Communication and Physical Assessment Flashcards
head to toe diff
depends on child age
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
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
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
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
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
BIG: Privacy and confidentiality
Communicate like an adult
Address them first
Oftentimes parent not in room
Adolescence
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
Little medication under your skin
shot/stick
See how ____ is working
Test
Bed on wheels
Moveable bed
stretcher/gurney
Special opening
incision/cut
Color
Special medication
Dye
Ouchie
Pain
Stickers
Electrodes
Sample
Specimen
Pee
Poop
Whatever they call it
stool/urine
Make better
Fix
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
Infant:
Toddler:
Preschooler
School-age
Adolescents
Sequence of the examination
Goals of pediatric Assessment
Gen approaches toward examining the child
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:
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:
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
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
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
VS
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
