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Chapter 6 Pediatric Assessment Flashcards

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1
Q

The first step in peds assessment

A

Obtain a History

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2
Q

When obtaining history we want to make sure that?

A

The patient and fam feel that they can trust you.

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3
Q

When interviewing pts or parents, what type of questions do we ask?

A

Open-ended: what brought you to the ER today?

Closed-ended: How high was the fever?

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4
Q

Sequence of assessment for younger children?

A

Foot-to-head & out of sequence allows least distressing parts of the exam to be completed first

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5
Q

Sequence of assessment for older children

A

Older children easily tolerate a more traditional head-to-toe approach.

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6
Q

Approach to Exam: Newborns/Infants <6 months:

A

Keep parents close to aid in the exam

Allow normal activities that do not interfere with the exam (Feeding, Holding, Pacifier)

Alter the sequence of the exam if necessary

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7
Q

Approach to Exam: >6 months:

A

Because of STRANGER ANXIETY, examining the infant in the parent’s lap is often best.

Examining feet & hands may be less anxiety producing then the trunk.

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8
Q

Approach to Exam: Toddlers

A

Toddlers still possess stranger anxiety so keep family present

Demonstrate instruments (i.e., otoscope or stethoscope) to decrease anxiety.

Do NOT ask the child if you can do something; rather, explain what you will do.

Offer choices when possible

Consider less invasive areas (hands & feet) first & more invasive last. (those that require equipment.

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9
Q

Approach to Exam: Preschoolers

A

Assess each child’s willingness to be separated from parents.

Allow the child to examine the equipment prior to use

Allow choices when possible

Use distraction to gain cooperation and provide praise for cooperation

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10
Q

Approach to Exam: School-age

A

Often, school-age children want to help with the exam

By this age a head-to-toe exam is fine

Children this age like to learn about their bodies during exams, and it is fine to teach them and allow participation

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11
Q

Approach to Exam: Adolescents

A

Modesty is often utmost importance during this age

Exam should be conducted without others present unless the child asks otherwise

This is a great time to build rapport and allow the child to ask any private questions

Any time a breast, genitals or an anorectal exam or procedure is done a chaperone should be present

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12
Q

When is length taken?

A

Birth-24 months (Measuring board)

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13
Q

When is the height taken?

A

After age 2 years (stadiometer / Standing)

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14
Q

Head Circumference

A

Done until age 3 years

Measure 2x chart once

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15
Q

Chest Circumference

A

Done until 1 year of age

Measure across nipple line

Useful to compare to head circumference

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16
Q

Is the head 2 cm larger than chest circumference at birth?

A

Yes. Over time the values tend to equal out until 2 years of age when the chest circ. surpasses head circ.

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17
Q

Weight

A

Infant scale, measured in kg/grams, remove clothing, zero scale to account for the diaper & sheet. Standing scale when older.

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18
Q

When does weight double?

A

5-6 months

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19
Q

When does weight triple?

A

1 year old

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20
Q

Neonate HR ? <1yr

A

100-180 awake
80-160 asleep

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21
Q

Infant HR ? 1m-1yr

A

100-160 awake
75-160 asleep

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22
Q

Toddler HR ? 1-3 yr

A

80-110 awake
60-90 asleep

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23
Q

Preschooler HR ? 3-6 yr

A

70-110 awake
60-90 asleep

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24
Q

School-age HR ? 6-12 yr

A

65-110 awake
60-90 asleep

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25
Adolescent HR ? >13 yr
60-90 awake 50-90 asleep
26
How long do we auscultate apical pulse
1 full minute using stethoscope
27
Infant RR
30-60
28
Toddler RR
24-40
29
Preschooler RR
22-34
30
School-age RR
18-30
31
Adolescent RR
12-16
32
In children <6 yo how do we observe RR
We observe the rise and fall of the ABD (rather than the chest).
33
For temp, what is the gold standard?
(Oral temp) in all able children who are able as it is a "core" temp and most reliable.
34
When do we typically do axillary temp?
Usually, <4 years
35
Hypothermia (newborns)
< 36.5 C
36
Hyperthermia (newborns)
>38.0 C
37
Low temps, especially infants, can be indicative of what?
Sepsis! and warrants attention
38
(Blood pressure) For children >1 year old, how do we get SBP?
90 + (2 x age in years) e.g., 90 + 2 X 5 yr = 100
39
Pediatric Hypotension (5th percentile) Est.
Age - Systolic BP Term Neonates - <60mmHg Infants 1 mo-12 mo - <70mmHg Children 1-10 years - <70mmHg + 2x age in years Children >10 years - <90mmHg
40
BP cuff (To large)
= low BP
41
BP cuff (To small)
= high BP
42
General Assessment
"Across-the-room assessment" What is the child's overall appearance? Are they comfortable? Are they in any distress? Does the child appear well-nourished? Does the child appear secure with the parent? What is your gut instinct?
43
Inspection
Observation of the child's physical features and behaviors. Physical feature characteristics include shape, color, movement, position, and location. Detection of odors os also part of the inspection.
44
Palpation
Use of touch to id characteristics include texture, moistness, tenderness, temp, position, shape, consistency, and mobility of masses and organs.
45
Auscultation
Listening to sounds produced by the airways, lungs, stomach, heart, and blood vessels, to identify their characteristics.
46
Percussion
Striking the surface of the body, either directly or indirectly, to set up vibrations that reveal the density of underlying tissues and borders of internal organs.
47
Skin (color)
The color of the child's skin usually has an even distribution. Check for color variations- such as increased or decreased pigmentation, pallor, mottling, bruises, erythema, cyanosis, or jaundice.
48
how to do we eval tugor
pinch the abdomen
49
if there is edema?
Skin feels doughy and boggy.
50
Cap refill
time is normally 2 sec or less and may be checked on hands, feet, or trunk.
51
Primary lesions
The skin's initial response to injury or infection is macules, papules, and vesicles (Pimple).
52
Secondary lesions
Such as scars, ulcers, and fissures are the result of irritation, infection, and delayed healing or primary lesions (scratches or lesions around the pimple)
53
Children have a rounded skull with a...
prominent occipital area
54
How should the anterior and posterior fontanelles feel?
flat and flush/soft
55
A TENSE fontanelle, bulging above the margin of the skull, is an indication of what?
Increased ICP
56
A SUNKEN fontanelle below the margin of the skull is an indication of what?
Dehydration
57
Posterior fontanelle closes by?
2-4 months
58
Anterior fontanelle closes by?
1-2 years (usually 18 months)
59
Conjunctivae should be
pink and glossy
60
Lacrimal punctum should have
No redness or excess tearing should be present
61
Sunset sign
may indicate retracted eyelids or hydrocephalus
62
Normal pupils
round, clear, and equal in size
63
If a white reflex is seen
referred to as leukocoria, and a retinoblastoma may be present.
64
Infant eyes are assessed based on
being able to track objects
65
Snellen chart used for
3-6 yo
66
6 cardinal fields of gaze
test extraocular movements, hold a toy or penlight 12 in from the child's eyes and move it in all six directions.
67
Otoscopic exam up or down?
Children < or equal to 3 PULL PINNA DOWN Children > 3 PULL PINNA UP
68
Nasal flaring
sign of respiratory distress
69
Mouth inspection
Lips, Teeth (# of teeth appropriate for age, dental caries?), Gums and buccal mucosa (lesions = Viral infections), tongue (midline), Palate (cleft palate), throat and tonsils (exudate 0-4 uvula midline)
70
Tonsil size
normal: 1 and 2 Infection: size three and when size four or kissing it can become an airway issue. *mono (the infection)
71
Nodes
moveable and tender
72
sternum protrudes (pigeon chest)
pectus carnatum
73
Funnel chest
pectus excavatum
74
Breathing issue: visible depressions of the tissue between the ribs of the chest wall.
Retractions: This is an indication of increased work of breathing and resp. Distress. They can be mild, moderate, or severe.
75
Another sign of resp. distress
head-bobbing: use of extra muscle to breath
76
Fine crackles
High-pitched, discrete, noncontinuous sounds heard at the END of inspiration; does not clear with cough Cause: Air passing though watery secretions in the smaller airways ( alveoli and bronchioles)
77
Coarse crackles
Loud, lower pitched, more moist or bubbly sound heard during inspiration; does not clear by coughing. Cause: air passing through thicker secretions in the airway.
78
Wheezing
Higher pitched, musical, squeaking, or hissing noise usually heard cont. During INSPIRATION or EXPIRATION. But generally louder with EXPIRATION; does not clear with coughing. Cause: Air passing through thick secretions that partially obstruct the larger bronchi and trachea.
79
Stridor
High pitched, piercing sounds most often heard during inspiration without a stethoscope Cause: Whistling sounds as air passes through a narrowed trachea and larynx, ASSOCIATED WITH CROUP.
80
Cardiac Inspection
should be done sitting and lying down
81
Cardiac palpation
Apical impulse = the point of max intensity, is located where the (L) ventricle taps the chest wall during contraction * pt. over 1 yo you can go radial. Less than 1 yo go brachial.
82
ABD inspection
shape Umbilicus: Observe the newborn's umbilical stump for color, bleeding, *odor, and drainage can be a sign of FILITUS which can lead to sepsis*
83
ABD palpation
1st = Light palpation 2nd = Deep palpation: defines the shape and consistency. If an enlarged kidney or mass os detected, do not continue to palpate the kidney. Pressure on the mass may release cancerous cells.
84
When assessing the GU of a child how can me make them feel better
Position them on the parent's lap with their legs spread apart in a position of comfort. DO THIS LAST!
85
Female GU exam.
Inspect the external genitalia for: color, size, and symmetry of the pubis, labia, urethra, and vaginal opening.
86
Male GU exam.
Inspect the male genitalia for the structural and pubertal development of the penis, scrotum, and testes. For uncirced boys, ask the child or parent to pull the fore back.
87
How do we stimulate the cremasteric reflex.
Touch the inner thigh of each leg. The testicles and scrotum typically rise. Indicates intact function of the spinal cord at the T12, L1, and L2 levels. ABSENT REFLEX CAN INDICATE TESTICULAR TORSION.
88
Tanner Staging
Stages 1-5 indicates the stage of puberty the pt is in.
89
Spine alignment
No lateral curve should be present in either position *scoliosis
90
Hips assessment
Dislocation or subluxation . The same number of folds should be present on each leg.
91
Uneven skin folds can indicate
hip dislocation or difference in leg length (Allens sign)
92
Ortolani-Barlow maneuver
is used to assess for dislocation or subluxation of the hips.
93
End of chapter 6
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Pediatrics (6 decks)

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