Chapter 9 - Assessment Techniques and the Clinical Setting Flashcards

Question

Developmental Considerations for Infants

Answer 1

The major task of infancy as establishing trust. If basic needs are met promptly and consistently, the infant feels secure and learns to trust others. Perform the examination 1 to 2 hours after the baby is fed, when the baby is not too drowsy or too hungry. Maintain a warm environment. Use a soft, crooning voice during the examination; babies respond more to the feeling in the tone of the voice than to what is actually said. Offer the baby a pacifier for crying or during invasive steps. When a baby is sleeping, seize the opportunity to listen to heart, lung, and abdomen sounds first. Perform least distressing steps first. Save the invasive steps of examination of the eye, ear, nose, and throat until last. Elicit the Moro, or “startle,” reflex at the end of the examination because it may cause the baby to cry.

Answer 2

Toddlers are beginning to develop autonomy. Toddlers may be difficult to examine; do not take this personally. Because they are acutely aware of being in a new environment, toddlers may be frightened and cling to the parents. Also, toddlers fear invasive procedures and dislike being restrained. A toddler should be sitting up on the parent's lap for all of the examination. When the toddler must be supine. Children 1 or 2 years of age can understand symbols, and so a security object, such as a special blanket or teddy bear, is helpful. Child 1 to 6 years old, focus more on the parent. Then turn your attention gradually to the child, at first to a toy or object the child is holding, or perhaps to compliment a dress or their hair. Children 1 or 2 years of age like to say, “No.” Do not offer a choice when there really is none. Use clear firm instructions, in a tone that expects cooperation: “Now it is time for you to lie down so I can check your tummy.” Demonstrate the procedures on the parent. Praise the child when he or she is cooperative.

Answer 3

Preschool-age children display developing initiative. The preschooler takes on tasks independently, plans the tasks, and follows them through. A child of this age is often cooperative, helpful, and easy to involve. With a 3-year-old child, the parent should be present and may hold the child on his or her lap. A 4- or 5-year-old child usually feels comfortable on the “Big Girl” or “Big Boy” (examining) table, with the parent present. A preschooler can talk. Verbal communication becomes helpful now, but remember that the child's understanding is still limited. Use short, simple explanations. The preschooler is usually willing to undress. Leave underpants on until the genital examination. Talk to the child and explain the steps in the examination exactly. Preschoolers like to help; have the child hold the stethoscope for you. Compliment the child on his or her cooperation

Answer 4

During the school-age period, the major task of children is developing industry. When successful, they have a feeling of accomplishment. Break the ice with small talk about family, school, friends, music, or sports. The child should undress himself or herself, leave underpants on, and don a gown and drape. Comment on the body and how it works. An 8- or 9-year-old child has some understanding of the body and is interested to learn more. As with adults, progress from head to toes.

Answer 5

The major task in adolescence is developing a self-identity. This takes shape from various sets of values and different social roles (son or daughter, sibling, and student). Peer group values and peer acceptance are important. Examine the adolescent alone, without a parent or sibling present. The adolescent's body is changing rapidly. During the examination, the adolescent needs feedback that his or her own body is healthy and developing normally. The adolescent has a keen awareness of body image, often comparing himself or herself with peers. Communicate with some care. Do not treat the teenager like a child, but do not overestimate and treat him or her like an adult, either. Focus your teaching on ways in which adolescents can achieve their own wellness. As with the adult, a head-to-toe approach is appropriate. Examine genitalia last, and do so quickly.

Answer 6

During later years, the tasks are developing the meaning of life and one's own existence and adjusting to changes in physical strength and health. Arrange the sequence to allow as few position changes as possible. Allow rest periods when needed. The pace of the examination may need to be slowed. Use physical touch (unless there is a cultural contraindication). This is especially important with older adults because other senses, such as vision and hearing, may be diminished. Note: Do not automatically mistake diminished vision or hearing for confusion. Use the head-to-toe approach as in younger adults.

Answer 7

For a patient in some distress, alter the position during the examination. Example: A patient with shortness of breath or ear pain may want to sit up, whereas a person with faintness or overwhelming fatigue may want to be supine. Initially, it may be necessary just to examine the body areas appropriate to the problem, collecting a mini-database. You may resume a complete assessment after the initial distress is alleviated.