When are we able to share documentation?
We are only ever able to share documentation or medical information to a child’s parent or guardian. Any other sources require legal proof such as a subpoena.
What are some situations in which a minor can provide their own informed consent.
Mature minor (Older than 14) or an Emancipated minor
What is assent? Dissent?
Assent: child’s participation in decision making process about health care
Dissent: Disagreeing with the treatment (may be ethically binding)
What are some laws that protect clients medical information?
- The Privacy Act (1985)
- Personal Information Protection and Electronic Document Act (2000)
What is covered under mandatory reporting?
- Physical or sexual abuse.
- Injuries due to weapons or criminal acts
- Infectious diseases
- Threat to self
- Threat to others
What are some signs of physical child abuse?
- Unusual bruising
- Burn marks
- Bite marks
- Pattern injuries
- Injuries that don’t fit the history
- Fractures
What are some signs of emotional abuse?
- Shy, introverted child
- Aggressive, angry child
- Does not respond to affection
What are some signs of sexual child abuse?
- Vaginal tears
- Unexpected STIs
- Vaginal discharge
- Anal injuries
- Anal itchiness
- Emesis of sexual fluids
- Inappropriate sexual behavior or knowledge
What should a nurse do when suspecting abuse?
Document everything, report to appropriate people and never confront parents.
How can nurses prevent abuse?
- Teach parents how to appropriately discipline their children
- Teach parents how to cope with a babies crying
- Screen parents for evidence of financial problems and make appropriate referrals
- Teach adolescents about love vs. abuse
- Teach children about good versus bad touching
What are some methods used when educating parents? How does this differ from educating children?
When we educate parents we want to address their specific concerns, ensure they are aware of normal developmental milestone, and don’t attempt to minimize concerns. When educating a child we want to be at eye level and use concrete terms.
How can we communicate with infants?
Talk with parents to gain understanding and try to use a calm tone and smile at the baby. Ensure to explain what is going on.
How should we be communicating with toddlers? What should we look for?
We are going to communicate primarily with the parent but we want to speak to the child as well. We want to offer choice, but avoid yes/no questions as they will say no. Observe how the parents interacts with the child or handles tantrums. Show procedures on parent first.
How should we communicate with school aged children?
Engage in concrete conversation with the child. Allow the child to assist you, do procedures on a parent or doll first. Watch what you say as they are very literal. Teach them through games or interactive activities.
How should we communicate with adolescents?
Treat them with dignity and respect. Ask for a history without the parent present. Ask candidly about risk taking behaviors and bring up delicate subjects.
How should we communicate with cognitively impaired children?
We should adapt our approach not to actual age but to functional age.
What should a nurse do when admitting a child to hospital?
Greet the child and the parent. Give them the proper identification and complete whiteboards etc. Tour the unit with the family. Address the parents concerns. Encourage the child to bring a transition object.
What should a nurse do when discharging a child from hospital?
Ensure the child leaves with the parent. Provide teaching to the parent about any procedures that were done or medications that are being prescribed.
How should we assess a newborn or infant?
Allow the parent to hold the child while you auscultate their lungs, heart and abdomen. Take vitals prior to undressing the child, then undress the child and complete a head to toe.
How should we assess a toddler?
We should attempt to incorporate play when possible. We can allow toddler to sit in the caregivers lap.
How should we assess a preschooler?
We need to keep in mind that they may have a fear of mutilation or body invasion. They will withdraw from anything that they deem invasive.
How should we assess a school aged child?
We should be very realistic and intentful with our words.
How should we assess an adolescent?
Treat them how you would treat an adult.
What are we assessing when we assess the pediatric population?
- Health Interview and history
- Parent-child Interaction
- Assessment of the child’s emotional, physiologic, cognitive and social development
- Physical examination
