2nd Year GNM Nursing ODISHA Child Health Nursing 2025
ODISHA NURSES & MIDWIVES EXAMINATION BOARD
SECOND YEAR ANNUAL EXAMINATION IN GNM-2025
Paper-IV
(Child Health Nursing)
I. Solve answer question
OR
a. What is paediatric nursing? [3]
Paediatric
nursing is a specialised branch of nursing that deals with the health care
of infants, children and adolescents, recognising their unique
physiological, developmental, emotional and psychosocial needs.
In this role the nurse delivers preventive, promotive, curative and
rehabilitative care to children from birth up to adolescence (or young
adulthood in some settings).
It emphasises holistic child-centred care (including family involvement)
because children are not “small adults” — their care must be adapted to age,
growth and development.
b. Write briefly about trends in
paediatric nursing. [5]
Here are
key trends currently seen in paediatric nursing:
- Family-centred care – The family is recognised
as an essential part of the child’s care team; nurses empower and enable
families to participate in decision-making and care.
- High-technology care and
evidence-based practice – With advances in diagnostics, neonatal
intensive care, monitoring, etc., paediatric nursing requires the use of
technology and applying evidence-based protocols.
- Preventive and
community-oriented care – There is increasing emphasis on health
promotion, immunization, early detection and in community settings (not
just acute hospital care).
- Atraumatic care /
child-friendly environment – Care settings are being modified so that
children experience less distress, pain and separation when hospitalized.
- Expanded roles and
multi-disciplinary collaboration – Paediatric nurses are not only caregivers
but also educators, counsellors, researchers, case-managers, collaborating
with other professionals.
These
trends reflect the shift from just treating illness to promoting health,
supporting families and adapting to complex technologies and psychosocial
needs.
c. Describe the role of a paediatric
nurse in child care. [7]
The role
of a paediatric nurse (also called paediatric nurse-caregiver) is
multi-faceted. Below are the main roles and how they function in child care:
- Primary Care-giver
- Provide direct nursing care
to children (infants, children, adolescents) in various settings
(hospital, clinic, community).
- Carry out assessment of
child’s physical, developmental and psychosocial health, monitor vital
signs, administer medications, assist in procedures, ensure safe
environment.
- In community or preventive
settings: immunisation, growth monitoring, health checks, screening.
- Coordinator & Collaborator
- Coordinate with other
health-team members (paediatricians, physiotherapists, dieticians, social
workers) to ensure holistic care.
- Act as a link between
child, family and multidisciplinary team so that care plan is consistent
and family-centred.
- Advocate for the Child and Family
- Safeguard child’s rights,
ensuring safe care, consent where applicable, protecting vulnerable
children.
- Support families in
decision-making, ensuring they understand the child’s condition, care
options and enabling them to participate.
- Health Educator
- Educate children (where
appropriate) and their families on health promotion, disease prevention,
home care after discharge, nutrition, immunisation, developmental
milestones.
- Use age-appropriate
teaching and communication strategies (play, visual aids, simple
language) to engage children.
- Counsellor & Consultant
- Provide emotional support
and counselling to the child and family during illnesses,
hospitalisation, chronic conditions or bereavement.
- Act as consultant to the
family on child-rearing, accident prevention, feeding practices etc.
- Case Manager / Resource Manager
- Organise and monitor the
child’s nursing care plan, evaluate outcomes, ensure continuity of care
(from hospital to home/community) and coordinate referrals.
- Manage resources (play
area, child-friendly equipment, support services) and ensure the child’s
environment is conducive to healing and development.
- Recreationist / Social Worker /
Researcher
- Provide opportunities for
play and developmental activities—important in paediatric care to reduce
anxiety, support development and normalise hospitalisation.
- Liaise with social welfare
agencies for children with special needs or chronic illness.
- Participate in research and
quality improvement to advance paediatric nursing practice.
- Promoter of Growth & Development
- Ensure nursing care
supports not just the treatment of disease but the child’s optimal
growth, development and psychosocial well-being.
- Recognise developmental
stages, tailor interventions accordingly, monitor developmental
milestones, support rehabilitation if needed.
- Safety & Ethical Guardian
- Ensure that the child’s
safety is prioritized (prevention of infection, accidents, medication
errors).
- Uphold ethical principles
(consent, assent in older children, privacy, dignity) and address issues
specific to children (e.g., vulnerability, dependence).
OR
a. What is tonsillitis? [3]
Tonsillitis
is the inflammation of the tonsils (the paired lymphoid tissues at the back of
the throat) usually due to infection.
It may be caused by viral or bacterial agents, and leads to the tonsils
becoming red, swollen, sometimes with exudate (white or yellow patches) on
their surface.
Clinically, it presents with sore throat, difficulty swallowing and swelling of
the tonsils.
b. Signs, symptoms and aetiology of
tonsillitis. [6]
Signs
& Symptoms:
- Red, swollen tonsils.
- White or yellow patches or
coating on the tonsils.
- Sore throat and pain /
difficulty when swallowing (odynophagia).
- Fever (raised temperature).
- Enlarged, tender lymph nodes
(glands) in the neck (anterior cervical) region.
- “Scratchy” or muffled voice;
bad breath; in younger children: stomach-ache, vomiting, drooling.
Aetiology
(Causes):
- Viral infections are the
most common cause (e.g., viruses that cause common cold, influenza,
Epstein-Barr virus etc).
- Bacterial infections —
particularly Group A Streptococcus (GAS) — especially in children aged
5-15 years.
- Less common causes: other
bacteria like Staphylococcus aureus, Haemophilus influenzae; sometimes
non-infectious causes (though infection is principal).
c. Nursing management of a patient
with tonsillitis. [6]
Nursing
management aims at relief of symptoms, preventing complications, maintaining
hydration and nutrition, and educating the patient/family. Key points include:
- Assessment & Monitoring
- Monitor vital signs
(temperature, pulse, respiratory rate) and observe for signs of
respiratory distress, airway obstruction (especially in children).
- Observe the throat
(tonsils) for swelling, redness, exudate, and check cervical lymph nodes.
- Monitor swallowing ability,
oral intake (fluids, food), drooling (in children) and any signs of
dehydration.
- Evaluate pain level
(especially throat pain when swallowing) and general discomfort.
- Symptom Relief &
Supportive Care
- Encourage rest and
reduction of physical exertion.
- Provide
analgesics/antipyretics as prescribed (e.g., for throat pain and fever).
- Encourage warm fluids, soft
foods, soothing throat care (e.g., warm saline gargles if age
appropriate) to ease swallowing.
- Maintain adequate fluid
intake to prevent dehydration; consider IV fluids if oral intake is poor.
- Humidify air, maintain
comfortable environment, minimize irritants (smoke, dust) in children’s
rooms.
- Maintain Airway &
Prevent Complications
- In severe cases, observe
for airway obstruction (tonsils may swell large) and ensure airway
patency.
- Encourage mouth breathing
if necessary but monitor for secondary problems.
- Prevent spread of
infection: apply standard precaution (hand hygiene, isolate if necessary,
avoid sharing utensils/dishes) especially in children.
- Nutrition & Hydration
Management
- Encourage soft,
easy-to-swallow foods (soups, mashed, soft diet) and adequate fluid
intake (water, juices) to maintain energy and hydration.
- Monitor for signs of
dehydration (reduced urine output, dry mucous membranes, sunken eyes) and
intervene accordingly.
- Education and Health
Promotion
- Educate child (age
appropriate) and family about the condition: causes (viral vs bacterial),
need to complete full course of antibiotics if prescribed.
- Teach throat-care measures:
warm saline gargles, avoiding irritants, good oral hygiene, rest, how to
manage pain.
- Teach preventive measures:
proper hygiene (hand washing), avoiding sharing eating utensils, avoiding
close contact with infected persons.
- Planning for Follow-up &
Referral
- Evaluate the need for
referral if recurrent tonsillitis, airway obstruction, difficulty
swallowing, or abscess formation.
- Prepare for possible
surgical intervention (e.g., tonsillectomy) if indicated (recurrent
episodes, obstructive symptoms).
- Provide discharge
instructions: when to seek help (e.g., difficulty breathing, drooling,
unable to swallow, high fever persisting) and ensure scheduled follow-up.
II. Solve Answer Questions
OR
a. Define diarrhoea. [2]
Diarrhoea is defined as the passage of three or more loose or watery
stools in one day, or a change in consistency of stool from the
individual’s normal pattern.
In children, it often means frequent watery bowel movements that are abnormal
for the child’s usual pattern.
b. Write the causes, signs, symptoms of diarrhoea. [7]
Causes (Aetiology):
·
Viral infections (e.g., rotavirus, norovirus)
are common causes of acute diarrhoea in children.
·
Bacterial or parasitic infections (e.g., E.
coli, Salmonella, Giardia) can cause diarrhoea.
·
Malabsorption (damage to intestinal mucosa,
e.g., from prolonged diarrhoea or chronic conditions) leads to osmotic
diarrhoea.
·
Poor hygiene, contaminated food/water,
inadequate sanitation especially in children in developing settings.
Signs & Symptoms:
·
Frequent passage of loose or watery stools.
·
Increased stool frequency and volume; may be
accompanied by abdominal pain, cramping.
·
Vomiting or nausea may accompany diarrhoea in
children.
·
Dehydration signs: dry mouth, decreased urine
output (or fewer wet nappies in infants), sunken eyes, lethargy.
·
Fever, blood or mucus in stool in some cases of
bacterial diarrhoea.
·
Poor appetite, weight loss or failure to gain
weight (especially in chronic diarrhoea).
c. Describe the treatment plan of a paediatric diarrhoea patient.
[6]
Here is a treatment / nursing-care plan outline for a child with diarrhoea:
1. Assessment
& Monitoring
o
Monitor stool frequency, consistency, volume and
presence of blood or mucus.
o
Check vital signs (temperature, pulse,
respiration) and signs of dehydration (capillary refill, mucous membranes, skin
turgor, urine output).
o
Monitor weight daily if needed, intake/output
charting, fluid balance.
2. Fluid
& Electrolyte Management
o
Give oral rehydration solution (ORS) in frequent
small amounts if mild/moderate dehydration and child can drink.
o
In severe dehydration or inability to drink,
intravenous fluids as per protocol.
o
Continue feeding (age-appropriate) and resume
regular diet as soon as possible (not prolonged fasting unless indicated).
o
Avoid high-sugar drinks, excessive fruit juices
or colas which may worsen diarrhoea.
3. Nutrition
& Diet
o
Encourage continued breast-feeding in infants.
o
Offer small frequent feeds of starchy foods,
pulses, vegetables, meat/fish if appropriate; add small amounts of oil to meals
in children.
o
Monitor for growth and nutritional status,
ensure the child does not become malnourished.
4. Infection
Control & Hygiene
o
Apply standard precautions: hand hygiene, proper
disposal of stools, avoid contaminated water or food.
o
In hospital or ward settings ensure cleaning of
bed/linen, proper isolation if needed (depending on infection).
5. Skin
& Comfort Care
o
Because of frequent stools, skin around
buttocks/perineal area may become irritated; provide skin care, barrier cream,
gentle cleansing.
o
Minimize discomfort: provide oral hygiene, keep
environment comfortable, reduce fever/ pain as required.
6. Health
Education & Prevention
o
Educate caregivers about signs of dehydration
(what to look for), when to seek help (e.g., inability to drink, persistent
vomiting, blood in stool).
o
Teach about safe drinking water, sanitation,
proper food handling, breastfeeding, timely immunisation (e.g., rotavirus
vaccine where applicable).
o
Advise on rehydration at home, how to prepare
ORS if commercial not available, what foods to give and what to avoid.
Summary outcome expectation: The child will maintain
adequate hydration, return to normal stool consistency and frequency, maintain
or regain weight/ nutritional status, and avoid complications (like severe
dehydration, malnutrition).
OR
a. Define anaemia. [3]
Anaemia (or anaemia) is a condition in which the number of red blood cells
(RBCs) or the haemoglobin concentration is below the normal range,
resulting in reduced oxygen-carrying capacity of the blood to the body’s
tissues.
In children, anaemia means the child’s haemoglobin is lower than
age-appropriate cut-offs, and this may impair growth, development and general
health.
b. Write the causes, classification and clinical manifestation of
anaemia. [5]
Causes:
·
Nutritional deficiency: Iron deficiency is the
most common cause in children (due to poor dietary intake, malabsorption,
chronic blood loss).
·
Chronic blood loss (e.g., parasitic infections
like hookworm, gastrointestinal bleeding) or acute haemorrhage.
·
Haemolysis (destruction of RBCs) or bone marrow
suppression/failure (reduced production of RBCs).
·
Other causes: Vitamin B12/folate deficiency,
inherited disorders (thalassaemia, sickle cell), chronic diseases.
Classification:
Broadly, anaemias in children can be classified by mechanism:
·
Deficient production (e.g., iron deficiency,
vitamin deficiency, bone marrow failure)
·
Increased destruction (haemolytic anaemias)
·
Blood loss (acute or chronic bleeding)
Also by RBC indices (microcytic, normocytic, macrocytic) but for exam a
simplified classification is acceptable.
Clinical Manifestation (Signs & Symptoms):
·
Pallor of skin and mucous membranes (palpebral
conjunctiva, nail beds).
·
Fatigue, weakness, decreased activity tolerance
(child tires easily).
·
Irritability, poor concentration.
·
In severe cases: Tachycardia, breathlessness on
exertion, growth retardation, developmental delay.
·
Other features depending on cause: koilonychia
(spoon nails), glossitis, angular stomatitis in iron deficiency.
c. Explain the nursing management of anaemia. [7]
Here is a nursing management outline for a child with anaemia:
1. Assessment
& Monitoring
o
Obtain detailed history: dietary intake, chronic
illness, bleeding history, parasitic exposure.
o
Physical examination: check for pallor,
tachycardia, growth/weight parameters, signs of nutritional deficiency
(glossitis, koilonychia) and other systemic signs.
o
Monitor laboratory results: RBC count,
haemoglobin, haematocrit, iron studies, reticulocyte count, others as per
cause.
2. Correct
Underlying Cause & Therapeutic Measures
o
Ensure iron supplementation (oral or parenteral)
if iron deficiency–based; follow prescribed dosing, monitor for side-effects,
ensure adherence.
o
Treat any underlying bleeding source (e.g.,
parasitic infestation) or haemolysis, or other nutritional deficiencies.
o
In severe anaemia: prepare for/assist in blood
transfusion if indicated, monitor patient during transfusion.
3. Nutrition
& Diet Education
o
Educate caregivers and child (as appropriate) on
a diet rich in iron (meat, fish, legumes, green leafy vegetables), vitamin C to
enhance iron absorption, avoid inhibitors (tea, coffee with meals).
o
Encourage regular meals, adequate calories and
protein, ensure other micronutrients (folate, B12) are adequate.
4. Symptom
& Activity Management
o
Monitor for fatigue; encourage rest and avoid
excessive exertion.
o
Teach energy-conservation techniques: shorter
play/activity periods, frequent rest breaks.
o
Monitor cardiovascular signs (tachycardia,
pallor) especially when anaemia is severe.
5. Prevention
of Complications & Supportive Care
o
Prevent infections (since anaemia can lower
immunity); ensure immunisations are up to date, good hygiene practices.
o
Monitor for signs of complication: heart failure
in extreme anaemia, growth retardation, developmental delay.
o
Educate about adherence to follow-up and
laboratory monitoring till parameters normalize.
6. Health
Education & Follow up
o
Teach caregivers about the importance of
continuing iron therapy even after symptoms improve (often total course 3–6
months or more).
o
Educate about signs of worsening (bleeding,
worsening pallor, fatigue) and when to seek medical attention.
o
Arrange regular follow-up for lab tests and
growth monitoring.
7. Evaluation
of Outcomes
o
Expect increase in haemoglobin/haematocrit
values, improvement in activity tolerance, decrease in pallor and fatigue,
normal growth parameters.
o
Adjust care plan if no improvement (reevaluate
cause, adherence, absorption issues).
III. Write short notes on any three of the following.
a. Failure to Thrive
Definition
/ overview
- Failure to Thrive (FTT) —
sometimes called growth faltering — is a condition in which a child fails
to gain weight or grow in length/height as expected, relative to
age-matched norms or standard growth charts.
- It is more of a clinical
observation than a single disease.
Causes /
risk factors
- Inadequate caloric intake:
e.g., poor feeding, breastfeeding problems, formula preparation errors,
insufficient food.
- Poor nutrient absorption or
utilisation: e.g., gastrointestinal disorders, chronic illness, metabolic
demand increased (heart disease, chronic lung disease)
- Psychosocial factors:
poverty, neglect, feeding difficulties, family stress.
Clinical
features
- Weight gain significantly
slower than expected; may drop off growth curves.
- Height/length may also slow
down, head circumference may be affected in infants.
- Other signs: irritability,
less interaction, developmental delays, tiredness, feeding problems.
Significance
- If untreated, FTT can impact
physical growth, cognitive development, immunity, and long-term health.
b. Exclusive Breast Feeding
Definition
- Exclusive Breastfeeding
(EBF) means feeding the infant only breast milk from his/her mother (or a
wet nurse) from birth up to about 6 months, with no other food or drink
(not even water), except vitamin/mineral drops or medicines if needed.
Key
points / benefits
- Breast milk alone is
sufficient to meet an infant’s nutritional needs for the first 6 months.
- It protects against many
infections (e.g., diarrhoeal disease, respiratory infections) and supports
better immunity.
- Promotes bonding, is
hygienic, always available, cost-effective.
- WHO and national guidelines
recommend EBF up to 6 months.
c. Immunization Schedule
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What is
it?
- Immunisation schedule refers
to the planned timing of vaccinations given to infants, children (and
sometimes pregnant women) to protect against vaccine-preventable diseases.
Key
features for India
- The National Immunization
Programme (NIP) / Revised National Immunization Schedule lists vaccines,
age at which they should be given, doses, route, site.
- Examples: At birth – BCG;
Birth‐dose Hepatitis B; OPV zero; At 6 weeks, 10 weeks, 14 weeks – OPV,
IPV, etc.
Purpose /
importance
- Protects children against
deadly or serious diseases (tuberculosis, polio, measles, etc.).
- Achieves herd immunity,
reduces morbidity/mortality in childhood.
- Key part of child health
nursing: checking immunization status, educating parents, ensuring
follow‐up.
d. Child Labour
Definition
- According to UNICEF: “Child
labour refers to work that children are too young to do or that, by
its nature or circumstances, is harmful to their physical and/or
mental development, deprives them of schooling, their childhood, or both.”
- In India: child labour
includes children under 14 engaged in any employment including domestic
help or hazardous work.
Causes
& consequences
- Major causes: poverty, lack
of access to education, migration, family indebtedness, informal economy.
- Consequences: interrupted or
no schooling, stunted growth/health, exploitation, hazard exposure,
perpetuation of poverty cycle.
Relevance
to Child Health Nursing
- Nurses working in
paediatric/community settings must recognise health risks (injuries,
infections, malnutrition) among child labourers, advocate for child
protection, assess growth and development, liaise with social
welfare/education sectors.
e. Scabies
Definition
/ overview
- Scabies is a contagious skin
infestation caused by the mite Sarcoptes scabiei var. hominis, which
burrows into the skin, causing intense itching and rash.
Key
features / epidemiology
- Especially common in crowded
living conditions, among children in vulnerable populations, institutional
settings.
- Clinical signs: very itchy
rash (especially at night), small burrows, papules/vesicles often in web
spaces of fingers, wrists, elbows, axillae in children.
- Spread via close personal
contact and sharing bedding/clothing.
Nursing
implications / control
- Detect early: assess for
itching, rash in children and contacts.
- Provide or assist in
treatment: topical scabicide (as per local policy), treat all close
contacts simultaneously, wash clothes/bedding in hot water or sealed for
72h.
- Educate families on hygiene,
avoidance of sharing clothes/linens, environment cleaning, reduce
reinfestation.
- Monitor for complications
(secondary bacterial infection).
IV. A. Write down the role of a nursing personnel while dealing with the following paediatric patients.
a. Tetanus
Role of
Nursing Personnel:
- Assessment & Wound Care: Evaluate the wound for
tetanus risk and administer appropriate wound care, including debridement
if necessary.
- Vaccination & Immunoglobulin: Administer tetanus
vaccination and tetanus immune globulin (TIG) as per guidelines.
- Monitoring & Support: Monitor for signs of
tetanus, manage muscle spasms, and provide supportive care.
- Education: Educate caregivers on wound
care, vaccination schedules, and prevention strategies.
b. Hepatitis
Role of
Nursing Personnel:
- Assessment: Monitor for symptoms such
as jaundice, fatigue, and abdominal pain.
- Supportive Care: Ensure adequate hydration
and nutrition; monitor liver function.
- Medication Administration: Administer antiviral
medications if prescribed.
- Education: Provide information on
disease transmission, vaccination, and prevention.
c. Measles
Role of
Nursing Personnel:
- Identification &
Isolation:
Recognize symptoms and implement isolation protocols to prevent spread.
- Symptom Management: Provide supportive care for
fever, rash, and respiratory symptoms.
- Vaccination Advocacy: Promote MMR vaccination to
prevent outbreaks.
- Monitoring Complications: Watch for potential
complications like pneumonia or encephalitis.
d. Tuberculosis (TB)
Role of
Nursing Personnel:
- Screening & Diagnosis: Conduct TB screenings and
assist in diagnostic procedures.
- Treatment Administration: Administer anti-TB
medications and monitor for side effects.
- Education & Adherence: Educate families on
treatment adherence and infection control measures.
- Follow-up Care: Ensure regular follow-up
appointments and sputum tests.
e. Thumb Sucking
Role of
Nursing Personnel:
- Assessment: Evaluate the frequency and
duration of the thumb-sucking habit.
- Behavioral Strategies: Implement positive
reinforcement and distraction techniques.
- Physical Barriers: Use gloves or bandages as
reminders to discourage the habit.
- Parental Guidance: Provide support and
guidance to parents for managing the behavior.
B. Fill in the blanks.
Answer:
i. The
Juvenile Justice Act was launched in 20th century.
ii. The
first treatment of Diarrhoea is oral rehydration therapy (ORS).
iii. The
main reason of female foeticide is gender bias / preference for male child.
iv.
Kolpik's spot is seen in measles.
v. The
full form of NSAID is Non-Steroidal Anti-Inflammatory Drug.
vi. The
first permanent teeth usually appear by the age of 6 years.
vii. The
most important indicator of neurological development of a newborn is reflexes
/ neonatal reflexes.
viii. The
average head circumference at birth is 34–35 cm.
ix.
Failure to grasp the nipple at birth indicates poor sucking reflex /
neurological immaturity.
x.
Pathological jaundice develops within 24 hours of birth.
V. A. Write the full forms of the following abbreviations.
Answer:
i. PCEC
– Primary Health Care Expansion Centre (sometimes also “Primary Care
Emergency Centre” depending on context in India)
ii. GAVI
– Global Alliance for Vaccines and Immunization
iii. DT
– Diphtheria and Tetanus vaccine
iv. BMV
– Bag and Mask Ventilation
v. DIC
– Disseminated Intravascular Coagulation
VI. B. Write True/False.
Answer:
a.
Phimosis can be corrected by retraction method. – False (Phimosis often
requires gentle stretching or circumcision; simple retraction may not correct
it.)
b.
Diphtheria is a bacterial infection. – True
c.
Salmonella typhi causes enteric fever. – True
d.
Osteomyelitis is inflammation of the muscles. – False (It is
inflammation of the bone.)
e. Sleep
walking is known as bruxism. – False (Sleep walking = somnambulism;
bruxism = teeth grinding.)
