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Copy of Pediatric Assessment
Transcript of Copy of Pediatric Assessment
Anatomical/Physiological Differences Pediatric Assessment Triangle (P.A.T.) Psychosocial Development Review major anatomical and physiological differences between children and adults Objectives: Review the Pediatric Assessment Triangle approach to pediatric assessment Discuss approaches to assessment based on psychosocial development Pediatric Airway Tongue is large in comparison to size of oral cavity Trachea is shorter and narrower; cartilage is more soft and collapses easily Smaller & narrower upper and lower airways Obligate nose breathers for first 2 - 4 months; smaller nares Larynx & glottis are higher in the neck What does this mean? Children are susceptible to edema and inflammation from foreign objectives, allergic reactions or infections Pediatric Breathing Immature chest wall & cartilageous ribs Higher metabolic rates (2x); require more energy and consume more oxygen Under 10 years of age, have fewer and smaller alvelio and less lung volume Are diaphragmatic breathers until 4 - 5 month of age What does this mean? Children have difficulty increasing the depths of their respirations. And since the diaphragm is the primary breathing muscle the have difficulty eliminating carbon dioxide, making them susceptible to metabolic acidosis. Pediatric Circulation Have less circulating blood volume Have a greater % of body weight as water Heart muscle not fully developed until 6 years of age Infants at higher risk for heart failure due to the immature heart which is more sensitive to volume or pressure overload What does this mean? The infants metabolic rate and oxygen requirements are double at birth so the heart rate is higher to maintain high cardiac output and adequate oxgenation Pediatric Neurologic Head is large in proportion to body Neck muscles are poorly developed Immature muscles of spine, cartilagenous vertebral bodies At birth the neurological system is complete but immature What does this mean? Due to the large head, poorly developed neck muscles, thin cranial bones and unfused sutures, infants are at risk for cranial fractures and brain injuries due to falls or shaking. Look at the child; listen to the parent Be systematic Follow your "gut" feeling Infants (0 - 12mon) Preschool
(3-5 yrs) Toddlers
(1-3yrs) Golden Rule Varying your approach to the pediatric client based on their age is one of the keys to a successful physical assessment Freud:
Oral Stage Erikson: Trust vs Mistrust Piaget: Sensorimotor Freud:
Anal Stage Erikson: Autonomy vs Shame/ Doubt Piaget: Sensorimotor ends; Preoperational Begins Freud:
Phallic Stage Erikson: Initiative vs Guilt Piaget: Preoperational School Age
(6-12 yrs) Freud:
Latency Stage Erikson: Industry vs Inferiority Piaget: Concrete Operational Adolescents
(12-18 yrs) Freud:
Genital Stage Erikson: Identity vs Role Confusion Piaget: Formal Operational The child's appearance is generally more important than the chief complaint The physiological status of the child can change very quickly; reassess often When working with a child with special needs it is important to conduct a developmentally-appropriate assessment, not age-specific assessment Family-centered care Infants have proportionally higher amounts of extracellular fluid Have a high daily fluid requirement with little fluid volume reserve Children under 2 lose a great proportion of fluid each day, thus are dependent on adequate intake Higher BSA and therefore greater water losses through the skin Infants and children can quickly become dehydrated through day-to-day activities. Assessment of hydration status is essential. What does this mean? Pediatric Fluid & Electrolyte Kidneys are immature and thus are unable to conserve or excrete water and solutes effectively Kerry Rusk, MN, BScN, RN
Faculty of Nursing, University of Alberta