Health Assessment Of Children Flashcards
Never assume people with child are what?
Ask child or family what
Never assume its the parents
Ask child or family who is in the room
Communicating with infants
Observe what and listen to what
Observe nonverbals
Listen to vocalizations
Communicating with early childhood (toddlers and preschoolers 1-6)
They take everything how?
Take everything literally so be careful
Egocentrism (so focus all on them) (nice shirt)
Communicating with school-age
Explain steps
Show interest in their interest
Encourage them to vocalize fears
Communicating with adolescents
Goes between child and adult thinking
Seek permission for sensitive info and physical exam
Privacy and confidentiality is important
We will get wt, ht, and head circumfrence until what age?
3
Pediatric physical assessment (prior to doing it)
Introduce self
Take time to play first
Look before touch
Eye level with child
Provide distractions
Peds physical assessment (explaining steps)
Use dolls, puppets or drawings to show what happens
Allow child to manipulate equipment first
Examine in comfortable position (even with parent)
Peds vital signs
Temp locations
Rectal (birth-5y/o)
Axillary (any age)
Oral (as early as 3y/o)
How long to measure 1st HR
Where to get BP on peds
Apical 60 seconds
Lower leg for BP
Peds assessment head and neck
Larger heads in infants in ratio to body
Assess fontanels if appropriate for age
Peds neuro system and mental status
note verbalization (cries, laughs, coos)
Pupil assessment
Eye contrack/tracking
Social smile?
If infant assess: fontanels, primitive vs protective reflexs
Central vs peripheral pulses
Central:
Apical, femoral, carotid
Peripheral:
Radial, pedal
Look before you touch or touch before you look?
Look before you touch
GI & GU
Pattern of elimination
Urine: color, clarity, odor
Stool: often/much, color, consistency
When changing diaper assess what
Redness
Diaper rash
Discharge
Circumcision if male
Musculoskeletal
Gross motor milestone
Assess spine
Gross motor milestones:
Crawling, walking, sitting unsupported
Assess spine:
no dimples/tufts of hair, no lateral curvature
(Spina bifida)
Pain signs
Infants vs toddlers
Infants:
-loud cry
-rigid body
-withdrawal from pain
-facial expression
Toddlers:
-loud cry/screaming
-verbalization
-thrashing
-avoid stimilus
-non cooperation
-cling to caregiver
Pain signs
School-age vs adolescent
School-age: (similar toddler)
-Stalling behavior
-muscular ridgity
Adolescent:
-verbal expression
-muscle tension
Common misconceptions with pain (6)
-do not feel or respond to pain
-cant tell you where they hurt
-do not remember pain
-if child is active they are not in pain
-they always tell the truth about pain
-they cannot be addicted to pain meds
Different pain scales and when to use them
NIPS
FLACC
Wong-baker faces
Oucher pain scale
0-10
NIPS (neonatal infant pain scale)
-up to one year old (behavioral scale)
FLACC (face, legs, activity, cry, consolability)
-2months - 7y/o
-can be used with non-verbal and cognitively impaired (when not alert/awake)
Wong-baker faces (3+ y/o)
Oucher pain scale (3-13y/o)
0-10 (5+y/o)
Non-pharmacological interventions
Distract
Relax
Meditate/guided imagery
Containment (swaddling)
Nonnutritive sucking and sucrose
Kangaroo care
Massage
Hot/cold compress
Pharmacological interventions
Type of meds and names
Mild-mod:
-acetaminopen
-NSAIDS
Mod-severe: (opioids)
-morphine
-hydromorphone
-fentanyl
Give meds how
Scheduled/routinely
NOT PRN
ORAL
Its the what route
Names
Preferred route
-acetaminophen
-Nsaids
Opioids:
Hydrocodone w/ acetaminophen (Hycet)
Oxycodone w/ acetaminophen (Roxicet)
IV
IVP Bolus vs PCA pump
IVP bolus:
-morphine
-hydromorphone
-fentanyl
patient controlled analgesia (PCA pump)
-basal (slow continuous rate)
-bolus (1dose)
-combination
IM is what
Not recommended (it hurts)
Reassess after pain meds when
30min-1hr
