Transcript pediatric assessment - American Academy of Pediatrics, New Jersey

PEDIATRIC ASSESSMENT
Essentials for
School Nurses
Patti Lucarelli, MSN, RN, CPNP
Jersey Shore University Medical Center K. Hovnanian Children’s Hospital
Family Health Center
Georgian Court University
School of Nursing
Objectives
• Understand the importance of Assessment and
Triage and how they interplay in the Health Care
Setting
• Identify essential components of a “focused”
Pediatric Assessment
• Utilize the assessment information to differentiate
between minor and more serious conditions (Triage)
• Identify and implement nursing interventions based
on the assessment and triage provided
Sound Familiar?
Essential Pediatric Nursing Skills
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Knowledge of Growth and Development
Development of a Therapeutic Relationship
Communication with children and their parents
Understanding of family dynamics and parent-child
relationships: IDENTIFY KEY FAMILY MEMBERS
Knowledge of Health Promotion & Disease Prevention
Patient Education and Anticipatory Guidance
Practice of Therapeutic and Atraumatic Care
Patient and Family Advocacy
Caring, Supportive & Culturally Sensitive Interactions
Coordination and Collaboration
CRITICAL THINKING
Equipment
What’s in Your setting?
• Airway support
equipment, Ambu-bags
• Stethoscope &
Sphygmomanometer
• Pen Light
• Pulse Ox & Cardiac
Monitor
• Nebulizer
• Otoscope /
Opthalmoscope
• O2
The single most important part of
the health assessment is……
the
History
Bio-graphic Demographic
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Name, Date of Birth, Age
Parents & siblings info
Cultural practices
Religious practices
Parents’ occupations
Adolescent – work info
Past Medical History
•Allergies
•Past illness
•Trauma / hospitalizations
•Surgeries
•Birth history
•Developmental
•Family Medical/Genetics
Current Health Status
•Immunization Status
•Chronic illnesses or conditions
•What concerns do you have today?
Review of Systems
• Ask questions about each system
• Measurements: weight, height, head
circumference, growth chart, BMI
• Nutrition: breastfed, formula, favorite
foods, beverages, eating habits
• Growth and Development: Milestones
for each age group
History: Review of Systems
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Skin
HEENT
Neck
Chest & Lungs /
Respiratory
• Heart &
Cardiovascular
• GI
• GU & GYN
• Musculoskeletal
& Extremities
• Neuro
• Endocrine
THIS OLD CART
O____
L_______
D_______
C______________
A__________ _______
R________ _______
T________
Patti’s Nitty Gritty Trio
• Sleep & Activity
• Appetite
• Bowel & Bladder
• In a time crunch, these three questions
should give you enough insight into the
child’s general functioning –
• Can get more detailed if any (+) responses
Components of a
Focused Pediatric Assessment
• Always ABCs!
• PAT: Pediatric
Assessment
Triangle
• Ongoing Triage –
• Minor vs.
• Serious vs.
Life-Threatening
• Problem- Focused
Examination
Appearance
Includes
LOC & Behavior
PAT
Breathing Changes Skin Circulation
PAT
General Appearance
Work of Breathing
Circulation to the Skin
APPEARANCE
Tone
Interactiveness
Consolability
Look/gaze
Speech/cry
Work of Breathing
• Increased or
Decreased
Respirations
• Stridor
• Wheezing
Circulation to the Skin
• Inadequate perfusion
of vital organs
• Leads to
compensatory
mechanisms in nonessential functions
• Ex: vasoconstriction in
the skin.
Initial Assessment (s)
• Primary
• Secondary
• E = Exposure
• A = Airway
• F = Full Set of Vitals
• B = Breathing
• G = Give Comfort
• C = Circulation
Measures including Pain
Assessment & Tx.
• D = Disability
• H = Head –to-Toe
assessment & history
• I = Inspect posterior
surfaces – rashes,
bruising
Physical Assessment
• The approach is:
• Orderly
• Systematic
• Head-to-toe
• But FLEXIBILIY is essential
• And be kind and gentle
• but firm, direct and honest
Physical Assessment
General Appearance & Behavior
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Facial expression
Posture / movement
Hygiene
Behavior
Developmental Status
Vital Signs
• Temperature: rectal only when
absolutely necessary
• Pulse: apical on all children under 1
year
• Respirations: infant use abdominal
muscles
• Blood pressure: admission base line
• And the “Fifth” Vital Sign is ____ ?
Pediatric Vital Signs – Normal Ranges
Infant
• Heart Rate
80-150
Toddler
70-110
School-Age
Adolescent
60-110
60-100
• Respiratory Rate
24-38
22-30
14-22
12-22
• Systolic blood pressure
65-100
90-105
90-120
110-125
• Diastolic blood pressure
45 - 65
55-70
60-75
65-85
Physical Assessment
• General
• Skin, hair, nails
• Head, neck,
lymph nodes
• Eyes, ears, nose,
throat
• Chest, Tanner Scale
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Heart
Abdomen
Genitalia, Tanner Scale,
Rectal
Musculoskeletal: feet,
legs, back, gait
Physical Assessment
•
Four Basic Skills:
1. Inspection
2. Palpation
3. Percussion
4. Auscultation
• Sequence for abdominal:
1.inspection, 2.auscultation,
3.percussion, 4.palpation
Inspection
• Use all your
senses
• The essential
First Step of the
Physical Exam
Palpation
• Use of your fingers
and palms to
determine:
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Temperature
Hydration
Texture
Shape
Movement
Areas of
Tenderness
• Warm hands and
short nails
• Palpate areas of
tenderness / pain last
• Talk with the child
during palpation to
help him relax
• Be observant of
reactions to palpation
• Move firmly without
hesitation
Palpation
• For the ticklish child: place her hands over
your hands and have the child do the
pressing down.
Percussion
Use of tapping to
produce sounds that
are characterized
according to:
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Intensity
Pitch
Duration
Quality
Direct vs. Indirect
Auscultation
• Listening for body sounds
• Bell: low-pitched
• - heart
• Diaphragm: high-pitched
• – lung & bowel
LUNGS:
Listen to all lung fields
FRONT AND BACK!
auscultate for breath sounds and adventitious sounds
“I P P A”
• Practice, Practice, Practice
• by knowing what the norm is, you’ll be able
to pick up on the abnormal, even if you
can’t diagnose it….
• The important thing is to be able to say
“This is not right”
• and refer appropriately!
H E E N T
Head
Eyes
Ears
Nose
Neck
Throat
HEENT: Head & Neck, Eyes, Ears,
Nose, Face, Mouth & Throat
• Head: Symmetry of skull and face
• Neck: Structure, movement, trachea, thyroid,
vessels and lymph nodes
• Eyes: Vision, placement, external and internal
fundoscopic exam
• Ears: Hearing, external, ear canal and
otoscopic exam of tympanic membrane
• Nose: Structure, exudate, sinuses
• Mouth: Structures of mouth, teeth and pharynx
Head
• Shape:
“NormoCephalic –
ATraumatic”
• Lesions
• ? Edema
Head: Key Points
• Head Circumference (HC
• Fontannels/sutures: Anterior closes at 10-18
months, posterior by 2 months
• Symmetry & shape: Face & skull
• Bruits: Temporal bruits may be significant after 5
yrs
• Hair: Patterns, loss, hygiene, pediculosis in school
aged child
• Sinuses: Palpate for tenderness in older children
• Facial expression: Sadness, signs of abuse,
allergy, fatigue
• Abnormal facies: “Diagnostic facies” of common
syndromes or illnesses
Neuro Assessment
• LOC / Glasgow coma scale
• Confusion, Delirium, Stupor, Coma
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Pupil size
CNS grossly intact: II – XII
Vital Signs
Pain
Seizure Activity
Focal Deficits
Neurological Key Points
• Cranial Nerves
• Cerebral Function:
• Mental status, appearance, behavior, cooperation
• LOC, language, emotional status, social response,
attention span
• Cerebellar Function
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Balance, gait & leg coordination, ataxia, posture, tremors
Finger to nose (fingers to thumb) 3-4 yrs
Finger to examiner's finger 4-6 yrs
Ability to stand with eyes closed (Romberg) 3-4 yrs
Rapid alternations of hands (prone, supine) school age
Tandum walk 4-6 yrs
Walk on toes, heels school age
Stand on one foot 3-6 yrs
• Motor Function: Gross motor & Fine motor movements
• Sensory function
• Reflexes
Cranial Nerves
C1 - Smell
C2 - Visual acuity, visual fields, fundus
C3, 4, 6 - EOM, 6 fields of gaze
C5 - Sensory to face: Motor--clench teeth,
C5 & C7 - Corneal reflex
C7 - Raise eyebrows, frown, close eyes tight, show
teeth, smile, puff cheeks, taste--anterior 2/3 tongue
C8 - Hearing & equilibrium
C9 – say "ah," equal movement of soft palate & uvula
C10 - Gag, Taste, posterior 1/3 tongue
C11 - Shoulder shrug & head turn with resistance
C12 - Tongue movement
Reflexes
Deep tendon:
• Biceps C5, C6
• Triceps C6, C7, C8
• Brachioradialis C5, C6
• Patellar L2, L3, L4
• Achilles S1, S2
Superficial:
• Cremasteric T12, L1, L2
• Abdominal T7, T8, T9, T10, T11
Infant Automatisms:
• Primitive Reflexes
Glasgow Coma Scale
The lowest possible GCS is 3 (deep coma or death) while the
highest is 15 (fully awake person).
1
2
3
4
5
6
EYES
Does not
open eyes
Opens eyes
in response
to painful
stimuli
Opens
eyes in
response
to voice
Opens eyes
spontaneously
N/A
N/A
VERBAL
Makes no
sounds
Incomprehen
sible sounds
Utters
inappropri
ate words
Confused,
disorientated
Oriented,
converses
normally
N/A
MOTOR
Makes no
movements
Extension to
painful stimuli
Abnormal
flexion to
painful
stimuli
Flexion /
Withdrawal to
painful stimuli
Localizes
painful
stimuli
Obeys
commands
Source :Wikipedia
Bacterial Meningitis
Clinical Manifestations in an Older Child
• High fever
• Headache
• LOC Changes / GCS
• Nuchal rigidity / stiff neck
• + Kernigs = inability to extend legs
• + Brudzinski sign = flexion of hips when neck is
flexed
• Purple rash (check for blanching)
• “Looks Sick”
HEAD INJURY
• Very common in pediatrics
• Most often not serious
• requires observation only
• Symptoms
- headache
- vomiting
- lethargy
- altered behavior
•Altered mental status: GCS
HEAD INJURY - Physical Findings
• PUPILS
• PAPILLEDEMA
• CUSHING TRIAD:
• bradycardia, irregular respirations and
hypertention
• Look for signs of alcohol/drug abuse in
adolescents
• Lack of external signs of head trauma
does not rule out significant brain injury
CONCUSSION
• Traumatic alteration in mental status
- disturbance of vision
- loss of equilibrium
- amnesia
- headache
- cognitive function
- LOC (not necessary for diagnosis)
• Needs complete neurological exam
• Second-impact syndrome
• MRI
Colorado Medical Society Guidelines
Grading &1st Concussion Guidelines
Grade Confusion
Amnesia
LOC
Minimum time
to return
to play
I
Yes
No
No
20 min
When
examined
II
Yes
Yes
No
1 week
1 week
III
Yes
Yes
Yes
1month
1 week
Time
asymptomatic
Time to return to contact sports
after repeat concussion
Grade
Minimum time to
Time
return to play
asymptomatic
I (2nd time)
2 weeks
1 week
II (2nd time)
1month
1 week
III (2nd time)
I,II (3rd time)
Season over
Eyes
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PERRL & EOM
Red Reflex
Corneal Light Reflex
Strabismus:
• Alignment of eye important due
to correlation with brain
development
• May need to corrected surgically
• Preschoolers should have
vision screening
• Refer to ophthalmologist is there
are concerns
o
Eyes: Key Points
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Vision: Red reflex & blink in neonate
Visual following at 5-6 weeks
180 degree tracking at 4 months
Pictures or Tumbling E charts & strabismus check
for preschool child
Snellen chart for older children
Irritations & infections
PERRL
Amblyopia (lazy eye): Corneal light reflex, binocular
vision, cover-uncover test
EOMs: tracking 6 fields of vision
Fundoscopic exam of internal eye & retina
Conjunctivitis
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Viral – most common cause
Very contagious
8 day incubation period
Pinkish-red eyes
Watery or serous discharge
Crusty eyelids on awakening
c/o “gritty sensation in eye
May c/o URI symptoms
Can be either unilateral or
bilateral
Vesicles around eye could be
herpes lesions
Immediate referral to
ophthalmologist
Bacterial – more common in
school-age children
Symptoms:
• Red eyes
• Purulent or mucopurulent
discharge, matted eyelids
upon awakening
• c/o “gritty” sensation
• Usually starts unilaterally
and then progresses to
bilateral
• Often concurrent otitis
media
• Culture if < 1 month of age
Conjunctivitis
Allergic
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Often seasonal
Erythema due to dilated vessels
Itching, burning
May be seasonal
Tearing, watery eyes
Eyelid swelling
Clear or stringy eye discharge
bilateral
Ears: Key Points
• Ask about hearing concerns
• Inquire about infant’s response to
• Observe an older infant’s/toddlers speech
pattern
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Inspect the ears
•Assess the shape of the ears
Determine if both ears are well formed
•Assess
Common Ear Infections
Otitis Media
• Most common reason
children come to the
pediatrician or
emergency room
• Fever or tugging at ear
• Often increases at night
when they are sleeping
• History of cold or
congestion
Otitis Externa
• Pain –especially
when pinna is slightly
tugged at
• Discharge
(sometimes odorous)
• “Swimmer’s Ear”
Nose & Throat / Mouth
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Turbinates
Exudate
Pharynx
Tonsils
Signs & Symptoms of
Allergic Rhinitis
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Streaking
Cobble stoning
Post-Nasal Drip
Injection
Erythema
Or is it infection?
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Palate
Gums
Swallow
Oral Hygiene
Condition of teeth
Missing teeth
Orthodontic
Appliances
Nose: Key Points
• Exam nose & mouth after ears
• Observe shape & structural deviations
• Nares: (check patency, mucous
membranes, discharge, turbinates,
bleeding)
• Septum: (check for deviation)
• Infants are obligate nose breathers
• Nasal flaring is associated with
respiratory distress
Nose: Variations
• Allergy: “allergic salute” - line across
nose.
• Infection
• Foreign body:
• Foul odor or unilateral discharge
• Structure variations
• Bell’s palsy
Nose and Throat
Sinusitis:
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Fever
Purulent rhinorrhea
Facial Pain – cheeks, forehead
Breath odor
Chronic cough – could be day and night
(+) Post-nasal drip
Mouth & Pharynx: Key Points
• Lips: color, symmetry, moisture, swelling, sores,
fissures
• Buccal mucosa, gingivae, tongue & palate for
moisture, color, intactness, bleeding, lesions.
• Tongue & frenulum - movement, size & texture
• Teeth - caries, malocclusion and loose teeth.
• Uvula: symmetrical movement or bifid uvula
• Voice quality, Speech
• Breath - halitosis
Ears, Nose and Throat
Sore Throats
Is it strept or is it viral
or could it be mono?
Lymph nodes
& ROM
Neck: Key Points
• √ position, lymph nodes, masses, fistulas,
clefts
• Suppleness & Range of Motion (ROM)
• Check clavicle in newborn
• Head control in infant
• Trachea & thyroid in midline
• Carotid arteries (bruits)
• Torticollis
• Webbing
• Meningeal irritation
Chest Assessment
•How does the child look?
•Color
•Work of Breathing: Effort
used to breathe
Auscultation
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All 4 quadrants
Front and back
Take the time to listen
Be sure about “lungs CTAB”
(clear to auscultation bilaterally)
Lungs & Respiratory: Key Points
• Quality of Respirations:
• Symmetry, Expansion, Effort, Dyspnea
• S & S Respiratory Distress:
• Color: cyanosis, pallor, circumoral cyanosis, mottling
• Tachypnea
• Retractions
• Nasal flaring
• Grunting (expiratory)
• Stridor - inspiratory: croup
• Adventitious sounds:
• Crackles / Rales
• Rhonchi - course breath sounds
• Wheeze – inspiratory vs. expiratory
Lungs & Respiratory: Key Points
• Clubbing
• Snoring (expiratory): upper airway
obstruction, allergy,
• Fremitus:
• Increased in pneumonia, atelectasis, mass
• Decreased in asthma, pneumothorax or FB
• Dullness to percussion: fluid or mass
Work of Breathing
• Increased or
Decreased
Respirations
• Stridor
• Wheezing
Chest Assessment
• Auscultation
• Wheezing
• Retractions
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Subcostal
Intercostal
Sub-sternal
Supra-clavicular
Red Flags:
• grunting
• nasal flaring
• stridor
All that Wheezes
isn’t always Asthma…
Think:
• Infection
• Foreign body aspiration
• Anaphylaxis
• Insect bites/stings,
medications, food
allergies
And all Asthma
doesn’t always Wheeze!
• Cough
• Fatigue
• Reduced
exercise
tolerance
Coughs
• Allergies
• Asthma
• Infections – pneumonia, bronchitis,
bronchiolitis
• Sinusitis – Post-nasal drip
• GERD
• Cigarette smoking
• Exposure to secondhand smoke,
• Other pollutants
Cough - Characteristics
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Dry, non-productive
Mucousy – productive
Croupy
Acute – less than 2-3 weeks
Chronic – more than 2-3 weeks
Associating Symptoms
Chest Pain
• Call 911 if severe, acute, unremitting –
needs immediate attention - very rare
• Non-cardiac – most common
• Musculoskeletal: costochondritis
• Pulmonary
• Gastrointestinal e.g. GERD
• Psychogenic
• Often no significant physical findings
• Must rule out Cardiac origin – refer to PCP or
pedi cardiologist
Circulatory
•Auscultating Heart Sounds
The Auscultation Assistant – Hear Heart Murmurs, Heart Sounds,
and Breath Sounds. http://www.wilkes.med.ucla.edu/inex.htm
Pillitter
•Perfusion – capillary refill
•“Warm to touch”
Murmurs:
• may be systolic, diastolic or continuous
• timing, location, quality -course, harsh, blowing, high pitched
• GRADE:
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I - faint, may not be heard sitting
II - readily heard with stethoscope
III - loud, no thrill
IV - loud with stethoscope, thrill
V - loud with stethoscope barely to chest, thrill
VI - loud with stethoscope not touching chest, thrill
Functional Murmurs:
Change or disappear with position change (usually loudest supine)
Low grade, soft or musical
Intensity range from I-III/VI
Systolic (never diastolic)
Do not radiate
Occur in absence of significant heart disease or structural
abnormality
Gastro-Intestinal
Abdominal Assessment
Pillitteri
Abdomen: Key Points
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Contour
Bowel Sounds & Peristalsis
Skin: color, veins
Umbilicus
Assess for Tenderness, Ridigity, Tympany,
Dullness
• Hernias: umbilical, inguinal, femoral
• Masses - size, shape, dullness, position,
mobility
• Liver, Spleen, Kidneys, Bladder
Bowel Sounds
• Normal: every 10 to 30 seconds.
• Listen in each quadrant long enough to
hear at least one bowel sound.
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Absent
Hypoactive
Normoactive
Hyperactive
Stomachaches and
Abdominal Pain
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Excessive gas
Chronic constipation
Lactose intolerance
Viral gastroenteritis
Irritable bowel
syndrome
• Heartburn or
indigestion
• GERD
• Food allergy
• Parasite infections
(Giardia)
What are we most concerned about?
Stomachaches and Abdominal Pain
• Appendicitis
• Bowel obstruction -Cholecystitis with or without
gallstones
• Food poisoning
(salmonella, shigella)
• Inflammatory Bowel
Disease –
• Crohn's disease
• Ulcerative colitis
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Hernia
Intussusception
Kidney stones
Pancreatitis
Sickle cell crisis
Ulcers
Urinary tract
infections
Signs and Symptoms
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Appearance –color, facial, ROM, gait, position
Pain – get your pain scales out
Nausea
Vomiting
Diarrhea
Bloating
Vomiting
Inability to pass gas or stool
Diagnostic breakdown of one year's admissions for
abdominal pain in a district general hospital.
Davenport, M. BMJ 1996;312:498-501
Copyright ©1996 BMJ Publishing Group Ltd.
Bottom Line: Acute or Not
Soft, non-tender,
non-distended
no rebound, no HSM,
no mass,
BS NA x 4Q
Can the child hop?
Ball & Bindler
Musculo-Skeletal
• FROM, MAE - neck, shoulder, elbow, wrist, hip,
knee, ankle, foot, digits
• Alignment, contour, strength, weakness &
symmetry
• Limb, joint mobility: stiffness, contractures
• Gait – observe child walking without shoes
• Spinal alignment - Scoliosis
• Muscle Strength & Tone
• Hips – O & B
• Reflexes
• Pre-Participation Sports P.E. –
• NJ’s new guidelines:
http://www.state.nj.us/education/districts/ppeq.doc
Scoliosis
Lateral curvature of spine
Key Points:
•Barefoot
Medline.com
•Feet Together
•Bend Over –”Diving Of a Diving Board”
•Check Hips
Assessment
• The Five P’s:
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Pain
Paresthesia
Passive stretch
Pressure
Pulse-less-ness
Skin, Nails & Hair
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Rashes
Lesions
Lacerations
Lumps
Bumps
Bruises
Bites
Infections
Common Skin Lesions
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Macule
• Scale
Papule
• Crust
Vesicle, bulla
• Keloid
Pustule
• Fissure
Cyst
• Ulcer
Patch
• Petechiae
Plaque
• Purpura
Wheal
• Ecchymosis
Striae
Capillary bleeding: Petichiae and purpura
usually indicate serious conditions
Skin Infections
• Bacterial infections
• Abscess formation
• Severity varies with skin integrity,
immune and cellular defenses
• Examples:
• impetigo
• cellulitis
Viral Skin Infections
• Most communicable diseases of
childhood have characteristic rash
• Examples: verruca, herpes simplex
types I and II, varicella zoster,
molluscum contagiosum
Fungal Skin Infections
• Superficial infections that live on the
skin
• Also known as dermatophytoses, tinea
• Transmission from person to person or
from infected animal to human
• Examples: tinea capitis, tinea corporis,
tinea pedis, candidiasis
Contact Dermatitis
• Inflammatory reaction of skin to chemical
• Initial reaction in the exposed region
• Characteristic sharp delineation between
inflamed and normal skin
• Primary irritant
• Sensitizing agent
• Examples: diaper dermatitis, reaction to
wool, reaction to specific chemical
• Poison Ivy, Oak, and Sumac - urushiol
Miscellaneous Skin Disorders
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Urticaria
Psoriasis
Alopecia
Intertrigo
Stevens-Johnson syndrome
Neurofibromatosis
Atopic Dermatitis
• A type of pruritic
eczema that begins
during infancy
• Hereditary tendency
• Often associated
with history of food
allergies, allergic
rhinitis, and asthma
• Three forms:
• Infantile eczema:
begins at age 2-6
months
• Childhood eczema:
may follow infantile
form
• Preadolescent and
adolescent: 12 years
to early adult age
Therapeutic Management of
Atopic Dermatitis
Goals:
• Relieve pruritus
• Hydrate skin
• Reduce inflammation
• Prevent or control secondary infection
WOUND CLASIFICATION
CLINICAL
FEATURES
NON-TETANUSPRONE WOUNDS
TETANUS-PRONE
WOUNDS
Age of wound
<6 hours
>6 hours
configurations
Linear wounds,
abrasions
Stellate, avulsion
depth
<1cm
>1cm
Mechanism of injury
Sharp surface
Crush, burn, missile
Sings of infection
absent
present
Devitalized tissue
absent
present
Contaminants (dirt,
feces, soil, saliva )
absent
present
Denervated/ischemic
tissue
absent
present
The School-Age Child
• Privacy and
modesty.
• Explain procedures
and equipment.
• Interact with child
during exam.
Adolescent
• Privacy issues – first
consideration
• HEADS: home life,
education, alcohol,
drugs, sexual
activity / suicide
• GAPS Guidelines for
Adolescent
Preventive Services
• Bright Futures
Psychosocial Assessment
HEADS
• Home life
• Emotions /
Depression or
Education
• Activities
• Drugs / Alcohol /
Substance
Abuse
• Sexuality
activity or
Suicide
SHADESS
•School
•Home
•Activities
•Drugs / Substance
Abuse
•Emotions /
Depression
•Sexuality
•Safety
Common School Health
Focused Assessments
• The “I don’t feel good”
– where do I begin?
• Behavioral / Mental
Health Concerns
• Chronic Conditions &
Special Needs
• What Else?
The “I don’t feel good”
Appearance
Includes
LOC & Behavior
PAT
PAT
and
Breathing Changes Skin Circulation
This OLD CART
Common School Health
Focused Assessments
• Emergencies & Trauma –
Allergic Reactions,
Asthma, Head, Abdomen,
Limb, Other
• Skin – Rashes, Lacerations,
Lumps, Bumps & Bruises
• The Frequent Fliers –
Headaches, Stomachaches,
Chest Pain, Coughs &
Fevers
• Other HEENT
Emergencies & Trauma
• Allergic
Reactions
• Asthma
• Head
• Abdomen
• Limb
• Other
The Frequent Fliers
•
•
•
•
•
•
Headaches
Stomachaches
Nosebleeds
Chest Pain
Coughs
& Fevers
Frequent Fliers
If only you could cash in on those miles!
Behavioral / Mental Health
Concerns
•
•
•
•
•
Developmental Delays
Depression
Aggressive Behaviors
Suicide Risks
Other Mental Health
Issues
Chronic Conditions &
Special Needs
•
•
•
•
•
•
Asthma
Diabetes
Neuro – seizures
Sickle Cell Anemia
Cerebral Palsy
ADHD
Additional “To – Do’s”
• Documentation
• –SOAP Notes
• Quality Improvement
– - chart reviews
• Confidentiality –
seriously!
Resources and References
• Jan Chandler RN, MSN, CNS, PNP Pediatric Nursing: Nursing Care of
Children and Young Adults: Pediatric Physical Assessment
• Colyar, M. Well Child Assessment for Primary Care Providers. Philadelphia,
PA: F.A. Davis Company.
• Duderstadt, K. Pediatric Physical Examination.
St. Louis, MO: Mosby, Inc.
• Engel, J. Pediatric Assessment 5th. Ed. St. Louis, MO: Mosby, Inc.
• Wong’s Essentials of Pediatric Nursing 8th ed.
• AAP Preparticipation Physical Evaluation. Available @ www.aap.org
• Resource Manual for the Nurse in the School Setting http://www.emsc.org/school/frameschool.htm
• American Medical Association Guidelines for Adolescent Preventive
Services (GAPS) http://www.ama-assn.org/ama/pub/category/2280.html
• American School Health Association http://www.ashaweb.org
• The Auscultation Assistant @
http://www.wilkes.med.ucla.edu/intro.html
• BMI Calculator: http://www.cdc.gov/nccdphp/dnpa/bmi /
• 2007 Asthma Guidelines:
http://www.nhlbi.nih.gov/guidelines/asthma/index.htm
We Know
It’s a Jungle Out There!
The Power of Nursing
Never doubt how vitally important you are;
never doubt how important your work is –
and never expect anyone to acknowledge it
before you do.
Every moment, in everything you do,
you are making a difference.
In fact, you are in the business of making a
difference in other people’s lives.
In that difference lies their healing
and your power.
Never forget it.
Leah L. Curtin, RN, MS, MA, DSC, FAAN