Ped- 244 final
Card Set Information
Ped- 244 final
What info do you collect in a pediatric health history?
Maternal history, biographic data, labor and delivery, present health status, and family history
What does anxitey indicate?
What is the approach you should take to the peds assessment?
get acquainted time
determine best exam place
be systematic, yet flexible
examine intrusive or painful areas last
What is a newborn?
Newborn- birth to 28 days
: <37 weeks
: 37-42 weeks
Post-term- >42 weeks
What are infants?
Birth- 6 months
: Immoblie, safety, comfort, sensory stimulation
6 months-12 months
: Separation/stranger anxity, warm up play techniques, examine infant on parents lap if appropriate
What is a toddler?
age 1-3 years, parent's lap provide security, play, least inrusive assessment first, avoid no responses, offer choices, and let touch equipment
What is a pre-school age child?
age 3- 5/6, keep parent close, exam table, protect modesty, consider magical thinking, use safe words, let touch equipment
What is a school age child?
age 6-10/12: Head to toe exam , address questions directly to child, give concrete explanations, answer questions honestly
What is pre adolescent and adolescent?
Pre- 10-12 years
privacy (exam alone)
: body issues, eating disorders, pregnancy, STD, violence
What do you look for in the lungs and thorax for pediatrics?
: rapid breathing
: intercostal retractions- trouble breathing
Anxiety & air hunger
Second hand smoke
What is the difference in a child's trachea?
It is higher and shorter so more respiratory problems
What are signs of airway obstruction?
Restlessness, anxiety or agitation indicate hypoxia, increased HR and RR, stridor/retractions, pallor/xyanosis, avoid sedatives that deress repirations
What are the differences in RR in children?
Higher than adults go to 12-20 a min b/w 10-18 years
Respirations should be counted for a full minute
Assess when child is calm
Infants/children under 7 are abdominal breathers
BV in lungs when younger
What is croup?
Acute spasm of larynx resulting in partial airway obstruction
: 6 months-2 years, grow out of
Mild fever, inspiratory stridor, barking cough
Give plenty of fluids
What is epiglottitis?
Severe inflammation of eiglottis that progresses rapidly
: 3-8 years
High fever, trouble swallowing, cherry red color, severe distress, upper airway obstruction, DO NOT examine throat
What is laryngotracheobronchitis?
Inflammation of larynx, trachea, and bronchi.
Predominately in infacts and toddlers
What is pneumonia?
Inflammation of bronchioles and alveoli
Retractions, tachypnea, labored resps
vesicular BS change to Bronchial or BV
What is the difference in HR of children?
Higher HR than an adult
In infants under 1 year take aprical pulse because radial pulse is difficult to palpate, count for a full minute
What are normal BP in children?
Birth to 1 year
1 to 5 years
5 to 10 years
10 to 16 years
Measure annaully at age 3 and up
use dynamap in infants
use appropraite pediatric cuff
What do you assess in a CV/PV assessment?
-Apical impulse at 4th ICS left of MCL, by age 7 reaches 5th ICS at MCL
-Heart sounds louder and more high pitched
-Some children have physiologic murmurs, does not indicate disease
-Assess peripheral pulse, especially newborns
What do you look for in CV/PV history?
Growth patterns, clubbing, SOB, fatigue, suck reflex, having trouble keeping up with activity, murmurs, chest pain
What do you look for in an abdominal assessment in an infant?
: breast or bottle fed, spitting up, response to new foods, bowel movements, food allergies.
Infants have a soft, round abdoment with slight protrusion- bowel sounds in center of abdomen
-Diastatis recti- when crying, muscle seperation
: 2 arteries, 1 vein
-Liver palpable .5-2.5 cm below right costal margin for newborns, 1-2 cm below for infants
What do you look for in an abdominal assessment in children?
-24 hr diet recall, likes, dislikes, Pica- eating non-nutritional foods like stuffed animals
-liver palpable 1-2 cm below right costal margin
-Spleen 1-2 cm below left costal margin
-Less palpable with age
What do you look for in an abdominal assessment for an adolescent?
-Eatting patterns, 24 diet recall, weight loss or gain, level of activity
-laxative use, vomiting
-View self as thin or overweight
-Same assessment as the adult
-Privacy issues with exam
What are some eating disorders?
OBessesd with food, weight, distorted body image
Tooth decay, anemia, dry skin, hypotension, etc
What do you look for in musculoskeletal in infants?
Cranial bones soft at birth (soft sport)
Sutures ossify around age 6
assess for congenital birth defects
Bones arent fused at birth
What do you look for in musculoskeletal in children and adolescents?
: Height, weight each visit, look at percentiles
Assess gait, knees for alignment
Toddlers have a wide stance which ends after 2.5 years
Screen for scoliosis
Injuries due to sports or trauma
What do you look for in an infants lymphatic assessment?
System develops at 20 weeks, very susceptible to infection due to inability to produce immunoglobulins
Receive IgG from Mother through passive immunity
What do you look for in a child lymphatic assessment?
increase b/w ages 6-9, larger than adults, shotty nodes 3mm to 1 cm in cervical and inguinal areas, small nontender nodes
What to look for in a infant & pediatric HEENT
: Symmetry of skull and face
: Structure, movment, trachea, thyroid, vessels, lymph nodes
: vision, placement
: hearing, external ear, ear canal, and otoscopic exam of tympanic membrane
: nose and sinuses
: Structures of mouth, teeth and phaynx
Assessment of head: Infant
Head circumference: asses each visit for first 2 years of life Measure just above eyebrows, rapid increase in HC during first 3 months of life 34-35 cm at birth
Fontanels: Anterior 2.5-4 cm, close by 24 months. Sunken- dehydration, bulging: increased hemorrhage
Molding: cone head, overlapping of sutures due to pressure from birth. Resolves in a week
What is caput succedaneum?
Accumulation of fluid beneath scalp
crosses the suture line
: resolves in 3-4 days after birth
What is cephalhematoma?
-Collection of blood and fluid beneath scalp, localized over one cranial bone, does not cross suture line
: take 3-4 weeks to resolve
Assessment of the Face
Assess for symmetry, twitching-should be none, tics, edema
Assessmentof the eyes
: outer canthus should align with pinna of ear
Wide set or close eyes can indicate chromosomal problems
Assess conjunctive for drainage
: can focus on objects
: coodination of EOM and follow objects
: Follows peoples movements, plays with hands
Visual acuity in children
Gets to 20/20 at age 6
Use E on snellen chart to assess vision until age 6
Color vision age 4-8
Assessment of the Neck
Turns head side to side by 2 weeks of age
Steady head control at 3-5 months
Assess for short neck (Down Syndrome) or webbing (turners Syndrome)
Head lag (poor neck control) after 6 months may indicate CP
Assess shape and size of thyroid
Oral Pharynx assessment
Assess color, drainage, uvula size
Bed breath can indicate chronic sinusitis, infected tonsils
Tonsils grow to maximum size between 2-6 years, can obstruct airway
Assess nasal patency
Infants are nose breathers
Nasal flaring is respiratory distress
watery discharge with allergies
Yellor or green discharge
Maxillary and Ethmoid sinuses present at birth
Frontal sinuse develops around age 7
palpate and transilluminate
Inspect mucosa, gingivae, tongue
Assess for cleft palate
Lips for color
Salivary glands developed by 3 months
4-6 months- infant turns head to sound
6-10 months- responds to name and follows sounds
Assess for hearing loss if decreased vocabulary
Assess ears for abnormalities of auricle
Low set ears- mental retardation
Tragus and auricle pain
: otitis externa
To examine pull pinna down and back to straighten out until age 3
hearing screenings at birth
: Reflex, posture, tone
closely tied with developmental tasks
voluntary control will take over as brain develops
Functions develop in orderly process
What are the soft signs in school-age children
Signs are vague and conroversial
Clumsiness, language distrubances
delay in child to perform age specific activites
continued presnce is a developmental delay or lag
What are infant reflexes?
Moro or startle
: Head to one side, other side arm and leg up disappears 4- 6 months
: Disappers 3-4 months
Step in place
Babinski- Disappears at 18 months
: disappears at 3 months
Newborn red in color-decreased fat, vasomotor instability
Covered with white wazy coating (Vernix Caseosa)
Immediately after birth lips, nail beds, and feet may be cyanotic
Temp regulation not develop
Sub-Q fa layer is poorly developed
Apocrine glands not active until adolescense-mid perspiration odor
What are some infant skin conditions?
Storkbites, Angelkiss- Vascular birthmarks
Strawberry Mark- Immature hemangioma, slightly raised sharp demarcation 2-3 cm in diameter, disappear by age 5
Cavernous Hemangiomas- reddish round mass blood vessels, may continue to grow until 10-15 months, regularly reassess
Infant hair and nails
Lanuago- soft fine hair on ears, shoulds, and back-sheds 10-14 days after birth
Postmature infants will have long nails
Tufts of hair on back of spine- spina bifida
Children skin, hair and nails
Bruising-inconsistent brusing with development= suspicion
Common lesions associated with communicable diseases
Rubella, Rubeola, Roseola
What is diaper Rash?
Result of prolonged contact with urine and feces
Can be fungal with lesions
: If dry, wet it. If wet, dry it!
Caldesene medicated powder or desitin cream
What is Impetigo?
Most common cause is Staphyloccus aureus, can be strptococcal.
Predisposing factors; poor hygiene, antecednet lesions
Occurs around the mouth and nose as oozing that becomes honey-crusted lesions
Scratching will spread the infection
: antiseptic soap/water, ATB
What is Tinea corporis?
: superficial fungal infection that is most prevalent in hot, humid climates and children
Transmitted by direct or indirect contact and is communicable as long as lesion is present
: fungal cream or griseofulvin for systemic treatment
Keep skin dry, avoid tight clothing
What is scabies?
Caued by mites that burrow under the skin to lay eggs
Pruitus is caused by feces and ova
Highly communicable and spread skin to skin
Most common sites are the finger webs, wrists, and anticubial fossa
Lesions are linear, threadlike, grayish burrows
: Elimite cream applied and left on skin 8-14 hours head to toe
Apocrine glands enlarge and become active
Incresed sebaceous gland activity
Have oiler skin
Adolescent hair and Nails:
Increased andrgoen levels
Axillae adn pubic areas will develop coarse terminal hair
: same as adults
Tanner Stages- developmental assessment
Asymmtrically-normal may resolve
Gynexomastia- normal, resolves
Should children warm up before sports?
Yes, if not many injuries can occur
What is the most common disorder in babies?
What is the test used to assess development of a newborn/infant/child?
The Denver developmental Screening Test- tests approproiate milestones for a child's gross motor, language, fine motor, and personal social development
What are the developmental stages of infants/newborns?
Cognitive and Language development (Piaget)- Sensorimotor stage
Moral Development (Kolberg)- Love and affection of the parents, follows them
Psychosocial Development (erikson)- Trust v. Mistrust
Psychosexual Development (Freud)- Oral Stage
What is the APGAR scoring in Newborns.
Check at 1 and 5 minutes after birth
Score less than 8 may indicate poor transiton from intrauterine to extrauterine life
Female Breast Development Rating
Stage 1-5 based on Tanner
Male Genitalia and Public Hair Rating
Stage 1-5, based on Tanner
: No hair
: Adult configuration, adult pattern hair
Female Pubic Hair Rating
Stage 1-5, based on Tanner
: No hair
: Inverse Triangle
Developmental Stage based on Piaget from Toddler to Adolescents
Toddler- Sensorimotor to Preoperational Stage
: Formal Operations Stage
Moral Development by Kolberg from Toddler to Adolescent
Toddler- precoventional stage, punishment and obedience
Preschooler- preconventional stage, 10 years, external control
School-age child- role conformity-please others
Adolscent- postconventional, individual conscience and defined set of moral values
Psychosocial Development by Erikson from Toddler to Adolescent
Toddler- Autonomy versus shame and doubt
Preschooler- initiative v. guilt
School-age child- industry v. inferiority
Adolescent- identity v. role diffusion
Psychosexual Development by Freud from Toddler to Adolescent
: Anal stage
: Phallic Stage
: Latency period
: Genital Stage