A Clinical Daily Diary of Child Health Nursing (Pediatric Nursing) A Sudhakar
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1A CLINICAL DAILY DIARY OF CHILD HEALTH NURSING (PEDIATRIC NURSING) for MSc, BSc, PBBSc and GNM NURSING STUDENTS
A Sudhakar MSc (N), MBA (Hospital Management), PGDC (NICU and ICU), Associate Professor cum HOD, Pediatric Nursing Department Ramakrishna Mission Sevashram, Vivekananda College of Nursing Lucknow, Uttar Pradesh, India Foreword Prof Dr A Jayasudha
2
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A Clinical Daily Diary of Child Health Nursing (Pediatric Nursing)
First Edition: 2016
9789385999949
Printed at
3
The Florence Nightingale
Pioneer of Modern Nursing
12-05-1820–13-08-1910
The ‘Nightingale Pledge’
I solemnly pledge myself before God and presence of this assembly.
To pass my life in purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous
and will not take or knowingly administer any harmful drug.
I will do all in my power to maintain and elevate the standard of my profession
and will hold in confidence all personal matters committed to my keeping
and family affairs coming to my knowledge in the practice of my calling.
With loyalty will I endeavor to aid the physician in his work,
and devote myself to the welfare of those committed to my care.'
The Nightingale Pledge was composed by Lystra Gretter, an instructor of nursing at the old Harper hospital in Detroit, Michigan, and was first used by its graduating class in the spring of 1893. It is an adaptation of the Hippocratic Oath taken by physicians.
4Dedicated
to my parents and
my dear wife
Mrs Syama Sudhakar
5Foreword
Innovations in healthcare and technology has brought challenges for nurse educators to prepare young nursing students in meeting the healthcare needs of people in our society.
Nursing is a practice-based profession where clinical education becomes an essential part of the nursing curriculum. Students require effective clinical placements/experiences to allow the application of theory to practice and to be a competent and independent practitioner. Through nursing education, nursing students will be able to obtain necessary knowledge and skills to assist public health. The existing clinical education does not meet the clinical skills competence of the students because of the large gap between theoretical and clinical nursing education. Pediatric nursing is a very special vocation, because it provides the opportunity to play a key role in a child's life. Nurses who specialize in pediatrics devote their knowledge and skills to caring for children from infancy through the 18 years and their families. Pediatric nurses can perform physical examinations, measure vital statistics, take blood and urine samples and order diagnostic tests and visit schools to perform physical exams, immunize children, and provide routine developmental health screenings. This clinical daily diary acts as a guide for the students and teachers about implementation of learned objectives in clinical setting and will definitely provide adequate knowledge, attitude and skills required to care children.
‘Thoughts to contemplate - Reflect - Discover - Explore - Inspire and Enrich Yourself’.
A Jayasudha
Associate Professor
Female College of Applied Medical Sciences,
King khalid University, Bisha
Kingdom of Saudi Arabia
Place: Saudi Arabia6
7Preface
Pediatric nursing is a very essential profession in the care of the child's health. In the medical field, the pediatric nurses have more responsibility to take care of the child and its parents. It must be expected that all the child health nurses have the competence and accountability, good judgment ability, skill-based, and subspecialized up-to-date knowledge, and positive attitude towards the care of the child's health.
A pediatric nursing student should be talented to understand the problems of the children and be ready to help them whenever healthcare is needed. They should have special preparation and training to contribute to the effective healthcare of the children.
I have been in the nursing profession for the past 16 years. I felt that one pediatric nursing clinical daily diary record is needed, which is prepared according to the new syllabus of the Indian Nursing Council (INC). The main concept of this diary is to makes the students comfortable in maintaining their clinical activities, and it should also have the accountability of the clinical activities. I have decided to take up this project with the spirit of my hard-work schedule to help the pediatric nursing students.
This clinical daily diary covers the MSc, BSc, PB BSc and GNM nursing student's clinical requirements as per newly revised INC syllabus. I hope this diary will help the pediatric students and nurses to review their knowledge and practice in the various aspects of child healthcare.
In this diary, I have used references of many journals written by eminent Indian authors, foreign books, WHO news, and internet. I have invested my best efforts to prepare and enrich this diary, considering the level of the students and the placement of the course according to the INC syllabus. In this clinical diary, unintentional mistakes are regretted and will be rectified.
Hereby suggestions for further enrichment of this diary will be gladly accepted. Constructive criticisms and comments are always heartily welcome. I hope my hard work will be useful for all the pediatric nursing students and clinical nurses.
Learn More and Serve the Nation
A Sudhakar
8Acknowledgments
This is my duty to say sincere gratitude to the almighty for his love and kind grace in the completion of this book. Hereby I credit my lovable thanks to my parents Mr P Anumanthan and Mrs Dhanalakshmi, who helped me succeed in all walks of life.
I feel honor to convey my special thanks and gratitude to our respected Secretary Swami Muktinathananda Ji for his great support, special prayer and blessing for the completion of my project successfully.
I also extend my gratitude to our honorable Professor Mrs Chandini Tyagi, Principal, Vivekananda College of Nursing, Lucknow for her timely suggestion and feedback for the clinical daily diary project.
I would like to take the opportunity to thank honorable Professor Mr I Clement and Professor Mrs Nisha Clement, who have helped and inspired me to take up this project.
This is my great job to say thanks to my principal, respected Professor Dr A Jayasudha, former Principal of Sri Gokulam College of Nursing, Salem, Tamil Nadu, India, for her special guidance and support to complete my project.
I wish to express my special thanks to our honorable Vice Principal, Professor BR Ravi Kumar Msc (N), PhD (Scholar), Vivekananda College of Nursing for his truthful prayers and efforts to complete this project successfully.
I extend my warm thanks to our respected Hostel Administrator Shanthi Mayee Ji, Vivekananda College of Nursing, Lucknow for her special prayer for this project.
I wish to express my special thanks to my dear close friends Mr Prabu [MSc (N)] and Mr Nagaraj [MSc (N)] for their truthful efforts to make this project a success.
My sincere thanks are due to all my seniors, colleagues and friends who encouraged me to write this diary.
I convey my loveable thanks to my dear wife Syama Sudhakar and my sister-in-law Mrs Hema Anil NS, who have given me encouragement to complete this diary.
I convey my heartfelt thanks to my dear sweet daughters SS Jayani Sree and SS Navanya Sree for showing enough patience and their love and affection at the time of my project work and also for the contribution of their photographs in this project.
I convey my special thanks to my dear in-laws Mr Sankaran and Mrs Umadevi for their special prayers for the successful completion of my project.
I express my deep sense of gratitude and thanks to my brother and sister-in-law Mr A Gajendra Prasad, Mrs G Sathya and their children Pooja Hasmi and Bhavan for rendering emotional support during the hardworking period of the preparation of this project.
I convey my heartfelt thanks to Respected Mr Ashwani Kumar Saini, Marketing Executive, Lucknow branch, Jaypee Brothers Medical Publishers (P) Ltd, who has helped me to publish this diary successfully within time.
I convey my sincere thanks to especially Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy), Ms Payal Bharti (Project Manager), Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India for their sincere efforts and suggestions.
9Syallbus
Practical Syllabus and Regulations Child Health (Pediatric) Nursing
MSc, BSc, PBBSc and GNM (Nursing)
Indian Nursing Council
Combined Council Building, Kotla Road,
Temple Lane, New Delhi–110002
10CLINICAL SPECIALTY–I
Child Health (Pediatric) Nursing
Placement: MSc Nursing Ist Year
Hours of Instruction
Theory 150 hours
Practical 650 hours
Total: 800 hours
 
COURSE DESCRIPTION
This course is designed to assist students in developing expertize and in-depth understanding in the field of pediatric nursing. It will help students to appreciate the child as a holistic individual and develop skill to function as neonatal and pediatric nurse specialist. It will further enable the student to function as educator, manager and researcher in the field of pediatric nursing.
 
OBJECTIVES
At the end of the course the students will be able to:
  • Appreciate the history and developments in the field of pediatrics and pediatric nursing as a specialty
  • Apply the concepts of growth and development in providing care to the pediatric clients and their families
  • Appreciate the child as a holistic individual
  • Perform physical, developmental and nutritional assessment of pediatric clients
  • Apply nursing process in providing nursing care to neonates and children
  • Integrate the concept of family centered pediatric nursing care with related areas such as genetic disorders, congenital malformations and long-term illness
  • Recognize and manage emergencies in neonates
  • Describe various recent technologies and treatment modalities in the management of high risk neonates
  • Appreciate the legal and ethical issues pertaining to pediatric and neonatal nursing
  • Prepare a design for layout and management of neonatal units
  • Incorporate evidence-based nursing practice and identify the areas of research in the field of pediatric/neonatal nursing
  • Recognize the role of pediatric nurse practitioner and as a member of the pediatric and neonatal health team
  • Teach pediatric nursing to undergraduate students and in-service nurses.
 
Practical
Total = 660 hours
1 Week = 30 hours
S. no.
Department/Unit
No. of Weeks
Total Hours
1
Pediatric medicine ward
4
120 hours
2
Pediatric surgery ward
4
120 hours
3
Labor room/maternity ward
2
60 hours
4
Pediatric OPD
2
60 hours
5
NICU
4
120 hours
6
Creche
1
30 hours
7
Child guidance clinic
1
30 hours
8
Community
4
120 hours
Total
22 Weeks
660 hours
 
Student Activities
  • Clinical presentations
  • Growth and developmental assessment
  • Assessment and prescription of nursing interventions for sick children
  • Health education related to disease conditions
  • Nutritional assessment
  • Project work
  • Field visits.
 
CLINICAL SPECIALTY–II
Pediatric (Child Health) Nursing
Placement: MSc Nursing IInd Year
Hours of Instruction
Theory 150 hours
Practical 950 hours
Total: 1100 hours
 
Course Description
This course is designed to assist students in developing expertize and in-depth understanding in the field of pediatric nursing. It will help students to develop advanced skills for nursing intervention in various pediatric medical and surgical conditions. It will enable the student to function as pediatric nurse practitioner/specialist. It will further enable the student to function as educator, manager and researcher in the field of pediatric nursing.
 
Objectives
At the end of the course the students will be able to:
  • Apply the nursing process in the care of ill infants to preadolescents in hospital and community
  • Demonstrate advanced skills/competence in nursing management of children with medical and surgical problems
  • Recognize and manage emergencies in children
  • Provide nursing care to critically ill children
  • Utilize the recent technology and various treatment modalities in the management of high risk children
  • Prepare a design for layout and describe standards for management of pediatric units/hospitals
  • Identify areas of research in the field of pediatric nursing.
 
Practical
Total = 960 hours
1 Week = 30 hours
Field visits
S. no.
Department/Unit
No. of Weeks
Total Hours
1
Pediatric medicine ICU
4
120 hours
2
Pediatric surgical ICU
4
120 hours
3
NICU
4
120 hours
4
Pediatric OT
2
60 hours
12
5
Pediatric medicine ward
6
180 hours
6
Pediatric surgery ward
6
180 hours
7
Emergency/casualty
4
120 hours
8
Field visits*
2
60 hours
Total
32
960 hours
*Child care center, Anganwadi, play school, special schools for challenged children, Juvenile court, UNICEF, orphanage, creche, SOS village.  
Essential
 
I. Procedures Observed
  • Echo cardiogram
  • Ultrasound head
  • ROP screening (retinopathy of prematurity)
  • Any other.
 
II. Procedures Assisted
  • Advanced neonatal life support
  • Lumbar puncture
  • Arterial blood gas
  • ECG recording umbilical catheterization–arterial and venous
  • Arterial BP monitoring
  • Blood transfusion-exchange transfusion full and partial
  • IV cannulation and therapy
  • Arterial catheterization
  • Chest tube insertion
  • Endotracheal intubation
  • Ventilation insertion of long line
  • Assist in surgery.
 
III. Procedures Performed
  • Airway management
    • Application of Oropharyngeal airway
    • Oxygen therapy
    • Continuous positive airway pressure (CPAP)
    • Care of tracheostomy
    • Endotracheal intubation
  • Neonatal resuscitation
  • Monitoring of neonates—clinically and with monitors, CRT (capillary refill time), assessment of jaundice, ECG
  • Gastric lavage
  • Setting of ventilators
  • Phototherapy
  • Assessment of neonates: Identification and assessment of risk factors, APGAR Score, gestation age, anthropometric assessment, weighing the baby, newborn examination, detection of life threatening congenital abnormalities,
  • Admission and discharge of neonates
  • Feeding—management of breast-feeding, artificial feeding, expression of breast milk, OG (orogastric) tube insertion, gavage feeding, TPN, breast-feeding counseling
  • 13Thermoregulation—axillary temperature, kangaroo mother care (KMC), use of radiant warmer, incubators, management of thermoregulation and control
  • Administration of drugs: IM, IV injection, IV cannulation and fixation infusion pump, calculation of dosages, neonatal formulation of drugs, use of tuberculin/insulin syringes, monitoring fluid therapy, blood administration.
  • Procedures for prevention of infections: Hand washing, disinfections and sterilization, surveillance, fumigation
  • Collection of specimens
  • Setting, use and maintenance of basic equipment: Ventilator, O2 analyzer, monitoring equipment, phototherapy unit, flux meter, infusion pump, radiant warmer, incubator, centrifuge machine, bilimeter, refractometer, laminar flow.
 
IV. Other Procedures
 
CHILD HEALTH NURSING PRACTICAL
Placement: BSc Nursing III year
IV year
Time: 300 hours (9 weeks)
Internship: 145 hours (3 weeks)
Areas
Duration in weeks
Objectives
Skills
Assignments
Assessment methods
Pediatric medicine ward
3
  • Provide nursing care to children with various medical disorders
  • Counsel and educate parents
Taking pediatric history physical examination and assessment of children. Administer of oral, IM and IV medicine/fluids. Calculation of fluid requirements. Prepare different strengths of IV fluids. Apply restraints administer O2 inhalation by different methods. Give baby bath, feed children by katori, spoon, etc. Collect specimens for common investigations. Assist with common diagnostic procedures. Teach mothers/ parents malnutrition oral rehydration therapy, feeding and weaning immunization schedule, play therapy specific disease conditions
Give care to three assigned pediatric patients. Nursing care plan-l, case study/presentation-I/ health talk-l
Assess clinical performance with rating scale. Assess each skill with checklist OSCE/OSPE evaluation of case study. Presentation and health education session, completion of activity record
Pediatric medicine ward
4
Recognize different pediatric surgical conditions/ malformations. Provide pre and postoperative care to children with common pediatric surgical conditions/ malformation counsel and educate parents
Calculate, prepare and administer IV fluids—bowel wash
Care for ostomies—colostomy irrigation
Ureterostomy gastrostomy enterostomy urinary catheterization and drainage feeding nasogastric gastrostomy. Jejunostomy care of surgical wounds dressing suture removal
Give care to three assigned pediatric surgical patients.
Nursing care plan-1, case study/presentation-1
Assess clinical performance with rating scale. Assess each skill with checklist OSCE/OSPE. Evaluation of case study. Presentation completion of activity
Pediatric OPD/immunization room
1
Perform assessment of children—health, developmental and anthropometric perform immunization. Give health education/ nutritional education
Assessment of children:
  • Health assessment
  • Developmental assessment
  • Anthropometric assessment
  • Immunization health/nutritional education
Developmental study-I
Assess clinical performance with rating scale. Completion of activity record
Pediatricmedicine and surgery ICU
1 + 1
Provide nursing care to critically ill children
Care of a baby in incubator/warmer, care of a child on ventilator endotracheal suction chest physiotherapy administer fluids with infusion pump, total parenteral nutrition phototherapy monitoring of babies cardiopulmonary resuscitation
Nursing care plan-I/observation report-1
Assess clinical performance with rating scale.
Completion of activity record. Evaluation of observation report
 
INTERNSHIP
14
Areas
Duration in weeks
Objectives
Skills
Assignments
Assessment methods
Pediatric medicine ward/ICU
1
Provide comprehensive care to children with medical conditions
Integrated practice
Assess clinical performance with rating scale
Pediatric surgery ward/ICU
1
Provide comprehensive care to children with surgical conditions
Integrated practice
Assess clinical performance with rating scale
NICU
1
Provide intensive care to neonates
Integrated practice
Assess clinical performance with rating scale
 
CHILD HEALTH NURSING
Placement: Post Basic BSc Nursing 1st Year
Time allotted: Theory: 90 hours
Practical: 300 hours
 
COURSE DESCRIPTION
This course is aimed at developing an understanding of the modern approach to childcare the common health problems of children neonates in health and sickness.
 
OBJECTIVES
At the end of the course, the student will be able to:
  • Explain the modern concept of child care and the principles child health nursing
  • Describe the normal growth and development of children different ages
  • Manage sick as well as healthy neonates and children
  • Identity various aspects of preventive pediatric nursing and them in providing nursing care to children in hospital community.
 
PRACTICUM
This student will be able to:
  • Clinical experience in pediatric medical and surgical ward OPD in hospital health center and neonatal unit
  • Health education and health counseling to individuals, families and groups
  • Assessments and screening tests
  • Visit a center for handicapped children and child welfare center and write observation report
  • Write an observation study of normal children of various age groups in home/nursery school/creche
  • Follow nursing process in providing care to 3–6 children
  • Write at least two nursing care studies and do presentation
  • Give two planned health teachings one in hospital and one in OPD/health center.
  • Practice the following nursing procedures
    • Taking pediatric history
    • Physical assessment of children
    • Baby bath
    • Feeding
    • Restraining
    • Calculation of dosage of drugs and administration of medications and injections
    • Collection of specimens
    • Enema bowel wash colostomy irrigation
    • Steam and oxygen inhalation
    • Preparation to assist with diagnostic tests and operation.
15
 
CHILD HEALTH NURSING PRACTICAL
Placement: GNM II/III year
Time: 336 hour
8 weeks
Internship: 2 weeks
Areas
Duration
Objectives
Skill
*Assignments
Assessment methods
Pediatric medicine ward
3 weeks
  • Perform physical assessment
  • Assist in diagnostic procedure and provide pre and post care related to diagnostic procedure
  • Administer the drugs
  • Provide health education
  • Perform basic resuscitation
  • Taking pediatric history
  • Perform physical examination and assessment of children
  • Administration of oral, IM and IV medicine/fluid
  • Calculation of fluid requirements
  • Prepare different strengths of IV fluids
  • Apply restraints
  • Administer O2 inhalation by different methods
  • Feed children by katori (bowl) and spoon, pallada, etc.
  • Collect specimens for common investigations
  • Assist with common diagnostic procedure
  • Teach mothers/parents on balance diet for child of different age group
  • Oral rehydration therapy
  • Feeding and weaning
  • Play therapy
  • Check vital signs
  • Give enema
  • Insert suppositories
Give care to assigned pediatric patients. Nursing care plan-1, case study or presentation-1, health talk-1
  • Assess performance with rating scale
  • Assess each skill with checklist
  • Evaluation of nursing care plan, case study, health talk, case presentation
  • Completion of activity record
Pediatric medicine ward
3 weeks
  • Recognize different pediatric surgical condition
  • Provide pre and post operative care to children with common pediatric surgical conditions/ malformation
  • Counsel and educate parents
  • Do bowel wash
  • Care for ostomies:
    • Colostomy irrigation
    • Ureterostomy
    • Gastrostomy
    • Enterostomy
  • Urinary catheterization and drainage
  • Feeding
    • Asogastric
    • Gastrostomy
    • Jejunostomy
  • Care of surgical wound
    • Dressing
    • Suture removal
Give care to three assigned pediatric surgical patients, nursing care plan-1 case study or presentation-1
  • Assess performance with rating scale
  • Assess each skill with checklist
  • Evaluation of Nursing care plan, case study, case presentation
  • Completion of activity record
Pediatric OPD/Imm unization room/ well baby clinic/adolescent clinic
2
  • Perform assessment of children of children, health development and anthropometric
  • Perform immunization
  • Give health education/nutritional education
  • Assessment of children
    • Health assessment
    • Developmental assessment
    • Anthropometric assessment
  • Immunization
  • Health/nutritional education
Health assessment of the child health talk-1
  • Assess performance with rating scale
  • Completion of activity record
  • Assessment of the health talk
16
17
18STUDENT PROFILE
Name of the Student
:
……………………………………………………………………….
Register No/Enroll No
:
……………………………………………………………………….
Course/Year
:
……………………………………………………………………….
Subject
:
……………………………………………………………………….
Batch
:
……………………………………………………………………….
Name of university/Board
:
……………………………………………………………………….
Name of the Institute
:
……………………………………………………………………….
Address of the Institute
:
……………………………………………………………………….
……………………………………………………………………….
……………………………………………………………………….
……………………………………………………………………….
Signature of the student
Subject Coordinator/HOD
Principal
19CLINICAL DAILY DIARY  
CHILD HEALTH NURSING PRACTICAL
 
TABLE OF CONTENT
Total clinical hours
Total weeks
S.No
Placement
Year
Inc req. hours
Planned hours
Inc req. weeks
Planned weeks
1.
GNM Nursing
2nd/3rd Year
336 Hours
8 weeks
Internship
2nd/3rd Year
60 Hours
2 Weeks
2.
BSc Nursing
3rd Year
300 Hours
9 Weeks
Internship
4th Year
145 Hours
3 Weeks
3.
Post Basic BSc Nsg
1st Year
300 Hours
9 weeks
4.
M.Sc Nursing
1st Year
650 Hours
22 weeks
5.
M.Sc Nursing
2nd Year
960 Hours
32 weeks
 
CLINICAL DUTY ROSTER PLAN
Date of posting
Clinical block
Signature of the students
Signature of the teacher
S. No
Month
Weeks
Ward/Unit
From
To
Partial
Full
1.
1.
2.
3.
4.
2.
2.
3.
4.
3.
1.
2.
3.
4.
4.
1.
2.
3.
4.
5.
1.
2.
3.
4.
6.
1.
2.
3.
4.
Internal Examiner
Mr/Mrs……………………
Date :……/……/…20….…
External Examiner
Mr/Mrs……………………
Date :……‥/……‥/20…….
20