Week 2: CH 6 Flashcards
What is the first part of a pediatric assessment?
History
What is the general assessment rule for young children?
Foot-to-head & out-to-in sequence allows least distressing parts of the exam first
What is the general assessment rule for older children?
A more traditional head-to-toe traditional approach is easily tolerated by older children
Developmental approach to newborn/infant less than 6 months
Keep the parents close by, allow normal activities that don’t interfere (holding, pacifier), alter the exam sequence as necessary
Developmental approach to infants greater than 6 months
Examine the patient in the parent’s lap
Developmental approach to toddlers
Keep family present, demonstrate instruments, do no ask (offer choice of spot/reward)
Developmental approach to preschoolers
Assess child’s willingness to be separated from parent, allow child to examine equipment, allow choices when possible, use distraction
Developmental approach of school age
Let them help, normal head-to-toe is appropriate, teach them during the exam
Developmental approach in adolescents
Modesty is the most important part, conduct exam without parent present, build rapport and ask private questions, have a chaperone present during genitalia
Neonate HR awake
100-180
Infant HR awake
100-160
Toddler HR awake
80-110
Preschool HR awake
70-110
School age HR awake
65-110
Adolescent HR awake
60-90
Neonate HR asleep
80-160
Infant HR asleep
75-160
Toddler HR asleep
60-90
Preschool HR asleep
60-90
School age HR asleep
60-90
Adolescent HR asleep
50-90
Where to observe respirations under 6 years old?
abdomen
Where to observe adolescent respirations?
chest wall
Infant respiratory rate
30-60
Toddler respiratory rate
24-40
Preschool respiratory rate
22-34
School age respiratory rate
18-30
Adolescent respiratory rate
12-16
Where to get temperature in children less than 4 years old?
axillary
Abnormal temperatures
Less than 36.5 or greater than 38
Normal SBP for children greater than one
90mmHg + (2 x age in yrs)
Too large of a cuff
low BP
Too small of a cuff
high BP
Skin and Hair assessment
- clean?
- color? (jaundice, mottling)
- missing hair?
- rash?
- temp?
- texture?
- moisture?
- turgor? (abdomen/leg)
- cap refill? (palm/sole of foot)
Head and Face assessment
- fontanelles? (sunken/bulging)
What does a tense/bulging fontanelle mean?
ICP
What does a sunken fontanelle mean?
Dehydration
Eye assessment
- symmetry?
- pupils?
- color?
- discharge?
- PEERLA
- vision? (6yr)
- cardinal gaze?
Rule of 6 months in baby’s eyes
Their eye color at 6 months is gonna be their eye color or the rest of their life
Ear assessment
- grey tympanic membrane?
- drainage?
- pull up pinna for over 3yr
- pull pinna down for under 3yr
Indications of hearing loss
not getting startled, not able to speak by 2 years of age
Nose assessment
same as adult
Mouth assessment
- amount of teeth
- palate defect
- tonsils
tonsil size grading
1-2 is normal
3- big (common with strep)
4 tonsils are “kissing”
Chest assessment
- shape?
- pectus carinatum (pigeon)
- pectus excavatum (sunken)
- deviation? (scoliosis)
Respiratory assessment
- retractions?
- headbobbing?
- crepitus?
- tactile fremitus?
Retraction classifications
mild
moderate
severe
all retraction can indicate something is wrong
normal wheezing
inspiratory or expiratory
stridor wheezing
only inspiration
cardiac assessment
normal with adults
Abdominal assessment
- umbilicus (bleeding/odor)
Genitalia assessment in young patients
- position in parents lap
- perform immediately after abdominal assessment
- rash?
- breakdown?
- bleeding?
Genitalia assessment in adolescents
- get chaperone
- have same-sex chaperone present for genital or breast-exams if parent is not present
cremasteric reflex
touch inner thigh to see testicle rise, this checks for testicular torsion and intact T12, L1/L2
Tanner stage 1 (pre-puberty)
no sexual hair, flat chest
Tanner stage 2 (8-11.5yr)
pubic hair appears, testicular enlargement, breast bud forms
Tanner stage 3 (11.5-13yr)
coarser pubic hair, penis size/length, breast enlarged, mound forms
Tanner stage 4 (13-15yr)
coarse hair across pubis, penis width, breast enlarged, raised areola, mound on mound
Tanner stage 5 (over 15yr)
coarse hair across pubis and thigh, penis and teste enlarged to adult size, adult breast contour, areola flattened
Hip assessment
- symmetrical skin folds
- different knee height
- hip dislocate click
