Communication and Physical Assessment of the Child and Family

Question 1

Guidelines for communication and interviewing

Answer 1

-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)

Question 2

Communicating w/ families

Answer 2

-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

Question 3

Empathy vs sympathy

Answer 3

-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

Question 4

Blocks to communication: nurse

Answer 4

-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

Question 5

Signs of information overload: patient

Answer 5

-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

Question 6

Using an interpreter

Answer 6

-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

Question 7

Communication techniques

Answer 7

-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

Question 8

Hx taking

Answer 8

-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

Question 9

General approaches towards examining the child

Answer 9

-Sequences of examination
-Preparation of child –> nursing guidelines
-Atraumatic care –> reduce fear
-Count HR and RR while sleeping
-Examine oral cavity while crying

Question 10

Physical exam

Answer 10

-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)

Question 11

Habits to explore during hx interview

Answer 11

-Nail biting, thumb sucking, pica, rituals, unusual mvmts
-ADLs such as sleep, exercise, toileting, bedwetting
-Response to frustration
-Use of alc, drugs, caffeine, tobacco

Question 12

Physiologic measures: temperature

Answer 12

-Oral, rectal (most accurate but most traumatic, axillary (preferred), tympanic, temporal artery
-Based on pt’s age, development, illness severity

Question 13

Physiologic measurements: pulse

Answer 13

-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

Question 14

Physiologic measurements: respiration

Answer 14

Breathing is diaphragmatic and irregular

Question 15

Physiologic measurements: blood pressure

Answer 15

-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

Question 16

Infant and toddler vital sign measurement

Answer 16

1) Count respirations (before disturbing child)
2) Count apical HR
3) Measures BP
4) Measure temp

Question 17

Skin assessment

Answer 17

-Color, texture, temperature, moisture, turgor, lesions or rashes
-Accessory structures: hair and scalp, nails, palms

Question 18

Head and neck assessment

Answer 18

-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

Question 19

Eyes assessment

Answer 19

-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)

Question 20

Ears assessment

Answer 20

-Inspect external structure: alignment, pinna, pits/openings, tags or sinuses, hygiene
-Inspect internal structure

Question 21

Nose assessment

Answer 21

-Placement and alignment
-Internal structures: mucosal lining, turbinates, septum
-Testing for smell
-Check nares for flaring, flaring is a sign of respiratory distress

Question 22

Mouth and throat assessment

Answer 22

-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

Question 23

Chest assessment

Answer 23

-Inspect size, shape, symmetry, movement
-Bony landmarks
-Breast development (tanner. staging)
-Adventitious breath sounds can occur, but should never be absent or diminished

Question 24

Lungs assessment

Answer 24

-Lungs: respiratory effort (rate, rhythm, depth, quality)
-Breath sounds
-Percussion quality

Question 25

Abdominal assessment

Answer 25

-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

Question 26

Genitalia assessment

Answer 26

-Use “matter of fact” approach
-Ensure privacy (drape)
-Reinforce self-exam, safety, hygiene

Question 27

Anus assessment

Answer 27

-Gluteal folds (asymmetric = hip dysplasia)
-Anal reflex
-Diaper rash
-Fecal matter is indicative of hydration and nourishment

Question 28

Spine and extremities assessment

Answer 28

-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)