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LESSON PLAN

Section I

1. Name of the teacher : Ms. Ashly Elizabeth Emmanuel

2. Subject : Child Health Nursin

!. "nit : #es$iratory System

%. &o$ic : As$hy'ia Neonatorum

(. )uration : 1 hour 

*. )ate : 1+,-!,2-1%

. Number of $artici$ants :

+. Class :

/. 0reious no3lede of $artici$ants: hae $reious no3lede reardin the anatomy and $hysioloy of res$iratory system 4 normal ne3born

1-. Method of teachin : 5ecture cum discussion

11. 5ist of A6 aids : chal board7 8H07 5C)

12. Name of the su$erisin teachers:

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13. Central objective

  At the end of the class7 $artici$ants 3ill ain no3lede reardin the definition of as$hy'ia neonatorum7 its causes7 $atho$hysioloy7 clinical

features7 and manaement and a$$ly this no3lede 3hile tain care of a child 3ith as$hy'ia neonatorum 3ith a $ositie attitude.

14. Specific objectives

&he students 3ill be able to7

• )efine $yloric stenosis

•9dentify the causes of $yloric stenosis

•  E'$lain the $atho$hysioloy of $yloric stenosis

• "nderstand the clinical features of $yloric stenosis

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Time e!avio"ral

objectives

Content Teac!in#

activities

Learnin#

activities

A$

ai%s

Eval"ation

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1.( mts

1 mt )efine $yloric

stenosis

Intro%"ction

0yloric stenosis or infantile hy$ertro$hic

 $yloric stenosis; is a condition that causes seere

omitin in the first fe3 months of life. 9nfantilehy$ertro$hic $yloric stenosis 9H0S; is a medical

emerency. 9mmediate treatment re<uires

correction of fluid loss7 electrolytes7 and acid=base

imbalance. 8nce intraenous access is obtained7 an

initial fluid bolus 2- m5,; of crystalloids

should be infused immediately if the infant is

dehydrated.

&efintion

0yloric stenosis is the narro3in of the lo3er

 $ortion of the stomach $ylorus;

 Narrates

the to$ic

)escribes

5istens

8bseres

4 5istens

Chal

 board

5C) >hat is $yloric

stenosis?

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Inci%ence

• &he incidence is 2.% $er 1--- lie births in

3hites7 1.+ in His$anics7 -. in African

Americans7 and -.* in Asians.

• Caucasian babies 3ith  blood ty$e @ or 8

are more liely than other ty$es to be

affected.

• &he usual ae of $resentation is

a$$ro'imately ! 3ees of life 1=1+ 3;.

• A$$ro'imately /( of 9H0S cases are

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1.( mts

! mts

9dentify the causes of

 $yloric stenosis

E'$lain the

 $atho$hysioloy of

 $yloric stenosis

dianosed in those aed !=12 3ees

Etiolo#' ( )is* +actors

9dio$athic

Hereditary

6ariations in infant feedin reimens

E'cessie $roduction of astrinmaternal

and infant;

deficiency of nitric o'ide containin neuro

transmitters.

abnormalities in enteric nerous system

Pat!op!'siolo#'

Etioloical factors

B

Hy$ertro$hy and hy$er$lasia of circular muscle

 $ylorus

Size and sha$e of olie;

B

 Narro3in of $yloric canal

E'$lains

E'$lains

5istens

5istens

5C)

Chal

 board

>hat are the causes of

 $yloric stenosis?

>hat is the the

 $atho$hysioloy of

 $yloric stenosis?

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! mts "nderstand the

clinical features of

 $yloric stenosis

B

8bstruction

 9nflammation,edema delayed astric

em$tyin

B B

Com$lete obstruction 0rojectile omitin

B

)ehydration7 metabolic alalosis7

failure to thrie

Clinical manifestations

1. Cardinal sin is $rojectile omitin and

nonbilious omitin. 9nitially reuritation

may be $resent but eentually omitin

increases in fre<uency and intensity.

2. 5oss of 3eiht

!. E$iastric distension

%. Consti$ation

(. E'cessie huner 

E'$lains 5istens Chal

 board

>hat are the clinical

features of $yloric

stenosis?

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! mts Enlist the dianostic

measures of $yloric

stenosis

*. )ehydration

. )ecreased urine out$ut

+. 0al$able $yloric mass olie sha$ed; in

riht u$$er <uadrant of abdomen best felt

durin feedin

&ia#nostic eval"ation

• 0al$ation of $yloric mass: 8lie size

sha$ed $yloric mass is $al$ated

• "ltrasound ealuation: as confirmatory

dianosis

• @arium u$$er 9 series indicated if

ultrasound is inconclusie

• D=ray

• "rine analysis: urine alaline and

concentrated

• @lood haemolobin and haematocrit:

eleated due to hemoconcentration

• 5aboratory studies reeal lo3 serum

 $otassium and sodium leels. 8f reater

im$ortance is   a serious decrease in the

serum chloride concentration 3ith an

E'$lains 5istens Chal

 board

>hat are the

dianostic measures of

 $yloric stenosis?

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1( mts E'$lain the

manaement of

 $yloric stenosis

increase in $H and in bicarbonate content.

&hese findins are due to the $roloned

omitin   3ith resultin metabolic

alalosis.

,e%ical mana#ement

• Considered as medical emerency.

9mmediate treatment re<uires correction of

fluid loss7 electrolytes7 and acid base

imbalance.

S"r#ical mana#ement

• &he definitie surical $yloromyotomy

no3n as #amstedts $rocedure diidin

the muscle of the $ylorus to o$en u$ the

astric outlet;. &his is a relatiely straiht

for3ard surery that can $ossibly be done

throuh a sinle incision usually !=% cm

lon;.&his is a $rocedure of choice.

•  5a$arosco$ic $ylorotomy also effectie as

of #amstedts $rocedure 3ith better

E'$lains

8bseres

4

5istens

5C)

>hat are the

manaement for

 $yloric stenosis?

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cosmetic results.

• 8nce the stomach can em$ty into the

duodenum7 feedin can commence. Some

omitin may be e'$ected durin the first

%+ hours after surery as the astro=

intestinal tract settles. Hy$ertro$hy of the

muscle reresses 3ithin 12 3ees after

surery.

N"rsin# mana#ement

Preoperative care

1. 8bserin and recordin the ital sins7

fluid and electrolyte imbalance7 and

amount and characteristics of the omitus

and stools.

2. Collectin s$ecimens

!. Assistin 3ith dianostic $rocedures

%. >ithholdin oral feedins and

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administerin and monitorin $arenteral

fluids as $rescribed and7

(. 5aain the stomach 3ith isotonic saline

solution as ordered.

*. 0arent education

Post operative care

1. 0roision of ade<uate fluid and nutrition

2. 8bseration for sins of com$lications

!. 0arent education

%. Follo3 u$ care

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

Pre-operative

1. )eficient fluid olume related to fre<uent

omitin

2. Acute $ain related to astric distention

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Enlist the

com$lications of

 $yloric stenosis

!. 9mbalanced nutrition less than body

re<uirement related to omitin

%. 0arental an'iety related to illness7 and

surery of the child

Post operative

1. Acute $ain related to $resence of

surical incision in riht u$$er

<uadrant of abdomen

2. 9mbalanced nutrition less than body

re<uirement related to N08

!. 0arental an'iety related to $ronosis

and manaement of child after surery.

%. #is for deficient fluid olume related

to $ost o$eratie com$lications

(. #is for 3ound infection related toincision.

Complications

E'$lains 5istens Chal

 board

>hat are the

com$lications of

 $yloric stenosis?

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2mts

• )ehydration

• Seere electrolyte imbalance

• Hematemesis

• Failure to thrie

S"mmar'

0yloric stenosis is the narro3in of the lo3er

 $ortion of the stomach $ylorus;

Cardinal sin is $rojectile omitin and nonbilious

omitin

0yloric stenosis is manaed by surical relief of

the $yloric obstruction $yloromyotomy;.

)ecent a%vancements

  Non surical treatment for infantile hy$ertro$hic

 $yloric stenosis 3ith atro$ine sulfate7 both

intraenous and oral7 has sho3n encourain

results. 9n one study7 infants 3ere ien 21 days of

atro$ine ia nasoastric tube and reression of

 $yloric hy$ertro$hy 3as monitored

sonora$hically. 8ne $atient needed intraenous

atro$ine7 as nasoastrc tube feedins 3ere not

tolerated for the first 2 days7 but the $atient did

3ell subse<uently. 9n this study all 12 $atients

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3ere successfully treated non surically 3ithout

com$lication.

C!al* boar% plan

Main headins Sub headins #ouh 3or  

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• MANAEMEN&

• C8M059CA&98NS

•#ECEN&

A)6ANCEMEN&S

• C8M059CA&98NS

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0#E6EN&98N

iblio#rap!'

1. Marlo3 #. )orothy7 #eddin A. @arbara7 &e't boo of 0ediatric NursinI7 *th edition7 Elseier $ublications7 0hiladel$hia

2. u$ta 0iyush7 Essential 0ediatric NursinI7 A. 0 Jain 4 Co.

!. 0illitteri Adele7 Child health nursin7 Care of the child and familyI7 5i$$incott7 0hiladel$hia7 Ne3 Gor 

%. 5i$$incott7 &e't boo of 0aediatric NursinI7 Mosby 0ublishers

(. Mary Ann Hoan7 Judy E >hite7 Child health NursinI7 0rentice hall7 Ne3 Jersey

*. u$te Suraj7 &he short te't boo of 0ediatricsI7 1-th edition7 Jay$ee brothers medical $ublishers0; 5&)7 Ne3 )elhi

. AcharKs te't boo of $aediatricsI7 !rd edition2---;7 orient lonman limited

8. 333.betterhealth.ic.o.au,...,)eelo$mentalL!ip L%'splasia Le'$lained

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9. 333. !ip =baby.or,

10. 333.l$ch.or,diseaseHealth9nfo,Health5ibrary,...,ddh.html

esson plan on

Pyloric Stenosis

S"bmitte% to S"bmitte% b'

  ,s. As!l' Eli/abet! Emman"el