1. MUHIMBILI UNIVERSITY OF
HEALTH AND ALLIED SCIENCES
SCHOOL OF NURSING.
PEDIATRIC NURSING
CASE STUDY PRESENTATION
PRESENTER: SONGOMA JOHN
SUPERVISOR: MR .NDILE.

2. CASE PRESENTATION
• PATIENT NAME:x.
• AGE :8 Month
• SEX :MALE
• PLACE: kinyerezi
• Registration No.A 673555.

3. HISTORY OF PATIENT
The patient is eight month old , male he is
referral from Passada through Temeke
with a diagnosis of PAID with severe
malnutrition and anemia
CHIEF COMPLAIN
The chief complain of child was weight
faltering for three month and cough for two
week.

4. HISTORY OF PRESENT ILLNESS
• The mother reported the child to have been
born with body weight of 3.5kg and attained
weight and attained weight of 4.8kg in which
the mother reported child have had episode
of fever and recalls the maximum weight to
have attained to have been 7kg for three
month past where the child started deterating
and recently the child weight 5kg

5. • The mother reported to have breastfeed
exclusively only three month in which she
introduced water , plain porridge with added
salts in which the child fed four times a day
Given ½ small cups and by 6 month age the
child was introduced to stiff porridge mashed
banana and potatoes , bean and meat
occasionally fed 4-5 times a day . Recent child
is being breastfed on demand

6. • The child started coughing 2 week prior to
admission accompanied difficult in breathing
but no fever . The cough was non productive
and non postural rerated to related .
• The cough has been progressive increasing
more during the day time
• In course of this illness the mother was
counseled and tested for HIV tested and
found to be positive.

7. PAST MEDICAL HISTORY .
• Admission 2nd admission previous Temeke for
fever , cough , difficult in breathing , malaria
• Prenatal booked at 4th month of pregnancy .
Attended at kisaki RCH
• Checked for HIV non reactive
• VRDL non reactive .
• Given hematenics
• Not given ant malaria
• Deworm

8. • Natally delivery at term 3.5kg SVD at kisaki
dispensary baby cried immediately after.
• Postnatally stayed for one days and cord
drops in three days.
• Immunization : No BCG scar , No RCH card.
Not received Measles and vitamin A .

9. Developmental history
Social smile achieved at in 2month
Neck control achieved in three month
Sitting on support , crawling achieved in 5
month ,crasp .Now can not craw

10. FAMILY AND SOCIAL HISTORY
• Single parent , mother was never living with
her grand mother ,Not married , petty
business women , std seven leaver and uses
Tsh 4000/= for food per day
• The child is the third child in family of three
children.
No history of TB contact
No history of inherited disease.

11. • REVIEW OF SYSTEM.
• HEENT-hair was soft , there was no discharge.
• GI : abdomen moves with respiration soft
consistency palpation
• RS : Symetrical chest moves with respiration
• CVS:Normal
• CNS: Recognize mother , follow the direction
of objective , babinsk , normal

12. Medical diagnosis
• PAID iv stage
• Marasmus
• Pneumonia
• Severe anaemia

13. MEDICAL MANAGEMENT
• At admission.5/6/2012
Give 50ml dextrose 10% per oral start
• Give 60ml of F75 2 hours
• Administer IV ampicillin 350mg 6hourly for
one week
• IV Gentamycin
• Tab folic acid

14. DIAGNOSTIC MEASURE DONE
• HIV Serology DNA –PCR.
• FBP
• BS for malaria parasite.
• Comprehensive chemistry panel
• Urine test

15. Management which done by
nurses and my self.
• 7/6/2012
• The patient weight was 5.3kg
• The milk therapy given is F75- 90ml 3hourly
• Vital sign monitored
• Patient continued with antibiotics continued.

16. • 8/6/2012
• The children given F75-90ml
• Antibiotic was given as ordered
• Vital sign monitored
• The weight was 5.1kg.
• 9/06/2012
• The patients given F75-90ml
• Antibiotics given as ordered
• The weight of patient was 5.05kg.

17. • 11/06/2012.
• The patient continued with F75-90ml
• Continued with antibiotics
• Tablet fluconazo 50mg o.d prescribed and
given
• Vital signs monitored
• 12/06/2012.
• The patient given F100-90ml
• Guathrone cream prescribed

18. • 13/06/2012.
• The child continued given F100-90ml 3hrs
• The vital signs monitored
• Weight was 5.2kg
• The patient continued with antibiotics
• 14/06/2012.
• F100-90ml the volume increased each feed by
10%maximum was 145.
• Continued with antibiotics

19. • 15/05/2012.
• The child send to VCT and started ARVS
• Continued with F100-145ml
• 16/06/2012
• The patient discharged after nutrition
counselling.

20. Assessment
Weight 5.3kg
• Length 68c
• Severe wasting
• Dehydration
• Fungal infection
• Vital signs
• BP-100/70
• T-37.5C
• RR-34b/m
• PR-120b/m

21. • NURSING MANAGEMENT

22. Nursing diagnosis
1.Potential to hypothermia related to low
energy store
• INTERVETION-
• Cover the child to protect from heat loss
• Keep the room temperature warm
• Monitor vital signs

23. 2.Potential to infection related to impaired body
immunity
• INTERVENTION
• Aseptic technique adhered ,hand washing was
observed, mother taught to wash hand and
wash clothes of child every day.
• Antibiotics was administered as prescribed.

24. 3.Nutritional imbalance , less than body requirement
related to disease condition and inadequate food
intake as evidenced by severe wasting.
Interventions.
• The food F75 and F100 provided every 2 hour at fist
and then every 3 hours
• The mother taught on how to feed the child at home
after discharge.
• To educate the mother do not give other food to
avoid interfere with milk therapy.

25. • 4.Dehydration related to impaired absorption
as evidenced by dry mouth , decrease skin tag
• Intervention.
• Give oral rehydration therapy.

26. Etiology
• HIV is a retrovirus that is transmitted by lymphocytes and
monocytes.
• It is found in the blood, semen, vaginal secretions, and breast
milk. It has an incubation period of months to years . There
are different strains of HIV. HIV-2 is prevalent in Africa,
whereas HIV-1 is the dominant strain in the United States and
elsewhere.
• Horizontal transmission of HIV occurs through intimate
sexual contact or parenteral exposure to blood or body fluids
containing visible blood. Perinatal (vertical) transmission
occurs when an HIV-infected pregnant woman passes the
infection to her infant. There is no evidence that casual
contact between infected and uninfected individuals can
spread the virus.

27. Pathophysiology
• The HIV virus primarily infects a specific subset of T
lymphocytes, the CD4+ T cells. The virus takes over
the machinery of the CD4+ lymphocyte, using it to
replicate itself, rendering the CD4+ cell
dysfunctional. The CD4+ lymphocyte count gradually
decreases over time, leading to progressive immune
deficiency. The count eventually reaches a critical
level below which there is substantial risk of
opportunistic illnesses followed by death.

28. Clinical Manifestations
• Common clinical manifestations of HIV infection in
children are varied .The diagnosis of AIDS is
associated with certain illnesses or conditions.
• The most common AIDS-defining conditions
observed among American children Other problems
in these children may include short stature,
malnutrition, and cardiomyopathy. CNS
abnormalities resulting from HIV infection may
include neuropsychologic deficits; developmental
disabilities; and deficits in motor skills,
communication, and behavioral functioning.

29. Common Clinical Manifestations of HIV
Infection in Children
• Lymphadenopathy
• Hepatosplenomegaly
• Oral candidiasis
• Chronic or recurrent diarrhea
• Failure to thrive
• Developmental delay
• Parotitis

30. Common AIDS-Defining
Conditions in Children
• Pneumocystis carinii pneumonia (PCP)
• Lymphoid interstitial pneumonitis (LIP)
• Recurrent bacterial infections
• Wasting syndrome
• HIV encephalopathy Candidal esophagitis
• Cytomegalovirus disease
• Mycobacterium avium-intracellulare complex infection
• Severe herpes simplex infection
• Pulmonary candidiasis
• Cryptosporidiosis

31. Diagnostic Evaluation
• For children 18 months of age and older, the HIV enzyme-
linked immunosorbent assay (ELISA) and Western blot
immunoassay are performed to determine HIV infection. In
infants born to HIV-infected mothers, these assays will be
positive because of the presence of maternal antibodies
derived transplacentally. Maternal antibodies may persist in
the infant up to 18 months of age. Therefore other diagnostic
tests are employed, most commonly the HIV polymerase
chain reaction (PCR) for detection of proviral DNA. With this
technique, more than 95% of infected infants can be
diagnosed by 1 month of age (Ezekowitz and Stockman,
2003).
• The Centers for Disease Control and Prevention (CDC) (1994

32. Therapeutic Management
• The goals of therapy for HIV infection include slowing the
growth of the virus, preventing and treating opportunistic
infections, and providing nutritional support and symptomatic
treatment. Antiretroviral drugs work at various stages of the
HIV life cycle to prevent reproduction of functional new virus
particles. Although not a cure, these drugs can suppress viral
replication, preventing further deterioration of the immune
system, and thus delay disease progression. Classes of
antiretroviral agents include nucleoside reverse transcriptase
inhibitors (e.g., zidovudine, didanosine, stavudine, lamivudine,
abacavir), nonnucleoside reverse transcriptase inhibitors (e.g.,
nevirapine, delavirdine, efavirenz), nucleotide

33. • reverse transcriptase inhibitors (e.g., adefovir),
protease inhibitors (e.g., indinavir, saquinavir,
ritonavir, nelfinavir, amprenavir), and adjunctive
antiretrovirals (e.g., hydroxyurea). Combinations of
these drugs are used to forestall the emergence of
drug resistance. Antiretroviral therapy regimens and
guidelines are continually evolving. Therapy is
lifelong, making adherence difficult. Laboratory
markers (CD4+ lymphocyte count, viral load) assist in
monitoring both disease progression and response to
therapy.

34. • Immunization against common childhood illnesses is
recommended for all children exposed to and infected with
HIV . Varicella (chickenpox) vaccine and measles-mumps-
rubella (MMR) vaccine can be administered if there is no
evidence of severe immunocompromise close contacts. The
pneumococcal and influenza vaccines are recommended.
Because antibody production to vaccines may be poor or
decrease over time, immediate prophylaxis after exposure to
several vaccine-preventable diseases (e.g., measles, varicella)
is warranted.
• It should be recognized that children receiving IV gamma
globulin prophylaxis may not respond to the MMR vaccine

35. • HIV infection often leads to marked failure to thrive and
multiple nutritional deficiencies.
• Nutritional management may be difficult because of
recurrent illness, diarrhea, and other physical problems.
• Intensive nutritional interventions should be instituted when
the child's growth begins to slow or weight begins to decrease
Malnutrition continues to be a major health problem in the
world today, particularly in children younger than 5 years of
age. Lack of food, however, is not always the primary cause
for malnutrition

36. MALNUTRITION
• Malnutrition continues to be a major health problem in the
world today, particularly in children younger than 5 years of
age. Lack of food, however, is not always the primary cause
for malnutrition. In many developing and underdeveloped
nations, diarrhea is a major factor. Additional factors are
bottle-feeding (in poor sanitary conditions), inadequate
knowledge of proper child care practices, parental illiteracy,
economic and political factors, and simply the lack of
adequate food for children.. The most extreme forms of
malnutrition, or protein and energy malnutrition (PEM), are
kwashiorkor and marasmus.
• In the United States milder forms of PEM are seen, although
the classic

37. • In many developing and underdeveloped nations,
diarrhea is a major factor. Additional factors are
bottle-feeding (in poor sanitary conditions),
inadequate knowledge of proper child care practices,
parental illiteracy, economic and political factors,
and simply the lack of adequate food for children..
The most extreme forms of malnutrition, or protein
and energy malnutrition (PEM), are kwashiorkor and
marasmus.
• In the United States milder forms of PEM are seen,
although the classic

38. • Marasmus results from general malnutrition of both calories
and protein. It is a common occurrence in underdeveloped
countries during times of drought, especially in cultures
where adults eat first; the remaining food is often insufficient
in quality and quantity for the children.
• Marasmus is usually a syndrome of physical and emotional
deprivation and is not confined to geographic areas where
food supplies are inadequate. It may be seen in children with
failure to thrive in whom the cause is not solely nutritional
but primarily emotional

39. • . Marasmus may be seen in infants as young as 3 months of
age if breast-feeding is not successful and there are no
suitable alternatives. Marasmic-kwashiorkor is a form of PEM
in which clinical findings of both kwashiorkor and marasmus
are evident; the child has edema, severe wasting, and stunted
growth. Marasmus is characterized by gradual wasting and
atrophy of body tissues, especially of subcutaneous fat. The
child appears to be very old, with flabby and wrinkled skin,
unlike the child with kwashiorkor, who appears more
rounded from the edema. Fat metabolism is less impaired
than in kwashiorkor, so that deficiency of fat-soluble vitamins
is usually minimal or absent.

40. • The child is fretful, apathetic, withdrawn, and
so lethargic that prostration frequently
occurs. Intercurrent infection with debilitating
diseases such as tuberculosis, parasitosis, HIV,
and dysentery is common

41. Therapeutic Management
• The treatment of PEM includes providing a diet with high-quality proteins,
carbohydrates, vitamins, and minerals. When PEM occurs as a result of
diarrhea (see also Diarrhea, Chapter 24), three management goals are
identified: (1) rehydration with an oral rehydration solution that also
replaces electrolytes, (2) medications such as antibiotics and
antidiarrheals, and (3) provision of adequate nutrition either by breast-
feeding or a proper weaning diet. When the child is too ill to tolerate oral
fluids, intravenous administration of fluids, electrolytes, minerals and
vitamins will be required to prevent death. Additional management of
PEM is aimed at restoring or replacing essential vitamins and minerals,
namely vitamin E, vitamin A, selenium, and zinc which have been shown
to have significant roles in infection and congestive heart failure related to
PEM