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Physical Assessment

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Title: Pediatric Medications; Physical assessment Author: ACC Last modified by: ACC Created Date: 9/17/2007 4:42:37 PM Document presentation format – PowerPoint PPT presentation

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Title: Physical Assessment


1
Physical Assessment Medication Documentation
  • Spring 2008
  • Susan Beggs, RN MSN

2
Common considerations
  • Communication strategies
  • Identifiers
  • Questioning of the child or parent
  • Strategies to gain cooperation
  • Removing distractions
  • Privacy
  • Awareness of growth and development milestones

3
Types of health histories
  • Data from birth to current status (the complete
    history)
  • Well history
  • Problem-oriented history
  • Psychosocial data
  • Daily routines, issues that impact daily living

4
Beginning the assessment
  • Exam begins with the 1st mtg
  • All measurements are taken wt, ht, head
    circumference
  • Should be plotted to obtain the percentile

5
Review of symptoms
  • Developmental approach to the exam
  • Young child foot to head
  • Older child head to toe

6
Exam techniques
  • Vary by the age of the child
  • Build rapport with the family
  • Develop cultural competence
  • Involve the child in the interview if age
    appropriate
  • Be honest with the child when answering questions
  • Utilize careful listening

7
Nursing Practice techniques for physical
assessment
  • Inspection
  • Palpation
  • Auscultation
  • Percussion

8
Normal findings in children
  • Small, firm, nontender, and shotty lymph nodes
    may be palpable
  • Tonsils of varying sizes often larger in young
    children
  • Pupils of equal size, round and reactive to light
    and accommodation
  • Pulses in upper and lower extremities
    bilaterally symmetric

9
Terminology for head shape
  • Normocephalic
  • Microcephalic
  • Macrocephalic
  • Bossing

10
Physical exam
  • Skin perfusion, turgor, color, lesions
  • Hair distribution, loss, lice, pubic areas
  • Head/skull symmetry, circumference, sutures in
    infants
  • Eyes/ears red reflex, TM, muscles of the eye,
    lacrimal glands, conjunctiva

11
Physical exam, cont.
  • Lips, tongue, gums, palate, teeth
  • Neck movement, nodes, thyroid
  • Chest shape, movement, effort, function
  • A B
  • Funnel chest
  • (Pectus excavatum)

  • pigeon chest


    (pectus carinatum)

12
Physical Assessment
  • Heart sounds murmurs, apical rate, arrhythmias,
    blood pressure, and rhythm
  • Abdomen shape, bowel sounds, underlying organs
  • Genitals Preparation for the exam crucial!
    Include the anus and rectum, assessment for
    pubertal development and sexual maturity

13
Physical Assessment, cont.
  • Musculo/skeletal system one and joints, ROM,
    strength, posture, spinal alignment
  • Inspection of the limbs
  • Nervous system cognition, balance, CN function,
    language, reflexes

14
Physical exam of dark-skinned children
  • Erythema dusky red or violet
  • Cyanosis black or dusky
  • Jaundice diffusely darker than the childs
    normal color

15
Psychosocial Assessment
  • Home environment
  • Employment and education
  • Eating
  • Activities
  • Drugs (substance use)
  • Sexuality
  • Suicide/depression
  • Safety

16
Concluding the exam
  • What questions should be asked at the end of
    every interview?

17
Ask yourself
  • What if a 14 year old girl weighs 93 lbs. Would
    the nurse be concerned?
  • What if she weighed 110 lbs 6 months earlier?
  • What if a year earlier she had weighed 105 lbs?

18
Ask yourself.
  • A 2 yr old child being seen for well check is
    resistant to the exam. What techniques would be
    helpful for the nurse to use with a toddler?

19
Another challenge.
  • Kelly, aged 15 months, comes in for a well child
    check. How would the nurse assess height and
    weight?

20
Suspicions of child abuse/neglect detected during
assessment
  • Dress
  • Grooming and personal hygiene
  • Posture and movements
  • Body image
  • Speech and communication
  • Facial characteristics and expressions
  • Psychologic state

21
Critical thinking after the exam
  • Compiling the data
  • Describing the elements of the health history
  • Modifying assessments based on ages
  • Determining the sexual maturity
  • Recognizing 5 important signs of a serious
    alteration that require urgent attention

22
Critical thinking exercise
  • Leah, 17 years old, is a single mother who brings
    her 6 month old child to the clinic. Leah has
    not kept her appointments the last two months.
    She reports, I hate to take time off work when
    she is well but my supervisor said it was
    important for her to get a checkup I guess I
    messed up

23
Part II Medications for the pediatric patient
  • Small, very accurate dosages
  • All medications ordered must be calculated by the
    nurse
  • All weights based on kilograms

24
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25
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26
Calculations of the medications
  • The nurse is responsible for the accurate
    ADMINISTRATION of the medication
  • The most accurate ADMINISTRATION is performed by
    the nurse calculating the dosage before giving

27
Lets calculate
  • John weighs 8.2 kilograms. The doctor orders
    Ampicillin 200 mg q 6hrs. Is this amount
    appropriate for 24 hrs?
  • Sarah, age 12 and weighing 44 kilograms, has a
    temp of 102º. The doctor has ordered Tylenol 81
    mg q 6 for fever above 101.8º. Is this an
    appropriate dose for Sarah?

28
Syringe pump vs. Plum
  • How do you make a decision about the type of pump
    to use?
  • All meds given IV are administered on a pump
  • Making the decision..

29
Lets Have a Great Rotation!
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