peds. .pptx

Pediatrics

1. PEDIATRIC NURSING HISTORY TAKING

2. OBJECTIVES At the end of this presentation students should be able :- Define history taking Understand strategies on history taking Explain the components of history taking

3. INTRODUCTION Pediatric history taking This is the process of obtaining relevant information from the patient or caregiver for the purpose of making a diagnosis The goal is to determine why the patient/parent came to see the physician A correct diagnosis lies on a good history and physical examination Taking a history is an art that comes with time Watch how others do it But find what works for you

4. CONT…. Pediatric history is different from adult history because parents are the main historian variability on developmental stages perinatal events are important immunization status during child’s development is important

5. STRATEGIES FOR HISTORY TAKING The following strategies are helpful: Make self-introduction (name, title or position). Explain the purpose of the interview Direct the focus of the interview with open-ended questions. For example: “Tell me what problems led to Baraka's admission”. Use close-ended questions or directing statements to clarify information.

6. Cont … Close-ended questions – to clarify the information; example “Was Baraka having fever together with convulsions?” “Was Baraka coughing since he had fever” Provide privacy and remove as many distractions as possible during the interview Ask one question at a time Take into consideration child’s developmental stage let the children speak school-age and older children

7. Cont …. Ensure that the informant does not get out of the main subject of discussion Refer parents by their name, instead of by title. for example, you could say, “Is Mr. Ramathani here?” instead of “Is your husband here?” or “Is the baby’s father here?” “Husband”, “wife”, “father,” or “mother” may not be appropriate to some parents

8. Cont … It is important to establish a rapport with the child. if possible, make a positive statement to the child, such as, “that is a really nice doll you have” or “what an interesting haircut!” Use an interpreter to improve communication when not fluent in the family’s primary language

9. COMPENTS 1.General information 2. Chief complaint 3. History of present illness 4. Past health history Prenatal history Birth or delivery history Postnatal history

10. CONT.. 5. Feeding history 6. Immunization history

11. GENERAL INFORMATION Biographic data date of interview name age, birth date and sex referral source if appropriate relationship of the child and informant Contacts Address, and telephone numbers of the informants

12. CHIEF COMPLAINT Is the reason for hospital admission or visit to a healthcare setting Stated in the parent’s or child’s exact words. The care giver is aware of cues to the child’s illness It is not unusual that the stated complaint is not the true reason May start by asking “why did you bring………to the hospital or health care centre ?“

13. HISTORY OF ILLNESS Is a detailed description of the current health problem. the expanded details of the chief complaint This includes onset and sequence of symptoms characteristics of and changes in symptoms over time influencing factors

14. CONT…. Example onset sudden or gradual, episodes, date and time began location generalized or localized (anatomically precise)

15. CONT… duration continuous or episodic, length of episodes severity effect on daily activities, e.g., interrupted sleep, decreased appetite.

16. CONT… Influencing factors what relieves or aggravates symptoms, what precipitated the problem previous and current treatment Prescribed or current drugs used or other treatments tried (heat, ice, rest), response to treatments

17. Past health history History of present illness is recorded in chronologic order It is helpful to begin: "The child was apparently well until "X" number of days before the visit This is followed by a daily documentation of events leading up to the present time including signs, symptoms, and treatment, if any

18. Prenatal history Whether the pregnancy was planned Health of the mother before pregnancy any infections such as gonococcal infection, syphilis or malaria conditions like anemia, gestational diabetes mellitus Previous pregnancies and their results Medications taken during the pregnancy Results of serology of the mother

19. Birth history Site of birth (hospital, home, birthing center) Gestation age at birth Single or multiple birth Labor; induced or spontaneous, duration of labor, time/duration or rupture of membranes Vaginal or cesarean birth, forceps or suction used, vertex or breech position

20. Cont …. Condition of baby at birth weight any breathing difficulty Determine whether the bay cried immediately after birth Any unusual appearance of the child such cyanosis or respiratory distress any resuscitative efforts that took place and their duration

21. Cont.. The time of onset of any abnormal states may be significant Whether the mother was able to stay with the baby immediately after delivery provide information about neonate’s condition at birth

22. Postnatal history If hospital delivery, how long was the hospitalization for mother and baby Any breathing or feeding problems during the first week Any medication given during the first week If the mother and the baby stays together during hospitalization

23. Cont … Baby’s color at one week Feeding of the baby after delivery breast feeding or bottle feeding and how well the baby took the first feeding

24. Feeding history If the baby is breast fed any difficulty in breast feeding how many times in 24 hours the baby is breast fed an infant should breast fed at least 8 times in 24 hours If the infant was not breast fed recently as the mother to put the bay to the breast observe breast feeding

25. Cont … The baby should be fed as often as he/she want If the baby has been bottle-fed inquire about the type of formula used and the amount taken during 24-hour period How many wet diapers does the baby have in a 24 hours period infants should have at least six, very wet diapers every 24 hours

26. Cont … Does the baby already started solid foods? determine the ages at which solid food were introduced how often the mother introduce solid food one new solid food should be started after every 7 to 14 days

27. IMMUNIZATION HISTORY The types of immunizations received, with the number, dates, sites given, and reactions should be recorded as part of the history Determine missed opportunity or need for booster immunizations

28. Tanzania routine immunization for chldren VACCINE AGE AT ADMINISTRATION OPV 0,BCG AT BIRTH OPV 1,DPT-Hb,Hib,PCV,ROTA 1 6 WEEKS OPV 2,DPT-Hb,Hib,PCV,ROTA 2 10WEEKS OPV 3,DPT-Hb,Hib,PCV 14WEEKS MEASLES,HPV 1 9MONTHS BOOSTER MEASLES,HPV 2 18MONTHS

29. REFERRENCES Terri .K and Susan .C. Essentials of Pediatric Nursing, second edition 2013. Wolters Kluwer Health Lippincott Williams and Wilkins Marilyn J. Hockenberry and David Wilson. Wong’s. Essentials of Pediatric Nursing second edition, ninth edition. Mosby, an imprint of Elsevier Inc 2013 Nancy T. Hatfield . Broadribb’s Introductory Pediatric Nursing seventh edition 2008. Wolters Kluwer Health | Lippincott Williams & Wilkins

30. GROUP MEMBERS AMINA KAPANDA BHOKOBOLA PETER FLORA MWASAGALIZYE HYASINTA PHILIP JUMA HARUNA MALUSHANI MABULA MWANAISHA BAKARI