Pediatric Assessment & Communication with the Pediatric Patient

1. Pediatric Assessment&Communication with the Pediatric Patient Presented by Marlene Meador RN, MSN, CNE

2. Considerations and strategies for cooperation: Remember developmental age (why is this crucial to success?) p 802 table 32.3 • Honesty • Involve child- speak directly to the child • Involve parents when appropriate

3. Barriers to Communication • Language • Cultural differences • Distraction • Stress/conflict

4. Quick Question? • What is the best way to ruin the relationship between the nurse and child client?

5. More questions? • What is the best nursing rationale for a nurse allowing the parent to administer medications to the hospitalized child? • Can you name another reason?

6. Adapting the physical assessment to children: • Physical proximity to the child/patient • Physical contact • Sequence of assessment

7. Why is an accurate history the single most important component of the physical examination? • Substantive data • Objective data

8. Three types of health history • Complete or initial • Conception to current status • Well or interim • Previous well visit to current visit • Problem-oriented or episodic • Information related to current problem

9. Two types of assessment: • Primary- ABCDE’s • Airway, breathing, circulation, LOC (disability, & exposure) • Secondary • VS, pain, history and head-to-toe assessment and inspection • Height/weight, diagnostic testing

10. Adaptations in Emergency Assessment • S- signs and symptoms • A-allergies • M-medications and immunizations (OTC and herbal) • P- prior illness or injury • L- last meal and eating habits • E- events surrounding illness/injury

11. Obtaining a history: • Open-ended questioning • Re-phrase rather than repeat • Listen actively (reflective reply) • Cultural differences • Avoid judgmental questions Give an example of each type of question with a more therapeutic version.

12. Priority Assessment! • What are the areas of priority assessment?

13. Priority Assessment! • Airway- • Breathing- • Circulation- • VS-

14. Obtaining a Health History • Presenting illness/injury • Onset of symptoms • Type of symptoms • Location • Duration • Severity • Aggravating factors • Lab findings • Previous or current illness

15. Obtaining a Health History • Birth History • Prenatal care (onset and duration) • Mother’s age and health at time of birth • Mother’s history of illness, injuries • Mother’s impression of pregnancy (also significant other’s impression)

16. Obtaining a Health History • Familial or Inherited Disorders • Chromosomal disorders in other family members • Height and weight • Diabetes • Cardiovascular disease • Asthma/ reactive airway disease • Allergies

17. Assessment Findings: head to toe (page 817-847) • Head (eyes, ears, hair, shape, FOC) • Chest- cardiac, respiratory, excursion- shape • Abdomen- size, shape, tone • Musculoskeletal- posture, tone, symmetry • Neuro- reflexes • Skin- including hair • Genitalia- age appropriate

18. Quick Review: • Why is it important for the nurse to know the normal range of vital signs specific to the age of patients? Table 33-1

19. How does the nurse prioritize assessment findings? • Stay alert to what would cause harm… • Is this an acute need? Or at risk for? • How does the nurse select the intervention? • How do you evaluate the effectiveness of the intervention?

20. What physical and psychosocial findings suggest abuse or neglect? • Dress • Grooming and personal hygiene • Posture and movements • Body image • Speech and communication • Facial characteristics and expressions • Psychological state

21. When would the nurse notify CPS? • What are the nurse’s legal obligations • What are the nurse’s ethical obligations?

22. Please contact Marlene Meador RN, MSN if you have any questions or concerns regarding this information. Mmeador@austincc.edu 512-422-8749