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
DQ 1: Child Abuse
Child abuse and maltreatment is not limited to a particular age—it can occur in the infant, toddler, preschool, and school-age years. Choose one of the four age groups and outline the types of abuse most commonly seen among children of that age. Describe warning signs and physical and emotional assessment findings the nurse may see that could indicate child abuse. Discuss cultural variations of health practices that can be misidentified as child abuse. Describe the reporting mechanism in your state and nurse responsibilities related to the reporting of suspected child abuse.
DQ 2: Physical Assessment
Expert Answer and Explanation
DQ 1: Child Abuse and Maltreatment
Child abuse among school-age children is a global problem with life-long consequences. School-age children experience various types of violence, including sexual abuse, physical abuse, and psychological mishandling. Van der Kolk (2017) describes child sexual abuse has a sexual act between a child and an adult, including intercourse, rape, oral sex, sodomy, and penetration.
Also, physical child abuse results from all types of physical aggression such as beating, pinching, severe physical punishment and kicking (Van der Kolk, 2017). Kleinman (2015) specifies that emotional or psychological child abuse includes attitude and behavior, interfering with a child’s social development and mental health. Thus, emotional violations can range from a simple verbal insult to severe punishment.
In addition, numerous warning signs are indicating different types of child abuse. For example, the deterrent signs of sexual child abuse include fearing of a particular member of the family or a person, seductiveness, and excessive violence. Van der Kolk (2017) also states that signs indicating physical child abuse include fearing of adults, burns, and bites in the shape of objects, and child fear to go home. Kleinman (2015) mentions that the nurse can find if a child experiences any abuse by examining his or her injury, depression, anxiety, dissociative illnesses, and personality disorders.
Moreover, any individuals can report child abuse cases in my state. The person is required to give a complete and honest account of the occurrence that he or she has observed, and which has led to suspicion of child abuse event (Kleinman, 2015). The report is received by Child Protective Services (CPS) who assess it and determine if it meets the legal definition of child abuse.
CPS also examines the state of the event reported to them by taking any legal actions against the abuser. Lastly, the key responsibilities of the nurse on reported child abuse being suspected are three. The roles include informing the law enforcement such as CPS about the abuse, reporting the case to physician or nurse practitioner, and connecting the victim to counseling services.
Kleinman, P. K. (2015). Diagnostic imaging of child abuse. Cambridge University Press.
Van der Kolk, B. A. (2017). This issue: child & victimization. Psychiatric Annals, 35 (5), 374-378.
Alternative Answer and Explanation
The Health Assessment of Infants
All children including infants, toddlers, pre-school, and school-age children can experience child abuse in many forms. School-age children are among the most exposed to many forms of abuse, as they have encounters with parents, teachers, as well as other individuals outside the family.
Warning Signs that Indicate Child Abuse
There are several warning signs in school-age children that could indicate possible child abuse. Among the most common include underperformance, disruptive behavior, and lateness in school. The child can also appear dirty and unkempt, indicating a form of neglect from the family or guardians (Hodges & McDonald, 2019). In cases of sexual abuse, the child could also have suicidal thoughts and experience shame among his or her peers.
Cultural Practices that can be misidentified as Child Abuse
There are different cultural practices that can be mistaken to be child abuse. For example, in some communities, it is mandatory that school-age children above 14 years to have part time jobs. This can be easily misunderstood to be child labor (Lee & Kim, 2018). Another practice is the act of disciplining a child which could happen in many forms including physical discipline. However, this kind of discipline must not result in the child shedding blood.
Reporting Mechanism in Delaware and the Responsibility of the Nurse in Reporting Suspected Child Abuse
Delaware is one of the counties that take child abuse cases seriously in that there is a rigid reporting system. A person who witnesses child abuse should call the community hotline, and in cases of emergency, they should call 911 and also help the child. Nurses should report suspected cases of child abuse in the facilities as they provide treatment as this would help to avoid further psychological and physical harm of the child.
Hodges, L. I., & McDonald, K. (2019). An Organized Approach: Reporting Child Abuse. Journal of Professional Counseling: Practice, Theory & Research, 46(1-2), 14-26.
Lee, H. M., & Kim, J. S. (2018). Predictors of intention of reporting child abuse among emergency nurses. Journal of pediatric nursing, 38, e47-e52.
DQ 2: Physical Assessment
When carrying out a physical assessment of both a child and an adult, the foremost thing is to collect as much information from the patient as possible through observation of the physical attributes. For both, checking for the vital signs, blood pressure, and temperature is done during physical assessment. The normal parameters for both however vary, with the distinction taken into consideration during assessment.
Cardiac assessment is however, different for both, due to the level of heart development and prevalent issues which might be there for adults and not in children. Analysis of the airway and breathing patterns also vary for the two groups.
When offering instruction, the nurse is required to first consider the age of the patient, social, education, and cultural background of the patient. After learning of these attributes, a proper communication strategy can be formulated to provide instruction in a manner that can be understood. The instructions offered should also be done in a respectful manner. When carrying out the assessment, the nurse should first introduce themselves to create a good rapport with the patient.
Two-way communication, which includes patient’s feedback is an essential aspect in collecting as much relevant data from the patient as possible (O’Hagan et al., 2014). When communicating, choosing a language that is simple and can be easily understood can help the patient feel at ease and be more engaging.
For children, the nurse would opt to be less threatening by showing a more friendly face and language used. The nurse should try as much as possible to reduce the stress level of the child. Being honest when communicating with the child can also help them to be more responsive and calmer during the assessment. For adults, explaining to them using simple and understandable words on the procedures done during assessment can help them to be more engaging (Dempsey, Reilly & Buhlman, 2014). Encouragement during the procedure can also help to improve both child and adult patient engagement.
Dempsey, C., Reilly, B., & Buhlman, N. (2014). Improving the patient experience: real-world strategies for engaging nurses. Journal of Nursing Administration, 44(3), 142-151.
O’Hagan, S., Manias, E., Elder, C., Pill, J., Woodward‐Kron, R., McNamara, T., … & McColl, G. (2014). What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. Journal of advanced nursing, 70(6), 1344-1355.
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During an assessment, a nurse may need to provide instructions to the patient to gather information, ensure safety, or perform a procedure. Here are some general steps that a nurse may follow to offer instruction during the assessment:
- Introduction: The nurse should introduce themselves and explain the reason for the assessment. They may also explain the importance of following the instructions.
- Active listening: The nurse should listen actively to the patient and address any concerns or questions they may have before providing instructions.
- Simplify instructions: The nurse should use simple, clear, and concise language to ensure the patient can understand the instructions. They may also use visual aids or demonstrate the procedure if necessary.
- Ask for feedback: The nurse should ask the patient to repeat the instructions or explain the procedure in their own words to confirm their understanding. They may also ask if the patient has any questions or concerns.
- Provide reassurance: The nurse should provide reassurance and support throughout the assessment and the procedure if necessary.
- Follow-up: The nurse should document the instructions provided, follow-up with the patient, and provide additional instructions or clarification if needed.
It is important for the nurse to establish a rapport with the patient and create a safe and comfortable environment for the assessment. They should also be aware of any cultural or linguistic barriers that may affect the patient’s understanding and adapt their instructions accordingly.
Difference between pediatric and adults
Pediatric and adult patients have distinct differences in their anatomy, physiology, psychology, and medical needs. Here are some of the key differences between pediatric and adult patients:
- Anatomy: Pediatric patients have smaller and less developed body structures, such as smaller airways, smaller veins and arteries, and smaller organs. They also have developing immune systems that are more susceptible to infections.
- Physiology: Pediatric patients have different vital sign ranges and metabolic rates compared to adults. They also have developing organs and different nutritional needs.
- Psychology: Pediatric patients require different communication and interaction approaches due to their developmental stages, which can impact their level of comprehension and ability to follow instructions.
- Medical needs: Pediatric patients often require specialized care, such as neonatal care, developmental and growth evaluations, and vaccination schedules. They also require age-specific medication dosing and administration, and may need family-centered care that involves parents or guardians in decision-making.
- Caregiver involvement: Pediatric patients require involvement from caregivers or parents in their care, as they are often not able to make their own decisions or communicate effectively.
In summary, pediatric patients require specialized care due to their unique anatomy, physiology, psychology, and medical needs, as well as the involvement of caregivers or parents in their care. Healthcare professionals who work with pediatric patients must have specialized knowledge and skills to provide age-appropriate care and communicate effectively with the patient and their family.
What is a focused assessment
A focused assessment is a type of nursing assessment that is tailored to a specific issue or concern related to a patient’s health. Unlike a comprehensive assessment, which is a broad and in-depth evaluation of the patient’s overall health status, a focused assessment focuses on a specific aspect of the patient’s health, such as a symptom, condition, or potential complication.
A focused assessment may be conducted during a routine check-up, in response to a patient’s complaint or a change in their condition, or as part of a follow-up after a treatment or procedure. The purpose of a focused assessment is to quickly and efficiently gather relevant data to inform clinical decision-making and develop a targeted plan of care.
The steps of a focused assessment may vary depending on the issue or concern being assessed, but generally involve:
- Clarifying the purpose of the assessment and obtaining consent from the patient.
- Collecting relevant data through observation, physical examination, and/or interview.
- Documenting the findings, including the patient’s response to the assessment and any changes in their condition.
- Analyzing the data to identify any potential problems or concerns.
- Developing a plan of care that addresses the identified issue or concern.
Examples of a focused assessment include assessing a patient’s pain level and location, checking for signs of infection at a wound site, evaluating a patient’s breathing pattern, or measuring a patient’s blood glucose level.
Performing a physical examination on a toddler can be challenging, as they may be uncooperative, fearful, or easily distracted. Here are some general guidelines for performing a physical examination on a toddler:
- Approach the child calmly and positively: Greet the toddler in a friendly and reassuring manner to build trust and make them feel more comfortable. It can be helpful to involve the child’s parents or caregiver in the examination to provide emotional support.
- Use a step-by-step approach: Explain each step of the examination to the toddler in simple language, using a reassuring tone of voice. It can be helpful to demonstrate each step on a toy or stuffed animal to help the child understand what will happen.
- Use distraction and play: Toddlers may be more cooperative if they are engaged in play or distracted by toys, books, or songs. The nurse or parent can use distraction techniques to keep the child calm and focused during the examination.
- Use a head-to-toe approach: Start the examination with non-invasive procedures, such as visual inspection or auscultation, and gradually move to more invasive procedures, such as palpation or blood pressure measurement. This will help the toddler become more comfortable with the examination as it progresses.
- Provide praise and encouragement: Praise the toddler for their cooperation and participation in the examination. Positive reinforcement can help the child feel more comfortable and confident.
- Be mindful of cultural practices and beliefs: Some cultural practices or beliefs may affect the examination process, so it is important to be aware of these and adapt the examination accordingly.
In summary, performing a physical examination on a toddler requires a calm and positive approach, using distraction and play, and a step-by-step approach to build trust and cooperation. Engaging the parents or caregivers can also be helpful, and it is important to be aware of cultural practices and beliefs that may affect the examination.
The pediatric assessment triangle (PAT) is a tool used in the initial assessment of a pediatric patient to quickly and efficiently identify potential life-threatening conditions. It consists of three components, which are:
- Appearance: This component involves observing the child’s overall appearance, including their level of consciousness, skin color, and work of breathing. The nurse or healthcare provider should assess for signs of lethargy, irritability, or unresponsiveness, as well as signs of respiratory distress or cyanosis.
- Work of breathing: This component involves assessing the child’s respiratory effort, including the use of accessory muscles, nasal flaring, and grunting. The nurse or healthcare provider should observe the child’s breathing pattern, rate, and depth, and listen for any abnormal breath sounds.
- Circulation: This component involves assessing the child’s circulation, including their heart rate and peripheral perfusion. The nurse or healthcare provider should check the child’s pulse, capillary refill time, and skin temperature and color.
The PAT is a rapid and systematic approach to identifying potential life-threatening conditions in a pediatric patient. If any abnormalities are identified in any of the three components of the PAT, immediate interventions may be necessary to stabilize the child’s condition and prevent further deterioration.