Pediatric Physical Assessment Flashcards
principles of communication
make it developmentally appropriate
get on eye level
approach gently and quietly
be truthful
give them as many choices as possible
how to perform a health history
identifying information
chief complaint
present illness
past history
current meds
immunizations
pain history
psychosocial history
family med history
sexual history
ROS
age classifications for newborns, infants, toddlers, preschool, school age, adolescents
birth to 1 month
1 month to 12 month
1 year to 3 year
3-5 years
6-11 years
12-18/20 years
how to obtain growth measurements
recumbent length for infants up to 36 months + weight and head circumference
what is considered outside expected paramaters for height, weight, and head circumference
less than 5th or greater than 95th percentile
appropriate approach to examine a young infant
parents lap or on exam table
listen toh eart lungs first
undress, keep them in diaper, covered
distraction*
appropriate approach to examine an older infant
able to sit unsupported
stranger anxiety
sit on parents lap
prevent prolong eye contact
address the parents
instrucive procedures last
appropriate approach to examine a toddler
sitting or standing
separation anxiety so keep parents in view
talk with parents first
utilize play
instrusive procedures last
let htem handle the equipment
have parent remove clothing
transitional objects
demonostrate assessment on a toy
praise and reward
appropriate approach to examine a preschool age
lying, standing, sitting, keep parents close
cooperative modified head to toe
play games
instrusive procedures last
let them handle equipment
self undress
demonstrate
tell a story
educate with exam
leave on underpants
appropriate approach to examine a school age or adolescent
sitting
address child first
head to toe assessment
privacy, self undress
teach about bodily functions and health habits
offer choices
what to assess for general appearance
faces
posture
position
body movement
hygiene
nutrition
behavior
development
skin assessment
color
texture
temperature
moisture
tissue turgor
pigment lesions
accessory structures- hair and nails
head and neck
shape
symmetry
head control
head posture
ROM of neck
anterior fontanel should be closed around when:
12-18 months
the posterior fontanel cranial sutures close by when:
6-8 weeks
what is plagiocephaly
flat head
what is craniosynotosis
premature closing of sutures, or ICP
eyes assessment
size
shape
symmetry
conjunctiva
cornea
pupils
fundoscopic exam
(fundus, red, reflex, blood vessels)
vision testing
(ocular alignment, visual acuity, peripheral vision, color vision)
strabismus
eye misalignment
normal up until 3 months of age
age 3-8 need objective vision screening how often
yearly
what are tests for visual acuitiy for ages 3-5
illiterate E or HOTV
what ages use the Snellen chart
6+
ear assessment
external structures: position, cerumen
internal structures: landmarks, light reflex
nose assessment
external structures: position and placement, nasal flaring
internal structures: mucosa, turbinates, septum
nasal drainage and odor
tonsil sizing
1- normal
2- normal
3- viral pharyngitis, strep
4- airway obstructions
chest and back assessment
size, shape, symmetry
movement
nipples
breast development
scapular symmetry
spinal curvature
ROM
pectus excavatum
sternum is compressed in, concerned about heart or blood vessels
common in scoliosis
pectus carinatum
pigeon chest
sternum protrudes outward
can affect pulmonary function
respiratory assessment
rapid rate
adventitious vs oral sounds
chest wall more compliant
infant- chest rounded
neonates-obligatory nose breath
under 6-7 years - abominal breathing
flaring/grunting/retractions
cardiac assessment
under 7- PMI @ 4th ICS, laterl to MCL
over 7- PMI @ 5th ICS, lateral to MCL
cap refill <2
sinus arrythmia is normal
assess heart upright and supine
abominal assessment
inspection, auscultation, palpation
contour
movement
umbilicus
hernias
bowel sounds
palpation
tanner scale
puberty changes into adolescence (1-5)
male genitalia assessment
male structures: penis glans and shaft, urethral meatus, scrotum and testes
hair distrubution
tanner stage
anus
female genitalia assessment
structures: labia majora/minora, clitoris, urethral orifice, vaginal orifice
hair distrubiution
tanner stage
anus
musculosketal and extremity exam
hips (infants)
bowleggedness (until 2 years)
knock knees (2-7 yers)
appearance of flatfoot (infants)
tibial torsion
babinski (normal until 18 months)
muscle strenght
gait
sole and palm creases
bowleg
genu varum
knock knee
genu valgum
neurological assessment
balance and coordination
finger to nose test
heel to shin
romberg test
reflexes- triceps, biceps, patellar, achilles
cranial nerves
