Age-Specific Physical Assessment

1. Discuss the age specific physical assessment/s properly completed this week. State techniques you used in completing the physical assessment of your patient. Often these techniques will differ from an examination of an adult.

* L. was a 3 month old female, diagnosed with a central line infection. Prior before performing the physical assessment, I gathered information her diagnosis, in order to assess her appropriately. When I walked into the room, I introduced myself to the mother and told her that I would be assessing L. from her head to feet. I observed L. by looking at her appearance and behavior. L. was very calm because the mom was their touching her and talking to her during the assessment. The mom was very involved during the physical assessment by answering questions appropriately and being knowledgeable about L.’s diagnoses. Her face was symmetric with a normal skin color for ethnicity and anterior fontal were soft and flat along with the posterior fontal. L. L. was deaf and was unable to respond to sound or to mom’s voice. I assessed her mucus membranes, which were pink and moist. I auscultated

her heart and lungs, and heard S1S2 and heard bronchial breath sounds in all four quadrants. L. was also diagnosed with anoxic ischemic brain damage, which is lack of oxygen to the brain. L. had an absent gag reflex and was unable to swallow secretions. I auscultated her abdomen checking for bowel sounds, which were active. I assessed L.’s broviac site checking for signs of infection, there was some redness and a pus pocket, and I advise the mom not to attempt to pop it. I assessed her arms, checking her skin turgor for dehydration and her radial pulse, which was strong and equal. I checked her capillary refills that were less than 2 seconds and checked her lower leg extremity, which was strong for age by L. demonstrating kicking legs. I palpated her pedal pulses bilaterally, which were strong and equal. Throughout the physical assessment, I used distraction techniques and help from the mother in order to complete the assessment. Although L. was deaf the mother still communicated with her by using touch for comfort during the physical assessment.
2. Identify problems and needs of the hospitalized child and their family. These can be physical, mental, spiritual, cultural, environmental and social problems or needs.
* The mother had a difficult time communicating with different agencies concerning the daughters home health care. The mother seemed very stressful at times, she stated she stopped working since her daughter was born with many problems that required hands on throughout the whole day. The mother was very knowledgeable on starting L.’s tube feedings and giving medications expect her IV antibiotics so, teaching was involved on how to clean the hub before connecting the tubing and to make sure the tubing was unclamped. L. need physical support with her care because she needed suctioning throughout the day for adequate oxygen and comfort to help calm her down.
3. Identify the percentile value for one of your patient’s growth (height, weight, and head circumference if applicable) and discuss any abnormal findings. Plot the information on a growth cart and state the percentile value for each parameter and then state whether the measurement is normal or abnormal. State the probable rationales for abnormal findings.
* M was in the 95th percentile in his weight and 90th percentile for his height, these are normal findings.
4. Analyze the developmental level in detail for one patient during this week’s rotation. (If possible, please choose a different age group each week. Notify the instructor is you can’t meet this goal;)
a. According to your patient’s age, state their expected cognitive development according to the text and give examples of how they are meeting or not meeting their expected cognitive norms.
* M is in the preoperational stage.

The young child thinks by using words as symbols, but logic is not well developed. The vocabulary and comprehension increases greatly, but the child shows egocentrism the ability to see things from the perspective of another. Rudimentary problem solving, creative thought, and an understanding of cause and effect relationship. M. is meeting the normal cognitive norms because he appeared to have a broad vocabulary for his age. M. was able to verbally communicate with me when I asked him simple questions. Also, M. was worried about going to the play room other than taking his medications and vital signs because that’s what he wanted to do.

b. According to your patient’s age, state their expected psychosocial level according to the text and give examples of how they are meeting or not meeting their expected psychosocial

norms.
* Toddlers find the company of other children pleasurable, even though socially interactive play may not occur. Parallel play is used when two toddlers tend to play with similar objects side by side, occasionally trading toys and words. Toddlers engage in play activities they have seen at home, such as talking on the phone. M is meeting the expected psychosocial norms because play with others in the play room that involved building blocks and scribbling on paper. Also, M. enjoyed interacting with his brother in his room with communicating and sharing the toys. M. is in the autonomy versus shame and doubt. The toddler’s sense of autonomy or independence is shown by controlling body excretions, saying no when asked to do something and directing motor activity. M. is meeting the normal psychosocial norms because he wanted to put his socks on by himself without help before going to the play room.
c. According to your patient’s age, state their expected motor developmental milestone according to the text and give examples of how they are meeting or not meeting their expected motor development norms.
* The toddler learns to pour, dress self, and use their fine motor skills to build tower of four blocks. The toddler can jump, throw balls over their head, and kick balls. The toddler is able to feed themselves using a fork or spoon. M. is meeting the motor norms because he was able to build blocks in the play room and help his mom put his new gown on.
5. State the highest priority nursing diagnosis for each of your patients from this week’s rotation and why you chose the diagnosis as the highest importance.

* The highest nursing diagnosis for L. was impaired skin integrity related to effects of mechanical factors or pressure secondary to broviac line. This nursing diagnosis was the highest because L. had an infection around the port that presented with redness and pus-filled. The highest nursing diagnosis for M. was acute pain related to tissue trauma and reflex muscle spasms secondary to surgery. This nursing diagnosis was the highest because M. had a tonsillectomy and adenoidectomy and EUA bilateral ear tubes. M. showed facial grimaces with moaning and picking at his ears.
6. Choose one of the diagnoses you listed in objective 5 and list all of the interventions that were implemented associated with that diagnosis and the rationale for each intervention.
*The interventions implemented for L. included assessing the skin for any signs of infection: erythema, swelling, warmth, discharge. The immune system is activated when signs of infection appear. Another intervention was to administer the scheduled Cefepime and Gentamicin. Antibiotics are medications to treat infections by working against the bacteria. Then, I followed the contact isolation precautions that included gown, mask, and gloves prior to entering L.’s room and handwashing. The purpose of wearing gloves is to protect you from being contaminated with microorganisms and to prevent the spread to others.
7. List all medications administered and procedures performed.
* Glycopyrrolate 0.25mg G- tube Q6hr.
Cefepime 200mg IV syringe Q12 hr. infused over 30 minutes.
Ibuprofen
Acetaminophen 150mg PO Q6hr.
Ofloxacin otic 5 drops
Suction
Gastric Tube medications administration