Chapter 29 Communication, History, and Physical Assessment All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Establishing a setting Appropriate introduction Assurance of privacy and confidentiality Computer privacy and applications in nursing Telephone triage and counseling Guidelines for Communication and Interviewing 2 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 3 Communicating with parents Encouraging the parents to talk Directing the focus Listening and cultural awareness Using silence Being empathetic Providing anticipatory guidance Avoiding blocks to communication Communicating through an interpreter Communicating with Families 4 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Communicating with children Communication related to development of thought processes Infancy Early childhood School years Adolescence Communicating with Families (Cont.) 5 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 6 7 Communication techniques A variety of techniques Open-ended questions Word games Nonverbal techniques Play Communicating with Families (Cont.) 8 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Performing a health history Identifying information Informant, most likely the parent Chief complaint Present illness Analyzing a symptom or symptoms History Taking 9 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. History Birth history Dietary history Previous illness, injuries, and operations Allergies Medications Immunizations Growth and development Habits History Taking (Cont.) 10 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Performing a health history Sexual history Family medical history Geographic location Family structure Assessment Composition History Taking (Cont.) 11 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Psychosocial history School adjustment Unusual habits Parent-child relationships Review of systems Specific and thorough review of each body system History Taking (Cont.) 12 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Dietary intake Clinical examination of nutrition Hair, skin, mouth, eyes Evaluation of nutritional assessment Malnourished At risk Well nourished Overweight or obese Nutritional Assessment 13 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 14 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Sequence of the examination Head-to-toe sequence for assessing adult clients Sequence for pediatric assessments generally altered to accommodate childs developmental needs Use chronological age as the main criteria General Approaches Toward Examining the Child 15 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Minimize stress and anxiety associated with assessment of various body parts Foster trusting nurse-child-parent relationships Allow for maximum preparation of child Preserve security of parent-child relationship Maximize accuracy of assessment findings Goals of Pediatric Assessment 16 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Childs perception of painful procedures Cooperation usually enhanced with parents presence Age-appropriate techniques Positioning and preparation Preparation of the Child 17 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 18 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 19 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Growth measurements Growth charts Length Height Weight Skin full thickness and arm circumference Head circumference Physical Examination 20 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 21 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 22 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 23 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 24 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 25 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Physical states of vital function Temperature Electronic intermittent thermometer Infrared thermometer Electronic continuous thermometer Pulse Respirations Physiologic Measurements 26 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Pediatric blood pressure (BP) Measurement devices Selection of cuff Cuff placement BP measurement and interpretation Orthostatic hypotension Physiologic Measurements (Cont.) 27 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 28 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 29 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. General appearance Skin Hair, nails, hygiene Lymph nodes Head and neck Eyes, ears, nose, and throat Physical Assessment 30 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 31 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 32 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 33 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 34 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 35 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 36 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 37 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 38 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 39 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 40 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 41 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 42 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 43 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 44 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Chest Lungs Heart Abdomen Genitalia and anus Back and extremities Neurologic assessment Physical Assessment (Cont.) 45 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 46 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 47 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 48 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 49 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 50 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 51 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 52 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 53 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 54 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 55 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 56 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 57 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 58 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 59 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 60 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 61 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 62 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 63 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 64 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 65 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. 66 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc. Which approach would be best to use to ensure a positive response from a toddler? Assume an eye-level position and talk quietly. Call the toddlers name while picking him or her up. Call the toddlers name and say, Im your nurse. Stand by the toddler, addressing him or her by name. Question 67 All Elsevier items and derived items 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.