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Chapter 34
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Guidelines for Communication
Computer privacy and applications in nursing
Telephone triage and counseling
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Fig. 34-1. Child plays while nurse interviews parent.
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Communicating with Families
Communication with parents
Directing the focus
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Fig. 34-2. Nurse assumes position at child's level.
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Communicating with Families—cont’d
Communicating with children
Infancy
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Communicating with Families—cont’d
Communication techniques
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History Taking
Allergies
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History Taking—cont’d
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History Taking—cont’d
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Nutritional Assessment
Dietary intake
24-hour recall
Clinical examination
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General Approaches Toward
Examining the Child
Sequence for pediatric assessments generally altered to accommodate child’s developmental needs
Respirations first on small children
Familiarize child with equipment
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Goals of Pediatric Assessment
Minimize stress and anxiety associated with assessment of various body parts
Foster trusting nurse-child-parent relationships
Preserve security of parent-child relationship
Maximize accuracy of assessment findings
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Preparation of the Child
Cooperation usually enhanced with parent’s presence
Age-appropriate techniques
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Physical Examination
Growth measurements
Recumbent length for infants up to age 36 months + weight and head circumference
Standing height + weight after age 37 months
Plot on growth chart
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Fig. 34-9. Measurement of height.
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Growth
Expected growth rates at various ages
Use of skin-fold thickness and arm circumference for evaluation of body composition of muscle and adipose tissue
Significance of head circumference measurements
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Infant and toddler vital signs
Count respirations FIRST (before disturbing the child)
Count apical heart rate SECOND
Measure blood pressure (BP) (if applicable) THIRD
Measure temperature LAST
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Physical Assessment
General appearance
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Physical Assessment—cont’d
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Fig. 34-34. Location of structures in abdomen.
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Fig. 34-35. Location of hernias.
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Fig. 34-36. Palpating femoral pulses.
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Fig. 34-40. Bowleg.
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Fig. 34-41. Knock-knee.
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Developmental Assessment
Screening procedures
To identify children whose developmental level is below normal for chronologic age and who therefore require further investigation
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Denver Developmental Screening Test II
AKA Denver II
Widely used, standardized measures
Examiners must be specifically trained and certified in use of the tools
Interpretation of test
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Key Points
When communicating with parents, nurses need to encourage involvement, listen carefully, and be empathetic
Communication with children must reflect their developmental stage
Nonverbal communication includes writing, drawing, and play
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Key Points—cont’d
Objectives of health history are pertinent information, chief complaint, analysis of present illness, review of systems, family medical history, psychosocial and sexual history
Family assessment focuses on home and community environment
Family function interview examines interaction, roles, and communication
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Key Points—cont’d
Nutritional assessment includes review of dietary intake, clinical exam, and biochemical markers
Growth measurements focus on length, weight, skin fold thickness, arm and head circumference
Temperature, pulse, respiration, and BP constitute physiologic approach to assessment
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Key Points—cont’d
Assessment of skin focuses on color, texture, moisture, and turgor
Assessment of lymph nodes is performed by palpation
Head is inspected for symmetry, mobility, and muscle control
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Key Points—cont’d
Ear examination encompasses external and internal structures and auditory testing
Lungs are examined by palpation, percussion, and auscultation
Auscultation is most important procedure for examining heart
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Key Points—cont’d
Examination of genitalia may provoke anxiety in child
Neurologic assessment addresses behavior, motor, sensory, cerebellar function, cranial nerves, and reflexes
Developmental screening completed using Denver II