Pediatric Physical Assessment Flashcards
1
Q
Development
A
- Physical
- Cognitive (piaget)
- Psychosocial (Freud)
- Psychosocial (Erickson)
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
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
4
Q
Toddler approach
A
- Most challenging
- Talk to parent first
- Allow to touch equipment
- Leave uncomfy for last
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
6
Q
School age approach
A
- warm up - school, sports, friends
- ask them questions too
- head to toe
- respect their modesty
- Time to teach
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
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
9
Q
Weight
A
SAFETY
- infants- no clothing or diaper, lay or sit on scale
- older: stand on scale
10
Q
Height/Length
A
- lay flat until they are able to stand independently and follow directions
- mark and measure
11
Q
Head circumference
A
- Birth to 3 years
- Prominent part of occiput and above eyebrows
- Consider: measure 3 x
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%
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
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
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
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
Lymphnodes
may have small, firm, nontender, mobile = "shotty (small and random)"
-warm, red, tender = infection
26
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)
27
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)
28
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
29
Tongue, tonsils
Tongue: milk covering vs thrush
Tonsils: prominent
Soft and Hard palate (if not in tact, risk for aspiration when sucking)
30
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
31
Sign of Resp distress
1. Increased RR
2. Retractions
3. Nasal Flaring
4. Head bobbing
32
Heart and pulses
- Sinus arrhythmias are common, esp with respirations
- murmurs
- cap refill
33
Abdomen
- round in infants and toddlers
- may be able to palpate stool in colon
- Hernias are common
- relaxation is key
34
Musculoskeletal
- Adolescents: scoliosis
| - Bowleg (normal in toddlers)/knocked knee (2-7 years old)
35
Neuro
- dev milestones
- reflexes
- posturing, movement
- muscle tone
36
Genitalia
-Penis, meatus (hypospadius: underside of penis; epispadius: on upper side of penis), descended testicles
37
Puberty/sexual maturation
- normalize
- anticipatory guidance
- Girls start earlier than boys
- Tanner scale
38
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)
39
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
