Pediatric Assessment

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

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Barriers to Communication

• Language
• Cultural differences
• Distraction
• Stress/conflict

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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?

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Adapting the physical assessment to children

• Physical proximity to the child/patient
• Physical contact
• Sequence of assessment

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Why is an accurate history the single most
important component of the physical examination?

• Substantive data
• Objective data

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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

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Two types of assessment

• Primary- ABCDEs
• Airway, breathing, circulation, LOC (disability,
  exposure)
• Secondary
• VS, pain, history and head-to-toe assessment and
  inspection
• Height/weight, diagnostic testing

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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

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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.

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Priority Assessment!

• What are the areas of priority assessment?

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Priority Assessment!

• Airway-
• Breathing-
• Circulation-
• VS-

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Obtaining a Health History

• Presenting illness/injury
• Onset of symptoms
• Type of symptoms
• Location
• Duration
• Severity
• Aggravating factors
• Lab findings
• Previous or current illness

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Obtaining a Health History

• Birth History
• Prenatal care (onset and duration)
• Mothers age and health at time of birth
• Mothers history of illness, injuries
• Mothers impression of pregnancy (also
  significant others impression)

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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

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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

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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

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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?

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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

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When would the nurse notify CPS?

• What are the nurses legal obligations
• What are the nurses ethical obligations?

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• Please contact Marlene Meador RN, MSN if you have
  any questions or concerns regarding this
  information.
• Mmeador_at_austincc.edu
• 512-422-8749