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Physical Assessment. Ball & Bindler Donna Hills RN EdD. Parts of the Physical Exam. History Physical Developmental Assessment Parent/Child Interaction Immunizations. History. Birth History incl. Prenatal Care Past medical history incl. Injuries/accid/hosp
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Physical Assessment Ball & Bindler Donna Hills RN EdD
Parts of the Physical Exam • History • Physical • Developmental Assessment • Parent/Child Interaction • Immunizations
History • Birth History incl. Prenatal Care • Past medical history incl. Injuries/accid/hosp • Well child care: Immuniz/illnesses • G & D Milestones • primitive reflexes • Nutrition/Sleep/Elimination/Socialization • Dental health/fluoride
History (cont.) • Home environment:lead risk/basic resource availability • Parent’s perceptions of the child • Safety: car sears/helmets • Social hx: peers/group activities/after school care/day care
History (cont.) • Responsibilities:chores in the home/job • Family hx: risks and concerns • Review of lab data: assess what is needed
Physical Assessment in the Ambulatory Care Setting • general approaches accd to dev.level. • Height/weight/head circ./plot on the growth curve • observe the general behavior of the infant/parent • assessment by systems(or problem oriented) • neurologic assessment • chest to toes then head.
Developmental Assessment in the Acute Hospital Setting • vital signs at assigned times;move often as needed • assess pain Q1-2hr as appropriate • body system assessment (s) as related to the pt’s condition • assessments to determine nursing diagnoses/interventions
Developmental Assessment • multiple tools to assess parameters of development • Denver II:fine/gross motor, lang., personal/social • Ballard Scale assesses gestational maturity • Preterm infant growth charts for gestational age and for corrected age for premies<2yr.
Parent/Child Interaction • How does the parent respond to the child’s needs? • Is there eye-contact? • Is there communication with sibs? • Do the parents communicate to each other/pt with sensitivity and respect? • Does the parent handle and respond to the child in a developmentally appropriate way?
FIGURE 8–2 Children are not just small adults. There are important anatomic and physiologic differences between children and adults that will change based on a child’s growth and development. Can you identify which of these differences are of greatest concern for the hospitalized child and why? Jane W. Ball and Ruth C. BindlerChild Health Nursing: Partnering with Children & Families © 2006 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458All rights reserved.
How are children different? • See figure 8-2 p. 236 (B&B) • proportionately greater body surface area for weight • large tongue, short narrow trachea • myelinization (mostly) completed by 1st yr • higher BMR, O2needs, caloric needs
Measurement • Head circumference • Technique • Measure until age 2 yrs or closure of anterior fontanel. • Length: lying until age 2yr • Then standing. • Weight: consistency for time and clothing.
Skin • Mongolian Spots • Variation of normal coloration in the skin. • Misinterpreted as bruises. • Turgor and Capillary Refill normal skin is elastic; dehydrated skin will tent. • Lice • inspect the hair shaft for nits that adhere to the hair.
HEENT • Fontanels; should be flat. Bulging indicates increased intracranial pressure. Sunken indicates dehydration. • Posterior closes 2-3 mos of age • Anterior closes 12-18 mos of age. • Down Syndrome facies • Strabismus; ocular asymmetry due to muscle imbalance. • Red Reflex: indicates clear lens (lack of cataracts)
Chest • Inspection: observe for increased work of breathing, retractions, respiratory rate. • Auscultate: R and L; anterior and posterior. • Crackles/rales • Course breath sounds or wheezes • Listen (with ear) for stridor with inhalation
Heart • Auscultate with diaphragm and then bell at 4th intercostal interspace in infants and 5th intercostal interspace in older children. • Determine rate per minute • Determine if rate is regular and WNL for age and activity level. • Try to identify the heart sounds S1 and S2. • Obtain BP using approp.size cuff.
Abdomen • Inspection: shape and contour • Auscultation: presence or absence of bowel sounds • Palpation: soft/ firm/ hard • Lightly first to assess for pain in all quadrants, then deeper. • Palpate liver along R costal margin • Palpate for spleen (if applic) under L costal area.
Genitalia • In acute care setting, will probably not be part of your assessment unless condition requires it or changing a diaper. • Be aware of Tanner stages of pubertal development.
Musculoskeletal • Spine: screen for posture and scoliosis • Muscle strength and tone • Hip range of motion Fig.8-60 p.287 • Gross motor milestones Table 8-18 p.284.
Neurologic • Cognitive function for age • Language development for age • Table 8-19 p.287 • Gait and balance milestones Table 8-20 p.288 • Fine motor milestones Table 8-21 p. 289 • Primitive reflexes Table 8-23 p.291-4.
Case Study #1 • Adam is a 4mo old admitted for 3 days of fever, 8 diarrhea stools per day, and vomiting with each feeding. His mother reports 3 wet diapers in past 24 hrs. He cries alot and has to be wakened to be fed. • What would your assessment of Adam include? • What would you list for nursing diagnoses?
Adam • Assess: • Nursing Diagnoses:
Case Study #2 • Cassie is a 9 yr old, first day post-op with a ruptured appendectomy. • What would your assessment of Cassie include? • What would you list for nursing diagnoses?
Cassie: s/p appendectomy • Assess: • Nursing Diagnoses:
Case Study #3 • Jarod is an 8yr old admitted with acute asthma exacerbation. • What would your assessment of Jarod include? • What would you list for nursing diagnoses?
Jarod: asthma • Assess: • Nursing Diagnoses:
Case Study #4 • Brian is 9yrs old and admitted to R/O meningitis. • What would your assessment of Brian include? • What would you list for nursing diagnoses?
Brian: meningitis • Assess: • Nursing Diagnoses: