Pediatric+Assessment

Pediatrics Overview Today pediatric nursing focuses on preventing acute and chronic illnesses while promoting normal growth and development…
 * Pediatric Nursing Overview: **

•Immigration •Poverty •Homelessness •Migrant farm workers •Violence
 * Societal trends: **

•Lower IQ’s •Lower income •Malnourishment •Growth and development can be delayed •Emotional and behavioral problems
 * Resulting in: **

•Infant mortality <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Child mortality <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Access to health care - PCMH
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Current Initiatives: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Family-centered care <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Atraumatic care
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pediatric care involves: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Advocate (first and foremost) <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Caregiver <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Educator <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Researcher <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Manager <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Leader
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pediatric nurse is: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Children in in-patient facilities more acute illnesses <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Short length of stay in facility <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Increased incidence of chronic illness <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Constraints on delivery of care <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">•Advances in technology
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Challenges: **

<span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 240%;">Legal Considerations for Pediatric Care <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Check individual state laws <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Informed consent for minors, exceptions: <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Emancipated minors <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;"> Pregnancy, STDs, substance abuse <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">State may take custody if guardian refuses care for child <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Divorce <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Organ donation <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Genetic testing <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Research

<span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 180%;">Consents: <span style="color: #ca2121; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Informed Consent: <span style="color: #404040; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Must be obtained from a parent or legal guardian <span style="color: #404040; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Must be over 18 or emancipated <span style="color: #404040; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Must receive information with which to make a informed consent <span style="color: #404040; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Must be voluntary, no coercion

<span style="color: #ca2121; font-family: 'Times New Roman',Times,serif; font-size: 22px;">Assent <span style="color: #404040; font-family: 'Times New Roman',Times,serif; font-size: 17px;"> should be obtained <span style="color: #404040; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Not a legal requirement, an ethical one

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">Written consents you will see... <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">HIPAA <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px; line-height: 27px;">General hospital consents <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Consent to treatment <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lewis Blackmon

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Lewis Blackman consent: media type="youtube" key="WElE_hRucpo" height="315" width="560"

<span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 240%;">Confidentiality <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">***When can a health care provider breach confidentiality?** <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">1. Mandatory child abuse reporting <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">2. Mandatory injury from gun, knife, criminal act; public health concerns - STDs, TB, HIV, hepatitis, poisonings <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">3. Duty to warn 3rd parties (psychiatrist); failure to warn <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">4. Ability to detect risks through genetic testing

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">2003 - Health Insurance Portability and Accountability Act <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Prevent unauthorized access or disclosure media type="youtube" key="5UNnsLvZ_Hc" height="408" width="546" <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Negligence – Owes duty to another, failure to fulfill duty causes harm <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Malpractice – Professional negligence, must be damages and harm <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%; line-height: 1.5;">Duty – Care for patient during required time <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Breach of Duty – Nurse fails to meet the standard of care <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Causation – Injury result of the breach in standard of care <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Damages - Unless there is damage when the mistake is made, there is no malpractice <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nurse Practice Act – Scope of nursing practice, defines illegal and unprofessional conduct, state specific – state board of licensing <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Autonomy - freedom to make own decisions based on informed consent <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Beneficence - 'to do good' <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Nonmaleficence - 'first, do no harm' <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Justice - fair and equitable care <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Veracity - clear open communication <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Fidelity - keeping one's word
 * <span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 240%;">HIPAA **
 * <span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 240%;">Nursing Ethical and Legal Terms **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Obtain all information <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Define ethical dilemma <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Determine stakesholders and values <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Generate alternatives, weight options <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Make decision, carry it out <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Assess the outcomes <span style="font-family: 'Times New Roman',Times,serif; font-size: 18px;">Examples: newborns on edge of viability, DNR orders, withdrawing treatment, prenatal genetic testing, newborn screening, immunizations, palliative care, organ donations, research.
 * <span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 240%;">Ethical Decision Making Process **
 * Ethics Councils
 * Parents may ask...What would you do if this were your child? Reassure parents it is their decision based on the knowledge of their child and what they believe to be in the best interest of their child and family.**

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Ethics - guide conduct <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Bioethics - ethics in healthcare providers <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Morals - based on personal values, spiritual or religious beliefs <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Professional Code of Ethics <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Assent <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Confidentiality <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">HIPAA <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Withholding or terminating life support <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Genetic testing <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Organ donation/transplantation <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">NB screening <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Religious preferences and immunizations <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Children in research <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Ethics Councils
 * <span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 240%; line-height: 1.5;">Ethical Considerations for Pediatric Care **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Guidance for Ethics provided by the
 * <span style="color: #d33636; font-family: 'Times New Roman',Times,serif; font-size: 20px;">American Nurses Association - Code of Ethics for Nurses: **
 * [] **


 * <span style="color: #008000; font-family: 'Times New Roman',Times,serif; font-size: 240%;">Cultural Considerations for Pediatric Care: **
 * <span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 220%;">Culture – ****<span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 140%;">“A pattern of assumptions, beliefs, and practices that unconsciously frames or guides the outlook and decisions of a group of people…” **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Differs from race and ethnicity <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Culturally prescribed patterns of behavior for persons in a variety of social positions

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Primary – intimate <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Secondary – limited
 * <span style="color: #d42121; font-family: 'Times New Roman',Times,serif; font-size: 180%;">Social groups - **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Bi-Cultural <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Minority - more at risk
 * <span style="color: #d42121; font-family: 'Times New Roman',Times,serif; font-size: 180%;">Sub cultures in America: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Confusion, food, language <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Customs - <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Religious activities, folk medicine <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Misunderstanding <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Coining <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Cupping <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Green tomatoes <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Placenta
 * <span style="color: #d42121; font-family: 'Times New Roman',Times,serif; font-size: 180%;">Culture shock – **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Heredity/Genetic considerations – <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Susceptibility <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Excellent family medicine article on cultural medicine addresses coining, cupping, and other terms and treatments
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">http://www.aafp.org/afp/2005/1201/p2267.html **


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">http://childabuse.stanford.edu/faq.html **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Observe and respect <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Question and accommodate <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Golden Rule <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> *Need to be aware of own cultural values and spiritual beliefs* <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Watch personal judgements!!!
 * <span style="color: #1fc118; font-family: 'Times New Roman',Times,serif; font-size: 180%;">How can you be culturally competent? **

<span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Pediatric Assessment


 * <span style="color: #260001; font-family: 'Times New Roman',Times,serif; font-size: 17px;">//~ "When I think about all the patients and their loved ones that I have worked with over the years, I know most of them don't remember me nor I them. But I do know that I gave a little piece of myself to each of them and they to me and those threads make up the beautiful tapestry in my mind that is my career in nursing."// **


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">//Donna Wilk Cardillo reflected in A Daybook for beginning Nurses// **




 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">// clients will change, // **
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">//locations will change// **
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">//diagnoses will change// **
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">//what will not change is the public's view of your responsibility and the trust you will incur simply by your profession.// **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">The biggest difference between medical surgical nursing and peds is the age and developmental stage of the patient. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Also, you are not simply dealing with the patient but also with the family. <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">Dynamics which may affect the patient include the age, diagnosis, family situation, culture, gender, religion.


 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 140%;">// *Your assessment is the most important skill you have, use it! Think through the nursing process with the information that you have …it's like CSI…only better.* // **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">A head to toe assessment is needed in the hospital. This usually will be performed on admission and once a shift, every 12 hours, every 8 hours or every four hours, depending on the patient and their stability. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> If the patient is brittle or postsurgical assessments are being completed in recovery they are performed every 5-15 minutes. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Once on the floor, immediate assessments may be every every 30 then every hour and then progress to every 4 hours.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">But first things first...is the patient stable?

<span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 230%;">Assessment Triangle:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">This first video introduces the assessment triangle. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">This type of assessment is usually //performed quickly in an outpatient setting or ER.// <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">In addition to these quick assessments a detailed history is obtained. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">The assessment triangle is used to quickly assess the needs of the patient. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Do they need O2, should they be seen first? Are they critical or stable, sick or not sick. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">The triangle assesses the child's appearance, work of breathing and circulation. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">It is non-invasive, non-threatening, quick and easy.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Acronym TICLS to assess <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">tone, interactiveness, consolability, look/gaze and speech/cry. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Breathing is assessed. Note the rate, the work involved ... retractions, nasal flaring, the child's position...tripoding, and the child's anxiety. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Circulation** is assessed. What is the child's color? Are they pale, mottled, ashen. Is there any cyanosis? How about capillary refill?
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Appearance **

===<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 140%;">//***A more detailed assessment is performed after the initial assessment triangle is completed and the patient is stabilized.***// ===

<span style="font-family: 'Times New Roman',Times,serif;">media type="youtube" key="ssqwGjwSI_8?version=3" height="481" width="588"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Infants are assessed using <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">FLACC, children are asessed using <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">FACE and older children and adults are assessed using <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">NUMBER. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">All these are rated using <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">1-10 with zero being no pain and ten being excruciating. <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">Remember pain is what the patient says it is.
 * <span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 230%;">*Pain is also assessed with all patients per JACHO standards.* **



<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 170%;">***This is an example of a Face pain rating scale. Be aware that it can be based 0-5 or 0-10. The principle is the same. Most are based on the 0-10 scale as are the others.**




 * <span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 230%;">In hospital health assessment: **
 * <span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 170%;">Begin with Health History Interview: **


 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Introduction – **<span style="font-family: 'Times New Roman',Times,serif; font-size: 14pt;"> Introduce yourself, state your title, where you are from, the purpose of the interview and approximately how long it will take.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Name/DOB/allergies/medications <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">What brings you here today? Chief complaint? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> When did it begin? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Where the symptoms are? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> How long do they last? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> Note characteristics of the symptoms. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"> What makes the symptoms better? Worse? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Are there accompanying symptoms? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Has self-treatment been tried? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pain? where, when, how long, constant, intermittent, relief? 5th vital sign <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Sleep - Is the patient resting well? What are their current sleep patterns like? Do they nap? How about caffeine ingestion? <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Nutrition – Ask the patient about their nutrition and diet. Are there any food allergies or intolerances? Appetite? Note BMI
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Discussion **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;"><span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 120%;">**Summary** – recaps the patient’s history and clarifies data received. It briefly retells what the nurse understands.


 * <span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 130%;">*The introduction, discussion and summary gives the nurse much needed information; while performing this history you are assessing their overall appearance and noting the patient's level of consciousness. Are they oriented to person, place and time? **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Vital signs <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Clean, well-rested, and talkative? Or disheveled, inattentive, and lethargic? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Note body movements, emotions, temperament, speech patterns and behavior <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Observe for muscle tension, perspiration, or tremors <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Alterations in some vital signs can influence other vital signs. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">For example, an increased temperature can cause an increase in respiratory rate and heart rate. Pain can increase blood pressure.
 * <span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 200%;">Physical assessment: **
 * <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Overall Appearance **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Next begin to review each system: <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 150%;">*While completing the physical assessment the nurse uses her skills of inspection, palpation, percussion and auscultation. If pain is a symptom, palpation of the involved area is last!

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Skin, hair, nails – <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Skin integrity, breakdown, rashes, tears, bruises, birth marks, scars, moles, acne, discolorations, tatoos, texture and turgor <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Incision and dressing for drainage <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">IV site for swelling or redness. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Hair for cleanliness, parasites, dryness or brittleness <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nail beds for integrity, cleanliness, or habitual nail biting

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Head and neck – <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Symmetry <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">ROM, movement <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Tenderness, redness, swelling? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Palpate thyroid and lymph nodes <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ask, any headaches or dizziness?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Nose, paranasal sinuses, sinuses, mouth – <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Oral, nasal facial symmetry <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Nares for patency and color. Discharge? Color and amount? Odor? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Color, symmetry, moisture and texture of the lips. Moist, cracked, dry? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Gums, tongue, and throat for color, bleeding, or exudate. Oral hygiene. Oral lesions? Sore throat?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Ears and auditory system – <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Alignment, position, placement on head, <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ear size, shape, symmetry, intactness, tags <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">External meatus for discharge or lesions. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pull down and back under 3, Up and back over 3, to visualize the tempanic membrane <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Responses to questions, can they hear without difficulty? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Any difficulties with ears? Tinnitus? Any ear pain?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Eyes and visual system – <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Eyebrows, symmetry and hair distribution. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Eyelids, eyelashes, and blinking; <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Globe position in the socket. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Color of the eye, the color of the conjunctiva <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Lacrimal puncta for color, moisture or discharge. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Redness or crustiness need to be noted as such. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">PERRLA - Pupils should be equal, round, reactive to light and accommodation. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Difficulties with their vision? Do they see spots, wear glasses or contacts?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Lungs and respiratory system – <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Posture, appearance, effort, and positioning. Even and unlabored? Tripoding? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Shape, muscle development and symmetry of the chest. Anterior to posterior diameter, transverse diameter <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Respiratory rate and quality, retractions, nasal flaring, O2 SAT <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Auscultate breath sounds, wheezing, stridor, rhonchi <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">SOB or coughing. Is there any history of reactive airway disease or asthma?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Heart and peripheral vascular system – <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Appearance <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Position <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Skin color? pale, cyanotic... <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Breathing effort. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Blood pressure <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Jugular vein for pulsations, lifts, or heaves. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Auscultate S1 and S2 heart sounds for rate, rhythm, pitch, or splitting. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pulses for rate, rhythm, amplitude and contour. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chest pain or palpitations?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Abdomen - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Tone, soft, hard, guarding the abdomen or are the legs drawn up in pain? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Bowel sounds? X4? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Incisions or dressings? Edges approximated? With steri strips? staples? sutures? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Drainage? color? amount? Dressing? Outline the drainage with a pen - date, time, initial - to see if the area enlarges.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Musculoskeletal - Extremities - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%; line-height: 24px;">What is the tone of the muscles? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%; line-height: 24px;">Are the reflexes normal? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%; line-height: 24px;">Are the extremities normal color? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%; line-height: 24px;">Is the skin well hydrated? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%; line-height: 24px;">What is the capillary refill of the toenail beds? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%; line-height: 24px;">Are the pedal pulses palpable?

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Neurological - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cognizant of the day and time? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">What is their level of consciousness? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Can they move and respond appropriately? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">PERRLA, Headache, blurred vision, photophobia

<span style="font-family: 'Times New Roman',Times,serif; font-size: 180%;">Rectum/Genitalia - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Preserve modesty. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Assessed only if problem with parent, guardian or chaperone. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Remind the child that this area is private. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">This area can be assessed for rashes, sores, or discharges.

<span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 220%;">A pediatric hospital assessment <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">media type="youtube" key="iRpt7eUZM0Y" height="377" width="672"

Diet - type and amount consumed. Was it tolerated? Safety measures - call light proximity, clutter free floor, adequate lighting, age appropriate toys Pain level - Pain is often called the fifth vital sign. Noting the pain level with an appropriate tool is a JACHO standard. <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Incision: Are the edges approximated? Were sutures, staples or steri strips used? Is there redness, drainage? <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Dressing: Is the dressing dry and intact? If there is drainage present is it new? Grossly bloody or serous fluid? <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Drains: Is there a drain in place? Is there drainage? Note the amount and color. <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Intake: Intake can come from many sources. Be sure and note the source, amount and how it is tolerated.
 * <span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 18pt;">For documentation purposes note: **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Calculate the weight of a child in kilograms: __<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Weight of child in pounds __<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">= Weight in kilograms example: 24 lb child = 10.91 kg <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Divided by 2.2 pounds/kg 2.2 lb/kg

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Diet <span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Infants require 100 calories per kilogram of body weight (Adults 30-40) <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Oral <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">G Tube <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">IV fluids <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">TPN
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Intake: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">**Output:** Output can also occur in various forms. Be careful to note all output **<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">. **

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Bladder capacity in ounces = child’s age +2, Example - 3 year old has the capacity of 5 ounces.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Calculating output for infants = 1 - 2 ml/kg/hour, ex. 5kg infant has 5 - 10 ml. urine per hour.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">1 gram weight diaper weight = 1 ml of urine

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Urine <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Emesis <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Stool <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Blood

<span style="color: #43d331; font-family: 'Times New Roman',Times,serif; font-size: 180%;">*Pediatric drop factor for IV is 60

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Newborn Assessment:

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px; line-height: 0px; overflow: hidden;">media type="youtube" key="4Lvv0YQ4CmI" width="616" height="346"

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Pediatric Data Base and Concept Map is available for download and copying under the heading Pediatric Clinical.

<span style="color: #09ab36; font-family: 'Times New Roman',Times,serif; font-size: 160%;">Family Teaching/Education <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Often in the outpatient and ambulatory care system and later before discharge in an acute care setting, children are sent home with illnesses to recuperate. Parental teaching is vital to guide these parents as they care for their child so teaching is crucial. Remember to provide clear, simple explanations, have the patients acknowledge their understanding and ask the patient or caregiver to repeat back the instructions. //Then document, patient acknowledged understanding and returned demonstration. If this is not done you cannot be reimbursed for this effort!//

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Daycare centers sick policies, where food is prepared, ratio of children to daycare workers. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Immunizations questions welcomed and answered. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Medications, comfort measures, therapies <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Sick child care <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Discharge instructions <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">How do I know if they are not getting better? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">When can they return to school or daycare?
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Family teaching topics often discussed: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Illness information <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">How long illness may last <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">How long they will be contagious <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Signs and symptoms of worsening illness – spell it out! <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Who to call, what to do and where to go if the child gets worse
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Educate: use of medications, comfort measures and when to call the doctor. **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Tylenol - analgesic, antipyretic; may be in cold meds, helps with headaches, malaise, sore throat, muscular aches,pain <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Ibuprophen (also known as Motrin, Advil) takes care of these symptoms and relieves inflammation as well. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Benadryl or Atarax for itching <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Beware of aspirin products and derivatives <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Do not assume that parents know the differences between medications or what is in a cold and flu OTC medication
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Common OTC Medications: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Handwashing! Cover your cough! No kissing! <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Popsicles, gatorade, pedialyte, ice chips, suckers for sore throats (Boo-Boo pops) and dehydration, cool or warm compresses <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pruritic lesions (chicken pox) can be soothed with baking soda or oatmeal added to baths. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Calamine can be applied topically to dry the lesions <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Scratching needs to be discouraged, pat. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Aquaphor for eczema <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Fingernails should be kept short and clean. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Cool the burn, but no ice! Blisters are the body’s Band-Aid. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">ORT, clear liquids <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor for output, sunken eyes <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor symptoms, record occurrences, diary <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Diet – increase fiber, fluid <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Baths, barrier cremes <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Humidifiers <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Place child in the bathroom with mist from the shower, cold night air. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor how hard they are breathing, are they making sounds? <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Monitor color <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Headaches/ joint aches – Dim lights, decrease sound and visitors, warm baths, ice or warm compresses, monitor for fever, nuchal rigidity <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Injuries – 5 P’s, monitor pain, swelling, color, RICE, Ibuprophen
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Comfort Measures/Teaching tips: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Integumentary: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">GI bugs: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">GU: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Respiratory illnesses: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Neuro: **
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Musculoskeletal: **

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Dehydration - dry mouth, low output (not going to the bathroom, decrease in wet diapers), sunken fontaneles or eyes. <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Worsening condition - spell it out <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Difficulty breathing, color off <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Change in LOC: unrousable, lethargic...
 * <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">When to call the doctor: **

//<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">*Some diseases are reportable by law to local and state health departments, who then report them to the CDC. The CDC monitors disease trends and the effectiveness of intervention //

<span style="color: #df3a3a; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">References: <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Hockenberry, M. J., & Wilson, D. (2009). Wong's essentials of pediatric nursing (8th ed.). St. Louis, MO: Mosby Elsevier.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their families (3rd ed.). New York, NY: Delmar Cengage Learning.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Videos located at: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Lewis Blackman <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/WElE_hRucpo

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px; line-height: 25px;">HIPAA <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/5UNnsLvZ_Hc

<span style="color: #df3a3a; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Hockenberry, M. J., & Wilson, D. (2009). Wong's essentials of pediatric nursing (8th ed.). St. Louis, MO: Mosby Elsevier.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their families (3rd ed.). New York, NY: Delmar Cengage Learning.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 130%;">Videos located at: <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pediatric assessment triangle located at <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/ssqwGjwSI_8

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Pediatric Assessment - <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/iRpt7eUZM0Y

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Newborn Assessment

https://youtu.be/4Lvv0YQ4CmI