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Pedi Exam 1 > Physical Assessment > Flashcards

Physical Assessment Flashcards

1
Q

Communication

A

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

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2
Q

Communications to assist in Data collection

A 
Introduction
Purpose
Privacy
Focus
Involve child
One question at a time
Honesty
Style of language
Interpreter needs
Listen carefully
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3
Q

Data to collect

A 
Patient information
Physiological data (Chief complaint, History of present illness, Past history, Current health status
Psychological data
Development data 
Review of systems
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4
Q

Physical examination Purpose

A

Help you with the plan of care and help you obtain baseline data information

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5
Q

General appearance

A 
Height
Weight
FOC
Chest circumference
Abdominal circumference
Vital signs 
Behavior
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6
Q

Vital signs: Temp

A

Most accurate is oral or rectal

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7
Q

Vital signs: Temp: Axillary

A

For <4-6 yr and anyone who is uncooperative, immunosuppressed, neurologically impaired, and had oral surgery

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8
Q

Vital signs: Temp: Oral

A

5-6 yr

No cold or hot liquids 30 minutes before

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9
Q

Vital signs: Temp: Rectal

A

Lucricate, use for 1-2.5cm

Contraindicated in neonate, immunosuppressed, diarrhea or bleeding disorder

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10
Q

Vital signs: Pulse

A

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

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11
Q

Vital signs: Respirations

A

Count 1 full minute

Infants are diaphragmatic breathers

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12
Q

Vital signs: BP

A

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

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13
Q

Skin color

A

Note variations, mottling, bruises
Freckles
Mongolian spots
Buccal mucosa and tongue

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14
Q

Skin: palpation

A 
Temperature
Texture
Moistness
Turgor
Cap refill
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15
Q

Hair inspection

A

Loss of hair?
Ringworm?
Check for lice
Unusual hair growth: on spine may indicate a spinal deficit

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16
Q

Skull

A 
Head control
Shape changes as child matures 
FOC (hydrocephalus/Microcephalus)
Inspect facial expressions for symmetry
Palpate skull
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17
Q

Eye structure

A

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

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18
Q

Eye muscles

A

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

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19
Q

Vision test: Blink reflex on infant

A

moving the hand towards the babies open eyes a quicker blink than normal

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20
Q

Vision test: Tracking objects

A

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

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21
Q

Vision test: Ophthalmoscope

A

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

22
Q

Vision test: Strabismus

A

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

23
Q

Ear structure

A

External ear (low set associated with renal disorders)
Drainage? (clear or blood tinged could be CSF from basilar skull fracture)
Hearing assessment

24
Q

Nose/Sinuses

A 
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
25
Q

Mouth, teeth, throat, gums

A

Lips (pale, cyanotic?)
Teeth (Present, cavities?)
Odors (sweet- diabetic acidosis, bad-infection or hygiene)
Gums (normally pink, inflammation and tenderness could be infection or poor nutrition)
Sucking reflex?
Buccal mucosa (normally pink)
Tongue (normally pink and moist, look for thrush, should move in all directions)
Palate (use tongue blade and light, infant suck your finger)
Tonsils (pink without exudate, fissures may indicate previous infection)
Gag reflex (AHH: uvula should go up and down, CN 9,10)

26
Q

Neck inspection

A

size, symmetry swelling, abnormality

Webbing could be Turners syndrome

27
Q

Lymph nodes

A

Should not be able to feel

28
Q

Trachea

A

determine position: normal: midline

deviation could be tumor or collapsed lung

29
Q

Thyroid

A

Lobes can only be felt if they are enlarged

30
Q

Neck ROM

A

Chin to each shoulder, chest, then look up to the ceiling

31
Q

Neck ROM: Torticollis

A

Persistent head tilting from a birth injury to the sternocleidomastoid muscle

32
Q

Neck ROM: Brudzinski sign

A

pain with flexion of the neck toward the chest

the stretching of the meninges is indicative of meningitis

33
Q

Respiratory

A

Nose breathers until 4wks

Diaphragmatic/abdominal breathing until 6yr

34
Q

Respiratory assessment:

A

Rate
Depth (normal, hypopnea- shallow, hyperpnea-deep)
Ease (effortless, dyspnea, orthopnea (difficulty breathing when upright, intercostal and/substernal retractions, flaring nares, bobbing head, grunting)
Labored breathing (continuous, intermittent, steadily worse, sudden onset, rest and/or exertion, associated with wheezing or grunting, pain)
Rhythm

35
Q

Respiratory assessment: Other observations

A 
Evidence of infection 
Cough
Wheezing
Cyanosis
Chest pain
Sputum
Bad breath
36
Q

Auscultation

A

Egophony (increased resonance of voice sounds heard- caused by lung consolidation and fibrosis )
Whispered pectoriloquy (increased loudness of whispering)
Bronchophony (abnormal transmission of sounds from the lungs or bronchi, type of pectoriloquy)
Stridor
Wheezing
Cough
Hoarseness
Crackles
Rhonchi

37
Q

Breath sounds

A

absent or diminished

Pleural friction rub

38
Q

Cardiac inspection/palpation

A

Palpation (apical pulse)
Heave
Lifts
Thrill

39
Q

Cardiac auscultation

A

Apical pulse for 1 minute
Rhythm
Heart sounds (S1- tricuspid and mitral valve closure, S2- aortic and pulmonic valve closure, S3, S4- abnormal)
Splitting (normal, more blood returns to the R ventricle causing the pulmonic valve to close a fraction of a second later than aortic valve)
Murmurs (blood passing through a defective valve or vessel or heart structure problem)

40
Q

Pulse: Newborn

A

120

41
Q

Pulse: 0-2yr

A

110

42
Q

Pulse: 2-6 yr

A

100

43
Q

Pulse: 6-10 yr

A

90

44
Q

Pulse: 10-16 yr

A

85

45
Q

Blood pressure

A

1-7 yr: add 90 to their age for systolic BP

8-18yr: double their age and add 83 to get systolic BBP

46
Q

Abdomen: Inspection

A

Shape (symmetry, sunken abdomen, dehydration, contour and bulges on inspiration)
Umbilicus (hernia, protrusion, cord falls off in 7-14 days, inguinal hernia)
Rectus muscle
Movement (peristaltic waves indicate intestinal obstruction-pyloric stenosis)

47
Q

Abdomen: Auscultation

A

Borborygmi (loud gurgling heard especially when hungry)

Hard board like abdomen many indicate paralytic ileus and intestinal obstruction

48
Q

Allis sign

A

Uneven skin folds may indicate hip dislocation or difference in leg length

49
Q

Neurological: Cognitive

A

Behavior
Communication skills
Memory
LOC

50
Q

Neurological: Cerebellar

A

Balance
Coordination
Gait

Pedi Exam 1 (18 decks)

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