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Peds Exam 1
Physical Assessment pt 2
| Question | Answer |
|---|---|
| skin differences | Thinner Lower concentration of fat Immature immune system Children at greater risk for skin breakdown Seborrheic dermatitis- cradle cap Assess symmetry skin folds |
| Lower concentration of fat in children which means | mottling |
| Immature immune system | prone to diaper rash- diaper dermatitis |
| Children at greater risk for skin breakdown | more so on the back of their heads since its the biggest part of them, not really on coccyx |
| how often should you bathe children | 3x a week until the first bday |
| inspect these things in children | color, for nevi, vascular and other lesions Location, size, distribution, characteristics, color |
| Pigmented nevi (birth marks) | darker patch of skin, do not fade |
| Hyperpigmented nevi (formerly Mongolian spots) | blue, gray, irregular shaped macules, common in dark- skinned infants, fade over time, may be mistaken for bruise |
| Café-au-lait spot(s) | light brown macules, > 6 can indicate genetic condition |
| vascular lesions | Salmon nevi: (“stork bite”) Strawberry nevus: (hemangiomas) Nevus flammeus: (“port-wine stain”) |
| Salmon nevi: (“stork bite”) | light pink macule typically on eyelids, nasal bridge, back of neck Usually fade over. No complications |
| Strawberry nevus: (hemangiomas) | raised reddish papule made of blood vessels. Present at or develop after birth; recede over time, usually by the age of 9 years. Usually no complications |
| Nevus flammeus: (“port-wine stain”) | dark purple-red flat patch, grows with the child. May be associated with Sturge–Weber syndrome. May be disfiguring; may be removed with laser therapy |
| observe for what in genitalia of younger children | Observe for diaper rash |
| male genitalia | Foreskin if non-circumcised Undescended testes Swelling in scrotum- could indicate inguinal hernia Testicular enlargement- first sign of puberty |
| Foreskin if non-circumcised in male genitalia | Takes time to separate from penis Don’t force- gently pull back foreskin if able Phimosis- cannot retract Paraphimosis- stuck in retraction, emergency, can cut off blood flow |
| female genitalia | Limited to observation of external structures First sign of puberty is breast development or pubic hair |
| what to observe for in head | Symmetry and shape Flattening, palpable ridge, balding spots infant |
| fontanels | Posterior - closes at 6-8 weeks Anterior- closes 12-18 months (as early as 9 months) sunken - dehydration balding - neuro issues hydrocephalous - bulging |
| neck | Short in infants Head control Range of motion |
| things to consider in neck of infant | if trach - need extension no head lag by 4 mo torticolus - head stuck in 1 spot |
| most babies are born with what eyes | blue eyes but need exposure to melanin to have iris color, needs 3 years for hazel color |
| eyelids placement | upper lid should fall near upper iris |
| iris | round, permanent color 6-12 months |
| extraocular movement | Asymmetric in newborns, cross eye until 4 month which is binocular movement |
| if infants are squinting, | evaluate |
| red reflex | shine light in their eye, you want it to be red if it's white, retinoblastoma which is eye cancer |
| ears | Height- top of ear at/above outer eye Assess for pain, drainage Hearing Young children, leave for end of exam |
| issues with ears | problem with kidneys |
| low set ears can mean | cognitive issues |
| differences in children ears | Eustachian tubes- shorter, narrow more horizontal < 3 years-down and back >3 years- up and back |
| nose | Assess for drainage or secretions Nasal flaring |
| Nasal flaring | nostrils widen during breathing- indicates respiratory distress |
| mouth | Inspecting the mouth can be upsetting Teeth- presence, any dental decay Palate- is it intact, feel roof of mouth with finger Oral candidiasis |
| Inspecting the mouth can be upsetting so | leave for end of exam- infant, toddler |
| at 6 months, how many teeth | 2 bottom teeth |
| Oral candidiasis | thrush, mouth is white if comes off with wet gauze then it's not thrush but if it doesn't come off then tell HCP |
| neuro assessment | Level of consciousness - alertness and cognition PERRLA Orientation Cough/gag reflex Extremity strength Cranial nerves |
| cranial nerves | Extraocular movements Facial movement Shoulder shrug Stick out tongue |
| neuro assessment in infants | Fontanel Size and shape head - brain bleed if horizontal Motor function- posture, tone and muscle strength Motility including symmetry of movements |
| babinski reflex at which age | 1 year, not reliable less than 1 year |
| babies should never have | return of NB/primitive reflexes and if they do its a sign of severe brain injury |
| Neurological Assessment Level of Consciousness: Quick Assessment | AVPU- quick assessment A- awake and alert V- responds to voice P- responds to painful stimuli U- unresponsive |
| Neurological Assessment Level of Consciousness: GCS | GOLDEN STANDARD Eye opening Verbal response Motor response |
| GCS scoring | 8 or below = brain injury highest score is 15 |
| change in LOC | earliest indicator of improvement or deterioration in neurologic status |
| GCS Eye Opening- same as adults | 4= Spontaneous 3= To command 2= With pain 1= No response |
| GCS Motor Response | 6=Obeys verbal command (Normal spontaneous movement) 5=Localizes Pain, pull away and push away 4=Flexion withdrawal to pain, pull away from painful stimuli 3=Abnormal flexion (decorticate) 2=Abnormal extension (decerebrate) 1=No response |
| decerebrate | more serious brain injury |
| Chest size, shape, symmetry, movement, breast development | Breast development- begins between 8-12 years, starts elevated nipple, then nodule (breast bud), may be uneven Gynecomastia- boys, early to mid puberty |
| Chest symmetric bilaterally with | breathing >7 years - respirations are thoracic, belly breathers until 7yrs |
| evaluate respirations for | Rate- number/minute Rhythm – regular, irregular, periodic Depth- deep or shallow Quality- effortless, automatic, difficult, labored Symmetry |
| crackles/rales | usually fluid overload and go away with fluids fine - rub hair between fingers course - velcro |
| wheezes | narrowed passages whistle occurs on expiration mostly but can also be inspiration |
| rhonchi | secretions sound like snoring, go away if cough |
| stridor | obstruction squeaky, trying to get air, edema |
| differences in children: pulmonary | Smaller airway < 2 months - obligate nose breathers < 7 years abdominal/diaphragmatic breathers Weak -use accessory muscles for breathing Transmitted sounds common in younger children Respiratory rates are faster in children |
| smaller airway in children which means they can | collapse more |
| Weak -use accessory muscles for breathing | so increase RR, tire out quickly |
| first sign for respiratory distress | tachypnea!!! flared nostrils retractions - substernal, subcostal, intercostal |
| where to listen for children breath sounds | listen at mid axillary line when assessing breath sounds |
| Signs of Respiratory Distress | Tachypnea!!! Nasal Flaring Retractions Grunting Cyanosis |
| grunting | trying to keep airway from collapsing, late sign of resp distress breathing against a partially closed glottis increases expiratory pressure and improve oxygenation |
| cyanosis | Bluish tone of skin/lips- indicates hypoxia- decreased oxygen levels |
| heart sounds | Quality- clear and distinct, not muffled or distant Intensity Rate- should be same as radial pulse Rhythm – should be regular and even Infant- sinus arrhythmia; increased with inspiration and decreases with expiration-normal Murmurs |
| Murmurs | innocent murmur in preschoolers, blood vessels are growing |
| cardiovascular in children | Assess pulses: strength, equality bilaterally, if peripheral weak, assess central Capillary refill < 3 seconds Light touch, don't occlude |
| cardiovascular differences in children | Fixed stroke volume Increase cardiac output by increasing heart rate Hypotension- late sign of shock Rarely have dysrhythmias |
| signs of shock include | Cool skin temperature Decreased peripheral pulses Delayed capillary refill > 3 seconds Decreased urine output |
| if in shock, | shut down capillaries and maintain BP, children will have symptoms of decreased perfusion but normal BP |
| abdomen assessment | inspect, auscultate, palpate - superficial then deep |
| inspecting abdomen | Symmetry, umbilicus for size- hernia, flat or distended |
| auscultating abdomen | Peristalsis, bowel sounds Listen at least 30 seconds before noting absent/diminished bowel sounds |
| palpating abdomen | Save for last, it may distort abdominal sounds Feel for tenderness, masses A tense abdomen is abnormal finding-should be soft, non-distended |
| umbilical hernia gets bigger when | cries |
| Musculoskeletal in children | Focus on symmetry, mobility, strength, and tone Observe throughout interaction Observe for deformity Assess curvature of the spine- scoliosis Bowlegs common < 2 years |
| Observe for deformity by assessing | range of motion |
| If ambulatory: assess | gait, posture, balance, and coordination |
| intake and output | Strick I & O-hospitalized children |
| urinary output | Wet diapers can be weighed 1gram=1ml |
| NPO hospitalized children need | IV fluids |
| how many wet diapers a day | 1 for 1 day old, 2 for 2 days old, etc day 6 should have 6-8 wet/day |
| pain is | 5th Vital Sign Subjective Whatever the experiencing person says it is Exists whenever the experiencing person says it exists |
| pain has self report scales unless | younger than 4 |
| pain is generally | underreported because kids don't want meds |
| manifestations of pain | Facial expressions- grimacing, crying Body movement- pulling or rubbing, position Gait Immobility, guarding Flushing diaphoresis Elevated HR, respirations, BP, shallow breathing |
| CRIES scale | Used for newborns to approximately 2 months old 10- point, observational scale Objective |
| CRIES stands for | Crying Requires O2 for saturation 95% Increased VS Expression Sleepless |
| FLACC scale | 2 months to 7 years Communication or cognitive deficits Observational 10 -point scale Objective |
| FLACC scale is good for | non verbal |
| FACES scale | > 3 years Self report scale Children point to face, DO NOT match the child’s expression to scale |
| OUCHER scale | 3-12 years Observation poster Number scale for older children, 0-10 Picture scale for younger children Have child pick which one describes their pain |
| Numeric Rating scale (NRS) Numeric Visual Analog Scale (NVAS) | Used for children 8 years old to adult 0-10 scale Self report scale If need to explain more than twice, should use a different scale |
| Documentation for children in the hospital | Head to toe assessment every shift ( 8 or 12 hours) Focused/detailed assessment at minimum every 4 hours Includes specific area of concern More frequent assessment is required for patients who are more critically ill |
Created by:
leh195