UNIT -I

INTRODUCTION TO
PEDIATRIC NURSING

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 Session objective
• At the end of this session students are expected to
– Define pediatric nursing
– Describe goals and principle of pediatric
nursing
– Identify role of pediatric nurse to the
hospitalized child developmental stage of child
– Describe pre and post operative care of child
– Explain common pediatric procedures

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 Cont...
• 'Pediatrics' comes from the Greek words
– 'pedia' which means child,
– 'iatrike' which means treatment and
– 'ics' which means branch of science.

• This means Pediatric nursing is the science

of child care and scientific treatment of
childhood.
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 Cont...
• The study of pediatrics began in the 1800s,
under the influence of a Prussian-born
physician, Abraham Jacobi (1830–1919), who
is referred to as the Father of Pediatrics.

• Jacobi broke new ground in the scientific and

clinical investigation of childhood diseases.

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 Cont...
• In the late 1800s nursing became a trained
profession in England with standards,
registrations, and regulations led by Florence
Nightengale. The United States quickly
followed.
• The very first hospital dedicated to helping
and treating children was founded in
Philadelphia in 1855.

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 Cont...
• The purpose of this hospital was to
provide excellent child care and to
decrease child morality.
• Very soon after this many more children
hospitals were opened in major cities all
over the United States.

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 Cont...
• During the early 1900s children that had
communicable diseases were not allowed to be
admitted to these children hospitals because the
mortality rates were so high.
• Because of this problem there was a rise in the
number of nursing schools in the country.
• These classes brought about a huge number of
nurses interested in pediatrics.

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 Qualities of Good Pediatric
Nurse:
 Good observer.
 Honest and truthful.
 Empathetic, kind, patient and cheerful.
 Love to work with children.
 Interested in family care.
 Able to provide teaching to children and their
families.

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 Hospital environment for the sick child
• Pediatric unit consists of the following facilities.
– Few beds in a room
– Sinks & latrine should be child & adult size.
– Playroom and recreation facilities should be
provided.
– Children should be placed in the ward according to
their age and their disease.
– Small & critically ill children have placed very near
to the nurse stations.
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 The role of pediatric nurse in caring for
hospitalized child cont’d
• Monitoring of vital signs
• Administration of fluid ,electrolytes and drugs
• Diagnostic and therapeutic procedures.
• Nursing procedures
• Resuscitation skills
• Vaccination
• Prevention of nosocomial infection
• preventing or minimizing separation
• Minimizing loss of control
• Preventing or minimizing fear of bodily harm and
mutilation
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 Principles of pre and post-operative care

Definitions
• Preoperative phase – begins when the decision to
have surgery is made and ends when the client is
transferred to the OR table.
• Intraoperative phase – begins when the client is
transferred to the OR table and ends when the
client is admitted to the post anesthesia care unit
(PACU).
• Postoperative phase - begins with the admission
of the client to the PACU and ends when the
healing is complete.
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 Preoperative nursing care
 Pre-operative teaching
 Pre-operative protocols
 Informed consent
 Patient preparation
– NPO Status
– Intravenous Access
– Bowel preparation
– Pre-operative Medications.
– skin preparation
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 INITIAL POSTOPERATIVE ASSESSMENTS
• Level of consciousness.
• Vital signs.
• Effectiveness of respirations.
• Presence or need for supplemental oxygen.
• Location of drains and drainage characteristics.
• Location, type, and rate of intravenous fluid.
• Level of pain and need for analgesia.
• Presence of a urinary catheter and urine volume.
• Skin integrity
• Condition of surgical wound
• Position of patient

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 Postoperative Management

• Maintain a patent airway

• Stabilize vital signs

• Ensure patient safety

• Mobility and self-care

• Recognize & manage complications

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 Postoperative Nursing Care
• When caring for post-surgical patient, think of
the “4 W’s”

1. Wind: prevent respiratory complications

2. Wound: prevent infection

3. Water: monitor I & O

4. Walk: prevent thrombophlebitis

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 Common Pediatric nursing
Procedures
Bathing
Feeding
Urine Collection
Venipuncture
Lumbar Puncture
Oxygen Therapy
Suctioning
Intake and Output
Medication Administration
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 PEDIATRIC
HISTORY TAKING
AND
PHYSICAL EXAMINATION

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 Pediatric history
• Identification
• Name ,age ,sex,name of parents ,date of exam ,
religion and residence
• Chief complaint
• What is the reason for the health visit
• History of present illness
• Chronology , elaboration, associated symptoms ,
duration, evident negatives, aggravating and relieving
factors should be included
• Past medical history
• Review of systems
• Check list of symptoms
• Social and family history
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 Nutritional history
• Type of feeding
– Duration of exclusive breast feeding ,time of
initiation, frequency, total duration of breast
feeding
• 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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 Immunization
• 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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 Perinatal history
• Antenatal follow up of the mother
• Any illness during pregnancy like hypertension,
diabetes mellitus
• Immunization for tetanus. If there is neonatal
tetanus
• The onset ,duration of labor or rupture of
membrane (ROM), the mode of delivery, the
birth weight ,APGAR score or did the new born
cried immediately after birth
• Any problems during neonatal period like
jaundice

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Developmental history
• Ages at which milestones were achieved
and current developmental abilities
• Smiling, rolling, sitting alone, crawling,
walking, running, 1st word, toilet training,
riding tricycle, etc (see developmental
charts)
• School-present grade, specific problems,
interaction with peers
• Behavior - enuresis, temper tantrums,
thumb sucking, pica, nightmares etc

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 P/E
Includes;
• General appearance
• Vital signs(v/s and anthropometric)
• HEENT
• LGS
• CVS
• RS
• GIS
• GUS
• MSS
• IS
• NS
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Infant Reflexes

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What are Infant Reflexes?
• Involuntary stereotyped movement responses to
a particular stimuli.

• Dominant movement form during the last 4

months of prenatal life and first 4 months after
birth.

• Occur subcortically (below the level of the higher

brain centers)

• Examples?

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Why is the study of infant reflexes important?

• Dominant form of movement for last 4

months prenatally and first 4 months
postnatally.
• Primitive reflexes critical for human survival.
• Postural reflexes believed to be foundation for
later voluntary movements.
• Appearance and disappearance helpful in
diagnosing neurological disorders.
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 Role of the Reflexes in
Survival
• Human infants essentially helpless.
– Highly dependent on their caretakers and reflexes for
protection and survival.

• Primitive reflexes occur during gestation or at birth

and most are repressed by 6 months of age.

• Primitive reflexes are important for protection,

nutrition, and survival.

• Examples?

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Role of Reflexes in Developing Future Movement
• Postural reflexes are related to the
development of later voluntary movement.
– Reflexes integrated, modified, and incorporated
into more complex patterns to form voluntary
movements.
– Automatic movement is “practice” for future
voluntary movements.
– Some believe reflexes may not be related to future
motor development.
– Examples?
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 Primitive Reflexes
• Palmar Grasp
• Sucking
• Root
• Moro
• Startle
• Babinski
• Others

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 Primitive Reflexes ~ Palmar Grasp
Stimulus / S: Palm stimulated
Response R: 4 fingers (not thumb) close
Duration 5 months gestation - 4 months postpartum
Concerns No palmer grasp may indicate neurological
problems (spasticity)
Other One of the most noticeable reflexes
May lead to voluntary reaching / grasping
May predict handedness in adulthood

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 Primitive Reflexes ~ Sucking
Stimulus / S: touch of lips
Response R: sucking action
Duration In utero - 3 months postpartum
Concerns No reflex problematic for nutrition
Other Often in conjunction with searching reflex

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 Primitive Reflexes ~ root
Stimulus / S: touch cheek
Response R: head moves toward stimuli
Duration Weeks prenatal - 3 months postpartum
Concerns No reflex problematic for nutrition
No reflex or lack of persistence may be sign
of CNS or sensorimotor dysfunction.
Other Often in conjunction with sucking reflex.
Contributes to head/body-righting reflexes.

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 Primitive Reflexes ~ Moro
Stimulus / S: Suddenly but gently lower baby’s head
Response S: Hit surface beside baby
R: Arms and legs extend
Duration Prenatal – 4-6 months postpartum
Concerns May signify CNS dysfunction if lacking
May signify sensory motor problem if
persists
May delay sitting & head control if persists
May indicate injury to one side of brain if
asymmetical
Other Reaction time increases with age
Preceeds startle refle
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Primitive Reflexes ~ Moro

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 Primitive Reflexes ~ Startle
Stimulus / S: Same as Moro
Response R: Arms and legs flex
Duration 2-3 months after Moro disappears – 1 year
Other Less severe startle reflexes elicited through
lifespan

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 Primitive Reflexes ~ Plantar Grasp
Stimulus / S: Touching the ball of foot
Response R: Toes grasp
Duration Birth – 1 year
Other Must disappear before the baby can stand
or walk.
Issue of shoes versus no shoes?

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 Primitive Reflexes ~ Babinski
Stimulus / S: Stroke bottom or lateral portion of foot
Response R: Great toe turns downward
Duration Birth – 4 months
Concern Test of the pyramidal tract (i.e. ability to
perform conscious / voluntary movement)

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 Postural Reflexes
• Stepping
• Crawling
• Swimming
• Labyrinthine
• Others

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 Postural Reflexes ~ Stepping
Stimulus / S: Infant upright with feet touching surface
Response R: Legs lift and descend
Duration After birth – 5-6 months
Concerns Essential forerunner to walking
Other Sometimes called walking reflex
Developmental changes in reflex over time

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 Postural Reflexes ~ Crawling
Stimulus / S: Prone position on surface, stroke
Response alternate feet
R: Legs and arms move in crawling action
Duration Birth – 3-4 months
Concerns Precursor to later voluntary creeping

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 Postural Reflexes ~ Swimming
Stimulus / S: Infant held horizontally
Response R: Arms and legs move in coordinated
swimming type action
Duration 2 weeks after birth – 5 months
Other Recognition of reflex led to popularity of
infant swim programs

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 Postural Reflexes ~ Labyrinthine
Stimulus / S: Baby held upright, tilted in one direction
Response R: Baby tilts head in opposite direction
Duration 2-3 months – 1 year
Concerns Related to upright posture
Other Also considered primitive reflex

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 END !!
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