Module 1 Chapter 32 Components of Effective Communication Touch Physical Proximity and Environment Listening Visual Communication Tone of Voice Body Language Timing Effective communication with Families Include all involved family members Develop open lines of communication Encourage families to write their questions Respect and encourage feedback from families Avoid assumptions about core family beliefs and values See Table 32-3 on pages 802-803 Developmental milestones and approach to communication Infants Toddlers (0-12 mo) (1-2 yr) Preschoolers School-age (3-5 yrs) (6-11) Adolescents Use of calm voice; respond to cries, mimic baby sounds, talk and read regularly, use a slow approach and allow time to get to know you Offer choices, use play or “storytelling” for explanations, simple sentences, picture books, puppets, be concise; limit length of explanations Engage in conversations about their interests, use of videos to explain, foster independence, preparatory materials up to 1 wk in advance, respect privacy needs Learn the toddler’s words for common items, picture books, respond to their receptiveness, preparation should occur immediately before event Photos, books videos, diagrams, establish limits, use play, introduce preparatory materials 1-5 days in advance of the event (12 and older) Chapter 33 How would the nurse adapt the assessment of a child from the assessment of the adult? Adaptation Change the sequence of the physical exam of a young child by: delaying any painful or frightening procedures until the end of the assessment Perform assessments that will not disturb the child first Adapt the physical examination to the child’s age and developmental level See General Approaches On page 811 - 815 Facilitating Examination of Infants Parental presence Physical comfort and relaxation Distraction Auscultate when quiet Procedures that provoke crying at end of exam Facilitating Examination of Toddlers Parent’s lap Play Security object Instruments Control and choice Facilitating Examination of Pre-schoolers Sequence Games and activities Demonstrate and touch instruments Distraction Facilitating Examination of Older Children and Adolescents Modesty and privacy Choices Explanations of body parts and functions Parental presence or absence/need for chaperones Reassurance of normalcy (adolescents) Summary of Strategies to gain cooperation Perform assessment in appropriate area Minimize stress and anxiety associated with assessment Foster a trusting parent-child nurse relationship Praise the child for positive behaviors Allow maximum preparation of the child Preserve essential security of parent –child Be aware of growth and development and promote health teaching and recognition of deviations from the norms. Getting Started Verify patient – National Patient Safety Goal Introduce self – tell purpose of assessment/ interview Use open-ended questions Ask only one question at a time Direct the question to the child when appropriate Obtain feedback from parents to confirm understanding Talk in soothing voice. Initial Interview Statistical information Childs name, nickname, age, sex, ethnic origin Birth date, religion Important phone number and parent contact information General Appearance Note parent-child interaction Note clues about child’s behavior and health status History Taking Problem-oriented History – gather data regarding the current Chief Complaint – major focus Health History Family History Lifestyle and Life Patterns History of Present Illness or Injury Characteristic Defining Variables Onset Sudden or gradual, date and time began Type of Symptom Pain, itching, cough, vomiting, runny nose, diarrhea, etc General or localized Location Severity Influencing factors Previous and Current Treatment Effect on daily activities – interrupted sleep, decreased appetite What relieves or aggravates symptoms, what precipitated the problem Medications used, treatments used (heat, ice, rest), response to treatment A Health History Data is gathered from birth to current status and includes: Birth history including condition of baby at birth Health maintenance – child’s primary provider, dentist, and other healthcare providers Medications Allergies Immunizations Activities and exercise Nutrition Sleep Family History Focuses on health status of parents, siblings, and specific blood relatives. Purpose is to gather data about any hereditary factors that are likely to affect the child’s health. Lifestyle / Psychosocial Data Family composition Housing / home environment School or childcare arrangements Daily Routines – very important Potential Indicators of Child Abuse Dress - Inappropriate for weather; excessively dirty Hygiene- dirty teeth, matted hair, broken fingernails Posture and Movement – crouching in corner, slow, concentrated movements Communication – using one syllable words, seeking approval for answers; waiting for someone else to answer question Facial characteristics – fearful, anxious, tearful, sad Psychological state – demanding, bizarre, overly dramatic or condescending Summary During the first contact with the child and parent, the nurse forms an initial impression by making a general survey. It will give the nurse a subjective impression of the: Physical appearance State of nutrition Behavior and Personality Interactions with parents and nurse Posture Development Speech Vital Signs Temperature Normal temperature runs around 99 degrees until > 36 months. A variance of 1-2 degrees is OK. A temperature <97 degrees in an infant and > 100.5 degrees is indicative of a problem and should be noted. Temperatures are taken commonly either axillary or tympanic. Be sure to document how taken. Vital Signs Pulse Apical pulse rates are most commonly taken in children; especially in those under 2. Assess based on limits for age and norms for that child. **See Table 33-1 – Normal Vital Signs for Age Normal Heart Rates for Children of Different Ages Vital Signs Respirations Assess the rate, depth, and ease of respiration in the child. Varies with age of child. Respirations should be quiet and effortless Infants are abdominal breathers / nose breathers 4 weeks to 4 months. By age 7 – costal breathers Normal Respiratory Rate Ranges for Different Age Groups Blood Pressure Choose a cuff with a bladder width that is approximately 40% of the arm circumference of the upper arm. When the cuff is wrapped around the upper arm, the bladder length usually covers 80% to 100% of the arm’s circumference. Measurements Height Weight Head Circumference Chest Circumference Growth Charts Systematic Body System Assessment Refer to your textbook for specific examples of performing a physical assessment – see pages 820 - 846. Review Most Important elements to include in an assessment: 1. 2. 3. 4. 5. 6. 7. Developmental data Chief complaint History of present illness or injury Past history Current health status Review of body systems Psychosocial data Prioritization of Care After collection of the data, the nurse should be ready to prioritize the data and intervene as needed Prioritization of Care First Level Airway Breathing Circulation Signs Vital sign abnormalities are very crucial in children. (A temp too low is just as serious as an elevated temp.) Prioritization of Care Second Level Psychological problems Elimination problems (has not voided after surgery, no wet diapers, no BM, diarrhea) Risk of Infection Signs and symptoms of untreated medical problems Nutrition problems Prioritization of Care Level 3 Health concerns that do not immediately threaten the physiological status of the child such as: knowledge deficit / Patient teaching Coping Health maintenance Activity Rest