Pediatrics Essay

Pediatrics Essay

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Pediatric Experience 1 Kimberly Testi 205-68-4533 Foundations of Nursing Judy Tate November 30,1999 Pediatric Experience 2 The Primary Care Clinic located in Children's Hospital is dedicated to the care of children. It is a place where children can be examined for routine physicals and sick visits. It is convenient because it is open until 9:00pm so children can be seen in the evening. This experience demonstrates that there are many differences in treatment of children and adults. T.T., a three year old male, was seen first. He was visiting the clinic due to a high temperature, 39.6oF(Jarvis,1996). Despite his fever, T.T. was very energetic. He was talking and playing. On observation enlarged tonsils, a strawberry tongue, and a rash on his torso were evident. He was diagnosed as having strep throat and scarlet fever. Expected findings include small tonsils, a pink tongue with no bumps or lesions, and a smooth torso with no rashes evident(Jarvis,1996). The nurse had useful techniques when assessing T.T. For example, when assessing his lungs, she was having a difficult time getting him to take deep breaths. She tried holding up her finger and telling him to pretend it was a birthday candle and to blow it out. When this did not work, she ripped up little pieces of paper and asked him to Pediatric Experience 3 blow them away. This technique not only worked for the assessment, but also in keeping T.T. happy. The next child, M.M., was a 10 year old male. He was visiting the clinic for a routine physical. The nurse began the assessment by asking questions. She started with history, asking if he'd been in the hospital before, if he was on any medications, and if he had any current complaints. The only concern he and his mother had was the fact that his right heel would get sore after physical activity. The nurse then moved to nutrition. M.M. claimed to have healthy eating habits, eating all food groups and not too much fat and sugar. After that, the nurse asked about physical activity. M.M. plays basketball but he doesn't get outside to play as much as he'd like. The nurse then began the physical assessment. She looked at all body systems. Musculoskeletal was fun for M.M. He had to do things such as touch his toes, hop on one foot and squat down to walk across the room. She assessed the genital area last. All she had to do was look to make sure he was developing correctly for his age. He said he was uncomfortable with this so she asked if he would like his mother to leave the room. He said no, so she proceeded to look very quickly. He was developing fine. There were no unusual findings on physical assessment. Pediatric Experience 4 An x-ray was taken of M.M.'s heel. It showed that a piece of bone had broken off at 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. Pediatric Experience 7

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