Physical Assessment Flashcards
Communication
Build rapport
Avoid giving advice, offering false reassurance, giving over ready encouragement, defending a situation or opinion, using cliches or stereotypes, limiting emotional expression, interrupting
Use open ended questions
Communications to assist in Data collection
Introduction Purpose Privacy Focus Involve child One question at a time Honesty Style of language Interpreter needs Listen carefully
Data to collect
Patient information Physiological data (Chief complaint, History of present illness, Past history, Current health status Psychological data Development data Review of systems
Physical examination Purpose
Help you with the plan of care and help you obtain baseline data information
General appearance
Height Weight FOC Chest circumference Abdominal circumference Vital signs Behavior
Vital signs: Temp
Most accurate is oral or rectal
Vital signs: Temp: Axillary
For <4-6 yr and anyone who is uncooperative, immunosuppressed, neurologically impaired, and had oral surgery
Vital signs: Temp: Oral
5-6 yr
No cold or hot liquids 30 minutes before
Vital signs: Temp: Rectal
Lucricate, use for 1-2.5cm
Contraindicated in neonate, immunosuppressed, diarrhea or bleeding disorder
Vital signs: Pulse
Apical pulse on infants 2yrs and younger
count for a full minute any assessment following the initial one can use the 30 sec x 2
Compare radial and femoral pulses at least once during infancy to detect the presence of a circulatory impairment
Vital signs: Respirations
Count 1 full minute
Infants are diaphragmatic breathers
Vital signs: BP
Use correct size cuff
Measure both upper and lower extremities at least once to make sure the BP is the same and there isn’t a heart deformity
Skin color
Note variations, mottling, bruises
Freckles
Mongolian spots
Buccal mucosa and tongue
Skin: palpation
Temperature Texture Moistness Turgor Cap refill
Hair inspection
Loss of hair?
Ringworm?
Check for lice
Unusual hair growth: on spine may indicate a spinal deficit
Skull
Head control Shape changes as child matures FOC (hydrocephalus/Microcephalus) Inspect facial expressions for symmetry Palpate skull
Eye structure
Size and spacing (hypertelorism: widely spaced eyes that could be normal or a sign of endocrine disorder
Eyelids (ptosis: or drooping eyelid, could be an injury to an eye nerve, Sunset sign: sclerae is seen between the upper lid and iris and indicates retracted eyelid or hydrocephalus)
Eye color
Pupils (CN: 2,3,4,6, tiny black marks in sclerae are heavily pigmented and considered normal
Eye muscles
Vision test
Eye muscles
Extraocular movement: move an object through the 6 positions testing the CN 3,4,6
Corneal light reflex: shine a light on the child’s nose and reflection should be equally on the corneas
Cover-uncover test: shouldn’t see any movement in either eye during this test
Vision test: Blink reflex on infant
moving the hand towards the babies open eyes a quicker blink than normal
Vision test: Tracking objects
baby should be able to follow an object that is 6 in away from their face. if not present by 3-4 month: need further evaluation
Vision test: Ophthalmoscope
MD or NP looks at the optic disc margin and it should be sharply defined, round, and yellow to creamy pink.
Blurring means increased ICP
Vision test: Strabismus
Crossed eye
One eye is deviated when looking at an object
Lazy eye needs to be corrected by 4-6 yr or amblyopia can occur (blindness from diffuse of that eye or when vision in one of the eyes is reduced because the eye and brain are not working together correctly)
Tested with cover-uncover test
Ear structure
External ear (low set associated with renal disorders)
Drainage? (clear or blood tinged could be CSF from basilar skull fracture)
Hearing assessment
Nose/Sinuses
External nose (pain? tenderness?) Nasal patency (nasal flaring?, breathing sound should be noiseless, obstruction is common, use bulb syringe to suck out drainage from nose) Smell assessment (CN1 usually done on older children) Internal nose (Mucous membranes: damp and pink, Nasal septum: should be straight, Drainage?) Sinuses
