LESSON PLAN ON

POLIOMYELITIS
SUBMITTED TO
MRS. JIBAN LATA
ASSISTANT PROFESSOR
HOLY FAMILY COLLEGE OF NURSING

PREPARED BY:
VARSHA SHARMA
TUTOR
HOLY FAMILY COLLEGE OF NURSING
 IDENTIFICATION DATA

NAME: MS. VARSHA SHARMA

SUBJECT: PEDIATRIC NURSING
TOPIC: POLIOMYELITIS
GROUP: GNM 3rd YEAR
NO OF SUDNETS: 30
METHODS OF TEACHING: LECTURE CUM DISCUSSION
AV AIDS: PPT, CHALK BOARD
DATE AND TIME:
DURATION: 60 MINUTES
VENUE/PLACE: GNM 3RD YEAR CLASSROOM
LANGUAGE: ENGLISH

PREVIOUS KNOWLEDGE OF GROUP:

GROUP HAS SOME KNOWLEDGE ABOUT POLIOMYLITIS.
General Objective:
After the completion of class students will be able to gain in depth knowledge about Poliomyelitis.

Specific Objectives:
At the end of teaching students will be able to
1. Define poliomyelitis.
2. Enlist about factors that increase the risk of polio infection or affect the severity of the disease poliomyelitis.
3. Explain about pathophysiology of poliomyelitis.
4. List down the clinical types of poliomyelitis.
5. Enlist clinical manifestation of poliomyelitis
6. Explain about Diagnostic evaluation of poliomyelitis.
7. Explain about management of poliomyelitis.
8. Enlist preventive management of poliomyelitis
9. Enlist complications of poliomyelitis.
TIME SPECIFIC CONTENT TEACHING LEARNING EVALUATION
OBJECTIVE ACTIVITY/A.V. AIDS

2 Min INTRODUCTION
Poliomyelitis (polio) is a highly
infectious viral disease, which
mainly affects young children.
The virus is transmitted by
person-to-person spread mainly
through the feco-oral route or,
less frequently, by a common
vehicle (e.g. contaminated
water or food) and multiplies in
the intestine, from where it can
invade the nervous system and
can cause paralysis.
4 Min At the end of DEFINITION Teacher defines poliomyelitis What is
teaching students Acute viral infectious disease caused by the RNA with the help of PPT. poliomyelitis?
will be able to entrovirus, called as poliovirus.
define • Transmitted by person to person contact, through faeco-
poliomyelitis. oral route or oro-oral route.
• Incubation period- 6 to 20 days
. • Infectious 7-10 days before appearance of symptoms
and as long as virus is in saliva or faeces.
5min At the end of Factors that increase the risk of polio infection or Teacher enlists about factors What all factors
teaching student affect the severity of the disease that increase the risk of polio are responsible
will be able to : • Immune deficiency infection or affect the severity for the increase
enlist about • Malnutrition of the disease with the help of risk of polio
factors that • Tonsillectomy PPT. infection?
increase the risk • physical activity immediately following the onset of
of polio infection paralysis
 or affect the • skeletal muscle injury due to injection of vaccines or
severity of the therapeutic agents
disease
poliomyelitis.
10Min At the end of PATHOPHYSIOLOGY Teacher explains about Explain
teaching student  Through Mouth to pharynx and intestinal pathophysiology of pathology of
will be able to mucosa. poliomyelitis with the help of poliomyelitis?
explain about  Replication in intestinal lymphoid cells--- PPT.
pathophysiology Viremia TO deep cervical and mesenteric
of poliomyelitis. lymph nodes.
 Sustained replication in muscle, fat--
-Major viremia.
 CNS invasion---local inflammatory
response.
 Poliovirus spreading along nerve fibers
destroys motor neurones within spinal
cord, brainstem or motor cortex.
 Lesions in spinal ganglia, also vestibular
nuclei, cerebellar vermis, deep cerebellar
nuclei, hypothalamus and thalamus.
5Min At the end of CLINICAL TYPES OF POLIOMYELITIS Teacher explains about clinical What are the
teaching student The infections with poliovirus may present as the types of poliomyelitis with the clinical types of
will be able to following clinical types: help of PPT. poliomyelitis?
1. Asymptomatic poliomyelitis or subclinical
list down the
infections.
clinical types of
2. Abortive poliomyelitis or minor illness.
poliomyelitis.
3. Non paralytic poliomyelitis.
4. Paralytic poliomyelitis.
 Spinal
 Bulbar
 Bulbospinal
 Encephalitic
PARALYTIC POLIO
 Incidence and extent increase with age
 In children, non-paralytic meningitis
-most likely consequence, and paralysis
-only 1 in 1000 cases
 In adults, paralysis -1 in 75 cases.
 In children < 5yrs, paralysis of one leg is
most common; in adults, extensive
paralysis of the chest and abdomen and
quadriplegia is more likely.

SPINAL POLIO
 Most common form of paralytic
poliomyelitis
 Viral invasion of the motor neurons of the
anterior horn cells, or the ventral gray
matter section in the spinal column, which
are responsible for movement of the
muscles, including those of the trunk,
limbs and the intercostal muscles.
 Without nerve stimulation, the muscles
atrophy, (weak, floppy and poorly
controlled)
 Progression to maximum paralysis rapid
(2 to 4 days), Associated with fever and
muscle pain
 Deep tendon reflexes -usually absent or
diminished sensation -not affected.
 The extent of spinal paralysis depends on
region of cord affected (cervical, thoracic,
or lumbar)
 Asymmetrical paralysis -Any limb or
 combination of limbs may be affected—
one leg, one arm, or both legs and both
arms. More severe proximally than
distally (fingertips and toes).

BULBAR POLIO
 Destruction weakens the muscles supplied
by the cranial nerves, producing
symptoms of encephalitis, and causes
difficult breathing, speaking and
swallowing.
 Nerves affected:
 Glossopharyngeal nerve-difficult
swallowing, impaired throat,
tongue movement and taste
 Vagus nerve -the heart, intestines,
and lungs.
 Accessory nerve -upper neck
movement.
 Trigeminal nerve and facial nerve
-the cheeks, tear ducts, gums, and
muscles of the face, double vision;
difficulty in chewing; abnormal
respiratory rate, depth, and
rhythm--respiratory arrest.
Pulmonary edema and shock also
possible, and may be fatal.

BULBOSPINAL POLIO
 Cervical spinal cord (C3-C5) and
paralysis of the diaphragm occurs.
 Nerves affected are the phrenic nerve,
 which drives the diaphragm to inflate the
lungs, and those that drive the muscles
needed for swallowing.
 Breathing Affected-ventilator needed.
 Paralysis of the arms and legs and heart
functions

ENCEPHALITIS
Confusion, headache, fever, fits, spastic paralysis.

10Min At the end of CLINICAL MANIFESTATIONS Teacher explains about clinical What is the
teaching student EARLY SYMPTOMS manifestation of poliomyelitis clinical
will be able to  High fever, headache, stiffness in the back with the help of PPT. manifestation of
enlist clinical and neck poliomyelitis ?
manifestation of  Asymmetrical weakness of various
poliomyelitis. muscles, sensitivity to touch, difficulty
swallowing, muscle pain
 Loss of superficial and deep reflexes,
paraesthesia (pins and needles)
 Irritability, constipation, or difficulty
urinating.

5min At the end of DIAGNOSTIC EVALUATION Teacher explains about What all
teaching student 1. Detailed history taking Diagnostic evaluation of investigations
will be able to 2. The health care provider may find: poliomyelitis with the help of are required for
explain about  Abnormal reflexes PPT. diagnostic
Diagnostic  Back stiffness evaluation of
evaluation of  Difficulty lifting the head or legs when poliomyelitis?
poliomyelitis. lying flat on the back
 Stiff neck
 Trouble bending the neck
1. Tests include:
  Cultures of throat washings, stools, or
spinal fluid Spinal tap and examination of
the spinal fluid (CSF examination)
 Test for levels of antibodies to the polio
virus

5Min At the end of MANAGEMENT Teacher explains about Enlist

teaching student  The goal of treatment is to control management of poliomyelitis Management of
will be able to symptoms while the infection runs its with the help of PPT. poliomyelitis?
explain about course.
management of  People with severe cases may need
poliomyelitis. lifesaving measures, especially breathing
help.
 Tracheostomy care is often needed in
patients who require long-term ventilator
support
 Symptoms are treated based on their
severity. Treatment may include:
1. Antibiotics for urinary tract infections
2. Moist heat (heating pads, warm towels) to
reduce muscle pain and spasms
3. Painkillers to reduce headache, muscle
pain, and spasms (narcotics are not
usually given because they increase the
risk of breathing trouble)
4. Maintain of fluid and electrolyte balance.
5. Fecal impaction is frequent in cases of
paralytic disease and can be treated with
laxatives as soon as it develops.
6. Physical therapy, braces or corrective
shoes, or orthopedic surgery to help
 recover muscle strength and function
7. Surgical Care - Total hip arthroplasty is a surgical
therapeutic options for patients with paralytic
sequelae of poliomyelitis who develop of hip
dysplasia and degenerative disease.

7Min At the end of PREVENTIVE MEASURES Teacher explains about Preventive

teaching student 1. Active immunization with oral and preventive management of management to
will be able to injectable polio vaccine. poliomyelitis with the help of prevent
enlist preventive 2. Global eradication of polio virus charts. poliomyelitis?
management of because man is the only host.
poliomyelitis. 3. The strategy for eradication is four
pronged:
 High routine immunization
coverage with OPV
 Supplementary
immunization in the form
of national immunization
day or pulse polio
immunization program
 Effective surveillance
system
 Final stage consisting of
mopping up by door to
door immunization
campaigns.
1. Avoidance of open field
defecation.
2. Promotions of environmental
sanitation, safe food hygiene are
important measures for the
prevention of poliomyelitis.
3min At the end of COMPLICATIONS Teacher explains about What are
teaching student complications of poliomyelitis complications of
will be able to 1. Pulmonary complications: Respiratory distress, with the help of charts. poliomyelitis?
it is a serious life threatening condition due to
enlist
paralysis of diaphragm and intercostal muscle,
complications of
obstruction of upper respiratory passage,
poliomyelitis.
involvement of medullary respiratory center or
vagus nerve and local lung conditions like
pneumonia, atelectasis, pulmonary edema etc.
Respiratory failure may also develop.
2. Cardiovascular problems: Heart failure,
myocarditis, hypertension, and cardiac arrest.
3. Gastrointestinal problems: GI bleeding,
perforation, fecal impaction.
4. Urinary problems: Transient paralysis of
bladder, urinary tract infection and renal stone.
5. Post-polio residual paralysis and bony deformity.

3min SUMMARY
Poliomyelitis, often
called polio or infantile
paralysis, is an infectious
disease caused by
the poliovirus. In about 0.5
percent of cases there is muscle
weakness resulting in
an inability to move. This can
occur over a few hours to a few
days. Initial symptoms of polio
include fever, fatigue,
headache, vomiting, stiffness in
the neck, and pain in the limbs.
In a small proportion of cases,
 the disease causes paralysis,
which is often permanent.
There is no cure for polio, it can
only be prevented by
immunization

5min CONCLUSION
Poliomyelitis (polio) is a highly
infectious viral disease, which
mainly affects young children.
The virus is transmitted by
person-to-person spread mainly
through the faeco-oral route or,
less frequently, by a common
vehicle (e.g. contaminated
water or food) and multiplies in
the intestine.
REFERENCES
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3. Orenstein WA, Committee on Infectious Diseases. Eradicating polio: how the world's pediatricians can help stop this
crippling illness forever. Pediatrics. 2015 Jan. 135 (1):196-202. 
4. CDC. Poliovirus infections in four unvaccinated children--Minnesota, August-October 2005. MMWR Morb Mortal Wkly
Rep. 2005 Oct 21. 54(41):1053-5. 
5. Poliovirus. Pediatrics. 2011 Oct. 128(4):805-8.  Choudhury P, Thacker N, Gargano LM, et al. Attitudes and perceptions of
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