SAS 4

• Subjective data is information spoken by the child or family.
• Most subjective data are collected through interviewing the family caregiver and the child.
• The interview helps establish relationships between the nurse, the child, and the family.
• Listening and using appropriate communication techniques help promote a good interview.
• The nurse should be introduced to the child and caregiver and the purpose of the interview stated.
• A calm, reassuring manner is important to establish trust and comfort; the caregiver and the nurse should be comfortably seated, and the child should be included in the interview process.
• The family caregiver provides most of the information needed in caring for the child, especially the infant or toddler.
• Rather than simply asking the caregiver to fill out a form, the nurse may ask the questions and write down the answers; this process gives the opportunity to observe the reactions of the child and the caregiver as they interact with each other and answer the questions.
• The nurse must be non-judgmental, being careful not to indicate disapproval by verbal or nonverbal responses.
• Neurologic assessing the neurologic status of the infant and child is the most complex aspect of the physical exam.
• Gait and posture should be noted when the child enters or is walking in the room.
• The back should be observed for symmetry and for curvature of the spine; in infants the spine is rounded and flexible; as the child grows and develops motor skills, the spine further develops.
• The extremities should be warm, have good color, and be symmetrical; by observing the child’s movements during the exam, the nurse notes range of motion, movement of the joints, and muscle strength.
• The nurse uses a neurologic assessment tool such as the Glasgow coma scale; the use of a standard scale for monitoring permits the comparison of results from one time to another and from one examiner to another; using this tool, the nurse monitors various aspects of the child’s neurologic functioning.
• The practitioner in the health care setting assesses the neurologic status of the child by doing a complete neurologic exam; this exam includes detailed examination of the reflex responses, as well as the functioning of each of the cranial nerves.
• It is important that the preschool child and the older child be included in the interview.
• Use age-appropriate toys and questions when talking with the child.
• Showing interest in the child and in what he or she says helps both the child and caregiver to feel comfortable; by being honest when answering the child’s questions, the nurse establishes trust with the child.
• The child’s comments should be listened to attentively, and the child should be made to feel important in the interview.
• Upon completion of this lesson, the nursing student can: Identify the sources of subjective and objective data from a pediatric client; Learn how to do a complete physical examination of a pediatric patient; Know the different normal vital signs of each stage of childhood.
• Interviewing the adolescent can be challenging, as they often do not share information in front of their caregivers.
• When a child is brought to any health care setting, it is important to gather information regarding the child’s current condition, as well as medical history.
• The nurse obtains identifying information about the child, including the child’s name, address, and phone number, as well as information about the caregiver; a questionnaire often is used to gather information, such as the child’s nickname, feeding habits, food likes and dislikes, allergies, sleeping schedule, and toilet-training status.
• The reason for the child’s visit to the healthcare setting is called the chief complaint; to best care for the child, it is important to get the complete explanation of what brought the child to the healthcare setting.
• The nurse should introduce themselves to the child and caregiver and state the purpose of the interview.
• In the older school-age child or adolescent, note evidence of breast development.
• Abnormal or unusual heart sounds might indicate the child has a heart murmur, heart condition, or other abnormality that should be reported.
• While wearing gloves, the nurse inspects the genitalia and rectum; observe the area for any sores or lesions, swelling, or discharge.
• Take the measurement at the nipple level with a tape measure; observe for chest size, shape, movement of the chest with breathing, and any retractions.
• Chest measurements are done on infants and children to determine normal growth rate.
• The abdomen may protrude slightly in infants and small children.
• The back and extremities should also be assessed for abnormalities.
• To describe the abdomen, divide the area into four sections and label sections with the terms left upper quadrant (LUQ), left lower quadrant (LLQ), right lower quadrant (RLQ), and right upper quadrant (RUQ).
• Using a stethoscope, the nurse listens for bowel sounds or evidence of peristalsis in each section of the abdomen and records what is heard.
• Evaluate respiratory rate, rhythm, and depth; report any noisy or grunting respirations.
• Observe the eyes for symmetry and location in relationship to the nose; note any redness, evidence of rubbing, or drainage; ask the older child to follow a light to observe his or her ability to focus; an infant will also follow a light with his or her eyes.
• Assess the nose, mouth, and throat by having the older child hold his or her mouth wide open and move the tongue from side to side; with the infant or toddler, use a tongue blade to see the mouth and throat; observe the mucous membranes for color, moisture, and any patchy areas that might indicate infection; observe the number and condition of the child’s teeth.
• Using a stethoscope, the nurse listens to breath sounds in each lobe of the lung, anterior and posterior, while the child inhales and exhales; describe, document, and report absent or diminished breath sounds, as well as unusual sounds such as crackling or wheezing.
• Assess the ears by drawing an imaginary line from the outside corner of the eye to the prominent part of the child’s skull; the top of the ear, known as the pinna, should cross this line; note the child’s ability to hear during normal conversation; a child who speaks loudly, responds inappropriately, or does not speak clearly may have hearing difficulties that should be explored.
• The nurse listens for the rhythm of the heart sounds and counts the rate for 1 full minute.