Chapter 29
Communication, History,
and Physical Assessment
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Guidelines for Communication
and Interviewing
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Establishing a setting
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Appropriate introduction
Assurance of privacy and confidentiality
Computer privacy and applications in nursing
Telephone triage and counseling
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Communicating with Families
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Communicating with parents
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Encouraging the parents to talk
Directing the focus
Listening and cultural awareness
Using silence
Being empathetic
Providing anticipatory guidance
Avoiding blocks to communication
Communicating through an interpreter
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Communicating with Families
(Cont.)
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Communicating with children
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Communication related to development of thought
processes
Infancy
Early childhood
School years
Adolescence
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Communicating with Families
(Cont.)
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Communication techniques
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A variety of techniques
Open-ended questions
Word games
Nonverbal techniques
Play
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History Taking
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Performing a health history
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Identifying information
• Informant, most likely the parent
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Chief complaint
Present illness
• Analyzing a symptom or symptoms
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History Taking (Cont.)
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History
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Birth history
Dietary history
Previous illness, injuries, and operations
Allergies
Medications
Immunizations
Growth and development
Habits
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History Taking (Cont.)
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Performing a health history
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Sexual history
Family medical history
Geographic location
Family structure
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Assessment
Composition
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History Taking (Cont.)
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Psychosocial history
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School adjustment
Unusual habits
Parent-child relationships
Review of systems
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Specific and thorough review of each body system
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Nutritional Assessment
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Dietary intake
Clinical examination of nutrition
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Hair, skin, mouth, eyes
Evaluation of nutritional assessment
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Malnourished
At risk
Well nourished
Overweight or obese
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General Approaches Toward
Examining the Child
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Sequence of the examination
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Head-to-toe sequence for assessing adult clients
Sequence for pediatric assessments generally altered
to accommodate child’s developmental needs
Use chronological age as the main criteria
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Goals of Pediatric Assessment
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Minimize stress and anxiety associated with
assessment of various body parts
Foster trusting nurse-child-parent relationships
Allow for maximum preparation of child
Preserve security of parent-child relationship
Maximize accuracy of assessment findings
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Preparation of the Child
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Child’s perception of painful procedures
Cooperation usually enhanced with parent’s
presence
Age-appropriate techniques
Positioning and preparation
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Physical Examination
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Growth measurements
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Growth charts
Length
Height
Weight
Skin full thickness and arm circumference
Head circumference
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Physiologic Measurements
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Physical states of vital function
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Temperature
• Electronic intermittent thermometer
• Infrared thermometer
• Electronic continuous thermometer
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Pulse
Respirations
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Physiologic Measurements (Cont.)
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Pediatric blood pressure (BP)
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Measurement devices
Selection of cuff
Cuff placement
BP measurement and interpretation
Orthostatic hypotension
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Physical Assessment
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General appearance
Skin
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Hair, nails, hygiene
Lymph nodes
Head and neck
Eyes, ears, nose, and throat
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Physical Assessment (Cont.)
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Chest
Lungs
Heart
Abdomen
Genitalia and anus
Back and extremities
Neurologic assessment
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Question
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Which approach would be best to use to ensure
a positive response from a toddler?
Assume an eye-level position and talk quietly.
Call the toddler’s name while picking him or her
up.
Call the toddler’s name and say, “I’m your
nurse.”
Stand by the toddler, addressing him or her by
name.
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