Any Tips For Assessment of Wiggly Kids?

[SunnyPupRN]

What hacks do you have for assessing kids who don't want to be assessed? We have orders for full assessment of all systems q shift of preteen with heart defects, gtube, trach, OCD, and undiagnosed developmental disabilities. These are long standing orders, so she's used to it, but probably sick of being probed and touched two or three times a day for years. I have lots of trouble finding and counting pedal pulses due to constant movement: same with trying to listen to heart and lungs. The stethoscope is always being grabbed or the wiggling makes a ton of ambient noise. Redirection is useless. Waiting til she sleeps sometimes works, but we're supposed to do the assessment within the first hour of the shift. Every system is a challenge but you get the idea. Ideas please?

[NotReady4PrimeTime, RN]

There are some things you can assess without touching her - assessing mental status, respiratory rate and rhythm, work of breathing, colour, and so on. So do what you can before you need to do any touching. I don't bother COUNTING pedal pulses, I just make sure I can feel them. So you can tell her you want to check out how well her toes wiggle, then put your fingers over the area where the dorsalis pedis pulse is to feel for it. Then you can say you need a different grip because the way you're holding her foot is keeping her from a full wiggle, shifting your grip to cup her heel with you fingers over the area where the posterior tibialis pulse is. You can play a similar game with her radial pulses - hold both wrists in your hands with your fingertips over the radial pulse, then ask her to wiggle her fingers one at a time. That'll give you time to assess presence, rhythm and strength of pulses. You might even be able to count the rate. For brachials, tell her you want to check her muscles. For chest auscultation, offer to let her listen first. Then tell her how great it was that she sat so still and go on to do your listening. It shouldn't take you more than a few minutes to do a full head-to-toe on a pre-teen. Make your assessment something that you'll have to do before doing something she likes, and she'll be more cooperative.

[GE90]

if you don't mind me asking, is this a normal policy for american hospitals to do full assessment on every patient regardless of their conditions and acuities?

[sergel02, BSN]

if you don't mind me asking, is this a normal policy for american hospitals to do full assessment on every patient regardless of their conditions and acuities?

Typically you do at least one full head to toe during your shift. It varies by unit though. Emergency room nurses told me they just do a focus assessment depending on what the patient is in for, and some floor nurses will do one quick head to toe and some focus assessments after that. When I was in ICU though it was a full head to toe every 4 hours.