Pediatrics Essay Research Paper The Primary Care

Pediatrics Essay, Research Paper

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 Works

Cited 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.

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 Works Cited 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