Child Health Assessment - Nursing

Child Health Assessment By: Aileene D. Mendoza, RN, MAN Objectives: Describe the purposes and techniques of health assessment in children of all ages. Assess a child and family health interview, physical examination, and developmental screening. Formulate nursing diagnoses based oh h...

Child Health Assessment By: Aileene D. Mendoza, RN, MAN Objectives: Describe the purposes and techniques of health assessment in children of all ages. Assess a child and family health interview, physical examination, and developmental screening. Formulate nursing diagnoses based oh health assessment findings. Identify expected outcomes based on health assessment as well as help parents manage seamless transitions across differing healthcare settings.  Implement nursing care, such as conducting an age- appropriate health interview or physical examination by modifying techniques based on child’s age. Evaluate expected outcomes for achievement and effectiveness of care.  Assessment Take time and listen carefully to family’s concerns and response to questions. Do not rush an interview/physical examination. Allow familiarization of environment and equipment to be used.  Nursing Diagnosis Never overlook diagnosis that accentuate the healthy functioning of a child and family in addition to addressing any specific problems Ex. that have been identified. A. 4 years child ambulate by wheelchair who feels uncomfortable around other children. “Impaired social interaction r/t lack of self-esteem secondary to disability” B. 4 years child ambulate by wheelchair who’s parents have difficulty adapting to their child’s disability but is eager to accept advice from health expert. “Readiness for enhanced family coping”  Outcome Identification & Planning Health promotion & illness prevention are vital part of outcome identification. Planning for child’s next developmental stage Making aware of important safety measures  Implementation Physical examination & health interview Great Skills Practice  Outcome evaluation Ongoing process that does not end when the first database is created Child change drastically Needs to be update/change to fit current status/need Health History: Establishing a Database Purpose: 1. Gather information that will direct physical or laboratory examinations to complete a thorough health evaluation. 2. Foundation of Health Education and Health promotion.  Principles of Child Health Interview 1. Conducive interview setting best with private room with comfortable seat that can maintain eye-to-eye contact. calling the child/parent by name let the parent feel that their input and opinions about how their child is developing are valued.  2 Types of effective questions: 1. Close-ended questions - Answerable with “Yes” or “No” - directly ask for fact/s - Effective if particular point is being sought - Limit in scope Ex. “Did you take Anna's temperature?” 2. Open-ended questions - allows elaboration - encourage to fully describe a situation/problem. Ex. “What did you do for Anna's fever?”  3 Types of question to avoid: 1. Compound questions combining two or more information or data at the same time. can create confusion and sometimes elicit inaccurate data. Ex. “ Did Anna have Nausea and Vomiting?” 2. Expansive questions open-ended questions which are too vague to answer leaves a person confuse of where and how to start Ex. “ What can you tell me about Anna?” “ How was Anna been since her last visit?” 3. Leading questions supply their own answers Ex. “ Anna has had all her immunizations, hasn't she?”  CONTENT OF A HEALTH INTERVIEW 1. Introduction and explanation 2. Demographic data 3. Chief complaint/concern 4. History of chief complaint/concern 5. Health and family profile 6. Day history 7. Past health history, including pregnancy history 8. Family health history 9. Review of systems  Transitional Statement use of statement before shifting from one topic to another. EX. Before we talk about Anna's current symptoms, let me ask you some general questions about your family so I can you better.” 2. Demographic Data child's name gender informant (esp. if parents are divorced/ deceased) child's culture/ ethnicity place of birth religious/spiritual practices primary and secondary language 3. Chief concern/complaint reason they brought their child to the healthcare agency. to use open-ended questions Correct: “Why did you bring Anna to the clinic today?” Incorrect: Thinks only of “How is Anna feeling today?” PHYSICAL “Is Anna ill?” ASPECT  reveals not only information about disease condition but also depth of the parent's concern about symptoms. EX. “She has constant headache” vs. “Headache” 4. History of Chief Concern 6 ASPECTS OF A PROBLEM √ Duration √ Intensity √ Frequency √ Description √ Associated symptoms √ Actions taken 5. Health & Family Profile 1. Parents status/ legal guardian 2. How many are in the family 3. Parent's/ guardian's occupation to establish socioeconomic level and time available for childcare. 6. Day History ( Typical day/routine) current skills sleep pattern hygiene practices eating habits 24 H recall FOOD PREFERENCE interaction with the family 7. Past health histories past serious illness immunization history previous surgery previous hospitalization 8. Family health histories inherited/familial disease EX. TB cardiac disease seizure DM cancer 9. Review of systems Cephalocaudal 10. Physical assessment 1. Inspection EXCEPT ABDOMEN!!! 2. Palpation AIPP 3. Percussion 4. Auscultation  may obliterate bowel sounds  Variation for age and developmental stage Should be tailored to the age and development stage Expected findings also depends on the child's age and developmental stage.  Newborn immediately and the first 24H cover body areas that are not being directly examined performs examination under a radiant heat warmer because maintaining body temperature is difficult for NB. First temp = rectal Succeeding = tympanic/axillary --> prevent rupture of rectal mucosa heart rate = apically access FEMORAL PULSES = rule out Coarctation of the Aorta reflexes HC assessment of gestational age  Infant assess heart and lung function first Intrusive procedures ( ex. ears and throat) last --> to lessen cry 7-12months - Fear of Stranger - establish rapport - approach with a normal tone fo voice - bright colors help in distraction  Toddler and Pre-schooler can do assessment independently --> less threatening leave intrusive procedure (ex. genetalia, ears) last be generous in praising and appreciation for cooperation explain both to parents and patient --> children this age sense parental trust or suspicion  School-Age Explanation of procedure “What is th extend of the examination? ” Ask if they need parents during assessment comment on body parts as you examined the Ex. “your heart sounds good” “your ears looks fine” Cephalocaudal --> last genetalia Include height and weight -- > common problem obese & DM & HPN Blood pressure  Components of Physical examinations 1. vital signs -T -P -R - BP -Pain  Mental Status Assessment level of consciousness orientation (person, time and place) assessment of recent memory Ex. What he/she had for breakfast?  Body measurement A. Weight chronic illness --> difficulty in gaining weight --> normal weight and height cannot be maintained Overweight - can lead to illnessess ( heart disease, endocrine, lungs) B. Height - measuring equipment for newborn C. Head Circumference D. Chest & Abdominal Circumference E. Skin temperature, color, dryness, turgor, texture skin findings in children that suggest illness E.1. Newborn ruddy, subQ is thin Erythema toxima mongolian spots E.2. Toddler, pre-schooler & School-age minor lesions ecchymotic spots to lower extremities Atopic dermatitis E.3. Adolescent Acne face and back lesions/ rashes due to cosmetic allergy 5. Head INDENTED BULGING = = Infant DHN Increase in ICP - fontanelles anterior closes at 12-18 months posterior 2 months  Toddler, pre-schooler & School-age - nits - pediculi (head lice) - fungal infection 6. Neck trachea lymph nodes < 4 months cannot pull head up 7. Lungs Breath sounds on auscultation 8. Heart Heart sounds on auscultation 9. Genitorectal area Hypospadia – is a birth defect (congenital condition) in which the opening of the urethra is on the underside of the penis instead of at the tip.  Hydrocele – is a type of swelling in the scrotum that occurs when fluid collects in the thin sheath surrounding a testicle.  Varicocele – is an enlargement of the veins within the loose bag of skin that holds your testicles (scrotum). TO DO: 1. Quiz- Child Health Assessment Quiz - 2. Assignment- Individual Output of Pediatric Health Assessment