynamic, the skin is pale and dry, facial features are pointed. Subfebrile body temperature = 37.1º C, C, PS = 52 beats per minute. weak filling, A/D 78/40.

Medical diagnosis: CINE (intestinal infection of unknown form).

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.
^

Sample answers

1. The needs are violated: to be healthy, to eat, to drink, to excrete, to maintain body temperature.

Patient problems:

real:

Diarrhea,

Repeated vomiting

Dehydration,

Weakness,

Body temperature is low-grade;

potential:

The risk of deterioration of the condition associated with the development of complications, heart failure, dehydration.

2. Priority problems: diarrhea, dehydration.

Short-term goals: prevent the child from aspiration of vomit and further dehydration, stop diarrhea. Protect contacts from infection.

Long-term goals: The baby will be healthy at the time of discharge.

Plan	Motivation
Nurse: will provide
1. Correct position: child (lying on his back, head turned to the side), use a functional bed.	1. To avoid aspiration of vomit.
2. Control the volume of excrement and vomit.	2. To prevent exicosis.
3. Hygienic child care. Frequent change of linen.	3. To prevent diaper rash, skin irritation, and purulent complications.
4. Constant monitoring of the child’s condition (A/D, PS, t).	4. For early diagnosis and timely provision of emergency care in case of complications.
5. Following the doctor’s medication prescriptions.	5. To ensure the effectiveness of treatment.
6. At the outbreak, he will provide isolation of contacts, monitoring of contacts for 7 days, and a biological examination. Preventive treatment of contacts.	6. To avoid the spread of infections.
7. Sanitary clearance. work on the prevention of intestinal and especially dangerous infections.	7. To avoid the spread of infections.
8. Giving an emergency notification to the SES.	8. To avoid the spread of infections.

Assessment: the patient will note an improvement in condition, absence of diarrhea and vomiting. The goals will be achieved.

During a regular visit to the clinic by a 1-year-old child weighing 10,700 grams, the nurse noticed a sharp pallor of the skin and mucous membranes. The mother reported that the child gets tired quickly, is irritable, inactive, and noted a loss of appetite. When questioning the mother, it was possible to establish that the child’s diet was monotonous: dairy foods, dairy products. The mother prefers not to give fruits and vegetables for fear of digestive problems. A child under 1 year old had ARVI 3 times. Blood history: Hb-100 g/l, Er-3.0x10 12, c.p. - 0.8

Medical diagnosis: Iron deficiency anemia.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.
^

Sample answers

1. Violation of the need: - to eat, to be healthy, to rest, to play.

Patient problems:

real:

Anorexia errors in diet,

Fast fatiguability,

Irritability,

Weakness,

Paleness of the skin and mucous membranes.

potential:

Risk of developing moderate to severe anemia

The priority problem is anorexia.

1) short-term - the child’s appetite will improve by the end of the first week

2) long-term - the child’s parents will note an improvement in the child’s condition at the time of discharge, and will not complain about the child’s lack of appetite or increased irritability of the child.

Plan	Motivation
Nurse:
1. Provides mental and physical peace.
2. Organizes the correct daily routine and nutrition (iron-containing foods).	2. To ensure the necessary content of protein, vitamins and microelements in the body.
3. The baby will be fed warm, small portions 5 times a day every 4 hours.	3. For better absorption of nutrients in the body.
4. Provide walks in the fresh air (in winter at least 3 times a day, in summer all day long), ventilation of the home (in winter - 5-10 minutes, in summer the whole day).	4. For the prevention of secondary infectious diseases. For better aeration of the lungs, enriching the air with oxygen.
5. Have a conversation with parents about the need for adequate nutrition.	5. To compensate for the loss of protein, Fe, vitamins and increase the body’s defenses.
6. Will observe the appearance and: condition of the patient.	6. For early diagnosis and timely provision of emergency care.
7. Carry out a set of hygiene measures.	7. To maintain cleanliness of the skin and mucous membranes to prevent bedsores.
	8. For the effectiveness of treatment.

Assessment: the patient will feel satisfactory, become active and sociable. Parents will demonstrate knowledge about proper nutrition for their child. The goals will be achieved.

A 9-month-old boy was visited by a local doctor at home, on call. Parents complain of an increase in T to 39.2º C, convulsive twitching. I have been sick for 2 days, I have a runny nose and a dry cough. A child from the first pregnancy, which occurred with gestosis in the second half. Childbirth is urgent, physiological. Weight at birth - 2900 g, length - 49 cm. Breastfeeding up to 1 month. Rickets was diagnosed at 2 months, acute respiratory infections at the age of 5 months. Parents are healthy, there are no occupational hazards, higher education. Housing and living conditions are satisfactory.

Objectively: the condition is of moderate severity. Consciousness is clear. The skin is clean and pale. Extremities are cold. The pharynx mucosa is hyperemic. Nasal breathing is difficult, serous discharge from the nasal passages. Micropolyadenia. Muscle tone is diffusely reduced. A large fontanel 2.0x1.5 cm, the edges are dense, there is no craniotabes. 2 teeth. The chest is compressed from the sides, deployed in the lower aperture, “rosary”. “Bracelets” are palpated. Percussion and auscultation of the lungs without pathology. The boundaries of the heart are not expanded. The tones are loud, clear, rhythmic. The abdomen is soft and painless. The liver and spleen are not enlarged. Stool and urination are not impaired. No meningeal symptoms were detected.

In the presence of a doctor, an attack of convulsions occurred. The child had twitching of the limbs and bending of the body. The duration of the attack was 7 seconds, it stopped on its own. The body temperature at this moment was 39.5º C. After the attack, consciousness was restored.

Medical diagnosis: Rickets. ARVI.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.
^

Sample answers

1. The needs are violated: to be healthy, to breathe, to eat, to drink, to be clean, to play, to rest, to maintain body temperature.

Patient problems:

real:

Runny nose,

Dry cough,

Fever;

Cramps,

Weakness;

potential:

Threat of death due to hyperthermia.

2. The patient’s priority problem is fever, convulsions.

Short-term - the patient will note a decrease in body temperature, absence of cramps, absence of runny nose and cough after 2 days;

Long-term - the patient will note the absence of all symptoms of the disease at the time of discharge.

Plan	Motivation
The nurse will provide:
1. Mental and physical peace.	1. To ensure the correct rhythm of the processes of higher nervous activity.
2. Drink plenty of warm drinks.	2. In order to reduce intoxication and dehydration.
3. Strict bed rest.	3. To prevent complications;
4. Care for skin and mucous membranes.	4. For the prevention of purulent complications.
5. Monitoring the patient’s condition (t ,PS, AD, NPV).	5. For early diagnosis and timely assistance in case of complications.
6. Following doctor’s orders.
7. Taking vitamins.	7. To enhance immunity.
8. Use of physical methods to cool the child.	. To reduce a child's temperature.
9. Have a conversation with parents about the prevention of hyperthermia.	9. For the prevention of hyperthermia and seizures.

Assessment: the patient will note a significant improvement in his condition, the temperature will drop, and the seizures will stop. Parents will demonstrate knowledge of hyperthermia prevention. The goal will be achieved.

Tolya Ch., 5 months. The mother went to the doctor with complaints about the child’s restlessness, poor sleep, and itchy skin. These complaints appeared 4 days ago. A child from the 1st pregnancy, which occurred with toxicosis in the first half. Urgent birth, birth weight 3450 g, height 52 cm. He screamed immediately. In the maternity hospital, toxic erythema was noted. He was discharged on the 6th day in satisfactory condition. The late neonatal period proceeded without changes. He was breastfed for up to 3 months. From this age he was transferred to mixed feeding due to maternal hypogalactia. From the age of 4 months he was switched to artificial feeding and receives the “Baby” formula. Five days ago, 5% semolina porridge with cow's milk was introduced into the diet. From 2 months he receives freshly prepared apple juice, currently in an amount of 50 ml. He suffered from ARVI at 3 months of age, and therefore was not vaccinated. Parents consider themselves healthy. Mother works in the chemical laboratory of the Tasma plant. My maternal grandfather suffers from bronchial asthma. My paternal grandmother has erosive gastritis. Father smokes.

Objectively: the child is in moderate condition, excited, scratches his skin during examination. There are greasy crusts on the scalp and eyebrows. The skin of the cheeks is dry, flaky, and brightly hyperemic. On the skin of the trunk and limbs there are a small number of smooth, shiny papules and scratch marks. In the groin areas the skin is eroded, moderate hyperemia. Micropolyadenia. In the lungs there is a percussion sound of pulmonary, puerile breathing. The boundaries of the heart are not expanded, the tones are clear, the abdomen is painless. The spleen is not enlarged. The stool is unstable up to 4-5 times a day, semi-liquid, without pathological impurities.

Blood test: Er-4.0x10 12 /l, Hb-120 g/l, leuk-10.2x10 9 /l, p-4%, s-26%, e-9%, l-56:, m- 5%, ESR-16 mm/h. Urinalysis - specific weight - 1012, leukemia - 3-4 in the field of view, squamous epithelium - 1-3 in the field of view.

Medical diagnosis: Exudative diathesis.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.
^

Sample answers

1. Needs are violated: to be healthy, to be clean, to sleep, to rest. Patient's problem: play, communicate, allocate.

real:

Skin itching;

Sleep disturbance;

Unstable stool;

Poor sleep;

The skin of the cheeks is dry, flaky, brightly hyperemic, papular rash on the body and limbs, eosinophilia in the blood, micropolyadenia.

potential:

Threat of developing chronic diseases (eczema, bronchial asthma)

2. The patient’s priority problems are skin itching, sleep disturbances.

Short-term: the child will notice a decrease in itching, improved sleep by the end of the first week;

Long-term: the child will note the absence of itching, rash, sleep will become restful by the time of discharge.

Plan	Motivation
Nurse:
1. Provide the child with complete mental and physical peace.	1. To ensure the correct rhythm of the processes of higher nervous activity.
2. Apply hygienic baths with: chamomile infusion, furatsilin solution or ointment dressings.	2. To reduce and treat itching.
3. Provides care for the skin and mucous membranes;	3. For the prevention of purulent complications.
4. Ensure compliance with the daily routine, long stay in the fresh air.	4. To improve the child’s condition, to prevent complications, and better aeration.
5. Provide ventilation of the premises.	5. To improve lung aeration.
6. Fulfill doctor’s orders.	6. For the effectiveness of treatment.
7. Have a conversation with parents about the prevention of allergies and the need for a hypoallergenic diet.	7. For the prevention of allergic conditions.

Assessment: the child will notice an improvement in his condition, the itching will go away, there will be no rash, the parents will demonstrate knowledge about preventing allergies in the child. The goals will be achieved.

A 13-year-old boy was admitted to the hospital with complaints of pain in the epigastric region. Before admission to the hospital, there was vomiting “coffee grounds”, after which the pain subsided, but weakness, palpitations, dizziness, and tinnitus appeared.

On examination: pallor of the skin, reduced A/D, PS 110 per minute, upon palpation muscle tension in the epigastric region.

Medical diagnosis: Gastric ulcer.

Stomach bleeding.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.
^

Sample answers

1. The needs are violated: to be healthy, to eat, to excrete, to move, to be clean, to communicate, to study.

Patient problems:

real:

Vomiting coffee grounds

Decrease in A/D,

Decrease in circulating blood volume,

Pain in the epigastric region,

Weakness,

Heartbeat

Dizziness,

Noise in ears,

Paleness of the skin;

potential:

The risk of developing an acute decrease in circulating blood volume and hemorrhagic shock.

2. The patient's priority problem: vomiting coffee grounds.

Short-term: the patient will note a decrease in weakness by the end of the day, there will be no vomiting on the 2nd day;

Long-term: the patient will note the disappearance of weakness and palpitations after 7 days, pain in the epigastric region will disappear by 9-10 days.

Plan	Motivation
Nurse:
1. Provide an urgent call to a doctor.	1. To provide emergency medical care
2. Puts the patient in a horizontal position.	2. To prevent further complications.
3. Place a rubber balloon with ice on the epigastric region, first place a towel on the body	3. To reduce bleeding.
4. Will monitor PS, A/D, and skin.	4. For early diagnosis of possible complications
5. Will strictly follow the doctor’s orders	5. To ensure effective treatment.
6. Conduct a conversation about the prevention of peptic ulcers and intestinal bleeding.	6. To prevent possible complications.

Assessment: the patient will note a significant improvement in his condition, there will be no vomiting of coffee grounds. The patient will demonstrate knowledge about the prevention of peptic ulcer disease and complications. The goal will be achieved.

Seryozha, 3 years old, became acutely ill, with a temperature rise to 38.8º C. One-time vomiting, headache, and pain when swallowing were noted. By the end of the day a rash appeared. On examination: condition of moderate severity, temperature 39.3º C. There is an abundant pinpoint rash on the skin on a hyperemic background. White dermographism, tongue coated with white coating. The pharynx is clearly hyperemic, the tonsils are hypertrophied and swollen. Cardiac tachycardia. The tones are loud, the abdomen is painless. Stool and urine output are normal.

Medical diagnosis: scarlet fever.

Tasks

1. Identify the needs whose satisfaction is disrupted; formulate and justify the patient’s problems.

2. Identify goals and create a motivational nursing intervention plan.
^

Sample answers

1. The needs are violated: to eat, drink, be healthy, be clean, maintain body temperature, sleep, rest, play.

Patient problem:

real:

Headache,

Fever,

A sore throat;

potential:

The risk of developing lymphadenitis, otitis,

Risk of developing nephritis, rheumatic carditis.

2. Priority problems: fever, headache, sore throat.

Short-term - the child will notice a decrease in itching, sore throat, improved sleep, by the 3rd day of the disease;

Long-term - the patient will note the disappearance of all symptoms of the disease.

By the 10th day, itching and sore throat will disappear, sleep will normalize.

Plan	Motivation
Nurse:
1. Isolates the child in a separate room.	1. To prevent scarlet fever from infecting other family members.
2. Provide bed rest for at least 7 days	2. To avoid complications from the heart and kidneys.
3. Teach the child to gargle with furatsilin solution and soda solution after eating.	3. To eliminate a sore throat and prevent a secondary infection.
4. Provide the child with plenty of fluids.	4. To eliminate intoxication.
5. Repeat urine and blood tests.	5. For early diagnosis of complications.
6. After recovery, he will give the mother: a referral to a rheumatologist, an ENT doctor, and an ECG.	6. For early diagnosis of complications.
7. Will monitor the appearance and: condition of the patient, PS, respiratory rate.	7. For early diagnosis and timely provision of: emergency care in case of complications.
8. Will follow doctor’s orders.	8. For effective treatment.
9. Have a conversation with the child’s parents about the prevention of infectious diseases.	9. For the prevention of infectious diseases.

Assessment: disappearance of all symptoms of the disease. Parents will demonstrate knowledge about the prevention of infectious diseases.

The goals will be achieved.