Pediatrics Flashcards
Measurements
hi emma
Chest and Heart
heart-apical rate
abdominal movement with respirations
retraction
Abdomen-umbilicus and skin turgor
Chest and Heart
heart-apical rate
abdominal movement with respirations
retraction
Abdomen-umbilicus and skin turgor
Abdomen
inspect shape of abdomen and skin condition
inspect the umbillicus, count vessels, note condition of cord or stump and presence of any hernia, palpate skin turgor, plapte femoral pulse and inguinal lymph nodes
Head and face
note any moulding of cranium after delivery, any swelling and bulging of fontanelle with crying or rest
palpate the fontanelle, suture lines for swelling
positioning and symmetry of facial features of infant at rest and during crying
eyes
Parent can hold baby, inspect eyelids (edematous in newborns) nystagmus, conjunctivae, discharge
Pupillary reflex, blink reflex, corneal light reflex, assess tracking
opthalomoscope, elicit red reflex
Red reflex
retina reflex that helps show if there are visual opacities like cataract abnormalities
Ears
WAIT UNTIL END
size, shape of auricles, patency of auditory canals, and extra skin, tags or pits
note startle reflex to loud noise
palpate flexible auricles
Nose and throat and mouth
inspect the gums, lips, high arched intact palate, buccal mucose, salivation
note rooting reflex
insert a gloved finger into infants mouth and note sucking reflex and palpate palate
Neck and upper extremities
ROM and muscle tone
inspect and manipulate
count fingers, palmar creases and note hand colour
thumb in babies palm. note the head lag and their grasp
Lower exremities
inspect
manipulate legs and feet, note ROM, muscle tone and skin condition
allignment of feet and toes, look for flat soles, count toes
ortolani manouvre tests for hip stability
babinksi reflex
Genitalia-
inspect and palpate scrotum for testis
Neuromuscluar
shoulder muscle tone and infants ability to stay in your hands without slipping
rotate newborn side to side and note dolls eye reflex
turn infant around so the back is to you, elicit the stepping reflex and the placing reflex against the edge of the exam table
Dolls eye reflex
deviation of eyes opposite to way their head is being moved
Spine and rectum
skin inspection
tufts of hair, protrusions, sinus opening
Moro reflex
let head and trunk drop back a short way to see f they startle
Neonatal reflexes
Eye blink-shine bright light at eyes or clap near head
Rooting-stroke cheek near mouth
Sucking-finger in mouth
Swimming-face down in pool of water
moro-let head drop back slightly
palmar grasp-finger in infants hand
tonic neck-turn infant to one side while infant is laying on back
stepping-bare feet touch surface when you hold infant under arms
babinksi-stroke sole of foot-toes curl
Health assessment for kids
observation
interview the patient
interviewing the child
physical assessment
Bio-graphic Demographics
Name, age, health care provider
Parent’s names and ages
Siblings names and ages
Ethnicity and cultural practices
Religion and religious practices
parent occupation
child occupattion
child occupation-adolescent
Past Medical History
Important to gather info on allergies, childhood illness, trauma or hospitalizations, birth history (premature delivery, babe in NICU, how long until babe is discharged)
Genetics-any investigations or concerns
developmental delays
Current health status
immunizations
medications
allergies
how they are currently feeling?
Neonate
birth to one month
Infant
one to 12 months
Toddler
1-3 years
Preschooler
3-6 years
School age
6-12 years
Adolescent
12-18 years
Principles of communication with children
Include their name
make communication developmentally appropriate
approach child gently and quietly
always be truthful
give child choices as appropriate-doll or toy
involve child play and pay attention to them
Developmental considerations
Birth-2=sensorimotor (object permanance and stranger anxiety)
2-6 years=preoperational (pretend play, egocentrism, language)
7-11 years=concrete observational (conservation, mathmatical transformation
12-adulthood=formal operational (abstract logic, mature moral reasoning)
Approaching the pediatric patient
OBSERVE
remain calm and confident
don’t separate child from parent unless absolutely necessary (infant can sit on lap)
establish rapport with child and parent
Be honest with both
Assessment Tips: Infant
Have parent nearby or holding baby
warm enviornment
leave diaper on
warm hands
talk softly
comfort measures
timing around feeds may be helpful
Assessment tips for toddlers
Do exam quickly or on parents lap if child is uncooperative
greet the child by name but pay attention to the caregiver more initially
use play therapy
let the toddler play qith equipment
observe non-verbal behaviours
give choices and praise them frequently
demonostrate on yourself first
Assessment tips for preschoolers
Increase verbal communication
keep it simple
may be able to “help”
hold the measuring tape or stethescope
use games
Assessment tips for school agers
Allow the older child the choice if parent is present
use small talk for older children as appropriate (Ask questions about school, friends)
Exaplain procedures and equipment
Be patient, give choices, ge honest
again, parents can help too
Assessment tips for adolescents
Privacy
Provide reassurance as the body is charging rapidly
need feedback that they are healthy and normal
communicate with care-don’t treat them like a child, but not as an adult either
great time for health teaching and promoting positive attitudes
Systematic Assessment
vital signs
measurements
head to toe
systems
reflexes
growth and development
head and neck
eyes/ears
mouth/nose
chest
abdomen
msk
genitalia
elimination
neuro
Know the normal peditaric vital sign ranges
slide show
Apical pulse
moves when kids get older (starts high then moves down)
What is the 5th vital sign?
Pain
assess subjectively and objwectively
non-verbal behaviours
vital sign changes from baseline
Wong Baker Faces Scale
Other paediatric pain scales as appropriate
Measurements
head circumference
weight
height
Systematic approach
Look-observation, position, movement, behvaiour, colour
Listen-auscultation, cry, respiratory effort
Feel-palpation, muscle tone, skin temperature
Neuro assessment
General level of consciousness
behaviour
interest in enviornment
alertness (awake)
orientation
speech
cry (lusty, high pitched, weak)
Fontanelles
soft
flat
firm
sunken
bulging
tense
Pup[il reactivity
one of the earliest signs of ICP is an increase in pupil size and decrease in pupil response to light
movement of limbs (coordinated, purposeful
ambulation (independent
Glasglow Coma scale modified
strength of suck
tone
Cardiovascular assessment
blood pressure (within normal limits) BP machine
Heart rate (assess for one full minute, apical in those under 2
rythym normal sinus, sinus arrhythmia is common)
PMI=heart sounds S1 and S2, murmurs and pericardial rub
Cap refill (under 3 seconds)
skin colour
chest shape
Sskin
texture
joints and swelling or edema
skin integrity
hydration status
temperature
peripheral pulses
Respiratory assessment
assess for a full minute
diaphragmatic-observe abdominal movements
rythm
depth
auscultation
Gastrointestinal assessment
abdomen (soft, round, flat, hard, distended, firm, tender with palpation)
bowel sound, location, frequency and quality)
flatud
stools (colour, consistency, amount, frequency, bloof, mucous
Diet (NG tube)
More GI for babies
Apetite (normal, decreased)
Emesis (colour, consistency, amount, frequency, blood, bile)
Colostomy/ileostomy (amount, stoma, colour, consistency)
Buttovk and spine
GI
Urine output (accurate, weighing diapers, 12 and 24 hour balances
urine type
pain with urination
catheter
External genitalia
Signs of precious puberty (hair growth, breast development)
rashes
descended testis vaginal discharge
patent anus
MSK
Coordinated movements
Casts
Tone
Mouth, eyes and ears
mouth-palate, condition fo teeth, brushing
Eyes-red-reflex, strabismus, 5 and older = vision screening
Ears-ear infections common
examine pinna by pulling down and back under 3 years of age
