trends in pediatrics and ped nsg
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TRENDS IN PEDIATRICSTRENDS IN PEDIATRICSAND PEDIATRIC NURSINGAND PEDIATRIC NURSING
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Current statistics related to child
health Perinatal mortality rate (PMR)
late fetal and early neonatal deaths
weighing over 1000 gm at birth
PMR= --------------------------------------------- x 1000
total live birth weighing over 1000 gm at birth
PMR in India 33 / 1000 total births, (2003)Rural- 36
Urban- 20
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Risk factors of PMR:
Low socio-economic factors High or low maternal age
High parity
Short staturemother
Bad obestetrical history
Maternal malnutrition
Severe anemia
Multiple pregnancy etc
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Neonatal mortality rate
no. of deaths of children under 28 daysof age in a year
NMR = ---------------------------------------- x 1000
total live birth in the same year
NMR in India (2003)=37/1000 live birth
55-60%-within neonatal period
50%-first week of life
Neonatal deaths occurring during the neonatalperiod, ie, from birth to 28 completed days of
life.
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Common causes ofNMR
LBW
Postnatal asphyxia
Birth injury
Difficult labor Congenital anomalies
Hemolytic diseases of newborn
Conditions of placenta and cord
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Infant mortality rate (IMR)
no. of deaths of children less than 1 yr ofage in a year
IMR=------------------------------------------------x 1000
no. of live births In the same year.IMR in India (2004)=58/1000 live birth
Orissa=77, Kerala=12
The ratio of infant death registered in a given yr,
to the total no. of live birth registered in the
same yr.
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Causes of IMR
LBW
ARI
Diarrhoeal diseases Congenital malformations
Infections
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Under-five mortality rate (child
mortality rate)
Annual no. of deaths of children aged under 5
yrs, expressed as a rate per 1000 live births.
no. of deaths of children less than 5 years
of age in given year.
CMR=-------------------------------------------x1000
no. of live births in the same year.
Global CMR (2004)=79/1000live birth
India 85 / 1000 (2004), 242/1000 (1960)
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TRENDS IN MATERNAL AND CHILD
HEALTH NURSING POPULATION
CAUSES OF CHANGE:
CHANGES IN SOCIAL STRUCTURE
VARATION
S IN
FAMILY
L
IFESTYL
E INCREASED HEALTH CARE COSTS
IMPROEMENT IN MEDICAL TECHNOLOGY
CHANGING PATTERN OF ILLNESS
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Some of the social changes which
leads to alteration in h. care :-
Small family
Single parents
Working mothers
Homeless family/ mobile homes
Abuse
More health conscious. Cost of living
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TRENDS IN HEALTH CARE ENVIRONMENT
1. MANAGED CARE
FOCUS ON REDUCING THE COST OF H. CARE BY
CLOSELY MONITERING THE
COST OF PERSONNEL,
USE AND BRANDS OF SUPPLIES,
LENGTH OF HOSPITAL STAYS,
NUMBER OF PROCEDURES CARRIED OUT,
NO. OF REFERRALS REQUESTED etc.
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Under managed care the agency receives
a certain sum of amount for the clientcare, no matter how many supplies,
procedures, or personnel are used in
care. Nurses have an important role:
Use generic brand spplies,
never breaking into kits to remove
single item
Use disposable supplies.
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Effects of managed care:
Limits the no. hospital days,
Distribution of personnel
Increased accountability and responsibility ofRN
Created role of advanced practice case
managers.
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Rules to follow while delegating:
Right task for the situation
Right person to complete the task
Right communication concerning what is to be
done.
Right feedback or evaluation that the task was
completed.
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2. Alternative settings and styles for
health care. Home delivery to hospital delivery.
40% live birth occurred in hospitals by 1940and it increased to 98% by 2000.
Now more families are choosing alternativebirth settings other than hospitals.
It provided expanded roles for nsg
practitioners. Hospitals catered consumers demand by
refitting labor & delivery room envt as laborsuites and birthing room.
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Health care setting for children:
The home
Community centers Out patient clinics
Well baby clinics
Schools
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3. Strengthening the ambulatory care
system Reduce incidence of separation and it has a
positive effect in childs development.
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4. Shortening hospital days.
Treatment without requiring an
overnight stay.
Short hospital stay require intensivehealth teaching by the nurse and follow
up by the home care nurses.
Teach the parents to watch the dangersigns.
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5. Including family in the health care
setting
Open visiting hours.
Allow one parent with child.
Encourage parents to give some care.
Encourage room-in
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6. Increase in the number of intensive
care units.
Increase in no. ofNICU and PICU
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7. Regionalization of intensive care.
Regionalization
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Increased reliance on comprehesive
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