J G COLLEGE OF NURSING

AHMEDABAD

SUBJECT: Pediatric Nursing

TOPIC:Nursing care plan

SUBMITTED TO
PROF.U RAMYA
PRINCIPAL
J G COLLEGE OF NURSING
SUBMITTED BY
BINAL JOSHI
F Y MSC NURSING
J G COLLEGE OF NURSING

1
 IDENTIFICATION DATA

Name: TOHFIKBHAI ALLAHRAKHABHAI BEGGER

Age:2 MONTHS Year/Month:2010

Sex:MALE WARD: 13(medical)

Diagnosis:Pneumonia,bilateral inguinal hernia, umbilical

hernia

Date of Admission:29-11-2010

Date of Discharge:--

OPD number:op1011114114

IPD number: ip10111032097

Birth date:25-8-2010

Department :pediatric department

Address :sunrise park,sarkhej,ahmedabad.

Dr:unit: PUB

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 HISTORY

• CHIEF COMPLAINTS

♣ COUGH

♣ DIFFICULTY IN BREATHING

♣ SWELLOWING OVER THE SCROTUM

♣ DECREASED URINE OUTPUT

♣ CONVULSION

• PRESENT MEDICAL HISTORY:

• On admission

Before the day of admission patient developed breathing difficulty.

He kept his mouth opened and excessively crying. He was also
refusing to take food and not calmed down when his mother took
him for breast feeding. So they went to near by clinic and
consulted the doctor at private clinic. Then the doctor gave him
primary treatment to him and referred him to V S HOSPITAL for
further treatment.

When I had attended the patient, the child having the

complain of cough, dry and non paroxymal, difficulty in breathing
and excessive crying. He developed swelling on scrotum.Urine
output was decreased and twice there was a convulsion. mother
was not having adequate flow of breastfeeding because of
3
disturbed state of mind. the child was disturbed and irritated. He
had swelling on hand because of many punctures for vein flow
insertion. Day by day umbilical hernia became more protruded.

• PAST HISTORY

Patient is 2 months old. There is no any major medical or

surgical illness to the baby in the past.

• FAMILY 'HISTORY:

50 years 65 years

Asthma

Father mother

Labour work housewife

male

female

Grand father was suffering from asthma and had been died at
the 50 years of age before one year. The grand mother is also

4
having breathing difficulty when she walks .Any other family
member has not any medical, surgical or psychiatric illness,
history of blood transfusion or accidental injury. No history of the
diabetes, genetic disorder or tuberculosis in family.

• BIRTH HISTORY

♣ ANTINATAL HISTORY

Mother had registered at near by hospital for her delivery 7 month

of pregnancy, she is not having any infection during the term. she
had taken only one dose of injection tetanus toxoid.her weight
was adequate. But the death of the grand father made her to be
in stress and depression during gestation period. She had taken
TT vaccination . Mother’s father was died during the period the
mother was facing family stress.

♣ PERINATAL HISTORY

The child was born at full term. Normal vaginal delivery was
conducted at hospital, near by home. Child cried immediately after
birth and there was no need of resuscitation or oxygen therapy or
ventilation. The birth weight was 3kg.Apgar score is not available
with the patient’s records. The child is not having any congenital
malformations. All the reflexes were present.

♣ IMMEDIATE POSTNATAL HISTORY

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Child was normal, no cyanosis developed. No fever or convulsion
present. The child was putted on amul gold as mother was not
able to give breastfeeding. After two days the mother gave
combination of both the top milk and breast feeding as per
demand schedule.

• SOCIO ECONOMIC HISTORY

In patients family total five persons are living together. The father
is labourer. The family income is only 3000 per month. The child
comes from the poor socio economical status. The family is living
in the society at sarkhej,having pakka house with facility of the
toilet bathroom. There is no safe water supply.

• IMMUNIZATION HISTORY

The client was immunized with 0 polio and BCG at birth, then after
no any other vaccine is introduced to the baby.

• DIETARY PATTERN

Breast feeding was started at the third day of the birth, till the
time the baby was on amul gold. then for 11 days the mother
gave continually breast feeding but then after she did not have
the flow of milk that satisfies the baby so again she started to give
amul gold. At present the baby receives the both,Breastfeeding
and amul milk with dilution,1:3.

• ANTHROPOMETRIC MEASUREMENTS

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 Measurement Patient's(at birth) Normal Remarks
Height . 50 cm 50 cm
value Weight is

Weight 3 kg not
2.7-4 kg
adequate
Mid arm 1.2 cm 1.7 cm
according
Circumference
to age
Head 33 cm 33.5 to
circumference
35.5 cm
_

• When I attended:

Measurement Patient's Normal value Remarks

Height . 50 cm
value 50 cm Wight is not

Weight 1.8 kg 3-4 kg adequate

according
Mid arm 1.2 cm 1.7 cm
to age
Circumference

Head 33.5 cm 33.5 to 35.5

circumference cm
_

Percentage of malnutrition: actual weight*100/ideal weight

: 1.8 *100/4

:45%

• VITAL SIGNS

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 Vital signs Patient's value Normal Value Remarks

Temperature 99 f 98.6 f . .
Fever
Pulse 136 110-130
Tachycardia
Respiration 46 35-40
tachypnoea

DEVELOPMENTAL HISTORY –

Growth and Normal Baby

development
Fine motor 2 month
• Hands remain Present
closed
• Grasp reflex Absent
gradually
disappears till 3
month of age
• Open hands Absent
spontaneously

Gross motor • Ventral Absent

suspension
• Lifts the chin Absent
above the
ground Absent
• Head lag
decreases
Psycho social • Social smile Absent
• Recognizes Present
mother
language • responds to sound Present
• Coos laughs a loud Absent

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 HEAD TO TOE ASSESSMENT

Possible Major Deviations and

Assessment Textbook Information Complications Observation

I. GENERAL MEASUREMENTS
a. Age Term = start of 38th wk. end of 42nd week. preterm = before end of 37th wk. 2 months
posterm = after end of 42nd wk.
b. Weight 6.5-7.75 lbs <6 lbs 7 lb
>9 lbs
c. Length 18-20.5 in 50 cm
45-52.3 cm
d. Apgar Score 7-10 <7 Not available
II. HEAD MEASUREMENT
a. Shape Round symmetrical Microcephaly <32 cm Hydrocephaly
may have molding-->overriding sutures. Hydrocephaly >4 cm from chest
Slight asymmetry. Cephalohematoma
b. Size in relation to body 33-35 cm 35 cm
2 cm> chest circ
c. Fontanels size, shape, Sutures, palpable Full bulging, large, depressed Palpable,open,soft, normal in size
consistency slight Closed sutures
pulsation
1. Anterior Soft
3-4 cm long
2-3 cm wide
diamond shape
2. Posterior 1-2 cm normal
triangular
III. EYES
a. Color Grayish blue or gray brown iris. Blue Jaundiced sclera. Normal
white sclera.
b. Movement Random, jerky, uneven. Focus Gross nystagmus Normal
momentarily. Follows to midline. Constant Strabimus
Doll’s eye’s > 10 d.
c. Reaction to Light Pupils equal in size, round and reactive to Pupils unequal, restricted, dilated, fixed Reacted
light. May turn toward soft light.
d. Tears Without or occasionally. Discharge Not present

e. Evidence of sight Focuses and follows by 15 min of age. Does not respond to light, focus or follow. Present
See above, reaction to light.
f. Eyelids Size and movement symmetric. Blink Does not respond to light, focus, or follow. Symmetric

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 reflex. Edema from prophylaxis. Eyes on
a parallel plane.

IV. EARS

a. reaction to noise Startle reflex to loud noise. Attends to Absence of reaction. Present
sound. By 15 min. of age may move eyes
in direction of sound. Responds to
crooning by relaxation.

b. Position Line drawn through inner and outer canthi Low placement Normal
of eye comes to top notch of ear (where it
connects with scalp.) Symmetrical.

c. Patency Evidence of hearing. Reaction to noise. Present

V. NOSE Midline

a. Mucus Clear Copius drainage Not absent

b. Patency Infants obligatory nose breathers. Cyanosis at rest. Mouth breather

Sneezing is common. Flaring or nares.
c. Reflexes Dependent on state of wakefullness and Written in last colomn
hunger.

1. Sucking Present

2. Swallow Present

3. Gag See Section XXI. REFLEXES Present

VI. MOUTH Symmetrical Mouth drawls to one side Normal

Presence of gag and swallowing
Hard & soft palate in tact
Epstein’s Pearls
Clefts

VII. NECK

a. Length Short, thick, surrounded by skin folds. Webbing Normal

b. Mobility Head held midline. Free movement from Rigid. Less rigid.no head control
side to side. Full flexion and extension. Restricted movement.
Cannot move head past shoulder. Head held at angle.

Without head control.

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VIII. CHEST

a. Size 1-2 cm <head circ. <30 cm 32 cm

30-33 cm
b. Breast tissue 3-10 mm breast nodule Lack of breast tissue Lack of breast tissue
Nipples prominent
c. Characteristic shape Almost circular. Bulging of chest.
Barrel shaped. Retractions.
Bowel sounds in chest.
IX. RESPIRATIONS

a. Rate 30-60/min Tachypnea > 60/min Tachypnoea74/mn

Bradypnea < 25/min

b. Rhythm Shallow. Labored breathing. Labored breathing.

Irregular when infant awake.

c. Breath Sounds No sounds heard without stethoscope. Grunting, rales, rhonchi, wheeze (with or wheeze (with stethoscope)
without stethoscope)

Bronchial. Loud, clear, near. Apnea > 15 sec. Not applicable

d. Muscular activity involved Simultaneous rise and fall of chest and Subcostal and substernal retractions. Flaring Subcostal and substernal retractions.
abdomen. Diaphragmatic and abdominal of nares. Chin tug.
breathing.
X. PULSE
a. Rate 120-160/min. Persistent tachycardia-- > 170 136
180 with crying Bradycardia-- < 120
100/min. if asleep

b. Rhythm May be irregular for brief periods Persistent irregular rhythm. regular
especially after crying.
c. Peripheral circulation Femoral pulses palpable, equal, strong. Sluggish Weak or absent. weak
peripheral circulation.
XI. ARMS AND HANDS
a. Length Arms equal in length. Anelia, phocomelia normal
Arms longer than legs.
b. Movements Spontaneous. Limited movements. Normal but less
Full range of motion. Asymmetry of movements.
c. Muscle tone Generally flexed. Fist often clenched with thumb tonicity Poor tone
under finger. Asymmetric contour.
Poor tone/floppy.
+ scarf sign.
d. Fingers
1. Number Correct Absence of or additional. Correct
Short.
2. Webbing Without Polydactyl No

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 Syndactyl
e. Position Fists often clenched with thumb under finger. Rigid flexion. Present
Persistent fists.
XII. ABDOMEN
a. Contour Rounded, protruding Abd. distended. Round
Scaphoid.
b. Musculature Not fully developed. Sounds in chest. Not fully developed,umbilical hernia,
Bowel sounds audible 1-2 hours after birth. bowel sounds heard
XIII. UMBILICAL CORD

a. Number of vessels at 2 arteries 1 artery Not known

birth 1 vein

b. Appearance Clear, gelatin. Bleeding or oozing.

Odorless. Drying. Drainage or redness.

XIV. GENITAL-URINARY Not applicable

a. Female Ambiguous genitals

1. Labia Usually edematous

a. Size Covers labia minora Majora widely separated

b. Appearance May have pigment. Minora prominent.

Symmetric in size.

2. Vaginal discharge Absence of vaginal orifice.

a. Color Smegma under labia. Fecal discharge.

May be blood tinged.

b. Type Mucoid/white

b. Male Ambiguous genitals

1. Testes in scrotum Palpable each side. Undescended. Inguinal hernia

Large. Rugge. Cremasteric. Scrotum smooth.

2. Urethral meatus at end Correct position. Not at tip of penis. Normal

of penis Prepuce covers glans. Adherent prepuce.
Not easily retractable.

3. Circumcised Yes or no. Excessive bleeding, swelling or No

By day 2 white exudate may cover glans penis. discharge.

c. Voidings

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 normal
1. Color Clear, light yellow.
200 -300 ml per day
2. Amount Well saturated diapers
Every half an hour
3. Frequency By 24 hrs after delivery. At least 3-4 times/day

4. Specific gravity 1.008-1.010 Normal

XV. RECTUM

a. Patency Good sphincter tone of anus. Good wink reflex. No control

b. Stools

1. Number Meconium by 24 hrs. after birth. Failure to pass meconium. Present

Mild distention
2. Color Depends on age of infant and type of Abd. distention.
feeding she is receiving. Diarrhea—curdy, green, large water
3. Consistency ring, forceful.

4. Frequency See your book for specifics. Trice a day

XVI. HIPS

a. Symmetry Gluteal folds even Congenital hip dysplasia Normal

b. Femur heads Intact Normal

No protrusion.

XVII. BACK
Straight
a. Appearance Straight, easily flexed.

b. Turns head from side to side in prone Yes Limitation of movement. Cant raise head
position. Can raise head momentarily. Pigmented nevus with tuft of hair
located at base of spine.
Spina bifida.

XVIII. LEGS AND FEET

a. Appearance May appear to have bowed legs. Absent

1. Warmth Equal Different temps. equal

b. Length Legs of equal length. Unequal Equal, normal

Shorter than arms.

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 c. Movement Full ROM Hypermobility. Lack of leg movement
Lack of leg movement.

d. Alignment Foot in straight line. Club foot. Normal

May appear to turn in but easily
rotated externally.
Present
e. Muscle tone General flexion

f. Toes Feet flat. Well lined over 2/3 of normal

surface.

1. Number Correct Absent or excessive digits.

2. Webbing Without Syndactyly

g. Position General flexion. Most often see legs Rigid or floppy posture.
drawn up against abd.
XIX. SKIN
a. Color Generally pink. Jaundice. pink
Acrocyanosis. May see some Cyanosis.
mottling. Pallor or dark red.
b. Textures Smooth, soft. Flexible.May have dry Thinner or thicker texture. Smooth, soft. Flexible.May have dry
peeling hands and feet. Fish scale skin. peeling hands and feet.
Without edema. Without edema.

c. Birthmarks Teleangiectases Hemangiomas no

Mongolian spots.
Transient hyperpigmentation of
areolas, genitals.

d. Characteristics Not applicable

1. Milia Distended sebaceous glands Not applicable

particularly on nose and cheeks.

2. Lanugo Over shoulder, pinnias, forehead, Absent or excessive. Not applicable

back.

3. Vernix caseosa White, cheesy, odorless. In creases Absent of excessive. Yellow, green Not applicable
and folds. or foul odor.

4. Ecchymosis Peteciae over presenting part. Over other areas. Not applicable
Ecchymosis from forceps.

5. Hair Amount varies. Silky, growth pattern Fine, woolly. Coarse, brittle. present
toward face and neck. Unusual growth pattern.

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 6. Nails Present, extended beyond fingertips. Absence. present

7. Peeling Of hands and feet at about day 3. Generalized cracking and/or peeling. Not applicable

XXI. REFLEXES

a. Local
1. Blink Response to light stimulus. Tap on Continued blinking with repeated taps. Present
forehead, bridge of nose, maxilla when
eyes open—blink first 4-5 times.

2. Pupillary Response to light is equal. Round. Failure to respond. Response unequal. Present
Pupil constricts.

3. Doll’s eyes When head is turned, eye movement Present

lags behind.

4. Rooting Turns head in direction of stimulus, Weak or absent. Present

opens mouth.

5. Sucking/swallowing Follows rooting. Takes hold, sucks ad Weak or absent. Gagging, coughing Present
obtains fluids. or vomiting with swallowing.

6. Gag Safety reflex. Do not try to elicit. Present

7. Yawn Spontaneous. Absent

8. Grasp Finger curl around examiner’s finger. present

Toes turn downward.

9. Babinski Hyperextension of all toes with Absent. Absent

dorsiflexion of big toe when one side of
sole is stroked from heel across ball of
foot to toe.
b. Generalized Present

1. Moro (Startle) Symmetric abduction and extension of Present

arms.
Finger may fan with forefinger and
thumb forming a C. Arms then adduct
in embracing motion and return to
relaxed flexion.

2. Tonic neck (fencing) When head is turned to one side, Absent

extremities on same side extend and on
opposite side flex.

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 3. Dance/Walking when held upright with one foot Asymmetry of stepping. Not applicable
touching a flat surface, will stimulate
walking. Will step alternately.

4. Crawling While on abdomen, will make crawling Absent. Not applicable

movements with arms or legs.
XXII. CRY

a. Frequency Individual, 15-20 min q. 24 hrs to 2 hrs Unconsolable Cries continuously.sleeps for very
q. 24 hrs. few minutes

b. Pitch Lusty, strong. Moderate pitch. High pitch. Moderate pitch

Weak or absent.

XXIII. PERSONALITY AND BEHAVIOR

a. Response to handling Touch, massaging, warmth--> soothing Cries,gives response

b. Reactions to environment Low pitch voice--> relaxation. Unconsolable Unconsolable

Responds with quietness and increased
alertness and cuddling, voice.

c. Parent-infant interaction Turns head and focuses when No focus on person handling. No focus on person handling,no
interested. Coordinates body bonding, cries in even mother’s lap
movement to parent’s voice and body
movement.

d. Eating-Sleeping patterns Variations in interest/ hunger. Usually Lethargy Sleeps for very few minutes
feeds well within 24 hrs. Wakeful
periods about q. 3-4 hours.

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 INVESTIGATIONS

SAMPLE PATIENT NORMAL INFERENCE

VALUE VALUE
Hemoglobin 11.1 mg/dl 12.3-15.3 3.7 more
mg/dl
RBC 13.1 4.5-5.1 0.2 more
million/cu million/cu
Hematocrit 60.6% 35.9-44.6% 16% more
WBC 19300/cumm 4,400- 15500 more
11,000
Differential
count
Neutrophil 40% 50-70% 10%less
Lymphocyte 55% 20-40% 15% more
monocytes 4% 2-6% Normal
Eosinophils 1% 1-6% 5%
Basophils 0% 0-2.5% 2.5%
Platelet 4,75,000/cu 1,50,000- Normal
count mm 4,50,000
Renal
function test
Blood urea 62.6 mg/dl 15-45mg/dl Normal
Serum 0.88 mg/dl 0.7-15 mg/dl Normal
creatinine
Liver
function test
Billirubin 0.8 0.2-1.2 Normal
total
dire - 0.0-0.5 -
ct
indire - 0.0-0.2 -
ct
Serum 184 <500 less
alkaline
phosphate
S.G.P.T 39U/L 0-55U/L Normal
Prothrombin 13sec 9.5-14.1 sec Normal
time
INR 1.13Sec - -
C-Reactive 4mg/dl <0.6mg/dl Positive

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protein

OTHER INVESTIGATION:
• echo findings
two atrias seen normal in size
intra atrial septum is intact
two a v valves are present structurally
good binocular function
no effusion
• csf examinatios
quantity:1 cc
appearance :clear
blood:present
protein:h98
sugar:58
polymorphs:0
lymphocytes:o
rbc:0
• ultrasonography:

urinary bladder empty

no fluid
umbilical hernia with herniating bowel loops
bilateral inguinal hernia

• Chest x-ray: consolidation on left lower lobe of lung is

present.
• Culture for endotracheal secretion: AFB not seen
• Peripheral smear: polymorphoneuclear leucocytosis

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19
Assess- Nursing Nursing Planning Impleme- Evalu-
ment diagnosis goal ntation ation
Subjective Self care deficit The child will Plan to give basic care The child looks
data Related to look fresh • Bedding clean and
Mother says he hospitalization and healthy • Done the bedding fresh, no foul
looks as evidenced by • Sponge bath smelling
dirghty,and foul poor personal • Gave partial sponge
smell comes hygiene • Eye care bath to the child
from his body • Given eye care to the
Objective data • Oral care child
Foul smelling •
from the body, • hair care Given oral care
Crecked ,reddish •
lips, nails are • Foot care Done oiling in the hair
long and with •
dirght • Nail care

Subjective Ineffective The child will Assess the respiratory Respiratory status The child kept
data breathing establish a status assessed .Oxygen his moth
Mother says he pattern Related normal - Encourage an concentration was closed.
is taking very to pneumonia as breathing increase in fluid intake 88/mn Stooped to cry
fast breath with evidenced by pattern - Position the client in continuously
mouth open irregular high fowlers Given oxygen therapy and slept
Objective data breathing Give oxygen therapy by hood method 2
Keeps the mouth pattern, As prescribede liters/mn
opened tachypnoea
,tachypnoea, - Administer meds Encouraged fluid intake
Dyspnea (bronchodilators & by iv line
Coughs etc.) prn.

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 Appears - Monitor vital signs
weak, - Maintain a caring
Nasal and calm attitude in
Flaring dealing with the
patient
-

Subjective Altered The child will Assess the nutritional -Assessed the -The child got
data: nutrition ,less get 500 gm status of the child nutritional status 300 gm weight
Mother says the than body of weight -encourage more fluid gain on third
child is refusing requirement gain at the intake orally. -Orally breastfeeding day of the
breastfeeding Related to end of this was given as per week.
and cries only. refusal of food week -give iv fluids demand schedule. -Food intake
also not taking and dyspnoea as of the child is
outside milk with evidenced by -give ryle’s tube Inj. Rl is given 1pint increased.
spoon. weight loss of feeding throught the day
Objective data the baby
weight loss,able Reassess the child ‘s -35 cc of milk is given
to visualize the nutritional status every 3 hourly to the
ribs beyond skin, child through ryle’s tube
inadequate food
intake

Subjective data Pain related Relieving Assessed the Pain is

Mother says insertion of the pain and Assess the level of on level.largely inflamed reduced,the
inflammation iv canula as inflammation inflammation area all over the palm child became
over the iv site evidenced by calm and
Objective excessive Apply tropical agent of Applied tropical agent slept.inflamma
data:Child cries crying analgesic over the skin tionn was also
when touching to reduced.
I v canula Maintain the patency Gave injections slowly
of the canula and gentally and applied

21
 splint below the
Apply magnesium insertion
sulfate gause over the
inflamed site Applied mgso4 gauses
to relieve inflammatiion
Reassess the status

Subjective Parentral role Restore To educate the Explaind the parent The parents
data: the conflict related parent child parents about their about the importance of understood
mother says the to illness of the attachment role in their child;s parents role in the first and the
child is not child as illness year of the chil’s pronice that
brought good evidenced by life.remove the wrong they will give
luck for them.he poor infant child Educating about care beliefs and give love good care to
brought troubles attachment of the child and care to the child. the child
for them Advised to solve their
Explaining risk factors internal conflicts to be
Objective of in adequate care of their child healthy and
data:anxiety, their child in future good flow of breast milk
not attending
child
well,quarreling
between mother
and father

22
NAME OF DOSE ACTION INDICATIONS SIDE EFFECTS NURSING RES-
DRUG AND PONSIBILITY
ROUTE

Inj. Taxim AVAILABLE ANTIBACTE LOWER RESPIRATORY Local (4.3%)— Injection site -observe the site of
IN 1 RIAL TRACT , inflammation with IV injection
GM.DILUTE PNEUMONIAINFECTIO administration.
IN 10 ML. NS,GENITO URINARY -check for the
Hypersensitivity (2.4%)— hypersensitivity and skin
GIVE 2 CC INFECTIONS,
Rash, pruritus, fever, rashes
I/V 8 SEPTICEMIA,SKIN -monitor vital signs
HOURLY,1 INFECTIONS ETC. eosinophilia and less
50 frequently urticaria and
Monitor blood counts
MG/KG anaphylaxis.
/DAY Observe intake and
Gastrointestinal (1.4%)— output
Colitis, diarrhea, nausea,
and vomiting.

Symptoms of
pseudomembranous colitis
can appear during or after
antibiotic treatment.

Nausea and vomiting have

been reported rarely.

Inj mikacin (100/2)2:8 aminoglyc bacterial septicemia Neurotoxicity-Ototoxicity: Monitor renal function
,3 CC I /V oside (including neonatal Toxic effects on the eighth tests
12 antibiotic sepsis); in serious cranial nerve can result in Go for urine examination
HOURLY, infections of the hearing loss, loss of balance,
Observe skin
(15 MG respiratory tract, or both. Neurotoxicity-

23
 /KG?DAY bones and joints, Neuromuscular Blockage: Monitor vital signs
central nervous Acute muscular paralysis and
system (including apnea Nephrotoxicity: skin Monitor blood pressure
meningitis) and skin rash, drug fever, headache,
Measure intale output
and soft tissue; intra- paresthesia, tremor, nausea
chart adequately
abdominal infections and vomiting, eosinophilia,
(including peritonitis); arthralgia, anemia, and
and in burns and post hypotension.
operative infections
(including post
vascular surgery).
1 GM_10 Glycopepti staphylococcal anaphylactoid reactions, Observe for anaphylactic
Inj CC)0.6 CC de endocarditis.pneumo including hypotension (see reaction
vancomyci INTO 20 antibiotic nia, given when other Animal Pharmacology),
ne CC NS used in the drugs are not wheezing, dyspnea, urticaria, Monitor respiratory rate
Observe skin reaction
GIVE treating effective or pruritus
SLOWLY gram Monitor blood pressure
OVER 30 positive
MNS(20 bacteria
MG
/KG/DAY

Tab 100 mg bronchodil Sinusitis, bronchitis, Headache,nausea, vomiting, Monitor respiratory rate
thambutol thrice a ator otitis media etc dryness of the mouth etc
day(to Encourage flud intake
mg/kg/day

1.5 ctwice a Phenobarbit Epilepsy,convulsion Nausea,diarrhea.headache, dry Monitor the child’s

Syp. eptoin day)5 urate mouth respiratory rate
mg/kg/day antiepilectic Encourage fluid intake
orally or drug
through
ryle’s tube

24
25
BIBLIOGRAPHY

1. Bauchner Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa:
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medical publication ,Mumbai.

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