Pediatric Physical Assessment

Question 1

Communicating with Families

Answer 1

• Communicating w/ parents
  > encouraging parents to talk
  > directing the focus
  > listening & cultural awareness
  > using silence
  > being empathetic
  > providing anticipatory guidance
  > avoiding blocks to communication
  > communicating through an interpreter

Question 2

Communicating with Children

Answer 2

• Communication r/t development of thought process
• Infancy: ?s directed to parents
• Toddler: ?s directed to parents 1st, then toddler
  > egocentric (analogies)
  > don’t want to lose control
• Preschool
  > let parents stay in room
  > body integrity
  > blame themselves
• School years
  > explanations/rationales
  > encourage them to communicate fears
• Adolescence
  > talk to like an adult
  > privacy & confidentiality

Question 3

History Taking

Answer 3

• Birth hx
• Dietary hx
• Previous illness, injuries, & operations
• Allergies
• Current meds
• Immunizations
• Growth & development
• Habits
• Reproductive hlth hx
• Family hlth hx
  > geographix location
• Family structure
• Psychosocial hx
  > mental hlth concerns
• Review of systems

Question 4

General Approaches Toward Examining Child

Answer 4

• Sequence of examination
  > head-to-toe sequence
  > altered to accommodate child’s developmental needs
  > use chronological & developmental age
• Goals of pediatric assessment
  > observe for readiness to cooperate
  > minimize stress & anxiety associated w/ assessment of various body parts
  > foster trusting nurse-child-parent relationships
  > allow for max preparation of child
  > preserve security of parent-child relationship
  > max accuract of assessment findings

Question 5

Sequence of Assessment

Answer 5

• Newborn: 1st RR, 2nd HR; least invasive to most (diaper last)
• Toddlers: make them comfortable, RR, HR, diaper last
• Preschool: offer gown, explain everything
• School age: normal assessment
• Adolescent: treat like adult

Question 6

Growth Measurements

Answer 6

• Growth charts
• Length: 1st 2yrs take laying down
• Height: after 1st 2yrs take standing up
• Weight: 1st 2yrs take diaper off
• Head circumference: 1st 3yrs

Question 7

Vital Signs - Temperature

Answer 7

• Temportal
• Tympanic: wait until 2yrs
• Oral: at 5yrs
• Axillary: 1st 5yrs
• Rectal: only in emergencies

Question 8

Vital Signs - Pulse

Answer 8

• Apical: most accurate
• Radial: can use around 2yrs
  > still need to feel for them

Question 9

Vital Signs - Respirations

Answer 9

• Belly breathers
• Count for a full minute

Question 10

Vital Signs - Blood Pressure

Answer 10

• Start taking in PCP office around 3yrs
• Heart defects: 4 point BPs

Question 11

Vital Signs - Oxygen Saturation

Answer 11

Take on feet

Question 12

Physical Assessment - General

Answer 12

• General appearance
  > clothes
  > affect
• Skin
  > bruising
  > pigment
  > scars
• Lymph nodes
• Extremities
• Head & neck
  > hair
  > ROM
  > helmets more common

Question 13

Eyes

Answer 13

• External structures
• Internal structures
  > preparing child
• Funduscopic examination

Question 14

Vision

Answer 14

• PERRLA
• Visual acuity; hard to assess
• Peripheral vision
• Color vision
  > red reflex; checking for cataracts, want the reflex
• Ocular alignement
  > looking for lazy eye
  > Strabismus (needs to be detected by 4-6yrs)
  > cover test: eye should not need to adjust
  > corneal light reflex
  > amblyopia: blindness from severe lazy eye tht is not treated

Question 15

Ears

Answer 15

• External structures
• Internal structures
  > positioning child
• Otoscopic examination
  > 3 or younger: pull pinna down & back
  > Older than 3: pull pinna up & back
• Auditory testing

Question 16

Nose

Answer 16

• External structures
  > septum present, any holes
• Internal structures

Question 17

Mouth & Throat

Answer 17

• Internal structures
  > tonsils visible in school age
• Teeth
  > shark teeth

Question 18

Chest

chest area

Answer 18

• Chest shape
  > infant very round
• Breast development
  > school age: 8-9yrs
  > prepubescent, andronarc
• Lungs
  > listen to all quadrants
• Heart

Question 19

Abdomen & Genitalia

Answer 19

• Abdomen
  > inspection
  > auscultation
  > palpation (mindful of ticklish spots)
• Genitalia
  > male: check if testes have dropped by 1st yr, may go up & down; incrd risk for cx & long term infertility if not dropped by then
  > female: pseudomenses
  > enuresis: more concerning for school age
  > nocturesis
  > UTIs: common in little boys
• Anus: must poop before discharge after birth

Question 20

Hypospadias

Answer 20

• Head of urethra in wrong spot
• If hypospadias or epispadias present, monitor urine output & notify provider

Question 21

Hernia

Answer 21

• Protrusion of portion of an organ through an abnormal opening
  > danger of incarceration/strangulation
• Types
  > diaphragmatic
  > abdominal wall
  > inguinal canal

Question 22

Back & Extremities

Answer 22

• Spine
  > bending over
• Extremities
• Joints
• Muscles

Question 23

Neurologic

Answer 23

• Cerebellar function
  > finger-to-nose
  > heel-to-shin
  > Romberg test
• Reflexes
• Cranial nerves

Question 24

Pediatric Assessment Triangle

Answer 24

• Circulation to skin
  > color: pallor, mottling, cyanosis
• Work of breathing
  > position
  > retractions
  > flaring
  > breath sounds
  > apnea/gasping
• Appearance
  > mentation
  > consolability
  > tone
  > interactiveness
  > speech
  > look/gaze