Paediatric - Assessment Flashcards

1
Q

Assessment Triangle

A
  • appearance
    • inspection findings
    • cardiovascular
    • neurological
    • respiratory
  • work of breathing
    • use of accessory muscles
    • trouble breathing
  • circulation to skin
    • colour / pallor of skin
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2
Q

Assessment guidelines

A
  • warm, well lit room
  • firm, direct approach, limit options, quiet, calm, confident voice
  • inspect painful areas last, reward & positive reinforcement
  • involve parents & support parents
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3
Q

Across the Room

A
  • rapid overview of the clinical condition of the child
  • directs urgency of care & intervention
  • paediatric assessment triangle
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4
Q

Paediatric Assessment - Weight & Height

A
  • who
    • any child who is admitted
  • why
    • for drug calculations, checking for FTT
  • when
    • during initial admission process
  • how
    • has to be bare weight, no nappies / clothing, age + 4 x 2
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5
Q

Paediatric Assessment - Hydration Status

A
  • who
    • anyone who is admitted, anyone with primary complaint of fluid loss, burns, heat loss, vomiting, gastro
  • what
    • fluid intake & output, excessive loss through sweating
  • when
    • admission, once per shift, FBC done half hourly
  • why
    • to calculate fluid re-hydration therapy, bolus / maintenance amounts, to find out prognosis - is treatment effective
  • how
    • standard FBC
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6
Q

Paediatric Assessment - Respiratory Assessment

A
  • who
    • anyone with primary complaint from respiratory, included in regular vitals for all admissions
  • when
    • vitals - at least twice per shift
  • why
    • strong indicator of child’s condition, provides baseline data
  • how
    • inspection, percussion, palpation, oscultation
    • level of activity, interest in surroundings, lethargy - tells about breathing & neurological status
    • colour of patient, any obvious hypoxia, conscious state, mild, drowsy, unconcious, best source of information is parents
    • respiratory rate & airflow - higher than adult - 25-30 breaths per minute is normal, respiratory effort, accessory muscle use
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7
Q

Paediatric Assessment - Respiratory Assessment

A
  • look
    • what do you see?
    • level of activity, colour, conscious state, respiratory rate, respiratory effort
  • listen
    • what do you hear?
    • across the room - coughing, stridor (asthma / obstruction)
    • with a stethoscope - breath sounds - crackles (pneumonia), wheeze, degree of air entry (start from front, go to back, Z pattern)
  • feel
    • pulse oximetry
    • blood gases - carbon dioxide (co2), oxygen (o2), bicarbonate (HCo3), pH
    • peak flow - high - alkalosis, low - acidosis, respiratory & metabolic, peak flow only for children old enough to comprehend explainations
    • chest xray - fluid, foreign bodies, shape of chest
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8
Q

Paediatric Assessment - Respiratory Distress

A
  • clinical state characterised by level of respiratory effort to achieve adequate respiratory function
  • clinical symptoms
    • tachypnoea
    • tachycardia
    • dyspnoea
    • respiratory noises (stridor / wheeze)
    • restlessness (from hypoxia)
    • irritability
    • use of accessory muscles
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9
Q

Paediatric Assessment - Cardiovascular Assessment

A
  • who
    • any patient being admitted, history of cardiac conditions
  • why
    • baseline data, to plan treatment
  • when
    • admission, twice per shift as part of vitals
  • how
    • vitals, inspection, auscultation, palpation
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10
Q

Paediatric Assessment - Cardiovascular Assessment

A
  • look
    • what do you see
    • colour (cap refill, perfusion of face / body), degree of activity (if impairment, level of activity is reduced), respiratory effort, perspiration, oedema (heart failure)
  • listen
    • what do you hear
    • heart sounds - 1, 2 (standard), 3, 4 - third heart sound can be normal, fourth is very rare, heart rate - up to 120-130, regular, intensity of sound, strength, rhythm - irreg: gallop sounds, when you hear all four heart sounds
    • tricuspid - left 4th intercostal space next to sternum, base - 2nd intercostal space, apex - left 5th intercostal space, lateral to mid clavicular line
    • murmur generated due to turbulence of the blood flow, narrowing, valve problems
  • feel
    • pulses - apical, brachial (medial side of arm), femoral (groin, medial portion of upper thigh), pedal
    • capillary refill time (3 secs), skin turgor (abdomen, arm, sacral area), blood pressure, oxygen saturations
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11
Q

Paediatric Assessment - Cardiac Failure

A
  • tachycardia
  • tachypnoea
  • perspiration
  • decreased urine output
  • fatigue
  • weakness
  • restlessness
  • pale, cool extremities
  • weak peripheral pulses
  • decreased blood pressure
  • gallop rhythm
  • cardiomegaly - left ventricle enlarged
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12
Q

Paediatric Assessment - Neurological Assessment

A
  • when
    • neurological surgery - brain tumor, spine, lumbar punctures
    • post anesthetic
    • DKA - type 1 diabetes
    • seizures
    • severe respiratory distress
    • neurological compromise
    • overdose
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13
Q

Paediatric Assessment - Neurological Assessment - AVPU

A

A - alert

V - responds to voice

P - responds to painful stimuli

U - unresponsive

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14
Q

Paediatric Assessment - Patient History

A
  • present illness
  • associated signs / symptoms
  • past history, previous episodes
  • prenatal & perinatal birth history
  • growth & development
  • family history
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15
Q

Paediatric Assessment - General Behaviour

A
  • is the child communicating & interacting in age appropriate manner
  • does the child recognize parents / familiar objects
  • does the child respond to usual comforting measures
  • does the child react in an age appropriate manner to procedures
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16
Q

Paediatric Assessment - Unwell Child

A
  • across the room
  • primary assessment
  • secondary assessment
17
Q

Paediatric Assessment - Primary Assessment

A

A - airway

B - breathing

C - circulation

D - disability / deformity

18
Q

Paediatric Assessment - Secondary Assessment

A

E - exposure, weight, checking for injury

F - full set of vitals

G - give comfort

H - head to toe examination

19
Q

Paediatric Assessment - Red Flags

A
  • parents concerned their child is acting out of character
  • poor balance, inability to walk in a straight line
  • a child who no longer recognizes / responds to their parents
  • a child that does not resist either physically or verbally to invasive procedures