• QUESTION -1

Discuss on the physiologic Assesement of the newborn.

• A neonatal assessment should be done within 2 hours after birth

• The initial assessment provides the baseline data and assists in determining the course of
nursing and medical care.

• It involves evaluation of APGA score, general survey, and complete assessment.

General Survey

 Take history and review the prenatal record and birth record

 Observe the respiratory pattern and assess respirations and breathe sounds

 Observe posture

 Assess the skin for color, birth trauma, and birthmarks.

 Observe the level of alertness/activity.

 Assess muscle tone and posture.

 The complete assessment begins after this initial overall observation

• General survey include assesement of the following:

1. General appearance: Physical activity, tone, posture, cyanosis, jaundice and level of
consciousness

2. Skin: Color, texture, nails, presence of rashes, birth marks, skin sepsis

Head and neck including

1. Face

2. Eye

3. Ear

4. Nose

5. Mouth and

6. Neck

Vital signs include

TEMPERATURE

Place a clean thermometer probe in the axillary or rectal area

Finding: 36.4°–37.2°C (97.5°–99°F)

RESPIRATIONS

Observe the rise and fall of the chest and abdomen /min

Finding: 30–60 breaths per minute

PULSE

Assess apical pulse rate by auscultating for one full minute

Finding: 120–160 bpm

Blood Pressure

Blood pressure is not a routine

Can be obtained from both the arm and the leg

Fining: 50–75/30–45 mm Hg

Systematic assesement

INTEGUMENTARY/SKIN

Inspect the skin for color, intactness, bruising, birth marks, dryness, rashes, warmth, texture, and
turgor. Inspect nails.

Finding: Skin is pink

CARDIAC

Auscultate heart sounds; listen for at least one full minute. Palpate peripheral pulses

Finding: PMI at the 3rd or 4th intercostal space, normal heart beats

ABDOMEN

Inspect size and shape of the abdomen.

Palpate the abdomen for tone, hernias, and

Auscultate for bowel sounds. Inspect the umbilical cord.

GENITO-URINARY (FEMALE)

Inspect the genitalia

Assess for the presence and position of clitoris, vagina, and urinary meatus

RECTUM

Inspect the anus.

GENITOURINARY MALE

Inspect the penis for urinary meatus

Inspect and palpate the scrotum

MUSCULOSKELATAL

Inspect extremities, spine, and gluteal folds.

Palpate the clavicles.

QUESTION -2

With reference to Moro, Rooting, Sucking, Startle and Palma Grasp reflex write short note
on the Neurological Assesement of the newborn.

MORO REFLEX: disappears by 6 months.

Hold the baby in a semisitting position and let the head slightly drop back.

Finding: Symmetrical abduction and extension of arms and legs

ROOTING: disappear btw 3 & 6 month

Brush the side of a cheek near the corner of the mouth.

Findings: The neonate turns his head toward the direction of the stimulus and opens his mouth

SUCKING: Place a gloved finger or nipple of a bottle in the neonate’s mouth

STARTLE disappears by 4 months

Make a loud sound near the neonate

Findings: Same as Moro response

PALMER GRASP Place a finger in the palm of the neonate’s hand

Finding: The neonate grasps fingers tightly

Group Three proposed questions

1. Describe the Factors that contribute in the development of behavioral problems in children

2. Write a on the following behavioral problems based on the following headings

I. Defination

Ii.causes /risk Factors

iii. Types

iv. Sing and symptoms

v. Management

a. Enuresis or bed wetting

b. Encopresis

c. Tics or Habit Spasm

ANSWER
i. Faulty Parental Attitude : This involves how the parents interact and train the children like

Overprotection, dominance, unrealistic expectation, over criticism, unhealthy comparison, under

discipline or over discipline, parental rejection, disturbed parent-child interaction, broken family

(death, divorce), etc. are responsible factors for development of behavioral problems.

ii. Inadequate family environment : This involves Poor economic status, cultural pattern,

family habits, child rearing practices, superstition, parent’s mood and job satisfaction etc

influence on child’s behavior and may cause behavioral disorders.

iii. Mentally and physically sick or handicapped conditions

Children with sickness and disability may have behavioral problems. Chronic illness and

prolonged hospitalization can lead to this problem.

iv. Influence of social relationship

Maladjustment at home and school, disturbed relationship with neighbors, school teachers,

schoolmates and playmates, favoritism, punishment, etc. may predispose behavioral problems.

v. Influence of mass media

Television, radio, periodicals and high-tech communication systems affects the school children

and adolescence leading to conflict and tension which may cause behavioral disorder.

QUESTIONS TWO
A. Enuresis or bed wetting

i. Definition

Enuresis is the repetitive involuntary passage of urine at inappropriate place especially at bed,

during night time, beyond the age of 4 to 5 years.

ii. cuases

 small bladder capacity

 Improper toilet training

 Deep sleep with inability to receive the signals from distended bladder to empty it.

iii. Types of enuresis

a primary enuresis

Primary or persistent enuresis is characterized by delayed maturation of neurological control of

urinary bladder, when the child never achieved normal bladder control usually due to organic

cause.

b. Secondary enuresis

In secondary or regressive enuresis the normal bladder control is develop for several months

after which the child again starts bed wetting at night usually due to regressive behavior like

illness and hospitalization or due to any emotional deprivations.

iv.Sing and symptoms

  Repeated bed-wetting.

 Wetting in the clothes.

 Wetting at least twice a week for approximately three months.

v. Management

Assessment of exact cause is very essential by thorough history, clinical examination and

necessary investigations

 Emotional support to the child and parents along with environmental modification.

 The child needs reassurance

 Restriction of fluid after dinner

 Voiding before bed time and arising the child to void, once or twice, three to four hours

later.

 Interruption of sleep before the expected time of bed wetting is essential. The child can

assume responsibility for changing the bed cloths.

 Parents should encourage and reward the child for dry nights.

 Bladder stretching during daytime to be done to increase holding time of urine.

 Drugs therapies with tricylic antidepressant (Imipramine) are useful.

 Supportive psychotherapy is important for child and parent.

 Changes of home environment to remove the environmental causes are essential.

B.Definition

I. Encopresis : Encopreis is the passage of feces into inappropriate places after the age of 5

years, when the bowel control is normally achieved.

ii.Causes
  Emotional disturbances due to unconscious anger

 stress

 anxiety.

iii.typs

a.Primary Encopresis

Occur at the results of delayed maturation of neurological control to rectum when l usually due

to organic cause.

b.Secondary Encopresis

This type occur older children and some time adult after achieving complete rectal control

usually associated to stress and anxiety.

iv.Sing and symptoms

 Constipation with dry, hard stool.

 Avoidance of bowel movements.

 Reduce bowel movement

 Lack of appetite.

 Painful dedication

 Stool lekage

v. management

 History of bowel training, use of toilets and associated problems.

 The child needs help in establishment of regular bowel habit, bowel training, Detary

lntake of roughage and intake of adequate fluid.

  Parental support, reassurance and help from psychologist for counseling of child and

parents may be essential in persistent problems.

C.Tics or Habit Spasm

Tics are sudden abnormal involuntary movements. It is repetitive, purposeless, rapid stereotype

movements of striated muscles, mainly of the face and neck.

ii.causes

No known clear causes of tics but associated to some emotional Factors,Stress and sleep

deprivation and some certain drugs are implicated.

iii.types

a.motor tics

Motor tics can be found as eye blinking, grimacing, shrugging shoulder, tongue protrusion, facial

gesture, etc

b.Vocal tics:

vocal tics can be found as throat clearing, coughing, barking, sniffing, etc.

iv.sign and symptoms

 Eye blinking

 Voughing

 Shrugging

 Throat clearing

 Tongue protrusion

 Clearing, Voughing,etc

v. Management
Behavior therapy, counseling and drug therapy with haloperidol group of drug.

Parental reassurance and counseling of the child and parent usually useful to managed the simple

motor or vocal tics.

PROPOSED EXAMINATION QUESTIONS

1. Aliyu haruna, a 5 year old child is presented to EPU with complain of oedema on face, legs,
arms and abdominal cavity as well as fatigue.
a. Identify the expected diagniosis of Aliyu haruna
b. Mention the classical features of aliyu’s condition
c. Explain the pathophysiology of the identified condition
d. What are the nursing management of the identified condition ?

QUESTION 2
 Describe Acute glomerulonephritis based on the following headings:
 Definition
 Pathophysiology
 Diagnostic evaluation
 management

MARKING SCHEME

1a. nephrotic syndrome.

 1b. clinical state caused by glomerular damage

 It is characterized by:

 protenuria

 hypoalbuminaemia

 hyperlipidaemia and gross oedema.

1c

 . Impairment in the permeability of the glomerulus from any known or unknown

condition

 This leads to the increase in the glomerular permeability

 This then result to the escape of proteins in form of albumin in the urine which
give rise to proteinuria,this is called hyperproteinuria.

 Decrease in the amount of the proteins in the blood called albumin which lead to
hypoalbuminemia.

 Liver in trying to compensate with the protien lost, it synthesizes proteins in form
of lipoproteins
  This lead to accumulation of lipid in the blood which is refered to as
hyperlipidemia.

 decrease in intravascular pressure with the increase in the hydrostatic pressure

will lead to accumulation of fluid in the extremities called gross edema.

1d.
 Provide skin care
 Give warm soak to the periorbital oedema
 Feed small frequent measured meal, intake and
output.
 Prevent contact with people with infection
 Administer diuretic and corticosteroids
 Consider NG tube feeding if child is unable
 Observe and maintain fluid balance, hydration status, monitor ascities.
 Encourage high intake of proteins,decrease sodium and teach parent about importance of
restriction.

QUESTION 2 MARKING SCHEME

a. Definition: This is simply refers to the acute inflammatory conditions of the glomeruli.
b. PATHOPHYSIOLOGY
 cellular proliferation
 Infiltration of the glomerulus by leukocytes and
 thickening of the glomerular filtration basement
 membrane leading to scaring and loss of filtering surface.
 In acute glomerulonephritis, the kidneys become large, swollen and congested.
 All the renal tissues-glomeluli , tubules and blood vessels are affected in all forms of
glomerulonephritis.
 In each form the tissues are involed to varying degrees
 Antigen outside the body (bacteria or virus) initiate the process in some patient.
 complexes to be deposited in the glomeruli.
 In others, the membrane tissue of the kidney
 becomes altered by diseases and serves as the inciting antigen.

c. Diagnostic evaluation
 Scanty bloody urine

 Anuria for one or more days (rare)

 Proteinuria (usually 2g/ 24 hours)

 Increased value of BUN and serum creatinine

 Anaemia – ASO (Antistreptolysin 0) titres

 Renal biopsy – chest x-ray (may show pulmonary eodema)