Physical assessments are performed on both adults and children. There are some aspects of the assessments that resemble each other, but some aspects are different depending on if they are being performed on an adult or a child. The nurse will need to be aware that uncertainty and anxiety can be exhibited by both populations when having a physical assessment performed. Therefore, with both adults and children the nurse should express confidence, kindness, and compassion when performing the assessment to allow the patient to feel more at ease. In both scenarios the nurse will measure height and weight, assess vitals such as temperature, heart rate, respirations, and blood pressure. In adults the physical assessment is done in a head to toe order, and with a child the assessment order may not be as structured but will still be entirely completed. A good recommendation for a child assessment would also be to start with the least invasive portion of the assessment and ending with the most invasive such as the examination of the throat and ears. The interview and health history will be communicated with the adult by the nurse. Where with a child the information exchange will take place with the parent or caregiver. Children show differences from adults in the size of their bodies, and in their behaviors as they progress in their development. In a child assessment there is an added focus on their physical development and reaching age appropriate milestones as they are progressing in both areas rapidly. (Jarvis, 2015).
From infancy to adulthood multiple transitions take place in the psychosocial development of a human. Erik Erikson suggests that human development goes through a total of eight stages. When the nurse is performing a physical assessment and interview, they need to be aware of Erikson’s psychosocial developmental stages so that they will know how to best offer instruction and communication. How the nurse approaches an individual child will vary dependent of what stage of psychosocial development they are in. (Falkner, 2018).
An infant will be in the trust stage meaning that they look for their basic needs to be met establishing trust. The infant is completely reliant on their parent or caregiver. The nurse will direct most of the instruction and communication towards the parent during this stage but will be able to communicate with the infant by talking in a soft, calm tone, making eye contact, and smiling. If fussiness is exhibited the nurse can offer a brightly colored toy as a distraction method, or a pacifier for comfort. Toddlers are in the autonomy stage of development meaning they are becoming curious and more aware of their environment. They are seeking independence while still being dependent on their parent. In the toddler stage the nurse should acknowledge the parent as well as the toddler upon entering the room. The nurse can first interview the parent allowing the toddler to feel more at ease. The assessment should be performed with the parent in close view or if needed on the parent’s lap. Communication and instruction should be age appropriate, as well as clear, and direct. The nurse can allow the toddler to touch and feel the stethoscope prior to listening to their heart and lungs or demonstrate on the parent first to ease any associated fear. The preschooler will be in the initiative stage of development. During this stage, the preschooler begins to independently perform tasks, enjoy being involved and are helpful. Their verbal communication is present at this stage and will be helpful as the nurse performs the assessment. Directions as well as explanations should be short and simple. The nurse can communicate what they are doing as they move through the assessment. Including the preschooler in parts of the assessment such as allowing them to hold the stethoscope on their chest while you listen will allow them to feel helpful.
School-age children are in the industry stage. In this stage the child is developing both in school and socially and seeks approval from parents and teachers. At this stage language development has grown significantly, but their level of understanding still needs to be approached at an age appropriate level. (Jarvis, 2015). During this stage, the nurse can establish a relationship and open communication by offering a compliment such as “That’s a cool hat you have on.” (House, 2008). While performing the assessment the nurse can provide education on how the body works as this age group has interest and enjoys learning. In the adolescent stage self-identity is developing. In this stage the adolescent is trying to figure out who they are, and peer acceptance is extremely important. The nurse should not treat the adolescent like a child, but understand they are not yet an adult. The parent no longer needs to be present in the exam room during the assessment. This will allow for open communication and the ability to ask questions freely. While assessing the adolescent the nurse can take the opportunity to also offer education and information that can help promote health wellness. (Jarvis, 2015)
Strategies that can help encourage engagement during the assessment will vary upon the developmental stage. With most speaking calmly and in a non-threatening tone will help establish a positive rapport. Providing the infant or toddler with a comfort item such as a pacifier, special blanket or toy can help them feel more comfortable. Encouragement in the pres-chool and school-age child can be demonstrated by turning an assessment into a game, as well as allowing them to touch and feel equipment. For the adolescent engagement is more likely achieved by showing them a nonjudgmental attitude as well as treating them as an individual. (Jarvis, 2015).