1 nega Pediatrics-Introduction-1.ppt

Larson & Farber, Elementary Statistics: Picturing the World, 3e 1
1
Nursing Health Assessment

6/25/2023 2
 NEGA TEZERA (BSC, N, MSC, N)
UNIVERSTY OF GONDAR
COLLEGE OF MEDICINE AND HEALTH SCIENCE
DEPARTMENT OF NURSING
Pediatrics Nursing and Child Health
Care
For Bsc nursing student

Unit one: Introduction
Outline
Overview of pediatric Nursing
Definition of pediatric Nursing
Current trends in child health care
The nurse’s role in child care
Modern concepts of pediatric nursing care
Overview of pediatric health assessment
Common pediatric nursing procedures
6/25/2023 3

Objectives
At the end of this session the students will be able
to:
define pediatric nursing
describe the modern concepts of pediatric nursing
care
explain the basics of pediatric health assessment
differentiate normal and abnormal V/S values
identify common pediatric nursing procedures
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Overview of pediatric nursing
Relatively new medical speciality (1800s)
In the earlier times:
 Epidemics were common
 Many children died during infancy/childhood
 Families were large (compensation)
 Children were cared by families or neighbours
 Children were not considered important
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Overview ...
•Hospitalized children were cared as adults
•Unsanitary conditions
•Mortality rates were commonly 50% to 100%
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Overview ...
After world war I:
•A period of strict asepsis
•Babies were placed in individual cubicles
•No one was allowed to pick up children
•No toys
•Infant mortality rates continued
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Overview ...
1970s to 1980s
•Hospital regulations changed slowly
•Isolation practices relaxed
•Nurses used play as therapeutic tool
•Children visited playroom
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Factors influence the health and
illness patterns of a child
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External Factors
Internal Factors

Pediatric Nursing is:
A parent-nurse partnership
Nurse’s goals are: to promote a therapeutic
relationship between parent and child
Accomplished by family-centered care
To promote continued growth and development
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Pediatric Nursing ....
is the art and science of giving nursing care to
children from birth through adolescent with
emphasis on the physical growth, mental,
emotional and psycho-social development
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Current trends in child health care
Family-centred care
Regionalized care
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 Are children considered as little adult?
Point out the difference between adult and
child ?
(think-pair-share)
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Anatomical difference
Immaturity and inadequate ossification
Suture and skull are not united
Infant tongue is large
Nasal and oral air way passage are relatively
small
No tears in early infancy

Eustachian tube is short and straight in children
Trachea is short and narrow under 5 years
children
Children cardiac sphincter of stomach is relaxed

Physiological difference
Poor thermoregulation is attributed to
immaturity of Hypothalamus
Shivering and sweating mechanism are
absent in newborn
GFR and tubular function are lower in
neonate.

Psychological differences
Fear, escape and avoid stranger till 5 years
of age
Explore the environment
Infancy: more bonding with parents
 separation anxiety is very common
Toddler: Negativistic behavior

Why pediatrics ... ?
1. The health problems of children differ from those
adults in many ways
2. Children’s response to an illness is influenced
by age
3. Managements of childhood illness are
significantly different from an adult
4. Children need special care since they are among
the most vulnerable groups
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Modern concepts of child care
Previously the emphasis was on the care of the ill
child as an individual
Current emphasis:
 Prevention of illnesses and accidents
Holistic nursing care
Independent practice
Interdisciplinary approach
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Tips for pediatric nursing care
1- Critical observation
2- Honesty and truthfulness
3- Love to work with children
4- Family-centered care
5- Nurse-parent relationship
6- Parent & child education
7- Each family is unique
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Overview of Pediatric Health Assessment
Contents of Pediatric History
1. Personal details
2. C/C
3. HPI
4. Past medical History
21

...pediatric history
5. Family history
6. Immunization history
7. Nutritional history
8. Developmental history
9. Review of systems
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Personal details
Date and time of interview
Name of patient
Address
Age
Sex
Historian
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Chief Complaint (C/C)
The main complaint that has brought the patient
to seek for medical help
In the words of the patient
√e.g., yellowish discoloration of the eyes
Symptom + Duration
√e.g., cough of three days
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History of present illness
The details should include
Chronology of symptoms
-Mode of onset (insidious, sudden)
-Elaboration of symptoms and relevant questions
about positive and negative statements (help for
differential dx)
-Aggravating and relieving factors
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For pain ask about:
Onset
Location
Quality (mild, moderate, severe)
Severity
Alleviating and aggravating factors
Radiation
Associated symptoms
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For fever ask about:
Pattern (intermittent, remittent, continuous or
relapsing)
√Tertian: a 3 day pattern; peaks every other day
at a gap of 48 hours. E.g. P. vivax
√Quartan: a 4 days pattern; peaking every 3rd
day. E.g. P. malaria
Associated symptoms (coryza, skin rash,
urinary symptoms)
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For cough ask about:
Character (hacking, brassy, barking or paroxysmal)
Associated symptoms (stridor, whoop)
Characterize sputum (color, amount, and odor)
Dyspnea (indicates cardiac problem), if present
grade it
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For diarrhea ask about:
Duration
Frequency
Consistency of the stool
Associated symptoms
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Past medical history
Includes prenatal, labor, delivery, neonatal,
infancy, and childhood events
Recorded in chronological order with diagnosis and
outcome
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Past ....
Childhood illnesses should be specifically asked
(measles, pertussis, mumps, chicken pox etc;
surgical conditions and medications, allergies)
6/25/2023 31

Family history
Social history
√General demographic and socio-economic
information (housing, income, water supply, family
size, waste disposal, etc)
6/25/2023 32

Family ...
Medical history
√Possible familial (diabetes, bronchial asthma) and
hereditary diseases (Hemophilia, thalasemia)
√Clustering of disease in family (scabies, infectious
hepatitis, cholera, etc)
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Immunization history
Ask:
When the vaccine was given
The route of administration
For the immunization card (when applicable)
6/25/2023 34

Nutritional history
Type of food
Amount
Frequency of feeding
Share of the same plate with older siblings?
Food hygiene
6/25/2023 35

Nutritional ...
For infants
Duration of exclusive breast feeding
Duration of breast feeding
Initiation of complementary feeds
Types of complementary feeds
Exposure of sunlight
6/25/2023 36

Developmental history
One of the cardinal manifestations of diseases and
deprivation in children is psychomotor
developmental delay
Developmental milestones are used to assess the
past progress of the child
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Developmental ...
The questions should address:
Gross motor: control of head, trunk and extremities
Fine motor: the development of fingers’ movements
6/25/2023 38

Developmental ...
Language development: production of sound, single
or combination of words, gestures, facial
expressions and understanding of others
Personal and social: sleeping habits, identification
of objects and persons, ability to play with others,
manipulation of objects, etc.
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Pediatric Physical Examination
The aim is the same as adults but the
approach is different
Both the techniques and interpretations
vary according to the age of the patient
Examination of infants under the age of 6
months is much easier than the older ones
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Physical ...
Be opportunistic in examining a child!
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V/S: PR, BP, & RR (Normal values)
Age Heart rate, Beats/min BP, mmHg Respiratory rate,
breath/minute
Premature 120-170 55-75/35-45 40-70
0-3 months 100-150 65-85/45-55 35-55
3-6 months 90-120 70-90/50-65 30-45
6-12 months 80-120 80-100/55-65 25-40
1-3 years 70-110 90-105/55-70 20-30
3-6 years 65-110 95-110/60-75 20-25
6-12 years 60-95 100-120/60-75 14-22
6/25/2023 42

V/S: Temperature
Normal body temperature: 36.5oC to 37.5oC (97.7-
99.5oF)
Hyperthermia: >37.5oC
Hypothermia: <36.5oC
Mild hypothermia: 36-36.4oC
Moderate hypothermia: 32-35.9oC
Severe hypothermia: <32oC
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The nursing process
1. Assessment
2. Nursing diagnosis
3. Planning
4. Intervention
5. Evaluation
6/25/2023 44

Common pediatric nursing procedures
Medication administration
NG-tube insertion and feeding
Oxygen administration
Resuscitation
Administering enema
Tracheostomy care
6/25/2023 45

...pediatric procedures
Blood transfusion
Specimen collection
Iv cannulation , etc ...
6/25/2023 46

Assignment-1 (Non-graded)
Read and take short note about common
pediatric nursing procedures by considering
the following points when appropriate.
Indications
Contraindications
precautions
Steps with its rationale
Differences from the adult
6/25/2023 47

Thank you so much!
6/25/2023 48

1 nega Pediatrics-Introduction-1.ppt

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