Assessment Flashcards
Infants: communication
Communicate through nonverbal and crying
Respond to non verbal behavior of adults - rocking, holding, patting
Respond well to gentle physical contact
Older infants = separation and stranger anx
<6 mo tolerate lying on exam table; >6 mo let sit on parent’s lap
Conduct exam so they can see parent or be held by parent
Allow security object
High pitched, soft voice and smile
Toddlers: communication
Can’t effectively verbally communicate
Interpret literally - use short concrete terms, repeat explanations and descriptions, visual aids (puppets, dolls), allow them to handle any equipment you will use, allow comfort object, allow access to parent
Pre-schoolers: communication
More sophisticated verbal communication, intuitive reasoning, older like to conform, know most external body parts, may be interested in parts of assessment, allow them to handle equipment and answer questions, modest - expose minimally, allow to undress themselves, allow opportunities for questions, parental proximity important
School ages: communication
Think in concrete terms at more sophisticated level, can rely on past experiences with providers to guide them, fear injury or embarrassment, allow time for composure and privacy, use simple diagrams and teaching dolls, curious about function of equipment and usefulness
Adolescent: communication
Sophisticated verbal communication even if behavior may not indicate, may respond with monosyllables, anger or other behaviors, nurse may have to talk more, helpful to ask what they know about health and explain rationale for assessment, privacy and confidentiality - can perform away from parents, preoccupied with body image and function - give feedback from assessment, diagrams and models can enhance feedback, avoid too abstract/technical/detailed
Parents
Broad Q’s, save more focused and closed Qs for later, listen without interrupting, involve parents, avoid overwhelming, provide recognition, praise, reassurance for strengths
Health hx
Intro and explanation, demographic area, chief concern, H/O chief concern, health and fam profile, day hx, past health hx (include pregnancy), fam health hx, review of systems
Conclude: is there any more about ___ that we should know?
Preparation
Be prepared in entirety before approaching child
Supplies: thermometer, stethoscope, tongue depressor, sphygmomanometer, tape measure, tuning fork, reflex hammer, rubber gloves, client gown, toys for distraction - stickers, bubbles, etc
Body measurements
Important for detecting disease processes or abnormalities
Height: growth chart
Weight: use table scale for <2; use sale paper to decrease infection spread; weigh infant nude; never leave child alone on scale; plot on growth chart
Body measurements: head circumference
Brain growth and potential neuro function
Measured at birth and at check ups until age 1
Above eye brows and most prominent part of back of head
Plot on growth chart
Should correlate with child’s length
Body measurements: abdominal girth
Detect disease
Not usually in outpatient setting
Largest portion - usually at naval
Vital signs
Temp: same limits as adult; axillary, oral, tympanic, rectal, temporal
Pulse: measure when child at rest; infant = brachial or apical; toddlers and older = radial, brachial, or apical; best accuracy = measure for 1 min
Respirations: measure when undisturbed or at rest
BP: >3 is routine in outpatient, correct cuff size
Mental
Alert, oriented, memory intact
Cognitive
Age related changed in mental activities
Piaget stages: intuitive, concrete operational, formal operational
Developmental: Denver II screening test
Widely used
Series of standard tasks 0 - 6, compare to children of same age
Personal, social, fine motor, adaptive, lang, gross motor
