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
