OMED 1401 - Advanced Patient Assessment (PAEDIATRIC ASSESSMENT) Flashcards
What is the Structure for the Paediatric Assessment?
Check Danger, Response, Airway, Confirm no Arrest.
Correct any ABC issues, Otherwise continue the “Hands Off’ Approach.
Paediatric Triangle:
- Confirm no ABCDE Issue - OK to Approach Patient
- History Taking - Consider Age/Development, Immunisations, Obstetric History, Family History.
- Observations: Have a Rough Estimate of Age per Page.
- Is the Patient Time Critical?
IF THE PATIENT IS NOT TIME CRITICAL, YOU MAY CARRY ON WITH AN ADVANCED PATIENT ASSESSMENT.
What are sone things to Consider in a Paediatric Assessment?
Meningitis - Using Tests and History
Septicaemia
Dehydration
Rash
Pain, Fever, Fatigue, Alleviate Fear
Pain Assessment
System Based Patient Assessment E.g. Respiratory, Cardiovascular, Abdominal, Neurological.
Consider Non-Accidental Injury, Safeguarding/Welfare Concern.
Check Lymph Nodes - Is there any Inflammation?
What is the Paediatric Assessment Triangle: Work of Breathing?
Abnormal Airway Sounds:
- Snoring (Occlusion of the Airway), Stridor (Caused by a Blockage or Narrowing in your Childs Upper Airway - Laryngotracheabronchitis, Epiglotitis), Grunting (Body’s way of Trying to keep Air in the Lungs so they will stay Open), Wheezing, Hoarse Speech.
Abnormal Position:
- Tripoding, Sniffing, Head Bopping, Preferred Seating
Abnormal Additional Signs:
- Obvious Distress, Sternal Recession (Bones are no Fused, Bending), Intercostal Retraction (Evident Sucking in), Abdominal Breathing (Paradoxical to Chest Retraction).
What is the Paediatric Assessment Triangle: Circulation to Skin?
Pulses
- Absent, Weak or Abnormal Pulses.
Colour
- Mottled, Pallor, Cyanosed (Central Cyanosis is Worst Case)
Delayed Capillary Bed Refill.
Obvious Fluid Loss
- Significant Blood Loss, Burns, Dehydration (Dry Nappies), Urinary Retention.
What is the Paediatric Assessment Triangle: Appearance?
TONE
- Floppy
INTERACTIVENESS
- Level of Interaction with Environment/People
CONSOLABILITY
- Response to Care
LOOK/GAZE
- Eye Tracking, Focused/Non-Focused Gaze.
SPEECH
- Zero or Alarming High Pitch Cry.
How to Use DRCABCDE in a Paediatric Assessment?
AIRWAY
Is the Child Talking/Crying?
BREATHING
Effort/Effectiveness of Breathing?
Additional Noises, O2 Sats.
CIRCULATION: Assessment of Adequacy of Circulation
- Heart Rate, Pulse Volume, Capillary Refill, BP
- Effect of Circulatory Inadequacy
- Sign of Heart Failure
- Normal HR Parameters
- Urine Output.
DISABILITY
Can be Caused by Hypoxia and Shock - ABC must be Addressed First.
ASSESS BY AVPU SCALE:
- Alert
- Voice
- Pain
- Unresponsive
Pupil Size
Abnormal Posture
Observed Convulsion - Duration, Frequency, Type
Hypoglycaemia
Headaches, Visual Disturbances.
How does the Paediatric GCS differ to a Normal GCS?
Eyes
4 - Spontaneous
3 - To Verbal
2 - To Pain
1 - No Response
Verbal
5 - Smiles, Orientated to Sounds, Follows Objects
4 - Cries but Consolable, Inappropriate Interactions.
3 - Inconsistently Inconsolable, Moaning
2 - Inconsolable, Agitated
1 - No Response
Motor
6 - Moves Spontaneously and Purposefully.
5 - Withdraws from Touch
4 - Withdraws from Pain
3 - Flexion to Pain
2 - Extension to Pain
1 - No Response
What to Consider when History Taking in a Paediatric Assessment?
If you want to know what is wrong with the Child - ask the Parents too.
Family Centered Care, the Child is Rarely Seperated from their Family or Primary Caregiver.
Developmental Aspects should always be Considered. Milestones, Developmental Delay, Special Needs.
Aetiology maybe age Related (Febrile Convulsions) or Seasonal (Bronchiolitis)
Development - May Identify Congenital/ Chronic Problems.
Immunisations - May Indicate Anaphylaxis or Likely Conditions from Lack of Immunisations.
Family Circumstances - Family History, Recreational Habits of Family Members.
Drug/Allergies - Current Medication of Child/Family Members Medication that Child could have Access to. Maternal History and Birth History
What are Some Additional Assessment And History Questions for the Childs Family?
Has the Child Experienced:
- Drooling/Inability to Drink
- Cyanosis
- Abdominal Pain
- Apnoea
- Feeding Problems
- Fluid Loss
- Breathlessness
- Fever/Palpitations/Tachycardia/Heart Murmur/Pallor/Cool Skin or Hot Skin.
- Peripheral Oedema
- Cyanosis
- Hypotonia (Muscle Loss)
- Drowsiness
What do you Need to Consider about how Different Causes may be Linked to Age?
Babies - Choking, Fever and Febrile Convulsions, Respiratory Illness; Scalds and Burns; Distributive and Hypovaleamic Shock.
Crawlers/Toddlers - Fever & Febrile Convulsions; Head Injuries; Poisoning & Respiratory Illness; Scalds and Burns, Lacerations & Bruising; Fractures.
School Age - RTA, Abrasions & Lacerations, Fractures; Head Injuries; Infectious Diseases.
Adolescents - Overdose/Self Harm; RTC; Head Injuries; Fractures; Trauma.
What is Meningitis in Children and How does it Present?
Inflammation of the Meninges within the Brain caused by an Infection within the Brain or Brain Stem. Most Common is Viral, But Bacterial is Most Deadly.
Why are Under 5s more at Risk?
- Babies and Young Children are Particularly Vulnerable to Meningitis as they Cannot easily Fight Infections because their Immune System is not yet Fully Developed.
Facts:
- Bacterial Meningitis can be Fatal and needs Rapid Admission to Hospital and Urgent Medical Treatment. Whilst most Children will make a Good Recovery, around 10% will Die and Some will be Left with Lifelong Disabilities.
Kernig Sign - Positive Kernig Sign if any Involuntary Resistance or Flexing of Contralateral Leg.
Brudzinski’s Neck Sign - An Indication of Meningitis; Flexing the Neck Causes Hips and Knees to Flex.
What is Septicaemia?
Septicaemia is the Blood Poisoning Form of Meningococcal Diseases.
When Meningococcal Bacteria Invade the Bloodstream, they Produce Poisons. This Makes the Patient feel Ill and Feverish, and the Poisons begin to Attack the Lining of their Blood Vessels, so that they Leak.
As Blood Fluids leak from Blood Vessels throughout the Body, the Smaller Volume of Blood that is Left is not Enough to Carry Oxygen to all Parts of the Body.
The Lungs have to Work Harder, and in order to Maintain Circulation to the Vital Organs, the Circulatory System Reduces the Blood Supply to your Hands and Feet and the Surface of your Skin.
This is How Symptoms of Septicaemia such as Pale Skin, Cold Hands and Feet and Rapid Breathing Develop.
What are the Symptoms of Septicaemia of Meningitis and Which Occur Together?
Occurs Together
- Fever, Cold Hands and Feet
- Vomiting
- Drowsy, Difficult to Wake
- Confusion and Irritability
- Severe Muscle Pain
Septicaemia
- Stomach Crams and Diarrhoea
- Spots/Rash see Glass Test
Meningitis
- Severe Headache
- Stiff Neck
- Light Sensitivity
How to Assess Dehydration in Children?
- Dry Mouth and/or Cracked Lips
- Few or no Tears when Crying
- Dark Urine, Urinating Less and Constipation
- Easily Irritated and Frustrated
- Poor Concentration
- Headaches
- Drowsy, Dizzy
- High Body Temperature
- Sunken Fontanelles
If a Childs Urine is Pale like Lemonade, thats a Sign of Proper Hydration. If it’s Dark like Apple Juice, they need more Fluid.
How to Assess Rashes in Paediatrics?
Every Child with Unknown Illnesses should be Examined for a Rash. Involves Removal of Clothing: Check Armpits, Buttocks, Top of Legs, Groin as well as Visible Body.
- Chicken Pox Rash
- Measles Rash
- Heat Rash
- Scarlet Fever Rash (Pink/Red Rash and Blotches, Feels like Sandpaper, Looks like Sunburn, May be Itchy)
- Impetigo Rash (Red, Itchy Sore, Heals Crusty Yellow or Honey Coloured into a Scab. May leak a Clear Fluid)
- Roseola (Spotty Rash, Pink Small Flat Spots on Chest and Stomach, May Spread to Face and Arms)
- Hives Rash
- Molluscum Contagiosum Rash (Small Clear or Flesh Coloured Bumps, Can Spread around the Body)
When to See a Doctor:
- Rash Comes with a Fever
- Rash is Infected
- Rash is Painful
- Rash Comes with Dizziness or Fainting
- Rash started after Medication
- Rash Last for more than 3 Days
- Rash Comes with Breathing Difficulties.
