Week 1 Objectives
Chapter 4- Communication, Physical, and Developmental Assessment
1. Identify strategies to effectively communicate with pediatric patients and their family
a. establish setting (introduction/ privacy/ confidentiality); play provision to keep
child distracted during parent-nurse interview
b. encourage parents to talk during interview
c. direct the focus: guiding statements, listening/ using silence, empathy
d. anticipatory guidance: provide families with info on normal growth/ nutrition,
safety, etc.
e. avoid information overload
2. Identify methods to effectively complete an interview with the family of a pediatric
patient
a. I messages: instead of saying you start with “I sometimes…”
b. Third person: “some parents find this helpful…”
3. Perform a complete age-specific head-to-toe assessment
a. infants
i. sequence: examine heart, lungs, abdomen, hips→ spine, back, sacrum
(traumatic procedures last)
ii. prep: undress to diaper, distraction techniques
b. toddler
i. sequence: minimal physical contact initially, play, auscultate, percuss,
palpate while quiet
ii. prep: parent removes clothing, allow them to inspect equipment, praise the
child
c. preschool
i. sequence: perform head to toe if cooperative
ii. prep: children undress, brief demonstration of equipment, describe the
process
4. Understand the importance of a thorough history
a. Chief Complaint (CC): establish reason for seeking health care
b. History of Present Illness (HPI): obtain all details related to CC
c. Medical History: birth history, dietary history, illness/ injuries, allergies, vaccines,
medications, growth/ development, sexual history (adolescents)
5. Identify how to obtain physiologic measures in the pediatric patient
a. count respirations first (before disturbing the child)
b. count apical heart rate second
c. measure BP third
d. measure temp. last
6. Understand the importance of atraumatic care
a. avoid invasive procedures when possible, choose words carefully
7. Understand the key components of the individual systems during a physiologic
assessment (i.e., what are we looking for?) ati ch. 2
a. growth measurements, growth charts
b. temp: method based on facility, age, development, illness severity
i. axillary for infants, tympanic/ axillary/ oral for toddlers and older
, c. pulse: <2 years→ measure apical for 1 minute
i. compare radial and femoral pulses in infancy
ii. HR decreases as they get older
d. respirations: count; decreases as they get older
e. BP: use correct cuff size; compare upper and lower extremities
i. increases with age
f. SaO2: should be >92% (ideally near 100%)
g. skin: birthmarks, palms, abuse, lesions/ rashes, color, texture, temp. HSN
i. cafe au lait (not size and #; implicated neurofibromatosis)
ii. mongolian spot: present at birth and fades
iii. palm creases: Simian crease (transverse palmar crease)--> Down
Syndrome
iv. palpable lymph nodes; are they painful, red, moveable
h. head and neck: shape, symmetry, head control/ range of motion, facial
symmetry/ movement/ appearance, fontanels (anterior→ 12-18 months;
posterior→ 2-3 months)
i. ears:
i. external structures alignment, pits/ tags/ sinuses/ discharge
ii. internal: assess canal/ tympanic membrane→ pull pinna down and back
j. nose: internal turbinates, septum, smell
k. mouth/ throat: lip color/ moisture, tongue movement/ appearance, buccal mucosa,
thrush, dentition, tonsils/ uvula/ oropharynx
l. chest: size, shape, symmetry, movement, breast development
m. lungs: breathing effort, rate/ rhythm, depth, quality, retractions, sounds
n. heart: apical pulse, rate, rhythm, sound (murmur 1-5), heaves, thrills, lifts
o. abdomen: 4 quadrants, inspection (umbilicus stump falls at 2 weeks), hernias),
auscultation (sounds), palpation
p. genitalia: tanner staging, signs of abuse (tears, bruising, discharge)
q. spine and extremities: curvature, tuft of hair/ dimples (spina bifida), ROM, joints,
muscles (strength, ROM, gait, posture), deformities
r. neuro: physical, behavioral, emotional, cerebellar function, reflexes (primitive
reflexes, DTRs), cranial nerves
i. babinski reflex gone by 1 year (fanning of toes)
s. developmental: denver ii, ages/stages, autism
Chapter 5- Pain Assessment and Management in Children
1. Identify influencing factors on pain assessment
a. age, developmental level, cause/ nature of pain, ability to express pain, cultural
consideration
2. Understand the differences in the types of pain (e.g., chronic, recurrent)
a. acute: less than 3 months
b. chronic: longer than 3 months or after illness has been resolved (headaches)
c. recurrent: pain that is episodic/ recurs (migraines, sickle cell pain, etc.)
3. Understand how to appropriately assess pain in children
a. behavioral (infants to age 4 years)
, i. observational→ vocalization, facial expression, body movements,
crying, rigidity/ sudden movements
ii. FLACC scale (2m-7y): facial expression, leg movement, activity, cry,
consolability
iii. CRIES (neonates)- observational; crying, requires O2, increased BP/HR,
expression, sleepless
b. self report (> 4 years)
i. faces scale, numeric rating scale (8y and older)
c. children with communication/ cognitive impairment
i. high risk for inadequate treatment of pain
ii. Non-Communicating Children’s Pain Checklist (NCCPC): vocal, social,
facial activity, body and limbs
iii. Pain Indicator for Communicatively Impaired Children
d. Children with chronic and complex pain
i. difficult to isolate pain symptom from other symptom (children with
cancer)
ii. rating pain does not always accurately convey how they really feel
e. Assessment components: OLDCARTS (onset, location, duration, characteristics,
aggravating factors, relieving, severity), is current treatment effective
4. Identify how and when to evaluate pain relief
a. dangers of unrelieved pain: longterm consequences, physiologic stress: increased
ICP, HR, RR, BP, decreased SaO2, behavioral changes (muscle rigidity, facial
expression, crying, withdrawal, sleeplessness, chronic pain syndromes
b. nonpharmacologic interventions
i. distraction, relaxation, guided imagery, cutaneous stimulation
ii. decrease perceived threat of pain, provide sense of control, enhance
comfort, promote rest/ sleep
iii. infants
1. non-nutritive sucking (pacifier), sucrose, swaddling/ containment
2. kangaroo holding (skin to skin contact)
c. medications
i. nonopiods→ mild to moderate pain (acetaminophen, ibuprofen)
1. antipyretic, antiinflammatory, analgesic
2. good for nociceptive pain (tissue injury)
ii. opiods→ moderate to severe pain (morphine, codeine, hydromorphone,
fentanyl, oxycodone)
1. potential side effects: constipation, respiratory depression,
sedation, N/V, agitation, mental clouding, tolerance, withdrawal
2. physical dependence: stopping the opioid results in withdrawal
symptoms
iii. timing is important
1. continuous pain→ around the clock (ATC); helps to avoid pain
breakthrough
2. clock-watching: can occur with prn orders; meds administered
only when pain has broken through→ can result in higher
Chapter 4- Communication, Physical, and Developmental Assessment
1. Identify strategies to effectively communicate with pediatric patients and their family
a. establish setting (introduction/ privacy/ confidentiality); play provision to keep
child distracted during parent-nurse interview
b. encourage parents to talk during interview
c. direct the focus: guiding statements, listening/ using silence, empathy
d. anticipatory guidance: provide families with info on normal growth/ nutrition,
safety, etc.
e. avoid information overload
2. Identify methods to effectively complete an interview with the family of a pediatric
patient
a. I messages: instead of saying you start with “I sometimes…”
b. Third person: “some parents find this helpful…”
3. Perform a complete age-specific head-to-toe assessment
a. infants
i. sequence: examine heart, lungs, abdomen, hips→ spine, back, sacrum
(traumatic procedures last)
ii. prep: undress to diaper, distraction techniques
b. toddler
i. sequence: minimal physical contact initially, play, auscultate, percuss,
palpate while quiet
ii. prep: parent removes clothing, allow them to inspect equipment, praise the
child
c. preschool
i. sequence: perform head to toe if cooperative
ii. prep: children undress, brief demonstration of equipment, describe the
process
4. Understand the importance of a thorough history
a. Chief Complaint (CC): establish reason for seeking health care
b. History of Present Illness (HPI): obtain all details related to CC
c. Medical History: birth history, dietary history, illness/ injuries, allergies, vaccines,
medications, growth/ development, sexual history (adolescents)
5. Identify how to obtain physiologic measures in the pediatric patient
a. count respirations first (before disturbing the child)
b. count apical heart rate second
c. measure BP third
d. measure temp. last
6. Understand the importance of atraumatic care
a. avoid invasive procedures when possible, choose words carefully
7. Understand the key components of the individual systems during a physiologic
assessment (i.e., what are we looking for?) ati ch. 2
a. growth measurements, growth charts
b. temp: method based on facility, age, development, illness severity
i. axillary for infants, tympanic/ axillary/ oral for toddlers and older
, c. pulse: <2 years→ measure apical for 1 minute
i. compare radial and femoral pulses in infancy
ii. HR decreases as they get older
d. respirations: count; decreases as they get older
e. BP: use correct cuff size; compare upper and lower extremities
i. increases with age
f. SaO2: should be >92% (ideally near 100%)
g. skin: birthmarks, palms, abuse, lesions/ rashes, color, texture, temp. HSN
i. cafe au lait (not size and #; implicated neurofibromatosis)
ii. mongolian spot: present at birth and fades
iii. palm creases: Simian crease (transverse palmar crease)--> Down
Syndrome
iv. palpable lymph nodes; are they painful, red, moveable
h. head and neck: shape, symmetry, head control/ range of motion, facial
symmetry/ movement/ appearance, fontanels (anterior→ 12-18 months;
posterior→ 2-3 months)
i. ears:
i. external structures alignment, pits/ tags/ sinuses/ discharge
ii. internal: assess canal/ tympanic membrane→ pull pinna down and back
j. nose: internal turbinates, septum, smell
k. mouth/ throat: lip color/ moisture, tongue movement/ appearance, buccal mucosa,
thrush, dentition, tonsils/ uvula/ oropharynx
l. chest: size, shape, symmetry, movement, breast development
m. lungs: breathing effort, rate/ rhythm, depth, quality, retractions, sounds
n. heart: apical pulse, rate, rhythm, sound (murmur 1-5), heaves, thrills, lifts
o. abdomen: 4 quadrants, inspection (umbilicus stump falls at 2 weeks), hernias),
auscultation (sounds), palpation
p. genitalia: tanner staging, signs of abuse (tears, bruising, discharge)
q. spine and extremities: curvature, tuft of hair/ dimples (spina bifida), ROM, joints,
muscles (strength, ROM, gait, posture), deformities
r. neuro: physical, behavioral, emotional, cerebellar function, reflexes (primitive
reflexes, DTRs), cranial nerves
i. babinski reflex gone by 1 year (fanning of toes)
s. developmental: denver ii, ages/stages, autism
Chapter 5- Pain Assessment and Management in Children
1. Identify influencing factors on pain assessment
a. age, developmental level, cause/ nature of pain, ability to express pain, cultural
consideration
2. Understand the differences in the types of pain (e.g., chronic, recurrent)
a. acute: less than 3 months
b. chronic: longer than 3 months or after illness has been resolved (headaches)
c. recurrent: pain that is episodic/ recurs (migraines, sickle cell pain, etc.)
3. Understand how to appropriately assess pain in children
a. behavioral (infants to age 4 years)
, i. observational→ vocalization, facial expression, body movements,
crying, rigidity/ sudden movements
ii. FLACC scale (2m-7y): facial expression, leg movement, activity, cry,
consolability
iii. CRIES (neonates)- observational; crying, requires O2, increased BP/HR,
expression, sleepless
b. self report (> 4 years)
i. faces scale, numeric rating scale (8y and older)
c. children with communication/ cognitive impairment
i. high risk for inadequate treatment of pain
ii. Non-Communicating Children’s Pain Checklist (NCCPC): vocal, social,
facial activity, body and limbs
iii. Pain Indicator for Communicatively Impaired Children
d. Children with chronic and complex pain
i. difficult to isolate pain symptom from other symptom (children with
cancer)
ii. rating pain does not always accurately convey how they really feel
e. Assessment components: OLDCARTS (onset, location, duration, characteristics,
aggravating factors, relieving, severity), is current treatment effective
4. Identify how and when to evaluate pain relief
a. dangers of unrelieved pain: longterm consequences, physiologic stress: increased
ICP, HR, RR, BP, decreased SaO2, behavioral changes (muscle rigidity, facial
expression, crying, withdrawal, sleeplessness, chronic pain syndromes
b. nonpharmacologic interventions
i. distraction, relaxation, guided imagery, cutaneous stimulation
ii. decrease perceived threat of pain, provide sense of control, enhance
comfort, promote rest/ sleep
iii. infants
1. non-nutritive sucking (pacifier), sucrose, swaddling/ containment
2. kangaroo holding (skin to skin contact)
c. medications
i. nonopiods→ mild to moderate pain (acetaminophen, ibuprofen)
1. antipyretic, antiinflammatory, analgesic
2. good for nociceptive pain (tissue injury)
ii. opiods→ moderate to severe pain (morphine, codeine, hydromorphone,
fentanyl, oxycodone)
1. potential side effects: constipation, respiratory depression,
sedation, N/V, agitation, mental clouding, tolerance, withdrawal
2. physical dependence: stopping the opioid results in withdrawal
symptoms
iii. timing is important
1. continuous pain→ around the clock (ATC); helps to avoid pain
breakthrough
2. clock-watching: can occur with prn orders; meds administered
only when pain has broken through→ can result in higher
