Pediatric Assessment & Communication with the Pediatric Patient Presented by Marlene Meador RN, MSN, CNE

Considerations and strategies for cooperation: Remember developmental age (why is this crucial to success?) p 802 table 32.3 Honesty Involve child- speak directly to the child Involve parents when appropriate 1.      What are common considerations and strategies to gain cooperation from the child during a physical assessment? P.802 Table 32-3; be honest with the child, involve the child as age permits, allow parents to assist/hold child. In the older child, basic explanations and answer questions honestly and accurately Do not inform parents/child of medical information that the primary healthcare provider has not provided- you are not to disclose diagnosis or prognosis. Nurses role is to clarify

Barriers to Communication Language Cultural differences Distraction Stress/conflict

Quick Question? What is the best way to ruin the relationship between the nurse and child client?

More questions? What is the best nursing rationale for a nurse allowing the parent to administer medications to the hospitalized child? Can you name another reason?

Adapting the physical assessment to children: Physical proximity to the child/patient Physical contact Sequence of assessment

Substantive data Objective data Why is an accurate history the single most important component of the physical examination? Substantive data Objective data

Three types of health history Complete or initial Conception to current status Well or interim Previous well visit to current visit Problem-oriented or episodic Information related to current problem

Two types of assessment: Primary- ABCDE’s Airway, breathing, circulation, LOC (disability, & exposure) Secondary VS, pain, history and head-to-toe assessment and inspection Height/weight, diagnostic testing

Adaptations in Emergency Assessment S- signs and symptoms A-allergies M-medications and immunizations (OTC and herbal) P- prior illness or injury L- last meal and eating habits E- events surrounding illness/injury

Obtaining a history: Open-ended questioning Re-phrase rather than repeat Listen actively (reflective reply) Cultural differences Avoid judgmental questions Give an example of each type of question with a more therapeutic version. Ask single question at a time- allow time for an answer. If the family does not understand simply re-phrase the question. Do not just repeat the same question. Vocabulary is crucial to understanding. Careful listening, developing cultural competence, communication strategies (these are listed in the book for each age child) Remember to phrase questions in a non-judgmental manner. Ask open-ended rather than questions that require a yes-no response (use these to narrow information) Give examples of each type of question.

Priority Assessment! What are the areas of priority assessment? Airway, breathing & circulation- including vital signs

Priority Assessment! Airway- Breathing- Circulation- VS-

Obtaining a Health History Presenting illness/injury Onset of symptoms Type of symptoms Location Duration Severity Aggravating factors Lab findings Previous or current illness 1.      What are the types of health histories? present problem- onset of symptoms, type of symptoms, location, duration, severity, aggravating factors, lab findings, previous and current illnesses: birth hx,- prenatal care, mother’s age and health, illnesses, injuries, mother’s impression of the pregnancy: familial/inherited disorders, p. 965

Obtaining a Health History Birth History Prenatal care (onset and duration) Mother’s age and health at time of birth Mother’s history of illness, injuries Mother’s impression of pregnancy (also significant other’s impression) 1.      What are the types of health histories? present problem- onset of symptoms, type of symptoms, location, duration, severity, aggravating factors, lab findings, previous and current illnesses: birth hx,- prenatal care, mother’s age and health, illnesses, injuries, mother’s impression of the pregnancy: familial/inherited disorders, p. 965

Obtaining a Health History Familial or Inherited Disorders Chromosomal disorders in other family members Height and weight Diabetes Cardiovascular disease Asthma/ reactive airway disease Allergies

Assessment Findings: head to toe (page 817-847) Head (eyes, ears, hair, shape, FOC) Chest- cardiac, respiratory, excursion- shape Abdomen- size, shape, tone Musculoskeletal- posture, tone, symmetry Neuro- reflexes Skin- including hair Genitalia- age appropriate a.      Head (eyes, ears, hair, shape, FOC (with every visit up to 1 yr)- FOC b.      Chest (cardio, breathing, murmurs, p. 990, 998) c.      Abdomen (p. 1000-1004) d.      M/S (1010-1012) e.      Neuro (1013-1017) f.       Skin g.      Genitalia (if indicated)

Quick Review: Why is it important for the nurse to know the normal range of vital signs specific to the age of patients? Table 33-1

How does the nurse prioritize assessment findings? Stay alert to what would cause harm… Is this an acute need? Or at risk for? How does the nurse select the intervention? How do you evaluate the effectiveness of the intervention? ABCs and vital signs

What physical and psychosocial findings suggest abuse or neglect? Dress Grooming and personal hygiene Posture and movements Body image Speech and communication Facial characteristics and expressions Psychological state

When would the nurse notify CPS? What are the nurse’s legal obligations What are the nurse’s ethical obligations?

Please contact Marlene Meador RN, MSN if you have any questions or concerns regarding this information. Mmeador@austincc.edu 512-422-8749