Chapter 32: Health Assessment of Children Flashcards
Performing a health history
Demographics: once a rapport between the nurse and the patient has started, sensitive questions can be asked. First obtain the name, nickname birthdate gender address book number caregiver.
Chief complaint and history of present illness
Past history including prenatal perinatal and development problems. Includes medications and menstrual history
Family health history including three generations
Review of systems
Developmental: determine the age when landmarks and control were achieved. Document speech problems.
Functional history includes information about the child’s daily routine including safety, nutrition, activity, television, sleep, sexual practices
Family composition, resources, and home environment. Determine the employment status occupation, income, health insurance, the home and how old it is. Pets
Steps of the physical examination
Inspection. Palpation. Percussion. Auscultation
Obtaining vital signs
Temperature: Tympanic, if younger than three , pull down and back. Child must be three months old.
Temporal: not for 10 palpate for full minute
Respirations: Before 1 year count the abdomincal movements for 1 minute
After 1 year, count the thoracic movements
Blood Pressure: If under three years old, only measure if they have risk factors such as being premature, low birth weight, congenital heart disease, recurrent urinary tract infections or renal disease, malignancy, bone marrow or organ transplants, treatment with medications that raise blood pressure, systemic illnesses, or increased intracranial pressure.
To wide a cuff is a low reading, a narrow cuff gives a high reading.
In children older than one year systolic pressure in the thigh is usually 10 to 40 higher than in the arm.
FLACC scale
For children who are too young to verbally or conceptually quantify their pain, or if there is a language barrier.
Faces scale
Children are older and can express that pain is worsening or improving. Goes from 0 to 5
BMI
For children 2-20
lbs/Inches^2 X703
kg/m^2 x 10000
95% overweight
Variations and causes in skin color
Pallor: anemia, shock, fever, syncope.
Peripheral cyanosis: anxiety, cold, or also with central cyanosis.
Central cyanosis is around oral membranes, hypoxia or circulatory collapse
Jaundice: physiologic or hematapoeitic disease.
Yellowing of the nose palms and soles may result from excess intake of yellow vegetables.
Redness from bruising, exposure to cold, hyperthermia, inflammation, or alcohol ingestion.
Lack of color in the skin, hair, and eyes is related to albinism
Neck
It is short until about four years old. Webbing or excess folds may be associated with Turner syndrome. Lacks next skin occurs with down syndrome. Cranial nerves of 11 by turning head against resistance.
Eyes
Epicanthal folds in Asian, genetic abnormalities, FAS
Absence of pupillary reflex action after three weeks may indicate blindness. Strabismus is crossing of eye and is normal until three months. After six months it should be evaluated. Test cranial nerves three And four by having them follow the six positions of gaze. The absence of red reflex may indicate the presence of cataracts.
Heart
The younger the child the more responsive the heart rate is to activity changes. It increases with fever, fear, crying, or anxiety and decreased sleep, sedation, or vagal stimulation. The point of maximum intensity is located at the third to fourth intercostal space just medial of the child’s midclavicular line until age 4. From age 4 to 6 is at the fourth space at the left midclavicular line. By age 7 it is at the fifth intercostal space left of the midclavicular line. Clubbing of the fingertips or distention of neck veins can be associated with heart disease.
Irregular is normal. Increases with inhalation, decreases with exhalation. Note the location, timing, of a murmur. Systolic murmur is with s1, diastolic with s2. Innocent murmurs are heard 2nd or 4th ic space and are systolic.
Split S2 and sinus arrhythmia is normal
Grading of murmurs
One: barely audible, sometimes heard sometimes not. Usually heard only with intense concentration.
Two: quiet and soft. Heard each time the chest is auscultated.
Three: Audible with intermediate intensity.
Four: audible with a palpable thrill.
Five: Loud, audible with edge of stethoscope lifted off the chest. Six: very loud, audible with stethoscope place near but not touching the chest
Deep tendon reflex
Zero no response 2+ average for 4+ very brisk. The newborn deep tendon reflexes are normally brisk 3 plus. They decreased to average 2+ by four months of age. Absent or sluggish may indicate disease
