During the next visit. What will happen for the untimely appearance of the patient for an appointment? Specializing in "Medicine"

During the next visit to the children's polyclinic, did the pediatrician hear a heart murmur in your child? The worst thing that parents can do in this case is to start panicking. With a fright, you can do a lot of stupid things, but in this situation you need to get together and act. At first, it is advisable to consult a pediatric cardiologist and understand not only the intricacies of terms that the baby’s card will be full of, but also try to figure out how to deal with this problem.

Heart murmurs in children: what you need to know

For the sake of reassurance for parents, it is worth saying that basically, heart murmurs in a child do not indicate any serious problems. Strictly speaking, they are divided into three main types: functional (they are also called "innocent"), acquired and congenital.

As for functional heart murmurs in children, their causes may be rheumatism or disruption of the heart muscle. This type of pathology occurs in many young children. As you grow older, the noises disappear, and by reaching adolescence, you can forget about them altogether. The diagnosis is made by a cardiologist for the sole purpose of: at subsequent examinations, the parents should inform the doctor that such disorders have already been detected before.

Functional noises do not lead to disruption of the circulatory system, therefore they do not have any effect on the heart and other organs. Most often, they indicate changes in the baby's body (and such noises are mainly found in newborns), and are the result of the adaptation of the cardiovascular system to life outside the womb. It happens all the same, but much less often, that such problems are also found in adults, but this is rather an exception to the rule. According to statistics, up to 50% of all diagnosed heart murmurs are of such a “safe” nature.

The cause of pathological noises is considered to be congenital anomalies of the heart, which lead to impaired blood circulation. Usually, the diagnosis is made very early (in the first months of a child’s life), because there are quite expressive symptoms on the face: cyanosis of the skin, shortness of breath, developmental delay, etc. But sometimes nothing but noises indicate deviations in the work of a small heart, and not only parents , but doctors themselves may lose sight of a rather dangerous violation. Worse, heart murmurs may not even be audible, but are detected only when the blood circulation has already been rebuilt in a certain way. If, over time, heart murmurs increase, this is a very unfavorable symptom.

With regard to acquired heart murmurs in a child, their causes are most often rheumatic attacks that provoke inflammation of the heart valves. As a result, scars remain on them, which negatively affect normal blood flow. The detection of murmurs in the heart that were not previously observed clearly indicates an active rheumatic process. But in this case, other signs will also appear in parallel: changes in blood counts, fever, etc. If these symptoms are not observed, it is possible that heart murmurs are provoked by old scars after a previous attack of rheumatism.

Congenital murmurs, as the name implies, are heard most often in the first months of a child's life (very rarely - after a few years). They signal heart disease that is not associated with the inflammatory process. In this case, it is not the noises themselves that should be disturbing, but how the congenital defect will affect the work of a small heart. In a child, the disease may be accompanied by growth retardation, cyanosis of the skin, and breathing problems. Children with congenital heart murmurs need constant monitoring by specialists, and in especially severe cases, they may need surgery. With congenital heart murmurs in a child, parents should try to protect him from the slightest infection. Even when visiting a dentist, it is necessary to inform the doctor about the illness of a small patient, since the risk of infection also exists during dental treatment.

Required Research

If a heart murmur is detected in a child, it would be advisable to conduct a series of additional studies in order to accurately determine the cause and develop the correct treatment strategy.

Ultrasound (echocardiography, or Echo-KG) is considered one of the main diagnostic methods. This is an absolutely safe and painless way to determine any disturbances in the work of the heart, which, moreover, is highly informative. Thanks to modern technologies, it is possible to obtain an image of the heart in both two-dimensional and three-dimensional projections. In addition, the method allows you to learn about the speed of blood flow and pressure in certain parts of the vascular system. Making the correct diagnosis depends on the skill of the specialist who will interpret the results.

In addition to Echo-KG, problems in the work of the heart are diagnosed using computed or magnetic resonance imaging. Such research methods are very useful if it is necessary to simultaneously monitor the state of several body systems, for example, cardiovascular and respiratory. The complexity of these techniques lies in the fact that for their correct implementation, complete immobility of the patient is necessary, and it is quite difficult to achieve this from a small child. Therefore, if necessary, for the correct diagnosis, the study can be carried out under anesthesia. Not a very pleasant nuance can also be called the high cost of these procedures.

If it is necessary to determine the oxygen content and pressure in the cavities of the heart, the doctor may prescribe catheterization. In this case, a contrast agent is injected into the vein in order to visualize the cavities of the heart and blood vessels (angiocardiography). Such a study, due to the complexity of the conduct, may require the stay of a small patient in a hospital.

Text: Tatyana Okonevskaya

4.88 4.9 out of 5 (25 votes)

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

Tasks

2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.

4. Diagnostic study plan.

5. Vegetable puree technique .

Sample answers

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

Sample answers

The conclusion was given on the basis of complaints and an objective examination: vomiting "coffee grounds", dizziness, weakness, pallor of the skin, tachycardia, decreased blood pressure, pain in the epigastric region.

2. First aid - lay the patient down, cold on the stomach area, swallow pieces of ice, urgent hospitalization in a hospital, consultation with a surgeon.

3. Diagnostic study plan in the hospital:

a) general analysis of blood, urine;

b) FEGDS - to determine the nature and localization of the ulcerative defect of the gastric mucosa.

Treatment: diet - table No. 1a, No. 1b, No. 1. Of the medicines, drugs are needed that suppress Helicobacter pylori infection: de-nol, de-nol + oxacillin, de-nol + trichopolum. Antisecretory agents: pepsin, cholinomimetics, atropine, platifillin, selective M1-cholinomimetics - gastrocetin, antacids and adsorbents: almagel. maalox, vikalin. Gastrocytoprotectors: cytotec, smecta, agents that normalize gastric motility: cerucal, no-shpa, papaverine. Sedatives: elenium, diazepam, valerian. Reparants: sea buckthorn oil, rosehip oil.

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

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

Task number 5. (pediatrics)

Tasks

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

3. Plan for a diagnostic study in a hospital.

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

5. Demonstrate the Zimnitsky urinalysis technique .

Sample answers

The diagnosis is substantiated by the data of the anamnesis and complaints: the child has weakness, abdominal pain, fever in the evenings, frequent urination, cloudy urine.

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

3. Diagnostic studies in the hospital: general urinalysis, urinalysis for flora and sensitivity to antibiotics, Nechiporenko urinalysis, Zimnitsky test, X-ray urological research methods, ultrasound of the kidneys.

4. The treatment of pyelonephritis is complex. The child is prescribed a regimen and diet appropriate to his condition, antibacterial and stimulant drugs. Strict bed rest during the acute period of the disease.

Antibiotics are prescribed. Carry out phytotherapy. Lysozyme, prodigiosan, methyluracil, pentoxyl, sodium nucleinate are used as immunocorrective agents.

With an increase in blood pressure, antihypertensive drugs are prescribed.

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

5. The collection of urine analysis according to Zimnitsky is carried out according to the algorithm for performing manipulations.

Sample answers

1. Violated needs: breathe, sleep, rest, play, be healthy, communicate.

Patient problems

real:

Ineffective airway clearance;

Sleep disturbance;

Concern about the outcome of the disease;

potential:

High risk of suffocation;

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

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

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

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

Evaluation: the patient will notice an improvement in the condition, elimination of suffocation, demonstrate knowledge about the prevention of suffocation attacks. Goals will be achieved.

Problem #59

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

Medical diagnosis: KINE (intestinal infection of unclear form).

Tasks

1. Violated needs: to be healthy, eat, drink, excrete, maintain body temperature.

Patient problems:

real:

repeated vomiting,

dehydration,

Weakness,

Body temperature subfebrile;

potential:

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

2. Priority problems: diarrhea, dehydration.

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

Long-term goals: The child will be healthy by the time of discharge.

Evaluation: the patient will note an improvement in the condition, the absence of diarrhea, vomiting. Goals will be achieved.

Problem #60

During the next visit to the clinic by a child of 1 year old, weighing 10700 grams, the nurse noticed a sharp pallor of the skin and mucous membranes. The mother reported that the child quickly gets tired, irritable, inactive, noted loss of appetite. When questioning the mother, it was possible to establish that the child's diet is monotonous: dairy food, dairy products. The mother prefers not to give fruits and vegetables for fear of indigestion. A child under 1 g had ARVI 3 times. Blood history: Hb-100 g/l, Er-3.0x10 12, c.p. - 0.8

Medical diagnosis: iron deficiency anemia.

Tasks

1. Identify the needs, the satisfaction of which is violated; formulate and justify the patient's problems.

2. Set goals and plan nursing interventions with motivation.

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

Tasks

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

4. Teach the mother how to care for the child's nasal cavity.

5. Demonstrate eye and nose drops to a child.
^

Sample answers

Patient problems:

real:

Ineffective airway clearance

bad sucking

Anxiety.

potential:

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

The priority problem is ineffective airway clearance.

2. Short term goal: improved airway clearance after one week.

Long-term goal: normalization of nasal breathing.

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

4. The student will demonstrate to the mother the right technique for the rules of nasal cavity care.

Examination: body temperature - 36.4º C, Ps - 130 per minute, NPV 40 per minute. The skin is pale, clean. Respiration is noisy, with labored inhalation. During inspiration, the intercostal spaces, supraclavicular regions, and jugular fossa are drawn in. The child has a dry barking cough. Harsh breathing in the lungs. Heart sounds are muffled. Physiological functions are normal.

Tasks

2. Set goals and plan nursing interventions with motivation.

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

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

5. Demonstrate a hot footbath to a 1 year old.
^

Sample answers

Patient problems

real:

Ineffective airway clearance (cough),

Labored breathing.

potential:

High risk of suffocation

Deterioration of the child's condition associated with complications.

The primary problem is difficulty breathing.

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

After 1-2 days.

Long-term goal: The mother will have no complaints of shortness of breath by the time of discharge.

Evaluation: the child's breathing is normal. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her the need for inpatient treatment in an accessible, competent and reasoned manner.

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

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

On examination, the movements of the girl are uncoordinated, violent. On the face, almost constantly, grimaces appear. The girl cries for no reason, then suddenly starts laughing. Sleep is disturbing, appetite is reduced. The skin is clean, pale. Pulse 100 per minute, respiratory rate 20 per minute. The heart sounds are sonorous, a systolic murmur is heard at the apex and in the so-called Botkin. Vesicular breathing in the lungs. Physiological functions are normal.

Tasks

3. Explain to the mother the need to comply with the protective regimen.

4. Train the mother to communicate with the girl.

5. Demonstrate the technique of injecting 500,000 penicillin.
^

Sample answers

Child problems

real:

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

potential:

Increased neuromuscular excitability.

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

Dress, undress, use the toilet.

2. Short term goal: Uncoordinated violent movements will decrease by the end of the week. The girl will calm down.

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

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

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to comply with the protective regime.

4. The student will demonstrate to the mother the right method for teaching communication with her daughter.

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

Tasks

2. Set goals and create a nursing intervention plan with motivation.

3. Explain the need for bed rest.

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

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

Sample answers

Patient problems

real:

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

Exercise intolerance due to endomyocarditis,

Fever,

Decreased appetite.

potential:

Acquired heart disease

Repeated attacks of rheumatism.

2. Short-term goal: by the end of the week, body temperature returns to normal, the symptoms of polyarthritis will decrease.

Long-term goal: by the time of discharge, the child will not be disturbed by pain in the joint, with physical exertion there will be no shortness of breath and palpitations.

Evaluation: after 7 days the child's condition will improve: pain in the right knee joint will disappear, body temperature will return to normal. Reduced shortness of breath on exertion. The goal will be reached.

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

4. The student will demonstrate to the mother the right method for organizing the leisure time of the child who is on bed rest.

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

Tasks

2. Set goals and create a nursing intervention plan with motivation.

3. Explain to the mother the nutritional features of a child with spasmophilia.

4. Teach the mother how to make calcined curd.

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

Sample answers

Patient problems

real:

Increased neuromuscular excitability

disturbing dream,

Irrational feeding.

potential:

Possible occurrence of repeated convulsions.

Delay in neuropsychic development with prolonged seizures.

Of these problems, the priority is increased neuromuscular excitability.

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

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

Evaluation: the mother will note that by the end of the week the child has become calmer, the convulsions have ceased to recur. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her the features of the child's nutrition with spasmophilia in an accessible, competent and reasoned manner.

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

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

On examination: the temperature is 39.5 ° C, the skin is pale, clean. At the time of examination, the child is worried, he has an increased sensitivity to all kinds of stimuli. The child has severe stiff neck muscles, positive upper and lower Brudzinski's symptoms, Kernig's symptom. Heart sounds are muffled, vesicular breathing in the lungs. The abdomen is soft, there was no stool.

Tasks

2. Set goals and create a nursing intervention plan with motivation.

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

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

5. Demonstrate the technique of injecting 400,000 penicillin.
^

Sample answers

Patient problems

real:

Fever,

Hypersensitivity to all kinds of stimuli,

Headache,

Vomiting due to cerebral edema.

potential:

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

Of these problems, the priority is headache.

2. Short-term goal: by the end of the week, headaches will become less disturbing, the child will stop fever at high numbers.

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

Evaluation: By the end of the week, the child's headaches will decrease, the fever will drop to subfebrile numbers. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her the need for a lumbar puncture in an accessible, competent and reasoned manner.

4. The student will demonstrate to the mother the rules for caring for a child after a lumbar puncture.

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

Tasks

2. Set goals and create a nursing intervention plan with motivation.

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

4. Teach your child to rinse the mouth.

5. Demonstrate the technique for administering DTP vaccine.
^

Sample answers

Patient problems

real:

Fever,

Pain in the throat when swallowing due to the inflammatory process,

Headache.

potential:

Swallowing disorders, speech and vision disorders.

Of these problems, the priority is sore throat when swallowing.

2. Short-term goal: by the end of the week, the child will have less sore throat when swallowing, body temperature will normalize.

Long-term goal: By the time of discharge, the child will have a clinical recovery.

Evaluation: by the end of the week the child's condition will improve: the body temperature will return to normal, the symptoms of intoxication will decrease, sore throat when swallowing. The goal will be reached.

4. The student will demonstrate to the mother the rules of rinsing the mouth.

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

During a nursing examination, the nurse received the following data: while crying, the child's shortness of breath increased, cyanosis of the whole body appeared. After providing emergency care, the child was taken to the hospital. Congenital heart disease in a child was diagnosed from birth. With physical exertion, the child increases shortness of breath, cyanosis. The child has reduced appetite, poorly gaining weight.

On examination: NPV - 60 per minute, pulse 160 beats per minute, the child lags behind in physical development, the skin is pale, acrocyanosis is pronounced. Heart sounds are sonorous, a rough systolic murmur is heard over the entire region of the heart. Puerile breathing in the lungs, the abdomen is soft. Physiological functions are normal.

Tasks

2. Set goals and create a nursing intervention plan with motivation.

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

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

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

Sample answers

Patient problems

real:

Dyspnea,

Exercise intolerance due to heart failure

decreased appetite,

O-breathing cyanotic attacks.

potential:

decompensated heart failure,

High risk of death during dyspnea-cyanotic attacks, a sharp lag in physical development.

Of these problems, the priority is exercise intolerance.

2. Short-term goal: Within a day, the child's dyspnea and cyanosis should improve.

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

Evaluation: The child's shortness of breath and cyanosis will decrease during the day. He will become better able to tolerate physical activity, and his appetite will improve. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to limit the child's physical activity.

4. The student will demonstrate the correct method of teaching the mother and the rules for counting breath and assessing the color of the skin.

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

During the nursing examination, the nurse received the following data: T body-38 o C, pronounced edema on the face, trunk, limbs. The child is lethargic, capricious. The skin is pale. Appetite is reduced. Pulse - 116 per minute, NPV - 24 per minute, BP-105/70 mm Hg. Urinating rarely, in small portions. Complains of back pain. Pasternatsky's symptom is positive on both sides. In the analysis of urine: protein - 3.3%, density - 1012, leuk. - 2-3 p / sp., er.-2-3 in p / sp., cylinders - 5-6 in p / sp.

Tasks

2. Set goals and plan nursing interventions with motivation.

3. Explain to the mother how and why urine is collected according to Zimnitsky.

4. Teach the mother how to count fluids she has drunk and excreted.

5. Demonstrate the manipulation "Collecting urine from infants".
^

Sample answers

Maintain state.

Patient problems

real:

oliguria,

Fever,

Back pain.

potential:

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

Of these problems, the priority are edema and oliguria.

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

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

Evaluation: swelling will decrease, urination will become more frequent. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her the essence of the assigned examination in an accessible, competent and reasoned manner.

4. The student will demonstrate the correct method for teaching the mother to count the amount of fluid drunk and excreted. Provides training in accordance with the manipulation standard.

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

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

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

Tasks

2. Set goals and plan nursing interventions with motivation.

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

5. Demonstrate measles vaccination.
^

Sample answers

Patient problems

real:

Purulent conjunctivitis,

Dry cough, serous discharge from the nose,

Photophobia,

maculopapular rash,

Tachycardia,

tachypnea

Insulation.

potential:

The risk of developing pneumonia

Blepharitis.

Of these problems, the priorities are photophobia, dry cough.

2. Short-term goal: The child's fever and catarrh will decrease in 2-3 days.

Long-term goal: catarrhal phenomena and rashes stop after a week.

Evaluation: catarrhal phenomena are stopped, the rash will disappear, the child will be safe in 9 days. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to isolate the child.

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

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

When collecting data, it was revealed: T-37.2 o C. The condition is satisfactory. Disturbed by a slight runny nose, coughing. On the whole body, more on the buttocks, extremities, itchy, small-spotted rash. Palpated enlarged lymph nodes up to 1.0 cm in diameter, b/b, mobile. Physiological functions are normal.

Tasks

2. Set goals and plan nursing interventions with motivation.

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

4. Educate the mother on mucosal care

5. Demonstrate eye drops.
^

Sample answers

Patient problems

real:

Runny nose,

coughing,

small rash,

Insulation.

Of these problems, the priority is itching.

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

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

Evaluation: the rash will disappear in 2-3 days, the child will be healthy in 5 days. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to isolate the child.

4. The student will demonstrate the correct method for teaching the mother the rules of mucosal care.

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

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

On examination: the child's condition is satisfactory, active, playing. During examination of the pharynx, a coughing attack developed, a series of coughing shocks, accompanied by deep whistling breaths. The child's face is hyperemic, with a cyanotic tint, swelling of the cervical veins, tongue protruding from the mouth. The attack ended with the discharge of a small amount of viscous sputum. The temperature is normal. The skin is clean. On organs and systems without pathology. Diagnosis: whooping cough, period of spasmodic cough.

Tasks

2. Set goals and plan nursing interventions with motivation.

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

4. Teach your mother how to make mustard plasters.

5. Demonstrate the setting of mustard plasters.
^

Sample answers

Patient problems

real:

paroxysmal cough,

Urinary incontinence,

potential:

The risk of complications: bronchitis, pneumonia, prolapse of the rectum, hernia, hemorrhages in the sclera, brain.

Of these problems, the priority is paroxysmal cough.

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

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

Evaluation: coughing fits will decrease in a week, the child will be healthy in 30 days without complications. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need for a calm environment in the family.

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

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

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

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

Diagnosis: scarlet fever, severe course.

Tasks

2. Set goals and plan nursing interventions with motivation.

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

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

5. Demonstrate throat and nose swabs on BL.
^

Sample answers

Patient problems

real:

Sore throat,

Headache,

Joint and muscle pain,

Fever,

Purulent plaque on the tonsils,

Child isolation.

potential:

The risk of developing myocarditis, nephritis.

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

Articular, muscular, head).

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

Long-term goal: The child will be healthy in 10 days without complications.

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

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her the need for taking antibiotics in an accessible, competent and reasoned manner.

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

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

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

Tasks

2. Set goals and create a nursing intervention plan with motivation.

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

4. Teach the mother how to wash the baby.

5. Demonstrate washing the baby.
^

Sample answers

Real Problems:

Fever,

polymorphic rash,

Headache,

refusal to eat,

^ Potential issue:

The risk of developing stomatitis, "chickenpox", pyoderma.

Priority problems: fever, polymorphic rash.

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

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

Evaluation: the child will be healthy in 9 days without complications. The goal will be reached.

4. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her the need for skin treatment in an accessible, competent and reasoned manner.

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

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

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

There is slight hyperemia in the pharynx. On the part of other organs and systems, no visible pathology was detected. Diagnosis - epidemic parotitis.

Tasks

2. Set goals and create a nursing intervention plan with motivation.

3. Explain to the mother what “child isolation” means for an infectious disease.

4. Teach the mother how to take thermometry.

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

Sample answers

Real problems:

Fever,

Pain and swelling in the parotid region on the right,

Throat hyperemia,

Capriciousness of the child.

potential:

The risk of developing serous meningitis, pancreatitis, purulent parotitis.

Priority problem: parotid pain and fever.

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

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

Evaluation: the child will be healthy without complications in 9 days. The goal will be reached.

3. The student will demonstrate the correctly chosen level of communication with the mother, the ability to explain to her in an accessible, competent and reasoned manner the need to isolate the child.

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

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

Exercise

2. Set goals and plan nursing interventions with motivation.
^

Sample answers

Patient problems

real:

Ineffective airway clearance;

Sleep disturbance;

Concern about the outcome of the disease;

potential:

High risk of suffocation;

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

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

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

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

Evaluation: the patient will notice an improvement in the condition, elimination of suffocation, demonstrate knowledge about the prevention of suffocation attacks. Goals will be achieved.

Medical diagnosis: KINE (intestinal infection of unclear form).

Tasks

2. Set goals and plan nursing interventions with motivation.
^

Sample answers

Patient problems:

real:

Diarrhea,

repeated vomiting,

dehydration,

Weakness,

Body temperature subfebrile;

potential:

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

2. Priority problems: diarrhea, dehydration.

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

Long-term goals: The child will be healthy by the time of discharge.

Evaluation: the patient will note an improvement in the condition, the absence of diarrhea, vomiting. Goals will be achieved.

Medical diagnosis: iron deficiency anemia.

Tasks

2. Set goals and plan nursing interventions with motivation.
^

Sample answers

Patient problems:

real:

Anorexia errors in the diet,

Fast fatiguability,

Irritability,

Weakness,

Paleness of the skin and mucous membranes.

potential:

Risk of developing moderate to severe anemia

The main problem is anorexia.

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

2) long-term - the child's parents will notice an improvement in the condition by the time of discharge, they will not complain about the child's lack of appetite, increased irritability of the child.

Evaluation: the patient will feel satisfactory, become active, sociable. Parents will demonstrate knowledge about the proper nutrition of the child. Goals will be achieved.

Objectively: a state of moderate severity. Consciousness is clear. The skin is clean, pale. Extremities are cold. The mucous membrane of the throat is hyperemic. Nasal breathing is difficult, serous discharge from the nasal passages. Micropolyadenia. Muscle tone is diffusely reduced. Large fontanel 2.0x1.5 cm, dense edges, no craniotabes. 2 teeth. The chest is compressed from the sides, deployed in the lower aperture, "rosary". "Bracelets" are palpated. Percussion and auscultation from the lungs without pathology. The borders of the heart are not expanded. The tones are loud, clear, rhythmic. The abdomen is soft and painless. The liver and spleen are not enlarged. Stool and urination are not disturbed. Meningeal symptoms were not detected.

In the presence of a doctor, an attack of convulsions occurred. The child noted twitching of the limbs, over-bending of the torso. The duration of the attack - 7 seconds, stopped on their own. The body temperature at that moment was 39.5º C. After the attack, consciousness was restored.

Medical diagnosis: Rickets. SARS.

Tasks

2. Set goals and plan nursing interventions with motivation.
^

Sample answers

Patient problems:

real:

Runny nose,

Dry cough,

Fever;

convulsions,

Weakness;

potential:

Threat of development of a lethal outcome owing to a hyperthermia.

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

Short-term - the patient will notice a decrease in body temperature, no seizures, no runny nose and cough after 2 days;

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

Evaluation: the patient will notice a significant improvement in his condition, the temperature will decrease, the convulsions will stop. Parents will demonstrate knowledge about the prevention of hyperthermia. The goal will be reached.

Objectively: the child's condition is moderate, excited, scratching the skin during the examination. There are greasy crusts on the scalp and eyebrows. The skin of the cheeks is dry, flaky, brightly hyperemic. On the skin of the trunk and extremities there are a small number of smooth, shiny papules, traces of scratching. In the inguinal areas, the skin is eroded, moderate hyperemia. Micropolyadenia. In the lungs percutere lung sound, puerile breathing. The boundaries of the heart are not expanded, the tones are clear, the abdomen is painless. The spleen is not enlarged. The chair is unstable up to 4-5 times a day, semi-liquid, without pathological impurities.

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

Medical diagnosis: Exudative diathesis.

Tasks

2. Set goals and plan nursing interventions with motivation.
^

Sample answers

real:

Skin itching;

Sleep disturbance;

Unsteady stool;

Bad sleep;

The cheek skin is dry, flaky, brightly hyperemic, papular rash on the body and extremities, blood eosinophilia, micropolyadenia.

potential:

The threat of developing chronic diseases (eczema, bronchial asthma)

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

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

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

Evaluation: the child will notice an improvement in the condition, the itching will pass, there will be no rash, the parents will demonstrate knowledge about the prevention of allergies in the child. Goals will be achieved.

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

Medical diagnosis: peptic ulcer of the stomach.

Stomach bleeding.

Tasks

2. Set goals and plan nursing interventions with motivation.
^

Sample answers

Patient problems:

real:

Vomiting coffee grounds

Decreased A / D,

Decrease in circulating blood volume

Pain in the epigastric region

Weakness,

heartbeat,

Dizziness,

Noise in ears,

Paleness of the skin;

potential:

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

2. Patient's priority problem: vomiting coffee grounds.

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

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

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

Medical diagnosis: scarlet fever.

Tasks

2. Set goals and plan nursing interventions with motivation.
^

Sample answers

Patient problem:

real:

Headache,

Fever,

Sore throat;

potential:

The risk of developing lymphadenitis, otitis media,

The risk of developing nephritis, rheumatic heart disease.

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

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

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

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

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

Goals will be achieved.

The patient's failure to appear without good reason at the appointed time for a medical examination is the basis for reducing the amount of disability benefits from the date of failure to appear. In addition, in certain cases, your absence from work can be regarded as absenteeism, the extreme measure of punishment for which is dismissal (paragraph “a”, paragraph 6 of part 1 of article 81, article 192 of the Labor Code of the Russian Federation; paragraph 2 of part 1 , paragraph 1, part 2, article 8 of the Law of December 29, 2006 N 255-FZ).

1. A note about late attendance at a doctor's appointment

The fact of late attendance at the reception should be recorded by the attending physician in the disability certificate. To do this, in the line “Notes on violation of the regime”, he indicates the code for the type of violation (- untimely appearance for an appointment with a doctor), the date of untimely appearance and puts his signature.

2.2.2. Calculation of benefits if you came to the doctor late while still sick

If you missed the date of your appointment with the doctor and came to him later, continuing to get sick, you can extend the sick leave. At the same time, it should be borne in mind that the extension of the disability certificate for the past time can be carried out in exceptional cases by decision of the medical commission when you apply to a medical organization or visit you by a medical worker at home (clause 14 of the Procedure).

Benefits for the period following the date you missed your appointment until your recovery date will be paid in full if you have good cause. If the reason for not attending a doctor's appointment is disrespectful, the allowance for these days can be calculated on the basis of the minimum wage (parts 1, 8, article 6, part 2, article 8 of Law N 255-FZ).

At the same time, judicial practice proceeds from the fact that the legislation does not contain a provision that failure to appear at the appointed time for a medical examination entails a reduction in the amount of benefits from the day of failure to appear for the entire period of disability. In addition, this measure must be proportionate to the violation (Resolution of the Presidium of the Supreme Arbitration Court of the Russian Federation of February 14, 2012 N 14379/11).