NURS2036 Lecture Week 4 S2.24 (1) PDF

NURS2036 Professional Practice 3 Week 4 Lecture Course Coordinators and Lecturers: NSW- Renee Pinkney/Sondos Khazma WA- Katie Janz/Jessica Brow n ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodian...

NURS2036 Professional Practice 3 Week 4 Lecture Course Coordinators and Lecturers: NSW- Renee Pinkney/Sondos Khazma WA- Katie Janz/Jessica Brow n ACKNOWLEDGEMENT OF COUNTRY The University of Notre Dame Australia is proud to acknowledge the traditional owners and custodians of this land upon which our University sits. The University acknowledges that the Fremantle Campus is located on Wadjuk Country, the Broome Campus on Yawuru Country and the Sydney Campus on Cadigal Country. Learning Outcomes Assessment and management of children and young people by understanding the following: Discuss the concepts of growth and development Outline child development theories and stages of development Demonstrate a physical assessment of a child/young person Undertaking an eye and ENT-focused assessment Application of effective communication techniques (family-centred care) Assessment and management of the principles and practice of intravenous therapy in both adult and paediatric patients Development Theorists Freud Vygotsky (psychosocial) (psychosocial) Erikson Kohlberg (psychosocial) (moral) Growth and Development Growth and development occur in a cephalocaudal and proximodistal direction Development begins with simple acts and progresses to more complex becoming increasingly differentiated through response and progression of skilled specific responses Certain stages of growth and development are more critical than others All humans follow the same pattern, although the pace is not even Physical development: changes in shape and size Psychosocial development: changes in emotions and personality Cognitive development: changes in ways of thinking and interpreting Source: VitalSource Bookshelf: Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 Stages of growth and development Source: VitalSource Bookshelf: Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 Stages of growth and development Source: VitalSource Bookshelf: Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 Concepts of Growth and Development Growth Physical changes and increase in size Measured quantitatively E.g. height, weight, head circumference (Berman et al., 2018, p. 367) Concepts of Growth and Development Development Increase in the complexity of function and skill progression Capacity and skill of a person to adapt to the environment behavioural aspect of growth E.g. learning to walk, run, talk (Berman et al., 2018, p. 367)  Growth How do we assess growth? Head circumference Height percentile Weight percentile BMI percentile Source: Body mass index-for-age (BMI-for-age) (who.int) Child growth standards (who.int) Growth charts Source: Length/height-for-age (who.int) Growth charts Source: Length/height-for-age (who.int) Domains of Development Physical Cognitive Social/Emotional Language Child development: the first eight years https://raisingchildren.net.au/babies/videos/development-first-eight-years (Berman et al., 2018, p. 368) Cognitive Development Source: VitalSource Bookshelf: Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 Psychosocial Development Source: VitalSource Bookshelf: Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 Stages of Growth and Development Infant (Birth to 1 year) 2 months Social/Emotional Looks at your face Calms down when spoken to or picked up Smiles when you talk to or smile at them Language/Communication Coos, makes gurgling sounds Reacts to loud sounds Source: (Centers for Disease Control and Prevention. (2021). CDC’s developmental milestones. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-2mo.html) Stages of Growth and Development Infant (Birth to 1 year) 2 months Cognitive (learning, thinking, problem-solving) Watches you as you move Looks at a toy for several seconds Movement/Physical Development Holds head up when on tummy Moves both arms and both legs Opens hands briefly Source: (Centers for Disease Control and Prevention. (2021). CDC’s developmental milestones. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-2mo.html) Stages of Growth and Development Infant (Birth to 1 year) 6 months Social/Emotional Knows familiar people Likes to look at self in the mirror Laughs Language/Communication Responds to sounds by making sounds Makes squealing noises Source: 6-Month-Old Sleep Schedule: Sample Nap Times & Tips (whattoexpect.com) (Centers for Disease Control and Prevention. (2021). CDC’s developmental milestones. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-2mo.html) Stages of Growth and Development Infant (Birth to 1 year) 6 months Cognitive (learning, thinking, problem-solving) Puts things in their mouth to explore them Reaches to grab a toy they want Movement/Physical Development Rolls from tummy to back Pushes up with straight arms when on tummy Leans on hands to support self when sitting (Centers for Disease Control and Prevention. (2021). CDC’s developmental milestones. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-6mo.html) Stages of Growth and Development Infant (Birth to 1 year) 9 months Social/Emotional Is shy, clingy, or fearful around strangers Looks when you call their name Reacts when you leave Smiles or laughs when you play peek-a-boo Language/Communication Makes a lot of different sounds Lifts arms up to be picked up (Centers for Disease Control and Prevention. (2021). CDC’s developmental milestones. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html) Your 9-month-old baby's growth and development | BabyCenter Stages of Growth and Development Infant (Birth to 1 year) 9 months Cognitive (learning, thinking, problem-solving) Looks for objects when dropped out of sight Bangs two things together Movement/Physical Development Can get into a sitting position by self Sits without support Stages of Growth and Development Infant (Birth to 1 year) 12 months Social/Emotional Plays games with you, like pat-a-cake Has favourite things and people Language/Communication Waves ‘bye-bye’ Calls a parent ‘mama’ or ‘dada’ or another special name Understands ‘no’ (Centers for Disease Control and Prevention. (2021). CDC’s developmental milestones. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-1yr.html) Stages of Growth and Development Infant (Birth to 1 year) 12 months Cognitive (learning, thinking, problem-solving) Puts something in a container, like a block in a cup Looks for things they see you hide Movement/Physical Development Pulls up to stand Walks, holding onto furniture Drinks from a cup without a lid Source: google.com/url?sa=t&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwi- lLbs_46HAxV9SmwGHc33CPoQh- wKegQIGxAC&url=https%3A%2F%2Fparenting.firstcry.com%2Farticles%2Fyour-12-months-old-baby- growth-and-development%2F&usg=AOvVaw0GpDxQebGup7uO6tZiMTA0&opi=89978449 (Centers for Disease Control and Prevention. (2021). CDC’s developmental milestones. https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html) Stages of Growth and Development Early Childhood (1 to 4 years) 2- 3 years old says own name plays co-operatively walks upstairs with both feet on one step walks few steps on tiptoes begins to run begins to hop 1-3 times catches a ball holds pencil near point and copies circle matches colours joins in make believe play Source: Development Milestones for Your 3-Year-Old Child - Children's Hospital of Orange County (choc.org) Stages of Growth and Development Early Childhood (1 to 4 years) 3-4 years old alternate feet upstairs walks in a straight line able to hop 4-6 times pedals and steers a tricycle tripod grasp of pencil, draws a person with head, trunk, legs, arms and fingers uses a fork well use scissors relate recent experiences using sentences sympathy for others in distress recognises own name in print Source: 4-Year-Old Milestones - New Horizon Academy Stages of Growth and Development Early Childhood (1 to 4 years) 4-5 years old alternates feet downstairs begins to skip hops 7-9 times smoothly throws ball with the shift of the body catches ball with hands Source: Japanese Girl (5 Years Old) Playing With Jump Rope Stock Photo, Picture and Royalty Free Image. Image 145646483. (123rf.com) Stages of Growth and Development Middle Childhood (5 to 12 years) 5 years old complex motor tasks e.g. skipping, walking along a line pencil skills for drawing a person, copying a triangle and colouring within outlines can give name and age engage in conversation about a recent or routine past even Makes friends Source: The 5 stages of children's friendships | Kids First Children's Services (kids-first.com.au) Stages of Growth and Development Middle Childhood (5 to 12 years) 6-7 years old rides two-wheel bike uses knife, fork and spoon legibly prints letters learns to tell time learns to read enjoys games with peers 8-9 years old plays team sports able to use household tools understands concepts of time knows the date and month likes competitive games Source: An age-by-age guide to picking the best sport for your child (sheknows.com) Stages of Growth and Development Middle Childhood (5 to 12 years) 10-12 years old eye-hand coordination well developed fine motor skills developed developing ability for abstract thought able to write stories rules are important interest in opposite sex desire for more independence Source: Developmental Checklist for 11-13 Year Olds (scholastic.com) Stages of Growth and Development (Adolescence) 13-20 years old Begins with puberty and ends when the individual is physically and psychologically mature and able to assume adult responsibilities Physical growth accelerates during this period (puberty) Body image Increased independence Risk-taking behaviours Privacy is important Source: VitalSource Bookshelf: Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 Development How do we assess development? PEDS Ages and Stages Questionnaire Developmental delay https://raisingchildren.net.au/newborns/development/understanding-development/baby-development Source: Ebooks - Cengage eReader (cenreader.com) PEDS Source: “Parents’ evaluation of development status (PEDS)” by The Royal Children’s Hospital Melbourne, 2020 https://www.rch.org.au/ccch/peds/About_PEDS/ Copyright 2020 by The Royal Children’s Hospital Melbourne. 7 Principles of Family-Centred Care The following are incorporated into policy and practice: Family is constant in a child’s life, and HP fluctuate Exchanging complete and unbiased information between family and HP in a supportive manner Recognition & honouring of cultural diversity, strengths, & individuality within & across all families Respect and recognition of the different methods of family coping, provide support to meet the diverse needs of families Encourages & facilitates family-to-family support & networking Ensures home, hospital and community services for children needing care is flexible, accessible and comprehensive to individual family needs Appreciates families as families and children as children Source: 3,337 Chain Cutout Paper People Royalty-Free Photos and Stock Images | Shutterstock Nursing Assessment Accommodate the age and developmental stage Implement behaviours that show respect Modify language and communication style Family Centred Care: introduce yourself to the child and family Use play techniques for infants and young children Observation first Use a systematic approach Encourage the child and family to ask questions Cluster assessment Source: Ebooks - Cengage eReader (cenreader.com) (The Royal Children’s Hospital Melbourne, 2017) Communication Allow time for the child to feel comfortable Talk in a calm, quiet and friendly voice Speak clearly in simple words and sentences Always tell the truth Be sensitive to children’s non-verbal cues Allow children to express their concerns and anxieties Use play, writing, drawing etc Communication through transition objects (Forster & Fraser, 2018, p 3) Assessment Structure Patient History Prenatal, birth and postnatal (were they term?) Vaccinations/immunisations Childhood illnesses Accidents/injuries (consider NAI) Home environment (personal habits, position in the family) General Appearance Vital Signs Additional Measurements- Weight, Height, Head Circumference, BSL/BGL Physical Assessment (The Royal Children’s Hospital Melbourne, 2017) 3 Source: Ebooks - Cengage eReader (cenreader.com) Patient History Reason for Hospitalisation Social and developmental history Immunisation history Medications Allergies Medical and Surgical History- Atraumatic Care 10 PAT assessment Source: Pediatric Assessment | MedicTests General Appearance Level of alertness and responsiveness Body posture and movements Skin colour Breathing How they interact and react to others (Forster & Fraser, 2018, p. 45) Vital Signs Temperature Respiratory rate Heart rate Blood pressure Oxygen saturation Pain PARROT chart for documentation Source: VitalSource Bookshelf: Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 (The Royal Children’s Hospital Melbourne, 2017) Vitals Source: https://www.rch.org.au/clinicalguide/guideline_index/Normal_Ranges_for_Physiological_Variables/ Vitals Source: Ebooks - Cengage eReader (cenreader.com) Pulse and respirations Source: VitalSource Bookshelf: Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 Additional Measurements Weight Height Head circumference Blood sugar/glucose level (BSL/BGL) Source: Ebooks - Cengage eReader (cenreader.com) (The Royal Children’s Hospital Melbourne, 2017) Physical Assessment Primary assessment: Airway Breathing Circulation Disability Exposure Fluids Glucose Secondary assessment: History Head to Toe Full set of vitals Sources: Wong-Baker faces pain rating scale | Download Scientific Diagram (researchgate.net) Face, Leg, Activity, Cry, Consolability (FLACC) scale. | Download Scientific Diagram (researchgate.net) Focused Assessment Respiratory System Cardiovascular Neurological System Gastrointestinal Renal Musculoskeletal Skin Eye Ear/Nose/Throat (ENT) Focused assessment: eyes, ears, nose and throat Relating to the specific presenting problem Relating to current patient concerns Symptoms that are common or concerning Health history Subjective and objective data  Assessment of eyes Snellen vision chart Estes, M., Calleja, P., Theobald, K., & Harvey, T. (2020). Health assessment and physical examination (3rd ed.). Cengage Learning Australia. Chapter 23. Assessment of eyes Common conditions that will be discussed include: Cataracts-are the leading cause of blindness in the world: over 10.8 million people are blind and 35.1 million people have visual impairment due to cataracts. Glaucoma- is the leading cause of irreversible visual impairment internationally, with 74% of cases being primary open angle glaucoma (POAG) Source: Ebooks - Cengage eReader (cenreader.com) Assessment of eyes Age-related macular degeneration- is the leading cause of blindness in both Australia and New Zealand (National Health Committee, 2015; Vision Australia, n.d) Diabetic retinopathy- Caused by uncontrolled diabetes. Eye injuries/trauma such as corneal ulceration and foreign bodies- Falls (35%) and assaults (25%) led to eye injuries requiring hospitalisation, Assessment of eyes Objective data is: Equipment collected during the physical Penlight examination of the patient Nonsterile gloves usually collected after subjective data Snellen chart (age specific) information that is measured or Rosenbaum (near vision pocket observed by the clinician as screening card) opposed to being reported by the patient Vision occlude vital to the overall health Cotton-tipped application assessment, to enable you to Light source/pen torch make clinical decisions that are representative of the whole patient picture Approach to Examination of the Eyes 1.Greet the patient and explain the techniques that you will be using. 2.Use a quiet room that will be free from interruptions. 3.Ensure that the light in the room provides sufficient brightness to allow adequate patient observation. 4.Place the patient in an upright sitting position on the examination table. 5.Visualise the underlying structures during the assessment process to allow adequate description of findings. 6.Always compare the two eyes. 7.Use a systematic approach that is followed consistently each time the assessment is performed Assessment of eyes Examination of Visual Acuity: Examination of Extraocular Muscle Function Inspection Inspection (CN2-6) Distance vision Corneal light reflex Near vision Cover/uncover test Colour vision Cardinal fields of gaze Examination of Visual Fields Examination of Anterior Segment Structures Examination of External Eye and Lacrimal Inspection Apparatus (teardrops): Conjunctiva Inspection Sclera Eyelids, eyebrows and eyelashes Cornea Lacrimal apparatus Anterior chamber Palpation Iris Lacrimal apparatus Pupil Lens Neurological observations: Assessing the eyes Source: imgurl:https://gildanahealthcare.com.au/images/thumbs/0015469_neurological-observations-chart-mr189-100s.png - Search (bing.com) https://aci.health.nsw.gov.au/__data/assets/pdf_file/0018/201753/AdultChartEdPackage.pdf Assessment of eyes Subconjunctival haemorrhage: Cataract: Possible stroke or ptosis: Conjunctivitis: Global rupture: Sources: https://mmcneuro.wordpress.com/2013/01/27/drooping-eyelids-ptosis/ https://www.medicalnewstoday.com/articles/321551 Focused assessment: Ear Subjective data Objective data Changes in or loss of External ear hearing abnormalities Otalgia (discomfort) (asymmetry, deformity, Tinnitus (ringing) haematoma, cyst) Hx of Otorrhoea (liquid Swelling, redness drainage) Source: Ebooks - Cengage eReader (cenreader.com)  Ear assessment External Ear Internal ear Inspection of Pinna With your thumb and forefinger grasping the otoscope, Position use the lateral side of the hand to prevent the head The top of the ear is below from jerking. Your other hand can also be used to the imaginary line drawn stabilise the patient’s head. from the outer canthus to Pull the lower auricle down and out to straighten the the occiput. canal. This technique is used in children up to about 3 years of age. Use the adult technique after age 3. Kidneys and ears are Insert the speculum about 0.5 cm to 1.25 cm, formed at the same time in depending on the patient’s age. embryonic development. If Suspected otitis media must be evaluated with a a child’s ears are low set, pneumatic bulb attached to the side of the otoscope’s renal anomalies must be light source. ruled out. Low-set ears can Select a larger speculum to make a tight seal and also occur in Down prevent air from escaping from the canal. syndrome. Gently squeeze the bulb attachment to introduce air into the canal. Observe the tympanic membrane for movement. Source: Ebooks - Cengage eReader (cenreader.com) Anatomy of an Otoscope | American Diagnostic Corporation (adctoday.com) Assessment of the ears Cerebrospinal Fluid (CSF) Drainage from the Ear- Urgent finding! If the patient has cerebrospinal fluid, clear liquid that tests positive for glucose on Dextro-stix and leaking from the ear, be sure to use good hand washing technique and avoid placing any objects into the ear canal in order to prevent the development of meningitis. A patient with this finding needs immediate referral to a qualified specialist for emergency assessment. Assessment of the ears Auditory Screening includes: Voice whisper test Tuning fork test (Weber and Rinne Test) Inspection: External ear, palpation Otoscopic examination Source: https://www.stlukes-stl.com/health-content/health-ency-multimedia/1/000638.htm. Common Paediatric ear conditions Grommet/s insertion to assist with ongoing ear infections Source: Ear Grommets - ENT Clinic Sydney (ent-surgery.com.au)  Assessment of the nose Inspect the external surface of the nose Inspect for rhinorrhoea and CSF Assess nostril patency bilaterally Test olfactory sense Conduct internal assessment with nasal speculum: mucosa, turbinates, septum Inspect, percuss and palpate frontal and maxillary sinuses Source: Examination of nose | PPT (slideshare.net) Focused assessment: mouth and throat Subjective data Objective data Inspect and palpate for: Pain in the mouth or throat Deformities/asymmetry Hx of excessive discharge or Haematoma/redness/swelling/ secretions masses Reports of Lips/Teeth/gums/buccal blockage/congestion/swelling mucosa Hard/soft palate/oropharynx/neck Source: Ebooks - Cengage eReader (cenreader.com) Assessment of the mouth and throat Assessment of the mouth Assessment of the throat Note breath odour Inspect the lips, buccal mucosa, Inspect the oropharynx gums, and hard and soft palates Test gag reflex (CNs IX, X). Inspect and count the teeth Test taste (CN VII) Inspect the tongue: ask the Palpate the lips and mouth, if patient to stick out the tongue indicated (CN XII) Inspect the uvula: note movement when the patient says ‘ah’ (CNs IX, X) Inspect the tonsils: note grade Source: Ebooks - Cengage eReader (cenreader.com) Consent in Paediatrics Different states have different legislative practice Consent can be considered as valid if it is: Voluntary Informed Provided with capacity (mature minors) Current Consent may also be implied or sought during exceptions (emergency) Generally, parents or suitable decision-makers authorise consent and treatment for minors where circumstances permit  Principles and practice of Intravenous management Wherever possible, the enteral route should be used, however, if a child requires IVT there are specific Paediatric considerations: Calculated as per the body surface area, weight and age Based on the proportion of the usual adult dose Consider adjustment of doses based on the child’s response Site PIVC hourly during an infusion Assess regularly for signs of fluid overload and adjust accordingly Consider glucose or potassium Fluid resuscitation order: 10-20ml/kg (blood, NaCl, CSL, Plasma) Maintenance: total fluid required = maintenance + replacement of deficit + replacement of ongoing loss The same principles and practices apply to adults regarding PIVC indication (using DRIP) and PIVC assessment. Refer to the week three lecture for further information. Additional reading DeLaune et al. Fundamentals of Nursing: Chapter 17 The life cycle Chapter 18 Paediatric Care Estes Health Assessment 3rd edition: Chapter 20 The Paediatric consumer Kozier and Erb’s Fundamentals of Nursing, volumes 1-3: Unit 5: Lifespan development (chapters 21-25) Chapter 30 vital signs Chapter 31 health assessment Chapter 33 safety Chapter 36 medications Chapter 37 skin integrity and wound care Levett-Jones Clinical Reasoning: Learning to Think like a Nurse 3rd edition: Chapter 5 caring for a child with type 1 diabetes Tollefson Clinical Psychomotor Skills 8th edition: Chapter 15 Physical assessment Chapter 23 Height, weight and waist circumference measurements References Australian Commission on Safety and Quality in Health Care. (2023). Antimicrobial Stewardship in Australian Health Care antimicrobial_stewardship_in_australian_health_care_-_july_2023_up_to_chapter_20.pdf (safetyandquality.gov.au) Berman, Frandsen, G., Snyder, S., Levett-Jones, T., Burston, A., & Dwyer, T. (2020). Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 EBook. Pearson Education Australia Brown, D., Edwards, H., Buckley, T., & Aitken, R. (2020). Lewis’s medical-surgical nursing; assessment and management of clinical problems (5th ed.). Pp362. Elsevier. Department of Health. (2016). WA Health Consent to Treatment Policy. Government of Western Australia. https://www.healthywa.wa.gov.au/~/media/Files/Corporate/Policy%20Frameworks/Clinical%20Governance%20Safety%20and%20Quality/Pol icy/WA%20Health%20Consent%20to%20Treatment%20Policy/Supporting/WA-Health-Consent-to-Treatment-Policy.pdf DeLaune, S.C., Ladner, P.K., McTier, L. & Tollefson, J. (2024). Fundamentals of Nursing. Australia and New Zealand. (3rd ed). Cengage. Australia Estes, M., Calleja, P., Theobald, K., & Harvey, T. (2020). Health assessment and physical examination (3rd ed.). Cengage Learning Australia. Chapter 21. Estes, M., Calleja, P., Theobald, K., & Harvey, T. (2020). Health assessment and physical examination (3rd ed.). Cengage Learning Australia. Chapter 23, pp849. Levett-Jones, T. (2023). Clinical reasoning: Learning to think like a nurse (3rd ed.). Pearson Australia. Orenstein GA, Lewis L. Erikson Stages of Psychosocial Development. (2022 Nov 7). Stat Pearls Publishing; https://www.ncbi.nlm.nih.gov/books/NBK556096 Queensland Government, Queensland health (2023) https://www.childrens.health.qld.gov.au/guideline-preschool-wheeze-emergency- management-in-children The Royal Children’s Hospital Melbourne. (2022). Pain Assessment and Measurement. Clinical Guidelines (Nursing) : Pain assessment and measurement (rch.org.au) The Royal Children’s Hospital Melbourne. (2020). Intravenous fluids. Clinical Practice Guidelines : Intravenous fluids (rch.org.au) Tollefson, J., & Hillman, E. (2022). Clinical psychomotor skills assessment tools for nurses (8th ed.). Cengage Learning Australia. Sanders, C. E. (2022, November 30). Lawrence Kohlberg’s stages of moral development. Encyclopedia Britannica. https://www.britannica.com/science/Lawrence-Kohlbergs-stages-of-moral-development Saul McLeod, Sigmund Freud's Theories, updated 2018, https://www.simplypsychology.org/Sigmund-Freud.html World Health Organization. (2024). Child Growth Standards. Child growth standards (who.int)