Pediatric Assessment Flashcards
What is a complete physical assessment?
- Initial detailed assessment completed on admission or at annual check-ups
- Physical exam
- Health history
- If infant, birth information
- Demographic data
- Current health problems
What is a complete physical assessment?
- Initial detailed assessment completed on admission or at annual check-ups
- Physical exam
- Health history
- If infant, birth information
- Demographic data
- Current health problems
What is a focused-shift assessment?
- Completed on successive shifts
- Physical exam directed at current health problems
- Information pertinent to daily care
- Quick
Describe a general approach to the pediatric assessment.
- Consider the age/developmental stage of child
- Introduce yourself to the child and family and establish rapport. Use play techniques for infants and young children.
- Gather as much information as possible by observation first. “doorway assessment”
- Use systematic approach; but be flexible to accommodate child’s behavior.
How can you take into account the age and developmental stage of the child?
Implement language and communication techniques consistent with child’s developmental level and family’s needs.
What is a “doorway assessment”?
This is very important with younger children who may be afraid of you. Gather what you can from the doorway.
What systematic approach would you use with assessment of younger kids?
- Examine least intrusive areas first (i.e. hands, arms, feet) and painful and sensitive assessment last (i.e. ears, nose, mouth)
- Determine what parts of the exam is to be completed before possible crying or lack of cooperation (i.e. heart, lungs & abdomen)
- Where possible, assessments should be clustered with other care at a time when the child is relaxed and compliant.
What vital signs do you need to know?
Hypotension: < 70 + (2 x age)
Doubles birth weight by 6 months
Triples birth weight by 1 year
Quadruples weight by 2 years
*TEMP 35.5-37.5 oral (95.9-99.5 F)- May vary by source/method
Temp > 101.5 (38.5 C) - Childrens 38, 100.4 is considered febrile
What assessment of systems will you include?
- General Appearance
- Neuro
- Integumentary
- Respiratory
- Cardiovascular/Circulatory
- Abdominal/GI/GU
- Musculoskeletal
- Focused
- Other
- Safety
What will you consider what evaluating general appearance of a child?
- Lethargic or active
- reflexes
- Agitated or calm
- Compliant or combative
- Infants
- Parent - infant interaction
- Strong cry - consolable or inconsolable?
- Young Child/Adolescent
- Mood and affect
- Personal hygiene
- Communication
What will you assess in a neurological exam?
- Development
- Orientation
- PERRLA
- Sleep
- Pain
- Vision
- Hearing
What are some considerations for a neuro exam?
Infant – primitive reflexes, raising head, tracking objects, turning, sitting, standing; fontanelles
- posterior closes: 1-2 months, anterior closes: 9-18 mos
Toddler – crawling, walking, talking 2-3 word sentences
Preschooler – increases in motor skills and language
School-Age and Adolescent – increases in communication skills
What will you assess in an integumentary exam?
- Pigmentation
- Turgor - abdomen
- Lesions
- Bruising
- Wounds
- Scars
- Mucosa - pink and moist
- Body Temperature
What are some considerations for an integumentary exam?
Infants – check skin turgor in the abdomen or groin (versus hand or arm in older child and adult)
Mucosa pink and moist
What are the aspects of the respiratory assessment?
- infants are obligatory nose breathers
- Noises, secretions, cough
- Respiratory rate, rhythm
- Air movement
- Breath sounds
- Work of breathing (accessory muscles, retractions, nasal flaring)
- Oxygen requirement and delivery mode
- Respirations for FULL minute
- infants - apnea up to 20 seconds, so important to count RESP for FULL minute
what are some considerations of a respiratory assessment?
- Infant – School-Age:
- Obligate nose breathers/abdominal breathers
- Count respirations for 1 full minute
- Respirations are irregular and include cessation up to 20 seconds in infants
- Unable to increase depth of respirations
- Count respirations by watching abdominal movement; but also listen for air flow
- Auscultate and observe work of breathing UNDER the clothes
- pulling, diff names for retractions
Describe considerations for WOB?
Upper airway noises, stridors, can you hear wheeze without a stethoscope
Work of breathing
Pulling? – retractions, diff names based on where we see them.(ie. Above sternum, below)
- Mild, moderate, starting to work more, severe - really pulling in, see outline
- Head bob trying to get air
- Moving air, areas of decreased breath sounds, pneumonia? Crackles, oxygen and what delivery of oxygen?
What sites will you assess lung sounds in children?
What sites do you use to assess heart sounds?
- Listen over the valves
- Aortic: 2nd IC space (Right)
- Pulmonic: 2nd IC space (Left)
- Tricuspid: 5th IC space (Left)
- Mitral: Apical pulse **most important**
- 3rd/4th IC space (Left) midclavicular (infants)
- 5th IC space (Left) midclavicular (older child)
Murmur - sometimes unexpected and can escalate, sometimes we expect a murmur
What do you include for a cardiovascular assessment?
- Heart rate and rhythm Heart rate can be really fast. 200 + beats per minute. Make sure that it correlates with monitor. Hard to count.
- Heart sounds
- Perfusion (CPETC©)
- Color
- Pulses
- Edema
- Temperature
- Capillary Refill **different** < 3 seconds is normal, 3-4 sec, delayed, 5-6 sec is bad sign
- Neurovascular Checks
- 5 P’s (pulselessness, pallor, pain, paresthesia, paralysis)
What are additional considerations for cardiovascular assessment?
- Count Apical pulse for 1 full minute (infant – school-age)
- Adult heart increases stroke volume by increasing strength of contractions and heart rate
- Pediatric heart only increases heart rate
- Infant
- Central pulse – brachial, apical, femoral
- Edema – periorbital
- Cap refill – hand, foot, forearm, leg
- Child
- Central pulse – carotid, apical, femoral
- Peripheral pulse – radial, pedal
What is CPETC?
- Color
- Pulses
- Edema
- Temperature
- Capillary Refill
What do you assess for Abdominal/GI/GU?
- Bowel sounds
- Soft/firm/distended - small kids, can have rounded abdomen, look at them in the rest of the body
- GI/GU - TANNER stages - development of hair, armpits, pubic area, dev of breast tissue
- I&O
- Nutrition
- Feedings
- Puberty
Other considerations for abdominal, GI, GU?
- Infants – ambiguous genitalia
- Adolescents
- Secondary sex characteristics are assessed using Tanner stages
- Presence of secondary sex characteristics before 8 years in girls and before 9 years in boys requires further evaluation for Precocious Puberty - can happen in kids with hormonal disturbances
What do you assess in a musculoskeletal exam?
- Hand grasp
- Range of motion
- Movement of extremities
- Gait
- Symmetry
Other musculoskeletal considerations?
- Infants
- Different knee height when hips and knees are flexed should be further assessed for hip dislocation
- Muscle tone
- Toddler/Preschoolers
- Bow legs are normal through the toddler period
- Knock-knee is normal until school-age
What is a focused assessment?
Assessment of presenting problem
- More in-depth assessment of the system (s) involved, or other identified issues (cardiovascular, respiratory, renal, musculoskeletal, etc.)
Other misc things to assess if needed?
- IV/lines
- Tubes/drains
- Dressings
- Casts
- Monitors
- Labs
- Isolation
Other considerations for overall /misc assessment.
- Always assess the patient before the equipment (treat the child, not the technology)
- Infants – School-Age
- IV sites are typically covered with something to prevent the child from seeing and “playing” with the insertion site
- EKG leads and O2 sat probes may be placed in nontraditional spots for infants and younger children
Describe safety considerations for children.
- Oxygen set up at the bedside
- Suction set up at the bedside
- Siderails (up to right height)
- Bed (low and locked)
- Call light
- ID bands (on patient)
additional safety notes for children.
- Infants
- No lines/cords or choking hazards within reach
- No extra bedding or pillows, etc.
- Toddlers – Preschoolers
- Keep things out of reach
- Choking hazards
What are the 5 Ps of neurovascular status?
Pain, pallor, pulse, paresthesia and paralysis
