Mosby's Pocket Guide to Pediatric Assessment

497 Pages·2006·3.28 MB·English

by  Joyce K. Engel PhD RN MEd

Mosby’s
POCKET GUIDE TO
Pediatric Assessment
Joyce K. Engel, RN, MEd, PhD
Dean of Students
Medicine Hat College
Medicine Hat, Alberta, Canada
Fifth Edition
with 100 illustrations
11830 Westline Industrial Drive
St. Louis, Missouri 63146
MOSBY’S POCKET GUIDE TO PEDIATRIC ISBN-13: 978-0-323-04412-7
ASSESSMENT, FIFTH EDITION ISBN-10: 0-323-04412-3
Copyright ©2006 by Mosby, Inc., an affiliate of Elsevier, Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in
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ing, or any information storage and retrieval system, without permission in writing
from the publisher. Permissions may be sought directly from Elsevier’s Health Sciences
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239 3805, e-mail: [email protected]. You may also complete your request
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Notice
Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our knowledge, changes in practice, treatment and drug
therapy may become necessary or appropriate. Readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manu-
facturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is
the responsibility of the practitioner, relying on their own experience and knowl-
edge of the patient, to make diagnoses, to determine dosages and the best treat-
ment for each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the Author assumes any
liability for any injury and/or damage to persons or property arising out or related
to any use of the material contained in this book.
The Publisher
Previous editions copyrighted 2002, 1997, 1993, 1989
ISBN-13: 978-0-323-04412-7
ISBN-10: 0-323-04412-3
Acquisitions Editor: Catherine Jackson
Managing Editor: Michele D. Hayden
Publishing Services Manager:John Rogers
Senior Project Manager: Cheryl A. Abbott
Senior Design Manager: Bill Drone
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Reviewers
Sherry D. Ferki, RN, MSN
Adjunct Faculty
Old Dominion University School of Nursing;
Adjunct Faculty
College of the Albemarle
Portsmouth, Virginia
Mary Ann McClellan, ARNP, CPNP, MN, CFLE
Assistant Professor
University of Oklahoma College of Nursing
Oklahoma City, Oklahoma
The author would also like to acknowledge consultants and
reviewers who participated in previous editions of this book:
Barbara W. Berg, RN, PNP, MN
Head Nurse
Rose Children’s Center at Rose Medical Center
Denver, Colorado
Dena K. Cuyjet, RN, MS, CPNP
Pediatric Nurse Practitioner
Newborn Discharge Coordinator
Kaiser Permanente San Francisco
San Francisco, California
Terry Fugate, RN, BSN
Formerly Adjunct and Associate Faculty
Texas Tech University, Health Sciences Center
Lubbock, Texas
iii
iv Reviewers
Sarah G. Fuller, RN, CPNP, PhD
Associate Professor
College of Nursing, University of South Carolina
Columbia, South Carolina
Sandra L. Gardner, RN, MS, PNP
Director
Professional Outreach Consultation
Aurora, Colorado
Marilyn B. Hartsell, RN, MSN
Coordinator
Tri-Regional Education and Networking Development
System
University of Delaware
Newark, Delaware
Karen Halvorson, RN, MN
Chief Patient Care Officer
Highline Medical Center
Seattle, Washington
Christina Bergh Jackson, RN, CPNP, MSN
Pediatric Nurse Practitioner
Pennsylvania School of the Deaf
Philadelphia, Pennsylvania;
Instructor
Eastern College
St. Davids, Pennsylvania
Carol A. Kilmon, RN, MSN, PhD, CPNP
Assistant Professor
The University of Texas Medical Branch
Galveston, Texas
Reviewers v
Catherine F. Noonan, RN, MS, CPNP
Nurse Practitioner
Children’s Hospital;
Assistant Professor
Nurse Education Department, Bunker Hill Community
College
Boston, Massachusetts
Mary Ann Norton, RNC, PhD, CPNP
Associate Professor
North Michigan University
Marquette, Michigan
Margaret C. Slota, RN, MN
Pediatrics Consultant
Pittsburgh, Pennsylvania
Janet F. Sullivan, RN,C, PhD
Clinical Associate Professor
Parent Child Health Nursing
State of New York Health Sciences Center
Stony Brook, New York
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Preface
As in previous editions, the goal of Mosby’s Pocket Guide to
Pediatric Assessment is to present the complexities of assessing the
health of children within a portable, usable, accessible, and practical
format. The emphasis of the pocket guide on children 1 month to
late adolescence assumes the influences of families, culture, genetics,
and of the prenatal and neonatal periods.
Organization and Approach
This edition continues to set about the physical assessment of chil-
dren through a systematic, body systems approach. This approach
is replicated in the family assessment model, which strongly reflects
its foundations in systems. The presentation of approaches to the
home environment, culture, communication, development, abuse,
and psychosocial and mental health places assessment of the child
within a broader and holistic framework related to the health of
children and families. Sections on assessment methodologies and
findings are usually preceded by discussion of developmental vari-
ations that assist in rooting the process of assessment within the
context of the child. Clinical alerts draw the attention of beginning
and advanced nurses to significant findings and/or deviations from
normal that might commonly be found in pediatric clients. Nursing
diagnoses complete the assessment.
The New Edition
Since the fourth edition was written, we have been confronted with
global concern about diseases such as SARS and avian flu. These
infectious diseases, along with West Nile virus, while perhaps less
devastating among children than adults, reflect the global chal-
lenges that infections present for the young. Infections, suicide,
and unintentional injuries represent leading causes of death among
children and adolescents. In recognition of this, the fifth edition
provides up-to-date information and assessments associated with
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viii Preface
the new viral infections and with athletic and head injuries. It also
offers a new chapter on assessment of mental health in children and
adolescents, as well as incorporation of mental health findings
throughout the text, including those associated with eating disorders.
Nearly every chapter includes revised or new content. Expanded
assessment material on the common childhood symptoms of fever,
vomiting, and diarrhea has been incorporated into charts, similar to
those included in earlier editions on cough, headaches, and abdom-
inal pain, with the goal of providing nurses with information that
is quickly available in these areas that often crop up in everyday
practice with children.
Continued Journeys
The expansion of knowledge and the causes of illness are reminders
that health is dynamic and complex, just as are families and children.
It is my hope that Mosby’s Pocket Guide to Pediatric Assessment
will provide a concise, practical guide to assist in making sound
decisions that will in turn help families and children toward
making sense of their experience and toward positive coping.
Joyce Engel
Contents
UNIT I HEALTH HISTORY
1 Beginning the Assessment, 3
Guidelines for Communicating with Children, 3
Communicating with Infants, 4
Communicating with Toddlers, 5
Communicating with Preschool-Age Children, 6
Communicating with School-Age Children, 6
Communicating with Adolescents, 7
Communicating with Parents, 7
Communicating with Parents and Children from Diverse
Cultures, 8
Establishing a Setting for the Health History, 9
2 Dimensions of a History, 32
Guidelines for Interviewing Parents and Children, 32
Information for Comprehensive History, 34
3 Family Assessment, 44
Rationale, 44
General Concepts Related to Assessment, 44
Stages in Family Development, 46
Tasks and Characteristics of Stepfamilies, 47
Guidelines for Communicating with Families, 47
Assessment of the Family, 48
Related Nursing Diagnoses, 56
4 Home Visits and Assessments, 58
Making Home Visits, 58
Making the Initial Visit, 59
Assessment of the Home Environment, 59
Related Nursing Diagnoses, 61
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