Newman: Pediatric Evaluation + lab Flashcards
Purpose and importance of well child visits/preventive pediatric health care (5)
- Prevention (immunizations, nutrition and safety)
- Tracking growth and development
- Parents can express concerns/ask questions
- Docs can perform and address ABNL PE findings, screenings
- Establish a medical home
When is a CBC performed at a well-child visit?
1 YO
What is the Bright Futures program?
Gives you info about EVERY well-child exams and what is done from newborn to 21YO, when to perform immunizations.
One of the big differences in getting the Hx during a peds encounter is what?
Information comes from the
parent; trust them, but occasionally know that they may be overly/under-concerned about some things . Thus, you have to educate, reassure and explain.
What is important to add in a pediatric history, especially if < 5YO, have a chronic illness, developmental delay, syndromic features or respiratory issues.
- Pregnancy (prenatal) Hx:
A. Meds
B. Complication
C. Prenatal care - Delivery (perinatal) Hx:
A. Complications
B. Need for resuscitation/O2/NICU
C. APGAR score (score assigned 1-5 min after birth based on HR, breathing, muscle tone, reflects, color): used to GUIDE CARE after delivery; not predict outcome of bb - Nursery (postnatal) Hx:
What should be included in Nursery (postnatal) Hx?
- NICU history (if any)
- Well baby nursery history
- If the baby got to go home with mom, assuming mom didn’t have an extended stay for some reason, it usually means that everything went OK.
- Parent may know if they passed their oxygen saturation test-
- Done prior to DC on all babies
- Screen for possible Critical Congenital Heart Defect (CCHD)
In peds well visit, also ask about Developmental History. What should be discussed?
Milestones at certain ages (based on DDST/Denver)
What should be included in longitudinal assessment during PE?
- Height (plot on growth curve)
- Weight (plot)
- BP
- Sexual maturity
What is a resource for pediatric immunizations?
CDC immunization schedule
PE tips
- Open door slowly
- Be gentle: approach slowly, dont be “BIG”, read room and bb
- Ask the parent how the bb will be more comfortable: on exam table, moms dad/lap, sitting next to parent
- Lap exams = super helpful (check lungs/heart on parents lap)
PE tips
- Open door slowly
- Be gentle: approach slowly, dont be “BIG”, read room and bb
- Ask the parent how the bb will be more comfortable: on exam table, moms dad/lap, sitting next to parent
- Lap exams = super helpful (check lungs/heart on parents lap)
- Ask parent/caregiver to help
If child gets angry or scared, how should you act?
If too scared?
If child is ill and injured and you HAVE to perform an important part of exam?
Don’t be too persistent; back off and come back to that part of exam.
If too scared, document “no exam” and state reason
If child is ill or injured, you may have to restrain, but don’t force parent to help you if not comfortable. Ask staff
What is an important part of well child check up?
Genital exam (longitudinal assessment of sexual maturation).
Tips to perform a genital exam in child check up (5)
- Have the parent join you at the exam table for younger children
- if age appropriate, ask if they have had the “good touch, bad touch” discussion
- Remind the child that you are a doc and that their mom or dad is “right here”
- In older children, even if the parent is in the room, have a chaperone
- Always protect your patient’s modesty
- Always perform a _____ exam on males with abdominal pain
- Always perform a ______ exam on all patients wearing diapers
- Ask the ____ to help you localize the injury
12 ____ is key for a successful ear exam
- genital
- GU
- Parent
- Positioning
Objective 5: Discuss why observation is a
critical part of the pediatric assessment.
- Lets examiner gather info B4 pissing off BB.
- developmental skills and overall state of health
The younger the patient is, the _____ the heart rate and respiratory
rate will be
faster; thus, listen longer and count
What ages should you get head circumference?
Birth - 36 months
- Length: a measurement made while the patient is _____
2. Stature: a measurement made while the child is ______
- Supine
2. Standing
Objective 2: Get an age appropriate history from the parent. What should you include that is not covered in adults?
- Pediatric history should be age specific (ask about age appropriate diet,
elimination, sleep patterns, etc.) - Pregnancy (prenatal), delivery (perinatal) and newborn (neonatal) history
- Developmental history
