LESSON PLAN Section I 1. Name of the teacher 2. Subject !. "nit %. &o$ic (. )uration *. )ate .. Number of $artici$ants +. Class : Ms.

Ashly Elizabeth Emmanuel : Child Health Nursin : #es$iratory System : As$hy'ia Neonatorum : 1 hour : 1+,-!,2-1% : :

/. 0re1ious 2no3led e of $artici$ants: ha1e $re1ious 2no3led e re ardin the anatomy and $hysiolo y of res$iratory system 4 normal ne3born 1-. Method of teachin 11. 5ist of A6 aids : 5ecture cum discussion : chal2 board7 8H07 5C)

12. Name of the su$er1isin teachers:

13. Central objective At the end of the class7 $artici$ants 3ill ain 2no3led e re ardin the definition of as$hy'ia neonatorum7 its causes7 $atho$hysiolo y7 clinical features7 and mana ement and a$$ly this 2no3led e 3hile ta2in care of a child 3ith as$hy'ia neonatorum 3ith a $ositi1e attitude. 14. Specific objectives &he students 3ill be able to7 )efine $yloric stenosis 9dentify the causes of $yloric stenosis E'$lain the $atho$hysiolo y of $yloric stenosis "nderstand the clinical features of $yloric stenosis

Enlist the dia nostic measures of $yloric stenosis E'$lain the mana ement of $yloric stenosis Enlist the com$lications of $yloric stenosis

Time

e!avio"ral objectives

Content

Teac!in# Learnin# activities activities

A$ ai%s

Eval"ation

Intro%"ction
0yloric stenosis :or infantile hy$ertro$hic 1.( mts $yloric stenosis; is a condition that causes se1ere Narrates 1omitin in the first fe3 months of life. 9nfantile the to$ic hy$ertro$hic $yloric stenosis :9H0S; is a medical emer ency. 9mmediate treatment re<uires correction of fluid loss7 electrolytes7 and acid=base imbalance. 8nce intra1enous access is obtained7 an initial fluid bolus :2- m5,2 ; of crystalloids should be infused immediately if the infant is dehydrated. 1 mt )efine stenosis $yloric 5istens Chal2 board

&efintion
0yloric stenosis is the narro3in $ortion of the stomach :$ylorus; of the lo3er

)escribes 8bser1es 4 5istens

5C)

>hat stenosis?

is

$yloric

Inci%ence
&he incidence is 2.% $er 1--- li1e births in 3hites7 1.+ in His$anics7 -.. in African Americans7 and -.* in Asians.

Caucasian babies 3ith blood ty$e @ or 8 are more li2ely than other ty$es to be affected.

&he

usual

a e

of

$resentation

is

a$$ro'imately ! 3ee2s of life :1=1+ 32;. A$$ro'imately /(A of 9H0S cases are

1.( mts

9dentify the causes of $yloric stenosis

dia nosed in those a ed !=12 3ee2s

E'$lains

5istens

5C)

>hat are the causes of $yloric stenosis?

Etiolo#' ( )is* +actors

9dio$athic Hereditary 6ariations in infant feedin E'cessi1e $roduction of and infant; re imens astrin:maternal

deficiency of nitric o'ide containin neuro E'$lains transmitters. ! mts E'$lain $atho$hysiolo y $yloric stenosis the abnormalities in enteric ner1ous system

5istens

Chal2 board

>hat

is

the

the of

$atho$hysiolo y $yloric stenosis?

of Pat!op!'siolo#' Etiolo ical factors B Hy$ertro$hy and hy$er$lasia of circular muscle $ylorus :Size and sha$e of oli1e; B Narro3in of $yloric canal

B 8bstruction 9nflammation,edema delayed astric em$tyin B Com$lete obstruction B 0rojectile 1omitin B )ehydration7 metabolic al2alosis7 failure to thri1e

Clinical manifestations
1. Cardinal si n is $rojectile 1omitin ! mts "nderstand $yloric stenosis the and

nonbilious 1omitin . 9nitially re ur itation may be $resent but e1entually 1omitin increases in fre<uency and intensity. 2. 5oss of 3ei ht !. E$i astric distension %. Consti$ation (. E'cessi1e hun er E'$lains 5istens Chal2 board >hat are the clinical features stenosis? of $yloric

clinical features of

*. )ehydration .. )ecreased urine out$ut +. 0al$able $yloric mass :oli1e sha$ed; in ri ht u$$er <uadrant of abdomen best felt durin feedin

&ia#nostic eval"ation
! mts Enlist the dia nostic measures of $yloric stenosis 0al$ation of $yloric mass: 8li1e sha$ed $yloric mass is $al$ated "ltrasound e1aluation: as dia nosis @arium u$$er C9 series indicated if ultrasound is inconclusi1e D=ray "rine analysis: urine al2aline and confirmatory E'$lains 5istens Chal2 board >hat are the dia nostic measures of $yloric stenosis? size

concentrated @lood haemo lobin and haematocrit:

ele1ated due to hemoconcentration 5aboratory studies re1eal lo3 serum $otassium and sodium le1els. 8f reater im$ortance is a serious decrease in the serum chloride concentration 3ith an

increase in $H and in bicarbonate content. &hese findin s are due to the $rolon ed 1omitin al2alosis. 3ith resultin metabolic

,e%ical mana#ement

Considered

as

medical

emer ency.

9mmediate treatment re<uires correction of fluid loss7 electrolytes7 and acid base imbalance. 8bser1es 1( mts E'$lain mana ement $yloric stenosis the S"r#ical mana#ement of

>hat E'$lains 4 5istens 5C)

are

the for

mana ement $yloric stenosis?

&he definiti1e sur ical $yloromyotomy 2no3n as #amstedtEs $rocedure :di1idin the muscle of the $ylorus to o$en u$ the astric outlet;. &his is a relati1ely strai ht for3ard sur ery that can $ossibly be done throu h a sin le incision :usually !=% cm lon ;.&his is a $rocedure of choice.

5a$arosco$ic $ylorotomy also effecti1e as of #amstedtEs $rocedure 3ith better

cosmetic results.

8nce the stomach can em$ty into the duodenum7 feedin can commence. Some 1omitin may be e'$ected durin the first %+ hours after sur ery as the astro= intestinal tract settles. Hy$ertro$hy of the muscle re resses 3ithin 12 3ee2s after sur ery.

N"rsin# mana#ement
Preoperative care 1. 8bser1in fluid and and recordin electrolyte the 1ital si ns7 imbalance7 and

amount and characteristics of the 1omitus and stools. 2. Collectin s$ecimens !. Assistin 3ith dia nostic $rocedures %. >ithholdin oral feedin s and

administerin

and monitorin

$arenteral

fluids as $rescribed and7 (. 5a1a in the stomach 3ith isotonic saline solution as ordered. *. 0arent education Post operative care 1. 0ro1ision of ade<uate fluid and nutrition 2. 8bser1ation for si ns of com$lications !. 0arent education %. Follo3 u$ care

N"rsin# %ia#nosis accor%in# to priorit'

Pre-operative 1. )eficient fluid 1olume related to fre<uent 1omitin 2. Acute $ain related to astric distention

!. 9mbalanced nutrition

less than body

re<uirement related to 1omitin %. 0arental an'iety related to sur ery of the child Post operative 1. Acute $ain related to $resence of sur ical incision in ri ht u$$er <uadrant of abdomen 2. 9mbalanced nutrition less than body E'$lains 5istens Chal2 board >hat are the of illness7 and

re<uirement related to N08 Enlist com$lications $yloric stenosis the of !. 0arental an'iety related to $ro nosis and mana ement of child after sur ery. %. #is2 for deficient fluid 1olume related to $ost o$erati1e com$lications (. #is2 for 3ound infection related to incision. com$lications $yloric stenosis?

Complications

 2mts

)ehydration Se1ere electrolyte imbalance Hematemesis Failure to thri1e

S"mmar'
0yloric stenosis is the narro3in $ortion of the stomach :$ylorus; of the lo3er

Cardinal si n is $rojectile 1omitin and nonbilious 1omitin 0yloric stenosis is mana ed by sur ical relief of the $yloric obstruction :$yloromyotomy;.

)ecent a%vancements
Non sur ical treatment for infantile hy$ertro$hic $yloric stenosis 3ith atro$ine sulfate7 both intra1enous and oral7 has sho3n encoura in results. 9n one study7 infants 3ere i1en 21 days of atro$ine 1ia naso astric tube and re ression of $yloric hy$ertro$hy 3as monitored sono ra$hically. 8ne $atient needed intra1enous atro$ine7 as naso astrc tube feedin s 3ere not tolerated for the first 2 days7 but the $atient did 3ell subse<uently. 9n this study all 12 $atients

3ere successfully treated non sur ically 3ithout com$lication.

C!al* boar% plan

Main headin s 9N&#8)"C&98N )EF9N9&98N 9NC9)ENCE E&9858CG 0A&H80HGS9858CG C59N9CA5 FEA&"#ES )9ACN8S&9C E6A5"A&98N )9ACN8S&9C E6A5"A&98N E&9858CG 0A&H80HGS9858CG Sub headin s 9N&#8)"C&98N 9NC9)ENCE #ou h 3or2

MANACEMEN& C8M059CA&98NS #ECEN& A)6ANCEMEN&S C8M059CA&98NS 0#E6EN&98N

iblio#rap!'
1. Marlo3 #. )orothy7 #eddin A. @arbara7 H&e't boo2 of 0ediatric Nursin I7 *th edition7 Else1ier $ublications7 0hiladel$hia 2. Cu$ta 0iyush7 HEssential 0ediatric Nursin I7 A. 0 Jain 4 Co. !. 0illitteri Adele7 H Child health nursin 7 Care of the child and familyI7 5i$$incott7 0hiladel$hia7 Ne3 Gor2 %. 5i$$incott7 H&e't boo2 of 0aediatric Nursin I7 Mosby 0ublishers (. Mary Ann Ho an7 Judy E >hite7 H Child health Nursin I7 0rentice hall7 Ne3 Jersey *. Cu$te Suraj7 H &he short te't boo2 of 0ediatricsI7 1-th edition7 Jay$ee brothers medical $ublishers:0; 5&)7 Ne3 )elhi .. AcharKs Hte't boo2 of $aediatricsI7 !rd edition:2---;7 orient lon man limited
8. 333.betterhealth.1ic. o1.au,...,)e1elo$mentalL!ipL%'splasiaLe'$lained

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Lesson plan on Pyloric Stenosis

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