Ch 4- Communication, Physical & Developmental Assessment Flashcards
Communicating & Interviewing
> Establishing the setting
- Introduction
- Ensure privacy and confidentiality
- Appropriate computer & phone communication
Communicating & Interviewing
> Cultural considerations
- Interview w/o judgment
- Using silence
- Clear communication
- Provide anticipatory guidance
- Use appropriate interpreters
Communication Parents/Caregivers
> Encouragement during interviewing
Directing the focus
Cultural awareness
Listening/using silence
Empathy
Providing anticipatory guidance
Avoiding blocks and information overload
Using an interpreter
Communication Techniques
> Play
Developmentally appropriate creative techniques
> Verbal - 1 messages, 3rd person
> Non-verbal- writing or drawing
History taking
> Chief complaint
Present illness
HX: Birth, Dietary, illness, Injuries, hospitalizations, surgeries, allergies, medications, immunizations, growth and development, sexual hx for adolescents, and psychosocial and personal status
Review of system
General
Skin
HEENT
Chest
Respiratory
CV
GI
GU/GYN
Musculoskeletal
Neurologic
Endocrine
Nutritional Status Exam
Dietary Hx
24-hr recall
Food diary
Anthropometric measures
Assess general growth
- wt, ht, head circumference, BMI
Body system
- Skin & hair
- HEENT
- Chest
- Abdomen
- Neuro
Examining the child
> USe developmental and chronologic age as main criteria for assessment sequence
> Prepare the child to ensure Atraumatic Care
> Use guidelines for positioning children of various ages
Physical exam
Growth measurements
- Key element in evaluating the health of children
. Ht/length
. wt
. skinfold thickness and arm circumference
. Head circumference (HC)
. BMI (age > 2 years
> Documentation on growth charts
Physiologic Measurement
> temp
> Method of measurement
- oral
- rectal
- axillary
- tympanic
- temporal artery
> Various devices for measurement
Measurement based on potential age, development, and illness severity
Physiologic Assessment
> Pulse
- <2 years, measure APICAL for 1 full minute
- Grade pulses
- Compare radial and femoral pulses during infancy
> Respiration
- Breathing is diaphragmatic and irregular
> Blood Pressure
- USE CORRECT CUFF SIZE
- Annually after age 3 years using auscultation
- Automated devices in newborns and infants
Infant and Toddler VS measurement
> Count respirations FIRST (before disturbing the child)
> Count apical heart rate SECOND
Measure blood pressure (if applicable)
> THIRD
Measure temperature LAST
Physiologic Assessment
General Appearance
Physical appearance
State of nutrition
Behavior
Personality
Interactions with parents, siblings, and nurse
Posture
Development
Gross motor
Fine motor
Language
Social skills
Physiologic Assessment
SKIN
Color
Texture
Temperature
Moisture
Turgor
Lesions or rashes
Accessory Structures
Hair and scalp
Nails
Palms
Physiologic Assessment
Head and Neck
Shape and symmetry
Head control and range of motion
Suture lines, fontanels, swelling
Anterior fontanel closes between 12 -18 months
Face for symmetry, movement and, appearance
“Make a face”
Neck for size, movement, range of motion, and skin folds
Physiologic Eyes Assessment
Eyes
Inspect for placement of eyes, symmetry, and lids
Assess conjunctivae and sclera
Assess pupils for size, shape, movement, and accommodation
Check for Red Reflex bilaterally
Vision acuity
Light perception, fix, and follow (infants)
Snellen test (after age 3 years)
Peripheral vision
Check ocular Alignment
Cover test
Physiologic Ears Assessment
Ears
Inspect external structure
Alignment
Pinna
Pits/openings/tags or sinuses
Hygiene
Inspect internal structure
Assist to provide atraumatic exam
Assess tympanic canal
Tympanic membrane
Light reflex and bony landmarks
Auditory testing
Physiologic Nose, Mouth Assessment
Nose
Placement and alignment
Internal structures
Mucosal lining, turbinates, septum
Testing for smell
Mouth and Throat
Lip color, moisture, symmetry
Tongue movement and appearance
Buccal mucosa color, moisture, ulcers
Teeth, gingiva, mucous membranes
Tonsil size, uvula and oropharynx color, moisture
Chest/Lungs Assessment
Chest
Inspect size, shape, symmetry, movement
Bony landmarks
Breast development (Tanner staging)
Lungs
Respiratory effort
Rate, rhythm, depth, and quality
Breath sounds
Percussion quality
Heart
Heart
Apical impulse and PMI
Assess rate, rhythm, sound (murmur)
Back
Spine and Extremities
General curvature of the spine
Assess for tuft, hair, dimples, or skin discoloration on lower back
Inspect for
Deformity of hands, feet, limbs
Symmetry of limbs
Movement and range of motion of limbs
Assess joints and muscles
Strength
Movement
Range of motion
Gait, posture
Abdomen
> Abdomen
Four quadrant approach
> Inspection
Size, shape, skin covering abdomen
Peristaltic waves
Umbilicus size, hygiene, hernias
> Auscultation
Presence of bowel sounds
> Palpation using atraumatic approaches
Superficial
Deep palpation
Femoral pulses
Genitalia
> Genitalia
Use “Matter of fact” approach
Ensure privacy (drape)
Reinforce self-exam, safety, and hygiene
> Anus
Gluteal folds
Anal reflex
Neurological Assessment
> Physical, behavioral, and emotional assessment throughout the exam
Cerebellar function
- Balance and coordination
> Reflexes
- Consider the persistence of primitive reflexes, loss of reflexes, and hyperactivity of deep tendon reflexes
> Cranial nerves
See Table 4-11 for strategies of assessment
