MINISTRY OF HEALTH

SOLWEZI COLLEGE OF NURSING AND

MIDWIFERY
ASSIGNMENT ONE (1)

GROUP NUMBER : FIVE

COURSE : PAEDIATRICS AND CHILD HEALTH NURSING

TASK : ASSIGNMENT I

TUTOR : MADAM MANYIKA

INTAKE : JULY 2022

DUE DATE : 9TH APRIL, 2024

QUESTION:
POLIOMYELITIS
INTRODUCTION
Poliomyelitis is also called infantile disease or acute flaccid paralysis, it is an infectious disease
caused by polio virus. According to the world health organization (WHO), 1 in 200 polio
infections will result in permanent paralysis. Polio was eradicated in 1953 in the following
region and certified polio free in regions like America, Europe, Western pacific amd Southern
Asia. Polio vaccine was developed in 1953 and made available in 1957, despite having other
region polio free, other countries like Nigeria and DRC are still having polio cases.
DEFINITION OF TERMS

1. Virus-is a small particle that is capable of infecting a living cell and potentially causing
disease (https;/www.high veld.com/virology)

2. Incubation period-is a period of being exposed to infection to the time the first symptoms
appear.

3. Paralysis-this is loss of muscle function in part of the body(Medline plus)

4. Lymph nodes-is an ovoid or kidney shaped organ of the lymphatic system that contains
immune cells that help fight infections

5. Poliomyelitis-this is an acute viral disease that is caused by a polio virus affecting the central
nervous system characterized by fever and paralysis.
POLIOMYELITIS

Poliomyelitis-this is an acute viral disease that is caused by a polio virus affecting the central
nervous system characterized by fever and paralysis.

It’s an acute infectious enterovirus disease that affects the central nervous system and spinal
cord.

CAUSES

It is caused by a polio virus

MODE OF TRANSMISSION

1. Through fecal oral route

2. Food or water containing human feces
3. Infected saliva

PREDISPOSING FACTORS

1. Poor sanitation due to poor disposal of fecal matter

2. Immune compromised children due to low immunity

3. Non immunized children against polio

4. Tonsillectomy-the tonsils help fight infections therefore when the tonsils are removed the
body will be unable to fight infections

5. Refugees due to poor medical services

PATHOPHYSIOLOGY

The entero virus infects the human intestinal tract mainly through the fecal oral route; the virus
begins to multiply first in the oropharynx and the upper gastro intestinal tract mucosa during the
first 3 weeks of incubation period. The virus then drains into the cervical and mesenteric lymph
nodes and finally to the blood stream leading to viremia. The presence of these virus in the blood
stream enables it to be widely distributed throughout the body then crosses the blood brain
barrier and attacks the anterior horns cells of the central nervous system provoking a local
inflammatory process example the meninges including the spinal cord leading to flaccid
paralysis of the muscles and affects the neurons. The paralysis may vary from weakness of the
muscles to complete paralysis of one or more limbs.

TYPES OF POLIOMYELITIS

1. Abortive poliomyelitis : Minor illness of poliomyelitis

 2. Acute anterior poliomyelitis: Major illness of poliomyelitis
3. Ascending poliomyelitis: poliomyelitis with a cephalic progression
4. Bulbar poliomyelitis: A severe form affecting the medulla oblongata, which may from
dysfunction of swallowing mechanism and circulatory distress
5. Cerebral poliomyelitis: This extends into the brain.

SIGNS AND SYMPTOMS

1. Non-Paralytic Poliomyelitis

Signs and symptom of non-poliomyelitis can last from 1-10days.

1. Fever-due to infections in the blood stream

2. Headache-due to presence toxins in the blood stream

3. Vomiting-due to increased intracranial pressure

4. Fatigue-due to the infections in the blood stream

5. Meningitis-invasion of the virus in the brain meninges

2. Paralytic Poliomyelitis

Initial symptoms are similar to non-paralytic polio but after a week they become more severe and
these include

1. Loss of reflexes-due to infections in the spinal cord

2. Muscle pain-leading to spasms

3. Loose and floppy limbs sometimes symmetrical

4. Deformity of the limbs especially the hips, ankles and feet –due to impaired blood circulation

5. Drooling of saliva-due to invasion of the virus to the trigeminal neurons

CLASSIFICATIONS

 Spinal polio (79%) this one affects the spinal cord.

 Bulbo polio(2%) affects the brain stem
 Bulbospinal polio (19%) affects both the spinal cord and the brain stem.

INVESTIGATIONS
1. Physical examination to note for any paralysis
2. Stool for virology to isolate the polio virus
3. Lumber puncture to rule out meningitis
4. Blood slide to rule out malaria
5. Full blood count will shows leukocytosis

NURSING CARE PLAN

PROBLEM NURSING OBJECTVE INTREVENTION/RATIONAL EVALUATION

DIAGNOSIS
Altered Altered body To maintain Open nearby windows to reduce Fever reduced by
body temperature normal body temperature by convection. 1oc degrees
temperature related to temperature Tepid sponging with warm water Celsius evidence
of 39oc presence of within 1 hour to reduce temperature by by temperature
polio virus in of evaporation. of 38oc
the blood steam hospitalization Give antipyretics such as
evidenced by paracetamol syrup 120mg every
temperature of 8hours.
39oc degrees
Celsius
Impaired Impaired To immobilize Strict bed rest to prevent pain. Affected limb
physical physical the affected Position the affected limb using mobilized
mobility mobility related limb sandbags to maintain body evidenced by
to paralysis alignment. child being calm.
evidenced by Foot boardswill be used to
loose and prevent foo drop.
floppy limbs or Nurse the child on a bed with a
loss of muscle hard board to maintain body
control alignment.
Railed bed to prevent falling.
Pain To relive pain Hot, moist compress applied to Pain relieved
within 30 the muscles to relieve pain and evidenced by
minutes of muscle spasms. child resting and
hospitalization Minimal handling of affected not crying
part to relieve pain.
Analgesia such as paracetamol
syrup 120mg every 8hours to be
given orally to relieve pain.

Ineffective Ineffective To maintain Position the child in a lateral Airway

airway airway patent airway position with head tilted to the clearance done
clearance clearance through out side to allow drainage of evidence by
related to hospitalization. secretions. normal
muscle Suctioning to be done when saturation of
paralysis. necessary to clear airway. <85%
Oxygen administration if need
arises to promote tissue
perfusion.
Imbalanced Imbalanced To promote Oral care to be done to promote Nutrition
nutrition nutrition less good nutrition appetite. maintained
than body and hydration Small frequent feeds to be given evidenced by
requirement status to promote nutrition and fluid child not losing
related to throughout intake. weght.
anorexia, hospitalization. Breastfeeding to maintain good
nausea and nutrition status.
vomiting. Naso-gastric feeding every 2
hours to promote good nutrition
and hydration.
 COMPLICATIONS
1. Meningitis due to infections in the central nervous system
2. Osceolosis one leg will be shorter than the other
3. Osteoporosis due to infections in the bone
4. Paralysis due to presence of virus in the CNS
5. Encephalitis due to presence of infections in the brain stem
6. Neuropathy
7. Skeletal deformities
8. Respiratory distress due to paralysis of the diaphragm and intercostal.
 PREVENTION
1. Vaccination: The primary and most crucial preventive measure against polio is
vaccination. The oral polio vaccine (OPV) and the inactivated polio vaccine (IPV) are
widely used for immunization. These vaccines provide long-term protection against polio
and help to prevent transmission.

2. Routine immunization: It is recommended that children receive a series of polio

vaccinations starting from infancy. The standard immunization schedule includes several
doses of the polio vaccine at specific intervals. Completing the full course of
recommended vaccinations is essential for adequate protection.
3. 3. Routine vaccination campaigns: National immunization campaigns are conducted in
many countries to ensure maximum coverage. These campaigns aim to reach every child
below a certain age within a specific time frame, regardless of their previous
immunization status.
4. Surveillance and monitoring: Active surveillance systems are crucial for detecting any
polio cases and monitoring the circulation of the virus. This helps in identifying and
responding to outbreaks promptly.
5. Improved sanitation and hygiene: Since poliovirus spreads through the fecal-oral route,
maintaining proper sanitation and hygiene practices is important. This includes access to
clean water, proper waste disposal, and promoting handwashing.
6. Travel recommendations: People traveling to areas where polio is still endemic or where
outbreaks have occurred should receive a polio vaccine booster dose before traveling.
This helps to prevent the importation of the virus into non-endemic areas.
7. Public education and awareness: Educating the public about polio, its transmission, and
the importance of vaccination play a significant role in prevention. Public health
campaigns can help dispel myths, address vaccine hesitancy, and encourage vaccine
uptake.
REFERENCES

1. Essential pediatrics 3rd edition

2. Wong’s nursing care of infants and children 10th edition
3. Polio case count world health organization 27th December 2017
4. Poliomyelitis, epidemiology and prevention of vaccine-preventable diseases (the pink
book)public health foundation chapter 18, 30th December 2016
5. Pediatric nursing care plans. Assuma beevi jaypee2012 first edition.