Pediatric Assessment Survival
Pediatric assessments are very important nursing skills that students will acquire during clinicals. Children are not just small adults, therefore assessments and treatment should be different from adults. There should be a concise but comprehensive approach to health assessment for the pediatric client. Clinical instructors usually want students to obtain a general description of history, the know how to approach children at various ages, nutritional assessment, measurement and evaluation of vital signs. Emphasis is on “how to” information, including how and what to assess in each body system. Psychosocial, anatomical, and physiological development variations are incorporated as appropriate, as well as normal and abnormal findings. Given the extensive information provided, this reference is ideal for nursing students that need a quick review on pediatric assessments.
Erikson’s Eight Stages of Development is the first thing nursing students learn about before starting pediatric clinicals. In order to communicate well with pediatric patients, nurses have to know what developmental stage the child is in.
1. Trust v/s Mistrust Birth to 12 months
2. Autonomy v/s Shame & Doubt 18 months to 3 yrs.
3. Initiative v/s Guilt 3 to 6 years
4. Industry v/s Inferiority 6 to 12 years
5. Identity v/s Role confusion 12 to 18 years
6. Intimacy v/s Isolation 19 to 40 years
7. Generativity v/s Stagnation 40 to 65 years
8. Egointegrity v/s Despair 65 to Death
Before you perform a pediatric assessment, look. If the parent holds the child, sit or stand several feet away and observe the child’s behavior and appearance. A healthy child will have normal muscular tone, her skin will have a healthy hue, she won’t have any respiratory distress, and she’ll be interested in what’s going on around her. You will be able to determine several neurological and skin assessments while observing.
Talk as you watch the child, ask her parents about her history. Begin with simple questions for example, “What brought you here today?” Work your way up to more complex or sensitive questions. Do the same thing when you interview school-age children and teenagers. After performing your initial observation, direct questions to the child, beginning with less threatening or impersonal questions to establish trust and rapport. Ask about school, movies, or hobbies that might interest them. Teenage patients will appreciate privacy and confidentiality; you can have their parents leave when you ask about drugs, alcohol use or sexual activity.
Try to be as nonthreatening as you can while performing a physical examination. Move slowly towards the patient and make no sudden movements. If your clnicals are at a hospital, the patient is most likely used to being touched so it will be easier for a student to perform an assessment. Always explain any assessment or procedure that you are doing before starting. Infants and toddlers may not understand your words, but they’ll respond to a gentle, soothing voice. Tell adolescents, school-age, and preschool children what they’ll see, hear, and feel. For teenagers and school-age children, respect their modesty by covering as much of their body as possible until you need to assess that area. Make sure you draw the curtain or close the door for privacy. Infants and very young children might not be modest, but they’re more prone to hypothermia if they’re left uncovered.
As soon as you complete the examination, reassure the child that it’s over and return her to her parents for comfort. Pediatric assessments can cause nursing students anxiety and children pick up on this. Try to take a deep breath and complete the assessment accurately so you can receive your passing grade and move on to the next clinical rotation.
Erik Erikson’s 8 Stages of Psychosocial Development. (2010). Summary Chart. Retrieved from: http://web.cortland.edu/andersmd/erik/sum.html