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Physical Assessment of Children

الكلية كلية التمريض     القسم قسم التخصصات التمريضية     المرحلة 3
أستاذ المادة عبد المهدي عبد الرضا حسن الشحماني       17/11/2016 08:36:28
Physical Assessment of Children
Depending of Age
Physical Assessment of Infant
Assessment is NOT in the head-to-toe manner
When quiet, auscultate heart, lungs, abdomen
Assess heart & respiratory rates before temperature
Palpate and percuss same areas
Perform traumatic procedures last
Elicit reflexes as body part examined
Elicit Moro reflex last
Encourage caretaker to hold infant during exam
Distract with soft voice, offer pacifier, music or toy
Physical Assessment of Toddler
Inspect body areas through play – “count fingers and toes”
Allow toddler to handle equipment during assessment and distract with toys and bubbles
Use minimal physical contact initially
Perform traumatic procedures last
Introduce equipment slowly
Auscultate, percuss, palpate when quiet
Give choices whenever possible
Physical Assessment of Preschooler
If cooperative, proceed with head-to-toe
If uncooperative, proceed as with toddler
Request self undressing and allow to wear underpants
Allow child to handle equipment used in assessment
Don’t forget “magical thinking”
Make up “story” about steps of the procedure
Give choices when possible
If proceed as game, will gain cooperation
Physical Assessment of School-Age Child
Proceed in head-to-toe
May examine genitalia last in older children
Respect need for privacy – remember modesty!
Explain purpose of equipment and significance
Teach about body function and care of body
Physical Assessment of the Adolescent
Ask adolescent if he/she would like parent/caretaker
present during interview/assessment
Provide privacy
Head-to-toe assessment appropriate
Incorporate questions/assessment related to
genitals/sexuality in middle of exam
Answer questions in a straightforward, non-
condescending manner
Include the adolescent in planning their care



Pain Assessment
Pain
“Pain is whatever the experiencing person says it is, existing whenever the person says it does.”
McCaffery and Pasero, 1999

This includes VERBAL and NONVERBAL expressions of pain
Pain Facts and Fallacies
FACT: Children are under treated for pain
FACT: Analgesia is withheld for fear of the child becoming addicted
FALLACY: Analgesia should be withheld because it may cause respiratory depression in children
FALLACY: Infants do not feel pain
Principles of Pain Assessment in Children: QUESTT
Question the child
Use a pain rating scale
Evaluate behavioral and physiologic changes
Secure parent’s involvement
Take the cause of pain into account
Take action and evaluate results
Pain Rating Scales
Not all pain rating scales are reliable or appropriate for children
Should be age appropriate
Consistent use of same scale by all staff
Familiarize child with scale
Pain Scales
FACES pain rating scale
Numeric scale
FLACC scale
Facial expression
Legs (normal relaxed, tense, kicking,
drawn up)
Activity (quiet, squirming, arched,
jerking, etc)
Cry (none, moaning, whimpering,
scream, sob)
Consolability (content, easy or difficult to console)
Nonpharmacologic Interventions
Based on age
Swaddling, pacifier, holding, rocking
Distraction
Relaxation, guided imagery
Cutaneous stimulation
Anesthetics: Topical and Local
Major advancement for atraumatic care
EMLA
NUMBY stuff
Intradermal local anesthetics
Importance of timing
Analgesics
Opioids
NSAIDs
“Potentiators”
Lytic cocktail (DPT)—Demerol, Phenergan, and Thorazine
Co-analgesics, amnesics, sedatives, etc.
Role of placebos
Dosage of Analgesia
Based on body weight up to 50 kg
Concept of “titration”
Ceiling effect of non-opioids
First pass effect
PCA
Fears of Bodily Injury and Pain
Common fears among children
May persist into adulthood and result in avoidance of needed care
Pain Assessment: Infants
Assessment of pain includes the use of pain scales that usually evaluate indicators of pain such as cry, breathing patterns, facial expressions, position of extremities, and state of alertness

Examples: FLACC scale,
NIPS scale

Young Infant’s Response to Pain
Generalized response of rigidity, thrashing
Loud crying
Facial expressions of pain (grimace)
No understanding of relationship between stimuli and subsequent pain
Older Infant’s Response to Pain
Withdrawal from painful stimuli
Loud crying
Facial grimace
Physical resistance
Pain Assessment: Toddlers
Toddlers may have a word that is used for pain (“owie,” “boo-boo,” “ouch” or “no”); be sure to use term that toddler is familiar with when assessing.

Can also use FLACC scale, or Oucher scale (for older toddlers)
Young Child’s Response to Pain
Loud crying, screaming
Verbalizations: “Ow”, “Ouch”, “It hurts”
Thrashing of limbs
Attempts to push away stimulus
Pain Assessment:
Preschoolers
Think pain will magically go away
May deny pain to avoid medicine/injections
Able to describe location and intensity of pain
FACES scale, poker chips and Oucher scale may be used
School-Age Child’s Response
to Pain
Stalling behavior (“wait a minute”)
Muscle rigidity
May use all behaviors of young child
Pain Assessment:
Older Children
Older children can describe pain with location and intensity

Nonverbal cues important, may become quiet or withdrawn

Can use scales like Wong’s FACES scale, poker chips, visual analog scales, and numeric rating scales
Adolescent
Less vocal protest, less motor activity
Increased muscle tension and body control
More verbalizations (“it hurts”, “you’re hurting me”)
Let’s Review
The nurse begins a full assessment on a 10 year-old patient. To ensure full cooperation from this patient it is most important for the nurse to:

A. Approach the assessment as a game to play.
B. Provide privacy for the patient.
C. Encourage the friend visiting to stay at the
bedside to observe.
D. Instruct the child to assist the nurse in the
assessment.
Let’s Review
During a routine health care visit a parent asks the nurse why her 10 month-old infant is not walking as her older child did at the same age. Which response by the nurse best demonstrates an understanding of child development?

A. “Babies progress at different rates. Your infant’s
development is within normal limits.”
B. “If she is pulling up, you can help her by holding her
hand.”
C. “She’s a little behind in her physical milestones.”
D. “You can strengthen her leg muscles with special
exercises to make her stronger.”
Let’s Review
When assessing a toddler identify the order in which you would complete the assessment:

Ear exam with otoscope
Vital signs
Lung assessment
Abdominal assessment
Let’s Review
When assessing pain in an infant it would be inappropriate to assess for:

Facial expressions
Localization of pain
Crying
Extremity movement


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .