care for pediatric patients

CARE FOR PEDIATRIC PATIENTSChester Bigay

• Patient History: (Subjective information)

• Obtained from..• The client/ parent interview• Chart, Medical Records

• Includes: • Family History• Past Medical History; medications;

allergies • History related to current need for care

or treatment• Chief Complaint

• - Current issue being cared

• Physical Exam (mostly objective information) • Objective Information:

• Vital Signs, height, weight (if applicable)• Head to Toe assessment

• Should include focused exams by system: Inspection, Auscultation, Percussion, alpation

• Focused Assessments• What systems? How often?

• Subjective information: • Symptoms r/t system assessing

• (Ie. pain, tenderness)

COMPONENTS OF A COMPREHENSIVEASSESSMENT

NORMAL VALUES

NORMAL VALUES

NORMAL VALUES

Airway / BreathingRespiratory rate• Respiratory effort• Air entry• adequate• adventitious breath sounds

Circulation• Skin Temperature• Heart rate• regularity/rhythm/rate

• Pulses• strength and regularity• central vs. peripheral

• Perfusion• capillary refill• skin color (e.g. pale, mottled

BASIC HEAD TO TOE ASSESSMENT

Neurological• Level of consciousness• Mental status, interaction• Activity, movement, muscle tone• Age appropriate responses

GI/GU• Bowel sounds• Appetite• Bowel movement/Emesis• Hydration status• Urine output• Moist oral mucosa• Skin Turgor• Fontanelle

BASIC HEAD TO TOE ASSESSMENT

Red Flags of Respiratory Distress• Tachypnea• Mechanics of breathing• Retractions• Nasal flaring• Head bobbing• Grunting on exhalation• Prolonged expiratory phase

• Diminished air entry• Change in breath sounds• Stridor• Wheezing

Late signs• Skin color changes-dusky/cyanotic• Inaudible air entry• Apnea/irregular respiration• Changes in level of

consciousness/activity• Bradycardia

WARNING SIGNS

Red Flags of Cardiovascular Collapse• Tachycardia• Altered perfusion• Skin• Prolonged capillary refill > 2 sec• Increased core to skin temperature

gradient• Brain• Altered level of

consciousness/activity• Decreased response, “worried”

appearance • Kidneys• Decreased urinary output

<1ml/kg/hr

• Decrease in pulse quality

• Late signs• Decreased response to pain• Flaccid tone• Hypotension• Bradycardia

WARNING SIGNS