Presented by Marlene Meador RN, MSN, CNE

Therapeutic CommunicationHow does a nurse communicate with a patient who does

not use words?

Physical Proximity and environmentTouchListening Visual CommunicationTone of VoiceBody LanguageTiming

Considerations and strategies for cooperation:Remember developmental age (why is this crucial to

success?) p 60 & 61 table 4.3Honesty Involve child- speak directly to the childInvolve parents when appropriate

Developmental milestones and approach to communicationInfants (0-12 mo)

Toddlers(1-2 yr)

Preschoolers(3-5 yrs)

School-age(6-11)

Use of calm voice; respond to cries, mimic baby sounds, talk and read regularly, use a slow approach and allow time to get to know you

Learn the toddler’s words for common items, picture books, respond to their receptiveness, preparation should occur immediately before event

Offer choices, use play or “storytelling” for explanations,simple sentences, picture books, puppets, be concise; limit length of explanations

Photos, books videos, diagrams, establishlimits, use play, introduce preparatory materials 1-5 days in advance of the event

Barriers to Communication

LanguageCultural differencesDistractionStress/conflict

Quick Question?What is the best way to ruin the relationship between the nurse and child/family/patient?

How is the assessment of a child different

than the assessment ofan adult?

Adapting the physical assessment to children:Physical proximity to the

child/patientPhysical contact Sequence of assessment

Examination of InfantsAllow parents to hold and participateAuscultate when quiteWarm equipmentInvasive procedures last

Rectal temperatures Lab draws)

Examination of ToddlersEncourage parents to participateIntroduce equipmentPlayChoices/controlSecurity object

Examination of Pre-School AgeDemonstrate and introduce

equipmentSequence Games and playDistraction

Examination of School Age and AdolescentProvide privacy (parental presence or

absence/chaperone)Choices of exam sequenceExplanation of body parts and functionsReassurance of normalcy

Beginning the ExaminationVerify patient- National Patient Safety Goal Introduce self- explain purpose of assessmentUtilize therapeutic communication (open-

ended questions) Address the child (direct questions, make eye

contact- WHY?)Obtain feedback from parents when

necessary

Why is an accurate history the single most important component of the physical examination? Page 807 Box 33-3

Substantive dataObjective data

Three types of health historyComplete or initial

Conception to current statusWell or interim

Previous well visit to current visitProblem-oriented or episodic

Information related to current problem

Obtaining a history:Open-ended questioningRe-phrase rather than repeatListen actively (reflective reply)Cultural differencesAvoid judgmental questionsPsychosocial data is critical to health

promotion

Problem-Oriented HistoryCharacteristics Defining Variables

Chief complaint and onset

Body Location

QualityQuantityAggravating and alleviating

Previous & current treatment

Use the child’s own words to describe when & how began

Anatomic location general or localized

Burning/stabbing/dull/achingIntensity of pain or problemWhat increases or relieves the

pain or problemMedications, thermo therapy,

responses to treatment

Obtaining a Health HistoryBirth History

Prenatal care (onset and duration)Mother’s age and health at time of birthMother’s history of illness, injuriesMother’s impression of pregnancy (also

significant other’s impression)

Obtaining a Health History cont…Familial or Inherited Disorders

Chromosomal disorders in other family members

Height and weightDiabetesCardiovascular diseaseAsthma/ reactive airway diseaseAllergies

Prioritizing Care

Primary- ABCDE’sAirway, breathing, circulation, LOC (disability, &

exposure) A temperature too low is as serious as too high

Adaptations in Emergency Assessment S- signs and symptomsA-allergiesM-medications and immunizations (OTC and

herbal)P- prior illness or injuryL- last meal and eating habitsE- events surrounding illness/injury

Prioritizing Care cont…Secondary

VS, pain, history and head-to-toe assessment and inspection

Height/weight, diagnostic testingPsychological problemsRisk of infectionNutritional problems

Prioritizing Care cont…Tertiary

Health concerns that do no immedicately threaten the physiologic status of the child:Knowledge deficit / Patient teachingCopingHealth maintenanceActivityRest

Assessment Findings: head to toe (chapter 33)

Head (eyes, ears, hair, shape, FOC)Chest- cardiac, respiratory, excursion- shapeAbdomen- size, shape, tone Musculoskeletal- posture, tone, symmetryNeuro- reflexesSkin- including hairGenitalia- age appropriate

Quick Review:Why is it important for the nurse to

know the normal range of vital signs specific to the age of patients?

Table 33-1 page 808

How does the nurse prioritize assessment findings?Stay alert to what would cause harm…Is this an acute need? Or at risk for?How does the nurse select the

intervention?How do you evaluate the effectiveness of

the intervention?

What physical and psychosocial findings suggest abuse or neglect?

DressGrooming and personal hygienePosture and movementsBody imageSpeech and communicationFacial characteristics and expressionsPsychological state

When would the nurse notify CPS?

What are the nurse’s legal obligations

What are the nurse’s ethical obligations?

Recognize your own limitations and protect yourself. The Health Science Programs of Austin Community College

recognize the additional stressors associated with becoming a nurse.

We offer free counseling services to all students through the Student Services Department

These counselors offer confidential assistance to any student as well as test taking skills and tips

EVC- Sandra Elizondo (512) 223-5810 selizond@austincc.edu RRC- Julie Reck (512) 223-0235 jcuellar@austincc.edu

Please contact Marlene Meador RN, MSN if you have any questions or concerns

regarding this information.

Mmeador@austincc.edu512-422-8749