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PEDS

Chapter 4-Communication and Physical and Developmental Assessment of the Child

QuestionAnswer
COMMUNICATION Introduce self-intension and Provide privacy developmentally appropriate-INVOLVE PATIENT in communication Avoid long sentences, medical jargon; think about “scary” words
How to communicate with parent? I AM GOING TO GIVE YOUR ARM A HUG , TO SEE HOW YOUR HEART BEAT ALWAYS STAY FOCUS WHO GIVE HX? BE EMPATHETIC
WHAT IS Developmentally appropriate FOR INFANTS? Nonverbal-crying Nurse could hold or caregiver can hold the infant
Developmentally appropriate-EARLY CHILDHOOD(Toddler) Include child in communication Have toys /books present as a distraction Be consistent-avoid asking question(egocentric) explain what how and why-USE WORDS CHILD KNOWS
Developmentally appropriate-School-Age concern about skin integrity-shy want explanations and reasons reassurance that they are ok
Developmentally appropriate-Adolescent Privacy need-INFORM them that everything will be confidential i.e-abdominal pain=when was the last time you had sex? Acknowledge peer influence developmental regression can occur BE TOTALLY HONEST
HEALTH HISTORY SHOULD INCLUDE: CC, PI(present illness) who else is sick? Temp(route)- SUBJECTIVE vs OBJECTIVE Current meds-dosage+frequency IMZ-where? PSYCHOSOCIAL HX FMHX SEXUAL HX REVIEW OF SYSTEMS
Nutritional Assessment IS: Diet HX-Last time at at restaurant Food Dairy-24h recall and food record Dietary intake-ask child-FAV RESTAURANT,FOOD(MOM COOKS)
NUTRITIONAL STATUS Evidence of adequate /nutritional deficiencies Measure BMI HGB
Goals of Pediatric Assessment IS TO: FOSTER NURSE-CHILD-PARENT RELATIONSHIP MINIMIZE STRESS AND ANXIETY START FROM NON INVASIVE TO INVASIVE ALLOW LOTS OF PREPARATION TIME TO CHILD MAXIMIZE ACCURACY OF FINDINGS
How do we measure growth ? Recumbent (supine)length or infants (up to age 36 months )+ weight and head circumference standing height + weight after age 37 months HEAD, CHEST , ABDOMINAL CIRCUMFERENCE
How do we measure growth ? Plot information on growth chart  By gender and prematurity (if appropriate)  Less than 5th or greater than 95th percentile considered outside expected parameters for height, weight, head circumference
What is most important with PEDS? MEET THE FAMILY AT THEIR LEVELS. GATORADE INCREASE BP
WHEN do you stop measuring head circumference ? Stop at 18-2 years
THE NURSE SHOULD KNOW THAT THE FIRST VITAL TAKE IS? Respirations FIRST -30-60 RR (before disturbing the child) Count apical heart rate SECOND 120-160 BPM; 80> IF SLEEPING  Blood pressure (if applicable) THIRD-  Temperature LAST-unless they are older and do not mind
Early Childhood 1-4 years of age , THE NURSE SHOULD EXPECT? GROWTH SPURTS-after 2years of age they gain 2-3 kg. and grow 5 cm./year
Gross motor skills develop ? QUICKLY-most can walk by 15 months old and run by 2 years old, peddle a tricycle by 3years.
ONE COMMON DISEASE AMONG CHILDREN IS? DOWN SYNDROME-CLINICAL REPRESENTATION- PALMAR LCREASES-SMALL EARS
THE SIMPLE WAY TO NOTE LYMPH NODES? PEA SIZE, MARBLE, GOLF-BALL SIZE KIDS ALWAYS CERVICAL LYM
WHY IS IT IMPORTANT TO USE RIGHT BP CUFF? The most common “cause” of elevated blood pressure is from improper cuff size
WHAT INCREASE BP RESULT? Renal and cardiac conditions are commonly the cause of elevated BP in children
WHAT INCREASE BP RESULT? Crying, exercise, anxious, nervous feelings will cause BP to be elevated
CAN INFANTS BE BORN WITH CONGENITAL CATARACT? YES-THIS MAKES IT IMPOSSIBLE TO SEE RED REFLEX
Sign is respiratory distress are? grunting, retracting and nasal flaring ORTHOPNEA OR TACHYPNEA, STRIDOR, CYNOSIS, PALLOR, ABNORMAL BREATH SOUND
WHAT IS INCLUDE IN ABDOMINAL PHYSICAL ASSESSMENT? CHECK FOR UMBILICUS SIZE HERNIAS, HYGIENE , ESPECIALLY WITH YOUNG CHILDREN
GENITALIA ASSESSMENT? MATTER-OF-FACT, ALWAYS INSURE PRIVACY, REINFORN=CE SAFETY AND HYGIENE
IS ANAL REFLEX NORMAL? YES, AND GLUTEAL FOLD ASS WEL
WHAT IS HYPOSPADIAS? Urethral opening is located below the glans penis or anywhere along the underside of the penile shaft-VENTRAL SURFACE OF PENIS CAN NOT BE CIRCUMCISED -FORESKIN COVER HOLES
HOW IS IT TREATED? Nursing assessment of every male newborn Requires surgical correction
WHAT IS HYDROCELE? IT'S AN ACCUMULATION OF FLUID IN SCROTUM NON-COMMUNICATING-fluid from mesothelial, lining of tunica vaginalis, no connection w/ peritoneum COMMUNICATING-lack of process vaginalis closure, connecting w/ peritoneum DISAPPEAR BY 1YEAR
HOW IS IT TREATED? SURGICAL PROCEDURE FOR OUTPATIENT SURGICAL REPAIR IF COMMINICATING PERSIST AFTER 1YEAR CHECKING WITH LIGHT, IT SHOULD TRANSLUMINATED TEMPORARY EDEMA OR DISCOLORATION OF SCROTUM RESOLVE SPONTANEOUSLY
WHAT IS CRYPTORCHIDISM? Failure for 1 or 2 testes to descend normally through the inguinal canal into the scrotum could b e due to retractile or undescended (cryptorchid) testes TESTES BACK UP IN THE STOMACH
HOW IS IT TREATED? IF SPONTANEOUS UNDESCENDED CONGENITAL TESTES DOESNT OCCUR AFTER 6 MONTHS, SURGICAL REPAIR WILL BE DONE IN THE FOLLOWING YEAR. INFECTION PREVENTION AND PAIN CONTROL CLEANLINESS OF OPERATIVE SITE
WHAT IS EPISPHADIAS? URETHRAL OPENING ON DORSAL OPENIING OF PENIS FAILURE OF URETHRAL TO CLOSE NORMALLY
HOW IT IS TREATED?
WHAT IS EXTROPHY BLADDER? OPEN INSIDE-OUT-BLADDER WITH INNER SURFACE EXPOSED AND THE DORSAL URETHRA ON THE LOWER ABDOMINAL WALL
HOW IT IS TREATED? COMPLETE REPAIR OF BLADDER EXSTROPHY W/IN 72HOURS OF BIRTH OR DELAYED FOR ABOUT 2 MONTHS PREVENT TRAUMA OF THE EXPOSED MUCOSA
WHAT IS OBSTRUCTIVE UROPATHY AND HOW IS IT TREATED? IT IS CONGENITAL RENAL IMPAIREMENT THAT LIMITED OR MAY POTENTIALLY LIMIT NORMAL RENAL DEVELOPMENT COULD BE UNILATERAL OR BILATERAL NURSES SHOULD ASSIS WITH DIAGNOSTIC PROCEDURE AND HELP CHILDREN/PARENTS IW/ COPING
WHAT IS PHIMOSIS AND HOW IS IT TREATED?? IT IS A NARROWING OR STENOSIS OF THE PREPUTIAL OPENING OF THE FORESKIN, THAT PREVENT RETRACTION OF THE FORESKIN OVER THE GLANS PENIS IT IS TREATED BY: Gentle daily HYGIENE+manual retraction, Topical Corticosteroid Ointment Application or Circumcision.
AT WHAT AGE HE MONGOLIAN SPOT DISAPPEAR? NORMAL AND DISAPPEAR BY 2 YEARS OF AGE. THEY ARE IRREGULAR BLUE SPOT ON SACRAL AND GLUTEAL REGIONS. SEEN IN AFRICAN, HISPANIC, ASIAN AND NATIVE AMERICAN NEWBORNS
WHAT ARE COMMON AMNORMALITIES? BOWLEG, (Genu VARUM)KNOCK-KNEE(Genu VAGUM)
WHAT ARE REFLEXES? automatic, action that your body does in response to something — without you even having to think about it.
INFANCY IS: THE MOST RADIP GROWTH, BECAUSE THEIR BRAIN IS ABSORBING EVERYTHING. Read to them, sing, pray , do anything.
WHAT IS A PREPUCE? IT IS A FORESKIN THAT COVERS THE URETHRAL OPENING AT A NEWBORN'S PENIS GLANS(OPENING) IT SHOULD NOT BE RETRACTED
WHAT ARE THE DIFFERENT TYPE OF HEAT LOSS? EVAPORATION:BODY HEAT LOSS TO MOISTURE(MOST CMMON ONE) RADIATION:H.L FROM INDIRECT CONTACT TO COOLER SOLID OBJECT, INDIRECTLY T CONDUCTION:H.L FROM DIRECT CONTACT W/ A COOLER SOLID OBJECTER SKIN-TO-SKIN: KANGAROO CARE CONTACT-FOSTERING MATERNAL BOND
HOW OFTEN SHOULD A NEWBORN BATH? 2-3 TIMES WEEKLY FOR THE FIRST 2-4 WEEKS WITH A PLAIN WARM SPONGE. CLEANING IS CEPHALAUCODAL(HEAD-TO-TOE) DO NOT CRUB VIGOROUSLY TO REMOVE VERNIX-ALLOW TO FALL OFF INDEPENDTLY SKIN PH 5
Created by: Seka_nurse
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