Peaditric assessment Flashcards
when to use PEWS
Identifies risk for clinical deterioration with pediatric inpatients and like the primary survey.
what is pearls/pitfalls?
Originally developed to provide a practical and objective method to identify pediatric inpatients at risk for cardiac arrest. Can be used by staff at all levels of escalate care for sick patients
why do we use PEWS?
Provides an objective measurement for patients who ‘look sick’.
Pediatric health assessment
- Healthy children should have regular health maintenance visits.
- History, physical exam, and developmental assessment
- Height, weight, head circumference, growth chart plotting, BP, strabismus, visual acuity, dental, speech, sexual development.
- Immunizations given according to provincial guidelines.
- Health promotion and counselling
- Nutrition, safety, and expected developmental and behavioural events, parent-child interactions, parent counselling.
Tips and techniques for pediatric patients
- Include children as historians with additional details by parents/caregivers.
- Appropriately interact with children based on developmental stage (e.g., smile, coo, play etc…) - Developmentally appropriate interaction in terms of explanations
- Grant adolescents’ privacy and confidentiality, interview them alone, and with adolescent’s permission discuss with parent/caregiver.
- Age-appropriate toys
- For young child: have parent/caregiver hold the child when possible and do intrusive/distressing parts of exams at end, choose quietest moment for cardiac and respiratory assessment.
Physical exam of an infant/child- general apearance
Level of consciousness, alertness, general behaviour and appearance (how well the baby looks).
- Symmetry of body proportions
- Posture of limbs (flexed, extended)
- Body movements (for example, arms and legs, facial grimace)
- State of nutrition and hydration
- Colour
- Any sign of clinical distress (for example, respiratory distress includes dyspnea, pallor, cyanosis, irritability)
- Gait
- Breathing frequency and pattern.
- Responses to sound.
- Fine and gross motor skills as the child plays
- Lesions (for example, petechiae, eczema, impetigo).
- Responses to parental comforting measures.
- Ability to entertain themself while the caregiver is talking.
- Quality of infant’s cry or quality of child’s voice.
- Interaction pattern, speech, and nature of child’s responses to parent(s) and health care staff. - general appearance
vital signs for newborns
- Temperature 36.5°C to 37.5°C
- Heart rate 120–160 beats/minute
- Respiratory rate 30–60/minute, up to 80/minute if infant is crying or stimulated.
- Systolic blood pressure 50–70 mm Hg
- Oxygen saturation (If warranted)
growth measurements
- Measure and record length, weight and head circumference.
- Average length at birth 50–52 cm
- Average weight at birth 3500–4400 g
- Average head circumference at birth 33–35 cm (this is done only at well-child visits unless hydrocephalus is suspected)
WEIGHT:
- Done at each visit for any infant under 1.
- Those presenting for a well-child visit.
- At least annually for older children.
- For any infant or child who presents with vomiting, diarrhea, signs of shock, or in need of a medication where dosage is dependent on weight.
- Measurements of recumbent length (until 24 months old) or height, weight and head circumference (until 24 months old) should be part of every health maintenance visit. These parameters should be recorded on gender- appropriate growth curves, which should form part of the child’s health record.
Skin colour inspection
- Pallor associated with low hemoglobin or vasoconstriction (for example, in shock).
- Cyanosis associated with hypoxemia.
- Plethora associated with polycythemia or vasodilation.
- Cherry red face associated with carbon monoxide poisoning.
- Jaundice associated with elevated bilirubin.
skin lesions inspection
- Stork bite: Pink and flat nevus simplex; usually on face or back of the neck; those on face usually disappear by 18 months.
- Café au lait spots: Irregular brown, flat macules. Suspect neurofibromatosis if there are many (more than 5 or 6) large spots.
- Mongolian spots: dark bluish/purplish patches present at birth, usually on back and buttocks but may be on limbs; common in First Nation’s and Inuit children; usually fade away in first year of life.
- Acne: blackheads, whiteheads; more severe forms have papules, pustules and nodules; usually on face and sometimes on back, chest and shoulders; most common in adolescence
head inspection
- Palpate anterior and posterior fontanelles (size, consistency, bulging or sunken) and cranium.
- Bruising of head, behind the ears or periorbitally.
- Size and shape of the head.
- Facial symmetry at rest and while crying for the infant
eyes inspection
- Check cornea for cloudiness, eyelids, and external structures.
- Assess for nystagmus.
- Check conjunctiva for erythema, exudate, orbital edema, subconjunctival hemorrhage, jaundice of sclera.
- Check for position and alignment of the eyes using cover-uncover test.
- Check for corneal light reflex and ability to track movement for cardinal fields of gaze.
- Check for pupillary size, shape, equality and reactivity to light, accommodation.
- Inspect red reflex, fundus.
- Check visual acuity in children over 3 years of age.
ear inspection
- Check for asymmetry, irregular shape, setting of ears in relation to corner of eye
- Look for fleshy appendages, lipomas, or skin tags.
- Palpate and inspect auricles.
- Perform otoscopic examination.
nose inspection
- Determine if nares are patent. Look for foreign body.
- Look for nasal flaring, which is a sign of increased respiratory effort.
- Look for hypertelorism or hypotelorism (increased or decreased space between eyes).
- Note nasal discharge or sneezing.
- Look at the mucosa, septum, and turbinates with otoscope.
mouth inspection
- Inspect lips, gums, palate, buccal mucosa, tongue, palate, tonsils.
- Inspect tongue size and frenulum of tongue in infants.
- Inspect teeth for number, character, condition, position and caries.
- Palpate palate in young infants.
- Note if uvula is midline.
