Pediatrics

Question 1

Measurements

Answer 1

hi emma

Question 2

Chest and Heart

Answer 2

heart-apical rate
abdominal movement with respirations
retraction

Abdomen-umbilicus and skin turgor

Question 2

Chest and Heart

Answer 2

heart-apical rate
abdominal movement with respirations
retraction

Abdomen-umbilicus and skin turgor

Question 3

Abdomen

Answer 3

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

Question 4

Head and face

Answer 4

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

Question 5

eyes

Answer 5

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

Question 6

Red reflex

Answer 6

retina reflex that helps show if there are visual opacities like cataract abnormalities

Question 7

Ears

Answer 7

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

Question 8

Nose and throat and mouth

Answer 8

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

Question 9

Neck and upper extremities

Answer 9

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

Question 10

Lower exremities

Answer 10

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

Question 11

Genitalia-

Answer 11

inspect and palpate scrotum for testis

Question 12

Neuromuscluar

Answer 12

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

Question 13

Dolls eye reflex

Answer 13

deviation of eyes opposite to way their head is being moved

Question 14

Spine and rectum

Answer 14

skin inspection
tufts of hair, protrusions, sinus opening

Question 15

Moro reflex

Answer 15

let head and trunk drop back a short way to see f they startle

Question 16

Neonatal reflexes

Answer 16

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

Question 17

Health assessment for kids

Answer 17

observation
interview the patient
interviewing the child
physical assessment

Question 18

Bio-graphic Demographics

Answer 18

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

Question 19

Past Medical History

Answer 19

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

Question 20

Current health status

Answer 20

immunizations
medications
allergies
how they are currently feeling?

Question 21

Neonate

Answer 21

birth to one month

Question 22

Infant

Answer 22

one to 12 months

Question 23

Toddler

Answer 23

1-3 years

Question 24

Preschooler

Answer 24

3-6 years

Question 25

School age

Answer 25

6-12 years

Question 26

Adolescent

Answer 26

12-18 years

Question 27

Principles of communication with children

Answer 27

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

Question 28

Developmental considerations

Answer 28

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)

Question 29

Approaching the pediatric patient

Answer 29

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

Question 30

Assessment Tips: Infant

Answer 30

Have parent nearby or holding baby warm enviornment leave diaper on warm hands talk softly comfort measures timing around feeds may be helpful

Question 31

Assessment tips for toddlers

Answer 31

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

Question 32

Assessment tips for preschoolers

Answer 32

Increase verbal communication keep it simple may be able to "help" hold the measuring tape or stethescope use games

Question 33

Assessment tips for school agers

Answer 33

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

Question 34

Assessment tips for adolescents

Answer 34

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

Question 35

Systematic Assessment

Answer 35

vital signs measurements head to toe systems reflexes growth and development head and neck eyes/ears mouth/nose chest abdomen msk genitalia elimination neuro

Question 36

Know the normal peditaric vital sign ranges

Answer 36

slide show

Question 37

Apical pulse

Answer 37

moves when kids get older (starts high then moves down)

Question 38

What is the 5th vital sign?

Answer 38

Pain assess subjectively and objwectively non-verbal behaviours vital sign changes from baseline Wong Baker Faces Scale Other paediatric pain scales as appropriate

Question 39

Measurements

Answer 39

head circumference weight height

Question 40

Systematic approach

Answer 40

Look-observation, position, movement, behvaiour, colour Listen-auscultation, cry, respiratory effort Feel-palpation, muscle tone, skin temperature

Question 41

Neuro assessment

Answer 41

General level of consciousness behaviour interest in enviornment alertness (awake) orientation speech cry (lusty, high pitched, weak)

Question 42

Fontanelles

Answer 42

soft flat firm sunken bulging tense

Question 43

Pup[il reactivity

Answer 43

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

Question 44

Cardiovascular assessment

Answer 44

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

Question 45

Sskin

Answer 45

texture joints and swelling or edema skin integrity hydration status temperature peripheral pulses

Question 46

Respiratory assessment

Answer 46

assess for a full minute diaphragmatic-observe abdominal movements rythm depth auscultation

Question 47

Gastrointestinal assessment

Answer 47

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)

Question 48

More GI for babies

Answer 48

Apetite (normal, decreased) Emesis (colour, consistency, amount, frequency, blood, bile) Colostomy/ileostomy (amount, stoma, colour, consistency) Buttovk and spine

Question 49

GI

Answer 49

Urine output (accurate, weighing diapers, 12 and 24 hour balances urine type pain with urination catheter

Question 50

External genitalia

Answer 50

Signs of precious puberty (hair growth, breast development) rashes descended testis vaginal discharge patent anus

Question 51

MSK

Answer 51

Coordinated movements Casts Tone

Question 52

Mouth, eyes and ears

Answer 52

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