When visiting a family in their home environment or in a community setting, there are many opportunities to assess physical, cognitive, and social-emotional health. You have the opportunity to observe the natural environment and activities of daily living in each unique family. Being aware of normal variations in growth and developmental milestones for infants, children, and adolescents will allow red flags to be observed more easily. Early identification of developmental concerns allows for early intervention and optimized outcomes! Children are physiologically different from adults. Pediatrics is not something to fear, rather it is a population to study for the differences. Don’t forget that confidentiality and the rights of minors should be kept in mind as you obtain the most honest and accurate information.
When seeing children in a home or community-based setting, it is important to include them in the interviewing and data gathering process. The use of open-ended questions, understandable vocabulary and language, active listening, assessment for verbal and nonverbal cues, and cultural competence will allow you to obtain more thorough and accurate information. You should be aware of cultural norms when interviewing families and children, and be aware of red flags for concern so that medical referrals will be implemented in a timely manner. Historical data gathering, along with gathering current information needed to optimize recovery for the child and family, is the first step to the pediatric assessment.
When examining children, knowing various strategies for approaching the exam will provide comfort and trust. Providing anticipatory guidance with the exam will most likely ensure a more positive experience for the child and a more complete exam for you. It is important to provide an atmosphere that is non-threatening and comfortable. Be honest if you will be causing discomfort and tell the child how long a procedure will last. Do all you can to decrease the stress of the exam for the child and the caregiver. One way to reduce stress is to have an awareness of psychosocial development. After considering the psychosocial stage of development, your working plan on how to examine the child may change depending on the age.
A thorough head-to-toe assessment is important in children. Once children are assured that what you are doing is to make sure they are well and that it should not hurt, they will most likely cooperate. There are tips by developmental age that you can utilize to facilitate cooperation with the exam. Unless it is not age appropriate, the head-to-toe progression is an orderly way for all of the systems to be assessed.
The ABCs of an Emergent Initial Assessment
The ABCs of initial assessment are a quick tool to use to determine if an emergent situation is present and the need for medical referral is necessary. After establishing the child’s health safety, you can proceed to the physical exam. Referring to the normal blood pressure charts and vital sign normal values when examining the pediatric child will make it easier to determine the health status of the child quickly. The community setting does not always offer a quick resource, so you must be knowledgeable of normal and abnormal parameters for all parts of the physical assessment. Children are different than adults not only in size, but also physiologically. As a nurse who may need to assess an infant, child, or adolescent in a home or community setting during an emergency, recognizing these differences will aid you in the pediatric assessment. Often it is difficult to determine how severe an illness or injury is in a child when it is early in its development. The following basic ABC’s will give you pediatric pearls of wisdom to include in your thought processes for decision making. If at all possible, allow the child to remain with the caregiver during your assessment.
Children under five years have a narrow trachea, which makes them susceptible to foreign body obstruction. Observe for an abnormal cry or absent speech. If the child is showing a decreased response to their caregiver or to environmental stimuli, proceed to notify emergency services immediately. In an older child or adolescent, you may see signs of distress in a forward leaning posture or unwillingness to lie down flat. Observe patency, positioning, and breath sounds to rule out an obstruction.
Breathing is everything to a child. Children are unable to increase the depth of respiration related to respiratory difficulty. Instead they will increase the rate of respiration to compensate. Conversely, adults can increase rate and depth to help alleviate respiratory difficulty.
There are differences between the child’s and the adult’s cardiovascular systems. The adult heart has the ability to increase the strength of contraction and the rate of contraction when there is cardiac compromise. The child, however, can only increase the rate of contraction. Until late school age, the pediatric heart is unable to compensate like an adult. A child’s heart rate is significant when evaluating cardiac function. When a child’s heart rate is low, it is an emergency as this often indicates a significant decrease in cardiac output. Seek medical attention. To perform a cardiac assessment, you should check heart rate, capillary refill and perfusion, pulses, and skin temperature. Any cyanosis, mottling (outside of being cold), paleness/pallor, or significant bleeding are red flags and require medical attention. A pulse or systolic blood pressure outside of normal for their age, and a capillary refill greater than two seconds with other abnormal findings are also indications to seek medical attention. Capillary refill is very accurate in children because they do not have vascular disease normally seen in adults. In a normal child, capillary refill is less than or equal to two seconds. Accurate sites to check on a child are the knee cap or forearm, or another warm area of the body.
Utilizing tools to assess vital signs, normal milestone development in pediatrics, delays in growth, developmental disabilities, and risky behaviors is very important in the pediatric assessment. Many websites have free materials to use, while others should be purchased by your organization and incorporated in the standard of care for pediatric individuals. Pediatric assessment tools are a way to ensure content is covered thoroughly when doing a pediatric assessment. The health of the family, as well as optimal outcomes for the child in need, is the goal of every pediatric assessment.
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