TECHNIQUES OF PHYSICAL EXAMINATIONBASED ON A CHILD’S AGE

AGE TECHNIQUESNewborn Undress only the part being examined or use radiant heat warmer to conserve heat (be

certain all body parts as exposed during examination)

Examine heart and respiratory systems first before infant cries; then follow head-to-toe procedure performing all manipulative procedures such as throat and eyes last. Examine newborn with parents present, using these assessment time to teach them about normal appearance and development

Infant As with newborns, begin examination with heart and respiratory assessment, and then follow head-to-toe procedure, performing all manipulative procedures such as throat and ears last. Begin examination while parent holds infant in arms or lap to calm the child. Talk to the infant as proceed; infants calm to sound of your voice or the feeling tone that you radiate as much as they do what you actually say. Positive feeling tone (“this is like a game”) therefore often brings cooperation than strict, business like approach. Infants older than 3 months like to handle tongue blades. They can be distracted by brightly colored toys while you listen to their heart or lungs. They cooperate best if parent holds them for major portion of examination. Offering a bottle of water or pacifier may be necessary during heart assessment.

Toddler Allow toddler to handle equipment; include games, such as blowing out otoscope light, to relax child. Ask parent to remove clothing or allow child to do it independently.

Use head-to-toe procedure; leave uncomfortable procedures such as throat and ear examination for last.

Preschooler Use games such as “Simon says” to ease child’s fright. Ask child to undress; do not remove underpants.

Preschoolers are extremely threatened by intrusive procedures. Thus, they are frightened of examining instruments. Allow them to handle instruments before use. Assure them that instruments do not hurt. Children up to school age often need to be restrained for ear and throat examinations because they grow fearful about procedures performed on a part of the body they cannot see (ears) or about a throat examination that may be uncomfortable.

School-age child

Ask whether child wants parent present or not.

Proceed with head-to-toe assessment; leave genitalia for last.

Allow child to undress except for underpants; supply gown.

Explain equipments and reasons for procedures. Teach whys and hows of procedures.Adolescent Ask if the adolescent wants parent or not.

Teach adolescent about good health care during examination. Comment on body parts as examine them. “Your heart sounds good”, “Ears look fine” sometimes an adolescent is so concerned with a part of her body (a supernumerary nipple, for example) that she is unable to voice her concern. A comment such as, this is a supernumerary (extra) nipple. Does it ever worry you that you have that?” may help the adolescent to talk about what has been worrying for years.

Use head-to-toe procedure; leave genitalia for last.Include health teaching on breast & testicular self-examination.

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

SUMMARY OF FREUD’S AND ERIKSON’S THEORIES OF PERSONALITY DEVELOPMENT

FREUD’S STAGES OF CHILDHOOD ERIKSON’S STAGE OF CHILDHOODPsychosexual Stage Nursing

ImplicationsDevelopmental Task Nursing

Implications

Infant Oral stage: child explores the world by using mouth especially the tongue.

Provide oral stimulation by giving pacifiers; do not discourage thumbsucking. Breastfeeding may provide more stimulation than formula-feeding because it requires the infant to expend more energy.

Developmental task is to form a sense of trust versus mistrust. Child learns to love and be loved.

Provide a primary care-giver. Provide experiences that add to security, suchas soft sounds and touch. Provide visual stimulation for active child involvement.

Toddler Anal stage: Child learns to control urination and defecation.

Help children achieve bowel and bladder control without undue emphasis on its importance. If at all possible, continue bowel and bladder training while child is hospitalized.

Developmental task is to form a sense of autonomy versus shame. Child learns to be independent and make decisions for self.

Provide opportunities for decision making, such as offering choices of clothes to wear or toys to play with. Praise for ability to make decisions rather than judging correctness of any one decision.

Preschooler Phallic stage: Child learns sexual identity through awareness of genital area.

Accept child’s sexual interest, such as fonding his or her own genitals, as a normal area of exploration. Help parents answer child’s questions about birth or sexual differences

Developmental task is to form a sense of initiative versus guilt. Child learns how to do things (basic problem solving) and that doing thing is desirable

Provide opportunities for exploring new places or activities involving water; clay (for modeling); or finger paint.

School-age child

Latent stage: Child’s personality development appears to be non active or dormant.

Help the child have positive experiences so his or her self-esteem continues to grow and the child prepares for the conflicts of adolescent.

Developmental task is to form a sense of versus inferiority. Child learns how to do things well

Provide opportunities such as allowing child to assemble supplies for a dressing change (short projects finished completely), so that child feels rewarded for accomplishment

Adolescent Genital stage: Adolescent develops sexual maturity and learns to establish satisfactory relationships with the opposite sex.

Provide opportunities for the child to relate with opposite sex; allow child to verbalize feelings about new relationships.

Developmental task is form a sense of identity versus role confusion. Adolescent learns who he or she is and what kind of person he or she will be by adjusting to a new body image; seeking emancipation from parents choosing a vocation, and determining a value system

Provide opportunities for the adolescent to discuss feelings about events important to him or her. Offer support and praise for decision making.

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250

DR. CARL E. BALITA REVIEW CENTER TEL. NO. 735-4098/410-0250