BSc Nursing 3rd Year Child Health Nursing Chapter 7 Extra Question And Answers

Extra Short Answer Questions

Question 1. Neonatal sepsis
Answer:

Neonatal sepsis:

Sepsis is a serious medical condition caused by the body’s response to an infection. In newborns, sepsis can cause swelling throughout the body and possible organ failure.

Sepsis in newborns causes:

• Bacterial infections are the most common cause of sepsis. However, sepsis can also be caused by fungi, parasites, or viruses.
• The infection can be located in any of a number of places throughout the body.

Read And Learn More: Bsc Nursing 3rd Year Child Health Nursing Previous year Question And Answers

Ways by which newborns get sepsis:

• Newborns can get sepsis in several different ways:
• If the mother has an infection of the amniotic fluid (a condition known as chorioamnionitis)
• Premature birth (premature babies are at a higher risk for sepsis) Low birth weight of the infant (risk factor for sepsis)
• If the mother’s water breaks early (more than 18 hours before the baby is born)
• If the baby is being treated for another condition while still in the hospital
• If the mother’s birth canal is colonized with bacteria. some symptoms of infections in newborns

Symptoms of infections in newborns include:

• Not feeding well
• Being very sleepy
• Being very irritable
• Rapid breathing or breathing pauses (apnea)
• Vomiting or diarrhea
• Fever (temperature over 100.4 degrees F or over 38.1 degrees C)
• Inability to stay warm — having a low body temperature despite being clothed and wrapped in blankets
• Pale appearance.

Sepsis in newborns diagnosed:

Tests for sepsis in newborns can include:

• Blood tests (blood cell counts, blood cultures)
• Urine tests (urinalysis and culture)
• Skin swabs
• Spinal tap (also known as lumbar puncture) to test for meningitis.
• A spinal tap is a procedure in which a very small needle is inserted into the space around your child’s spine to withdraw spinal fluid to test for infections.

Sepsis in newborns treated:

Babies who have sepsis are admitted to an intensive care unit.

Treatments may include the following:

• Intravenous (IV, directly into a vein) fluids
• IV antibiotics
• Medications for fever (rarely used in newborns)
• Extra oxygen and other forms of respiratory support, if needed
• Occasionally, babies may need blood transfusions.

Question 2.  Juvenile Delinquency
Answer:

Juvenile Delinquency:

Juvenile Delinquency Of the various behavior problems that are encountered in children, antisocial behavior is the most taxing and troublesome, affecting not only the family but also various levels of society.

• Parents refer to these children as bad boys who need to go to the house of correction.
• Teachers call them incorrigible and beyond correction.
• The psychiatrist and psychologist call them ‘emotionally disturbed’ while the judiciary has one term for them – ‘Delinquents’.

Juvenile Delinquency Definition:

Juvenile delinquency is an antisocial behavior, in which a child or adolescent purposefully and repeatedly does illegal activities. The Children Act, of 1960 in India defines a delinquent as “a child who has committed an offense such as theft, sexual assault, murder, burglary or inflicting injuries, running away from home, etc”.

Presentation of Antisocial Problems in Children

The common forms of presentation of Juvenile delinquency are

• Constant Disobedience
• Lying
• Stealing
• Fire setting
• Destructiveness
• Cruelty
• Truancy from school
• Running away from home ix.
• Sexual problems
• Drug and alcohol intake with dependence
• Gambling

Other forms of delinquency that are not so commonly seen are assault robbery, rape, homicide, burglary, theft, forgery, fraud, trading stolen goods and property, vandalism, prostitution, bootlegging, and smuggling.

Juvenile Delinquency Etiology:

• Genetics.
• Body build
• Sex
• Age
• Intelligence
• Family background

Diagnostic:

The diagnostic procedure should be carried out carefully and accordingly, the following regime may be recommended:

• Interview: It is essential to interview in detail, not only the delinquent but also his parents.
• The interview should preferably consist of a structured procedure to avoid omitting or failing to elicit essential data.
• Mental status examination: It is also essential to carefully evaluate the delinquent using a systematic Mental Status Examination, to obtain information about the present mental state and abnormalities that may prevail.
• Neurological examinations: A neurological examination must be carried out in every delinquent to detect any evidence of abnormality.
• E.E.G: It is most essential to recommend an EEG of the delinquent, to rule out any organic cause for the problem.
• Psychological test: The personality which is the totality of an individual’s physical, temperamental, emotional, and mental make-up is evaluated in case of delinquents by suitable personality tests, like Rorschach’s tests, the M.M.P.I etc.

Juvenile Delinquency Prevention: 

• Prevention of delinquency is often a very difficult problem and can best be described as under
• Primary prevention extends to the removal of all factors which directly or indirectly, cause delinquency.
• Secondary prevention aims at prompt diagnosis and treatment of delinquency.
• Tertiary prevention aims at the rehabilitation of delinquents.
  • Prevention of juvenile delinquency may extend to marriage guidance that may help to create a happier family.
  • Effective family planning so that all children are wanted is useful.
  • Methods to bring- up stage and a balance of discipline and permissiveness should be encouraged in parents. An atmosphere of emotional and financial security should be there at home.
  • Proper physical care prevents delinquency.
  • Close contact of children with parents also prevents delinquency. Children should be taught at prenatal
  • The energy of adolescents should be channelized to prevent delinquency

Juvenile Delinquency Management:

• It is difficult to decide, whether the delinquent should be put away in an institution or treated in the community.
• The therapy for delinquency should be of two types:

Preventive therapy: Already discussed above

1. Corrective therapy
2. Drug therapy

1. Corrective Therapies:

• Corrective therapies used for juvenile delinquents are:
• Protective therapy, which is not only to custodial care but also to probation or parole.
• Punitive therapy, with an idea to serve as a deterrent.
• Reformative therapy brings about certain changes in the personality and behavior of the delinquent.
• Rehabilitative therapy is essential to assist the delinquent in his progress and give him a new way of living.

2. Drug Therapy:

• The use of drug therapy for delinquents is beneficial only in cases of aggressive behavior.
• Tranquilizers in adequate doses need to be given. Chlorpromazine, given orally in doses of 25- 50 mg, three times a day is the best.
• Also, Haloparidol can be given orally in doses of 1.5-10 mg, three times a day. In case of severe uncontrolled aggression, the injectable route can be used.

Question 3. Reflexes in child.
Answer:

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Question 4. Hypothermia
Answer:

Hypothermia Definition:

Normal axillary temperature is 36.5-37.5°C. In hypothermia, the temperature is below 36.5 degrees centigrade.

According to severity, hypothermia is classified as:

1. Hypothermia: 36.0°C to 36.4°C
2. Moderate hypothermia: 32.0°C to 35.9°C
3. Severe hypothermia: <32°C

Hypothermia Prevention :

• According to the concept of “Warm Chain,” a baby must be kept warm at the place of birth (home or hospital) and during transportation for special care either from home to hospital or within the hospital.
• Satisfactory control demands both the prevention of heat loss and the promotion of heat gain.
• The “warm chain” is a set of ten interlinked procedures carried out at birth and later, which will minimize the likelihood of hypothermia in all newborns.

Warm delivery room (>25°C):

• Warm resuscitation
• Immediate drying
• Skin-to-skin contact between the baby and the mother
• Kangarooing.
• Breastfeeding
• Bathing and weighing postponed
• Appropriate clothing and bedding
• Mother and baby together
• Warm transportation
• Training/awareness of healthcare providers.

Hypothermia Clinical Features:

The manifestations of hypothermia are as follows

1. Peripheral vasoconstriction:
   • Acrocyanosis
   • Cool extremities
   • Decreased peripheral perfusion
2. CNS depression:
   • Lethargy
   • Bradycardia
   • Apnea
   • Poor feeding
3. Increased metabolism:
   • Hypoglycemia
   • Hypoxia
   • Metabolic acidosis
4. Increase in pulmonary artery pressure:
   • Distress
   • Tachypnea
5. Chronic signs:
   • Weight loss
   • Poor weight gain

Hypothermia Management:

• The diagnosis of hypothermia is confirmed by recording actual body temperature.
• A hypothermic baby has to be rewarmed as quickly as possible.
• The method selected will depend on the severity of hypothermia and the availability of staff and equipment.

The methods used to manage cold stress include:

• Skin-to-skin contact
• A warm room or bed
• A 200 watt bulb
• A radiant heater or an incubator

Infection should be suspected if hypothermia persists despite the above measures. Monitor axillary temperature every ½ hour till it reaches 36.5°C, then hourly for the next 4 hours, 2 hourly for 12 hours, thereafter 3 hourly as a routine.

Moderate hypothermia (>32 to >36 °C):

• Skin-to-skin contact should be in a warm room and a warm bed.
• A warmer/ incubator may be used, if available. Continue rewarming till the temperature reaches the normal range. Monitor every 15- 30 minutes.
• In case of severe hypothermia (<32) use air heated incubator (air temp 35-36°C) or a manually operated radiant warmer or thermostatically controlled heated mattress set at 37-38°C.
• Once the baby’s temperature reaches 34°C the rewarming process should be slowed down.
• Alternatively, a room heater 200-watt bulb or an infrared bulb may be used.
• Monitor the baby’s blood pressure, heart rate, temperature, and glucose level. In addition
• Measures must be taken to reduce heat loss.
• 10% Dextrose must be started intravenously at the rate of 60-80 ml/kg/day.
• Administer Vitamin K 1mg to term and 0.5 mg to preterm.
• Provide oxygen.

Question 5. Hyperbilirubinemia
Answer:

Hyperbilirubinemia Introduction:

Hyperbilirubinemia or icterus neonatrum is observed during the first week of life in approximately 60% of term infants and 80% of preterm infants.

Hyperbilirubinemia Definition:

Jaundice is the visible manifestation of hyperbilirubinemia. Hyperbilirubinemia refers to an excessive accumulation of unconjugated bilirubin in the blood resulting in yellowish discoloration of skin and mucous membranes. An indirect bilirubin level of more than 5mg/dl manifests as jaundice.

Bilirubin is formed from the breakdown of RBCs. It is excreted from the body in the form of Urobilinogen (through urine) and Stercobilinogen (through stool). Jaundice occurs when the liver can not excrete sufficient bilirubin from the plasma.

Hyperbilirubinemia Classification:

Jaundice is of the following types:

• Physiological Jaundice
• Pathological Jaundice
• Breast Milk Jaundice
• Breast Feeding Jaundice

Physiological Jaundice/ Icterus Neonatrum:

• About 60% of term and 70% of preterm babies develop jaundice within 1st week of life. This is known as
• ‘Physiological Jaundice’. In term babies maximum intensity of jaundice is on the 4th day and subsides by the 7th day, whereas in preterm babies maximum intensity is on the 5th-6th day and it subsides by the 14th day.

Causes of Physiological Jaundice:

1. Increased bilirubin load on liver cells:

• Increased Erythrocyte volume
• Increased Erythrocyte destruction due to their shorter life span (90 days in children as compared to 120 days in adults)
• Increased Enterohepatic circulation of bilirubin (In the newborn’s intestine the enzyme B glucuronidase converts conjugated bilirubin into an unconjugated form which is reabsorbed by intestinal mucosa and transported to the liver.
• This process is known as enterohepatic circulation)

2. Defective Hepatic uptake of bilirubin from plasma:

• Decreased Cytoplasmic ligandin
• Decreased Serum Albumin Concentration

3. Defective bilirubin conjugation: UDPGT activity

4. Decreased bilirubin excretione& DANS:

Feeding the baby stimulates peristalsis and produces rapid passage of meconium, thus reducing the amount of absorption of conjugated bilirubin by stool.

Jaundice Clinical Features:

The clinical features of Jaundice are

• Yellow discoloration of skin, sclera, or nails
• Lethargy
• Refusal to Feed
• Dark urine and stool

Jaundice Management:

1. Pharmacologic management:

• Phenobarbitone:  Phenobarbitone promotes hepatic glucuronyl transferase synthesis which increases bilirubin conjugation. It also promotes synthesis of albumin which increases hepatic uptake of bilirubin for conjugation.
• Metalloporphyrins:  Metalloporphyrins especially tin-protoporphyrin and tinmesoporphyrin inhibit heme oxygenase activity thus reducing the breakdown of heme to biliverdin.

2. Exchange Blood Transfusion:

• Bilirubin can be removed from blood most rapidly by exchange transfusion.
• It is used when Serum bilirubin is more than 20mg/dl in term infants and more than 15mg/dl in preterms.
• It is also used when there are serious complications of hyperbilirubinemia. It is rarely used in physiological jaundice.

3. Phototherapy: Phototherapy is the use of fluorescent light for the conversion of unconjugated bilirubin into conjugated bilirubin.