Fundamentals of Nursing I

Introduction:

Obtaining an accurate and useful history and physical assessment is a vital skill. This topic will help you effectively assess paediatric and older adult by familiarizing you with the physical, psychosocial, and cognitive developmental changes that occur.

 

Topic Learning Outcome (TLOs):

By the end of this topic, you should be able to:

1. Describe the adapting assessment to paediatric.
2. Describe the adapting assessment to older adult.

Adapting Assessment for Paediatric

 

At this age, the assessment is performed with the parent or guardian present. Even so, you need to explain what you are doing and why. Because the toddler thinks in a very concrete way, keep your explanations very simple. Toys, such as hand puppets, or games can be helpful when examining the toddler or pre-schooler. If some procedures might cause discomfort—such as the otoscopic examination if the child has an earache—leave them until the end.

 

As you perform the exam, keep in mind the normal developmental changes affecting this age group. As with all assessments, the process involves subjective and objective data collection, nursing diagnoses, planning, interventions, and evaluation.

 

When physical assessment the paediatric, keep in mind the specific variations that are unique to this developmental period.

 

Begin with a general survey, obtaining height, weight, and vital signs such as temperature and blood pressure (BP). Keep track of the child’s growth and development by plotting height and weight on growth charts. The toddler usually gains 4 to 6 pounds and grows 3 inches a year. Head and chest circumferences are usually equal by age 2. The preschooler gains 5 pounds and grows 21⁄2 to 3 inches a year. Changes in vital signs include a slight, gradual increase in BP and a slight decrease in temperature, pulse, and respirations.

 

 

Once you have completed your assessment, document your findings, identify any nursing diagnoses, and formulate a plan of care.

 

Let watch this video clip “Head-to-Toe Assessment: Child"

Video:

FORUM:

1.      How does assessment of the paediatric differ from assessment of other patients?

2.      What health concerns should you keep in mind as you proceed with the assessment?

Adapting Assessment for Older Adult

 

A complete history and physical exam are essential to providing comprehensive, holistic care for the older adult. If the patient has a long and complicated medical history, you may need to do the history and physical exam on separate visits and schedule an hour for each

visit. You may also need to allow more time to help your patient into the exam room and with dressing and undressing. When obtaining a history, ask one question at a time and allow enough time for your patient to respond. You may also need to repeat questions and confirm answers.

 

Remember that older adults may not present in the same way as younger people when they are ill. When performing your assessment, keep these three factors in mind:

■ Older adults may minimize or ignore symptoms.

■ They often have several concurrent medical problems.

■ They often present with atypical signs and symptoms of disease.

 

 

Once you have completed the health history, collect objective data through your physical exam.

 

Approach

When examining the older patient, make sure the environment is as safe and appropriate as possible. To ensure a senior-friendly environment, do the following:

■ Keep examination rooms warm

■ Use bright but no glaring lights.

■ Keep background noise to a minimum.

■ Provide higher than standard seating (because patients might have trouble getting up, and if they have had joint replacement, they shouldn’t flex the joint more than 90 degrees) with arm rests on all chairs.

■ Use exam tables that mechanically elevate the patient from lying to sitting and vice versa and a broad-based step stool to help patients get onto the table.

■ Use a private exam room, if possible, or at least pull the privacy curtain if there is a roommate.

■ Minimize position changes to keep the patient from getting tired.

■ Uncover only the area being assessed, making sure that patient is warm and covered with blankets or drapes.

■ Provide reading materials with large print.

■ Allow more time than usual for the exam. The complete exam may need to be scheduled over several meetings.

■ Make safety a priority. If your patient can’t tolerate or perform what is expected for the exam, then adapt the exam to meet her or his needs.

■ Take the time to explain everything you are doing to your patient.

 

Let watch this video clip on "Head-to-Toe Assessment: Older Adult"

Video:

The history and physical exam of the paediatric and older adult should take into consideration the normal changes associated with aging and focus strongly on function.