Wk 13 Peds Flashcards
9 IMP things for documenting peds history
- Birth history*
- Do they have any chronic or resolved medical problems?
- Development*
- Surgeries
- Medications
- Diet*
- Immunizations/Vaccines*
- Family History
- Social History*
ROS for infants
- General: Have you noticed any fever, tiredness?
- Illness: Have you noticed any cough, congestion, runny nose, vomiting, diarrhea, rash?
- RESP:Haveyounoticedanytroublebreathing?
- GI:Howiss/heeatinganddrinking?Howisyourchild growing? Wet diapers? Stool diapers?
- CV:Haveyounoticedyourchildbeingtiredmoreoften? Sweating with feeding?
- NEURO:Haveyounoticedanychangesinhowthey move? Clumsiness, falling, loss of the ability to do things they have done before?
ROS Pediatric
- General: Have you noticed any fever, tiredness?
- Illness: Have you noticed any cough, congestion, runny nose, vomiting, diarrhea, rash, sick contacts?
- RESP:Haveyounoticedanytroublebreathing?
- GI:Howiss/heeatinganddrinking?abdominalpain? Bowel habits?
- CV:Haveyounoticedyourchesthurtingorfeelinglike you can feel your heart beating? Have you been lightheaded or dizzy?
- NEURO:Doesanythingfeelfunnytoyou?
Infant PMH
- Birth history
– The newborn’s history is really mom’s history * Fertility issues, pregnancy losses - Prenatal course/care (inc labs/US)
- Medications/drugs used in pregnancy
– Gestational age at birth
– Birth weight
– Delivery/Nursery course
– Medications given (ex Vit K)
5 IMP measures for development
- Gross motor * Fine motor * Cognitive
- Language
- Social and Emotional
What year of life is heavily gross motor dev?
1st year
What type of dev is heavily done in 2nd year?
Fine motor
What is an autism spectrum disorder screening tool?
MCHAT
What is the social history acronym for teens?
HEADSS
* Home
* Education and Employment
* Activities
* Diet and Drugs
* Sexuality
* Suicide/Depression
* Safety
* (Self-Image)
Pediatric norm vitals
IMP growth measurements
height
weight
head circumference
7 IMP assessment categories in baby PE
- General * HEENT * CV
- RESP
- ABD
- NEURO
- Tanner staging
Where do we check infant pulses during CV exam?
femoral
HEENT exam
- Head: shape, flattening, fontanelle
- Eyes: red reflex, EOM
- Neck: lymph nodes, torticollis
- Ears: drainage, tenderness, TM
- Throat: if they cry at any point in the exam, that is a good time to look
5 Concerns during RESP exam
- Work of breathing - rate, retractions
- length of exhale
- audible sounds without stethoscope
- auscultate
- often don’t percuss b/c kids don’t like it
3 types of rectractions and indications
- supraclavicular
- intercostal
- subcostal
Is it normal to palpate liver?
yes, 1-2 cm below right costal margin
6 components of Neuro/Msk exam
- Observe
- Movement - incl gait
- Tone
- Strength
- Reflexes
- Sensation
Tone, reflexes
- Tension present in relaxed muscles (different from strength)
- What is normal for that age?
- Hypotonia
- Hypertonia
- Clonus
- The presence of primitive reflexes
What are the Tanner stages?
Way to evaluate puberty - sexual maturity rating
Questions for Tanner staging
- Does the puberty stage match the age of the child?
- Delayed puberty: illness, malnutrition, chromosomal disorders, etc.
- Precocious puberty: CNS tumors, genetic syndromes
- What ages did the parents enter puberty? “Late bloomers”
IMP things w/ kids as minors
- Until age 18: patients are considered minors and cannot consent to own medical care unless:
– Emancipated, lawfully married, unaccompanied homeless minor
– STI treatment
– Pregnancy related care (except abortion) - Minors cannot consent to STI prevention OR treatment for substance abuse in Utah
- Family planning services (ie contraception) are available to minors but only if services are not state funded (the U is not able to provide but other institutions such as planned parenthood can)
