Therapeutic bath of a newborn algorithm. Hygienic bath for an infant. Schematic representation of manipulation

sterile tray;

waste material tray;

kraft bag with cotton balls, shaving brushes and gauze napkins;

tweezers in des. solution;

medicines: 3% hydrogen peroxide solution, 5% potassium permanganate solution, 70% alcohol.

Check for clean diapers;

Treat the changing mattress with a disinfectant solution (macrocid-liquid, terralin, sideks);

Open the used laundry bin.

Wash and dry hands, put on gloves.

Spread diapers on the changing table.

Unwrap the baby in the crib. (Wash it, dry the skin, if necessary).

9. Place the baby on the prepared changing table. Performing a manipulation

With your left hand, spread the edges of the umbilical ring.

Moisten the shaving brush with 3% hydrogen peroxide by watering over the tray for the used material.

Cover generously umbilical wound hydrogen peroxide, in one motion, inserting the shaving brush perpendicular to the navel of the wound, rotating the shaving brush 360 °, in a movement similar to a comma.

With your left hand, spread the edges of the umbilical ring, dry the wound with a dry shaving brush (introducing the shaving brush perpendicular to the navel of the wound with a movement similar to a comma).

Throw the shaving brush into the waste tray.

Moisten a new shaving brush with 70% ethyl alcohol.

With your left hand, spread the edges of the umbilical ring, treat the wound with a movement similar to a dot, introducing the shaving brush perpendicular to the navel.

Throw the shaving brush into the waste tray.

As prescribed by the doctor: with a brush moistened with a 5% solution of potassium permanganate, treat only the wound, without touching the skin; point movement. Throw off the brush.

The final stage of the manipulation

Swaddle the child.

Lay in bed.

Process the changing table dez. solution.

Remove gloves, wash and dry hands.

Schematic representation of manipulation

1)  H2O2 2)  dry 3)● alcohol 70° 4 ) ● K MnO4 5%

Carrying out a hygienic bath for a newborn baby

The first hygienic bath is carried out on the 2nd day after discharge from the hospital; Until the umbilical wound heals, boiled water or permanganate solution is used.

potassium (2-3 weeks);

in the 1st half of the year they bathe daily for 5-10 minutes, in the 2nd half of the year you can bathe every other day.

The temperature of the water in the bath is 37-38.0 C; soap is used once a week.

T air in the room - 22-24 C.

Bathe before the penultimate feeding.

Technical training

Two containers - with cold and hot water(or tap water).

A solution of potassium permanganate (95 ml of water - 5 g of K Mn O4 crystals, the prepared solution is filtered through cheesecloth, and the crystals should not

get into the bath).

Jug for rinsing.

Bath.

Water thermometer.

"Mitten" made of terry cloth (flannel).

7. Baby soap (baby shampoo).

8. Sterile oil (baby cream, vegetable).

9. Diapers, undershirts. 10. Changing table.

11.Des. solution

Preparatory stage

Wash and dry hands.

Lay out the diapers on the changing table.

Put the bath in a stable position (pre-treated with a disinfectant solution or washed with baby soap).

The bath is filled - by 1/2 or 1/3 of its volume.

Add 5% potassium permanganate solution to a slightly pink solution.

Measure the T° of the water with a thermometer.

Performing manipulation:

Undress the child. After defecation, rinse with running water. Throw soiled linen into the waste bin.

Take the child with both hands: put the child on left hand an adult, bent at the elbow, so that the child's head is on the elbow; With the same hand, grab the left shoulder of the child.

Place the baby in the bath, starting with the legs so that the water reaches the line of the baby's nipples.

Legs after immersion remain free. Immersion level - up to the nipple line.

For several minutes, wash the neck and chest of the child.

Body wash:

put on a mitten;

lather the glove with gel, or soap, or shampoo;

gently lather the body of the child;

wash the folds of the child with a soapy mitten;

rinse the child.

Washing head:

it is advisable to wash your head last, as this procedure can cause a negative reaction of the child).

moisten the hair (from the forehead to the back of the head), pouring water over them from a ladle (jug);

apply shampoo or foam to the hair;

gently massaging the head, lather shampoo or foam;

wash off the soap foam with water in the direction from the forehead to the back of the head so that the soapy water does not get into the eyes;

turn the child over the bath with his back up;

rinse the child with water from a jug

Remove the child from the water in the position - face down.

Rinse with water from a jug and wash.

Throw a towel or diaper over the baby, put it on the changing table and dry the skin. Throw a wet diaper into the tank.

The final stage

Treat skin folds with vegetable oil.

Treat the umbilical wound, hold the toilet of the nasal and auditory passages.

Swaddle the child.

Drain the water and process the bath.

Wash and dry hands.

Newborns should only be bathed in boiled water, because his skin is very delicate, and simple plumbing hard water, as well as in order to avoid infections in the umbilical wound. If the umbilical wound has not yet healed and is not covered with skin, you can add a few crystals of potassium permanganate to the bathing water (so that the water is pale pink). Before using such a bath, you need to consult a pediatrician (he will give recommendations on the concentration of the solution that is suitable for your baby).

Make sure the bathroom is not high humidity. The best option- dry and warm. If the air temperature in the bathroom is cool, it is better to warm the room with a heater, rather than running hot water for a long time, as the humidity negatively affects the child's respiratory system. Otherwise, you can swim in the room.

So, for the bath you will need:

10l chilled boiled water
- 10 liters of hot boiled water
- baby bath
- water thermometer
- baby soap
- a clean diaper or towel (preferably immediately with a hood)
- dry linen
- sterile cotton balls
- sterile oil (special baby oil is possible)
- flannel mitt
- jug

Action plan:

1. Wash the tub thoroughly with baby soap.
2. Pour boiling water over it.
3. Pour into a tub of cold water.
4. Put a water thermometer in the tub.
5. Add hot water to a temperature of 37-38C.
6. Prepare a pitcher of water at 37°C.
7. Undress the child.
8. Put the child on your arm so that his head is on the elbow bend, and you can grab his leg under the knee with your hand.
9. Lower the child into the water so that the head is above the water.
10. Water the child for 3-5 minutes.
11. Put on and lather a flannel mitt.
12. Soap the baby's body with a mitten.
13. Wash all the folds of the baby's body.
14. To wash hair.
15. Wash the child with bath water.
16. Turn the child upside down.
17. wash clean water from a jug.
18. Wrap the baby in a towel.
19. Dry the body with gentle movements.
20. Put the child on clean linen.
21. Treat wrinkles with baby oil.
22. Wrap the child in clean linen/dress the child.
23. Dry the ear canals, eyes, clean the nasal passages.

After each bath, the mitten must be boiled! In boiled water, bathe the child at least until the umbilical wound heals.

While bathing, talk softly to your baby to calm him down. Bathing should be carried out together according to the principle - one holds the child, the other waters. If during the first baths the baby cries, be patient and affectionate, this is not a reason to refuse bathing. Over time, the child will get used to it, will feel free, and the bath will become a pleasure not only for him, but also for you.

Bathing is best done in the evening, between feedings. Try not to bathe the baby immediately after eating (to avoid spitting up), and also immediately before feeding (so that the baby does not feel hungry and is not nervous). Best time for bathing - the interval before the evening, but not before the night feeding. In this case, the child, who is mellow after water procedures, eats little in the evening feeding (he will quickly get tired and fall asleep), and at night he will have full feeding and subsequent good sleep.

A hygienic bath is carried out when patients are admitted to a hospital and in a medical department, with prolonged bed rest. The patient should be washed in a bath or shower at least once a week.

Equipmente: water thermometer, washcloth, soap, towel, clean underwear, brush and 0.5% chloramine.

Action algorithm:

1. Wash the bath with a brush with soap or detergent, rinse with a solution of chloramine.

2. Close the vents, place a wooden grate near the bathtub.

3. Fill the tub first 1/3 cold water and 2/3 hot.

4. Measure the temperature of the water by lowering the thermometer into the bath (should be 37ºС).

5. Help the patient undress and:

A). it is convenient to sit in the bath so that the water reaches the xiphoid process.

b.) wash with a washcloth with soap (first the head, then the torso) and dry off.

V). get out of the bath, change into clean clothes.

Note

1. The duration of the bath is 15-30 minutes.

2. During hygienic bath the nurse should monitor the patient's well-being, his appearance and pulse.

3. To take a hygienic shower in the bath, put a stool on which the patient will sit.

The skin of a seriously ill patient must be wiped daily, at least 2 times.

Rubdown

Equipment: gloves, a basin of warm water, a mitten or cotton swab, a towel.

Action algorithm:

1. Wash your hands, put on gloves.

2. Soak a mitt or cotton swab (you can use the end of a towel) in warm water.

3. Wipe the patient's chest and abdomen in sequence.

4. Then pat your skin dry with a towel. Especially carefully wipe and dry the skin folds under the mammary glands in women (especially obese women), armpits.

5. Turn the patient on their side and wipe the back while doing a light massage. Then dry.

6. Lay the patient comfortably, cover with a blanket.

7. Remove gloves, wash your hands.

Remember! Particularly careful care is required for natural skin folds and places where bedsores may form.

Hygienic shower

A hygienic shower is a component of sanitization in the emergency department upon admission of the patient to the hospital, in the medical department once every 7-10 days.

Equipment: air temperature thermometer, soap, towel, clean underwear, brush, 0.5% bleach solution.

Action algorithm:

1.Wash the bath;

2. Place a small bench in the bath and seat the patient on it;

3. Turn on the shower, adjust the water temperature and help the patient to wash in the same sequence as in the bathroom;

4. Help the patient get out of the bath or shower, dry off with a towel, get dressed and walk to the room. Use a wheelchair if necessary.

Lesson number 7. Care of febrile patients.

Lesson objectives:

The student must know:

Physiological mechanisms of temperature maintenance internal environment organism;

· Kinds medical thermometers; device mercury thermometer;

· Rules for storage of thermometers;

Rules for using a thermometer;

· Ways of processing of thermometers after their use;

Areas of the body used to measure temperature;

Types of temperatures, indications for their registration;

Time of measurement of body temperature, daily fluctuations;

· Rules for constructing a temperature curve;

· Fever: concept, types;

periods of fever

· Clinical manifestations in the 1st, 2nd, 3rd periods of fever;

Features of patient care at different periods of fever;

The student must be able to:

Measure body temperature;

· Register the results of temperature measurement in the temperature sheet;

· Provide assistance to the patient in the 1st, 2nd and 3rd periods of fever;

· Clean up thermometers after use;

Ethical and deontological aspect of the topic. If you have any doubts about the veracity of the patient regarding his temperature, repeat the temperature measurement in your presence, referring to possible malfunction thermometer.

Precautionary measures. When working with a thermometer, a chalk sister can accidentally break it. Mercury vapor is hazardous to human health. Ask patients to leave the room. Collect the mercury and place it in a sealed container, then wash your hands.

thermoregulation

thermoregulation called a set of processes of regulation of heat generation and heat transfer. Maintaining a certain balance between these processes ensures that healthy person relatively constant body temperature.

Heat generation carried out due to oxidative processes in muscles and internal organs: the higher the intensity of metabolism, the greater it is.

Heat dissipation carried out by conduction, heat radiation and evaporation (sweating).

When the ambient temperature rises the blood vessels of the skin expand, its thermal conductivity and heat radiation increase, sweating increases, which leads to an increase in heat transfer and prevents overheating.

When the ambient temperature drops heat transfer decreases due to a decrease in the thermal conductivity of the skin and narrowing it blood vessels, heat production increases due to increased contractile activity of skeletal muscles (muscle tremors), which prevents a decrease in body temperature and hypothermia.

AT HOME

Mandatory conditions:

Equipment:

Preparation for manipulation:

Note:

Performing manipulation:

End of manipulation:

4. Wash, dry your hands.

CHECKWEIGHING TECHNIQUE

Required condition: Control feeding should be carried out in a calm environment.

Equipment: Bowl scales, history of child development f.112, class B waste container, rags for processing scales, handle.

Preparation for manipulation:

1. Explain to the mother the course of the procedure, obtain informed consent.

2. Install the scales on a fixed bedside table.

3. Treat the scales with a disinfectant solution, lay a diaper.

4. Balance the balance (by setting the weights to the “O” mark) using the weights of the counterweight with the shutter open.

5. Close shutter.

Performing manipulation:

1. Put the child on the scales with his head on the widest part.

2. Open the shutter, weigh the child in clothes, moving the weights to the right.

3. Fix in F.112-(weight No. 1).

4. Close shutter. Take the child off the scale.

5. Mom feed the baby for 20-30 minutes.

6. Weigh the child in the same clothes.

7. Weight No. 2 - fix in f.112. The difference in weight between #2 and #1 is the amount of sucked milk.

End of manipulation:

1. Compare the amount of sucked milk with the age norm.

2. Treat the balance with a disinfectant solution, remove gloves, wash and dry your hands.

Note:

If during feeding the child urinates and recovers, do not change the diaper, weigh the diaper or diaper;

Explain to the mother that control feeding during the day is carried out several times (at least 3).

TECHNIQUE OF CARRYING OUT A HYGIENIC BATH FOR A NEWBORN CHILD

AT HOME

Mandatory conditions: do not bathe immediately after feeding; when bathing, ensure the temperature in the room is 22-24 degrees.

Equipment: Baby bath, jug, 2 pots of boiled cold and hot water, water thermometer, baby soap, rags, bottle with 5% potassium permanganate solution, sterile vegetable oil, a dirty laundry bag, a large terry towel, a clean changing kit.

Preparation for manipulation:

1. Explain to the mother the course and purpose of the procedure, obtain consent.

2. Wash the bath with hot soapy water, rinse it with boiling water, put it in a stable position.

3. Put a diaper folded several times on the bottom of the bath.

4. Fill the bath with water at a temperature of 37-38°C.

5. Draw water into a jug for rinsing (T 36.5 - 37.0 ° C).

6. Spend sanitization hands

Note: Determine the temperature of the bathing water only with a thermometer (it is not allowed to determine the temperature of the water by dipping your elbow into the water).

Performing manipulation:

1. Take the child so that the head and torso of the patient is on the left forearm, and then immerse the entire body of the child to the line of the nipples.

2. With your left hand, support the child's head above the surface of the water.

3. Wash your hair with baby soap.

4. Wash the whole body using a rag (especially thoroughly wash the folds on the neck, in the armpits and inguinal areas, between the buttocks).

5. Turn the child upside down.

6. Pour clean water from a jug (during bathing, rinse water cools down to 34-35°C).

End of manipulation:

1. Wrap the baby in a soft warm diaper (terry towel) and dry with blotting movements.

2. Treat natural skin folds with sterile vegetable oil.

3. Dress the baby, swaddle and put to bed.

4. Wash, dry your hands.

Indications:

• 
  compliance with body hygiene;
• 
  providing for the universal need of the child to “be clean”;
• 
  formation of cleanliness skills;
• 
  hardening of the child.

• 
  bath for bathing;
• 
  bath diaper;
• 
  jug for water;
• 
  water thermometer;
• 
  terry or flannel mitten;
• 
  baby soap or bottle with 5% potassium permanganate solution;
• 
  large terry towel;
• 
  a clean changing set or clothes placed on the changing table;
• 
  sterile vegetable oil
• 
  latex gloves;
• 
  disinfectant solution, rags;
• 
  dirty laundry bag.

• 
  first hygienic bath spend on 7-10 days of life.
• 
  do not bathe immediately after feeding;
• 
  when bathing, ensure the temperature in the room is 22-24 0 С;
• 
  determine the temperature of the bathing water only with a thermometer (it is not allowed to determine the temperature of the water by immersing the elbow in water).

« Anatomy physiological features children infancy»

Introduction:

Methodical recommendation designed for the possibility self-study student of this topic with self-control on the quality of assimilation of the material. The student must first familiarize himself with the learning objectives of the module, and then work step by step

The student must submit:

• 
  basic elements of massage and exercise for infants;
• 
  how to organize a routine, games, walks for infants;
• 
  basic educational activities for infants.

• 
  characteristics of the period of infancy;
• 
  anatomical and physiological features of organs and systems of the period of infancy;
• 
  the importance of the regime and educational activities in the formation of skills baby;
• 
  normal values ​​of general blood and urine tests.

• 
  assess the condition of the skin, subcutaneous tissue, musculoskeletal system;
• 
  measure and estimate the size of a large fontanel;
• 
  count the pulse, respiratory rate, measure blood pressure and evaluate them;
• 
  percussion and auscultation of the lungs and heart, palpation of the abdomen; palpate lymph nodes;
• 
  take care of the skin and mucous membranes of the infant;

I. Check out the lesson plan :

1. seminar - 1 hour

2. practical part:
preclinical stage - 45 min

independent work on the implementation of the nursing process - 90 min

3.

II. Study the material of lecture number 3 and answer the questions for self-control:

1. 
   What period of a child's life covers infancy?
2. 
   Name the main features of the child during this period.
3. 
   Explain the frequency of skin lesions in an infant.
4. 
   What are the physiological characteristics of the skin at this age?
5. 
   What are the features of skin care in connection with its anatomical and physiological features?
6. 
   Name the causes of sclerema and scleredema.
7. 
   What is the difference between bone tissue in an infant?
8. 
   Name the features of the skull, spine, chest.
9. 
   The manifestation of physiological hypertonicity of the muscles - flexors, the timing of its disappearance on upper limbs, on the lower extremities.
10. 
    Timing of eruption of milk and permanent teeth.
11. 
    How to assess the condition of a large fontanel?
12. 
    How many lobes, segments in the lungs of an infant, the relative number of alveoli?
13. 
    List Features respiratory tract, lungs, predisposing to inflammatory diseases.
14. 
    How to calculate the respiratory rate in an infant?
15. 
    What is the respiratory rate in an infant?
16. 
    What is the type of breathing in infancy?
17. 
    List the anatomical features of the heart and blood vessels in an infant.
18. 
    How to calculate heart rate infants What is their normal heart rate?
19. 
    Why is blood pressure lower in infants than in adults?
20. 
    Causes of physiological salivation, the timing of the appearance of this phenomenon.
21. 
    What is the stomach capacity of a newborn baby? at 3 months old? by the year?
22. 
    What are the features of the liver? intestines?
23. 
    The concept of intestinal microflora, features of its composition, depending on the type of feeding.
24. 
    Characteristics of the baby's stool, its registration.
25. 
    What features of the urinary tract contribute to the stagnation of urine and the development of inflammatory processes in the pelvis?
26. 
    The number of urination in infants.
27. 
    How to determine diuresis in infants after a year?
28. 
    What is the density of urine?
29. 
    The concept of physiological hematological decussations.
30. 
    Features of hematopoiesis in infancy, blood composition, ESR.
31. 
    Features of work nurse with an infant.

1. Specify the duration of the period of infancy.

2. List the skin functions that are poorly developed.

3. Specify the terms of cervical lordosis formation.

4. Age of appearance of the first milk teeth.

5. Name the formula of the teeth.

6. What is the pulse of a 1 year old child.

7. Indicate the respiratory rate of a 1 year old child.

8. Age of closure of a large fontanel.

9. What formula is used to calculate blood pressure in infancy?

10. The nature of the microflora during natural feeding.

11. Indicate the volume of the stomach of a newborn baby.

Sample answers:

1. from 1 month to 1 year.

2. protective and thermoregulatory.

3. 2 months.

4. 6-8 months.

6. 110-120 beats per minute.

7. 30-35 per minute.

8. 12-15 months.

10. bifidumflora and lactobacilli.

11. 30-35 ml

IV. Learn the method of objective examination.

Plan:

1. 
   Assessment of the condition of the skin and subcutaneous fat.
2. 
   Assessment of the skeletal system.
3. 
   Assessment of the muscular system.
4. 
   
5. 
   Grade respiratory system.
6. 
   Assessment of the cardiovascular system.
7. 
   Grade digestive system.

• 
  Color evaluated visually. Normal skin is pale pink, flesh-colored. In pathology, it can be hyperemic, cyanotic, icteric, pale.
• 
  Purity determined by the presence of postoperative scars, bruises, rashes, etc. Normally, the skin is clean.
• 
  Humidity determine the back surface of the hand on the anterior surface of the chest, abdominal wall. Normal skin is moderately moist.
• 
  Elasticity determined on the back surface of the child's hand. The skin is collected in a fold, released and watched how quickly it straightens out.
• 
  Turgor determined by the resistance of soft tissues to inner surface shoulder or hip.

Skeletal assessment:

• 
  Measurement of a large fontanel.
• 
  Estimation of the number of teeth is carried out according to the formula n - 4.
• 
  Palpation of the chest.
• 
  Evaluation of the shape of the legs.
• 
  Assessment of the state of the joints (presence of swelling, hyperemia of the skin over the joint, range of motion in the joint)
• 
  
• 
  

Palpation of the chest carried out for the presence of rachitic rosaries. We put our fingers on the ribs along the lateral surfaces of the chest and draw them towards the sternum. In the presence of rachitic rosaries, there are thickenings of bone tissue on the border of the cartilaginous and bone parts of the ribs. Normally, there are no clear cuts.

Evaluation of the shape of the legs. They ask the child to stand straight, heels together, socks apart, arms along the body. At correct form legs should have 4 points of contact: hips, knees, calf muscles, ankle. Also, the shape of the legs can be O-shaped, X-shaped.

Inspection of the foot for flat feet. A dye is applied to the foot and an imprint is made on paper - plantography. The shape of the feet normal, flattened, flat, excavated. The normal foot is characterized by a moderate plantar arch height, the supporting surface occupies less than 1/3 of the plantar arch.

Posture assessment for scoliosis. The patient is asked to stand straight with his back to the health worker, arms along the body, heels together, socks apart. Visually assess whether the shoulder girdle, lower angles of the shoulder blades, upper iliac spines are at the same level. The patient is then asked to lean forward and run the fingers along the spine. Determine whether there is a curvature to the right or to the left. Normally there is no scoliosis.

Assessment of the muscular system It is carried out according to two characteristics: strength and tone. For determining strength infants give them a toy in their hand and try to take it away. In older children, force is determined with a dynamometer, a handshake, or as follows: the patient is asked to bend his arm at the elbow joint. In turn, the health worker with his left hand rests on the patient's shoulder, with his right hand he grasps the forearm. They offer the patient to pull his hand towards himself and at the same time pull his hand towards himself.

For determining tone in infants, they take the child by the wrists and pull them towards themselves. Normally, 2 phases are observed: 1. - arms are extended, 2. - the child bends his arms and pulls himself up to the adult. In older children, muscle tone is determined as follows: the patient is asked to bend his arms at the elbow joints, his arms are fixed in the wrist area, the patient's arms are flexed and extended (while the patient does not strain the muscles of the arms). Normally, there is little muscle resistance.

Palpation of the lymph nodes.

Groups of lymph nodes: occipital, submandibular, sublingual, posterior and anterior cervical, supra- and subclavian, axillary, ulnar, inguinal, popliteal.

Normally, the lymph nodes are not palpable. If they are palpated, then their following characteristics are determined: size, soreness, mobility, consistency.

Features of palpation of the axillary lymph nodes: the child raises his hands up. The health worker puts his hands vertically in the axilla of the child. Then the patient lowers his hands down and begins palpation with rolling movements.

At healthy child cervical, submandibular, axillary and inguinal l / nodes can be palpated: single, small, soft, mobile, painless.

When assessing the respiratory system, studies such as counting the number of respiratory movements, percussion and auscultation of the lungs are carried out.

Calculation of NPV in infants, it is carried out during the child's sleep, bringing the membrane of the phonendoscope to the nose and mouth of the child. Calculate the frequency by the number of breaths. The calculation is carried out within a minute, because. in children, respiratory arrhythmia may be observed.

NPV in newborns 40-60 per minute, At 6 months - 35-40 per minute, At 1 year -30-35 per minute, 5 years -25 per minute, 10 years - 20 per minute.

Comparative percussion of the lungs. Determine lung sound. Normally it is clear. In pathology, dullness of percussion sound, boxed, tympanic sound can occur. Percussion is performed with the middle fingers of both hands. The middle finger of the left hand is always tightly applied to the patient's body - this is a finger - a plessimeter. With the middle finger of the right hand, two short blows are made on the finger-plessimeter perpendicular to the latter.

From the front, percussion is carried out at symmetrical points in sequence:

• 
  Above the collarbones parallel to them
• 
  On the collarbone without a finger-plessimeter
• 
  Under the collarbones
• 
  In the second intercostal space.

• 
  Above the shoulder blades (finger-plessimeter in a horizontal position)
• 
  Between the shoulder blades (Plessimeter finger parallel to the spine)
• 
  Under the shoulder blades (finger plessimeter in a horizontal position)

Auscultation of the lungs is carried out relatively at symmetrical points in the same place as percussion, with the exception of: in front - the clavicle, the second intercostal space. Auscultation (listening) is carried out with a phonendoscope. Ask the patient to take a deep breath and exhale. Auscultation of the lungs determines breathing and the presence of wheezing. Normally, breathing up to 3 years is puerile - inhalation and exhalation are heard, over 3 years - vesicular - only inhalation is heard. There are no wheezes.

Assessment of the cardiovascular system (counting the pulse, auscultation of the heart)

Pulse count in infants is carried out in the following places:

• 
  Carotid arteries
• 
  Temporal arteries
• 
  Femoral arteries
• 
  Pulsation of the apex beat of the heart
• 
  Pulsation of a large fontanel

On the arteries, you can determine all 5 characteristics of the pulse, and on the large fontanelle and the apex of the heart, only rhythm and frequency.

Auscultation of the heart carried out at 5 standard points with a phonendoscope:

1. 
   Projection mitral valve – 5th intercostal space on the left. To listen to this valve, first find the apex beat of the heart. The right hand is placed to the left of the patient's sternum in the region of the 5th intercostal space, thumb while directed along the sternum. By palpation, the point of the greatest pulsation of the heart is determined, the fingertips are moved there, the membrane of the phonendoscope is applied - this is the apex beat of the heart.
2. 
   Projection aortic valve- 2nd intercostal space to the right of the sternum.
3. 
   Projection pulmonary valve- 2nd intercostal space to the left of the sternum
4. 
   Tricuspid valve- the lower third of the sternum.
5. 
   Botkin-Erba point– additional for auscultation aortic valve- 3rd intercostal space to the left of the sternum.

To assess the state of the digestive system, superficial palpation of the abdomen, deep palpation of the abdomen and liver are performed.

Superficial palpation of the abdomen is carried out in the supine position without a pillow on the couch, legs bent at the knees, arms along the body. This position promotes maximum relaxation of the muscles of the anterior abdominal wall. With superficial palpation, abdominal pain and muscle tension of the anterior abdominal wall are determined. Palpation is carried out warm hands in the following sequence:

1. 
   left iliac region
2. 
   left hypochondrium
3. 
   epigastric region
4. 
   right hypochondrium
5. 
   right iliac region
6. 
   mesogastric region (near-umbilical region)
7. 
   hypogastric region (suprapubic region)

Deep palpation of the abdomen and liver. The position of the patient with deep palpation is the same as with superficial. Palpate the abdomen in the following sequence:

1. 
   sigmoid colon
2. 
   descending intestine
3. 
   transverse colon
4. 
   ascending intestine
5. 
   cecum
6. 
   stomach
7. 
   small intestine
8. 
   bladder
9. 
   the liver is palpated using respiratory movements child. With the left hand, it is necessary to fix the edge of the costal arch, lay the right hand on the anterior abdominal wall. Ask the patient to take a deep breath into the abdomen, then exhale and at the same time bring the hand under the edge of the costal arch. In children under 3 years of age, the tone of the muscles of the anterior abdominal wall is absent, therefore, the liver is palpated without using respiratory movements.

• 
  size,
• 
  pain,
• 
  mobility,
• 
  consistency.

"Neuro-psychic development of infants"

Introduction:

The methodical recommendation is designed for the possibility of independent study of this topic by the student with self-control on the quality of assimilation of the material. The student must first familiarize himself with the learning objectives of the module, and then work step by step

Learning goals.

After completing the topic

The student must know:

anatomical and physiological features of the nervous system in children of the first year of life;

• 
  patterns of neuropsychic development of infants;
• 
  rules for assessing neuropsychic development;
• 
  the importance of the regime and education to meet the needs of the child: sleep, eat, move, communicate.

• 
  realize nursing process according to the assessment of neuropsychological development;
• 
  collect information about the neuropsychic development of the child;
• 
  define goals and draw up a plan for nursing interventions to organize a regimen, games, walks, educational activities for infants;
• 
  ensure the implementation of activities to meet the needs: sleep, move, communicate.

I .

1. seminar - 1 hour

2. practical part:
preclinical stage - 45 min.

independent work on practicing practical manipulations - 90 min.

3. final test control, summing up the lesson - 30 min.

II . Study the material of lecture No. 4: "Neuropsychic development of infants" and additionally the material of the microlecture.

Microlecture

Neuropsychic development of infants

Indicators for assessing the neuropsychic development of infants are:

1. 
   Working out conditioned reflexes/ first signaling system/.
2. 
   Speech development /second signaling system/.
3. 
   

A child is born with congenital unconditioned reflexes: sucking, swallowing, sneezing, blinking, defecation and urination, search reflex, automatic walking reflex.

With the development of the child, unconditioned reflexes fade away / by one year of life / and under the influence external environment conditioned reflexes are developed, i.e. the first signal system is formed. An example of the formation of conditioned reflexes: a child at the age of 6-12 days of life gives a reflex “to position under the breast” - whoever takes the child /grandmother, grandfather, mother/ into the feeding position, the child has sucking movements with his lips. At 2-3 months of life, the reflex “to the position under the breast is manifested when only the mother picks up the child, since at this age the participation of visual and olfactory analyzers is added, i.e. the child already knows the sight and smell of the mother.

For the formation of conditioned reflexes requires the influence of the external environment /full wakefulness/ and the development of the senses.

Development of motor skills.

Newborn - Chaotic movements of the limbs, does not hold his head. Sleeps 22 hours a day

day, after feeding immediately falls asleep.

1. 
   month - For a few seconds, fixes his gaze on the toy.
2. 
   months - Holds his head. After feeding, stays awake for 30 minutes, examines

3 months - In the position on the stomach, raises the body, holds the head well

in such a position. It rests firmly on the legs, bent at the hip joints.

Hands out toys suspended by 30 cm. laughs. Gulit. Revitalization complex.

4 months - Rolls from back to side, locates by sound

toys, deals with hanging toys /feels, grabs them/. He recognizes his mother, rejoices at her.

5 months - Rolls over from back to stomach, holding a toy in hand. Smooth

stands with support under the armpit. He hums for a long time, distinguishes the intonation of his voice, his mother knows.

6 months - Rolls from stomach to back, moves around crib, tries to

crawl, sit up. He babbles for a long time. He eats well from a spoon, drinks from a cup held by an adult.

7 months - Crawls well, sits and lies down on his own, sits well. Looks for

through the eyes of an object called mother. Knocking, swinging a rattle.

8 months - Gets up, holding onto the barrier with his hands, steps over, holding on to the barrier.

Plays patty. Eats a piece of bread.

9. months - Walks by both hands in the arena. Fulfills requests: “give me a pen”, “before

goodbye." Sleeps 15 hours, 2 times a day.

10 months - Moves to and from a low surface. By request

"give" finds and gives familiar items.

11. months - Stands alone without support, takes the first independent steps.

12 months - Walks independently without support, can bend over without crouching, understands

names of objects /without showing them/, understands the word “not allowed”, pronounces 8-10 words, independently takes a cup and drinks.

Mode days - basis for the proper development of the central nervous system. The basis of any daily routine is

activity, sleep, staying on outdoors, nutrition. A properly organized daily regimen provides the body with the necessary pauses that ensure alternation of periods of greater and lesser brain activity, eliminates overwork, ensures harmonious development, calm and good mood during the day.

The components of the daily routine for children of 1 year of age should alternate in this order:

Dream à Feeding à Awake.

In this case, wakefulness will be complete for the child. Babies older than 9 months of age may have sleep and then wakefulness.

The duration of sleep per day can be calculated by the formula /for children of the first year of life/: 22 - 1/2 x m, where m is the number of months of life.

Daytime sleep in the first year of life should be 3-4 times:

Up to 5 months - 4 times,

From 5 to 10 months - 3 times,

From 10 . months to 1.5 years - 2 times.

Newborn baby most sleeps for a day, but as it grows, the duration of wakefulness increases, and by 3 months it is 1.5 hours, by a year - up to 3 hours.

The mental development of children occurs in the process of vigorous activity. Therefore, from the first months of life, it is important to properly organize the wakefulness of the child.

3-6 months of life: constantly talk with the child, maintain a smile, laughter, stimulate crawling, turns from back to stomach, then from stomach to back.

6-12 months of life: cause the child to imitate spoken syllables and simple words/ mom, dad, give, etc. /. to develop understanding of speech, you need to talk a lot with him, show objects and actions. Encourage crawling from 5.5-6 months, getting up - from 7.5 months to walking with support - from 6-9 months, without support - from 11-12 months.

It is necessary to develop elementary skills in children: hold a spoon, drink from a mug already 1-cm year of life. To do this, when introducing complementary foods /4.5-5 months/, it is necessary to only bring food in a spoon to the mouth, without dropping it into the baby's mouth. The child must remove food from the spoon with his lips. Children should be able to drink from a mug held by an adult by the age of 6 months. At 6.5-7 months, the child should be given a piece of white bread, cracker, biscuits /to develop the ability to chew/.

From 8-9 months, the child is seated for feeding in a special chair, which is moved to the table with food.

III. Answer the questions for self-preparation:

1. 
   What is the main function of the central nervous system?
2. 
   What percentage of body weight is the brain in children and adults?
3. 
   What happens to the convolutions and furrows of the child's brain as it grows?

1. 
   Features of the structure of brain tissue in children of the 1st year of life?
2. 
   What are unconditioned reflexes? What do you know?
3. 
   What conditions must be met for proper education conditioned reflexes?
4. 
   Which sense organs are well developed at the time of birth, which ones are worse?
5. 
   What is the first signaling system?

1. 
   What is the second signaling system?
2. 
   When does the child hold his head, sit, stand, walk?
3. 
   How to assess the neuropsychic development of a child of the 1st year of life?
4. 
   Name 8 leading lines of development of children of the 1st year of life.
5. 
   Drawing up part of the daily routine and the order of their alternation.
6. 
   How to create a full wakefulness for a child in the 1st year of life?

1. 
   The first mature nerve cells appear at the age of 1.5 years.
2. 
   In children, the mass of the brain is 1/8-1/9.
3. 
   The revitalization complex appears at 3 months.
4. 
   Baby sits down at 4 months.
5. 
   The child begins to distinguish colors at 3 years.
6. 
   The child stands independently at 10 months.
7. 
   The baby starts crawling at 7 months.
8. 
   A child drinks from a cup held by an adult at 8 months.
9. 
   Takes a toy from the hands of an adult and holds it in his hand at 5 months.
10. 
    The child distinguishes between a strict and affectionate intonation of the voice at 7 months.

1.Yes,2. Yes,3. Yes, 4. No, 5. No, 6. No, 7. Yes, 8. No, 9. Yes, 10. No.

1.N.V. Ezhova, E.M. Rusakova, T.I. Kashcheeva - Minsk: "Pediatrics", "Higher School", 1997.

2. I.N. Usov. Directory of local pediatrician. - Minsk, Belarus, 1991.

3. M.Ya.Studenikin. Handbook of the pediatrician. - Moscow: Ellislack, 1994.

« Physical development, education and hardening of children

infancy"

Introduction

The methodical recommendation is designed for the possibility of independent study of this topic by the student with self-control on the quality of assimilation of the material. The student should first become familiar with the learning objectives of the module and then work step by step.

learning goals

After completing the topic the student must know:

• 
  the importance of physical education for the development of the child;
• 
  fixed assets and hardening rules;
• 
  types and meaning of massage;
• 
  patterns of weight gain and growth.

• 
  weigh, measure height, head circumference, chest;
• 
  determine physical development according to centile tables;
• 
  determine approximately the appropriate height, weight, head and chest circumference;
• 
  define goals and draw up schemes of tempering activities for children of different ages;
• 
  evaluate the effectiveness of hardening procedures;
• 
  have a conversation with the mother about the importance of hardening activities and gymnastics to improve the health of the child.

I . Check out the lesson plan below:

1. seminar - 1 hour

2.

3.

4 final test control, summing up the lesson - 30 min.

II . Study the material of lecture No. 4: "Physical development, education and hardening of infants" and additionally the material of the micro-lecture.

Microlecture.

Hardening principles:

• 
  early onset, gradual
• 
  systematic,
• 
  individual approach,
• 
  positive emotional attitude
• 
  the child must be healthy.

Air Hardening Methods : air baths, walks, sleep in the fresh air.

Air bath technique. Baths begin from the first days of life. When a child is changed diapers, undressed, changed clothes, he is left naked for 1-2 minutes, from 3 weeks - 4-5 minutes, the air temperature is 22 0, gradually reduced to 18-20 0. Then they begin to combine an air bath with a massage.

walks begin to carry out from the second week of life. In winter, they first walk for 30 minutes in a room with open windows, from 3-4 weeks they begin walking on the street. Up to 3 months at a temperature not lower than -5 0, older than 3 months of life not lower than -10 0, preferably in calm weather. In summer, walks begin immediately after discharge from the hospital, depending on the weather. The duration of walks by 1 year increases to 1-1.5 hours 2-3 times a day.

Water hardening methods:

Local: washing, local wiping, dousing the feet;

Are common water procedures : full wiping, full pouring, bath, shower, swimming in open water.

Methods water hardening for newborns: Washing, washing - these are hygiene procedures, at a water temperature of 28 0 they will have a hardening effect. They bathe in water 36-37 0, rinse with water a degree lower. The diaper with which the child is wiped does not need to be heated.

Rubdown begin to carry out from 2 months of life. First you need to prepare the skin of the child for this procedure. To do this, dry flannel or pieces of soft woolen cloth are rubbed daily in the morning on the body, arms and legs of the child until Pink colour. After 1.5-2 weeks, they switch to wiping with water. With a terry cloth mitten soaked in water and wrung out with blotting movements, wipe the child's hands from the fingertips to the shoulders. After 3 days - arms and chest, another 3 days - arms, chest, stomach, then back, buttocks, and finally legs - from the feet to the pelvis. The water temperature is 35 0 , in summer-32 0 . After 3, for a complete rubdown, the water temperature is less every 5-6 days by 1 0, bringing it to 27 0. It is better to carry out in the morning after washing, the duration of the procedure is from 2 to 5 minutes.

Half a month after rubbing, they begin to pouring feet(foot baths). Only the feet and lower legs are poured over, the water temperature is 28 0, gradually lowering the temperature by 1 0 per week, bringing it to 20 0, the duration of the procedure is 20-30 seconds. From 9 months, a full douche is carried out: the child is put in a bath and poured from a ladle in the following order: back, chest, stomach, shoulders, arms. The initial temperature in summer is 35, in winter 37-36. In summer, the temperature is reduced by 1 every 2-3 days, bringing it to 28 0, in winter - after 5-6 days, bringing it to 30 0.

Shared shower -1.5 years. Duration - 1-2 minutes. This is the most energetic procedure. The cold effect is combined with the massaging effect of the water jet. The temperature of the water is the same as for pouring. Do in the morning, because. acts exciting.

All hardening procedures are stopped if the child falls ill, with increased excitability.

sunbathing Recommended from 1 year old. Before sunbathing, air baths are recommended for 10-20 minutes. Sunbathing is carried out from 9 am to 11 am in 1-1.5 hours after a light breakfast. Start with 1 minute, working up to 10 minutes on each side (back, stomach). After a sun bath, douche or shower is recommended, the water temperature is 36 0, gradually reducing the temperature to 28 0.

Massage and gymnastics for children under 1 year of age

Massage is carried out from 1.5 months of life. Gymnastics is carried out from 2 months of life. They are carried out daily, at the same time, 40 minutes after eating. The duration of classes is 5-12 minutes. Each exercise is repeated 4-6 times.

Importance of massage for babies : skin capillaries expand, blood circulation, tissue trophism and metabolism improve, muscle strength increases, elasticity and mobility of the ligamentous apparatus improves, has a tonic effect on nervous system.

Massage techniques:

stroking- these are light, sliding movements with the back or palmar surface of the hand, has a calming effect on the nervous system, relieves pain, dilates the blood vessels of the skin;

rubbing and kneading- this is a stronger pressure of the hands, it acts not only on the skin, but also on the subcutaneous fat, muscles, tendons, joints;

tapping- has a reflex effect, improves the nutrition of deep-lying muscles;

vibration- for children over one year old

Kinds gymnastic exercises :

1. According to the nature of the movements and participation in them, the child is distinguished a) reflex; b) passive; c) active.

2. according to the participation of muscle groups: a) arms and shoulder girdle; b) legs and feet; c) back; d) spine; d) abdominals.

From 2-3 months - reflex exercises based on unconditioned reflexes

From 3-4 months - passive movements

Older than 4 months - active movements.

From 4-6 months of age, movements should be aimed at encouraging crawling and developing hands.

At 6-10 months: exercises for the muscles of the trunk, legs, bone and ligamentous apparatus, they prepare the child for proper sitting, standing, walking, prevents the development of flat feet, spinal curvature.

The value of gymnastics : strengthens the musculoskeletal system, the working muscle irritates the periosteum, which stimulates bone growth; blood flow increases, stagnation in organs and tissues decreases, improves metabolism, increases the content of hemoglobin erythrocytes, increases the immune activity of blood and tissues, and increases the emotional tone of the child.

1.5-3 months of life.

A \ massage - stroking: arms, legs, back, abdomen.

B \ active movements based on unconditioned reflexes / reflex /: exercises for the feet, extension of the spine in the position on the side, laying on the stomach.

3-4 months of life.

A balance is established between the flexor and extensor muscles - therefore, passive movements gradually enter the complex of exercises:

A \ abduction of arms to the sides and crossing on the chest;

B \ turn from back to stomach / by the hands /;

B \ "floating" on the stomach.

4-6 months of life.

Movements are aimed at encouraging crawling and developing hands.

A \ "sliding steps";

B \ turn from back to stomach while supporting the legs;

B \ fall in the supine position;

G \ flexion and extension, together and alternately.

6-10 months of life.

Exercises for the muscles of the trunk, legs, bone and ligament apparatus. This prepares the child for proper sitting, standing, walking, prevents the development of flat feet, curvature of the spine.

Added:

A \ sitting down with support for both allotted handles;

B \ lifting the torso from a position on the stomach with the support of the hands;

Crawling.

10 months - 1 year 2 months .

Add:

A \ circular movements of the hands;

B \ torso tilt and straightening;

B \ sitting down independently with fixation of the legs;

G \ squatting with the support of the hands with rings.

The room where the child is engaged should be ventilated, the temperature is 19-20 degrees. In summer it is better in the air, in the shade. Solid gymnastics table, flannelette blanket, oilcloth, diaper. Hands are warm. Powder and petroleum jelly are not used for general massage in young children. The massage therapist is located opposite the child.

III. Questions for self-preparation.

1. 
   Average weight, height, head and chest circumference of a full-term newborn.
2. 
   Monthly weight gain, height in children in the 1st year of life.
3. 
   Formulas for an approximate calculation of weight, height, head circumference, chest roundness for infants.
4. 
   Average weight and height of a child at 1 year old.
5. 
   When does a baby's weight double and triple?
6. 
   How many centimeters does a child grow in the first year of life?
7. 
   Basic principles and methods of hardening infants.
8. 
   What massage techniques do you know? The value of massage for children of the 1st year of life.
9. 
   Types of gymnastic exercises. At what age is which type used? The meaning of gymnastics.

V. Complete creative tasks:

1. Abstract on the topic: " Non-traditional methods hardening"

2. Drafting individual plan measures for hardening a child from 1 month to a year (message, health bulletin, booklet).

3. Drawing up an individual plan for the physical development of the child (massage and gymnastics) from 1 to 3 months, from 3 to 4 months, 4 - 6 months, 6 - 10 months, 10 - 14 months. (abstract, message, memo, sanbulletin).

VI . Answer the graphic dictator's questions

1. Average weight full-term newborns is 2500 g.

1. 
   The average height of full-term newborns is 50-52 cm.
2. 
   The increase in body weight for the 3rd month of life is 750g.
3. 
   The height of a child at 1 year old is 100 cm.
4. 
   The weight of a child of 1 year of age is 10 kg.
5. 
   The massage recommended for children under 3 months is rubbing.
6. 
   Up to 3 months of life, the gymnastics complex is built on reflex movements
7. 
   The monthly increase in growth in the third quarter is 2.5 cm.
8. 
   The circumference of the chest in children of 6 months averages 45 cm.
9. 
   Massage is recommended to be carried out 40 minutes after eating.

1. No, 2. Yes, 3. No, 4. No, 5. Yes, 6. No, 7. Yes, 8. No, 9. Yes, 10. Yes

Used Books:

1. 
   Mazurin A.V., Vorontsov I.M. Propaedeutics of childhood diseases. - M.: Medicine, 1986.
2. 
   Leontyeva N.N., Marinova K.V. Anatomy and physiology of the child's body. - M., 1986.
3. 
   Neopathology. - edited by V.V. Gavryushov and K.A. Sitnikova. - Leningrad: "Medicine", 1985.
4. 
   K.A. Svyatkin. Childhood diseases. - Moscow: "Medicine", 1988.
5. 
   Preschooler - from the series "The World of Childhood" - edited by A.G. Khrapkova. - M .: "Pedagogy", 1980.

"Infant Feeding".

Introduction: The methodical recommendation is designed for the possibility of independent study of this topic by the student with self-control on the quality of assimilation of the material. The student should first become familiar with the learning objectives of the module and then work step by step.

Accounting purposes

The student must know:

• 
  features of the digestive processes in infants and the period of milk teeth;
• 
  types of feeding and their characteristics;
• 
  the benefits of breastfeeding;
• 
  breastfeeding rules;
• 
  ways to satisfy the need to "eat" depending on the type of feeding and age.
• 
  Types of feeding. The benefits of breastfeeding.
• 
  Hypogalactia, its causes, prevention.
• 
  Feeding regimens for newborns during infancy.
• 
  Terms and rules for the introduction of corrective additives, complementary foods.
• 
  Formulas for calculating the single and daily amount of food for children of the first year of life.

• 
  collect information about feeding a child;
• 
  identify feeding problems;
• 
  ensure the implementation of measures to meet the need "to eat";
• 
  preparing mother and child for breastfeeding;
• 
  putting the baby to the breast;
• 
  feeding a child from a bottle, from a spoon;
• 
  preparation of basic foodstuffs; control feeding.
• 
  Calculate the volume of one-time and daily amount of milk.
• 
  Create a menu for breastfeeding.

• 
  preparation of vegetable puree,
• 
  5% and 10% porridge, cottage cheese, jelly;
• 
  heating the mixture; nipple treatment,
• 
  bottles, dishes.
• 
  The sequence of your actions:

• 
  1. seminar - 1 hour
• 
  2. practical part: preclinical stage - 45 min.
• 
  3. independent work on practicing practical manipulations - 90 min.
• 
  4 . final test control, summing up the lesson - 30 min.

III. Answer the questions for self-control

1. 
   The role of balanced rational feeding for the development of a healthy child.
2. 
   Types of feeding. Satisfaction of the need is with natural feeding.
3. 
   The concept of lactation, hypogalactation. Types of hypogalactation.
4. 
   Benefits of breastfeeding.
5. 
   Breastfeeding rules.
6. 
   Diet and regimen of a nursing mother.
7. 
   Feeding difficulties on the part of mother and child. Contraindications for breastfeeding.
8. 
   Feeding regimen for children of the 1st year of life.
9. 
   Calculation methods required amount milk to a child of the 1st year of life.
10. 
    Additional factors or corrective additives for breastfeeding.
11. 
    Complementary foods and rules for its introduction.
12. 
    Mixed feeding.
13. 
    Satisfaction of needs is with mixed feeding. Supplementary feeding
14. 
    The timing of the introduction of complementary foods with mixed feeding.
15. 
    Classification of milk mixtures.
16. 
    Satisfaction of needs is artificial feeding.
17. 
    Bottle feeding rules.
18. 
    Control feeding.
19. 
    Processing teats, bottles, dishes.
20. 
    Preparation of vegetable puree, 5% and 10% porridge, cottage cheese, jelly.
21. 
    Heating the mixture.
22. 
    There are problems in violation of the satisfaction of needs.
23. 
    Satisfying the need to eat children of the period of milk teeth.

1. 
   Hypogalactia is the spontaneous secretion of breast milk.
2. 
   Transitional milk is colostrum, it is excreted from the 4th day of lactation.
3. 
   At 4 weeks, the baby is fed 6 times a day.
4. 
   The duration of breastfeeding is 15-20 minutes.
5. 
   Remaining milk after breastfeeding is not necessary to express.
6. 
   The amount of food for a child of 3 months is 1/6 of body weight.
7. 
   Fruit purees are introduced at the age of 4.5-5 months.
8. 
   Complementary foods are introduced after breastfeeding.
9. 
   The first complementary foods are introduced in the form of 5% semolina porridge.
10. 
    The best type of feeding is mixed feeding.
11. 
    In "B" the mixture includes 1 part of milk and 1 part of cereal broth.
12. 
    Supplementation is given after breastfeeding.
13. 
    "B" mixture is given from 2 weeks to 3 months of life.
14. 
    Non-adapted mixtures are milk and its dilutions.
15. 
    Mixtures before feeding are heated to 35°C.
16. 
    Complementary foods with artificial feeding are introduced 2 weeks later.
17. 
    With 6 single feedings, the night break is 4 hours.
18. 
    A single amount of food for a child of 1 year of age is not more than 200 ml.

Sample answers to questions of graphic dictation: 1 - no, 2 - no, 3 - no, 4 - yes, 5 - no, 6 - yes, 7 - no, 8 - no, 9 - no, 10 - no, 11 - yes, 12 - yes, 13 - yes, 14 - yes, 15 - no, 16 - no, 17 - no, 18 - yes.
v. Learn manipulation techniques andcook one of the dishes baby food (vegetable puree, milk porridge, cottage cheese, jelly).
Guidelines for students on the implementation of manipulations.
Preparation of 100% sugar syrup

Prepare: 100g sugar, 50ml water, saucepan, gauze.

Sequencing.

1. 
   Put 100g of sugar /4 tablespoons/ and 50ml of water into a saucepan.
2. 
   Bring to a boil, stirring over low heat for 10 minutes.
3. 
   Strain through a double layer of cheesecloth.
4. 
   Pour boiling water through a double layer of gauze to a volume of 100 ml.
5. 
   Boil.
6. 
   Pour hot syrup into a pre-boiled glass bottle.
7. 
   Close the bottle tightly.

Preparation of 10% saline solution

Prepare: saucepan, cheesecloth, 15g salt, 150ml water.

Sequencing.

1. 
   Pour 150 ml of water into a saucepan and put 15 g of salt /3 teaspoons/.
2. 
   Bring to a boil - 5 minutes.
3. 
   Strain through a double layer of cheesecloth.
4. 
   Pour into a glass bottle.
5. 
   Close the bottle tightly.

Prepare: saucepan, sieve, for 100g puree you need: 40g potatoes, 30g cabbage, 30g carrots, 10ml milk, 2ml sugar syrup, 2ml salt solution, 5g butter or 3g vegetable oil.

Sequencing.

1. 
   Wash vegetables, peel and rinse again.
2. 
   Chop vegetables and place in a bowl.
3. 
   Pour some water into a saucepan.
4. 
   Steam vegetables until tender.
5. 
   Pass hot vegetables through a sieve.
6. 
   Put butter, sugar syrup, sodium chloride solution, hot boiled milk into the puree and stir.

Prepare: a saucepan, for 100g of 5% porridge you need: 5g of cereal / 1 teaspoon /, for 10% -10g of cereal / 2 teaspoons /, 100 ml of milk, 20 ml of water, 1.5 ml of table salt, 5 ml of sugar syrup, 3 g of butter. Sequencing.

1. 
   Pour 20 ml of milk into a saucepan and add 20 ml of water.
2. 
   Dilute 5g of cereal /1 teaspoon/ in a saucepan /10g of cereal - 2 teaspoons at 10%/.
3. 
   Boil the cereal for 15 minutes over low heat.
4. 
   Remaining milk /80ml/ heat until steam appears /do not boil/.
5. 
   Pour milk into a saucepan, stir well.
6. 
   Bring to a boil.
7. 
   Add salt solution, syrup, oil.
8. 
   Remove the saucepan from the heat.
9. 
   Cool down to t - 37°С.

1 way

Prepare: a saucepan, a jar, gauze, 300 ml of milk, 300 ml of kefir.

Sequencing.

1. 
   Mix milk and kefir in a 1:1 ratio in a jar.
2. 
   Place the jar in a water bath and bring to a boil.
3. 
   Let it rest.
4. 
   Throw on cheesecloth.

Prepare: a saucepan, a jar, gauze, 500 milk, 1 teaspoon of sour cream.

Sequencing.

1. 
   Add 1 teaspoon of sour cream to 500 ml of milk.
2. 
   Put in a warm place for 2 hours.
3. 
   Put milk in a jar in a water bath and bring to a boil.
4. 
   Let it rest.
5. 
   Throw on cheesecloth.

Prepare: saucepan, cheesecloth, sieve, 15 g of cranberries or black currants, raspberries, 30 ml of water, 23 ml of sugar syrup, 4 g of potato flour, 20 mg of ascorbic acid.

Sequencing.

1. 
   Sort the cranberries, rinse with cold water, transfer to a sieve.
2. 
   Pour boiling water over, mash with a crush.
3. 
   Squeeze out the juice and put in a glass dish with a closed lid in the cold.
4. 
   Pour cranberry pomace with 90 ml of water.
5. 
   Bring to a boil, strain through a sieve.