Sonoma State University

SONOMA STATE UNIVERSITY Department of Nursing Nursing 342 Assessment of Children Infant

You are admitting a 6 month old for dehydration. Her mother, a single working mom, and her grandparents attend her.

1. What are your initial physical assessment concerns?

2. Developmental?

3. Family?

4. How would you evaluate the needs of the baby? Mother? how are reflexes, eating sleep weight patterns, stool. this kid is seriously ill. recent vaccination? bad reaction? sick w/ diarrhea Breast or bottle feeding? Always ask what's the kid's routine: when they eat, sleep, who's with them, bedtime rituals, what they sleep with, etc. SONOMA STATE UNIVERSITY Department of Nursing Nursing 342 Assessment of Children Toddler

Jimmy James age 2 was jumping on his brother’s bed and fell off to cause a fracture of his wrist serious enough to need a closed reduction and placement of a fiberglass cast to his right wrist. He comes back from PACU to your floor for observation and DC when criteria met.

1. What are your initial physical assessment concerns?

2. Developmental?

3. Family?

4. How would you evaluate the family?

5. What communication techniques will you use to assess Jimmy? Use objects, talk simply. They understand more than they can speak. Casts are not a badge of courage to a 2 year old.

6. What “criteria” might need to be met prior to DC? he has to be awake, VSA WNL, not too dopey, not in too much pain, educated about the cast, good CSMs, eliminating, not puking. SONOMA STATE UNIVERSITY Department of Nursing Nursing 342 Assessment of Children Preschool

4-year-old Joey Moreland was in a MVA and fractured his right femur. He is in skeletal traction--that means there's a pole screwed into his leg and it's pulling to align everything-- for two weeks prior to casting. He has been on your unit for three days. You have just received report and walk in the room for your am assessment. [he'll get a cast from hip to ankle on the leg] Femur is pretty normal break in children in MVA's with a restraint.

1. What are your initial physical assessment concerns? ABC's, skin breakdown, what's his pee sitch [pee in the bottle, or a diaper?] Check those pins in his legs--infection risk. Other injuries?

2. Developmental?

3. Family?

5. What communication techniques will you use to assess Joey? positive reinforcement. No one moves much with traction. He needs distraction and puzzles and play and books and stuff. All kids need to be able to play. bring it from home--his home. He needs his comforts. The new stuff from the gift shop are always associated with hospitalization. the kids know you're there to hurt them-- just b/c you're in uniform. 6. What are your long-term goals for this family?

What to do with this kid's stress and his eating and stuff? Can parents get food from home? Get the kids' menu at the hosp

SONOMA STATE UNIVERSITY Department of Nursing Nursing 342 Assessment of Children School-age

Michaela Franz age 7 was on the playground when a friend approached her and said let’s play. Close your eyes and I will walk you around. The next thing that Michaela remembers is her waking up on the ground in pain. She had been lead behind a swinging child that hit her, knocked out on front tooth, broke her nose and left her unconscious for a few minutes. She is currently in your ED and you are taking the history and speaking to her father who rushed from work to be there.

1. What are your initial physical assessment concerns? ABC's, VS, may need suction to control bleeding, where is the tooth? LOC, neuro. CT needed for the face, bones, etc. Where else on her body is injured?

2. Developmental? she's in the industry vs inferiority age-- Deb calls this the making-little-things-and collecting-things stage. 3. Family? Who's the fam, who's in it? Does dad even know what happened? How's dad doing right now?

5. What communication techniques will you use to assess Michaela? Simple language [concrete thinkers], work at their eye level, explain everything. Never lie ever never period. if it's gonna hurt, be honest. Know that they are going to want to watch everything you do. how do we assess pain: well, they're crying at this age and the forehead is wrinkled. Use the face scale in younger kids you might offer them coloring to get where they are hurting. Kids do deal with pain like big people-- sometimes they'll be stoic

6. What follow-up may be needed regarding this accident? Dental care referral. It's possible that she knocked out an adult tooth. Do we suspect bullying at school? Has this stuff happened before?

About assessing for abuse: certain bruises are normal. Some are suspicious: spiral fractures to the arm bones. Burns are suspicious: kids spill things on their fronts, but butt and back burns are obvious.

SONOMA STATE UNIVERSITY Department of Nursing Nursing 342 Assessment of Children Adolescent

17-year-old Autumn Brass was driving with a BA of .10 when she missed a turn and ran into a tree. She had three passengers. One was ejected and was pronounced DOA, one was uninjured and one sustained minor injuries to her forearm. Autumn sustained a T12 injury and at this time is unable to move or feel her lower extremities and control her elimination. She has been on your unit for 24 hours and all four of her parents are at her bedside. What else from report? has anyone told her that a friend is dead? VS, I/O, pain, n/v, symptoms of ETOH, what tests done or ordered Always w/ MVA's: was her seat belt fastened? Meaning seat belt could injure her, or she may have greater injuries from a seat belt. Who were those people in that car? Were any of them siblings? I WANT MY PSYCH CONSULT Where are the PO and what are their next steps?

1. What are your initial physical assessment concerns? Breathing, VS, ABC's, skin breakdown, cat or xray to check for other breaks, check skin for other bruising and injuries, check her foley, ETOH: watch for aspiration, watch for withdrawal; check pain level, neuro check/LOC, pedal pulses

2. Developmental? How's your sex life? Do you have a partner or several partners? What does she think about her safety/risk taking [teen think they're invincible?] What do you think about rules and laws? Body image issues r/t injury and disability? How will she take the news about the death? could be full of attitude or very guilty and depressed. At her age she's more concerned that she may not walk again rather than that someone is dead.

3. Family? Who do you consider family? What up with your fam? Who do you get along with, do you have siblings? Who are you or what do you do for your family? What parenting style is the family using [lassiez faire, authoritative]? What does your family do for you? Who do you live with.

4. How would you evaluate the family? how does the family get along, ask the family members how they feel they interact. Ask who's married to who and who lives where? What's your culture? did you know your daughter was drinking this way?

5. What communication techniques will you use to assess Autumn? Cultural background. Therapeutic, non judgmental, open ended. Don't forget Maslov: food, safety, pain, etc.

6. What are your long-term goals for this family? Sex ed, drug and etoh ed, counseling for the whole 'going to juvie' thing. A social worker? A shrink? THESE PARENTS CARE ABOUT WALKING. How is education going to continue? OT, PT, rehab?

Legal stuff: no cops are going to come arrest her here and cuff her to the bed [meow!] What do I do if she asks me how the other passengers are? Well, we're not allowed by HIPPA to tell her what's going on. Best plan: ask what she remembers, tell her to call one of the well passengers. She likely does know: she wasn't super drunk. Always good to ask what she remembers-- it's not my job to tell the family.

My job is not to tell the parents anything-- unless they ask. in these cases, the responsible person is the driver: it doesn't matter how drunk the passengers are. Also: where did they get the alcohol? And this happens all the time, and it doesn't matter if ETOH is in the mix or not.