Module 1

1. Pediatric Assessment Module 1

2. Communicating with Children and Families Chapter 32

3. One of the first steps in Preparation for Assessment is to Establish Effective Communication

4. Components of Effective Communication • Touch • Physical Proximity and Environment • Listening • Visual Communication • Tone of Voice • Body Language • Timing

5. Effective communication with Families • Include all involved family members • Develop open lines of communication • Encourage families to write their questions • Respect and encourage feedback from families • Avoid assumptions about core family beliefs and values

6. Developmental Milestones and Relationship to Communication Approaches See Table 32-3 on pages 802-803

7. Developmental milestones and approach to communication

8. Physical Assessment of Children Chapter 33

9. How would the nurse adapt the assessment of a child from the assessment of the adult?

10. Adaptation • Change the sequence of the physical exam of a young child by: • delaying any painful or frightening procedures until the end of the assessment • Perform assessments that will not disturb the child first • Adapt the physical examination to the child’s age and developmental level

11. Approaches to the Examination See General Approaches On page 811 - 815

12. Facilitating Examination of Infants • Parental presence • Physical comfort and relaxation • Distraction • Auscultate when quiet • Procedures that provoke crying at end of exam

13. Facilitating Examination of Toddlers • Parent’s lap • Play • Security object • Instruments • Control and choice

14. Facilitating Examination of Pre-schoolers • Sequence • Games and activities • Demonstrate and touch instruments • Distraction

15. Facilitating Examination of Older Children and Adolescents • Modesty and privacy • Choices • Explanations of body parts and functions • Parental presence or absence/need for chaperones • Reassurance of normalcy (adolescents)

16. Summary of Strategies to gain cooperation • Perform assessment in appropriate area • Minimize stress and anxiety associated with assessment • Foster a trusting parent-child nurse relationship • Praise the child for positive behaviors • Allow maximum preparation of the child • Preserve essential security of parent –child • Be aware of growth and development and promote health teaching and recognition of deviations from the norms.

17. Sequence of Physical Examination

18. General Appearance

19. Getting Started • Verify patient – National Patient Safety Goal • Introduce self – tell purpose of assessment/ interview • Use open-ended questions • Ask only one question at a time • Direct the question to the child when appropriate • Obtain feedback from parents to confirm understanding • Talk in soothing voice.

20. Initial Interview • Statistical information • Childs name, nickname, age, sex, ethnic origin • Birth date, religion • Important phone number and parent contact information • General Appearance • Note parent-child interaction • Note clues about child’s behavior and health status

21. History Taking • Problem-oriented History – gather data regarding the current Chief Complaint – major focus • Health History • Family History • Lifestyle and Life Patterns

22. History of Present Illness or Injury Characteristic Defining Variables Sudden or gradual, date and time began Pain, itching, cough, vomiting, runny nose, diarrhea, etc General or localized Effect on daily activities – interrupted sleep, decreased appetite What relieves or aggravates symptoms, what precipitated the problem Medications used, treatments used (heat, ice, rest), response to treatment • Onset • Type of Symptom • Location • Severity • Influencing factors • Previous and Current Treatment

23. A Health History Data is gathered from birth to current status and includes: • Birth history including condition of baby at birth • Health maintenance – child’s primary provider, dentist, and other healthcare providers • Medications • Allergies • Immunizations • Activities and exercise • Nutrition • Sleep

24. Family History • Focuses on health status of parents, siblings, and specific blood relatives. • Purpose is to gather data about any hereditary factors that are likely to affect the child’s health.

25. Lifestyle / Psychosocial Data • Family composition • Housing / home environment • School or childcare arrangements • Daily Routines – very important

26. Potential Indicators of Child Abuse • Dress - Inappropriate for weather; excessively dirty • Hygiene- dirty teeth, matted hair, broken fingernails • Posture and Movement – crouching in corner, slow, concentrated movements • Communication – using one syllable words, seeking approval for answers; waiting for someone else to answer question • Facial characteristics – fearful, anxious, tearful, sad • Psychological state – demanding, bizarre, overly dramatic or condescending

27. Summary • During the first contact with the child and parent, the nurse forms an initial impression by making a general survey. • It will give the nurse a subjective impression of the: • Physical appearance • State of nutrition • Behavior and Personality • Interactions with parents and nurse • Posture • Development • Speech

28. Vital Signs

29. Vital SignsTemperature • Normal temperature runs around 99 degrees until > 36 months. • A variance of 1-2 degrees is OK. • A temperature <97 degrees in an infant and > 100.5 degrees is indicative of a problem and should be noted. • Temperatures are taken commonly either axillary or tympanic. • Be sure to document how taken.

30. Vital SignsPulse • Apical pulse rates are most commonly taken in children; especially in those under 2. • Assess based on limits for age and norms for that child. **See Table 33-1 – Normal Vital Signs for Age

31. Normal Heart Rates for Children of Different Ages

32. Vital SignsRespirations • Assess the rate, depth, and ease of respiration in the child. Varies with age of child. Respirations should be quiet and effortless • Infants are abdominal breathers / nose breathers 4 weeks to 4 months. • By age 7 – costal breathers

33. Normal Respiratory Rate Ranges for Different Age Groups

34. Blood Pressure Choose a cuff with a bladder width that is approximately 40% of the arm circumference of the upper arm. When the cuff is wrappedaround the upper arm, the bladder length usually covers 80% to 100% of the arm’s circumference.

35. Measurements • Height • Weight • Head Circumference • Chest Circumference • Growth Charts

36. Body System Assessment

37. Systematic Body System Assessment • Refer to your textbook for specific examples of performing a physical assessment – see pages 820 - 846.

38. Review • Most Important elements to include in an assessment: • 1. Chief complaint • 2. History of present illness or injury • 3. Past history • 4. Current health status • 5. Review of body systems • 6. Psychosocial data • 7. Developmental data

39. Analyzing the Data

40. Prioritization of Care After collection of the data, the nurse should be ready to prioritize the data and intervene as needed

41. Prioritization of Care • First Level • Airway • Breathing • Circulation • Signs • Vital sign abnormalities are very crucial in children. (A temp too low is just as serious as an elevated temp.)

42. Prioritization of Care • Second Level • Psychological problems • Elimination problems (has not voided after surgery, no wet diapers, no BM, diarrhea) • Risk of Infection • Signs and symptoms of untreated medical problems • Nutrition problems

43. Prioritization of Care • Level 3 • Health concerns that do not immediately threaten the physiological status of the child such as: • knowledge deficit / Patient teaching • Coping • Health maintenance • Activity • Rest