Pediatric Physical Assessment Flashcards
Development
- Physical
- Cognitive (piaget)
- Psychosocial (Freud)
- Psychosocial (Erickson)
Communication
- 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
Infant - Approach
-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
Toddler approach
- Most challenging
- Talk to parent first
- Allow to touch equipment
- Leave uncomfy for last
Preschool approach
-more cooperative, but still need parents close by
-have them do jobs
-handle equipment, play
-head to toe
MAGICAL THINKING
School age approach
- warm up - school, sports, friends
- ask them questions too
- head to toe
- respect their modesty
- Time to teach
Adolescent approach
- who will be present
- talk to both then individually
- head to toe
- invite parent back in after exam
- puberty
- talk about normal too
Anthropometric measures
- 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
Weight
SAFETY
- infants- no clothing or diaper, lay or sit on scale
- older: stand on scale
Height/Length
- lay flat until they are able to stand independently and follow directions
- mark and measure
Head circumference
- Birth to 3 years
- Prominent part of occiput and above eyebrows
- Consider: measure 3 x
Growth charts
- 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%
Infancy physical dev
- 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
toddlers/preschool physical growth
- 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
School age / adolescent physical growth
- 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
HISTORY
- Perinatal, obstetric history
- Birth wt, apgar, overall health
- Immunization
- Growth and dev - major milestones
- Habits and other hot topics
Vital signs temp
-Temperature: route is debatable
Key points: document site, trends are important, validate if out of range or unsure
Temp routes
- 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
Pulse
- 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
Respirations
- Count for 1 full minute
- Periodic breathing
- Auscultate esp in infant, young child
Blood pressure
- 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
General appearance
- 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
Skin, Hair and Nails
- 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
Head and Neck
- 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
Lymphnodes
may have small, firm, nontender, mobile = “shotty (small and random)”
-warm, red, tender = infection
Eyes
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)
Ears and Nose
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)
Mouth
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
Tongue, tonsils
Tongue: milk covering vs thrush
Tonsils: prominent
Soft and Hard palate (if not in tact, risk for aspiration when sucking)
Thorax and lungs
- 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
Sign of Resp distress
- Increased RR
- Retractions
- Nasal Flaring
- Head bobbing
Heart and pulses
- Sinus arrhythmias are common, esp with respirations
- murmurs
- cap refill
Abdomen
- round in infants and toddlers
- may be able to palpate stool in colon
- Hernias are common
- relaxation is key
Musculoskeletal
- Adolescents: scoliosis
- Bowleg (normal in toddlers)/knocked knee (2-7 years old)
Neuro
- dev milestones
- reflexes
- posturing, movement
- muscle tone
Genitalia
-Penis, meatus (hypospadius: underside of penis; epispadius: on upper side of penis), descended testicles
Puberty/sexual maturation
- normalize
- anticipatory guidance
- Girls start earlier than boys
- Tanner scale
Girls: secondary sex characteristics
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)
Boys: secondary sex characteristics
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
