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
Mouth, teeth, throat, gums
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)
Neck inspection
size, symmetry swelling, abnormality
Webbing could be Turners syndrome
Lymph nodes
Should not be able to feel
Trachea
determine position: normal: midline
deviation could be tumor or collapsed lung
Thyroid
Lobes can only be felt if they are enlarged
Neck ROM
Chin to each shoulder, chest, then look up to the ceiling
Neck ROM: Torticollis
Persistent head tilting from a birth injury to the sternocleidomastoid muscle
Neck ROM: Brudzinski sign
pain with flexion of the neck toward the chest
the stretching of the meninges is indicative of meningitis
Respiratory
Nose breathers until 4wks
Diaphragmatic/abdominal breathing until 6yr
Respiratory assessment:
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
Respiratory assessment: Other observations
Evidence of infection Cough Wheezing Cyanosis Chest pain Sputum Bad breath
Auscultation
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
Breath sounds
absent or diminished
Pleural friction rub
Cardiac inspection/palpation
Palpation (apical pulse)
Heave
Lifts
Thrill
Cardiac auscultation
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)
Pulse: Newborn
120
Pulse: 0-2yr
110
Pulse: 2-6 yr
100
Pulse: 6-10 yr
90
Pulse: 10-16 yr
85
Blood pressure
1-7 yr: add 90 to their age for systolic BP
8-18yr: double their age and add 83 to get systolic BBP
Abdomen: Inspection
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)
Abdomen: Auscultation
Borborygmi (loud gurgling heard especially when hungry)
Hard board like abdomen many indicate paralytic ileus and intestinal obstruction
Allis sign
Uneven skin folds may indicate hip dislocation or difference in leg length
Neurological: Cognitive
Behavior
Communication skills
Memory
LOC
Neurological: Cerebellar
Balance
Coordination
Gait
