History and examination Flashcards
What is part of the introduction to an examination?
WIPE (wash hands, introduce self, cheack pt details, explain & consent)
Should also find out relationship of adult to child
What is looked for in the general inspection?
Activity
Irritability
Colour
Adjuncts around bed
What shows increased respiratory effort?
Resp rate
Recession (subcostal, intercostal, sternal)
Tracheal tug and head bobbing
Accessory muscle use
What do you look for to assess hydration status?
Wet nappies
Mucous membranes
Skin turgor
Cap refill time (central, peripheral)
Normal resp rate & HR in infant (under 1)
30-40 RR
HR 110-160
Normal RR and HR in child aged 1-2
RR 25-35
HR 100-150
Normal RR and HR in child aged 2-5
RR 25-30
HR 95-140
Normal RR and HR in child aged 5-12yrs
RR 20-25
HR 80-120
Normal RR and HR in child over 12
RR 15-20
HR 60-100
What questions do you ask mum in a NIPE?
Labour:
How long since delivery, type of delivery, problems in labour, medications in labour
Mother:
Ant fevers, overall health in pregnancy, Hx of congenital hip dysplasia, eye problems, ear problems, heart problems
Baby:
Preterm/term/post, weight, feeding? Urine within 12 hrs, meconium within 48 hrs, breathing
What overall things do you look for in a NIPE?
Cry
Colour (cyanosis, pallor, jaundice, rashes)
Birth trauma (subconjunctival haemorrhage, forcep marks, cephalohaematoma)
Dysmorphic features (cleft lip, jaw)
Posture, tone and movements
What do you check at the head end?
Cepahlohaematoma, cranium deformities, fontanelles and sutures
Face for dysmorphic features, cleft lip
Feel for cleft palate/high arched palate, suck reflex
Red reflex in eyes
What do you look for in the arms?
Check shoulders are aligned and clavicles
Extend arms
Palmer creases
Count digits
What do you examine for chest/abdomen
Chest: RR, cap refill, resp distress isgns, auscultate heart and lung sounds
Abdo: inspect for distension, scaphoid abdo due to diaphragmatic hernia, umbilical stump, palpate for masses and kidneys
What do you look for in the groin?
Femoral pulses
Genitalia (check testes distended, vulval fusion)
Patent anus
Hip test in NIPE?
Ortolani’s test (flex hips to 90º, turn out to full abduction and apply anteiror force to upper leg. CLICK relocation)
Barlow’s (Adduct hips and flex to 90º, push posteriorly in line of femoral shaft, CLICK dislocation)
What do you check for in the legs in a NIPE?
Extend, check same length Talipes? (club foot) Calcaneovalgus? (abducted forefoot, dorsiflex ankle) Rotation at ankle Count digits
What do you look for on a baby’s back in a NIPE?
Lipomas, port wine stain, mongolian blue spot
Palpate for spinal abnormalities, look for tuft of hair-> spina bifida
What reflexes do you test for in a NIPE?
Grasp
Startle (moro)
What do you say to finish off a NIPE?
To complete my exam I would measure head circumference, length and weigh the baby
I will fully document my findings in the infant’s red book
Summarise
What are the added parts of a paeds hx?
Birth Feeding Growth Development Immunisations
What do you ask about birth?
Pregnancy (problems, maternal illness/drug use)
Place of birth, gestation, weight
Mode of delivery, complications
Resus required? injury? malformations?
Neonatal jaundice? fits? fevers? feeding?
What do you ask about feeding?
Diet and appetite (breast/bottle) Breast: feed every 2 hrs? Bottle: which formula, 150ml/kg/day Weaning 6-12 months puree, mash, solids Solids and cows milk from 12 months
Toileting (training 2-4yrs, dry by day 2 yrs, dry by night 3-4yrs)
Frequency
What do you ask about growth
Look at red book
Puberty if older (11yrs girls, 12 yrs boys)
What do you ask about development? Screen?
Any concerns School progress/attendance Screen Smiling by 6 weeks Sitting by 9 months Turn to sound 6 months First words 18 months Walking 18 months Talking 3 word sentence 3 years
Social history in paeds?
Family unit Anyone who smokes? inside/outside Housing situation Social services involved? Playgroup from age 2, nursery from 3, school 5-16 Hobbies/travel/pets
Name a strategy for consultations with adolscents
H – Home E – Education & Employment A - Activities D – Drugs S – Sexuality S – Suicide/depression
