Discuss fully the similarities and differences of pediatric patients and adults in terms of health assessment. Moreover, identify the salient points of assessing pediatric patients with alterations in Cardiovascular Functions (for Block C only) and and pediatric patients with alteration in Reproductive of Genitourinary functions.
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Sunday, July 1, 2007
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The health assessment for pediatric patients are similar to adults regarding the cephalocaudal procedure but they are also different in many ways like in anatomical & physiological differences between pediatric patients and adults. The body proportion, airway, and musculoskeletal system of pediatric patients are not like in adults. In terms of physiological differences, the metabolic rate of pediatric patients is higher than adults so they require more fluid, energy and consume more oxygen. Also we are doing the APGAR scoring for infants which is not initiated in adults. The child’s general appearance is the most important thing to consider when determining how severe the illness or injury is, the need for treatment, and the response to therapy. The vital signs and normal values of pediatric patients are also different from adults. The physiologic status of the child can change very quickly, so repeated assessments are necessary.
When assessing pediatric patients with alterations in cardiovascular functions, the general physical appearance should be evaluated. The patient may appear tired because of a chronic low cardiac output; the respiratory rate may be rapid in cases of pulmonary venous congestion. Central cyanosis, often associated with clubbing of the fingers and toes, indicates inadequate oxygenation of blood by the lungs. Cyanosis in the distal extremities, cool skin, and increased sweating result from vasoconstriction in patients with severe heart failure.
When you conduct health assessment for pediatric patients,as a nurse you must possess patience,always talk to them with their level of understanding,maintain a matter-of-fact attitude and the most important not to forget is clarifying any misconceptions the child may have.
During assessment,the presence of the child parents is indespensable.Establish rapport first before doing any procedure to the child.Allay their anxiety regarding any surgical procedures may be done.Because one common problem in dealing patient with reproductive problem is body image,sometimes it relates or they think about the appearance of their genitals after surgery. It is necessary also to provide an explanation of the anatomy and physiology of the certain system related to his/her disease in terms that the child can understand,you may use a body outline.
as we all know,children and adults are different in some ways,especially when we view in anatomical structures,physiological aspects.On my own opinion,doing health assessment for adults and children are both required precision in every vital signs we get from them.
With adults,privacy and confidentiality is always priority especialy patients having reproductive problem.Assess their distress and fears regarding with the disease and allow them to verbalize their worries.
Safe and effective assesment or treatment for infants, children and adults requires a thorough comprehension of the basic principles and practices. The similarities and differnces of a pediatric patients and adults in terms of health assesment are:
* first, The body, not the type, but the system of the body is the same. But, the maturity of the function is different.
* 2nd, is the basic phisiological needs or the basic needs. like, air, water, shelter foods, etc.. But the different is the amount of needs is not that much compare to adult. ex. the foods they eat.
* 3rd, Emotional needs, like, love, care, gentleness, sympathy, etc.
* 4th, is the treatment, but the different is the dosage given. Because the largest surface area, size, weight is different. so, the dosage given to a children is much smaller or lower compare to adult one.
* 5th, is about the Surgery, of course, for the surgeon or for the pediatrician, its really hard for them to operate for the children or infant, because the size of the organs is too small, compare to the adult.
* 6th, is the Disease. they have their common diseases. but, there are also diseases which are not common to children. like, hypetention, heart disease.
* 7th, Gathering data. but the process in gathering data is different. because, in adult patient is more easy to gathered data, compare to children.
The salient points in assesing pediatric patiet with alteration in Reproductive of Genitourinary functions. Are the Vital signs, medical history, physiacal examination, growth chart, developmental flow sheet, screening test, and baseline laboratory test or urinalysis.
The most important skills of a nurse is the ability to assess a patient. This skill is necessary to obtain data that will enable the nurse to make nursing care plan.
Pediatric are concerned with children and to their development, and the care treatment of their underlying disease or abnormalities. When assessing them, we have to establish rapport to won their trust. Some children have so called "strngers anxiety", so you've to prepare such strategies such as play with them, offer a toy or tell them a story to build trust and let threir mother be present during the assessment. Theres a lot of explanation needed before you handle them, especially in assessing their most sensditive area of their body. They are ashamed to reveal their private organ to other people except to their parents.
During infancy, the parents are really bothered to their child abnormality. Infants means of communication is through crying so health assesment is through APGAR scoring. Parent most concern now is to treat their child abnormalities earlier and to have a normal life as he or she grows old.
Adults are having reached full maturity. They are likely to maintain good health. But some adults now are prone to such diseases like cancer, because of their lifestyle. Their disease is not easily treated because they only seek doctors when it is already malignant. Health assessment needed privacy and the data being collected is confidential. Also have to explain what is to be expected.
Some people are educated to effectively assess and manage the critical pediatric patient. Providing the best care possible can only be achieved by obtaining an appropriate history, coupled with an accurate physical exam. They must be capable of identifying any and all immediate or potential life threats in a child.
Airway Anatomy & Physiology
It is important to identify differences between adult and pediatric anatomy and physiology. The anatomical and physiologic variations between adults and children can cause confusion if the EMS provider does not fully understand these differences.
One of the most obvious anatomical differences between an adult and child is the tongue. The pediatric tongue is larger than the adult in relation to the amount of free space in the oropharynx. The large tongue creates a significant probability for airway occlusion and leaves little room for airway swelling. The size of the tongue is thought to be one explanation for why children are obligate nose-breathers: breathing through the nose is easier because it provides a direct path for airflow without concern for any obstruction that the tongue may cause.
The pediatric trachea is much more pliable and smaller in diameter than the adult and has immature tracheal rings. The increased pliability of the trachea can be troublesome in the pediatric patient because hyperextension or hyperflexion of the neck may lead to complete or partial occlusion of the airway. The small diameter of the trachea allows for only a minimal amount of swelling before significant compromise of airflow occurs.
The pediatric epiglottis tends to be large and is more u-shaped or oblong, making it more difficult to control when attempting intubation. There are a variety of practices related to pediatric intubation, including the preferential use of a straight (Miller) blade versus a curved (McIntosh) blade. The reason for this preference is attributed to the unique shape of the epiglottis: The curved blade fits into the vallecula and indirectly lifts the epiglottis from the glottic opening, whereas the straight blade is inserted under the epiglottis and directly elevates it for visualization of the vocal cords. This allows for better control of the epiglottis. The long epiglottis can easily flop down around the curved blade and cause visual obstruction of the glottis and vocal cords.
The position of the adult larynx is at about the level of the fourth or fifth cervical vertebrae; the pediatric larynx is at about the level of the first or second cervical vertebrae. If the pediatric larynx were lower, children would aspirate food into the trachea as they swallow. This is an important anatomical airway consideration, since the higher larynx is more anterior.
The mainstem bronchi in young children have less angle than in adults. As a result, aspiration can occur in either the left or right mainstem bronchi. As children grow, an increase in chest diameter causes the angle of the left bronchus to increase as well.
Red Flags in Pediatric Assessment
There are several clinical signs that must be considered when assessing a sick child. If any of the following signs are present, aggressive intervention should be employed as quickly as possible to prevent the child from going into cardiopulmonary arrest.
Respiratory rate greater than 60
Significant hemorrhage
Respiratory distress or failure
Significant trauma
Nasal flaring
Alterations in mentation
Uncorrected noisy respiration
Seizures
Cyanosis
Fever or history of fever with a global rash
Mottling
Heart rate greater than 180 bpm
Pallor
Heart rate less than 60
Cardiovascular Anatomy and Physiology
Although the pediatric and adult heart share identical anatomy, several important distinctions need to be made between the adult and pediatric cardiovascular systems.
First, the adult heart increases its stroke volume by increasing inotropy (strengthening contractions) and chronotropy (increasing heart rate). In contrast, the pediatric heart can only increase chronotropy in an attempt to increase stroke volume. The pediatric heart has low compliance as it relates to volume; therefore, it cannot compensate well by increasing stroke volume. Consequently, heart rate should be seen as a significant clinical marker when monitoring cardiac output in the fetus, neonate and pediatric patient. When the pediatric patient becomes bradycardic, it should be assumed that cardiac output has been drastically reduced. Bradycardia is most commonly caused by hypoxia. Bradycardia may be an early sign of hypoxia in the neonate; however, it is an ominous sign of severe hypoxia in the infant and child.
Structural Variations
The bones in young children are not completely calcified and tend to be flexible. Children's ribs are more horizontal than they are rounded, as seen in adults. The horizontal nature of the ribs provides for little leverage to increase the anterior and posterior diameter of the chest. This does not facilitate the degree of lift that is necessary to increase the volume of air within the chest when it is needed most. In addition, younger children have less-developed accessory muscles, making it more difficult to increase the strength and depth of ventilations.
When looking at a chest x-ray, it is easy to appreciate the relative amount of space the heart occupies in the chest of a child. The relationship between heart size and thoracic cavity size helps to explain why children have less pulmonary reserve than adults. Children have less ability to increase volume within the lungs, because the lungs are only capable of expanding to the degree there is space to expand; the heart occupies much of the thoracic cavity.
The pediatric abdominal cavity is small and has large organs compressed within it. A significant problem with the overcrowding that occurs in the abdomen is that it has a negative effect on the compensatory mechanisms of respiration in children. Children rely heavily on rate of respiration to compensate for respiratory difficulty because they are unable to increase the depth of respiration due to the inability of the diaphragm to move farther downward against the compacted abdomen. Conversely, adults can increase rate and depth of respiration when they experience respiratory difficulty.
Physiologic Variations
One of the first things to remember when dealing with pediatric patients is that the pediatric body surface area-to-volume ratio is four times that of an adult, while its heat production is only one-and-a-half times as high. This variation predisposes the pediatric patient to a greater risk for accidental hypothermia that can easily result in significant physiologic compromise. Additionally, the pediatric patient's muscle tone may be immature and, as a result, cannot effectively induce muscular shivering as an effective mechanism for preserving heat to the body core. Compounding this heat production and maintenance concern is that these patients generally have smaller amounts of adipose tissue, which contributes to poor insulation and additional difficulty in maintaining core body temperature.
Infants and small children are also at a greater risk for developing acute hypoglycemia because their livers are underdeveloped and they typically have decreased glycogen stores. The decreased glycogen stores, coupled with an increased metabolic rate resulting in the use of large quantities of serum glucose, makes the pediatric patient prone to hypoglycemia. Stress may induce hypoglycemia in the pediatric patient. A bedside glucose level should be evaluated in all infants regardless of the diagnosis.
A General Approach to Pediatric Assessment
Approach to the pediatric patient varies with the patient's age and the nature of illness or injury. It is critical that EMS providers be cognizant of the emotional and physiological needs of a child throughout the assessment. It is equally important to identify the needs of the child's family members. In this stressful environment, family members will be trying to find the cause of injury or illness in their child and may be unruly when the answers they seek are not available or are contrary to what is expected.
In many pediatric scenarios, EMS providers tend to rely on family members as their primary historians. However, as children become older, they may be as good or better than their caregivers at providing an accurate medical history. Although you should attempt to collect the history from children who are four years of age or older, older children are typically better at localizing pain or explaining their symptoms.
The key to pediatric assessment in EMS is to identify and manage immediate life threats. It is often easy to determine whether a child is sick just by looking at him. Sick kids look sick. If a child is active, appropriate and alert, he is not sick. The opposite is true as well. If a child is inactive and non-interactive, assume he is sick until proven otherwise.
Forming a General Impression
The most widely accepted approach to forming a general impression in a child is using the Pediatric Assessment Triangle--an objective tool developed by the American Academy of Pediatrics that can be used to determine the severity of illness in a child. This tool is especially useful because the assessment criteria are determined during the general impression. This assessment can be performed from across the room, before contact with the patient is ever made. The triangle is composed of three sides: appearance, work of breathing and circulation.
Appearance relates to the child's overall mental status, body position and muscle tone.
Work of breathing relates to the visual effort or audible sounds associated with respiration.
Circulation is assessed by determination of skin color.
Initial Assessment
Following implementation of the pediatric assessment triangle (PAT) to form a general impression, assess the child's level of consciousness, ABCs and vital signs.
It is important to realize that "normal vital signs" is a relative term. Children of various ages have different metabolic needs and therefore have different normal values. EMS providers should not rely on their memory to recognize normal versus abnormal vital signs. There are dozens of quick-reference charts or tools that can be used to aid in determining normal vital sign ranges. It is equally important to remember that there are few instances where a single vital sign or set of vital signs has any clinical significance. Vital signs are most beneficial and clinically relevant when they are used for trending changes in the patient's status over time.
Airway Assessment
The No. 1 cause of death in children is hypoxia. Lack of a patent airway or breathing adequacy is the most common reason for development of hypoxia. Studies suggest that in the majority of cases, children do not require prehospital intubation and tend to do well by bag-mask ventilation alone. It is for this reason that assessment of the pediatric airway is aimed at facilitating bag-mask ventilation. The MOANS mnemonic is used to identify a patient who may be difficult to ventilate with a bag-valve-mask device.
MOANS
Mask seal
Obesity/Obstruction
Age (greater than 55)
No teeth
Stiffness
Mask seal
Successful bag-mask ventilation is dependent on just two factors: mask seal and a patent upper airway. A recessed chin, as seen in some congenital malformations, may make sealing the mask difficult. In the prehospital setting, when prolonged ventilation is necessary, a mask seal may become loose and ineffective due to muscle fatigue in the EMS practitioner's hands. Constantly monitor the mask seal to ensure there is no air leakage.
Obesity/Obstruction
Obstruction is a consideration in pediatric patients. Obstruction of the upper airway may be caused by epiglottitis, angioedema or peritonsillar abcesses and can make the child's airway difficult to establish and manage.
Age
Age is not a factor in pediatric airway management.
No teeth
It is extremely difficult to create a mask seal in edentulous (toothless) patients due to the lack of a platform for the mask to rest upon to create an effective seal.
Stiff lungs
Stiff lungs require higher airway pressures to ventilate, and may result in difficulty in performing positive pressure ventilation. Bronchospastic conditions, such as asthma, are associated with higher airway resistance and may lead to more difficult ventilation states. Disease processes that create either compliance or higher airway resistance may create a situation in which increased ventilation pressures are necessary to generate adequate oxygen saturation.
Breathing Assessment
Normal respirations in an infant can be irregular and, as a result, respiratory rates should be assessed over a minimum of 30 seconds, but ideally 60 seconds. In adults, we often have a tendency to evaluate respiratory rates for 15 seconds and multiply those rates by 4. The variability of respiration in infants may not produce an accurate rate when only observed for 15 seconds. It is important to note that the variable rate of respiration in infants may include cessation in breathing for up to 20 seconds. Anything greater than 20 seconds should be considered abnormal and will require intervention.
One of the most common techniques for assessing the lungs is to determine lung sounds by auscultation. Auscultating lung sounds in a child ideally should be conducted in a relatively quiet environment and take into consideration that the child has a small and thin chest wall. Auscultate lung sounds in the midaxillary (below the armpits) region to ensure that referred breath sounds (sounds that can be transmitted from one side of the chest to another) are not heard. Hearing referred breath sounds is possible because a thin chest wall is capable of transmitting sounds easily.
In addition to lung sounds, it is imperative to determine the depth of respiration to ensure the child is maintaining an adequate tidal volume. Remember that the work of breathing that was identified in the PAT should be re-evaluated regularly throughout transport to make certain the child has not decompensated.
Pulse Oximetry
The use of pulse oximetery in children is highly recommended. Pulse oximetry readings can be used to monitor and document saturation readings over time and to make a possible correlation to improvements after interventions or worsening of the patient's condition. Caution should be taken when pulse oximetry is used for anything other than trending patient compensation or response to therapy.
A pulse oximetry reading of greater than 94% is generally adequate. If a child cannot maintain saturations above 94% on room air, he is in significant distress and will require supplemental oxygenation. If the saturations stay below 90% on a non-rebreather mask, this child is not getting enough oxygen and will require assisted ventilations. EMS providers must remember that a child may still be sick despite adequate pulse oximetry readings. Treat the patient, not the monitor. If the child looks sick, he likely is sick and will require intervention.
Capnography
Capnography is most useful when quantitative and graphic readings are available, as in continuous waveform capnography. This form of capnography allows for continuous airway and ventilation monitoring. It has been found to be especially useful during CPR. At the onset of cardiac arrest, carbon dioxide levels drop far and fast. Despite cardiac arrest, the carbon dioxide levels begin to rise with effective CPR; even more amazingly, they return to near-normal levels with a return of spontaneous circulation (ROSC). Clinical studies have proven that end-tidal CO2 levels have been predictive of cardiac output and coronary perfusion pressure (CPP). As such, it can be deduced that since ETCO2 can determine cardiac output and CPP, it can also effectively measure compression effectiveness during CPR.
In the prehospital environment, one study suggested that children are at a much greater risk for accidental endotracheal tube dislodgement (between 16% and 25% according to Gausche, et al.). It may be easier to identify a dislodged tube in children than in adults because of their sensitivity to hypoxia, but it may still be difficult. As a result of this statistic, there have been recommendations to make the use of continuous waveform capnography a staple of assessment in pediatric airway management instead of an optional tool. It is not a sin to have a misplaced endotracheal tube; the sin is not identifying it.
Circulatory Assessment
Pediatric heart rates are variable. Pulse points are no different in children than they are in adults, but there are some differences in the way these pulses are evaluated. The small anatomy of children, coupled with the lower palpable magnitude of pediatric cardiac output, makes palpation of pulses in certain anatomical regions impossible, or extremely difficult. In small children, it is recommended that peripheral pulses be obtained at the brachial artery (inside of the bicep) and central pulses be obtained at either the femoral or carotid arteries. If no pulses can be palpated, consider auscultating an apical pulse using a stethoscope. If a heartbeat can be heard, the child has a pulse; however, the presence of a pulse does not automatically indicate adequate perfusion.
Capillary refill time is typically quite accurate in children and considered to be reliable in most cases. Healthy children do not have the vascular disease adults do; therefore, their capillary blood flow is very responsive. Just as in the adult patient, environmental factors like cold ambient temperatures can influence capillary refill times. For this reason, capillary refill time should be assessed closer to the core in areas like the kneecap or forearm. Normal capillary refill time is less than two to three seconds.
Disability
The AVPU scale is a universally accepted method for determining the degree of mentation in both adults and children. An additional method of determining mentation in a noncommunicative child is the TICLS (pronounced tickles) scale (Table I).
A final method used for determining mentation is the pediatric Glasgow Coma Score or PGCS (Table II). It is important to note that the standard GCS model must be modified in the noncommunicative child.
Summary
Some children, regardless of what is done for them, will get sick and die. Fortunately, this is more rare than regular. An EMS provider who appropriately assesses a sick child with a potential to survive will be able to identify life-threatening conditions and manage those conditions. The most common cause of pediatric death is hypoxia. A hypoxic child without proper intervention will ultimately experience cardiovascular collapse and eventually death.
Most healthy children have no difficulty in maintaining normal cardiovascular function until and unless they become extremely hypoxic. EMS providers must understand that the most effective management processes require an understanding of why children present in the way they do. If an assessment is not thorough and accurate, a child may continue to deteriorate. Assessment is the key to pediatric management.
----belgene g. gorospe
The ability to assess the patient regardless of the age is one of the most important skills of a nurse.Patient assessment is necessary to obtain data that will enable the nurse to make a nursing diagnosis,identify and implement nursing intervention and assess their effectiveness.In assessing pediatric patient,you should be a keen observer,more conscious and meticulous in physical assessment.Because they cant communicate that much to the HCP.They cant convey their feelings of discomfort clearly.Crying is the only mean of communication.You will need the cooperation and coordination of their family to obtain health history and maternal health during gestation.In assessing to an adult patient,lifestyle check is the most important data to be gathered.You will need an honest answer from the pt. so you will anticipate what step youre going to do.It is easier to assess an adult pt. because they can render all data about health history,complete composite lifestyle data and can complain the unusual changes and alteration in their system.In assessing pediatric pt. with cardiovascular disorder,complete physical examination is performed to confirm the data obtained in the health history.Comprehensive observation on general appearance and a cardiac examination must be perform.To gain maximum information,health history of the family and maternal health history must be achieved.Heart murmurs is the cardinal sign of cardiac problem.So the location,timing,intensity,pitch,quality and radiation must ausculate and assess accurately.In assessing pediatric patient with reproductive and genitourinary disorder,complete and comprehensive physical examination must be rendered.Health history,genetic alliance,and general health related concerns must be gathered.As a HCP,skills in observation,efficiency and professionalism must be applied to attain maximum outcome on health assessment..
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Patients, whether pediatric or adult, needs to be assessed well and must have to be attended with their needs and treatment cephalocaudal with the same priority of ABC but the assessment should vary since pedia patients needs to be assessed well thus taking much priority than that of the adults because pediatric patients doesn’t know how to express what they really feel. So there must be an intensive care for pediatric patients. If ever pedia patients have genitourinary defect, they should be treated promptly, since by the way it means for elimination and later for reproduction. Any defect that may affect pedia patients’ general condition should be treated as a priority.
Because Aging is the process of growing old, physiologically and psychologically human get mature. The similarity of pediatric and adult in terms of assessment is getting their medical history. The difference is their physical examination (cardiovascular, neuromuscular…) vital sign (respiratory…) thermoregulation, motor development… because babies are in the process of development most commonly cardiovascular diseases are about immaturity/maldevelopment or atresia of the heart. In this case, the salient points in assessing the pedia patient are their color and heart sound. Most pedia pt. with cardiovascular disease is cyanotic, accompanied with murmur as auscultate in the chest part a wide variety of heart malfunctions can occur one of the most common abnormalities is a septal defect. Inguinal canal it usually closes after birth but sometimes remained open and is then often the site of herniation it is common in pediatric pt. with alteration in reproductive of genitourinary functions.
Assessment is the systematic collection of data to determine the patient health status and identify any actual or potential health problems:data are gathered through the health history and the physical assessment. in assessing adult patient his or her health history gathered by interview personal dialogue bet. the patient and the nurse conducted in order to obtain the information...and physical assessment may be carried out before,during or after the health history depending on the patient physical and emotional state.It requires to used of sight,hearing,touch and smell. While in pediatric assessment the relevant information should be obtain from the patients family or significant others,It develop your patient and skills to show your quality and abity being a effective nurse when you assess pedia. as we all know their are fear in strangers, you must know the effective technique for gain their trust.physical assessment in pedia is near the same in adult interms of cephalocaudal but ofcourse its consider the developmental stage.Maternal factor has a big cooperate in cardiovascular disorders of the pedia.the baby may be sufering fatigue, diaphoresis,DOB, cyanotic. murmur sound when ascultation is done, tires easily befor feeding is completed, also underweight. because of abnormal circulation of the blood in the heart. Its really need immediate examination to survive.
In the health assessment for pediatric clients are also similar to an adult client but in assesing those client the nurse should have confident to himself or herself in assessing or nurses must have potentials, in assessing we must talk to the client in the level of understanding so that they can easily follow the instruction given to them, to pediatric patient we must gain fisrt there trust because if they dont trust you, pediatric patient will not cooperate same also to the old age patient, in assessing the patient with alterations in cardio vascular function, we must assess the patient carefully, because this cases are risk for injury, the general physical appearance are evaluated. Patient with this disease need always have an assistance because they are not allowed to have an extraneous movement because they easily get tired, and if that happen respiratory rate of the patient may vey fast in cases of pulmunary venous congestion, interventions must be very well implemented specially to those patient with cardiac problem.
the similarities and differences of health assessment between the pediatric patient and adult are the anatomical and physiological differences.example is that the airway of the infant are different from adult,the physical appearance between them,the treatment between them are also different,the medicine and the therapy they give to them are different,their vital sign are also different.regarding to this problem they are so many
ways in assessing them because the infant and the adult are different in terms of the sign and symptoms.but of course in terms of caring we both render care to them we need to established rapport for them to have trust with you.we need to give them a better understanding the possibility risk problem may occur to the patient.in the salient points of assessing pediatric patient with cardiovascular we should monitor their appearance and their vital sign to know what are the thing changes to them.
There are certain kind of procedure being done with the adult pt together with the pediatric pt.However in assessing the pediatric pt it requires more fully a special skills to prevent risking the life and
health of the infant.Likewise in administering meds either in what form for any route of administration, it must be given partly as necessary.A nd interms of health condition the pediatric pt have lower immune system compaire to that with the adult,so as to prevent further ailments,it shld be monitored of the health status of the pt.And the term dehydration usually pertain to that with thge infant or the younger age. Support of the cardiovascular system is directed at optimizing cardiac output and oxygen delivery. This is accomplished by optimization of heart rate, preload, afterload, and intropy, and is guided by invasive, non-invasive, and laboratory monitoring. When cardiac output measurement is not available, mixed venous oxygen saturation trends can provide information regarding the adequacy of oxygen delivery. Studies have demonstrated that mixed venous saturations are a reliable and early indicator of cardiovascular dysfunction and failure to measure this may worsen outcomes in some situations.8 A decreasing mixed venous oxygen saturation, despite escalating support, indicates abnormal convalescence and the need for aggressive intervention. Another indicator of failing oxygen delivery is the development of lactic acidosis.And for the under development of the genitourinary maybe suggest for gene4ral procedure to prvent further complications
In the health assessment the similarities between the pediatric pt. and Adult pt. are we both take their Vital signs as the first basis for any abnormalities, and we observe their appearances for physical assessment. In terms to their differences on adult they can verbalized their own feelings example the history of their illness or they can express or describe the pain they feel while in pediatric patient we can assess their health status through observation and statement of their parents or guardian. The health practitioner should be extra careful in assessing pediatric pt. another thing is they are more sensitive.
The salient points of assessing pediatric pt. with alteration in cardiovascular function are through observing General appearance (Physical appearance and condition can give clues to the pt's over all health). Observe for cyanosis (Extremities for color), skin temperature, and evidence of edema, signs of easy fatigability or an increase in symptoms on exertion. Observe for anemia, respiratory status including any use of accessory, muscles, rate and type of cry. Auscultator for heart murmurs (quality of rhythm of the apical pulse), breath sounds. Observing the podia’s behavior and recording those observations provide vital clues to a condition another points of assessing are takings of vital signs, height, weight; we also consider the podia’s age and developmental needs.
proper health assessment is important for nurse in order for him or her to end up with correct identification of problems, correct planning, correct intervention, correct diagnosis and to render his or her therapeutic care effectively, before assessing an adult or pedia pt. first we must establish rapport to the pt. and on to his or her S.O. to get their trust and cooperation for adult pt. pedia and adult pt. are the same in cephalocaudal structure or in terms of thier anatomical structures that they have both head, body, hearth, brain, and other organs or system that a normal human being have, assessing an adult pt. is easier compare to pedia, because in adult you can ask her or him a question that help you to assess him or her easily, he or she can express his or her feelings verbaly and it is easy to assess them because they can follow instruction or procedure that you have to instruct them, unlike a pediatric pt, that you have to do APGAR scoring to assess them wether they are in danger sign or not, because they can not verbalize their fellings yet, and sometimes they are afraid to other person other than their care giver or guardians, regarding their vital signs pedia pt. has higher rate than in adult pt., in adult we can easily know if they have problems in their reproductive organs or function because they can easily tellto the nurse if they feel something wrong or unusual on them just like if they have difficulty in voiding or they cannot urinate not just like in pedia pt. that they must undergo examination to know the abnormalities on their reproductive organ or functions.
The difference of pediatric pt to adult in terms of health assessment in pediatric pt its difficult in terms in assessing because mostly of them had did not know or he can not able to verbalized his feeling if what parts of his body particularly they feel hurts and we all know taht this stage mostly of them has prone in diseases while on adult pt it slight easier them to pediatric pt because adult was already know the better way regardin gthier health so its easier to make an assessment for them bbecause he know the good and bad things rgarding thier health.In the similarrities of pediatric pts to adult pt as both of them have they acquired illnesses and for alteration in cardiovascular function and pediatric ot we all know cardiovascular disease remains the most common cause of death because of the high incidence of heart disease and the seriousness of its complications as a assessment know how to assess the cardiovascular system upon assessing a pt with alteration of cardiovascular functin to a pediatric pt by doing a proper loving tender care to your pt.you must monitored teh medication because over the counter drug can cause destroyed of our cardiovascular and also proper positioning.....
Initial assessment methods used for adults are modified for children due to developmental and physiological considerations. Modifying the assessment approach for children means that this will consider signs and symptoms a bit differently than for adults. ABC and Mental status remain the cornerstones of assessment for children as well as for adults. The initial assessment can also be thought of as the “over and over again” assessment. It should be repeated every few minutes in order for you to immediately detect changes in the child’s condition. Dealing with ill and injured children can be unnerving.
The rapid first impression gives you the means to figure out the urgency of the child’s condition. Although most of the children you will encounter will be non-urgent, there will be some that can be hard to figure out. If you follow the rapid first impression and initial assessment procedures, you will be able to make good decisions when faced with those children. In performing a rapid first impression, you begin by direct observation. Small children are curious about everything. When a stranger comes into their immediate environment they may react with fear or be intensely interested in the strangers actions. The child may even react in a friendly way. No matter what the reaction is, children normally react.
Lack of reaction should raise serious concern about the child’s mental state. Changes in mental state are often associated with inadequate perfusion of the brain, which occur due to hypoxia or hypoperfusion. Small children, even infants, are active. Lack of muscle tone, the inability to maintain an upright posture for a child older than about 6 months or sitting very still or stiffly are all signs that the child’s condition is urgent. Because the mechanics of the chest wall of a child is different than for an adult and because most serious life threatening problems of children involve the respiratory system, observing the chest wall is another way to begin to understand the child’s condition.. Extra breathing effort that is visible alerts you to the need to get definitive care for the child as soon as possible. It also alerts you to the need to provide the child with high concentration oxygen immediately. If the chest wall is not moving, you will already have observed a problem with the child’s appearance as the posture and the mental status will not be normal. If the chest wall is not rising , adequate breathing is not occurring.
Oxygen exchange cannot take place so you need to ventilate the child with a bag-valve-mask and supplemental oxygen. AND YOU NEED TO TRANSPORT IMMEDIATELY. The skin tone gives you the first clue about how effectively oxygen is being delivered throughout the body. When you see anything other than pink, think high concentration oxygen and transport. Time is of the essence in any child who appears urgent. The child needs care not available in the pre-hospital setting. Supporting the ABCs while transporting is the best clinical decision to be made for any child with an urgent condition. Initial assessment is continued throughout the transport. In doing the initial assessment, the nature of the problem may become clearer and further treatment may be indicated. Delaying transport is not an option for the urgent child.
It is always more important to be moving to definitive care than it is to complete the focused history or initial assessment. The unresponsive child can not afford transportation delays. Treatment of the unresponsive child begins with strict attention to maintaining an open airway, ventilation and support of the circulation. A child with severe trauma should be treated with immobilization, modified jaw thrust, if needed and ventilation. Once the airway is opened, transport must be started. When the child appears non-urgent, consider that your goal is to minimize agitation of the child. Agitation causes crying and further exacerbates or provokes respiratory distress. With the non-urgent child, take the time to establish a rapport with the child and the parent as you perform the assessment and the focused history. Circulation assessment is the key to detecting the presence of and the progression of hypoperfusion in children. Perfusion deficits are first detected at the feet and hands, so comparisons between the extremities (periphery) and the trunk (core) are used to determine overall perfusion status. Blood pressure does not indicate hypoperfusion as early as physical assessment does. Blood pressure can be measured in children over three, particularly when the condition is non-urgent and there is no need to expedite transport. When the child is non-urgent and BP is to be measured, cuff size is important. Use a cuff that is about twice the circumference of the upper arm and half the length of the upper arm for the most accurate reading. Unlike adults, blood pressure is not a reliable indicator of poor perfusion in children and should not be the reason to diagnose a child as hypoperfused. The determination of hyperfusion (shock) is the result of assessment findings.
Adequate circulation requires three things, the pump (heart), the vessels to carry what the heart pumps (vasculature) and volume (blood). If the vessels are damaged, bleeding is occurring. Visible bleeding should be controlled. Internal bleeding should be suspected with a significant mechanism of injury, even when there is no outward sign. Consider asking parents about blood loss in terms of how many cups or tablespoonfuls were lost. Even when the heart rate is fast, the pulse can be felt distinctly. It may be difficult to count an extremely fast heart rate, however. Although capillary refill by itself may not be a reliable indicator of the perfusion state, it should be considered as one factor among other signs that could indicate poor perfusion. Pain, fever, fear, and agitation can all increase heart rate in otherwise healthy children. Symptomatic children, however, whose heart rates are elevated cannot be presumed to be merely agitated, fearful or in pain. Slow heart rates are of great concern in a symptomatic child.
AVPU is modified for small children. Children who are school age and older can be evaluated as adults. Any child who is not alert should be re-evaluated for airway, breathing and circulation. If, at any time, the child’s mental status deteriorates, reassessment and upgrading his condition to urgent and changing your treatment plans is indicated. For school age children and older, AVPU can apply as for adults. Children of school age can be expected to know their names, locations and can differentiate between day and night. A – Alert to person, place and time. V – Responsive to verbal stimulus. P – Responsive to painful stimulus. And U – Unresponsive.
Focused history means focusing not just on the presenting problem but on the circumstances surrounding the problem. The immediate past, the associated complaints and related events are all parts of the focused history. Use the SAMPLE: S - signs and symptoms –assessment findings plus history. A – Allergies especially to medications. M - medications that the child is currently taking. P - past medical problems. L – last food or liquid the child has taken. And E – events leading to illness or injury. History taking is primarily a skill of meaningful listening. The parent may not immediately articulate all of the information you would like to know due to anxiety of the moment. Patience is often necessary in order to get all of the desired information. These methods: SAMPLE and AVPU can be used by both the adults and the pediatric patients.
In pediatric patients with altered in repro of genitourinary func...the nurse must first check for the VS then health history - use the Gordon's 11 functional health patterns - give due attention to the nutritional and metabolism pattern and the Elimination pattern of the child. Always involve the mother in every Health assessment of a child.
there are similar health assessments in pediatic patients and to the adult,similar in terms of cephalocaudal procedure but different in terms of asesing the physiological appearance because pediatric patient body parts are not yet fully develop not like in adult patient..different in their vital signs,physiologic status,and general appearance.
Assessing the pediatric patient with alterations in cardiovascular function requires us to be a good observer.Physical appearance of the pediatric patient is important to analyze how iii our patient is..being cyanotic,clubbing of fingers,growth of the patient is not appropriatein age should be noted..how the patient tolerate specific activies.this are important point to determine our patient condition.
In assessment of similariteis and differences of pediatric patient is you must assess with providing teaching and psychological suffort.Always estalish rapport to the patient, like to giving him a toys and play with him so that you will gain there attention and cooperation. Because pediatric patient is on the stages of growth and developement so that its very hard to let him understand about what procedure that are we going to him. on that stages there is a fear of strangers and fear of being alone. For the adults some of them are prone to any kind of diseases just because they are reached and fully matured.Health assessment needed for adult patient is respect,promote privacy for the data being collected is still confidential. Also explain what to be expected and how to managed himself after the procedure.
in assessing the adult health with cardiovascular,it is very important to determine the presence of psychosocial factors,we have to explain to the pt's. stress,depression, and anxiety are one of the causes of cardiovascular desease.Therefore,pt's. need to be assessed for presence of negative and positive emotion.So that the pt. have a cooperations to the nurses and nurses knows the limitations regarding questioning and taking physical assessment.The adult pt's. are easy to assess than pediatric pt. because in adult pt. you can use questioner like(where is your pain?,what does the pain feels like?)through this we can determine how severe the pain.The advantage of adult pt they express his/her feelings or emotion.Through that questioning we can get easily the lifestyle of the patient also the family history wich is very important on assesssing patient.
In assessing pediatric patients health with cardiovascular,for me is very difficult.We all know that they are very sensitve ,and theres some instances that the child scared when they saw a white uniform,thats why we have to give them a proper caring support ang love.In these case sometimes we cannot used the subjective assessment rather than we use more on objectives in assessing them.Pediatric patients with cardiovascular should be assess the cardiac output.Physical examination includes the determination of heart rate,blood pressure,pheriperal perfusion,urine output,and level of conciousness.We also need to monitor thier vital signs.In terms of the family of the patient we should give them comfort and emotional support to lessen the burden feelings and anxiety.
In terms of health assessment of pedia it is more difficult to distinguish the manifestation or objective as well as subjective signs & symptoms of a pedia because of undeveloped body parts and unstable vital signs, while an adult pt. could verbalized what & how they feel especially in times of pain.
Salient points of assessing pedia pt. especially in males are very prominent like in the case of hypospadia wherein the urethra or opening for urine outflow of male is in posterior part of the penis.
During this assessment stablish rapport first before doing any procedure,Interms of health assessment of pediatric patient and adult are different like the vital sign and normal values of pediatric patient and adult are different because the adult are reach having maturity while the pediatric patient was not fully developed. When dealing patient with alteration in reproductive genitourinary function first you need to provide privacy and advice the patient to undergo examination to determine the abnormalitie of reproductive organ.............
good assessment to the pt. may lead to continous health improve mof the pt; thats why assessing pt is important in curing and preventing the underlying causes of the pt.
Pedia pt. needs more attention than adults pt.; however they are all need for medical assistance.
Adults pt. are more vocal in what they feel; a nurse needed for the subjective cues of assesment. They even cooperate when doing the assesment.
In pedia pt; its hard to assess because 5they cant teel us what they feel although we xcan assess itru their facial expression. and through S.O.
Patients with cardiovascular disease, the general appearance is much observe. It manifest cyanotic, clummy skin, clubbing of the nails due to decrease carciac output and decrease oxygenated blood by the lungs
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The similarities of pediatric and adult patients is same prone on cardiovascular function, although a disease among children and elderly person is similar to that adults. Several unique issues affecting these group waarrant further discussion. The patient who have cardiovascular disfunction is one of the major cause of death of patient with ESRD, the over all mortality rate for cardiovascular disease for people whebn renal failure is 30 times that of general population. Even after stratification of age, end-satge renal disease affects almost every body system. It cause an accumulation of nitrogenous wastes, alter sodium, water excretion, and alter regulation of body levels of potassium, calcium etc. It also causes skeletal disorders anemia, alteration in cardiovascular function, neurologic disturbance, gastrointestinal dysfunction and disomforting changes. The genitourinary system have wide-spread effects on physical and psychological function affecting sexually and reproductive function. The reprodutive structures are located close to other pelvic structure, particularly those of urinary system and disorders of reproductive system may affect urinary function. It is focus on infection and infection benign conditions.
The similarities of pediatric and adult patients is same prone on cardiovascular function, although a disease among children and elderly person is similar to that adults. Several unique issues affecting these group waarrant further discussion. The patient who have cardiovascular disfunction is one of the major cause of death of patient with ESRD, the over all mortality rate for cardiovascular disease for people whebn renal failure is 30 times that of general population. Even after stratification of age, end-satge renal disease affects almost every body system. It cause an accumulation of nitrogenous wastes, alter sodium, water excretion, and alter regulation of body levels of potassium, calcium etc. It also causes skeletal disorders anemia, alteration in cardiovascular function, neurologic disturbance, gastrointestinal dysfunction and disomforting changes. The genitourinary system have wide-spread effects on physical and psychological function affecting sexually and reproductive function. The reprodutive structures are located close to other pelvic structure, particularly those of urinary system and disorders of reproductive system may affect urinary function. It is focus on infection and infection benign conditions.
In assessing a pediatric patient it includes a review of the mother's preganacy history, physical examination of the infant, and the analysis of laboratory reports such as hematocrit and blood type of the infant. assessment is done to know if their is any abnormalities. assessment begins either after birth and when the infant is in the hospital, which is continued at every contact. It is necessary to teach the parents also to have an assessment concerning their infant temperature, respiratory rate and overall health is crucial so that they can continue to monitor their child health at home. In the assessment of a pediatric patient we get the weight of the child to know if the child is underweight or overweight, the vital signs of the infant which include the temperature, cardiac rate, and respiratory rate, and all the physical aspect of the system especially the urinary function.
In oediatric patient with alteration in genitourinary function, the possibility of obstruction in the urinary tract can be assessed by observing the force of the urinary stream in both male and female infants. Male should void with enough force to produce a small projected arc, female should pruduce a steady stream, not just continuous dribbling. Projecting urine farther than normal also may signal urethral obstruction, because it may indicates that the urine is being forced through a narrow channel. Whenever the child voids or eliminate they usually cried because someinfant get irritable when their pampers are wet.
In adult patient, the genitourinary system continues to function adequately, although thier is a decrease in kidney mass primarily, because of the loss of nephrons. When the person is stress the kidney function changes it includes a decreased filtration rate, diminished tubular function with less effiency in reabsorbing are concertrating the urine, and a slower restoration of acid-base balance. Some adult often suffer sterss and urge incontinence. Stress incontinence occurs when a small amount of urine leak out during exercise or when they cough, laugh, or sneeze. This is also common on men to experience it after prostate surgery. Urge incontinence happens when the need to urinate comes on so quickly and there is not enough time to get to the toilet. So, it is advisable to everyone to empty the bladder every after 3-4 hours. One of the contributing factor of the uirinary incontinence is constipation, in responce to this problem, the nurse should advise the patient to increase the fluid intake, have high fiber diet and imncrease the mobility to promote regular bowel function. Urinary tract infection also called bladder infection or cystitis are common health problem for women, young girls,and some infant boys. It may also occurs include the effect of decreased estrogen, which shortens the urethral length, allowing esier passege of bacteria into the bladder. To prevent this problem patient should drink more fluids; water is best, urinate frequently to empty the bladder. In women they should wipe from front to back after going to the toilet to reduce the spread of bacteria from the anus to the urethtra and avoid alcohol and caffeine.
Health assessment is the initial thing we do to our patient to know what’s wrong with them it includes the complaint of the patient or what we called subjective and the things we observes to our patient or the objectives.
Using the techniques of palpation, percussion, inspection and auscultation to determine if there are abnormalities in their body that cause their sickness does assessment.
Similarities and differences:
S - Both need to take their vital sign for baseline data
- Both have to undergo assessment for the same reason of further observations
- Both have the right to be informed even their significant others or relatives guardians about the assessment been done to the patient
- Both have the right to privacy, so we as we performed the assessment procedure we must observed the privacy of the client.
- And on the cephalocaudal procedure
D – The adult have matured body structures; pediatric patients have more sensitive body parts, we must be more careful in handling the patient
- Adults can easily identify what the feel and can describe it, which is our advantage for easy assessment;
- While in pediatric patients they can only cry as loud as they can to caught our attention and look for what they cry for.
In assessing pediatric patients with reproductive genitourinary functions must be focus with the patient genitalia, which we can see some abnormalities on there genitals.
Second focus is their parents or guardians, the level of understanding so we can ex plain why does this occurred and how it can be treated for example is the hypospadia for male infants, it can be identify easier because after delivering the child we monitor his urination so we can observed were does his urine came out. In this care the presence of urethral meatus is on the ventral surface of the penis, which is not normal. It can only be treated trough surgery procedure. So with this case we have to assess the parents of the infant for them to understand the situation of their child. Another focus is to the family history of the patient, which will be coming from the guardians, or the parents of the patient because some of the genitourinary function abnormalities are inherited meaning it is in the genes of the couple that affect the baby. These are the some points to consider in assessing pediatric patients with alteration in genitourinary functions.
Nj-cruz
In assessing the patient it is the same the method that we used, but when it comes to the age of the patient it has a difference like in a pediatric patient and adult patient. In the pediatric patient, when we dealing to them you may feel like you are taking care of the two patient when parent or guardians is present , and the children usually behave in a way consistent with how they truly feel. The anatomical differences between the pediatric patient and the adult patient, in the pediatric patient in the airway the trachea shorter and narrower, cartilage is more elastic and collapse especially in the thoracic cavity or chest wall is softer and more complaint than the adult patient. The pediatric patient the weaker the abdomen muscle cause appearance. In the pedia the metabolic rate is higher than the adult, they varying approach to the pediatric patient based on their age of the keys to a successful physical assessment. The method that usually used in assessing is the cephalocaudal.
The salient point for assessing pediatric patient with alteration in reproductive genito urinary function, you must focus to the patient based. Althoughthe general component of the patient assessment will remain that the same for the adult, should be made by from children. When completing the detailed physical exam, it does not matter whether you proceed head-to-Toe or toe-To - head as long as all anatomic areas are included.
In assessment we need a thorough diagnostic interview begins the assessment process. The information is gathered in the following areas, developmental history, health history. In adult we assess the patern alcohol and drug history, the past and present health medical history, the history of problem of the urinary function and also the bowel and bladder control and the frequency of urination.
The similarities and differences of a pediatric patients, we need to take the body proportions, airway and musculoskeletal. The body proportion is head relatively larger than the rest of the body. The airway is the smaller and narrower, narrowest part of the airway is at the circoid cartilage, unlike adult which is at the level of the vocal cords. The newborn musculoskeletal have 2 fontannels, the anterior closes between 10 and 16 months, and the posterior closes between birth and 3 months. The higher fluid requiements due to higher metabolic rates, newborn's total body weight is 70-80% water (adult only 50-60%). Also we are doing the APGARS scoring to find the abnormalities of the infant, we need to take the weight, the head and abdominal circumference and the length of the infant and also the babinski reflex, moro reflex, and sucking reflex. we monitor also the vital signs,cardiac rate, temperature, and pulse rate and observed the pediatric patient if there is presence of epispadia,hydrocelle,and ernia to perform early circumcision to prevent further complication. The adult in terms of assessment is likely similar to the pediatric assessment it perform the cephalocaudal assessment, and also the BPH assessment (drifus) dribbling and difficulty of urinating, retention, inability to void before alcohol and cold exposure, small less forceful urine system. In responce to this problem the nurse should advise IFC insertion to
empty the bladder.
In assessing pediatric and adult patients it is a "MUST" to treat them "EQUALLY" regardless of their condition,status,and "AGE".
We must assess them both in cephalocaudal procedure, even their anatomic structure is merely different.
Some of their differences and similarities are;
The responce of children to illness depends on their cognitive development,past experiences and level of knowledge. Their responsese to illness prevention is particularly difficult for children to understand or health education has not focused as much on health promotion as it has on health restoration at this level. Knowing how children view illness has implication for nursing care,(eg. Children who think illness comes as punishment for breaking rules can interpret nursing procedures like "taking a rectal temperature or giving an injection as punishment".They maybe confused about explanations of procedures because some words sounds alike or have double meanings(eg.the word "DYE" as used in radiographic studies and as it related to death, or drawing a picture and drawing blood).Until they can understand that illness does not occur for unknown reasons but from predictable cause such as exposure to microorganisms,they are not ready to participate in procedure to stay well or get better when ill. These distorted perceptions of illness explain why explanations of procedures are not always successful of children in relieving their stress level.Unlike in adult it is more easier to assess, and easy to deal with.
Children are not just small adult,This is important to keep in mind when evaluating how children react to illness,percieve an illness, or react to health care.Children's body images as evidence in thier drawings are different from those of adults.They may have difficulty telling which body part are indispensable and which are not.
Very young children do not have the vocabulary to discribe symptoms. Headache, for example,is a symptoms that children have difficulty discribing.Dizziness and nausea are equally bewildering because children do not have the words to express this phenomena.Unlike adult, they can easily express their feelings,"they are more expressive than of young children".
When hospitalized,young children are unable to monitor thier own care.Adult who are hospitalized,often ask about medication they are taking.
Children do not think as adult. They have fear that are strictly childhood fears.
There are also physiologic differences in the way illness affect a child compare with an adult.Children have different physiologic need and responds to imbalances in different way.Children need more nutrients(calories,protein,minerals and vitamins) per pound of body weight than adult because their basic metabolic rate is faster and they must take in not only enough to maintain body tissues but enough to allow growth.
An infant does not have the store of water in the cell that an adult has and thus it is more likely to lose a devastating amount of body water with diarrhea and vommitng and may have hospitalized.
Children tend to respond to desease systematically rather than locally, because their body are immature unlike adult their immune system are well developed.
Because of their growth requerement and their immaturity,children are more susceptible to some disease that do not affect adult....
All thuogh similarities of children with an adult is in the way they expresses their feelings through facial expressions.
Growing up with special health care needs is similar to growing up without special health care needs. However, there are important and fundamental differences to consider, and it was already identified by my classmates.
Though the transition of a person with “special health care needs” (like having an abnormalities) from pediatric to adult care, is more complex. In a larger sense whether your patient is a baby or an adult having alterations or what so ever, the quality of service or care that you will be giving is just the same. The only difference is the way we approach them... Well as what I have said in my past blog, we must approach them at their “level of understanding”. To gain their TRUST and COOPERATION,in order for us to have a successful assessment and an unconditional care.
There are some differences and similarities in the assessment of adult and pediatric patients in terms of health. One of their similarities is that we assess both of them cephalocaudally (head to toe) during the physical assessment. We do such kind of examination to find out and render appropriate nursing managements if there are certain abnormalities that were discovered which contributed to the occurrence of the disease or illness of the patient or maybe, one of the signs and symptoms caused by the disease process.Possibly,another problem that may arise aside from the diagnosed problem. In addition, we should handle all patients with care no matter if they are adult or pedia or regardless of what their status is. We should treat them equally for they are human beings who have the right to live and have the freedom from harm.
On the contrary, the differences between adults and pedia with regards to health assessment is that we can gather complete details/information in adult patients except for the unconscious ones while in pediatric patients we need the help of the patient’s significant others/parents. We can also easily adjust ourselves to adult patients in terms of their level of understanding compared to pediatric patients.Therefore,it is easier to provide nursing interventions to adult patients unlike with pediatric patients that most often, we need the assistance of the significant others.
In assessing pediatric patients with alteration in reproductive genitourinary, we should bear in mind that the patient is too young to suffer such kind of abnormalities or illness especially if she/he will undergo surgery. So, as a student nurse we should let them feel our tender loving care right from the very start. We should assess the patient carefully and properly, as they say, pedia patients are fragile so we should handle them with much care. We should alleviate the pain by doing effective nursing interventions such as proper positioning, divertional activities (playing toys, watching television, etc…) ,providing comfort, and many more. Educating and providing health teachings and information to the significant others particularly the parents regarding the present condition of their child is also important to reduce their anxiety. Finally, we must render services willingly towards the care of patients to the best of our capabilities.
Health assessment is one of the most essential & critical in the responsibility of nurses because it is in this part wherein nurses must be very keen in observing any abnormalities the patient may manifest. In assessing the health status of patient either adult or pedia we always perform the same procedure (cephalocaudal),and general appearance as determinant factor in the severity of the illness,the mode of treatment as well as the responses. In a way they are prominently different as to the body built as well as the child's increased metabolic rate wherein there is a need to also increase intake of fluids & energy to compensate with their body's demand. In adult we commonly use Vital Signs values as our immediate resource while pediatrics was on the result of the APGAR & newborn screening but as a nurse we should not always rely on that because their status might fluctuate at any time & rate thereby consistent assessment is necessary. Adult patient normally maintaned better health than pedia,thus effective assessment on pediatric patient needs the cooperation of the immediate family to note of the pertinent medical history for appropriate health care.
When performing health assessment for alterations in the function of Cardiovascular,evaluation of the patients general appearance is again vital. Rapid respirations resulted from cases of congestion. Child may manifest easy fatigability due to abnormal cardiac output. Cyanotic, finger & toe clubbing indicates inadequate oxygenation. Patient with increased perspiration & cool skin resulted vasoconstriction in heart failure.
The similarities of pediatric patient. and adult patient in terms of health assessment with alteration of cardiovascular function are the following:
=manifestation:
Both of adult and pedia manifest cyanosis,cardiomegaly,and tachycardia in some cases.
=Method use for assessment: both of them are using this method the "IAPP"
=Both are prone to complication.
DIFFERNCE:
=vital sign
=structure of the body
=manifestation: tel spel, get tired easily
=medication
The importance in assessing a patient with cardiovascular function is to evaluate the degree and nature of the disease in order to cure or treat or how we are going to manage their condition.
The similarities of pediatric patient. and adult patient in terms of health assessment with alteration of cardiovascular function are the following:
=manifestation:
Both of adult and pedia manifest cyanosis,cardiomegaly,and tachycardia in some cases.
=Method use for assessment: both of them are using this method the "IAPP"
=Both are prone to complication.
DIFFERNCE:
=vital sign
=structure of the body
=manifestation: tel spel, get tired easily
=medication
The importance in assessing a patient with cardiovascular function is to evaluate the degree and nature of the disease in order to cure or treat or how we are going to manage their condition.
In terms of assessing the pediatric patient and adults, they are similar because we used the cephalocaudal procedure, but they are different in many ways. When assessing a pediatric patient in all ages, we communicate to them through the nonverbal components of the communication process convey the most significant messages. It is difficult to disguise feelings, attitudes, and anxiety when relating to children because they are very alert to surrounding and attach meaning to every gestures and move that is made, it is particularly true of very young children, we must allow children time to feel comfortable, avoid sudden or rapid advances, broad smiles, extended eye contact, or other gestures that may be seen as threatening to them, we communicate through transition objects such as dolls, puppets, stuffed animals before questioning a young child directly; assume a position that is at eye level with child, speak to them in a quiet, unhurried, and confident voice, speak clearly, be specific, use simple words and short sentences, and allow them to express their concerns and fears before doing the asesment for the pediatric pastient..., we must determine their heart rate and rhythm, describe heart sounds , including any murmurs, determine the poitn of maximum intensity (PMI, the point at which the heartbeat sounds and palpates loudest (a change in the PMI may indicate a mediastinal shift), we must describes the infant's color (maybe of cardiac, respiratory or hematopoitic origin);cyanosis, palor, plethora, jaundice, or mottling, we also assess the color of the nail beds, mucous membrane, lips, and determine blood presure, we must indicate extremity used and cuff size; check each extremity at least once, we must also describes the peripheral pulses, capillary refill (< 2 to 3 sec.), peripheral perfusion (mottling), this all things is what we are going to do. In adult, in assessing them we must document the shortness of breath on minor exertion, hypertension, heart murmurs or S3 gallops, and chest pain, and in adults we can see the manifestaTIONS of decreased vesel elasticity due to calcification and connective tissue, decreased number of heart muscle fibers, with increased size of individuaL fibers (hypertrophy), the decrease filling capacity, decreased stroke volume, decreased sensitivity of barroireceptors and degeneration of vein valves, in genitourinary of pediatric and adult patient are the same, it is one of the most important part of the body system, when it is not use properly, the underlying infection will appear.
We all know it is hard to assess an adult patient and also a pediatric patient.As a nurse we should have the "trust" and "confidence" in assessing them. in terms of cardiovascular function, pediatric patient is the one who hard to assess. their heart are not yet well developd than an adult patient.they are more prone in heart disease.In assessing them we used the cephalocaudalprosedure.But different in physiological appearance. As i said the organs of pediatric patient is not yet developed.We need to do the physical exam in order to know the abnormalities of a patient. "CRYING" is the only means of communication of those pediatric patient. While in adult, we can easily know their illness through verbal. we can also give them ideas on how to manage their illnesss, like cessation of smoking, balanced diet, exercise an etc. First management of an adult with cardiovascular problem is oxygenation, the pattency of airway,medication and etc. the v/s of the adult is different in pediatric patient. in v/s itself we already detertmine the problems of a patient. While the treament of those pediatric patient who have cardiovascular disease are medication and surgery. wWe need to be alert and active in assessint pt.
the diffences in between a pediatric and adult patient is, in pediatric they are hard to communicate they are afraid on a nurse while in adults they can communicate without fear they are just shy to express their feelings. when assessing a pediatric patient you have to established or gain their trust before doing any procedure,explain the procedure and tell to the patient that it is for his/her own good, you have to be more knowledgeable in caring a patient specially in pediatric.
When assessing children, the Pediatric Assessment Triangle (PAT) should be added to the patient assessment sequence.Although the general components of the patient assessment will remain that same as for the adult, modifications should be made for children.When completing the detailed physical exam, it does not matter whether you proceed head-to-toe or toe-to-head, as long as all anatomical areas are included.Do not delay the transport of critically ill or injured child in order to complete the focused history and detailed physical exam; if time allows, this can be performed en route to the hospital.For critically ill/injured or unconscious children, follow the same patient assessment sequence as for the unconscious adult. Assists in determining the level of severity, urgency for life support, and the key physiologic problems.PAT can be completed in 30 to 60 seconds; the three components can be assessed in any order. Appearance: reflects the adequacy of ventilation, oxygenation, brain perfusion, body homeostasis, and central nervous system function, assess from across the room; allow child to remain on caregiver’s lap, use bright lights or toys to measure interactiveness.
Characteristic: Features to look for:
Tone Extremities should move spontaneously, with good muscle tone; should not be flaccid or move only to stimuli
Interactiveness Should respond to environmental stimuli orpresence of a stranger; should not be listless, obtunded or lethargic
Consolability Easily comforted or calmed by caretaker (i.e., speaking softly, holding child, or offering a pacifier)
Look/Gaze Should maintain eye contact with objects or people; should not have a “nobody home” or glassy-eyed stare
Speech/Cry Should be present, strong and spontaneous; should not be weak, muffled, or hoarse
GOLDEN RULE:
The child’s general appearance is the most important thing to consider when determining how severe the illness or injury is, the need for treatment, and the response to therapy.
Work of Breathing is a more accurate, quick indicator of oxygenation and ventilation than respiratory rate or chest sounds on auscultation.Reflects the child’s attempt to make up for difficulties in oxygenation and ventilation.
Characteristic: Features to look for:
Abnormal airway sounds Snoring muffled or hoarse speech, stridor, grunting, wheezing
Abnormal positioning Sniffing position, tripoding, refusing to lie down
Retractions Supraclavicular, intercostal, or substernal retractions of the chest wall; head bobbing in infants
Flaring Nasal flaringCirculation to Skin
Reflects the adequacy of cardiac output and core perfusion, or perfusion of vital organs.Cold room temperatures may cause false skin signs, i.e., the cold child may have normal core perfusion but abnormal circulation to the skin. Inspect the skin (i.e., face, chest, abdomen) and mucous membranes (lips, mouth) for color in central areas.In dark skinned children, the lips and mucous membranes are the best places to assess circulation.
Characteristic: Features to look for:
Pallor White or pale skin or mucous membrane coloration
Mottling Patchy skin discoloration due to vasoconstriction
Cyanosis Bluish discoloration of skin and mucous membranes
1). Assess environment: May need to manipulate the environment. Environmental factors. Patient location (home, street, baby-sitter’s house, school). Weapons, toys, objects (may indicate trauma mechanism). Medications (may offer clues to past medical history). Witnesses (may help to explain circumstances)
2). Airway: (determine responsiveness and patency of airway) Approaching an alert child too fast may cause crying and agitation, which interferes with assessment and may increase respiratory distress. Initiate spinal precautions if indicated. Introduce self to child or adult patient. Obtain client name and age; use name throughout exam. Determine LOC in an age appropriate manner.
3). Breathing: (assess rate, rhythm, and tidal volume). Look at abdominal area for respiratory movement since they are abdominal breathers. If labored breathing, place the child/adult on oxygen.
4). Circulation:
a. Palpate for pulse noting rate, rhythm and quality.Check the peripheral pulses (i.e., brachial or radial) for quality. If it is strong, the child/adult patient is probably not hypotensive. If non-palpable, attempt to find a central pulse (i.e., femoral for infants and carotid for older children). Compare peripheral and central pulses; discrepancies in quality of pulse can be due to cold air temperatures or decreased cardiac output.
b. Assess capillary refill. Check capillary refill at the kneecap or forearm; normal refilling time is less than 2 to 3 seconds. Cold room temperatures can affect capillary refill.
c. Check for obvious bleeding; control if necessary
5). Skin signs: (assess color, temperature and moisture). Skin color has already been assessed with the PAT. With adequate perfusion, the child’s skin should be warm near the wrist and ankles
6). Assess neurological status: (assess level of consciousness and neuro deficits). Complete Glasgow Coma Score: For the child and adult. Child is considered to be age 12 months to 14 years; GCS has been found to be unreliable in infants but can be used as an estimation as appropriate.
7). Determine chief complaint
FOCUSED HISTORY AND DETAILED PHYSICAL EXAMINATION
1). Elicit history of chief complaint or problem (PQRST). Usually have to rely on caregiver for details of history; may ask child questions if age appropriate
2). Elicit personal history (HAM). Medical history/under a doctor’s care, allergies/age,medications-current over the counter and prescription.
3). Vital Signs. May be unreliable indicator of the child's true condition. Can vary greatly with age, body temperature and anxiety. May be difficult to obtain due to constant motion, agitation and resistance of child
Blood Pressure:Take only if appropriate size cuff available; width of cuff should be approximately 2/3 the length of arm between the shoulder and the elbow. Too difficult to obtain in children < 3 years old; however, should attempt on any child who is critically ill or injured. Hypotension is almost always a sign of late shock. Hypertension is uncommon; not a clinical problem for children in the field.
Heart Rate:For younger children and infants, heart rates are easier to obtain by palpating the brachial pulse or auscultating the apical pulse in the area of the left nipple. For older children, heart rates are obtained the same as adults. Take the rate for 15 seconds and multiply by 4; irregular rates may be taken for 30 seconds and multiplied by 2. Tachycardia is usually caused by hypoxia, fever, acute infection, anxiety, and can be an early sign of shock. Fevers: Each degree of fever raises the heart rate 8-10 beats/minute. Bradycardias can be due to critical hypoxia and/or ischemia
Respiratory Rate:For children < 8 years old, observe abdominal movement for respiratory rates; alternative methods are placing your hand on the back or abdomen while counting rate or auscultating rate with a stethoscope (usually done at the same time that heart rate is being taken). To obtain a respiratory rate, count the number of respiration for 30 seconds and multiply by 2. Hyperventilation may be due to hypoxia, fever, pain, anxiety or excitement. Fevers: Each degree of fever raises the respiratory rate by 4 breaths/minute. Hypoventilation may be the result of drug overdose, severe head injury, exhaustion from labored breathing
CARDIAC MONITORING: ECG should be continuously monitored in children who have any respiratory or cardiovascular instability. A rhythm disturbance in a child should only be treated as an emergency if it compromises cardiac output or has the potential to degenerate into a lethal rhythm.
PEDIATRIC WEIGHT: Needed to calculate drug dosages or fluid challenges. Ask parents for actual weight, if known. Estimate - Use length-based measuring tape (Broselow).
5). Pertinent Body Check: Medical or minor trauma - perform body check pertinent to chief complaint. Should complete a total body check whenever possible, even if complaint is minor. Use toe-to-head exams for infants, toddlers, and preschoolers.
Head-to-Toe or Toe-to-Head Examination:
The following areas warrant special mention:
Anterior Fontanel:
Should be assessed routinely in infants
Should be assessed with the infant sitting upright and not crying
A firm or bulging fontanel may indicate increased intracranial pressure; crying may also cause bulging
A sunken or depressed fontanel may be the result of dehydration
Breath sounds:
Because of the small size of the chest and lack of musculature, breath sounds in infants are easily transmitted throughout the chest. Auscultate breath sounds at the mid-axillary line bilaterally.
Abdomen:
Optimal assessment is done when the child is quiet, lying down, and knees bent; distracting the child may be necessary since he/she may tense their abdominal muscles if they anticipate your approach.
General Inspection:
Look for any bruises, hematomas, abrasions, lacerations, fractures, unusual markings, etc.; be alert to any injuries that cannot be explained or is inappropriately explained, or not possible due to the age of the child.
Observe skin for rashes, especially accompanied by fevers
Signs of dehydration
GOLDEN RULE:
The physiologic status of the child can change very quickly, so repeated
assessments are necessary.
Salient points on alterations on cardiovascular functions.
Cardiovascular System
a) Assess pulse for: rate, rhythm, quality; presence of pulse deficit.
b) Assess blood pressure for: equality on right and left arm; pulse pressure; postural hypotension.
c) Inspect neck veins for distension, with head of bed elevated to 45° angle.
d) Assess temperature by appropriate method.
e) Palpate chest to locate point of maximal impulse of heart.
f) Palpate chest to determine presence of heaves or lifts.
g) Auscultate heart sounds for: the presence of S1 and S2 at the point of maximal impulse; extra heart sounds, murmurs and rubs.
h) Inspect mucus membranes and skin for color. Observe for cyanosis or flushing.
i) Palpate skin for temperature.
j) Palpate dependent areas and extremities for edema and determine grade if applicable. Include inspection of facial edema.
k) Inspect nailbeds for clubbing.
l) Inspect and palpate digits for capillary refill.
m) Palpate extremities to locate and determine quality of peripheral pulses.
n) Assess for evidence of bleeding (nosebleed, GI bleed, vascular abscess, incisions, eyes, bruising on skin).
o) Review chart to assess: drugs that affect the cardiovascular system, and diagnostic tests.
adult and pediatric patient has acertain differences,pediatric patient are very scared on the persons who are wearing white uniforms specially when they have a syringes, its hard to get the mood of pediatric patient because they are moody and also hard ro get their trust,while adult patient are not too much moody because its only easy to get their trust or their cooperation as long as your not doimg bad to them or your not hurting their physical and emotional aspect.
pediatric paient with alteration of reproductive of genitourinary functions are hard to communicate because of their age as pedia are very sensitive, they dont want to others to see or touch their reproductive.
in assesing for pedia pt.and adult they are different in terms in cephalocaudal procedure.in ases a pt always establish rapport to gain their cooperation and trush to us both adult & pedia pt.in terms of asesing their health in cephalocaudal structure that in terms in anatomical structure that they have same function the difference the abnormalities of the pedia to the adult pt. in asses a adult pt it easier to get family hx. past illness but compre in adult you can ask her question that help u to ases and give clear and expres her feeling if they have something wrong for them he express her feling verbaly because he understand and she follow instruction or procedure that u have intruct .unlike in pedia u asess apgar score which is not iniated in adult.to do apgar if they have a sign of abnormalities to the pedia pt.in adult pt we can esily determine if they have abnormalities of their reproductive organ because it can easily to tell something xrng. just like pedia he did not verbalize felling to us.if they have abnormalities to their reproductive organ.
The difference and similarities between pediatric patients and adults in terms of assessment,is,pediatric patient is more difficult to assess because it requires efficient and effective approach to the child in order to have a baseline data prior to treatment..this assessment includes oxygenation,patency of airway,and body temp..pediatric patients is more likely to be sensitive than adult patients in terms of health assessment because infants needs full attention and continous monitoring in order to secure and ensure safetiness of pediatric patients,this measures are more likely initiated than in adult patients......
One of the most complicated problems of pediatric patients have, is mostly, heart problems,either congestive heart failure or congenital heart defects.In this case,the infant will surely experience some manifestations of heart problems,this will include,being cyanotic because of decrease oxygen supply, fatigue because of increase heart beat, diaphoresis,edema,and systolic murmur heard during auscultation..therefore, it is very necessary to assess proper oxygenation, breathing pattern, patency of airway, and body status to promote the exchanges of gas, reduction of mucus secretion production, and promote better blood circulation of pediatric patients....
Alterations in reproductive of genitourinary functions includes hypospadias,epispadias,urinary tract infections and others..
It is important to address parent's concerns at the time of birth.Preoperative teaching can relieve some of their anxiety about the future appearance and functioning of the penis..Some necessary assessment that will help the patients,this includes,oral fluid intake to maintain adequate urinary output and patency of stent..It is also important to assess the adequacy of urine output and blood urine chemistries to detect signs of renal damage..Infant having epispadias and hypospadias, it is more likely to restrict the infant or toddler from activities, encourage to drink control oral fluid intake to ensure adequate hydration, and also be sure to give complete course of prescribed antibiotics to avoid infections..............;)
Were all know it has a big difference among a pediatric and adult patient regarding on assessment.You must adjust yourself as a student nurse in handling pediatric patient,they are very sensitive everytime you touch the and see someone who is wearing a white uniform,i thought that they bear in their mind that we hurt them.They cant express their own feelings,no good communication.we need the cooperation of their family to obtain their health history.If ever a pediatric patient have genitourinary defect,they should be treated promptly and generally should be treated as a priority.Pedia patient with cardiovascular diseasemost of them are cyanotic and murmur is heard as we auscultate in the chest part,a wide variety of heart malfunctioning can occurs.In assesing adult patient first you must know their lifestyle and the culture they have so that you will know how to communicate with them.A pediatric and adult patient are the same in terms of gathering assessment because both were getting their medical history,family history,past and present illness,physical examinations from cephalocaudal.Only lifestyle,attitude,culture are not the same.....
The similariteis between pediatric and adults contains a branch of medicine dealing with the development, care and disease while in terms of health assessment in pediatric patients we have to assess the ..
1.past medical history includes
- antenal history
- perinatal history
- and past illness
2.the feeding history
3.development history
4.immunization
5.family and genetic history and also medication of allergy, and regarding to nursing assessment in pediatric patients we have four mechanism of heat loss in profiling of the new born. The conduction,radiation evaporarion and convection. But in terms to adults we have to assessed the social and family history, personal and reproductive medical history, current pregnancy and labored delivery.
When assessing cardiovascular disorders, the general risk factors may be classified by the nonn modifiable and modifiable risk factors, the physical examination, common clinical manifestation of the diagnostic test. This is very important things to considered when determining how the illness or injury severe need for treatment, vital signs and normal values, and also for adults.
We all know then that there are similarities in the health assessment of pediatric patient with the adults regarding of getting the family history, past and present illness and the cephalocaudal but they are also differ in many ways like in the proportion of the body,also they differ in tne normal values of vital signs.
Pediatrics are very sensitive, isn't it? So, as a nurse you must be patient enough and adjust yourself with the level of understanding of the patient but still we have to gain the trust and cooperation of the parents for us to get the history of the patient.
Pediatric patient with altered cardiovascular function may appear cyanotic and the respiratory rate will be rapid.
With the adults, we must be careful and assess them correctly, and as a nurse we must be knoledgeable because one's life is what we're handling.
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The similarities of pediatric patients and adults in terms of health assessment are comport of the patient and the oxygenation must be observe. And the patient must be monitored strictly; and the health teaching should be done. And the differences of pediatric patients and adults in terms pf assessment are; when conducting a physical examination cause in adult the physical exam than in cephalocaudal while in pediatric patient it was than starting at the abdominal going to the other part of the body. And also in terms of pain cause you will never know what is painful in the child. And also in terms of body resistance the child has the lowest resistance.
In assesing pediatric patient it is more difficult to deal with because they cannot verbalize their feelings while an adult patient it is much easier because tou could easily assess their illness.Pediatric patient are prone to illnesses because their immune system is not fully develop while adults had the antibodies in heir body to fight against diseases.there is also big difference in terms of medication and the normal vital signs.Providing a thorough GU evaluation as a routine part of well child care is important to establish a baseline from which future comparisons can be made. In the pediatric population, GU disorders and GU complaints in otherwise well children are among the most common problems that practitioners manage. Additionally, in cases where sexual abuse is suspected, having a baseline GU examination is critical to the evaluation process. Furthermore, making the GU examination a part of each well child examination will reduce the anxiety produced by this examination as the child grows. It will also send the message to the child and the family that this area is important and requires good care in order to maintain overall well-being.In metabollic rate pedia needs more fluid,energy for daily living and vitamins for the development of the immune system.
we can assesst the pediatric pt.1st of all we need to get there trust to us and also we need to have a phychological and moral support.to explain step by step the procedure to be done.and also explain the procedure to the significant others to understand the procudure needed.to a adult pt we need to discuss the important of health assessment for there further improvement..
Discuss fully the similarities and differences of pediatric patients and adults in terms of health assessment. Moreover, identify the salient points of assessing pediatric patients with alterations in Cardiovascular Functions (for Block C only) and pediatric patients with alteration in Reproductive of Genitourinary functions.
The most and first prariority in assessing the pediatric patient and adult patient with Cardiovascular Functions are the fallowing:
1. A stand for airway.
2. B stands for breathing.
3. C stand for circulation.
The different between pedia and adult are the airway passage, the physical appearance, treatment between them, the medication, and taking the vital sign are also different.
The infant with cardiovascular disorders baby may be suffering from fatigue, diaphoresis, DOB, cyanotic. Murmur sound when auscultations is done, tires easily before feeding is completed, also underweight.
The adult with cardiovascular disorders may be suffering from coronary artery disease coronary artery disease, congestive heart failure, high blood pressure, heart blockages, heart attack, heart rhythm disorders, and blood vessel and circulation problems
of course when assessing pt.with alteration in reproductive of genitourinary function the assessment is similar because you can assess by asking the pt. so how it could happen maybe when asking the pediatric pt.some are ashame of telling the truth .so just asked the significant others when interms of giving health teaching.adults pt. easily understand the procedure while some pediatric pt.are not.it depends upon the age so include the S.O for health teaching....
The assessment of heart disease in children begins with a through history and physical assessment more specific diagnostic studies, such as electrocardiography or echocardiography, are ordered as indicated because all children with hearth disorders may affect growth and development, developmental testing also is incorporated into the assessment the pediatric patient with alteration with cardiovascular function are easily fatigued there is also noticeable poor weight gain and growth failure and also feeding difficulty. In physical examination of patients. There is a decrease height and weight, nose bleeds, tachypnea and tachycardia and heart murmur. The adult with alteration in the cardiovascular functions. In addition to observing the patients general appearances, a cardiac physical examination should include an evaluation of the following; effectiveness of the hearth as a pump, filling volumes and pressures, cardiac output, compensatory mechanisms. The examination, which proceed logical from head to toe, can be preformed in about 10 minutes with practice and cover the following area: general appearances, cognition, kin, BP, arterial pulse, Jugular venous pulsation and pressures , heart , extremities , lungs and abdomen.
Managing patients either adult or pedia needs a lot of care,it requires a keen knowledge,patience and at the same time it measures your abilities and skills.
Assessing an adult in cephalocaudal manner can be difficult the fact that wide knowledge is needed in a long run in order to attain a suuccessful goal: knowledge regarding the procedure to be done,knowledge about dealing with patient and ability to establish rapport. It is quite difficult but it's easier than that of the pediatric patients because dealing with them needs a lot of considerations and real effort. Dealing with pediatric patients may feel like you are taking care of two patients when the parent or guardian is present. The fact that children are sensitive especially in terms of their behaviors and being pedias,handling them aggressively can traumatize a child physicaly and psychologicaly. Varrying approaches to the pediatric patient based on age is one of the keys towards a successful aim. It is better to start with "across the room" and obtain a history from a distance before a hands-on exam so the child does not perceive your presence as an immediate threat. Approach them slowly and keep physicaly contact to a minimum untill he/she is familiar with you. Always stay on or at eye level with the child and talk on a calm and reassuring manner,always look at the child and listen to the parent because parents knows how the child truly feels. Toddlers may be terrified and gets easily afraid on starngers,providing toys/play can help change their thought,introducing equipments slowly and encouraged toddlers to hold it can make up their minds.
Pediatric patients has sensitive body parts,thus it needs a lot of care in assessing it: the fontanels should be assess routinely in upright position and noy crying because crying may also cause bulging which indicates increased intracranial pressure. Assessing thoracic cavity/chest wall and abdominal area needs care and protection because it is softer,more compliant and weaker.
Although the general component of the assessment will remain the same as for the adult,modifications should be made for the children,when completting patient for pediatric patient,do not delay the procedure in order to complete the focused detailed physical assessment,it does not matter whether you proceed head-to-toe (cephalocaudal) or toe-to-head as long as all anatomical ares are included.
It feels better after having physical assessment successfully but what matters mostis the experience and added informations gained which can make you better and more competent in your chosen carrer.
There are similarities in assessing an adult and pediatric pt but there are also different in many ways.In assessing the child with cardiovascular disorder a nurse assess first get the healht history of a child. Usually the chief concerns are the ffg: fatigue, cyanosis, frequent upper resoiratory infection, feeding difficulty, poor weight gain and growth failure.It is imporant to ask if others members of the family have heart disease. In regards to a physical assessment, a child shows the ffg :decreased height and weight, easily fatigued, frequent nose bleeds, cyanosis of mucous membrane or polcythemia(redness), tachypnea or tachycardia, heart murmurs,enlarged liver and clubbing of fingers.In assessing an adult pt with cardiovascular disoder poceeds logically from head to toe similar when assessing a pediatric pt,it covers the ffg. Areas: general appearance and cognition to determine the severity of illness, inspection of skin, blood pressure, arterial pulses,jugular venous pulsation and extremities if there is presence of edema. In assessing, it depends on what type of cardiovascular disorder that a child or adult acquired.
Health screening has traditionally been an important aspect of child and adult health care. The goal has been to detect health problems regardless of age and sex.Adult and pediatric patient became similar that in assessing them we use or follow the cephalocaudal approach of assessment.That on this,we are to start with the head to the foot.While on the other hand they become different where as the adult patient can able to verbalize him/herself regarding the history of illnesses.But the child can't able to verbalize an accurate data abouthis/her histopry and such...
The severity of the patient's symptoms,THE PRACTICE SETTING OF THE NURSE,and the purpose of the assessment are factors that need to be considered when determining the frequency and extent of the nursing essessment required.The assessment of the acutely ill cardiac patient will be different from that of a patient with stable or chronic cardiac conditions.For example, the patient assessment performed by an emergency department nurse caring for a patient who is experiencing an acute MI must be very focused and must be performed rapidly. The nurse must assess the patient for complications associated with MI,screen the patient for contraindications to coronary artery reperfusion strategies including thrombolytic therapy or primary percutaneous tranluminal coronary angioplasty (PTCA) and evaluate the patient response to medical and nursing interventions. For this patient, the health history, physical assessment and important nursing interventions(e.g., cardiac monitoring, administration of IV meds) are performed simultaneously
Assessment is a systematic colection of data to determine the patient health status and identify the actual or potential health problems. The central figure in health care services is the patient.Assessing an adult and pedia pt. has a big difference but then there is also similarities one of the similarities are:
1.both need to assess physically by means of Cephalocaudal.
2.both need to conduct the health history.
3.both need to study the health records.
-the differenceis that:
1.anatomical differences-pedia pt. has sensitive body parts.
2.Pedia can'verbalized their feelings.
3.Pedia has an apgar scoring.
4.Their differ in vital signs.
the diffences in between a pediatric and adult patient is, in pediatric they are hard to communicate they are afraid on a nurse while in adults they can communicate without fear they are just shy to express their feelings. when assessing a pediatric patient you have to established or gain their trust before doing any procedure,explain the procedure and tell to the patient that it is for his/her own good, you have to be more knowledgeable in caring a patient specially in pediatric. patients have genitourinary defect, they should be treated promptly, since by the way it means for elimination and later for reproduction. Any defect that may affect pedia patients’ general condition should be treated as a priority.
as we all know that it is hard for as to handle both pediatric and adult patient more on pediatric patient because as we all know that pediatric patient they afraid people wearing white or more on white like as "nurse". As a student nurse we should provide the best thing that we can be to our patient,we should provide enough care and also treat them as a normal human bieng because they have the right to live here.
We all know that pedia and adult patient have their own different similarities and differences not only to their physical but also to thier health status.One of thier similarities is when we get thier physical asssessment we all know that we use the cephalocaudal technigue so that this is our giude to get all abnormalities and normal findings to our patient and so that we find out our nursing management that we can apply to our patient.
the Differences of pedia and adult patient is first we start in pedia patient if we gather some information to our patient not directly tou our patient or instead to our patient the significant others are the one answering our question because as we all know that all pedia patient is thier level of thier understanding is not enough to undrestand and not mature enough or answer our question because pedia patient is they focus on playing or something else .it is easy for me to handle adult patient tha pedia because lot of information that we can gather with them and it is easy for me to have nursing care to the adult patient that to the pedia, because pedia patient is not easy to handle them but it depence on how we treat them.
It is easy for me to provide nursing intervention to the adult patient than to the pedia most especialy on giving medication with them it is more difficult in pedia than to the adult we should be extra careful in giving meds to the pedia.and as a student nurse we should be gain trust first to our patient so that it is easy for as to handle them or work with them.
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