Children and Older Adults Flashcards
Exam techniques for infants
Perform less invasive maneuvers early an distressing ones near end of exam
- Auscultate heart/lungs early
- ears/mouth/abdomen end
- Examine painful areas last
Tests for newborns at birth
Apgar score – at 1 & 5 min after birth
- Classify neurologic recovery from the stress of birth and immediate cardiopulmonary adaptation to extrauterine life
Skin inspection for infants
- Sutures and fontanelles
- Skull symmetry/circumference
- Facial symmetry
- Chvostek sign (tap zygomatic bone in front of ear
- facial grimacing +
Examination of the newborn - steps
- Careful observation before (and during) the examination
- Heart
- Lungs
- Head, neck, and clavicles
- Ears and mouth
- Hips
- Abdomen and genitourinary system
- Lower extremities, upper extremities, back
- Eyes, whenever they are spontaneously open or at end of examination
- Skin, as you go along
- Neurologic system
- reflexes with finger rather than reflex hammer
Scrotal/testicular examination for newborns
- Palpate the testes, if they are up in the inguinal canal milk down toward the scrotum. Should be 10mm wide x 15mm length and in the scrotal sac most of the time
- Cryptorchidim – undescended testes – appears underdeveloped and tight, palapation reveals absence of scrotal contents
- Examine for swelling
- Does it transilluminate –> hydrocele
Inguinal hernia? –> does not transilluminate
Acrocyanosis
Bluish discoloration appearing on the palms and soles.
Caused by spasm of the small blood vessels within the skin, usually in response to cold or emotional stress. Can also be cardiac or respiratory problem.
Jaundice
skin yellowing, physiologic occurs in 2-5 days of life, progresses head to toe
Miliaria Rubra
Scattered erythematous papules, vesicles, or pustules, usually on the face, neck and trunk, result from obstruction of the sweat gland ducts; disappears spontaneously within weeks.
Erythema toxicum
Rash – erythematous macules with central pinpoint pustules on erythematous base, scattered diffusely over the entire body. Disappear in 1 week.
Transient neonatal pustular melanosis
more common in black infants, the rash presents at birth as some combination of pustules, scale, and hyperpigmented macules. The pustules and scale resolve by around 2 weeks, leaving behind hyperpigmented macules that resolve after several months.
Milia
Pinhead-sized white, pearly papules, without surrounding erythema, on the nose (seen here), chin, and forehead result from retention of sebum in the openings of the sebaceous glands. Although occasionally present at birth, milia usually appear within the first few weeks and disappears over several weeks.
Eyelid patch
Birthmark to eyelid, fades within 1st year of life
Salmon patch
“stork bite” – splotchy pink mark fades with age
Café au lait spots
light-brown pigmented lesions usually have borders and are uniform. They are noted in more than 10% of black infants. If more than five café-au-lait spots exist, consider the diagnosis of neurofibromatosis
Congenital dermal melanocytosis
blue patch to legs or buttocks of dark skin babies.
Developmental milestones at 12 months
Gross motor - stands independently, starts taking first steps
Fine motor - scribbles, holds crayon, makes tower with 2 cubes
Language - says one word with meaning, points to get objects, follows one step commands
Social/emotional - Shows objects to parents to share
Developmental milestones at 15 months
Gross motor - stoops to pick up toys, climbs on furniture, runs with stiff legs
Fine motor - uses spoon with some spilling, places 10 cubes in a cup, turns book pages
Language - 3-5 words, mature jargon speech, points to one body part
Social/emotional - shows empathy, gives hugs on request
Developmental milestones at 18 months
Gross motor - creeps down stairs, runs well
Fine motor - makes 4 cube tower, imitates vertical stroke
Language - uses 10-25 words, points to 3 body parts, points to self, familiar people
Social/emotional - engages in pretend play
Developmental milestones at
Gross motor -
Fine motor -
Language -
Social/emotional -
Developmental milestones at 24 months
Gross motor - walks downstairs holding rail, both feet on one step, kick ball
Fine motor - imitates horizontal line, opens door knob, sucks through straw
Language - 2 word sentences, uses 50+ words, has 50% intelligibility, refers to self by name
Social/emotional - parallel play
Developmental milestones at 30 months
Gross motor - walks up stairs holding on - alternating feet, jumps in place
Fine motor - makes tower with 8 cubes, wash hands, brush teeth with help
Language - refers to self with correct pronoun, understands action words, understands prepositions
Social/emotional -imitates adult actions (cooking, phone, cleaning)
Developmental milestones at 3 years
Gross motor - goes up stairs without holding on - alternating feet, pedals tricycle
Fine motor - copies circule, strings small beads, draws 2-3 part person
Language - uses 3 word sentences, 75% intelligibility, understands negatives, knows own gender
Social/emotional - Starts to share, imaginative play, fears imaginary things
Developmental milestones at 4 years
Gross motor - balances on one foot for 8 seconds, throws ball overhand, catches bounced ball
Fine motor - copies square, goest to toilet alone, draws 4-6 part person
Language - 100% intelligible, follows three step commands, understands adjectives
Social/emotional - has a preferred friend, imaginative play, labels feelings, group play
Developmental milestones at 5 years
Gross motor - walks down stairs alternating feet, hops on one foot, skips
Fine motor - copies triangle, cuts with scissors, writes first name
Language - 6-8 word sentences, counts to 10, knows telephone number, retells stories, enjoys rhyming words
Social/emotional - has a group of friends, apologizes for mistakes
Tanner staging
objective classification system to document and track the development and sequence of secondary sex characteristics of children during puberty.
Stage 1 - preadolescent
Stage 2 - sparse growth of long, slightly pigmented hair
Stage 3 - Darker, coarser, curlier hair spreading sparsely
Stage 4 - Coarse and curly hair as in adult (greater area than 3)
Stage 5 - hair in adult quantity and quality spreads to thighs
Turner syndrome and its symptoms
One of the X chromosomes is missing or partially missing
Symptoms:
- Short height
- Failure of ovaries to develop
- Heart defects
- Wide, weblike neck
- Broad chest, wide spaced nipples
- High, narrow palate
- Arms turn out at elbows
- Slowed growth
- Receeding or small jaw
- Short fingers/toes
Developmental elements
- physical
- gross
- motor
- social
- emotional
- cognitive
Presbyopia
unable to see near objects with age due to loss of elasticity of the lens
Presbycusis
gradual hearing loss associated with aging (usually after 50)
TRAP test
Test for parkinson’s disease. Looks at:
T- tremor
R - rigidity
A - akinesia
P - posturual instability
Cognitive Assessment in the Elderly
Three D/s
- Delirium – acute confusion state characterized by sudden onset, fluctuating course, inattention, alteration of consciousness.
- Dementia – declines in memory and cognitive ability that interfere with activities of daily living.
- Depression – men have increased risk for suicide
Physiologic changes associated with the aging process
- pupil size
- Decreased arm swing and spontaneous movements
- Increased leg rigidity
- Abnormal gait
- Presence of snout and grasp reflexes
- Decreased toe vibratory sense
Pain assessment for older adults
- In older adults pain is less severe, guarding and rebound tenderness may be diminished or absent
Alcohol recommendations for older adults
Max 2 drinks per day, 7 max per week
10 Minute Geriatric Screener
- Vision - difficulty with actives due to eyesight? –> snellen eye chart <20/40
- Hearing - test 1000 and 2000 dB test
- Timed Get up and Go test - rise from the chair, walk 10 feet, turn walk and sit back down - less than 10 seconds
- Urinary incontinence - incontinent in last year, incontinent >6 times
- Nutrition/weight loss - lost 10 lbs in 6 months without trying
- Memory - three item recall
- Depression - assess
- Physical disability - strenuous activity, heavy work, shopping, get to places, bathe, dress yourself.
The Joint National Committee (JNC) guidelines for blood pressure
For adults aged ≥60 years, the eighth Joint National Committee (JNC8) recommends blood pressure targets of ≤150/90 but notes that if treatment results in SBP <140 and is “well tolerated and without adverse effects to health or quality of live, treatment does not need to be adjusted
