Communication and Physical Assessment of the Child

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  1. Ways to Communicate with Children
    Make communication developmentally appropriate

    Get on child's eye level

    Approach child gently and quietly

    Always be truthful

    Give child choices as appropriate

    Avoid analogies/metaphors

    Give instructions clearly/in positive manner

    Avoid long sentences, medical jargon, "scary words" (little stick in the arm; cough your head off; cut, tubes, etc...)

    Give older child opportunity to talk without parent present
  2. Developmentally appropriate communication of infant:
    • Nonverbal
    • Crying-- type known to caregiver

    (**Parents are source of hx/observation/exam)
  3. Developmentally appropriate communication of Early Childhood
    Focus on child in your communication!!

    Explain what, how, why

    Use words he/she will understand

    Be consistent (don't smile when doing painful procedures)
  4. Developmentally appropriate communication of adolescent
    • Be honest with them-- helps gain trust
    • Be aware of privacy needs
    • Think about developmental regression
    • Importance of peers
    • Have confidential time
  5. Goals of Pediatric Assessment
    Minimize stress and anxiety associated with assessment of various body parts

    Foster trusting nurse-child-parent relationships

    Allow for maximum preparation of child

    Preserve security of parent-child relationship

    Maximize accuracy of assessment findings
  6. General approaches toward examining child
    Head-to-Toe sequence for assessing adult clients

    Sequence for pediatric assessments generally altered to accommodate child's developmental needs
  7. Physical Assessment of INFANT
    • Try not to wake baby
    • Examine on parent lap if possible
    • Leave diaper on
    • Comfort measures such as pacifier or bottle
    • Talk softly
    • Start with heart/lung sounds
    • Ear/Throat exam last
  8. Physical Assessment on TODDLER
    • Examine on parent lap if uncooperative
    • Use play therapy
    • Distract with stories
    • Let toddler play with equipment/BP
    • Call by name
    • Praise frequently 
    • Quickly do exam
  9. Physical Assessment on PRESCHOOL
    • Allow parent to be within eye contact
    • Explain what you are doing
    • Let them feel the equipment
    • Use simple explanations
    • Offer available choices to the child
    • Use games to get the child to cooperate
  10. Physical Assessment on School Age
    • Allow choice of having parent present
    • Privacy/Modesty
    • Ask if child has any questions or concerns
    • Explain procedures/equipment
    • Interact with child during the exam
    • Be matter of fact about examining genital area
  11. Physical Assessment of Adolescent
    Ask about parent in the room

    Should have some private interview time: time to ask difficult questions

    Provide privacy

    Provide info about physical changes in matter-of-fact manner
  12. V/S measurement of Infant/Toddlers
    • Count Respirations FIRST
    • Count apical heart rate SECOND
    • Measure BP 3rd
    • Measure temp LAST
  13. Count the apical pulse for children <2 for
    1 full minute
  14. Panic Levels for respiratory assessment on infant/toddler
    • <10
    • >60
  15. Respiratory assessment:
    Count for 1 full minute (usually before infant wakes...rates are elevated with crying/fever)

    ...if under 1 year count abdominal movements!
  16. Places to take BP
    • Brachial artery
    • Radial
    • Popliteal
    • Dorsalis Peds
    • Posterior tibial
  17. Normal VS ranges for infant
    • R= 30-60
    • P= 100-160
    • SBP= >60
  18. Normal VS for Toddler
    • R= 24-40
    • P= 90-150
    • SBP= >70
  19. Normal VS for Preschooler
    • R= 22-34
    • P= 80-140
    • SBP = >75
  20. Normal VS for School Age
    • R= 18-30
    • P= 70-120
    • SBP= >80
  21. Normal VS for adolescent
    • R= 12-20
    • P= 60-100
    • SBP= >90
  22. Head assessment (measured until 3 years)
    • Check fontanels
    • -anterior (12-18 months)
    • -posterior (closes by 2 months)

    Shape- flat headed babies are due to back-to-back sleep position
  23. Neck Assessment
    • Symmetry
    • Palpate for masses and lymph nodes
  24. Eye Assessment
    • External Structures
    • Internal Structures
    • Vision (parent role)

    *Infants should be able to focus on one object referred to binocularity by the age of 3-4 months of age
  25. Pinna is pulled _____ to straighten ear canal in children < 3 years old
    Down and Back
  26. Respiratory Red Flags
    Grunting or Nasal Flaring or Retractions
Card Set:
Communication and Physical Assessment of the Child
2015-02-25 03:20:51
Communication Physical Assessment Child

Communication and Physical Assessment of Child
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