NRS-434VN 2 DQ 2 Physical assessment of a child
Nurses are taught that the physical assessments begin the moment you encounter the patient whether it is a child or an adult; while simultaneously taking note of their appearance, nutritional status, hygiene, level of consciousness, skin color, body posture, respiratory rate, and movements (Dean, Falkner, & Green, 2018, ch. 1, & Dean, Falkner, & Green, 2018, ch. 4). The physical assessment has both similarities and differences, and they both focus on the collection of objective and subjective data. NRS-434VN 2 DQ 2 Physical assessment of a child. In nursing school, nurses are taught to conduct an assessment from head to toe leaving the area or areas associated with pain last. When assessing a child, the nurse must mindful that they dictate the course of the assessment and should be flexible leaving the most invasive assessments for last (Dean, Falkner, & Green, 2018, ch. 1). During the assessment, it is important for the nurse to be watchful of the interaction of the child and older adults with their caregiver for signs of abuse or neglect (Dean, Falkner, & Green, 2018, ch. 1) NRS-434VN 2 DQ 2 Physical assessment of a child.
As the physical contact begins, “talking to the infant and playing peekaboo, or other age-appropriate play helps to build infant trust” (Dean, Falkner, & Green, 2018, ch. 1). With the infant or child interaction with the parent is an integral part of the assessment because they are the means of gaining information. With an adult, the interview process not only helps the nurse gain information regarding main complaints, history, and social details,” it also aids in building trust between nurse and patient (Dean, Falkner, & Green, 2018, ch. 4). NRS-434VN 2 DQ 2 Physical assessment of a child.
During the assessment process communication and the way, it is delivered are key. While it is safe to say nurses can do baby talk with an infant or child, it is never a good idea to interact with an adult in that manner. In both cases, they must speak to the patient on their level of understanding. Children learn by touching and can also reduce fear so allowing the child to hold instruments and act as if they are doing an assessment would be acceptable (Dean, Falkner, & Green, 2018, ch. 1). For an adult, you would simply explain what needed at the time of assessment and access how the instruction is followed (Dean, Falkner, & Green, 2018, ch. 4). NRS-434VN 2 DQ 2 Physical assessment of a child
Dean, J. K., Falkner, A., Green, S. Z. (2018). Health Assessment: Foundations for Effective Practice. Retrieved January 21, 2021 from https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-assessment_foundations-for-effective-practice_1e.php
Compare the physical assessment of a child to that of an adult. In addition to describing the similar/different aspects of the physical assessment, explain how the nurse would offer instruction during the assessment, how communication would be adapted to offer explanations, and what strategies the nurse would use to encourage engagement.
I work oncology with a strictly adult population. I have not assessed a child other than my own since nursing school. There are similarities in physical assessments, but there are also stark differences. Some of the similarities are rather obvious, such as assessing cardiac sounds, lung sounds, and gastrointestinal sounds in both patient populations. In addition, both physical examinations include pain assessments, but the pain scale used will vary based on population. For example, I most often use the Numerical Pain Rating Scale (NPRS) with alert and oriented adults, the Pain Assessment in Advanced Dementia (PAINAD) for confused adults, and Assume Pain Present with my comfort care/inpatient hospice patients when they are sedated on drips. With pediatric patients, I would use the Neonatal Infant Pain Scale (NIPS) with infants, Wong-Baker FACES pain rating scale with toddlers, and the NPRS with school-aged children NRS-434VN 2 DQ 2 Physical assessment of a child.
Moreover, adult patients typically present to the hospital with extensive medical histories and numerous comorbidities that require assessment. For example, many patients present with a combination of conditions such as hypertension, congestive heart failure, hyperlipidemia, deep vein thrombosis, chronic obstructive pulmonary disease, gastroesophageal reflux disease, and diabetes. As such, these adults are likely receiving an array of different medications. On the other hand, many pediatric patients have very limited medical histories and take little to no medications. Their physical assessment will more often than not be less disease-oriented and aimed more towards progression of developmental stages. NRS-434VN 2 DQ 2 Physical assessment of a child
When I conduct a physical assessment on an adult, I usually proceed in a head-to-toe fashion unless it is an emergent situation where I need to start with a focused assessment instead. This can differ with pediatric assessments, especially with younger pediatric patients where you will assess in the least threatening order possible. When assessing an adult, assessment data is usually gathered from the patient themselves. In pediatric populations, assessment data, is often collected through second-hand observations from the parent at the bedside. However, history gathering can be difficult when the most appropriate person to answer assessment questions is not at the bedside. Dersch-Mills (2018) believes this introduces the potential for inaccuracy as “Changing custody or living arrangements may impact a caregiver’s ability to provide a history, or one parent may be ‘in charge’ of the medical care of the child. However, the registered nurse should always include the child in the assessment if old enough to participate, offering instructions in short sentences using age-appropriate terms. NRS-434VN 2 DQ 2 Physical assessment of a child. With younger children, the nurse should provide encouragement by forming rapport with the caregiver. It is also a good idea to incorporate play into the assessment, and allow children to touch equipment used whenever possible to alleviate anxiety. Another strategy is to communicate with the child at eye-level to minimize appearing intimidating to the child. NRS-434VN 2 DQ 2 Physical assessment of a child
Dersch-Mills, D. (2018). Assessment considerations in pediatric patients. Patient Assessment in Clinical Pharmacy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7123523/ NRS-434VN 2 DQ 2 Physical assessment of a child