Nurs III Final
Development
CHILDREN ARE NOT SMALL ADULTS!!!
APPROACH
•Take time w/ child & family before you give meds or do any procedure
•See & talk to you so child & family can acclimate (Never “hit & run!”)
•Assess & respect cultural differences…
•Talk to child as well as parents
•Always give TLC after intervention
Physical Exam
•Always go prepared
•Have all supplies on hand
•Focused assessment
•Move quickly (borrowed time)
•Least to most invasive not necessarily head to toe
Hold and Comfort the Infant
Toddlers, Preschoolers like to imitate, help
Explain what you are doing to school aged
kids
Selected BP Sites
Pain Scale (FACES)
Infants height‐ head to toe
NEVER take your hand off an
infant/toddler! Head circumference until 36
months!!
Older children stand‐ height
Measuring weight
The “Growth Chart”
•Wt and ht are plotted
•Values compare child’s growth relative to others of the same age
•Range= 5th to 95th percentile
Page 1 of
,Nurs III Final
Beginning the Exam • General Appearance
Page 2 of
,Nurs III Final
•Skin •General Appearance
•Hair, Nails •HEENT
•Equipment •Breath sounds/Heart tones
•Caregivers present ?? •Bowel sounds/Abd exam
•Peripheral pulses
Quick Exam •Anything attached?
Infants‐ anterior fontanel closed at (18mos)
Ear Differences
•Child with normal ear anatomy
•Child with low‐set ears (common w many genetic d/o)
When performing an ear exam……
•Pinna down and back if under age 3
•Pinna up and back if over age 3
Dental Issues
•During school‐aged years, children begin to lose their ‘baby’ teeth; remember that when assessing your 5‐12 year olds
Open Wide and Say AAAHH!!!
•Open up wide like an alligator
•And blow out the candle when you’re done!
•(Make everything a game and it will be more fun for both of you!)
Physical Chest Deformities
•Pectus excavatum (funnel chest)
Common Sites of Retractions
•If a child has respiratory distress, these are common sites of
retractions Pediatric Heart
•Location of the heart in the child
•PMI can be between 3rd‐5th ICS at Left MCL (infant‐school)
Abdomen‐ Umbilical Hernia
Newborn Assessment‐Descended?
Page 3 of
, Nurs III Final
Tanner Staging‐ Puberty
Guidelines for Exam
Erikson: Psychosocial Development
• Trust vs. Mistrust (Birth‐ 1 yr) Establish trust in care providers; mistrust if needs inconsistently, inadequately met
• Autonomy vs. Shame and Doubt (1‐3yrs) Inc. self control, symbolizes autonomy through control of bodily secretions, says “no”
often. If successful, develops autonomy and willpower; if criticized or unsuccessful, develops shame and doubt in own abilities
• Initiative vs. Guilt (3‐6yrs) Initiative shown when child formulates and carries out a plan of action; develops
conscience; successful‐ dev. direction and purpose, if not‐ leads to feelings of guilt and lack of purpose
• Industry vs. Inferiority (6‐12yrs) Learns to follow rules, if successful‐ dev. confidence, enjoys learning about new things;
if compared to others may dev. feelings of inadequacy, inferiority if too much is expected
Piaget: Cognitive Development
• Sensorimotor (Birth‐2 years) Reflexes, repetitive, imitative behaviors; cause and effect; language helps child better
understand world; learn through curiosity, exploration, experimentation; object permanence
Page 4 of
Development
CHILDREN ARE NOT SMALL ADULTS!!!
APPROACH
•Take time w/ child & family before you give meds or do any procedure
•See & talk to you so child & family can acclimate (Never “hit & run!”)
•Assess & respect cultural differences…
•Talk to child as well as parents
•Always give TLC after intervention
Physical Exam
•Always go prepared
•Have all supplies on hand
•Focused assessment
•Move quickly (borrowed time)
•Least to most invasive not necessarily head to toe
Hold and Comfort the Infant
Toddlers, Preschoolers like to imitate, help
Explain what you are doing to school aged
kids
Selected BP Sites
Pain Scale (FACES)
Infants height‐ head to toe
NEVER take your hand off an
infant/toddler! Head circumference until 36
months!!
Older children stand‐ height
Measuring weight
The “Growth Chart”
•Wt and ht are plotted
•Values compare child’s growth relative to others of the same age
•Range= 5th to 95th percentile
Page 1 of
,Nurs III Final
Beginning the Exam • General Appearance
Page 2 of
,Nurs III Final
•Skin •General Appearance
•Hair, Nails •HEENT
•Equipment •Breath sounds/Heart tones
•Caregivers present ?? •Bowel sounds/Abd exam
•Peripheral pulses
Quick Exam •Anything attached?
Infants‐ anterior fontanel closed at (18mos)
Ear Differences
•Child with normal ear anatomy
•Child with low‐set ears (common w many genetic d/o)
When performing an ear exam……
•Pinna down and back if under age 3
•Pinna up and back if over age 3
Dental Issues
•During school‐aged years, children begin to lose their ‘baby’ teeth; remember that when assessing your 5‐12 year olds
Open Wide and Say AAAHH!!!
•Open up wide like an alligator
•And blow out the candle when you’re done!
•(Make everything a game and it will be more fun for both of you!)
Physical Chest Deformities
•Pectus excavatum (funnel chest)
Common Sites of Retractions
•If a child has respiratory distress, these are common sites of
retractions Pediatric Heart
•Location of the heart in the child
•PMI can be between 3rd‐5th ICS at Left MCL (infant‐school)
Abdomen‐ Umbilical Hernia
Newborn Assessment‐Descended?
Page 3 of
, Nurs III Final
Tanner Staging‐ Puberty
Guidelines for Exam
Erikson: Psychosocial Development
• Trust vs. Mistrust (Birth‐ 1 yr) Establish trust in care providers; mistrust if needs inconsistently, inadequately met
• Autonomy vs. Shame and Doubt (1‐3yrs) Inc. self control, symbolizes autonomy through control of bodily secretions, says “no”
often. If successful, develops autonomy and willpower; if criticized or unsuccessful, develops shame and doubt in own abilities
• Initiative vs. Guilt (3‐6yrs) Initiative shown when child formulates and carries out a plan of action; develops
conscience; successful‐ dev. direction and purpose, if not‐ leads to feelings of guilt and lack of purpose
• Industry vs. Inferiority (6‐12yrs) Learns to follow rules, if successful‐ dev. confidence, enjoys learning about new things;
if compared to others may dev. feelings of inadequacy, inferiority if too much is expected
Piaget: Cognitive Development
• Sensorimotor (Birth‐2 years) Reflexes, repetitive, imitative behaviors; cause and effect; language helps child better
understand world; learn through curiosity, exploration, experimentation; object permanence
Page 4 of
