Comprehensivepaediatric nursing

Comprehensive

paediatric nursing

By

Rajalakshmi MuruganAssistant Professor and Head

Department of Paediatric Nursing, Centralized School of Nursing Faculty of Medicine,

Addis Ababa University, Ethiopia

Reviewed by

Dr Amha MekashaAssociate Professor

Paediatric and Child Health Department, and Head of Medical Education in Ethiopia Unit,

Addis Ababa University, Ethiopia

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Comprehensive PADIATRIC NURSING

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First Edition : 2012, Reprint 2013, Second Edition : 2017ISBN 978-93-81159-30-9

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Bran

ches

To my beloved Parents and

All children in Ethiopia, who could have benefited from treatment of different diseases and

appropriate nursing care

Foreword

As the number of children in the world, younger than age 15 increases annually, now representing more than 30% of the total population. It becomes apparent that clinical nursing and midwifery students need to know about well-child health care, acute and chronic diseases states in paediatric population and appropriate nursing intervention. Recognizing development stages, acquiring skills and teaching families are critical in the care of children and require different skill sets than caring for adults. Nurses and midwives with strong grasp of these important concepts are in a good position to help the families deal with everyday situation, resulting in positive outcomes for their children. Unfortunately, the clinical experience in the care of children are commonly limited in nursing programmes because most ill children are cared for in the home and hospital stays are short. Therefore, to be well prepared to care for these patients and their families and to have adequate knowledge and competence on paediatric practice.

This edition has a wide range of coverage and includes the relevant issues of all paediatric diseases and care. The book also has evidence based neonatal and children interventions, including instructional and community based care aspects.

Mrs Rajalakshmi has worked hard to structure the text especially according to our context, so this book is educationally sound and very relevant in the field of neonatal and child health nursing. It is my sincere belief that this book will contribute to reduce the neonatal and child mortality and morbidity in this country, besides it helps to overcome the shortage of paediatric nursing textbook. I appreciate her efforts to our nursing profession especially for child health, surely all nursing and midwifery students will get benefit from this book.

Mr Asrat Demisse

Director, Centralized School of Nursing

Faculty of Medicine, Addis Ababa University

Ethiopia

PreFace to the Second edition

This fully revised book, now in its Second Edition, continues to provide a compact state of the art resource for clinicians in simple, lucid and user-friendly manner for easy understanding.

I have received numerous emails, and letters from readers commenting on the book and suggesting how it could be improved. With the aid of all this information, I have completely revised. In this Edition, new topics such as paediatric formulas, calculation of drugs, degrees of malnutrition as for IPA/WHO, calculation of weight according to age, and to find out the degree of malnutrition, identification of dehydration, current immunization schedule, and breast feeding and calculation of artificial feeding have been included at appropriate places. Some sections are also updated to enrich the contents.

Let me thank everyone who has provided me with suggestions and corrections for improving the First Edition. I am extraordinarily grateful to them all.

author

PreFace to the FirSt edition

It gives me immense pleasure and satisfaction in introducing Comprehensive Paediatric Nursing to the Ethiopian society. Today nurses are challenged to make quick yet critical and update clinical practice about variety of patient’s/client’s problems occurring within the context of a complex and rapidly health care system. Our nursing profession is increasingly in the development of scientific knowledge related to its practice. I have been teaching paediatric nursing in Ethiopia for the last 8 years. There is no adequate books and those available are costly and of the standard of developed countries. Keeping in view the problems and needs of Ethiopian nursing students and nurses, I conceived the idea of writing a book on paediatric nursing since there is a lacunae of such books in Ethiopia by the local authors.

This edition of the Comprehensive Paediatric Nursing provides a compact state of the art resource for clinicians in simple, lucid and user-friendly language for easy understanding. It has been designed to ensure that specific information can easily be identified and applied in clinical setting. This book provides special information on Care of Children with HIV/AIDS and Integrated Management of Neonatal Childhood Illness (IMNCI).

The text of the book has been divided into 14 chapters. Chapter 1 focuses on growth and development and includes concepts, principles, theories, assessing and measuring of growth and development from newborn to adolescent period. Chapter 2 provides an essential component of the physical assessment like purpose, approaches and detailed physical examination. Chapter 3 provides a summary of twenty neonatal common health problems and interventions. Each illness/disorders includes concise description of the problems, schematic presentation of pathophysiology, clinical sign and symptoms, investigations, treatment and nursing management. Chapter 4 deals with the care of newborn with congenital anomalies. It includes anomalies of each organ system in detail. Chapter 5 provides the details of altered respiratory conditions. It includes etiology, pathophysiology, clinical manifestations, treatment and nursing management. Chapter 6 details the alteration in cardiovascular functions and their management. Chapter 7 describes the details of altered gastrointestinal functions and their nursing management. Chapter 8 deals with the alterations in genitourinary functions and their nursing care. Chapter 9 provides the information about neurological disorders and the role of nursing care in their management. Chapter 10 deals with the management and care of altered musculoskeletal conditions. Chapter 11 provides the details of altered haematological conditions, their management and nursing care. Chapter 12 is specially devoted to the causes, pathophysiology, complications, clinical manifestations, investigations, medical management and nursing care of common oncological conditions and Chapter 13 deals with altered endocrine conditions, finally Chapter 14 describes care of children with HIV/AIDS.

I hope the Comprehensive Paediatric Nursing will fill the gap for a book on paediatric nursing in the Ethiopian context as well as for developing countries. This book will provide enough knowledge related to paediatric nursing and enable the students to apply it in clinical practice and it will be definitely useful for faculty who is teaching paediatric nursing.

The suggestions for improvement would be gratefully accepted and will be incorporated in next revised edition.

author

acknowledgementS

I take this opportunity to express my deepest sense of gratitude to Mr Asrat Demisse, Director of School of Nursing, Addis Ababa University and the President, Ethiopian Nurses Association for his inspiration for writing this book, great encouragement and cordial support.

I am deeply appreciative of Dr Amha Mekasha, Associate Professor of Paediatrics and Child Health, Medical Faculty, Addis Ababa University for his valuable guidance and wholehearted efforts in editing the book.

I am greatly indebted to all my professional colleagues and friends in the institution who have initiated and encouraged me to write this textbook.

Finally not least but most, my acknowledgement goes to my sons and husband Mr Murugan for their enthusiastic encouragement and continuous effort to complete this book.

I also take this opportunity to express my heartfelt thanks to management, consultant and the staff of Laxmi Publications Pvt. Ltd. for giving proper shape to bring out and efforts to publish the first Indian book in the field of nursing in Ethiopia.

author

contentS

Foreword (vii)

Preface to the Second Edition (viii) Preface to the First Edition (ix)

Acknowledgements (x) List of Plates (xv) List of Figures (xvi)

List of Tables (xviii)

IntroductIon to PaedIatrIc nursIng 1–3

Principles of Paediatric Nursing 1 Role of the Nurse in Paediatric or Child Health 1

Nursing Process in Paediatric Care 2

growth and develoPment 4–24

Concepts of Growth and Development 4 Assessing and Measuring of Growth and Development 7 Infant (Birth through Age 1) 8 Toddler (Ages 1 to 3) 12 Preschool Child (Ages 3 to 5) 15 School-Age Child (Ages 5 to 12) 18

Adolescent (Ages 12 to 18) 21

PaedIatrIc assessment 25–40

Overview 25 Assessment of Growth Pattern and Nutrition 25 Physical Examination of Body System 26 Neurologic “Soft” Signs 40

care of neonates wIth common health Problems 41–72

Care of the Preterm Newborn (Premature Baby) 41 Low Birth Weight Infants 45 Meconium Aspiration Syndrome 47 Asphyxia 48 Respiratory Distress Syndrome (RDS) 50

xii n Contents

Neonatal Pneumonia 52

Neonatal Hypoglycaemia 53

Anaemia in Newborn 55

Injuries of the Newborn (Birth Injury) 56

Haemolytic Disease of the Newborn 59

Hyperbilirubinemia 62

Infection of Newborn 65

Neonatal Sepsis 65

Necrotizing Enterocolitis (NEC) 67

Ophthalmic Neonatorum 68

Oral Thrush (Oral Candidiasis) 68

Neonatal Seizures 69

Neonatal Coagulation Disorders 70

Haemorrhagic Disease of the Newborn (HDN) 71

care of newborn wIth common congenItal anomalIes 73–98

Congenital Abnormalities 73

Head 73

The Eye 76

Mouth 77

Esophageal Atresia with Tracheoesophageal Fistula 79

Hypertropic Pyloric Stenosis 81

Obstructive Disorders 83

Hirschsprung’s Disease (Congenital Aganglionic Megacolon) 84

Anorectal Malformation 85

Hernias 87

Neural Tube Defect 89

Cleft Foot 92

Developmental Dysplasia of the Hip 94

Defects of Genitourinary Tract 95

Down’s Syndrome 97

altered resPIratory condItIons 99–111

Respiratory Infection 99

Common Upper Respiratory Tract Infections (URTI) 100

Croup Syndrome 102

Lower Respiratory Tract Infections (LRTI) 104

altered cardIovascular functIons 112–129

Anatomy and Physiology of Paediatric Differences 112

Congenital Heart Diseases 112

Contents n xiii

Acyanotic Defects 113

Non-Obstructive Defects 114

Obstructive Defects 117

Cyanotic Heart Defects 120

Hypoplastic Left Heart Syndrome 124

Common Signs and Symptoms of Cardiac Diseases in Infants 124

General Nursing Care of the Child with Congenital Heart Diseases 125

Congestive Heart Failure 125

Rheumatic Fever 128

altered gastroIntestInal functIons 130–141

Diagnostic Tests 130

Nursing Diagnoses 131

Appendicitis 132

Meckel’s Diverticulam 132

Intussusception 133

Gastroenteritis 134

Complications 135

Inflammatory Bowel Diseases, Crohn’s Disease and Ulcerative Colitis 136

Nutritional Disorders 138

Rickets 141

altered genItourInary functIons 142–151

Understanding Kidneys and Urine 142

Urinary Tract Infection 143

Glomerulonephritis 144

Nephrotic Syndrome 147

Wilm’s Tumor (Nephroblastoma) 150

altered neurologIcal condItIons 152–164

Assessment of Neurological Conditions 152

Convulsion 154

Meningitis 156

Encephalitis 158

Cerebral Palsy 159

Mental Retardation 160

Head Injuries 162

Skull Fracture 163

altered musculoskeletal condItIons 165–181

Diagnostic Tests 165

Deformities of Spine 166

Comprehensive Paediatric Nursing

Publisher : Laxmi Publications ISBN : 9789381159309Author : RajalakshmiMurugan, Dr AmhaMekasha

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