3. Learning Objectives:
At the end of this session, the students will be able to
describe:
Historical development of pediatric nursing
Promotive, preventive and curative aspects of child
health
Hospital environment for sick child
The role of pediatric nursing in caring for hospitalized
child
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4. Introduction
Definition:
Child Health is the purview of pediatrics.
I.e. Pediatrics ↔ Child Health.
Pediatrics: the term pediatrics is derived from Greek
words:
“pedia” meaning a child
“iatrike” meaning treatment (Rx.)
“ics” meaning a branch of science.
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5. Definition…
Thus, pediatrics is a study of the child from conception
through adolescence; their growth and development,
and their opportunity to achieve full potential as adults.
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6. Origin and history of pediatrics:
Pediatrics became a medical specialty in the mid –19th
century.
Before that time the care and treatment of childhood
diseases was included with in general medicine and
obstetrics (midwifery).
Virtually all nations have practicing departments of
pediatrics or child health.
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7. Cont’d
With some reasons, pediatrics become an
independent medical specialty:
The health problems of children differ from those of adults.
Children response to an illness is influenced by age.
Management of child hood illness is significantly d/t with
that of adults.
Worldwide, children represent a higher proportion of total
population.
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8. Qualities of Good Pediatric Nurse
The good pediatric nurse must be:
1- Good observer
2- Honest and truthful
3- Sympathetic, kind, patient and cheerful
4- Love to work with children
5- Interested in family care
6- Able to provide teaching to children and their families
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9. Role of Pediatric Nurse
The goals of nursing care of children, based on primary health
care are:
1) Promote the healthy maturation of the child as a physical,
intellectual and emotional being within the context of his family
and community (primary level)
2) Provide health care for the child who requires treatment from
disease(s) (secondary level)
3) Dealing with the Child's disabilities (tertiary level) or rehabilitation
which means maximizing the child's potential level of his body
function.
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10. Children need special health care
because:
Large numbers:
High mortality:
High Morbidity:
Vulnerable due to developmental drawbacks:
Preventable disease are common in children
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11. Definitions of some Terms (Age
Classifications)
Infancy
Neonate
Birth to 1 month
Infancy
1 month to 1 year
Early Childhood
Toddler
1-3 years
Preschool
3-6 years
Middle Childhood
School age
6 to 12 years
Late Childhood
Adolescent
13 years to
approximately 18 years
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12. Terms from child health indicators:
Still birth - the death of the fetus after 28 weeks of
gestation.
Neonatal death - is death of live born up to 28 days
Early neonatal death - is death of infant during
first seven completed days /168 hrs/
Late neonatal death - is the death of live born
infant after 1 w/k but up to 28 completed days of life.
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13. Cont’d
Post natal death is the No. of infants death after
28 days but less than one years of age
Children mortality: the No of death b/n 1 and 4
years of age
Infant mortality
- No of death infants <1yrs of age
Postnatal + neonatal death
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14. UN Convention on the Rights of the
Child (1989):
A right to life
To have a name & identity
To be raised by his/her parents within a family or
cultural grouping
To have a relationship with both parents
Children have a right to express their own opinions
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15. UN Convention…
To have those opinion heard & acted upon appropriately
To be protected from abuse or exploitation
To have their privacy protected
Capital punishment is forbidden regarding children
African charter on the rights and welfare of the
child (1990).
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16. Promotive, Preventive and Curative
aspects of Child Health:
Promotive: refers to increases healthiness through
health education.
Curative: refers to treatment of diseases through
medication (drug use).
Preventive: refers to prevention of diseases through:
Health education, Immunization, and Environmental
sanitation.
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17. Cont’d
Health maintenance: refers to health care of children
who have chronic illness or those who are well.
Prevention is the best measure for maintaining health.
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18. Levels of Prevention
Primary prevention
The aim is to avoid disease before its onset.
Growth monitoring: a strategy to monitor the nutritional
status of the children.
Oral re-hydration: prevent dehydration
Promotion of breast feeding:
Immunization: developing immunity against infection through
vaccination
Health education on sanitation:
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19. Cont’d
Secondary prevention
Aim: early detection and treatment of the precursors of
the disease.
Screening methods such as tuberculin surveys
Vitamin A deficiency surveys
Treating the respective health problem
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21. Nursing process in the care of children
Nursing process is systematic way of problem solving
approach to nursing care.
It is a foundation for nursing practice which provides a
framework for the care of clients.
It has five components; which are interconnected,
continuous and cyclic.
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23. Steps in nursing process…
Assessment
Data collection
Subjective data-through interview of a child or family
Objective data from physical assessment or lab
findings.
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24. Steps in nursing process…
Nursing diagnosis
Conclusion or judgment of actual or potential problems and
needs which a nurse is responsible to solve or provide a care.
Different from medical diagnosis
NANDA approved label of nursing diagnosis
Can have two components
Actual NDx-PES…Problem related to the etiology(cause) as
evidenced/manifested by sign and symptom
Potential or risk NDx-PE.. potential problem (risk) related
to the etiology (cause).
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25. Steps in nursing process…
Planning
Planning nursing care to solve the identified problem or to
satisfy the children need.
Goal setting steps
Individualized, measurable, Attainable and time bounded
Priority should be made.
Nursing care plan: blue print for nursing care
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26. Steps in nursing process…
Implementation
It is a process of putting the nursing care plan into
action.
These actions may be independent, dependent, or
interdependent.
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27. Steps in nursing process…
Evaluation
It is an ongoing process measures the success or failure
of the nursing plan of care.
If the goals have not been met in the specified time or if
implementation is unsuccessful, a particular intervention
may need to be reassessed and revised.
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29. Pediatric History And Physical
Examination
• Key elements in the history taking process
include.
• establishing a warm, caring atmosphere
• asking questions in a no confrontational, unhurried
manner
• Use simple language
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30. Cont’d
• Good eye contact and a sense of undivided
attention should be maintained.
• Sit opposite the caregiver and/or patient at a
comfortable distance
• Outside interruption should be kept to a minimum.
• Write few notes, and refer to written data as little as
possible.
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31. Cont’d
• Ascertain who is with the child, It may not be the mother
but another family member.
• Greet in a friendly manner and introduce your self .
• Older child should be involved in the history .
• Even younger children should be asked simple things in
words they can understand.
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32. Cont’d
• Remember that the mother is giving you her
version of the problem, not the child's.
• Always take notice of what the mother is saying, and
listen to her complaints.
• The mother will know what is worrying her about the
child, and any interruptions should be to guide her
rather than try and impose your diagnosis on her.
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34. History
• Identification:
• Name, age, sex, name of parents (informant), date of
examination, date of admission, source of referral
• Chief complaint:
• What is the reason for the health visit
• Must be informant’s own word and must include the duration.
• History of present illness:
• Chronology, elaboration, associated symptoms
• Pertinent negatives
• History of past illness:
• Previous admission, surgery, trauma…
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35. History…
Perinatal history:
Antenatal follow up of the mother
Any illness during pregnancy like hypertension, diabetes mellitus
Immunization for tetanus
The onset, duration of labor , the mode of delivery, place of
delivery, who conducted the delivery, the birth weight, APGAR
score or did the new born cried immediately after birth any
procedure immediately after birth.
Jaundice, cyanosis, convulsion during neonatal period
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36. History…
Nutritional(dietary)history:
Type of feeding
Duration of exclusive breast feeding, time of initiation, frequency,
total duration of BF.
Formula feeding,
Animal milk, commercial infant formula, how is it diluted, amount
Complementary feeding
Start at 6 months with liquid and semisolid foods
Current diet
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37. History...
Immunization history:
Is the child/infant being immunized?
Was he immunized only during National polio
campaigns?
When was the last vaccination?
Route of vaccine?
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38. History...
Developmental history:
Growth and development follows a predictable pattern
Always is cephal to caudal and proximal to distal
Affected by biological, emotional, social and
environmental factors
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39. History...
• Personal history:
• Child relation with the sibls, other family member and
children in the school
• Family history:
• health status of siblings, parents and grand parents.
• Socioeconomic history:
• Family income, occupation of the parents, housing,
school and play facilities available for the child.
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40. History...
• Review of systems:
• Check list of symptoms
• Almost similar with adults
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41. Pediatrics Physical Examination
IMPORTANT HINTS
Avoid irritating the child and prevent him from crying (if
possible).
Examine the child in the most comfortable way
according to his age (exam table, mother’s hands,
mother’s lap, while playing with a toy…).
Postpone the painful and/or irritating examination
(throat/ears).
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43. Cont’d
General appearance
State of alertness/ level of consciousness.
Awareness to environment
Facial expression
State of nutrition
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45. Cont’d
Vital signs vary based on the age of the patient .
For newborns and infants take apical heart rate
Take respiratory rate for full minute
For measuring BP use the appropriate cuff which should
cover at least 1/3 (40%) of the width and 2/3 of the arm
length, ratio of width to length is 1:2.
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47. Anthropometric Measurements (Wt.,
Ht, HC)
Always use growth charts and indicate the percentiles.
Use appropriate scale for age to measure the weight.
Naked weight (when possible)
Measure recumbent length till 2 years of age and then
standing length (height) after that.
HC is the occipitofrontal circumference and measures
the circumference passing through the most distal
points on the occiput and the frontal area.
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54. Lungs
Inspiration and Expiration
Chest size and symmetry
Bell or diaphragm (warm first)
Breath sounds harsher in infants and young children
Tracheal, bronchial and adventitial
Distinguish lower from transmitted upper airway sounds
Abnormalities - decreased BS, crackles, wheeze, stridor,
rate, retractions (distinguish IC from SC)
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55. Cardiovascular
Pulses
Apical pulse - varies with age
Rate and rhythm
Sinus arrhythmia common
Functional murmur
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56. Abdomen
Warm hands, palpate gently
Look at Face not hands
Spleen tip and liver edge commonly palpable in infancy
If abdomen tense, try flexing legs at hip
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In primary level
Through health education to the child and his parents and providing child's basic needs and immunization.
The nurse can:
Maintain child's health.
Help the child to achieve his optimal growth and development.
Prevent diseases and their complications.
In secondary level
The nurse has to provide care to sick children and their families by:
Assessing their needs.
Planning for their care .
Implementing the nursing care plan.
Evaluating children's condition and the plan of care
Providing health teaching to children and their parents
In tertiary level
The nurse should assist children to return to their maximal level of functioning following illness and or disabilities.
Knowledge of basic science is important to differentiate normal from abnormal finding.
Analysis of the obtained information
Example: ineffective airway clearance secondary to increased mucus production as evidenced by wheezing and dyspnea
Risk for Injury related to uncontrolled muscular activity secondary to seizure
Strategies for gaining cooperation of pediatric assessment
There are so many differences between pedia and adult history
Content difference
Approach difference
Parents as primary informant….
Which percentile? CDC, WHO, HC for less than
Sinus arrhythmia – abnormal heart rhythm
Functional murmur – primarly due to physiologic condition outside the heart
S3 –ventricular galop – after s2when the mitral valve open
S1 and s2 are high pitched and s3and s4 are low pitched sound