Transcript Powerpoint Pediatric Assessment

Presented by
Marlene Meador RN, MSN, CNE
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
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
Developmental milestones and
approach to communication
Infants
(0-12 mo)
Toddlers
(1-2 yr)
Preschoolers
(3-5 yrs)
School-age
(6-11)
Use of calm voice;
respond to cries,
mimic baby
sounds, talk and
read regularly, use
a slow approach
and allow time to
get to know you
Learn the
toddler’s words
for common
items, picture
books, respond to
their
receptiveness,
preparation
should occur
immediately
before event
Offer choices, use
play or
“storytelling” for
explanations,
simple sentences,
picture books,
puppets, be
concise; limit
length of
explanations
Photos, books
videos, diagrams,
establish
limits, use play,
introduce
preparatory
materials 1-5 days
in advance of the
event
Barriers to Communication
Language
Cultural differences
Distraction
Stress/conflict
Quick Question?
What is the best way to ruin
the relationship between the
nurse and
child/family/patient?
How is the assessment
of a child different
than the assessment of
an adult?
Adapting the physical
assessment to children:
Physical proximity to the
child/patient
Physical contact
Sequence of assessment
Examination of Infants
 Allow parents to hold and participate
 Auscultate when quite
 Warm equipment
 Invasive procedures last
 Rectal temperatures
 Lab draws)
Examination of Toddlers
 Encourage parents to participate
 Introduce equipment
 Play
 Choices/control
 Security object
Examination of Pre-School Age
Demonstrate and introduce
equipment
Sequence
Games and play
Distraction
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
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
Why is an accurate history
the single most important
component of the physical
examination? Page 807 Box 33-3
 Substantive data
 Objective data
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
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
Problem-Oriented History
Characteristics
 Chief complaint and onset
 Body Location
 Quality
 Quantity
 Aggravating and alleviating
 Previous & current treatment
Defining Variables
 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
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)
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
Prioritizing Care
Primary- ABCDE’s
 Airway, breathing, circulation, LOC (disability, &
exposure)
 A temperature too low is as serious as too high
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
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
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
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
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
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?
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
When would the nurse notify
CPS?
What are the nurse’s legal
obligations
What are the nurse’s ethical
obligations?
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 [email protected]
RRC- Julie Reck (512) 223-0235 [email protected]
Please contact Marlene Meador RN, MSN
if you have any questions or concerns
regarding this information.
[email protected]
512-422-8749