Child Health Assessment: Nursing & Outcome Planning

• Health promotion and illness prevention are an important part of outcome identification for child health assessment
• A child's health interview, physical examination, and developmental screening should be assessed
• Expected outcomes should be identified, so parents can manage transitions across healthcare settings
• Nursing diagnoses are formulated using health assessment findings
• Nursing care includes age-appropriate interviewing/examination with modified techniques
• Expected outcomes should be evaluated for achievement and effectiveness of care
• A proper health assessment includes taking time to listen, not rushing and allowing child to familiarize with the environment

Nursing Diagnosis

• Never overlook diagnoses that accentuate healthy functioning of a child and their family in addition to addressing any specific problems identified

Outcome Identification & Planning:

• Health promotion and illness prevention are a key part of outcome identification
• Planning includes taking the child's next developmental stage into account
• Awareness of important safety measures

Implementation

• Great skills with practice leads to successful implementation
• This includes physical examination and health interview

Outcome evaluation

• A child's situation will change drastically, requiring the database to be updated to fit need
• The evaluation is on ongoing process that doesn't end when the first database is created

Health History Database

• Ensures gathering of information that directs physical/lab exams for a thorough health evaluation
• Health education and health promotion has this is the foundation

Principles of Interview

• Interviews should be in private rooms with comfortable seats to maintain eye contact
• Address child/parent by name
• Parents should feel that their input and opinions are valued

Types of Effective Questions:

• Closed-ended questions: Answerable with "Yes" or "No", directly asks for facts, and is effective if a particular point is being sought after
• Open-ended questions: Allows elaboration and encourages a full description of the situation

Questions to Avoid:

• Compound questions: Combining two or more questions at once to avoid confusion and inaccurate data from patients ex. "Did Anna have Nausea and Vomiting?"
• Expansive questions: Are open-ended questions that are too vague and confusing, like "What can you tell me about Anna?"
• Leading questions: Supply their own answers, like "Anna has had all her immunizations, hasn't she?"

Content of a Health Interview

• The content includes an introduction and explanation of what you will be doing
• The health interview should take into account demographic data, the chief complaint, the history of that complaint, the family profile
• It should also take into account any relevant day history or past medical history, including pregnancy history
• Finally, take into account a thorough review of systems

Transitional Statement:

• Transitions should be statements before shifting from one topic to another, for example "Before we talk about Anna's current symptoms, let me ask you some general questions about your family so I can you better.”

Demographic Data:

• Includes the child's name, gender, and ethnicity
• Include the informant, especially if the parents are divorced or deceased
• Also the child's culture, place of birth, and religious/spiritual practices
• Includes the primary and secondary languages

Chief Concern/Complaint:

• Includes the reason the child was brought to the HC agency
• Open-ended questions must be used such as "Why did you bring Anna to the clinic today?" instead of "How is Anna feeling today?" or ‘Is Anna ill?"
• It reveals information about the disease and parent's deeper concerns about the symptoms

History of Chief Concern: 6 Aspects of problem

• Includes duration, intensity, frequency, and a description of the problem
• Includes associated symptoms and any actions taken

Health & Family Profile:

• This includes parent statuses, legal guardian, how many are in the family
• Occupation of parent/guardian will help establish socioeconomic level and childcare availability

Day History:

• Current skills, sleep pattern, and hygiene practices are aspects of someone's daily routine
• Include eating habits, the 24-hour recall of what they ate, and their food preferences
• Interaction with the family

Past Health History:

• Past serious illnesses, immunization history, previous surgeries, and previous hospitalizations

Family Health History:

• These are inherited or familial diseases.
• Common examples include TB, cardiac disease, seizures, DM, and cancer

Review of Systems:

• Cephalocaudal meaning, head-to-toe, assessing all different body systems

Physical Assessments:

• This includes inspection, palpation, percussion, and auscultation, except when the abdomen should be auscultated first

Physical Assessment Variation:

• The assessment should be tailored to the age and developmental stage of the child
• Expected findings depend on the child's age and developmental stage

Newborn Physical Assessments:

• These should be done immediately on babies and the first 24 H
• Examination under a radiant heat warmer
• Temperature should be measured rectally first, followed by tympanic or axillary
• Assessment should include feeling for femoral pulses
• Includes reflexes, head circumference, and assessment of gestational age

Infant Physical Assessments

• Heart and lung function must be assessed first on infants
• Intrusive procedures like ear and throat exams should be done last to lessen crying

Infant Fears:

• 7-12 month olds have a fear of strangers
• Establishing rapport, use a normal tone of voice, and bright colors helps

Toddler and Pre-Schoolers Physical Assessments:

• Assessments can be done with the child independently to make it less threatening
• Intrusive procedures, like ears and genitals, should be done last
• Generously praise and appreciate their corporation
• Tell the parent and child what to expect --> these age sense parental trust and suspicion

School-Age Physical Assessments:

• You must explain what you are doing
• Offer them a chance to do the assessment without their parents
• Comment on body parts as you examined ex. ‘your heart sounds good”
• The process is cephalocaudal, with genitals examined last
• Common problems like obesity, DM, and HPN should be observed
• Blood pressure is assessed

Components of Physical Examinations:

• Vital signs include T, P, R, BP, and pain
• The mental status assessment includes level of consciousness, orientation, and recent memory.
• Includes Body Measurement such as height and weight

Body Measurements & Skin:

• Chronic illnesses, gaining weight, and maintaining normal weight and height should be considered when assessing a patient
• Overweight children can suffer heart disease, endocrine, and lung problems
• Includes the need for measuring equipment for newborns for height
• Head circumference, as well as chest and abdominal circumference is also measured
• On the skin, temperature, color, dryness, turgor, and texture play a part

Newborn Skin Findings:

• The skin can be ruddy, subQ is thin, there can be erythema toxima, and mongolian spots

Toddler/Preschooler & School-Age Skin Findings:

• Minor lesions, ecchymotic spots to lower extremities,
• Atopic dermatitis

Adolescent Skin Review:

• Acne on the face and back are common findings
• Lesions and rashes due to cosmetic allergies are also common

Head Assessment:

• Fontanelles in infants are an important part, anterior closes at 12-18 months
• Posterior closes at 2 months

Toddler/Preschooler and School-Age Head Findings:

• Nits, head lice, and fungal infections

Neck Inspection:

• Assure that the trachea and the lymph nodes appear normal
• Under 4 months, the infant cannot pull the head up

Lung Auscultation

• Crackles: Also called rales, are discontinuous clicking, rattling, or bubbling sound during inhalation that may sound wet or dry, fine or coarse.
• Wheezing: High-pitched and continuous breathy whistle which can sometimes be heard without a stethoscope. A squawk is a short version of a wheeze during inhalation.
• Rhonchi: Continuous, lower-pitched, rough sounds that many people compare to snoring.
• Stridor: A harsh, high-pitched, wheeze-like sound in people who have a blocked upper airway, usually when they are breathing in.

Heart auscultation include:

• Includes S1-Lubb, S2-Dupp, and S3, S4
• Heart sounds are produced due to vascular, muscular, and valvular activity

Genitorectal Inspection:

• Hypospadia: birth defect where the opening of the urethra is beneath the penis instead of at the tip
• Hydrocele: scrotum swelling due to fluid collection in the thin sheath surrounding a testicle
• Varicocele: enlargement of veins within the loose bag of skin that holds testicles (scrotum)

Health promotion and illness prevention for children are important for outcome identification. A child's health should be assessed through interviews, physical examinations, and developmental screenings. Nursing diagnoses are formulated using health assessment findings. Outcomes should be evaluated for achievement and effectiveness of care.