Need Help with Pediatrics Rotation

Hey guys,

I start my Peds clinical rotation on Monday. I am scared as I have never assessed an infant, baby or toddler. Can anyone tell me where I can find the steps to a pediatric assessment, in particular infants and babies, so I don't miss anything. I am also nervous about the peds math and IV syringe pumps. Any advice or help is so appreciated.

Thanks!!

Susan, LVN to RN California

Graduating June 2009:yeah::bowingpur

Here's a pedi assessment form that I found very helpful during my pediatric rotation.

Forms.assessment.PEDI.document.08.rev.doc

Here is a site I found with some pretty good info.

The best bet is to look in your ped book for the assessment breakdown. Photocopy the page with the assessment and fold it up and bring it with you to clinicals.

http://www.lbfdtraining.com/Pages/emt/sectiond/pediatricassessment.html

I was scared too, until I took that tiny stethoscope, pressed it to that tiny chest and heard the fastest heartbeat in my entire life.

Best of luck!

Tait

Sorry off topic a little :)

The big difference (for me anyway) was that it was a change assessing someone who could not communicate their issue to me. Thus, when you assess a child, try to do a more thorough assessment... in the adult population, they can tell you what is bothering them or what seems abnormal to them.

With the infants, remember to assess their fontanelles and umbilicus (they may have the umbilical cord remains) and their reflexes. If you need to do a newborn assessment, I would read up on that before going to clinicals (you do things you normally would never think of, such as ear recoil, "hip click", etc.). If the child has an IV, meticulously assess it every hour and ensure you chart on it every hour -- children are prone to IV infilitration.

Remember to do a general head-to-toe assessment but try focusing on the problematic area (ex: if the child is asthmatic, focus on respiratory... if the child is in there for cardiac issues, focus on cardiac... etc.). Children usually do not have multi-system problems, thus it is important to focus on the issue that brought the child to the hospital.

Regarding peds math, it is not much different than any other dosage calculations with the exception that we use weights when dosing medications.

The big difference (for me anyway) was that it was a change assessing someone who could not communicate their issue to me. Thus, when you assess a child, try to do a more thorough assessment... in the adult population, they can tell you what is bothering them or what seems abnormal to them.

With the infants, remember to assess their fontanelles and umbilicus (they may have the umbilical cord remains) and their reflexes. If you need to do a newborn assessment, I would read up on that before going to clinicals (you do things you normally would never think of, such as ear recoil, "hip click", etc.). If the child has an IV, meticulously assess it every hour and ensure you chart on it every hour -- children are prone to IV infilitration.

Remember to do a general head-to-toe assessment but try focusing on the problematic area (ex: if the child is asthmatic, focus on respiratory... if the child is in there for cardiac issues, focus on cardiac... etc.). Children usually do not have multi-system problems, thus it is important to focus on the issue that brought the child to the hospital.

Regarding peds math, it is not much different than any other dosage calculations with the exception that we use weights when dosing medications.

That's very good advice. As to the peds math, I actually found it more straightforward and simple than adult meds math.

Thanks guys for your tips and advice. I really appreciate all the tips and websites. I have printed everything to go through before Monday. You are all my heros!!!

Susan RN 2009!!!!:bby::bby::bby::monkeydance:

One thing that helped me was practicing on as many baby's and children as possible. There were so many of them I kept asking nurses if I could assess them for them- and they were all more than willing to let me do it. You will lose that fear by the end of the day!

Good Luck! That's such a wonderful rotation. You will love it! :wink2:

I was scared too, until I took that tiny stethoscope, pressed it to that tiny chest and heard the fastest heartbeat in my entire life.

Best of luck!

Tait

Sorry off topic a little :)

Tait, was that the baby, or were you listening to your own nervous tachycardia?

The hardest thing for me was discerning heart/lung and even bowel sounds in infants as everything is so close together. After you practice a while it will come to you. I think pedi is the best place to learn assessment as you do not depend on what the patient tells you. It is more objective. Also, they are easier to flip over!

I will warn you that older infants and toddlers can be the worst pts to assess!

With a toddler, go in the room at first and completely ignore them and don't get close. I start out as far away as possible and talk to the parent. If at all possible, let them sit in the parent's lap and have the kid hold your equipment before you use it on them. Don't go straight for their head or chest. That is their center and they are very protective of it. I start listening to heart sounds with my stethoscope at their shins or feet and move it up to the right place. Sometimes demonstrating on the parent first can help (with the older toddler)

Also make lost of funny noises to distract them (or bring in a new toy for them to play with while you are doing your assessment). I like to do animal sounds while I'm listening to them because then they look at ME and not what I am doing. Save anything that could potentially hurt until the end so you can hightail it outta there right after.

And in infants and toddlers you usually want to listen to the HR and RR for a full minute when doing VS, otherwise you can get some strange numbers.

Also, you might want to get a pocket-sized bubble soln and wand (or a pinwheel would work too). This is great for distraction AND for getting the preschoolers to deep breathe when you are trying to listen to lung sounds. It also is great for doing IS for the younger kids. I love bubble soln and would be totally impressed by a student that showed up with it on the first day to use for the above reasons. You might want to get more than one because the kid might not let you have it back though!

One more thing, in peds a good developmental assessment is just as important as a physical assessment. Make sure you have a good cheat sheet that goes over important developmental milestones from birth to 5 years of age.

Oooh, and one more thing, kids don't circle the drain like adults, they will crash and burn (upside is they also improve faster), so keep a close eye on those resp distress kids (it is RSV season).

The hardest thing for me was discerning heart/lung and even bowel sounds in infants as everything is so close together. After you practice a while it will come to you. I think pedi is the best place to learn assessment as you do not depend on what the patient tells you. It is more objective. Also, they are easier to flip over!

Yup, no big back strain from lifting those 16 lb babies!