CHILD ABUSE

CHILD ABUSE ppt

child health nursing

paediatric nursing GNM2nd year

behavioural problems in childrens

introduction

this blog is made for all nursing students who need more knowledge and wish to do nursing

             ADRENAL GLAND

• THE ADRENAL OR SUPRARENAL GLANDS ARE PAIRED ENDOCRINE GLAND SITUATED OVER THE MEDIAL ASPECT OF UPPER POLES OF EACH KIDNEY.
• THE ADRENAL GLANDS CONSIST OF OUTER CONNECTIVE TISSUE CAPSULE,A CORTEX AND A MEDULLA.
• THE OUTER CORTEX AND THE INNER MEDULLA ARE THE FUNCTIONAL PORTIONS OF THE GLANDS . THEY ARE TWO SEPARATED ENDOCRINE GLANDS, WITH DIFFERENT EMBRYOLOGICAL ORIGINS: 
• CORTEX: DERIVED FROM THE EMBRYONIC MESODERM.
• MEDULLA: DERIVED FROM THE ECTODERMAL NURAL CREST CELL. 
• CORTEX :IT IS YELLOWISH IN COLOUR . IT SECRETES TWO CHOLESTEROL DERIVED HORMONES:CORTICOSTEROIDS AND ANDROGENS .
• FUNCTIONALLY THE CORTEX CAN BE DEVIDED INTO THREE REGIONS ( SUPERFICIAL TO DEEP):
• ZONA GLOMERULOSA:PRODUCES AND SECRETES MINERALOCORTICOIDS SUCH AS ALDOSTERONE.
• ZONA FASCICULATA:PRODUCES AND SECRETES CORTICOSTEROIDS SUCH AS CORTISOL. IT ALSO SECRETES A SMALL AMOUNT OF ANDROGENS. 
• ZONA RETICULARIS:PRODUCES AND SECRETES ANDROGENS ( DEHYDRO EPI ANDROSTERONE (DHES)) AND A SMALL AMOUNT OF CORTICOSTEROIDS. 

ADRENAL GLAND LOCATION                      

    

• MEDULLA:                                                                                                                                                                                                             

MEDICAL SURGICAL NURSING PART - 2

ADMISSION OF THE CLIENT

     DEFINITION--

 Admission of a client means, receiving a client to stay in the hospital for observation, investigations, treatment and care.

    PURPOSE--

1. To welcome the patient and establish a positive relationship with patient and close relatives.
2.  To offer immediate management and care of acute conditions.
3. To orient patient to immediate environment and services available.
4. To acquire baseline data of a patient through history and physical examination.
5.  To collaborate with patient in planning and providing comprehensive care.

PRINCIPLES OF ADMISSION TO HOSPITAL

1. Sudden change or strangeness in the environment produces fear and anxiety.
2. Entering the hospital is a threat to one’s personal identity.
3. People have diversity of habits and modes of behaviour.
4. Illness can be novel experience for the client and bring stress on his physical and mental health.

PRINCIPLES

1. SUDDEN CHANGE OR STRANGENESS IN THE ENVIRONMENT PRODUCES FEAR AND ANXIETY 

• For many, admission may be the first time in the hospital.
• It is a new and sometimes a frightening experience. The nurses should be friendly and courteous and make him feel that he will receive sympathetic as well as efficient care.
•  Remember ‘” the first impression is the best and lasting impression”
• The first persons to meet the client and his family members are greeted and treated are most important.
•  treat all clients with interest and respect and establish healthy personnel relationship to gain the confidence and cooperation of the clients and his family
• Submitting to examination, taking ill tasting medications and injections with no explanations, putting restrictions over his freedom of movement, eating habits etc can cause emotions of anger, fear and anxiety in the clients.
• Fear and anxiety can be produced in the clients who are left alone in their units or in darkness, when the clients hear the loud cries of other clients and face the unpleasant sight such as death of a clients.
• social humiliations (social stigma of certain diseases),economic insecurity and lack of privacy produce fear and anxiety in the clients.
• UNKNOWN FEARS:IT MAY BE DUE TO:

 Lack of knowledge about illness.

 Being in a strange place with strange articles around.

 Being alone and away from the family members.

being housed with strangers and cared for by the strangers.

 fare of treatment and fear of failure of treatment.

 fear of pain and fear of loss of body parts.

 fear of being experimented on.

 fear of being neglected.

 fear of exposure.

 having nothing to be to pass time with minimum activity.

 The nurse can do much to allay this fear and anxiety. 

 Talking with the clients and clarifying their doubts, listening to their problems,

 introducing the hospital department,

 the hospital personnel and other clients to the newcomer, explaining the hospital routine,

 taking care of the clients valuables,

 giving explanations foe treatments ,

 allowing the family members and friends to spend some time with the clients

 Establishing an effective nurse-client relationship can reduce fear and anxiety to a greater extent.

 Remember ‘’uncertainty builds up anxiety and knowledge dispels fear 

 

2.ENTERING A HOSPITAL IS A THREAT TO ONE'S PERSONAL IDENTITY 

 Every client admitted to the hospital should be considered as a unique person in terms of personality, needs and extent of illness.

 e.g. All fever cases are not the same in their needs even though they appear to be the same in the eyes of the nurses.

 Never to identify the clients either by the number or by the diseases that they suffer from.

 The nurses should address them by their name and proper title .

 greet the client pleasantly and enquire about his welfare every day .

 allow the client to use his own articles as far the hospital policy permits.

 Make the client feel that he is considered and cared for .

 the nurse should find out the likes and dislikes of the clients and include the clients in their plan of care.

 The hospital routines should not be too rigid but applicable to everyone.

3.PEOPLE HAVE DIVERSITY OF HABITS AND MODES OF BEHAVIOUR

 Every nurse should understand the behavioural patterns of clients according to age, sex, race, caste and socioeconomic factors.

 Their needs should be met in an appropriate manner.

 Assist them to develop good health habits and to retain their behaviour as far as they do not any harm to their health.

4.ILLNESS CAN BE NOVEL EXPERIENCE FOR THE CLIENT AND BRING STRESS ON HIS PHYSICAL AND MENTAL HEALTH 

 The nurse can do much to improve the physical and mental health by formal and informal health teachings.

 To give satisfaction to the clients, the nurse should recognize the various needs of the clients and meet them without delay 

 The needs of the clients according to Maslow are:

 physiological needs: the for oxygen, water, food, elimination, rest and sleep, exercise and temperature regulation .

 stimulation needs: need for activity, exploration novelty and change.

 Protection needs: The safety and security of the client .

 Love and belonging needs: the need for love and affection, need for intimacy and the need to belong.

 Esteem needs: Need for recognition and self esteem.

 Spiritual needs: Freedom to practice one’s own religious practices .

 Much of the stress due to illness can be eliminated by proper explanations about the disease, its prognosis and its complications in the language the client can understand.

 The clients develop certain behaviour patterns called mental defence mechanisms during illness.

 Recognition of these mental mechanisms and their associated behaviour patterns will help the nurse to understand the fears and anxiety of people and do her best to help them.

ADMISSION PROCEDURE

 The admission of a client to a hospital can be either emergency and routine. 

 THE Emergency admission means that the clients are admitted in acute conditions requiring immediate treatment, e.g. clients with heart attack, accidents, acute appendicitis, poisonings, labour pains, diarrhoea dysentery, hyperpyrexia, haematemesis, dyspnoea, shock etc.

 In emergency admission, every moment is precious. Therefore, the clients should be admitted to the casualty department or emergency ward and the immediate treatment is initiated to save the life of the client.

 Routine admission means that the clients are admitted for investigations and planned treatments and surgeries, e.g., the clients with hypertension, diabetes, chronic appendicitis, jaundice, chronic renal failure nephritis, bronchitis etc.

 Outpatient department (O.P.D.)

 Reception of the client

 The personnel in the admitting department should greet him and make him at ease.

  In emergency conditions, no time should be lost to initiate the treatment.

 The manner in which the nurse and the physician receive and treat the client is the important aspect of his reception and admission.

 RECORDING OF SOCIAL AND MEDICAL DATA

 The recordes section is responsible for recording data essential for identification of the client.

 He questions the client or his family members to get the name, address, age, sex, religion, occupation, income, marital status, the business address and the telephone number.

 The name and address of the nearest relative, if any.

 He records it in the outpatient record.

 Clients very sick should be admitted immediately and the necessary data is supplied by the family or friends .

 The client is given the OPD number which is essential for the future reference.

 Give necessary direction on how to proceed further.

 A detailed social and medical history of the client is taken by the physician and is recorded.

 The client’s temperature, pulse, respiration and blood pressure etc. are recorded.

 A thorough examination of the body from head to foot will reveal any deviations from the normal structure & functions which will help the physician to diagnose the disease and to prescribe the treatment..

INPATIENT DEPARTMENT (I.P.D)

 The clients who are suffering from mild ailments are sent home with necessary treatment. Others are admitted to the hospital for further investigations and treatment.

TRANSPORTING A CLIENT FROM O.P.D. TO I.P.D .

 Clients who are not very ill and are allowed to walk are taken to the clinical division by a nurse or an attender. Wheel chairs & stretchers should be available for those who are too sick, weak or lame to walk. A seriously ill client should never be left in the hands of an untrained personnel. A female client should never be left with a male attender.

ARTICLES REQUIRED

 1. Prepared bed

 2. Thermometer tray 🔲📨

 3. Bp apparatus 4. Weighing machine

 5. Admission advisory form( from admitting department)

 6. Documents such as:

                                     Doctor’s order sheet, TPR sheet, nursing assessment form, nurse’s record, progress record, laboratory master sheet, additional sheets as indicated like: diabetic urine chart, intake & output chart and specific flow sheets, admission consent form.

 7. Kidney tray and emesis basin

 8. Tissue paper

 9. Bedpan and /or urinal

 10.Bath towels and wash cloth 

PROCEDURE 

 

THE INTEGUMENTARY SYSTEM

                                  THE SKIN

                                            

 Skin is the largest organ in the body. It has a surface area of 1.5- 2 square meters in adults. It varies in thickness in different parts of the body. It is thinnest on the eyelids and the thickest on the palms and soles of the feet. 

LAYERS OF THE SKIN

Epidermis or cuticle: is the superficial layer

Dermis or corium: is the layer below the epidermis

the subcutaneous layer:is the layer between the dermis and underlying structures and it is composed of areolar tissue and adipose tissue.

 The Epidermis: is the superficial layer. It is composed of stratified keratinized squamous epithelium. The epidermis has no blood vessels or nerve endings. It is entirely dependent on the underlying dermis for nutrients and blood supply. The main types of cells in the epidermis are Keratinocytes Melanocytes ,and Langerhans cells.

 Lyers of epidermis: There are several layers of cells in the epidermis which extends from the deepest basal or germinative layer to the most superficial stratum corneum (horney layer) . The epidermis contains 5 layers, from bottom to top the layers are named

• STRATUM BASAL OR GERMINATIVE LAYER
• STRATUM SPINOSUM
• STRATUM GRANULOSUM
• STRATUM LUCIDUM
• STRATUM CORNEUM OR HORNEY LAYER 

THE BASAL OR GERMINATIVE LAYER

It is the deepest layer and consists of single layer of columnar cells and is attached by a membrane to the under surface of dermis. These are the cells from which new epidermal cells are constantly being produced. The new cells push the older cells upwards away from the basal layer towards the surface. Upward projections from the dermal layer the dermal papillae anchor the dermis securely to the epidermis and allow passage and exchange of nutrients and wastes to the lower part of the epidermis. As they approach the surface of the epidermis these cells become flattened and become the stratum granulosum. (granular layer)

STRATUM GRANULOSUM

 The nucleus of cells in the granular layer contains granules of keratiohyaline. Enzymes in the nuclei convert keratiohyaline in to keratin. In the thickest 2 areas of the skin over the palms of the hands and soles of the feet granular layer become in to stratum lucidum and the other areas it become in to Stratum corneum (horney layer). 

STRATUM CORNEUM 

  it consists of thin, flat, non-nucleated cells composed of keratin. The cells of the honey layer are constantly being shed and replaced by cells from the deeper layer. The life span of epidermal cell is between 28- 30 days. Between the cells of the basal layer there is other type of cells known as melanocytes. Melanocytes produce melanin pigment which is responsible for the color of the skin and they also protect the deeper structures from ultra violet rays and other injurious light. Melanin is produced from tyrosine under the influence of enzyme tyrosinase. 

THE DERMIS

Dermis or corium lies deep to the epidermis. It is composed of dense connective tissue, and matrix contains collagen fibers interlaced with elastic fibers. Collagen fibers bind water and give the skin its tensile strength. Fibroblasts, macrophages, and mast cells are the main cells found in the dermis. 

Structure found in the dermis are 

a. small blood  and lymph vessel 

b. sensory nerve endings 

c. sweat glands and their ducts 

d. hairs,arector pili muscles and sabeceous gland 

 BLOOD AND LYMPH VESSELS

arterioles from a fine network with capillary branches supplying , sweat glands, sebaceous glands, hair follicles, and the dermis. Lymph vessels also form a network throughout the dermis.

SENSORY NERVE ENDINGS 

The sensory nerve endings are widely distributed in the dermis and it contains the nerve endings of touch, pain, temperature, and presser. Skin is an important sensory organ through which individuals receive information about their environment. Nerve impulses, generated in the sensory receptors in the dermis are transmitted to the spinal cord by sensory nerves. From there impulses are conducted to the sensory area of the cerebrum, where the sensations are perceived.

SWEAT GLAND 

 these are widely distributed throughout the skin and are most numerous in the palms of the hands, soles of the feet, axillae, and groins. The bodies of the glands lie coiled in the subcutaneous tissue. There are two types of sweat glands. Eccrine and the apocrine.

THE ACCRINE GLANDS

are the more common type and open on the surface through tiny pores. Sweat glands have a coil which is buried deep in the dermis and a duct which opens on to the surface of the skin at minute depression called pores. Sweat is a clear watery Fluid important in regulating body temperature.

THE APPOCRINE GLANDS

 these are large sweat glands, which open in to the hair follicles above the sabaous gland. They are found in the rectal and anal area, axilla, nipples and areola and begin to function after puberty. The most important function of the sweat is the regulation of body temperature.

HAIR

Hair grows from a hair follicle. The part extending above the skin surface is called shaft and the part which is embedded in the skin is the root. The lower end of the follicle expands to form the hair-bulb. At the base of the follicle is a cluster of cells called hair papilla or hair bulb. Papilla contains blood vessels, nerve endings and melanocytes. Hair is formed by multiplication of cells of the bulb and as the hairs are pushed upwards away from their source of nutrition, the cells die and become keratinized. The color of the hair is due to pigment melanin.

The arrector pili; the walls of the hair follicle ,there is minute bundle of smooth muscle fibres called arrector pili. Contraction of the muscle fibers makes the hair to stand erect. This causes the skin around the hair to become elevated giving the appearance of gooseflesh.

Sebaceous gland ; : Sebaceous glands are found all over the bodies except the palms of the hand and soles of the feet. They are most numerous on the scalp, fore-head, cheeks and chin. Secretion of the Sebaceous gland is called sebum which is an oily antimicrobial substance. Sebum is discharged in to the hair follicle by their ducts. Sebaceous glands

which are in the lips, eyelids, nipple, labia minora, and glans penis discharge their Secretion directly on to the surface. Sebum keeps the hair soft and pliable, and gives it’s a shiny appearance. It waterproofs the skin and acts as a bactericidal and fungicidal agent preventing infection. It also prevents drying and cracking of skin. 

Nails;  are the appendages of the skin. It is a modified horny cells and forms protective covering over the fingers and toes. It has got a body or nail plate which is attached to the nail bed. Each nail has a root which is embedded in the skin and covered by the cuticle, which forms the hemispherical pale area called lunula. The Subcutaneous layer: Subcutaneous layer, containing areolar tissues and varying amounts of adipose tissue, lies under the dermis. 

 Function of the skin

1. PROTECTION

The skin forms a protective covering for the internal structures of the body. It acts as a barrier preventing the entry of microorganisms and other harmful agents such as:

• Invasion by micro-organism
• chemicals
• Physical agent’s e.g. mild trauma, ultraviolet light: The sensory nerve endings the dermis conveys information about the external environment to the brain, and serves as an important protective mechanism for the body. The pigment Melanin protects against harmful ultraviolet rays in sunlight.
• Dehydration. It helps to maintain a stable internal environment by preventing excessive loss of water, and electrolytes.  

    2. REGULATION OF BODY TEMPERATURE 

The constant level of body temp. is maintained by a balance between the heat produced and the heat lost by the body. Heat production; Heat is constantly produced in the body by varies chemical reactions in the body. The principle organs involved in heat production are .

• Skeleton contraction : skeletal Muscle contraction which produces large amount of heat. The more strenuous the muscular exercise the greater the heat produced. 
• The liver :  the liver performs metabolic activities and heat is produced.
• The digestive organs :   heat is produced by the contraction of alimentary tract and by digestion of food.

MECHANISM OF HEAT LOSS 

Heat is lost from the skin by; radiation, evaporation ,conduction and convection. Heat is lost from the body in several ways. 97% by the skin. 25 in expired air 1% in urine and faces.

Heat is lost from the skin by; radiation, conduction and convection.

Rdiation: in radiation the exposed part of the body radiat heat away from the body. 

conduction: the heat is transferred to any object in direct contact to the body.  In conduction the cloths in contact with the skin conduct heat away from the body.

convection:  heat is transferred away from the body surface by movement of air. In convection the air passing over the exposed parts of the body is heated and rises cool air replaces it.

3. Formation of vitamin D

Vitamin D is formed by the action of sunlight on 7- dehydrocholesterol, a fatty substance widely distributed in the skin. 

4. Cutaneous sensation: Sensory receptors in the dermis can be sensitive to touch, pressure, temperature and pain. Stimulation generates impulses in sensory nerves which are transmitted to the cerebral cortex.

5. Absorption: Substances can be absorbed through the intact skin into the blood stream.e.g. Administration of certain drugs (sublingually) because it is quickly absorbed through the mucous membrane of the mouth to bring rapid relief from the chest pain. Also some toxic chemicals e.g. mercury. 

6. Excretion: The skin is a minor excretory organ for some substances including:

 Sodium chloride in sweating, urea, when kidney function is impaired, and aromatic substances e.g. garlic and other spices.

7. Storage :The skin and subcutaneous tissues act as a store for water and fat. Approximately 15% of the total water content of the body is contained in the skin, while the subcutaneous tissue serves as one of the main fat depots of the body.

8. Secretion:The secretion of sebum by the sebaceous glands helps to maintain the integrity of the skin. Sweat produced by the eccrine and apocrine gland plays an important part in the regulation of body temperature and aids in the excretion of metabolic waste products.