Ch 4- Communication, Physical & Developmental Assessment

Question 1

Communicating & Interviewing

Answer 1

> Establishing the setting
- Introduction
- Ensure privacy and confidentiality
- Appropriate computer & phone communication

Question 2

Communicating & Interviewing

Answer 2

> Cultural considerations
- Interview w/o judgment
- Using silence
- Clear communication
- Provide anticipatory guidance
- Use appropriate interpreters

Question 3

Communication Parents/Caregivers

Answer 3

> Encouragement during interviewing
Directing the focus
Cultural awareness
Listening/using silence
Empathy
Providing anticipatory guidance
Avoiding blocks and information overload
Using an interpreter

Question 4

Communication Techniques

Answer 4

> Play
Developmentally appropriate creative techniques

> Verbal - 1 messages, 3rd person

> Non-verbal- writing or drawing

Question 5

History taking

Answer 5

> Chief complaint
Present illness
HX: Birth, Dietary, illness, Injuries, hospitalizations, surgeries, allergies, medications, immunizations, growth and development, sexual hx for adolescents, and psychosocial and personal status

Question 6

Review of system

Answer 6

General
Skin
HEENT
Chest
Respiratory
CV
GI
GU/GYN
Musculoskeletal
Neurologic
Endocrine

Question 7

Nutritional Status Exam

Answer 7

Dietary Hx
24-hr recall
Food diary
Anthropometric measures
Assess general growth
- wt, ht, head circumference, BMI

Body system
- Skin & hair
- HEENT
- Chest
- Abdomen
- Neuro

Question 8

Examining the child

Answer 8

> USe developmental and chronologic age as main criteria for assessment sequence

> Prepare the child to ensure Atraumatic Care

> Use guidelines for positioning children of various ages

Question 9

Physical exam

Answer 9

Growth measurements
- Key element in evaluating the health of children
. Ht/length
. wt
. skinfold thickness and arm circumference
. Head circumference (HC)
. BMI (age > 2 years

> Documentation on growth charts

Question 10

Physiologic Measurement

Answer 10

> temp

> Method of measurement
- oral
- rectal
- axillary
- tympanic
- temporal artery

> Various devices for measurement
Measurement based on potential age, development, and illness severity

Question 11

Physiologic Assessment

Answer 11

> Pulse
- <2 years, measure APICAL for 1 full minute
- Grade pulses
- Compare radial and femoral pulses during infancy

> Respiration
- Breathing is diaphragmatic and irregular

> Blood Pressure
- USE CORRECT CUFF SIZE
- Annually after age 3 years using auscultation
- Automated devices in newborns and infants

Question 12

Infant and Toddler VS measurement

Answer 12

> Count respirations FIRST (before disturbing the child)

> Count apical heart rate SECOND
Measure blood pressure (if applicable)

> THIRD
Measure temperature LAST

Question 13

Physiologic Assessment

Answer 13

General Appearance
Physical appearance
State of nutrition
Behavior
Personality
Interactions with parents, siblings, and nurse
Posture
Development
Gross motor
Fine motor
Language
Social skills

Question 14

Physiologic Assessment

Answer 14

SKIN
Color
Texture
Temperature
Moisture
Turgor
Lesions or rashes
Accessory Structures
Hair and scalp
Nails
Palms

Question 16

Physiologic Assessment

Answer 16

Head and Neck
Shape and symmetry
Head control and range of motion
Suture lines, fontanels, swelling
Anterior fontanel closes between 12 -18 months
Face for symmetry, movement and, appearance
“Make a face”
Neck for size, movement, range of motion, and skin folds

Question 17

Physiologic Eyes Assessment

Answer 17

Eyes
Inspect for placement of eyes, symmetry, and lids
Assess conjunctivae and sclera
Assess pupils for size, shape, movement, and accommodation
Check for Red Reflex bilaterally
Vision acuity
Light perception, fix, and follow (infants)
Snellen test (after age 3 years)
Peripheral vision
Check ocular Alignment
Cover test

Question 18

Physiologic Ears Assessment

Answer 18

Ears
Inspect external structure
Alignment
Pinna
Pits/openings/tags or sinuses
Hygiene
Inspect internal structure
Assist to provide atraumatic exam
Assess tympanic canal
Tympanic membrane
Light reflex and bony landmarks
Auditory testing

Question 19

Physiologic Nose, Mouth Assessment

Answer 19

Nose
Placement and alignment
Internal structures
Mucosal lining, turbinates, septum
Testing for smell
Mouth and Throat
Lip color, moisture, symmetry
Tongue movement and appearance
Buccal mucosa color, moisture, ulcers
Teeth, gingiva, mucous membranes
Tonsil size, uvula and oropharynx color, moisture

Question 20

Chest/Lungs Assessment

Answer 20

Chest
Inspect size, shape, symmetry, movement
Bony landmarks
Breast development (Tanner staging)
Lungs
Respiratory effort
Rate, rhythm, depth, and quality
Breath sounds
Percussion quality

Question 21

Heart

Answer 21

Heart
Apical impulse and PMI
Assess rate, rhythm, sound (murmur)

Question 22

Back

Answer 22

Spine and Extremities
General curvature of the spine
Assess for tuft, hair, dimples, or skin discoloration on lower back
Inspect for
Deformity of hands, feet, limbs
Symmetry of limbs
Movement and range of motion of limbs
Assess joints and muscles
Strength
Movement
Range of motion
Gait, posture

Question 23

Abdomen

Answer 23

> Abdomen
Four quadrant approach

> Inspection
Size, shape, skin covering abdomen
Peristaltic waves
Umbilicus size, hygiene, hernias

> Auscultation
Presence of bowel sounds

> Palpation using atraumatic approaches
Superficial
Deep palpation
Femoral pulses

Question 24

Genitalia

Answer 24

> Genitalia
Use “Matter of fact” approach
Ensure privacy (drape)
Reinforce self-exam, safety, and hygiene

> Anus
Gluteal folds
Anal reflex

Question 25

Neurological Assessment

Answer 25

> Physical, behavioral, and emotional assessment throughout the exam

Cerebellar function
- Balance and coordination

> Reflexes
- Consider the persistence of primitive reflexes, loss of reflexes, and hyperactivity of deep tendon reflexes

> Cranial nerves
See Table 4-11 for strategies of assessment