Maternal and Childhealth Advocacy International and the Advanced Life Support Group INTERNATIONAL MATERNAL AND CHILD

HEALTHCARE: A PRACTICAL TEXTBOOK FOR HOSPITALS WORLDWIDE Editors:

Contents
INTRODUCTION How to use this textbook

SECTION 1: Essential systems of health care within the hospital 1. 2. 3. 4. Hospital Management Ethical systems within the hospital Prevention of hospital acquired infection Basic nursing needs of patients nursing sick children nursing pregnant women and girls 5. Morale, motivation, responsibilities and communication for hospital staff 6. Continuing medical education for healthcare professionals 7. Essential imaging facilities X-ray and ultrasound 8. Essential operating theatre resources 9. Essential drugs and equipment and their management 10. Drug and fluid administration 11. Safe blood transfusion practice 12. Essential laboratory services 13. Record keeping, history taking and examination of patients 14. Basic and Advanced Life Support 15. Principles of triage and the structured approach to the management of emergencies 16. The structured approach to the seriously ill or injured pregnant women/girls, babies and children 17. Intensive/high dependency care of the critically ill and injured 18. Non-invasive respiratory support 19. Pain control, including the management of opioid drugs 20. Palliative care for the dying child 21. Hospital issues regarding immunisation 22. Recognition of the abuse of pregnant women/girls and children and the prevention of further injury 23. Facilities for children with special needs and learning difficulties 24. Transport of ill patients

SECTION 2 Essential antenatal care for the hospital practitioner SECTION 3: System or organ dysfunction in pregnancy

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The pregnant girl or woman presenting with a disorder of the airway or breathing
o o o o o o o o o Heart failure Rheumatic heart disease Asthma Lower respiratory tract infection Anaphylaxis Pulmonary embolus Amniotic fluid embolus Severe anaemia Shock Severe dehydration Severe gastroenteritis

The pregnant girl or woman presenting with a disorder of the circulation

The pregnant girl or woman presenting with diabetes mellitus The pregnant girl or woman presenting with acute renal failure The pregnant girl or woman presenting with neurological symptoms
Meningitis or encephalitis Tetanus The pregnant girl or woman with a sexually transmitted disease The pregnant girl or woman with HIV infection The pregnant girl or woman subject to violence within the family The pregnant girl or woman with malaria The pregnant girl or woman with pre-eclampsia or eclampsia

SECTION 4: The pregnant girl or woman presenting with a complication of pregnancy Presenting with abdominal pain Early pregnancy Obstetric and gynaecology related Ovarian cyst Ruptured ectopic pregnancy Coincidental Acute appendicitis Cystitis Acute pyelonephritis Peritonitis Late pregnancy Preterm labour Normal labour Placental abruption

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Ruptured uterus Chorio-amnionitis Pelvic abscess

Presenting with vaginal bleeding Early pregnancy Miscarriage Threatened Silent Blighted ovum Incomplete Complete Inevitable Molar pregnancy Ectopic pregnancy Vulvo-vaginal or cervical causes Late pregnancy Placental abruption Placenta praevia Ruptured uterus Vasa praevia

Presenting with fever during pregnancy Gynaecological or obstetric related Septic abortion Chorio-amnionitis Pelvic abscess Coincidental Cystitis Acute pyelonephritis Pneumonia Malaria Typhoid Hepatitis

SECTION 5: Normal labour and delivery and its management SECTION 6: Complications of labour and delivery Before birth Obstructed labour Shoulder dystocia

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Multiple pregnancy Mal-presentations and mal-positions Prolapsed cord After birth Inverted uterus Post partum haemorrhage Ruptured uterus SECTION 7: The pregnant girl or woman presenting with a complication of the post delivery period Puerperal sepsis Endometritis Breast infection Post natal depressive illness SECTION 8: Anaesthesia in pregnancy SECTION 9: Resuscitation of the Newborn Recognising at risk babies: environment or family Preparation for birth Management of delivery Stabilising the term baby after birth ABCDEF of resuscitation of the newborn Airway management Trachea blocked Breathing Mask inflation Mouth to mouth/nose Preterm Circulation Drugs Acute blood loss Umbilical venous catheter Environment Family Poor response to resuscitation Decision to stop resuscitation Documentation SECTION 10: Clinical problems in the infant in the first month of life General issues of healthcare for the newborn infant Preterm and low birth weight problems Preventing infection Temperature regulation-hypothermia and its prevention Feeding and Glucose management

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Fluid and electrolyte management Oxygen treatment Birth Trauma Common congenital malformations The baby born to the mother with diabetes The baby born to the mother dependent on drugs and alcohol during pregnancy Neonatal emergencies Breathing problems Respiratory distress syndrome Transient tachypnoea of the newborn Aspiration pneumonia Bacterial pneumonia Persistent fetal circulation Pneumothorax Congenital malformations Recurrent apnoea Neonatal infection Diagnosis Early v late onset Meningitis Antibiotic and other treatment Skin, eye and mucous membrane infections Syphilis HIV prevention Neonatal bleeding Jaundice Causes and diagnosis Phototherapy Exchange transfusion Late jaundice Anaemia Fits, spasms and coma Management of fits Hypoglycaemia Meningitis Tetanus Biochemical Kernicterus Inborn errors of metabolism Birth asphyxia Drug related Developmental disorders Anticonvulsant treatment

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Bowel emergencies Oesophageal atresia Trache-oesophageal fistula Necrotising enterocolitis SECTION 11: The child presenting with a system or organ dysfunction 11A The child presenting with an airway and/or breathing problem Upper airway (difficulty breathing/stridor/cough) Croup Epiglottitis Diphtheria Anaphylaxis Foreign body in the upper airway-choking Tonsillitis, otitis media and mastoiditis Sleep related upper airway obstruction Lower airway (difficulty breathing/cough) Bronchiolitis Asthma Pertussis Foreign body in the bronchus Lung (difficulty breathing/cough/fever) Very severe pneumonia Severe pneumonia Pneumonia (not severe) Cystic fibrosis Congenital lung disorders Pleural effusion and empyema TB Cardiac (difficulty breathing) Heart failure Congenital heart disorders Rheumatic heart disorders Severe anaemia Neurological (apnoea and hypoventilation) 11 B The child presenting with a circulatory problem C Shock due to dehydration (diarrhea) Shock due to infection Bacterial sepsis Dengue haemorrhagic fever Severe malaria

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Cardiogenic shock Congenital heart disorders Cardiac arrhythmias 11 C The child presenting with a renal problem Renal failure Medical Renal Problems Vesico-Ureteric Reflux 11 D The child presenting with a liver problem Acute liver failure Chronic Liver Disease 11 E The child presenting with an endocrine disorder Diabetes mellitus Adrenal insufficiency Hypoglycaemia 11 F The child presenting with a psychiatric disorder Depression Acute psychosis 11 G The child presenting with a nutritional problem Vitamin Deficiencies Severe Malnutrition 11 H The child presenting with a hematological disorder Anaemia Sickle Cell Disease Haemolytic Anaemias Blood Clotting Disorders 11 I The child presenting with a gastroenterological disorder Acute diarrhoea Post-infectious persistent diarrhoea Constipation Inflammatory bowel disease Gastrointestinal bleeding Malabsorption and coeliac Disease 11 J The child presenting with an auto-immune disorder Connective Tissue Disorders Juvenile rheumatoid arthritis 11 K The child with a malignancy

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11 L The child with an Eye Disorder Trachoma 11 M The child with a Neurological disorder Coma Encephalitis Epilepsy-including status epilepticus Neuropathies Guillain-Barre Syndrome Muscular Dystrophies Breath-Holding Spells Migraine Neurosurgical Disorders 11 N The child with an orthopaedic problem other than due to injury 11 O The child with a developmental disorders and/or learning difficulties 11 P The child with a skin disease 11 Q The child with a surgical disorder SECTION 12: Infectious Diseases and individual infections affecting children 12 A BACTERIAL INFECTIONS Bacterial Meningitis Sexually Transmitted Diseases Botulism Brucellosis Buruli ulcer Campylobacter Chlamydia Cholera Diphtheria Haemophilous Influenzae infections Leprosy Leptospirosis Meningococcal Disease Pertussis Plague Relapsing fever (borrelia) Shigellosis Staphyloccocal infections Streptococcal Disease

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Tetanus Tuberculosis Typhoid and paratyphoid 12 B VIRAL INFECTIOUS DISEASES AND INFECTIONS Chicken Pox Dengue Hepatitis Herpes HIV Infection Measles Mumps Poliomyelitis Rabies Management and Prevention after Animal Bites Viral Haemorrhagic Fevers Yellow Fever 12 C INFECTIONS CAUSED BY PARASITES Systemic protozoal infections African Trypanosomiasis Leishmaniasis Malaria Toxoplasmosis Intestinal Protozoal Infections Amoebiasis Cryptosporidiosis Giardiasis Helminthic Protozoal Infections (worms) Cestodes (tapeworms) Hydatid disease Trematodes (flukes) Schistosmiasis Nematodes (round worms) Ascariasis Dracunculiasis (Guinea worm) Enterobiasis (pin-worm) Filiariasis (Elephantiasis) Hookworm Loa-Loa Onchocerciasis Trichionosis Trichuriasis (whip worm) Rickettsial Diseases Lyme disease Scrub Typhus

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SECTION 13 Major injuries in pregnant women, pregnant girls and children Accidents and their Prevention Child Ill Treatment and Abuse Domestic violence Female genital mutilation Wounds and their management Life-Threatening Trauma
Structured approach Primary survey ABCDE Secondary survey Emergency radiology Analgesia

Head Injuries Chest injuries Tension pneumothorax Haemothorax Abdominal injuries Electrocution Fractures Spinal Cord Injuries Landmine Injuries Gunshot Wounds Burns Poisoning Envenoming Drowning Heat Stroke Hypothermia SECTION 14: Procedures In both pregnant women and children Hand washing Post operative Management Basic nursing issues Post operative complications In children Measuring nutritional status, growth and development in children Restraining Children for Procedures Giving Injections Sampling Blood from Heel Pricks in Infants Peripheral Venous Cannulation Non-Invasive Ventilatory Support Insertion of Oro/Nasogastric Tube

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Incision and Drainage of Abscess Liver Biopsy Abdominal Paracentesis Lumbar Puncture Central Venous Cannulation Cut Down Venous Cannulation Umbilical Vein Catheterisation Exchange Transfusion Physiotherapy for Respiratory Disorders Intraosseous Needle Insertion Intraperitoneal Infusions Emergency Thoracocentesis Insertion of a Chest Drain Intubation Insertion of an Emergency Surgical Airway Defibrillation Needle Pericardiocentesis Supra-pubic Aspiration of Urine Microscopy of the Urine In pregnant women and girls Safe urinary catheterization Instrumental delivery: Ventouse Forceps Caesarean section Episiotomy and its repair Repair of cervical and vaginal tears Manual removal of placenta Symphisiotomy Destructive procedures In major trauma Chest drain Cervical spine immobilisation Log roll

15. APPENDIX
Fluid and electrolyte management WHO Treatment Plan A for gastroenteritis: Home therapy to prevent dehydration and malnutrition Formulas and recipes for severely malnourished children Example of 24 hour food intake chart Example of drug treatment chart for sick children Example of care chart for sick children

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Example of monitoring chart Example of care chart for neonatal unit Example of treatment chart for neonatal unit Mother's discharge advice card (WHO) Estimating body surface area WHO/NCHS reference weight for length and weight for height charts Example of weight progress chart (WHO) Normal values for vital clinical signs and laboratory measurements Clinical Tests for Brain Stem Death Example of vital signs nursing chart Example of feeding and progress chart

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