Muscle weakness or paresis (may indicate nutritional deficit) or extreme
asymmetry of strength in extremities, hands, and fingers should be reported.
Developmental delays, detected through examination with tools such as
the Denver II or other inventory, should be noted and reported along with any
relevant historical data.Diagnostic Procedures
When preparing the client and family for diagnostic procedures, explain things
as simply as possible and remain concrete and avoid abstractions. Be very
clear about what the child needs to do (hold still, turn on side, etc.). Involve
the older child when possible, in holding tape, counting while medicine is
pushed, or other task. Give the adolescent choices and control whenever pos-
sible in assisting during the diagnostic procedure.Laboratory Tests
Diagnostic findings, particularly biochemical tests, often vary based on
the age of the client. The greatest age-related difference in test results is noted
between those of the newborn or infant and test results of children >12 years
of age to adulthood. Lab values should be interpreted with consideration for
client age. The following are examples of tests that may be performed:
Biochemical tests involve blood analysis of nutrients, electrolytes, and pro-
tein products as described in the earlier discussion of nutrition assessment.
These and other tests can indicate dysfunction in pediatric body systems:
Complete blood count (CBC): Hematocrit, hemoglobin, red blood cell
count, platelets. Decreased or increased levels may relate to respiratory,
cardiovascular, renal, or bone marrow malfunction, or hydration prob-
lems (elevated hematocrit with hemoconcentration due to dehydration);
decreased or elevated platelet levels can indicate risk for bleeding or
clotting disorder.
Prothrombin time (PT) or partial thromboplastin time (PTT): High lev-
els mean blood is less likely to clot, indicating a risk for bleeding.Blood chemistries
Potassium, sodium, chloride, calcium, magnesium, phosphorus, and oth-
ers indicate electrolyte imbalances due to deficits or excess in dietary
intake, malabsorption, or medication side effects, or glucose elevation or
decrease (diabetes or pancreatitis).
Venous carbon dioxide, in addition to arterial blood gases, shows imbal-
ances in respiratory system.
Blood urea nitrogen and creatinine reveal renal damage.
White blood cell (WBC) count and erythrocyte sedimentation rate (ESR)
might be elevated in infection. WBC is decreased in bone marrow or
immune system depression.4(^44) Pediatric Nursing Demystified