Pediatric Assessment Flashcards
If the child is under 2 what should you get the circumference of?
Head, chest, and abdomen
Normal vital signs for newborn - 1 year of age
Resp: 30-60
HR: 100-170
BP: 65/45
Normal vital signs for a 1 -4 year of age
Resp: 20-40
HR: 70-110
BP: 90/55
Normal vital signs for 5 - 12 years of age
Resp: 16-22
HR: 60-95
BP: 100/60
Normal vital signs for over 12 years of age
Resp: 12-20
HR: 60-95
BP: 120/80
What impacts children’s vital signs?
stress, fear, activity, and crying
Normal oral temp
98.6 (37.0)
Normal rectal temp
99.6 (37.6)
Normal axillary temp
97.6 (36.5)
A child is not febrile unless what?
unless the temp is above 100.4 (38.0)
In infants and toddlers when should you auscultate?
when they are quiet and save the eyes and ears for last
What do you assess in infants and toddlers?
head to toe development and considerations
What do you assess in preschool age children?
head to toe if possible
What do you assess in school age and adolescence?
head to toe and genitalia for last
What is Erythema Toxicum?
“baby acne”
What is eczema?
inflammatory, painful itching disease of the skin
What are mongolian spots?
bluish discoloration over buttocks and base of spine, probably present on at least one of the parents. Benign and will usually fade in 1-2 years.
What do you assess with the eyes?
PERALA
anisocoria
check for eye drainage
visual tracking
What is anisocoria?
When one pupil is a different size than the other
What do you assess with the ears?
check placement
canal more horizontal in infants
assess language skills
check for drainage
If the ears are below ear level what could this indicate?
downsyndrome
Who are the obligatory nose breathers?
neonates
What teaching is necessary for parents of a neonate?
teach parents to clear nasal passages prior to feeding
what do you assess with the mouth?
- examine palate, tongue, and gums
- assess dentition prior health problem in children
- frequent swallowing postop nasopharyngeal surgeries may indicate bleeding
what do you assess with neck and lymph nodes?
- neck mobility
- palpate nodes: cervical, post auricular, supraclavicular, inguinal, axillary
How much has the brain grown by 2 years of age?
75%
How much has the brain grown by 6 years of age?
90%
when do the skull sutures close but not ossify?
10-12 years of age
what is not fully developed in the brain?
the blood brain barrier and water can always pass through
what type of breathers are babies?
abdominal breathers
What does the respiratory look like in babies?
- airways are small in diameter
- trachea is short and narrowest portion at cricoid ring so you need to use uncuffed ET tubes
- chest wall compliant
- lungs are noncompliant
- the respiratory muscles lack power/tone
- alveoli is decreased number and compliance
What do you assess with respiratory?
color- cyanosis requires 5 grams of desaturated hgb to be visible rate excursion effort-retractions breath sounds
what does the oxyhemoglobin dissociation curve do?
relates oxygen saturation and partial pressure of oxygen in blood determined by how readily hemoglobin acquires and releases oxygen
What do you assess with the abdomin?
- examine while the child is quiet
- elimination pattern
- liver- 2 cm or less below the LICM
- palpate spleen
- infants/toddlers dont localize pain
what is important with cardiovascular in children?
right and left ventricles are similar in size at birth
* Kids are rate dependent
Where is the PMI in infants and toddlers?
2-4 ICS, left of the MCL
where is the PMI in preschool age children?
4-5 ICS MCL 7 & up -5th ICS, right of MCL
What is the CBV in infants
80 cc/kg
what is the CBV in children?
75 cc/kg
What is the CBV in adolescents?
70 cc/kg
What are early signs of decreased cardiac output?
- pulse rate- tachycardia
- skin- mottled, pale and cool extremities
- increased capillary refill time is greater than 2 seconds
- LOC -decreased sensorium
- Urine output is decreased
- metabolic acidosis
what are late signs of decreased cardiac output?
decompensation: hypotension & bradycardia
What is the normal urine output for a child?
1.0-2.0 cc/kg
what is the normal urine output for a child postop?
0.5cc-1.0cc/kg
What do you assess with Renal/GU?
history of UTIs
- examine external genitalia
- assess for pubertal changes
- menstrual history
- testicles descended
How do you give medications to children?
based on weight
mg/kg
the dose is different for each child
what happens when the WBCs differentiate?
shift to the left
What does an increase in bands indicate?
bacterial infection or inflammatory process
What are monocytes?
(2-8%)
macrophages-phagocytosis, remove debris from wounds engulf foreign particles role in dissolving clots
-elevated with chronic bacterial/viral infections, rise with acute bacterial infections if extensive or prolonged
Lymphocytes
25-45 %
- produced in thymus, lymph, marrow, spleen, tonsils, combat viral infections
- provide humoral & cell mediated immunity
- elevated-mono, CMV, Mumps, Rubella
- Decreased- aids, after burns or trauma
What is the metabolic assessment?
- increased BMR
- neonates-nonshivering thermogenesis
- may need additional glucose supplies under stress
- stress, IV fluid, gluccocorticoids, & DM increase blood sugar
Where are gastric tubes?
Nasogastric (NG)
Orogastric (OG)
Gastrostomy (GT)
Where are duodenal/jejunal tubes?
Gastro-Jejunal (GJ)
Transpyloric (TP)
how do you obtain a urine collection from a small child?
clean and dry the perineum
-apply adhesive to perineum. penis should be inside opening males
