Pediatric Assesment

I. Growth and Development

A. Compare the normal growth/development of your pediatric client to the "textbook picture" of the specific age group.

The client demonstrates that she is able to do all of the developmental milestones with the exception of wiggling her thumb. The mother stated that the child had never played thumb wars or thumbkins, so I was not surprised by the child's inability to perform this task. The child appears to be developing at the same pace as most children her age. The child is well developed in the gross motor skills as evidenced by the child's ability to perform all gross motor tasks on the Denver II.

Normal Client

1. Gross motor skills: Walks up stairs, alternating feet on steps; Walks down stairs, two feet on each step; Pedals tricycle; Jumps in place; Able to perform broad jump

The child walks independently up and down stairs; She pedals her tricycle and scooter; She jumps all over the place and from sofa to sofa; and she jumps over a piece of paper lying on the floor

2. Fine motor skills: Can unbutton front buttons; Copies vertical lines within 30 degrees; Copies zero; Begins to use fork

Unbuttons buttons with ease; makes a nearly straight vertical line; makes a closed oval shape for zero; and uses fork easily

3. Sensory: Visual acuity has improved to near 20/40, hearing has reached adult level, taste buds are sensitive to the natural tastes of food, child uses sense of smell to aid in taste preferences, uses touch as a self comforting technique(fund)

Visual acuity is 20/40 according to last eye exam; hearing is good enough to hear whispering; likes apples but refuses them when we put sugar on them; did not witness her sense of smell aiding taste; rubs a blanket edge between thumb and finger at bed time for comfort

4. Language: Increasing vocabulary with intelligible speech; dysfluency is common; names four familiar objects and begins to describe qualities or actions of objects; begins color identification; uses symbolic language; asks "how" and "why" questions often; counts to three; says name, age and gender(McKinney, James, Murray, Ashwill, 2009).

Client demonstrates a large vocabulary using several different words during my visit; no dysfluency witnessed; names pictures on Denver II and tells what sounds or actions they make; names several colors; says a butterfly is like a bird (symbolic language); client asks how do I put earrings on, and why does she have to use her fork; counts to 10; says her name age and gender

5. Socialization: Dresses self with help with back buttons; Pulls on shoes; Parallel play; Able to share toys

She picks out her clothes (did not match) and dresses herself; she puts on boots; and plays with doll beside me while I play with the blocks next to her (parallel play); she does let me play with her toys but only for a few minutes before she wants them back

6. Cognition: At this stage their conscience develops, have an active imagination, can demonstrate basic social skills, can delay gratification, use more acceptable outlets to express frustration, and can expand their environment beyond home.wilson

The child's understanding of right seems to be developing even though it is hard for her to do the right thing she appears to know the difference between right and wrong.

(Harkreader, Hogan, Thobaben, 2007).

II. Interpersonal interactions

A. Describe interactions between:

Child and primary caregiver. The child stays with her mother Sunday through Thursday of each week. Her father is the primary caregiver on Friday and Saturday. The child talks with mother about needs and wants easily. The child asked her mother for a drink and the mother responded quickly. The mother and the child engaged in several tickling episodes with the child responding with a delighted laugh. The child showed me a painting and a craft she and her mother had made earlier in the morning indicating that the mother was interacting with the child. The child is expected to keep her food in the kitchen and when she does not her mother uses a firm tone of voice and clear instruction for the child to correct her behavior. The child appears to have loving, caring feelings toward her mother. The child wraps around mothers leg and snuggles with her throughout the visit.

Primary caregiver and the nursing student. The mother seems to tolerate me well. She is very interested in the information I am gathering and the information I share with her about the norms for her child. The mother seems to enjoy my company and has offered me food and drinks throughout the interview. The mother and I have enjoyed playing and talking with the child together during this process.

Child and the nursing student. The child has a good relationship with me. This is evident by the way she sits in my lap, snuggles with me, plays the "getcha" game with me and hugs and kisses me. The child listens to my instructions as long as it seems like a game and I give her full attention. She does ask to go watch a movie a few times through out the interview but is overall attentive and loving towards me.

III. Physiologic status

A. Immunizations

The Centers for Disease Control and Prevention (CDC) recommends the first Hepatitis B (Hep B) shot be given at birth, the child received it on 9-13-07 approximately 2 months after birth. Either at one or two months old the client is to have the second Hep B and the first Rotavirus (RV), Diphtheria, Tetanus, and Pertussis (DTaP), Haemophilus influenzae type B (Hib), Pneumococcal Conjugate Vaccine (PCV), Polio (IPV). The child received the first RV, DTAP, Hib, PCV, and IPV at 2 months of age (9-13-07) the second Hep B was given on 11-27-07 at approximately 4 months of age. At 4 months old the CDC suggest the second round of RV, DTaP, Hib, PCV, and IPV be administered. The child had theses immunizations administered on 11-12-07 at approximately 4 months of age. At six months of age the child should receive the 3rd dose of RV, DTaP, Hib, and PCV. The child in question received these vaccines at approximately 6 months of age on 1-11-08. Starting at 6 months of age the child may receive the influenza vaccine yearly. This child has not received an influenza vaccine. The child should receive the third Hep B and the third IPV between 6 months and 18 months. The child received these immunizations at approximately 6 months of age on 1-11-08. At 12 months the child should receive the fourth Hib and PCV the first