PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development ...
-
Upload
arlene-aubrey-stevenson -
Category
Documents
-
view
215 -
download
2
Transcript of PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development ...
![Page 1: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/1.jpg)
PEDIATRIC ASSESSMENT
![Page 2: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/2.jpg)
ESSENTIAL PEDIATRIC NURSING SKILLS
Knowledge of Growth and Development Development of a Therapeutic Relationship Communication with children and their parents Understanding of family dynamics and parent-
child relationships: IDENTIFY KEY FAMILY MEMBERS
Knowledge of Health Promotion & Disease Prevention
Patient Education and Anticipatory Guidance Practice of Therapeutic and Atraumatic Care Patient and Family Advocacy Caring, Supportive & Culturally Sensitive
Interactions Coordination and Collaboration CRITICAL THINKING
![Page 3: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/3.jpg)
INTRODUCTION
Key elements. Times: Every month in the 1st year. Every 3 month of the 2nd and 3rd year. Each 6 month of 4th and 5th year. Yearly after the 6th year.
![Page 4: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/4.jpg)
Avoid touching painful areas until confidence has been gained.
Begin exam without instruments. Allow child to determine order of exam
if practical. Use the same format as adult physical
exam.
PHYSICAL EXAM
![Page 5: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/5.jpg)
INFANT EXAM
Examine on parent lap. Leave diaper on. Comfort measures such as pacifier or
bottle. Talk softly. Start with heart and lung sounds. Ear and throat exam last.
![Page 6: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/6.jpg)
TODDLER EXAM
Examine on parent lap if uncooperative.
Use play therapy. Distract with stories. Let toddler play with equipment / BP. Call by name. Praise frequently. Quickly do exam.
![Page 7: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/7.jpg)
HISTORY
Bio-graphic Demographic Name, Date of Birth, Age Parents & siblings info Cultural practices Religious practices Parents’ occupations Adolescent – work info
Past Medical History• Allergies• Past illness• Trauma / hospitalizations• Surgeries• Birth history• Developmental• Family Medical/Genetics
Current Health Status• Immunization Status
• Chronic illnesses or conditions• What concerns do you have today?
Personal Hx., Life styles, Health Hx. (past and current), and Family Hx.
![Page 8: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/8.jpg)
EQUIPMENT WHAT’S IN YOUR SETTING?
Stethoscope & Sphygmomanometer
Pen Light
Otoscope / Opthalmoscope
Scale
![Page 9: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/9.jpg)
REVIEW OF SYSTEMS
Ask questions about each system Measurements: weight, height, head
circumference, growth chart, BMI Nutrition: breastfed, formula, favorite
foods, beverages, eating habits Growth and Development:
Milestones for each age group
![Page 10: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/10.jpg)
PHYSICAL EXAM TECHNIQUE
Inspection- eye only. Palpation- tip of finger. Percussion- use. . . Dullness (solid organ), resonance (over
solid organ or filled air), tympanic (hollow organ).
Auscultation- stethoscope.
![Page 11: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/11.jpg)
HISTORY: REVIEW OF SYSTEMS
Skin HEENT Neck Chest & Lungs /
Respiratory Heart &
Cardiovascular
GI GU & GYN Musculoskeletal
& Extremities Neuro Endocrine
![Page 12: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/12.jpg)
Sleep & Activity Appetite Bowel & Bladder
In a time crunch, these three questions should give you enough insight into the child’s general functioning –
Can get more detailed if any (+) responses
![Page 13: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/13.jpg)
PHYSICAL ASSESSMENT The approach is:
Orderly Systematic Head-to-toe
But FLEXIBILIY is essential And be kind and gentle but firm, direct and honest
![Page 14: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/14.jpg)
PHYSICAL ASSESSMENT
Facial expression Posture /
movement Hygiene Behavior Developmental
Status
General Appearance & Behavior
![Page 15: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/15.jpg)
VITAL SIGNS
Temperature: rectal only when absolutely necessary
Pulse: apical on all children under 1 year
Respirations: infant use abdominal muscles
Blood pressure: admission base line And the “Fifth” Vital Sign is ____ ?
![Page 16: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/16.jpg)
PEDIATRIC VITAL SIGNS – NORMAL RANGES
Heart Rate 80-150 70-110 60-110 60-
100
Respiratory Rate 24-38 22-30 14-22 12-
22
Systolic blood pressure 65-100 90-105 90-120 110-
125
Diastolic blood pressure 45 - 65 55-70 60-75
65-85
Infant Toddler School-Age Adolescent
![Page 17: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/17.jpg)
PHYSICAL ASSESSMENT
General Skin, hair, nails Head, neck,
lymph nodes Eyes, ears, nose,
throat Chest, Tanner Scale
Heart Abdomen Genitalia, Tanner
Scale, Rectal Musculoskeletal:
feet, legs, back, gait
![Page 18: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/18.jpg)
PALPATION
Use of your fingers and palms to determine: Temperature Hydration Texture Shape Movement Areas of
Tenderness
Warm hands and short nails
Palpate areas of tenderness / pain last
Talk with the child during palpation to help him relax
Be observant of reactions to palpation
Move firmly without hesitation
![Page 19: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/19.jpg)
H E E N T
HeadEyes
EarsNose
Neck Throat
![Page 20: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/20.jpg)
HEENT: HEAD & NECK, EYES, EARS, NOSE, FACE, MOUTH & THROAT
Head: Symmetry of skull and face Neck: Structure, movement, trachea,
thyroid, vessels and lymph nodes Eyes: Vision, placement, external and
internal fundoscopic exam Ears: Hearing, external, ear canal and
otoscopic exam of tympanic membrane Nose: Structure, exudate, sinuses Mouth: Structures of mouth, teeth and
pharynx
![Page 21: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/21.jpg)
HEAD
Shape: “NormoCephalic –
ATraumatic” Lesions ? Edema
![Page 22: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/22.jpg)
HEAD: KEY POINTS
Head Circumference (HC Fontannels/sutures: Anterior closes at 10-18
months, posterior by 2 months Symmetry & shape: Face & skull Bruits: Temporal bruits may be significant
after 5 yrs Hair: Patterns, loss, hygiene, pediculosis in
school aged child Sinuses: Palpate for tenderness in older
children Facial expression: Sadness, signs of abuse,
allergy, fatigue Abnormal facies: “Diagnostic facies” of
common syndromes or illnesses
![Page 23: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/23.jpg)
![Page 24: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/24.jpg)
![Page 25: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/25.jpg)
NEURO ASSESSMENT
LOC / Glasgow coma scale Pupil size Vital Signs Pain Seizure Activity Focal Deficits
![Page 26: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/26.jpg)
BACTERIAL MENINGITISClinical Manifestations in an Older Child
High fever Headache LOC Changes / GCS Nuchal rigidity / stiff neck + Kernigs = inability to extend legs + Brudzinski sign = flexion of hips when
neck is flexed Purple rash (check for blanching) “Looks Sick”
![Page 27: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/27.jpg)
EYES
PERRR Red Reflex Corneal Light Reflex Strabismus:
Alignment of eye important due to correlation with brain development
May need to corrected surgically
Preschoolers should have vision screening Refer to ophthalmologist is
there are concerns
o
![Page 28: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/28.jpg)
EYES: KEY POINTS
Vision: Red reflex & blink in neonate Examine external structure of the: 1- Conjunctiva- glassy 2- Sclera- clear 3- Cornea- cover the iris and pupil 4- pupils- compare for size, shape, test for reaction. 5- Iris- color, size and clarity. 6-12 M. Snellen chart for older children Irritations & infections PERRL Amblyopia (lazy eye): Corneal light reflex,
binocular vision, cover-uncover test
![Page 29: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/29.jpg)
EARS: KEY POINTS Ask about hearing concerns
Inquire about infant’s response to Observe an older infant’s/toddlers speech
pattern Inspect the ears •Assess the shape of the ears Determine if both ears are well formed •Assess External shape and size. Pinna: line, low set ear (retardation). Internal structure.
![Page 30: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/30.jpg)
EAR EXAM
Pinna is pulled down and back to straighten ear canal in children under 3 years.
![Page 31: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/31.jpg)
COMMON EAR INFECTIONS
Otitis Media
Most common reason children come to the pediatrician or emergency room
Fever or tugging at ear Often increases at
night when they are sleeping
History of cold or congestion
Infection can lead to rupture of ear drum.
Chronic effusion can lead to hearing loss.
OM is often a contributing factor in more serious infections: mastoiditis, cellulitis, meningitis, bacteremia.
Chronic ear effusion in the early years may lead to decreased hearing and speech problems.
![Page 32: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/32.jpg)
NOSE & THROAT / MOUTH
Exudate Pharynx Tonsils Signs & Symptoms of
Allerg Assess for symmetry,
deformity, skin lesion. Palpate for septal
deviation. Smooth and moist, with
pinkish color. ic Rhinitis
Palate Gums Swallow Oral Hygiene Condition of teeth Missing teeth Orthodontic
Appliances
![Page 33: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/33.jpg)
NOSE: KEY POINTS
Exam nose & mouth after ears Observe shape & structural deviations Nares: (check patency, mucous
membranes, discharge, turbinates, bleeding)
Septum: (check for deviation) Infants are obligate nose breathers Nasal flaring is associated with
respiratory distress
![Page 34: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/34.jpg)
NOSE AND THROAT
Sinusitis:
Fever Purulent rhinorrhea Facial Pain – cheeks, forehead Breath odor Chronic cough – could be day and
night (+) Post-nasal drip
![Page 35: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/35.jpg)
MOUTH & PHARYNX: KEY POINTS
Lips: color, symmetry, moisture, swelling, sores, fissures
Buccal mucosa, gingivae, tongue & palate for moisture, color, intactness, bleeding, lesions.
Tongue & frenulum - movement, size & texture
Teeth - caries, malocclusion and loose teeth. Uvula: symmetrical movement or bifid uvula Voice quality, Speech Breath - halitosis
![Page 36: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/36.jpg)
EARS, NOSE AND THROAT
Sore Throats
Is it strept or is it viral or could it be mono?
Lymph nodes& ROM
![Page 37: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/37.jpg)
NECK: KEY POINTS
√ position, lymph nodes, masses, fistulas, clefts
Range of Motion (ROM) Check clavicle in newborn Head control in infant Trachea & thyroid in midline Carotid arteries (bruits) Meningeal irritation
![Page 38: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/38.jpg)
All 4 quadrants Front and back Take the time to listen Be sure about “lungs CTAB” (clear to auscultation bilaterally)
Chest Assessment• How does the child look? • Color• Work of Breathing: Effort used to breathe
Auscultation
![Page 39: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/39.jpg)
CHEST
Anatomy. Inspection: symmetry, movement of
chest wall. Breathing pattern- abdominal
breathing. Palpation: 1- light palpation: in light circular
motion to detect lesion and masses 2- deep palpation: palpate for internal
organ like liver and spleen.
![Page 40: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/40.jpg)
LUNGS & RESPIRATORY: KEY POINTS Clubbing Snoring (expiratory): upper airway
obstruction, allergy, Dullness to percussion: fluid or mass
Increased or Decreased RespirationsStridorWheezing
![Page 41: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/41.jpg)
![Page 42: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/42.jpg)
CHEST ASSESSMENT
Auscultation Wheezing Retractions
Subcostal Intercostal Sub-sternal Supra-clavicularRed Flags: grunting nasal flaring stridor
![Page 43: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/43.jpg)
ALL THAT WHEEZES ISN’T ALWAYS ASTHMA…
Think: Infection Foreign body aspiration Anaphylaxis
Insect bites/stings, medications, food allergies
![Page 44: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/44.jpg)
AND ALL ASTHMA DOESN’T ALWAYS WHEEZE!
Cough Fatigue Reduced
exercise tolerance
![Page 45: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/45.jpg)
COUGH - CHARACTERISTICS
Dry, non-productive Mucousy – productive Croupy Acute – less than 2-3 weeks Chronic – more than 2-3 weeks Associating Symptoms
![Page 46: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/46.jpg)
• AUSCULTATING HEART SOUNDS
Pillitter
Circulatory
The Auscultation Assistant – Hear Heart Murmurs, Heart Sounds, and Breath Sounds. http://www.wilkes.med.ucla.edu/inex.htm
• Perfusion – capillary refill• “Warm to touch”
![Page 47: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/47.jpg)
ABDOMINAL ASSESSMENT
Pillitteri
Gastro-Intestinal
![Page 48: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/48.jpg)
ABDOMEN
Use supine position with pillow under the head and knee flexed.
Divide abd. to 4 Quadrant, and examine from button to top.
Examination of the abdomen involve the inspection, auscultation, palpation and percussion.
![Page 49: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/49.jpg)
ABDOMEN: KEY POINTS
Contour Bowel Sounds & Peristalsis Skin: color, veins Umbilicus Assess for Tenderness, Ridigity, Tympany,
Dullness Hernias: umbilical, inguinal, femoral Masses - size, shape, dullness, position,
mobility Liver, Spleen, Kidneys, Bladder
![Page 50: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/50.jpg)
![Page 51: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/51.jpg)
![Page 52: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/52.jpg)
ABDOMINAL GIRTH
Abdominal girth should be measured over the umbilicusWhenever possible.
![Page 53: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/53.jpg)
BOWEL SOUNDS
Normal: every 10 to 30 seconds. Listen in each quadrant long enough to
hear at least one bowel sound. Absent Hypoactive; peritonitis, paralytic illeus Normoactive Hyperactive, GE, Intestestinal obs.
![Page 54: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/54.jpg)
STOMACHACHES AND ABDOMINAL PAIN
Excessive gas Chronic
constipation Lactose
intolerance Viral
gastroenteritis Irritable bowel
syndrome
Heartburn or indigestion
GERD Food allergy Parasite infections
(Giardia)
What are we most concerned about?
![Page 55: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/55.jpg)
Appendicitis Bowel obstruction --
Cholecystitis with or without gallstones
Food poisoning (salmonella, shigella)
Inflammatory Bowel Disease – Ulcerative colitis
Hernia Intussusception Kidney stones Pancreatitis Sickle cell crisis Ulcers Urinary tract
infections
Stomachaches and Abdominal Pain
![Page 56: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/56.jpg)
SIGNS AND SYMPTOMS
Appearance –color, facial, ROM, gait, position Pain – get your pain scales out Nausea Vomiting Diarrhea Bloating Vomiting Inability to pass gas or stool
![Page 57: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/57.jpg)
MUSCULO-SKELETAL FROM, MAE - neck, shoulder, elbow,
wrist, hip, knee, ankle, foot, digits Alignment, contour, strength,
weakness & symmetry Limb, joint mobility: stiffness,
contractures Gait – observe child walking without
shoes Spinal alignment - Scoliosis Muscle Strength & Tone Hips – O & B Reflexes
![Page 58: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/58.jpg)
Bone, joints-cartilages, ligaments and muscles.
Inspect the joint for flexion and extension, abduction, adduction, rotation.
Inspect the symmetry and observe the edema.
![Page 59: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/59.jpg)
![Page 60: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/60.jpg)
SCOLIOSIS
Lateral curvature of spine
Medline.com
Key Points:
• Barefoot• Feet Together• Bend Over –”Diving Of a Diving Board”• Check Hips
![Page 61: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/61.jpg)
ASSESSMENT The Five P’s:
Pain Paresthesia Passive stretch Pressure Pulse-less-ness
![Page 62: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/62.jpg)
SKIN, NAILS & HAIR
Rashes Lesions Lacerations Lumps Bumps Bruises Bites Infections
![Page 63: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/63.jpg)
COMMON SKIN LESIONS
Macule Papule Vesicle, bulla Pustule Cyst Patch Plaque Wheal Striae
Scale Crust Keloid Fissure Ulcer Petechiae Purpura Ecchymosis
Capillary bleeding: Petichiae and purpura usually indicate serious conditions
![Page 64: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/64.jpg)
SKIN INFECTIONS
Bacterial infections Abscess formation Severity varies with skin integrity,
immune and cellular defenses Examples:
impetigo cellulitis
![Page 65: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/65.jpg)
THE SCHOOL-AGE CHILD
Privacy and modesty.
Explain procedures and equipment.
Interact with child during exam.
![Page 66: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/66.jpg)
ADOLESCENT
Privacy issues – first consideration
HEADS: home life, education, alcohol, drugs, sexual activity / suicide
GAPS Guidelines for Adolescent Preventive Services
Bright Futures
![Page 67: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/67.jpg)
PSYCHOSOCIAL ASSESSMENT
HEADS Home life Emotions /
Depression or Education
Activities Drugs /
Alcohol / Substance Abuse
Sexuality activity or Suicide
SHADESS• School• Home• Activities• Drugs / Substance Abuse
• Emotions / Depression
• Sexuality• Safety
![Page 68: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/68.jpg)
COMMON SCHOOL HEALTHFOCUSED ASSESSMENTS
The “I don’t feel good” – where do I begin?
Behavioral / Mental Health Concerns
Chronic Conditions & Special Needs
What Else?
![Page 69: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/69.jpg)
THE “I DON’T FEEL GOOD”
![Page 70: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/70.jpg)
THE FREQUENT FLIERS
Headaches Stomachach
es Nosebleeds Chest Pain Coughs & Fevers
![Page 71: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/71.jpg)
![Page 72: PEDIATRIC ASSESSMENT. ESSENTIAL PEDIATRIC NURSING SKILLS Knowledge of Growth and Development Development of a Therapeutic Relationship Communication.](https://reader038.fdocuments.us/reader038/viewer/2022110207/56649d8b5503460f94a72a55/html5/thumbnails/72.jpg)
THE POWER OF NURSING
Never doubt how vitally important you are; never doubt how important your work is – and never expect anyone to acknowledge it
before you do. Every moment, in everything you do,
you are making a difference. In fact, you are in the business of making a
difference in other people’s lives. In that difference lies their healing
and your power. Never forget it.
Leah L. Curtin, RN, MS, MA, DSC, FAAN