Pediatric Assessment Exam 1

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Pediatric Assessment Exam 1
2014-09-14 15:13:09
lccc ADN Nursing Pediatric

For Gosselins Exam 1
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  1. 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
  2. In what order should you assess pediatric vital signs?
    • Least intrusive to most intrusive
    • Example: resps, apical, bp, temp (if oral, axill, rectal)
  3. 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
  4. 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
  5. What is the normal BP for a new born, infant, preschooler and school age child?
    • Newborn:70/50
    • Infant:99/50
    • Preschool:94/54
    • School Age:100/60
  6. 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
  7. 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)
  8. What are the techniques of a physical examination?
    • Inspection
    • Palpation
    • Percussion
    • Auscultation
  9. At what age can you expect the anterior and posterior fontanels to close?
    • Posterior Fontanel: 6-8 weeks
    • Anterior Fontanel: 12-18 months
  10. What should you assess for the eyes?
    • Assess placement and alignment
    • Eyes should track (binocularity) by 3-4 months of age
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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)
  16. 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%
  17. 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
  18. 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
  19. 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
  20. 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
  21. 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
  22. 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
  23. 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
  24. 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
  25. 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)
  26. 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
  27. 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
  28. 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
  29. 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
  30. What is the best indicator of hydration?
    Daily weights!!