Compare the physical assessment of a child to that of an adult. In addition to describing the similar/different aspects of the physical assessment, explain how the nurse would offer instruction during the assessment, how communication would be adapted to offer explanations, and what strategies the nurse would use to encourage engagement.
Adam, great response. You provided an accurate and detailed assessment, which highlights that the assessment techniques used for adults and children are similar, with some variation. As you mentioned, differences lie in the vocabulary and communication style used during the assessment, taking into consideration the child’s developmental stage, and how much information the caregiver provides. It is essential to have an open and flexible approach when assessing children to ensure that they are comfortable and relaxed during the process. Simple communication strategies, visual aids, or demonstrations can genuinely enhance the child’s understanding of the assessment, and the nurse can gain valuable insights into the child’s health status. Obtaining a health history is vital to identify any underlying health issues or concerns, including abuse or neglect. The difference in obtaining information between children and adults is a crucial point to consider, as caregivers may reveal pertinent details that can assist in providing appropriate care to the child.
NRS 434 Topic 2 DQ 2
Physical assessment of the child and that of an adult is done similarly yet differently. The act of auscultation, palpation, taking the vital signs to get the objective data are done the same but the normal range limits are different.
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For example, the healthy adult blood pressure normal range is from 90/60 mmHg – 120/80 mmHg, pulse rate 60-100 beats per minute and temperature of 97.8 ‘F to 98.6″F whereas to a 1-11-year-old child has a heart rate of 70-120 bpm, blood pressure of 90-110 systolic and 55-75 diastolic.
NRS 434 Topic 2 DQ 2
In using Erikson’s theory, an adult’s stage of development is focused on the fear of loneliness if there is no long-lasting relationship and adult contemplates their contribution to society with their achievements or lack of, and for a school-aged child, the focus is more on establishing trust and self-esteem (Grand Canyon University, 2018).
Communication and approach with these two different age groups also differ. A caring and comfortable environment is needed for a school-aged child in order to extend their trust from their parents to the healthcare provider. NRS 434 Topic 2 DQ 2
The questions are also formulated so that the child is able to answer. Whereas for the adult, a more factual and straightforward questioning is done. NRS 434 Topic 2 DQ 2 Utilizing the evidence-based practice tools provided to the health care team, a thorough and effective assessment is done to promote health and have an effective nursing process.
Grand Canyon University (Ed). (2018). Health assessment: Foundations for effective practice. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/
Medline Plus. Retrieved from: Vital signs: MedlinePlus Medical Encyclopedia
C.S.Mott Children’s Hospital .Retrieved from: Vital Signs in Children | CS Mott ChilVital Signs in Children | CS Mott Children’s Hospital | Michigan Medicinedren’s Hospital | Michigan MedicineNRS 434 Topic 2 DQ 2
Child development assessment is defined as a process of getting data about their growth and development. The Nurse aims at getting a record growth in all areas while collecting the information. The data being collected include language, cognitive and social-emotional and approaches to learning. Child assessments is important in ascertaining children with special needs that may require extra support (Kaufman, 2018).
Comparing physical assessments of a child to an adult
Obtaining data is different at each age because human needs vary with age. In addition, the mode of assessment used is dynamic. For example, piece of information is obtained from the parent or care giver in a 5-year-old compared to the nineteen-year-old that can express themselves coherently. NRS 434 Topic 2 DQ 2
The Nurse uses Observation as one of the techniques used in the assessment. Here, the care provider interacts with the child and concludes based on their conduct. The other methods include standard test, portfolios, care provider ratings and parent ratings. However, all methods are best applicable for different ages.
NRS 434 Topic 2 DQ 2
There is need to modify the techniques in some situation. For example, reading out questions on a standardized test for a five-year-old and writing out the answers for them. However, when the same approach is used on a twelve-year-old, they are left to read, interpret, and even answer the questions on the test with minimal assistance,
Communication strategies a nurse would use to encourage engagement NRS 434 Topic 2 DQ 2
Nine-year-old Ben was born at 37 weeks with 2600grams via safe vaginal delivery and was admitted for 2 weeks due to birth asphyxia. He had gained 300grams on discharge. He was breastfed exclusively for the first 6 months and was weaned with different soft foods. He could roll over at 4 months and began sitting at 6.
He was hospitalized for severe malnutrition for a month while he was 9 months old. This delayed his milestone and he only crawled when he was 16 months.
He could say four-letter words at 6 months and could say complete simple sentences at 24 months. He has good relationship with his family members. He started school at 4 years, is obedient, has average performance, loved by teacher and friends at school. Ben fits into the 4th stage of Erikson developmental theory, known as Industry vs. Inferiority.
The basic virtue at this stage is competency (Cherry, 2018). Based on Erikson`s theory, the nurse should focus on his ability to read, do simple sums, and write. The assessor will obtain information on Ben`s friends and this assessment done with he is with his friends. The friends he does not like will make him feel inferior.
NRS 434 Topic 2 DQ 2 Conclusion
Child development assessment is important because it provides opportunity for the care provider to establish any special needs that the child may require. Moreover, the assessment provides a ground where both the care provider and the parents can provide support for the child. However, the needs of the child change with time and hence the mechanisms used in assessing as well as the results (Kaufman, 2018).
NRS 434 Topic 2 DQ 2 References
Cherry, K. (2018). Erik Erikson`s Stages of Psychosocial Development. Retrieved June 5, 2018.
Kaufman, A. S. (2018). Contemporary intellectual assessment: Theories, tests, and issues. Guilford Publications.
An organized physical examination that allows a nurse to acquire a thorough assessment of the patient’s health status is known as a physical health assessment (Barness, 1999). In most cases, four procedures are employed in physical evaluation. Inspection, palpation, percussion, and auscultation are the four methods.
There are several strategies for completing a physical examination on a kid patient that are also applicable to adult patients. Inspection, palpation, percussion, and auscultation are the most common procedures utilized.NRS 434 Topic 2 DQ 2
When evaluating a child patient, it’s common to begin with an abdominal examination; in this situation, palpation and percussion can change bowel sounds, so you’d inspect, auscultate, and percuss. Here, we need to take steps to shape a general impression of the primary examination of the child patient, evaluate responsiveness, and conduct a rapid scan consisting of testing and correcting issues with the airway, breathing, and circulation of the patient.
As you know very well that children are both cognitively and physically advanced, their needs are changing as users of health care products and services. Therefore, the complex nature of childhood development affects planning a cohesive approach to pediatric protection and efficiency (Zabar, 2012).
NRS 434 Topic 2 DQ 2
Children’s needs as consumers of health care goods and services alter as they age cognitively and physically. As a result, the fluid nature of juvenile growth affects the planning of a cohesive strategy to pediatric safety and quality (Sirard, 2001). When children are in the hospital, especially those who are very young and nonverbal, they rely on their caretakers, their parents, to provide the most important information.
Because children are dependent on their caregivers, their care must be approved by parents at all encounters. Although children can accurately express their requirements, they are unlikely to receive the same acknowledgement as adult patients.
Children in hospitals require acute episodic care rather than long term care like adult patients. Planning safety and quality programs within a wellness framework that is interrupted by acute conditions has unique challenges and necessitates a shift in mindset. Children are more likely to live in poverty and face racial and ethnic health inequities.
Children are more reliant on government programs like the State Children’s Health Insurance Program and Medicaid. There are no generally accepted standard guidelines for pediatric patient safety. However, a flexible standard framework for categorizing pediatric adverse events has been developed.
Zabar, S., Kachur, E., Kalet, A., & Hanley, K. (Eds.). (2012). Objective structured clinical examinations: 10 steps to planning and implementing OSCEs and other standardized patient exercises. Springer Science & Business Media.
Sirard, J. R., & Pate, R. R. (2001). Physical activity assessment in children and adolescents. Sports medicine, 31(6), 439-454.
Barness LA in McMillan JA, ed., Oski’s Pediatrics, 3rd ed., Philadelphia:Lippincott, 1999, pp. 39-52.
The physical assessment of a child differs from that of an adult due to differences in cognitive, psychosocial, and physical development. In terms of similarity, the general steps in assessment for children and adults are the same – inspection, palpation, percussion and auscultation (except for the abdomen, in which auscultation comes before palpation) (AAP, n.d.).
In both groups, history taking precedes examination and the taking of the vital signs and data including height and weight is done before examining the systems. However, depending on age, some children cannot effectively partake in history taking by accurately answering assessment questions. While many adults have the control of giving their own history, not all children can do that. Caregivers or parents may thus help to answer history questions during a child’s physical assessment.
Furthermore, some younger children including toddlers and preschoolers may be afraid of strangers based on their psychosocial developmental stage, and it would thus be appropriate for the nurse to adopt strategies such as letting the child play with the stethoscope to allay their anxiety and build some trust before proceeding with the physical assessment (ODPHP, 2017).
To communicate and engage with the child, the nurse may apply role play, distraction with toys, or use popular stories and characters to try and captivate the child’s attention and trust depending on their age and developmental stage. According to the American Academy of Pediatrics (n.d.), the nurse should physically stoop down to maintain their eye at the level of the child’s to avoid intimidating the child.
American Academy of Pediatrics [AAP]. (n.d.). Preparticipation physical evaluation. Retrieved from https://www.aap.org/en-us/about-the-aap/Committees-Councils-Sections/Council-on-sports-medicine-and-fitness/Pages/PPE.aspx
Office of Disease Prevention and Health Promotion [ODPHP]. (2017). Early and middle childhood. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/early-and-middle-childhood
Assessment is key component in nursing, it is required in planning and provision of patient centered care. Physical assessments of adults and children are the same apart from a few variations. It is good practice to consider the level of education of every patient when communicating, explain procedures and what you are about to do calms the patient. Adults can easily comprehend what is going on and they understand explanations unlike children who are not conversant with assessments.
Physical assessment of both child and adult should be done using the four techniques, Inspection, palpation, percussion and auscultation. Both objective and subjective data should be collected when doing an assessment. Pain is part of the assessment (Thrane, Wanless, Cohen, & Danford, 2016). Considering the psychosocial stage of development will help in examining the child in accordance with their development stage, how you handle communication with this child will also affect how the child will relate to you.
The nurse will use age-appropriate language when asking questions to the child, avoiding jargon terms in communication makes it easy for them to effectively communicate and give you the needed information. It is also important to provide a conducive atmosphere that is non-threatening and comfortable for the child. (Lancet, 2017). Establish trust between the child and the nurse let the child know that they can trust you be friendly, smile and offer emotional support.
Children need to feel safe, if they have stranger anxiety allow them to be held by the parent during examination. Allow the child to handle the objects used during examination explain what every object is used for, doing this will help reduce anxiety. Consider which assessment to complete last, keep in mind that a child’s attention is very short therefore assess before their interest is gone and they start crying. Engage the parents to answer questions that cannot be answered by the children. Parents will help in a child’s assessment by calming them down and answering important questions.
Babakr, Z. H., Mohamedamin, P., & Kakamad, K. (2019). Piaget’s Cognitive Developmental Theory: Critical Review. Education Quarterly Reviews, 2(3), 517–524.
Lancet, T. (2017). How best to assess children presenting to emergency care. The Lancet, 389(10076). https://doi-org.lopes.idm.oclc.org/10.1016/S0140-6736(17)30870-X
Thrane, S. E., Wanless, S., Cohen, S. M., & Danford, C. A. (2016). The assessment and non-pharmacologic treatment of procedural pain from infancy to school age through a developmental lens: A synthesis of evidence with recommendations. Journal of Pediatric Nursing, 31(1), e23-e32. doi: 10.1016/j.pedn.2015.09.002
Topic 2 DQ 2
The process of physical assessment of both the children and adults plays a major role in knowing more and various aspects of the individuals. Therefore, as part of training, nurses are aware that the process of physical assessment starts when they first encounter the patient and start noting down vital information, including respiratory rates, body posture, skin color, and temperature, among other things (Jarvis, 2023).
Physical assessment of a child and an adult have both similarities and differences. In both cases, a detailed examination is carried out by following four main processes, including inspection, palpations, percussion, and auscultation. In addition, in both cases, relevant questions must be asked to obtain relevant data (Chen & Liu.,2021). One of the main differences is that information is usually obtained from the adult, while in the case of the child, the parent or the caregiver has to help in answering the assessment questions.
The nurse also uses various strategies to offer instruction during assessment and adapts communication to offer explanations. The nurse asks questions and educates the patient or caregiver on any abnormalities observed. In case some data is impressive, then the nurse can commend the patient or caregiver as a morale booster.
The nurse has to adapt communication, for example, using simple words to explain technical terms to the patient for better understanding (Dalton et al.,2019). The nurse may also need to adjust the tone depending on the patient. For example, in the case of a child, the nurse may need to speak with a low tone and use simple language.
However, in the case of an adult, a louder voice may be used for more clarity. Nurses can also use various strategies to encourage engagement during the assessment. Some of the strategies include using simple language, repeating words, and active listening (Arnold & Boggs, 2019). Babies can be given toys to help them cooperate and calm down.
Arnold, E. C., & Boggs, K. U. (2019). Interpersonal relationships e-book: professional communication skills for nurses. Elsevier Health Sciences.
Chen, S. L., & Liu, C. C. (2021). Development and evaluation of a physical examination and health assessment course. Nurse Education Today, 107, 105116.
Dalton, L., Rapa, E., Ziebland, S., Rochat, T., Kelly, B., Hanington, L., … & Richter, L. (2019). Communication with children and adolescents about the diagnosis of a life-threatening condition in their parent. The Lancet, 393(10176), 1164–1176. https://doi.org/10.1016/S0140-6736(18)33202-1
Jarvis, C. (2023). Physical examination and health assessment-Canadian E-book. Elsevier Health Sciences.
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