Consent In most circumstances, the parent of a minor gives consent for the medical treatment. However, in some instances, a minor is able to consent to his or her own treatment, provided that the minor is able to understand the risks, benefits, and potential alternatives for treatment. Decision-making involving the health care of older children and adolescents should include, to the greatest extent feasible, the assent of the patient as well as the participation of the parents and medical provider. Personnel During the Examination As few people as possible should be present during the physical examination and evidence collection process. The examining medical provider, a support person and/or a nurse should be the attending personnel. Law enforcement or child protective agency representatives or others involved in the investigation should not be in attendance. Under no circumstances should the examination be held in the presence of a parent or guardian suspected of perpetrating the abuse. Show The child/adolescent is usually given a choice regarding the presence of parents or other support person(s). However, before being given that choice, you need to decide whether the presence of a caregiver during the medical examination is desirable. Ideally, the parent or guardian should be supportive of the child/adolescent and help decrease anxiety. There are, however, certain situations when the presence of the caregiver may be detrimental to the examination. These situations include:
If you decide that the parent should not be present, a member of the medical team should take the child/adolescent to a private area, provide support and comfort, and explain why the examination is being conducted and what it will include. Preparing the Child/Adolescent for the Examination Preparing the child/adolescent for the physical examination helps reduce anxiety and minimizes trauma. It also enhances your ability to perform a comprehensive examination. Make an effort to increase the child/adolescent's sense of control and suggest relevant coping strategies. In addition, throughout the exam, reassure the child/adolescent about the healing of any injuries.
Sedation and Anesthesia It is unusual to use sedation or anesthesia for the examination. The use of medication should be restricted to situations where suspected major injuries require assessment or surgical repair. These include: large lacerations; active bleeding; evidence of internal bleeding, such as dried blood on the perineum; generalized bruising; or extreme tenderness. In addition, developmentally delayed children/adolescents may require anesthesia. In rare cases when a child/adolescent is too frightened to cooperate despite preparation and relaxation techniques and the exam is urgent, sedation or anesthesia may be indicated. However, consider the negative emotional effects of "putting the child to sleep" on a victim who has been drugged during abuse. If sedation or anesthesia must be used, carefully explain the procedures to the child/adolescent and parent or caregiver and obtain consent. Reassure the child/adolescent that he/she will be protected while sedated. Sedatives and anesthesia may result in a relaxation of the anal sphincter and perineal muscles, thus significantly affecting the physical findings. The type of sedative used will depend on hospital practice and policy. Which method is the most commonly used during physical assessment?Inspection. Performed first, inspection is the most repeated of the four physical examination methods. Teaching students about inspection emphasizes using sight and smell to check specific areas for normal color, shape, and consistency.
What techniques are used during a physical assessment?WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment.
Which technique of physical assessment should be performed first?When performing a physical assessment, the technique the nurse will always use first is: ANS: inspection. The skills requisite for the physical examination are inspection, palpation, percussion, and auscultation.
What is the correct order of a physical examination?Order of physical assessment: Inspect, palpate, percuss, auscultate.
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