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
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
3
Q
Across the Room
A
- rapid overview of the clinical condition of the child
- directs urgency of care & intervention
- paediatric assessment triangle
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
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
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
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
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
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
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
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
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
13
Q
Paediatric Assessment - Neurological Assessment - AVPU
A
A - alert
V - responds to voice
P - responds to painful stimuli
U - unresponsive
14
Q
Paediatric Assessment - Patient History
A
- present illness
- associated signs / symptoms
- past history, previous episodes
- prenatal & perinatal birth history
- growth & development
- family history
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
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
