Professional Documents
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1 Introduction To Pediatrics
1 Introduction To Pediatrics
04/05/2024
INTRODUCTION TO PEDIATRICS NURSING
04/05/2024
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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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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Definition…
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Origin and history of pediatrics:
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Cont’d
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Role of Pediatric Nurse
Large numbers:
High mortality:
High Morbidity:
Vulnerable due to developmental drawbacks:
Preventable disease are common in children
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Definitions of some Terms (Age
Classifications)
Infancy Middle Childhood
Neonate
School age
Birth to 1 month
Infancy
6 to 12 years
1 month to 1 year Late Childhood
Early Childhood
Adolescent
Toddler
1-3 years
13 years to
Preschool approximately 18 years
3-6 years
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Terms from child health indicators:
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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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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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UN Convention…
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Promotive, Preventive and Curative
aspects of Child Health:
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Cont’d
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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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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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Cont’d
Tertiary prevention
Aim:- rehabilitation (e.g. polio mellitus), to prevent
deformities.
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Nursing process in the care of children
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Steps in nursing process
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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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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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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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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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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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Pediatric History
Taking And Physical
Examination
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Pediatric History And Physical
Examination
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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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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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Cont’d
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Content Differences
Peri-natal history
Developmental history
Social history
Immunization history
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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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History…
Perinatal history:
score or did the new born cried immediately after birth any
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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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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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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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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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History...
• Review of systems:
• Check list of symptoms
• Almost similar with adults
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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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Cont’d
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Cont’d
General appearance
State of alertness/ level of consciousness.
Awareness to environment
Facial expression
State of nutrition
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Vital signs
Temperature
Heart Rate
Respiratory Rate
Pulse Oximetry
Blood Pressure
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Cont’d
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Vital signs based on the age of the
patient:
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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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Stadiometers for Measuring Children and
Adolescents
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Skin, Hair, and nails
Skin: - Color, elasticity, texture, rash
Hair: - Texture, color, distribution, areas of hair loss.
Nails: - Color, texture, shape.
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Head and neck
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Cont’d
Ears:- size, position, deformity, discharge, ext. canal &
Tympanic membranes (shape, color, position, light
reflex).
Mouth:- mandible, size, lips, tongue, gum, teeth,
palate, throat and uvula.
Neck:- Length, pulsations, thyroid, LN
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Lungs
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Cardiovascular
Pulses
Apical pulse - varies with age
Rate and rhythm
Sinus arrhythmia common
Functional murmur
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Abdomen
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Cont’d
Look For:
Masses, lesions, discolorations
Distention, fluid
Liver, spleen, kidneys
Abdominal aorta
Large bowel
Bladder
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Spine
Lumbar lordosis in toddler
Screen at all ages for scoliosis,
Look for shoulder/scapular height, spine, arm/torso
triangle, pelvis tilt, height of posterior ribs (spine flexed)
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Musculoskeletal
• Gait
• Symmetry
• Strength
• Range of motion
• Dyskinetic movements
• Joint mechanics
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Developmental
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Thank You