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paediatrics jenna to sort > An Approach to Assessing Children > Flashcards

An Approach to Assessing Children Flashcards

1
Q

Whats the best thing to help with diagnosing children?

A

Start with the age:

  • Guides approach to history taking and examination
  • Common pathologies differ
  • Conditions manifest differently at different ages
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2
Q

What is different in the paediatric history from the adult?

A

Anticipate what is different to adult consultations:

  • Parents observers
  • Play is essential and clinical helpful
  • Specialised nursing staff
  • Treatment differs by weight and age
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3
Q

What are the key stages of the history?

A
  • Introduction
    • Introduce yourself, identify patient and who is with them
    • Generate rapport
  • Presenting complaint
  • History of presenting complaint
    • Onset, progress, variation, effects, observations
    • Chronological stages (including GP, A and E, ward)
    • General/systems enquiry may be appropriate here
  • Birth history
    • Details depends on age and presentation
  • Past medical history
  • Immunisations
    • Up to date, missed
  • Development
    • What can they do
    • Basic enquiry essential (walking, words, support)
  • Drugs and allergies
    • This illness, regular, previous
  • Family and social history
    • Recent and related health issues
    • Parents/siblings (age and health)
    • Relationship dynamics
    • School and nursery
    • Parental social history – smoking, alcohol, drugs, occupation, stress
  • Addressing concerns and closure
    • ICE
    • Summarise
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4
Q

What does take an age appropriate apprach mean?

A
  • Consider the age and developmental stage
  • Consider language and intellectual skills
    • First engage in non-medical talk such as toys to get an idea
  • Most questions directed to parents, but some for child
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5
Q

What questions should be asked when exploring history of presenting complaint?

A
  • Details depends on age and presentation
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6
Q

What is asked about immunisations?

A
  • Up to date, missed
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7
Q

What should be asked about development?

A
  • What can they do
  • Basic enquiry essential (walking, words, support)
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8
Q

What should be asked about drugs and allergies?

A
  • This illness, regular, previous
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9
Q

What should be asked about family and social history?

A
  • Recent and related health issues
  • Parents/siblings (age and health)
  • Relationship dynamics
  • School and nursery
  • Parental social history – smoking, alcohol, drugs, occupation, stress
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10
Q

What unit do we measure weight in?

A

kg and g, but parents often use lb and ounces

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11
Q

What is:

  • 1lb in kg
  • 1 ounce in lb
  • 1 ounce in g
  • 1 stone in lb
A
  • 1lb is 0.4536kg
  • 1 ounce is 1/16 of 1 lb (28.35g)
  • 1 stone is 14 lbs
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12
Q

What is the normal weight gain of infants?

A
  • About 150-200g/week from week 1 to 6 month
    • Which is an average of 20-30g per day
  • Up to 10% loss in first few days common
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13
Q

What do we measure feed volumes in?

A

ml, but parents often measure in ounces

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14
Q

What is:

  • 1 ounce in ml
  • 1 ounce in pint
  • 1 pint in ml
A
  • 1 ounce is 28.4ml
  • 1 ounce is 1/20th of a pint (568ml)
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15
Q

How much feed should a baby take if:

  • well
  • unwell
A
  • Probably 140-180ml/kg/day
    • 100ml/kg/day if ill
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16
Q

What should you ask about stool?

A
  • Frequency
  • Size, shape, appearance and consistency
  • Difficulties passing
  • Pain on passing
  • Blood or mucus
17
Q

What are you trying to examine in paediatric examination?

A
  • ABCDE and baseline observations/vital signs
  • General conditions and peripheries
  • Respiratory system
  • Cardiovascular system
  • Alimentary system
  • Neurological and MSK systems
  • ENT and skin
  • Developmental skills
  • Measurements and centile
18
Q

What are some tips for paediatric examination?

A
  • Observe first
  • Be friendly and smile
  • Speak to the child (even if they are weeks old)
  • Get down to their level
  • Be careful moving them
  • Show interest in their toys and play
19
Q

Describe the method for examination?

A
  • Use method for that age
  • Start with observation
    • General – appearance, play, interaction, obs
    • Resp – effort, noise, rate, recession, O2, nebs
    • CVS – colour, perfusion
    • GI – feeding, vomit, abdominal distension/movement
    • Neuro – alertness, interaction, play, posture
    • MSK – mobility, limb movements, posture, splints, mobility aids
    • Other – rashes, bruises, infusions, tubes, lines, toys, pictures, cards, games, caffeine, books
  • Progress by area, think by system
    • Hands and arms
      • Warms, cap refill, radial.brachial pulses (rate/rhythm)
      • Clubbing, nail changes, hand skills, pen marks
    • Head and neck
      • Eyes (jaundice), lips (colour, moisture), tongue, nose
      • Scalp changes, bruises, rashes, frontanel
    • Neck
      • Rashes and nodes (easier from front) – size, shape, mobility, position, consistency, symmetry
      • Tracheal tug – don’t push for carotid pulse or trachea
    • Chest and back
      • Murmurs (timing, pitch, quality, location, radiation)
      • Apex beats, thrills, chest expansion
      • Breath sounds (all areas, reduced, symmetry, added)
      • Percussion (limited in infants, not routine)
      • Resonance and fremitus
      • Rashes and skin marks
      • Spine alignment, deformity, sacral dimples)
    • Abdomen and groin
      • Tenderness – watch face and movement
      • Masses and organomegaly (spleen, liver, kidneys)
      • Bowwel sounds and bruits
      • Femoral pulses
      • Hernias (and testis)
      • Genital/anal appearance (routine for children in nappies but not often appropriate for older children)
      • DON’T DO RECTAL EXAM
    • Legs and feet
      • Mobility, changing posture, movements, tone
      • Reflexes, plantars, clonus – babies have primitive reflexes
      • Power, coordination, sensory assessment
      • Pulses, warmth, capillary refill, colour, mottling
      • Rashes, bruises, marks
      • Deformities and gait
20
Q

What are you looking for in the initial examination?

A
  • General – appearance, play, interaction, obs
  • Resp – effort, noise, rate, recession, O2, nebs
  • CVS – colour, perfusion
  • GI – feeding, vomit, abdominal distension/movement
  • Neuro – alertness, interaction, play, posture
  • MSK – mobility, limb movements, posture, splints, mobility aids
  • Other – rashes, bruises, infusions, tubes, lines, toys, pictures, cards, games, caffeine, books
21
Q

What are you looking for in the hands and arms?

A
  • Warms, cap refill, radial.brachial pulses (rate/rhythm)
  • Clubbing, nail changes, hand skills, pen marks
22
Q

What are you looking for in the head and neck?

A
  • Head and neck
    • Eyes (jaundice), lips (colour, moisture), tongue, nose
    • Scalp changes, bruises, rashes, frontanel
  • Neck
    • Rashes and nodes (easier from front) – size, shape, mobility, position, consistency, symmetry
    • Tracheal tug – don’t push for carotid pulse or trachea
23
Q

What are you looking for in the chest and back?

A
  • Murmurs (timing, pitch, quality, location, radiation)
  • Apex beats, thrills, chest expansion
  • Breath sounds (all areas, reduced, symmetry, added)
  • Percussion (limited in infants, not routine)
  • Resonance and fremitus
  • Rashes and skin marks
  • Spine alignment, deformity, sacral dimples)
24
Q

What commens should be made about murmurs?

A
  • Timing
  • Pitch
  • Quality
  • Location
  • Radiation
25
Q

What comments should be made about breath sounds?

A
  • Reduced, symmetry, added
26
Q

What are you looking for in the abdomin and groin?

A
  • Tenderness – watch face and movement
  • Masses and organomegaly (spleen, liver, kidneys)
  • Bowwel sounds and bruits
  • Femoral pulses
  • Hernias (and testis)
  • Genital/anal appearance (routine for children in nappies but not often appropriate for older children)
  • DON’T DO RECTAL EXAM
27
Q

What are you looking for in the legs and feet?

A
  • Mobility, changing posture, movements, tone
  • Reflexes, plantars, clonus – babies have primitive reflexes
  • Power, coordination, sensory assessment
  • Pulses, warmth, capillary refill, colour, mottling
  • Rashes, bruises, marks
  • Deformities and gait
28
Q

Describe the reflexes of babies?

A

Primitive reflexes

29
Q

Why is play important?

A

Play and examination is important:

  • Creative approach needed
  • Let child continue to play as appropriate
  • Select age appropriate toys
    • Use play to illustrate, as a distractor and as a clinical tool
30
Q

Why is knowing your children’s characters useful?

A
  • Helps dialogue with child

paediatrics jenna to sort (37 decks)

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