Pediatric Concept Rna Notes

A Dedicated Institute for Nursing Competitive Exam
INTRODUCTION
The term paediatrics is derived from Greek words, „Pedia‟ means child „iatrike‟ means
treatment and „ics‟ means branch of science. Thus pediatrics means the science of child care and
scientific treatment of childhood disease.
Abraham Jacob (1830-1919) is known as the „Father of pediatrics‟ because of his many
contributions to this field.
Paediatrics Nursing:-
It is the branch of nursing concerned with the care of infants and children.
 Current concept of Paediatrics Nursing:-
A - Advocate for child and family
C - Communicate for the child
A - Activate the child‟s activities
D - Disseminate information related to child health programme.
E - Educate the public about child health
M - Motivate people to participate in child care
I - Investigate available resources
C - Collaborate care
“ALL BIRDS FIND SHELTER DURING RAIN.

BUT
EAGLE AVOIDS RAIN BY FLYING ABOVE THE CLOUDS”
- A. P. J. ABDUL KALAM
C-6, 80 Ft. Road,Shanti Nagar, Near Gyan Ashram School/Sankriti College, Jaipur. (Raj) Mo.7426955591, 7426955593 2
CARE OF NEW BORN
Care of New Born:-
 Newborn:- From birth to 4 weeks (28 days) of age, the baby is called newborn or neonate.
 Early neonatal period:- From birth to 7 days of life or 168 hours.
 Late neonatal period:- From 7th days to 28th days of life.
 Live birth:- It is defined as complete expulsion or extraction from mother of product of
conception, which after separation shows signs of life for at least 1 hour.
 Term Baby:- Any neonate born between 37-42 week of gestation.
 Pre-term:- Any neonate born before 37th week of gestation.
 Post term:- Any neonate born at or after 42 weeks of gestation.
 Perinatal period:- The period extending from 22nd week of gestation to 7 days after birth.
Infant:- A baby of age group 0-1 year

Classification of new Born
According to Birth weight According to Gestational Age

1. Low birth weight (LBW) infant 1. Premature (Preterm) infant
 An infant whose birth weight is less  An infant born before completion of 37
than 2500g, regardless of gestational. weeks of gestation regardless of birth
weight.
2. Moderately-low-birth-weight (MLBW) infant
2. Full-term-infant
 An infant whose birth weight is 1500  An infant born between the beginning
to 2500g of 38 weeks and completion of 42
3. Very-low-birth-weight (VLBW) infant weeks of gestation. Regardless of birth
 An infant whose birth weight is less weight.
than 1500g 3. Postmature (Post-term) infant
4. Extremely-lowbirth-weight (ELBW) infant  An infant born after 42 weeks of
Gestational age, regardless of birth
 An infant whose birth weight is less weight.
than 1000g
According to size
1. Appropriate-for- gestational -age (AGA) infant
 An infant whose birth weight falls between
the 10th and 90th percentiles on intrauterine
growth curves.
2. Small-for-dates (SFD) or small for Gestational
age (SGA) infant
 An infant whose rate of intrauterine growth
was slowed and whose birth weight falls
below the 10th percentile in intrauterine
growth curves.
3. Intrauterine growth retardation (IUGR)
 Infant whose intrauterine growth is retarded
4. Large for gestation-age- (LGA) infant
 An infant whose birth weight falls above
90th percentile on intrauterine growth charts.
CARE OF NEW BORN
Assessment of New Born:-
I. Initial Assessment :-
The first assessment in the newborn is initiation of respiration.
 Assess for signs of respiratory distress:-
(i) Nasal flaring
(ii) Inter costal retraction
(iii) Grunting sound (Expiratory grunting)
(iv) Tachyapnea
(v) Cyanosis
 Assess for gross congenital abnormality.
II. Apgar Scoring :-

 Discovered by Dr. Virginia Apgar in 1952.
 5 Characteristics are assess in apgar scoring.
A - Appearance (Skin colour)
P - Pulse (Heart rate)
G - Grimace (reflex response)
A - Activity (muscle tone)
R - Respiratory efforts.
A 0 1 2
1. Heart rate Absent < 100 > 100
2. Respiratory Apnea Slow, irregular Normal regular
efforts
3. Skin colour Complete blue Acrocynosed Complete Pink
4. Reflex No Response Grimace Full cry
(Hypoactive)
5. Muscle tone flaccid Some flexion of fully flexed
extrimitics body
 Mild distress or No distress :- 8–10 Normal routine care.

 Moderate distress: - 4–7 O2 therapy or stimulation.
 Severe distress: - 0–3 immediate resuscitation.
Immediate care of New born:-
1. Maintain Airway:-
 Suction pressure for a term newborn is 60–80 mm of Hg.
 Time duration is 5-10 second
 In case of preterm newborn the suction pressure is 40–60 mm of Hg
 And the duration is never more than 10 sec.
CARE OF NEW BORN
 Asepto bulbar syringe or suction catheter can be used.
 Suction gently and quickly.
2. Initiation of Breathing:-
 Stimulate crying by rubbing
 Position properly by sidelying.
 Provide oxygen when necessary.
3. Maintain Temperature :-
 Dry immediately.
 Place in infant warmer
 Wrap warmly
4. Care of Eyes :-
 Eye should be cleaned by using sterile cotton swabs soaked in sterile water or normal
saline.
 Each eye should be cleaned using a separate swab from inner canthus to outer
canthus.
5. Clamp & Cut the Umbilical Cord:-

Two kochar forceps can be used for cord clamping and a surgical blade for cord
cutting. (It is also used in artificial rupture off membrane)
 First clamp at the distance of 2.5 cm from the umbilicus.
 And second clamp at the distance of 5 cm from the umbilicus and then cut in
between them.
Normal Routine Care :-
 Dry the new born with a pre warmed linen.
 Place the new born in radiant warmer.
 Apply Identification band, colour coding is used, pink for girls or Blue for boys.
 Start breast feeding as early as possible in a normal delivery case within half a hour
and in caesarian section with in 4 hour.
 Administer Vit-K inj. 1 mg. IM in vastus lateralis muscles.
Total No. of fontanell – 6
Anterior fontanelle - 1
Posterior fontanelle - 1
Mastoid - 2
Sphenoid - 2
Note :-
 Purpose of Vit-K is to prevent bleeding.
 Vitamin K help in the formation of clotting factors 2,7,9,10
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ysfdu eu ls gkjk gqvk balku dHkh ugha thr ldrkA”
PHYSICAL EXAMINATION OF NEW BORN
Vital sign :-
 Heart Rate- 120-160 B/M.
 R.R. - 30-60 B/M.
 Temp. - 36.50C–37.50C.
Blood Pressure :-
 Systolic B.P - 60–80 mm of Hg
 Diastolic B.P - 40–50 mm of Hg
Body Measures :-
 Weight : 2.5-4 kg
 Length : 45-55 cm (50 cm)
 Head circumference : 33-35 (34 cm)
 Chest circumference : 30-32 cm (2-3 cm less then Head circumference)
 Abdominal circumference : 31-33 cm
 Mid upper arm circumference : 11-12 cm
Head :-
 The length of head should be 1/4 part of the total body length.
 Assess for moulding.
Moulding :-
 Overlapping of cranial bones to pass through the bony pelvis.
 It resolves within 72 hours.
 Palpate sutures that are widely separated.
 Sutures are Joint between cranial bones and it is an example of fibrous Joint.
 Palpate fontanelless (fontanelless are wide gap between sutures)
(a) Frontal suture :- B/w two frontal bone.
(b) Coronal suture :- It is a Joint b/w parietal and frontal bone and 2 in number.
(c) Saggital suture:- B/w parietal bones.
(d) Lamboidal suture :- Joint b/w parital or occipital bone and 2 in No.
Fontanelles (Total 6 in No.):-
(i) Anterior
(ii) Posterior
(iii) Mastoid (2)
(iv) Sphenoid (2)
Anterior Fontanelle Posterior Fontanelle
1. Also called bregma Also called lambda.
2. Formed the 4 suture 2. Formed the 3 suture
 Frontal (1)  Sagital (1)
 Coronal (2)  Lambdoidal (2)
 Sagital (1)
3. Diamond Shaped Triangular shaped.
4. Diameter : Diameter.
Anteroposterior : 3-4 cm Anteroposterior 1.2 cm
Transverse : 2-3 cm Transverse 1.2 cm
5. Fuse at 12 to 18 month of age. Fuse at 6 week of age.
Caput succedanum Cephalhematoma
1. Occur due to improper 1. Occur due to rupture of
venous drainage. minor emissary vein.
2. Accumulation of fluid 2. Accumulation of blood.
3. Fluid accumulated between 3.Blood accumulate b/w
periostium and scalp periostium and bone.
4. Always present at the time of 4. Never present at the time of
birth. birth.
5. Can cross suture line 5. Cannot cross suture line.
6. Spontaneously resolves 6. May resolve spontaneously
within 72 hrs. or may require incision and
drainage.
Eye :-
 Eye should be clear and symmetrical (equal).
 Any purulent discharge or eye redness indicates infection.
 Commonly two infections occurs in the eyes of newborn.
(i) Opthalmia neonatorum :- Neisseria gonococcus.
(ii) Neonatal conjuctivitis :- Chalamydia trachomatis.
PERRLA Examination :- Assess Pupils.

P - Pupil
E - Equal
R - Round
R - Reactive to
L - Light and
A - Accommodation
 Eyes may cross it is due to weak extra occular muscle.
 Eye drop erythromycin is used to prevent infection.
 Red reflex should be present.
 Absences of red reflex indicate congenital cataract or retinoblastoma.
Ear:-
 Microtia :- Small ear pinna
 Anotia :- Absent of earpinna
Down syndrome :- feature - simian crease (1 ydhj gkFk esa)
 Ear should be symmetrical at normal location (Top of the pinna should be at the level or above
the line drawn from outer canthus of the eye).
 Low set ears indicates down syndrome.
 Ear cartilage should be firm.
 Soft ear cartilage indicate preterm newborn.
Nose :-
 Should be in the centre of face.
 Normally appearce flat and broad.
 Nares should be patent ([kqyk gqvk)
 If nasal flaring is present it indicates respiratory distress.
Mouth :-
 Assess for cleft lip and cleft palate.
 The gums should be pink and moist.
 Assess for epstein pearl and oral thrush.
 Take a gauze piece and rub it on the white patch, If the white patch is removed and does not
cause pain it indicates epstein pearl, If the white patch are not removed and caused painful
condition it indicate oral thrush.
Neck :-
 Trapezius, sterno cleidomastoid helpful in neck movement and supplied 11th cranial Nerve.
 Neck should be short and thick.
 Trachea in the midline.
 Assess for torticolis.
 Torticolis :- It is twisting of neck toward one side due to demage in the 11th cranial Nerve
(Accessory Nerve). The condition also known as wry neck and loxia.
Chest :-
 Chest is round because anteroposterior diameter and transverse diameter of the chest are equal.
 Assess for intercostal retraction if present it indicate respiratory distress.
 Auscultate normal breath sound and assess for grunting.
 Assess rib fracture or fracture of clavicle. Clavicle fracture is most common after normal
delivery.
 Measure Nipple size if more than 5 mm indicate term new born of less than 5 mm it indicate
preterm.
Abdomen :-
 Assess for abdominal wall defect that can be omphalocele and gastrochisis.
 Assess umbilical cord for the no. of vessels. There are two umbilical arteries and one umbilical
vein if deficiency of any vessels that inform to the physician.
 auscultate bowel sound it is be present within one hour after birth.
 Assess for the passage of meconium it should be passed within first 24 hours after birth is the
meconium is not passed it indicate any congenital abnormality.
 Assess for hernia.
 Assess for infection of the umbilical cord. (Omphalitis- inflammation of the umbilical cord)
Genitals :-
(a) Male:-
 Cryptorchidism (Undescended testes).
 Assess the descending of testis if they are not descended that condition is called
cryptorchidism.
 Assess for epispadias and hypospadias.
(a) Epispadias :- Urethral opening on the dorsal surface of penis.
(b) Hypospadias :- Urethral opening on the ventral surface of penis.
 Assess for phimosis & paraphimosis
(b) Female :-
 Labia may be swollen
 Clitoris may be enlarge.
 Pseudomenstruation may be present due to withdrawal of maternal hormones mainly
estrogen.
 Pseudomenstruation :- Just after birth occur vaginal bleeding due withdrawal of
hormone.
Extremities :-
 Assess for any fracture in the extremities.
 Assess for acrocynosis.
 Assess for developmental Dysplasia of hip
Spine :-
 Assess for Neural tube defect. It may be present as tuft (xqPNk) of hairs and a sac like protrusion.
 Assess for scoliosis (lateral deviation of spine).
Skin :-
 Assess skin colour normally it is pink.
 Vernin caeseosa (a cheesy white substance) present on the entire body in preterm newborn b/w
folds in a term newborn and may be absent in post term new born.
 Assess for lanugo (fine body hair) mainly be present on the back of newborn.
 Dark red (plethoric skin) indicates preterm newborn, and dry peeling skin, indicates (parchment
like skin) post term newborn.
 Assess for cyanosis.
 Assess palmer creases if not properly developed it indicate preterm newborn and a single
transverse creases also called simian creases indicates down syndrome.
 Assess the nails if developed up to the finger tips it indicated term newborn if nails are short
indicates preterm new born, If nails are longer indicates post term new born.
Birth marks :-
(i) Telangiectatic Nevi (Stork bite):-
 It is dilated Capillaries appearance pink or red mainly on the tip of the nose and occipital
region.
 Usually disappears within 2 years of age.
 No cosmetic surgery require.
(ii) Nevus Flammeus (Port wine stain) :-
 It is a tuft of capillaries and example of capillary angioma.
 It appears dark red in in colour and mainly on face region.
 It is flat and clearly demarcated.
 If does not disappear with time and requires cosmetic surgery in future.
(iii)Nevus vasculosus (Strawberry mark):-
 It is an example of capillary hemangioma appears mainly on the head region.
 It is elevated and clearly remarketed.
 Disappear within 7-9 year of age.
(iv) Mongolian Spot:-
 It is bluish discoloration of the lumbo-secral area.
 It is mainly seen in dark skin people.
 It disappears within one year of age.
(v) Milia :-
 It is white dots on the forehead of new born due to blockage in the secretions of
sebaceous gland.
REFLEXES OF NEW BORN
1. Rooting Reflex :-
When we touch the cheeks or Lips of the new born from one side the new born respond by
opening the mouth & turn the face towards stimulate sides.
 Age of disappearance:- 3-4 month but may persist up to the age of 1 year.
2. Sucking Reflex :-
When anything is entered in the mouth of a newborn the newborn starts sucking.
 Disappearance:- 1 year.
3. Swallowing Reflex :-
When the food particles fill the oral cavity than the new born swallowing occurs.
 Disappearance:- Never disappear.
4. Sneezing Reflex:-
When any foreign particle stimulates the upper airway the newborn respons by sneezing.
 Age of D.P :- Never.
5. Coughing Reflex:-
When any forgien partical stimulates, the lower air way the new born response by coughing.
 Age of D.P :- Never.
6. Gag Reflex:-
When any thing stimulats the posterior pharyngeal part the new born respond by regurgitation of
stomach contents.
 Age of D.P.:- Never Disappear.
7. Doll's eye Reflex:-

When we turn the head of New born in either side but the newborn's eye does not move with the
movement of face.
 Age of D.P.:- 3-4 Months.
8. Tonic Neck Reflex:-

(Fencing reflex) When the new born is sleeping and we turn the head of new born to one side,
the new born response by extension of the extremities of same side and flexion of extremities of
opposite side.
9. Moros Reflex:-
Hold the newborn in semi sitting position and then immediately drops down the head and 300.
 The Newborn response by sharp extension with abduction followed by sharp flexion and
adduction, the thumb and four fingers in C. Shape position.
REFLEXES OF NEW BORN
10. Startle Reflex:-
When we produce a loud noise before the newborn, the new born response by Flexion and
adduction.
11. Palmer grasp Reflex:-

When we put any thing in the palms of new born, new born grasp that object.
 Age of D.P. :- 4 Months.
12. Planter Reflex:- When we provide stimulation on the sole at the base of toes then newborn
response by curling the toes downwards.
13. Babinski Reflex :-

Use a blunt object to stimulate the sole of the foot start from the heel then move upward along
the lateral aspect of the sole to reach the ball of the foot then the neonate responds by hyper extension of
toes & Dorsiflexion of a Big toe.
 Age of D.P. :- After one year may persist up to the age of 2 year.
 If the reflex of positive any time after 2 years it indicates Neurological abnormality.
14. Dancing Reflex (Stepping Reflex) :-

Hold the new born in vertical position and allow one or both foot to touch a firm surface, the
new born response by rapid flexion and extension of lower extremities and it gives the appearance that
the new born is dancing or walking.
15. Perez Reflex :-

Place the new born in prone position on a firm surface than compress the spine by thumb
starting from cervical to sacral vertebra and moves towards cervical vertebra, The new born response by
crying, flexing the extremity and lordosis of spine.
16. Gallant Reflex :-

When we stimulate the new born from lateral of the spine the new born response by lateral
flexion of spine to ward stimulated site.

17. Parachute Reflex :-
When we throw the new born in air during returning the new born response by extension of the
extremity.
 Age of appearance :- 6-7 Months
 Disappearance:- Never.
HIGH RISK CONDITIONS IN NEW BORN
High risk newborn‟s are those neonate‟s whose condition is very severe at birth and requires
immediate interventions to prevent further complications and death of neonate.
1. Birth Asphyxia :-
Failure to initiate and maintain proper respiration characterized by hypoventilation,
anaerobic glycolysis and lactic acidosis.
Etiological Factor :
(a) Antipartum factors :-
 Malnutrition
 Anemia
 Gestational hypertension
 Pre-eclampsia
 Substance abuse
 Infections
 DM
(b) Intra partum factors :-
 Prolonged labor
 Cord prolapse
 Tight umbilical cord around the fetal neck.
(c) Post partum factors :-
 Pulmonary cardiac vascular or Neurological abnormalities of the new born.
Clinical Manifestation :-
(a) Asphyxia livida :-
 Moderate distress
 It is stage of cyanosis.
 Apgar scoring is 4-6
(b) Asphynia pallida :-
 Severe distress.
 Stage of shock.
 Shock occurs due to vasomotor failure.
 Apgar scoring is 0-3
Management:-
Suction the new born :-
 Cut the umbilical cord
 Receive the baby in pre warmed linen.
 Place under radiant warmer.
 Slightly extend the neck and provide stimulation.
 Than assess respiration, HR, Skin colour
(i) Respiration regular, HR above 100 and Acrocyanosis
Intervention :- Provide Routine Care.
(ii) Respiration regular, HR above 100 in cyanosis.
Intervention :- Provide O2 therapy.
(iii) Irregular respiration, HR above 100 and cyanosis.
Intervention :- Provide positive pressure ventilation by bag and mask, and
provide O2 therapy.
(iv) Irregular respiration, HR below 100 and cyanosis.
Intervention :- Provide positive pressure ventilation by beg, and mask and O2
therapy.
(v) Ir-regular respiration, HR below 60, and cynosis.
Intervention :- Start CPR.
Neonatal - Resuscitation :-
 For chest compression two methods can be used.
(a) Thumb method.
(b) Two finger method.
 Provide chest compression at lower 3rd of the sternum.
 Compress the sternum by 1/2 to 3/4 inch.
 Provide 90 chest compression and 30 ventilation in 1 mint with a ratio of 3 : 1.
2. Newborn of Diabetic Mother:-

A Neonate born to the mother who is diabetic is called new born of diabetic mother.
Assessment finding:-
 Larger for gestational age.
 Puffiness on the face due to deposition of fat.
 Hyperbilirobenemia.
 Hypocalcemia :- In our body two type hormone present parathyroid hormone and
calcitonine, PTH ↑ se calcium level and calcitonine ↓ se calcium level.
 Sign of respiratory distress.
 Hypoglycemia:- apnea, twitching, lethargy, poor feeding and seizures.
Management:-
 Assess blood glucose level.
 Assess respiratory status.
 Check the sucking ability.
 If the child is able to suck than start breast feeding.
 If breast milk is not available give glucose in water or formula feeding.
 If the new born is unable to suck than start IV therapy is dextrose 10%.
Normal blood glucose in new born:-
 40-60 mg/dl :- During 1st day of life.
 50-90 mg/dl :- After 1st day of life.
Hypoglycemia in new born:-
 <40 mg/dd :- During 3 days.
 <45 mg/dd :- After 3 days.
3. Neonatal-Jaundice, Hyperbilirubinemia & Icterus Neonatorum:-
Accumulation of bilirubin in the blood characterized by yellowish discoloration of the skin and
tissues.
 Normal bilirubin level :- 1.0 to 1.3 mg/dL in adult.

 If more than 2 mg/dL in adults called jaundice.
 And new born more than 5 mg/dL is called jaundice.
Types :-
(i) Physiological Jaundice:-
Jaundice caused by normal physiology is called physiological Jaundice.
Causes :-
(i) Polycythemia
(ii) ↓ se life span of RBC.
(iii)Immature liver :- UDPG-T (Uridine di-phosphate glucuronyl transferees) is secreted in
low amount.
Characteristics :-
Appearance within 30-72 hours but in preterm may appear slightly earlier but never
before 24 hours.
 Serum bilirubin level is never more than 15 mg/dl.
 No treatment require self resolve within 7-10 days in preterm it may take up to 14 days.
(ii) Pathological Jaundice:-

Jaundice caused by any disease is called pathological Jaundice.
Causes :-
(i) Hemolytic disease of newborn.
 Rh incompatibility.
 ABO incompatibility.
 Sickel cell anemia.
 Hereditary spherocytes (RBC is spherical shape).
 G-6 PD deficiency. (glucose-6 phosphate dehydrogenase)
(ii) Viral hepatitis
(iii) Congenital Obstruction of common bile duct
Characteristics:-
 Appears within first 24 hours after birth.
 Bilirubin level may be more than 20 mg/dL.
 Treatment is always require.
Assessment :-
Elevated serum bilirubin level.
 Yellow discoloration of skin and tissues.
 lethargy
 Poor feeding
 If bilirubin level is more than 20 mg/dl it can cross blood brain barrier and causes
bilirubin. encephalopathy also known as Kernicterus.
Diagnosis:-
 Physical Examination
 Kramer index :-
 5 mg/dl : face
 10 mg/dl : Umbilicus
 12 mg/dl : Mid thigh
 15 mg/dl : Ankle and wrist
 More than 15 mg/dl : palms and soles
 Ingram icterometer
 Serum bilirubin level.
Management:-
Three options for T/t
(i) Phototherapy.
(ii) Exchange blood transfusion.
(iii)Drug therapy.
Phototherapy :-
In this therapy light is used to convert unconjugated bilirubin into the conjugated bilirubin.
 Blue and white light can be used.
 Wave length 420-600 nm
 Distance- 45 cm, 18 inch
Complication :-
 Dehydration
 Electric shock
 Bronze baby syndrome: It occurs due to accumulation of photo degradation product
under the skin.
Nursing responsibility :-
 Cover the eyes and genital area.
 Expose as much body area as possible.
 Assess hydration status.
 Provide additional fluid to the baby that is 20-40 ml/kg/day.
 Provide breast feeding at regular interval.
Exchange Blood transfusion :-
 In this therapy blood is exchange to reduce serum bilirubin level.
 Blood use 160-180 ml/kg.
Procedure :-
Umbilical vein cannula is inserted.
 Apply a three way than use 10 or 20 ml/syringe.
In each activity remove 10 ml blood from the new born and then administer 10 ml fresh
blood.
 Repeat the same episodes.
 After every 50 ml of transfusion administer 0.5 ml calcium gluconate to prevent
hypocalcaemia.
Hyperkalaemia:-
When old blood transfusion RBC is destruct and K+ is reach out and increase in blood.
Complication :-
 Hyperkalamia
 Hypocalcaemia
 Cardiac failure
 Air embolism
 Umbilical vein perforation
 Hepatitis-C infection
Drug therapy :-
 Phenobarbitone is the drug of choice in neonatal jaundice.
 It stimulates the secretion of UDPG-T enzyme.
4. Fetal Alcohol Syndrome:-
Note:-
 Alcohol withdrawal symptoms drug of choice is chlordiaze poxide.
 Disulfiram is drug of choice for aversion therapy.
Teratogenic :-
A substance which used by mother and can cross placenta and produce effect in organ
formation.
Iatrogenic :-
 Any disease which provide by health care provider during hospitalization.
 Seizures is prevent by ↓se environment stimuli.
Definition :-
 If a mother uses alcohol during pregnancy than her newborn is affected by fetal alcohol
syndrome.
 Alcohol is a teratogenic substance.
Assessment findings :-
 Facial structure changes.
 Short palpebral fissure.
 Thin upper lip
 Low nasal bridge.
 Short upturned nose.
 Hypo plastic philtrum.
 Congenital heart abnormalities.
 Abnormal palmer creases.
 Crying, irritability, tremors, seizures, sign of respiratory distress.
Nursing Intervention :-
 Continuously monitor for sign of respiratory distress.
 Keep the face turn towards one side to prevent aspiration.
 Keep resuscitation equipments available at the bed side.
 Keep suction apparatus at the bedside and do suctioning as necessary.
 Maintain strict intake and output chart.
 Decrease environmental stimuli.
5. Respiratory Distress Syndrome:-
Surfactant :- It is phospholipid, phospholipid is two type.
(i) Lecithin
(ii) Sphingo myelin
Definition :-
 RDS occurs due to deficiency or absence of surfactants.
 Surfactant is a phospholipid which reduces the surface tension in the lungs and prevents
collapsing of alveoli.
 Surfactant is a combination of two chemicals.
 Lecithin
 Sphingomylin
 The normal ratio b/w both is 2 : 1.
 Surfactant is formed by alveolar type-II cell (pneumocytes Type-II cells) start at 20 weeks
and completes at 35 weeks of gestation.
Risk Conditions :-
 Pre term.
 New born diabetic mother.
Assessment findings:-
 Signs of respiratory distress appear after 6 hours of birth which becomes severe gradually
with times.
 The most severe form is hyaline membrane disease.
Diagnosis :-
(i) Shake test / Bubble test :-
0.5 ml (amniotic fluid) + 0.5 ml (NS)

↓
1 ml ethanol 95%
↓
Shake for 1 minute.
↓
Place the tube verticle for 15 mints
If bubbles are If no bubbles.

present in the tube.
Indicate fetal lung Indicate deficiency

maturity. or
Immature Lungs
(ii) ABG analysis :- Indicate respiratory acidosis.
(iii) Chest x-ray:- Ground glass mottled appearance indicates hyaline membrane disease.
Prevention :-
 Drug of choice is β-methasone 12 mg for 2 days.
 Minimum 48 hours is required b/w drug administration and delivery.
 Second choice is dexamethason (β-methasone stimulates alveolar type-2 cell to produce
surfactants.)
Management :-
 Provide O2 therapy.
 CPAP may be used (Continues positive air way pressure) may use to prevent collapsing
of alveoli.
 Surfactant need to be administered through intra tracheal route.
6. Preterm-Newborn:-
Definition :-
If the new born take birth before 37 weeks of gestation it is called preterm new born.
 Birth weight may be less than 2.5 kg.
 Head circumference less 30 cm.
 Chest circumference less 30 cm but the difference b/w head and chest circumference is
more than 3 cm.
 Length less than 47 cm.
 Poor neonatal reflexes.
 Undescended testes, crytorchidism.
 Short nails does not reaching up to the finger tips.
 Venix caeseosa covers entire body.
 Dry and red skin (Plethoric skin).
 Breast nodule less than 5.
 Soft ear pinna.
 Scarf sign :- If the newborn arms are crossed and stretched and than if antecubital fossa
cross the mid line. It indicates pre term newborn and antecubital fossa does not cross the
midline it indicates term newborn.
 Risk for Jaundice and RDS.
7. Post-Term:-
 If the new born take birth after 42 weeks of gestation. It is called post term newborn.
 Vernix caseosa absent.
 Long nails.
 Long and thin body.
 Muscle wasting.
 Parchment like skin.
 Hypoglycemia.
8. LBW Baby:-
 If the birth weight of a new born is less than 2.5 kg. It is called LBW baby.
 If less than 1.5 kg:- Very low birth weight. Baby.
 If less than 1 kg: - Extremely LBW baby.
9. Small For Gestational Age:-
 If the birth weight. of the new born is less than 10th percentile for a gestational age. It
is called SFGA.
Causes :-
(i) Maternal causes :-

 Malnutrition.
 Anemia
 Heart disease
 Pre eclampsia
 Any infection
(ii) Fetal causes :-
 IUGR
 Multiple pregnancy
 Chromosomal abnormalities
(iii) Placental causes :-
 Chronic placental insufficiency due to abnormalities in the placenta.
10. Large For Gestational Age:-

 If the birth weight. of a new born is more than 90th percentile for their gestational
age. It is called LGA.
 Mostly seen in new born of diabetic mother.
Management:-
(i) Care at NICU :-
 These high risk new born should be managed at NICU.
 Use Proper aseptic techniques to prevent infection in the new born.
(ii) Maintain breathing :-
 Position the newborn supine with neck slightly extended.
 Provide stimulation and O2 therapy.
 Use positive pressure ventilation by bag and mask or ventilation if necessary.
(iii) Maintain warmth :-
 Use pre warmed towel to dry the newborn.
 Cover the newborn properly.
 Place the newborn under radiant warmer.
(iv) Maintain Nutrition :-
 Provide breast feeding.
 If the breast feeding is not available than provide formula feeding.
(v) Monitor for Complication:-
 Continuously assess the newborn for sign of any complication like respiratory
distress, hypoglycemia, hypothermic cyanosis.
(vi) Vaccination :-
 All vaccines should be administered according to the national immunization
schedule.
(vii) Transportation:-
 KMC is the best choice during transportation.
11. New born of Hepatitis-B Positive Mother:-
Intervention:-
 Avoid invasive procedures during the gestational period.
 Just after delivery clean the newborn.
 Before any invasive procedure bath the new born.
 Administer hepatitis-B immunoglobulin as early as possible after delivery.
 Administer hepatitis-B vaccine at O, 1, 6 month of age (0.5 ml).
 Breast feeding is allowed if the new born is vaccinated.
12. HIV Positive Mother's New born:-
 Avoid invasive procedures during the gestational period.
 Just after delivery clean the newborn.
 Before any invasive procedure bath the new born.
 Administer Neviraphine syrup for 6 weeks and then acc. to HIV status of new born.
 An antibody against HIV crosses the placenta and found in the circulation of the
newborn so ELISA and western blot test should not be done up to 18 months of age.
 P24 Antigen and Polymerase chain reaction can be done to detect HIV in the newborn.
Note:-
 P24 Ag Confirmative HIV test for pregnant woman 14th week- Zidovudine-Tab.
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anti body vk;sxkA 18 month ds ckn vxj baby HIV positive gks rks mlds [kqn dh anti body cukus yxsxkA
Post exposure prophylaxis drugs.

 Zidovudine
 Lamivudine
 Indinavir
Chances of infection after needle stick injury:-
 HIV - 0.35%
 Hepatitis B - 20.25%
13. Hypothermia:-
 If the temp of newborn is less than 36.50C it is called hypothermia.
 It is also known as silent killer of new born.
Type :-
(i) Cold stress :- 36.40-360C
(ii) Moderate hypothermia :- 320C – 35.90C
(iii)Severe hypothermia :- Less than 320C
Initial symptoms :-
 Hand and feet are cold to touch.
 Poor sucking ability.
 Peripheral vasoconstriction.
Late sign :-
Respiratory rate Decrease se
 H. R. decrease
 Lethargy
 Cyanosis
 Death
Management:-
Assess the temperature of newborn by dorsal aspect of hand.
 If the hands and feet are cold to touch and abdomen is warm it indicates cold stress.
 If the abdomen is also cold it indicates moderate of severe hypothermia.
 Maintain warm chain to prevent heat loss.
 Heat loss can be occur by four mechanism.
(i) Conduction
(ii) Convection
(iii) Evaporation
(iv) Radiation- 60%
 Use radiant warmer or incubator to maintain temperature.
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DISORDERS OF GIT SYSTEM
1. Oesophageal atresia with trachio esophagcal fistula:-
 Failure of the esophagus to from a continues path way from pharynx to stomach is called
EA.
 Abnormal connection b/w trachea and oesophagus is called trachio esophageal fistula.
 Before 4 week of gestation trachea and oesophagus is a common cavity after 4 week both
forms the seprate cavity.
Causes :-
 Infection.
 Radiation exposure
 Substance abuse.
 Drug therapy.
 Any maternal disease.
Types :-
(i) Only oesophageal atresia (8% chances).
(ii) OA with ToF (Upper) :- Most rare condition but very severe. (1% chances).
(iii) OA with ToF (Lower) :- Most common form 80-90% chances.
(iv) OA with ToF :- (Both upper and lower) (1% chances).
(v) ToF (H Type) :- (4% chances).
 Drooling of forthy saliva from the mouth.
 3 "C" Sign
 Coughing
 Choking
 Cyanosis
 Abdominal distension
 Regurgitation
 Vomiting
 Sign of respiratory distress.
Diagnosis :-
 USG
 Radio opaque catheter.
 Chest X-ray
Surgical Management:- 2 types.
(i) One stage surgery - If distance b/w both ends of esophagus is less than 2.5 cm if
condition of infant is good and Hb is good than end to end anastmosis of esophagus
is done with ligation of fistula.
(ii) Two Stage surgery :- If the distance b/w both end of esophagus is more than 2.5 cm
and condition and condition of fetus is not good, Hb is very low than first stage
gastrostomy is done and after one year second stage is perform.
Nursing Management:-
Post operative :-
 Check vital sign.
 If gastrostomy tube is inserted left is open.
 After feeding close the gastrostomy tube for 1-2 hrs and head end should be elevated.
 Assess for signs of infection that are purulent drainage fever and ↑se WBC count.
 5-7 days after surgery of esophagus oral feeding should be started.
 Broad spectrum anti biotic should be used.
2. Lactose intolerance:-
Deficiency or absence of lactase enzyme in the secretion of small intestine that causes inability to
digest lactose.
 Lactose is a carbohydrate that is found in milk.
 Lactose is converted into glucose + galactose in the presence of lactase enzyme.
Lactase
Lactose Glucose + Galactose
If lactase
absent.
Lactose accumulation
↓
Fermentation by bacteria
↓
Excessive flatus and watery diarrhea.
 Symptoms appear after ingestion of milk and milk production.
 Abdominal distension.
 Abdominal Pain.
 Excessive flatus.
 Watery diarrhea.
Diagnosis :-
Lactose tolerance test - Fasting sugar level is assessed than lactose 2 gm/kg is given orally
1
after 1–1 2 hurs blood sugar level is repeated.
 If blood sugar level ↑se by more than 20 mg/dl it indicates negative test result and the infant is
normal.
 If blood sugar level increments is <20 mg/dl it indicate positive test result and infant is affected
by lactose intdrance.
Management:-
 Avoid milk and milk products.- Supplement the lactase enzyme tab with milk.
 Yogurt, cottage cheese, hard cheese can be usages it contain lactase enzyme in inactive form.
 Limit the consumption of milk at one time.
 Supplement calcium and Vit-D.
3. Cleft lip and Cleft palate:-

Cleft lip:-
 Normally lip formation occurs at the age of 5-12 weeks of gestation by fusion of vermillion
border.
 If vermillion border fails to Fuse and notch is present is called cleft lip.
 It is also known as Hare lip and cheiloschisis
Cleft palate:-
 Normally palate formation occurs at 12-14 weeks of gestation by fusion of lateral palatine
process at medially.
 Failure of this fusion cause cleft palate, it is also known as palatoschisis.
Types:-
 Pre alveolar - Only cleft lip.
 Post alveolar - Cleft palate.
 Combined - both.
Complication :-
Immediate - Feeding problem chances of aspiration.
Late Complication :- Repetitive otitis media
Hearing loss
Hyper nasal speech
Misplacement of teeth.
Management:-
Immediate management:-
 Prevent aspiration.
 Assess the sucking ability.
 Provide feeding by paladespoon or aseptic syringe.
 Modified feeding technique can be used that is ESSR Techniques.
E - Enlarge nipple
S - stimulate sucking
S - Swallow
R- Rest
 After feeding the baby should be placed in propped - UP position.
Surgical management:-
 Cleft lip- Surgery is called cheiloplasty done at 3-6 month of age.
 Rule of 10 can be follow.
Age - 10 weeks
Weight - 10 pound
Hb - 10 gm/dl
Post operative Management :-
 Prone position and side lying position towards surgical site is contra-indicated.
 Provide supine and side lying position towards unoperated side.
 Assistive devices can be used to prevent stretching of suture line.
 e.g. - Logan Bow.
 Use Elbow or Jacket restraints to prevent injury at surgical site.
 Avoid crying.
 After feeding clear the suture line by normal saline.
Cleft palate :-
 Surgery is called as palatoplasty done at 6-24 months of age.
Post operative management :-
 Supine position is contraindicated to prevent aspiration.
 Prone position or side lying position can be provided.
 Oral packing is generally present for 2-3 days.
 Avoid the use of oral thermometer, tongue depressor, straw or spoon to prevent injury at surgical
site.
 If hyper nasal speech developed then consult with speech therapist.
4. Hypertrophic Pyloric Stenosis:-

Hypertrophy of circular muscle fibers in pyloric part causes narrowing of the lumen, It is called
hypertrophic pyloric stenosis.
 It is an acquire condition develops after few days of birth.
 Projectile vomiting (forceful vomiting).
 Vomiting contents are not bilious.
 Olive shaped mass is palpated in epigastric region.
 Metabolic alkalosis.
 Dehydration.
 Electrolyte imbalance.
 Hypokalamia and hypocalcaemia.
Diagnosis:-
USG, Physical Examination
Management:-
 Prevent aspiration.
 Prevent dehydration and electrolyte imbalance.
 Provide I.V. fluid therapy.
 Confirmatory management is surgery pyloromyotomy and also known as Fredet ramstedt's
procedure.
5. Hirschsprung's Disease OR Aganglionic megacolon:-

During gestational development ganglion nerve fibers of parasympathetic Nervous system is
distributed to different portion of GIT.
 If some portion of Intestine does not receive the ganglionic nerve fibers that portion becomes
aganglionic and peristaltic movement does not occur in that part.
 It causes obstruction in the passage of food particles and food partials accumulated just proximal
to aganglionic part that portion is called megacolon.
 The most common affected parts rectosigmoid.
Assessment findings in Neonates:-
 Failure to pass meconium.
 Poor sucking.
 Abdominal distension
Older children :-
 Weight loss
 Abdominal pain
 Ribbon like stool
 Constipation alternating with diarrhea.
 Vomiting (bilious).
Diagnosis :-
 USG
 Rectal biopsy in confirmatory test.
Medical Management :-
 Stool softener.
 Bowel irrigation with normal saline.
Surgical Management :-
Two stage surgery.
 In first stage colostomy is done, To provide rest to megacolon portion.

 In 2nd stage aganlionic part is cut and removed and then end to end anastmosis is done.
 Assess the colostomy stoma, It should be pink and moist, if it becomes blue it indicate cyanosis
and dark red colour indicates bleeding.
 Assess for the sign of infection purulent drainage, elevated temp, ↑se WBC count.
Surgical Procedure
 Duhamel procedure.
 Soaves procedure.
 Swenson procedure.
6. Intussusception:-
Telescoping of the intestine into another portion is called intussusception.
 Abdominal pain (Colicky).
 Abdominal distension.
 Vomiting (bilious).
 Current Jelly like stool contains blood and mucus.
 Sausage shaped mass is palpated per abdomen.
Diagnosis :-
 Physical Examination
 USG
Interventions :-
 Assess for signs of intestinal rupture.
 Continuously monitor for the passage of normal brown stool it indicates. The condition is self
resolve.
 Hydrostatic reduction can be done to correct the condition.
 If the condition is not resolve by hydrostatic reduction than surgery is perform.
7. Celiac Disease:-
 It is an allergic reaction.
 The infant is allergic to gluten protein.
 Gluten protein causes destruction of intestinal villai.
 Diarrhea with bulky and malodorous stool.
 Steatrrhoea
 Weight loss
 Muscle wasting
 Abdominal pain
B- Barley
R- Rye
Contain gluten protein
O- Oats
W- Whey
Intervention :-
 Avoid food particles that contain gluten protein.
 Educate family members to read the ingredients if they purchase packaged food.
 Supplement the fat soluble vitamins.
 Rice and millets can be used as grains.
 Celiac crisis- Sudden severe. Exacerbation of symptom occurs in infection or excessive
gluteningestion.
Foods allowed :-
 Meat
 Egg
 Milk and milk products
 Rice
 Millets
Food not allowed:-

 Bear, bread, cake, ice-cream, barley, Rye, oats, wheat, cookies, macaroni noodles.
8. Abdominal Wall Defect:-
 During gestation if abdominal wall is not formed completely it is called abdominal wall defect.
 It has two types-
 Omphalocele
 Gastroschisis
Omphalocele :-
 Defect in abdominal wall at the level of umbilical ring.

 Organs are protuse and covered with a transparent membrane.
Gastroschisis :-
 Defect in the abdominal wall at the level of lateral to the umbilical ring.
 Organs are protrudes but not cover with any membrane.
Etiology :-
 Folic acid deficiency.
 Radio therapy.
 Drug therapy.
 Any infection.
Diagnosis :-
Antenatal diagnosis :-
 USG
 Maternal serum alpha feto protein test (MSAFP).
 If level is elevated it indicates abdominal wall defect or neural tube defect.
 If value is lower than normal it indicates Down syndrome.
After birth :-
 Physical examination.
 Immediately after birth cover the defect with at sterile gauze piece dipped in normal
saline.
 For additional protection from water loss a plastic drap can be used.
 Surgery is required for confirmatory treatment.
9. Ano-rectal malformation:-
 Defect in the formation of anal canal and rectum during gestation period is called ARM.
 Normally anal canal and rectum forms at 8 week of gestation.
Etiology :-
 Due to effect of teratogenic substance.
Types :-
 Imperforate anal membrane - The external anal opening is covered with a membrane.
 Anal stenosis - Narrowing of the anal canal.
 Anal agenesis - Failure of formation of anal canal.
 Rectal agenesis - Failure in the formation of rectum and anal canal.
Assessment Findings :-
 Failure to pass meconium.
 A greenish bulging membrane.
 Anal opening is absent only anal dipple is present
 Constipation.
 Ribbon like stool.
 Fecal matter in urine.
 Stool passage through the vagina.
Diagnosis :-
 USG
 Endoscopy
 Invertogram
Surgical Management :-
 In case of imperforate anal membrane only incision is done.
 In anal stenosis anal opening is enlarge.
 In case of anal agenesis and rectal agenesis reconstructive surgery is require.
Nursing Management :-
 Educate the family members about how to use anal dilator it is prescribed by the surgeon.
10. Diarrhoea
 Passage of loose watery stool more than 3 times in a day it is called diarrhea.
Etiology :-
 Infectious cause.
 Non infectious cause.
Infectious Causes:-
Virus
 Rota virus
 Adeno virus
Bacteria
 Vibreo cholera
 Salmonella typhi
Parasite
 Giardia lamblia
 Ent. amoeba histolytica.
Fungus
 Candida albicans
Non Infectious Causes :-
 Mal-absorption syndrome.
 Celiac disease.
 Lactos intolerance.
 Hirchsprungs disease.
Types :-
(i) Acute
 Less than 2 Weeks
(ii) Chronic -
 More than 3 weeks.
(iii) Persistent / progressive diarrhea :-
 More than 2 week with infectious causes.
Acc. to Clinical Manifestation :-
 Rice water stool - Cholera
 Pea soup stool - Typhoid
 Blood diarrhea - Dysentery (Ent. amoeba histolytic and shigella)
 Dehydration
 Electrolytic imbalances
 Depressed fontanells
 ↓se tear production
 ↓sed skin turger
 Tachycardia
 Hypotension
 Lethargy
 Metabolic acidosis
 Dry mucus membrane
 Hypokalamia.
Diagnosis
 Stool culture
 Stool hanging drop
 Pinch test for assessment of dehydration.
Types of Dehydration :-
(i) According to severity:-
 Mild dehydration – 2-5% fluid loss.
 Moderate dehydration - 6-9% fluid loss.
 Severe dehydration - More than 10% fluid loss.
(ii) Acc. to clinical manifestation :-
(a) Isotonic dehydration :-
 Equal water and electrolyte loss.
 Hypovolemia occurs should be treated with isotonic solution.
(b) Hypertonic dehydration :-

 Excess water loss from the body.
 Cell shrinkage occurs.
 Should be treated with hypotonic fluid.
(c) Hypotonic dehydration :-
 Excess electrolyte loss occurs.
 Cell swelling occurs.
 Should be treated with hypertonic fluid.
Management:-
 Mgt of dehydration should be done immediately and according to the severity.
 Plan A for mild dehydration- Can be managed by home available food.
 ORS can also be used.
If less than 2 year - 500 ml/day.
2-10 year - 1000 ml/day.
> 10 year - 1500 ml/day.
 Zinc supplementation is required and dose is
<6 month - 10 mg/day
>6 month - 20 mg/day
Plan B for moderate dehydration:-
ORS is used
 < 4 month - 200 - 400 ml
 4-11 month - 400 - 600 ml
 12-23 month - 600 - 800 ml
 2-4 year - 800 - 1200 ml
 5-14 year - 1200 - 2200 ml
 >15 year - > 2200 ml
 –Stool replacement 10-20 ml/kg/ loose stool.
Plan C severe dehydration :-
 IV fluid therapy is required RL is used most commonly but if not available NS can be
used.
 For < 2 year
Loading dose - 30 ml/kg over half hour.
Maintenance dose - 70 ml/kg over 5 hour.
 For > 2 year
Loading dose - 30 ml/kg/hour.
1
Maintenance dose - 70 ml/kg/ 22 hour.
ORS :-
Contents -
 Sodium chloride - 2.6 gm
 Potassium chloride - 1.5 gm
 Trisodium citrate - 2.9 gm
 Glucose - 13.5gm
20.5 gm
Osmotic value : -
 Sodium - 75
 Glucose - 75
 Chloride - 65
 Potassium - 20
 Citrate - 10
245 MOSM/Liter
Drugs : - (Opioid)
 Loperamide for non infectious diarrhea.
 Antibiotics for infections diarrhea.
11. Vomiting:-
Retrograde ejection of stomach contents through the mouth is called vomiting.
Etiology :-
(i) Infectious causes
 gastritis
 appendicitis
(ii) Non infections causes
 GERD
 Increase ICP
 Hypertrophic Pyloric stenosis
 Intestinal obstruction
(iii) Psychological Causes-
 Anorexia Nervosa
 Bulimea Nervosa
Clinical Manifestation:-
 Dehydration
 Same as diarrhea
 metabolic alkalosis
Sign:-
 Coughing
 Chocking
 Cyanosis
Character of Vomitus:-
 Bilious
 Non bilious
 Haematemesis
Management:-
 Assess for sign of aspiration
 Provide side lying position during vomiting episode.
 Correct the dehydration and electrolyte imbalance.
 Anti emetic drugs can be used ondasterone, domepridone, metachlopromide
12. Poisoning:-
 Most common poisoning in India is kerosene poisoning. and second is insecticide poisoning
Definition:-
 Ingestion of harmful substance or in excess of a normal substance is called poisoning
 The most common poisoning in India is kerosene poisoning.
 less than 11 years it is called poisoning
 More than 11 years, it is called suicidal attempt.
(i) Paracetamol poisoning Ingestion of excess PCM:-
 Injestion of excess PCM more than 150 mg/kg
 Initial symptoms
 Malaise
 Nausea, vomiting
 Sweating
Latent period:-
 Within 4-6 hrs the symptoms are subside.
Hepatic Involvement:-
 Jaundice
 Right upper quadrant pain
 elevated SGOT and SGPT
 Prolong PT
 Lethargy
Management:-
 Maintain patent airway
 Decrease the absorption of PCM
 Induced vomiting
 Gastric Lavage
 Activated charcoal
 Administer specific antidote that is N- acetyl cysteine
 N- Acetyl should be given with juice or soda due to its offensive order.
 Never give N-acetyl cystic through orally if activated charcoal is given
 Aspirin Poisoning (acetyl salicylic acid)
(ii) Aspirin poisoning
 Ingestion of aspirin in excess amount is called aspirin of poisoning.
Two types -
 Acute poisoning - 300-500 mg/kg.
 Chronic Poisoning- 100mg/kg for - 2 days
The chronic poisoning is more dangerous than acute.
(i) GIT-
 Nausea
 Vomiting
 Metabolic acidosis
(ii) C.N.S-
 Convulsion
 Seizures
 Coma
 Hyper ventilation
 Death
(iii) Hematopoietic Effect - Bleeding tendency
(iv) Renal effect - Oliguria
(v) Electrolyte effect - Hypocalcaemia Hyponatrimia
Management:-
 Maintain patent airway
 Decrease rate of absorption by gastric lavage induction of vomiting and activated
charcoal.
 Provide symptomatic mgt like NaCo3 for acidosis, Vit-k, bleeding tendency ,
Diuresis for oligourea.
 If condition of the patient does not improve the final option is hemodialysis.
(iii) Lead Poisoning-

Excessive accumulation of lead in blood and tissue is called lead poisoning.
 It is also called as plumbism
 <5 mcg/dl is normal value.
 The lead enter the body in three way
(i) food (ii) water (iii) Air
Organ affected:-
 Most commonly bone, teeth, RBC and CNS is azzected.
 Most serious effect are seen on CNS
Screening:-
 1-2 yr of age child are screened.
 2-5 yr of age can be included if previously not screened.
Diagnosis:-
Blood lead level
 Erythrocyte protoprophyrin test 35ug/dl is normal and elevated level indicate anemia.
Management:-
 Blood lead level assessed if 10 mcg/dl than health education environmental
modification and repeated screening is required.
 If 20mg/dl than treatment should be started and > 70mg/dl is an medical emergency
and require immediate treatment.
 Antidote for lead poisoning is calcium disodium EDTA. (CaNa2 EDTA)
 Dimercaprol can also be used it is also known as BAL (British Anti Lewisite)
 Assess the child for peanut allergy dimer caprol is used.
 If allergy is peanut dimercaprol should be contraindicated.
 Assess the renal function and urine output before administering antidote.
(iv) Organophosphate Poisoning-
 Ingestion of organophosphate that is found in insecticide.
 It stimulate the parasympathetics that is nervous system and produce symptoms

Symptoms:-
 Bradycardia
 Excessive Salivation
 Excessive Tear Production
 Increase peristaltic activity cause diarrhea
 Excessive meosis of pupils.
Management:-
 Maintain airway
 Increase absorption
 Administer specific antidote atropine sulphate.
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DISORDERS OF CARDIO-VASCULAR SYSTEM
Fetal circulation:-
 The fetus is connected to the mother by umbilical cord.
 Umbilical cord contain 2 umbilical artery and 1 umbilical vein.
 Umbilical vein, enter the fetus through the umbilical and goes to the liver.
 In liver it given of branches to the left lobe of liver and mixing of blood portal vein occurs.
 Then blood enters the ductus venosus to reaches the inferior venacava.
 By inferior venacava blood enters the right atrium.
 Blood from superior venacava also enters the right atrium.
 Remaining 25 % of blood enters the right ventricle through the tricuspid valve blood from right
 Ventricle enter the pulmonary artery and than through the ductus arteriosus minimum blood
enter the descending aorta.
 Remaining some portion of blood enter the lungs for it supply
 From the lungs blood reaches the left atrium through the pulmonary vein.
 From the left atrium blood enter the left ventricle to mitral valve.
 From left ventricle blood goes into aorta.
 The deoxygenated blood reaches the placenta through the umbilical arteries.
After birth change in fetal circulation:-

 Due to cessation of placenta blood flow decreased pulmonary resistance.
 Umbilical vein close after birth and become ligamentum teres (2-3 month)
 Ductus venosus anatomical closer 2-3 month and become ligamentum venosum
(i) Foramen ovale:-

 anatomical closer 1yr and become fossa ovalis
(ii) Ductos arteriosus:-

 Closure 1-3 month and becomes superior vesicle artery.
 Distal parts become later / umbilical ligament.
Congenital Heart Disorder:-
Etiology:-
 Infection (rubella)
 Radiation therapy
 Drug abuse
 chromosomal abnormalities
 Consanguineous marriage
Classification:-
(i) Acyanotic
 ASD
 VSD(25%)
 PDA
(ii) Cyanotic
 TOF
 Transposition of great arteries
(iii) Obstructive
 Coarctation of arota
 The most common congenital heart disease is ventricular septal defect.

 The most common acynotic heart disease is TOF.
1. VSD (Ventricular septal defect):-

 Abnormal opening in the septum b/w two ventricles left to right shunt is seen.
 Tachy cardia, murmer like heart sound tachyopnea.
 sweating with activities repeated chest infection
 failure to gain weight.
Diagnosis:-
 ECG
 Cardiac catheterization
Management:-
 Surgery is required as early as possible.
Complication:-
 Eisenmenger‟s syndrome - In late stages of acyanotic heart disease there is incessive
accumulation of blood in the lungs. It causes increase pulmonary resistance. So right side of
the heart pressure Increased and direction of blood flow is right to left.
2. ASD (Atrial Septal Defect)

 Abnormal opening in the septum b/w both atrium.
 It causes left to right shunt.
Types
 Ostium primum (ASDI)- abnormal opening is present at lowest part of the arterial
septum.
 Ostium secundum (ASD II) - Abnormal opening in the middle of septum.
 Sinus venosus (ASD II)- Abnormal opening in the upper part of septum where superior
venacava enters the right atrium
 Tachycardia, murmur like heart sound tachypnoea.
 sweating with activities repeated chest infection
 Failure to gain weight.
Diagnosis :-
 ECG
Management:-
 Same as VSD
3. PDA (Patent Ductus Arteriosus):-
 If DA remains open after birth it is calls patent DA.
 Before birth blood flow is from pulmonary artery to descending aorta.
 But after birth pressure in the left side increase and now blood from descending aorta to
pulmonary artery.
 Tachycardia
 Tachypnoea
 Corrigon pulse (water pulse hammer)
 repeated chest infection
 sweating during activity
Diagnosis:-
 Cardiac Catheterization
 used 0.1 -0.25 mg/kg for 3 dosage. (IV slow infusion over 30 mint)
 If the condition does not resolve than surgery is require.
 Ligation of DA is done
4. Tetralogy of Fallot (TOF)
 It is a combination of four diseases
 Ventricular septal defect
 Pulmonary stenosis
 Overidding of aorta
 Right ventricular hypertrophy
 Right to left shunt is present
 Right to left shunt is present
 at birth some cyanosis is present but the cyanosis becomes severe as the child growth.
 During crying or feeding sudden cyanosis may be seen it is called tet spell or blue spell
 In older children - clubbing of finger. Loviband angle becomes more than 1650 normally it is
less than 1650, and schamroth sign can also be seen schamroth sign is positive due to
drumstick appearence of nails.
 Failure to thrive - (FTT)
 Muscle wasting
Diagnosis:-
 Echocardiography
 Chest x- ray- Boot
 Shaped heart due to right ventricular hypertrophy.
Management:-
 Surgical mgt is required
 T/T of VSD and Pulmonary stenosis is done.
Nursing responsibility:-
 During tet spell provide knee chest position or squatting position.
 Provide O2 therapy and antibiotic should be given.
DISORDERS OF NERVOUS SYSTEM
1. Hydrocephalus:-
 Excessive accumulation of C.S.F. in the brain causes increased intra cranial pressure and
it is called hydrocephalus.
Types :
 Communication Hydrocephalus. no obstruction in the flow of C.S.F. but there is
abnormal production and absorption
 Non communicating - obstruction in the not communicating by Hydrocephalus.
 Bulging fontanelle
 thin skull bone
 widely separated suture it produces cracked pot sound on percussion. It is called
Macewan‟s sign
 High pitch shrill cry
 Dilated scalp vein
 Setting sun eye
Older children:-
 Headache , Nausea and vomiting ataxia, nystagmus and altered level of consciousness
and seizures.
Diagnosis:-
 C.T. Scan
 MRT
 x-ray
Management:-
 Medical
 Manitol and acetazalamide is used.
Surgical:-
 Ventriculo paritoneal shunt is used in this mechanism a tube is connected b/w lateral
ventricles and peritoneum to drain the C.S.F.
 Alternative options are ventriculo, arterial, ventriculo urethral, ventriculo pleural shunt
 Pre-Operative:- Change the position of head o prevent pressure sore.
 Post- Operative:-
 Assess the surgical site for infection.
 Position the child on un-operated side.
 Always assess the patient for sign of shunt failure.
 In infants - Bulging fontanelle high pith shrill cry may be seen.
Older children:-
 Altered level of consciousness
 Elevate the head of bed (15-300) If the sign of increased ICP are seen.
 Shunt repetition proceed ure is required as the child grows.
2. Neural Tube Defect (NTD):-
 NTD failure of the neural tube to close completely with in 3rd gestational week.
 The vertebral arches fails to fuse in lumbosecral area.
Causes:-
 Infection
 Radiation exposure
 Drug abuse
 folic acid deficiency
 Spina bifida is the most common neural tube defect.
 Spina bifida has two types.
(i) spina bifida oculta
(ii) spina bifida cystica
(i) Spina bifida occulta:-
 Abnormal opening in the vertebral Colum at L5 and S1 level.
 Organs are not protruded through the defect
 At the location of defect their may be tuft of hairs or dimple or portwine stain.
 spinal cord and meninges are intact.
 neurological deficit is seen.
(ii) Spina bifida cystic:-

 In this defect organs are protruded through the opening and covered by a transparent
membrane.
 Two types (i) Meningocele
(ii) Meningomyelocele (myelomeningocele)
(i) Meningocele:-
 Meninges and C.S.F are protrudes through the defect.
 No severe neurological deficit is seen
(ii) Meningomyelocele (myelomeningocele)

 Meaninges, CSF, Nerve roots & Spinal cord protruats through the defect.
 Opening in the lumbosecral area
 Tuft or hairs or portwine stain may be seen.
 A sack may be protrude
 Paralysis of lower extremities
 Abnormality in bladder and bowel control
 Hydrocephalus
 Hip in stability
Diagnosis:-
 Antenatal Diagnosis-
Maternal serum Alfa Feto protein level become elevated.
after birth- Physical examination CT scan
MRI
 Provide the prone position to prevent injury of the defect.
 Cover the defect with sterile normal saline dipped gauze.
 Surgical - The protrudes organ is reverted back to their normal location and the defect is
close.
Post operative management:-
 Use aseptic techniques during dressing changes.
 Assess for the sign of infection
 Always monitor for sign of increased I.C.P.
3. Cerebral palsy:-
 It is a disorder of muscle contraction body movement, posture and coordination
 In this disease extra pyramidal, pyramidal tract or cerebellum may be affected.
 It is a non progressive disorder
Causes:-
 Hypoxia in brain- Birth asphyxia is most common cause.
 other causes abruptio placentae, umbilical card prolapse and than preeclampsia, tight
umbilical cord around the fetal neck.
 Toxin use by mother
 Severe hypoglycemia
 Head trauma
 Torch infection
Types:-
(i) Spastic Cerebral palsy- most common type of cerebral palsy
 Pyramidal tract is affected, severe spasm of muscles is seen.
(ii) Athetoid cerebral palsy (Dyskinetic)
 Extra pyramidal tract is affected
 slow and involuntary movement occur.
 It is known as worm walking.
(iii) Ataxic cerebral palsy-
 Cerebellum is affected
 Uncoordinated movement occur.
(iv) Mixed- symptoms of all types can be seen in a patient
 Delayed developmental milestone
 late disappearance of neo-natal reflexes.
 opisthotonus positioning
 scissor gait
 Toe‟s walking
 paraplegia, hemiplegia, monoplegia or quatriplegia may be seen.
Diagnosis:-
 By C/F and C-T scan or MRI diagnosis is done after 18 months of age.
Management:-
 No treatment is present
 Muscle relaxant drugs can be provided during muscle spasm. like baclofen,
Dantrolene, succinyl choline.
 Communicate will the child acc. to his developmental level and not acc. to his
chronological age.
4. Reye’s syndrome
 In this disorder encephalopathy occurs due to fatty changes in the liver
 The adjunct cause is unknown.
 This disorder is most commonly seen in a patient affected with viral infection like
influenza, vericella and also take aspirin drug.
 History of viral illness is present.
 Nausea and vomiting
 Neurological deterioration
 Increase blood ammonia level
 Seizures may also present
Diagnosis:-
 The test are targeted towards functioning of the liver.
 Liver biopsy is confirmatory diagnosis.
Management:-
 Decrease the environmental stimuli to prevent seizures.
 Continuously monitor the patient to assess alteration in level of consciousness.
 Administer lactulase drug to reduce the blood ammonia level.
 The paracetamol is better choice for fever in viral infection than aspirin.
5. Down’s syndrome
 It is a genetic disorder caused by the presence of all or part of a third copy of
chromosome 21.
 It is also known as trisomy 21.
 It is typically associated with physical growth delays, characteristic facial features
and mild to moderate intellectual disability.
 It is the common chromosomal disorder in children.
Etiological/Risk factors:-
 Third copy of chromosomal 21
 Advanced age pregnancy (Mother above 35 years)
Clinical features:-
 The children with down‟ syndrome have a characteristics look like mongolism races
i.e. chines, Japanese, so they are called as “Mangol” and the condition as mongolism.
 Round Face
 Flat nasal bridge
 Single planer-crease
 Ears are small
 Neck is short and broad with low hair line.
 Hands are short and broad
 In the feet, there is wide gap between the big and second toes.
 Hypotonia
 They are cheerful, affectionate, friendly, fond of music and has grossly delayed
milestones with both physical and mental retardation. The maximum mental age is
around 8 years and average IQ is about 40. So these children were previously termed
as “cheerful idiot”.
Diagnostic Evaluation:-
 History Collection
 Physical examination
 Chromosomal study
 Dermatoglyphic finding Confirm Diagnosis
 Radiological finding of bony abnormalities
 Antenatal diagnosis can be done in suspected cases.
Management:-
 Educational Support
 Sheltered work environment
 Parental counseling especially when they are planning to have another child.
“YOU MUST DO,

THE THING
YOU THINK
YOU CANNOT DO”
DISORDERS OF RESPIRATORY SYSTEM
1. Cystic Fibrosis:-
 It is an autosomal recessive disorder
 The Chromosome no. 7 is most commonly affected.
 In this disorder secretion of exocrine gland becomes thick and cause complication
 The most commonly affected system are-
(i) Respiratory
(ii) GIT
(iii) Reproductive
(iv) Integumentory
(i) Respiratory:-
 The mucous becomes thick and stagnation of mucus occur.
 It provides a better medium for the growth of bacteria.
 In late condition emphysema and atelectasis may occur.
 Pneumothorax can also occur.
(ii) GIT:-
 Failure to pass meconium
 Pancreatic secretion becomes thick and obstruction occurs.
 Problem in the digestion occur.
 Large bulky stool from it may cause rectal prolapse.
 Weight loss and muscle wasting may occur.
(iii) Reproductive System:-

 The male become sterile due to absence of sperm in the ejaculation.
 In females
 The cervical secretion becomes thick and formes a mucus plug. it prevents the entry of
sperm into the uterus and prevents fertilization. So the female becomes infertile.
(iv) Integumentary:-
 Secretion of sweat gland becomes thick so concentration of sodium and chloride

becomes increased in sweat.
 Very salty sweat on skin.
Diagnosis:-
Sweat chloride test-
 By pilocarpine. iontophoresis a sample of sweat is collected.
 Minimum 75 mg sample is sufficient.
 The normal Nacl concentration in sweat is less than 40 mEq/L
 If chloride concentration is between 40-60 mEq/L. It is suggestive of cystic fibrosis and
require repeated test.
 More than 60 mEg/L is confirmatory for cystic fibrosis.
Management:-
 Mucolytic therapy can be used bronchodilators should be administer before chest
physiotherapy.
 Chest physiotherapy include
(i) Percussion
(ii) Postural drainage
 The child should receive all immunization with influenza vaccination.
DISORDERS OF RESPIRATORY SYSTEM
 Huff coughing can also be used to expectorate the secretion.
 Pancreatic enzyme supplementation is required.
 It should be administered with in 30 mint of every meal.
 If pancreatic enzyme enteric coated tablet is use. it should not be broken or chewed.
 Fluid and electrolytic replacement is necessary.
 High calorie, high protein, well balanced diet should be provided.
 In between meals high calorie snack in between meals
2. Croup Syndrome:-
It is a group of disorder includes:-
 acute epiglottis
 spasmodic laryngitis
 Bacterial trachitis
 Laryngotracheobronchitits
Acute epiglottis:-
 It is of bacterial origin
 Hemophillus influenza type- B or streptococcus is responsible
 Common in 3-5 yrs of age and occurs in winter.
 And individual immunized with hemophillus influenza type-B has less chances of this
disease
 High grade fever
 sore throat
 Horsness of voice
 Dysphonia or aphonia
 Dysphagia and odynophagia
Spasmodic laryngitis:-
 Sudden spasm of larynges occurs and causes obstruction in the respiratory tract.
 It is allergic in origin- inflammation of trachea causes respiratory distress.
Laryngotrachio bronchitis:-
 It is most common form of croup disorder.
 In this condition inflammation of larynx, trachea and bronchus occurs.
 It is of viral origin
 severe respiratory distress may present
 stridor sound may be produced
 muffled voice may be present
 sign of dehydration may be present
 Tachypnoea or cyanosis may be present
Management:-
 Assess the respiratory status of the child.
 Provide High humidified O2
 Bronchodilators and corticosteroid therapy may be used
 Anti bacterial and antiviral medication is used to treat the infection.
“START SMALL AND DREAM BIG”
DISORDERS OF REPRODUCTIVE SYSTEM
1. Cryptorchidism:-
 Failure of the testes to descent in scrotal sac is called cryptorchidism.
 The scrotal sac is empty.
Management:-
 The condition spontaneously resolve and the testes descent in the scrotal sac within first
year of life.
 If the Condition does not resolve than mgt option are available
(i) Medical Management:-
 HCG is administered which stimulates the secretion of testosterone and helps in the
descending of testes.
(ii) Surgical Management:-
 Surgery is known as orchidopexy.
Post operative Management:-

 Assess the surgical site for sign of infection like purulent. Discharge. elevated WBC
count and temperature and for sign of bleeding like tachycardia and hypotension.
2. Epispadias and Hypospadias:-
Epispadias :-
 Abnormal urethral opening on the dorsal surface of penis is called epispadias.
Hypospadias :-
 Abnormal urethral opening on the ventral surface of penis.
Complication :-
 Repeated urinary tract infection.
 Infertility due to improper ejaculation in the vagina.
Management:-
 Reconstructive surgery should be done at the age of 16-18 months.
 Immediately after surgery a pressure dressing is applied to the surgical site to prevent
bleeding and mobility.
 Some type of urinary diversion may be present or urinary stand can also be used.
 Continuously monitor the patient‟s vital signs and check urine output every one hour.
 If urine output is absent than informed surgeon.
DISORDERS OF URINARY SYSTEM
1. Exstrophy of Bladder:-
 Urinary bladder is exposed directly to environment and anterior wall is absent.
 Bladder is exposed.
 Deformity of pelvis
 Epispidias
Management:-
 Cover the exposed bladder mucosa with sterile normal saline deeped gauze.
 To prevent dehydration and infection.
 The confirmatory mgt is surgery and it should be done as early as possible.
2. Wilm's tumor Or Nephroblastoma:-
 The peak incidence is at the age of 3 years.
 5 stages.
 Stage I - The tumor is localized to one part of kidney.
 Stage II - The affected kidney is complete involve.
 Stage III - The lymph nodes near the kidney are involved.
 Stage IV - Tumor is met astasised to lungs and liver.
 Stage V - Both the kidneys are affected.
Assessment:-
 Abdominal mass in flank region.
 Abdominal pain.
 Hematuria
 Anemia (Weakness, fatigue, pallor)
 Hypertension due to excessive production of rennin by tumor.
Diagnosis:-
 USG
 CI Scan
 MRI
 Renal biopsy is not done to prevent damage of the capsule of tumor.
 Abdominal palpation is strictly contraindicated because it can cause rupture of the tumor.
Management:-
 Chemotherapy and surgery is done to remove the tumor.
 In stage I and stage Ii wilm's tumor it can be removed by surgery.
 In other stages combined chemotherapy and surgery is required.
“SUCCESS IS A JOURNEY
NOT A DESTINATION”
DISORDERS OF MUSCULOSKELETAL SYSTEM
1. DDH (Developmental dysplasia of Hip):-
 Abnormal hip formation occurs during the development and it cause disturbance in normal
functioning of the hip joint.
Assessment :-
 Shortening of the affected trimity known as galezzi's sign or allis sign.
 Unequal gluteal fold.
 Ortolani sign -When the lower extremity are abducted and greater trochenter is pushed
towards the hip it causes the head of the femur is move inside the acetabulum cavity and
produce a clicking sound.
 Barlow sign - When the lower extremity are adducted and hip is pushed downward and
backward it causes head of the femur is moved out of acetabulum cavity.
 Trendenlenburg Sign - This sign indicates hip instability. This is assessed in older
children.
 When the child is stand on one affected extremity than another hip is moves down than
the affected hip.
Management:-
 During first - 6 month pavlik harness and assisted device is used to maintain stability of
the hip joint.
 Pavlik harness maintains the extremity in slight flexion and abducted condition.
 In older children hip spica cast may be used.
 Surgical Mgt can be done by open reduction.
2. Scoliosis:-
 Lateral deviation of the spine is called scoliosis.
 It occurs during the adolescence age group.
 Spine is laterally deviated.
 Rib cage is deformed.
 Problem in respiration and physical comfort may occur.
Diagnosis -
 Adom's test - It shows the deformity of rib cage.
 One part of rib cage is elevated than other.
 X-Ray
Management:-
 Braces - Milwauke brace is used. It prevents the further progression of lateral deviation
of spine.
 It should be weared 16-23 hours in a day.
Surgery:-
 Spinal fusion is done.
 Assess the patient for a complication of surgery that is superior mesenteric syndrome.
 It is characterized by abdominal pain and vomiting with bile contain.
 It occurs due to displacement of abdominal organs during surgery.
DISORDERS OF MUSCULOSKELETAL SYSTEM
3. Club-Foot:-
 Congenital abnormality of the foot is called club foot.
 it is a non-traumatic condition.
Types:-
 Talipesequanus - Planter flexion.
 Talipescalcaneous - dorsal flexion.
 Talipesvarus - Abduction and inverted foot.
 Talipes valgus - Abduction with extroverted foot.
Their may be combination of one or more condition occurs like

 Equanovarus
 Equanovalgus
 Calcaneovarus
 Calcaneovalgus
Management:-
 Treatment should be started as early as possible.
 Shoes or splint may be used during first 6-12 weeks of age.
 Surgery can be done b/w 4-9 months of age.
 Post operatively the foot is immobilize for at least 12 weeks. (Dennis browne bar shoes,
Bebax shoes)
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thr mruh gh 'kkunkj gksxhA^^
DISORDERS OF INTEGUMENTARY SYSTEM
1. Impetigo:-
 It is an skin infection caused by staphylococcus or β-hemolytic streptococci.
 Most commonly affected part is face, around the mouth and neck region.
 Initially maculapapular rashes appears and progress into vesicles.
 The fluid in the vesicle becomes thick and produces honey coloured crust.
 Pruritis, errythma and lymph nodes may be affected.
Management:-
 Maintain contact precaution because it is a highly contageous disease.
 Apply topical antibiotic ointment.
 If condition does not treated with topical antibiotic than oral antibiotic should be started.
 Clothes of the patient and other belong of the pt should be separated and washed
properly before use.
 Warm saline compresses can be used to smoothen the crust and promote healing.
 Cephalosporine drug are most commonly used.
2. Scabies:-
 It is a parasite infection caused by sarcoptesscabie(Itch mite)
 The female parasite enters the skin and forms burrow and lays her eggs there and
becomes died. Then within 4-6 days eggs hatches out and normal parasite is formed.
 Itching and grayish red burrows.
 Puritic popular rash
Management:-
 The scabicidal agent permethirin is used.
 Lindane can also be used but contraindicated in less than 2 year of age child, because it
causes heurotoxicity and seizures.
3. Eczema:- (atropic dermatitis)

 It is inflammation of the skin due to allergic reaction or family history.
 Erythema
 Itching
 Papular lesion may also be seen. Vesicle may be present.
 Weeping & crusting of lesion.
Management:-
 Antipruritic drugs can be used like antihistamin and corticosteroid can be used.
 Avoid the use of soap to ↓se allergy.
 Avoid repetitive bathing.
 Cool compresses can be used to reduce itching.
 Skin emollients used to avoid skin dryness.
DISORDERS OF INTEGUMENTARY SYSTEM
4. Pediculosis:-
 Infection of lice on humans is called pediculosis.
Type:-
 Pediculosiscapitis - Lice on head.
 Pediculosiscorporis - Lice on body hair.
 Pediculosiscruris - Lice on pubic hair
- Nits are the minor form of lice and found as whitish part on the shaft of hair.
Management:-
 Permethrin can be used.
 Olive oil and petroliumproduct can also be used to treat pediculosis.
 Avoid the sharing of comb and towel with family members.
5. Psoriasis:-
 It is an autoimmune disorder characterized by excessive keratinization of skin.
 The adjectetilogy is unknown, the predisposing factors are-
(i) Stress
(ii) Environmental changes
(iii) Skin Injury.(Koebherphenomenon)
 Pruritis
 Dry white scaly lesion.
Management:-
 Corticosteroid therapy
 Topical administration is done to reduce the creatinization of skin.
 Ultraviolet rays.
 Methotrexate, imunomodulator can be used.
“NOTHING IS PARTICULARLY HARD

IF YOU DIVIDE IT INTO SMALL JOBS”
DISORDER OF HAEMATOLOGIC SYSTEM
1. Anemia:-
 It is the most common blood disorder in infant and children
Causes:-
 The common cause of anemia is haemolysis due to different intrinsic and extrinsic factors.
 Nutritional deficiency is also another cause. example Iron deficiency
 The most common nutritional anemia is iron deficiency anemia
 Iron deficiency anemia causes microcytic hypochromic anemia.
2. Thalassemia (Cooley’s anemia, Mediterranean anemia):-

 It is a group of hereditary haemolytic anemia characterized by reduction in the synthesis of
haemoglobin.
 It can be considered as haemolytic and hypoproliferative anemia related to abnormal haemoglobin.
3. Haemophila:-
 It is an inherited bleeding or coagulation disorder to deficiency of plasma coagulation factors.
 It is characterized by excessive bleeding after injury/trauma.
Classification:-
A. Haemophila-A:-
 It occurs due to deficiency a plasma factor VIII, the antihaemophilic factor. It accounts for 80 to 85%
of all haemophilies.
B. Haemophilla-B (Christmas disease)
 It occurs due to deficiency of plasma factor IX, the plasma thromboplastic component (PTC) &
accounts for about 15 to 20% of cases.
C. Haemophila-C:-
 It results from deficiency of factor XI, plasma thromboplastic antecedent (PTA). It accounts for few
cases only.
4. Leukemia:-
 It is the most common type of childhood malignancy characterized by persistent and uncontrolled
Production of immature and abnormal white blood cells.
 It is a disease of abnormal proliferation and maturation of bone marrow.
 About 95-98 % of childhood leukemias are acute type.
 The most common type is acute lymphocytic leukemia.
SYNDROME
1. Shaken baby syndrome:-
If the child is physically abuse and vigorously shaken it is called SBS.
 Excessive cry
 Fractures
 Cerebral edema
 Retinal hemorrhages
Management:-
 Provide family counseling to avoid child abuse.
 Provide symptomatic treatment.
 Report the child abuse to the competent authority.
 Child help line No. (1098)
2. Sudden Infant Death Syndrome:-

 Sudden death of a infant and the causes of death are undectable it is called sudden infant
death syndrome.
 The male child most commonly affected.
 Most commonly 2-3 months of child are affected.
Risk factor :-
 Prone position
 Soft mattress
 Hypothermia
 Sleeping aside adults
 Over heating
 Pulse less and cyanosed infant.
 Blood tinged saliva.
 Drooling from the mouth.
 Urine and stool is passed.
 First clenched the mattress.
Management:-
 Provide psychological support to family member.
Prevention -
 Avoid prone position during sleeping, prevent hypothermia, avoid the use of soft
mattress. Best position for child during sleeping is supine.
 Prevent positional plagiocephaly (Occipital baldness) by changing the position of the
infant when the infant is awake.
“MISTAKES ARE PROOF THAT YOU ARE TRYING”
KANGAROO MOTHER CARE
Definition
Kangaroo mother care (KMC) is a special way of caring of low birth weight babies. This includes early
prolonged continuous skin to skin contact with mother (or care giver) and exclusive breastfeeding. It
stabilizes body temperature promotes breastfeeding and prevents infection.
Components
The two components of KMC are as follows:
(i) Skin-to-skin contact:-

Early, continuous and prolonged skin contact between the mother and her baby is the basic component
of KMC. The infant is placed on her mother‟s chest between the breasts in her blouse. For comfort a
small nappy is fine, and for warmth a cap may be used.
(ii) Exclusive breastfeeding:

The baby on KMC is breast fed exclusively. Skin to skin contact promotes lactation and facilitates the
feeding interaction.
Pre-requisites of KMC
(i) Support to the mother in hospital and at home:

A mother cannot successfully provide KMC all alone. She would require counseling along with
supervision from care provides, and assistance and cooperation from her family members.
(ii) Post Discharge follow up:

KMC is continued at home after early discharge from the hospital. A regular follow up and access to
health providers for solving problems is crucial to ensure safe and successful KMC at home.
Benefits
KMC has following benefits.
(i) Breastfeeding:
KMC results in increased breastfeeding rates as well as increased duration of breastfeeding. KMC has
been shown to exert a beneficial effect on breastfeeding. KMC stabilizes baby‟s physiology and
improves weight gain.
(ii) Thermal control:

Prolonged skin-to-skin contact between the mother and her preterm/LBW infant provides effective
thermal control with reduced risk of hypothermia.
(iii) Early discharge:
KMC cared LBW infants could be discharged from the hospital earlier than the conventionally managed
babies. The babies gain more weight on KMC than on conventional care.
(iv) Less morbidity:

Babies receiving KMC have more regular breathing and less predisposition to apnea. KMC protects
against nosocomial infections. KMC is associated with reduced incidence of severe illness including
pneumonia during infancy. KMC leads to a significant reduction of neonatal mortality when compared
to conventionally cared babies.
(v) Other effects:

KMC helps both infants and parents. New born feels more secure, mothers are less stressed as
compared with a baby kept in incubator. Mothers prefer skin-to-skin contact to conventional care. They
report a stronger bonding with the baby, increased confidence, and deep satisfaction that they were able
to do something special for their babies.
Criteria
(i) For Baby:-

All stable babies are eligible for KMC.
Note: - KMC can be initiated in a baby who is otherwise stable but still on Intravenous fluids,
tube feeding and/or oxygen.
Mother:
 All mothers can provide KMC, irrespective of age, parity, education, culture and religion. The
following aspects must be taken into consideration when counseling for KMC:
 Willingness
 General health and nutrition
 Hygiene
 Supportive family – The other family members e.g. father or grandmother should also be
encouraged to provide kangaroo care to the LBW baby when she wishes to take rest or she is
sick to provide KMC.
 Supportive community – Community awareness about the benefits of the KMC should be
created.
Preparing for Kangaroo Mother Care

Mother Clothing
 KMC can be provided using any front-open, light dress as per the local culture KMC works well
with blouse and sari, gown or shawl.
 Baby should be dressed with cap, socks nappy and front-open sleeveless shirt or Jhabala.
Note – KMC can be provided using any front open garment. You can innovate/design a garment
which would help mother to provide KMC to her baby.
Kangaroo positioning-
 The baby should be placed between the mother‟s breasts in an upright position.
 The head should be turned to one side and should be in slightly extended position. This slightly
extended head position keeps the airway open and allows eye-to-eye contact between the mother
and the baby. Avoid both forward flexion and hyperextension of the head.
 The hips should be flexed and abducted in a “frog” position; the elbows should also be flexed.
 Baby‟s abdomen should be at the level of the mother‟s epigastrium. This way baby has enough
room for abdominal breathing. Mother‟s breathing stimulates the baby, thus reducing the
occurrence of apnea.
Note – When mother is not available, other, family members such as grandmother, father or
other relative can provide KMC.
Note – Remember that baby’s neck is not too flexed or too extended. Breathing is normal and feet
and hands are warm.
Initiation and Duration of KMC

KMC can be started as soon as the baby is stable.
 Sessions that last less than one hour should, however, be avoided because frequent handling may
be too stressful for the baby.
 The length of skin-to-skin contacts should gradually be increased up to 24 hours day interrupted
only for changing diapers. Minimum duration of 6-8 hours should be practiced.
Note – It may not be possible for mother to provide KMC for prolonged period in the beginning.
Encourage her to increase the duration each time. The aim should be to provide KMC as long as
possible.
 The baby should gain adequate weight (15-20 gm/kg/day up to 40 weeks of post conception age
and 10 gm/kg/day subsequently.
Follow up Plan
 One follow-up visit once or twice weeks until 37-40 weeks of post conceptual age or baby
reaches 2.5-3.0 kg weight.
 Thereafter one follow-up in two weeks till 3 months of age.
 One follow-up every 1-2 months during first year of life.
“LOSERS QUIT WHEN THEY FAIL.

WINNERS FAIL UNTIL THEY SUCCEED.”
INFANT AND YOUNG CHILD FEEDING AND COUNSELING

BREST FEEDING
 Human milk – 66 k calorie
 Cow milk – 67 k calorie
 Best food for the newborn.
 Exclusive breast feeding should be done for first 6 month. After four month additional food is
required to fulfill the nutritional requirement of the baby. It is called weaning.
 Breast feeding should be continued up to 2 year.
Advantage :-
(i) Nutritive value:-
 Fulfill the calorie requirement of the infant.
 Breast milk contains cysteine and taurine which acts as Neurotransmitters.
 Each 100 ml human milk provides 66 k/calorie
Lactation woman start contraceptive 3 month after delivery, non-lactating start after 3 week.
(ii) Protective value:-

 Breast milk provide IgA, IgM antibodies and bifidus factor which helps in prevention of
infection in the newborn.
 Breast milk is easily digestible.
(iii)Psychological benefit-
 It promotes emotional bounding b/w mother and newborn.
 Easily available and very economic.
Benefits to mother-
 Prevents post partum hemorrhage.
 Natural Contraception.
 Helps in restoration of iron.
 Helps in involution of uterus.
 ↓se the chances of breast cancer and ovarian cancer.
Contraindication:-
REAL therapy
R- Radio therapy
E- Ergot alkaloid
A- Anti metabolite
L- Lithium
Difficulty in breast feeding:-
 Inverted nipple
 Breast engorgement
 Mastitis
 Sore nipple
Composition of breast milk :-
Human milk (66 k/c) Cow milk (67 k/c)

(each 100 ml)
Protein - 1.2 gm Protein - 3.5 gm
Fat- 3.8 gm Fat- 3.5 gm
Lactose - 7 gm Lactose - 4 gm
Types of breast milk:-

1. Colostrums: It is the milk secreted during the first week after delivery. It is yellow, thick and
contains more antibodies and white blood cells. Though secreted only in small quantities. It has higher
protein content and is most suited for the needs of the baby it should NEVER be discarded.
2. Transitional Milk: It is the milk secreted during the following two weeks. Rich in sugar and fat but
immunoglobulin and protein content is decreased.
3. Mature milk: It follows transitional milk. It is thinner and watery but contains all the nutrients
essential for optimal growth of the baby.
4. Preterm Milk: It is the breast milk of a mother who delivers prematurely. Contains higher quantities
of proteins, sodium, iron, and immunoglobulin‟s that are needed by her preterm baby.
5. Foremilk: It is the milk secreted at the start of a feed. It is watery and is rich in proteins, sugar,
vitamins, minerals, and water. Satisfies the baby‟s thirst.
6. Hind milk: It comes later towards the end of a feed and is richer in fat content. It provides more
energy, and satisfies the baby‟s hunger.
The four key signs of good attachment are given below.
 More areola is visible above the baby‟s mouth than below it

 Baby‟s mouth is wide open
 Baby‟s lower lip is turned outwards
 Baby‟s chin is touching the breast.
Note – NOT TO INTRODUCE BOTTLE FEEDS at any point of time.
Note - Correct positioning and attachment will ensure effective sucking and prevent sore nipples
and breast engorgement.
 Help the mother to assess if the infant is sucking and swallowing effectively.
Note – If an infant is not able to attach and suckle effectively at the breast, or is not able to suckle
for long enough to complete a feed, he or she will need to be fed with a spoon or paladin until
effective ability develops.
Frequency and Adequacy of Breast feeding

 A healthy newborn baby can be breastfeed ON DEMAND i.e. whenever the baby cries for feeds.
The usual time interval between each feed is about 2 to 3 hours. Mothers should be advised that
they should feed their babies. AT LEAST 8-10 times in 24 hours.
Assessing the Adequacy of Breastfeeding:
 Sleeps well in between feeds 2-3 hours after feeding.

 Passes urine atleast 6-8 times in a day/24 hours.
 Gains weight atleast @ 25-30 g/day after initial 7-10 days.
 Breastfeeding is considered adequate if it results in softening of breast after feeding and
the Baby shows following characteristics.
Contraindications of Breastfeeding:
REAL therapy
R- Radio therapy
E- Ergot alkaloid
A- Anti metabolite
L- Lithium
Difficulty in breast feeding:-

 Inverted nipple
 Breast engorgement
 Mastitis
 Sore nipple
(i). Flat and Inverted nipples-
 Flat or short nipple which protract well, cause no problem and in this case you need to reassure
the mother.
 Inverted Nipple is manually stretched and rolled our several times a day.
 A plastic syringe or a pump is used to draw out the nipple.
(ii) Sore nipples-
 Sore nipple may be caused due to following:
(i) Incorrect attachment of baby to breast.
(ii) Frequent washing with soap & water.
(iii) Pulling off the breast while still sucking.
(iv) Fungal infection of the nipple after few weeks.
 You should ensure correct positioning and attachment of baby to breast.

 Hind milk can be applied to the nipple after feeding nipple should be aired and allowed to heal
in between feeds.
 Frequent washing with soap & water should be avoided baby should not be pulled off while still
sucking.
(iii) Breast Engorgement:
 In breast engorgement breast becomes swollen, hard, warm and painful. It may be caused due to
delayed and infrequent feeding, inaccurate positioning and poor attachment of baby to breast.
How to prevent and manage breast engorgement:
 Early and frequent breast feeds and correct attachment of the baby to the breast.
 Application of local warm water packs for not more than 15 minutes
 Paracetamol can be given to the mother to relieve the pain
 Gently express the milk to soften the breast and then help the mother to correctly latch the baby
to the breast.
(iv) Breast Abscess:
 Breast abscess may develop if engorged breast, cracked nipple, blocked duct or mastitis are not
treated early due to which mother may develop high grade fever and pain in the breast.
How to manage breast abscess:
 Common causes of not enough milk may be infrequent breastfeeding, too short or hurried breast
feed, poor positioning, breast engorged or mastitis.
 Assess is baby is gaining weight adequately and passing urine sufficiently, then only reassurance
is needed and mother.
 Make sure that baby is well attached.
 Take care of painful conditions like sore nipples or mastitis.
 Advice mother to increase fluid intake and massaging breast may help.
 Back massage 15-30 minutes, 3-4 time/day are especially useful for stimulating lactation by
relaxing the mother and hormone production.
Difficulties of the baby in Breastfeeding:
Low birth weight baby: Tube feeding of expressed milk.
Temporary illness: Cerebral irritation, respiratory tract infections, nasal obstructions etc.
 Over distension of the stomach with swallowed air can be prevented by burping the baby after
feeding.
Cleft palate: Feeding with spoon or paladai.
 Mother should express her milk in a clean wide mouthed container. Expressed breast milk can
be stored at room temperature for 8 hours & in the refrigerator for 24 hours.
 It should be given with cup spoon or paladai.
 Expression of milk can be done manually with thumb & forefinger by pressing the areola.
 By using breast pump breast milk can be expressed electrically.
Positioning-
 Sitting position
 Sleeping position
 Mother should be mentally relax during breast feeding.
Time/duration:-
 20 mints during each breast feeding episode and 10-10 mints for both breasts.
 Time interval :- 2-3 hours.
 After breast feeding do the burping to prevent regurgitation.
PROMOTING AND MONITORING GROWTH AND DEVELOPMENT AND
USE OF GROWTH CHART
Growth:-
 Increase in the number and size of cells is called growth. It is physical maturation.
 It can be measured.
Development:-
 Increase in the functioning of cells and tissues is called development.
 It is physiological maturation.
 It cannot be measured.
Developmental stages :-
(a) From conception to 2 weeks - Ovum
(b) From 2 Weeks to 8th Week- Embryo
(c) 9 Week till delivery – fetus
(d) From birth to 28 days - Neonate (first 7 days early neonate, and 8-28 day late neonate).
(e) 1 Year – Infant
(f) 1-3 Year - Toddler
(g) 3-6 Year- Pre-school
(h) 6-12 Year - School going
(i) 12-18 year - Adolescent
Principles of G and D :-
(a) Growth and development parallel process.
(b) There may be individual differences in G and D.
(c) G and D follow a sequence of stages.
(d) G and D is Cephalocaudal and proximodistal.
(e) G stops after puberty but D is a continuous life long process.
Factors affecting growth and development :-
(a) Heredity
(b) Prenatal factors
(c) Cultural influences
(d) Socio-economic status
(e) Harmonal influence
(f) Environmental factor
Assessment of Growth
 Growth monitoring is the process of maintaining regular close observation of a child‟s growth to
assess growth adequacy and identify any deviation. It starts with measurement of weight every
month-during first year, every two months during second year, and every three months up to five
to six years. To monitor growth, you must use the growth chart on the back of the child health
card.
Note – Importance of Growth Monitoring:
 For early detection of abnormal growth and development.

 To facilitate the early treatment or correction of any conditions that may be causing abnormal
growth and development.
 To provide an opportunity for giving health education and advice for the prevention of
malnutrition.
 To monitor growth, you must use the growth chart on the back of the child health card. Blue
chart is used for boys and pink colour for the girls.
Measuring Growth -
There are various measurements that are used to measure growth. These are given below:
 Weight
 Height
 Head circumference
 Chest circumference
 Mid Upper Arm Circumference (MUAC)
 The eruption of teeth
Weight :-

The neonate losses 10% of his birth weight, during first week after birth due to immature
kidney and meconium excretion.
 The neonate regain his birth weight by 7-10 days.
 During first 6 month 30 gm/day weight increase and after 6 month, till 12 month 20
gm/day increase
 Birth weight:-
 2 times - 5 month
 3 times - 1 year
Note - For measuring the weight, electronic weighing scale, bema balance or spring balance is
used.
Length :-
 Length increase with an average of 2-2.5 cm/m for the first 6 month.
 1-1.5 cm for the next 6 month.
 At birth - 50 cm
 3 month - 60 cm
 9 month - 70 cm
 1 year- 75 cm
 2 years - 87-90 cm
 4-4.5 years- 100 cm
 13 years - 150 cm
Note - Length is measured by Infantometer (up to 3 years of age) & Height is measured by
Stadiometer (after 3 years of age).
(2-12 year, length formula =Age in year × 6 + 77 cm)
Head Circumference:-
 Average ↑se in head circumference during first 3 month 2 cm month.
 Next 3 months 1 cm/M and than next 6 month 0.5 cm/M.
 At birth 33-35 cm (34 cm).
 At 3 month 40 cm
 At 2 year 48 cm
 At 12 year 52 cm
Chest Circumference:-
At birth the difference b/w head and chest circumference is 3 cm. Both becomes equal at 1 year of age
and after 1 year chest circumference is always more than head circumference.
 Chest circumference is measured at the level of nipple in mid inspiration.
Mid upper arm Circumference:-

 At birth 11-12 cm
 1 year 12-16 cm
 1-5 year 17 cm
 12 year 18 cm
 15 year 20-22 cm
 The mid upper arm circumference is measured using a tape or string in the absence of a tape.
 The tape or string is placed around the upper arm, midway between the olecranon and acromion
processes.
 Usually left arm is measured.
 Sakir tape can be used to measure MUAC. It is a fiber glass tape marked with red colour
at less than 12.5 cms, yellow 12.5 to 13.5 cms and green colour greater than 13.5 cms.
Health worker can assess nutritional status without remembering the normal limits of
MUAC.
Teeth :-
At birth- no teeth are present start at 6 month.
 Two types of teeth.
(i) Milk teeth (Deciduous) - Total 20 in no.
 First teeth appear is lower central incisor at 6 months of age.
 Upper central incisor 7 month than upper lateral incisor 8 month, lower later incisor 10 month,
upper first molar 12 month, lower first molar 14 month, upper canine 16 month, lower canine 17
month, second molar 24-30 month.
(ii) Permanent teeth total 32 in No. formula is I:C:P:M.
 First molar at 6 year is.
 Incisor at 7-8 year.
 Canine and PM 9-11 year.
 Third molar (wisdom teeth) 18 year.
Used of Growth Curve:

 Useful tool for growth monitoring.
 Diagnostic tool to detect a high risk child.
 Educational tool for the mothers to participate more actively in growth monitoring and to teach
them the importance of adequate feeds during illnesses like diarrhoea.
 Tool for action on the type of intervention that is needed and helps make referrals easier.
 Helps in evaluating the effectiveness of corrective measures and thus to note the impact the
programmes.
 Helps in policy making at local and central levels.
Note - To determine an individual child’s growth pattern, weight measurements from birth are
plotted on the growth chart of the child of the child health card. The plotting produces a line or
graph. This line constitutes that individual child’s growth pattern or curve.
Interpretation of the Growth Curve

 Interpretation simply means determining whether the child is growing appropriately or not.
 On each growth chart, there are 3 printed growth curves. There are called Reference Lines or Z
score Lines. These are used to compare and interpret the growth pattern of the child and assess
her/his nutritional status.
 The 1st top curve line on the growth chart i.e. upper border of green band is the median which is
the average.
 Second line is the junction of green and yellow bands and 3rd line is the junction of yellow and
orange bands. Weight of all normal and healthy children, when plotted on the growth chart, fall
above 2nd curve (green band): weight of moderately underweight children fall below the 2nd
curve to 3rd curve (yellow band); and weight of severely underweight children fall below the 3rd
curve (orange band).
 Note that regular weighing of infants (monthly) and young children (at least once every two
months) should be done.
Growth Chart
IMMUNISATION AND SAFE INJECTION PRACTICES

Safe and Best Injection Practices:
 The patient/child, when health workers use sterile needles and syringes and appropriate injection
techniques.
 The health worker, when he or she avoids needle-strick injuries.
 Waste handlers and the community, when used injection equipment is disposed of properly and
does not cause injuries or pollution.
Note: Health-care settings should ensure an adequate supply of single-use injection devices, to
allow providers to use a new device for each procedure. It is also important to ensure availability
of hub cutters and waste segregation bags.
 Assemble the necessary equipment like syringe and needle, spirit/alcohol/boiled swag,
medication/vaccine vial/ampoule, diluents, hub cutter and the bin to dispose the syringe.
Note – The Ministry of Health and Family Welfare, Government of India has already Introduced
Auto Disabled (AD)/ plastic syringes for the universal immunization programme throughout the
country in 2005.
Note – Prevent accidental injury to adjoining structure like nerves and blood vessels, Access the
site safely where the injection needs to be given (muscle, subcutaneous tissue or dermis).
Note- Irrespective of the route of injection it is important to examine the local skin for any signs
of any inflammation, swelling, infection or other skin lesions and avoiding such sites where these
may be present.
Preparing the skin:
 Before giving the injection, clean the site with spirit/alcohol/boiled swarb, in a circular motion
starting from the centre of the site towards its periphery.
 Allow 30 seconds for the spirit to dry for effective action.
Note – Spirit swabs should not be used for vaccines.
Giving the injection;
Note – Follow seven Rights for safe Injection delivery.
 Right medication
 Right dose
 Right patient/client and site
 Right time
 Right route of administration
 Right documentation
 Right disposal
Note – Always use Aseptic Technique for injections: it refers to the manner of handling,
preparing, and storing of medications and injection equipment/supplies (e.g., syringes, needles
and IV tubing) so as to prevent microbial contamination.
 Swabbing vial tops or ampoules.

 If any of these parts (Needle adapter, Needle shaft & Bevel) are touched, the needle and syringe
and get new sterile ones.
Note – Always keep an Emergency kit ready for use at the injection/immunization centre for use
in case of emergency (like anaphylaxis) following injection. The kit should be checked AT LEAST
once a month for availability and expiry of medicines.
Intra-dermal injection (BCG)-

 An Intra-dermal injection is given directly into the dermis (skin) layer, Carry out the following
steps when giving an intra-dermal injection.
 Position the baby, and load the reconstituted BCG vaccine 0.05 ml for infants under one month
and 0.1 ml for infants older than one month.
 Insert the tip of the needle into skin-just the bevel and a little bit more at 15° angle.
 Do not push too far, and do not point downward (This way, the needle will go under the skin and
will make the injection subcutaneous, instead of intradermal).
 If you have injected BCG correctly, a flat-topped swelling appears on the skin. The swelling
may look pale with very small pits (like an orange peel).
 After 2-3 weeks of a correct injection, a papule develops which increases slowly in size up to 5
weeks (4-8mm). It then subsides and breaks into a shallow ulcer. Healing occurs spontaneously
within 6-12 weeks, leaving a permanent tiny round scar, 4-8 mm in diameter. This is a normal
reaction.
Intra-muscular injection (DPT, TT and Hepatitis B)

 Hold the syringe like a pen in the right hand and push the needle straight down at 90°.
 Do not massage the injection site after vaccination.
 Withdraw the needle and press the site of injection with a dry cotton swab.
Note – Caution: Infants should never be given injection in the buttock as evidence indicates that
there is risk of damaging the nerves in the area. The vaccine will also be less effective if injected
deep into fatty tissues.
Subcutaneous injection (Measles and JE)-

 A subcutaneous injection is one that is given into the thin layer of tissue between the dermis
(skin) and the muscle. The injection should be given in the right arm on the deltoid site of the
skin.
 Make sure the reconstituted vaccine has not expired. (To be used within four hours of
reconstitution).
 Push the needle in a slanting position at 45° angle into the pinched-up skin.
Angles of different Injection
Oral administration (OVP)-

 The Oral Polio vaccine (OPV) comes in a glass/plastic vial with a sterile dropper. The vaccine is
given orally; two drops in the child‟s mouth as shown in.
 Check VVM on the vial before vial.
Note – Contraindications to immunization:
 Anaphylaxis or a severe allergic reaction is an absolute contraindication to subsequent doses of a

vaccine. Persons with a known a allergy to a vaccine component should not be vaccinated.
 Any serious AEFI reported during previous vaccination to the child with the same vaccine is
also a contraindication. e.g. convulsion and encephalitis with a previous dose of DPT.
 High fever.
IMMUNISATION SESSION
 Check label: Make sure the label on the vaccine vial is attached and clear enough to read. If the
label is not clear enough to read or has come off, discard the vial.
 Check vaccine and diluents: Check that the vaccine and diluents being given are the correct
one.
 Check expiry: Look for the expiry date on the vial. If the expiry date has passed, do not use the
vial: Discard it.
 Check the vaccine vial monitor (VVM) on vaccine vials to make sure that the vaccine is in the
usable stage.
 Shake the T-series and Hep.B vials to rule-out freezing or floccules.
 Note down the batch number of each vaccine vial and diluents.
Note- Mild fever, diarrhoea, and cough are not contraindications for immunization.
 Do not massage the injection site after giving the injection.
Note – Diluents for BCG are normal saline. Diluents for measles are pyrogen-free, double-distilled
water. Diluents for JE are phosphate buffer solution.
 Check expiry date on the label and VVM on the cap of vaccine vial. This VVM indicates
whether the dry vaccine is usable or not. Once reconstituted, VVM indicates whether the dry
vaccine is usable or not. Once reconstituted, VVM is of no use as the vaccine has to be used
within 4 hours.
ABREVIATION
AD : Auto Disposable
BMW : Bio Medical Waste
CVC : Central Venous Catheter
DPT : Diphtheria Pertussis Tetanus vaccine
HBV : Hepatitis B Virus
HCV : Hepatitis C virus
HIV : Human Immunodeficiency Virus
ID : Intradermal
IM : Intramuscular
IV : Intravenous
NACO : National Aids Control Organization
NSI : Needle Stick Injuries
OPD : Out Patient Department
PEP : Post Exposure Prophylaxis
RUP : Reuse Prevention
SC : Subcutaneous
SEMD : Safety Engineered Medical Devices
WHO : World Health Organization
USE OF EQUIPMENTS
1. Radiant Warmer
 Newborn babies, in particular, the preterm and the low birth weight babies are extremely
predisposed to hypothermia. Special care of newborn babies can be provided with radiant
warmers.
 Temperature selection knobs select the desired skin temperature. This information is processed
by the microprocessor inside the control panel and matched against the actual temperature of the
baby. If the temperature of the baby is lower than the set temperature, the microprocessor will
send feedback to the quartz rod heater to increase the heat output till the baby‟s temperature
reaches the set temperature. At this point the heater output will be reduced. This system in which
the heater output is determined automatically based on skin temperature information is called
servo system.
 Servo system is the preferred method of running the open care system.
 The heat output from the quartz heating rod could also be increased or decreased manually. This
is done by the heater output control knobs/buttons. This is called the manual mode of operation.
 In the servo mode, whenever the baby‟s temperature rises by more than 0.5°C above the set
temperature, a visual/audible alarm is activated. You must pay attention to sort out the fault.
Often this occurs when the temperature probe comes off the baby‟s skin.
 Power consumption is around 750 watts. In good equipment, temperature stability is usually
with an accuracy of + or – 0.5°C.
 Serve-mode should be used with skin probe applied to the baby and skin temperature set at
36.5°C.
 In the manual mode, record baby‟s axillary temperature at 30 minutes and then 2 hourly.
 Apply probe over the right hypochondrium area in the supine position.
 Apply probe to the flank in the prone position.
 Use of cling wraps to decrease insensible water losses.
Radiant warmer
2. Weighing Scales
 Weight record is essential to monitor the adequacy of nutrition as well as fluid balance. Weight
at birth is the single most useful predictor of neonatal morbidity and mortality.
Indications
 All babies at birth.

 All LBW babies at 2 weeks (to check for regaining of the birth weight), 4 weeks (to ascertain a
weight gain of 80-100 kg per week) and then every month.
 Stick new born once or twice a day
 VLBW (<1500 g) babies once or twice daily to monitor and plan fluid therapy.
 Measuring urine output by pre-weighed napkin.
Note -
 Record weight prior to feeding.

 Adjust the digital display to zero by manually adjusting the knob some weighing scales
have automatic zero facility.
 Disinfectants like savlon or Glutaraldehyde may be used to clean the pan. Sprit/alcohol
should be avoided as it can damage the pan material or LED display.
Electronic Weighing Machine
3. Pulse Oximeter
 A pulse oximeter is a device used for the nonivasive monitoring of a patient‟s blood oxygen
saturation.
 It also displays the pulse rate and produces a plethysmogram.
 Pulse oxmieters are accurate mainly when the oxygen saturation is between 80 to 95%.
 Avoid compromising blood flow to the limb to which the probe is attached e.g. by inflating a BP
cuff to prevent a false low reading. Also, change the site of the probe every 2-3 hours.
 Pulse oximeter is not reliable (in such conditions an ear probe may be more reliable than a finger
probe.)
 The probe can be positioned on the fingers or toes of a patient or on the hand, foot, or wrist of
the neonate. Newer probes allow for forehead placement.
 Cleanse the probe with alcohol and let it dry before using on another patient.
 Observe and changes site at least once per shift (6-8 hrs.)
4. Phototherapy Unit
 Phototherapy is the use of visible light to treat severe jaundice in the newborn. It reduces the
serum concentration of bilirubin and the risk of bilirubin toxicity. This has dramatically reduced
the need for exchange transfusion. Unconjugated bilirubin in the skin gets converted to water
soluble photo products on exposure to light of a particular wavelength (425-475 nm). These
products are water soluble, nontoxic and excreted through the intestine and in the urine.
Phototherapy involves exposure the skin of the jaundiced baby to blue or cool white light of
wavelength 400-520 nm.
Procedure for giving phototherapy:
 Undress the baby completely except for a small nappy.

 Cover the eyes to prevent damage by the bright lights.
 Keep the baby at a distance of 45 cm from the light source.
 Provide frequent breastfeeding. During breastfeeding switch off the phototherapy unit.
 Turn the baby after each feed to expose maximum surface area of the baby to light.
 Monitor temperature every 2 to 4 hourly or more frequently if temperature variation is noted.
 Record weight daily.
 Ensure that the baby passes adequate urine (6-8 times per day).
 Monitor bilirubin levels at least once a day.
 Discontinue phototherapy when bilirubin returns to a safe level and watch for rebound increase
after stopping phototherapy.
Phototherapy Unit
Note -
 Phototherapy may lead to dehydration or hypothermia/hyperthermia.

 Blue light may interfere with monitoring of cyanosis.
 The efficiency of the phototherapy unit should be checked periodically with the help of a
flux meter.
5. Suction Device
 Suctioning is used to remove secretions from the oral and nasopharyngeal area of a patient using
a catheter to ensure patency. It is often used to prevent aspiration of oral or gastric secretions.
 DeLee’s suction trap and suction bulb.
 It consists of two tubes arising from a small plastic jar.
 The operator applies negative suction with his mouth.
Bulb syringe
 It consists of a rubber bulb attached to a plastic tube. Air is expelled out and on releasing
vacuum is created which pulls secretions into the bulb.
 Suctioning baby‟s nose with a suction bulb.
1. Bulb Syringe 2. DeLee’s Suction trap
Electrically operated suction machine:
 It consists of a motor, vaccum gauge with a precision regulator, jars.

 If a lot of suctioned material is expected as in surgery or caesarean section, a two jar suction
machine may be used.
3. Electrical Suction Machine 4. Manual Suction Machine
Foot suction:
 It is useful even in the absence of electricity.
6. Self Inflating Bag

 It is also known as AMBU bag. As the name implies, it inflates automatically without a
compressed gas source.
Self Inflating Bag (AMBU Bag)
1. Air Inlet
2. Oxygen inlet
3. Patient outlet
4. Valve assembly
Using the bag:
 The self-inflating bag comes in different sizes – neonatal, infant, pediatric and adult.
 When the self inflating bag is connected to 100% oxygen through the oxygen inlet without an
oxygen reservoir the oxygen connect ration delivered to the patient is 40-70%.
 By attaching an oxygen reservoir one can deliver 90-100% oxygen to the patient.
 A pressure release or pop-off or safety valve. In a neonatal bag this is set to release at 30-40 cm
of water thereby preventing excess pressure from being transmitted to the neonate.
7. The Flow Inflating Bag
 The flow inflating bag is also called anesthesia bag. It fills only when the source of compressed
gas (oxygen, air, or a mix of two) is connected. PEEP can be provided by adjusting the flow of
gas out of the bag through the flow control valve. Large leaks at the face mask, or too low a
flow, will result in collapse of the bag and inability to deliver any positive pressure breath.
Flow Inflating Bag (Bain Circuit)
8. T Piece Resuscitator
 T piece resuscitator is a flow controlled pressure limited ventilator device. Piped compressed gas
is delivered at one port of T piece. A preset peak inspiratory pressure (PIP). Positive end
expiratory pressure (PEEP) and maximum circuit pressure is set. The newborn is ventilated by
placing a finer over the outlet aperture (hole in the PEEP valve) and removing it periodically at
about 40-60 times a minute.
T Piece Resuscitator
9. Resuscitation Masks
 Masks come in a variety of shapes, sizes and materials. Resuscitation masks should have a
cushioned rim for better seal. For the mask to be correct size, the rim will cover tip of the chin,
the mouth and the nose but not the eyes.
Resuscitation Masks
10. Sphygmomanometer
 A sphygmomanometer is a device used to measure blood pressure. It consider of an inflatable
cuff to collapse and then release the artery under the cuff in a controlled manner and a mercury
or mechanical manometer to measure the pressure.
Note – Mercury Sphygmomanometer is no more used now.
 Mercury sphygmomanometers and Aneroid sphygmomanometers require a stethoscope for

auscultation.
Digital sphygmomanometers:
 They use oscillometric measurements and electronic calculations rather than auscultation.
 Choose the proper BP cuff size. The bladder length should be more than 80% of the arm
circumference and the width should be at least 40% of the arm circumference. If the cuff is too
large the measured BP value is lower than the actual value whereas if the cuff is small one will
record erroneous high values.
 Place the BP cuff on the patient‟s arm. For correct placement the midline of the cuff bladder
should be placed over the arterial pulsation in the patient‟s arm after palpating the brachial
artery. There should be a 2-3 cm space for the stethoscope between the lower end or the cuff and
the antecubital fossa.
 For accuracy record two readings and take their average.
11. Oxygen Cylinder
 Oxygen is used as a medical treatment in several acute and chronic conditions both in and out of
the hospital.
 Oxygen for hospital use is available as compressed oxygen stored in gas linders.
 A humidifier containing fresh distilled water should be used to humidify the oxygen.
 The oxygen cylinder should be kept away from heat and open flames as oxygen can cause fire
easily.
 Make sure to watch for correct COLOUR CODE of the linder. Oxygen cylinders are black in
colour with white top and sometimes small cylinders are entirely black in colour.
Oxygen Cylinder
PAEDIATRIC MEDICATION ADMINISTRATION & CALCULATION
ORAL MEDICATIONS:
 Most oral pediatric medications are in liquid or suspension form because children usually are
not able to swallow a tablet.
 Solutions may be measured by using an oral syringe or other acceptable measurement or
administration device.
 Medications in suspension settle to the bottom of the bottle between uses, and thorough
mixing is required before pouring the medication.
 Suspensions must be administered immediately after measurement to prevent setting and
administration of an incomplete dose.
 Administer oral medications with the child sitting in an upright position and with the head
elevated to prevent aspiration of the child crisis or resists.
 Never pinch the infant or child‟s nostrils when administering medication.
 Place the small child sideways on the lap the child‟s closers arm should be placed under the
adults arm and behind the adults back; cradle the child‟s head and hold the child‟s hand, and
administer the medication slowly with a plastic spoon, small plastic cup or syringe.
PARENTERAL MEDICATIONS:
 The preferred site for intramuscular injections in infant is the vastus lateralize
 Usually not more than 0.5 ml (infant) to 2 ml (child) is injected per intramuscular or
subcutaneous site and the site of injections is rotated if frequent injections are necessary.
 The usual needle length and gauge for pediatric clients are ½ to 1 inch and 22 to 25 gauge.
 Needle length also can be estimated by grasping the muscle for injection between the thumb
and forefinger, half the resulting distance between the thumb and forefinger would be the
needle length.
CALCULATION OF MEDICATION DOSAGE:

Metric units:
1 Gram (g) = 1000 milligrams (mg)
1 milligram (mg) = 1000 microgram (mcg)
1 microgram (mcg) = 1000 nano gram (ng)
1 Liter (L) = 1000 milliliter (ml)
1 kg = 2.2 lb(pounds)
PAEDIATRIC MEDICATION ADMINISTRATION & CALCULATION
VOLUME OF DRUG TO GIVE:

What you want
Volume needed = × The volume it is in.
What you ' ve got
CLARK’S RULE:
Weight (in lbs )

Child‟s dose = × Adult dose
150
Clark‟s rules uses weight in lbs, never in kg.
YOUNG’S RULE:
Age (in years )

Childs dose = × Adult dose
Age  12
FRIED’S RULE:
Age child (in month )
Childs dose = × Adult dose
150
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Paediatrtic Nursing
MCQs MCQ {CHO}
Q.1 During fetal life, which structure Q.12 The equipments used in newborn
enables the blood to enter the right resuscitation are:
atrium to left atrium? (a) De Leep trap (b) Stethoscope
(a) Placenta (c) Bag & mask (d) All the above
(b) Ductus Venosus Q.13 Size of Endotracheal tubes used for
(c) Foramen ovale newborn is:
(d) Ductus Arteriosus (a) 2.5 mm – 3.5 mm
Q.2 Normal heart rate of newborn: (b) 2.5 mm – 4 mm
(a) 100-120 beats/min (c) 2 mm – 4 mm
(b) 120-160 beats/min (d) 2.5 mm – 4.5 mm
(c) 100-160 beats/min Q.14 During NBR, check umbilical pulsation
(d) 120-140 beats/min heart rate of baby for:
Q.3 Maximum APGAR score is: (a) 10 seconds (b) 6 seconds
(a) 7 (b) 6 (c) 3 seconds (d) 1 minute
(c) 10 (d) 12 Q.15 Indication for PPV
Q.4 Infants in the age of 6-12 months should (a) LBW (b) Jaundice
be given vitamin A in a dose of: (c) Baby is gasping (d) All the above
(a) 1 lakh I.U (b) 2 lakh I.U Q.16 Observational care of newborn
(c) 50,000 I.U (d) 25,000 I.U includes:
Q.5 Capacity of neonatal resuscitation bag: (a) Provide warmth
(a) 200-500 ml (b) Initiate breastfeeding
(b) 250-500 ml (c) Monitor newborn
(c) 250-750 ml (d) All the above
(d) 200-750 ml Q.17 When to start chest compression if heart
Q.6 What is the size of resuscitation face rate is:
mask for preterm? (a) >60 bpm (b) <60 bpm
(a) 0 (b) 00 (c) >100 bpm (d) <100 bpm
(c) 1 (d) 2 Q.18 Dangers of chest compression include:
Q.7 What is the sequence of routine (a) Damage to xiphoid
newborn care? (b) Injury to internal organs
i. Assure open airway if needed (c) Fracture of ribs
ii. Dry baby on mothers abdomen (d) All the above
iii. Cut cord in 1-2 min Q.19 In following which is not a
iv. Provide warmth characteristic features of neonatal
(a) i, ii, iii, iv asphyxia?
(b) ii, iv, i, iii (a) Hypoxia
(c) ii, iv, iii, i (b) Hypoperfusion
(d) iv, ii, i, iii (c) Acidosis
Q.8 Full form of PPV: (d) Hypocapnia
(a) Pressure Positive Ventilation Q.20 Hirschprung’s disease is most
(b) Positive Pressure Ventilation commonly associated with:
(c) Periodic Pressure Ventilation (a) Pyloric stenosis
(d) Pressure Periodic Ventilation (b) Down syndrome
Q.9 PPV is discontinued when the heart rate (c) Tuberculosis
is: (d) Turner syndrome
(a) Above 120 bpm Q.21 Pentavalent vaccine or 5 in 1 vaccine
(b) Above 100 bpm provides protection against:
(c) Below 120 bpm (a) Diptheria, Pertussis, Tetanus,
(d) Below 100 bpm Hepatitis-B, Influenza
Q.10 The recommended intravenous dose in (b) Measles, Mumps, Rubella, TB, Polio
newborn is: (c) Diphtheria, Pertussis, Tetanus, Polio,
(a) 1 to 3 ml/kg Measles
(b) 0.1 to 0.3 ml/kg (d) Diphtheria, Pertussis, Tetanus, Polio,
(c) 0.01 to 0.03 ml/kg Measles
(d) 1.5 to 3 ml/kg Q.22 Who is the father of pediatrics?
Q.11 How much amount of fetal blood flow (a) Abraham Jacobi
minute through the placenta: (b) Hippocrates
(a) 2000 ml (b) 300 ml (c) Marion
(c) 400 ml (d) 500 ml (d) Lillian wald
C-6, 80 Ft. Road,ShantiNagar,NearGyan Ashram school/SankritiCollege,Jaipur. (Raj) Mo.7426955591,7426955593 81

MCQs
Q.23 What is the age of Early neonate Q.36 Down syndrome is also known as:
period? (a) Trisomy 21 syndrome
(a) 0-8 days (b) 0-12 days (b) Mongolism
(c) 0-7 days (d) 0-28 days (c) Trisomy G
Q.24 Frozen DPT vaccine should be: (d) Cretinism
(a) Can be used later Q.37 Protruding abdomen and tongue, short
(b) Discard it and broad feet and hands are the
(c) We can use, after normal temperature symptoms of:
of it (a) Down syndrome (b) Cerebral palsy
(d) Immersed in hot water (c) Meningitis (d) Scurvy
Q.25 A preterm baby is a baby born before Q.38 Etiological factor for down syndrome is:
how many weeks of gestation? (a) Unhygienic condition
(a) 40 weeks (b) 32 weeks (b) Mother above 35 years of age
(c) 42 weeks (d) 37 weeks (c) Mother above 25 years of age
Q.26 Normally the umbilical cord contains (d) Poor intake of vitamin C
how many arteries and how many Q.39 Electro-encephalography is performed
veins? for assessing?
(a) 1 vein and 2 arteries (a) Heart problem
(b) 1 vein and 2 vein (b) Neurological problem
(c) 2 arteries and 2 vein (c) Respiratory problem
(d) 1 artery and 2 veins (d) Digestive problem
Q.27 The lifespan of RBC’S in neonates is: Q.40 Cause of Cerebral Palsy includes:
(a) 120 days (b) 20 days (a) Brain injury
(c) 120-180 days (d) 60-80 days (b) Brain anoxia
Q.28 Which drug is administered at birth to (c) Immaturity at birth
prevent the potential problem of (d) All the above
abnormal bleeding? Q.41 Most common type of Cerebral Palsy is?
(a) Inj. Tranexamic accid (a) Spastic Cerebral Palsy
(b) Inj. Vitamin K (b) Dyskinetic Cerebral Palsy
(c) Inj. Streptokinase (c) Ataxia cerebral palsy
(d) Inj. Ethamsylate (d) Mixed type
Q.29 A communicable disease included in six Q.42 Phimosis is characterized by:
killer disease is: (a) Absence of penis
(a) Chicken pox (b) Typhoid (b) Condition when site of urethral meatus
(c) Tuberculosis (d) Hepatitis is on penile ventral surface
Q.30 Measles vaccine is given at the age of: (c) Condition when site of urethral meatus
(a) 10 weeks (b) 9 months is on penile dorsal surface
(c) 16-24 months (d) 14 weeks (d) Condition in which the foreskin is
Q.31 What is the meaning of infant – a baby narrowed & cannot be retracted over glans
of age group? Q.43 Treatment of Phimosis include:
(a) 0-28 days (b) 0-3 months (a) Antibiotic Therapy
(c) 0-7 days (d) 0-1 year (b) Anti-inflammatory drugs
Q.32 Recommended daily intake of vitamin B (c) Incision of the foreskin of the glans
12 in an infant is: penis
(a) 1 mcg (b) 2 mcg (d) Removal of glans
(c) 0.8 mcg (d) 0.2 mcg Q.44 Complications of undescended testes
Q.33 Vitamin B2 is also known as: includes:
(a) Riboflavin (b) Biotin (a) Atrophy of testes
(c) Niacin (d) Thiamine (b) Sterility
Q.34 Average blood pressure in a term baby (c) Strangulated hernia
is around: (d) All the above
(a) 60/40 mmHg (b) 80/50 mmHg Q.45 Wilms tumor is the tumor of:
(c) 100/150 mmHg (d) 40/20 mmHg (a) Lungs (b) Brain
Q.35 The average head circumference is (c) Kidney (d) Intestine
between: Q.46 What do you mean by orchidoplexy:
(a) 33-35 cm (a) Mobilization of testes into the scrotum
(b) 32-36 cm (b) Removal of testes
(c) 33-35.5 cm (c) Inflammation of testes
(d) 32-35 cm (d) Removal of Ovary

MCQs
Q.47 Management of nephrotic syndrome Q.58 When mother is not available who can
include except: provide KMC:
(a) Low sodium & high protein diet (a) Father
(b) Complete bed rest (b) Grandmother
(c) High sodium & low protein diet (c) Other relatives
(d) Care of oedematious skin (d) All the above
Q.48 Causes of iron deficiency anaemia Q.59 At home the mother can sleep with baby
include except: in which position during KMC?
(a) Inadequate intake iron (a) Reclined
(b) Lack of absorption of iron (b) Prone
(c) Blood loss (c) Fowler’s
(d) Poor intake of cow’s milk in diet (d) Supine
Q.49 Manifestation of iron deficiency anemia Q.60 Standard criteria of the unit for
include: transferring baby from the nursery to
(a) Pale skin and conjunctiva the postnatal ward should be:
(b) Fatigue (a) Stable baby
(c) Growth retardation of child (b) Gaining weight
(d) All the above (c) Mother confident to look after the baby
Q.50 Which vitamin is essential for normal (d) All the above
vision: Q.61 KMC can be provided in following
(a) Vitamin C (b) Vitamin D scenarios except when:
(c) Vitamin A (d) Vitamin B3 (a) Baby on OG Tube
Q.51 Chest in drawing nasal flaring & (b) Baby receiving IV fluids
granting are the features of: (c))Baby is on ventilator
(a) Pneumonia (d) Baby receiving free flow oxygen
(b) Pertussis Q.62 Mother should practice KMC at least
(c) Mumps for ______ in one sitting:
(d) Chicken pox (a) 1 hour
Q.52 Which of the following suggest problem (b) Half an hour
with hematological system: (c) 2 hour
(a) Jaundice (b) Asthma (d) 5 hour
(c) Renal calculi (d) None of these Q.63 Benefits of breastfeeding to mother
Q.53 Which drug is given to prevent HIV include:
transmission from mother to child: (a) Helps in involution of uterus
(a) Nevirapine (b) Lamivudine (b) Delays Pregnancy
(c) Stavudine (d) Abacavir (c) Decrease mother’s workload
Q.54 Which of the following condition would (d) All the above
it indicate when a newborn fails to pass Q.64 Kangaroo care is useful for the
meconium within first 24 hours? treatment of:
(a) Hirschsprung disease (a) Seizures
(b) Celiac Disease (b) Hypothermia
(c) Intussusception (c) Enuresis
(d) Abdominal wall defect (d) Abdominal pain
Q.55 Kangaroo mother care is a way Q.65 What is the full form of IMNCI?
protecting the baby from: (a) International management of newborn
(a) Hypoglycemia (b) and childhood illness
Hyperglycemia (c) Hyperthermia (b) Indian maintenance newborn and
(d) Hypothermia childhood illness
Q.56 Components of KMC include: (c) Integrated management of newborn
(a) Skin to skin contact and childhood illness
(b) Exclusive breast feeding (d) Incorporated management of baby
(c) Thermoregulation friendly hospital initiatives
(d) Both (a) & (b) Q.66 What is the main purpose of baby
Q.57 During KMC baby should be placed in friendly hospital initiative?
position: (a) Immunize all the babies
(a) Frog like (b) To provide adequate medicine
(b) Kangaroo like (c) To improve breast feeding practices
(c) Both (a) & (b) (d) To provide family planning services
(d) None of the above

MCQs
Q.67 Milk ejection occurs due to hormone: Q.78 When is a toddler expected to start
(a) Prolactin (b) Estrogen running:
(c) Vasopressin (d) Oxytocin (a) 9 months (b) 7 months
Q.68 The milk is secreted during the first (c) 18 months (d) 15 months
week after delivery is called: Q.79 At which age a child starts to walk
(a) Foremilk upstairs:
(b) Colostrum (a) 10 months (b) 15 months
(c) Mature milk (c) 36 months (d) 24 months
(d) Transitional milk Q.80 At which age can a child say few
Q.69 Which is not key sign of good disyllables like mama, baba etc.
attachment of baby during (a) 6 month
breastfeeding: (b) 9 month
(a) More areola is visible above (c) 4 month
(b) Baby’s mouth is wide open (d) 12 month
(c) Baby’s chin touching the breast Q.81 Which age group identified illness as a
(d) Baby’s lower lip turned inward punishment for misdeeds?
Q.70 The cause of poor attachment may be (a) Infant
due to: (b) Toddler
(a) Use of feeding bottles (c) Preschool
(b) Inexperienced mothers (d) School going
(c) Inverted nipples Q.82 Which development task is associated
(d) All the above with middle childhood, according to
Q.71 The time interval between each Erikson’s growth and development
breastfeed should be about: theory?
(a) 1 to 2 hour (b) 2 to 3 hour (a) Trust
(c) 2 to 4 hour (d) 1 to 3 hour (b) Initiative
Q.72 The mother should provide breastfeed (c) Independence
to their babies at least ________ in 24 (d) Industry
hours: Q.83 Which play activity is best suited to the
(a) 6-8 times (b) 6-10 times gross motor skills of the toddler?
(c) 8-10 times (d) 8-12 times (a) Coloring book & Crayons
Q.73 Breastfeeding is considered adequate if (b) Ball
infant: (c) Building cubes
(a) Passes urine 6-8 times in 24 hours (d) Swing set
(b) Sleeps for 2-3 hours after feeding Q.84 Which of the developmental milestone
(c) Gains weight adequately puts the 4 months old infant at greatest
(d) All the above risk for injury?
Q.74 Which among the following activity is (a) Switching objects from one hand to
compromised in a newborn baby with another
cleft lip? (b) Crawling
(a) Sucking (c) Standing
(b) Swallowing (d) Rolling over
(c) Respiration Q.85 The nurse notes a swelling on the
(d) Facial expression neonate’s scalp that crosses the suture
Q.75 Parents are advised to start line. What is this assessment finding?
supplementary feeding at: (a) Cephal hematoma
(a) 5 month (b) 6 month (b) Caput succedaneum
(c) 3 month (d) 8 month (c) Hemorrhage edema
Q.76 IYCF Practices includes (d) Perinatal caput
(a) Early initiation of breast feeding Q.86 What is the use of administration of
(b) Feeding colostrums & don’t discard it Denver development screening test
(c) Continued breastfeeding for 2 years or (DDST) to five months old infant?
beyond (a) To assess the intelligent quotient
(d) All the above (b) To assess the emotional development
Q.77 Causes of sore nipple include: (c) To assess the social & physical
(a) Incorrect attachment of baby to breast activities
(b) Frequent washing with soap & water (d) To assess the pre-disposition to genetic
(c) Fungal infection of the nipple illness
(d) All the above

MCQs
Q.87 A nurse is providing instruction to a Q.97 Socio emotional milestone of age
new mother regarding the psychosocial between 5-6 year’s children are:
development of the newborn infant. (a) Choose own friends
Using Erikson’s psychosocial (b) Plays simple table games
development theory, the nurse would (c) Play competitive games
instruct the mother to. (d) All the above
(a) Allow the newborn infant to signal a Q.98 In growth chart, a curve deviating
need downwards indicates:
(b) Anticipate all of the needs of the (a) Normal situation
newborn infant (b) Very dangerous situation
(c) Avoid the newborn during the first 10 (c) Improving situation
minutes of crying (d) Dangerous situation
(d) Attend to the newborn infant Q.99 MOHFW, government of India has
immediately when crying introduced auto disabled, plastic
Q.88 Which age group has the greatest syringes for the immunization
potential to demonstrate regression throughout the country in:
when they are sick? (a) 2002 (b) 2005
(a) Adolescent (b) Young adult (c) 2010 (d) 2015
(c) Todler (d) Infant Q.100 How many rights should be followed for
Q.89 Average weight of normal newborn at safe injection delivery:
birth: (a) 5 rights (b) 6 rights
(a) 2-3 kg (b) 2.5-3.5 kg (c) 7 rights (d) 10 rights
(c) 2.5-4.5 kg (d) 2-4 kg Q.101 Route of safe administration of BCG
Q.90 Average length of normal children at vaccines is:
age 1 year: (a) Intramuscular 75° - 90° degree of angle
(a) 50 cm (b) 25 cm (b) Subcutaneous 45° - 90° degree of
(c) 75 cm (d) 100 cm angle
Q.91 Average MUAC of normal children at (c) IM and SC both
age 4 years: (d) Intra-dermal 10° - 15° degree of angle
(a) 10 cm (b) 12 cm Q.102 BCG vaccine recommended for infant
(c) 14 cm (d) 16 cm under the one month:
Q.92 Uses of growth curve are: (a) 0.05 ml (b) 0.1 ml
(a) Growth monitoring tool (c) 0.01 ml (d) 2 ml
(b) To detect high risk child Q.103 What is the size of papules developed by
(c) Educational tool for mothers administration of BCG vaccine:
(d) All the above (a) 4-8 mm in diameter
Q.93 On growth chart, there are 3 printed (b) 5-6 mm in diameter
growth curves. These are called as: (c) 1-2 mm in diameter
(a) Reference lines (d) None of these
(b) Z score lines Q.104 Route of safe administration of DPT,
(c) Both (a) & (b) TT and Hepatitis B vaccines:
(d) None of the above (a) Intradermal
Q.94 When can a baby can sit unsupported: (b) Intramuscular
(a) 3-6 month (b) 6-9 month (c) Subcutaneous
(c) 9-12 month (d) 9-18 month (d) Intravenous
Q.95 Motor skill milestone of age between 2-3 Q.105 Dilutant for BCG vaccine is:
year’s children are: (a) Normal saline
(a) Walks downstairs alternating feet (b) Normal tap water
(b) Picks up toys from floor without (c) Hypertonic solution
falling (d) Hypotonic solution
(c) Sits down standing Q.106 Contraindications for immunization in
(d) Creeping rapidly which condition:
Q.96 Motor skill milestone of age between 2-3 (a) Mild fever (b) Diarrhea
year’s children are: (c) Cough (d) Seizure
(a) Walks downstairs alternating feet Q.107 Which of the following vaccines leaves a
(b) Picks up toys from floor without scar:
falling (a) Measles (b) BCG
(c) Sits down from standing (c) DPT (d) MMR
(d) Creeping rapidly

MCQs
Q.108 Oral polio vaccine prepared from: Q.120 Pulse oxymeter is used to assess the
(a) Killed organism following parameters except:
(b) Live attenuated organism (a) Oxygen saturation
(c) Toxoids (b) Pulse
(d) Aerobic bacteria (c) Respiration
Q.109 MMR vaccine provides protection (d) Hypoxia condition
against all of the following diseases Q.121 Colour of oxygen cylinder is:
except: (a) Black and white (b) French blue
(a) Mumps (c) Grey (d) Only white
(b) Meningococcal Meningitis Q.122 Which of the following methods is used
(c) Rubella to give oxygen for an infant?
(d) Measles (a) Nasal cannula
Q.110 Toxic shock syndrome is caused by: (b) Oxygen hood
(a) Infected BCG vaccine (c) Face mask
(b) Infected DPT vaccine (d) Venturi mask
(c) Infected measles vaccine Q.123 Which instrument is used to assess the
(d) None of the above blood pressure:
Q.111 Hepatitis vaccine is administered (a) Manometer
through: (b) Sphgnomanometer
(a) IM (b) ID (c) Barometer
(c) SC (d) Orally (d) Thermometer
Q.112 Immunoglobulin present in breast milk Q.124 In Which position B.P. instrument gives
is: correct measurement:
(a) IgA (b) IgD (a) Arm is below the chest level
(c) IgG (d) IgM (b) Sitting position with above chest level
Q.113 The used discarded in which colour bag: (c) Sitting position and arm is in level of
(a) Yellow (b) Red heart
(c) White (d) Blue (d) Site is below the brachial
Q.114 What is the full form of AMBU: Q.125 Flow inflating bag is also known as:
(a) Artificial Manual breathing unit (a) Anaesthesia bag
(b) Advance material bag (b) AMBU bag
(c) Airway manual breathing unit (c) Suction
(d) Air mark breathe unit (d) None of the above
Q.115 AMBU bag used: Q.126 Intubation is:
(a) To provide artificial respiration and (a) Introducing the E.T. tube in trachea
resuscitation through nose or mouth
(b) To improve breathing (b) A process of maintaining airway
(c) In anesthesia (c) Help in oxygen inhalation
(d) Oxygen Inhalation method (d) All of the above
Q.116 Radiant warmer is also known as: Q.127 Size of E.T. tube for a new born infant
(a) Close Care System is:
(b) Open Care System (a) 2.5-4 mm (b) 4-5 mm
(c) Complex Care System (c) 5-6 mm (d) 6-7 mm
(d) None of these Q.128 What is the priority when carrying out
Q.117 What is the wavelength of phototherapy a suction:
light: (a) Provide 100% oxygen to the client
(a) 424-475 nm (b) 500-525 nm (b) Emergency tray preparation
(c) 100-150 nm (d) 200-300 nm (c) Consult to the doctor
Q.118 Choice of treatment for physiological (d) None of the above
jaundice: Q.129 Most commonly restrain used in infant:
(a) Oxygen therapy (a) Mummy restrains
(b) Photo therapy (b) Wrist restrains
(c) Incubator system (c) Both
(d) Antibiotic therapy (d) None of the above
Q.119 Which is the non-invasive pulse Q.130 Spirometer is mainly used to:
oxymeter site: (a) Prevent atelectasis
(a) Forehead (b) Tip of nose (b) Promote wound drainage
(c) Index finger (d) All of the above (c) Ambulation therapy
(d) Oxygen inhalation

MCQs
Q.131 Lung function test are determined by:
(a) Tonometer
(b) Sphygmomanometer
(c) Spirometer
(d) Barmeter
Q.132 How long should instruments be
immersed in gluteraldehyde:
(a) 8-10 hours, ideally for HLD
(b) 6-7 hours, ideally for HLD
(c) 5-12 hours, ideally for HLD
(d) 10-20 hours, ideally for HLD
Q.133 What is the shelf life of wrapped sterile
instrument:
(a) 7 days (b) 5 days
(c) 6 days (d) 10 days
Q.134 What is the time required for
sterilization in an autoclave:
(a) 20-30 minutes (b) 40-50 minutes
(c) 10-20 minutes (d) 15-20 minutes
Q.135 What is the temperature required for
sterilization in autoclave:
(a) 121°C (b) 125°C
(c) 122°C (d) 120°C
Q.136 Which of the following neonatal
condition required immediate
accessibility of radiant warmer:
(a) Hypothermia
(b) Hypoglycemia
(c) Hypercolcemia
(d) Hyperglycemia
Q.137 Which of the following is used to give
oxygen for an infant:
(a) Nasal prong
(b) Face mask
(c) Oxygen hood
(d) Trans tracheal oxygen delivery
Q.138 Height of siphon during gastric feeding:
(a) 10”
(b) 12”
(c) 14”
(d) 18”
Q.139 Strength of dettol solution is used to
disinfect thermometer is:
(a) 1:20
(b) 1:40
(c) 1:60
(d) 1: 80
Q.140 Steam under pressure is:
(a) Radiation
(b) Boiling
(c) Autoclaving
(d) Fumigation

MCQs
1 C 21 A 41 A 61 C 81 C 101 D 121 A
2 D 22 A 42 D 62 A 82 D 102 A 122 B
3 C 23 C 43 C 63 D 83 B 103 A 123 B
4 A 24 B 44 D 64 B 84 D 104 B 124 C
5 C 25 D 45 C 65 C 85 D 105 A 125 A
6 A 26 A 46 A 66 C 86 C 106 D 126 D
7 B 27 D 47 C 67 D 87 A 107 B 127 A
8 B 28 B 48 C 68 B 88 C 108 B 128 A
9 B 29 C 49 D 69 D 89 B 109 B 129 C
10 B 30 B 50 C 70 D 90 C 110 C 130 A
11 D 31 D 51 A 71 B 91 C 111 A 131 C
12 D 32 D 52 A 72 C 92 D 112 A 132 A
13 B 33 A 53 A 73 D 93 C 113 B 133 A
14 B 34 A 54 A 74 A 94 B 114 A 134 A
15 C 35 C 55 D 75 B 95 A 115 A 135 A
16 D 36 D 56 D 76 D 96 A 116 B 136 A
17 B 37 A 57 A 77 D 97 D 117 A 137 C
18 D 38 B 58 D 78 C 98 B 118 B 138 B
19 D 39 B 59 D 79 D 99 B 119 D 139 B
20 B 40 D 60 C 80 D 100 C 120 C 140 C

Pediatric Concept Rna Notes

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A Dedicated Institute for Nursing Competitive Exam

A - Advocate for child and family

C - Communicate for the child

A - Activate the child‟s activities

D - Disseminate information related to child health programme.

E - Educate the public about child health

M - Motivate people to participate in child care

I - Investigate available resources

“ALL BIRDS FIND SHELTER DURING RAIN.

Infant:- A baby of age group 0-1 year

According to Birth weight According to Gestational Age

II. Apgar Scoring :-

 Mild distress or No distress :- 8–10 Normal routine care.

Immediate care of New born:-

5. Clamp & Cut the Umbilical Cord:-

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PERRLA Examination :- Assess Pupils.

7. Doll's eye Reflex:-

8. Tonic Neck Reflex:-

11. Palmer grasp Reflex:-

13. Babinski Reflex :-

14. Dancing Reflex (Stepping Reflex) :-

15. Perez Reflex :-

 Age of D.P.:- 4-6 Months.

16. Gallant Reflex :-

 Age of D.P. :- 4 Months.

2. Newborn of Diabetic Mother:-

 Normal bilirubin level :- 1.0 to 1.3 mg/dL in adult.

(ii) Pathological Jaundice:-

0.5 ml (amniotic fluid) + 0.5 ml (NS)

If bubbles are If no bubbles.

Indicate fetal lung Indicate deficiency

(ii) ABG analysis :- Indicate respiratory acidosis.

(i) Maternal causes :-

10. Large For Gestational Age:-

Post exposure prophylaxis drugs.

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Surgical Management:- 2 types.

3. Cleft lip and Cleft palate:-

4. Hypertrophic Pyloric Stenosis:-

5. Hirschsprung's Disease OR Aganglionic megacolon:-

 In first stage colostomy is done, To provide rest to megacolon portion.

Food not allowed:-

 Defect in abdominal wall at the level of umbilical ring.

(b) Hypertonic dehydration :-

(iii) Lead Poisoning-

 It stimulate the parasympathetics that is nervous system and produce symptoms

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After birth change in fetal circulation:-

(i) Foramen ovale:-

(ii) Ductos arteriosus:-

 The most common congenital heart disease is ventricular septal defect.

1. VSD (Ventricular septal defect):-

2. ASD (Atrial Septal Defect)

(ii) Spina bifida cystic:-

(ii) Meningomyelocele (myelomeningocele)

“YOU MUST DO,

(iii) Reproductive System:-

 Secretion of sweat gland becomes thick so concentration of sodium and chloride

“START SMALL AND DREAM BIG”

Post operative Management:-

Their may be combination of one or more condition occurs like

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3. Eczema:- (atropic dermatitis)