Peds Physical Assessment Flashcards
communication with the parents/caregiver
-Encourage parents/caregiver to talk
-Directing the focus
-Listening and cultural awareness
-Using silence
-Being empathetic
-Providing anticipatory guidance
-Avoiding communication blocks
anticipatory guidance
understanding expected growth and development of their child, what is the next developmental milestone ect
Stranger anxiety
the fear of strangers that toddlers commonly display
intervention for stranger anxiety
leave child in parents lap, talk at eye level, let them see the tools you are using
Children younger than 5 are egocentric this means…
they think the whole world revolves around them
infant
newborn to 12 months old
toddler
12-36 months
transitional object
comfort item like a blanket, pacifier, doll, ect
preschool
36mo./3-5years
what is important to school aged children
body integrity: they are concerned about body changes and physical ability
-Can be at risk for bullying if they are considered “different”
school age
6-12 years
adolescent
12-18 years
Performing a health history
-Identifying information (Informant, most likely the parent)
-Chief complaint
-Present illness (Analyzing a symptom or symptoms)
Birth History
health during pregnancy, the labor and delivery, and infant’s condition immediately after birth
Allergies health history
Ask about commonly known allergic disorders
unusual reactions to drugs, food, or latex products
reactions to other contact agents, such as poisonous plants, animals, household products, or fabrics.
Review the child’s growth including the following:
- Measurements of weight, length, and head circumference at birth
- Patterns of growth on the growth chart and any significant deviations from previous percentiles
Nutritional Assessment
-Dietary intake
-Clinical examination of nutrition (Hair, skin, mouth, eyes)
-Evaluation of nutritional assessment (Malnourished, At risk, Well nourished, Overweight or obese)
Sequence of the Examination for peds patient
usually a head to toe direction is used but in children, the order is often altered to accomodate the childs developmental needs
Goals of Pediatric Assessment
Minimize stress: Keep it calm.
Build trust.
Prepare child: Get ready together.
Preserve security: Keep comfort.
Ensure precision.
when checking the symptoms fo a patient, what else is important to ask
symptoms the child doesn’t have right now, but previously had before doctor visit (previous illness
Weight and height are taken for:
medication dosages and for parameter of growth development and health status
Birth weight __ at 6 months and __ at 12 months
Doubles at 6 months, and triples at 12 months
occipital frontal circumference
Infant Head Circumference w/tape measure- across eyebrow above ear and around back to occipital
chronological age
actual age (years and months)
developmental age
A measure of a child’s development (in body size or motor skill or psychological function) expressed in terms of age norms, emotional ability
for infants and toddler, traumatic procedures during assessment should be done…
last
when preparing child for an assessment
Encourage parent/caregiver to be present and assist with holding the child.
until what age should you use the recumbent length board and two measurers
until the child is 2 years of age and is able to stand alone
how to measure childs recumbent length
(1) holding the head in midline
(2) grasping the knees together gently
(3) pushing down on the knees until the legs are fully extended and flat against the table.
height assessment
Measure height by having the child, with the shoes removed, stand as tall and straight as possible.
Be certain the child’s back is to the wall or other vertical flat surface, with the head, shoulder blades, buttocks, and heels touching the vertical surface.
where are respirations in an infant commonly seen
in abdominal movements because respirations are primarily diaphragmatic
AAP recommends all children over age 3 have blood pressure taken at
ALL exams (often annually)
Adolescents with BP > 120/80 is
hypertensive
too small of a cuff size can lead to
falsely elevated values
too large of a cuff size can lead to
inaccurate low values
Flattening of one part of the head, such as the occiput, may indicate
that the child continually lies in this position
Preparing the Child for the ophthalmoscopic examination
showing the child the instrument, demonstrating the light source and how it shines in the eye, and explaining the reason for darkening the room
Ocular Alignment: normal
by 3 to 4 months of age, children are able to fixate on one visual field with both eyes simultaneously (binocularity).
strabismus
cross-eye, one eye deviates from the point of fixation. If the misalignment is constant, the weak eye becomes “lazy,” and the brain eventually suppresses the image produced by that eye
If strabismus is not detected and corrected by 4 to 6 years of age…
blindness from disuse, known as amblyopia, may result.
Positioning the Child: otoscopic examination
-position the child properly and gently restrain (sit on parent’s lap and hold parent’s hands)
-Older children usually cooperate and do not need restraint
-Prepare them for the procedure by allowing them to play with the instrument, demonstrating how it works, and stressing the importance of remaining still
-A helpful suggestion is to let them observe you examining the parent’s ear
-Restraint is needed for younger children, because the ear examination upsets them
Mouth and Throat assessment
k the child to open the mouth wide; to move the tongue in different directions for full visualization; and to say “ahh,” which depresses the tongue for full view of the back of the mouth (tonsils, uvula, and oropharynx) (the use of a tongue blade (preferably flavored) to depress the tongue may be needed)
Genitalia assessment
child is still supine
Adolescents, inspection of the genitalia may be left to the end of the examination
The best approach is to examine the genitalia matter-of-factly, placing no more emphasis on this part of the assessment than on any other segment
It helps to relieve children’s and parents’ anxiety by telling them the results of the findings; for example, the nurse might say, “Everything looks fine here.”
Tanner stages
sexual-maturing ratings are based on predictable stages of puberty that are based on primary and secondary sexual characteristics.)
when is bowlegged normal
Toddlers are usually bowlegged after beginning to walk until all of their lower back and leg muscles are well developed
when is bowlegged abnormal
lateral or asymmetric bowlegs that are present beyond 2 to 3 years of age, particularly in African-American children, may represent pathologic conditions requiring further investigation
