week 11: paediatric assessment Flashcards
collecting data in general
Observations: Very large part; relates to how they’re feeling. For kids, playing is the largest sign of being okay; it’s bad if they aren’t playing
Interview Parent: Believe the parent if they say something’s wrong - keep an eye on the child; parents know their kids best and we rely on that info
Interview Child: If developmentally appropriate
Physical Assessment: Objective data
pediatric age classifications
Paeds goes from 0 (birth) - 18 years
12+ = physiologically similar to adults, 7 and under is where most variations are
Neonate: 0-1mo
Infant: 1-12mo
Toddler: 1-3yrs
Preschooler: 3-6yrs
School Age: 6-12yrs
Adolescent: 12-18yrs
principles of communication w children
Include the child; use their name or what they prefer to be called
Make communication developmentally appropriate: if they’re 5 but function at a 2 year old level, nurse them at a 2 year old level
Get on their eye level - Seen as equal rather than authoritarian; more comfortable
Assessments might be improvised; in parents arms, on the floor playing
Approach child quietly, gently, and be truthful: Ex., BP cuff is a “tight hug”
A needle: Will only hurt for a really short time and you’ll get a sticker after
Give the child choices as appropriate; introduce play - like the temperature thing or listening to their own heart - so long as it doesn’t take away from the assessment
Involve the child and pay attention to them
“normal” growth and development
Kids the same age can be at very different stages
Growth charts show percentiles to show if you’re concerned or not; look at the whole curve
They could even be completely normal regardless
Also consider culture, parent stature/height
piaget’s theory of cognitive development
Piaget’s Theory of Cognitive Development: Important w.r.t physical head-to-toe capabilities
Sensorimotor Stage: 0-2 yrs; object permanence, A-not-B error
Preoperational Stage: 2-6/7 yrs; egocentrism, lack of conservation
Concrete Operational: 7-11/12yrs; understanding perspectives, conservation, categories
Formal Operational: 12+yrs; abstract thinking, scientific reasoning
erikson’s psychosocial stages of development
Infant mental health, long-term outcomes in general
Life is a series of crises that are overcome to progress, develop from infancy to maturity
when approaching the paediatric patient
Always start with observing
Tends to be improvised with little order; can never just dive into the assessment
Remain calm, confident - kids love to push buttons if you’re panicking
Toddlers: No is their favourite word; don’t give them the choice
Don’t separate the parent and child if you don’t have to; use parent as resource
Establish rapport with parents AND child; parents are there to help
Be honest
tips w infants
WAHHHH is their favourite word - QUIET assessments
Parent should be nearby or holding baby, or in the crib
DON’T wake a sleeping baby unless concerned; depends on the situation and assessments are easier while the kid is sleeping; resp, HR - don’t do invasive ones
The second the baby cries = altered assessment, inaccurate
Comfort measures like pacifier, time assessments around feedings
tips w toddlers
NO is their favourite word - PLAY is big
Get the parents there to help; keep on lap, distract them
Greet by their name and pay attention to the parent
Use play therapy! Whatever toys, trucks, etc. are there
Infants love the “me do, me do” thing; let them play with equipment, BP cuff, stethoscope
Pay attention to their non-verbal behaviours
Praise the kids and give them choices, “what a good kid!” - parents and kids love it
Demonstrate what you’re gonna do on the parent, yourself, or on a doll first
tips w preschoolers
WHY is their favourite word - HELP with assessment
Increase verbal communication but keep it simple
Get them to “help” with their own assessments; hold the measuring tape, stethoscope
Use games
tips w school-age kids
May experience “developmental regression” - they might be 7 but act like they’re 4 because they’re scared of the unknown, retreat back to parents
Give them choices if the parent is present, but keep it appropriate
Use small talk for older kids when appropriate; school, friends, hobbies
Explain procedures and equipment so there are no surprises
Be patient and honest, get parents to help
tips w adolescents
PRIVACY is their big thing
Provide reassurance about their changing bodies; pull the curtains, ask if it’s okay for the parents to be there, put the stethoscope under shirt instead of lifting it up
Opportunity to provide information, health teaching, positive attitudes
When communicating, they’re not kids but they’re also not adults - be appropriate
pediatric measurements
Height/Length: From top of head to dorsiflexed foot, as straight as you can
Weight: Naked baby, zeroed scale (babies might pee when exposed to cool air)
Do before a feed; food weight throws it off
Head Circumference: Until 3 years; from frontal bone to occipital prominence (back of head)
Chest Circumference: Until 1 year; right below nipple line for babies
USE A CLEAN MEASURING TAPE
pediatric temp
Use axillary; halfway under arm and gentle pressure or up into armpit
DO NOT do rectal, tympanic (improper)
Oral around 5 years if they can hold it under their tongue
pediatric pulse
Apical before 2 years of age; one full minute because kids are arrhythmic
Landmark: <4 years = 4ICS, between LMCL and Anterior Axillary Line
After 4 years, use 5ICS LMCL - or radial pulse if you can feel it
Paediatric stethoscope makes it more precise
