Pediatric Assessment Flashcards
During a pediatric assessment it is most important to ALWAYS …
Include the parents
During a pediatric assessment, when should the most invasive procedures be done?
At the end of the assessment
What aspects should be assessed within the history of an illness / chief complaint? (3)
- Regression
- Sleeping patterns
- Unusual complaints (headaches, stomach aches)
What aspects of past medical history are assessed? (4)
- Birth history
- Childhood illnesses
- Injuries / accidents
- Immunizations
It especially important to keep children warm to prevent hypothermia if they are under the age of ______
6 months
Describe the general approaches used in the pediatric physical assessment (3)
- Warm, quiet room
- Allow the child to sit on the caregiver’s lap
- Maintain eye contact with the caregiver until child is comfortable
It may be helpful to complete what parts of the physical assessment while the child is sleeping? (2)
- Cardiac assessment
- Respiratory assessment
What age groups should be interviewed separately from parents?
Adolescents
______ allow the healthcare provider to plot the child’s growth pattern
Growth charts
What is shown on a growth chart?
Distribution of body measurements - height, weight, head circumference
Describe weight measurement during a physical exam (3)
- Zero scale first
- Measure in kg
- Infants and young toddlers should be nude
At what age is head circumference measured?
Up to age 2
At what age is chest circumference measured?
Up to age 1
Which method is most accurate for pediatric temperature?
Oral / rectal
Describe rectal temperature assessment (2)
- Lubricate tip
- Insert 1/2 - 1 inch to avoid perforation
______ in children is extremely critical (usually a result of hypoxia)
Bradycardia
Describe pediatric pulse assessment (2)
- Apical pulse on all children < 2
- Assess for 1 full minute
Describe pediatric respiratory assessment (2)
- Assess for 1 full minute
- DO NOT assess while child is crying
Investigate apnea lasting ______
> 15 seconds
Describe the breathing pattern unique to infants
Nose breathers until 3 months old
BP is routinely assessed at what age?
> 3 years
Describe pediatric BP assessment (2)
- Use electronic BP machine
- Determine correct cuff size
The BP cuff should be ______ of arm circumference
40%
Where on the arm is BP measured?
Between acromion process and olecranon process
In a clinically decompensating child, ______ will be the LAST to change
BP - even if BP is normal, do not assume patient is stable
Describe the neurological assessment of infants (2)
- Reflexes
- PERRLA not routinely assessed - unless concern of head trauma
Describe the neurological assessment of children (5)
- Alertness
- Affect
- Responsiveness
- Reflexes
- Balance / gait
What areas are assessed for skin color? (5)
- Lips
- Tip of nose
- External ear
- Hands
- Feet
What types of skin lesions are assessed? (3)
- Eczema
- Diaper dermatitis
- Mongolian spots
What are mongolian spots?
Benign gray areas that fade within a few years
Describe the skin assessment for temperature (2)
- Palpate skin with back of the hand
- Hands / feet my be slightly cooler
What skin texture finding is common within the first few weeks of life?
Milia - harmless white spots
What areas are assessed for skin turgor? (2)
- Abdomen
- Upper arm
What turgor assessment finding is considered abnormal?
Oliy / clammy skin
Describe abnormal hair assessment findings (2)
- Seborrheic dermatitis (cradle cap)
- Pediculosis capitis (head lice)
Describe expected findings in the head assessment (2)
- No depressions / protrusions
- Flattened occipital bone
Most infants have head control by what age?
4 months
When does the anterior fontanel close?
12 - 18 months
When does the posterior fontanel close?
1.5 - 3 months
Describe expected fontanel assessment findings (2)
- Soft / flat
- May have pulsation
What does a sunken / depressed fontanel indicate?
Dehydration
What does a bulging fontanel indicate? (2)
- Intercranial pressure
- Meningitis
How can crying affect fontanels?
May produce a temporary bulging appearance
Fontanels should be palpated until what age?
1 year
Describe the expected position of the pinna
At imaginary line from outer canthus to top of ear
What can low set ears indicate? (2)
- Downs syndrome
- Renal abnormalities
Describe the expected color of the tympanic membrane
Light gray / light pink
What does nasal flaring indicate?
Respiratory distress
What does purulent / yellow / green nasal discharge indicate?
Infection
What does clear watery nasal drainage indicate? (3)
- Allergic rhinitis
- Common cold
- Foreign body
Describe lymph node assessment (3)
- Extend chin
- Use a circular motion
- Generally not palpable
Describe variations in infant chest shape
May have slight barrel chest
What position must the child be in while auscultating lung sounds?
Sitting
What abnormalities should be assessed during the respiratory assessment? (5)
- Retractions
- Crackles
- Rhonchi
- Wheezing
- Stridor
What is stridor?
High-pitched inspiratory crowing sound
What can stridor indicate? (2)
- Croup
- Acute epiglottitis
Rapid / shallow respirations at a rate of ______ indicate respiratory distress
60 breaths per minute
What types of muscles can be present in retractions? (5)
- Suprasternal
- Substernal
- Supraclavicular
- Subcostal
- Intercostal
1
Suprasternal
2
Supraclavicular
3
Subcostal
4
Substernal
5
Intercostal
Describe cardiac variations in children (4)
- Less developed heart muscle
- Less compliant ventricle
- Decreased contractility
- Decreased stroke volume
Describe cardiac assessment findings
May have innocent murmur - difficult to detect
What assessment should take place if a child has a cardiac history?
Assess BP in all 4 extremities and compare
Swallowing is involuntary until what age?
6 weeks
When does potty training typically take place?
2 - 3 years
Describe liver variations in children (2)
- Large liver in infants
- Small liver in older children
Describe abdominal assessment (2)
- Inspect umbilicus for hernias
- Determine last BM
Foot arches are not fully developed until what age?
6 years
Describe musculoskeletal variations in children (2)
- Bones - more porous / less dense
- Growth plates - cartilage becomes ossified
Describe genitalia assessment of boys (3)
- Circumcision
- Urethra
- Scrotum
Describe genitalia assessment of girls (3)
- Labia minora / majora
- Vaginal introitus
- Clitoris
