Communication and Physical Assessment of the Child and Family Flashcards
Guidelines for communication and interviewing
-Specific form of goal-directed communication
-Address parents by Mr or Mrs
-Ask child their preferred name
-Requires an organized
-Turn off distractions
-Approach and takes time to master
-Computer privacy and applications in nursing
-Telephone triage w/ counseling (date, time, background, chief complaint, general s/s, systems review, steps taken)
Communicating w/ families
-Communicating w/ parents
-Encouraging parents to talk
-Distract child if crying
-Directing the focus
-Listening and cultural awareness
-Asked open-ended questions
-Give positive reinforcement to both children and parents
-Cultural considerations: interviewing w/o judgment, using silence, being empathetic, providing anticipatory guidance
Empathy vs sympathy
-Empathy: capacity to understand what another person is experiencing from within that person’s frame of reference
-Sympathy: having feelings similar to those of another person, rather than understanding those feelings
Blocks to communication: nurse
-Giving unrestricted and sometimes unsought advice
-Offering premature or inappropriate reassurance
-Giving overready encouragement
-Defending a situation or opinion
-Using stereotyped comments or cliches
-Limiting expression of emotion by asking directed, closed-ended questions
-Interrupting and finishing the person’s sentence
-Taking more than the interviewee
-Forming prejudged conclusions
-Deliberately changing the focus
Signs of information overload: patient
-Long periods of silence
-Wide eyes and fixed facial expression
-Constant fidgeting or attempting to move away
-Nervous habits (tapping, playing w/ hair)
-Sudden interruptions (asking to go to the bathroom)
-Looking around
-Yawning, eyes dropping
-Frequently looking at a watch or clock
-Attempting to change the topic of discussion
Using an interpreter
-Use for major things, not general assessments or questions, for legal/liability reasons
-Using children as interpreters
-Requires sensitivity to cultural, legal, ethical considerations
-Make the choice count and provide mutual respect
Communication techniques
-Play–> universal language of children
-Touch/repetitive actions/colorful items
-Natural curiosity
-Reveal their perceptions of interpersonal relationships thru play
-“I” statements
-3rd person technique
-Validating their feelings
-Storytelling
-Use of books
-Telling dreams
-“What if?”
-3 wishes
-Rating game
-Sentence completion
-Word association
-Pros and cons
-Writing
-Drawing
-Magic
Hx taking
-Direct or indirect –> identifying informant
-Direct: objective, asking parent
-Indirect: subjective, what you see
-Chief complaint
-Present illness
-Analyzing a symptom: location, severity, duration, influencing factors, pain
-Birth
-Diet
-Previous illnesses, injuries, hospitalizations, surgeries
-Allergies (medicine, environmental)
-Growth and development
-Habits
-Sexual hx for adolescents
-Family hx of 1st degree relatives
General approaches towards examining the child
-Sequences of examination
-Preparation of child –> nursing guidelines
-Atraumatic care –> reduce fear
-Count HR and RR while sleeping
-Examine oral cavity while crying
Physical exam
-Generally: use developmental and chronological age as main criteria for assessment sequences, use guidelines for positioning children fo various age
-Growth measurements: weight, height (length), skinfold thickness, arm and head circumference (key measurement in indication of growth)
-Documentation on growth charts (WHO, CDC)
Habits to explore during hx interview
-Nail biting, thumb sucking, pica, rituals, unusual mvmts
-ADLs such as sleep, exercise, toileting, bedwetting
-Response to frustration
-Use of alc, drugs, caffeine, tobacco
Physiologic measures: temperature
-Oral, rectal (most accurate but most traumatic, axillary (preferred), tympanic, temporal artery
-Based on pt’s age, development, illness severity
Physiologic measurements: pulse
-Less than 2 years, measure APICAL for 1 full minute
-Grade pulses
-Compare radial (weak d/t underdevelopment) and femoral pulses during infancy
-Pulse ox on foot of babies
-Must be over 95% and good waveform
Physiologic measurements: respiration
Breathing is diaphragmatic and irregular
Physiologic measurements: blood pressure
-Use correct cuff size (up to 3 or 5)
-Steady red light = working
-Right upper arm on babies
-Annually after 3 y/o using auscultation
-During inpatient: q4h thruout hospital stay
-Automated devices in newborns and infants
Infant and toddler vital sign measurement
1) Count respirations (before disturbing child)
2) Count apical HR
3) Measures BP
4) Measure temp
Skin assessment
-Color, texture, temperature, moisture, turgor, lesions or rashes
-Accessory structures: hair and scalp, nails, palms
Head and neck assessment
-Shape and symmetry
-Head control and ROM
-Suture lines and fontanels, swelling
-Anterior fontanel closes between 12-18 months
-Face for symmetry, mvmt, appearance
-Neck for size, mvmt, ROM, skin folds
Eyes assessment
-Inspect for placement of eyes, symmetry, lids
-Assess conjunctiva and sclera
-Assess pupils for size, shape, mvmt, accommodation
-Check for red reflex bilaterally
-Vision acuity: light perception and fix and follow (infants), snellen chart (after 3 years), peripheral vision
-Check ocular alignment (cover test)
Ears assessment
-Inspect external structure: alignment, pinna, pits/openings, tags or sinuses, hygiene
-Inspect internal structure
Nose assessment
-Placement and alignment
-Internal structures: mucosal lining, turbinates, septum
-Testing for smell
-Check nares for flaring, flaring is a sign of respiratory distress
Mouth and throat assessment
-Lip color, moisture and symmetry
-Tongue movement and appearance
-Buccal mucosa color, moistures, ulcers
-Teeth gingiva, mucous membranes
-Tonsil size, uvula and oropharynx color and moisture
Chest assessment
-Inspect size, shape, symmetry, movement
-Bony landmarks
-Breast development (tanner. staging)
-Adventitious breath sounds can occur, but should never be absent or diminished
Lungs assessment
-Lungs: respiratory effort (rate, rhythm, depth, quality)
-Breath sounds
-Percussion quality
Abdominal assessment
-4 quadrant approach
-Inspection: size, shape, skin covering abdomen, peristaltic waves, umbilicus size, hernias
-Auscultation: presence of bowel sounds
-Palpation using atraumatic approaches: superficial, deep palpation, femoral pulses
Genitalia assessment
-Use “matter of fact” approach
-Ensure privacy (drape)
-Reinforce self-exam, safety, hygiene
Anus assessment
-Gluteal folds (asymmetric = hip dysplasia)
-Anal reflex
-Diaper rash
-Fecal matter is indicative of hydration and nourishment
Spine and extremities assessment
-Curvature of spine
-Assess for tuft, hair, dimples, skin discoloration on lower back
-Inspect for deformity of hands, feet, limbs
-Assess joint and muscles (strength, ROM, gait, posture)
