admission assessment of pedi patients

[darla chick]

I would like to here from all pedi nurses please. We are having a delimma regarding admission assessment on pedi patients regarding genitalia. Would like input, do you examine up to a certain age or on every pedi patient?

[jsauce]

The only time I do a GU assessment is on babies/children with diapers and patients with catheters. And of course, if the pt was admitted for that particular reason or has any underlying history warranting physical assessment of the area. I think you just need to use nursing judgement when it comes to those sensitive "areas". I definitely don't think it needs to be routine all of the time, especially when it comes to teenagers and older children. You can also ask the patient/family if there are any problems regarding those areas, and that can guide your assessment. Our hospital doesn't stress strict GU assessment, and I don't personally think it is always necessary.

[peds rn]

I agree, in the 5 years I have been working peds I only do gu assessment with changing of diapers or if that is part of the admit complaint. I will ask all admits if having any complications.

[VivaLasViejas, ASN, RN]

We don't generally perform GU assessments on any peds patient, unless of course he or she is an infant or there is a specific complaint related to the area itself, and I don't mean just UTI or pyelo.....we're talking about little ones who have been sexually assaulted, or who have inserted a foreign object into an orifice where it doesn't belong. Children, and of course teenagers, are usually very modest, and they have a strong drive to protect themselves from exposure and from being touched in the 'wrong' places.......we've got to respect that.

Frankly, we don't do GU assessments on full-grown adults either for the most part; it's degrading, and it's completely unnecessary if the chief complaint has nothing to do with that area. We do ask questions regarding their voiding and bowel patterns, of course, but unless we're inserting a catheter, or the patient is incontinent and at risk for skin breakdown, we don't inspect the genitalia.

Now get this: When JCAHO was at our hospital last October, they came down on our doctors about not doing breast and pelvic exams on all hospitalized patients. I don't know about anyone else, but if my asthma flares up and I have to be admitted for IV steroids and Q2 hr. nebulizer tx, anyone who comes near me with a speculum is going to find it in a place they never considered putting it! Fortunately, our docs feel the same way we nurses do about patients' privacy and dignity, and they basically told JCAHO to forget it. I mean, when you admit someone for pneumonia, why put them through an embarrassing and uncomfortable procedure that has nothing to do with their diagnosis?

Just my two cents' worth.