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32 Cards in this Set

  • Front
  • Back
telephone triage guidelines
1. date and time
2. background: name, age, sex, illnes, allergies, meds, tx, immunizations
3. CC
4. symptoms: severity, duration, pain
5. systems review
6. steps taken:
-911
-see doctor
-home care
-or call back is symptoms get worse.
Communicating with Parents
Establish a setting
Ensure privacy and confidentiality
Encourage talking
Direct the focus
Listening and cultural awareness (listening blocks=enviro distraction and premature judgment)
Silence, empathy, and anticipatory guidance
Avoid communication block= info. overload
Communicating with Children
Make communication developmentally appropriate
Get on child’s eye level
Approach child gently and quietly
Always be truthful
Give child choices as appropriate
Avoid analogies and metaphors
Give instructions clearly
Give instructions in positive manner
Avoid long sentences, medical jargon; think about “scary words”
Give older child opportunity to talk without parents present
early social communicative stages of children (3)
1. perlocutionary stage (0 to 8/9mths)
reflexive to stimuli, increases purpose inaction
2. emerging illocutionary stage (8/9 to 12/15 mths)
communicates with signals and gestures
3. conventional illocutionary (12/15 mths to 18/24 mths)
communicates with gestures, vocalizations, and verbalizations.
communicating with infants
* If infants must be handled, simply pick them up firmly w/o gestures
* Hold infants so they can see their parents
communication with early childhood
* Younger than 5 years are egocentric
* Tell them what they can do or how they will feel
* Experiences of others are of no interests to them (don’t use another child’s experience)
* Allow them to touch and examine articles that they will come in contact (e.g. stethoscope bell will feel cold)
* Unable to work with abstraction and interpret words literally
* Think objects may jump, bite, cut or pinch by themselves
* Play is an important form of communication
communication with school aged children
* Rely less on what they see and more on what they know when faced with new problems
* Want explanations and reasons
* Therefore, show children how procedures will be done
communication with adolescence
* They often are willing to discuss their concerns with an adults outside the family
* Accepting of anyone who displays a genuine interest in them
* But reject persons who attempt to impose their values on them
* Confidentiality is importance (unless in case of suicidal behavior)
* Build a foundation
* Communicate effectively P105
communication technique: projective
present nonspecific material that enables individuals to externalize or project inner aspects of themselves to others.
the most important previous growth patterns to record are
1. weight at 6 mths, 1yr, 2, & 5
2. length at 1 yr & 4
3. dentition, age of onset, # of teeth, symptoms during teething
developmental milestones include
1. age of holding up head steadily
2. age of sitting alone without support
3. age of walking without help
4. age of saying first words with meaning
5. present grade in school
6. scholastic grades
7. interaction with other children, peers, adults
Every nutritional assessment should begin with a...?
dietary history
DRI, dietary reference intakes are made up off what 4 references?
1. EAR, estimated average requirement
2. recommended dietary allowance (RDA)
3. Adequate intake (AI)
4. tolerable upper intake level (UL)
what is the most common and easiest method of dietary history?
24-hour recall
anthropometry
essential parameter of the nutritional status, is a measurement of height, weight, head circumference, skinfold thickness, arm circumference.
1. height & head circ reflect past nutritional status.
2. weight, skinfold thickness, & arm circumference reflect present nutritional status.
General Approaches Toward Examining the Child
Head-to-toe sequence for assessing adult clients
Sequence for pediatric assessments generally altered to accommodate child’s developmental needs
Goals of Pediatric Assessment
-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
physical exam sequence for infants:
1. if quiet, auscultate heart, lungs, abdomen.
2. record HR, RR
3. proceed to head to toe direction
4. do eyes, ears, mouth- last
5. elicit reflexes as body part is examined
6. elicit moro reflex last
physical exam preparation for infants:
-completely undress if temp permits
-gain cooperation with distraction, bright objects, rattles, talking
-smile, use gentle voice
-pacify with bottle of sugar water
-use parent's aid when examining ears, mouth
physical exam sequence for toddlers:
-inspect body through play, " count fingers, tickle toes."
-use min. physical contact initially
-intro. equipment slowly
-auscultate, percuss, palpate whenever quiet
-perform traumatic procedures last
Infant and Toddler Vital Sign Measurement sequence (in ppt)
(key vitals)
-Count respirations first (before disturbing the child)
-Count apical heart rate second
-Measure blood pressure (BP) (if applicable) third
-Measure temperature last
preparation of physical exam, toddler:
-allow to inspect equipment (demonstrating equipment is usually ineffective)
-praise for cooperative behavior
-if uncooperative, perform procedures quickly
-use short phrases
preparation of physical exam, preschooler:
-offer equipment for inspection, briefly demonstrate use.
-make up story about procedure "I am seeing how strong your muscles are" (BP)
-Use paper doll technique
-give choices when possible
-expect cooperation "open your mouth"
preparation for physical exam, school age:
-respect need for privacy
-explain purpose of equipment and significance of procedure, such as otoscope to see eardrum, for hearing
-teach about body function and care
preparation for physical exam, adolescent
-respect need for privacy
-explain finding during examination
-matter-of-factly comment about sexual development
-emphasize normalcy of development
-examine genitalia as any other body part, may leave to end.
Length
refers to measurements taken when children are supine (aka recumbent length)
-until children are 24 months old (or 36 for birth to 36 mth charts), measure recumbent length.
height
aka stature, taken standing upright
weight
measured with a sized beam balance scale, which measures weight to the nearest 10 g for infants, and 100g for children.
a convenient measure of body fat is
skinfold thickness
- done by special calipers, such as Lange calipers.
- most common sites: triceps, subscapula, suprailiac, abdomen, and upper thigh.
an indirect measure of muscle mass is
-arm circumference
-measured with paper or steel tape.
Generally head and chest circumference are equal when?
-equal at about 1 or 2 yrs of age
-in childhood chest circ exceeds head size by 5 to 7 cm.
core temperature
reflects the temperature of blood flow through the carotid arteries to the hypothalamus.