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Assessment > Pediatric Physical Assessment > Flashcards

Pediatric Physical Assessment Flashcards

1
Q

Development

A
  • Physical
  • Cognitive (piaget)
  • Psychosocial (Freud)
  • Psychosocial (Erickson)
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2
Q

Communication

A
  • provide for privacy and comfort
  • Use age appropriate therapeutic techniques
  • Employ active listening
  • Observe nonverbal behavior
  • Show empathy and allow choices if possible
  • Assess level of understanding
  • Explain reason behind actions
  • Demonstrate/illustrate for young children
  • Don’t ever lie, warn them of hurts
  • Provide appropriate play
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3
Q

Infant - Approach

A

-in parent’s lap (stranger anxiety)
-Listen while they are quiet
-Leaving uncomfy stuff for last (ears, eyes, mouth, hips)
-Beware of pee
They are in sensorimotor phase!! Be expressive

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4
Q

Toddler approach

A
  • Most challenging
  • Talk to parent first
  • Allow to touch equipment
  • Leave uncomfy for last
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5
Q

Preschool approach

A

-more cooperative, but still need parents close by
-have them do jobs
-handle equipment, play
-head to toe
MAGICAL THINKING

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6
Q

School age approach

A
  • warm up - school, sports, friends
  • ask them questions too
  • head to toe
  • respect their modesty
  • Time to teach
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7
Q

Adolescent approach

A
  • who will be present
  • talk to both then individually
  • head to toe
  • invite parent back in after exam
  • puberty
  • talk about normal too
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8
Q

Anthropometric measures

A
  • Weight, height, head circumference, BMI
  • Growth charts
  • Trends are most important
  • Changes in any of the above may be first sign of a serious health status change
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9
Q

Weight

A

SAFETY

  • infants- no clothing or diaper, lay or sit on scale
  • older: stand on scale
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10
Q

Height/Length

A
  • lay flat until they are able to stand independently and follow directions
  • mark and measure
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11
Q

Head circumference

A
  • Birth to 3 years
  • Prominent part of occiput and above eyebrows
  • Consider: measure 3 x
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12
Q

Growth charts

A
  • Reference and monitor patterns
  • special ones for premature, Down syndrome, asians
  • Separate for birth to 3 and 2-19 boys and girls
  • Normal between 3 and 97%
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13
Q

Infancy physical dev

A
  • Birth weight doubles by end of first 6 months, triples by end of first year
  • birth length increases by about 50% by end of first year
  • Rapid growth in brain and body
  • Tone, strength and coordination increase from head to toe
  • Early intervention is key if anything is abnormal
  • Need opportunity to play with toys and food
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14
Q

toddlers/preschool physical growth

A
  • Birth weight quadruples by 2.5 years. Yearly gain: 4.4-6.6 lbs
  • Height at 2 years is approx. 50% of eventual adult height
  • Height gained during 2nd year - 4.8 inches, during 3rd year - 2.4-3.2 in
  • Increase in strength, coordination and dexterity; fearless and tired
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15
Q

School age / adolescent physical growth

A
  • Yearly weight gain 4.4 - 6.6 lbs
  • Yearly height gain after 6 years of age - 2 inches
  • Female pubertal growth spurt (10-14 yrs): weight gain 15-55 lbs (mean 36) / height gain 2-10 in. 95% of mature height achieved by onset of menarche or skeletal age of 13
  • Male pubertal growth spurt (12-16 years): weight gain 15-65 lbs; height gain 4-12 inches / 95% of mature height achieved by skeletal age of 15 years
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16
Q

HISTORY

A
  • Perinatal, obstetric history
  • Birth wt, apgar, overall health
  • Immunization
  • Growth and dev - major milestones
  • Habits and other hot topics
17
Q

Vital signs temp

A

-Temperature: route is debatable

Key points: document site, trends are important, validate if out of range or unsure

18
Q

Temp routes

A
  • rectal: if exact is needed
  • tympanic: down and back if less than 3; up and back if older than 3
  • axillary: infant, young children, immunosuppressed, oral surgery, neuro impaired
  • Oral: older than 5 or 6
19
Q

Pulse

A
  • apical site if less than 2 years, history of CHD or irregular: (if less than 7, left MCL and 4th ICS; if older than 7, left MCL and 5th ICS)
  • radial for all others
  • count for one minute
  • Changes w breathing are normal
20
Q

Respirations

A
  • Count for 1 full minute
  • Periodic breathing
  • Auscultate esp in infant, young child
21
Q

Blood pressure

A
  • Save for last
  • appropriate cuff size
  • hug, feel how strong (watch how use words)
  • Upper arms and legs
  • Document site, stay with same site
  • normal - age, height, gender
22
Q

General appearance

A
  • Appears undistressed, clean and well kept; eye contact after infancy
  • Follow simple commands as dev. appropriate
  • Spontaneous speech, movement, etc
  • Interaction with and response of/to parent and others
  • you can tell 80% of the time how a child is doing by just looking at them; what’s going on and look undistressed
23
Q

Skin, Hair and Nails

A
  • Temp, moisture, texture, hair, nails
  • Watch for: scalp, note lesions, hair loss in infants normal (some belly time is ok when this happens, but SUPERVISED) where lay in bed, secondary hair growth for adolescents
  • Mongolian spots: 80% of african american, indian and asian: darker areas of pigment; grayish background to them; fairly common; could be mistaken as a bruise; visible at birth; decrease and disappear by age 4-5
  • Yeast, contact dermatitis (contact dermitits not in folds, but yeast is in folds)
  • cradle cap - seb dermatitis: once scalp of baby, just a wax buildup
  • Ring worm
  • milia
24
Q

Head and Neck

A
  • Head: fontanels (post closes 2-3 months and ant closes 12-18 months)
  • anterior shaped like a diamond; post is the size of a nickel
25
Q

Lymphnodes

A

may have small, firm, nontender, mobile = “shotty (small and random)”
-warm, red, tender = infection

26
Q

Eyes

A

Iris: permanent color between 6-12 months

  • visual acuity: fix and follow objects if infant
  • older children
  • Watching for nystagmus (musculature of eye); strabismus (cover/uncover)
27
Q

Ears and Nose

A

Ears:
-Alignment (down syndrome is low set ears)
-hearing: neonates - blink, startle to loud sound; infants localize to sound; older - whisper test
Nose: watch for flaring (usually means sick; watch for retractions as well)

28
Q

Mouth

A

Teeth: deciduous teeth erupt by about 6 months and all 20 appear by about 2.5 years

  • during first 2 years: age of child in months - 6 = number of teeth
  • Teeth begin to fall out at about 6 years and permanent teeth erupt until 32 by late adolescence
29
Q

Tongue, tonsils

A

Tongue: milk covering vs thrush
Tonsils: prominent
Soft and Hard palate (if not in tact, risk for aspiration when sucking)

30
Q

Thorax and lungs

A
  • infants have irregular resp rhythm
  • younger children = belly breathers
  • Breaths sounds - refer
  • Deep breaths?
  • Breast: enlarged as infant (first several days) and female dev bw 10 and 14 years
31
Q

Sign of Resp distress

A
  1. Increased RR
  2. Retractions
  3. Nasal Flaring
  4. Head bobbing
32
Q

Heart and pulses

A
  • Sinus arrhythmias are common, esp with respirations
  • murmurs
  • cap refill
33
Q

Abdomen

A
  • round in infants and toddlers
  • may be able to palpate stool in colon
  • Hernias are common
  • relaxation is key
34
Q

Musculoskeletal

A
  • Adolescents: scoliosis

- Bowleg (normal in toddlers)/knocked knee (2-7 years old)

35
Q

Neuro

A
  • dev milestones
  • reflexes
  • posturing, movement
  • muscle tone
36
Q

Genitalia

A

-Penis, meatus (hypospadius: underside of penis; epispadius: on upper side of penis), descended testicles

37
Q

Puberty/sexual maturation

A
  • normalize
  • anticipatory guidance
  • Girls start earlier than boys
  • Tanner scale
38
Q

Girls: secondary sex characteristics

A

7-13: breasts begin to dev
8-14: pubic hair beings to grow
8-15: the vagina grows longer, and its outer lips (labia) become more pronounced
9-14: the body grows taller and heavier
9-16: menstruation begins
11-16: hair begins to grow under the arms
11-16: glands in the skin and scalp being to produce more oil, which can cause skin blemishes
*girls will start menstruation 2 years after breast buds develop (about)

39
Q

Boys: secondary sex characteristics

A

10-13: the testicles being to enlarge and the scrotum turns darker and coarser
10-15: pubic hair begins to grow
10-16: the body grows taller and heavier
11-15: the penis begins to grow longer and fuller
11-15: voice deepens
11-17: boys become fertile, meaning they are capable of ejaculating semen
12-17: hair begins to grow under the arms and on the face
12-17: glands in the skin and scalp begin to produce more oil, which can cause skin blemishes

Assessment (8 decks)

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