Whether the setting is a hospital or other healthcare facility, it is important to gather information regarding the child’s history and current status. Show
Collecting Subjective DataInformation spoken by the child or family is called subjective data. Conducting the Client InterviewMost subjective data are collected through interviewing the family caregiver and the child.
Interviewing Family CaregiversThe family caregiver provides most of the information needed in caring for the child, especially the infant or toddler.
Interviewing the ChildIt is important that the preschool child and the older child be included in the interview.
Interviewing the AdolescentAdolescents can provide information about themselves.
Obtaining a Client HistoryWhen a child is brought to any health care setting, it is important to gather information regarding the child’s current condition, as well as medical history.
Collecting Objective DataObjective data in nursing is part of the health assessment that involves the collection of information through observations. The collection of objective data includes the nurse doing a baseline measurement of the child’s height, weight, blood pressure, temperature, pulse, and respiration. General StatusThe nurse uses knowledge of normal growth and development to note if the child appears to fit the characteristics of the stated age.
Measuring Height and WeightThe child’s height and weight are helpful indicators of growth and development.
Measuring Head CircumferenceThe head circumference us measured routinely in children to the age 2 or 3 years or in any child with a neurologic concern.
Vital SignsVital signs, including temperature, pulse, respirations, and blood pressure, are taken at each visit and compared with the normal values for children at the same age. Temperature
Pulse
Respirations
Blood pressure
Physical ExaminationData are also collected by examining the body systems of the child. Head and NeckSymmetry or a balance is noted in the features of the face and in the head.
Chest and LungsChest measurements are done on infants and children to determine normal growth rate.
HeartIn some infants and children, a pulsation can be seen in the chest that indicates the heart beat, which is called the point of maximum impulse.
AbdomenThe abdomen may protrude slightly in infants and small children.
Genitalia and RectumWhen inspecting the genitalia and rectum, it is important to respect the child’s privacy and take into account the child’s age and stage of growth and development.
Back and ExtremitiesThe back and extremities should also be assessed for abnormalities.
NeurologicAssessing the neurologic status of the infant and child is the most complex aspect of the physical exam.
How do you do a physical assessment on an infant?Physical exam of a newborn often includes:. General appearance. This looks at physical activity, muscle tone, posture, and level of consciousness.. Skin. This looks at skin color, texture, nails, and any rashes.. Head and neck. ... . Face. ... . Mouth. ... . Lungs. ... . Heart sounds and pulses in the groin (femoral). Abdomen.. What are the 4 techniques of examination used in physical assessment?WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment.
When performing a physical examination on an infant or child what is most important for the nurse to remember?History Taking. Taking an accurate history is the single most important component of the physical examination. Practitioners obtain three different types of health histories: the complete, or initial, history; the well, interim history; and the episodic, or problem-oriented, history.
Which of the following is the best method for performing a physical examination on a toddler?When examining a toddler or any small child, the best way to perform the exam is from least to most intrusive. Starting at the head or abdomen is intrusive and should be avoided.
|