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Peds Exam 1
Physical Assessment pt 1
| Question | Answer |
|---|---|
| Components of Health supervision | History and physical assessment Developmental and behavioral-social-emotional screening Sensory screening Population- or risk-based screening Immunization Health promotion and anticipatory guidance Parent child interaction ID children at risk |
| History and physical assessment | Height, weight Head circumference (until 36 months) |
| Sensory screening for | vision and hearing at well checks |
| you want to intervene before there is a problem with these | Health promotion and anticipatory guidance Parent child interaction Identify children at risk |
| Frequency of Health supervision Encounters | AAP recommends 32 visits through age 21 years- without health problems |
| when are health supervision encounters | Newborn 1 week Months- 1, 2, 4, 6, 9, 12, 15, 18, 24, 30 and 36 Yearly after 36 months More frequent visits |
| when should you plan anticipatory guidance | based on when you're seeing them next |
| Principles of Physical Assessment with Children | Minimize anxiety/threat |
| how to minimize anxiety/threat in children | Least to most invasive/aversive Allow child to maintain eye contact with parent Encourage caregiver participation Maintain privacy Allow child to touch equipment |
| Allow child to maintain eye contact with parent because | parents are security for children |
| Encourage caregiver participation | involve them! they are able to get the kids to do what's needed |
| maintain privacy | can hear over gown or cover back up during the assessment and do one part at a time |
| principles of physical assessment | Allow choices when possible Assess readiness Adapt techniques to child Position of comfort Organized sequence Patient but firm |
| Adapt techniques to child | assessing actual to developing level |
| Position of comfort | it is easier to do stuff when the kid is calm and comfortable, lying down is vulnerable |
| organized sequence | try to be systematic |
| patient but firm | give praise but let them know expectations and reinforce appropriate behavior |
| effective communication: general guidelines | Introduce self, role Acknowledge child first At child’s eye level Age-appropriate language Be positive and honest |
| Acknowledge child first unless | initial interaction with caregivers in young |
| Be positive and honest so that | they trust you |
| Approach and Sequence | Differs with developmental age Typically head to toe approach- alter for infants/toddler Least to most invasive/traumatic |
| in older child/adolescent, | examine genitalia last |
| in infants/toddler, | examine chest to toe, head last! |
| Approach to Infants | Use quiet, calm tone; respond to baby’s social cues Limit body heat loss Assess between eating & sleeping cycles Usually, can do most on parent's lap Assess alertness Observe movements for symmetry, coordination & strength |
| Use quiet, calm tone; respond to baby’s social cues | any loud, sudden movement will be triggering pat their head and bottom, rub head and bundle them |
| Assess between eating & sleeping cycles | this is ideal, but if they are upset come back |
| Observe movements for symmetry, coordination & strength | if they are too young to obey commands do they calm down with certain things? |
| Infants Sequence | If quiet, auscultate heart, lungs and abdomen If obtaining vitals, count respirations first by observation Palpate and percuss Proceed head to toe Perform traumatic procedures last |
| If obtaining vitals, count respirations first by observation | Record respiratory and heart rates |
| Perform traumatic procedures last | eyes, ears, mouth |
| Approach to Toddlers (12-36 Months) | Approach cautiously Use distraction, keep child’s hands busy Allow child to sit on parent’s lap Praise cooperative behavior Introduce equipment gradually Inspect body areas through play Don’t ask yes, no questions |
| Approach cautiously | limit information, anticipate short attention span |
| for toddlers, Introduce equipment gradually and | allow them to touch but you don't have to demonstrate |
| Toddler Sequence | Minimize physical activity initially Auscultate, percuss, palpate whenever quiet Perform traumatic procedures last eyes, ears mouth - remember they have poor body boundaries |
| Approach to Preschoolers (3-5 years) | Incorporate play, imagination; focus explanations on sensory experience Like to explore environment Use playful techniques Simple, direct language- child is literal Give choices, but don’t ask if it’s “okay” |
| imagination in preschoolers | use this to your advantage! |
| Use playful techniques | praise them, use their toys |
| Simple, direct language- child is literal | don't mention any other patients because they are egocentric |
| Preschooler Sequence | If cooperative- head to toe If uncooperative- proceed same as toddler (chest to toe, head at end) |
| Approach to School Age Children (6-12 years) | Head to toe approach Include written/visual information Simple explanation use of equipment, reason for assessment Elicit specific questions/concerns - worried, afraid? Respect privacy |
| Approach to Adolescent (11-18 years) | Privacy important Concerned with body image - reassure about normal body changes |
| Privacy is important in adolescents | fluctuating between child and adult behavior, give privacy, accept they're not talking in the morning |
| Sequence School-Age and Adolescent | Head to toe May examine genitalia last |
| Therapeutic Play (universal language of children) | Effective technique in relating to child Reduces trauma of illness Prepares child for procedures |
| therapeutic play helps with | reducing trauma of being in hospital, ease their minds, works through injections psychosocial |
| Techniques Order of Assessment | Inspection (Observation) Palpation Percussion Auscultation |
| Techniques Order of Assessment exception | abdomen - auscultate before palpating or percussing |
| Pediatric Assessment: general appearance | Alertness Muscle tone Work of breathing/ respiratory effort Presenting appearance Body development & nutritional status Activity level Cooperativeness are they interacting with others, comfortable, in distress, well nourished, appropriate clothes? |
| Obtain History | Chief complaint and present illness - review symptoms including pain |
| History - Adult history plus: | Birth history - full term? delivery type? Immunizations - up to date? Growth and Development Functional history Dietary history |
| length of history determines | why they're being seen |
| History Red Flags - cardiac in infants | feeding difficulties - feeding is work for infants = ADL diaphoresis - should never sweat!! poor weight gain decreased wet diapers |
| History Red Flags - cardiac in older children | exercise tolerance/activity level dyspnea on exertion fainting spells |
| Pediatric Assessment | Includes physical and developmental assessment Obtain vitals and assess pain Weight Height Head Circumference birth-< 3 years old |
| Include physical and developmental assessment | Denver Developmental Screening tool |
| Weight | Limit clothing (unclothed if infant or small variations are critical, no diaper) Adult can hold child and subtract their weight |
| Height | Height/length: obtain in supine position up to 2-3 years (using infantometer), then standing upright (using stadiometer) |
| Head Circumference birth-< 3 years old | Occipital frontal circumference (OFC) At widest diameter (occipital prominence, center of forehead) |
| obtaining length in the first 2-3 years | two person job, one person holds head and one person flexes the feet and presses down on the knees |
| Height >3 years | Obtain standing With stadiometer |
| Head Circumference OFC | around crown of head, above the eyebrows/ears |
| Head Circumference OFC in abused children | brain bleed so increased head circumference at wellness check |
| what circumference do you compare head circumference with | chest circumference |
| pediatric physical growth: weight | Infants double weight in 4-5 months, triple in 12 months Toddlers quadruple weight in 2.5 years (30 months) |
| how pounds do toddler gain per year | 4-6 lbs/year |
| by 2 years, height | half of their adult height |
| how pounds do preschoolers gain per year | 5 lbs/year |
| how pounds do school aged children gain per year | 3-6 lbs/year |
| Adolescents have rapid growth patterns | Female 15-55 lbs. Male 15-65 lbs. |
| growth spurts in girls vs boys | girls 2 years before boys |
| growth charts | Series of percentile curves - height, weight, head circumference |
| growth charts for what ages | 0-2 years, CDC/WHO |
| further investigation for what percentile | <5th percentile, >95th percentile |
| growth concerns | stay on same percentile, can change 1 percentile but no more if there's tall parents and a short baby jumping percentiles is bad! |
| vitals assessment: influencing factors | Fever Crying/anxiety/fear, Pain Hypoxia/shock Movement/activity like crying Medications |
| fever increases | HR |
| Crying/anxiety/fear, Pain increases | HR, BP, RR |
| Hypoxia/shock decreases | CO, so tachycardia indicates shock |
| what should you compares patients values to | age normal values |
| when taking vitals, document and recheck | Document child’s behavior Recheck abnormal results - if sleeping, check awake and if cry, check calm |
| CO = | SV x HR |
| Infant and Toddler Vital Sign Measurement | Assess comfort level Count respirations first (before disturbing the child) Count the apical heart rate second Measure the blood pressure (if applicable) third Measure temperature last |
| when to measure BP | Well-child-care- annually in children > 3 years, unless concerns Inpatient hospital -every patient |
| temperature in infants | rather rectal over axillary |
| temperature sites for neonates | axillary |
| temperature sites for infants | rectal preferred, or axillary Temporal if > 3 months without risk fever |
| oral temp | assure child understands and follows directions, so not before 5 |
| Temporal Artery Temperature | >3 months, without risk of fever |
| rectal contraindications | Anal fissure, imperforate anus, rectal bleeding, rectal abscesses, anal/perineal or perineal surgery, diarrhea, neutropenia, anemia, and neonates in critical care |
| fever = | equal to or greater than 100.4 (38) |
| rectal temp details | Child-side lying with leg flexed, so you can control Infant and younger children- supine with legs bent toward chest Insert lubricated probe into rectum- red probe Be aware of contraindications |
| how far to insert lubricated probe into rectum | ½ inch for infant 1 inch for child (do not exceed 1 inch) |
| hypothermia | Indication of infection esp for neonates Newborns and infants at risk so keep them covered |
| <36.0 triggers | sepsis alert, might need spinal tap |
| heart rate | Apical when possible and always < 2 years |
| where is HR best heard | at apex of heart 4th intercostal space, medial to left mid clavicular line- infant, young child 5th intercostal space- older adult |
| listen to infants for | 1 full minute, may feel for radial/ brachial pulse to confirm rate |
| respirations | Watch/palpate chest rise and fall w/o touching Watch/palpate abdominal movement < 7 years |
| <7 years breathing >7 years breathing | abdominal breathers thoracic cavity breathers |
| infant respirations | Count for one full minute Respirations can be irregular - periodic breathing |
| tachypnea is an early indication of | respiratory distress |
| apnea | 20 seconds without any breaths |
| assessing BP | Annually for children 3 years and older, earlier if at risk All ages, if hospitalized |
| assessing BP determining the right size | Determined by extremity size Cuff too big- gives low reading Cuff to small- gives high reading |
| if abnormal reading for BP | check size and retake BP |
| cuff sizing | bladder width is the 1/2 circumference of arm |
| BP sites in infants and toddlers | Infants and toddlers -calf, higher reading in calf |
| Explain to child about BP | the tight feeling of the cuff inflating is like a hug on the arm or leg |
| physical assessment | Head to Toe Assessment: skin, head and neck, chest, abdominal, muscloskeletal |
| head and neck component of head to toe | Eyes, Ears, Mouth Neurological |
| chest component of head to toe | Lungs- pulmonary Heart- cardiac |
| general differences in children | Head is proportionally larger than body Higher metabolic rate Greater insensible losses Poor temperature regulation- infant Immature immune system Immature organs Can not verbalize symptoms– younger children |
Created by:
leh195