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Chapter 29
Communication, History,
Physical, and Developmental
Assessment
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Guidelines for Communication
and Interviewing
Establishing a setting of
of privacy and confidentiality
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Communicating with Families
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Communication with parents
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Encouraging the parent to talk
 Directing the focus
 Listening and cultural awareness
 Using silence
 Being empathetic
 Providing anticipatory guidance
 Avoiding blocks to communication
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Communicating with children should be
adapted to development level
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Infants…… Cry or bear down
Toddler….No NO NO play play play
PreSchooler “Whats THAT” show & play with
equipment
School age “Wait Wait I'm not ready” education
Adolescence direct ? to them instead of parent
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Fig. 34-3. A young child may take the expression “a little stick in the arm” literally.
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Communicating with Families
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Communication techniques
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Conventional interview methods
 Open-ended questions
 Word games
 Nonverbal techniques
 Draw a picture
 Play
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History Taking
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Performing health history NeerPerfect
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Identifying information
Chief complaint
Present illness
History
• Birth and dietary
• Previous illness, injuries, and operations
• Allergies
• Medications and immunizations
• Growth and development
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History Taking
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Performing health history
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Sexual history
Family medical history
Geographic location
Family structure
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Assessment
Composition
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History Taking
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Psychosocial history
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School adjustment
Unusual habits
Family and home environment
Review of systems
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Specific and thorough review of each body system
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Nutritional Assessment
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Dietary intake
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Clinical examination
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24-hour recall
Hair, skin, mouth, eyes
Evaluation of nutritional assessment
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Malnourished
At risk
Well nourished
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General Approaches Toward
Examining the Child
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Head-to-toe sequence for adult
Pediatric assessments age and
developmentally appropriate
 BE CREATIVE
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Goals of Pediatric Assessment
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Minimize stress and anxiety associated with
assessment of various body parts
Foster trusting nurse-child-parent
relationships
Allow for maximum preparation of child
Preserve security of parent-child relationship
Maximize accuracy of assessment findings
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Doorway Assessment
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General appearance color,
work of breathing
Skin
Hair, nails, hygiene
Position & Activity
Head and neck
Eyes, ears, nose,
Toys in room
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Tips Pediatric Assessment
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Initially use minimal physically contactMinimize stress and
anxiety
 Foster trusting nurse-child-parent
 Allow for maximum preparation of child
 Preserve parent-child relationship
 Child’s perception of painful procedures
 Cooperation usually best with parent’s
 Age-appropriate techniques
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Physiologic Measurements
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Infant and toddler vital signs
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FIRST Count respirations full minute
 SECOND apical heart rate full minute
 THIRD blood pressure (BP)
 LAST Measure temperature
Is patient on Apnea Monitor or Pulse Ox ?
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Pediatric BPs
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Correct size Cuff selection MOST
important WHY ???
Cuff placement
Interpretation of BP measurement
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Temperature in Peds
No Rectal Bleeding disorder or Cancer
Rectal (RED) insert ½ inch lubricated
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Physical Examination
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Growth measurements as needed
 Recumbent length for infants up to age 36 months +
weight and head circumference
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Fig. 34-10. A, Infant on scale. B, Toddler on scale. Note presence of nurse to prevent falls.
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Standing height + weight after age
37 months
Fig. 34-9. Measurement of height.
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Plot on Growth Chart
By gender
If prematurity note adjusted age
<5th or >95th percentile considered
outside expected parameters for
height, weight, head circumference
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Growth
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Ethnic differences
Expected growth
rates at various ages
Significance of head
circumference
measurements
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Physical Examination
Head & Neck Assessment
• Observe for shape & symmetry
• Note head control
• Evaluate ROM
• Palpate head & neck
 Head & Neck Alerts that need further evaluation
• Anterior Fontanels close before 12m or delayed closure after 18months
• Head lag after 6 months old further evaluation
• Hyperextension of head (opisthotonos) with Pain
• Any lumps or masses
• Asymmetry
• Difficulty or painful ROM
Fig. 34-14. Location of superficial lymph nodes. Arrows indicate directional flow of lymph.
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Snell Eye Chart
20 feet away with 1
eye covered
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Fig. 34-23. Positioning for visualizing eardrum in infant (A) and in child older than 3 years of age
(B).
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Fig. 34-26. Interior structures of mouth.
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Physical Assessment
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Heart
Chest & Lungs
Abdomen
Genitalia
Back and extremities
Neurologic assessment
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Infant & Children Variations
Observe Abdomen for respirations
in infants.
Children younger than 6 or 7 years,
respiratory movement in abdomen
or diaphragmatic
Fig. 34-28. Imaginary landmarks of chest. A, Anterior. B, Right lateral. C, Posterior.
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Fig. 34-35. Location of hernias.
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Fig. 34-38. A, Preventing cremasteric reflex by having child sit in “tailor” position. B, Blocking
inguinal canal during palpation of scrotum for descended testes.
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Bowlegged
normal for up to
1 year after walking
until toddlers
development
muscle
Fig. 34-40. Bowleg.
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Developmental Screen
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Screening procedures (Neerperfect)
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identify children whose developmental level
is below chronologic adjusted age
 Since “Education of the Handicapped Act of
1986” there has been greater emphasis on
children with disabilities
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Denver Developmental
Screening Test II
AKA Denver II
 Widely used, standardized measures
 Examiners must be specifically trained
and certified in use of the tools
 Interpretation of test
 Referrals to Early Intervention
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