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According to Lim (2018), Physical assessment can be defined as the procedure of assessing a patient’s health by applying the methods of inspection, palpation, percussion, and auscultation both in adults and children. The physical assessment of a child to that of an adult is different in that children may not understand medical conditions taking place in their bodies, therefore may fail to disclose such information to the nurse. On the other hand, Adults can speak for themselves and disclose information about their health to the nurse when they want to be treated. Generally, the order of assessment for adults is from head to toe whilst with infants the nurse can begin by listening to the lungs and heart as the child is sleeping so as to obtain accurate results. Other assessments may include skin texture and color, as often babies’ skin can appear mottled in relation to still-developing circulation and temperature control mechanisms, but that same finding in adults could be indicative of cardiac issues. Head circumference and fontanels are not items assessed in an adult but are routinely assessed in infants (Lim, 2018).
According to Mills (2020), communication with pediatric patients is referred to as “triadic,” meaning it is a collaboration between patient, parent, and nurse. Little children do not have the verbal skills to respond to all questions in a meaningful way, so asking relevant information from a parent or guardian is important. There are five communicational tips when dealing with children which include building a relationship, providing a comfortable environment, getting on their physical level, understanding common characteristics and preferences of the child prior to assessment, and letting them help. Kids should be greeted the moment they walk into a clinic or hospital.
Language must be suitable to the age group so that they understand what is being communicated. However respect and engagement should be offered to the older child, for example, a nurse may question a very young child where the “owie is”, but that type of language may not be suitable for a 12-year-old. A nurse can try to engage a child by giving him or her the stethoscope for examination to play with. The child will then be comfortable and familiar with tools to be used by the nurse, therefore the assessment will be easy. The nurse can also try to work slowly, clarifying all the procedures they are undertaking beforehand, mixing very simple pieces of education throughout assessment rather than disseminating a lot of data that could be confusing to the child. The child should also be given the chance to ask questions, be given what they want or need. (Mills, 2020).
REFERENCES
Lim, S. E. R. (2018). Assessment of Physical Activity of Hospitalized Older Adults: A systematic review. Journal of Nutrition, Health & Aging, 22(3), 377–386. Accessed March 9, 2022. https://doi-org.lopes.idm.oclc.org/10.1007/s12603-017-0931-2
Mills, M. (2020). Five tips for communicating with pediatric patients. Accessed March 9, 2022. https://www.nursechoice.com/blog/profiles-and-features/5-tips-for-communicating-with-pediatricpatients/
It is no secret that the physical assessment findings of a child will be different from that of an adult. Children are not “little adults” and come with their own set of assessment findings, lab values, and needs for communication and education that should be addressed with both the patient and caregiver. The nurse must also be mindful of the variations that exist between age groups of children, a 2-year-olds exam will be very different than that of a 12-year-old. Normative ranges based upon age, as well as developmental stages and milestones must be considered (Burks, 2016). Babies and children have faster heart rates and faster, irregular respiratory rates as compared to adults for example, so knowing the normal ranges is important. Other considerations may include skin texture and color, as often babies’ skin can appear mottled in relation to still developing circulation and temperature control mechanisms, but that same finding in adults could be indicative of cardiac issues. Head circumference and fontanels are not items assessed in an adult, but are routinely assessed in infants. Care should still be taken in children of any age, as well as adults, to conduct as thorough an assessment as is possible gathering data both subjectively and objectively for all systems in a head-to-toe fashion when possible.
The Texas Children’s Hospital often refers to communication with pediatric patients as “triadic,” meaning it is a collaboration between patient, parent, and nurse (Mills, 2020). Young or even preverbal children will not have the verbal skills to answer all questions in a meaningful way, so gathering data from a parent or caregiver is essential. Mills offers 5 tips for communicating with children which include building a relationship, providing a comfortable environment, getting on their physical level, understanding common characteristics and preferences of the child prior to assessment, and letting them help. Children should be greeted first. Language should be tailored to the age of the child, where simple and easy to understand wording is used in young children. At the same time, appropriate respect and engagement should be offered to the older child. For instance, a nurse may ask a very young child where the “owie is”, but that kind of verbiage would not be appropriate for a 12-year-old. Offering the stethoscope for examination or allowing the child to “blow out the pen light” could provide opportunities to engage and be less fearful in an unfamiliar situation. In all instances, the nurse should work slowly, explain everything they are doing before they do it, integrate very simple pieces of education during assessment as relevant rather than providing large chunks of information that could be overwhelming, and allow the child opportunity to express questions, needs, or wants as they arise.
References
Burks, J. (2016). Pediatric nursing assessments in the community and home health: Pearls of wisdom. relias.com. https://www.relias.com/blog/pediatric-nursing-assessment-in-the-community-and-home-health
Mills, M. (2020). Five tips for communicating with pediatric patients. nursechoice.com https://www.nursechoice.com/blog/profiles-and-features/5-tips-for-communicating-with-pediatric-patients/
