ATI 2 - Physical Assessment Findings Flashcards
keep medical equipement…
out of sight
age group to ask whether they prefer if their caregivers stay in or leave during examination
school-age + adolescent
recommended temperature routes for birth-12mo
axillary
rectal if exact measurement is needed
expected temp + age group [6m, 1, 3, 5, 7, 9, 13y]
6m 99.5 1y 99.9 3y 99.0 5y 98.6 7y 98.2 9y 98.1 13y 97.9
recommended temperature routes for 1-7 yr
- axillary
- tympanic
- oral (if cooperative)
- rectal (if exact measure needed)
recommended temperature routes for older than 7yo
- oral
- axillary
- tympanic
Pulse range [newborn, infant, toddler, preschool, school-age, adolescent]
newborn 110-160 infant 90-160 toddler 80-140 preschool 70-120 school-age 60-110 adolescent 50-100
Respiration range [newborn, infant, toddler, preschool, school-age, adolescent]
newborn 30-60
infant/toddler 25-30
preschool/school-age 20-25
adolescent 16-20
expected muscle tone in 4 month old
erect head posture
it is expected that a child makes eye contact when addressed except in…
infants
expected general appearance
- makes eye contact
- erect head
- follows simple commands
- use speech, lang, + motor skills spontaneously
- undistressed, clean, well kept
expected skin
- temp warm or slightly cool
- smooth, slightly dry
- not oily
- elastic skin turgor
- lesions are NOT expected
- symmetric skin folds
expected hair + scalp
- evenly distribtd
- smooth + strong
- clean
- not scaly
assess children approaching adolescence for…
presence of secondary hair growth
stringy, dull, brittle, dry hair is a sign of…
nutritional deficiencies
expected nails
- pink nail bed
- white at tips
- smooth + firm
- —flexible w infants
expected lymph nodes
nonpalpable
-can be small, palpable, nontender, mobile in children tho
expected head
- symmetric
- fontanels should be flat
posterior fontanel closes at
8 wks
anterior fontanel closes at
12-18 months
expected neck
-short in infants
expected conjunctiva
- palpebral fissures
- conjunctiva is pink
- bulbar conjunctiva is transparent
expected lacrimal apparatus
no excessive tearing, redness or discharge
sclera should be ___ and cornea should be ___
white; clear
permanent color manifests around…
6-12 months
visual acuity is difficult to assess in…
children younger than 3yo
how to assess visual acuity in infants
hold object in front of eyes and check if they can fix on object + follow it w eyes
visual acuity tests for kids who cant read letters or numbers
use HOTV or tumbling E test
peripheral visual fields
[upward, downward, nasally, temporally]
upward 50
downward 70
nasally 60
temporally 90
expected extraocular mvmt
- may not be symmetrc in newborns*
- symmetric corneal reflex
- cover/uncover test = equal mvmt
- no nystagmus in 6 cardinal fields
color vision test
ishihara color or hardy-rand-rittler test
expected internal exam
-red reflex present in infants
top of auricles should meet…
outer canthus of the eyes
is cerumen an expected finding?
yes
expected hearing findings [newborn, infant, older children]
newborn: intact acoustic blink reflex to sudden sounds
infants: turn towards sounds
older children: whisper test
white coat on tongue on infants
normal: fr milk, easily removable
not norm: candidiasis, NOT removable
infants should have 6-8 teeth by…
1 yr of age
how many deciduous teeth? how many permanent teeth?
D: 20
P: 32
expected tonsils
infants: might not be visible
children: barely visible to prominent
chest shape
infants: circular; ant post= lateral
children: transverse to ant post is 2:1
ribs in infants
more soft + flexible
-no protrusions or bulges
expected thorax mvmt
no retraction
- irregular rhythm in infants
- 7 or younger, more ab mvmt during resp
expected breath sounds
inspiration longer than expiration
expected breast finding
enlarged in newborns in first few days
in females, breasts typically develop….
bw 10-14 years
-should be asymmetric, have no masses
infant + toddlers have ____ abdomens; children + adolescents have __ abdomens
rounded; flat
the __ testicle hangs slightly lower than the ___
left lower than right
expected spine in INFANTS
- no dimples
- no tufts of hair
- midline
- C-shaped lateral curve
expected spine in TODDLERS
squat w short legs
-protuberant abs
expected spine in PRESCHOOLERS
more erect than toddlers
expected spine in SCHOOL AGED
developed cervical, thoracic, + lumbar curvature like that of adults
expected spine in ADOLESCENTS
midline
-no scoliosis
expected gait
toddlers + young children: bowlegged or locked knee is common
—-feet should face forward
older children + adolescents: steady gait
—even wear on sole of foot
cerebellar function tests are for which age group?
children + adolescents
types of cerebellar function tests
- finger to nose
- heel to shin
- romberg
