Pediatric Assessment ppt (up to but not including Health Supervision) Flashcards
Exam 1
Health assessment components in pediatrics
Health interview and history.
Observation of the parent–child interaction.
Assessment of the child’s emotional, physiologic, cognitive, and social development.
Physical assessment.
What is crucial for proper assessment of the family’s needs?
*Behavioral observations are crucial to proper assessment of the family’s needs.
Nurse role when assessing a pediatric patient
Establish rapport and trust.
Demonstrate respect for the child and parent/caregiver.
Approach child in a developmentally appropriate manner.
Communicate effectively by listening actively, demonstrating empathy, and providing feedback.
Observe systematically.
Obtain accurate data.
Validate and interpret data accurately.
Therapeutic communication
Active listening.
Using open-ended questions.
Identifying and eliminating barriers to communication.
Establishing rapport.
What is the foundation of an accurate health assessment
Health interview
Health history includes:
Demographics
Chief complaint
History of present illness
Past health history
Review of systems
Family health history
Developmental history
Functional history
Family composition
Resources
Home environment
Demographics
simple, non-intrusive; never assume who parent is
Chief complaint
Reason for the visit
History of present illness
Onset, duration, characteristics, and course (location, signs, symptoms, exposures, etc.).
Previous episodes in the child or family members.
Any changes in environment/daily routine.
Previous testing or therapies; what makes it better or worse.
What the concern means to the child and family.
Inquiry about any exposure to infectious/toxic agents.
Past health history
Prenatal or perinatal history, past illnesses, other developmental concerns.
Prior history of illnesses, accidents, or injuries.
Any operations or hospitalizations.
Diet (specifics) and allergies (type and reactions).
Immunization status.
Any OTC or prescription medications child is taking.
Menstrual history in adolescent females.
Health history: Development
Developmental: meeting milestones
Health history: Functional
Functional: Daily Routine; Sleep, safety, Dental, Physical play, nutrition, etc.
Assessment
General appearance, vital signs [PAIN – FLACC or Pain Faces], body measurements (height, weight, head circumference, BMI on appropriate growth charts), activity level, orientation, mood, and pain assessment.
Physical examination- what is the technique?
Inspection
Palpation
Percussion
*Auscultation
What is the largest body organ?
Skin
What does the skin reveal?
reveals nutrition, respiratory, cardiac, endocrine, and hydration status at a glance.
Inspecting variations in skin color and causes:
Pallor, central and peripheral cyanosis, jaundice, redness, etc.
Descriptive about lesions
Hair and Nails: What can dry brittle nails indicate?
Nutritional difficiency
Coarse dry hair can indicate what?
Thyroid or nutritional deficiency
In children, what you you assess about a child’s head?
Always assess symmetry (face and muscle movement)
What are the two fontanels
- Anterior
- Posterior
Anterior Fontanels
closed between 9-18 months
Posterior Fontanels
Posterior: smaller; closes between shortly after birth and 2 months
What are you checking for with the necks of babies?
Symmetry, webbing, ROM, lymph nodes
What are you checking for with the ears of the babies?
EARS: Symmetry, placed no lower than the eyes, skin tags
How to check inner ear of young infant/child
*Pull down earlobe of young infant/child
How to check inner ear of young older child
*Pull up on outer edge of pinna in older child
What are you assessing for eyes of babies?
EYES: Symmetry, spacing, epicanthal folds, accommodation (focusing at different distances),
PERRLA (pupils equal round reactive to light and accommodation), extraocular motility (tracking), Hirschberg test (small dot in reflected eye symmetrically in each eye)
Hirschberg test
(small dot in reflected eye symmetrically in each eye)
For nose, what are you checking for?
symmetry, patency, drainage, piercings
For Mouth and Throat, what are you checking for?
Lips for inflammation, lesions, edema; teeth; tonsils pink, uvula midline, no exudate
For the Thorax and Lung assessment what do you start with?
Begin assessment by observing shape and contour and determining work of breathing.
For thorax and lungs, what else are you assessing?
Observe rate and respiratory effort—easy, labored?
Note retractions or use of accessory muscles to breathe.
Listen for unusual sounds—wheezing, stridor, crackles, or diminished
Describe cough if present—dry, hacking, wet, productive.
Play games to get child to cooperate with deep breathing!
For breasts, what are you assessing?
Breasts: Assess based on Tanner Stage 1-5
When observing a child’s heart what do you assess?
Observe posture, color, symmetry, clubbing, vein distention, apical impulse (can be visible) at point of maximum intensity (PMI)
Pulses, warmth, cap refillWh
What is a common finding in children (having to do with the heart)
Murmur: common finding in children.
How is a heart murmur graded?
Grading is based upon how loud the murmur is:
Grade I (soft and intermittent) to Grade VI (loud, can be heard without the stethoscope touching chest).
When assessing a murmur, what should you note?
Note the anatomic location where the murmur is best heard.
Note where and if murmur radiates to other parts of the chest.
In children, how should you divide the abdomen?
Divide into 4 quadrants as in adult.
In children, what are you assessing for in the abdomen
Inspect for size, shape, symmetry; infant and toddler will be rounded, check cord in infants.
In the abdomen, what are you auscultating for?
Auscultate bowel sounds
What is the order of operations of assessing the abdomen?
- Inspect
- auscultate
- Percuss
- Palpate
How do you palpate the abdomen?
first light and then deep. Monitor pain, organs
(liver, spleen, kidneys rarely palpated)
When palpating the abdomen, what is expected?
Should be soft, nontender, nondistended
Report firmness, tenderness, or masses
When assessing the musculoskeletal, what does that include?
Includes clavicles, shoulders, spine, extremities, joints and hips. Determining range of motion. Tone.
Assessing the clavicle and shoulder, what are you checking for?
Clavicles & Shoulders: tenderness, crepitus, strength
Assessing the spine, what are you checking for?
Spine: posture, alignment, scoliosis
When assessing extremities what are you checking?
Extremities: move spontaneously , gait
Genu varum
bow legs
How long does genu varum last?
until 2-3 years
Genu valqum
knock knee
How long does Genu valqum last?
until 7 years old
Neurologically, what are you assessing?
Level of Consciousness:
Balance and Coordination:
Sensory:
Reflexes
Developmental:
Level of consciousness
alertness and attentiveness
Balance and Coordination
controlled by cerebellum: Gait, Romberg, heel to shin, rapid alternating movements, finger to finger, finger to nose
Sensory is assessing
Sensory: cranial nerves, vision, hearing, tasting, smelling, sharp and dull
Reflexes are assessing
Reflexes: primitive and protective reflexes. Deep tendon reflexes
Development, what should be done?
utilize screening tools
What assessment should you leave until the end
Genitalia/anus
What scale is used to assess genitalia and anus?
Tanner scale
Tanner scale
used for girls and boys to categorize degree of pubertal development.
How is the Tanner Scale recorded?
Recorded as Tanner Stages I–IV.
What is included in the tanner scale?
breast and pubic hair distribution for girls.
pubic hair, penis and scrotum size for boys.
When assessing anus, what is being checked?
Anus: assess for fissures, rash, hemorrhoids, skin tags
