Communication, History, Physical, and Developmental Assessment

Chapter 34
Communication,
History, Physical,
and Developmental
Assessment
Mosby items and derived items 2010, 2006, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.
Guidelines for Communication

and Interviewing
Establishing
a setting
Assurance of privacy and confidentiality
Computer
privacy and applications in nursing

Telephone triage and counseling
Fig. 34-1. Child plays while nurse interviews parent.

Communicating with Families

Communication
with parents
Encouraging the parent to talk

Directing the focus
Listening and cultural awareness
Using silence
Being empathetic
Providing anticipatory guidance
Avoiding blocks to communication
Fig. 34-2. Nurse assumes position at child's level.


contd
Communicating
with children
Communication related to development of

thought processes
Infancy
Early childhood
School years
Adolescence
Developmentally Appropriate
Communication
Infants
Nonverbal
Crying as communication
Types
of cries
Communicationcontd
Early
childhood
Focus on child in communication

Explain what, how, and why
Use words child will recognize
Be consistent: dont smile when doing
painful things
Communicationcontd
School-age
children
Want explanations and reasons why

Concern about body integrity
Reassurance needed
Fig. 34-3. A young child may take the expression a little stick in the arm literally.
10
Communicationcontd
Adolescents
Be honest with them

Be aware of privacy needs
Think about developmental regression
Realize importance of peers
11

contd
Communication
techniques
Conventional interview methods

Open-ended questions
Word games
Nonverbal techniques
Play
12
Play
Childrens
work
Childs developmental workshop
As therapeutic intervention
As stress reliever for child/family
As pain reliever/distracter
As barometer of illness
13
Play Therapy
Games
Peek-a-boo
Which hand do you take
Guess what I have in my hand
Reduces
trauma
Prepares children for procedures
Assessment tool
Method of intervention and evaluation
14
History Taking
Performing
health history
Identifying information
Chief complaint
Present illness
History
Birth
and dietary
Previous illness, injuries, and operations
Allergies
Medications and immunizations
Growth and development
15
History Takingcontd
Performing
Sexual history
Family medical history
Geographic location
Family
health history
structure
Assessment
Composition
16
History Takingcontd
Psychosocial
School adjustment
Unusual habits
Family and home environment
Review
history
of systems
Specific and thorough review of each

body system
17
Nutritional Assessment
Dietary
24-hour recall
Clinical
intake
examination
Hair, skin, mouth, eyes
Evaluation
of nutritional assessment
Malnourished
At risk
Well nourished
18
General Approaches Toward

Examining the Child
Head-to-toe
sequence for assessing adult
clients
Sequence for pediatric assessments
generally altered to accommodate childs
developmental needs
19
Goals of Pediatric
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
20
Preparation of the Child

Childs
perception of painful procedures

Cooperation usually enhanced with parents
presence
Age-appropriate techniques
21
Fig. 34-4. Using paper-doll technique to prepare child for physical examination.
22
Developmental Milestones
Holding
up head steadily
Sitting alone without support
Walking without assistance
Meaningful speech
Present grade in school
Scholastic performance
Friends/interactions with others
23
Fig. 34-5. Preparing children for physical examination.

24
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
By
gender and prematurity if appropriate

<5th or >95th percentile considered outside
expected parameters for height, weight, head
circumference
25
Fig. 34-6. Child preventive care time line. The information on immunizations is based on
recommendations issued by Advisory Committee on Immunization Practices, American
Academy of Pediatrics, and American Academy of Family Physicians. B, Birth; HIV, human
immunodeficiency virus; PKU, phenylketonuria; STDs, sexually transmitted diseases.
26
Growth
Ethnic
differences
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
27
Fig. 34-7. These children of identical age (8 years) are markedly different in size. Child on left,
of Asian descent, is at 5th percentile for height and weight. Child on right is above 95th
percentile for height and weight. However, both children demonstrate normal growth patterns.
28
Fig. 34-8. Measurement of head, chest, and abdominal circumference and crown-to-heel
(recumbent) length.
29
Fig. 34-9. Measurement of height.

30
Fig. 34-10. A, Infant on scale. B, Toddler on scale. Note presence of nurse to prevent falls.
31
Physiologic Measurements
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
32
Physiologic Measurements
contd
Pediatric
BPs
Measurement devices
Cuff selection
Cuff placement
Interpretation of BP measurement
Orthostatic hypotension
33
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
Temp of 100.4 (38 C) and above is
considered a fever
34
Vital signs
Expected
Vital Signs:
Birth to 1year 36.5 to 37.2 C (97.7 to 98.9F)
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)
35
Vital
Pulse
signs
Birth to 1 week- 100 to 160/min

(fluctuations)
1 week to 3 months- 100 to 220/min
3 months to 2 years- 80 to 150/min
2 to 12 years- 70 to 110/min
12 years and older 50 to 90/min
36
Vital
signs
Respiratory Rate
Newborn -30-60 bpm with short periods of

apnea
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
37
Vital
Signs
Age
Girls
Girls
Boys
Boys
systolic
diastolic
systolic
diastolic
1 year
97-107
53-60
94106
50 - 59
3 year
100-110
61-68
100-113
59-67
6 year
104 114
67-75
105-117
67-76
10 year
112-122
73-80
110-123
73-82
16 year
122-132
79-86
125-138
79-87
38
Fig. 34-11. Determination of proper cuff size. A, Cuff bladder width should be approximately 40% of
circumference of arm measured at a point midway between olecranon and acromion. B, Cuff bladder length
should cover 80% to 100% of circumference of arm. C, Blood pressure should be measured with cubital fossa at
heart level. Arm should be supported. Stethoscope bell is placed over brachial artery pulse, proximal and medial
to cubital fossa and below ottom edge of cuff.
39
Fig. 34-12. Sites for measuring blood pressure. A, Upper arm. B, Lower arm or forearm. C,
Thigh. D, Calf or ankle.
40
Physical Assessment
General
appearance
Skin
Hair,
nails, hygiene
Lymph nodes
Head and neck
Eyes, ears, nose, and throat
41
Fig. 34-13. Examples of flexion creases on palm. A, Normal. B, Transpalmar crease.

42
Fig. 34-14. Location of superficial lymph nodes. Arrows indicate directional flow of lymph.
43
Fig. 34-15. External structures of eye.

44
Fig. 34-16. Structures of fundus.

45
Fig. 34-17. A, Corneal light reflex test demonstrating orthophoric eyes. B, Pseudostrabismus.
Inner epicanthal folds cause eyes to appear misaligned; however, corneal light reflexes fall
perfectly symmetrically.
46
Fig. 34-18. Alternate cover test to detect amblyopia in patient with strabismus. A, Eye is
occluded, and child is fixating on light source. B, If eye does not move when uncovered, eyes
are aligned.
47
Fig. 34-19. Ear alignment.

48
Fig. 34-20. Position for restraining child (A) and infant (B) during otoscopic examination.
49
Fig. 34-21. Positioning head by tilting it toward opposite shoulder for full view of tympanic
membrane.
50
Fig. 34-22. Landmarks of tympanic membrane with clock superimposed.

51
Fig. 34-23. Positioning for visualizing eardrum in infant (A) and in child older than 3 years of
age (B).
52
Fig. 34-24. External landmarks and internal structures of nose.

53
Fig. 34-25. A, Encouraging child to cooperate. B, Positioning child for examination of mouth.
54
Fig. 34-26. Interior structures of mouth.

55
Physical Assessment
contd
Chest
Heart
Lungs
Abdomen
Genitalia
Back
and extremities
Neurologic assessment
56
Fig. 34-27. Rib cage.

57
Fig. 34-28. Imaginary landmarks of chest. A, Anterior. B, Right lateral. C, Posterior.

58
Fig. 34-29. Movement of chest during respiration.

59
Fig. 34-30. Location of lobes of lungs within thoracic cavity.

60
Fig. 34-31. Position of heart within thorax.

61
Fig. 34-32. Location of pulses.

62
Fig. 34-33. Direction of heart sounds for anatomic valve sites and areas (circled) for
auscultation.
63
Fig. 34-34. Location of structures in abdomen.

64
Fig. 34-35. Location of hernias.

65
Fig. 34-36. Palpating femoral pulses.

66
Fig. 34-37. Major structures of genitalia in uncircumcised postpubertal male.

67
Fig. 34-38. A, Preventing cremasteric reflex by having child sit in tailor position. B, Blocking
inguinal canal during palpation of scrotum for descended testes.
68
Fig. 34-39. External structures of genitalia in postpubertal female. Labia are spread to reveal
deeper structures.
69
Fig. 34-40. Bowleg.

70
Fig. 34-41. Knock-knee.

71
Fig. 34-42. Testing for triceps reflex. Child is placed supine, with forearm resting over chest, and
triceps tendon is struck. Alternate procedure: child's arm is abducted, with upper arm supported
and forearm allowed to hang freely. Triceps tendon is struck. Normal response is partial
extension of forearm.
72
Fig. 34-43. Testing for biceps reflex. Child's arm is held by placing partially flexed elbow in
examiner's hand with thumb over antecubital space. Examiner's thumbnail is struck with
hammer. Normal response is partial flexion of forearm.
73
Fig. 34-44. Testing for patellar, or knee jerk, reflex, using distraction. Child sits on edge of
examining table (or on parent's lap) with lower legs flexed at knee and dangling freely. Patellar
tendon is tapped just below kneecap. Normal response is partial extension of lower leg.
74
Fig. 34-45. Testing for Achilles reflex. Child should be in same position as for knee jerk reflex.
Foot is supported lightly in examiner's hand, and Achilles tendon is struck. Normal response is
plantar flexion of foot (foot pointing downward).
75
Fig. 34-46. Testing cardinal positions of gaze. Muscles responsible for movement: SR, Superior
rectus; IR, inferior rectus; MR, medial rectus; IO, inferior oblique; SO, superior oblique; LR,
lateral rectus.
76
Developmental surveillance is a
continuous process, occurring at each
office visit. A more formal
developmental screen may be utilized
during well-child visits.
Developmental surveillance is
different from developmental
screening.
77
Developmental
Screening
Developmental
Assessment
Detects a difference or
deviance in pattern of
development
Detects strengths and

weaknesses in pattern of
development
Not diagnostic
Diagnostic of delay
Brief
Longer, focused
Does not require formal

training
Often requires formal

training
78
Types of Developmental Screening

Parent-completed screening systems
Checklists or sheets for each child's chart
Instruments that require examination of
child
Denver system: prescreening
questionnaire, general developmental
screening instrument, and environmental
screening
Ages & Stages questionnaires (ASQ) for
children 0-60 months of age
Parents Evaluations of Developmental
Status (PEDS) for children 3-8 years of
age
79
Developmental Screening Versus Developmental

Assessment
Denver II
In 1990, the Denver Developmental Screening Test
(DDST) underwent a major revision. The revised test
is called Denver II.
Denver II has been standardized on over 2000
children.
In Denver II, certain items from DDST were omitted,
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.
80
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
Recommendations/referrals
81
Developmental
Assessment
Screening
procedures
To identify children whose developmental

level is below normal for chronologic age
and who therefore require further
investigation
Since Education of the Handicapped Act
of 1986 there has been greater emphasis
on children with disabilities
82

Communication, History, Physical, and Developmental Assessment

Caricato da

Informazioni sul documento

Descrizione originale:

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

Communication, History, Physical, and Developmental Assessment

Caricato da

Copyright:

Formati disponibili

Chapter 34

Guidelines for Communication

Assurance of privacy and confidentiality

privacy and applications in nursing

Fig. 34-1. Child plays while nurse interviews parent.

Communicating with Families

Encouraging the parent to talk

Fig. 34-2. Nurse assumes position at child's level.

Communicating with Families

Communication related to development of

Focus on child in communication

Want explanations and reasons why

Be honest with them

Communicating with Families

Conventional interview methods

Specific and thorough review of each

Hair, skin, mouth, eyes

General Approaches Toward

sequence for assessing adult

stress and anxiety associated with

Preparation of the Child

perception of painful procedures

Fig. 34-5. Preparing children for physical examination.

Recumbent length for infants up to age 36

gender and prematurity if appropriate

Fig. 34-9. Measurement of height.

Infant and toddler vital signs

Count respirations FIRST (before

Rectal temp- most accurate method, but

Birth to 1 week- 100 to 160/min

Newborn -30-60 bpm with short periods of

Fig. 34-13. Examples of flexion creases on palm. A, Normal. B, Transpalmar crease.

Fig. 34-15. External structures of eye.

Fig. 34-16. Structures of fundus.

Fig. 34-19. Ear alignment.

Fig. 34-22. Landmarks of tympanic membrane with clock superimposed.

Fig. 34-24. External landmarks and internal structures of nose.

Fig. 34-26. Interior structures of mouth.

Fig. 34-27. Rib cage.

Fig. 34-28. Imaginary landmarks of chest. A, Anterior. B, Right lateral. C, Posterior.

Fig. 34-29. Movement of chest during respiration.

Fig. 34-30. Location of lobes of lungs within thoracic cavity.

Fig. 34-31. Position of heart within thorax.

Fig. 34-32. Location of pulses.

Fig. 34-34. Location of structures in abdomen.

Fig. 34-35. Location of hernias.

Fig. 34-36. Palpating femoral pulses.

Fig. 34-37. Major structures of genitalia in uncircumcised postpubertal male.

Fig. 34-40. Bowleg.

Fig. 34-41. Knock-knee.

Detects strengths and

Does not require formal

Often requires formal

Types of Developmental Screening

Developmental Screening Versus Developmental

To identify children whose developmental

Potrebbero piacerti anche