Infant, Child, Adolescent (Exam 3) Flashcards
APGAR Score
AT 1 AND 5 MINUTES
provides evidence of newborns immediate adaptation to extra uterine life
*max: 10 points
*7 or less needs attention!
*min: 0 (needs reanimation)
APGAR
APPEARANCE
2: pink
1: extremities blue
0: pale of blue
APGAR
PULSE
2: >100 BPM
1: <100 BPM
0: no pulse
APGAR
GRIMACE
2: cries and pulls away
1: grimaces or weak cry
0: no response to stimulation
APGAR
ACTIVITY
2: active movement
1: arms, legs flexed
0: no movement
APGAR
RESPIRATION
2: strong cry
1: slow, irregular
0: no breathing
Sequence of Infant Assessment may be reordered based on…
• infants sleep and wakefulness state
• physical condition
• infant is supine on warning table with overhead heating unit
Infant Assessment Sequence Step 1
VITALS
HR, RR, temp
Infant Assessment Sequence Step 2
MEASUREMENT
weight, length, head circumference
Infant Assessment Sequence Step 3
APPEARANCE
• body symmetry, spontaneous position and movement, flexion of head and extremities
• skin color and characteristics, any obvious deformities
• symmetry and positioning of facial features
• alert, responsive affect
• strong, lusty cry
Infant Assessment Sequence Step 4
CHEST AND HEART
inspect, palpate, auscultate
Inspecting the chest and heart of an infant
Inspect…
• skin condition, chest configuration, nipples, breast tissue
note movement of abdomen with respirations and any chest retractions
Palpating the chest and heart of an infant
apical impulse (note location), chest wall (thrills), tactile fremitus if the infant is crying
Auscultating the chest and heart of an infant
• breath sounds
• heart sounds in all locations
• bowel sounds in abdomen and chest
Infant Assessment Sequence Step 5
ABDOMEN
inspect, palpate, percuss
Inspecting the abdomen of an infant
• shape of abdomen and skin condition
• umbilicus (count cord vessels, condition of cord/stump, detection of hernia!!)
• skin turgor
Palpating the abdomen of an infant
light palpation to note muscle tone, liver, spleen tip and bladder
deep palpation to note kidneys and potential masses
femoral arteries and inguinal lymph nodes!
Percussing the abdomen of an infant
all quadrants!
Infant Assessment Sequence Step 6
HEAD AND FACE
palpate, inspect, opening neonate eyes
NOTE MOLDING AFTER DELIVERY, SWELLING ON CRANIUM, BULGING OF FONTANELLE WITH CRYING OR AT REST!!
Palpating the head and face of an infant
fontanelles, suture lines, and any swellings
Inspecting the head and face of an infant
positioning and symmetry of facial features at rest and while infant is crying
How to open neonates eyes
• support head and shoulders
• gently lower baby backward OR ask parents to hold baby over their shoulder while you stand behind the parent
Infant Assessment Sequence Step 7
EYES, EARS, NOSE
Inspecting the eyes of an infant
• inspect the lids (edematous in the neonate), palpebral slant, conjunctivae, any nystagmus, and any discharge
• elicit pupillary reflex, blink reflex, and corneal light reflex using penlight (assess movement and tracking of light)
• elicit red reflex using an ophthalmoscope
Inspecting the ears of an infant
• inspect size, shape, alignment of auricles, patency of canals/any extra skin tags or pits (note startle reflex in response to a loud noise)
• defer otoscopic exam until the end of the exam
Inspecting the nose of an infant
• determine patency of nares
• note nasal discharge, sneezing, and flaring with respirations
Infant Assessment Sequence Step 8
MOUTH, THROAT, NECK
inspect and observe
lift shoulders and let head lag to inspect the neck/note midline trachea
palpate lymph nodes and thyroid to observe for any masses; with infant supine, elicit TONIC-NECK REFLEX
Inspecting the mouth, throat and neck of an infant
• lips and gums, high arched palate, buccal mucosa, tongue size, frenulum of tongue
• absent or minimal salivation in an infant
Observing the mouth, throat and neck of an infant
rooting reflex, sucking reflex and palpate the palate using gloved finger
Infant Assessment Sequence Step 9
UPPER EXTREMITIES
inspect
Inspecting the UE of an infant
• ROM, muscle tone, absence of scarf sign
• count fingers, palmar creases, note color of hands and nail beds
place thumbs in infants palm to note grasp reflex
wrap hands around infants hands to pull up and note head lag
Infant Assessment Sequence Step 10
GENITALIA
male, female
life the infant under the axillae and hold them facing you at eye level
Female infant genitalia
inspect labia and clit (edematous in newborn), vernix caseosa between labia and patent vagina
Male infant genitalia
inspect position of urethral meatus (do NOT retract foreskin), strength of urine stream is possible, rugae on scrotum and palpate testes
Infant Assessment Sequence Step 11
NEUROMUSCULAR
note shoulder muscle tone; rotate the infant slowly from side to side (note dolls eye reflex)
Position for infant neuromuscular exam
turn the infant around so their back is to you, elicit stepping and placing reflex against the edge of exam table
turn infant over and hold them prone in your hands OR place infant prone on exam table
Infant Assessment Sequence Step 12
SPINE AND RECTUM
inspect
NOTE PATENT ANAL OPENING; passage of meconium during first 24-48 hrs
Inspecting the spine and rectum of an infant
• length of spine, trunk incurvation reflex, and symmetry of gluteal folds
• intact skin, note any sinus openings, protrusions or tufts of hair
Infant Assessment Sequence Step 13
FINAL PROCEDURES
ELICIT MORO REFLEX
using an otoscope, inspect auditory canals and tympanic membranes
The Young Child
DONT ASK FOR PERMISSION, GIVE CHOICES!
preschool child (2-6 yrs) displays developing initiative and takes on tasks independently (is cooperative and easy to involve, fearful of body injury, may recoil from invasive procedures)
young child is developing industry (cooperative and interested in learning about the body)
Child Assessment Sequence
- health history
- general appearance
- evaluate and measurement
- UE, head, face, neck
- eyes
- nose, mouth, throat
- ears
- posterior thorax and breath sounds
- anterior thorax, heart, lungs
- abdomen and genitalia
- LE
Child Assessment: Health History
collect history including developmental data
note data on general appearance!
Child Assessment: General Appearance
• child’s ability to amuse while parent speaks
• caregiver and child interactions
• gross and fine motor skills as child plays with toys (gradually focus on and involve yourself with child, at first in a “play” period)
Child Assessment: Evaluate
• developmental milestones
• posture while child is sitting and standing
• alignment of legs and feet while walking
• speech acquisition
• vision and hearing ability
• social interaction
• use age appropriate techniques to engage child
Child Assessment: Measurement
height, weight, temp and BP
Child Assessment: UE and head, face, neck
INSPECT: arms and hands for alignment, skin condition, fingers and note palmar creases
PALPATE: radial pulse
TEST: biceps and tricep reflexes with reflex hammer; inspect the size and shape of head and symmetry of face
PALPATE: cervical lymph nodes, trachea, and thyroid
Child Assessment: Eyes
INSPECT: external structures (note any palpebral slant), conjunctivae and sclera
• elicit corneal light and pupillary light reflexes with penlight, observe cardinal gaze
• observe red reflex and inspect fungus using ophthalmoscope
if indicated, perform cover test, covering the eye with thumb in a young child or index card
Child Assessment: Nose
• inspect external nose, noting skin condition
• inspect nares, mucosa, septum, and turbinates using penlight
Child Assessment: Mouth and throat
inspect mouth, buccal mucosa, teeth and gums, tongue, palate, and uvula with penlight (use tongue blade as last resort)
Child Assessment: Ears
INSPECT: auricles, ear canal and tympanic membranes using otoscope, tympanic membrane for color, position, landmarks, and integrity
PALPATE: auricles
• note any discharge from auditory meatus; check for foreign body
GAIN CHILDS COOPERATION BY LETTING CHILD HANDLE EQUIPMENT OR TO LOOK IN PARENTS EAR USING OTOSCOPE
Child Assessment: Posterior thorax and breath sounds
INSPECT: posterior chest for configuration, skin characteristics, symmetry of shoulders and muscles
PALPATE: for lumps or tenderness over length of spinous processes
PERCUSS: over lung fields
AUSCULTATE: breath sounds, perform bilateral comparison in upper/lower lung fields; note any adventitious sounds
Child Assessment: Anterior thorax, heart and lungs
INSPECT: size, shape and configuration of chest wall; pulsations on the precordium (note nipple and breast development)
ASSESS: RESPIRATORY MOVEMENT
PALPATE: apical pulse and note location, chest wall for thrills and for tactile fremitus
AUSCULTATE: breath and heart sounds in all locations, count RR and HR; S1 and S2 across precordium (note presence of murmurs)
Child Assessment: Abdomen
INSPECT: shape, skin condition, periumbilical area
AUSCULTATE: bowel sounds
PALPATE: skin turgor, muscle tone, liver edge, spleen, kidneys, note presence of masses; femoral pulses and compare strength with radial pulses; inguinal lymph nodes
Child Assessment: Genitalia
INSPECT: external genitalia
PALPATE-MALES ONLY: scrotum for testes (if masses are present, then transilluminate)
Child Assessment: LE
INSPECT: toes, longitudinal arch
PALPATE: dorsalis pedis pulse bilaterally
• note alignment of legs and skin condition and feet
• check ROM of hips, knees, ankles
• elicit plantar, achilles and patellar reflex using reflex hammer
The Adolescent
• perform sequence in same head to toe format as adult
• major task of adolescent is IDENTITY
• increasingly self conscious and introspective
• allow them to wear street clothes and work around them
Sitting up for adolescent exam
• proceed with head, eyes, ears, neck and thoracic exam
• sit upright at edge of exam table
Supine position for adolescent exam
• conduct cardiac, abdominal and LE
• place drape over lower abdomen when examining inguinal area
• ask adolescent to unzip and lower clothes under drape
• pant legs can be pulled up to examine lower legs and feet
