GROUP MEMBERS:
COLOMA, Maricar Jeanne
DULAY, Sheina Lyn
FALAR, Cheerie
GALENG, John Nicole
GUINA, Robledo
ITARALDE, Katheryn Joy
LUCINA, Gellie Rose Kristine
SALVADOR, Aaron
LORMA COLLEGES
College of Nursing
City of San Fernando
PEDIATRIC NURSING
A Case Study Presented
To the Faculty of Nursing Department
LORMA COLLEGES, City of San Fernando, La Union
In Partial Fulfillment of the
Requirement in Related Learning Experience in
NCM-102
Submitted by:
B.S.N.2 Section-6
INTRODUCTION
For the fulfillment of requirements in Nursing Care and Management –
102 lectures, we conducted a case study about pediatric nursing. In order to
accomplish this case, I and my group mates used our efforts to know the
general conditions of the client; prior to the interview we already secure
consent to the family of the client regarding the study and as a respect for the
privacy of the client, instead using of his full name, we used his initial MLO as
a subject.
Early Child Health Care .Children have not always been in the valued
position they hold now in most families. In the past the well being of children
depended on the economic and cultural conditions of the society. In times of
economic instability children were viewed as expendable. For example in
Europe, after the weakening of the Roman Empire children were sold to pay off
parent’s debt. In other societies children were greatly valued. In Roman and
Greek civilizations children were educated and all their physical needs were
met. Also in North America during the 17th and 18th centuries, when
European settlements were trying to expand, children were valued because of
the desire to increase the population.
Development of Child Health Care .Child health care came from the
recognition that the emotional needs of hospitalized children usually weren’t
met. Children were very often prepared improperly for tests and procedures.
Also visiting was very controlled and even discouraged. Child health care now
recognizes and respects the pivotal role of the family in the lives of both well
and ill children. It supports the families in their natural care giving roles and
parents and professionals are viewed as equals in a partnership committed to
providing the best health care for the child.
` Pediatrics is the study and care of sick and healthy children. The word
pediatrics comes from the Greek and means “child-cure.” Pediatrics includes
the growth and development of a person from birth through adolescence. It also
works with the prevention, diagnosis, and treatment of disorders affecting
children.
Becoming a Pediatric Nurse .Pediatric nurses are registered nurses who
specialize in caring for children. They graduate from a nursing school within a
college or university and then take an exam called the NCLEX to become a
nurse. All nursing students learn to care for childrsen through classes and
clinical experiences and to specialize in pediatrics a nurse will apply to work in
a site that serves pediatric patients. These sites usually offer classroom and
clinical experience directed to the unique characteristics of the children. After
gaining experience the pediatric nurse will then take an exam to become a
Certified Pediatric Nurse. The nurse can then pursue advanced education to
earn a master’s degree in nursing and become a Pediatric Nurse Practitioner or
Clinical Nurse Specialist in Pediatrics.
The Pediatric Nurse. Child health care nurses today must be able to
communicate and teach children of different ages and levels of development
and education. They have to be able to think critically and use the nursing
process. The nursing process consists of five steps, which include: 1.
Assessment 2. Nursing diagnosis 3. Planning 4. Implementation of the plan 5.
Evaluation. In a study done by the National Certification Board of Pediatric
Nurse Practitioners and Nurses, to identify the roles and responsibilities of a
typical pediatric nurse, they found that some of the most frequent activities
include: maintaining privacy and confidentiality of the patient and family,
differentiating normal and abnormal physical findings, serving as a child
advocate, involving the family and child in plan of care, determining needs
based on symptoms, and medicating based on age appropriate guidelines."
"Pediatric nurses may practice in many different settings and in a number of
different roles." "The pediatric nurse serves as not only a caregiver but also a
teacher, collaborator, researcher and child and family advocate. The nurse as a
caregiver takes care of infants, children and their families in times of illness,
injury, recovery and wellness. The nurse will look over the child’s health
history, assess the child’s needs, monitor the growth and development of the
child, and provide treatment and care. Pediatric nurses are also teachers. They
prepare the child for procedures, surgery, and hospitalization by telling them
what happens and what to expect. They also teach parents how to provide care,
watch for important signs, and increase the child’s comfort. Nurses also teach
both children and parents about immunizations, safety, health care,
socialization and discipline. Pediatric nurses are also collaborators. They work
together with other members of health care, such as dietitians, social workers,
physicians, and others, to take care of the child’s needs. A nurse is also a
researcher; they research last techniques and cures for illnesses. Lastly they
serve as an advocate for the child and also the family. Sometimes the wishes
and needs of the child and family are ignored in the effort to treat and cure and
it is the nurse’s job to make sure the rights of the child and family are met.
OBJECTIVES
Patient - Centered objective
To impart knowledge and information to the family about child health
care.
Student Nurse – Client centered objective
To establish nurse-patient relationship in order to have an efficient
means of care and develop cooperation of the family.
To promote a student-client relationship in developing comprehensive
nursing process plan for maintaining the health of the infant.
Student-Centered objective
For the students to be able to impart some health teachings to the family
about the care of the infant.
To be able to learn and enhanced the knowledge of the students about
the care of pediatric clients.
PATIENT PROFILE
A.PERSONAL BACKROUND
Patient MLO, male is 6 months old. He was born on July 18, 2009
residing at San Francisco Sur, Sudipen, La Union. He has one older brother
His religious affiliation is Roman Catholic and belongs to a nuclear family. His
present weight is 6 kg.
B. SOCIO-ECONOMIC
His mother is a housekeeper, while his father is a farmer. Their total
income per month is 2,000 pesos. Their residential house is located just along
the highway. They live in semi-concrete house with one bedroom, comfort
room, and a small kitchen.
C. MEDICAL HISTORY
Patient MLO was born via normal spontaneous delivery at Bungol
Hospital. His birth weight is 2.8kg. He already received in their center the
following vaccination; BCG, HEPA B1,HEPA B2, DPT1, DPT 2, OPV 1, and OPV
2.During his first 4 months he was purely breastfed by his mother and at his
5th months up to now he was fed partially of cerelac. He was also taking celin
as vitamin C.
Developmental Milestone
Patient MLO is a 6 months old. During his 1st month of life the mother
told us that her baby can already lift his head and turned it to the side when in
prone position, she also stated that her baby hold his hands in fist so tightly
and permanently grasp all the object that he can touch, it is an evidence that
patient MLO has strong grasp reflex.
In 2nd months of age patient MLO can raised his heads and maintain the
position, but he cannot raise his chests high enough to look around yet. He
can also hold his fairly steady when sitting up, during this month his grasp
reflex is still present but unlike in the 1st month which holds object
permanently, now patient MLO grasp an object for only a few minutes before
dropping it.
In 3rd months of age his head, legs, and spine extend. When the head is
depressed, the hips, knees and elbow flex, so it means that landau reflex is
present. He lifts his head and shoulder well off the table and looks around
when prone. The mother also observed that his baby try to reach all attractive
objects that he can see.
In 4th months of age he can lift his chests off the bed and look around
actively, turning his head side to side. He also brings his hand together pulling
his shirt and when he has any object in his hand, he keep on shaking it for a
long time.
In 5th months of age he can straighten his back when held propped in a
sitting position. He rests his weight on the forearms when prone. Moro reflex is
fading.
In 6th months of age he rests his weight on hands with extended arms. He
can rest raise his chests and upper part of his abdomen off the table. He can
now sit momentarily without support. His grasping has advanced to a point
where he can hold objects in his both hands. He can hold a spoon and started
to learned feed himself. Moro, palmar grasps, and the tonic neck reflex have
completely faded.
PHYSICAL DEVELOPMENT:
General survey:
Head:
Chest:
Abdomen:
Length:
Temp.:
1. SKIN- normal, no allergies found, no lesions/edema. Soft and warm to touch
2. EYES- the outer canthus of the eyes are aligned with the pinnas. The
conjunctiva is clear. Pupil of the eye is equally round and reactive to light
accommodation. The eye lashes are equally distributed. Free of discharges and
redness.
3. NOSE- nares are patent. No presence of discharges or tenderness.
4. MOUTH- lips are moist. Tongue and buccal mucosa appears pink and moist.
No lesions present.
5. HEAD- symmetry and normocephalic. No lesions found.
6. THROAT- no difficulty of swallowing/sorethroat
7. EARS- no discharges found and equal in shape
8. Thorax and lungs- no adventitious sounds heard upon auscultation on both
lung fields.
9. BREAST- flat and symmetrical. No discharges found, no lesions nor edema
noted
10. ABDOMEN- umbilicus is pink, no discharges, no odor, and no redness.
Soft upon palpation, no masses noted and no tenderness
11. MALE GENITAL- penis is found. The urinary meatus is found at the tip of
the penis. No lesions, no redness found. The foreskin is retractable.
12. ANAL- anus is patent and moist. No hairs, no lesions found.
13. MUSCULOSKELETAL- normally developed. The feet and legs are
symmetrical. No lesions, edema, or redness found.
COGNITIVE DEVELOPMENT
The infant learns to initiate, recognize and repeat pleasurable experience
from environment, memory traces are present; the infant anticipate familiar
events (patient coming near him and pick him up). At this stage the infant that
objects in the environment─ bottles, blocks, bed or even a parent─ are
permanent continue to exist even though they are out of sight or change in
some way. The good toy at this stage is peek-a-boo.
MOTOR DEVELOPMENT
▪Fine Motor Development
The infant drop one toy when a second one is offered for the same hand.
Te infant can hold a spoon and start to feed his own self. Moro, palmar grasp
and the tonic neck reflex are completely faded.
▪Gross Motor Reflex
The infant can move his chest and the upper part of his abdomen off the
table. The infant sit momentarily without support. They anticipate being picked
up and reach up with the hands from this position. The infant often sit with
their legs spread and their arms stiffed between them, hands on the floor as a
prop. The infant support nearly their full weight when in a standing position.
EMOTIONAL DEVELOPMENT
The infant is increasingly aware of the difference between people who
regularly care for them and strangers. He begin to draw back from unfamiliar
people.
PSYCHOSOCIAL DEVELOPMENT
The infant is learning confidence of learning to love. The infant
discomfort are quickly remove, played with and come to view the world as a
safe place and people as a helpful and dependable. The infant is become fearful
and suspicious of the world and f people when their care is consistency,
inadequate or rejecting.
Health Promotion
A. Nutrition
Nutritional allowances for a newborn need to take into account both total
calories and total fluid intake.
Dietary Reference intakes for Newborns and infants
Nutrient Birth to 6 months
Calories kg x 110
Protein (g) kg x 2.2
Vitamin A 400
Vitamin D 5
Vitamin E (mg TE) 4
Vitamin C (mg) 40
Folate 65
Niacin (mg NE) 2
Riboflavin (mg) 0.3
Thiamin (mg) 0.2
Vitamin B6 (mg) 0.1
Vitamin B12 0.4
Calcium (mg) 210
Phosphorus (mg) 100
Iodine (mg) 110
Magnesium (mg) 30
Zinc (mg) 2
Iron (mg) 0.27
Calories
Growth in the neonatal period and early infancy is more rapid than at any
other period of life. Therefore, the caloric requirements exceed those at any
other age. An infant up to 2 months of age requires 110 to120 calories per
kilogram of body weight (50 to55 kcal/lb) every 24 hours to provide an
adequate amount of food for maintenance and growth. After 2 months of age,
the amount gradually declines until the requirement at 1 year is 100 kcal/kg
(45 kcal/lb) per day. The actual caloric requirement, of course, depends on an
infant’s individual activity level and growth rate.
Protein
Protein, necessary for the formation of new cells, has a high requirement
during the newborn and infancy periods to provide for rapid growth of new cells
as well as maintenance of existing cells. The nutritional allowance of protein for
the first 2 months of life is 2.2 g per kilogram of body weight. Unaltered cow’s
milk is not recommended for newborns because it contains about 16% of its
calories as protein, whereas human milk contains about 8%.
Fat
Linileic acid, an essentials fatty acid necessary for growth and skin
integrity in infants, is found in both human milk and commercial formulas.
Use of fat-free milk for long periods can result in linoleic acid deficiency.
Therefore, parents should not feed fat-free milk as a means of controlling
obesity in young infant.
Carbohydrates
Lactose, the disaccharide found in human milk and added to commercial
formulas, appears to be the most easily digested of the carbohydrates, lactose
also improves calcium absorption and aids in nitrogen retention. Adequate
lactose also allows protein to be used for building new cells rather than for
calories, encouraging normal water balance and preventing abnormal
metabolism of fat.
Fluid
It is important to maintain a sufficient fluid intake in newborns, because
their metabolic rate is so high. In addition, a newborn’s body surface area is
large in relation to body mass. This means that a baby loses water by
evaporation much more readily than an adult does. Because the kidneys of a
newborn cannot yet capable of fully concentrating urine, a newborn cannot
conserve body water by this mechanism to prevent dehydration. A newborn
needs 150 to200 mL/kg (2.5 to 3.0 oz/lb) of water intake every 24 hours.
Minerals
A number of minerals are particularly important to early growth.
Calcium
Calcium is important mineral in the newborn period because of its
contribution to bone growth. Because milk is high in calcium, tetany resulting
from a low calcium level seldom occurs in infants who suck well, regardless of
whether they fed human milk or commercial formula.
Iron
It is unnecessary to provide iron supplementation for the breast-fed
infants, because breast milk usually provides an adequate amount of iron.
Flouride
Fluoride is essential for building sound teeth and for preventing tooth
decay. Because teeth grow into their primary from during pregnancy, it is
important for mothers to drink fluoridated water during that time. If mother
breast-feeding and a source of fluoridated water is not available, a fluoridated
supplement, 0.25 mg daily, may be given to the infant beginning at 6 months
of age.
Vitamins
Vitamins additive are unnecessary for a formula fed infant because
vitamins A, C and D are incorporated into commercial formula. Because
vitamins are naturally included in breast milk, supplementation is not
necessary for breast-fed infants.
B. Socialization
Patient MLO is 6 months old. He doesn’t have much activity yet. At his
age thumb sucking is present. He get sleep most of the time. He is in the stage
of separated anxiety which he only want to be with those people whom he
always with. He is afraid from strangers. He can already crawl, sit, grasp things
that he saw and he can also walk by the support of his mother. He can slightly
hold his bottle when he is feeding.
C. Wellness and Health
Patient MLO already complete his vaccines except measles. He is suffering
from cough and colds. Her mother gave him Vitamin C to protect him from
other illness.
Evaluation
The mother of pt. MLO told us that in the first 2 months she doesn’t know
that she is pregnant. She told us that she only knew that she is pregnant when
the fetus is already 3 months old. Starting on that month she already eat lots
of fruits, because her mother told her so and the thing there is that those fruits
are also good source of vitamins and minerals needed for her good health
during her pregnancy. In between 4 to 5 months she already feel the fetus
kicking, and mostly of it happens at night. She doesn’t exercise most of the
time. She just live her life the same as she’s not pregnant. When the fetus is 9
months and ready to deliver, her husband didn’t buy any clothes because they
don’t know if the fetus is boy or girl, because her wife did not undergo
ultrasound.
During the labor, she consumed 48 hours of delivering the fetus, this is
because its her first baby and she did not perform any exercises when she was
pregnant. Mrs. M.O. already know how to breastfeed her baby, when we assess
the baby, it has a good attachment. The mother told us that when her baby is 3
months old she started to make it stand, we also try to perform the
walking/dancing reflex and our pt really can stand a little. The mother also
started feeding the infant with cereals, and some solid foods. The
developmental period of the infant is rapid, the infant can also grasp our finger
when we are doing our physical assessment on him. The infant always sucks
his hand, and we also told the mother that this activity of an infant is normal.
We advise the mother to give all essential vitamins specially vitamins c and
others. We also tell to the mother to complete all vaccines of the infant. We told
the mother to let the child suck his hands and not to tolerate it. We also advise
the mother to read some bedtime books during bedtime of the infant. We advise
the mother to give toys for her baby specifically those soft puzzle block toys
with letters and numbers on it, this will help develop the cognitive ability of the
infant at early age.
During our visit, the group was able to establish rapport and gain
knowledge about the patient and family’s activities of daily living. Thus,
meeting our student nurse-patient objective.
Likewise, the group was able to impact necessary health techniques as
anticipated to be practice at home, such as the importance of eating fruits and
vegetables, proper eating habits, and monitoring developmental milestones.
The group was able to meet our patient-centered objective since we were
able to let the parents understand about child health care.
Moreover, the group has been able to help the parents develop a working
plan based on knowledge of home and environmental conditions through the
health teachings being imparted. Thus, we were able to meet our student-
centered objective.
