Pediatric Assessment & Communication with the Pediatric Patient

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

2. Therapeutic Communication How does a nurse communicate with a patient who does not use words? Physical Proximity and environment Touch Listening Visual Communication Tone of Voice Body Language Timing

3. Considerations and strategies for cooperation: Remember developmental age (why is this crucial to success?) p 60 & 61 table 4.3 • Honesty • Involve child- speak directly to the child • Involve parents when appropriate

4. Developmental milestones and approach to communication

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

6. Quick Question? • What is the best way to ruin the relationship between the nurse and child/family/patient?

7. How is the assessment of a child different than the assessment ofan adult?

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

9. Examination of Infants • Allow parents to hold and participate • Auscultate when quite • Warm equipment • Invasive procedures last • Rectal temperatures • Lab draws)

10. Examination of Toddlers • Encourage parents to participate • Introduce equipment • Play • Choices/control • Security object

11. Examination of Pre-School Age • Demonstrate and introduce equipment • Sequence • Games and play • Distraction

12. Examination of School Age and Adolescent • Provide privacy (parental presence or absence/chaperone) • Choices of exam sequence • Explanation of body parts and functions • Reassurance of normalcy

13. Beginning the Examination • Verify patient- National Patient Safety Goal • Introduce self- explain purpose of assessment • Utilize therapeutic communication (open-ended questions) • Address the child (direct questions, make eye contact- WHY?) • Obtain feedback from parents when necessary

14. Why is an accurate history the single most important component of the physical examination? Page 807 Box 33-3 • Substantive data • Objective data

15. 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

16. Obtaining a history: • Open-ended questioning • Re-phrase rather than repeat • Listen actively (reflective reply) • Cultural differences • Avoid judgmental questions • Psychosocial data is critical to health promotion

17. Problem-Oriented History Characteristics Defining Variables • Chief complaint and onset • Body Location • Quality • Quantity • Aggravating and alleviating • Previous & current treatment • Use the child’s own words to describe when & how began • Anatomic location general or localized • Burning/stabbing/dull/aching • Intensity of pain or problem • What increases or relieves the pain or problem • Medications, thermo therapy, responses to treatment

18. 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)

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

20. Prioritizing Care • Primary- ABCDE’s • Airway, breathing, circulation, LOC (disability, & exposure) • A temperature too low is as serious as too high

21. 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

22. Prioritizing Care cont… • Secondary • VS, pain, history and head-to-toe assessment and inspection • Height/weight, diagnostic testing • Psychological problems • Risk of infection • Nutritional problems

23. Prioritizing Care cont… • Tertiary • Health concerns that do no immedicately threaten the physiologic status of the child: • Knowledge deficit / Patient teaching • Coping • Health maintenance • Activity • Rest

24. Assessment Findings: head to toe (chapter 33) • 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

25. 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 page 808

26. 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?

27. 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

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

29. Recognize your own limitations and protect yourself. The Health Science Programs of Austin Community College recognize the additional stressors associated with becoming a nurse. We offer free counseling services to all students through the Student Services Department These counselors offer confidential assistance to any student as well as test taking skills and tips EVC- Sandra Elizondo (512) 223-5810 selizond@austincc.edu RRC- Julie Reck (512) 223-0235 jcuellar@austincc.edu

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