PEDIATRIC

NURSING
NELSON MANDELA
RN, BSN & PH
INTRODUCTION
 Pediatric is concerned with health of infants, children, & adolescents.
 It includes the five stages of development according to erik erickson. Thus,
infancy, toddler, preschool, school and adolescent.
 It focuses on their growth & development to ensure they are given the
opportunities to achieve their full potential as adults.
 The young are most vulnerable or disadvantaged in society hence need
special attention. Children are individuals, not little adults who must be
seen as part of the family.
 Child health needs to be approached from a holistic and family centered
approach.
 Providing paediatric care to children and families requires knowledge of
different dynamics that influence it in contemporary society
 Examples of such changes include: parenting styles; nature and
structure of families; breakdown of traditional family systems; eating
habits; level of activity; information acquisition means ;adoption of western
cultures ;technical advancement.
THE CHILD IN THE CONTEXT
OF THE FAMILY
 No other factor in a child’s life has a greater influence than the family,
which is the first and the most important socializing agent in one’s life.
 Successful socialization is the process by which children acquire beliefs,
values and behaviours deemed significant in the society, this is a function
of parenting and other familial interactions.
 Their well-being is inextricably linked to the families, communities & the
society they live.
 Many familial factors have impact on children. Divorce, family size, absent
fathers, working mothers, sibling position, and sex.
LEGAL AND ETHICAL ISSUES
OF PAEDIATRICS
 Nurses are confronted by difficult ethical/ legal decisions especially for
nurses taking care of children in critical care conditions e.g. Does one
resuscitate a child or not? Hence the need to understand some legal/
ethical guidelines that can resolve these dilemmas.
 Different governments have different legal laws and regulations. Though
children have right to informed consent, usually, it’s the legal guardian or
parents who take the consent .children are said to “assent” i.e. Paediatric
client has been informed about the procedure and is willing to permit it
being performed. However, assent is not legally required but important for
child’s cooperation.
When is informed consent not required?
 Emergency situations – emergency life saving procedure. But should be
after attempts have been made to contract parent or legal guardian.
Adolescents can consent.
 Forensic examination – where evidence is required .may not require
informed consent but still is vital for child’s assent.
Minors can consent for care in a number of situations
 Where child may avoid care of caregivers e.g. Pregnancy, drug abuse
treatment, contraception, treatment of STIs.
 If minor is considered to be emancipated i.e. Legal recognition that a minor
lives independently and is legally responsible for his or her own support
and decision making.
Refusal of medical care by parent/caregiver
 Usually, this occurs if health care conflicts parent’s religious beliefs. Parents
may refuse to act to the best interest of the child. In such cases, the
government may make legal decision of the child.
 The theory of parens patrie is applied. This is a legal rule allowing
government to make decision in place of parents when they are unable or
unwilling e.g. To provide for the best interest of the child.
PERSPECTIVE ON PEDIATRIC
NURSING
1. Family centered care:
 paediatric care involves care of children and their entire family.
 Family centered care considers family contributions and involvement in
the plan and delivery of child care
characteristics of family centered care
 Policy recognition of need for family in child’s life.
 Enhance professional- family collaboration at all levels of care.
 Exchange of unbiased and complete information between family
and professionals.
 Incorporate into policy recognition of uniqueness of each family
in race, education, creed, culture and economic situations.
 Enhance family to family networking – social support especially
families of children with chronic illness/ aged caretakers.
 Ensure home, hospital and community child- health services are
of high standards.
 Family centered care empowers the family in relation to their
child care.
 The nurse should always look at how the child functions within
the family and how this influences his/her health. Gaps/ deficits
of care should be noted and addressed.
2. Atraumatic care:
 care that minimizes or eliminates physical or psychological distress for
children and other families in the health care environment.
 Many interventions are traumatic, stressful; painful hence the nurse should
recognize them and provide care that minimizes them.
Principles for the basis for atraumatic care
 Identify stress for child and family
 Minimize separation of child and care givers
 Minimize or prevent pain
 Examples of atraumatic interventions include: prepare
child/family before every procedure especially surgery e.g.
Allow the child to play with equipment, visit the hospital
prior to the surgery and reassurance ; involve caregivers to
support the child; control pain by administering analgesics
freely and provide social support to the family .
ROLE OF THE PAEDIATRIC
NURSE
The primary roles of the nurse include:
 care giver ,
 patient advocacy
 health education,
 researcher
 manager/ leader

Secondary role include:

 coordinator ,
 collaborator ,
 Communicator
 consultant .
Advanced practice roles
 nurse practitioner,
 clinical nurse specialist
 care manager
NURSE, CHILD AND FAMILY
COMMUNICATION
Nurses need to use effective communication skills in every interaction to:
 enhance cooperation of family and
 ensure interventions are likely to be optional because of good rapport.
COMMUNICATION…
 Nurses’ ability to establish a therapeutic relationship is related to her
communication abilities i.e ability for therapeutic communication.
 It’s a vital tool for history taking, physical examination, health education
and maintaining adequate rapport with child/ care giver
 it is the basic requirement for family or caregiver centered pediatric care.
EFFECTIVE COMMUNICATION
 There are certain considerations that are vital for effective
communication:
 rapport and trust,
 respect
 empathy
 listening
COMMUNICATION PRINCIPLES
BASED ON DEVELOPMENTAL LEVEL
 Infants: allow warm up to strangers; respond to cries timely; use soothing
& calm voice; talk to infant directly; crying, cooing, whining, or body
movement, face.
 Toddlers: approach carefully – not to cause fear; integrate familiar objects
in care; use dolls, story telling and picture books in conservation.
 Pre-school: allow choices as appropriate; use play, story telling; speak
honestly, simple language, concise; prepare procedure 1-3 hours before
they are done.
 School age: use books, diagrams, and videos in preparing for
procedure .prepare them for the procedure many days before. allow the
child to express feelings.
Adolescent: prepare them one week before the procedure. Provide respect
and privacy. Use appropriate medical terminologies.
 Use creative methods to explain experiences and procedures. The idea
that they construct should be merged with the real world by listening to
them.
 Attentiveness, acceptance, and freedom is important for adolescents and
should be provided. do not trivialise information they think is important for
them.
Communicating with the caregiver
 Explain equipment & procedures thoroughly
 address the question and concerns of caregivers honestly
 teach caregivers what to expect the child will look like and feel like during
treatment .
 Help caregivers to understand the bigger picture that is the long term/
short term effect of treatment e.g. Orchitis.
 Teach and allow the caregiver to carry out as many aspects of the child’s
care as feasible. make reassurance a part of family interactions, ask
caregivers how they are doing
PRINCIPLES OF EFFECTIVE
COMMUNICATION IN PAEDS SETTINGS
 Talk to caregivers if child is shy or appears hesitant.
 Use objects (toys, dolls, stuffed animals) instead of questioning child
directly.
 Provide privacy for older child
 Use clear, specific single phrases in confident, quiet and unhurried speech.
 Position – eye level.
 Allow expression of thoughts/ feelings.
 Provide honest answers
 Offer choices only if they exist
 Use a variety of age – appropriate methods/ techniques.
GENERAL PRINCIPLES OF
PAEDIATRIC NURSING
 Admission procedure
 History taking
 Physical exam and the place for the examination
 Investigations
 IMCI
ADMISSION PROCEDURE
 A concerned attitude calls for a kind approach and understanding on your part.
 Avoid criticising child’s parent/guardian who is misinformed about the nature of
disease, causes and prognosis
 The parents/guardians should be allowed to accompany their children to the assigned
bed within the ward.
 The parents should receive pleasant and friendly reception in a clean and a quiet
environment
 The older child, if not seriously ill on admission, should be introduced to other children.
This reduces possible anxiety and stress.
 Similarly, the parents should be introduced to other parents. It is important you use
the correct names and pronunciation.
 You should carry out the procedures carefully and methodically. You should also be
ready to answer any questions clearly and fully as ambiguity may cause distress and
misunderstanding to parents/ guardians.
 If older children are not seriously ill and are mobile, they and their parents/
guardians should be introduced to the ward or unit, including orientation to
available facilities such as call bell, toilets, bathrooms and playroom.
 Information such as visiting hours for friends, parents, guardians and siblings
including types of food and drinks, which may be brought should be given.
 You should make every effort to find out from the parents/guardians the
child’s likes, dislikes and the name they commonly use to call him/her. Such
investigations will enable you to adapt accordingly.
 The same enquiries should apply to family history and spiritual beliefs, which
you should address without causing embarrassment
 Finally, informed consent for care and operation should be obtained before
the parents/ guardians leave for home.
HISTORY TAKING
 In almost all cases, the history is usually taken from the parents or
guardians, especially when the child is young. For older children, additional
information as to how they feel may be obtained directly.
 The most important details to be recorded should include medical history,
that is, whether the child has been ill before and the nature of any previous
illness. It is also necessary to find out whether the patient has had any
surgery before and for what purpose.
 You should also take the family, social and economic history because these
may be contributing factors to illness. In addition, the mother’s obstetric
history.
 While taking the patient’s history, you will have the opportunity to apply
your communication, interviewing and teaching skills.
PHYSICAL EXAMINATION
 In order to make a nursing diagnosis and prepare the nursing care plan,
you should perform an objective physical examination from head to toe.
 When examining a child, try and make friends first exercising all the
patience. Be flexible in the order of examination, that is, do upsetting and
disturbing procedures last. In most cases the standard techniques of
inspection, palpation, percussion and auscultation is used.
Position/place for examination
 When examining a child, it is important to seek the help of the parent or guardian
to prevent unnecessary movement and resentment by the child.
 The young children will have to be undressed by the parent/guardian, while the
examination will be performed on his/her laps.
 The use of distracters may also win the child’s confidence and enhance his co-
operation.
 You should talk to the child and mother in a low voice and persuasive manner
maintaining eye contact at the level to that of the patient.
 Older children may be given the necessary instruction on what to do and should
be allowed to choose the position they wish to adopt during physical examination.
 The child’s developmental and nutritional status is also assessed during the
physical examination
INVESTIGATION
Some of the common investigations, which you may handle include:
 Body fluids, excretions and secretions, and tissues for culture and
sensitivity tests;
 Blood for white cell counts and differentials;
Haemoglobin and malarial parasites;
Grouping and cross matching;
 Urine for microscopic, albumen, sugar, acetone;
 Stool for ova and cysts and occult blood;
 Radiological investigations, although for very young babies this may have
to be kept to a minimum;
 Endoscopic investigations may also be carried out but only in a few
selected patients according to the problems they are suffering from;
 Sputum for microscopic culture and sensitivity. Where the patient is unable
to produce the specimen, insertion of a naso-gastric tube may be
considered and stomach content aspirated and sent to laboratory.
 You should endeavour to ensure that the parents and the patients are
physically and psychologically prepared before, during and after the
procedures.
 Above all, the principles of infection control must be observed when
handling specimen.
IMCI
 This is a strategy, which combines improved management of childhood
illnesses with aspects of nutrition, immunization and several other
important influences on child health, including maternal health.
 The imci strategy aims at reducing infant mortality rate, severity of illness
and disability by integrating treatment and prevention of major childhood
illness to contribute to an improved growth and development.
 Projections based on global burden of diseases analysis of 1996 shows that
five specific diseases, that is, acute respiratory infection, measles,
malnutrition, malaria and diarrhoea will continue to be major contributors
of childhood mortality right up to the year 2020, unless drastic and
significant efforts are made to control them.
EFFECTS OF ILLNESS AND
HOSPITALIZATION
 Biological
 Physical
 Social
 psychological
Disease patterns in childhood according to age group

Foetus Neonate School Age

Under 5 Yrs
Birth -1 Month 5 -12 Yrs
1 Month – 5yrs

1.Conditions in the mother that 1.Birth injuries 1.Resp. Infections 1.Anaemia

affect foetus: 2.Low birth weight 2.Whooping cough 2.Intestinal worms
 Drugs/Alcohol 3.Asphyxia 3.Pneumonia 3.Tuberculosis
 Toxaemia 4.obstetric complications 4.Malaria 4.Malnutrition
 Malnutrition 5..Neonatal Tetanus 5.Diarrhoea 5.Respiratory
 Infections, e.g. Rubella 6.Gastro-Enteritis 6.Protein energy infections
7.Opthalmia neonatorum malnutrition (PEM) 6.Malaria
2.Genetic abnormalities 8.Septicaemia 7.Measles 7.Skin Diseases
3.Congenital
INFECTIOUS CHILDHOOD DISEASES
POLIOMYELITIS
 Poliomyelitis is an acute infectious viral disease of the anterior horn cells of
the spinal cord and sometimes of the lower part of the brain.
 It occurs sporadically or is epidemiological and usually affects the under
fives but mainly under threes. It is characterized by varying degrees of
paralysis.
 The causative microorganism is poliovirus.
 There are three types of viruses. Type 1 is known as brunhilde, which is
commonly associated with paralytic illness.
 Type 2 is called lansing and type 3 is also known as leon. The latter two
are less commonly associated with paralysis.
 It has an incubation period of three to six days but can extend between
three to twenty one days.
 It has an infective period of three to fourteen days. The virus spreads
mainly through the oral route (gastro-intestinal tract) and then spreads to
the lymphatic system. It can also spread through droplets.
CLINICAL MANIFESTATION
 The patient presents with fever of 39-40oc;
 General malaise;
 Vomiting and headache;
 Painful and tender muscles follow this a few days later;
 Paralysis of one or more limbs occurs as the muscles become weakened.
 The paralysis of the respiratory muscles follows without the child
developing any other illness (this is referred to as flaccid paralysis).
 Only the motor system is affected but without sensory loss.
TYPES
Paralytic type
 This can be divided into spinal polio, where the virus attacks the anterior
horn of the grey matter (newness) and bulbar polio, where the virus attacks
the grey matter of the brain stem probably following a tooth extraction
during an epidemic.
 The patient normally shows signs of having the flu, usually complicated by
pneumonia.
Non- paralytic type
 The patient experiences muscle pain and stiffness. This type of polio can
also change to a paralytic type as a result of any kind of stress by im
injection, walking long distances and chilly weather.
investigations
 A lumbar puncture should be performed to exclude the possibility of
meningitis. Cerebral spinal fluid is usually clear in colour. Both lymphocytes
and polymorphs may be present in the csf.
MANAGEMENT
 This can be divided into supportive and preventive management.
 The patient should be strictly confined to bed. Activities in the first two
weeks of the infection risk possible increased paralysis and should,
therefore, be avoided.
 The patient should be nursed in isolation.
 Pain should be controlled through the administration of analgesics, for
example, paracetamol, and sedatives eg valium or phenobarbitone.
 Regular respiratory suction and postural drainage should be performed.
 N.g tube feeding should be high calorie and include substantial amounts of
protein.
 Change the patient’s position every four hours to avoid bedsores.
 Surgical procedures should also be avoided.
 No injections should be administered during this acute stage as they may
precipitate paralysis.
 Immobilize the affected limbs during the acute stage of the illness,
using splints to prevent flexion deformities and promote rest.
 After the acute stage has passed, you should begin gradual and gentle
exercise of the affected limbs.
 Ensure that there is proper disposal of faeces and urine to prevent spread
of infection.
 Urinary catheterisation must be passed but principles of asepsis must be
observed strictly.
 Maintain an intravenous infusion and fluid balance chart. Oxygen therapy
may be used when necessary.
 A tracheotomy and use of a mechanical respirator may be indicated
should the patient’s condition deteriorate.
 After being discharged, the child should return to the clinic at regular
intervals to ensure flexion deformities do not occur.
 A plaster of paris or back slab should be applied to the limbs if these
deformities actually occur.
 Special shoes and callipers may help severely affected children.
 Prolonged rehabilitation will be required at a later date when the patient is
fully recovered.
PREVENTION
 If polio occurs in an area, the district medical officer of health should be
notified in writing immediately.
 Sabin oral vaccines are given to children to prevent them from getting
poliomyelitis whenever there is an outbreak and routinely in mch clinics.
 Parents should be encouraged to ensure their children are immunized.
CHICKEN POX (VARICELLA)
 This is a mild viral infection, which is extremely contagious.
 Fever and a typical skin rash characterize it.
 The causative organism is varcella zoster virus (vzv).
 It is spread in several ways. These include through airborne droplet infection,
direct or indirect contact and dry scabs and nut infections.
 Droplets from the respiratory tract can transmit the varicella zoster virus from
one person to another. Even the wind is now known to transmit the virus
particles from the skin of the infected person over a distance of meters to
another person.
 Once infected, the disease leaves immunity against chicken pox but the virus
remains within the body and may reappear later in adult life as the herpes
zoster when the person’s immunity is weakened, for example, in aids, diabetes,
leukaemia and old age.
INCUBATION PERIOD
 It has an incubation period of ten to twenty one days.
 The period of communicability is about 5 days before the rash to 6 days
after the appearance of the vesicles.
CLINICAL MANIFESTATION
 The infection presents itself in the following ways:
 Slight fever and sore throat are the first to appear in older children while
younger children are affected by a skin rash;
 Maculopapular rash, which becomes vesicular within a few hours, appears
on the trunk and spreads to the face, armpits, scalp and sometimes the
extremities. Distribution to palms and soles is seldom. Vesicles are usually
superficial on the skin and in the mouth following the sensory nerve.
Groups of new pocks of rash will appear over many days;
 Pustules may form but usually the vesicles collapse and dry up after three
to four days leaving no scars;
 Anorexia and headache may be present;
 Skin irritation (itching) and lymphoadenopathy are sometimes present.
MANAGEMENT
 Confine the child to bed until the pyrexia settles down. Monitor the vital
signs at regular intervals.
 The child requires plenty of fluids and a nourishing diet. The fingernails
should be kept short and the child has to be restrained from scratching.
 General body cleanliness should be maintained. Soothing lotions, such as
calamine, should be applied to the skin to soothe itching.
 Antibiotics are given prophylactically. Occasionally, the child may have to
be sedated.
Complications
 Complications include secondary infections of skin lesions. Pneumonia or
encephalitis may also occur, but these are rare. Other possible
complications may be thrombocytopenia, arthritis and nephritis.
Prevention and control
 As part of active immunization, the live varicella vaccine is used selectively
for immune suppressed children. The varicella–zoster immune globulin is
used for high-risk individuals.
MEASLES
 This is an acute highly infectious disease. It is caused by the measles
virus.
 Transmission is by droplet spread or direct contact with secretions of the
nose and throat of infected persons. The child is most infectious to others
during the prodromal phase, often, before the diagnosis is made.
Incubation period
 It has an incubation period of 7 to 14 days usually 10 to 12 days.

Isolation period
 The isolation period is 5 days after appearance of the rash.
CLINICAL MANIFESTATION
Prodromal phase:
 This may last 3 to 7 days
 The first symptoms are runny nose, fever, conjunctivitis and coughing.
 These may be a faint rash which disappears quickly in the prodromal period.
 Koplik spots appear 24 – 48 hours before the main rash
 Koplik spots are small white spots on a red base inside the cheeks, usually
opposite the lower molars, but may occur on gums and inside lips as well.
Stage of advance:-
 The maculo – popular rash starts behind the ears and on the forehead and spreads
downwards.
 It takes about 3 days to reach the feet, at which point it starts to fade. Fever is
high and lasts for 4 to 5 days.
COMPLICATIONS
 Otitis media
 Respiratory infection
 Pneumonia – this is usually a viral pneumonitis
 Pulmonary tb
 Kerato – conjunctivitis
 Encephalitis is a serious complication often fatal or with residual brain
damage
 Gastroenteritis
 Oral thrush and/or oral herpes
MANAGEMENT
 Treatment is supportive, there is no specific treatment available.
 Supportive treatment include:-
 Antipyretics
 Plenty of oral fluids
 Eye and mouth hygiene
 Vit a 200,000 units orally daily for two days.
 Check the child frequently for complication.
 Uncomplicated cases can be nursed at home but complicated cases infants
and malnourished children should be treated in a hospital with isolation
facilities.
PREVENTION
 Measles can be prevented through active immunization with attenuated
live virus vaccine.
 All children should be vaccinated against measles as per DVI/UVIS
schedule of immunization.
 The infection can be aborted if vaccine is given within 12 hours of
exposure.
MUMPS(INFECTIVE/EPIDEMIC
PAROTITIS)
 This is a viral infectious disease of the parotid glands, which can also
affect other glands as well. It can spread by droplets or contact with the
salivary secretions of the infected person.
Incubation period
 The incubation period varies from patient to patient but is on average
between 14 and 21 days of infectivity after the onset of the parotid glands
swelling. All or some of the following symptoms may be present:
CLINICAL MANIFESTATION
 All or some of the following symptoms may be present:
 The salivary glands, namely, parotid, sublingual and submaxillary glands
may be infected;
 Painful swelling occurs in these glands. This may be one sided or both
sides;
 The child develops fever, and complains of headache and malaise;
 There is dysphagia (painful swallowing);
 The tongue is furred and mouth dry due to diminished saliva;
 Moderate lymphocytosis is noted on blood examination;
 The tenderness may last two to three days then gradually subside
NURSING CARE
 Isolate during period of communicability.
 Maintain bed rest in a warm room until swelling subsides.
 Give analgesics and antipyretics as required.
 Encourage fluids and soft bland foods.
 Avoid foods which contain acid and which require chewing because they
may increase pain.
 Apply heat or cold compress to neck whichever is more comfortable.
 Observe the child’s vital signs of temperature, pulse and respiration and
record them every four hours.
PREVENTION
 Since the condition is caused by a virus, there is no specific drug
treatment.
 However, the active immunity of a live attenuated vaccine is available for
those who are not already infected.
 The mumps virus vaccine is best given before puberty.
COMPLICATIONS
 The child may develop deafness;
 Inflammations of genital organs, such as the ovaries called oophoritis in
girls and testes - orchitis in boys may occur. In both cases this may result
in sterility in adulthood;
 Meningoencephalitis (inflammation of the meninges and brain);
 Pancreatitis, which is inflammation of the pancreas.
HEPATITIS
 This is the inflammation of the liver most commonly caused by various
types of viruses, namely a, b, c, d and e. In this sub-section, we shall briefly
look at hepatitis a, b and c as they are related to paediatric illnesses.
Hepatitis A virus (HAV), infectious hepatitis
 This virus usually occurs in epidemic form. It spreads from man to man by
the faecal-oral route – ingestion of contaminated material. The virus is
excreted in stools and urine from 3 weeks before to 1 week after the onset
of clinical symptoms. The incubation period is about 3 weeks.
CLINICAL FEATURES
 Gastro-intestinal upset (loss of appetite, nausea and vomiting )
 Fever, headache, joint, pains, tiredness
 Jaundice
 Clay-coloured stools, dark-brown urine
 Enlarged and tender liver
LABORATORY
INVESTIGATIONS
 Serum bilirubin (increase of mainly direct bilirubin)
 Liver function tests (abnormal)

NOTE
 The disease is usually milder in children than in adults. Many cases of
infectious hepatitis take a sub-clinical course, without jaundice; there may
be only mild symptoms such as slight fever and loss of appetite for a few
days. Very occasionally, the disease is severe and may cause death due to
acute liver failure.
MANAGEMENT
 Most cases get better without treatment
 Bed rest is usually recommended while jaundice is obvious
 Hygienic disposal of stool and urine
 Hand washing after contact with the patient
 Free diet (but fatty foods are likely to be refused).
 Refer patients to hospital if:-
- jaundice is very severe
 Vomiting persists
 Confusion, coma or bleeding tendency occur

 A vaccine is now available for contacts.

HEPATITIS B VIRUS(SERUM
HEPATITIS)
 Although a common infection on a global scale, it is more prevalent in sub-
sahara africa because of the high perinatal transmission rate and close
contact between toddlers.
 It can also be spread through other routes. It is caused by the hepatitis b
virus (hbv).
 The incubation period tends to be longer than that of other viruses, which
affect the liver but usually in the range of 40 to 180 days.
 The communicability period is just a few days to one month during which
period the individual has become a carrier. In many countries the carrier
number is as high as 5-20%.
ROUTE OF TRANSMISSION
 Trans-placental route - mother to foetus through the placenta (vertical);
 Blood transfusion, if the donor blood was not properly screened;
 Contact with other body fluids and secretions;
 Haemodialysis, especially children;
 Through injections with contaminated needles and broken skin surface.
INVESTIGATION
 Diagnostic investigations include the examination of venous blood
specimen in the laboratory when hepatitis b antigen/antibodies are found
to be positive.
 Blood should be examined for bilirubin and alkaline phosphates but tests
are not always conclusive.
 A liver function test may also be carried out but should be avoided in
children.
CLINICAL FEATURES
 The clinical manifestations occur very slowly.
 These may begin with mild fever, anorexia, general malaise, nausea and
vomiting.
 As the condition progresses, the patient will complain of abdominal
discomfort.
 Occasionally mild jaundice may be present. Bile in the urine and low white
blood count may be noticed.
MEDICAL MANAGEMENT
 Alpha-interferon is the single modality of therapy that offers the most
promise.
 Antiviral agents: lamivudine and adefovir.
 Bed rest
 Adequate nutrition: restrict proteins if symptoms indicate impaired liver’s
ability to metabolize protein byproducts.
 Antacids and antiemetics for dyspepsia and vomiting.
 Fluid therapy
 Evaluate for other blood borne diseases.
NURSING MANAGEMENT
 When nursing a child admitted to your ward with this condition, you should
allow him to regulate his own activities.
 The diet should be high protein, high calorie, and high carbohydrate but
low fat.
 Vomiting, which may be persistent ought to be managed by intravenous
administration of fluids.
 A fluid balance chart is maintained during this period. Precautionary
measures, which include wearing gloves, when carrying out intimate
procedures should be observed.
 No specific drug treatment in children but certain antibiotics may be
administered when there is onset of complications.
PREVENTION
 Active immunization with hepatitis B vaccine
 Screening of blood donors, use of disposable sharps, disinfecting work
areas in lab, use of PPE when handling patients
 In order to prevent spread of infections, you should make every effort to
ensure that your hands are thoroughly washed after handling the patient,
as well as all the articles, including linen, used by him/her.
 The toilets should be cleaned with disinfectants.
COMPLICATIONS
 Acute fulminating hepatitis characterized by rapidly rising bilirubin;
 Encephalopathy, which is a degenerative process of the brain;
 Oedema and ascites will always be present in the advanced stage;
 Hepatic com-unconsciousness due to liver failure;
 Chronic active hepatitis with hepatic dysfunction plus cirrhosis of the liver;
 In some cases cirrhosis of the liver may undergo malignant changes.

NB:
 Nowadays, active immunization with a hepatitis b vaccine is available. This
is given in three doses. The first is followed by a second four weeks later.
The third is administered six weeks thereafter.
HEPATITIS C
 This type of virus has ribonucleic acid (rna) in its nucleus. It causes
hepatitis in similar way to hepatitis b, although the risk to health care
workers and sexual transmission is less marked.
 The main difference however, is its high rate of persistent infection, which
increases the likelihood of the patient developing chronic hepatitis and
cirrhosis of the liver.
 It has an incubation period of approximately 2 to 26 weeks from the initial
entry of the virus.
 It is transmitted in the same way as hepatitis b except that both sexual and
vertical transmission are quite uncommon. There is no specific mode of
prevention.
 Nursing care is the same as for hepatitis b.
ASSIGNMENT
Read on
 Tuberculosis
THANK YOU