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

2. 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

3. Barriers to Communication
Language
Cultural differences
Distraction
Stress/conflict

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

5. 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?

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

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

8. 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

9. 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

10. 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

11. 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.

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

13. Priority Assessment!
Airway-
Breathing-
Circulation-
VS-

14. 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

15. 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

16. 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

17. 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 )
d.      M/S ( )
e.      Neuro ( )
f.       Skin
g.      Genitalia (if indicated)

18. 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

19. 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

20. 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

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

22. Please contact Marlene Meador RN, MSN if you have any questions or concerns regarding this information.