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coma 6. dehydration with electrolyte disturbances 7. liver failure 8. toxic coma as in typhoid fever and septicemia Management of coma: 1. Take care the airway does not become blocked by the tongue or secretions by placing the patient in the coma position with the mouth downwards and using suction p.r.n.( A,B,C, D of life saving measures) 2. Find and treat the cause, if possible or refer to hospital. A malaria blood film, a lumbar puncture, dextrostix in blood or clinistix in urine, measuring blood pressure, and a thorough history and examination will usually reveal the cause. If not: treat as malaria in any case. In case of a feverish, toxic, comatose child, also start treatment with penicillin and chloramphenicol and refer to hospital. Pediatric Nursing and child health care 35 3. Turn the patient every 2 hourly 4. Check the bladder regularly for retention 5. Insert NGT for feeding C) Convulsive seizure: Convulsions are much commoner during the first two or three years of life than at any other period. This is not only due to congenital malformation or perinatal injury to the central nervous system but also the frequency of “febrile“ convulsions in response to a rapid rise of temperature at the onset of acute infective illnesses 1. Management of Convulsion in children: • (A,B,C,D) of life saving measures • Give 20 % glucose ( IV or PO) • Give Diazepam, ( Rectal, IV,NGT) if convulsion does not stop • Give Phenobarbitone or Phenytine if convulsion does not stop • Give General anesthesia 2. Nursing Management during seizure: • Provide privacy • Protect head injury by placing pillow under head and neck • Loosen constrictive clothing’s • Remove any furniture from patient side • Remove denture if any Pediatric Nursing and child health care 36 • Place padded tongue blade between teethes to prevent tongue bit • Do not attempt to restrain the patient during attack • If possible place patient on side 3. Nursing Management after seizure: • Prevent aspiration by placing on side • On awaking re-orient the patient to the environment • Re-assure and calm the patient 3.4 Tracheostomy Care (Care of a child under Tracheostomy): A tracheotomy is a procedure in which an opening is made into the trachea. When an indwelling tube is inserted into the trachea, the term tracheostomy is used. A trachestomy may be either temporary or permanent. A trachestomy is performed to by pass an upper airway obstruction, to remove tracheoborncheal secretions, to prevent aspiration of oral or gastric secretions in the unconscious or paralyzed patient and to replace an endotracheal tube. There are many disease processes and emergency conditions that make a tracheostomy necessary. Pediatric Nursing and child health care 37 Procedure: The procedure is performed in the operating room or in an intensive care unit, where the patients condition can be well controlled an optimal aseptic technique can be maintained. An opening is made in the second or third tracheal rings. After the trachea is (opened) exposed a tracheostomy tube of appropriate size is inserted. The tracheostomy tube is held in place by tapes fastened around the patients neck usually, a square of sterile gauze is placed between the tube and the skin to absorb drainage and prevent infection. Complications: Early complications immediately after the trachestomy is performed include: • bleeding • pneumothorax • air embolism • aspiration • subcutaneous or mediastinal emphysema • recurrent laryngeal nerve damage or • posterior tracheal wall penetration. Pediatric Nursing and child health care 38 Long-term complications include: air way obstructions due to accumulation of secretions. • infection • dysphasia • tracheo-esophageal fistula • tracheal dilation • tracheal ischemia and necrosis • tracheal stenosis after removal of tracheostomy tube. Immediate Postoperative Nursing care: • The patient requires continuous monitoring and assessment. • The opening must be kept patent by proper suctioning of secretions. • After the vital signs are stable, the patient is placed in semi-fowler’s position to facilitate ventilation, promote drainage, minimize edema and prevent strain on the suture lines. • Analgesic and sedative drugs are administered with caution because it is undesirable to depress
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