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HEALTH ASSESSMENT > PHYSICAL EXAMINATION OF THE PEDIATRIC CLIENTS > Flashcards

PHYSICAL EXAMINATION OF THE PEDIATRIC CLIENTS Flashcards

1
Q

CHILDHOOD DEVELOPMENTAL STAGES
• Newborns
• Infants
• Toddlers

A

Birth -1mo. Old
1mo.-12mo. Old
1-3rys old

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2
Q
  • Preschoolers
  • School-age
  • Adolescence
A
  • 3 y.o – 6 y.o)
  • 6 y.o – 12 y.o)
  • (12 y.o – 20 y.o)
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3
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD
• – every visit from birth to 16 years of age

A

• Height

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4
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD
Every visit in the 1st 2 years in life

A

Head circumference

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5
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD

once in the 1st 2 years, once at 4-5 years, during school age years (only if there is a risk or concern about high blood pressure), and every 2nd year during adolescence

A

Blood pressure

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6
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD

Every visit in the 1st year in life

A

Eye assessment

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7
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD

Every visit in the 1st year in life

A

Strabismus assessment

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8
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD

initial
screening (e.g., snellen chart) at 3-5 years of age; every 2 years between 6- 10 years of age; then every 3 years until 18 years of age
A

Visual acuity testing

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9
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD

Every visit

A 
Dental assessment – 
• Speech assessment – 
• Developmental assessment
(MMDST) –
• Sexual development
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10
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD

– every visit after
child reaches school age

A

School adjustmen

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11
Q

IMPORTANT COMPONENTS THAT SHOULD BE ASSESSED AT EACH TIME PERIOD

consider during
assessment of children >8 years of age

A

Chemical abuse

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12
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Undress only the body part being examined or use radiant heat warmer to conserve heat

A

Newborn

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13
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Examine heart and respiratory system 1st before infant cries then follow head- to-toe procedure

A

Infants

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14
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Ask parent to remove clothing or allow child to do it independently

A

Toddler

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15
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Allow toddler to handle equipment such as blowing out otoscope light to relax the child

A

Toddler

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16
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Perform all manipulative procedures such as throat and ears last

A

Newborn

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17
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Immunization – according to schedule : at 2, 4, 6, 12, and 18 months and at 4- 6 and 14-16 years

A

Newborn

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18
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Safety counseling – every visit

• Parenting counseling – every visit

A

Newborn

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19
Q

Nutrition counseling – from birth to 5

years and for teenagers

A

Newborn

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20
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Begin examination while parent holds infant in arms or lap to calm the child. Talk the infant as you proceed.

A

Infants

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21
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Use games such as Simon Says to ease child’s fright

A

Preschooler

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22
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Ask child to undress but not the underpants.

A

Preschooler

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23
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

  • Teach about good health care during examination. Comment on body parts as you examine them.
    • Proceed with head-to-toe assessment; leave genitalia for last
A

Adolescent

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24
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Ask whether child wants parent present or not.

A

Adolescent

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25
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Allow them to handle instruments before use

A

Preschoolers

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26
Q

PEDIATRIC PHYSICAL EXAMINATION TECHNIQUES

Explain equipment and reasons for procedures. Teach whys and hows of procedures

A

Adolescent

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27
Q

Profile of the newborn

from birth to the 1st 28 days of life, “newborn or neonate”.

A

Neonatal Period

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28
Q 
Respirations
o Circulatory changes
o Neurologic, renal, endocrine,
gastrointestinal and metabolic
functions
A

Profound physiologic changes at the moment of birth

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29
Q

weight, length, head circumference, & chest circumference.

A

Vital statistics

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30
Q

o Serves as a baseline for future evaluatio

A

WEIGHT – 2.5 to 3.4 kg (5-8 lbs)

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31
Q

Weighing devices:

A

A.Digital weighing scales

b. Mechanical infant scales

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32
Q

LENGTh
o Female
o Male:

A

LENGTH
: 53 cm (20.9 in)
54cm(21.3in)

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33
Q

HEAD CIRCUMFERENCE

A 
N: 34-35 cm (13.5-14 in)
o 37 cm or < 33 cm should be further
 assessed.
o Small (SGA,
anencephaly) o Large (LGA,
increased ICP)
microcephaly, hydrocephalus,
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34
Q

CHEST CIRCUMFERENCE

A

N: 2 cm less than the HC

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35
Q

o Vital Signs
• Temperature 37.2 C (at birth)
• 36.5 C- 37.5C axillary

A

Anencephaly

36
Q

Methods of Heat Loss in Newborns:

A

a. Convection b. Conduction c. Evaporation d. Radiation

37
Q

Determined by listening for an
apical heart beat for a full minute,
rather than a pulse in an extremity.

A

Pulse – 120-160 bpm

38
Q

Depth, rate and rhythm are
irregular and periods of apnea w/o
cyanosis is normal

A

Respiration – 80 cpm at birth and settles at 30-60 cpm

39
Q

o Not routinely done unless a cardiac anomaly is suspected.

o Varies with activity, age and siz

A

Blood Pressure
o Approx. 80/46 mmHg at birth and
then rises to 100/50 mmHg

40
Q 
State of Health
•  Stature and Gait
• Weight and Body Proportion
• Dress, Grooming, and Personal
Hygiene

Manner
• Level of Consciousness

A

General data

41
Q

Check for overriding sutures, anterior

Fontanels size and posterior consistency)

A

Head

42
Q

Look for flaring of the alae nasi
• Palpate the areas over the frontal and maxillary sinuses for tenderness in children over 6 years old as this is a
sign of sinus infection

A

Nose

43
Q

Check cornea for cloudiness (sign of congenital cataracts).

• Assess for pupillary size, shape, equality and reactivity to light (PERRLA)

A

Eyes

44
Q

Check for symmetry, irregular shape, setting of ear in relation to corner of eye (low set ears may suggest underlying congenital problems)

A

Ears

45
Q

Palpate all muscles for lumps and the clavicles for possible fracture
• In adolescent, take note of palpable lymph nodes and thyroid glands

A

Neck

46
Q 
Inspect for cyanosis
• Assess for the RR and pattern
• Palpate for abnormal masses
• Breast may be slightly enlarged
• Auscultate for breath sounds
• Percussion is of little clinical benefit
A

Respiratory system

47
Q
  • Obtain the patient’s RR, HR and BP in the upper and lower extremities
  • Take note of the skin color for pallor, cyanosis
  • Locate the point of maximal impulse (PMI
A

CARDIOVASCULAR SYSTEM

48
Q 
Inspect for abdominal shape
• Assess for the contour
• Check for masses, visible peristalsis,
and other obvious malformations
• Assess the umbilical cord and count
the vessels
A

Abdomen

49
Q

Assess for any malformation or abnormalities

• Inspect the glans, urethral meatus, foreskin or the prepuce, and the scrotum

A

Male Genitalia

50
Q

• Check the labia, clitoris, urethral opening and external vaginal vault.
• Hymenal tags, should also be noted if
they occur, are normal.

A

FEMALE GENITALIA

51
Q 
• Check for scoliosis, kyphosis, lordosis, spinal defects, meningomyelocele.
• Assess the shoulder girdle for injury
and the clavicles for fracture
• Assess mobility of the shoulder and
extension of the elbow.
• Inspect palmar creases for assessment
of gestational age and count the
fingers.
A

MUSCULOSKELETAL SYSTEM

52
Q

– 1st stool, passed within 24 hrs after birth. A sticky, tarlike, blackish-green, odorless material.

A

Meconium

53
Q

2nd-3rd day of life is observed. Green and loose, resembles diarrhea.

A

Transitional stool

54
Q

light yellow stools and sweet smelling. Passes at least 3-4 stools per day

A

Breast-fed babies

55
Q

are noticed for babies receiving phototherapy.

A

Bright green stools

56
Q

are noticed for babies with bile duct obstruction.

A

Clay-colored (gray) stools

57
Q

stools usually indicate an anal fissure.

o If stools remain black or tarry, intestinal bleeding maybe suspected.

A

Blood flecked

58
Q

Within 24 hrs after birth, light-colored and odorless. About 15ml in single voiding.
• (-) within the 24 hr rule, maybe suspected of urethral stenosis or absent kidneys or ureters.
• Males should be assessed to void with enough force to produce a small projected arc; females should produce a steady stream, not just continuous dribbling

A

Urinary system

59
Q 
• Prone to infection up to 2 months
• With passive antibodies (IgG)
• NB routinely administered Hepatitis B
vaccine on the 1st 12 hrs of birth.
• Fever and leukocytosis may not be
present in a newborn
A

IMMUNE SYSTEM

60
Q 
Senses
Able to hear in the utero
• Responds specifically with generalized
activity to sound.
• Calms in response to soothing voice
and startle at loud voices.
• Believed to recognize the voice of
mother.
A

Hearing

61
Q

Senses
See as soon as they are born
• Demonstrate sight by blinking at strong
light
• Focus best on black and white objects • Pupillary reflex is present.

A

Vision

62
Q

Well developed at birth
• Demnstrate by quieting at a soothing
touch.
• (+) sucking & rooting reflex • Reacts to painful stimuli.

A

Touch

63
Q

Senses

Present as soon as the nose is clear of mucus & amniotic fluid.
• Used to document alertness, but not routinely done.

A

Smell

64
Q

Senses

Taste buds are developed.
• Turns away to bitter and salty taste,
readily accepts sweet taste.

A

Taste

65
Q

feel resilient if the skin is well hydrated. It should feel elastic.

A

Skin turgor

66
Q

– purplish blue discoloration

A

Cyanosis

67
Q

– involves extremities

A

Acrocyanosis

68
Q

– cyanosis of the trunk

A

Central cyanosis

69
Q

– yellowing of the skin

A

Jaundice

70
Q

– occurs

on the 2nd or 3rd day of life

A

Physiologic jaundice

71
Q

– occurs

within the first 24 hrs of life

A

Pathologic jaundice

72
Q
  • result of anemia
A

Pallor

73
Q

– a newborn who has been lying on one side will appear red on the dependent side and pale on the upper side.

A

Harlequin Sign

74
Q

vascular tumors of
the skin
o Nevus flammeus ‘port-wine stain’ o Strawberry hemangiomas
o Cavernous hemangiomas

A

Hemangiomas

75
Q

collection of pigment cells, slate-gray patches across the sacrum or buttocks.

A

Mongolian Spots

76
Q

is a white, cream cheese like substance. Serves as a skin lubricant.

A

Vernix Caseosa

77
Q

– fine, downy hair that covers the newborns shoulders, back and upper arm.
o by 2 weeks, it should have
disappeared.

A

Lanugo

78
Q

– pinpoint white papule (a plugged of unopened sebaceous glad)

A

Milia

79
Q

CRANIOTABES

• Cry tearlessly
• Iris usually gray or blue, sclera may be
blue.
• Appear clear, without redness or
purulent discharge
• Sometimes with red spots found in the
sclera.
• Edema often present
• Cornea is round, pupil is d
A

EYES

80
Q

CRANIOTABES

  • Pinna tends to easily bend.
  • (+) hearing test

The level of the top part of the external ear should be on a line drawn from the inner canthus to the outer canthus of the eye and back across the side of the head.

A

Ears

81
Q

CRANIOTABES

  • May appear large for the face
  • Test for choanal atresia
A

NOSE

82
Q

CRANIOTABES

  • Open evenly when NB cries. Tongue appears large.
  • Tongue is short creating an impression of “tongue tied”.
  • Palate should be intact.
A

MOUTH

83
Q

CRANIOTABES

  • Short & often chubby, with increased skin folds
  • (-) rigidity of neck (Congenital torticollis)
  • Not strong enough to support the total weight of the head
A

Neck

84
Q

CRANIOTABES

Breast maybe engorged.
• May appear small because head is
large in proportion.
• Breasts of the NB secrete a white thin
watery fluid (Witch’s milk)
A

Chest

85
Q

CRANIOTABES

Looks slightly protuberant
• Bowel sounds should be present within
1hr after birth.
• Edge of the liver should be palpable 1-
2 cm below the right costal margin
• Edge of the spleen should be palpable
A

Abdomen

86
Q

CRANIOTABES

A

HEALTH ASSESSMENT (3 decks)

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