NCM 107 Care of Mother, Child and

Adolescent Related Learning

Experience

PEDIA FOCUS

Submitted by: Dr. Rosalinda A. Abuy

Prof. Jessica A. Sabas

 OVERVIEW / INTRODUCTION

Health Assessment is a vital component of nursing practice, required for planning

and provision of client and family centred care. Assessment of the child’s overall
physical, emotional and behavioural state is a basic role of a pediatric nurse. The
examination must be comprehensive and must also focus on specific assessments that
are appropriate for the child’s age, developmental phase, and needs. Accurate and
reliable physical measures are used to monitor the growth of an individual, detect growth
abnormalities, and monitor nutritional status. The physical examination also provides
opportunities to identify silent illnesses or conditions and time for the health care
professional to educate children and their parents about the body and its growth and
development.
Health Teaching Plan is an outline of education to be provided to client, family and
community. It comprise of teaching objectives, contents methods, time frame, and
evaluation. This is done after assessing the client needs. It is important for nursing
profession to have a structured plan for providing audience with vital information. These
plans also must include a means to assess the learners' knowledge. Teaching plan must
be executed to clientele and family, and evaluate after the implementation.
This module will assist you on how to conduct a comprehensive and systematic
nursing assessment for children, plans and implement nursing care and to evaluate the
care rendered. Likewise, it will guide you to develop a health teaching plan for educating
the client and their family.

OBJECTIVES

At the end of the discussion, you will be able to:

1. Determine the roles of pediatric nurses.
2. Assess the child’s health status using health assessment.
3. Formulate nursing diagnosis focusing on health promotion and disease prevention.
4. Plan for care to be rendered.
5. Implement safe and quality nursing interventions.
6. Evaluate the nursing interventions provided.
7. Develop a health teaching plan.
8. Conduct individual/group health education, activities based on the priority needs
of children.
9. Evaluate the health teaching plan conducted.
Roles of Pediatric Nurses

A. Family Advocate: The primary responsibility of the nurse is to the child and the family.
The nurse assists in identifying their needs and goals and in developing appropriate
nursing interventions.

B. Health Promoter: The nurse assists in maintaining health and preventing disease by
fostering growth and development, proper nutrition, immunizations, and early identification
of health problems.

C. Health Teacher: The nurse provides the family with information on topics such as
anticipatory guidance, parenting, and disease processes.

D. Counsellor: The nurse supports the family through active listening and a therapeutic
relationship that includes caring as well as carefully defined boundaries between nurses
and the child and family.

E. Collaborator: As a key member of the interdependent healthcare team, the nurse

collaborates with and coordinates nursing services with other healthcare services.

F. Researcher: The nurse uses and contributes to research than enhances the nursing
care of children and adolescents and their families.

Pediatric nursing health assessment

A. General considerations

I. For the child:

a. Maintain eye contact (if culturally appropriate); bend to the child’s level as needed.
b. Use language appropriate for the child’s cognitive level; involve the child in the
assessment interview by asking appropriate questions.
c. Keep in mind that a child is aware of caregiver’s nonverbal communication and body
language.
d. Allow the child some warm-up time to become acquainted with the caregivers and the
environment; introduce yourself and explain your purposes.
e. Respect the child’s responses and need for privacy as appropriate for age.
f. Incorporate plain into the assessment as appropriate.

2. For the family:

a. Develop a family-oriented approach that encourages parents to participate in the child’s
assessment.
b. Choose a quiet environment for the assessment and for any teaching sessions.
c. Ask open ended questions to elicit responses other than “yes” or “no”.
d. Focus on the information needed or problem to be solved.
e. Communicate the importance of parental roles with the healthcare team in planning and
providing care for the child,
f. Listen attentively, respect responses, and provide appropriate feedback. Use silence
judiciously.
g. Encourage parents to express concerns and ask questions.

B. Health History

1. Purpose: to collect subjective data about the child’s health status and provide insights
into actual or potential health problems.
2. Interview techniques
a. Infants: Speak softly; allow the child to identify you with a parent; use touch.
b. Toddlers: Allow child to stay close to parent; acknowledge a favorite toy or a unique
characteristic about the child.
c. Pre-schoolers: Use simple questions and simple words without double meanings;
allow child to manipulate equipment; use toys, puppets, and play.
d. Schoolers: Offer explanations; teach about health; provide demonstrations.
e. Adolescents: Maintain confidentiality. Also, facilitate trust; ask to speak to adolescent
alone; encourage open and honest communication; be non-judgmental; use open-ended
questions.

3. Components of the history

a. Biographic data
b. Chief complaint
c. Current health or illness status
d. Past health status
e. Review of systems
f. Family health history
g. Nutritional history
h. Sleep history
j. Psychosocial data

4. Biographic data: name, address, telephone number, parents’ or guardian’s names, date
and place of birth, gender, race, religion, and nationality or cultural background

5. Chief complaint: the client’s reason for seeking health care of the parent’s (informant’s)
reason for seeking health care for the child.

6. Current health or illness status: the sequence of events leading up to the chief complaint
and related information, including:
a. Symptom analysis of chief complaint
b. other current or recurrent illnesses or problems
c. current medications
d. Any other health concerns

7. Past health: information concerning past health status, previous problems, and health
promotion activities, including:
a. Birth history (pregnancy, labor and delivery, perinatal history)
b. Previous illnesses, injuries, or surgeries
c. Allergies (identify and describe manifestations)
d. Immunization status
 e. Growth and developmental milestones
f. Habits

8. Review of systems
a. General: Overall health status
b. Integumentary: lesions, bruising, skin care habits
c. Head: trauma, headaches
d. Eyes: visual acuity, last eye examination, drainage, infections
f. Ears: hearing acuity, last ears examination, drainage, infections
g. Mouth: Lesions, soreness, tooth eruption patterns of dental care, last dental
examination
h. Throat: sore throat frequency, hoarseness, difficulty swallowing
i. Neck: stiffness, tenderness
j. Chest (respiratory) pain, cough, wheezing, shortness of breath, asthma,
infections
k. Breast: the arched, lesions, discharge, performance of breast self-examination
(BSE)
l. Cardiovascular: history of murmurs, exercise tolerance, dizziness, and
palpitations, congenital defects
m. Gastrointestinal: appetite, bowel habits, food intolerance, nausea, vomiting,
pain, history of parasites.
n. Genitourinary: Urgency, frequency, discharge, urinary tract infections, sexually
transmitted diseases, enuresis, sexual problems or dysfunctions (male); performance of
testicular self-examination
o. Gynecologic: menarche, menstrual history, sexual problems or dysfunctions
p. Musculoskeletal: pain, swelling, fractures, mobility problems, scoliosis
q. Neurologic: ataxia, tremors, unusual movement, seizures,
r. Lymphatic: pain, swelling or tenderness, enlargement of spleen or liver.
s. Endocrine or metabolic: growth patterns, polyuria, polydipsia, polyphagia
t. Psychiatric history: any psychiatric, developmental, substance abuse, or eating
disorders

9. Family history: Identification of any family genetic traits or diseases with familial
tendencies, communicable disease, psychiatric disorders, substance abuse

10. Nutritional history

a. Quantity and kind of food or formula ingested daily (use 24 – hour recall, food
dairy for 3 days: 2 weekdays and 1 weekend day; or food frequency record)
b. Problems with feeding
c. Use of vitamin supplements
d. Description of any special diets
e. Cultural or religious food practices, preferences, or restrictions
f. Assessment of dieting behaviours including body image, types of diets,
frequency of weighing, or use of self-induces vomiting, laxatives and diuretics

11. Sleep history

a. Time child goes to bed and awakens
b. Quality of sleep
c. Nap history
d. Sleep aids (blanket, toys)

12. Psychosocial history

a. Home and family: structure, including composition of family members,
occupation and education of members, culture and religion; function, including
communication patterns, family roles and relationships, financial status
b. School: grades, behaviour, relationship with teachers and peers
c. Activities: types of play, number of hours of TV viewing daily, amount of non-
school-related reading hobbies
d. Discipline: type and frequency at home
e. Sex: child’s preadolescent’s concerns, abuse history, sexual activity patterns,
number of partners, use of condoms and contraceptives, AIDS awareness
 f. Substance Abuse: amount, frequency, and circumstances of use for tobacco,
alcohol prescribed or illicit drugs, steroids and substances such as inhalants
g. Violence: domestic violence, self- abusive behaviours, suicidal ideation and
attempts, violence perpetrated on others by child or adolescent client

C. Physical Assessment

1. Purpose: to obtain objective data on body systems functioning and overall health status

2. General guidelines
a. In most cases, physical assessment involves a head-to-toe examination that
covers each body system.
b. Complete less threatening and least intrusive procedures first to secure child’s
trust
c. Explain what you will be doing and what the child can expect to feel; allow the
child to manipulate equipment before it is used.

3. Developmental approaches
a. Infants: Allow infant to sit in parent’s lap, encourage parents to hold infant; use
distraction; enlist parent’s assistance.

b. Toddlers: Allow toddlers to sit in parent’s lap; enlist parent’s aid; use play; praise
cooperation.
c. Pre-schoolers: Use storytelling and doll and puppet play; offer choices when
possible.

d. School ages: Maintain privacy; provide gown; explain procedures and

equipment; teach school age clients about their bodies
e. Adolescents: Provide privacy and confidentiality; provide option of having parent
present or not; emphasize normality; include health teaching.

4. Vital signs assessment

a. Blood pressure: Measure blood pressure annually in children 3 years and older.
Select appropriate cuff width, so that cuff covers three fourths of the upper arm.

(1) Normal systolic ranges:

systolic : 1 to 7 years = age in years + 90

8 to 18 years = (2x age in years) + 83
diastolic : 1 to 5 years = 56
6 to 18 years = age in years + 52
 b. Pulse rate: radial pulses may be taken in children over age 2
(1) Normal resting and awake rate:

1 week to 3 months: 100 to 200

3 months to 2 years: 80 to 150

2 years to 10 years: 70 to 110

10 years to adult: 55 to 90

c. Respiratory rate: monitor infants by observing abdominal movements; monitor older

children the same as adults.

(1) Normal respiratory rate ranges:

Birth to 6 moths: 30 to 50

6 months to 2 years: 20 to 30

3 to 10 years: 20 to 28

10 to 18 years: 12 to 20

d. Temperature: Use rectal, axillary, skin, and tympanic thermometer in children under age
4, Normal temperature ranges are the same as in adults.

5. Head to toe assessment

a. Measurements: height and weight, and head circumference in infants

b. General appearance: Physical appearance, nutritional state, hygiene, behavior,

interaction with parents and nurse, overall development and speech

c. Skin: color, texture, turgor, temperature, lesions, scars, edema, tattoos

d. Hair: distribution, characteristics

e. Nails: distribution, characteristics

f. Lymph nodes: swelling, mobility, temperature, tenderness

g. Head: symmetry, condition of fontanels

h. Eyes: visual acuity, external and internal, (ophthalmoscopic) examinations

i. Ears: hearing acuity, external and internal (otoscopic) examinations

j. Nose and sinuses: discharge, tenderness, turbinates’ (color, swelling)

k. Mouth: tooth eruption, condition of gums, lips, teeth, palates, tonsils, tongue, and buccal
mucosa

l. Neck: suppleness
m. Chest: shape, breast (sexual development stage), discharge, lesions

n. Lungs: breath sounds, adventitious sounds

o. Heart: heart sounds, murmurs, rubs

p. Abdomen: appearance of umbilicus, shape, bowel sounds, inguinal area for hernias,
liver, spleen, kidneys, masses, tenderness

q. Genitalia

(1) Female: sexual developmental stage (pubic hair), vulva, meatus,

external genitalia examination

(2) Male: sexual developmental stage (penis, scrotum, and pubic hair),
penis, scrotum, testes, urinary meatus

r. Anus: external examination

s. Musculoskeletal: muscle size and strength, posture and body alignment, symmetry,
range of motion, gait

t. Neurologic: cerebral function (language, memory, cognition), cranial nerve function,

deep tendon and superficial reflexes, balance and coordination, sensory function, motor
function, and infantile reflexes

For discussion enhancement on PE connect to the following link:

http://bit.ly/EKGCards Health Assessment.
https://www.dailymotion.com/video/x30d2a9

 Health Teaching

It is an outline of education to be provided to patient, family, community and other

learners; includes objectives, content, teaching methods, time frame and evaluation,
(Medical Dictionary). Health Teaching is fundamentally a process, including
planning, implementation, evaluation and revision. This implies that patient/client
education is recognized as a fundamental component of health care.

The first step in patient/client education is the review assessment for learning needs.
Then meet with the patient/client to determine what specific needs for that patient are.
Individualized Teaching is based on the patient/ client assessment, readiness to learn,
and patient/client and family needs.

How to Write a Nursing Teaching Plan

A. Objectives
The objectives are the main ideas that you want your learner(s) to understand and
apply after you are done teaching. In general, you should limit your objectives to one to
five objectives depending on the length of your teaching plan, the complexity of the topic,
and the prior knowledge of your audience. Regardless of the topic or level of complexity,
these objectives should serve as a guide for developing the rest of the teaching plan.
Everything in the plan should directly relate to one or more of these objectives.
 Describe the setting of specific, measurable, attainable or achievable, realistic or rel-
evant, and timely bounded or outcomes, providing clear direction in what is to be
achieved by the teaching session. SMART is an acronym for the guidelines nurses should
use when setting their goals. SMART objectives will help you prioritize work, monitor pro-
gress and evaluate the output. Hence, keeping things SMART helps you focus on what
is important and what needs to be done.

3 Steps to Make Your Objectives SMART

Step 1: Identify your priorities
Look at the vision you been set for your client and consider which of these key areas are
priorities.
Step 2: Make sure your objectives are SMART

SMART criteria for formulating objectives

Be specific. The learning objective describes concrete conditions and clear results.
Keep your nursing goals focused and detailed.
Keep it measurable. For goals to be effective, there must be some way to measure
your progress. This provides the opportunity to celebrate your victories and maintain
your motivation. Whatever measurement guide you choose, make sure you have clear
milestones and a defined finish line.
Keep it attainable. Nursing goals should be challenging, but it is important to verify that
they are not beyond your reach. Break down your goals into more manageable goals.
Be realistic. Make sure the nursing goals you set are not beyond your ability and skill
set. Similar to attainability, setting goals beyond your capability has the potential to over-
whelm you and kill your motivation. Keep your goals rooted on the ground to build your
professional momentum through successes you achieve along the way.
Keep it timely. Creating a target time line for each goal and milestone will give you a
better indication of your progress. Looming deadlines are also great motivators and can
help you gauge whether your efforts need to be increased to reach your self-imposed cut
off point.

Step 3: Make sure your objectives are in good fit

After you produced the objectives, have a common-sense check and make sure they fit
together to form a unified strategy.

For example, if you were speaking to a community group about corona virus preven-
tion, you may write the following objectives:
At the end of the health teaching on the prevention of corona virus the learners will be
able to:
1. Define corona virus.
2. Discuss how to prevent the disease.

B. Content/Teaching Methods
Once you determined the objectives for your teaching plan, you can decide what
content and teaching methods you will use. First, you will need to select the content of
your lesson. Depending on what you are teaching, this content may already be provided
by an organization you are representing, such as a college, medical organization e.g.,
the American Red Cross, or hospital. Often, these organizations have specific infor-
mation requirements when discussing particular topics.
If you are free to use your own content or can supplement existing information, in-
clude content that explains medical terminology in common language. Unpacking com-
plex medical terminology using easily understandable vocabulary can help learners
quickly comprehend the information you are presenting.
 When determining how to share the content of the lesson, think about how to ad-
dress varied learning styles, including auditory, visual and hands-on learners. Some sug-
gestions for presenting content include: diagrams and charts, videos, models, hands-on
simulations, observations of patients/healthcare personnel, and role-playing.

References:

Flagg. J & Pillitteri A. Maternal and Child Health Nursing (2018), Wolters Kluwer 9 th Edition.
Muscari, M. Lippincott’s Review Series Pediatric Nursing (2015), Wolters Kluwer Health,
5th Edition
nursechoice.com/traveler-resources/nursing-smart-goals-how-to-set-smart-goals-for-
nursing

 Activities

Find a client, either infant, toddler, preschool or school age, child in your family or
neighbour and do the following:
1) Assess the child
2) Develop a Nursing Care Plan, implement, and evaluate after three meetings.
3) Provide Health Teaching to the mother and child on Nutrition, Elimination, Rest and
Play, Hygiene and other health promotion activities depending on the need as assessed.
4) Submit the following:
a. Physical Assessment following the PE assessment format
b. 2 NCP
b. Teaching Plan using this format

General Objective:

Specific Content Methodology Resources and Time Evaluation

Objectives Material/s Allotted

c. Journal Reading on care of the child/ adolescent, specific to age assessed. Summarized
and reflect on the information obtained. Please include your reference using the APA
format of referencing.