Grand Canyon and vegas night bingo. What will happen for the untimely appearance of the patient for an appointment? During the next visit

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TASKS FOR THE EXAM
discipline: "Pediatrics with childhood infections"
for students of the specialty: "Medicine" 4 course, 8 semester

TaskN 1
A mother, with a 2.5-year-old girl, went to the local doctor about frequent and painful urination in the child, abdominal pain and fever up to 37.5 ° C. Examined by a surgeon, surgical pathology was excluded. These symptoms were observed twice during the year, and after the examination, the diagnosis of cystitis was made. The treatment was carried out on an outpatient basis. History of frequent colds (7 times acute respiratory infections in the last year). Parents are healthy, but my grandmother on my mother's side has a kidney disease.
Objectively: weight 11.5 kg, length 85 cm. Condition is satisfactory. Asthenic physique. The skin and visible mucous membranes are clean. Lymph nodes: tonsillar, painless, up to 0.8 cm in size, not soldered to the surrounding tissue. The subcutaneous fat layer is developed satisfactorily. Above the lungs percussion sound of the lungs, puerile breathing is heard. The borders of the heart correspond to age. The tones are clear and rhythmic. The abdomen is soft, painful above the bosom. The liver and spleen are not enlarged. Pasternatsky's symptom is positive on both sides. Painful urination, 15 times a day.
In the general analysis of urine: alkaline reaction, relative density of urine 1012, cloudy, leukocytes 20-25, squamous epithelium 3-5 in the field of view. Blood test: ESR 25 mm/hour, L - 12 x 109/l, Hb 108 g/l. Zimnitsky's test - daytime diuresis 300 ml, nocturnal diuresis 500 ml, specific gravity fluctuations 1005 - 1012.
Ultrasound of the kidneys: the size corresponds to the age, the position and mobility are normal, there is a seal of the pelvicalyceal system on both sides, doubling of the kidney on the right.

Tasks:

TaskN2
During the next patronage visit of a 1-year-old child, the paramedic drew attention to 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 was monotonous, milk porridge twice a day. Prefers not to give fruits and vegetables, fearing indigestion. On such a diet, the child gains weight, which pleased the mother. They live in a hostel and rarely go out.
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:

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.

Problem N3
A mother with a 5-year-old girl came to the children's polyclinic. The child has weakness, pain in the abdomen, loss of appetite, in the evenings the temperature rises to 37.9 ° C. The mother noticed that the girl urinates often, the urine is cloudy. Tongue dry, covered with white coating. In the lungs, breathing is vesicular, heart sounds are muffled. The abdomen is soft and painful. The liver and spleen are not enlarged.

Tasks:

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis and methods of investigation of this disease.
3. Tell us about the principles of treatment of the disease.

TaskN4
Parents of Sasha M., 3 years old, turned to a nephrologist with complaints of lethargy, swelling in the face and legs, loss of appetite, abdominal pain.
From the anamnesis, it was revealed that the boy often suffers from colds, and two weeks ago he had a sore throat. Home treatment: biseptol, pharyngosept, multivitamins. Genealogical and social history without features.
Objectively: the state of moderate severity, pale skin, blue under the eyes, swollen eyelids, swelling on the legs. In the pharynx, the mucous membranes are of physiological color, the lymph nodes are up to 0.5 cm in diameter, slightly painful, not soldered to the surrounding tissue. The subcutaneous fat layer is developed satisfactorily. From the side of the heart and respiratory organs, no pathology was detected. The abdomen is soft on palpation, there is slight pain, the liver and spleen are not enlarged.
In the general analysis of urine: protein 14 g/l, relative density 1030, alkaline reaction, erythrocytes up to 20 in the field of view. Leukocytes 8 - 10 in the field of view hyaline cylinders.
In the general blood test: E - 4.0 x 1012/l, Hb - 100 g/l, L - 4.7 x 109/l, ESR - 69 mm/hour. Blood biochemistry: residual nitrogen 35.7 mmol/l, urea 13.48 mmol/l, total blood protein 46.8 g/l.

Tasks:

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.
3. Tell us about the scope of first aid and the rules for transportation to the destination.
4. Make a plan for diagnostic studies in the hospital, tell us about the patient's preparation for them and the principles of treatment.

TaskN5
Sasha P.'s mother, 10 months old, complained of the child's fever, wet cough, mucous discharge from the nose, and loss of appetite. A child from young, healthy parents, from the first pregnancy, which proceeded safely. Delivery is urgent normal. Birth weight 3600, length 50 cm, Apgar score 8 points. The boy was breastfed up to 3 months. Complementary foods and vitamin D were introduced in a timely manner. The daily routine was respected, systematically went for walks. On examination, the body temperature was 38.2°C, shortness of breath was expressed with the participation of the wings of the nose. When crying, screaming, cyanosis of the nasolabial triangle appears, frequent wet cough. Muscle tone is sufficient, nutrition is good. Single, cervical, axillary, lymph nodes are palpable, mobile, painless. Large fontanel 0.5 x 0.5 cm, dense edges. Percutere: a sound with a slight tympanic tint, with auscultation against the background of hard breathing in the posterior lower sections and in the axillary regions, there is an abundance of small and medium bubbling moist rales. There is retraction of the intercostal spaces. Respiration 28 - 32 per min. The boundaries of the heart correspond to the age norm. The tones are distinct, the pulse is software in min. The abdomen is moderately swollen, painless on palpation, panerchymatous organs are not enlarged. Chair 2 times a day without pathological impurities. Complete blood count Hb - 142 g / l, E - 4.32x1012 / l, L - 11.2x109 / l, E - 2%, P - 2%, C - 64%, L - 28%, M - 4% , ESR - 24 mm/hour. Urinalysis - no features. X-ray of the chest organs: increased lung pattern, small-focal shadows in the posterior-lower sections on both sides. The roots are structureless, the sinuses are free, the heart is within the normal range.

Tasks:

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.
3. Tell us about the scope of first aid and the rules for transportation to the destination.
4. Make a plan for diagnostic studies in the hospital, tell us about the patient's preparation for them and the principles of treatment.

TaskN6
Seryozha, 9 years old, complains of high fever, pain in the chest and right side of the abdomen, shortness of breath, pain with deep inspiration, short painful cough, mostly dry, sometimes with scanty sputum. He fell ill last night, the temperature rose to 39 ° C, chills and all the listed complaints appeared.
Objectively: the child's condition is severe, "groaning" breathing, respiratory rate up to 40 per minute, the skin is pale, there is a blush on the right cheek. The cyanosis of the nasolabial triangle is pronounced, the lymph nodes are not enlarged. When examining the chest of the correct form, there is some lag in the right half in the act of breathing. On percussion, the borders of the lungs were not changed. Dullness of percussion sound is revealed on the right in the subscapular region. Auscultatory breathing is sharply weakened on the right, no wheezing, pulse 128 per minute. The belly of the correct form of the usual configuration, is involved in the act of breathing. The liver and spleen are not enlarged, stools and urination are not disturbed. Blood test E - 4.2x1012 / l, L - 14.0x109 / l, P - 8%, C - 62%, L - 24%, M - 3%, Hb - 134 g / l, ESR - 32 mm / hour. Urinalysis without pathology. On the radiograph - pulmonary fields of the correct form, increased bronchovascular pattern. In the lower lobe of the right lung there is a homogeneous intense eclipse. The sinuses are free, the cardiac shadow is without features.

Tasks:

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.
3. Tell us about the scope of first aid and the rules for transportation to the destination.
4. Make a plan for diagnostic studies in the hospital, tell us about the patient's preparation for them and the principles of treatment.

Problem N7
Ilsur Sh., 7 years old, went to the doctor with complaints of a rise in temperature up to 38.5 ° C, expressed: general malaise, weakness, lack of appetite. A sick child is considered within 2.5 weeks, when the temperature first rose to 39 ° C and pain in the joints appeared. Swelling of the joint was not noted, the pain was "flying" in nature. Twice there was a short nosebleed. The onset of the disease is associated with hypothermia. The child did not seek medical help, the child received Biseptol and Panadol for 5 days. About a month ago, the boy suffered from acute respiratory infections, was treated with folk remedies. Of the past diseases: 7 times angina, twice bronchitis, frequent acute respiratory infections. Grandmother on the mother's side suffers from rheumatism.
Objectively: a state of moderate severity, lethargic, pallor of the skin, moderate pastosity of the lower extremities, shortness of breath - respiratory rate up to 30 per minute. Lymph nodes without features. The musculoskeletal system without pathology, joints without visible inflammatory changes, active and passive movements in full. In the lungs without pathology. Heart - the tones are muffled, a rough blowing systolic murmur is heard at the apex, the pulse is 120 per minute. BP - 75/60. The liver and spleen are not enlarged. The chair is regular. Urinate 3-4 times a day.
Blood test: E - 4.2x1012 / l, L - 14.0x109 / l, P - 6%, C - 58%, L - 20%, M - 3%, E - 1%, Hv - 120 g / l , ESR - 42 mm/hour, Tr - 245x109/l, CRP +++, total protein 65%.
Urinalysis: straw-yellow color, transparent, specific gravity 1015, protein negative, leukocytes 1-2 in the field of view.

Tasks:

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.
3. Tell us about the scope of first aid and the rules for transportation to the destination.
4. Make a plan for diagnostic studies in the hospital, tell us about the patient's preparation for them and the principles of treatment.

TaskN8
Alyosha 5 years old. Complaints: the appearance of a rash on the skin of the trunk and limbs, recurring pain in the abdomen. The rash appeared 3 days ago, but the parents did not attach due importance to it, they did not go to the doctor, the boy continued to attend school and the sports section. Since yesterday, my mother noticed that the rash became much more abundant, I slept restlessly at night, woke up because of pain in my stomach. Two weeks ago, he had an acute respiratory viral infection and was treated on an outpatient basis.
Objectively: the state of moderate severity, pain in the abdomen, subfebrile temperature, noteworthy: a rash on the skin of the upper and lower extremities, mainly on the extensor surface, in the buttocks, on the auricles. The rash protrudes in relief above the surface of the skin, does not disappear with pressure, is symmetrically located, there are areas of a confluent nature of the rash. The mucous membranes of the mouth are clean. Joints are not deformed. Active and passive movements in full. In the lungs and heart without pathology, pulse 98 per minute. BP 110/70, abdomen of normal configuration, participates in the act of breathing, with superficial palpation soft, diffuse soreness, symptoms of peritoneal irritation are negative. The liver and spleen are not enlarged. The chair was black in the morning, decorated, urinates regularly.
Blood test: E - 4.2x109 / l, platelets - 245x109 / l, Hb - 134 g / l, leukocytes - 10.8x109 / l, P - 8%, C - 60%, L - 22%, M - 6 %, E - 4%, ESR - 32 mm/h, duration of bleeding according to Duke 3 min, urinalysis without pathology.

Tasks:

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.
3. Tell us about the scope of first aid and the rules for transportation to the destination.
4. Make a plan for diagnostic studies in the hospital, tell us about the patient's preparation for them and the principles of treatment.

TaskN9
A 10-year-old girl came to the clinic with complaints of nosebleeds and bloody vomiting. Has been bleeding since 4. years. Exacerbations occur 4-5 times a year in the form of nosebleeds and hemorrhages on the skin. Repeatedly treated in the hospital, the last time she received inpatient treatment 3 months ago, she was discharged with improvement. A girl from 1 normal pregnancy was born at term with a weight of 3200 g. From the age of one month on artificial feeding. I didn't get sick for a year. After a year, frequent acute respiratory infections. Allergological anamnesis is not burdened. Mother and father are 34 years old. The father suffers from hay fever.
Objectively: the condition of the girl is moderate. Attention is drawn to the pallor of the skin and the presence on the skin of the trunk and limbs of different colors of "bruises", ranging in size from 0.5x1.0 cm to 3x4 cm, as well as a petechial rash on the face and neck. Eschymoses are located asymmetrically. Single petechial elements on the oral mucosa, on the back wall of the pharynx, the blood of the tonsil does not protrude because of the arches. Lymph nodes are not enlarged. Vesicular breathing in the lungs. The heart sounds are clear, rhythmic, the pulse is 95 beats per minute. The liver and spleen are not enlarged, urination is not disturbed, the stool is formed, dark in color. In the blood test: Er. - 3.3x1012/l, Hb - 85 g/l, platelets 24.6x1012/l, leuk. -8.0x109/l. Duration of bleeding according to Duke 15 min. Gregersen's reaction is positive. Urinalysis without pathology.

Tasks

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.
3. Tell us about the scope of first aid and the rules for transportation to the destination.
4. Make a plan for diagnostic studies in the hospital, tell us about the patient's preparation for them and the principles of treatment.

TaskN 10
A 13-year-old girl went for a consultation with a nephrologist with complaints of overweight, the appearance of a large amount of protein in urine tests when she tried to refuse to take glucocorticoids. She has been sick since the age of 3, when edema, oliguria and proteinuria up to 14 g/l appeared after a sore throat. Since then, he has been constantly receiving 15 mg of prednisolone per day.
Objectively: the state of health is satisfactory. The skin of the face is red, there are cyanotic striae on the forehead, thighs and lateral surface of the abdomen. The subcutaneous fat layer is unevenly developed: excessive deposition in the face, neck, chest, abdomen. Lymph nodes are not enlarged. Nasal breathing is not disturbed. Palpation, percussion and auscultation did not reveal any changes in the respiratory organs. The area of ​​the heart is not changed and the boundaries are not expanded. The tones are clear, rhythmic, BP 115/60 mm Hg. on both hands. The abdomen is soft and painless. The liver and spleen are not enlarged. Stool and urination are not disturbed.
In the general analysis of urine without pathology. The nitrogen excretion function is not impaired. There are no deviations in the protein spectrum of the blood, the level of lipids and blood sugar.

Tasks

1. Formulate and justify the presumptive diagnosis.
2. Name additional symptoms to clarify the diagnosis, tell us about the method of their detection.
3. Tell us about the scope of first aid and the rules for transportation to the destination.
4. Make a plan for diagnostic studies in the hospital, tell us about the patient's preparation for them and the principles of treatment.

TaskN 11
Child 10 months I fell seriously ill. The temperature rose to 38.9°C. The condition deteriorated sharply, he became very lethargic, there was a single vomiting, he refuses to eat. He urinates often, in small portions, during the act of urination he is worried.
In the analysis of urine: protein - traces, erythrocytes - 1-2 in the field of view, leukocytes - 70-90 in the field of view. Escherichia coli was isolated from urine, the titer was 500,000 microbial bodies in 1 ml.

Tasks

1. Formulate and justify the presumptive diagnosis.
2. Where should this child be treated?
3. Features of the diet in this disease.

TaskN 12
You are a paramedic of the DCU. In the middle group of the kindergarten, 5 children underwent the Mantoux reaction with 2 TU. One of these children, a 5-year-old boy, had a negative Mantoux test a year ago. This Mantoux reaction with 2 TU is an 8 mm papule. The child does not complain. Active, emotional tone is preserved. Appetite is good. No changes were found in the internal organs. Analysis of blood, urine - no pathology.

Tasks

1. Formulate and justify the presumptive diagnosis.
2. What is your tactic?
3. Name the principles of treatment of this child.
4. What drug is used for the Mantoux test?
   Demonstrate the technique of its implementation on a phantom.

TaskN 13
You are a paramedic of a kindergarten, 20 children of the senior group were given a Mantoux test with 2 TU before the 1st BCG revaccination. In 5 children it was positive, in 15 it was negative.

Tasks

1. Name the vaccine used, describe it:
   • name the release form;
   • method and place of its introduction;
   • timing of vaccination and revaccination.
2. How is the vaccination process monitored?

TaskN 14
You are a medical assistant of the FAP, you are taking fixed appointments for children under one year old.
At the reception, a 7-month-old boy is breast-fed, healthy, growing and developing according to age. When carrying out anthropometry, the following data were obtained: body weight - 9200 g, body length - 72 cm, approx. head - 46.5 cm, approx. chest - 47 cm.

Tasks

1. Assess the physical development of the child using centile or sigma tables.
2. Describe his neuropsychic development and give recommendations for conducting classes with a child of this age.
3. Calculate the daily and one-time amount of food, make an approximate menu for 1 day.

TaskN 15
You are a FAP paramedic. During the patronage of a 3-month-old child, the mother complained that the baby was not suckling well on the 3rd day due to nasal congestion. Today he behaves uneasily, periodically cries, especially when sucking.
On examination: the patient's condition is satisfactory, body temperature is 37.2°C, mild serous discharge from the nose. Zev is clean. When pressing on the tragus - grimace, crying. On auscultation, breathing is puerile, NPV 35 r. in 1 min., PS 110 beats. in min. The abdomen is soft, stool, urination without features. Tasks

1. What is your tactic?
2. Prescribe treatment.

TaskN 16
Home call ambulance for a 9 month old baby. The day before he had a runny nose and a temperature of 37.2 ° C. At night he suddenly woke up and became restless. There was a barking cough, he began to choke. The temperature became 38°C.

Tasks

1. Formulate a presumptive diagnosis.
2. What urgent action should be taken?

TaskN 17
The child is 7 years old, attends school. The teacher notes that during the last "week the child became whiny, grimaces in the classroom, handwriting has changed.

Tasks

1. Formulate a presumptive diagnosis.
2. What disease can give such symptoms and to which doctor - specialist should the child be referred for a consultation? Tell us about the principles of treatment of this disease.

TaskN 18
A 2.5-year-old child suffering from congenital heart disease was admitted to the hospital with complaints of shortness of breath at rest and swelling in the legs.

Tasks

1. Formulate a presumptive diagnosis.
2. What kind of diet does the child need?
3. Help with heart failure.

TaskN 19
In the preparatory group of the kindergarten, 23 children underwent Mantoux test before BCG revaccination. In 3 children it was positive.

Tasks

1. Which children are eligible for revaccination?
2. What should a nurse do with children who have a positive Mantoux reaction?

TaskN20
The child is 15 years old. Recently, increased fatigue, loss of appetite, sweating, periodic rises in temperature to subfebrile have been noted. Fluorography revealed an increase in intrathoracic lymph nodes.

Tasks

1. Formulate a presumptive diagnosis.
2. Where should the child be referred for examination and diagnosis?

TaskN21
In the pioneer camp where you work as a nurse, a 10-year-old boy came to you with complaints of a headache, the appearance of urine of an unusual red color. On examination: swelling on the face under the eyes. The boy believes that he fell ill after swimming in the river (he has been in the camp for 7 days).

Tasks

1. Formulate a presumptive diagnosis.
2. What additional examinations need to be done?
3. What should a nurse do if there is no doctor in the camp?

TaskN22
A 10-year-old child was admitted to a children's hospital with complaints of headache, pain in the lumbar region. On examination, the boy is pale, his face is puffy, and there are swelling under the eyes. Daily diuresis is 600 ml. Tasks

1. Formulate a presumptive diagnosis.
2. What examinations should be carried out for the child?
3. What regimen and care does the child need?

TaskN23
Neighbors in the dacha turned to you for advice: their 5-year-old daughter began to urinate frequently and complains of cramps, pain when urinating. Urine cloudy with flakes.

Tasks

1. Formulate a presumptive diagnosis.
2. Does the girl need further examination?

TaskN24
Child, 4 months old, suffers from rickets. Treated on an outpatient basis. Gets vitamin D and calcium gluconate. Suddenly, in the morning, while eating, twitching of the limbs appeared, the child screamed, but the voice suddenly broke off, the child turned blue. After 30 sec. the skin turned pink, the convulsions stopped.

Tasks

1. Formulate a presumptive diagnosis.
2. What needs to be done?
3. What advice should be given to the mother?

TaskN25
A child, 15 days old, against the background of staphyloderma, suddenly developed a high temperature of 3-8.9 ° C, a grayish-cyanotic skin color, a pulse of weak filling and tension, and bloating. Respiration is frequent, with fluttering of the wings of the nose. Lung examination revealed no pathology. On the 5th day of illness, a clear shortening of the percussion sound diffusely over the entire surface appeared over the lungs, rales were moist, finely bubbling. On the radiograph, there is an infiltrate on the right in the middle lobe of the lung and a parietal pleura is constructed. Leukocytosis in blood 12.000 ml, ESR 22 mm/h .

Tasks

1. Formulate a presumptive diagnosis.
2. What could be the nature of this disease?
3. What is the danger of the disease?
4. Treatment (basic principles).

TaskN26
During the next visit to the clinic by a 1-year-old child, the doctor noticed a sharp pallor of the skin and mucous membranes. The mother reported that the child gets tired quickly, is irritable, inactive, and has lost his appetite. When questioning the mother, it was possible to establish that the child's diet is monotonous - dairy food (the mother gives the child a breast twice a day), the mother prefers not to give fruits and vegetables, fearing a digestive disorder. On such a diet, the child gained weight well, which pleased the mother.

Tasks

1. Formulate a presumptive diagnosis.
2. What additional examination can clarify the diagnosis?
3. What remedial measures should be taken?

TaskN27
Call for a 9 month old baby. Yesterday I had a runny nose and a dry cough. The temperature is 37.5° C. The child has manifestations of exudative diathesis. At night he suddenly woke up and became restless, there was a barking cough, shortness of breath, difficulty in breathing. The voice is hoarse. When examining the condition of the child of moderate severity, the child is restless. Peeling on the cheeks, hyperemia of the skin. Serous discharge from the nose. Hyperemia in the pharynx. In the lungs, dry rales against the background of hard breathing. Accessory muscles are involved in breathing.

Tasks

TaskN28
When taking blood from a finger, the child developed weakness, pallor of the skin, cold sticky sweat, blood pressure 60/40 mm Hg.

Tasks

1. Determine the emergency condition that the patient has developed.
2. Make an algorithm for emergency care.

TaskN29
An 8-year-old child undergoing inpatient treatment developed an asthma attack in the morning with difficulty exhaling, frequent dry cough, noisy breathing, wheezing wheezing can be heard at a distance.

Tasks

1. Determine the emergency condition that the patient has developed.
2. Make an algorithm for emergency care.

TaskN30
A 2-year-old child was delivered to the emergency department with nosebleeds, which is at home; it's been going on for about 1 hour now. The mother reported that a similar condition was observed 6 months ago. Then the boy was treated in a hospital with a diagnosis of hemophilia A.

Tasks

1. Determine the emergency condition that the patient has developed.
2. Make an algorithm for emergency care.

TaskN31
The mother of a 9-month-old child told the patronage nurse that since yesterday he had a runny nose, an increase in body temperature to 37.2 ° C, a hoarse voice, a loud “barking” cough appeared, the child began to choke, breathing was difficult, dry rales were heard in the lungs .

Tasks

1. Determine the emergency condition that the patient has developed.
2. Make an algorithm for emergency care.

TaskN32
A 10-year-old child hit his chest while playing. Complains of chest pain, coughing up bloody sputum

Tasks

1. Determine the emergency condition that the patient has developed.
2. Make an algorithm for emergency care.

TaskN33
An ambulance was called to the house for a 3-year-old child who was ill for the third day, and did not seek medical help. At night, the temperature rose to 38.5 ° C degrees, the child woke up, became restless, a barking cough appeared. When viewed in the pharynx, hyperemia of the pharynx is noted, breathing is difficult.

Tasks

1. Determine the emergency condition that the patient has developed.
2. Make an algorithm for emergency care.

TaskN34
Challenge for a 10 year old. Had a second rheumatic attack 1 year ago. Periodically complains of pain in the region of the heart, shortness of breath when climbing stairs, fatigue. Recently, the condition has deteriorated sharply, edema has appeared on the legs.

Tasks

1. Determine the emergency condition that the patient has developed.
2. Make an algorithm for emergency care.
3. Treatment.
4. Prevention.

Section "CHILDREN'S INFECTIONS"
TASK 1.
You are a paramedic, on a call from a 3-year-old child visiting a children's plant. Got sick three
days ago, he is worried about a strong cough, runny nose, lacrimation, body temperature 38 ° C - 38.5 ° C.
Epid. anamnesis: The child began to be vaccinated from the age of 2, vaccination was carried out
DPT and against polio. Contact with infectious patients is denied.
On examination: a state of moderate severity, photophobia, conjunctivitis, hyperemia in the pharynx, on
buccal mucosa - small-dotted white rashes, on the soft palate - enanthema. Breath
hard, heart sounds are quickened.

1. Where should this be treated? sick?

TASK 2.
You are a paramedic on a call from a 4-year-old child visiting a children's plant. He fell ill this morning, his body temperature rose to 37.8°C, he developed a slight cough and a red spotty-papular rash all over his body on a pale skin background, the rash covers the buttocks and the outer surfaces of the extremities more densely. In the pharynx - moderate hyperemia, occipital and posterior cervical lymph nodes are palpable, they are moderately painful. From the side of internal organs without changes.

1. What is your diagnosis, differential diagnosis?
2. Outline a plan of anti-epidemic measures in a preschool institution.

TASK 3.
You are a paramedic, on call from a child of 6 years old visiting a children's plant. Got sick at night
the temperature rose to 39 ° C, there was a headache, sore throat when swallowing, in the morning
a red rash was found all over the body.
On examination: a state of moderate severity, temperature 38.8 ° C, on the skin of the whole body for
hyperemic background, a red punctate rash with thickening in the folds of the skin and on
cheeks, nasolabial triangle pale. In the pharynx against the background of bright hyperemia on the left
purulent plaque in the lacunae in the tonsil. The tongue is covered with a gray coating, the pulse is frequent.

1. What is your diagnosis, differential diagnosis?
2. Where should such a patient be treated?

TASK 4.
You are a FAP paramedic, on call for a child of 6 years old. Sick day 2
worried about pain when chewing, turning the head, opening the mouth, fever.
On examination: temperature 38°C, swelling around the auricles on both sides,
painful on palpation. The child visits the children's plant, where there have already been cases
such a disease.

1. What is your diagnosis, justify it?
2. Your tactics in relation to the patient, his treatment?
3. Outline a plan of anti-epidemic measures in the children's plant.

TASK 5.
You are a paramedic, on call for a 5-year-old child. He fell ill acutely, for the 2nd day the temperature was 38.0-
38.7°C, decreased appetite, lethargy, pallor. On examination: moderate condition, pale, in the pharynx - moderate hyperemia of the tonsils, arches, swollen tonsils, on the left tonsil and on the anterior arch there are dense grayish plaques with clear edges. Enlarged and moderately painful submandibular lymph nodes on the left. The child attends kindergarten.

1. Your diagnosis, justify your answer.
2. Outline a plan of anti-epidemic measures in the DCU.

TASK 6.
You are a FAP paramedic on call for a 4-month-old child. This morning, all of a sudden, he
the temperature rose to 39 ° C, became restless, refuses to breast, on the skin
a rash appeared.
On examination: the condition is severe, lethargic, not interested in others, temperature 40.0 ° C,
pale skin, hemorrhagic rashes, star-shaped, size 3-5
mm, located on the buttocks, thighs, legs, eyelids. Tachycardia, muffled tones
hearts. At any touch, the child worries, cries.
Epid. anamnesis: a week ago, the mother had a runny nose, itching in her throat.

1. Your diagnosis, justify it.
2. Your tactics in relation to the patient, emergency care at the pre-hospital stage of treatment.
3. What medical documentation needs to be completed?

TASK 7.
You are a paramedic, on call for a child of 8 months. Sick 2nd day. Suddenly, the temperature rose to 38.9°C, he vomited twice, periodically he worries sharply, shudders in his sleep, the cry is monotonous.
On examination: a serious condition, severe lethargy, temperature 39.8°C, does not react to the environment, a large fontanelle bulges and is tense, the head is thrown back, during the examination it gave short-term convulsions.

1. Your diagnosis, justify it.
2. Your tactics in relation to the patient, emergency care.
3. Outline a plan of anti-epidemic measures in the outbreak.

TASK 8.
You are a paramedic, on call for a child of 3 months. During the examination, a coughing attack was observed in him: the attack began with coughing jolts following one after another, then a deep, labored breath came and again the child coughed, turned red, and then turned blue. The attack lasted a long time, ended in vomiting.

1. Your diagnosis, justify it.
2. Where to treat this patient, the period of isolation?
3. Outline a plan of anti-epidemic measures in the focus of infection.

TASK 9.
You are the paramedic of the children's plant. In the younger group, a 3-year-old child had a fever up to 37.8°C, a slight runny nose; a rash appeared on the skin of the face, chest, back, extremities in the form of small blisters with transparent contents, several blisters are located on the scalp. In the pharynx - moderate hyperemia.

1. Your diagnosis, justify it.
2. Where to treat the patient? period of isolation.
3. Outline a plan of anti-epidemic measures in the kindergarten.

TASK 10.
You are a paramedic, on a call for a 4-year-old child who is sick for the 4th day, has a temperature of 37.5-37.8 ° C, nausea, poor appetite, lethargy. Today, the mother of the child noticed the dark color of urine and light feces in the patient. In kindergarten there were cases of a similar disease.

1. Your diagnosis, justify it.
2. What is your tactic in relation to the patient?
3. Outline a plan of anti-epidemic measures in the kindergarten.

TASK 11.
You are a FAP paramedic, on call for a 6-year-old child. Sick 2nd day. The temperature has risen to 38°C, abdominal pain during and before the act of defecation. The chair is liquid with an admixture of mucus, frequent up to 10 times a day, during the act of defecation, the child strains. On examination: the state of moderate severity, pale, the abdomen is soft, painful in the left iliac region, spasmodic sigmoid colon is palpated there. The child visits the children's plant. 1 Your diagnosis, justify it.

1. Your tactics in relation to the patient.
2. Outline a plan of anti-epidemic measures in the kindergarten.

1. In a child 5 months of KINE with the phenomena of toxicosis and exsicosis.

2. Assign a water-tea diet for 4-6 hours with oral rehydration (regidron, glucosolan) 1-2 teaspoons
after 3-4 minutes and intravenous administration of plasma, rheopolyglucin, 5% glucose solution, vitamins. After

water-tea diet, you can give breast milk or sour mixtures: acidophilic milk or kefir, antibacterial drugs - polymyxin, etc.

Problem #36

Home call ambulance for a 9 month old baby. The day before he had a runny nose and a temperature of 37.2 ° C. At night he suddenly woke up and became restless. There was a barking cough, he began to choke. The temperature became 38°C.

Tasks

2. What urgent actions should be taken?

Sample answers

1. A 9-month-old child developed false croup against the background of SARS.

2. Provide emergency assistance:

distraction therapy (hot bath, soda inhalation), - drug treatment: hormones (prednisolone); desensitizing agents (suprastin, diazolin, pipolfen).

Problem #37

The child is 7 years old, attends school. The teacher notes that during the last week the child has become whiny, grimaces in class, handwriting has changed.

Tasks

1. Formulate a presumptive diagnosis.

2. What disease can give such symptoms and which specialist should be referred
child for counselling? Tell us about the principles of treatment of this disease.

Sample answers

1. A 7-year-old child has an active rheumatic attack, minor chorea.

2. It is necessary to consult a rheumatologist. Treat in a hospital. Antirheumatic treatment:
penicillin, aspirin, prednisolone, vitamins, suprastin, phenobarbital.

Problem #38

A 2.5-year-old child suffering from congenital heart disease was admitted to the hospital with complaints of shortness of breath at rest and swelling in the legs.

Tasks

1. Formulate a presumptive diagnosis.

2. What kind of diet does the child need?

Sample answers

1. A 2.5-year-old child with heart disease developed symptoms of heart failure.

2. The child must be hospitalized in a hospital, prescribe bed rest, a milk-vegetarian diet with
restriction of salt, liquid (up to 1 liter), from medicines - cardiac glycosides, vitamins.

Problem #39

A 10-year-old child was admitted to a children's hospital with complaints of headache, pain in the lumbar region. On examination, the boy is pale, his face is puffy, and there are swelling under the eyes. Daily diuresis is 600 ml.

Tasks

1. Formulate a presumptive diagnosis.

2. What examinations should the child have?

Sample answers

1. A 10-year-old child admitted to the hospital may have glomerulonephritis.

2. In a hospital, it is necessary to conduct an examination (test according to Zimnitsky, Nechiporenko, a general blood and urine test,
biochemical analysis of blood, ultrasound of the kidneys, excretory urography).

Task #40

The child was observed sanious discharge from the umbilical wound. Within one day, the child's condition changed: he became lethargic, lethargic, the skin acquired a gray-earthy hue. T=37.3°C. Around the umbilical wound there is a zone of hyperemia. The vessels of the anterior and abdominal walls are sharply contoured. A purulent discharge appeared from the umbilical wound.

Tasks

1. Formulate a presumptive diagnosis.

2. What can such a condition lead to?

Sample answers

1. A child may have omphalitis complicated by phlebitis.

2. It can lead to umbilical sepsis.

Task #41

Child, 4 months old, suffers from rickets. Treated on an outpatient basis. Gets vitamin O and calcium gluconate. Suddenly, in the morning, while eating, twitching of the limbs appeared, the child screamed, but the voice suddenly broke off, the child turned blue. After 30 sec. the skin turned pink, the convulsions stopped.

Tasks

1. Formulate a presumptive diagnosis.

2. What needs to be done?

Sample answers

1. In a child, spasmophilia (laryngospasm) can be assumed.

2. The child needs to be given urgent help: in case of laryngospasm, give access to fresh air, irritate the root of the tongue,
splash the skin with cold water, conduct a heart massage, artificial respiration. With an attack of convulsions intramuscularly
introduce a 25% solution of magnesium sulfate or a 0.5% solution of seduxen, a 20% solution of tomk.

Task #42

A child, 15 days old, against the background of staphyloderma, suddenly developed a high temperature of 38.9 ° C, grayish-cyanotic skin color, a pulse of weak filling and tension, and bloating. Respiration is frequent, with fluttering of the wings of the nose. Examination of the lungs revealed no pathology. On the 5th day of illness, a clear shortening of the percussion sound diffusely over the entire surface appeared over the lungs, rales were moist, finely bubbling. On the radiograph, there is an infiltrate on the right in the middle lobe of the lung and a parietal pleura is constructed. Leukocytosis in the blood 12000 ml, ESR 22 ml/h.

Tasks

1. Formulate a presumptive diagnosis.

2. What could be the nature of this disease?

Sample answers

1. A 15-day-old child has pneumonia.

2. Possibly staphylococcal nature.

Task #43

During the next visit to the clinic by a 1-year-old child, the doctor noticed a sharp pallor of the skin and mucous membranes. The mother reported that the child gets tired quickly, is irritable, inactive, and has lost his appetite. When questioning the mother, it was possible to establish that the child's diet is monotonous - dairy food (the mother gives the child a breast twice a day), the mother prefers not to give fruits and vegetables, fearing a digestive disorder. On such a diet, the child gained weight well, which pleased the mother.

Tasks

1. Formulate a presumptive diagnosis.

2. What additional examination can clarify the diagnosis?

Sample answers

1. A 1-year-old child developed symptoms of anemia due to poor nutrition.

2. A blood test will help clarify the diagnosis (decrease in hemoglobin and red blood cells).

Task #44

Sasha M., aged 15, fell ill acutely: the temperature rose to -38°C, pain during chewing radiated to the left ear. There is swelling in the left parotid region, the skin above it is of a normal color.

Tasks

1. Formulate a presumptive diagnosis.

2. Tactics in relation to the patient.

Sample answers

1. A 15-year-old child has mumps.

2. Isolate the child for the time of pronounced clinical manifestations, on the area of ​​the parotid gland on the left
put dry heat.

Problem #45

Serezha K., 3 years old, fell ill acutely with a rise in temperature to 38.8 ° C, there was a single vomiting, headache, pain when swallowing, a rash appeared by the end of the day. On examination: a state of moderate severity, temperature 39.9 ° C. On the skin, there is an abundant small-dotted rash against a hyperemic background. White dermographism, coated tongue. Zev is brightly hyperemic.

Tasks

1. Formulate a presumptive diagnosis.

2. What complications are possible from this infection?

Sample answers

1. A 3-year-old child has scarlet fever.

2. Possible complications - synovitis, purulent lymphadenitis, glomerulonephritis.

Task #46

In a child, 11 months old, who is in the hospital with a diagnosis of acute respiratory viral infections, on the 3rd day of stay there were changes in the color of urine and stool: urine became dark, stool (feces) - light.

Tasks

1. Formulate a presumptive diagnosis.

2. What is your tactics in relation to the patient?

Sample answers

1. The child is 11 months old. phenomena of epidemic hepatitis, obviously "B".

2. The patient is isolated in the infectious department. Assign bed rest, physiological nutrition
fortified, 5% glucose, vitamins, methionine, lipocaine. In severe cases, hormonal treatment.

6 years old, fell ill acutely, chills appeared, repeated vomiting, the temperature rose to 39o C. A local doctor was called, who, after examining the girl, gave a referral to the hospital.

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

1. Reveal the satisfaction of what needs is impaired in the child and the patient's problems with their justification.

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

1. The child's needs are violated: to be healthy, maintain body temperature, excrete, be clean, play, communicate.

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.

Plan

Motivation

Nurse:

1. Provides isolation of the child in a separate box for 10 days + 12 days of home regimen. Submit an emergency notice to the SES.

1. To prevent the spread of the disease (according to epidemic indications).

2. Provides bed rest until the temperature disappears, severe symptoms of intoxication.

Tasks

2. Set goals and plan nursing interventions with motivation.

Sample answers

1. Violation of the need: - eat, be healthy, rest, play.

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.

Plan

Motivation

Nurse:

1. Provides mental and physical peace.

2. Organizes the correct daily routine and nutrition (iron-containing products).

2. To ensure the necessary content of protein, vitamins and microelements in the body.

3. He will feed the child in small portions in a warm form 5 times a day every 4 hours.

3. For better absorption of nutrients in the body.

4. Provides walks in the fresh air (at least 3 times a day in winter, all day in summer), ventilation of housing (5-10 minutes in winter, all day in summer).

4. For the prevention of secondary infectious diseases. For better aeration of the lungs, air enrichment with oxygen.

5. Conduct a conversation with parents about the need for good nutrition.

5. To compensate for the loss of protein, Fe, vitamins and increase the body's defenses.

6. Will observe the appearance and: the condition of the patient.

6. For early diagnosis of timely emergency care.

7. Carry out a set of hygiene measures.

7. To keep the skin and mucous membranes clean for the prevention of bedsores.

8. For the effectiveness of the treatment.

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

Problem #61

A 9-month-old boy, the district doctor visited at home, on call. Parents complain of an increase in T up to 39.2º C, convulsive twitches. Sick for 2 days, runny nose and dry cough. A child from the first pregnancy, which proceeded with preeclampsia in the second half. Childbirth is urgent, physiological. Birth weight - 2900 g, length - 49 cm. Breastfeeding up to 1 month. At 2 months, rickets was diagnosed, acute respiratory infections at the age of 5 months. Parents are healthy, prof. no harm, higher education. Living conditions are satisfactory.

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

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.

Sample answers

1. Violated needs: to be healthy, breathe, eat, drink, be clean, play, rest, maintain body temperature.

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.

Plan

Motivation

The nurse will provide:

1. Mental and physical rest.

1. To ensure the correct rhythm of the processes of higher nervous activity.

2. Plentiful warm drink.

2. To reduce intoxication and dehydration.

3. Strict bed rest.

3. For the prevention of complications;

4. Care for the skin and mucous membranes.

4. For the prevention of purulent complications.

5. Monitoring the patient's condition
(t, PS, AD, NPV).

5. For early diagnosis and timely assistance in case of complications.

6. Fulfillment of doctor's prescriptions.

6. For the effectiveness of the treatment.

7. Taking vitamins.

7. To increase immunity.

8. The use of physical methods of cooling the child.

To reduce the temperature in a child.

9. Conversation with parents about the prevention of hyperthermia.

9. For the prevention of hyperthermia and seizures.

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.

Problem #62

5 months. The mother went to the doctor complaining of the child's anxiety, poor sleep, itchy skin. These complaints appeared 4 days ago. A child from 1 pregnancy, which proceeded with toxicosis of the first half. Delivery urgent, weight at birth 3450 g, height 52 cm. He screamed immediately. In the maternity hospital, toxic erythema was noted. Discharged on the 6th day in a satisfactory condition. The late neonatal period proceeded without changes. He was breastfed for up to 3 months. From this age, he was transferred to mixed feeding due to maternal hypogalactia. From the age of 4 months, he was transferred to artificial feeding, he receives the "Baby" mixture. Five days ago, 5% semolina porridge in cow's milk was introduced into the diet. From the age of 2 months he receives freshly prepared apple juice, currently in the amount of 50 ml. He had ARVI at 3 months of age, and therefore was not vaccinated. Parents consider themselves healthy. Mother works in the chemical laboratory of the Tasma plant. My maternal grandfather suffers from bronchial asthma. My paternal grandmother has erosive gastritis. Father smokes.

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 - beats. weight - 1012, leuk-3-4 in the field of view, squamous epithelium - 1-3 in the field of view.

Medical diagnosis: Exudative diathesis.

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.

Sample answers

1. Violated needs: to be healthy, to be clean, to sleep, to rest. Patient's problem: play, communicate, highlight.

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.

Plan

Motivation

Nurse:

1.  Will provide the child with complete mental and physical peace.

1. To ensure the correct rhythm of the processes of higher nervous activity.

2. Apply hygienic baths with: chamomile infusion, furacilin solution or ointment dressings.

2. To reduce and treat itching.

3. Provides care for the skin and mucous membranes;

3. For the prevention of purulent complications.

4. Ensure compliance with the daily regimen, a long stay in the fresh air.

4. To improve the condition of the child, to prevent complications, better aeration.

5. Provides ventilation of the premises.

5. To improve lung aeration.

6. Complete doctor's orders.

6. For the effectiveness of the treatment.

7. Talk to parents about allergy prevention and the need for a hypoallergenic diet.

7. For the prevention of allergic conditions.

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.

Problem #63

A 13-year-old boy was admitted to the hospital with complaints of pain in the epigastric region. Before admission to the hospital there was vomiting "coffee grounds", after which the pain subsided, but there was weakness, palpitations, dizziness, tinnitus.

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

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.

Sample answers

1. Violated needs: to be healthy, to eat, to excrete, to move, to be clean, to communicate, to study.

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.

Plan

Motivation

Nurse:

1. Provides an urgent call to a doctor.

1. To provide emergency medical care

2. Gives the patient a horizontal position.

2. To prevent further complications.

3. Put a rubber balloon with ice on the epigastric region, first put a towel on the body

3. To reduce bleeding.

4. Will monitor PS, A/D, skin.

4. For early diagnosis of possible complications

5.  Will strictly follow the doctor's orders

5. To ensure effective treatment.

6. Will talk about the prevention of peptic ulcer, intestinal bleeding.

6. For the prevention of possible complications.

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.

Problem #64

Serezha, 3 years old, fell ill acutely, the temperature rose to 38.8º C. There was a single vomiting, headache, pain when swallowing. By the end of the day, a rash appeared. On examination: a state of moderate severity, temperature 39.3º C. On the skin, there is an abundant small-point rash against a hyperemic background. White dermographism, tongue coated with white coating. Zev is brightly hyperemic, tonsils are hypertrophied, edematous. From the side of the heart tachycardia. The tones are loud, the abdomen is painless. Stool and diuresis are normal.

Medical diagnosis: scarlet fever.

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.

Sample answers

1. Violated needs: eat, drink, be healthy, be clean, maintain body temperature, sleep, rest, play.

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.

Plan

Motivation

Nurse:

1. Isolates the child in a separate room.

1. For the prevention of scarlet fever infection of other family members.

2. Provide bed rest for at least 7 days

2. To avoid heart and kidney complications.

3. Teach the child to gargle with a solution of furacilin and a solution of soda after eating.

3. To eliminate sore throat and prevent secondary infection.

4. Provides the child with plenty of fluids.

4. To eliminate intoxication.

5. Repeat urine and blood tests.

5. For early diagnosis of complications.

6. After recovery, she will give her mother: a referral to a rheumatologist, an ENT doctor, an ECG.

6. For early diagnosis of complications.

7. Will monitor the appearance and: and the condition of the patient, PS, NPV.

7. For early diagnosis and timely provision: emergency care in case of complications.

8. Will follow doctor's orders.

8. For effective treatment.

9. Conversation with the child's parents about the prevention of infectious diseases.

9. For the prevention of infectious diseases.

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

Goals will be achieved.

Tasks for the provision of first aid in emergency conditions

Problem #65

A 12-year-old girl was brought to the FAP, who accidentally drank a solution of caustic soda. Suffering from acute pain in the oral cavity, pharynx and behind the sternum. Salivation is noted due to the inability to take at least one sip. There are traces of burns on the lips, tongue, buccal mucosa. Severe condition. The girl is crying in pain, pale, pulse 100 beats/min.

Tasks

3. Demonstrate the intradermal injection technique.

Sample answers

1. Poisoning with a solution of caustic soda.

a) before gastric lavage, premedicate with a 1% solution of promedol 0.1 ml/year intramuscularly;

b) rinse the stomach with cold water, or with a weak solution of 1-2% citric acid;

c) introduce an enveloping agent;

d) to hospitalize in a hospital for further observation and treatment;

3. The technique of intradermal injection according to the manipulation algorithm;

1.

A 9-year-old girl suffers from diabetes. Gets 20 units in the morning. insulin. After the introduction of insulin, being late for school, I did not have breakfast. At the first lesson, convulsions suddenly appeared, she lost consciousness. Moist skin, shallow breathing, dilated pupils, tonic-clonic convulsions.

Tasks

1. Identify the emergency condition that the patient has developed.

2. Create an emergency care algorithm.

3. Demonstrate the technique of subcutaneous injection to a child.

Sample answers

1.  Hypoglycemic coma.

2. Urgent help algorithm:

a) inject intravenously 10-20 ml. 40% glucose solution;

b) with a decrease in blood pressure, inject intravenously plasma and its substitutes: polyglucin, reopoliglyukin, albumin and cardiac glycosides: corglycone - 0.06% solution 0.5 mg / kg intravenously slowly, hormones: prednisolone, hydrocortisone 5 ml / kg;

c) for convulsions, introduce diazepam 0.3-0.5 ml/kg intravenously slowly or sodium oxybutyrate 20% solution 0.5-0.75 ml/kg;

TASK 2

During the next patronage visit of a 1-year-old child, the paramedic drew attention to 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 was monotonous, milk porridge twice a day. Prefers not to give fruits and vegetables, fearing indigestion. On such a diet, the child gains weight, which pleased the mother. They live in a hostel and rarely go out.

On examination: the condition of the baby is satisfactory. Severe pallor of the skin and visible 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. UAC: er. 3.2 10 12 /l, Hb 85 g/l.

Sample response:

1. The child may have iron deficiency anemia. The main symptoms of the disease are: pale skin, fatigue, irritability, loss of appetite, lethargy. A systolic murmur is heard in the child's heart, the liver is enlarged. Reasons: one-sided milk nutrition, frequent illnesses, poor care and poor living conditions.

2. To clarify the diagnosis, it is necessary to conduct a general blood test, where you can detect a decrease in the amount of Er less than 3.5x10 12 l, hemoglobin below 100 g / l, color index below 0.8. Er smears are pale in color, decrease in size, moderate leukocytosis, reticulocytosis are noted.

In patients, additional symptoms of the disease are possible: seizures in the corners of the mouth, wax color of the ears, dry skin, dull brittle hair, muscle hypotension.

3. Treatment of a child should be comprehensive, with moderate and severe anemia, children are hospitalized, with a mild degree they are treated at home. It is necessary to organize the correct diet. Give foods containing iron and other trace elements: meat products, liver, cottage cheese, egg yolk, fruits, vegetables. More need to be outdoors.

A child of the first year is prescribed iron preparations: actifirin, hematofer, maltofer. Iron preparations are given after meals, drink water. You can not drink tea, as the tannin contained in the tea binds iron. Vitamin C, vitamins of group B. It is necessary to establish the correct daily routine for the child. The child should walk in the fresh air, he needs massage and gymnastics, daily bathing.

When hardening, children are less likely to get colds and anemia.

4. To prepare vegetable puree, take a combination of 2-3 vegetables, wash, cut and then boil them for 20 minutes, then rub through a sieve, add a decoction of vegetables and salt solution, butter, mix everything, bring to a boil. cool down.

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 the need for bed rest in an accessible, competent and reasoned manner.

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 a nursing examination, the nurse received the following data: T body-38 o C, pronounced edema on the face, torso, 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 she has 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 child.

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.