Communication, History, Physical, and Developmental Assessment(1).ppt

Mosby’s EMT-Basic TextbookMosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 34
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Mosby items and derived items © 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
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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Developmentally Appropriate Communication
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Developmentally Appropriate Communication—cont’d
Early childhood
Be consistent: don’t smile when doing painful things
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School-age children
Concern about body integrity
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Adolescents
Think about developmental regression
Realize importance of peers
Privacy is from their viewpoint
Illness>>act much younger; with pain>>act much younger
“I want Mommy,” etc.
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Communicating with Families—cont’d
Communication techniques
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Play
As pain reliever/distracter
It is HOW they learn and mature
Example of tea party to increase po intake
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Play Therapy
Guess what I have in my hand
Reduces trauma
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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
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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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Developmental Milestones
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Fig. 34-5. Preparing children for physical examination.
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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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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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Fig. 34-9. Measurement of height.
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Physiologic Measurements
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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Physiologic Measurements—cont’d
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Vital signs
Temperature
Rectal temp- most accurate method, but proper technique must be used to avoid injury
Tympanic membrane temp – quick and noninvasive measurement, reliability is a problem
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Vital signs
1 to 12 years (oral)
36.7 to 37.7 C ( 98.1 to 99.9 F)
12 years and older (oral)
36.6 to 36.7 C (97.8 to 98.0 F)
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Vital signs
2 to 12 years- 70 to 110/min
12 years and older – 50 to 90/min
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Vital signs
Respiratory Rate
Newborn to 1 year – 30 bpm
1 to 2 years - 25 to 30 bpm
2 to 6 years – 21 to 24 bpm
6 to 12 years – 19 to 21 bpm
12 years and older – 16-18 bpm
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Vital Signs
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Physical Assessment
General appearance
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Fig. 34-15. External structures of eye.
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Fig. 34-16. Structures of fundus.
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Fig. 34-19. Ear alignment.
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Fig. 34-22. Landmarks of tympanic membrane with “clock” superimposed.
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Fig. 34-24. External landmarks and internal structures of nose.
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Fig. 34-26. Interior structures of mouth.
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Physical Assessment—cont’d
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Fig. 34-27. Rib cage.
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Fig. 34-29. Movement of chest during respiration.
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Fig. 34-31. Position of heart within thorax.
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Fig. 34-32. Location of pulses.
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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 Screening
Developmental Assessment
Detects strengths and weaknesses in pattern of development
Not diagnostic
Often requires formal training
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Types of Developmental Screening
Instruments that require examination of
child
age
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Developmental Screening Versus Developmental Assessment
Denver II
(DDST) underwent a major revision. The revised test
is called Denver II.
children.
some were revised for clarification, and new items
were added, especially in the area of language.
Tests gross motor, language, fine motor/adaptive,
and personal-social skills.
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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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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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Communication, History, Physical, and Developmental Assessment(1).ppt