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Concept

• A developmental assessment for children under age 3 is an attempt to assess various aspects of the child's functioning, including areas such as cognition, communication, behaviour, social interaction, motor and sensory abilities, and adaptive skills.

Explanation

• Head circumference is routinely measured during the first 2 years of life.
• Head circumference is measured because it's an easy way to tell if there's a potential problem or if something needs to be watched.
• if the head grows too fast, it could sign hydrocephalus or water on the brain. If the head grows too slowly, it could be a sign of microcephaly or a smaller head than normal.

Additional Information Classic signs of macrocephaly include:

• Head circumference greater than 2 SD above the mean for gestational age
• Family history of large head

Classic signs of hemimegalencephaly include:

• Cranial asymmetry
• Epilepsy

Explanation

• Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache.
• Pain may be sharp or dull. It may come and go, or it may be constant.
• Treatment of pain in case of children can be treated using diversional therapy, and relaxation techniques.
• pain in child children can be assessed by using a pain rating scale.

Additional InformationThe four major types of pain are:

• Nociceptive Pain: Typically the result of tissue injury.
• Inflammatory Pain: An abnormal inflammation caused by an inappropriate response by the body's immune system.
• Neuropathic Pain: Pain caused by nerve irritation.
• Functional Pain: Pain without obvious origin, but can cause pain.

Explanation

• Hospitalization is the act of taking someone to the hospital and keeping them there for treatment:

Because of the severity of the accident, the patient required hospitalization.

• Hospitalization of a child can cause severe anxiety and stress in the parents as well as in the child.

Some common stressors that hospitalized children may experience include the following:

• Loss of bodily control
• Forced dependence
• Loss of competence
• Fear of bodily mutation or deformities
• Fear of loss of bodily functions
• Fear of pain​

Additional Information Some behavioural problems in children may include:

• Attention deficit hyperactivity disorder (ADHD)
• Oppositional defiant disorder (ODD)
• Autism spectrum disorder (ASD)
• Anxiety disorder.

Explanation

• Ureterostomy is the procedure performed to divert the flow of urine away from the bladder when the bladder is not functioning or has been removed.
• Ureterostomy permanently reroutes the flow of urine through an opening in the abdominal area to a collecting pouch outside of the body.
• Indications include bladder cancer, spinal cord injury, malfunction of the bladder, and birth defects such as spina bifida.

Additional Information Megacolon is an abnormal dilation of the colon that is not caused by mechanical obstruction. It is usually accompanied by symptoms such as abdominal discomfort resulting in serious complications (colonic perforation, peritonitis, and/or sepsis) if left untreated.

Explanation

• Chronic kidney disease (CKD) occurs when a disease or condition impairs kidney function, causing kidney damage to worsen over several months or years.
• Diseases and conditions that cause chronic kidney disease include Type 1 or type 2 diabetes.
• Kidneys are damaged, they produce less erythropoietin
• CKD may have low levels of nutrients, such as iron, vitamin B12, and folate, that are needed to make healthy red blood cells.

Important Points Symptoms of anaemia in CKD may include:

• fatigue or tiredness
• shortness of breath
• unusually pale skin
• weakness
• body aches
• chest pain
• dizziness
• fainting

Additional Information Other causes of anaemia related to CKD include

• Blood loss, particularly if you are treated with dialysis for Kidney failure
• Infection
• Inflammation
• Malnutrition

Explanation:

• Duchenne muscular dystrophy: It is an inherited X-linked recessive disorder.
• Characterized by progressive muscle degeneration & weakness.
• Caused by genes on the X-chromosome that mothers can pass on to their sons. so females have carrier genes.
• Males have only one copy of the X chromosome from their mother & one copy of the Y chromosome from their father.
• If their X chromosome has a Duchenne muscular dystrophy gene mutation,
• The gene affects a protein called dystrophin that muscles require to function normally.
• If the gene has Duchenne muscular dystrophy gene mutation it results in Duchenne muscular dystrophy disorder (DMD).
• DMD symptoms onset is in early childhood, usually between ages 2 & 3. The disease primarily affects boys, but in rare cases, it can affect girls.

Additional Information

• Diagnosis:
• An enzyme & protein blood test checks for elevated levels of an enzyme called creatine kinase, high levels can indicate muscle damage caused by muscular dystrophy.
• Electromyography (EMG) measures the electrical activity of muscles & nerves.
• A muscle biopsy looks for cell changes in muscle tissue.
• Genetic tests identify gene mutations linked to muscular dystrophy.
• Treatment:
• Physical & occupational therapies strengthen & stretch muscles, helping in maintaining function & range of motion.
• Speech therapy helps those who have problems swallowing.
• Corticosteroids, such as prednisone & deflazacort may slow disease progression.
• Surgery relieves tension on contracted muscles and corrects spine curvature (Scoliosis)
• Heart assist devices, such as pacemakers, treat heart rhythm problems & heart failures.
• Medical devices, such as walkers & wheelchairs, can improve mobility & prevent falls.
• Respiratory care, such as cough-assist devices and respirators, aid breathing.

Concept:

• Wound healing is a complex & dynamic process of replacing devitalized and missing cellular structures & tissue layers.
• Types of wounds:
• Acute wound: Heals without many complications within the expected time frame, e.g. surgical wounds & trauma wounds.
• Chronic wounds: Underlying pathology or infection causes wounds or interferes with the healing process. For example diabetic ulcers & pressure ulcers.

Explanation:

• Exudate: The fluid involved in inflammatory oedema is known as exudate.
• Serous exudate: Water-like exudate, seen in minor injury.
• Fibrinous exudate: Contains fibrin.
• Purulent exudate (pus): Creamy white exudate from dead neutrophils, seen in bacterial infection.
• Hemorrhagic exudate: Bloody red exudate.
• The nurse inspecting the surgical wound sees a discharge that is semi-bright pink in colour with red streaks. She understands that this inflammatory discharge is serum blood.
• The serum is a clear yellowish fluid & solute component of blood which does not play a role in clotting.
• It may be defined as blood plasma without the clotting factor or as blood with all cells and clotting factors removed.

Additional Information

• Stages of wound Healing:
• Homeostasis: A brief period of vasoconstriction as an attempt to stop the bleeding, caused coagulation.
• Inflammation: Starts immediately after injury and lasts for 2-6 hours.
• destroys bacteria & removes debris.
• Proliferation: It is a phase of the rebuilding of new tissue made up of collagen & extracellular matrix.
• Formation of granulation tissue ( pink to red moist tissue) followed by epithelization ( migration of epithelial cells across wound surface)
• A new network of blood vessels is constructed for a sufficient supply of oxygen & nutrients to granulation tissue.
• Maturation: Tissue gains strength & flexibility.
• wound healing can progress backwards or forward depending on internal & external patient conditions.

a Concept:

• Heart Block: it occurs as a result of a delay in the conduction of electrical impulses through the conduction pathway.
• It is classified as a first-degree atrioventricular block, second-degree atrioventricular block ( further classified as type I & type II), and third-degree atrioventricular block.

Explanation:

• Causes of ( AV) heart block:
• Drugs ( beta blockers,  Ca channel blockers)
• Digitalis ( digoxin)
• Antiarrhythmics drugs
• Muscle relaxant & sedative
• Antidepressant & antipsychotic
• All of these drugs slow the conduction of the heart's electrical impulses & cause heart block so these drugs are contraindicated in AVN block.
• Treatment:
• Atropine can be used for immediate treatment of symptomatic second-degree Atrioventricular (AV) block in the Atrioventricular node (AVN).
• Atropine is given to improve conduction through the AVN by reducing vagal tone via receptor blockage.
• Atropine often improves the ventricular rate if the site of block is in the AVN.
• The Peak increase in heart rate occurs in 2-4 minutes after IV administration.
• The half-life is 2-3 hours.

Additional Information

• First-degree Atrioventricular block:
• Slow conduction of electrical impulses through the AV node, which leads to a PR interval greater than 0.20 seconds.
• The ratio between the P & QRS complex is 1:1
• Usually, it is asymptomatic.
• Second Degree Atrioventricular block:
• Type I: Other names for this condition are Mobitz type 1.
• Electrical impulses from the SA node to the AV node are conducted at a slower rate than the previous impulses and finally, one beat will be missed.
• PR interval will be progressively lengthened.
• Type II: Also called Mobitz type II
• In this type intermittently AV node does not respond to the impulse from the AV node, as a result, some of the p waves are not followed by a QRS complex.
• Third Degree Atrioventricular block:
• It is also known as complete heart block.
• In this condition, impulses from the SA node are not conducted through the AV node, so ventricles will make it is own impulses at a slower rate.
• So P wave and QRS complex will occur at two different rates.
• A permanent pacemaker is the treatment of choice.

Concept:

• Chest tube (Thoracostomy), commonly referred to as putting a chest tube, is an invasive procedure in which a doctor inserts a thin plastic tube into the pleural space ( the area between the chest wall & lungs and attaches the tube to a suction device to remove excess fluid or air.
• Purpose: To remove the abnormal accumulation of air/ fluid ( blood, pus, lymph, serous fluid) from the pleural space.
• To return normal negative pressure of pleural space.
• Use CT, fluoroscopy & USG to help guide the placement of the chest tube.

Explanation:

• Hold your breath:- This is essential to prevent air from entering the pleural space during the moment of tube removal, decreasing the risk of pneumothorax.
• If you return home with the chest tube in place, Dr. instruction you to care for the tube & drainage system:
• Dr. may prescribe antibiotics & pain medication.
• Keep the skin around where the chest tube is inserted clean & dry.
• Take regular breaths followed by a cough.
• Change position often while lying down, and exercise if possible.
• Maintain the drainage system as instructed, keeping it below chest level.
• You should keep the chest tube free of all kinks & obstruction.

Additional Information

• Water Seal Drainage ( Close Chest Drainage):
• Drainage system to remove the abnormal accumulation of air, and fluid ( blood, pus, lymph, serous fluid) from the pleural space.
• Purpose: To treat pneumothorax, hemothorax & hydrothorax.
• Water Seal apparatus:
• Drainage bottle: It is connected with a chest tube to collect the drainage.
• Water Seal bottle: It contains water/ NS 100 ml. It makes a seal that prevents atmospheric air to enter pleural space.
• Suction Control bottle: Connected to suction to provide negative pressure.
• Note: Monitor the amount of drainage. If the amount is >70-100 mL/hour notify the physician.
• Water Seal Drainage: Water oscillates and rises during Inspiration.
• Fall during Expiration.
• Intermittent bubbling is normal.
• Continuous bubbling indicates Air leakage.

Concept:

• Growth:  It denotes the net increase in size or mass of tissue.
• It is a quantitative measurement.
• Development: It specifies the maturation of function.
• It is a qualitative measurement.

Explanation:

• Nurses Responsibility:
• Head Circumference: It is measured by placing tape over the occipital protuberance at the back and just over the supraorbital ridge and glabella in front.
• increased head circumference (HC): Hydrocephalus & Macrocephaly
• Decreased head circumference: Microcephaly.
• At the time of birth, chest circumference is 3 cm less than Head circumference.
• Head circumference & chest circumference are almost equal by 1 year of age and after that chest circumference exceeds the head circumference.
• Serial head circumference measurements of children will enable screening possible  for cognitive or motor delays
• It is a quick, simple, easy, and reliable method of assessment of the growth of the brain.
• Head circumference >3 SD below the mean for age & sex based on normative growth charts indicates Microcephaly.
• Generally, there is no treatment for microcephaly, but early intervention may help enhance your child's development & improve quality of life.

Additional Information

• Microcephaly:
• It is a rare neurological condition in which an infant's head is significantly smaller than the heads of other children of the same age & sex.
• Sometimes detected at birth.
• Microcephaly usually is the result of the brain developing abnormally in the womb or not growing as it should after birth.
• It is caused by a variety of genetic & environmental factors.
• Children with microcephaly have developmental issues.
• Treatment:
• Early childhood intervention: Speech, Physical & Occupational therapy may help a child to strengthen the abilities
• A complication of microcephaly like seizures & hyperactivity are treated with medication