the end of his heel. He went to orthopedics and they took care of him from
there. The third child observed was T.W., a 7 month old female. She was brought
to the clinic due to eye drainage. The nurse began by taking a rectal
temperature. Upon doing this, she noticed a flaming red rash on T.W.’s genital
area. She asked the parents about this and they said it had been like that for
about a week. She then went on to look at T.W.’s eyes. Her conjuctiva was very
red and she did have a greenish drainage in and around her eye. The first nurse
placed her on the exam table which was not very effective. T.W. was crying and
would not stay still. The second nurse performed her examination with T.W. while
her mother held her and this proved to be much more effective. T.W. was
diagnosed with conjunctivitis and a candidal infection. All examinations were
performed with the parent in the room. This was very effective. Infants,
toddlers, and preschool children should be examined with a parent in the room.
For children this age, the parent is the source of subjective data. For example,
T.W. could not speak for herself. T.T. could speak to an extent, saying such
things Pediatric Experience 5 as "My throat hurts". His mother,
however went into more detail about his symptoms. School-age children and
adolescents should be given the choice of whether or not they want their parents
present(Vessey,1995). When performing assessments on children, it is important
to remember that they are always developing. Determining the developmental level
of a child is important. This can be done through play. Children communicate
through play. By observing the play of children, it is possible to see how they
are developing not only physically, but intellectually and socially as well.
Therefore, play is an assessment tool(Whaley & Wong,1985). Since children
communicate through play, nurses can communicate with them through play. It is a
technique used to gain the trust of children. By playing with them you become a
friend(Whaley & Wong,1985). Also when working with children, the nurse needs
to understand that it is important to communicate not only with the child but
with the parent too(Perry & Potter,1997). This is crucial when it comes to
education. For example, when assessing T.W. the nurse asked if the parents
smoked. When they replied that they did she explained to them the effects this
could have on their infant. When assessing M.M. she educated both he and his
mother on the importance of using seatbelts. And lastly, Pediatric Experience 6
educated T.T. and his mother about the importance of handwashing. There are many
differences in children and adults. It is possible to communicate with an adult
simply through talking. Also adults are fully developed so it is not necessary
to note their development. There is also a physical difference which can be seen
by vital sign values. A child’s blood pressure is generally lower than that of
an adult. A child has a higher respiratory rate than adults do(Perry &
Potter,1997). The temperature in adults and children is generally the same
however it should be noted that rectal temperatures are 10F higher than oral
temperatures. Also the heartrate of a child is greater than that of an
adult(Jarvis,1996). It was thought a very long time ago that children were
simply miniature adults. It is obvious now that that is not the case. Children
are unique and special and are constantly growing and developing. They need
special attention and it is imperative that nurses understand that. Children
require patience and caring. When one understands this, they will be successful
in caring for them.
Jarvis, C.(1996). Physical examination and health assessment. (2nded).
Philadelphia: W.B. Saunders Company. Perry, P.A. & Potter ,A.G.(1997).
Fundamentals of nursing: Concepts, process, and practice. New York: Mosby.
Vessey, J.A.(1995). Developmental approaches to examining young children.
Pediatric Nursing,21(1),53-56. Whaley, L.F. & Wong, D.L.(1985). Effective
communication strategies for pediatric practice. Pediatric Nursing,11,429-432.