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Peds > 2.1 Physical Assessment in Pediatrics > Flashcards

2.1 Physical Assessment in Pediatrics Flashcards

1
Q

Newborn HR

A

Awake - 100-180
Asleep - 80-160
Fever/Exercise - Less than 220

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2
Q

1 Week - 3 Months HR

A

Awake - 100-220
Asleep 80-200
Exercise/Fever - Less than 220

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3
Q

3 Months - 2 Years HR

A

Awake 80-150
Asleep - 70-120
Fever/Exercise - Less than 200

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4
Q

2-10 Years HR

A

Awake - 70-110
Asleep - 60-90
Exercise/Fever - Less than 200

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5
Q

10+ Years HR

A

Awake - 55-90
Asleep - 50-90
Exercise/Fever - Less than 200

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6
Q

Respirations Per Age Group

A

Newborn - 35
1-11 Months - 30
2 Years - 25
4 Years - 23
6 Years - 21
8 Years - 20
10-12 Years - 19
14 Years - 18
16+ - 16-18

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7
Q

COMMICATION IN PEDIATRICS

A
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8
Q

Communicating with Parents

A

Introduction - Establish the parental roles (ask if they are mom and dad, biological or adopted), and ask how to address the parents

Encourage - Encourage talking using open ended questions

Listen and Observe - Observe for cultural queues.

Provide - Provide anticipatory guidance (providing parents with information about normal growth and development such as milestones they will go through)

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9
Q

Communication with Children

A
  1. Make sure communication is developmentally appropriate
  2. Get on child’s eye level (do not want to appear as a towering figure)
  3. Approach the child gently/quietly with caregiver present
  4. Always be truthful
  5. Give children choices as appropriate (they may feel a loss of control in a hospital)
  6. Include play whenever possible
  • Avoid analogies/metaphors (they don’t understand these)
  • Ask simple questions
  • Give instructions clearly and use simple terms
  • Use role-play, dolls, models for description
  • Give instructions in a positive manner (children can sense anxiety and fear)
  • Avoid long sentences and medical jargon (think scary words)
  • Give older adults an opportunity to talk without parents being present
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10
Q

Appropriate Communication for Infants

A
  • Communication is through non-verbal behaviors and crying
  • Smile/Coo when happy
  • Cry/Grimace when distressed or sad (unpleasant stimuli such as hunger or loneliness)
  • Infants can sense fear and anxiety so when you are stressed they will be stressed
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11
Q

Appropriate Communication with Toddlers/Preschoolers

A
  • Focus on the child through communication (do not just talk to parents)
  • They often don’t know if you are a person they can trust. Talk with parents first and gain their trust so that their child can also gain your trust
  • Make sure you don’t make them feel like a baby, so you need to address them as individuals, and use words that he/she will understand.
  • Involving parents in this age group is incredibly important (when you need to take vitals, allow parents to be close)
  • Be consistent in what you do (don’t smile when doing painful procedures as it will confuse them)
  • Allow children to explore and play with the medical equipment (allow them to inspect blood pressure cuff or stethoscope)
  • Repeat information in simple, consistent terms. (No medical jargon)
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12
Q

Appropriate Communication with School-Aged Children

A
  • Explain what, how and why you are doing things. Use concrete terms.
    (I’m going to get your temperature to check if you have a fever with this thermometer)
  • Allow them to play with medical equipment so they are comfortable with it
  • Personal possessions are incredibly important to this group, so have these items close to them and make sure they do not get lost
  • Use therapeutic play
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13
Q

Appropriate Communication with Adolescents (Teenagers)

A
  • THE MOST IMPORTANT THING IS HONESTY TO GAIN TRUST
  • Patient’s will have a lot of questions so have detailed explanations of treatments
  • PRIVACY IS VERY IMPORTANT (give them time to talk away from parents)
  • EVERYTHING THEY TELL US IS CONFIDENTIAL UNLESS THEY ARE AT RISK FOR HARMING THEMSELVES OR OTHERS
  • Plan for developmental regression during times of stress.
  • Importance of peers (friends may be more important than family during this time)
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14
Q

Difference in Health History between Pediatrics and Adults

A
  • Perinatal History (were they pre-term, were there maternal illnesses that could have been passed, APGAR scores, pregnancy complications, how many weeks were they born)
  • Birthing History (equipment needed to help with birth, or complications)
  • Immunization Status (one of the biggest things we track in pediatrics)
  • Developmental milestones (what milestones should they have hit and which ones are coming up. Are they on track?)
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15
Q

Pediatric “Play”

A
  • This is the “work” of a child. It is a universal language to them
  • This is the child’s developmental workshop (where they develop cognitive, reasoning, behavioral skills)
  • Play serves as stress/pain reliever and a therapeutic intervention

Examples
- A pre-school child struggles to have adequate fluid intake, have a tea-party to use play to help increase oral intake
- When a child wont play, it is an indicator that they may be very sick. When children want to play again, it may mean that they are getting better again.

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16
Q

Physical Assessment of a Child

A
  • Order may be different than adults because children may be resistant. You may need to change the order and get assessment data in a creative way.

GOALS
- Minimize stress/anxiety associated with the assessment
- Foster trusting relationship between nurse/child/parent by explaining everything we do.
- Allow children to prepare and acclimate to you being in the room.

17
Q

Assessment of an Infant

A
  • Order of Vitals (Least invasive to Most invasive)
  • Assess in crib, assessment table, or having parent’s holding them

FIRST
- Assess the infant when walking into the room to see if they are fussy
- RR and HR (because you need them to be as calm as possible)

LAST
- Invasive procedures such as hips or ears

Comfort Items
- Warm
- Feeding
- Pacifiers
- Cuddle

18
Q

Assessment of Older Infant or Toddler

A

Order - Least invasive to Most invasive
MOVE AS QUICKLY AS POSSIBLE
- STRANGER ANXIETY (4-8 months of age)

  • Assess in parent’s laps or wherever parents can be close
  • Praise their cooperative behavior
  • Use distractions (TV, movie, songs)
19
Q

Growth Measurements

A

Recumbent Length (up to 36 months)
- Patient lies down and you measure head to toe

Standing Height (after 37 months)

GROWTH CHART
- Less than 5% or greater than 95% is outside expected parameters
- Decline in 2 standard deviations is also outside expected parameters

  • Weight is always measured in kg
  • Height is measured in cm

USE THE SAME SCALE WHEN MEASURING WEIGHT AND MEASURE AT A SIMILAR TIME EVERYDAY OR THEY NEED TO BE NAKED/CLOTHED THE SAME EVERYTIME TO IMPROVE ACCURACY
- Chart the time of day, what they were wearing and etc during assessments.

20
Q

Measurements

A

Length - Measured until 3 years old (36 months)
Height - Measured with wall STADIOMETER w/o shoes after 3 years old (36 months)

Weight - Naked
- Round to the nearest 0.1 kg

BMI - Begins at 2 years old (due to rising childhood obesity)

Head Circumference - Up to age 2 if normal or 3 if abnormal
- Rounded to nearest 0.5 cm
- Head is 80% of adult size by age 2 (and fontanels close by age 2)

21
Q

Vital Signs (Infant-Toddler)

A

FIRST - Assess comfort levels of infant and toddler
Order - RR, HR, BP, Temperature

22
Q

Temperature (Infant-Toddler)

A
  • Axillary is the most common
  • Rectal temperature is the “Gold Standard” for accuracy
  • Fever (100.4+)

Fever Management
- Tylenol (any age group) or Motrin (6 Months or Older)
- Cold compress, lowering temperature in room, limiting clothes

23
Q

Heart Rate (Infant-Toddler)

A
  • Apical pulse or check pulse site
  • Sinus Arrhythmias with respirations are normal
  • Make sure to keep child’s heartrate baseline in check
  • Apical pulse is the “gold standard”
  • Brachial pulse is the most common before age 2
  • After age 2 radial pulse can be used (but cannot be used before age 2)
  • Pulses checked in the lower extremities is posterior tibial for infants and dorsalis pedis for toddlers.
24
Q

Respiratory Rate (Infant-Toddler)

A
  • Neonates (very young infants) have irregular respiratory rates
  • They have periodic apnea (short periods of apnea less than 15 seconds) which is NORMAL
  • ABNORMAL IF IT IS LONGER THAN 15 SECONDS
  • APNEA IS THE FIRST SIGN OF SEPSIS
  • BECAUSE OF THIS RR MUST BE LISTENED TO FOR A FULL MINUTE
  • Pediatric patients are abdominal/belly breathers until 6-7 years old
25
Q

Blood Pressure

A
  • Begins at 3 years for normal children
  • CHANGE IN 10% IS SIGNIFICANT
  • Hypotension IS A LATE SIGN OF DECOMPENSATED SHOCK
  • Toddlers and below BP is taken in lower calf
  • Preschoolers and above BP is taken on arm
  • Make sure not to take BP in extremities with IV’s or picc lines
26
Q

Pain Scales (Infant-Toddler)

A

INFANTS
- FLACC Scale for Infants
- Rates pain based off behaviors

TODDLER/PRESCHOOLER/SCHOOL AGED UNDER 9
- Wong-Baker FACES Scale (Ask them to point to the face that fits them best)

9 Years or Older
- Numeric Scale

SIGNS OF PAIN
- Increased HR/BP
- Parent’s perception if they think their child is in pain

27
Q

Unique Pediatric Physical Assessments

A

Palmar Creases - Should have many creases in palms. Some (down syndrome) only have 1 crease across their palm, because they did not move much in the womb.

Fontanels - Tells us about brain development and fluid status (if fontanels are bulging, there is an increase in fluid volume, or if it is sunken, they may be dehydrated)
Posterior Fontanel - Closed by 6-8 months
Anterior Fontanel - Closed between 1-2 years old (12-18 months)

Peds (72 decks)

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