Physical Assessment and Assessment of Pain in the Pediatric Patient General Approach to Assessment Head to Toe? o Generally, don’t do – little kids do least invasive – do less invasive first then move to more invasive Obtain VS at same time? o Listen to lungs, heart, do everything all at same time Often an observation of behavior, rather than following commands Vital Signs: Respiratory Rate Obtain first and while listening to lung and heart sounds One of the more important VS in children Auscultate for one minute o Place hand on chest, listen, watch Do not use the RR on the monitor (this is unreliable is generally just an apnea alarm (20s Ø chest wall movement) highly inaccurate (snapshot) RR is higher , the younger the child o Newborns breathe about 30-60 times per minute , for example o Infants and young children have irregular breathing patterns Ø labored breathing, but breathe very quickly then slow or stop, then speed up, then slowdown – cyclic = inaccurate monitor Vital Signs: Heart Rate Auscultate apical heart rate for one full minute Can switch to radial pulse for HR at about 2 years old o Brachial (under age 2), radial (over 2) Obtain while listening to lung sounds Try to do this first The younger the child, the higher the heart rate Infants’ heart rates are 90-120 bpm , for example
Vital Signs: Blood Pressure Try to obtain while child is calm Cuff can be applied to upper or lower extremity o Avoid lower in children who are able to walk Normal SBP: 70 + (age in years x2) o 2yo x2 = 4 + 70 = 74 Be careful with wording “ Take ” your Blood Pressure implies you are going to take something away from them measure? Ensure numbers stay consistent – look at trends, not always accurate As with adults, proper size is important o Too small, false high o Too large, false low Vital Signs: Temperature measured in Celsius using a temporal thermometer o across forehead & behind ear – hold button Infants 2 months and younger will get an axillary temp with a digital thermometer o place thermometer parallel with body No rectal temps ! Don’t add a degree or subtract a degree, just report the temp and route 98.6 F = 37 C What is a fever? o 38.5 C or higher – flagged in chart (blue triangle for low temp.) Always alert nurse or instructor if altered temp. o Do we treat every fever? No. but not your call – always report! o Can children under 6 months have Ibuprofen/motrin? NO! Tx children with Tylenol ( under 6mo ) or motrin. Hypothermia?
o Acetaminophen 10-15 mg/kg/dose q4-6 hours o Ibuprofen 10 mg/kg/dose q6 hours Vitals Signs: SpO2 – O ₂ sats. Usually want kids >92%, some variation for kids with respiratory or cardiac disease (Please NOTE: it is not >95% (adults)!!) o Asthma, other dz will affect needed SpO₂ Fingers, toes, sometimes more well tolerated!
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- Spring '17