Peds exam 1 Flashcards
developmental approach to exam:
newborns/infants under 6 months
allow parents to be involved
keeps things as normal as possible
start with the least distressing (“foot to head” or “out to in”)
developmental approach to exam:
infants over 6 months
exam the patient on the parents lap
exam feet and hands first then the trunk
developmental approach to exam:
toddlers
- demonstrate instruments to alleviate anxiety
- do not ask the child if you can do something rather explain what you are going to do
- offer choices when possible
- start with hands and feet then progress to more invasive procedures
developmental approach to exam:
preschoolers
allow child to examine equipment before use
allow choices
use distraction to gain cooperation
developmental approach to exam:
school aged children
- often want to help with them exam
- head to toe exam is appropriate (by age 6)
- child likes to learn about their body during exam –> teach them and allow for participation
developmental approach to exam:
adolescents
- MODESTY is very important
exams should be conducted without others present (unless asked otherwise) - build rapport and ask any “private questions”
- any time a rectal, breast, or anorectal exam is conducted a chaperone should be present (can be a parent but should have another staff to protect self)
length is measures during what age
measure how?
- infant to 24 months (2 years)
- which a measuring board or tape measure on bed
get standing height at what age
how?
after age 2
stadiometer (standing)
Head circumference
done until what age?
how?
done until age 3
wrap tape measure around head at supraorbital prominence, above the ears & around occipital prominence
measure 2x (to check)
Chest circumference
done until what age?
how?
done until1 year
measure across nipple line
how to weight an infant
measure in kg
remove clothing
zero scale to account for diaper
weight of an infant
weight doubles by 5-6 months
weight triples by 1 year old
Heart rate for neonate
awake: 100-180
asleep: 80-160
Heart rate for infant
awake: 100-160
asleep: 75-160
Heart rate for toddler
awake: 80-110
asleep: 60-90
Heart rate for Preschool
awake: 70-110
asleep: 60-90
Heart rate for school aged
awake: 65-110
asleep: 60-90
Heart rate for adolescents
awake: 60-90
asleep: 50-90
Auscultation of heart rate
auscultate apical pulse for one full minute
where to look for the respiratory rate
under 6: observe the abdomen
over 6: observe the chest
head vs chest circumference
head is about 2 cm larger that chest circumference at birth
at 2 years of age when the chest circumference surpasses head c.
respiratory rate for infant
30-60
respiratory rate for toddler
24-40
respiratory rate for preschool
22-34
respiratory rate for school age
180-30
respiratory rate for adolescent
12-16
temperature route that is most reliable
orally (considered a core temp)
can do axillary temp in children under 4 years
hypothermia in infants
when axillary temp is below 36.5
could indicate sepsis
the more premature the ___ chance of heat loss
greater
fever
38 C
calculate a normal systolic BP
90 mmHg + (2 x age in years)
pediatric SBP hypotension (5th percentile) term neonates
under 60 mmHg
pediatric SBP hypotension infants 1 mo - 12 mo
under 70 mmHg
pediatric SBP hypotension children 1-10 years
under 70 mmHg + (2 x age in years)
pediatric SBP hypotension over 10 years
under 90 mmHg
do BP last for young children – upsetting
four limb BP when screening for
congenital heart defect
location to assess skin color on dark-skinned patients
palms of hands and soles of feet
mottling indicates
poor perfusion
common in sepsis
skin should be
warm soft dry
where to evaluate skin turgor
abdomen
primary lesions
macules, papules, vesicles, pimples
skins initial response to injury or infection
secondary lesion
scars, ulcers, fissures, scratches, picking/digging
result of irritation infection, delayed healing
cap refill
less than 2 sec
inspection of hair
look for lice on hair shafts
hair loss in a child may be from
tight braids or skin lesions such as ringworm
hypothyroidism can cause
coarse brittle hair
the fontanelle should feel
flat and flush/soft
tense or bulging fontanelle indicates
increased intracranial pressure
a sunken fontanelle below the margin of the skull indicates
dehydration
posterior and anterior fontanelle closes at what age
posterior: 2-4 mo
anterior: 1-2 years (usually 18 mo)
red reflex
present = normal
white reflex is
referred to as leukocoria and a retinoblastoma
visual acuity for children 3-6 years old
use snellen picture cards
sunset sign
retracted eye lids or hydrocephalus
ear exam for child under 3
pull pinna down and back
ear exam for child over 3
pull pinna up and back
indications of hearing loss
babbles as a young infant but does not keep babbling or does not develop speech after 6 months
no speech by age 2
signs of respiratory distress
nasal flaring
retractions
head bobbing
what should be check for an ill baby before feeding
check nasal patency
infants don’t automatically open their mouth to breathe when their nose is occluded, suction nose before feeding
tonsil grade 4+ can indicate (tonsils that “kiss”)
Mono
OSA
chronic allergies
tonsils of 3+ can indicate
viral infections
strep throat
Erickson stages
trust vs mistrust
Piaget stages
pectus carnatum
when the sternum protrudes
increased AP diameter
pigeon chest
pectus excavatum
sternum is depressed
decreased AP diameter
funnel chest
where to watch respiratory rate for children over 6
watch chest rise and fall
where to watch respiratory rate for children under 6
watch abdomen
the diaphragm is the primary muscle used for breathing in infants and young children
crepitus
normally heard with a pneumothorax
crinkly sensation that is palpated
‘produced by air escaping subcutaneous tissue
decreased tactile fremitus indicates
air trapped in lung
asthma
increased tactile fremitus indicates
lung consolidation
pneumonia
stridor
high pitched
normally only heard on inspiration (sometimes heard without a stethoscope)
Narrowed trachea and larynx
croup or anaphylaxis
wheezing
lower airway problem (bronchioles)
normally heard on expiration (sometimes both)
preferred peripheral pulse locations
over 1 year: radial pulse
under 1 year: brachial
preferred central pulse location
over 1: carotid
under 1: femoral
light palpation of abdomen
should be done first
evaluates tenderness, the liver, and defects of the abdominal wall
deep palpation of abdomen
detects masses
if an enlarged kidney or mass is detected, do not continue to palpate the kidney, pressure on kidney mass may release cancer cells (cause metastasis)
inguinal, genital, or perineal assessment position for young children
position them on the parents lap with their legs spread apart or in a position of comfort
downward bowing of the penis may be caused by
chord associated with hypospadias
cremasteric reflex
touch the inner thigh of each legs to stimulate the testicle and scrotom to rise
intact T12, L1, and L2
no cremasteric reflex
could indicate testicular torsion (surgical emergency)
testicular torsion
red or swollen testicle
have about 4 hours from when the testicle flips to restore blood flow before the testicle dies
first stage of female pubertal development
breast budding
normal occurs between 9 and 14
spine alignment
stand behind the child, observe the height of the shoulders and hips
have child bend forward
** No lateral curve should be present in either position
ortolan-Barlow maneuver
checks infants for hip dislocation or subluxation
ch 6 in book for reflexes
