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Frequently Asked Questions
As a student nurse, you are admitting a 4-year-old girl to the pediatric unit
following a Pemberton osteotomy (hip surgery). She has come from the recovery
room and is very drowsy. The nurse you are working with has requested that you be
sure to get a good nutritional assessment. Why is it so important to obtain a
nutritional assessment for this child who was admitted for an orthopedic condition,
not for a nutritional concern?
Good nutrition is essential for all children’s heath and well-being. It is especially critical
for disease prevention and promotion of bone and muscle healing. This child will need
adequate amounts of protein, vitamins, and minerals to promote healing following this
orthopedic procedure. Completing the nutritional assessment will enable you and your
nurse to identify whether or not your client has a nutritional risk (poor muscle tone, poor
skin tone, underweight, small size for age, and etc.) and then to provide anticipatory
guidance. To perform a nutritional assessment, you will need to have a history of her
dietary intake over a few days’ time, including information on how much milk she has
consumed, how much fluid she drinks, whether she eats a variety of foods from all the
food groups, whether the family eats together, whether she eats healthy snacks, and so on.
Additional information (weight, height, lab values) will also be helpful to determine if a
nutritional risk exists.
You are the nurse admitting Roberto, 5 years old, to the unit with a diagnosis of rule
out cystic fibrosis. Roberto has just recently come to your state from Mexico. He
and his parents speak English well. Roberto has been attending preschool for the
past 3 months, but has missed about 2 to 3 days a week because of respiratory
complaints (e.g., coughing, increased mucus production). Roberto has never been to
a physician and has not been in a hospital before. He is very small for his age, and
his chest appears somewhat barrel-like. What is the best approach to completing
Roberto’s assessment?
Techniques for approaching children to complete an assessment vary according to age
and development. The first step is to build a trusting relationship. Be sure to call Roberto
by name and introduce yourself to both him and his parents. Explain what you are going
to do. Roberto may feel more comfortable with his mother or father sitting next to him.
Collect information from Roberto and his parents (parents are usually the experts
regarding their children and their children’s complaints). Begin your assessment with
less-invasive techniques. Allow Roberto to touch the equipment, even to listen to his or
your heart. Using transition objects may also be helpful. Take the time to teach as you
complete the assessment, explaining as you go along and answering questions as they
come up.
As a nurse working in a family clinic, you perform a developmental assessment as
part of the intake process. What is the purpose of doing a developmental
assessment, and what role should you assume after collecting this data?
An essential component of a health assessment is the evaluation of developmental
accomplishments and function. This assessment provides you with data that identifies
normal or delayed development, assists in early detection of problems, provides an
opportunity for parents to ask questions or to express concerns, and promotes an
environment that allows you to provide anticipatory guidance and teaching.
Serena is a 7-month-old seen in your family clinic for the first time since her birth.
As part of her health assessment, you complete a Carey-Revised Infant test. Upon
completion of this tool, you become concerned about her lack of interest in brightly
colored objects. She doesn’t reach for the rattle, and she is having difficulty sitting
up unsupported. You communicate this to the primary health care provider and go
into another room. Later you follow up with the provider who reports that Serena is
developmentally normal. What factors could lead to invalid results from your
developmental screening tool?
Various factors may affect an infant or child’s performance on developmental screening
tests. Some of these factors include lack of sleep, fear, and current illness, or disabilities
such as blindness or deafness. Serena might have been sleepy or suffering from an otitis
media infection. Other considerations to note include cultural differences or prematurity
issues.
Mrs. Johnson has brought 6-year-old Steven in to the nurse practitioner because his
teacher has noticed that he doesn’t respond when asked questions and he often
seems to be daydreaming while other children are participating in group activities.
You have been asked to perform an examination of his cranial nerves. What
adaptations will you need to consider when performing this examination?
Most of the time, testing of preschool-age children is similar to that of older children and
adults. Occasionally they present a challenge because they often cannot follow directions
or are unwilling to cooperate. To test CN I (olfactory), use common smells such as
peanut butter and chocolate. To test CN III, IV, and VI, move a brightly colored toy
along the line of vision. Note how well the child follows the item and the child’s
papillary responses. It is still somewhat difficult to evaluate sensory responses to light
and sharp touch. Evaluating cranial nerve function may be more easily accomplished
after establishing a trusting relationship.
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