Back & Spine: dimples or tufts of hair, posture, alignment, toddlers bowed back (beer belly appearance)GI: auscultate BS, gently palpate, last BM, consistency, normal diet, drink?GU: diapered children,- must do GU & assess skin, q 4 hrs, diaper wt, record stool color, size, consistency, urine color NOT CLARITYPotty trained: explain safety, modesty, do w/ parent in room, may be able to defer on subsequent exams if no GU/perineal complaints MSK: range of motionCast: ca[ refill, movement, circulation 5 P’s, pulse, pallor, paresthesia, pain
Wounds: color, drainage, approximated, dressing (how often change), periwound area (dry/moist)Skin: turgor (abdomen- newborn-8 yrs, clavicle- 8 & up) report bruising, Mongolian spots okay, diaper rash, bony prominencesMed admin: immature liver & kidney, higher risk for med errors due to diff dosages for each pt wt, different concentrationof meds, suppository admin- cut in half lengthwisePO: no regular spoons, measuring spoon, not in foodIV: head on infant, hand, scalp, feet, use protective equipment to guard IV, must be removable to access site, arm boards, tape Central Line: port a cath (removable), broviac (central linechest), PICC linesIM inj: vastus lateralis, site based on childs size ½ ml or less, limit vol injected in one site, school age- deltoid, may be able to give choiceSyringe: in the check, shake med 1stComfort Hold: parents hold, swaddle infants, restrain Pain: parental input is necessary- they know norm, want 3/10 or less, document pain number & scale usedCRIES: crying, requires O2, increased VS, expression, sleeplessness (32 wks to 6 mo)OPS: observational pain scale, infants to preschoolers & non communicative/developed pts, sedatedFLACC: observation, faces, legs, activity, cry, consolability, 2 mo – 7 yrs, non communicative ptsOucher: child points to face 3-13 yrsFaces: cartoon faces, 3yrs & up Numeric: 0-10 self report, 5 yrs & up, must have a good understanding of numbers Chronic Pain: with cancer, sickle cell, require higher dose of pain med due to CNS sensitization, symptoms may be less severe or not present at all (no elevation in HR or BP) treat whatever pain they say they haveAnalgesic Options: non pharmalogical interventions, oral OTC, IM/IV prescription analgesics, oral controlled substances, IV/IM controlled substances Growth & DevelopmentCephalocaudal: grow head to tail, motor, physical*1styear- most growth, 3x wt, double wt in first 6 mo, length increases 50% in first yearProximodistal: from center to limbs, milestones occur faster with femalesInfants: hold head up, roll, crawl, walk, birth to 1 yrToddlers: 1-3 yrsPreschool: 3-5 yrsSchool age: 6-11 yrsAdolescence: 12-21 yrsErikson’s StagesTrust vs Mistrust: birth to 1 yr, trust is faith & optimism, kids smile & reach out, mistrust- basic needs aren’t met Autonomy vs Shame: 1-3 yrs, autonomy is learning to control self & emotions, rituals promote routine, do things for themselves, shame- choices are disastrousInitative vs Guilt: 3-6 yrs, initiative is developing a direction, purpose, conscious, exploring, guilt- interest conflict with parents ideas, gets in trouble
You've reached the end of your free preview.
Want to read all 11 pages?
- Spring '17
- cough, fine motor skills, yrs, 1-3 yrs