Essentials in Paediatric Health Assessment

00:42:22
https://www.youtube.com/watch?v=SToYczPnOaU

摘要

TLDR本次网络研讨会涵盖了幼儿健康评估的基础知识，强调了照顾幼儿时需要考虑的重要因素。包括儿童生理特征与药物反应差异，评估发展里程碑以及快速评估临床恶化的技巧。 评估时需结合儿童的年龄段及发育里程碑，视觉评估优先于侵入性检查。家庭成员的参与被重视，以增进儿童的信任和安全感。不同年龄层的儿童在生理特征上存在差异，需要在解释生命体征的变化时考虑这些差异。兰克表等工具可用于进行疼痛评估和心理健康监测。最终，课程建议与医疗团队沟通评估结果，以实现有效的干预与治疗。

心得

  • 👶 儿童和成人在生理上存在显著差异。
  • 📅 理解儿童的发育阶段对于评估至关重要。
  • 🔍 家庭在健康评估中扮演着重要角色。
  • 📏 使用合适的方法进行快速评估是关键。
  • 🩺 循环与呼吸的整体状况评估有助于识别危机。
  • 🔄 逐步检查，非侵入性检查应优先进行。
  • 📊 及时与家庭沟通评估结果至关重要。
  • ⚖️ 药物剂量通常以体重为基础，需谨慎调整。
  • 👁️ 和儿童建立信任关系十分重要。
  • 🧸 运用游戏和沟通增强儿童参与感。

时间轴

  • 00:00:00 - 00:05:00

    本次网络研讨会的目的是介绍儿童健康评估的基本原则，强调儿童与成人在健康评估中的关键差异，包括家庭的参与、发展阶段、解剖差异以及药物反应的不同等。

  • 00:05:00 - 00:10:00

    儿童发展的不同阶段，如婴儿、幼儿、学龄前儿童和青少年，影响沟通和评估的方式，评估应考虑儿童的独特情况，以使他们感到安全和参与。

  • 00:10:00 - 00:15:00

    在儿童健康评估中，重要的是要了解和解释儿童的生命体征变化，注意生理和非生理因素对生命体征的影响，确保稳定的环境以获得准确的数据。

  • 00:15:00 - 00:20:00

    快速评估的目标是在六秒内确定儿童的整体状况，使用儿童评估三角形工具（PAT）进行快速评估，评估儿童的外观、呼吸工作和循环状态。

  • 00:20:00 - 00:25:00

    在进行更详细的系统评估时，应从观察开始，评估呼吸、心脏、神经和消化系统，使用适当的方法（如视诊、听诊和触诊）以获取准确的信息。

  • 00:25:00 - 00:30:00

    了解呼吸系统的正常和异常声音对于评估儿童的呼吸系统至关重要，识别呼吸窘迫的红旗信号和晚期症状并采取适当措施是必要的。

  • 00:30:00 - 00:35:00

    评估儿童的心血管系统时，观察皮肤颜色和灌注，掌握适合年龄的脉搏和血压测量规范，以便进行准确的评估，结合各类生理指标进行判断。

  • 00:35:00 - 00:42:22

    最终评估应包括神经系统、胃肠系统、泌尿系统和心理健康评估，理解儿童的痛苦表现和与家属的沟通对于提供全面的健康评估至关重要。

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思维导图

视频问答

  • 本次网络研讨会的主题是什么？

    主题是幼儿健康评估的基本原则。

  • 如何进行幼儿健康评估？

    通过了解其发展里程碑及特定评估策略进行。

  • 幼儿评估时需要注意哪些生理差异？

    幼儿有更大的头部，相对较薄的皮肤，以及更窄的气道等特征。

  • 评估中家庭的角色是什么？

    家庭成员应被纳入讨论，以提高幼儿的安全感。

  • 如何识别幼儿临床恶化？

    通过快速评估儿童的外观、呼吸和循环状态，并使用Pediatric Assessment Triangle（PAT）。

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  • 00:00:01
    welcome everyone thank you for joining
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    the essentials and Pediatric Health
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    assessment webinar hosted by connected
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    carot sick kits this is an overview of
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    basic principles in Pediatric Health
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    assessment please take a few moments to
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    review this disclaimer and you may pause
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    it at any moment if you need more time
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    to review the content on the
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    slide the following objectives will be
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    covered in this session those include
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    discussing key considerations in the
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    caring for the Pediatric population
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    reviewing developmental Milestones as
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    they relate to performing a Pediatric
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    Health assessment discussing rapid
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    assessments for the Pediatric
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    population recognizing the clinical
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    signs of
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    deterioration reviewing components of
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    the Pediatric Health assessment and
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    reviewing pediatric pain
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    assessment if it is important to
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    consider the differences between
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    pediatric clients or patients and adults
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    this will help to guide the strategies
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    you use during your assessment and while
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    providing care for
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    Pediatrics let's go through some of the
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    differences to consider when assessing
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    pediatric
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    patients the child is part of a family
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    unit depending on the age of the
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    Pediatric client you may be speaking to
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    them as well as their family Caregivers
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    for updates on assessment changes goals
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    and their plan of
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    it's important to promote independence
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    of pediatric clients and include them in
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    the discussion as
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    appropriate there are also different
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    developmental stages for Pediatric
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    clients and these May differ from the
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    chronological age you need to have
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    knowledge of the developmental stages
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    when performing assessments and how they
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    may influence your
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    findings there are anatomical
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    differences between Pediatrics and
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    adults that may impact your assessment
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    for example children have large L ger
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    heads thinner skin their Airway is more
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    narrow they have shorter necks and
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    softer bones and these can influence the
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    way a child responds or compensates to
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    Medical
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    changes there can also be differences in
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    how medications are administered as well
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    as how the child May respond to
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    medications the dose of medications are
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    weight based for Pediatrics there may be
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    an increase in side effects to the
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    medication due to organ immaturity and
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    mature blood brain barrier a lack of
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    research on the drug efficacy and a lack
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    of exposure to
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    medications different compensatory
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    changes may also be noted for children
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    for example children are more prone to
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    dehydration and heat loss than adults
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    because they have more body surface area
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    per pound of weight and they have
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    thinner skin and they breathe
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    faster also Vital sign changes signaling
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    decompensation can differ for Pediatrics
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    versus adults
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    for example blood pressure changes can
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    be a later sign of decompensation for
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    Pediatrics we are going to take a moment
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    to review the different developmental
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    stages and how you can adapt your health
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    assessment to accommodate
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    them remember that each child May
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    develop differently it is important to
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    understand the child's Baseline and any
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    conditions that may affect their
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    development before starting your
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    assessment the term infant covers the
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    first 12 months of age during this
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    developmental age the infant may look to
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    their caregiver for security and can
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    respond to the caregiver's anxiety
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    levels it can be helpful to include the
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    caregiver in the assessments to promote
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    feelings of safety for the child during
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    this stage starting with the least
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    invasive assessments can prevent crying
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    and moving which may affect the results
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    of the rest of your
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    assessment for example when checking
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    Vital Signs blood pressure and
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    temperature May invoke crying so it may
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    be helpful to save those till the
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    end the toddler stage encompasses years
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    1 to three during this stage the toddler
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    is starting to explore their
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    surroundings and become interested in
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    play it can be helpful to provide
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    explanation of what you are doing as
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    well as incorporating play into your
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    assessment allowing the toddler to touch
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    the equipment can also make them feel
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    safer
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    the preschool age is from 3 to 5 years
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    this child may ask more questions and
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    want to know what is happening during
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    this stage using plan explanation can be
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    helpful with preschoolers as well the
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    child can feel more comfortable when
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    they are included in their
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    assessment schoolage children are from 5
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    to 12 years of age a key feature of this
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    age group is that they're starting to
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    seek Aon aomy providing time to explain
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    the procedure or assessment and
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    providing options for the child can be
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    helpful when providing options it's
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    important to avoid yes or no questions
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    because if the child answers no you may
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    be in a challenging spot if the
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    assessment or procedure is
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    required a different way of providing
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    options may be to ask them which
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    assessment they would like to be done
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    first and offer breaks this can include
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    them in the decision- making while still
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    being able to complete the needed
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    tasks adolescents strongly value
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    autonomy and providing opportunities for
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    decision- making is important full
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    discussion of procedures and assessments
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    is required to allow for choice and
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    understanding it is also important to
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    provide time and privacy to promote
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    Independence this chart shows the
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    average ranges for pediatric vital signs
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    you'll see that there is a difference in
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    Pediatrics versus adults as the ranges
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    can change based on age it's very
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    important to know what the child's
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    Baseline is in order to interpret
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    changes just like adults pediatric vital
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    signs may change based on physiological
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    and non-physiological causes these are
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    important to consider when interpreting
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    vital signs as it may explain abnormal
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    results prior to assessing a child's
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    vital signs assess the surrounding
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    environment to know how it may impact
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    the child for example is this the first
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    time you're meeting the child and the
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    family has left the room is the child
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    anxious or fearful of you was the child
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    recently active or were they asleep is
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    the child in obvious pain or are they
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    crying it's also helpful to consider
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    physiological changes that may impact
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    their vital signs do you suspect that
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    the child has a fever or they showing
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    signs of respiratory distress has there
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    been a recent
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    injury have they taken any recent
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    medications these physiological and
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    non-physiological causes May provide
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    values that may not be a true reflection
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    of the clinical status or it may give
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    you a better understanding of what their
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    clinical status is and areas that you
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    can focus further assessments
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    on rapid assessments are designed to be
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    completed in less than 6 seconds with no
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    equipment to determine if the child
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    looks good or if they look
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    bad things to consider during a rapid
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    assessment include what is the child's
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    General appearance is it their Baseline
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    movement posture or
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    activity how are they interacting with
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    you as well as with their family does
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    the family appear or verbalize their
  • 00:07:52
    concern does a child appear frightened
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    or
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    concerned are there changes from the
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    last time you interacted Ed with the
  • 00:08:01
    child take a moment to reflect on your
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    past experience have you ever walked
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    into a room or a client's home and had a
  • 00:08:09
    gut feeling that something was wrong
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    what was the first thing that you
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    did the Pediatric assessment triangle or
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    Pat is a tool to complete a rapid
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    assessment a key part of the Pat is
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    knowing the child's Baseline normal
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    behaviors it's a quick 60-second scan of
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    the child's General appearance work of
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    breathing and
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    circulation when assessing the child's
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    appearance a helpful pneumonic is
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    tickles TI C LS this recalls the areas
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    to assess for their General appearance
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    this includes the tone interactivity
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    consolability look or gaze and speech
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    and cry you're assessing the child's
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    muscle tone and their mental status
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    thinking about is the child alert and
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    active or drowsy lethargic and
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    limp when assessing the child's work of
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    breathing you can assess the breathing
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    pattern rate and any audible sound you
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    may hear and a reminder to compare it to
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    their ba Baseline are you noticing
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    anything about the pattern of breathing
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    are they breathing deep or shallow are
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    you noticing whether there's any
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    increased work of breathing such as
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    nasal flaring or extended head
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    positioning or any accessory muscle Loop
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    use are they breathing faster or slower
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    than they normally do are you hearing
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    any abnormal audible sounds such as
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    wheezing gasping or
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    grunting the general circulation can be
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    assessed by observing the child's skin
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    color and temperature is the child's
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    skin tone their baseline or do they
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    appear pale and Dusky are there signs of
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    modeling or
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    cyanosis does the child look warm and
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    dry dry or do they appear flushed and
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    moist here are some examples of early
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    and late assessment findings that would
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    indicate a shift from the child's
  • 00:10:11
    Baseline for example when using the Pat
  • 00:10:14
    and assessing the work of breathing
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    early signs may be Topia and retractions
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    whereas late signs might be Topia with
  • 00:10:23
    increased effort and later signs may be
  • 00:10:26
    gasping ineffective breathing and no
  • 00:10:28
    resp
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    effort when you're assessing circulation
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    an early sign might be tardia with pale
  • 00:10:36
    cool extremities where a late sign might
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    be cyanosis or Poe profusion a later
  • 00:10:43
    sign might be arhythmia or weak pulses
  • 00:10:46
    or inadequate profusion and gray skin
  • 00:10:50
    tone when using the pat to assess the
  • 00:10:52
    general appearance early signs may be
  • 00:10:56
    irritability or restlessness to lethargy
  • 00:11:00
    whereas late signs might be stup with
  • 00:11:03
    decreased brain profusion and later
  • 00:11:05
    signs may be unresponsive flaccid or
  • 00:11:08
    tonic
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    posturing let's take a moment to use the
  • 00:11:16
    Pediatric assessment triangle in a
  • 00:11:19
    scenario you're caring for a
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    six-month-old infant who is admitted
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    with
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    RSV you walk into the room and you're
  • 00:11:27
    performing your rapid assessment
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    during this assessment you find the
  • 00:11:32
    respiratory rate is 62 breaths per
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    minute mild or tractions the infant is
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    warm and well profused and they're
  • 00:11:40
    crying and consolable by their
  • 00:11:43
    family what are the areas the of the pat
  • 00:11:46
    that are
  • 00:11:47
    affected what would you do
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    next take a moment to think about this
  • 00:11:52
    situation and we're going to discuss it
  • 00:11:54
    in more detail in the later
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    slides in this scenario there are
  • 00:12:00
    abnormal findings associated with the
  • 00:12:02
    work of breathing the average
  • 00:12:05
    respiratory rate for a 6-month-old is 22
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    to 52 breaths per minute a respiratory
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    rate of 62 with retractions are abnormal
  • 00:12:17
    findings take a moment to reflect on the
  • 00:12:19
    resource that you have access to are you
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    able to call someone for help do you
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    have access to provide oxygen if needed
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    if you're in the home consider when you
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    would take the child to the emergency
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    department 30 minutes later you're
  • 00:12:39
    reassessing the six-month-old infit and
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    now you know the respiratory rate has
  • 00:12:45
    increased to 60 breaths per minute The
  • 00:12:49
    retractions Have worsened and are now
  • 00:12:51
    accompanied with nasal flaring and
  • 00:12:54
    grunting the infant also appears pale
  • 00:12:57
    with cool extremity ities and they are
  • 00:13:00
    crying and
  • 00:13:02
    consolable this is a quick change in the
  • 00:13:05
    clinical status and you need help
  • 00:13:08
    urgently you are now noticing changes in
  • 00:13:11
    the work of breathing as well as the
  • 00:13:14
    circulation take a moment to reflect on
  • 00:13:17
    the resources you have access to and who
  • 00:13:20
    would you call for help I'll reminder
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    that hypoxia is a late finding of
  • 00:13:26
    decompensation and with little warning
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    before it in turn to complete
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    respiratory
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    failure now that we've looked at ways to
  • 00:13:40
    complete a rapid assessment of a
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    pediatric let's take a moment to look at
  • 00:13:45
    ways that we can complete a thorough
  • 00:13:47
    assessment of all
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    systems let's start with the respiratory
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    system this is an important assessment
  • 00:13:54
    in Pediatrics due to the physiological
  • 00:13:57
    immaturities of the respiratory system
  • 00:14:01
    their exposure to viruses in different
  • 00:14:03
    settings and the incidence of asthma and
  • 00:14:06
    allergies in
  • 00:14:07
    children the three main methods for
  • 00:14:10
    assessment are
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    inspection
  • 00:14:14
    osculation and
  • 00:14:18
    palpation while completing an assessment
  • 00:14:20
    of the child's respiratory system
  • 00:14:22
    remember to consider what the normal
  • 00:14:24
    ranges are for that
  • 00:14:26
    child inspection is recommend mended to
  • 00:14:29
    be completed first this allows you to
  • 00:14:31
    gather information prior to getting too
  • 00:14:34
    close to the child or touching them as
  • 00:14:36
    this may cause them stress and alter
  • 00:14:38
    your findings you can inspect the size
  • 00:14:41
    and shape of the chest the chest
  • 00:14:44
    movement are you noticing the breaths
  • 00:14:46
    are shallow or deep is there a
  • 00:14:48
    symmetrical
  • 00:14:49
    movement what is the child's respiratory
  • 00:14:52
    effort Do You observe any nasal flaring
  • 00:14:56
    retractions accessory muscle use
  • 00:14:59
    are they in the tripod position which is
  • 00:15:01
    hunched over trying to breathe are you
  • 00:15:04
    able to see any oxygen saturation with
  • 00:15:08
    an
  • 00:15:09
    oximeter after completing the inspection
  • 00:15:12
    you can then osculate the chest with a
  • 00:15:15
    stethoscope you want to osculate all
  • 00:15:18
    lung fields and compare both sides
  • 00:15:21
    listening to the front and back and to
  • 00:15:24
    the right side for the right middle L
  • 00:15:27
    ensuring there is Ade entry to all loes
  • 00:15:30
    is
  • 00:15:31
    important you also want to osculate for
  • 00:15:34
    the quality and characteristics of the
  • 00:15:36
    respiratory effort you're evaluating the
  • 00:15:40
    rate Rhythm depth quality and any
  • 00:15:44
    abnormal or absent breath
  • 00:15:47
    sounds for a pediatric context babies
  • 00:15:50
    breathe mostly through their nose for
  • 00:15:53
    the first 6 months of age it's important
  • 00:15:56
    to keep blankets and toys away from from
  • 00:15:58
    their nose or their mouth and if they're
  • 00:16:00
    congested it can be difficult for them
  • 00:16:03
    to
  • 00:16:03
    breathe babies and young children will
  • 00:16:06
    use abdominal muscles to pull the B
  • 00:16:09
    diaphragm down for breathing as well as
  • 00:16:11
    their as their intercostal muscles are
  • 00:16:14
    not fully developed you may see belly
  • 00:16:19
    breathing during a respiratory
  • 00:16:21
    assessment you may hear abnormal sounds
  • 00:16:26
    we are going to go through four common
  • 00:16:29
    abnormal sounds in
  • 00:16:31
    Pediatrics Strider is a high pitch noise
  • 00:16:35
    that occurs with obstruction in or just
  • 00:16:38
    below the voice box Strider can happen
  • 00:16:41
    when a child inhales or exhales or
  • 00:16:55
    both weine is a high p pitch noise that
  • 00:16:59
    occurs typically when breathing out on
  • 00:17:03
    expiration and it usually is due to a
  • 00:17:06
    spasm narrowing or obstruction of the
  • 00:17:09
    smaller Airways in the
  • 00:17:21
    lungs crackles are fine short high
  • 00:17:25
    pitched intermittently crackling sounds
  • 00:17:28
    the cause of crackles can be from Air
  • 00:17:31
    passing through fluid pus or mucus it's
  • 00:17:35
    commonly heard in the bases of lungs
  • 00:17:37
    during
  • 00:17:52
    inspiration grunting is forc
  • 00:17:56
    expiration caused by Brea breathing
  • 00:17:58
    against a partially closed
  • 00:18:10
    glotus this is a visual representation
  • 00:18:13
    of the differences between an adult and
  • 00:18:15
    a child Airway you can appreciate due to
  • 00:18:18
    these differences how children are prone
  • 00:18:21
    to obstruction Airway narrowing oper
  • 00:18:24
    respiratory issues and difficulty with
  • 00:18:27
    intubation these differences include a
  • 00:18:30
    cone-shaped Airway in children which
  • 00:18:32
    means it's wider at the top and narrower
  • 00:18:35
    at the
  • 00:18:36
    bottom children tend to have larger
  • 00:18:38
    tongues in relation to their mouth and
  • 00:18:41
    children have shorter and softer
  • 00:18:43
    tracheas all of these things can
  • 00:18:46
    contribute to why children are
  • 00:18:48
    predisposed to respiratory distress and
  • 00:18:50
    may require admissions for viruses that
  • 00:18:53
    may just be common Cults for
  • 00:18:55
    adults let's take a moment to review the
  • 00:18:58
    signs of respiratory distress including
  • 00:19:02
    red flags as well as late signs of
  • 00:19:04
    respiratory
  • 00:19:06
    distress red flags of respiratory
  • 00:19:09
    distress include
  • 00:19:11
    tpia changes in the mechanics of
  • 00:19:13
    breathing
  • 00:19:15
    retractions a tracheal tug nasal
  • 00:19:19
    flaring head bobbing grunting on
  • 00:19:23
    exhalation prolonged expiratory phase
  • 00:19:26
    diminished air entry change in breath
  • 00:19:29
    sounds Strider and
  • 00:19:32
    wheezing late signs of respiratory
  • 00:19:35
    distress include skin color changes such
  • 00:19:38
    as changes to Dusky or
  • 00:19:42
    cyanotic inaudible air entry or apnea or
  • 00:19:46
    irregular
  • 00:19:50
    respiration similar to the respiratory
  • 00:19:52
    system the cardiovascular system
  • 00:19:54
    assessment includes inspection
  • 00:19:56
    osculation and palpation
  • 00:19:59
    we will go through each of these
  • 00:20:03
    separately during inspection you are
  • 00:20:05
    looking for the color and profusion of
  • 00:20:08
    the child what is the color of their
  • 00:20:10
    skin is it appropriate for their skin
  • 00:20:13
    tone or is it at their
  • 00:20:15
    Baseline what is the child's profusion
  • 00:20:18
    are they pale or are they well
  • 00:20:20
    profused do you notice any signs of
  • 00:20:22
    Edema or
  • 00:20:24
    swelling this may be more noticeable
  • 00:20:26
    around the eyes the hands or the feet
  • 00:20:29
    the ankles or the
  • 00:20:33
    genitals listening to an infant or
  • 00:20:35
    child's heart rate can be very
  • 00:20:37
    challenging without practice as the
  • 00:20:38
    heart rate can be very fast it can be
  • 00:20:41
    very helpful to tap a finger or foot to
  • 00:20:44
    help you count the heart rate it may
  • 00:20:47
    also take a moment to discern the heart
  • 00:20:49
    rate from the breath sounds so make sure
  • 00:20:51
    you know which you're listening to
  • 00:20:52
    before you start
  • 00:20:54
    counting as part of the cardiac
  • 00:20:56
    assessment you want to listen into the
  • 00:20:58
    heart for a full 60 seconds manually at
  • 00:21:01
    the Apex you also want to ensure when
  • 00:21:03
    you're taking the blood pressure that
  • 00:21:05
    it's taken on the arm at level of the
  • 00:21:07
    heart while resting you want to ensure
  • 00:21:10
    that you have the appropriate Siz cuff
  • 00:21:12
    meaning the cuff is 75 to 80% of the
  • 00:21:15
    upper arm to ensure the most accurate
  • 00:21:17
    blood pressure reading a Doppler blood
  • 00:21:20
    pressure machine may be more appropriate
  • 00:21:23
    for in infants however they're not
  • 00:21:24
    always accessible in the community so a
  • 00:21:27
    manual or automatic blood pressure cuff
  • 00:21:29
    can still be used If the child can stay
  • 00:21:32
    still it's important to know the most
  • 00:21:35
    appropriate Central and peripheral
  • 00:21:37
    pulses based on the age of the infant or
  • 00:21:39
    child for infants the brachial or
  • 00:21:43
    femoral pulses are the most appropriate
  • 00:21:45
    C central pulses while older children
  • 00:21:48
    the kateed pulse is more
  • 00:21:50
    appropriate examples of peripheral
  • 00:21:53
    pulses include the radial pedial or post
  • 00:21:56
    tibial pulses
  • 00:21:58
    when assessing pulses you want to
  • 00:22:00
    compare both
  • 00:22:02
    sides when assessing capillary refill
  • 00:22:05
    press against the skin until it turns
  • 00:22:07
    white or blanches and count the time it
  • 00:22:10
    takes to go back to its
  • 00:22:13
    Baseline before moving on think of any
  • 00:22:16
    conditions or treatments that you've
  • 00:22:17
    seen that have influenced a change in
  • 00:22:19
    the heart rate temperature or blood
  • 00:22:21
    pressure of your patient or client what
  • 00:22:24
    actions were taken to resolve these
  • 00:22:26
    changes
  • 00:22:28
    things you may consider are fever or
  • 00:22:32
    sepsis the use of
  • 00:22:35
    venin any dehydration in a child or
  • 00:22:38
    infant or any signs of increased
  • 00:22:41
    intracranial
  • 00:22:45
    pressure neurological assessments can be
  • 00:22:48
    done at the first interaction and
  • 00:22:51
    depending on the child's underlining
  • 00:22:53
    condition more frequent assessments may
  • 00:22:55
    be needed it is important to know the
  • 00:22:58
    patient or child's Baseline to be able
  • 00:23:01
    to compare for changes in their
  • 00:23:03
    neurological
  • 00:23:04
    status some general components of a
  • 00:23:08
    neurological assessment include their
  • 00:23:10
    level of Consciousness their mental
  • 00:23:13
    status their interaction their movement
  • 00:23:16
    and their muscle tone you can also look
  • 00:23:19
    at any pupilar
  • 00:23:22
    response the glassco Coma Scale is often
  • 00:23:26
    used to assess neurological status
  • 00:23:28
    the components of this scale include
  • 00:23:30
    eyes opening verbal response and motor
  • 00:23:35
    response other points to consider when
  • 00:23:38
    assessing the neurological status of the
  • 00:23:40
    child includes their age as well as
  • 00:23:43
    their developmental stage and are they
  • 00:23:45
    responding appropriately based on
  • 00:23:48
    these remember to consider for infants
  • 00:23:52
    that may have open fontanels signs of
  • 00:23:54
    increased intracranial pressure may not
  • 00:23:57
    be
  • 00:23:59
    apparent another component of the
  • 00:24:01
    neurological assessment is any seizure
  • 00:24:05
    activity seizures May indicate a change
  • 00:24:07
    in neurological
  • 00:24:09
    status remember it's important to
  • 00:24:12
    understand if seizure activity is known
  • 00:24:14
    to the child or if this is a new
  • 00:24:18
    Behavior if it's their Norm is how do
  • 00:24:22
    these seizures normally present are they
  • 00:24:25
    currently their normal or is something
  • 00:24:28
    different you will also want to know how
  • 00:24:30
    they're treated and when they are
  • 00:24:35
    treated let's move on to reviewing the
  • 00:24:38
    GI and gu
  • 00:24:40
    systems inspecting and osculating these
  • 00:24:43
    systems first is important to ensure you
  • 00:24:45
    obtain accurate
  • 00:24:47
    assessments inspect the general
  • 00:24:49
    appearance of the child's abdomen does
  • 00:24:52
    it appear larger than Baseline do they
  • 00:24:55
    appear distended is there any changes to
  • 00:24:58
    the color of the skin around the abdomen
  • 00:25:01
    remember that young children typically
  • 00:25:03
    have a pot belly
  • 00:25:05
    appearance if measuring the abdominal
  • 00:25:08
    girth is needed you want to measure the
  • 00:25:10
    girth across the navl this may have to
  • 00:25:13
    be done regularly for patients with
  • 00:25:15
    certain abdominal issues it may be
  • 00:25:18
    helpful to Mark the abdomen to ensure
  • 00:25:21
    consistency for frequent measurements
  • 00:25:24
    you can also involve the family as
  • 00:25:26
    needed it can also be helpful to assess
  • 00:25:29
    any output whether urine or stool and
  • 00:25:32
    observe for changes from the Baseline
  • 00:25:35
    this can include change in color
  • 00:25:37
    consistency smell or
  • 00:25:40
    frequency you'll want to listen or
  • 00:25:42
    osculate for vowel sounds in all
  • 00:25:44
    quadrants of the abdomen and note any
  • 00:25:46
    changes or abnormalities such as
  • 00:25:48
    diminished or absent bowel
  • 00:25:51
    sounds after inspection and oscilation
  • 00:25:55
    use light palpation to assess for any
  • 00:25:57
    tend eress firm areas or any
  • 00:26:00
    masses young children and infants who
  • 00:26:02
    may not be able to express pain verbally
  • 00:26:05
    will guard their abdomen and bring their
  • 00:26:07
    knees to their chest in response to pain
  • 00:26:09
    or
  • 00:26:11
    discomfort when assessing the GU system
  • 00:26:14
    it's important to consider the
  • 00:26:16
    developmental stage and their need for
  • 00:26:19
    privacy assess any anatomical
  • 00:26:22
    abnormalities of the genitalia any
  • 00:26:24
    discharge present changes and
  • 00:26:27
    elimination
  • 00:26:28
    history of any UTI sexual activity as
  • 00:26:32
    well as
  • 00:26:34
    menstration hydration status is another
  • 00:26:36
    important assessment for these systems
  • 00:26:39
    and this includes the urine
  • 00:26:41
    output any moist oral
  • 00:26:45
    mucosa what what the skin turer is like
  • 00:26:49
    as well as assessing the fontanels in
  • 00:26:55
    infants it is important to understand
  • 00:26:57
    and the child's fluid balance how you
  • 00:27:00
    assess intake and output may vary
  • 00:27:02
    depending on your environment for
  • 00:27:04
    example in hospitals total fluid intake
  • 00:27:07
    or TFI and urine output calculations may
  • 00:27:10
    not be measured the same way as in
  • 00:27:12
    community or home
  • 00:27:14
    environments at home you may not be
  • 00:27:16
    weighing diapers or measuring the total
  • 00:27:19
    volume of each void but you can monitor
  • 00:27:22
    output by assessing if there are less
  • 00:27:25
    wet diapers than usual or if you're
  • 00:27:27
    finding that there is increased output
  • 00:27:31
    or are there other signs of dehydration
  • 00:27:33
    such as dry mucus membranes or the
  • 00:27:36
    change in the color of urine or anything
  • 00:27:39
    that seems out of the
  • 00:27:41
    ordinary a normal urine output in
  • 00:27:44
    Pediatrics is 1 to 2 milliliters per
  • 00:27:47
    kilogram per
  • 00:27:49
    hour one way of calculating the total
  • 00:27:52
    fluid intake or TFI can be to calculate
  • 00:27:56
    per hour
  • 00:27:58
    it can also be calculated for the total
  • 00:28:00
    day which we will look at
  • 00:28:02
    next to calculate the TFI for each hour
  • 00:28:07
    you can look at the 421
  • 00:28:10
    method this looks at 4 milliliters per
  • 00:28:14
    kilogram for the first 10 kg that you
  • 00:28:18
    would then add 2 milliliters per kilog
  • 00:28:21
    for the next kilog from 11 to 20 and
  • 00:28:25
    then 1 mgram per per kilog for every
  • 00:28:29
    kilogram above 20 and this will give you
  • 00:28:31
    an hourly rate now I understand that
  • 00:28:34
    that sounds confusing so let's look at
  • 00:28:36
    an
  • 00:28:37
    example on the slide you can see an
  • 00:28:40
    example for a child who weighs 25
  • 00:28:43
    kg if we were looking at the TFI for
  • 00:28:46
    each hour we would look at 4 milliliters
  • 00:28:51
    for the first 10
  • 00:28:53
    kg we would add that to 2 m
  • 00:28:58
    for the next 10
  • 00:29:00
    kg and then we would add 1 M for the
  • 00:29:04
    remaining 5
  • 00:29:06
    kg that leads to 40 millit plus 20 Mill
  • 00:29:12
    plus 5
  • 00:29:13
    Mill gives us 65 milliliters per hour as
  • 00:29:18
    our goal total fluid
  • 00:29:22
    intake another method to calculate the
  • 00:29:25
    total fluid intake or TFI
  • 00:29:27
    is to look at the requirement for the
  • 00:29:29
    entire day you can use the infant or
  • 00:29:32
    child's weight to calculate this
  • 00:29:35
    TFI For Infants 3 to 10 kg you will
  • 00:29:40
    calculate it by multiplying 100
  • 00:29:42
    milliliters per every
  • 00:29:45
    kilogram for children 11 to 20 kilg in
  • 00:29:49
    weight you will start with 1,000 ML and
  • 00:29:53
    then add 50 ml for every kilogram over
  • 00:29:58
    10 for children over 20
  • 00:30:01
    kg you will start with 1,500
  • 00:30:05
    M plus 20 millit for every kilogram over
  • 00:30:11
    20
  • 00:30:13
    kg to a maximum of 2.4 l or 2400 m per
  • 00:30:23
    day working our way through the
  • 00:30:26
    different systems of a body
  • 00:30:27
    we are now at the head Eyes Ears Nose
  • 00:30:31
    and Throat muscle scal and anagement or
  • 00:30:34
    skin
  • 00:30:35
    systems when assessing the head Eyes
  • 00:30:38
    Ears Nose and Throat it is important to
  • 00:30:40
    look for the size shape any Les lesions
  • 00:30:43
    lumps or contusions and as with other
  • 00:30:46
    systems visual inspection first is
  • 00:30:49
    important you want to compare the
  • 00:30:51
    Symmetry between the shape of the face
  • 00:30:53
    eyes and ears looking for changes in any
  • 00:30:56
    hearing or any Vision as well during
  • 00:30:59
    this
  • 00:31:01
    assessment for the muscle scal system it
  • 00:31:04
    includes the back joints muscle
  • 00:31:08
    extremities as well as gate
  • 00:31:11
    assessment based on the developmental
  • 00:31:13
    age different Milestones are expected to
  • 00:31:15
    be reached such as the ability to have
  • 00:31:18
    head control being able to sit
  • 00:31:21
    independently and as well as their motor
  • 00:31:23
    strength discussing the child's Norms
  • 00:31:26
    with their family is important to
  • 00:31:28
    understand if there are any areas of
  • 00:31:30
    concern for example when assessing
  • 00:31:34
    gate it's important to know that
  • 00:31:36
    toddlers have more of a broad base gate
  • 00:31:39
    whereas preschoolers tend to start to
  • 00:31:42
    bring their legs closer together so when
  • 00:31:45
    you're assessing gate you want to know
  • 00:31:47
    if there's any changes or if they're
  • 00:31:49
    starting to favor an extremity over the
  • 00:31:52
    other this is important because if a
  • 00:31:54
    child is unable to verbalize pain this
  • 00:31:57
    might be a sign that something else is
  • 00:31:59
    going on or there's inflammation causing
  • 00:32:03
    pain a common gate problem is being
  • 00:32:06
    pigeon toed or Towing in which results
  • 00:32:09
    from torsion deformities this is the
  • 00:32:12
    long bones of the leg are turned inside
  • 00:32:14
    or outside so the toes do not Point
  • 00:32:17
    Straight
  • 00:32:18
    Ahead the shape of the child's bones
  • 00:32:21
    changes with age for example bow leg or
  • 00:32:25
    knees that are more than 2 in apart can
  • 00:32:28
    be common in toddlers but may indicate
  • 00:32:30
    problems If the child is older than 3
  • 00:32:33
    years
  • 00:32:34
    old knock knees are when knees are
  • 00:32:36
    closer together but the ankles are
  • 00:32:39
    apart where they should be less than 3
  • 00:32:42
    in apart can be normal If the child is
  • 00:32:45
    between 3 to 7 years of old old but if
  • 00:32:49
    it's excessive or asymmetrical or
  • 00:32:51
    accompanied by short stature or evident
  • 00:32:54
    that the child nears puberty this may
  • 00:32:56
    requ require further
  • 00:32:58
    investigation additional assessments of
  • 00:33:00
    the feet joint and muscles can evaluate
  • 00:33:03
    a range of motion quality of muscle
  • 00:33:06
    development the tone and the
  • 00:33:10
    strength some important considerations
  • 00:33:13
    for the assessment of the ingent or the
  • 00:33:15
    skin skin of Pediatrics include that the
  • 00:33:19
    skin is thinner for Pediatrics and this
  • 00:33:22
    can allow for injury or damage there's a
  • 00:33:25
    larger surface area
  • 00:33:27
    in comparison to body mass for children
  • 00:33:30
    this means that there's a greater risk
  • 00:33:32
    of excessive loss of heat and
  • 00:33:34
    fluids the skin can provide significant
  • 00:33:37
    information of the child's nutrition
  • 00:33:40
    hydration status and cardiovascular
  • 00:33:42
    health for skin color it is important to
  • 00:33:45
    consider cultural
  • 00:33:48
    differences examples of changes in skin
  • 00:33:51
    color are cyanosis due to poor
  • 00:33:54
    oxygenation poar due to anemia edema and
  • 00:34:01
    shock paticia which is small pinpoint
  • 00:34:04
    hemorrhages suggestive of a blood
  • 00:34:06
    disorder such as decreased
  • 00:34:09
    platelets and it can be distinguishable
  • 00:34:12
    by attempting to blanch the skin and it
  • 00:34:14
    may not blanch
  • 00:34:16
    away
  • 00:34:18
    jaundice which always is significant to
  • 00:34:21
    note because it's caused by bile
  • 00:34:24
    pigments you want to be sure to ask
  • 00:34:27
    about the yellow vegetable intake such
  • 00:34:29
    as carrots as this can be a cause but
  • 00:34:32
    depending on the age of the child it may
  • 00:34:34
    indicate liver disorder as
  • 00:34:37
    well it can also be important to inspect
  • 00:34:40
    and palpate for the texture of moisture
  • 00:34:43
    and turer of the
  • 00:34:45
    skin another important assessment is
  • 00:34:48
    pain assessment in children there are
  • 00:34:50
    three main components to consider with
  • 00:34:53
    pain assessments for children these
  • 00:34:55
    include their self-reported pain your
  • 00:34:58
    observation as well as what the family
  • 00:35:00
    has observed regarding the child's
  • 00:35:02
    Behavior and the physiological response
  • 00:35:04
    to how the child reacts to
  • 00:35:07
    pain on the following slides we'll
  • 00:35:09
    discuss different tools that can be used
  • 00:35:11
    for when assessing pain for a pediatric
  • 00:35:13
    child but before moving on take a moment
  • 00:35:16
    to think about a child in pain and
  • 00:35:18
    what's the initial way that you would
  • 00:35:19
    notice that they're in pain is it based
  • 00:35:22
    on what the child says how they behave
  • 00:35:25
    or how they react or at a
  • 00:35:31
    combination the first three pain
  • 00:35:34
    assessment tools we'll discuss are ones
  • 00:35:36
    that can be used when the child can
  • 00:35:37
    self-report pain the first being the
  • 00:35:41
    word scale which is commonly used for
  • 00:35:43
    children 3 to 7 years of age or when the
  • 00:35:46
    child's unable to use the numeric
  • 00:35:48
    scale when using the word scale you can
  • 00:35:51
    you you can describe pain as how much
  • 00:35:54
    hurt sore pain does a child have is it
  • 00:35:57
    none a little medium or a lot of
  • 00:36:00
    pain there's also the numeric rating
  • 00:36:03
    scale this is commonly used for children
  • 00:36:05
    over 7 years of age or when they will
  • 00:36:08
    understand a scale of 0 to 10 zero being
  • 00:36:12
    no pain tend being a lot or the worst
  • 00:36:14
    pain they have ever had and then they
  • 00:36:17
    can describe how much pain they
  • 00:36:19
    currently have right
  • 00:36:21
    now there's also the faces Pain
  • 00:36:24
    Scale this is used for when children are
  • 00:36:28
    again unable to use the numeric rting
  • 00:36:30
    scale and it requires the least degree
  • 00:36:33
    of abstract thought because they can
  • 00:36:35
    compare their pain to the
  • 00:36:38
    faces now when you're using the faces
  • 00:36:40
    scale you're not comparing the way that
  • 00:36:43
    their face looks to these you're having
  • 00:36:46
    the child point out to what their pain
  • 00:36:49
    is based on these photos so they will
  • 00:36:51
    pick the face that best represents
  • 00:36:54
    them however it may represent mood and
  • 00:36:59
    may be
  • 00:37:00
    misrepresented in based on cultures so
  • 00:37:03
    you may want to take that into
  • 00:37:05
    consideration when using this
  • 00:37:08
    scale in addition to self-reporting pain
  • 00:37:12
    assessment tools there are also
  • 00:37:14
    behavioral observation tools that can be
  • 00:37:16
    used using these tools you're observing
  • 00:37:19
    behaviors of a child for a specified
  • 00:37:20
    amount of time and looking at the
  • 00:37:22
    behaviors to indicate that they're in
  • 00:37:25
    pain such as changes in facial
  • 00:37:27
    expression body movements their cry or
  • 00:37:30
    their ability to be consoled by Family
  • 00:37:33
    you also want to look at the context of
  • 00:37:35
    the behavior and when it's experienced
  • 00:37:37
    such as any changes in health sadness
  • 00:37:41
    what their current state is what's the
  • 00:37:43
    developmental stage was there anything
  • 00:37:45
    that happened before the assessment that
  • 00:37:47
    may change the behavior examples of
  • 00:37:50
    these tools are the premature infant
  • 00:37:52
    pain profile or the neonatal infant pain
  • 00:37:56
    scale scale or the revised flak scale
  • 00:37:59
    that looks at faces legs activity cry
  • 00:38:03
    and
  • 00:38:04
    consolability when you're using these
  • 00:38:06
    scales you will assess the child's
  • 00:38:09
    behavior and then find a number based on
  • 00:38:13
    that the higher the number generally the
  • 00:38:16
    more pain the child is
  • 00:38:19
    in mental health assessments are another
  • 00:38:22
    important component of Pediatric Health
  • 00:38:25
    assessment the mental status exam is a
  • 00:38:28
    psychosocial assessment that describes
  • 00:38:30
    the mental state and behavior of a
  • 00:38:32
    person the MSC can be used in any
  • 00:38:35
    setting to evaluate concerns about a
  • 00:38:37
    person's mental health it includes both
  • 00:38:40
    objective observations by the clinician
  • 00:38:43
    as well as any subjective descriptions
  • 00:38:45
    that was given by the patient or the
  • 00:38:48
    client one component of the msse is a
  • 00:38:51
    general appearance or behavior behavior
  • 00:38:54
    of the person how does the patient or
  • 00:38:56
    client appear to you is their posture
  • 00:38:59
    and motor activity appropriate to the
  • 00:39:01
    situation do they maintain eye contact
  • 00:39:05
    do they appear relaxed withdrawn or
  • 00:39:08
    irritable what do you notice about their
  • 00:39:10
    mood or
  • 00:39:12
    affect what are the patient or client's
  • 00:39:15
    facial expressions can you ask them how
  • 00:39:17
    they feel most days or if they felt sad
  • 00:39:20
    or discouraged lately or do they feel
  • 00:39:23
    energized or out of control you can also
  • 00:39:25
    take a moment to task but self harm or
  • 00:39:28
    any suicidal or homicidal
  • 00:39:31
    ideation during the msse you're also
  • 00:39:33
    assessing speech and language this is
  • 00:39:36
    assessing all aspects of the patient or
  • 00:39:38
    client's speech including the quality
  • 00:39:41
    rate and volume and whether it's
  • 00:39:43
    appropriate to the
  • 00:39:45
    situation you're also looking at thought
  • 00:39:48
    content and process to help understand
  • 00:39:52
    and evaluate what is the patient
  • 00:39:54
    thinking you can ask question questions
  • 00:39:56
    such as do You Hear Voices when no one
  • 00:39:59
    else is around or can you see things
  • 00:40:01
    that no one else can see or do you have
  • 00:40:04
    any unexplained Sensations such as
  • 00:40:07
    changes in smells or sounds or changes
  • 00:40:10
    in
  • 00:40:11
    feelings you'll want to evaluate whether
  • 00:40:13
    their responses are organized or
  • 00:40:17
    disorganized the msse also includes
  • 00:40:20
    impulsivity to estimate the degree which
  • 00:40:23
    of the patient or client's impulse
  • 00:40:25
    control
  • 00:40:27
    you can ask the patient or client about
  • 00:40:29
    doing things with or without planning
  • 00:40:31
    and how they
  • 00:40:33
    respond the final component of the msse
  • 00:40:37
    is judgment and
  • 00:40:38
    insight to evaluate this you can ask
  • 00:40:41
    questions about their understanding of
  • 00:40:43
    their illness or surgery if appropriate
  • 00:40:46
    you can also ask questions that require
  • 00:40:48
    some thought or some decision making
  • 00:40:51
    such as what would you do if you smelled
  • 00:40:54
    smoke in your
  • 00:40:55
    home
  • 00:40:56
    putting the information together that
  • 00:40:58
    you gather from the
  • 00:41:00
    MSC again can help describe their mental
  • 00:41:03
    state and the behaviors of the patient
  • 00:41:06
    or the client it also will highlight
  • 00:41:08
    areas of concern for the patient's
  • 00:41:10
    mental
  • 00:41:14
    health before ending this session here
  • 00:41:17
    are a few key points to keep in mind
  • 00:41:19
    when working with pediatric
  • 00:41:21
    patients remember children are not just
  • 00:41:24
    little adults there are physiolog iCal
  • 00:41:26
    differences that are important to
  • 00:41:29
    consider the developmental age of the
  • 00:41:31
    child can lead to a change in assessment
  • 00:41:33
    strategies to allow for the most
  • 00:41:35
    accurate
  • 00:41:37
    results you want to start with visual
  • 00:41:39
    assessments and leave invasive or
  • 00:41:41
    painful assessments till the end
  • 00:41:43
    remember to be honest about what
  • 00:41:45
    assessments are needed and what can
  • 00:41:47
    happen in each assessment to prevent
  • 00:41:49
    fear and
  • 00:41:52
    mistrust understand the child's norms
  • 00:41:55
    and include the family in the assessment
  • 00:41:57
    interpretation of Vital Signs can change
  • 00:42:00
    depending on the child's age and
  • 00:42:02
    remember to communicate any findings
  • 00:42:04
    with the family as well as the medical
  • 00:42:06
    team for further discussion and
  • 00:42:10
    intervention thank you for attending
  • 00:42:12
    this Pediatric Health assessment webinar
  • 00:42:15
    if you have any additional questions
  • 00:42:17
    please do not hesitate to contact
  • 00:42:19
    connected
  • 00:42:20
    care
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