Embedded Files
past. Past medical history section of pediatrics contains (Past illness, child hood illness, Prenatal history, birth history). Find out if your patient has been hospitalized previously and for what conditions. Do the symptoms he/she has now resemble the one he had in connection with these past conditions, if so then they might be due to the same illness. In the case of children ask about what childhood diseases they have had. If a child has a rash now which resembles measles you do not have to worry about this condition if he has already had measles or if he has been immunized against measles. D) Social and family history: The social history should include the parents’ occupation as Pediatric Nursing and child health care 15 well as the current living condition. Poverty and ignorance are major sources of ill health. You may have to educate a poor mother with malnourished baby that the best treatment for her baby is to be breast-fed exclusively till the age of one or more. If a mother feeds the baby food containing unbilled water the baby may get diarrhea. Teach the mother to boil water used for preparing food to infants. E) Immunization status: Immunization is a way of protecting children against the major diseases of childhood, which harm, cripple or kill thousands of children. Ask the mother about immunization status and if he/she is not properly immunized, take the opportunity of a minor illness to prevent major diseases by advice and vaccination. NB. No proper history can be obtained without observation of the child and the mother. Some rules in history taking: Be an intelligent observer (while you are waiting for the undressing of the child or while you are taking with the mother) Situation your action in history taking The very sick child try to find out quickly what is causes Pediatric Nursing and child health care 16 The Symptoms of disease (e.g. respiratory distress, dehydration, pain, anxiety). This will direct your history taking. The healthy looking child whose mother believes he is ill. See how the proposed illness affects the general wellbeing or growth of the child. History taking does not have to be long if he looks well. Inappropriate reaction of the mother the recent history may be irrelevant. Social history may be more important to get. Abnormal reaction of the child towards What is happening around him history may be directed towards CNS 2. Listen to the mother’s description of the complaints carefully and get the main symptoms. • How did the disease start, which symptoms followed? • Get the time factor. When the disease starts? Has the child had the same kind of symptoms before? • Ask about the condition of other members of the family? • How is the child eating at present? How was his appetite in the last month? • How is he doing between the attacks of illness? Is he weak and inactive or strong and active? • It may be necessary to obtain the social history in certain conditions such as malnutrition. • Get the ‘story’. Where has the child gone for help before? Pediatric Nursing and child health care 17 What sort of local treatment has he had? What are the mother’s beliefs about his illness/disease? • Always try to evaluate the weight progress of the child. This is best done by looking at the weight chart which the mother preferably should have and bring to outpatients’ department at every visit. • Ask about vaccinations done. • When the symptoms are vague and nonspecific, e.g. tiredness, abdominal pain etc. review the different systems of the body. 2.2 Review of Systems: The review of system is essentially the same as in the adult history. It is best organized from the head to down to the extremities. In the child, however, there should be increased emphasis on the symptoms related to the respiratory, gastrointestinal, and genitourinary systems. The high incidence of symptoms and diseases related to these symptoms obligate the interviewer to focus in this area. To get the important points: The patient usually comes with his mother and the task is to pick out from all the different information the mother is giving what is important. • Try to make good contact with her and with the child Pediatric Nursing and child health care 18 • Treat them as human beings who have come for help and advice and
Report abuse