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What position should the child be to chart height and weight? Where do you chart height and weight?
- Infant should be naked and supine on scale, children older than 2 year can stand on scale
- Height, weight and head circumfrence measured on growth chart
- By 6 mo the baby should be double the birth weight and by 1 yr they should be triple the birth weight
In what order should you assess pediatric vital signs?
- Least intrusive to most intrusive
- Example: resps, apical, bp, temp (if oral, axill, rectal)
What is the normal HR for a newborn, infant, preschooler, and school age child?
- Newborn: 125-190 bpm
- Infant: 120-160 bpm
- Preschooler: 100-120
- School Age: 90-110
What is the normal Resp Rate for a newborn, infant, preschooler, and school age child?
- Newborn: 30-40
- Infant: 26-40
- Preschool: 20-30
- School Age: 18-24
What is the normal BP for a new born, infant, preschooler and school age child?
- School Age:100/60
What size BP cuff should you use for a newborn, infant, preschool, and school age child?
- Newborn: 1.5in cuff
- Infant: same/as per size
- Preschool: 3in cuff
- School age: 4.5 in cuff
What are some things to remember about taking a pediatric BP (in terms of technique)
- Be sure to use the correct size
- May use arms and legs (if you think its inaccurate, recheck!!)
- Dynamaps are most frequently used
- Always explain procedures and expected sensations (tight squeeze)
What are the techniques of a physical examination?
At what age can you expect the anterior and posterior fontanels to close?
- Posterior Fontanel: 6-8 weeks
- Anterior Fontanel: 12-18 months
What should you assess for the eyes?
- Assess placement and alignment
- Eyes should track (binocularity) by 3-4 months of age
How do you assess the pediatric ear?
- Look for Pinna placement, the top attachment should match an imaginary line to the eyes
- <3yrs old= pull pinna DOWN and back
- >3yrs old= pull pinna UP and back
How do you assess the child's auditory reaction?
- Infants reflex to noise (whisper or name)
- After preschool age, rhinne and weber may be used
What specific infection would you be assessing for in the infants mouth?
- Mucus membranes should be pink, moist, and shiny
- Uvula should be midline
- No obvious lesions or swelling
- Candida infections: look for white patches in the mouth that do not scrape away
What are normal assessment findings for the neck?
- Trachea should be midline and neck should be symmetrical
- Lymph nodes may or may not be palpable (neck, in front of ears, groin). If palpable, should be small, nontender and movable
- Check neck ROM- if there is pain or leg flexion with forward flexion of the neck, meningitis is suspect
What are some normal and abnormal assessments for the chest?
- Chest should be round and becomes more oval at preschool age
- Head circumference larger than chest until age 3 (usually equal by age 2)
- At birth, may have edema in breasts and milk discharge (witch's milk)
During a respiratory assessment, what are some normal and abnormal findings?
- Asses resp rate and regularity
- Assess for adventitious breath sounds, as well as grunting from the the baby
- Describe the quality of the child's cry and look for circumoral cyanosis
- Pulse ox needs to be higher than 94%
Name the proper placement of the stethoscope to hear pediatric heart sounds
- Right 2nd ICS: Aortic Valve
- Left 2nd ICS: Pulmonary Valve
- Left 4-5th ICS: Mitral Valve
- Right 4-5th ICS: Tricuspid Valve
What is sinus arrhythmia?
- In school age to adolescent children, the HR increases during inspiration and slows down during expiration.
- This is a normal finding
What would be an abnormal heart sound?
- Hearing S4 (ken-TUCK-y) is an abnormal finding: it is abnormal filling of ventricles
- S3 (TENN-e-see) is a normal finding with rapid ventricular filling
- Heart murmurs may be functional (in a certain physical position) or pathologic
What are some normal and abnormal findings in an abdominal assessment?
- Infants may have a pot belly
- BS should be +4Q
- While palpating abdomen, look for guarding by the child
- The umbilicus should have a fascial ring no more than 2cm around
- Peristalsis may be visible in newborns, but may signify a bowel obstruction in children
- Assess for jaundice and ask parents about bowel movements and vomitting
Describe the normal assessment findings for female genitalia
- Genitalia should be symmetrical and absent of bruising or swelling (indicative of trauma and abuse)
- Labia minora is larger in infants
- Observe for the tanner stages of pubic hair and breast development
- Secondary sex characteristics should appear prior to menstration
- Teach adolescents about STDs and pregnancy prevention
Describe the normal and abnormal findings for male genitalia
- Assess for Tanner stages
- Assess for placement of urinary meatus (if on top of penis, called epispadias. If on the bottom of the penis, called hypospadias)
- Is the male circumcised?
- The foreskin is difficult to retract in children <3yrs
- After 4 years of age, if the foreskin can not be retracted it is called phimosis
- Left testes should be slightly lower than right
- May place finger over inguinal canal during palpation of the testes
- Hydrocele is a fluid filled sac in scrotum
- Variocele is an enlarged vein in the epididymus
How do you assess for inguinal hernias?
- Observe the groin area for bulging, especially when crying
- For school age to adolescent children, you can put finger on inguinal canal and have them cough
- Palpate the femoral nodes for swelling and infection
How would you assess the pediatric anus?
- Look for symmetry in the gluteal folds (if not symmetric, may signify displaced hips)
- Observe for polyps or prolapse
- Look for the anal reflex with tapped with thermom
What may you find during an assessment of the extremities?
- Look for symmetry in size, tone and strength
- Asses ROM, poldactyly and webbing of digits
- Infants and toddlers have bow legs (Genu varum)
- Genu valgum is knock knees
- Look for the color of nails and look for disformities that may indicate anemia, hypoxia or endocarditis
- Capillary refill should be <2sec
- Look for acrocynosis of extremities (common at birth until 5min APGAR)
Describe abnormal findings of the back and spine
- Observe for normal curvature and symmetry
- Dermal sinus: pinpoint opening at base of spine
- Spina Bifida Occulta: tuft of hair or hemangioma (defect of the canal, but not complete spina bifida)
- Pilonidal cyst: dermal cyst that may cause dimpling
- Scoliosis screening should be performed beginning at age 12
How would you assess normal neurologic findings?
- Assess deep tendon reflexes for motor and sensory function
- Assess balance and coordination
- Mental Status (A+O)
- Assess cranial nerves (make fun faces)
- Babinski reflex may be active until age 2
What assessment tool is sued for developmental assessment? What is this tool looking at?
- Denver Developmental Screening Test
- It looks at personal-social, fine motor, gross motor, and language
What is the best way to assess newborn and infant I/O?
- Measure all input
- Measure output according to number of wet diapers or by weight of diapers
- 1gm=1cc of fluid
What is the best indicator of hydration?