Daytime sleep of a child in kindergarten. Daytime sleep of a three-year-old child in kindergarten

This means inserting a needle into the pericardial cavity in order to remove excess accumulated fluid or to take exudate for diagnostic study. Pericardial puncture is performed according to indications when purulent pericarditis, in order to clarify the reason for the increased production of effusion by the pleural sheets, with the accumulation of blood and air in the pericardial cavity when damaged pleural cavity or chest wall for injuries.

An emergency indication for pericardial puncture is a life-threatening condition—cardiac tamponade. In the event of the development of tamponade - a complete blockage of cardiac activity due to compression of the heart by the contents of the pericardial sac, the doctor must act very quickly, which means that he must be fluent in the technique of pericardial puncture. IN modern medicine The Marfan pericardial puncture technique is actively used.

1 Manipulation technique

When performing a Marfan puncture, the doctor punctures at a special point - under the xiphoid process. It is necessary to clearly understand that the puncture site is made strictly in the middle of this anatomical landmark, neither on the left side nor on the right side of it. The middle position of the inserted puncture needle ensures its penetration into the pericardial cavity in the area of the right ventricle. The sterile puncture needle should be advanced slowly and smoothly at an angle of 30-45. The needle is first directed obliquely upward, then slightly posteriorly.

When approaching the heart area, the doctor can feel the pulsation transmitted, as well as the feeling of overcoming a certain obstacle when puncturing the directly outer pericardial layer. When it enters the pericardial cavity, the aspiration movements of the syringe attached to the needle remove the existing contents. Often a catheter is inserted into the pericardial cavity through a needle and fixed to certain time(up to 72 hours) to ensure drainage of the cavity and removal of exudate.

At in serious condition intrapericardial infusions can be performed on the patient during puncture and insertion of the catheter medications: prednisolone, hydrocortisone, antibiotics.

2 Patient preparation

Such a complex and rather dangerous manipulation as pericardial puncture requires patient preparation. Before the manipulation, the patient must undergo an echocardiography, radiography of the OGK, and an ECG. If the situation is emergency, list diagnostic examinations is reduced to radiography or other methods available to the doctor. The patient is placed on his back, raising the bed in the head section. Half an hour before the puncture, the patient is administered 1 ml of 2% promedol and 0.1% 0.5 ml of atropine for the purpose of pain relief and sedation.

The skin on the chest is exposed, the existing hair is shaved off, the surgical field is treated with an antiseptic, local anesthesia 1% lidocaine subcutaneously. As the needle moves deeper, an anesthetic is constantly injected so that the procedure is gentle for the patient in terms of pain. All the time from the beginning of the puncture to its completion, ECG monitoring is carried out; by changing the complexes on the ECG, one can judge correct technique performance of the manipulation, or about its possible violations.

For example, the appearance of ST segment elevation on the cardiogram indicates that the needle has come into contact with the myocardium, and damage to the heart muscle during pericardial puncture is a dangerous complication. The procedure can also be performed under ultrasound guidance. The ultrasound machine allows you to control the progress of the puncture needle, as well as identify the places where the maximum accumulations of pericardial fluid are located. They also control the position of the catheter or needle when performing a puncture. X-ray method with contrast.

3 Complications

The access point to the pericardium along the Marfan is relatively safe: this access, with the correct technique, minimizes the possibility of damage to the organs of the mediastinum, pleura, large vessels. Despite the instrumental methods of monitoring the technician’s performance of the Marfan puncture, complications do occur during its implementation. TO possible complications when performing pericardial puncture include:

damage great vessels, myocardium, mediastinal organs with an incorrectly defined Marfan point and gross violation of technique, which is a medical error;
development of arrhythmias;
introduction of infection during puncturing.

Exudative pericarditis is an inflammatory process affecting the serous pericardium and accompanied by abundant accumulation of effusion. The main problem with diagnosing pericarditis is that patients often ignore symptoms until it is too late. To prevent this from happening, learn about the symptoms and treatment. exudative pericarditis read the article in advance.

Features of the disease

In children, pericarditis is diagnosed extremely rarely: in approximately 1% of cases. Most common reason childhood pericarditis - viral diseases, such as influenza or Epstein-Barr. In adults, the list of reasons is much longer, although in some cases they cannot be established until fatal outcome.

Pediatric and adult pericarditis also differ in symptoms. Thus, in children, the disease often manifests itself with fever, heart pain and high blood pressure. Treatment of pericarditis is the same in all groups.

Schematic representation of effusion pericarditis

Types and forms

Typically, doctors use the classification according to Z. M. Volynsky, which distinguishes pericarditis:

Spicy:
1. effusion or exudative;
2. with tamponade;
3. without tamponade;
Chronic:
1. effusion;
2. adhesive;
3. asymptomatic;
4. with functional disorders of the heart;
5. with lime deposits;
6. with extrapericardial adhesions;

In turn, effusion pericarditis, chronic and acute, is distinguished by the nature of the inflammatory fluid, and it can be:

Serous. Consists of water and albumin, formed on early stages development of the disease.
Serous-fibrous. It is distinguished by a high number of fibrin strands.
Hemorrhagic. Appears in the background severe damage vessels, a significant number of red blood cells are found in its composition.
Purulent. The composition contains enough leukocytes and parts of necrotic tissue.
Putrid. Appears due to the entry of anaerobic microflora into the effusion.
Cholesterol. Effusion is characterized high content cholesterol.

So, what are the reasons for the appearance of exudative pericarditis in the medical history?

You can learn about what ecdysatic pericarditis looks like from the following video:

Causes

In many cases, determine exact reason the occurrence of exudative pericarditis is impossible. However, scientists have found that pericarditis rarely occurs on its own and is usually a consequence of some disease.

U different forms Disease etymology varies. Thus, the nonspecific form is often caused by bacteria and viruses like:

staphylococcus;
streptococcus;
pneumococcus;
flu;
ECHO;
Coxsackie virus;

The background for specific pericarditis is often: tuberculosis, tularemia, Brucella and typhoid fever, candidiasis, histoplasmosis, amoebiasis and other conditions.

If we develop the theme of forms, we can see the following connections:

The tuberculosis form often appears due to the penetration of bacteria from the lymph nodes into the pericardium.
The purulent type often appears against the background of operations performed in the cardiac region, when the patient is already undergoing immunosuppressive therapy, as well as when a pulmonary abscess breaks through.
Non-infectious forms of the disease are sometimes found in oncology, allergic processes such as serum sickness, after irradiation of the mediastinum.

The risk group for those who may develop pericarditis includes not only those in whose families the disease has been observed previously, but also patients with hypothyroidism, people with impaired cholesterol metabolism, and early stages heart attack.

Symptoms and signs of pericardial effusion

Symptoms largely depend on parameters such as:

rate of fluid accumulation;
degree of compression of the heart muscle;
severity inflammatory process in the pericardium;

Most early symptom- a feeling of heaviness and aching pain in the chest. Gradually, fluid accumulates, causing other symptoms such as shortness of breath, dysphagia, cough, and hoarseness. Pericarditis acquires symptoms similar to, for example, swelling in the face and neck. In certain positions, a pericardial friction rub may be heard.

Depending on the cause of pericarditis, other symptoms such as:

chills;
fever;
sweating;
decreased appetite;
orthopnea;
swelling of the veins of the neck;

Any specific symptoms no, so it is important to consult a doctor in time for a diagnosis of effusion pericarditis.

Diagnostics

Diagnosis of the disease begins with an examination by a cardiologist. The doctor’s task is to identify pericarditis and differentiate it from other diseases of cardio-vascular system like a heart attack.

For differentiation, a history of symptoms and an examination are used. Patients experience a small protrusion of the anterior chest wall, edema in the precordial region, as well as weakening or complete disappearance of the apical impulse.

To confirm the diagnosis, the following studies are prescribed:

X-ray chest. Reveals an increase in shadows and smoothing of the cardiac contours, as well as a change in the shape of the organ against the background of a large volume of fluid.
EchoCG. Allows you to detect whether there is free space between the pericardial layers and diastolic separation, which indicates pericarditis.
ECG. Indicates the presence of a decrease in the amplitude of the teeth.
Multislice CT. Helps confirm the presence of effusion and increased thickness of the pericardial layers.

A rare but accurate study is pericardial puncture. Puncture allows you to examine the pericardial fluid and with 100% probability identify the disease.

If it is impossible to conduct other studies, the patient is prescribed a pericardial biopsy.

Treatment

Treatment of exudative pericarditis is carried out in a hospital and under the supervision of a doctor. The basis of treatment is taking medical supplies, but sometimes patients are advised to undergo surgery. Cure pericarditis therapeutic method, and even more so folk remedies, impossible.

By medication

Treatment honey. drugs are aimed at eliminating pericarditis and its causes. To eliminate pericarditis, the patient is prescribed:

NSAIDs. Ibuprofen is often used because it rarely produces side effects. If pericarditis develops against the background of ischemia, then ibuprofen is replaced by diclofenac and aspirin. Third-line drugs include indomethacin.
Glucocorticosteroid drugs. Prednisolone is prescribed in cases of advanced patient condition.

At the same time, the root cause is treated with antibacterial, cytostatic and anti-tuberculosis drugs. Hemodialysis can be used to cleanse the blood.

Operation

Pericarditis is often accompanied by a very large volume of fluid. To pump it out, doctors use evacuation of effusion through a biopsy. The liquid is pumped out through a needle, so the operation is completely safe.
Sometimes drug treatment does not produce results, in which case a thoracotomy is prescribed. The patient's chest is incised and the pericardium is removed, without affecting the areas where the nerve passes. The mortality rate from such an operation is less than 10%.

Basics prophylactic, warning pericarditis - competent treatment viral diseases and/or their complications. Also important:

promptly treat connective tissue diseases;
treat complications of myocardial infarction;
according to the course prescribed by the doctor;
Avoid chest trauma as much as possible;
use radiation protection if danger arises radiation injury bodies;

General recommendations boil down to compliance healthy image life and measures to boost immunity. So, it is important to observe moderate physical exercise, especially cardio exercises, and also monitor nutrition and weight, take vitamins according to the course.

Complications

Most common complication pericarditis (more than 40%) - cardiac tamponade. In this case, fluid accumulates between the layers of pericarditis, which interferes with normal operation heart muscle. In approximately 30% of cases, pericarditis is complicated by paroxysmal atrial fibrillation or supraventricular tachycardia, but only if.

Sometimes pericarditis changes appearance, which is also a complication. Often the disease becomes chronic and constrictive.

Recurrent, idiopathic, adhesive, exudative and other types of pericarditis have their own prognosis and also affect a person’s life expectancy. We'll talk about this at the end.

Forecast

The prognosis largely depends on the cause of the disease and treatment. Generally, it is assessed as favorable, since more than 70% of patients survive for 5 years. On the other hand, if tamponade develops, the probability of death is high (more than 50%).

Even more useful information a well-known TV presenter will provide us with information on exudative and other types of pericarditis in the following video:

Considering that pericarditis is usually diagnosed quite late, it can become a cause of disability in the future. According to statistics, advanced pericarditis accounts for 0.05 - 0.5% of all cases of disability due to cardiovascular diseases. Disability is determined cardiovascular failure. It is observed mainly in constrictive and recurrent pericarditis.

To undergo a medical and social examination to determine the disability group, you must provide the results of the following studies:

general and biochemical analysis blood;
general and biochemical urine analysis;
microbiological and cytological examination pericardial effusion ( if a puncture was performed);
ECG results at various stages of treatment;
echocardiography results;
chest radiographs;
blood test for systemic lupus erythematosus cells ( LE cells).

Depending on the severity of structural and functional changes the patient at the end of treatment can be assigned I, II or III group disability. The criteria by which groups are allocated are different for each country. The first group usually includes patients with constrictive pericarditis or armored heart, who various reasons was not carried out surgery (pericardectomy).

If the patient remains able to work, he should pay attention to some restrictions that should be adhered to. They relate to the organization of the labor process. Patients should avoid working in areas with large changes in temperature, humidity or pressure. These factors environment affect hemodynamics ( blood pumping process), and the heart's ability to adapt to environmental changes after pericarditis is limited. In addition, excessive nervous or mental stress can affect blood pressure and, therefore, the work of the heart. Work that requires prolonged forced positioning of the body is also contraindicated, since static loads can cause serious violations hemodynamics.

Consultation on the topic: “ Daytime nap children in kindergarten».

Sleep is protection for nervous system, the possibility of development, growth, accumulation of strength, their restoration, an indispensable condition of life, as necessary as water and food.

The child does not sleep during the day not because he does not want to, does not fall asleep well in the evening not because he is not tired, but because the conditions for sleep have not been created (wakefulness, nutrition, daily regimen; uncomfortable bed, clothes, etc.). But children, just like adults, vary in their sleep needs. You should know about your children which of them like to sleep and which on the contrary, and regulate the organization of sleep in the group.

During the day, the child receives many impressions from the world around him; his active nature requires increased movement, a variety of games, and activities. All this leads to rapid fatigue nerve cells cerebral cortex. Therefore, the child needs rest not only at night, but also in between intensive activity in the middle of the day.

During the day, children 3 years old need to sleep 14-16 hours; 4-5 years - 13 hours; 5-7 years old - 12 hours. During the day, children 3-4 years old sleep 2 hours, 5-7 years old - 1 - 1.5 hours.

In kindergarten, beds should be placed at some distance from each other so that the teacher can approach each child, cover him or adjust the blanket, and help him get into a comfortable position.

In winter, beds should be arranged so that children do not lie with their heads close to the windows or heating appliances. For children under 3 years old, cribs are placed 120 cm long and 60 cm wide; the height of the bed above the floor is variable - 30 and 50 cm. For children from 3 to 7 years old, cribs have the following dimensions: length 140 cm, width 60 cm, height of the bed from the floor - 30 cm. It is very important that the child’s bed is comfortable, so that the mattress or the bedding corresponded to the size of the bed, and the pillow was narrow enough to fit the child's head, not the body, and its width corresponded to the width of the bed. (During the daytime sleep, it is advisable to lay out a thin bedding for children rather than a mattress; blankets should also be light enough.)

Bed linen is changed once a week. Before going to bed, children put their clothes on chairs located at a distance from their cribs so that the teacher, if necessary, can approach each of them and help them undress.

If there is no separate bedroom, cribs for daytime rest are placed in the group room before lunch and must be removed after the children get up. First of all, it is necessary to clear the part of the room where the toys are located from the beds, so that the children, after getting dressed, have the opportunity to start playing.

The manager, observing the sleep process, Special attention draws attention to the following:

How the children's beds are prepared (the condition of the bed of each crib, the cleanliness of the bed linen);

Do children know how to undress and dress independently and consistently; do they help each other, do they fold their clothes correctly;

Adult assistance and teacher guidance in this process;

How long does it take to undress before bed and get dressed after it?

Is the room where the children sleep well ventilated?

Do the teacher and nanny care about the health of children;

Children's mood before bedtime; How long did it take for the children to fall asleep? did they sleep peacefully? how many children woke up earlier than expected;

Does the teacher take into account individual characteristics children, whether they are raised gradually.

If any problems are found, the manager accepts necessary measures, gives orders to the caretaker and teachers.

Personal hygiene of a preschooler consists mainly of maintaining cleanliness of the skin and hairline, oral hygiene, maintaining cleanliness and neatness in clothing, maintaining a clean bed, order in the workplace, in the toy closet. It is necessary to teach preschoolers to wash their face, neck, ears every day in the morning and evening, and their hands several times a day as needed: before meals or when they are dirty (after cleaning the play corner, washing flowers, modeling clay, playing with sand, using the toilet).

It is necessary to create conditions so that children can wash themselves comfortably and pleasantly: the height of the washbasins should correspond to the height of the children (the height of the water jet above the level of the arm lowered and bent at the elbow is about 10 cm). If children have to raise their hands high when washing, water flows into their sleeves.

The piece of soap should be such that the child can easily take it with his hand; Each washbasin must have two soap dishes. The length of children's towels does not exceed 100 cm.

The teacher must organize washing so that there is no queue. He reminds children not to forget to roll up their sleeves and unbutton the collars of their dresses or shirts. It is imperative to ensure that children wash themselves thoroughly and dry themselves.

Checking the washing process, the head of the kindergarten notes:

Is everything prepared for washing: is there soap in place, do all children have towels, is water poured into the washbasins (if there is no running water);

What are children doing who are waiting to wash or have already washed;

Do children wash themselves thoroughly, dry their hands well, do adults help them and with what?

Duration of washing.

After naps, children are raised gradually. Those who fall asleep later than others (the weak or those who have had an illness) are woken up last, given the opportunity to sleep longer, but not kept in bed for more than the allotted time. The teacher makes sure that the children put on their clothes in a certain order, so that everyone has their hair done. The dressing process should not take much time: for older children - no more than 15 minutes, for children - 20-25 minutes. Older children make or clean their own beds. Preparing children for bed and waking up is used by the teacher to develop their cultural and hygienic skills and develop independence.

Tips for organizing daytime sleep.

Calm, quiet and soothing music, or reading a good book, helps you fall asleep easily.

In order for preschoolers to go to bed in a timely manner, the teacher must strictly adhere to the daily routine in the group. This contributes to the development of physiological habits in children. The body of preschool children gets used to a certain sequence regime moments. The moment the time comes quiet time, children's body already ready for a day's rest. Deviation from the daily routine is unacceptable, as this will negatively affect physiological state kids.

Before putting children to bed, they need to be calmed down. Organize quiet games(for example, board games, nursery rhyme games, etc.). Read a book to the children. Calm views activities will allow children to make a smooth transition from active games to relaxation.

Pay attention to the light in the bedroom. It should be muted, the curtains closed if possible.

The color of the walls, ceilings, and window curtains (or blinds) in the bedroom is of great importance. Colors should not be bright, so as not to excite the unstable psyche of children. Use pastel, calm colors to decorate your bedroom.

Play calming music for your children (for example, lullabies, classical pieces). It will allow children to calm down and relax. In addition, listening to music will contribute to the aesthetic education of preschoolers.

Do relaxation exercises with your children. These exercises allow some children to relieve tension, others - to concentrate their attention and relieve excitement.

Exercises to relax facial muscles.

"Naughty cheeks."

Take in air, puffing out your cheeks strongly. Hold your breath, slowly exhale the air, as if blowing out a candle. Relax your cheeks. Then close your lips with a tube, inhale the air, sucking it in. The cheeks are drawn in. Then relax your cheeks and lips.

Exercise to relax the arm muscles.

"Vibration".

What a wonderful day today! We will drive away melancholy and laziness. They shook their hands. Here we are healthy and cheerful.

"Lazy cat"

Raise your arms up, then stretch them forward, stretching like a cat. Feel the body stretch. Then sharply lower your hands down, pronouncing the sound “a”.

Relaxation exercise focusing on breathing.

"Blow out the candle."

Take a deep breath, drawing as much air into your lungs as possible. Then, stretching out your lips with a tube, slowly exhale, as if blowing on a candle, while pronouncing the sound “u” for a long time.

"Elephant".

Place your feet firmly, then imagine yourself as an elephant. Slowly shift your body weight onto one leg, raise the other high and lower it to the floor with a “roar.” Move around the room, alternately raising each leg and lowering it with the foot hitting the floor. As you exhale, say “Wow!”

Exercise to relax the leg muscles.

An exercise to relax the whole body.

"Birds."

Children imagine that they are little birds. They fly through the fragrant summer forest, inhale its aromas and admire its beauty. So they sat down on a beautiful wildflower and inhaled its light aroma, and now they flew to the tallest linden tree, sat on its top and felt the sweet smell of a flowering tree. But a warm summer breeze blew, and the birds, along with its gust, rushed to the babbling forest stream. Sitting on the edge of the stream, they cleaned their feathers with their beaks, drank clean, cool water, splashed around and rose up again. Now let’s land in the coziest nest in a forest clearing.

Exercises to relax the neck muscles.

"Curious Barabara".

Starting position: standing, feet shoulder-width apart, arms down, head straight. Turn your head as far as possible to the left, then to the right. Inhale - you exhale. The movement is repeated 2 times in each direction. Then return to the starting position, relax the muscles:

Curious Barabara

Looks left, looks right.

And then forward again -

Take a little rest here.

Raise your head up and look at the ceiling for as long as possible. Then return to the starting position, relax the muscles:

And Varvara looks up

Coming back -

Relaxation is nice!

Slowly lower your head down, pressing your chin to your chest. Then return to the starting position, relax the muscles:

Now let's look down -

The neck muscles are tense!

Let's go back -

Relaxation is nice!

What image appears in your mind's eye when you remember kindergarten? Most often - a noisy, polyphonic childish hive.

People who visited this establishment as children had varied impressions. Often they gradually form unexpected plots in dreams.

Lots and lots of pets

Why do you dream of a kindergarten with children? Kindergarten naturally associated with many children. If there are many of them in a dream, this portends a streak of surprises By the way, they may not always be pleasant.

A more “gentle” interpretation speaks of the onset of a playful mood, when an adult wants to play a little prank.

Miller's dream book promises the dreamer a peaceful course of life, if all this mass of children is busy with quiet things- modeling, drawing, appliqué, quiet games.

There is an opinion that a dream with kindergarteners tells the dreamer that he needs a break from his usual worries, and sometimes empty fuss.

Therefore, it’s worth taking a time out and figuring it out everyday affairs and determine how urgent the solution to each of them is.

Your child has long grown out of preschool age, and I took a kindergarten with children and dreamed about it. What is it for? Most likely, such a dream warns that you, with all your life experience and knowledge, you may find yourself completely helpless in the current situation.

If a woman often dreams of a kindergarten with children there, this may be a sign that she will soon become pregnant.

Extremely busy people often see a full kindergarten of children in their dreams. And the more kids run around there, the more tasks, assignments and troubles await the dreamer in real life.

If the dream “sent” you to nursery group, then such a plot can be regarded as a desire to have a child.

Seeing the kindergarten empty

According to the dream book, see empty kindergarten- good sign. Such a dream warns that the dreamer’s life will become calm and balanced, at least without stress.

Another interpreter suggests that this is a sign of shortage bright emotions, “adrenaline deficiency,” and advises taking up some extreme sport.

However, in search thrills You shouldn’t get too carried away, much less get involved in some adventures that can lead to unpredictable consequences.

In kindergarten and beyond

Autumn and Spring dream books as if they complement each other's interpretations. The first believes that the plot in which the dreamer takes his baby to the garden, but he resists and does not want to go, indicates that the parent is not paying enough attention to his child. And the second dream book speaks unequivocally: a person does not cope with parental responsibilities in the best way.

It is interesting that the reverse process - picking up from kindergarten - is absolutely not connected with educational issues and parental concerns.

Such a dream sets the sleeper up for professional actions: to improve his financial situation, he should engage in advanced training and generally grow above yourself, constantly learn something new, i.e. Do not stand still under any circumstances.

Dreaming of a teacher?

The image of a kindergarten teacher suggests that the dreamer should prepare for someone’s teachings.

Another version of the “educational” dream warns that the one who sees such a plot you shouldn’t count on someone to “cover up” his mistakes: You did it yourself - you can sort it out yourself.

I dream that a group of kids are playing with a teacher. According to the interpreter, the image indicates that the dreamer is able to cope with emotions and current situation he has it under control.

The autumn dream book is more realistic: the dream of a kindergarten teacher symbolizes nothing more or less than the pranks of children in reality.

Sleepy fantasies can easily “identify” the dreamer himself as the educator. Why do you dream of working in a kindergarten? A person who sees himself in the role of a teacher in reality sees himself as an accomplished person, ready to make others happy with knowledge and skills.

A smaller interpretation suggests that the dreamer will soon have to “educate” an adult who is distinguished by ignorance and lack of knowledge of the rules of decency.

Head of kindergarten

The head of a kindergarten, like the head in general in a dream, is a symbol of change in personal life. It is possible that soon a person will appear on the dreamer’s horizon who will bring new meaning into his existence.

The presence of a woman manager in a dream is a symbol of the fact that someone will begin to show her increased attention. And the man is waiting for a meeting with the girl of his dreams, who can become a real mistress in his house.

As you can see, dream books do not associate “kindergarten” dreams with any obvious negativity. Some changes in life are possible, filled with various events, perhaps not obviously joyful, but more troublesome. And your actions will determine how you overcome all difficulties and obstacles without complicating the situation.