*Compare the physical assessment of a child to that of an adult. **In addition to describing the similar/different aspects of the physical assessment, ***explain how the nurse would offer instruction during the assessment, ****how communication would be adapted to offer explanation, *****and what strategies the nurse would use to encourage engagement.
Sample Paper
Comparing the Physical Assessment of a Child to that of an Adult
The purpose of this essay is to compare and contrast physical assessment in pediatric versus adults. Infants, preschooler, and adolescents are physically and developmentally different from adults and so thus their needs. Consequently, pediatric assessment requires different approaches and assessment tools to those used in adult assessment. The age of the pediatric patient is important in obtaining an accurate medical history. Obtaining this data requires the applicable of knowledge of growth and development (Forbes, & Watt, 2015). Erickson is credited for grouping children into newborns (0-6 months), infants (6-16 months), toddlers (1-3 years), preschoolers (3-5 years), school-age children (6-12 years) and adolescents (13-19 years).
Similarities
The two group share some similarities when it comes to health assessment. To begin with, the various techniques used to conduct pediatric assessment are also used in adult assessment. These techniques include inspection, palpation percussion, and auscultation. Second, Physical examination involves taking measurements of vital signs: temperature, blood pressure, respiration, and pulse.
Differences
Traditional systematic approach to conducting physical exam is head-toe (start at the head, proceed to the whole body and end at the toes). However, infants, toddlers and preschoolers are assessed beginning at the feet and ending at the head. For older children, the head-toe approach may be used. When conducting pediatric physical exam, the examiner designs the assessment to the development level and age of the child. This is because toe-head approach is less threatening. For newborns, they are easy to examine because they offer no resistance. An unhappy newborn can be refocused by calmly talking in soft voice or providing a pacifier.
Physical assessment in children and adults involve both observation and exam. Physical assessment usually starts with obtaining subjective data and objective data. In pediatric patients, however, subjective data is obtained from historian and caregivers of newborns, infants, toddlers and preschoolers. Family caregivers provide most of the information needed in physical examination. School-age children and adolescents may be able give some of their own history. The examiner can ask the caregivers questions on immunization history, social history of family, developmental milestones and prenatal/birth history. In adults, the examiner ask patients questions along with head-toe exam to fulfill assessment procedure (Forbes, & Watt, 2015).
Objective data involves the gathering of data via observation. The gathering of objective data involves the examiner taking measurement of blood pressure, pulse, respiration weight, height and temperature. Observations such as child’s appearance, body posture and proportions, eye position and head shape can be made directly without taking measurements. Examining children require the knowledge of growth and development because each age-group respond differently. Infants and toddlers are dealing with the developmental task of trust versus mistrust. Therefore, they are difficult to examine due to stranger anxiety. This anxiety is a normal stage among infants and is overcome by keeping the child in the parent’s lap. The examiner distracts such an infant with useful play, objects, toys and stories to distract and make the child feel comfortable. The examiner can also allow the pediatric patient to hold the equipment first as this may decrease anxiety. It is also good to warm the stethoscope before placing it on the skin. Toddlers fall under autonomy versus shame stage.
Toddlers seem the most difficult and challenging to examine as they are uncooperative and their mood change quickly. The examiner can form supporting rapport with the toddler and parent by standing or sitting next to them and use firm, direct approach. Provide books and toys to make the toddler relax. The toddler can be allowed to touch the objects or equipment. The examiner can use age-appropriate words and speak with confidence in order to decrease the child’s fear.
Provide the preschooler with the choice of siting on the table or parent’s lap. Ensures the parent is within the child’s eye contact or close. Preschoolers like exploring and seeking answers. They are more cooperative and easy to please as long as their caregivers are around. The examiner can encourage the child’s participating by praising the child for cooperating. Modesty is also an issue with preschooler children.
School-age children are old enough to answer age-appropriate questions and can be encouraged to participate in the examination. Explain equip and procedures and teach them body functions. Faced with industry versus inferiority, they like to master tasks and solve problems. They can be allowed to display pain and fear. The examiner creates trust by asking the school-age child age-appropriate questions, such as about favorite friends, school and activities (Bowden, & Greenberg, 2010). This encourages the child to participate in the examination. On their part, the caregivers can support and encourage the child’s participation. The examiner can answer questions and provide feedback using simple words. This age-group is ready to be taught how the body works and conducting head-toe examination is possible.
Adolescents are comfortable with a direct approach and can be examined without the presence of parents. The parents should, however, be provided with another forum to air their concerns if any. Respect for privacy is highly regarded. Talk with adolescent and stress normal findings is necessary. Incorporate genital exam as physical exam provides the opportunity to explain developmental changes at puberty (Bowden, & Greenberg, 2010).
Conclusion
Pediatric patients are different from adult patient. Due to their unique needs, the approaches and equipment used to assess them are different. Physical examination revolve around specific assessments which are appropriate for the child’s developmental level, age and needs. By comprehending these differences, examiners can provide age-appropriate care to their pediatric patients.
References
Bowden, V. R., & Greenberg, C. S. (2010). Children and their families: The continuum of care. Philadelphia: Lippincott Williams & Wilkins.
Forbes, H., & Watt, E., (2015). Jarvis’s physical examination & health assessment. Chatswood, NSW: Elsevier Australia.
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