Communication and Physical Assessment Flashcards by Kelsey Klipfel

head to toe diff

depends on child age

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Encouraging the parents to talk - tell us what is going on; creating therapeutic environment and relationship; as older build with child; not build easily with toddler; child witnesses relationship
Directing the focus - parents love talk about kids; refocus on kid talking about
Listening and cultural awareness - IMP; care plans fams follow
Using silence - open ended questions imp
Being empathetic
Providing anticipatory guidance - teaching do
Avoiding blocks to communication - speaking a diff language and not get an interpreter, closed ended questions, socializing - not too much - changes relationship (peer than caregiver and not overdivulge) - hurts relationship, overloading parents, your opinion too much - political too much - thoughts and views
Communicating through an interpreter

Communicating with fams - Communicating with parents

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Infancy - not talk a lot; provide comfort; Still on mom’s lap; give pacifier
Toddler - hardest communicate; not understand/not want do staying; out normal routine; thrown off and out comfort zone; talking with them, start by talking with parent and slowly direct focus to child
Preschool
School years
Adolescence

Communication related to development of thought processes - Communicating with children

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Something holding/wearing/game, something fun and non-aggressive to start
Still on mom’s lap
Egocentric (analogies)
Don’t want to lose control
Do not understand analogies

Toddler - hardest communicate; not understand/not want do staying; out normal routine; thrown off and out comfort zone; talking with them, start by talking with parent and slowly direct focus to child

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Easier to talk with
start by talking with parent and slowly direct focus to child
Like answer questions - double check answers with parents
Poor Body integrity - get a cut, worry all insides come out; trouble defining boundaries and all coming out; fearful of everything
Blame themselves
Do not understand analogies

Preschool

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Easy to talk to
Ask lots of questions
Want explain why asking/doing things
Typ want parents present
Explanations/rationales
Encourage them to communicate fears

School years

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BIG: Privacy and confidentiality
Communicate like an adult
Address them first
Oftentimes parent not in room

Adolescence

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Lots of words - need fun creative terminology; less scary
shot/stick
Test
stretcher/gurney
incision/cut
Dye
Pain
Electrodes
Specimen
stool/urine
Fix

confusing/misunderstood words

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Little medication under your skin

shot/stick

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See how ____ is working

Test

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Bed on wheels
Moveable bed

stretcher/gurney

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Special opening

incision/cut

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Color
Special medication

Dye

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Ouchie

Pain

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Stickers

Electrodes

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Sample

Specimen

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Pee
Poop
Whatever they call it

stool/urine

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Make better

Fix

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What gone through; immunizations; seeing pediatrician
Birth history - Traumatic delivery? Cerebral palsy going on?
Dietary history
Previous illness, injuries, and operations
Allergies
Current medications
Immunizations
Growth and development - IMP; meeting milestones; weighing them - on growth curve; percentile more imp for pediatrician
Habits
Reproductive health history - adolescents - when start menstruating; reg cycles
Family health history - Geographic location; certain areas where certain health conditions more common; hx childhood hearing loss: extra screening
Family structure
Psychosocial history
Review of systems
Sim to adult - but typ not prioritize birth hx and immunization

Hx taking

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Infant:
Toddler:
Preschooler
School-age
Adolescents
Sequence of the examination
Goals of pediatric Assessment

Gen approaches toward examining the child

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If mom holding baby - leave in mom’s arms
Quiet and happy - RR
Touch and move them - RR and HR up
Listen with stethoscope - when touch them start waking them
Norm head to toe - assess and check head
Check all extremities
Anything invasive last: temp and diaper change for end
Hate temp taking
BP only if sick - let calm down and then take
Crying - assess mouth

Infant:

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Keep on lap
Talk with parent
Count fingers; look at overall appearance; dressed appropriately
Show them the equipment and show not hurt - worried about things hurt and losing control - help move things around
Assessment: temp and diaper end

Toddler:

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Parents in room
On bed/table
Answer questions - double check with parent
If seem mature and comfy start norm head to toe
If fine: VS first and move on
If timid: RR and HR, assessment, temp and genital area last
Typ underwear
Offer gown middle to end this age

Preschooler

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Norm head to toe
VS first and then head to toe
Tell what doing while doing it
Encourage questions
Parents typ in room
Offer gown

School-age

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Same as an adult Parents typ not in room Wants privacy - discuss with them Genital area last Offer gown

Adolescents

Head-to-toe sequence for assessing adult clients Sequence for pediatric assessments generally altered to accommodate child’s developmental needs Use chronological AND developmental age

Sequence of the examination

Observe for readiness to cooperate Minimize stress and anxiety associated with assessment of various body parts Foster trusting nurse-child-parent relationships Allow for maximum preparation of child Preserve security of parent-child relationship Maximize accuracy of assessment findings Main: a-traumatic care; change assessment on age and how appear: timid, nervous, perfectly fine

Goals of pediatric Assessment

HR: 80-160 Respirations (breaths): 25-55 BP: 65-100/45-65 mmHg Temp: 98.6 F; normal range: 97.4-99.6 F

- Normal VS

HR: 60-120 Respirations (breaths): 1-5yr: 20-30; 6-11: 12-20 BP: 90-110/55-75 mmHg Temp: 98.6 F; normal range: 97.4-99.6 F

Child: 1-11 yrs - Normal VS

HR: 60-100 Respirations (breaths): 12-18 BP: 110-135/65-85 mmHg Temp: 98.6 F; normal range: 97.4-99.6 F

pre-teen/teen: 12 and up - Normal VS

Growth measurements Growth charts - numbers Length - 0-2 yrs; examining pt; on paper; lay child down - mark head to heel then move them Height - older than 2 yrs Weight - as long as in diapers - take off; normal underwear leave on; not standing lay down Head circumference - first 3 yrs; measure brain growing - growing appropriately

Phys exam

Physical states of vital function

Temperature Pulse Respiration Blood pressure Oxygen saturation

Physical states of vital function

Temporal, tympanic, oral, axillary, rectal 0-2 yrs: axillary 2-5 yrs: axillary good; tympanic reliably; possibly oral - have be able shut mouth - going in toddlers mouth more scary than in armpit >5yrs: orally - most accurate Rectal - infants and toddlers - very sick and need definitive temp; try hard not do those; not do within first month - risk rupturing anus

Temperature

Apical (0-2yrs - listen to the heart - very fast) Radial pulse (>2 yrs)

Pulse

First thing do Infants: abdominal breathers - look at tummy and see breathing In more upright position see in chest Count same way as adult just faster

Respiration

Not do in healthy kids until 3 yrs - then get at yearly exam If come in sick then get BP Upper arm - easiest place esp when older Younger - lower legs/lower arms

Blood pressure

Often on toes; neonates: whole foot/wrist

Oxygen saturation

General appearance Skin Lymph nodes Extremities Head and neck Eyes Vision testing Ocular alignment Ears Nose Mouth and throat Chest Lungs Auscultation Heart Abdomen Genitalia Anus Back and extremities Neurologic assessment

Phys assessment

Clothes Affect

General appearance

How dressed Appropriate for weather How hair look Balding spots

Clothes

Appropriate for age

Affect

Bruising Pigment Scars transpalmar/simean crease

Skin

Toddler - Sev diff colors on leg or arm: not concer - esp in school leg If on chest, abdomen, bottom, or if appears belt hit child, arm grip, location: arm, back, bottom; mongolian spots: looks lot like bruising: in newborn common in African American, Asian, Native American, Pacific Islanders - not accuse parents abusing - common

Bruising

Stork bite - nevis splex - common - typ grow out of; hot/flushed

Pigment

Hemangioma - cluster of caps make red color - knick it bleeds a lot; med on it and slowly goes away; more concerning or close to eye - give beta blockers to help go away

Scars

Syndromes - down syndrome and suspected - look at hand; can have it and not have syndrome

transpalmar/simean crease

Sick lot more - inflamed a lot more

Lymph nodes

Hair ROM - how is this; see wearing now - helmets: flat head - even that out: lay on back - can be hard to prevent - want lot tummy time and up off back; awake not on back; infants do not like tummy time; cause of flat back - torticolis - stiffness in neck - cannot turn neck to one side easily: head to one side get into PT - correct without issue; helmets typ not covered by insurance unless so severe and shift symmetry in face

Head and neck

Same on both sides; symmetrical Drainage - teach pts - warm wash cloth and rub it - work it out; helpful if can get it out before becomes infected

External structures - Eyes

Preparing the child Funduscopic examination

Internal structures - Eyes

Not have visual acuity in younger kids - assessing structure: retina - red light reflex; older check acuity PERRLA - older kids Visual acuity in children Peripheral vision - older kids Color vision - older kids Red reflex - no cataracts

Vision testing

Strabismus (needs to be detected by 4-6 years) - Start focus both eyes on 1 object - 3-4 months - struggling and have cross eyed - focus on this - cont worried about lazy eye - deals with alignment; not corrected 4-6 yrs - start impact visual acuity - affect vision; get amblyopia; patch strong eye to make other eye stronger; can do surgery to make other eye stronger Cover test Corneal light reflex - light should be reflected in same spot in both eyes Amblyopia - can turn into blindness - focus on strong eye not weak eye - nerves and muscles not used as much and not need that eye - use good eye; need diagnosis this and treat ASAP; vision acuity Cover eye test

Ocular alignment

Cover one eye - focus on object - uncover other eye - if eye uncovered has to move to focus - is lazy; if not is strong

Cover eye test

Ear deformities - concerned about hearing; balance; kidneys (develop same time in utero) - do US to check kidneys; Outer canthus of eye goes right above eye - sign of syndrome - low set ears concerned about a syndrome - also born early

External structures - Ears

Positioning the child Otoscopic examination - can be scary for little kids; look in ear not hurt; do good ear first then bad ear; probably need to restrain them; use parents <3: down and back >3: up and back 3: look at best way to see it Auditory testing

Internal structures - Ears

External structures Internal structures

Nose

Nares patent Dry Boogers in there that need get that impacting bleeding Bloody noses common in kids - ask about that

Internal structures - Nose

Start cry/get back look in mouth

Internal structures - Mouth and throat

Around 6-8 months Baby can be more with teeth - take out = not in thee strong Biggest tonsils - school-age; most commonly get them removed Infants and toddlers hard visualize inflamed Brown spots - cavities - refer to cavities White patchy to yellowy spots - flourisis - too much fluoride - supplement and too much toothpaste Iron supplement - stain greenish, black supplement if cannot swallow whole

Teeth - Mouth and throat

Very round - infants; not same AP diameter

Chest shape

Chest shape Breast development

Chest

Listen same way

Lungs/Heart

Inspection Auscultation Palpation

Abdomen

Feel - laugh; put hand first then push and then move hand and feel

Palpation - Abdomen

Child can be born with partial circ - circumcisions very controversial - up to parents; if denied vitamin K do not do in hospital - risk bleeding Moms hormone: inflammation breast tissue as newborn - goes away Make sure testes descended: Block inguinal canal - make sure both descended - if cannot find them - do US if have them - if do and not descended going to watch for few months to see if descend; if do not do that go to surgery; if not do anything causes risk testicular cancer or infertility - 30 weeks gestation start descend; cont until older then worry; regularly assess for this

Male genitalia

Still have moms hormones - can have some discharge after birth Pseudomenses; discharge can be bloody - not concern Moms hormone: inflammation breast tissue as newborn - goes away

Female genitalia

accidents during day; previously potty trained; red flag to us; not concern if regression

Enuresis -

during night; common; often outgrow it

Nocturesis -

Not very common in kids If have: US - make sure not structural issue Common in baby boys versus girls

UTIs - Genitalia

Make sure patent; not always Type not allow until pass maconium - first poop - if patent and not passed - could indicate be bigger issue with GI sys

Anus

Spine Extremities Joints Muscles Scoliosis in older kids Arms and legs same length

Back and extremities

Cerebellar function Reflexes Cranial nerves - test for these; see what is going on

Neurologic assessment

Finger-to-nose Heel-to-shin Romberg test

Cerebellar function

Funny for kids; often do on self

Reflexes

Protrusion of portion of an organ through an abnormal opening Types

Hernia

Often bowels Danger of incarceration/strangulation

Protrusion of portion of an organ through an abnormal opening - Hernia

Diaphragmatic - worse - bowels push into lungs; in utero before born; life expectancy not long; lungs cannot develop; severe by 4-5 typ outgrow lungs Abdominal wall - fix with surgery Inguinal/umbilicial canal - fix with surgery; fairly common; push and goes back it; make sure is retractable; if not worry about blood supply; can hear bowel sounds Inguinal - protrude into scrotum: scrotum huge - painful and go in surgically and fix when

Types - Hernia