Topic 2 DQ 2
Compare the physical assessment of a child to that of an adult. In addition to describing the similar/different aspects of the physical assessment, explain how the nurse would offer instruction during the assessment, how communication would be adapted to offer explanations, and what strategies the nurse would use to encourage engagement.
Tanveer
Re: Topic 2 DQ 2
Medical assessment comparison between child and Adult
There are numerous procedures for medical and physical assessment on a child patient which also correlates with the adult patient but still there are lot of differences. Adults have lot more complicated medical history then children. General and central nervous system anatomy and physiology in children is different to that of adults. Pediatric patients are at increased risk of lacking vital signs documentation during prehospital care. (Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients, 2018)
The similar/different aspects of the physical assessment, instructions during the assessment, how communication would be adapted to offer explanations, and strategies the nurse would use to encourage engagement.
Age is not just a number (Similar/difference aspects of assessment)
Remember the names Erikson, Freud, and Piaget? Adult nurses reading this are cringing a little and feeling very relieved that those names are a distant nursing school memory. Pediatric nurses might not remember those exact theories on development, but treating patients based on age is a constant consideration in the pediatric population. The first major difference between adult and pediatric nursing is the role age plays in nursing care.
As a pediatric nurse, you could have 3- 5 patients of entirely different ages. As a nurse, this means 3-5 different reasoning strategies to convince them to take medications, different coping abilities for traumatic or painful procedures, different physical skills based on motor development, different cognitive abilities, different lab value and vital sign normal ranges… the list goes on. That’s a love or hate aspect of pediatric nursing – such a wide variety in developmental stages. With adults, the majority fall within very consistent expected cognitive, emotional, physical, and clinical data ranges. When you discuss a procedure or a diagnosis to an adult patient, you can use logical explanations to help them understand what to expect. You can address everyone in the room at once, including other family and visitors. With children, you are explaining in one manner to the parents, and entirely differently to the pediatric patient.
A 5 minute vs. 1-hour explanation of past medical history assessment
It’s no surprise that adults generally have more complicated and extensive medical histories than children. Because of this, adult nurses are much more concerned with the interconnectedness of illnesses within the patient. It’s particularly important to get a thorough history for adult patients because comorbidities can explain seemingly unrelated presenting symptoms, or medication interactions to treat different conditions can be contraindicated. Adult nurses usually have a good understanding of disease pathophysiology, and how one body system affects another.
Pediatric assessment is usually more straightforward. Children typically have fewer allergies, limited to no medical history, no surgical history, and a single medical problem with an associated etiology. But just because children tend to have less complex histories, does not mean they are any easier to care for medically. Pediatric patients actually crash quicker, they have less reserves, and can compensate normal vitals for extended periods of time before a sudden decline. Children don’t present the same way for sepsis, stroke, or heart conditions. And because some are too young to talk, it also requires keen assessment skills and reliance on intuition. (Hamstra, n.d.)
Assessment differs for Neuropathic Pain
The various screening and assessment tools available to clinicians for evaluating neuropathic pain. Despite the availability of the 15 tools discussed, a deficiency remains, particularly in the pediatric realm. To date, there is no well-validated neuropathic pain assessment tool for children younger than 5 years, no pediatric neuropathic pain screening tool that has been validated outside the domain of chemotherapy-induced peripheral neuropathy, and no consistent recommendation regarding the optimal tool to use with pediatric patients who have chronic pain. These areas, as well as others, would benefit from further research and development. (Kyle & Doralina, 2017)
Difference between dealing family/visitors during treatment and assessment and instructions
Adult patients have plenty of visitors throughout the day, but typically they are more self-sufficient. Their family and visitors will certainly fire tons of questions at you, but there is also usually a limit to their interference with your actual nursing duties.
However, pediatric nurses must get used to parents breathing down their necks with every little thing. And it is totally understandable and acceptable – we are caring for their precious babies after all – but some nurses really don’t like the additional pressure that parents can add to already stressful situations. When you are starting an IV on a 1 week old, you’re praying that you don’t miss either.
On the other end of the spectrum, sometimes parents have other children to care for or both parents work, and pediatric patients can be left alone often if they stay in the hospital for extended periods of time. That comes with other challenges as a nurse – doubling as the disciplinary, the caregiver, and the nurse. Sometimes it’s hard to know your place and to not overstep boundaries with families because your role is parental-like in some ways.
Fluids
Adults can be much easier in certain ways. They usually have larger veins for IVs, you can safely push medications and run blood products quickly. Everything in pediatric nursing is fragile and sensitive. Tiny doses of medications run slowly on pumps, small chest tubes, and even the slightest nursing errors can have big consequences. You need steady, careful, and gentle hands for pediatrics. Adults can withstand a lot more.
Communication strategies by nurse for pediatric and adult patients
When you discuss a procedure or a diagnosis to an adult patient, you can use logical explanations to help them understand what to expect. You can address everyone in the room at once, including other family and visitors. With children, you are explaining in one manner to the parents, and entirely differently to the pediatric patient. It’s like learning another language. BUT just because adult patients are older and supposedly more mature, don’t assume they’re more independent than children. I have seen plenty of adults that need more babysitting and reminders for baths and meds than pediatrics patients.
Strategies to encourage engagement
People often think of pediatrics as all play, and adults as all serious – but I challenge you (as an adult nurse) to break the mold if you don’t already. Even adults like to play sometimes. Who says adults wouldn’t enjoy a coloring book and a popsicle? And for the perception of pediatrics being all play, don’t forget about the tough moments that come along with caring for children – temper tantrums, infants crying, teenage mood swings, puberty…there are plenty of pros and cons for both nursing populations. (Hamstra, n.d.)
References
Differences in Prehospital Patient Assessments for Pediatric Versus Adult Patients. (2018, 8). Retrieved from Science Direct: https://www.sciencedirect.com/science/article/abs/pii/S0022347618304815
Hamstra, B. (n.d.). 4 Major Differences Between Pediatrics And Adult Nurses. Retrieved from Nurse.org: https://nurse.org/articles/differences-between-pediatrics-adults/
Kyle, M. J., & Doralina, A. L. (2017, 11). A Review of Adult and Pediatric Neuropathic Pain Assessment Tools. Retrieved from Wolters Kluwer Health, Inc.: https://journals.lww.com/clinicalpain/Abstract/2017/09000/A_Review_of_Adult_and_Pediatric_Neuropathic_Pain.10.aspx
Hello Tanveer,
Thank you for this great discussion, you have integrated all the aspects of the question with the subtopics. From your discussion, it is true that there are numerous procedures for medical and physical assessment on a child patient, which also correlates with the adult patient, but still there are lot of differences (Wachs & Sheehan, 2018). The assessments need to be carefully undertaken on the basis of the medical history as well as the conditions that the patients may show. Nurses and other medical professionals should always identify the correct procedures on how to undertake the diagnosis and the assessment processes. In the processes of assessments for both the adults and children, there is always the need to interrogate family members on the possible complication which may lead to the diseases. Also, there is always the need to apply effective medical equipment so as to facilitate the assessment processes.
References
Wachs, T. D., & Sheehan, R. (2018). Assessment of Young Developmentally Disabled Children. Boston, MA: Springer US.
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