Pediatrics

DEMLIE Z.(BSc, MSc)

INTRODUCTION TO PEDIATRICS NURSING
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
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.
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.
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.
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.
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
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.
Children need special health care
because:

 Large numbers:
 High mortality:
 High Morbidity:
 Vulnerable due to developmental drawbacks:
 Preventable disease are common in children
Definitions of some Terms (Age
Classifications)
 Infancy  Middle Childhood
 Neonate
 Birth to 1 month
 School age
 Infancy  6 to 12 years
 1 month to 1 year
 Late Childhood
 Early Childhood
 Toddler
 Adolescent
 1-3 years  13 years to
 Preschool
approximately 18 years
 3-6 years
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.
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
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
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).
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.
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.
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:
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
Cont’d

Tertiary prevention
 Aim:- rehabilitation (e.g. polio mellitus), to prevent
deformities.
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.
Steps in nursing process
Steps in nursing process…

Assessment
 Data collection
 Subjective data-through interview of a child or family
 Objective data from physical assessment or lab
findings.
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).
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
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.
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.
Pediatric History
Taking And Physical
Examination
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
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.
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.
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.
Content Differences
 Peri-natal history
 Developmental history
 Social history
 Immunization history
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…
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

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
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?
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
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.
History...
• Review of systems:
• Check list of symptoms
• Almost similar with adults
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).
Cont’d

 Specific techniques similar to adult

 Inspection
 Palpation
 Percussion
 Auscultation
Cont’d
General appearance
 State of alertness/ level of consciousness.
 Awareness to environment
 Facial expression
 State of nutrition
Vital signs

 Temperature
 Heart Rate
 Respiratory Rate
 Pulse Oximetry
 Blood Pressure
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.
Vital signs based on the age of the
patient:
Anthropometric Measurements (Wt.,
Ht, HC)
 Always use growth charts and indicate the percentiles.
 Use appropriate scale for age to measure the weight.
 naked/Unassisted 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.
  
                                       
  
Stadiometers for Measuring Children and
Adolescents
Skin, Hair, and nails
 Skin: - Color, elasticity, texture, rash
 Hair: - Texture, color, distribution, areas of hair loss.
 Nails: - Color, texture, shape.
Head and neck

 Head: - size, shape, fontanelles, sutures, craniotabes

 Face: - shape, complexion (pallor, cyanosis, jaundice),
Edema.
 Eyes: - degree of slanting, sclera, eyelids, spacing,
epicanthal folds, eyelashes, sunken, sunset, discharge,
redness.
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
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)

Cardiovascular
 Pulses
 Apical pulse - varies with age
 Rate and rhythm
 Sinus arrhythmia common
 Functional murmur
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
Cont’d
Look For:
 Masses, lesions, discolorations
 Distention, fluid
 Liver, spleen, kidneys
 Abdominal aorta
 Large bowel
 Bladder
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)
Musculoskeletal
• Gait

• Symmetry

• Bulk and tone

• Strength

• Range of motion

• Dyskinetic movements

• Joint mechanics

• Joint swellings and noise

Neurologic

 Similar to adult  Level of consciousness

 Mental status – cognitive
appropriate
 Cranial nerve examination
 Sensory examination
 Motor examination
 Deep tendon reflexes
Developmental

 Majority done by observation

 4 domains (Gross motor, fine motor, hearing/speech,
social)
 Express in developmental age
Thank You

by DEMLIE ZEWDU