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PLEASE RESPOND TO THE FOLLOWING CLASSMATE’S POST IN 50 WORDS OR MORE:
Discussion #2 week 3
Option 1)
L.G. is a 5-year-old boy being seen in the pediatric clinic for a yearly physical .
Subjective Data
The patient is accompanied by a parent (mother)
The mother said that the child takes no medications and is healthy.
Patient attends preschool
Plays T-ball
There are no smokers in the house
Lives with mother and father
Objective Data
Vital signs: T 37 P 124 R 12 BP 104/64
Weight: 35 lb
Height: 52 inches
Immunizations: Up to date
Questions
What should the nurse include in the general inspection of this patient?
General inspection should begin the minute the nurse lays eyes on L.G. and his mother. The mother should be included in the general inspection because at age 5, the child relies on his mother to provide shelter, nutrition, and a safe environment.
Four main areas should be considered for the general inspection of L.G.
Appearance, body structure, mobility, and behavior.
General appearance should include inspection of the head, eyes, ears, nose, neck, teeth, hair. Facial structure should be symmetric. It’s important to note symmetry of eyebrows and eyes, puffy face, goiter, flat midface, short nose, low nasal bridge etc. These can be signs of congenital hypothyroidism, down syndrome or even fetal alcohol syndrome. Skin should be free from discoloration, lesions, or wounds.
When a child gets to 5-6 years of age, primary teeth may start to fall out.
Clothes should be appropriate for the weather and occasion.
Body structure should be appropriate for the age group. Limbs are equal in length bilaterally. For toddlers, it is generally normal to have a potbelly, but by the time they reach school age, the potbelly should disappear, and bodies become more proportional. In addition, the nurse should assess whether L.G. appears well nourished, undernourished, or overnourished for his age group. Also assess whether L.G.’s height and weight are appropriate for a 5-year-old.
Mobility includes balance, gait should be steady. At this age, a 5-year-old can hop and may be able to skip, use a fork and spoon, uses the toilet independently, and can swing and climb.
Behavior- Nurse should note that L.G. responds appropriately to stimuli, Is alert and oriented. The nurse should also assess for any signs of slow mental processes or hyperactivity. In addition, mood/affect should also be assessed. Does L.G. appear happy or withdrawn?
How does L.G. interact with mother and other family members?
What observations are important regarding physical appearance and hygiene?
According to the CDC’s growth chart, L.G.’s BMI is severely underweight. His calculated BMI was 9.1. This means that L.G.’s BMI for this age group is less than the first percentile, meaning his BMI is less than 99.99% of the average 5-year-old boy.
Healthy weight for this age range and sex should range from the fifth percentile to less than the eighty fifth percentile. L.G. most likely appears undernourished for his age. The nurse should assess diet followed at home, food intolerances/ allergies, and eating patterns of the child.
Hygiene is also important at this age and is mostly provided by parents. Evidence of good hygiene would be groomed and washed hair, and skin. Clothes that fit appropriately and are clean. Good hygiene is usually a good indicator of overall health.
How should a 5-year-old child be assessed?
It is important to first understand differences between school-aged children and adults. This understanding will help guide strategies the nurse will need during the assessment process and plan of care.
Differences in school-aged children include:
Different developmental stages
Child is part of a family unit. At this age, the nurse will speak to the child and the family. It is important to promote independence and include the child in the discussion as appropriate.
Anatomical differences. Examples are that children have bigger heads and a shorter neck, thinner skin, narrow airway, and softer bones.
Differences in how medications interact and are administered. Medications are weight based.
For the assessment of a 5-year-old child, the clinical setting should provide an engaging environment appropriate for children. Books, toys, play space, and even the color of the walls can provide a more relaxing environment that can facilitate clinician and child interaction. After establishing a safe and engaging environment, the nurse should begin the general survey by observing appearance, facial expression, level of consciousness, body structure, poster and movement, behavior, and nutritional status. At this age, children want to know what is happening and may ask a lot of questions. The nurse should use play and explanation to introduce equipment. In addition, the child may feel more comfortable if they are included in their assessment. It’s important to discuss the child’s developmental milestones or any areas of concern with family.
Assess the head for symmetry and size. Yearly measurements are recommended up to age 6.
Musculoskeletal assessment should include balance, motor control and any involuntary movements.
Assessment of the lungs should include inspection, auscultation, and palpitation. Assess normal chest movement, respiratory effort and rate, oxygen saturation and size and shape of chest.
Cardiac assessment includes auscultation and palpation. Assessment of heart rate and sounds, perfusion, signs of edema and skin temperature are also important.
Gastrointestinal/Genitourinary assessment also includes inspection of contour, bowel sounds, and palpation for tenderness or masses.
Assess skin for any abnormalities such as rashes or lesions.
The fifth vital sign (pain) should also be assessed. Children at this age can express pain or discomfort.
What teaching is appropriate for this age group?
Children at this age are eager to learn new things and explore their environment. Appropriate topics for the nurse to teach for this age group include:
Nutrition and encourage healthy eating habits.
Exercise and play.
Dental health and hygiene.
Safety
Screen time
Disabled World. (2023, September 2). Average height to weight chart: Babies to teenagers. https://www.disabled-world.com/calculators-charts/height-weight-teens.php#mcLinks to an external site.
Your teeth (for kids) – nemours kidshealth. (n.d.-b). https://kidshealth.org/en/kids/teeth.htmlLinks to an external site.
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019, January). Clinical practice guidelines for assessment of children and adolescents. Indian journal of psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345125/Links to an external site.
Potbellies and toddlers. Mount Sinai Health System. (n.d.). https://www.mountsinai.org/health-library/special-topic/potbellies-and-toddlers#:~:text=It%20is%20generally%20normal%20for,feel%20soft%20and%20NOT%20tenderLinks to an external site..
Centers for Disease Control and Prevention. (2023, September 14). BMI Calculator Child and teen. Centers for Disease Control and Prevention. https://www.cdc.gov/healthyweight/bmi/calculator.htmlLinks to an external site.
Srinath, S., Jacob, P., Sharma, E., & Gautam, A. (2019, January). Clinical practice guidelines for assessment of children and adolescents. Indian journal of psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6345125/Links to an external site.
Your 5-year-old. ucsfbenioffchildrens.org. (n.d.). https://www.ucsfbenioffchildrens.org/education/your-5-year-old
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