Pediatric Nursing Critical Components of Nursing Care 3rd Edition
Pediatric History Taking - Involve child
Be honest with child
Open ended questions
Observe nonverbal communication
History of present illness - Birth history
Prenatal history
Intrapartum-history of delivery
Condition of baby at birth
Postnatal condition
Physiologic data - Current health data
Medications
Health providers
Allergies
Immunizations
Family history
Familiar or Hereditary diseases - See power points (9-14)
Psychosocial data - •Family composition
•Financial resources
•Home environment, housing, neighborhood
•School or child care
•Daily routines
Sleep, wake pattern, activities
Nutritional Assessment - •Dietary intake
•Clinical examination of nutrition
•Hair, skin, mouth, eyes
•Evaluation of nutritional assessment
,•Malnourished
•At risk
•Well nourished
Overweight or obese
Cultural Considerations - •Amount of eye contact
•Interactions with healthcare providers
•Physical touch
•May say "yes" to be polite
•Use of silence
General Approaches Toward Examining the Child - •Sequence of the examination
•Head-to-toe sequence for assessing adult clients
•Sequence for pediatric assessments generally altered to accommodate child's developmental
needs
•Use chronological age as the main criteria
Goals of Pediatric Physical Assessment - •Minimize stress and anxiety associated with
assessment of various body parts
•Foster trusting nurse-child-parent relationships
•Allow for maximum preparation of child
•Preserve security of parent-child relationship
•Maximize accuracy of assessment findings
Preparation of the child: - •Child's perception of painful procedures
•Cooperation usually enhanced with parent's presence
•Age-appropriate techniques
•Positioning and preparation
Facilitating Examination of Infants Under 6 Months of Age - •Praise parental presence and
responses.
•Promote physical comfort and relaxation.
•Distract infant with colorful toys.
•Use gentle, warm hands and warm stethoscope.
, •Auscultate when quiet or sleeping.
•Do procedures that provoke crying at end of exam.
Facilitating Examination of Toddlers - •Provide a security object.
•Demonstrate instruments on parent or other before examining child.
•Allow child to have as much control and choice as possible.
•Examine ears, eyes, mouth at end of the exam.
Facilitating Examination of Preschoolers - •Consider what sequence is best.
•Allow children to touch and play with equipment.
•Use games to reduce anxiety.
•Give positive feedback.
Facilitating Examination of Older Children and Adolescents - •Ensure modesty and privacy.
•Offer choices.
•Explain body parts and functions.
•Decide on parental presence or absence.
•Consider need for nonparent chaperones.
•Reassure adolescents of normalcy.
Sequence of Examination - •Young children
•Foot-to-head sequence allows least distressing parts of the exam to be completed first.
•Older children
•Head-to-toe approach
•Sequence may vary due to preferences, sleep, cooperation.
Examination Techniques - Inspection
Palpation
Percussion
Auscultation
Physical Examination - •Growth measurements
•Growth charts
•Length
Pediatric History Taking - Involve child
Be honest with child
Open ended questions
Observe nonverbal communication
History of present illness - Birth history
Prenatal history
Intrapartum-history of delivery
Condition of baby at birth
Postnatal condition
Physiologic data - Current health data
Medications
Health providers
Allergies
Immunizations
Family history
Familiar or Hereditary diseases - See power points (9-14)
Psychosocial data - •Family composition
•Financial resources
•Home environment, housing, neighborhood
•School or child care
•Daily routines
Sleep, wake pattern, activities
Nutritional Assessment - •Dietary intake
•Clinical examination of nutrition
•Hair, skin, mouth, eyes
•Evaluation of nutritional assessment
,•Malnourished
•At risk
•Well nourished
Overweight or obese
Cultural Considerations - •Amount of eye contact
•Interactions with healthcare providers
•Physical touch
•May say "yes" to be polite
•Use of silence
General Approaches Toward Examining the Child - •Sequence of the examination
•Head-to-toe sequence for assessing adult clients
•Sequence for pediatric assessments generally altered to accommodate child's developmental
needs
•Use chronological age as the main criteria
Goals of Pediatric Physical Assessment - •Minimize stress and anxiety associated with
assessment of various body parts
•Foster trusting nurse-child-parent relationships
•Allow for maximum preparation of child
•Preserve security of parent-child relationship
•Maximize accuracy of assessment findings
Preparation of the child: - •Child's perception of painful procedures
•Cooperation usually enhanced with parent's presence
•Age-appropriate techniques
•Positioning and preparation
Facilitating Examination of Infants Under 6 Months of Age - •Praise parental presence and
responses.
•Promote physical comfort and relaxation.
•Distract infant with colorful toys.
•Use gentle, warm hands and warm stethoscope.
, •Auscultate when quiet or sleeping.
•Do procedures that provoke crying at end of exam.
Facilitating Examination of Toddlers - •Provide a security object.
•Demonstrate instruments on parent or other before examining child.
•Allow child to have as much control and choice as possible.
•Examine ears, eyes, mouth at end of the exam.
Facilitating Examination of Preschoolers - •Consider what sequence is best.
•Allow children to touch and play with equipment.
•Use games to reduce anxiety.
•Give positive feedback.
Facilitating Examination of Older Children and Adolescents - •Ensure modesty and privacy.
•Offer choices.
•Explain body parts and functions.
•Decide on parental presence or absence.
•Consider need for nonparent chaperones.
•Reassure adolescents of normalcy.
Sequence of Examination - •Young children
•Foot-to-head sequence allows least distressing parts of the exam to be completed first.
•Older children
•Head-to-toe approach
•Sequence may vary due to preferences, sleep, cooperation.
Examination Techniques - Inspection
Palpation
Percussion
Auscultation
Physical Examination - •Growth measurements
•Growth charts
•Length
