Lecture 1 Health assessment of infants and children Flashcards
(42 cards)
Health promotion
Giving the patient/family resources to meet needs and stay healthy.
Health maintenance
Injury prevention and disease prevention (e.g., immunizations).
Three external factors influencing pediatric healthcare
Community, culture, and family.
Anticipatory guidance
Interventions by the nurse that are focused on providing families information on normal growth and development and nurturing childrearing practices, before potential problems occur.
Erik Erikson’s psychosocial stages of development (pediatric only)
- Birth to 1 year = Trust vs. mistrust.
- 12 to 36 months = Autonomy vs. shame and doubt.
- 3 to 6 years = Initiative vs. guilt.
- 6 years to adolescence = Industry vs. inferiority.
- Adolescence to adulthood = Identity vs. role confusion.
Jean Piaget’s cognitive developmental theory
- Birth to 24 months = Sensorimotor stage.
- 2 to 7 years = Preoperational stage.
- 7 to 11 years = Concrete operational stage.
- 11 to 17 years = Formal operational stage.
Infants
- 0-1 year of age.
- Nonverbal, crying/cooing, sensitive to parent’s presence - as much of assessment as possible can be done while the child is on the parent’s lap or in the parent’s arms. Sensitive to sounds and tone of voice. Undressing - have the parent undress the infant as needed.
- Erikson: Trust vs. mistrust.
- Piaget: Sensorimotor stage.
Early childhood
- 1-5 years of age; toddler and preschool.
- Egocentric - focus communication on the child. Believe in animism (drawings and objects come to life), take things literally. Keep equipment out of sight until needed and provide simple, concrete explanations. Toddlers - stranger anxiety.
- Erikson: Autonomy vs. shame and doubt (1-3 years), initiative vs. guilt (3-6 years).
- Piaget: Sensorimotor stage (until 2 years), preoperational stage (2-7 years).
School-age children
- 5-12 years of age.
- Increasing vocabulary, concerned about threats to body and separation, allow time for them to express fears and concerns. Interested in the functional aspects of procedures/equipment - provide simple explanations.
- Erikson: Industry vs. inferiority.
- Piaget: Preoperational stage (until 7 years), concrete operational stage (7-11 years).
Adolescents
- 12-20 years of age.
- Be straightforward, respectful, nonjudgmental. Better understanding of abstract concepts. Likely to have body image concerns, may be sexually active.
- Erikson: Identity vs. role confusion.
- Piaget: Formal operational stage.
Measuring height
From 0-36 months, measure laying down. From 2-18 years, measure standing up.
Taking temperature
- Birth to 2 years: Axillary temperature (always).
- After 2 years: May take axillary, tympanic, or oral temperature (if tolerated).
- Rectal temperatures not taken without MD order - usually only used when accuracy is essential.
Pulse
- Higher rate than adults.
- All pediatric patients: Apical pulse, taken for 1 full minute. Satisfactory radial pulses can be taken in children older than 2 years.
- Grade peripheral pulses (0 to +4).
- Compare radial and femoral at least once during infancy (upper to lower extremities).
Respirations
- Higher rate than adults.
- Count for 1 full minute because irregular breathing is common in children.
- Infants - diaphragmatic breathers; observe the abdomen rather than the chest (becomes thoracic around 6-7 years).
Blood pressure
- Both systolic and diastolic are lower than in adults.
- Auscultation, rather than automated devices, is preferred unless auscultation is difficult (e.g., newborns).
- The cuff should cover approximately 2/3 of the upper arm or at least 40% of the arm circumference.
The posterior fontanel closes by _
6-8 weeks.
The anterior fontanel closes by _
18 months.
Infants normally attain head control by _
5 months.
The top of the pinnae should be aligned with _
The lateral canthi of the eyes (low-set ears may be indicative of certain genetic disorders).
Inner ear examination
Until age 3: Pull the pinna down and back.
After age 3: Pull the pinna up and back.
Adequate urine output for a child
1 mL/kg/hr.
Wong-Baker FACES Pain Scale
Can be used for children as young as 3 years. Six cartoon faces ranging from a smiling face for “no pain” to a tearful face for “worst pain.” The child is asked to choose a face that describes his or her pain.
FLACC Postoperative Pain Tool
(An observational scale for post-op pain used from 2 months to 7 years.) Facial expression Leg movement Activity Cry Consolability
CRIES Neonatal Postoperative Pain Scale
Crying Requires increased oxygen Increased vital signs Expression Sleeplessness