Week 1 TUES Flashcards
PEDS: assessment and comfort
What makes an assessment successful?
- obtain accurate data
- use equipment correctly and right size
- validate and interpret data correctly
- demonstrate respect for child and caregivers
What is included in an assessment?
- health history
- observation of the caregiver-child interaction
- assessment of child’s emotional, cognitive, and social development
- physical examination
T or F
You will only talk to the children during an exam
FALSE!
you will talk to both caregivers and children
components of health history
- demographics
- chief complaints and history of present illness
- past health history
- family health history
- developmental history
- functional history
family/ friend/ school relationships
Developmental history
- asking about gross and fine motor skills, language development
- ask about walking, talking, sitting
Functional History
- focus on daily routine items; safety, well child checks, nutrition status, sleep, activity
What document allows nurse/ provider/ team the opportunity to review health history and ask more focused questions
Health history questionaries
What does the physical exam focus on?
chief complaints!
- what area is causing issues but also look at other systems around
What to look for while observing patient
- Eye: PERRLA
- Face: Symmetry, expression, mood
- Resp: breathing, nonlabored, distress
- Skin: color, turgor
- General appearance: hygiene, groomed, impaired
- teeth: intact, missing, drug use, vomiting
The physical exam starts with what?
General appearance
General appearance components
- are they crying? consolable?
- moving? appropriate movements?
- breathing? color appropriate
- tracking appropriately?
T or F?
Patient vital sign trends are more important than normals
TRUE!
What can impact vital signs
- anxiety
- fear
- crying
- feeding
- wrong size equipment
What age do you auscultate respiration and pulse for one minute
< 10 years old
First BP in a child with no risk factors is at what age
3 years old and older
- may be younger if patient has risk factors
T or F you should do a rectal temperature always
F!
- avoid rectal tmeperature
- oral, tympanic, auxiliary work well
Why are body measurements and growth charts important?
- growth is a good indicator of overall health
- helps monitor growth and can be predictive and helps spot of growth spurts and regression
- measure head circumference until 6 y.o.
Physical Examinations:
Skin
birthmarks, rash, lacerations, temperature, moisture, edema
Physical Examinations:
Hair and nails
dry, brittle nails may indicate nutritional deficiency
Physical Examinations:
Head
shape and symmetry, fontanels (open, closed, sunken, bulging)
Physical Examinations:
Eyes
symmetry, PERRLA, vision screening
Physical Examinations:
Ears
hearing screen, any drainage is abnormal
Physical Examinations:
Nose
drainage color and thickness, infants up to 6 m.o. are nose breathers
Physical Examinations:
Breast
development occurs around 13 y.o. and as young as 8 y.o.
Physical Examinations:
abdomen
size, shape, auscultations
- infants and toddlers have rounded bellys
Physical Examinations:
Genitalia and anus
- this should follow abdomen in most children
- occur at end part of the exam
Physical Examinations:
Musculoskeletal
Clavicles and shoulders, spine, extremities
Physical Examinations:
Thorax and lungs
Shape, work of breathing
- infants and toddlers are diaphragmatic breathers
Physical Exam findings for a peds pt
-Fontanelles: open or closed
-head size is proportionally larger
-trachea is short and narrow
- nose breathers until 4-6 months
- resp muscles and alveoli not fully developed
- more susceptible to trauma and illness
- bones are softer and easily fractured
- skin is thinner, fragile
- easily dehydrated/ electrolyte imbalances
T or F
We have to approach children the same as adults
False
- we have to use other strategies to help us get the data we need
Exam Strategies for peds
- address children and caregivers
- observation
- use distraction and play
- involve toys, characters, family
- utilize caregivers for questions
- create a friendly, nonthreatening environment
Physical exam: Newborns and infants
- if infant is alseep/ calm: auscultate heart rate, resp rate, and abdomen
- count HR and RR for 1 minute each
- undress but leave diaper on to complete exam and then remove before assessing genitals
- incorporate caregivers; calm/ sooth
- DON’T WAKE THEM!
Physical Exam: Toddlers
- remove clothing one at a time and then replace
- explain equipment/ use play
- use caregivers to have child sit on lap
- positive reinforcement and praise
- perform invasive parts last!
Physical Exam: Preschoolers
- simple explanations for each step
- allow them to help
- offer choices
- provide praise
Physical Exam: School-age
- use language child can understand
- avoid medical terms
- truthful and simple explanations
- allow them to wear underwear under their gown
- privacy
Physical Exam: Adolescents
- Privacy- when undressing/ changing
- consider having caregivers leave
- expose only the area you are assessing
- discuss physical changes that are occurring
- normalize what they are going through
T or F
Newborns do not feel pain?
Children learn to adapt to pain and painful procedure?
FALSE!!
Pain manifestations: behavioral
- knitted brows, squinted eyes, closed tight
- crying
- jerky, flailing mov’t
- stiff posture
- pupil dilation
- distressed, anxious, irritable, lethargic
- restlessness, agitation, hyperalert
- sleep disturbances
Pain manifestations: physiological
- Tachycardia, tachypnea, hypertension
- pale, sweaty, skin color changes
Goal of a pain assessment
to gather accurate information about the location and intensity of pain and its effect on the child functioning
T or F
Should we ask parents about pain history information?
True!!
- parents know their children and what works best and what doesn’t
- they know how they react to pain
QUESTT Pain approach
- Question the child (and caregivers)
- Use a reliable and valid pain scale
- Evaluate the child’s behavior and physiologic changes to establish baseline and effectiveness of intervention
- secure he caregiver’s involvement
- take the cause of pain into account when interviewing
- take action
Developmental considerations
children at different developmental stages use different strategies to cope with pain
- some may not complain of pain
Cultural considerations
- culture and social learning influence expression of pain
- imitate how parents respond to pain
- some encourage a stoic response, diminished pain expression
- some use of verbal/ nonverbal expression
Developmental considerations for pain rating: Toddlers
Can’t give a description of their pain, limited vocabulary
Developmental considerations: Preschoolers
May be quiet, withdrawn, hide, may think pain is punishment, assume the nurse knows they are experiencing pain
Developmental considerations: School-age
Able to communicate type, location, and severity but may believe they need to be brave and not worry their caregivers, may be afraid it will hurt more to have their pain treated
Developmental considerations: Adolescents
Body image concerns and loss of control, mood impacts their response to pain
Pain scales
- FACES Pain Rating Scale
- Numeric Scales
- r-FLACC behavioral scale for pain
FACES
- can be used by children young as 3-4 and up to 8
- nurse explains words associated with each face to the child
- child selects the facial expression to describe their pain
Numeric Scale
- nurse asks the child to pick the number best describes their pain level
- used for children 8 and older
r-FLACC Scale
- Useful in assessing a child’s pain when the child cannot accurately report in themselves
- used in children 2 months to 7 years and children with cognitive impairment
- scores are totaled, higher the total greater the pain
How do you choose a scale
- scale must be developmentally appropriate
- must be consistent from nurse to nurse> if wrong method fix and switch
- most document pain before and after
What pain scale for a 3 m.o. patient with an upper respiratory infection
FLACC scale
What pain scale for a 3 year old patient being observed for seizure activity
FLACC or FACES
Pain scale for a 11 y.o. patient post op
Numeric pain scale
Nonpharmacologic pain management
- behavioral cognitive strategies
- biophysical interventions
Behavioral cognitive strategies
- relaxing, distraction, imagery, biofeedback, thought stopping, positive self talk
Biophysical interventions
- sucking and sucrose
- heat and cold applications
- massage and pressure
Non-opioid Analgesics
- tylenol> given orally, rectally, IV
- NSAIDSs> orally, rectally
- mild-moderate pain
Opioid Analgesics
- morphine is the gold standard for severe pain
- moderate- severe pain and chronic pain
- DO NOT use codeine
Pharmacologic adverse effects
- respiratory depression
- respiratory arrest
- nausea and vomiting
- constipation
- urinary retention
- sedation; monitor LOC
Drug tolerance
increased dosage required for the same pain relief previously achieved with a lower dose
Physical dependence
need for continued administration to prevent w/d symptoms
T or F
you often have physical dependence with addiction, but you don’t always have addiction with physical dependence
TRUE
Pharmacologic pain management
- nonopioid analgesics
- opioid analgesics
- Adjuvant drugs
- local anesthetics
Adjuvant drugs
pain management alone or in combination
- secondary use of meds
- benzos for anxiety
- anticonvulsants for neuropathic pain
Local Anesthetics
- given with procedure- effective pain relief minimal side effects
- given via injection, cream, patch
Nurses role in pain management
- assess and reassess pain
- adhere to right med administration
- use age appropriate pain scale
- ask families what work best
- be knowledgeable about the medications given
- topical numbing cream before IVs/ procedures
What is the best position to take infants respirations
them sleeping on a parents lap
Priority nurse documentation oh hx includes
clients immunization records
Child has blue nail beds, what action should the nurse take next
assess childs oxygen level
If giving child an opioid make sure to continuous assessing what?
Respiration status
Pain scale used for a cognitive delayed 8 y.o.
FACES
