Approach to Assessing Children Flashcards

1
Q

What is the general approach to paediatrics?

A

Holistic multi-system approach

  • More than one problem may exist
  • More than one system may be involved
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2
Q

Why is age important to consider in paediatrics?

A
  • Guides approach to history taking and examination
  • Common pathologies differ
  • Conditions manifest differently at different ages
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3
Q

What is different from adults in the approach to children?

A
  • Parents/carers will be present
  • Play is essential and clinically helpful
  • Specialised nursing staff ( different rations, understandably protective, experienced at recognising sick children)
  • Treatments may differ by weight and age
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4
Q

What questions may you think about when preparing for a paediatric encounter?

A
  • Why have they come to see you or been referred to the hospital or clinic?
  • Do you know the child’s name age and sex?
  • Do you have an opportunity to observe the child before “starting” your assessment?
  • What is the likely differential diagnosis?
  • What conditions do you need to rule out?
  • What information have the nurses gathered?
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5
Q

Why is it important to take a good history?

A
  • Key step to making a diagnosis
  • Gather important information
  • Potentially rule out significant pathology
  • Help target examination
  • Facilitates in dealing with concerns and anxieties
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6
Q

What are the key stages of a paediatric history?

A
  • Introduction
  • Presenting complaint
  • History of presenting complaint
  • Birth history
  • PMH
  • Immunisation
  • Development
  • Drugs and allergies
  • Family history
  • School and nursery
  • Parent social history
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7
Q

How much weight should a baby gain?

A
  • 100g per week for 1st 6 months
  • 20-30g per day
  • Up to 10% loss in the first few days is common
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8
Q

How much feed should a baby take?

A

Probably 140-180ml/kg per day

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9
Q

What should you ask about a baby/child’s poo?

A
  • Nappies vs toilet trained
  • Frequency
  • Size, shape, appearance and consistency
  • Difficulties passing
  • Pain on passing
  • Blood or mucus
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10
Q

What are the 2 ends of the Bristol stool chart?

A
  • Type 1 is hard pellets

- Type 7 is entirely liquid

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11
Q

How can concerns be addressed and a closure to a consultation be achieved?

A
  • What made them come to see you today?
  • What concerns do they have?
  • What were they looking to understand?
  • Summarise key features
  • Check understanding and safety net
  • Document history and discussions
  • Note date, time, who was present/ gave history
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12
Q

What should be examined in paediatrics?

A
  • ABCDE and baseline observations/ vital signs
  • General condition and peripheries
  • Respiratory system
  • Cardiovascular system
  • Alimentary system
  • Neurological and musculoskeletal systems
  • ENT and skin
  • Developmental skills
  • Measurements and centile
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13
Q

How can an examination be commenced in paediatrics?

A
  • Observation first
  • Be friendly and smile
  • Get down to child’s level
  • Speak to the child
  • Be careful moving them
  • Gentle handling and gradual exposure
  • Show interest in toys and play
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14
Q

What do you observe for in paediatrics?

A
  • General: Appearance, play, interaction, obs
  • Resp: Effort, noise, rate, recession, O2, nebs
  • CVS: Colour, perfusion
  • GI: Feeding, vomit, abdo distension/ movement
  • Neuro: Alertness, interaction, play, posture
  • MSK: Mobility, limbs movements, posture, splints, mobility aids
  • Other: Rashes, bruises, infusions, tubes, lines
  • Other: Toys, pictures, cards, games, caffeine, books
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15
Q

What examination of the hands and arms is done in paediatrics?

A
  • Warmth, cap refill, radial/brachial pulses (rate/ rhythm)

- Clubbing, nail changes, hand skills, pen marks

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16
Q

What examination of the head and face is done in paediatrics?

A
  • Eyes (jaundice), Lips (Colour, moisture), Tongue, Nose

- Scalp changes, Bruises, Rashes, Fontanel

17
Q

What examination of the neck is done in paediatrics?

A
  • Rashes and Nodes (easier from the front); size, shape, mobility, position, consistency, symmetry
  • Tracheal tug (Don’t push for carotid pulse or trachea)
18
Q

What examination of the chest and back is done in paediatrics?

A
  • Murmurs (Timing, pitch, quality, location, radiation)
  • Apex beat, thrills, chest expansion (limited if wee)
  • Breath sounds (all areas, reduced, symmetry, added)
  • Percussion (limited in infants, not routine, commonly forgotten when dealing with pneumonia)
  • Resonance and fremitus? (most are pre-school!)
  • Rashes and skin marks (inc neuro-cutaneous)
  • Spine alignment, deformity, sacral dimples
19
Q

What examination of the abdomen and groin is done in paediatrics?

A
  • Tenderness- watch their face and movement
  • Masses (esp stool) and organomegaly (liver, spleen, kidneys). Thumb can be used to feel
  • Bowel sounds and bruits (v.rare)
  • Femoral pulses (essential in infants)
  • Hernias (and testis)
  • Genital/ anal appearance (routine in nappies but often not appropriate for older children)
  • DON’T DO A RECTAL EXAM! (Senior staff only)
20
Q

What examination of the legs and feet is done in paediatrics?

A
  • Mobility, changing posture, movements, tone
  • Reflexes (easy when v. young), plantars, clonus
  • Power, coordination, sensory assessment if older
  • Pulses, warmth, cap refill, colour, mottling,
  • Rashes, bruises, marks
  • Deformities and gait usually evident on inspection