Assessment Flashcards
Infants: communication
Communicate through nonverbal and crying
Respond to non verbal behavior of adults - rocking, holding, patting
Respond well to gentle physical contact
Older infants = separation and stranger anx
<6 mo tolerate lying on exam table; >6 mo let sit on parent’s lap
Conduct exam so they can see parent or be held by parent
Allow security object
High pitched, soft voice and smile
Toddlers: communication
Can’t effectively verbally communicate
Interpret literally - use short concrete terms, repeat explanations and descriptions, visual aids (puppets, dolls), allow them to handle any equipment you will use, allow comfort object, allow access to parent
Pre-schoolers: communication
More sophisticated verbal communication, intuitive reasoning, older like to conform, know most external body parts, may be interested in parts of assessment, allow them to handle equipment and answer questions, modest - expose minimally, allow to undress themselves, allow opportunities for questions, parental proximity important
School ages: communication
Think in concrete terms at more sophisticated level, can rely on past experiences with providers to guide them, fear injury or embarrassment, allow time for composure and privacy, use simple diagrams and teaching dolls, curious about function of equipment and usefulness
Adolescent: communication
Sophisticated verbal communication even if behavior may not indicate, may respond with monosyllables, anger or other behaviors, nurse may have to talk more, helpful to ask what they know about health and explain rationale for assessment, privacy and confidentiality - can perform away from parents, preoccupied with body image and function - give feedback from assessment, diagrams and models can enhance feedback, avoid too abstract/technical/detailed
Parents
Broad Q’s, save more focused and closed Qs for later, listen without interrupting, involve parents, avoid overwhelming, provide recognition, praise, reassurance for strengths
Health hx
Intro and explanation, demographic area, chief concern, H/O chief concern, health and fam profile, day hx, past health hx (include pregnancy), fam health hx, review of systems
Conclude: is there any more about ___ that we should know?
Preparation
Be prepared in entirety before approaching child
Supplies: thermometer, stethoscope, tongue depressor, sphygmomanometer, tape measure, tuning fork, reflex hammer, rubber gloves, client gown, toys for distraction - stickers, bubbles, etc
Body measurements
Important for detecting disease processes or abnormalities
Height: growth chart
Weight: use table scale for <2; use sale paper to decrease infection spread; weigh infant nude; never leave child alone on scale; plot on growth chart
Body measurements: head circumference
Brain growth and potential neuro function
Measured at birth and at check ups until age 1
Above eye brows and most prominent part of back of head
Plot on growth chart
Should correlate with child’s length
Body measurements: abdominal girth
Detect disease
Not usually in outpatient setting
Largest portion - usually at naval
Vital signs
Temp: same limits as adult; axillary, oral, tympanic, rectal, temporal
Pulse: measure when child at rest; infant = brachial or apical; toddlers and older = radial, brachial, or apical; best accuracy = measure for 1 min
Respirations: measure when undisturbed or at rest
BP: >3 is routine in outpatient, correct cuff size
Mental
Alert, oriented, memory intact
Cognitive
Age related changed in mental activities
Piaget stages: intuitive, concrete operational, formal operational
Developmental: Denver II screening test
Widely used
Series of standard tasks 0 - 6, compare to children of same age
Personal, social, fine motor, adaptive, lang, gross motor
Integumentary
Assess in conjunction with examination of each body system
Temp, texture, presence of lesions, color, turgor, lymph nodes
Head and neck
Head circumference, symmetric, fontanelles - soft and flat (posterior = 2 mo; anterior = 18 mo), head control at 4 mo, thyroid - nml not to palpate until adolescence
Eyes
Permanent eye color by 1 yr
Appearance: position, conjunctivae, sclera, lids - stork bite mark
Vision: 1 mo can fixate and follow object, 3 mo can follow across midline, snellen = 3+
Nose
Infants obligate nose breathers, symmetric, odor, color, patency, signs of drug use, flaring, drainage, mucosa (pink and moist)
Ears
Position, drainage, pain
Inspect: down and back under 2
Hearing: infant = use bell or other sound behind back and watch for reaction; preschooler = softly speak command; school age = whisper or audio testing
Mouth and throat
Teeth: first at 6 mo, all 20 decisions by 2.5 - 3 yrs, begin to lose at 6, dental caries
Membranes - pink, moist, lesions, tonsils red?
Drainage, thrush
Protruding tongue and uvula midline
Sucking of infant
Lips - pink and moist
neck
Symmetry, trachea midline
Palpate for lymph nodes
ROM
Adolescents: palpate thyroid gland for symmetry and possible nodes
Thorax and lungs
Shape: round in infants and young children, flattens at 6 yrs - symmetry
WOB: retractions, accessory muscles, rate, labored
Type of breathing: diaphragmatic - abd rises <7
Breath sounds: warm stethoscope; rattle or strider (high pitched crow), wheezing, grunting (indicated force of muscles)
Breasts: newborns may be swollen bc maternal hormones and have clear drainage, many begin development at 8 yrs, instruct on BSE at 14 yrs or tanner stage V, school age males may develop gynecomastia
Cardiovascular
Auscultate: listen early before they cry - rhythm, murmurs, rate
Assess pulses: radial, pedal, femoral, equality, rate, strength
Abdomen
Contour: potbelly okay until puberty
Always begin with inspection then auscultation palpation
Bowel hx
Inspect for umbilical, inguinal, femoral hernias - coughing may make more noticeable
Listen for bowel sounds and bruits
Palpate for tenderness or masses - may be ticklish (place their hands underneath yours
Genitalia
Do last!
Size - swelling, skin integrity, adhesions, genitals same size until puberty
Anus: fissures, rash, prolapsed scratch marks and bruises, use smallest finger to palpate
Male: testicles - L lower than R, undescended, hydrocele = fluid filled sac in scrotum, varicocele = enlarged vein of epididymis; penis - hypospadias = opening under surface of penis, epispadias = opening on upper surface of penis; instruct males at puberty about TSE
Female: Pap smear at 18 or if sexually active
Musculoskeletal
Gait, symmetric movements
Joints - movement, tenderness, swollen
Symmetry and curvature of spine
Clubbing of fingers
Neurological
Full neuro exam not routine
DTRs
Superior reflexes
General motor function
Pain assessment
Assess brain function - follow directions, oriented, behavior
