Assessment- Pain Scales Peds

comprehensive health history for peds

remember to ask about milestones, birth history (NICU and lung issues), and patterns of daily activities in addition to normal health history,

peds measurements

Length, Weight, Body mass index, Head circumference, Skinfold thickness

fontanels

Gaps between a baby's skull that slowly close up top: first 18 months of life, back: 2-3 months

- Hydration status and ICP

Abdominal breathing with infants

The diaphragm is not developed until they become ambulatory, so "belly breathing" is normal up until that point.

cardiac assessments with peds

PMI; heart sounds; edema; murmurs

- listen for a full 60 seconds

Abdominal assessment peds

- Contour; umbilicus; inguinal area; bowel sounds; organ palpation

- look for hallmark signs of infection such as erythema, edema, fever, and exudate

perineal assessment

signs of sexual abuse or neglect

routine health screenings

Lead poisoning (irreversible neurological deficits)

• Iron-deficiency anemia

• Cholesterol screening

• Tuberculosis screening (is the living area crowded?)

preterm weight in kg (<37 weeks)

0.7-2.5 kg

preterm resp rate (<37 wks)

50-70

preterm heart rate (<37 wks)

120-180

preterm systolic BP (<37 wks)

40-60

newborn weight in kg (37-42 wks)

2.5-4.3

newborn resp rate (37-42 wks)

40-60

newborn heart rate (37-42 wks)

100-170

newborn systolic BP (37-42 wks)

neonate weight in kg (1-28 days)

3.4-5

neonate resp rate (1-28 days)

30-50

neonate heart rate (1-28 days)

90-160

neonate systolic BP (1-28 days)

Infant weight in KG (1-12 mo)

4.5-10

Infant resp rate (1-12 mo)

80-160

Infant systolic BP (1-12 mo)

70-100

toddler weight in KG (1-3 yrs)

10-14.5

toddler resp rate (1-3 yrs)

20-30

toddler heart rate (1-3 yrs)

80-130

toddler systolic BP (1-3 yrs)

70-110

preschooler weight in KG (3-5)

14.5-19

preschooler resp rate (3-5)

20-30

preschooler heart rate (3-5)

80-110

preschooler systolic BP (3-5)

80-110

school age weight in kg (6-12)

19-41

school age resp rate (6-12)

20-24

school-age heart rate (6-12)

75-100

school-age systolic bp (6-12)

80-120

adolescent weight in kg (>13 yrs)

>41

adolescent resp rate (>13 yrs)

12-20

adolescent heart rate (>13 yrs)

60-90

adolescent systolic bp (>13 yrs)

94-130

vital signs note

Do not chart vitals when the child is freaked out, as it does not provide an accurate picture

assessing WOB

Assess the respiratory WOB first, before ever touching the child.

• For infants, listen to breath sounds together with apical pulse.

• Older children can be done separately.

• Warm your stethoscope!

(Try to assess CV/Resp first before waking a baby. Get the BP and temp last as the squeezing tends to make them cry)

cardiac assessment in infants

- listen for full min for children under one

- do not rely on monitors

-

blood pressure

- should use a cuff that measures approximately 2/3 of the area between the shoulder and elbow or the knee and ankle (if not ambulatory)

- You can let the parent hold the child to keep them still

pulse ox

Use 'band aid' style pulse oximeter probe.•

- Use side of foot for small infants,big toe or thumb for toddlers and fingers for older children.

• Make sure the light and receiver are lined up.

• Make sure pleth is uniform for pulse accuracy.

When to assume pain is present for a child?

If a child is unable to express pain (non-verbal,sedated, etc.) - assume pain is present if child has:

- Injury

- Infection

- Diagnostic tests

- Surgery or procedure

- Disease progression

pain assessment pre-verbal cues

Physiologic cues

- Behavioral cues

- History from parent/guardian (they know the child best)

physiologic pain cues

Body rigidity or thrashing

• Crying

• Facial expression (brows lowered, brows furrowed, eyes tightly closed, mouth open)

• Reflex withdrawal from stimulus

• Restlessness, irritability

FLACC scale

Looking at physiological cues that children give about pain, max score 10 min 0

2mo-7years

- primarily for young children and older children with developmental issues