Pediatric Assessment

Do this a couple times, then do practice questions and other research then adjust from there!!!!!!!!!!

Atraumatic care

Nursing care that REDUCES or ELIMINATES physical and psychological distress for children and families during hospitalization

Goals of atraumatic care

Minimize separation, promote sense of control with choices and education, and prevent/minimize bodily pain and injury

What are some ways to prevent physical stressors?

Prevent or minimize pain, discomfort, immobility, hunger/NPO, changes in elimination, unpleasant sensations

What’s the purpose of a treatment room?

Separate place where healthcare providers can perform procedures so they can keep the child’s room a safe place

Child Life Specialist

Helps children/families cope with age-appropriate explanations, therapeutic play, distractions, and coping strategies

How to communicate with families during care?

Establish trust and be HONEST while setting expectations, treat family as part of healthcare team as they know their child best

What is the general approach to physical exams?

Start with least invasive/frightening parts and then most invasive parts so child stays calm and doesn’t disrupt assessment and vitals (HR, RR)

What is a least to most invasive general assessment order for infants to preschoolers?

Inspection → auscultation → percussion → palpation

Physical exam order for newborns and infants (0-1yr)

If asleep, auscultate heart, lungs, and abdomen first before undressing. Continue w/ head-to-toe but leave ears, nose, mouth, throat (upsetting) until end

Physical exam order for toddlers (1-3yr) and preschoolers (3-5yr)

Use play and inspection, then examine least invasive to more invasive while only removing one clothing at a time

Physical exam order for school-age children (6-12yr)

Tolerates organized head-to-toe exam; explain procedures and preserve privacy and save genitalia and anus for last

Optimal patient position when assessing infant/newborn

Lie on examination table or in caregiver’s lap

Optimal patient position when assessing toddlers (1-3 yr)

More freedom of movement when possible; may stand between seated caregiver’s legs or sit on lap

Optimal patient position when assessing adolescents

Provide privacy when doing assessment with gown, older adolescents may have caregiver be asked to wait outside

How is a child’s pulse assessed?

Apical pulse for 1 min until age 10, then radial pulse for older

How is respiratory rate assessed in children?

Observe/feel abdominal movement in infants/young children when they’re quiet and chest movements in adolescents for 1 min

How should pediatric BP cuff be positioned?

Around the extremity with the cuff centered midway between top of shoulder and olecranon/elbow

How should a pediatric BP cuff be sized?

Cuff width should be 40% of extremity circumference and cover 80% of arm or thigh

How does crying affect a child’s BP, and what should nurse do?

Crying can raise systolic BP by 30-50 mmHg; allow child to calm for 2-10 minutes before measuring

Newborn normal HR

80-180 BPM

Newborn normal RR

30-55/min

Newborn normal systolic BP

60-70 mmHg

Infant (0-1yr) normal HR

80-150 BPM

Infant (0-1yr) normal RR

25-40/min

Infant (0-1yr) normal BP

70-100 mmHg

Toddler (1-3yr) normal HR

80-140 BPM

Toddler (1-3yr) normal RR

20-30/min

Toddler (1-3yr) normal BP

80-110 mmHg

Preschooler (3-5yr) normal HR

70-120 BPM

Preschooler (3-5yr) normal RR

18-27/min

Preschooler (3-5yr) normal systolic BP

80-110 mmHg

School-age child (6-12yr) normal HR

70-110 BPM

School-age child (6-12yr) normal RR

14-22/min

School-age child (6-12yr) normal systolic BP

80-120 mmHg

Adolescent (13-18yr) normal HR

60-110 BPM

Adolescent (13-18yr) normal RR

14-22/min

Adolescent (13-18yr) normal BP

110-120 mmHg

What temperature is considered fever in a child?

>100.4*F (38*C)

What temperature is considered hypothermia?

<96*C (35.5*C)

Nursing considerations when taking temperature

Method depends on developmental level, rectal requires order, NO aspirin