Pediatric Assessment & Communication with the Pediatric Patient

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

Barriers to CommunicationLanguageCultural differencesDistractionStress/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

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

Priority Assessment! What are the areas of

priority assessment?

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

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)

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

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?

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.

[email protected]

512-422-8749