session 6 child health history and physical assessment

Question 1

what are the areas are investigated when completing a paediactric hx

Answer 1

1. prenatal and birth hx- (ie gestational age at delivery)
2. developmental hx- (ie behavioural issues)
3. social hx of family- (ie support network, who is the legal guardian?)
4. immunisation hx -(ie is it up to date, any reactions or side effects)
5. Medications - (ie have they had any analgesia today/ what time?)
6. Allergies - (ie foods, tapes, medications - place sign above bed/ wrist band is red)
7. medical/surgical Hx - (ie have they ever been to hospital before?, trauma/ how many times/ ?abuse)
8. infectious status - ( ie children can still have HIV, have they been treated in a hospital outside WA in the last 12 mths-? MRSA)
9. general appearance- (ie do they look well cared for, do they look sick, look for symmetry)

Question 2

Why is blood pressure not an indication of shock for children?

Answer 2

Blood pressure is a late sign in children. They have compensatory vasoconstriction, so therefore when a child is in shock they can maintain their BP until the pre-arrest situation.

Question 3

What are more accurate indications for shock in children

Answer 3

Heart rate and resp rates are a better indication. They will be tachycardic and tachypnoea

Question 4

Why do we take heart rate and resp rates for a full minute in newborns?

Answer 4

Their respiratory drive is often sporadic and it is normal to have apnoea in their breathing

Question 5

how big is the BP cuff that is used on Paeds? what would happen if the wrong size is used?

Answer 5

it needs to be 2/3 rds the size of the arm otherwise this will impact the reading - give a false reading.

Question 6

Why is taking the childs weight so important?

Answer 6

Everything administered to a child is determined by weight

Question 7

What additional measurements are taken besides the weight for a child?

Answer 7

Height
head circumference
blood sugar level

Question 8

what are the normal vital signs for a

Answer 8

HR: 110-160, RR: 30-40, BP (systolic): 70-90

Question 9

what are the normal vital signs for a 5-12 yr old

Answer 9

HR:80-120, RR:20-25, BP (systolic): 90- 110
*Be aware that children that play alot of sport can have a different reading that is normal for them. Ask the parent if this is normal for them. Contact dr and explain situationt to change the parameters

Question 10

How would you calculate the weight of a child with no hx or identity - what method is used?

Answer 10

children under 9 (age +4) x2

children over 9 - 3 x age

Question 11

what is investigated in a physical assessment

Answer 11

Airway
Breathing
Circulation
Disabiltiy

Question 12

when is it necessary to do a focused assessment?

Answer 12

A focused assessment is done when the body system is investigated relating to the chief complaint
(ie child presents with a broken arm - the assessment would be neuromuscular)

Question 13

How are you going to get a child to cooperate with your focused assessment?

Answer 13

1. Gain as much information first by looking at them
2. Based on development age you involve them, ask them and explain things to them.
3. Keep the parent with the child, if the child is young have them sit on the parens lap
4. Dont tower over a child, stay down at their level
5. Explain things at their level
6. Do the least distressing thing last
7. Never lie to a child -this loss of trust will not only be with you but will continue with everyone else in the medical profession.

Question 14

what is involved in a newborn assessment

Answer 14

reflexes and a basic newborn assessment

Question 15

what is indicated in a infant that is not feeding, low nappy count, floppy and does not have a respiratory problem?

Answer 15

sepsis

Question 16

how is sepsis diagnosed?

Answer 16

blood cultures, MSU( some infants are born without valves that cause UTI) and a lumbar puncture is done

Question 17

on a head examination what does fading (washed out) in the colour of their hair indicate?

Answer 17

Worms

Question 18

why is it necessary to assess the fontanelle?

Answer 18

If the edges can be felt it can mean a fracture (dropped from the change table)
It the fontanelles are bulging it could indicate increases ICP
If the fontenelles are soft and boggy it could mean dehydration.

Question 19

If the pinna of the eye is below the line from the middle of the ear across - what disorder does this indicate in a child

Answer 19

Renal disorder

Question 20

In a head trauma that has presented with nasal discharge how do you test for CSF (cerebral Spinal Fluid)?

Answer 20

Blood glucose treatment as there will be sugar in it or
If there is blood and discharge coming out you can place it on a napkin and the CSF will migrate further from the blood making a halo shape

Question 21

Where do you palpate the pulse in a baby?

Answer 21

The brachial pulse is prefered over the femoral - placing finger near the nappy area would require gloves incase of a soiled nappy.

Question 22

what does the acronym APGAR stand for

Answer 22

Appearance
Pulse
Grimace
Activity 
Respiration

Question 23

why do we have a modified GCS for paeds?

Answer 23

because an infant cannot verbalise a response of being orientated or give a motor response of obeying commands

Question 24

what is hydoceles

Answer 24

a fluid filled sack around the testies that will make he scrotum swollen

Question 25

define torsion

Answer 25

where the testies become twisted and if not detected and surgically repaired can become nacrosed and require removal.

Question 26

What type of skin assessment are done on children?

Answer 26

Modified braden scale - children in theatre, ICU and global developmentally delayed children are at risk of pressure injuries because they are not moving

Question 27

What is the focus of a neurological assessmet of a child?

Answer 27

Cranial nerves
sensation
muscle tone and strength - look for symmetry
modified glascow coma scale

Question 28

how do you perform an abdomen assessment?

Answer 28

Inspect, palpate and ascultate

Question 29

What is checked in the musculoskeletal assessment?

Answer 29

curvature of the spine
joints - stability, swelling, motion
muscles - tone and strength
gait - limping (how is the child walking)

Question 30

what is the requirement for doing a GU assessment

Answer 30

always seek permission and have a chaparone present

Question 31

what are the components of a cardiovascular assessment

Answer 31

Insepect - skin colour, clubbing fingers, oedema, central capillary refill, for delayed growth
auscultate- rythm, listen for murmers
Palpate - pulses for quality of uppper and lower pulses

Question 32

what is involved in a moutha and throat assessment

Answer 32

check colour, mucosa (dry or moist), number and condition of teeth ( bottle drinkers may have rotten teeth from coke or lemonade use-need to educate parents), size, colour and exudate of tonsils, gag reflex

Question 33

what is involved in a neck assessment?

Answer 33

trachea position, masses - cysts or swollen lymphs

Question 34

what is involved in a head assessment?

Answer 34

observe size and shape 
assess the fontanelle
assess the sutures
summetry of the face
scalp and hair (look for lice)

Question 35

what is involved in an eye assessment?

Answer 35

[position, shape, symmetry
discharge and redness
PEARL
range of motion/ visual fields

Question 36

what is involved in an ear and nose assessment?

Answer 36

shape and position - lower set ears have renal problems
discharge
otoscopic examination -wax or foreign objects/ drum
nose- septum, mucosa, colour, tenderness, discharge

Question 37

what are the considerations for duraton and feeding pattern of bottle and breast fed children

Answer 37

At 6mths a child would have been started on solid food, ask the parent if they have been as some children won’t be the case.
Ask how the parent is making the formula - on hot days parents add more water can affect the childs sodium levels and make the child hyponatraemic, likewise adding too much formula can make the child hypernatraemic.
Parents that introduce cows milk too early can make their child anaemic (iron dificient) which could be a reason why they are breaking bones
Ask the parent what the feeding regime is- the child may have a chronic disability, global development delay and have a failure to thrive that will require enteral feeding

Question 38

what are the normal feed requirements for a child under the age of 6mths

Answer 38

150mLs/kg/24hours

Question 39

what are the normal feed requirements for a child over 6 mths?

Answer 39

120/mLs/kg/24 hrs
if they demand feed this would be divided by the number of feeds
so if they feed every 4 hours (24 /4 = 6) 120mLs/6 = 20mLS every feed

Question 40

what are the safe sleeping requirements for a baby?

Answer 40

1. sleep baby on their back from birth, not tummy or side
2. sleep baby with head and face uncovered
3. keep baby smoke free before and after birth
4. provide a safe sleeping environment night and day
5. sleep baby in their own safe sleeping place in the same room as an adult carer for the first 6 - 12 mths.

Question 41

what are additional adolescent assessments that need consideration during the examination process?

Answer 41

sexual health hx
substance abuse
smoking
mental health

Question 42

What is the purpose of a CEWT assessment?

Answer 42

completing the observations will give a score that correlates to a set of instructions depending on the severity of the situation. This tool has allowed nursing staff to ascertain the appropriate action and intervene earlier in emergency (MET call) situations to save lives.