It is a case study report of mucopolysaccharidosis, I did when I was posted in Kanti Children's hospital
Prepared by:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health Sciences
It is a case study report of mucopolysaccharidosis, I did when I was posted in Kanti Children's hospital
Prepared by:
Rashmi Regmi
B. Sc Nursing
Manmohan Memorial Institute of Health Sciences
History Taking
1.Name, age, sex, marital status, occupation, address (Demographics)
2. Presenting complaints
3. History of present illness
4. Systemic inquiry
5. Past history
6. Menstrual history
7. Treatment history
8. Family history
9. Personal and social history
10. Occupational history
History taking- oral pathology- Sreng at UHSSreng Pouv
History taking is very important for all doctor and dentist. Therefore, all doctor and dentist must spend 5-10mins for taking history from patients because it can make doctor's or dentist's treatment efficiency and potentially. In history-taking, there are 5 vital elements. They are :
- Date collection and chief complaint.
- Present History
- Past History
- Personal History
- Family History.
In those slides, also include the behaviour of doctor or dentist.
During interview, Dentist should be :
introduce yourself and asking some normal questions => patient feel comfortable for moving forward.
always listen carefully.
keep your appearance neat and clean => gain trust.
show courteous, respectful and confidential
always be friendly and interest in patients’ problems.
keep eye contact.
HISTORY TAKING AND FAMILY ASSESSMENT IN PEDIATRIC NURSINGRitu Gahlawat
History taking is an art as well as science that requires a thorough knowledge of medicine along with patience and good command on the language of the patient.
The history is the written record of all the facts about the patient's present and past illnesses.
The format used for history taking may be
(1)direct, in which the nurse asks for information via direct interview with the informant, or
(2)indirect, in which the informant supplies the information by completing some type of questionnaire.
Much of the identifying information may already be available from other recorded sources. However, if the parent and child seem anxious use this opportunity to ask about such information to help them feel more comfortable.
Informant. The person(s) who furnishes the information. Record (1) who the person is (child, parent, or other). (2) an impression of reliability and willingness to communicate, and (3) any special circumstances such as the use of an interpreter or conflicting answers by more than one person.
The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It may be the theme, with the present illness viewed as the description of the problem. Elicit the chief complaint by asking open ended, neutral questions And Avoid labelling type questions.
Occasionally, it is difficult to isolate one symptom or problem as the chief complaint because the parent may identify many. In this situation, be as specific as possible when asking questions.
The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present.
Its four major components are
the details of onset,
a complete interval history,
the present status, and
the reason for seeking help now.
Analyzing a Symptom. Because pain is often the most characteristic symptom denoting the onset of a physical problem, it is used as an example for analysis of a symptom.
Assessment includes type, location, severity, duration, and influencing factors.
The history contains information relating to all previous aspects of the child's health status and concentrates on several areas that are ordinarily passed over in the history of an adult, such as birth history, detailed feeding history, immunizations, and growth and development.
Birth History
The birth history includes all data concerning
the mother's health during pregnancy,
the labor and delivery, and
the infant's condition immediately after birth.Dietary History
Parental concerns are common and nursing interventions are important in ensuring optimum nutrition.
Previous illnesses, Injuries, and Surgeries
When inquiring about past illnesses, begin with a general question. In addition to illnesses, ask about injuries that required medical intervention, surgeries, procedures, and hospitalizations, including the dates of each incident. Focus on injuries because these may be potential areas for parental guidance.
Chief compliant(CC) Joshuas hyperactive and attentional difficultJinElias52
Chief compliant(CC) Joshua's hyperactive and attentional difficulties have been exhibited both at school and at home.
HISTORY: Joshua is a Hispanic or Latino 10-year-old boy. This evaluation was requested because
mother is worried about patient's aggressive behavior toward his younger brother and ADHD
symptoms. Mother report that patient was diagnosed at age 6 by pediatrician with ADHD,
medication was started at that time (mother unable to remember name) until age 9. Mother stopped
administering medication because it caused decrease appetite, insomnia and weight loss. Patient
is not currently taking any medication at this time.
Behavior Described In:
Symptoms/ behavior Joshua exhibits symptoms of inattention. He reports difficulty sustaining attention. His mind
wanders or he forgets. He does not seem to listen when spoken to directly. He often needs
directions repeated. Joshua is easily distracted by noises. by the radio. by other people. Joshua
needs supervision or frequent redirection. He has a short attention span.
Joshua exhibits signs of hyperactivity. He exhibits restlessness or fidgety behavior. This
behavior is evident during school hours. He tends to frequently leave his seat. He is
easily bored and changes activities frequently. Joshua 's excessive movement has been noted. He
is fidgety or squirms when required to sit still for a period of time. He frequently jumps or climbs.
Joshua exhibits signs of impulsive behavior. He frequently interrupts others. He often acts
in a reckless manner. He has difficulty accepting limits.
Joshua has other exhibited symptoms.
He exhibits stubborn or willful behavior.
EXAM: Joshua appears flat, inattentive, distracted, normal weight, He exhibits speech that is
normal in rate, volume, and articulation and is coherent and spontaneous. Language skills are
intact. Affect is appropriate, full range, and congruent with mood. Associations are intact and
logical. There are no apparent signs of hallucinations, delusions, bizarre behaviors, or other
indicators of psychotic process. Associations are intact, thinking is logical, and thought content
appears appropriate. Suicidal ideas or intentions are denied. Homicidal ideas or intentions are
denied. There are signs of anxiety. A short attention span is evident. Judgment appears to be
poor. Insight into problems appears to be poor. He is easily distracted. Joshua is restless. Joshua is
fidgety. There is physical hyperactivity. Joshua displayed defiant behavior during the examination.
Joshua made poor eye contact during the examination. Vocabulary and fund of knowledge indicate
cognitive functioning in the normal range. Cognitive functioning and fund of knowledge are intact
and age appropriate. Short- and long-term memory are intact, as is ability to abstract and do
Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
Comprehensive psychiatric evaluations are a way to reflect on your practicum experiences and connect the experiences ...
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
History Taking
1.Name, age, sex, marital status, occupation, address (Demographics)
2. Presenting complaints
3. History of present illness
4. Systemic inquiry
5. Past history
6. Menstrual history
7. Treatment history
8. Family history
9. Personal and social history
10. Occupational history
History taking- oral pathology- Sreng at UHSSreng Pouv
History taking is very important for all doctor and dentist. Therefore, all doctor and dentist must spend 5-10mins for taking history from patients because it can make doctor's or dentist's treatment efficiency and potentially. In history-taking, there are 5 vital elements. They are :
- Date collection and chief complaint.
- Present History
- Past History
- Personal History
- Family History.
In those slides, also include the behaviour of doctor or dentist.
During interview, Dentist should be :
introduce yourself and asking some normal questions => patient feel comfortable for moving forward.
always listen carefully.
keep your appearance neat and clean => gain trust.
show courteous, respectful and confidential
always be friendly and interest in patients’ problems.
keep eye contact.
HISTORY TAKING AND FAMILY ASSESSMENT IN PEDIATRIC NURSINGRitu Gahlawat
History taking is an art as well as science that requires a thorough knowledge of medicine along with patience and good command on the language of the patient.
The history is the written record of all the facts about the patient's present and past illnesses.
The format used for history taking may be
(1)direct, in which the nurse asks for information via direct interview with the informant, or
(2)indirect, in which the informant supplies the information by completing some type of questionnaire.
Much of the identifying information may already be available from other recorded sources. However, if the parent and child seem anxious use this opportunity to ask about such information to help them feel more comfortable.
Informant. The person(s) who furnishes the information. Record (1) who the person is (child, parent, or other). (2) an impression of reliability and willingness to communicate, and (3) any special circumstances such as the use of an interpreter or conflicting answers by more than one person.
The chief complaint is the specific reason for the child's visit to the clinic, office, or hospital. It may be the theme, with the present illness viewed as the description of the problem. Elicit the chief complaint by asking open ended, neutral questions And Avoid labelling type questions.
Occasionally, it is difficult to isolate one symptom or problem as the chief complaint because the parent may identify many. In this situation, be as specific as possible when asking questions.
The history of the present illness is a narrative of the chief complaint from its earliest onset through its progression to the present.
Its four major components are
the details of onset,
a complete interval history,
the present status, and
the reason for seeking help now.
Analyzing a Symptom. Because pain is often the most characteristic symptom denoting the onset of a physical problem, it is used as an example for analysis of a symptom.
Assessment includes type, location, severity, duration, and influencing factors.
The history contains information relating to all previous aspects of the child's health status and concentrates on several areas that are ordinarily passed over in the history of an adult, such as birth history, detailed feeding history, immunizations, and growth and development.
Birth History
The birth history includes all data concerning
the mother's health during pregnancy,
the labor and delivery, and
the infant's condition immediately after birth.Dietary History
Parental concerns are common and nursing interventions are important in ensuring optimum nutrition.
Previous illnesses, Injuries, and Surgeries
When inquiring about past illnesses, begin with a general question. In addition to illnesses, ask about injuries that required medical intervention, surgeries, procedures, and hospitalizations, including the dates of each incident. Focus on injuries because these may be potential areas for parental guidance.
Chief compliant(CC) Joshuas hyperactive and attentional difficultJinElias52
Chief compliant(CC) Joshua's hyperactive and attentional difficulties have been exhibited both at school and at home.
HISTORY: Joshua is a Hispanic or Latino 10-year-old boy. This evaluation was requested because
mother is worried about patient's aggressive behavior toward his younger brother and ADHD
symptoms. Mother report that patient was diagnosed at age 6 by pediatrician with ADHD,
medication was started at that time (mother unable to remember name) until age 9. Mother stopped
administering medication because it caused decrease appetite, insomnia and weight loss. Patient
is not currently taking any medication at this time.
Behavior Described In:
Symptoms/ behavior Joshua exhibits symptoms of inattention. He reports difficulty sustaining attention. His mind
wanders or he forgets. He does not seem to listen when spoken to directly. He often needs
directions repeated. Joshua is easily distracted by noises. by the radio. by other people. Joshua
needs supervision or frequent redirection. He has a short attention span.
Joshua exhibits signs of hyperactivity. He exhibits restlessness or fidgety behavior. This
behavior is evident during school hours. He tends to frequently leave his seat. He is
easily bored and changes activities frequently. Joshua 's excessive movement has been noted. He
is fidgety or squirms when required to sit still for a period of time. He frequently jumps or climbs.
Joshua exhibits signs of impulsive behavior. He frequently interrupts others. He often acts
in a reckless manner. He has difficulty accepting limits.
Joshua has other exhibited symptoms.
He exhibits stubborn or willful behavior.
EXAM: Joshua appears flat, inattentive, distracted, normal weight, He exhibits speech that is
normal in rate, volume, and articulation and is coherent and spontaneous. Language skills are
intact. Affect is appropriate, full range, and congruent with mood. Associations are intact and
logical. There are no apparent signs of hallucinations, delusions, bizarre behaviors, or other
indicators of psychotic process. Associations are intact, thinking is logical, and thought content
appears appropriate. Suicidal ideas or intentions are denied. Homicidal ideas or intentions are
denied. There are signs of anxiety. A short attention span is evident. Judgment appears to be
poor. Insight into problems appears to be poor. He is easily distracted. Joshua is restless. Joshua is
fidgety. There is physical hyperactivity. Joshua displayed defiant behavior during the examination.
Joshua made poor eye contact during the examination. Vocabulary and fund of knowledge indicate
cognitive functioning in the normal range. Cognitive functioning and fund of knowledge are intact
and age appropriate. Short- and long-term memory are intact, as is ability to abstract and do
Assignment 2: Comprehensive Psychiatric Evaluation and Patient Case Presentation
Comprehensive psychiatric evaluations are a way to reflect on your practicum experiences and connect the experiences ...
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
Letter to MREC - application to conduct studyAzreen Aj
Application to conduct study on research title 'Awareness and knowledge of oral cancer and precancer among dental outpatient in Klinik Pergigian Merlimau, Melaka'
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
The global radiation oncology market size reached US$ 8.1 Billion in 2023. Looking forward, IMARC Group expects the market to reach US$ 14.5 Billion by 2032, exhibiting a growth rate (CAGR) of 6.5% during 2024-2032.
More Info:- https://www.imarcgroup.com/radiation-oncology-market
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
2. The attributes of a Pediatrician
Good physical and
mental health
Knowledge and skills
Wisdom
Confidence
Patience
Politeness
Humility
Common sense
Pleasant demeanor
or bedside manners
Experience and
expertise
Tact
Compassion
Kind and
affectionate look
Love for children
Intuition
Healing touch
3. Building Rapport with Child & Parents
• Wear formal clothing and apron before you address the
child
• Take time ,do not appear hurried.
• Have smile on your face and keep your personal
worries and frustrations away .
• A mother and child feels comfortable when the doctor
displays appreciation of the child.
• Look at the patient and make eye contact , keep your
head at the level of patient
• Touch the baby appropriately
• Avoid distracting movements, like fidgeting or
constantly moving your leg.
• Avoid electing too many personal information like caste
,religious beliefs etc.
4. Objectives of History-taking
To elicit an accurate account of the
symptoms that represent the clinical
problem
To help in arriving at a diagnosis
To develop rapport with the child
and the parents
5.
6. “Methods of physicians
are like detectives, one seeking
to explain a disease , other a
crime”
‘History taking is an art
and demands skills of a lawyer ,
detective and judge.’
7. History Taking
• Pediatrics has been linked to veterinary medicine
because young children can not express their
symptoms.
• An intelligent observant mother can provide
satisfactory story of illness, but may exaggerate
facts due to her anxiety and concern. Father
spends little time with the child and is generally
less informed.
• Most common diseases can be diagnosed by
good history alone . Elicitation should continue
during physical examination to seek additional
information when unexpected abnormal physical
finding is detected.
8. Tips for History-taking
1. Ensure privacy and confidentiality
2. Respect the patient and parents
3. Use simple language
4. Listen actively, let the parents talk
5. Ask open-ended questions
6. Clarify any ambiguous information
7. List the problems and summarize.
9. Do’s
• Listen properly.
• Concentrate on what
the parents is saying
• Observe the speaker’s
non-verbal signals
• Adopt an accepting
attitude
• Express empathic
understanding
Don’ts
• Fake listening
• Interrupt needlessly
• Pass judgment too
quickly
• Argue
• Give advice unless it is
requested
• Switch topic
10. Process of History- taking
1. Place: Privacy and without disturbance
2. Informant : Mother , caretaker , or an
eyewitness to the event
3. Setting : Comfortable
4. Language : Understandable, no ambiguity
5. Sequence : From present to past, and
individual to family to society.
11. The Sequence : History-taking
1. Personal and Demographic details
2. Presenting complaints
3. History of present illness
- Symptoms review
- System review
- Medications received
4. Past history
- Perinatal events
- Significant illnesses and accidents
- Physical growth and developmental milestones
5. Family history
- Genetic diagram
6. Social History and lifestyle
7. Feeding History
8. Immunization status
12. Personal and Demographic details
1. Informant ( mother, father, relative, child etc.)
2. Name
3. Age (date of birth)
4. Sex
5. Parent’s Name
6. Complete address
7. Telephone number
8. Religion / cast (if relevant)
14. 6- Tips for Formulating Presenting
Complaints
1. Describe complaints as described by parents
along with their duration
2. Arrange the complaints in chronological order
3. Avoid use of medical terms as much as possible
4. Try to restrict numbers of complaints to a
maximum of four
5. Use appropriate phrases to describe the nature
of presenting complaints
6. Revisit your presenting complaint , after you
have finished your examination to include
retrospectively all significant findings which
influence the understanding of illness .
15. Chief complaints to be recorded as follows eg.
Chief complaints
• Fever lasting for 5 days
• Rash for 4 days
• Altered sensorium
• Two episodes of left-
sided convulsions
• Not moving the left half
of the body
Duration
10 days back
7 days back
For 5 days
3 days back
For 3 days
Total duration of illness is 10 days. illness started with fever lasted
for first five days only . Rash appeared 7 days back and lasted for 4
days.at present there is no fever& rash. Child had 2 episodes of
left focal seizures on day 8 of illness which were followed by
neurological weakness of the same side. child is having altered
sensorium for last 5 days and not able to move left side of body
for last 5 days
16. Analysis of Each Symptom
1. Onset- Time and nature
2. Duration, frequency, and consistency
3. Evolution and severity
4. Aggravating and relieving factors
5. Associated symptoms
17. Assessment of symptoms
• Onset: (exact date and time of onset)
• Nature of onset (acute , insidious or chronic)
• Duration
• Frequency
• Consistency (intermittent , continuous or remittent)
• Severity
• Evolution (progression ,static, or regression)
• Aggravating and relieving factors
• Diurnal variation
• Associated symptoms
• Response to treatment
18. Fever
• Duration
• Type of onset
• Character
• Degree and severity
• Presence of chills and rigors
• Sweating
• Association with cough, loose motions , burning
micturition etc
• Increased , decreased or stationary.
19. Loose motions
• Duration
• Frequency
• Consistency
• Volume of each stool
• Presence of blood , mucus
• color
• Foul smell
• Relation with food
• Abdominal pain
• Worm infestation
• Fluid intake (type & quantity)
• Frequency & quantity of urine
• Associated with fever, vomiting, dehydration ,
electrolyte imbalance
20. Review of Systems
A. General
(i) Growth and development
(ii) Appetite-if poor correlate with weight changes
(iii) Sleep- adequate, remains sleepy in day
(iv) Physical activity-normal, decreased , overactive ,
hyperactive causing disturbance to others.
(v) Behavior-normal, quite, shy ,out-spoken ,
friendly , quarrelsome with siblings
(vi) School performance
21. B. Gastrointestinal tract & Abdomen: Nausea,
vomiting , abdominal fullness , diarrhea.
Constipation, retro sternal or abdominal pain
,pain during swallowing or defecation, jaundice,
worms in stool, bleeding per rectum.
C. Respiratory System: Cough, dyspnea, stridor,
snoring, wheezing, chest pain, family history of
tuberculosis, asthma, eczema ,smoking
D. Cardiovascular System: breathlessness,
cyanosis, palpitation, edema over feet, cough,
recurrent pneumonia, joint pain, pain in right
hypo chondrium , abdominal distension
22. E. Nervous System: seizures, loss of consciousness,
paralysis , speech problems, vision or hearing
problems, abnormal movements, sensory
disturbances , gait abnormalities , bowel and
bladder disturbances, pain in neck, abnormal
posture, headache, vomit, neck retraction.
F. Urinary System: change in urinary frequency and
amount, color of urine, edema, pain in
micturition , frank pain or mass, nocturnal
enuresis
G. Genital System: age appropriate growth and
changes in primary and secondary sex characters
, menstruation in girls, pain discharge, and
swelling related to genitalia.
23. H. Blood anemia : fatigue , dyspnea ,
palpitation, edema , bleeding from (skin , nose
, GIT), swelling in neck , groin etc , dietary
intake , drugs which may cause bleeding, bone
marrow depression, family history of bleeding
disorder, thalassemia, sickle cell anemia etc.
I. Miscellaneous: skin eruption and itching, joint
pain and swelling, frequent falls and fluid
intake.
26. Past History
1. Prolonged illness
2. Surgery and injuries
3. Hospitalization
4. Diarrhea dysentery, worm infestation
,vomiting .pneumonia , upper respiratory
tract infection .malaria , otitis media, urinary
tract infections, pertussis , diphtheria,
tetanus, tuberculosis, measles, mumps,
chickenpox, allergies
27. Drug and Treatment History
1. Prescribed and non-prescribed
2. Amount and duration
3. Habit forming drugs
4. Surgical treatment
5. Adverse events following drug intake
6. Compliance to prescription
28. Antenatal History
1. Diet , drugs , and diseases of mother
2. Iron and folic acid supplementation
3. Tetanus vaccination
4. Antenatal check-ups
5. Fetal movements and growth
29. History points to be Elicited in
Antenatal Period
A. First trimester:
Ask for history of
1. Fever with rash (TOTCH infection)
2. Swelling in occipital region (occipital adeno -
pathy for rubella)
3. Drug intake
4. Radiation exposure
5. Alcohol / tobacco/substance abuse
6. Bleeding per vaginum
30. B. Second trimester:
Ask for history of
1. Headache , swelling of feet , blurring of vision,
documented hypertension (P/H)
2. Polyurea , polydipsia , deranged glucose readings
(diabetes mellitus)
3. Fetal movements, bleeding per vaginum, blood
transfusion
4. Weight gain
C. Third Trimester:
Ask the history of
1. Maternal fever
2. Bleeding per vaginum (APH, placenta previa)
3. Leaking per vaginum , foul smelling liquor .
4. Diarrhea / urinary problem ( ascending infection)
31. Natal or Birth History
1. Place and mode of delivery
2. Person conducting the delivery
3. Duration of labour
4. Immediate cry.
32. Postnatal History
1. Birth weight
2. Preterm or full-term or post-term
3. Resuscitation requirement
4. Initiation of breathing
5. Respiratory difficulty, cyanosis, jaundice,
feeding difficulty
33. National Immunization Schedule 2017
Age Vaccine
Birth BCG,OPV (0),Hep B (0)
6 weeks DPT (1),OPV (1),Hep B(1) ,HiB (1)*, IPV intradermal
10 weeks DPT (2),OPV (2),Hep B(2) ,HiB (2)*
14 weeks DPT (3),OPV (3),Hep B(3) ,HiB (3)*. IPV intradermal
9-12 months Measles vaccine (1)
16-24 months Measles vaccine (2)**
16-24 months DPT (booster 1),OPV (4)
5 yrs DPT (booster 2)
10 yrs TT
16 yrs TT
In addition,Japanese encephalitis (JE), vaccination is provided in endemic districts, in two
doses schedule (Ist) dose: 9-12 month age: 2nd dose 16-24 month age.
* Hib (given in pentavalent vaccine containing Hib + DPT+Hep– B) in selected states. **
Second dose of measles vaccine can also be given as MMR ( measles, mumps, rubella )
vaccine
34. Immunization History
• To ascertain whether child is fully immunized
• Vaccinated child is unlikely to suffer from that
disease
• Presenting problem may be related to recent
vaccination e.g., axillary lymphadenitis after BCG,
Mild rash & fever after measles vaccination , high
fever, convulsion following DPT,
• Write down name of vaccine administered, when
by whom, any missing dose and adverse reaction
• See BCG scar ,New vaccines received, OPV during
pulse polio immunization.
35. Developmental History
• Ask for developmental milestones the child
has achieved.
• Assess in 4 fields:
(i) Motor (gross motor & fine motor)
(ii) Adaptive
(iii)Language
(iv)Personal-social fields.
36. Nutrition and Dietary History
1. Breastfeeding
2. Complimentary feeding
3. Quality and quantity of feeds
4. protein and caloric intake per day
5. Diet balanced or not
6. Fast food
7. Vegetarian or mixed
8. Food beliefs fads, and allergies
37. Nutrition and Dietary History
Newborns and infants below 6 months
Time of initiation of breastfeeding , frequency and
duration of feeds, exclusive breastfed or not ,
expressed breastmilk , weather started top feeds.
Infants above 6 months-24 months:
Time of initiation, quality, thickness ,frequency
,quantity of complimentary foods .breastfeeding
continued or not.
From 2 yrs onwards:
Record all food taken in 24 hrs. Calculate total
proteins and calories consumed
38. Family History and Pedigree Charting
1. Type of family
2. Total members with relation
3. Age of mother and father
4. Name ,age , and sex of siblings
5. Health and diseases in members
6. Abortion, stillbirths
7. Death in close relatives
8. Tuberculosis , diabetes mellitus
9. Obesity, hypertension, heart disease
10.Pedigree up to 3 generations
39. Degree of consanguinity
Degree of
consanguinity
Percentage of
shared genes
Relationship
First degree 50% Parents;
Children and
Siblings
Second degree 25% Grandparents
Uncles , aunts
Nephews, nieces
Half-siblings
Third degree 12.5% First degree cousins
Second degree cousins
40. Social History
• Useful determinants of Socioeconomic status
are education and occupation of the family head
and monthly income,
• Nuclear or joint family
• Per capita income,
• Housing conditions, toilet facilities , sewage
disposal, water source,
• School attending ,rank in class
• Interactive behavior ,habits ,hobbies , interests,
41. Kappuswamy socioeconomic status scale
Parameter Scale
Education of family head
Illiterate to Professional 1-7
Occupation of family head
Unemployed to Professional 1-10
Income of family head per month
<1800 to above Rs. 36017 1-12
Total score ( A+B+C) (Socioeconomic class)
26-29 UPPER (I) 5-10 UPPER LOWER (IV)
16-25 UPPER MIDDLE (II) <5 LOWER (V)
11-15 LOWER MIDDLE (III)