Approach to the Pediatric Pt Flashcards
What is the best way to accomplish a full and accurate peds exam?
Distraction
What are the red flags for children?
- Sleepy/lethargic
- Not interactive with caregiver (not with you, they don’t like you and that is NORMAL)
- Looking overly tired
- Labored breathing
- Poor color
- PARENTAL CONCERN
A. They know this child best. They called you because something isn’t right (usually)
B. Especially true for kids w/ special needs
What are the red flags for children?
- Sleepy/lethargic
- Not interactive with caregiver (not with you, they don’t like you and that is NORMAL)
- Looking overly tired
- Labored breathing
- Poor color
- PARENTAL CONCERN
A. They know this child best. They called you because something isn’t right (usually)
B. Especially true for kids w/ special needs
How should you approach special needs kids?
- When they say something isn’t right, believe them
- Ask what their normal is
- Kids with special health care needs often have caretakers who know more than we do about their child AND their disease
- Ask lots of questions and listen!
What is the general approach to a well child exam?
- Observe child before touching him/her
- Keep child w/parent or caretaker
- Keep child warm & cozy
- No baby talk, but speak in simple terms
- Tell child what you are doing & include him/her in the process
- Save painful parts for last
- TELL THE TRUTH
What is the sequence of motor development?
- Newborns: Primitive reflexes, fixing gaze, flexed posture (fisted hands normal)
- 2 months: Smiles, less flexed, visually tracks
- 4 months: Hands to midline, rolls front to back
- 5 months: rolls back to front
- 6 months: sits, unilateral reach, raking grasp
- 8 months: crawls, immature pincer grasp
- 9 months: cruises (walks along furniture), claps
- 12 months: walks w/ help
What is the sequence of social/language development?
- Newborn: cries to communicate ALL needs
- 6 weeks: social smile
- 2 months : Coos (musical long vowels)
- 6 months: Babbles (repetitive consonants)
- 9 months: Says Ma Ma & Da Da, object permanence
- 12 months: Understands much, says 2 words
- 18 months: 10 words, maybe many more
- 2 years: 2 word sentences
- 3 years: 3 word sentences
I can wave bye bye, I can crawl well and I say Ma Ma and Da Da.
What age am I?
9 months
I can smile and coo. I can roll from front to back. I can’t sit alone or crawl. What age am I?
4 months
I can walk while holding a hand, I can say 3 words, I am very weary of strangers, & I can’t be reasoned with. What age am I?
12 months
What is the best way to distract young infants?
Anything shiny or moving, not visually complex
What is the best way to distract older infants?
Any calculator or cell phone, video, pat-a-cake, peek a boo, this little piggy…
What is the best way to distract toddlers?
Show a video, ask about TV shows/characters they like, what color is your shirt, do you like sprinkles on your ice cream, do you know how to ride a tricycle?
What is the best way to distract school age kids?
Sports they play, pet name, siblings names, what they want to be when they grow up?
What is the best way to distract school age kids?
Sports they play, pet name, siblings names, what they want to be when they grow up?
What are the general approaches for examining an infant?
- Don’t touch them right away
A. You’ll learn most of what you need observing their behavior
B. Do not place them on the table to examine them until necessary
C. Start w/ non-invasive exam techniques (save ears & throats for last)
D. Easy to distract at this age, but they WILL need to be restrained for part of the exam
E. Use the parents
What are the general approaches for examining a toddler?
- They will watch you
- They are curious & afraid of you
A. Reassure them. Speak gently & don’t make your first contact be w/ exam. Comment on their cute PJ’s. Give them a high five. Play. - Don’t trick them…Tell them what you are doing!
A. You need to examine them, speak in their terms.
B. “Look! I have a cool flashlight…I have to look in your ears. Which one do you want me to look in first?”
C. IT IS VERY HELPFUL TO ALWAYS PROVIDE THEM WITH A CHOICE! Bed or lap, right or left ear first,
lay down or sit up? - Be prepared for poor cooperation (expected & normal)
- START w/ discussion (ask about their favorite cartoon, show them your otoscope while you auscultate, keep them in their parents lap)
- Give them something to play with
- GIVE THEM OPTIONS
A. Do you know where the stethoscope goes? Should I listen to the front or back of your chest first? Do you want to stay on Mommy’s lap or on the bed?
What are the general approaches for examining older kids?
- Cooperation is your only real option for a good examination
- Gain their trust
- Be straightforward and include them in their care
- They can provide information & answer questions
- Respect their choices
how should you approach painful procedures?
- BE HONEST!!! Use accurate, clear terms that the child can understand
A. You can tell them it will be a little pinch or will hurt for a few seconds but DON’T tell them it won’t hurt if it will. Your credibility & the child’s trust will be lost.
B. Don’t explain to a 2 year old that you need to apply oxygen. Tell them you have a cool windy mask for them to try. Tell them it doesn’t hurt & they can hold it there if they want.
C. Let child help w/ minor procedure (TC, Liq. Nit.) - NEVER, EVER, under any circumstances LIE.
how should you approach painful procedures?
- BE HONEST!!! Use accurate, clear terms that the child can understand
A. You can tell them it will be a little pinch or will hurt for a few seconds but DON’T tell them it won’t hurt if it will. Your credibility & the child’s trust will be lost.
B. Don’t explain to a 2 year old that you need to apply oxygen. Tell them you have a cool windy mask for them to try. Tell them it doesn’t hurt & they can hold it there if they want.
C. Let child help w/ minor procedure (TC, Liq. Nit.) - NEVER, EVER, under any circumstances LIE.
What are the normal heart rates for peds?
Newborn - 3 mo 80 - 205 bpm 3 mo- 2 yr 75 – 190 bpm 2 -10 yr 60 – 140 bpm >10 yr 50 -100 bpm
What are the normal resp rates for peds?
Infant (birth - 12 mo) 30 - 60 Toddler (1 - 2 yr) 24 - 40 Preschoolers (3 -4 yr) 22 - 34 School Age (5 -12 yr) 18 - 30 Adolescent (13 -19 yr) 12 - 16
What are the general activity levels for kids?
- A febrile sick adult can usually verbalize what’s wrong & how badly they feel
- A sleepy, sick, febrile baby can be difficult to differentiate from a normal baby w/ a fever at nap time
A. “Give the child Ibuprofen &/or acetaminophen & reassess
B. If you’re worried, you can be aggressive initially & back off from your initial plan if the child becomes well appearing
What are the 3 big things to remember for kids?
- General Appearance
- Respiratory effort & energy level
- Circulation
What are the 3 big things to remember for kids?
- General Appearance
- Respiratory effort & energy level
- Circulation
How is difficult upper airway breathing treated?
STRIDOR (racemic epinephrine)
How is diffuclt lower airway breathing treated?
WHEEZING (albuterol)
