PED ASSESSMENTS

Question 1

How to obtain the health history from the child and primary caregiver

Answer 1

Obtain history as doing head-to-toe
Past illnesses, allergies, immunizations, medication, diet, when last ate
Ask parents about their impression of child’s behaviour
The child and parents are the best source of information

Assessing a Child with a mom

• introduce yourself
• how the mom think the child is doing
• LOC, feed, output, age of baby, what stage they are at for their developmental
• always do the most invasive last
• not to do a head to toe

Question 2

Describe the appropriate sequence of the physical examination

Answer 2

Head and face
Shape and symmetry – rounded skull with prominent occipital area
Fontanels – flat and firm
Anterior closes between 12 – 18 months of age
Posterior closes between 2 – 3 months of age
Symmetry of facial expressions

Eyes and vision
Same size – not bulging or sunken in appearance, or sunset eyes
Colour of sclera and iris
Pupil size, shape and response to light

Nose
Marks the beginning of the passageway through the respiratory track
Patent – to ensure oxygenation
Noiseless and effortless respirations
Absence of nasal flaring
Mouth
Colour of lips – cyanosis
Mucous membranes - dehydration

Chest
Size and shape of chest – symmetrical, pectus excavatum
Observe effort of breathing – chest expansion, abdominal rise, respiratory rate, retractions
Auscultation of breath sounds – listen to an entire inspiratory and expiratory phase at each spot on the chest

Absent or diminished breath sounds – partial or total obstruction
Crackles – high pitched sound heard at the end of inspiration
Stridor and wheezing – voice sounds

Heart
Auscultate apical pulse and heart sounds
Count the apical rate for a full minute

Abdomen
Inspect shape, contour, umbilicus, and abdominal movement
Auscultate for bowel sounds, listen in each quadrant to hear at least one bowel sounds
Genital and Perineal Areas
Normal structure

Extremities
Inspect for temperature, colour, and tenderness
Joints
Inspect for heat, tenderness, and swelling

Intake and Output
1 g of wet diaper = 1 ml of urine
Infants < 1 year void q 1-2 h
Toddlers q 3 h

Question 3

Identify the physiological differences between children and adults

Answer 3

Tracheal and bronchial cartilaginous support rings are C shaped rather than O shaped

Fewer alveoli. Newborn has 20 million compared to 300 million in adults. Alveoli have les elastic recoil and less supportive elastic tissue

Lung tidal volume is approx 10ml per kg i.e. 100 ml in a 10kg child compared to 500ml in an adult

Metabolic rate is twice that of adults and twice the oxygen consumption

Ribs more horizontal

Ribs cartilaginous and intercostal muscles immature

Diaphragm is the major muscle of breathing

Haemoglobin concentrations are approximately 75% that of an adult, or 10.5-12gm/100ml

Higher metabolic rate ↑ oxygen and caloric needs

Immature kidney function

Greater body surface area-to-mass ratio