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

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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:

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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:

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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
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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
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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
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