Teaching parents how to care for a child is a nursing process. Early Child Care
Features of the organization of nursing process in pediatrics
The nursing process is a method of organizing and providing nursing care to sick and healthy patients, which includes the patient, his parents and sister as interacting persons. Like any other organizational structure, nursing process has its own characteristics: purpose, organization of the nursing process and creativity. The nursing process is the most promising model of work, since during its organization the patient is considered not as a case of illness, but as an individual, and not only the “I” of the patient is taken into account, but also the reaction to his disease of others, relatives, loved ones, i.e. microsociety of the patient. That is why the introduction of teaching the nursing process during the cycle of clinical disciplines comes first in the system of training mid-level medical specialists, not only in the structure of secondary specialized education, but also of higher education, since detailed analysis situations, playing out a variety of problems to the fullest extent reveals all possible options for solving the problem of providing assistance and organizing effective and highly qualified care. This model is of particular importance when analyzing the features of organizing care and monitoring of children of different age groups. The nursing process is a relatively new concept, often, upon superficial acquaintance, causing a negative reaction, since its implementation requires a restructuring of not only methodological work, but also a restructuring of thinking and worldview in the light of the philosophy of nursing. It may be years and years before it is introduced into the structure of pediatric care. medical care, but as a teaching model, the nursing process is indispensable for the possibility of widespread introduction of innovative teaching methods, the prospect of increasing the level of knowledge of students and increasing the survival rate of knowledge, mastering the ethical and psychological components of the work of a nurse, regardless of the level of training (secondary or higher education).
Let's take a closer look at the application points of the nursing process directly in pediatrics. The basis of the philosophy of nursing is the nursing process as a method of organizing and providing assistance and care to sick and healthy patients. When working with the pediatric population, one often has to face certain difficulties, primarily due to the fact that the nursing staff of pediatric services, by force of circumstances, is forced to work not so much with the patient, but with his environment (parents, grandparents...). This imposes some specificity on the ethical behavior of nursing staff. It is when organizing the work of nurses at various levels that it is necessary to remember that the psychological component of the activity is equal in scope to a purely professional one, associated with knowledge of the anatomical and physiological characteristics of the child’s body and the conditions for the occurrence of certain diseases. Let's consider the components of the nursing process.
The purpose of the nursing process includes: identifying the patient's needs for care, since it is the nurse who must decide what the PATIENT needs in the first place.
It is customary to highlight universal needs, that is, inherent in all patients of a given age group, such as the need to eat, drink, be clean, maintain body temperature, dress, undress, sleep, stay awake, and so on. As a rule, isolating universal problems does not pose a problem, since they stem from ideas about the characteristics of development in various periods of childhood (the concept of rational nutrition, the system of nomenclature tables, the concept of drinking regime, correction of sleep disorders, personal hygiene of the patient, the concept of rational clothing etc.). When organizing nursing process in pediatrics In addition to identifying the patient’s problems, it is also necessary to determine the state of knowledge and ideas of the child’s relatives about his needs. It is not so rare for families in which, before the birth of their first child, the parents did not read a single popular science book, or did not go through a system of pediatric counseling on the development and upbringing of the baby.
In addition to universal problems, the most numerous, the nurse must be able to identify the patient’s problems associated with his development (mental retardation, physical development from this age group, pedagogical neglect in children, pathological types of education practiced in the family, impaired self-esteem, decreased intelligence, impaired social connections). It is these problems that pose the greatest difficulty for pediatric nurses, since they are often not ready to psychologically and professionally expand the scope of communication with the patient, to consider the patient’s behavior from different points of view. In the process of studying pediatric nursing, special attention should be paid to finding alternative approaches to each situation. Thus, for example, for each situation, a legal perspective is considered regarding what is established or prohibited by law (for example, the need to notify authorities that the patient's medical condition is caused by some action on the part of others when encountering battered child syndrome or abandonment). baby without help. Professional standards and professional etiquette are important when organizing the friendly work of the nursing staff of a children's clinic in a unified system of the obstetric-therapeutic-pediatric complex. A different point of view, considering people as part of a common “divine” scheme and allows us to judge their behavior by their behavior. how it fits into this scheme (for example, a “Yehovah’s witness” does not allow his daughter to have a blood transfusion, despite the fact that, according to doctors, this is the only way to save her life. An aesthetic point of view is also considered, which allows us to consider this situation in accordance). with whether or not behavior produces an effect that “looks great” (for example, the introduction of a universal uniform of professional clothing, different in each department of the hospital in bright colors; appropriate design of the interior of a children's hospital) and finally, a practical point of view is considered, that is, whether the action is the most in an efficient way achieving a set goal (for example, addressing a child by name rather than the impersonal “baby”, introduction game moments in the process of examination and performing medical procedures). The third type of problem that a nurse encounters when caring for her patients is health-related problems that are identified during the examination process. The examination can be difficult due to the age-related characteristics of the child’s development. Thus, children under 3-4 years of age cannot even roughly localize pain or explain their complaints reliably. It is in pediatrics that there is a sharp dissonance between the patient’s condition and his well-being, when with a slight decrease in body temperature to febrile levels, the child becomes more active and plays.
Identifying all three types of problems is necessary to implement the second goal of the nursing process - determining priorities for care and expected goals or results of care, since depending on the situation, either the patient's needs for care, the choice of a model for providing care, according to existing theories, will come to the fore. or their synthesis, for example, maintaining the personal hygiene of an infant patient, solving the problem of communication or education deficits, or health problems, for example, with hyperthermic or convulsive syndrome. Having determined the priorities for care and the expected results, the nurse can already choose and apply a nursing strategy aimed at meeting the needs of the patient, choosing the only correct approach to the patient, ensuring maximum sparing of the psyche and giving the greatest treatment result. When analyzing and developing a nursing strategy, special attention is paid to considering the moral aspects of actions. In our opinion, the most significant in nursing practice are the following seven aspects of action:
1. Respect for people, considered in the light of the child’s autonomy and choice.
2. The aspect of an action having certain qualities that makes it right or wrong in its essence (the ethical component of the nursing process), for example, “fairness” is seen as treating people equally regardless of their age, gender, nationality, sexual orientation, religion and political views.
3. Aspect of morality.
4. Seeking the best outcome, considering the situation from a utilitarian point of view (i.e., if a nurse is faced with a choice, her duty is to consider all the consequences that the action may have for all concerned) for example - it is inappropriate to place an IV on the right arm of a teenager -right-handers, if we want the patient to be as independent as possible, it is not rational to explain to parents how to divide the tablet into eight parts, if you can prescribe the drug in the required dosage in powders or mixtures.
5. The aspect of having the right motivation - it is necessary to carry out actions because they are correct, and not be guided by some other reasons - in other words, not to perform “duty for the sake of duty.” This aspect is especially important when working with a child’s family, when nurse is obliged to carry out explanatory work with the mother in such a way as to not only teach her the method of care and administering medications, but also explain to her exactly why this drug is needed for her baby, what will happen if this drug is not used.
6. The aspect of “acting in accordance with nature” - for example, preparing a patient for the use of high-tech diagnostic and treatment methods, depending on age, requires preliminary work with the problem of fear. A child over three years old cannot be told that it will not hurt at all if the manipulation involves pain. He needs to explain in advance, using examples of toys and game moments, what is required of him.
7. The aspect of "acting in accordance with the will of God" - people whose morals are based on religious beliefs, regardless of the type of religion, can agree with non-believers in certain situations about what needs to be done. For example, in the situation of deciding the inappropriateness of active treatment of a child with advanced cancer, a Muslim may support such a decision, believing that an attempt to delay inevitable death means acting against the will of God, a utilitarian - since as a result of active treatment the patient will suffer even more.
When organizing the nursing process, the nurse should not forget that the patient’s problems are also the problems of his relatives and loved ones. We must not lose sight of the patient’s microsocial environment, especially when deciding on the need for hospitalization, adapting him to hospital conditions, since the patient’s separation from the usual conditions of existence when admitted to the hospital, an unfamiliar environment, being left to one’s own devices, and a feeling of abandonment can cause both temporary and and persistent mental trauma, slow down the healing process, and reduce the effectiveness of the care and treatment process. And only training according to the nursing process model allows us to most fully reveal and resolve these problems.
The second component of the nursing process is its organization. The organizational structure of the nursing process, as you know, consists of five main elements: assessment, nursing diagnosis, plan, implementation and evaluation.
Working with any patient, whether healthy or sick, begins with an examination, that is, the process of collecting and recording information about the patient’s health status.
The sources of data are very extensive: this is the patient himself with his stories about health and well-being, his family, outpatient data, opinions of other medical specialists, literature.
The problem of making a nursing diagnosis, as a rule, does not have difficulties if a sufficiently complete collection of information is carried out at the examination stage. In pediatrics, a nursing diagnosis consists of three components - biological and genealogical (developmental features, previous diseases, injuries, features of obstetric history...); social (type of upbringing, household status); clinical (main health problems). When studying this stage of the nursing process, nurses must possess systematization skills and grouping skills.
When considering the principles of drawing up a nursing action plan, in addition to studying the actions necessary for a given situation to conduct additional research, emergency care, regimen, dietary, medication, etc. correction of the condition, it is necessary, in our opinion, to take into account nursing models of patient protection. Rights-based model (the nurse is responsible for educating the patient and his family about his rights in the hospital or health care system. The nurse must ensure that the patient understands these rights and knows how to use them within the system). The Values-Based Decision Model - This advocacy designates the nurse as a facilitator to discuss the patient's needs and interests and make choices that best fit the patient's values, lifestyle, or course of action, without imposing decisions on the patient. Model of respect for people - the human dignity of the patient is respected regardless of whether the patient is independent and self-sufficient. In the role of protector, the nurse remembers the patient's basic human values and always acts to protect his human dignity, privacy, and independent choice when necessary.
To systematize the approach to drawing up a nursing action plan, we use the so-called decision-making model:
Step 1 - Review the situation to identify health problems, solutions needed, ethical components, and key individuals.
Stage 2 - assemble additional information in order to clarify the situation.
Stage 3 - determine personal and professional moral positions.
Stage 4 - determine the moral positions of the main individual participants.
Step 5 - identify ethical issues related to the situation
Stage 6: Identify the contradiction of values, if any.
Step 7 - establish who makes the decision.
Step 8 - determine the range of actions and expected results.
Step 9 - choose the direction of action.
Stage 10 - implementation of actions.
If all psychological component situations are taken into account and decision-making follows the algorithm considered, then, as a rule, the implementation stage does not present any difficulties for nurses; only a lack of knowledge may be noted when covering certain issues.
1. What will the patient do (for example, be on bed rest, take medications, gargle).
2. One type of behavior for each attitude (it is necessary to separately discuss the characteristics of dietary nutrition, and not diet and intake medicines simultaneously).
3. Necessary observation and assessment for behavior change (during the treatment, the child may develop a fear of the white coats of doctors, or as the patient’s condition improves, the patient may follow prescriptions less carefully).
4. Be more detailed in the area of “criteria” - discuss with the patient and his relatives what exactly is necessary, for example, if strict bed rest is prescribed, then for what purpose
and what health complications may arise if bed rest is not observed, if dietary nutrition is prescribed, then what consequences may follow if the diet is violated.
5. Detailed discussion of goals with the patient or his relatives, not only short-term, but also long-term plans.
6. Realistic goals, for example, it is not realistic to plan for a complete recovery in a child with congenital heart disease.
The sister not only plans the necessary activities, but also implements them. Its actions include assistance in case of illness, preventive and health measures. As the picture of the disease changes, so does the implementation. Historically, there have been three main types of implementation:
1. Dependent, the most common type of nursing activity, characterized by the fact that instructions from a doctor are required to initiate action, but the knowledge and skills of the nurse must be used - for example, the doctor prescribes antibiotic injections, and the nurse carries out the prescriptions...
2. Independent - includes direct activities sisters, for example, teaching the mother massage techniques, techniques for preparing children's cuisine...
3. Interdependent - joint activities nurses with other medical specialists - for example, oral treatment after consultation with a dentist...
When organizing the nursing process in pediatrics, we place special emphasis on independent and interdependent types of implementation, since it is these types of implementation that will help students most fully master knowledge and practical skills.
At the implementation stage, the nurse must show all her wealth of experience to achieve the goal, because the success of treatment depends on properly organized care for the patient, his compliance with the regimen, and taking medications. If there is a pronounced reaction of protest on the part of the patient - establishing contact with the patient...
During the implementation stage, the nurse keeps a map of the nursing process, where in the “implementation” column she clearly indicates who should do what, and when. After completing the implementation stage, the nurse begins final stage nursing process - assessment. At this stage, the following indicators are taken into account:
1. Assessing the patient's response to an intervention - how the patient responds to an intervention - for example, the use of a bedpan while on strict bed rest.
2. Patient's opinion about the intervention.
3. Assessing the achievement of the set goal is necessary to determine the correctness of nursing activities. If the goal is not achieved within a certain period of time, it means that an erroneous tactic was chosen or an incomplete examination of the patient was made, and the nursing process should be started again from the first stage
4. Assessment of the quality of assistance provided.
At the stage of mastering the assessment of nursing activities, the nurse should pay the greatest attention to the “accountability - contractual relationship” assessment model, as the most promising model, in our opinion, since accountability includes relationships between at least two parties. This is a contractual relationship in which the nurse, as an actor, enters into a contractual agreement in order to provide assistance and be responsible for it in accordance with established conditions. Be responsible in this model, based on the nature of complete trust that exists between the patient and the nurse. This is an obligation that relates to the patient's right to free will and competent nursing care. It is accountability that protects the spiritual values of the nurse-patient relationship and maintains the traditions of nursing, providing both the practice and the social role of nursing with its necessary historical content.
From the presented material we can conclude: the nursing process is the most promising model of nursing work in pediatrics, since in style it is a convergence that allows for the realization of all the best that is in patients and nursing staff, transforming the nurse from a routine mechanical appendage of a doctor into a highly qualified specialist.
Thesis on the topic "
FEATURES OF NURSING CARE FOR YOUNG CHILDREN UNDER INPATIENT TREATMENT WITHOUT PARENTS." She was defended perfectly at the Kalmyk Medical College named after T. Khakhlynova!
Hospitalization in a hospital is one of the most powerful psychotraumatic factors for preschoolers and younger children school age. Psychotraumatization and, as a consequence, the occurrence of various emotional, behavioral, somato-vegetative abnormalities in children when they are admitted to a hospital are caused not only by the disease itself (and hospitalization, as a rule, is associated with an exacerbation of a chronic disease or the emergence of new serious symptoms), but also by that the child is separated from his parents, from his usual environment, his usual routine; experiences fear of unfamiliar medical personnel, undergoes painful procedures, and is often limited in movement and communication.
An extremely important psychotraumatic factor for children is separation from family, temporary loss without conditional emotional support in the person of the mother. A long stay outside the family can have adverse consequences for the child’s mental health, in some cases determining the formation of psychogenic emotional and behavioral disorders. Separation from the immediate social environment is one of the most significant factors of adaptation disorders in primary school age.
In case of hospitalization, the situation is complicated by the fact that the child is somatically weakened and his adaptive resources are limited.
Features of the diagnostic and treatment process, as well as the behavior of medical personnel, can also act as a source of psychotraumatization. The experience of fear of medical manipulations, of doctors and the possible negative consequences of their actions is typical for children of primary school age. These experiences can be intensified by the actions of medical personnel associated with insufficient responsiveness and lack of explanation of the procedures performed on them.
When assessing the level of adaptation of a child to hospital conditions, criteria are used according to which, in the optimal case, emotional stabilization and the child’s mastery of adaptive forms of behavior in the clinic occurs no later than 9-10 days. However, according to foreign studies, in 40-50% of children, full adaptation does not occur until the end of their hospital stay.
In connection with the above, a goal was formulated: to identify psychosocial risk factors for difficulties in psychological adaptation to hospital conditions in children early age(in connection with the tasks of psychological support).
To achieve this research goal it is necessary to study:
1. General concepts about the child’s adaptation in the hospital;
2. Nursing care when performing manipulations on young children;
To achieve this goal, the following tasks are set:
1) carry out a theoretical analysis of scientific and methodological literature on the research topic;
2) analyze the features of nursing care for young children;
3) conduct observation of young children in a hospital;
4) conduct surveys and testing;
Object of study: young children in hospital
Subject of the study: nursing care for young children undergoing inpatient treatment at the BURK Republican Children's Medical Center in the city of Elista.
Research methods:
- scientific and theoretical analysis of medical literature and Internet sources on this topic;
- an empirical method for studying young children in a hospital;
- bibliographic analysis (analysis of anamnestic information, study of medical documentation);
- psychodiagnostic analysis (conversation);
- survey of children by voluntary questioning using a self-developed questionnaire;
- generalization of the research results;
Hypothesis: We assume that nursing care for young children has certain features that help avoid complications associated with this period of adaptation of children in the hospital
INTRODUCTION………………………………………………………………………………. 3
CHAPTER I ORGANIZATION OF NURSING CARE FOR CHILDREN... 6
1.1 Features of nursing care for young children 6
1.2 Children’s reaction to hospitalization and adaptation to a medical institution……………………………………………………….. 10
CHAPTER II. PRACTICAL PART…………………………………… 19
2.1 Organization and methods of research………..………………………… 19
2.2 Study of emotional-behavioral characteristics of children and psychosocial factors in the process of adaptation to hospital conditions……………………………………………………………... 20
2.3 Results of the study during manipulations with young children………………………………………………………... 29
CONCLUSION…………………………………………………………………. 33
CONCLUSION……………………………………………………………... 35
LIST OF SOURCES AND LITERATURE USED...... 37
APPLICATION……………………………………………………………...
1. Agadzhanyan N.A. Adaptation and reserves of the body. - M.: Physical culture and sport, 2013. - 176 p.
2. Aseev V.G. Theoretical aspects of the problem of adaptation // - Irkutsk, 2016. - P.3-17.
3. Ball G.A. The concept of adaptation and its significance for personality psychology // Questions of psychology. - 2013. - No. 1. - pp. 92-100.
4. Barlas T.V. Features of socio-psychological adaptation in psychosomatic and neurotic disorders // Psychologist. magazine. - 2014. - No. 6. - pp. 116-120.
5. Berezin F.B. Mental and psychophysiological adaptation of a person. - L., 2014. - 270 p.
6. Vereshchagin V.Yu. Philosophical problems of the theory of human adaptation. - Vladivostok, 1988. - 164 p.
7. Volozhin A.I., Subbotin Yu.K. Adaptation and compensation are a universal biological mechanism of adaptation. - M., 2017. - 176 p.
8. Vostroknutov N.V. Shkol school maladjustment: key problems of diagnosis and rehabilitation // School maladjustment. Emotional and stress disorders in children and adolescents. - M., 2015. - P. 8-11.
9. Denisenkova N.S. Problems of formation of value orientations and social activity of the individual / Responsible. ed. V.S. Mukhina. - M.: MGPI, 2016. - 165 p. - P.52-57.
10. Dermanova I.B. Types of socio-psychological adaptation and inferiority complex // Vestnik St. Petersburg. University, series 6, issue 1. - No. 6. - P.59-67.
11. Zavadenko N.N. and others. Clinical and psychological study of adaptation: its main causes and approaches to diagnosis // Neurological Journal. - 2017. - No. 6.
12. Zavadenko N.N. and others. School maladjustment: psychoneurological and neuropsychological research // Questions of psychology. - 2015. - No. 4. - P.21.
13. Zotova O.I., Kryazheva I.K. Some aspects of socio-psychological adaptation of the individual // Psychological mechanisms of regulation of social behavior. - M., 2014. - P. 220.
14. Treasurer V.P. Modern aspects of adaptation. - Novosibirsk, 2015. - 192 s.
Admission to child care infancy.
The basis of care is adherence to the strictest cleanliness, and for a newborn child, sterility (asepsis). Care for infants is carried out by nursing staff with mandatory supervision and participation of a doctor. Persons with infectious diseases and purulent processes, malaise or elevated temperature bodies. Medical workers In the department of infants, it is not allowed to wear woolen items, jewelry, rings, use perfume, bright cosmetics, etc.
Medical staff of the department where infants are located must wear disposable or white, carefully ironed gowns (replace them with others when leaving the department), caps, four-layer marked masks and removable shoes. Strict personal hygiene is mandatory.
Care of skin and mucous membranes in newborns and infants. Hygiene.
Daily care for the newborn is carried out by a nurse in the children's ward of the maternity hospital or in the ward where mother and child stay together. After discharge from the maternity hospital, care is provided by the mother in a specially designated corner of the children's room, on a changing table, which should be covered with a blanket, oilcloth, and a clean diaper on top. Good lighting is necessary, air temperature is 20–22 o C.
In front of the toilet infant Be sure to wash your hands with warm water, a brush and soap for 2 minutes. After placing the undressed child on a pre-treated changing table, he is carefully examined, paying special attention to the umbilical wound, as well as the places most dangerous for diaper rash (behind the ears, neck, axillary, inguinal folds). Eyes washed boiled water, in the direction from the outer corner to the inner. Use separate sterile cotton swabs for each eye, first wet, then dry.
In the presence of conjunctivitis, the eyes are treated repeatedly during the day with a solution of furacillin at a dilution of 1:5000 or a solution of KMnO 4 at a dilution of 1:8000 (0.8% solution).
Toilet nasal passages carried out to remove dry crusts, mucus, and milk that may get there during regurgitation. The nose is cleaned with cotton swabs soaked in sterile vaseline oil, which are inserted into the nasal passage one to one and a half centimeters with rotational movements. To remove the crusts that form in the baby’s nose, first instill warm Vaseline oil into each nostril, and after 15 minutes, clean the nose with cotton wool. Cleansing of the nasal passages is carried out alternately, using different flagella. Using matches, sticks and other objects with cotton wool wrapped around them to toilet the nasal passages is strictly prohibited. Ears wipe with a well-wrung out damp cotton wool soaked in boiled water. Once every two to three weeks, clean the external auditory canals with wet and then dry cotton wool.
Oral toilet Children are performed only if there are special indications (thrush, aphthous stomatitis).
Thrush (candidiasis of the mucous membranes) appears on the mucous membrane of the oral cavity (cheeks, palate, gums, tongue) in the form of multiple pinpoint plaques, reminiscent of semolina or curdled milk, located on a hyperemic background. The plaque is easily removed with a gauze swab, revealing a moist, erosive, painful surface, which makes it difficult to move the mouth when sucking and swallowing. To treat thrush, the following solutions are used: 1% gentian violet solution, 2% soda solution, 20% borax solution with glycerin, nystatin, irrigation with ascorbic acid. Treatment of affected mucous membranes is carried out 3-4 times a day, before feeding. Using a sterile stick with cotton wool soaked in one of the solutions, carefully rotate the elements of the thrush without pressing.
The face, neck, and hands are washed with boiled water using a cotton ball. The skin of infants is very delicate and thin. It is easily damaged by the slightest impacts. Microbes freely penetrate through damaged skin, and the child’s body is not yet able to actively counteract them. Therefore, even isolated pustules, redness and damage to the skin can lead to generalization of infection in a short time. In this regard, any skin diseases in young children require medical consultation. The child's skin is carefully examined and wiped with sterile cotton wool soaked in sterile Vaseline or boiled vegetable oil. Can also be used to wipe skin baby cream. Particular attention is paid to natural folds, which are wiped in the following order: behind the ear, cervical, axillary, elbow, wrist, popliteal, inguinal, buttock.
Diaper rash- limited inflammatory changes in the skin, in areas easily subject to friction and maceration (natural folds). Diaper rash occurs when care for a newborn is not taken care of: infrequent washing, excessive wrapping, trauma to the skin with rough diapers, etc. Treatment of diaper rash comes down to eliminating defects in care. The child should be washed after each urination and bowel movement, the underwear should be changed frequently, and diapers should be changed at least every hour. General baths with KMnO 4 are prescribed (water temperature 36–38 o C), local air baths for 5–10 minutes. The affected areas are powdered with talc powder and dermatol (3–5%) and lubricated with sterile vegetable oil. When prickly heat(small red spots that merge into general redness), it is recommended to wipe the skin with vodka diluted half with water. Since prickly heat occurs when overheated, it is necessary to switch to loose swaddling. Daily baths with potassium permanganate or potassium permanganate are required. Air baths are also useful.
They wash the children with warm running water at a temperature of 36-38 o C. While washing, the child is held suspended in the left hand, and washed with the right. In case of heavy contamination, washing is carried out with a soapy hand. When washing, girls are held face up and must be washed from front to back; this is done to prevent infection of the urinary tract with fecal matter. Then the child is dried with careful blotting movements. They wash the child at the end of the morning toilet and after each act of defecation. Children with sensitive skin, with a tendency to diaper rash, it is recommended to wash it after each urination.
Toilet genitals in girls it is carried out in the presence of vaginal discharge. The cotton wool is moistened in a solution of furacillin 1:5000 or KMnO 4 1:8000, and the genital slit is carefully wiped. The accumulation of smegma between the foreskin and the head of the penis in boys should not be removed, as the mucous membrane can be damaged. For diaper rash and maceration of the penis, local baths with a solution of KMnO 4 1:8000 are recommended.
Nails The child is cut with small scissors at least once a week. Scissors are pre-treated with cologne or alcohol. To make the procedure less unpleasant, you can liken it to a game - tell something about each finger. On the hands, nails are cut in an arched manner, on the feet - with a straight cut (to prevent ingrown toenails). Nails are cut over an unfolded sheet of paper so as not to scatter them; the trimmings should not get into the child’s face or onto the bed. Hair cutting is a very unpleasant procedure for children, so it must be done carefully, using a clipper or sharp scissors; after cutting, you should wash your hair with baby soap or shampoo.
Bathing a child. Daily bathing of the newborn begins 2–3 days after shedding umbilical cord remnant, after healing of the umbilical wound. Bathing is recommended before the penultimate feeding. A hygienic bath is carried out daily up to 6 months of age, in the second half of the year - every other day, from one year to two - twice a week, after two years - once a week. In the first month, it is preferable to use for a hygienic bath boiled water. Children with unhealed umbilical wound A solution of potassium permanganate is added to boiled water (the color of the water is light purple). The child is bathed with soap no more than once or twice a week. Using soap more frequently may cause skin irritation. The duration of the bath for children of the first year is usually 5–7 minutes, the air temperature in the room is 20–22 o C, the water temperature for children in the first half of the year is 36.5–37.0 o C, for the rest - 36 o C.
The baby bath is washed with hot water, soap and a brush (if bathing is carried out in a child care facility, the bath is additionally treated with a disinfectant solution) and rinsed with hot water. Before bathing, prepare underwear for the child. It must be folded in the order in which it will be used after the bath. It is recommended to warm up the laundry, for which you can place it on a rubber or electric heating pad. The bath is filled with water so that the child can be immersed up to the shoulders. One diaper, folded in four, is placed on the bottom of the bath. Carefully immerse the child in the bath, supporting the buttocks with the left hand, and the head and back with the right hand (top left picture), with the child’s head on the bather’s forearm and the back on the palm. You can hold the child in another way with your right hand: the bather uses his hand to cover the child’s right shoulder, so that the child’s neck and head rest on his forearm. After this, left hand released. The child is washed with his free left hand (upper right and lower left pictures), with a special terry or flannel mitten or sponge. The scalp (lower right picture) is washed last, soaped in the direction from the forehead to the back of the head. Do not wash your face with bath water. After finishing bathing, the child is taken out of the bath with his back up and doused with water 1–2 0 C lower than the water in the bath. The bathed child is placed on an unfolded towel or sheet, wiped with blotting movements, while only the part that is being wiped remains open, the rest of the body remains closed to prevent cooling.
Clothing for children in the first months of life and the second half of the year.
The child's clothing should protect him from large heat loss, but at the same time not cause overheating and not restrict movement. In this regard, for infants it is used underwear from hygroscopic cotton fabrics, outerwear- from flannel or woolen fabrics.
A daily set of linen for swaddling a baby of the first 3–4 months includes a thin undershirt (8–12 pieces), a warm undershirt or blouse (4–6 pieces), a diaper (24 pieces), a thin diaper 80x80 cm (24 pieces), a diaper flannel 100x100 cm (12 pcs), flannel blanket (2 pcs), wadded blanket (1 pc), oilcloth (1–2 pcs), thin cap, hat or scarf (1–2 pcs).
After three months of age, the child is not swaddled, but dressed in vests with buttons, or with open tassels or rompers. A child is allowed up to 15 onesies per day; the calculation for the rest of the linen, with the exception of diapers, remains the same. The number of diapers after 3 months decreases almost threefold. For walks, the child is dressed in accordance with the time of year and the air temperature outside. The last quarter of the year is marked by increased motor activity of the child, in connection with this, rompers can be partially replaced with tights, you can use knitted woolen socks, and by the year, booties.
Rules for breastfeeding a child.
The ideal food for a child is his mother's breast milk, as it is closely related to his tissues. Breast milk contains all the substances and microelements necessary to nourish the baby in the optimal ratio and form, adapted to the characteristics of the baby’s digestive system. Milk is species-specific, its composition changes as the child grows, in accordance with changes in his needs.
Breastfeeding rules:
· The child is fed immediately after birth on demand, and not according to a schedule with a gradual formation of a regimen - with sufficient, established lactation in the mother.
· The duration of feeding is not limited, but no more than 15-20 minutes; if the child wishes, he is fed at night.
· It is not advisable to give a child a pacifier or pacifier.
· You can’t give your baby extra food in between feedings.
· It is necessary to observe the rules of personal hygiene and strictly follow the technology of proper feeding.
Technique breastfeeding:
· The mother should wash her hands with soap, wash her breasts with boiled water, and dry them without rubbing the area of the nipple and areola.
· When feeding, the position of mother and child should be comfortable.
· The baby should not twist or stretch his neck to reach the breast. Do not hold the child's head. The baby's face is turned towards the breast, the nose is at the level of the nipple, and the belly is towards the mother's belly.
· The breast must be placed in the child’s open mouth, so that the grip is full and deep, so that the nipple and part of the areola are in the depths of the mouth, touching the hard palate.
Control of breastfeeding.
Signs on the basis of which hypogalactia can be suspected: a small increase in the child’s weight per month (on average, the monthly increase in the first half of the year is 800 g), the child does not swallow milk after a large number of sucking movements, a rare (less than 6 times) number of urinations per day, and restlessness and crying after feeding.
Hypogalactia can be objectively confirmed by carrying out control feeding (dynamics of changes in body weight before and after feeding the child). Control feeding must be carried out at least three times a day.
The procedure for storing and using expressed milk breast milk.
At home, when taking milk from one perfectly healthy woman, expressing it correctly and hygienically, and storing it correctly, you can feed milk that has not been heat-treated. The duration of milk storage in a dark place at a temperature of 18–20 0 C is up to 24 hours, in a refrigerator at a temperature of +4 0 C - 72 hours, in a freezer at a temperature of -18 0 C - up to 4 months
Features of feeding a baby from a bottle with a nipple .
· Formula or milk should be given to the child heated to a temperature of 37-40 ° C. To do this, before feeding, place the bottle in a water bath for 5-7 minutes. The water bath (pan) must be marked “For heating milk”. Each time you need to check whether the mixture is warm enough or not too hot.
· When feeding, the bottle should be held so that its neck is always filled with milk (prevention of aerophagia - swallowing air).
· The position of the child is as when breastfeeding, or in a position on its side with a small pillow placed under the head.
· During feeding, you should not leave the baby; you need to support the bottle and monitor how the baby sucks. You can't feed a sleeping baby .
· After feeding, you need to thoroughly dry the skin around the baby’s mouth; Carefully lift the baby and place it in an upright position to remove air swallowed during feeding.
Stool in infants .
Age characteristics stool in children are presented in Table 1.
Age-related features of feces in children of the first year of life
| Age | Name | External features | ||
| Color | Consistency | Smell | ||
| 1-3 day | Meconium | Dark green | Thick, homogeneous | - |
| 3-5 day | Transitional | Sites different colors- white, yellow, green | Liquid, watery, with lumps, clot, mucus | Gradually becomes sour |
| From 5-6 days to 6 months. | Ordinary Natural feeding Artificial feeding | Golden yellow Light yellow | Type of liquid sour cream: Pasty | Sour Putrefactive, pungent |
| After 6 months | Regular (decorated) | Brown | Dense (shaped) | Normal (natural, natural) |
Development and prevention of skeletal deformities in infants.
Skeletal deformities occur if the child lies in the crib for a long time in one position, with tight swaddling, with a soft bed, a high pillow, or with an incorrect position of the child in his arms.
Prevention of skeletal deformities:
· A thick mattress stuffed with cotton wool or horsehair.
· For children in the first months of life, the pillow is not used.
· The baby must be placed in a crib in different positions and periodically picked up.
· When swaddling, it is necessary to ensure that the diapers and vests fit tightly around the chest. Tight swaddling and constriction of the chest can lead to deformation of the chest and disruption of lung aeration.
· Given the weakness of the muscular-ligamentous system, children under 5 months of age should not be seated. If the child is picked up, then the buttocks should be supported with the forearm of the left hand, and the head and back with the other hand.
Practical skills on the topic
1. Admission of a sick child to the hospital, examination of skin and hair to rule out infectious diseases and pediculosis.
2. Treatment of a child with pediculosis.
3. Observation appearance and the condition of the sick child.
4. Weighing, measuring height, head and chest circumference in children.
5. Change of underwear and bed linen for the child.
6. Swaddling children, selecting clothes and dressing children of different ages depending on the season.
7. Daily toilet for newborns.
8. Distributing food and feeding children of different ages, including infants.
9. Physiological and therapeutic tables for children of different ages, rules for feeding children and methods for processing dishes.
10. Feeding young children. Warming formulas for feeding. Processing bottles, nipples and utensils.
11. Assess and note in the medical history stool in young children, place them on the potty.
12. Toilet of the umbilical wound.
13. Treatment of the oral cavity for children of the first year with thrush.
Lesson equipment
1. Educational tables, computer presentations.
2. Phantom of an infant.
3. Diapers, blankets.
4. Gauze napkins, cotton balls, cotton swabs.
5. Scales, height meter, measuring tape.
The class is held on the basis of the pediatric department.
Literature to prepare for the lesson
1. General child care. Educational and methodological manual, ed. V. V. Yuryeva, N. N. Voronovich. -SPb:GPMA. -Part I. -2007. -53 s.
2. General child care. Educational and methodological manual, ed. V. V. Yuryeva, N. N. Voronovich. -SPb:GPMA. -Part II. -2007. -69s.
3. Mazurin A.V., Zaprudnov A.M., Grigoriev K.I. General child care. -M. -1998 -292 p.
4. Zaprudnov A. M., Grigoriev K. I. General child care: textbook. allowance. - 4th ed., revised. and additional -M. : GEOTAR-Media, 2009. – 416 p.
5. Shamsiev F. S., Erenkova N. V. Ethics and deontology in pediatrics. -M: University book. -1999. -184 pp.
State budget educational institution higher professional education
"St. Petersburg State Pediatric Medical Academy"
Ministry of Health and Social Development of the Russian Federation
Educational educational institution of secondary vocational education "Kursk Basic Medical College"Specialty: Nursing
PM 02. PARTICIPATION IN TREATMENT AND DIAGNOSTIC
AND REHABILITATION PROCESS
MDK 02.01 Nursing care for various diseases and conditions
Nursing care in pediatrics
Nursing care for functional disorders and diseases
infants, pre-school children and preschool age
Teacher T. V. Okunskaya Assignments for practical lesson No. 1
Questions to prepare for the seminar “Features of nursing
process (SP) when working with newborns and premature infants
children with borderline conditions, diseases and
emergency conditions"
1. AFO of a newborn child.
2. Organization of care and feeding of a healthy newborn.
3. Features of SP when working with newborns and premature babies
children with borderline conditions, illnesses and emergencies
conditions: conducting an initial nursing assessment
conditions, features of collecting information about the patient,
planning and implementation of the nursing process.
Literature for preparation:
Healthy person (Electronic manual) – topic No. 2.
N.G. Sevostyanova. Nursing in pediatrics. Pages 11-25.
Krasnov A.F. Nursing. T.2. (Electronic abstract).
N.N. Volodin. Neonatology: National Guide
(Electronic textbook). Section I-II. Plan:
1. Features of caring for an infant
for diseases.
2. Features of pre-school child care
age for diseases.
3. Features of preschool child care
age for diseases. Caring for a sick child
Caring for a sick child involves, first of all, creating
appropriate regime, environment.
At an early age, a child has a certain age regime.
If the condition is not severe, then the age regime is maintained,
which was before the child’s illness.
Regardless of the nature of the illness, a young child
it is necessary to provide access to fresh air. This is achieved
frequent (every 3 hours) regular ventilation of the rooms.
It is important to organize walks for children. Walking in the fresh air
or veranda is prescribed taking into account the nature of the disease and
the condition of the child, the time of year.
The hygienic maintenance of children is of great importance: clean
bed, regular washing, clean dry linen,
hygienic baths (taking into account the patient’s condition), skin care
and mucous membranes of the mouth, nose, and eyes. Early Childhood Nurse Assistant - Mother
sick.
An inexperienced mother needs to be taught care techniques.
Staying of a mother at the bedside of a sick child in cases
hospitalization is of great importance for maintaining
emotional tone of the child.
You should be allowed to take your child’s favorite toy into the room.
The nurse should ask about health status on a daily basis.
mothers coming to the department in order to avoid contact
children with sick mothers. In order to create a protective regime for the central nervous system, it is necessary
observe following rules:
affectionate and attentive attitude towards the patient (smile, kind
eyes can cause a reciprocal smile, joyful animation);
put the child at ease before giving him any
manipulations, especially those involving pain. For
performing the manipulation requires preparatory
work out of sight of the patient, and perform the manipulation itself
quickly and skillfully. An important factor in shaping the regimen of sick children is
sufficient sleep, night and day. Great value for
organization of daytime sleep has a skillfully designed schedule
manipulation procedures that should not interrupt sleep
patient, you should not allow him to become overtired before going to bed. Regimen for underlying diseases
The regimen is prescribed according to the child’s age with the provision
maximum exposure to fresh air. While walking
the child's face should be open to influence
ultraviolet rays and the formation of vitamin D3 in the skin.
The organization of wakefulness is of great importance in the regime
a child with rickets. Taking into account the age of the child it is necessary
encourage him to motor activity using toys.
Prevention of bone deformities.
Stimulation psychomotor development and positive emotions with
taking into account the main age lines of development.
The child's clothing should not restrict his movements.
It is necessary to bathe your child daily. Diet and nutrition
These are important factors in the treatment and care of young children.
Take into account the diet and nature of nutrition before illness, general
condition, severity of the disease and nature of the course.
Taking into account the frequency of possible or existing reactions with
side of the gastrointestinal tract in the form of functional disorders to the patient
early age during the acute period of the disease with severe
condition, the volume of food is often reduced, and the frequency of feedings
increase by 1–2.
Easily digestible food is prescribed, in a more liquid form.
Sick children should be prescribed fortified foods,
which is achieved by introducing juices, vegetable and fruit.
The patient should be provided with sufficient fluids
in the form of 5% tea, vegetable and fruit decoctions, glucose-salt
solutions. Under no circumstances should you force feed a child. Diet and nutrition
The amount of food eaten and liquid drunk should be
clearly mark on the nursing sheets, and also indicate the nature
appetite, whether or not there was regurgitation and vomiting, if yes, then at what time
time of day, their character and admixtures of bile, blood, mucus.
Regurgitation in young children can also be due to
swallowing air. If there is any suspicion of a connection
regurgitation with swallowing air is necessary after
during feeding, place the patient in a vertical position so that
so that he burps the air that has entered his stomach.
If regurgitation occurs, control feeding should be carried out
and avoid overfeeding.
If the child is hospitalized and his condition allows,
control feedings should be carried out daily, so
This will determine the volume of lactation in the mother. Results
feedings should be recorded on the nutrition sheet.
Optimally - breast-feeding: found in breast milk
the best ratio between calcium and phosphorus, contains
all necessary macro- and microelements.
For a child with manifestations of rickets in order to reduce acidosis
prescribe a diet with a predominance of alkaline valences:
mainly vegetable and fruit dishes.
Complementary foods in the form of vegetable puree are introduced from 5 months; porridge is cooked on
vegetable broth or use instant porridge, do not
requiring cooking, containing microelements; vitamins,
enriched with iron. Buckwheat, rice, oatmeal are recommended
porridge. In vegetable puree, use zucchini, cauliflower and
white cabbage, pumpkin, carrots, turnips and in smaller quantities
potato. Feeding for underlying diseases
A special place in nutrition is given to products containing
complete proteins, essential amino acids (meat, fish,
egg yolk, cottage cheese, green peas). Egg yolk for baby
a patient with rickets, can be prescribed from 5 months to 1/4, from 7 months to 1/2,
hard-boiled, mashed.
Complementary feeding with minced meat is prescribed 1-1.5 months earlier than
to a healthy child. At artificial feeding use
modern adapted mixtures. Feeding for underlying diseases
For anemia, the first complementary foods are introduced for 2-4 weeks ahead of schedule V
in the form of vegetable puree containing iron and copper salts.
In severe anemia, accompanied by a pronounced decrease in
appetite and dystrophy in infants, diet therapy
must be carried out according to the principle of dystrophy, following the stages
minimal, intermediate and optimal nutrition with
gradual introduction of iron-rich foods.
For diathesis - a special hypoallergenic diet. Caring for a sick child
The patient's thermometry is usually carried out 2 times: in the morning and in the evening.
The axillary areas should be wiped dry, thermometer
should be kept for 7–10 minutes. Measurement result
body temperatures are recorded on a special sheet.
In some patients, body temperature measurement may be
prescribed every 3–4 hours, in such cases the nurse must
clearly carry out this assignment and record the measurement time
temperature. Simultaneous measurement can be scheduled
temperatures in the armpits and rectum. At
When measuring the temperature in the rectum, the patient is placed on
side, thermometer, pre-lubricated with Vaseline, mercury
the end is inserted 2–3 cm into the anus. During
rectal temperature measurements of the buttocks are maintained in
closed position 5 min. Rectal temperature by 0.5 °C
above the axilla. Upon completion of temperature measurement
The thermometer must be washed thoroughly and
disinfect. Thermometers are stored in the nurses' closet in
jar with cotton wool at the bottom. Caring for a sick child
When caring, it is important to pay attention to children’s behavior (active,
passive, lethargy, agitation, etc.), monitor the reaction to
environment (does he show interest in toys, other children,
adults, etc.), record the characteristics of the reaction to
manipulations, especially injections.
The nurse should reflect all his observations in the nursing report.
sheet and report at morning conferences.
About a change in behavior or deterioration in the child’s condition,
If new symptoms appear, the nurse must immediately report
ward or duty doctor.
When the patient's behavior and condition changes, the nurse should
measure his body temperature again. Caring for a sick child
When caring for young children, it is important to maintain cleanliness.
their skin, hygienic baths are carried out daily (if not
prohibited by a doctor), in patients in serious condition the skin is wiped
partially, sometimes rubbing with alcohol is used
solution. Caring for a sick child
Medical staff should monitor stool patterns and
urination.
Frequency of stool, its character after personal examination by a nurse
records it on the nurse's sheet.
The number of wet diapers and how wet they are are noted.
If there are no contraindications due to the severity or nature of the
underlying disease, a patient of early age must
weigh daily. Caring for a sick child
When performing intramuscular injections, the nurse must:
Before injecting, check the condition of the tissues
places of previous injections in order to timely detect
possible infiltrates, hemorrhages, etc. About your
she should inform the doctor about her observations.
At the time of injection, it is necessary to monitor the patient's reaction.
After injections, especially antibiotics, it is necessary 20–30
minutes to approach the child and make sure that his condition is not
visible changes have occurred (the possibility of
allergic reactions). It is necessary to have ready for this case
all emergency aid.
Prescribed medications must be used strictly.
The nurse must ensure that she is giving or
administers exactly the medicine prescribed by the doctor, and for what period
The medicine has not expired. Caring for a sick child
In case of active resistance when administering the drug through
mouth, the nurse should administer the medication using the following technique:
press on the side of the cheeks with two fingers, at this moment
The lips open and the medicine can be poured into the mouth. Medicine
can be poured in by pinching the nose, the child opens his mouth to breathe, and
At this point you need to inject the medicine. Caring for a sick child
Subcutaneous injections are made into the outer surfaces of the shoulder and
thighs after thoroughly wiping the skin with alcohol.
Intramuscular injection is carried out in the upper outer
quadrants of the buttocks, thigh muscles. Need to make a quick
puncture. The needle must be removed strictly vertically, place
After removing the needle, hold the injections with a cotton ball,
soaked in alcohol. Caring for a sick child
As the child recovers, the child should be given the opportunity to
movements during wakefulness, the ability to communicate with children
older people, if they are on the department, you need
attract the patient's attention to a beautiful toy.
However, it is necessary to protect the child from contact with
patients with acute respiratory viral infection. Caring for a sick child
When caring for preschool children, it is important to consider:
what's in it age period of diseases in first place
frequency are infectious, determined by wide contacts
children, as well as respiratory diseases. However, diseases in children
during this period, as a rule, have a benign course.
Dispensary observation.
Prevention.
Forecast.
For recent years Due to the emergence of new technologies for caring for premature babies, their mortality rates have decreased.
Children with degrees I–II prematurity have a favorable prognosis. With a birth weight below 1500g, the prognosis is less favorable. These children have more high mortality rate from the addition of secondary infections, pathologies of the visual organs (myopia, astigmatism, strabismus - 25%) and hearing organs (hearing loss - 4%) are more common. They are often diagnosed with neurological changes of varying severity (vegetative-vascular disorders, convulsive, hypertensive-hydrocephalic syndromes, cerebral palsy). The formation of persistent psychopathological syndromes is possible.
· Protecting the health of the expectant mother, starting from early childhood.
· Timely sanitation of chronic foci of infection of a girl - an expectant mother.
· Planning pregnancy.
· Creating favorable conditions for pregnancy.
· Regular monitoring of the pregnant woman in the antenatal clinic, timely detection and treatment of diseases and toxicoses.
· Refusal of a pregnant woman from bad habits.
· If there is a threat of miscarriage, mandatory hospital treatment for a pregnant woman is required.
A premature baby must be registered at a dispensary in health group II (risk group) for 2 years. Once every 3 months, and more often if indicated, the child is examined by a neurologist, ophthalmologist, and once every 6 months by an otolaryngologist. At the age of 1 and 3 months - an orthopedist. In the second and third years, consultations with a child psychiatrist, speech therapist, endocrinologist, and gastroenterologist are necessary.
Possible problems for parents:
- Stress and worries in connection with premature birth.
- Worry and concern for the child.
- Feeling helpless.
- Lack of knowledge and skills in child care.
- High risk of developing hypogalactia.
- Lack of breast milk from the mother.
- Lack of family support.
- The search for those responsible for the premature birth of a child.
- Situational crisis in the family.
Nursing interventions:
- Give recommendations to a nursing mother on daily routine and nutrition:
- To maintain lactation, a nursing woman must adhere to a correct daily routine, which includes adequate sleep, exposure to fresh air, balanced nutrition, psycho-emotional comfort in the family, moderate physical activity.
- Nutritious food a lactating woman can be provided with a daily set of products: 150-200g of meat or fish, 50g butter, 20-30g cheese, one egg, 0.5 liters of milk, 800g vegetables and fruits, 300-500g bread. In addition, the diet should include fermented milk products, juices, various cereals, and nuts. Eliminate garlic, onions, hot seasonings (they worsen the taste of milk), strong coffee, and alcoholic drinks from your diet.
- The amount of liquid consumed should not exceed 2.5 liters per day (with 0.5-1 liters for milk and fermented milk products).
· If breast milk is available, use a free feeding mode, convince the mother of the need to put the baby to the breast frequently, because this stimulates lactation and develops the sucking reflex in the baby.
· The duration of feeding should not be limited; it may vary depending on different times days.
· The baby needs night feeding until he can suck the volume of milk he needs during the day.
· After the establishment of lactation and active sucking, with positive dynamics of body weight gain, the child can be transferred to a 6-time feeding regimen.
· If there is a lack of breast milk, use a mixed feeding regimen. Supplementary feeding is carried out by specialized adapted mixtures for premature babies during the first 2-3 months, then switch to feeding with adapted formulas for children in the first half of the year, and after 6 months - on formulas for children in the second half of the year. It is necessary to explain to the mother that supplementary feeding is introduced after breastfeeding, given with a spoon or from a horn, the nipple must be soft, imitate the shape of the breast nipple, and have an opening adequate to the sucking efforts of the child.
· In the absence of breast milk, use an artificial feeding regimen - feeding 6 times a day with formula recommended by a doctor.
· With mixed and artificial feeding, it is necessary to teach parents the technology of preparing and storing formula and the rules of feeding. If individual tolerance is good, it is advisable to use formulas from the same manufacturer, which reduces the risk of developing food allergies and increases the efficiency of feeding.
· Juices and complementary foods are introduced from 4 months. All types of complementary foods are introduced carefully, using the training method, starting with drops and bringing to the required volume over 8-10 days.
· It is necessary to monitor the child’s absorption of food (regurgitation, bloating, change in stool character).
- It is necessary to train parents in the peculiarities of caring for premature baby:
· The temperature of the room where the child is located must first be maintained within 24-26 o C, and gradually reduced to 22-20 o C.
· Train parents in the technique of performing a hygienic bath (room temperature not lower than 25 o C, water temperature 38-38.5 o C, then the water temperature is gradually reduced to 37-36 o C, and from the second half of the year - to 34-32 o C ), Hygienic baths are carried out daily, at first their duration is 5-7 minutes, gradually it increases.
· For irritated skin, teach parents how to conduct medicinal baths with infusions of string, sage, chamomile, and St. John's wort.
· Clothing for a premature baby should be made of soft, thin natural hygroscopic fabrics, without rough seams, scars, or buttons. Clothing should be multi-layered, and swaddling should be loose.
· Placement on the stomach must be carried out from the first day of the child’s stay at home. It is recommended to place it on a hard surface 3-4 times a day before feeding.
· Training methods of hardening (lowering water temperature, contrast dousing after bathing, air baths) begin to be used depending on the degree of maturity, individual characteristics and health status of the child. Air baths begin from 1.5-3 months for 1-3 minutes 3-4 times a day, gradually increasing the time to 10-15 minutes in combination with a stroking massage. From 4 months you can introduce other hardening elements.
· Stroking massage begins from 1-1.5 months, from 2-3 months other massage techniques are gradually introduced - rubbing, kneading, passive hand movements. To improve psychomotor development, massage and gymnastics of the hands are performed daily, and from 8-9 months, to stimulate the development of speech centers and coordination small movements, the child is offered games with small objects. It is necessary to train parents in performing all massage techniques and playing games.
- Train parents in the technology of psycho-emotional communication with their child:
· In the early stages, nursing a premature baby directly on the mother’s chest (“kangaroo method”), only for a short time the baby is placed in a crib.
· Subsequently, it is necessary to convince the mother to pick up the child more often, touch him using the language of bodily communication, constantly communicate and talk to him in a gentle voice, quietly sing songs to him
- Help parents realistically assess physical and mental development child, accept him as he is, see his achievements and prospects.
- Advise parents to maintain an atmosphere of emotional comfort in the family, avoid tension in a timely manner, avoid violent manifestations of emotions, actively interact with each other, pay as much attention to the child as possible, select toys and games according to age, and constantly engage with him.
- To acquaint parents with the features of the physical and neuropsychic development of a premature baby:
· Large loss of initial body weight (9-14%).
· Low weight gain in the first month of life. Subsequent monthly weight gain up to one year on average should be greater than in full-term infants.
· The monthly increase in height in premature babies is greater than in full-term babies (on average it is 2.5-3 cm).
· Head circumference in the first 2 months is 3-4 cm greater than chest circumference; by the end of the 1st year of life, head circumference is 43-46 cm, chest circumference is 41-46 cm.
· Teething begins later than in full-term babies (on average at 8-10 months).
· The appearance of psychomotor skills in the first year of life may be delayed (visual and auditory concentration, purposeful hand movements, the ability to sit, stand, walk, talk), especially in children with a birth weight of 1000 to 1500 g (for 2-3 months), from 1500 to 2000g (for 1.5 months).
· Most children with a birth weight of 2500 g catch up with their full-term peers by one year, and very premature children are compared with them by 2-3 years.
Security questions:
1. What risk factors for having a premature baby do you know?
2. What determines the degree of maturity of a premature baby?
3. List the degrees of prematurity and their main criteria.
4. What morphological signs of a premature baby do you know?
5. What are the manifestations of immaturity of functional systems in a premature baby?
6. What are the principles of feeding premature babies?
7. What is the purpose of the first stage of nursing premature babies and where is it carried out?
8. What is the purpose of the second stage of nursing and where is it carried out?
9. What are the requirements for the microclimate when nursing premature babies at the second stage?
10. What are the principles of drug therapy for a premature baby?
11. What are the criteria for discharging a premature baby home?
12. What is the individual rehabilitation and follow-up program for a premature baby?
13. What is the prevention of premature birth of children?
14. What is the prognosis for a premature birth?
15. What are the features of the physical and neuropsychic development of premature babies?
Sources of information:
· Textbook by Svyatkina K.A., pp. 25-27.
· Textbook of Ezhova N.V., pp. 148-160.
· Tutorial Sevostyanova N.G., pp. 171-191.
Basic lecture notes