Module 1 Chapter 2

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Module 1 Chapter 2
2011-04-08 14:49:56
Physical assessments

Physical Assessment Findings of Children
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  1. What it expected axillary temp for an infant age birth to 1 year?
    97.7 to 98.9 F
  2. What is expected oral temp for a child age 1 to 12 years?
    98.1 to 99.9 F
  3. What is expected oral temp of child 12 years and older?
    97.8 to 98.0 F
  4. What is normal pulse range from birth to 1 week?
    100-160/min with brief fluctuations depending whether crying or sleeping
  5. What is normal pulse range from 1 week to 3 months?
  6. What is normal pulse range from 3 months to 2 years?
  7. What is normal pulse range from 2 to 12 years?
  8. What is normal pulse range for 12 years and older?
  9. What is normal respirations for a newborn?
    30-60/min with short periods of apnea (less than 15 seconds)
  10. What are normal respirations for newborn to 1 year?
  11. What are normal respirations for 1 to 2 years?
  12. What are normal respirations for children 2 to 6 years old?
  13. What are normal respirations for children 6 to 12 years old?
  14. What are normal respirations for children 12-18 years old?
  15. What is normal blood range for an infant?
    • Systolic 60-80 mm Hg
    • Diastolic 40-50 mm Hg
  16. Blood pressure readings for ages 1 to 16 years should be compared to what standard measurement table?
    The National High Blood Pressure Program Tables
  17. Erect head posture is expected after what age?
    4 months
  18. What measurements identify growth rate for a child?
    • weight
    • height
    • BMI (Body mass index)
    • head circumference
  19. Where can you find growth charts for comparison?
    CDC- Center for Disease Control and Prevention
  20. Lymph nodes, if palpable, should be:
    small, nontender, and mobile
  21. Posterior fontanel closes between what ages?
    2 and 3 months of age
  22. Anterior fontanel closes between what ages?
    12-18 months
  23. Visual acuity in infants can be checked by:
    Holding an object in front of the eyes and checking to see if the infant is able to fix on the object and follow it.
  24. Which charts are used to check visual acuity of older children?
    Snellen chart or symbol chart
  25. Visual acuity is hard to determine until what age?
    3 years
  26. What test is used to assess color vision?
    The Ishihara test
  27. Peripheral vision fields for:
    • upward 50 degrees
    • downward 70 degrees
    • nasally 60 degrees
    • temporally 90 degrees
  28. A test to demonstrate equal movement of eyes is:
    Cover/Uncover test
  29. Evaluation of any sign of strabismus should done at what age?
    4-6 years of age
  30. To evaluate the presence of nystagmus, you would have the child perform:
    Six cardinal fields of gaze
  31. Palpebral means:
    of or pertaining to the eyelids
  32. Definition of red reflex (present in infants)
    A circular red light reflected from the retina of the eye.
  33. Definition of macula
    A minute yellowish area near the center of the retina. Can effect central vision.
  34. In infants, to visualize the tympanic membrane, you should:
    pull the pinna down and back
  35. To visualize the tympanic member in children 3 or older you should:
    pull the pinna up and back
  36. Normal color of tympanic member?
    pearly gray
  37. Which to landmarks should be visible when viewing the internal ear?
    • Umbo (tip of the malleolus)
    • Manubrium (long process or handle)
  38. Definition of medical home
    Primary healthcare provider who has a long-term and comprehensive relationship with the family.
  39. What are 4 special issues in health supervision?
    • Cultural influences
    • Community influences
    • Chronic illness in child
    • Child adopted internationally
  40. Comprehensive health supervision includes frequent psychosocial assessments including the following:
    • Health insurance coverage
    • transportation to health care
    • financial stressors
    • family coping
    • school's response to chronic illness
  41. Comprehensive screening for infectious disease is a must in internationally adoped children
  42. Common diseases in internationally adopted children are:

    intestinal parasites--aprox 25%
    Giardia lamblia--aprox 19%
    latent tuberculosis--19%
    hepatits B
  43. Components of health supervision
    • Developmental surveillance and screening
    • Injury and Disease Prevention
    • Health promotion
  44. Defintion of Developmental surveillance
    Ongoing collection of skilled observations made over time during health care visits.
  45. Developmental screenings
    Brief assessment procedures that identify children who warrant more intensive assessment and testing
  46. Factors placing an infant or toddler at risk for developmental problems include:
    • Birthweight less than 1,500 g--(3.31 lbs.)
    • Gestational age less than 33 weeks
    • Central nervous system abnormality
    • Hypoxic ischemic encephalopathy
    • Maternal prenatal alcohol or drug abuse
    • Hypertonia
    • Hyperbilirubinemia requiring exchange transfusion
    • Kernicterus
    • Congenital malformations
    • Symmetric intrauterine growth deficiency
    • perinatal or congenital infection
    • suspected sensory impairment
    • chronic (more than 3 months) otitis media with effusion
    • inborn error of metabolism
    • HIV infection
    • lead level above 19 mg/dl
    • parental concern about developmental issues
    • parent with less than high school education
    • single parent
    • sibling with development problems
    • parent with developmental disability or mental illness
  47. Hypoxic ischemic encephalopath
    Damage to cells in the central nervous system (the brain and spinal cord) from inadequate oxygen. Hypoxic-ischemic encephalopathy allegedly may cause in death in the newborn period or result in what is later recognized as developmental delay, mental retardation, or cerebral palsy. This is an area of considerable medical and medicolegal debate.
  48. Definition of

    a term that means brain disease, damage, or malfunction. Encephalopathy can present a very broad spectrum of symptoms that range from mild, such as some memory loss or subtle personality changes, to severe, such as dementia, seizures, coma, or death. In general, encephalopathy is manifested by an altered mental state that is sometimes accompanied by physical manifestations (for example, poor coordination of limb movements).
  49. Hypertonia
    condition marked by an abnormal increase in muscle tension and a reduced ability of a muscle to stretch. It is caused by injury to motor pathways in the central nervous system, which carry information from the central nervous system to the muscles and control posture, muscle tone, and reflexes. When the injury occurs in children under the age of 2, the term cerebral palsy is often used
  50. Hypotonia
    state of low muscle tone[1] (the amount of tension or resistance to movement in a muscle), often involving reduced muscle strength
  51. Hyperbilirubinemia
    the bilirubin level in the blood is higher than normal
  52. Kernicterus
    damage to the brain centers of infants caused by increased levels of unconjugated bilirubin
  53. Warning signs of any age

    No response to environmental stimilus
    Persistently up on toes (longer than 30 seconds) in supported standing position
    • No Response could mean sensory deficit
    • Up on toes could mean Cerebral Palsy
  54. Possible developmental concern if a child rolls over before 3 months
  55. Possible developmental concern if a child has persistent fisting after 2-3 months
    Neurologic dysfunction
  56. Warning sign of persistent head lag in a child after 4 months could indicate?
  57. Warning sign of a child 5 months or older not reaching for toys could indicate?
    Motor, Visual, or cognitive deficit
  58. Warning sign of a child 6 months or older with the lack of tripod sitting could indicate?
  59. A child 6 months or older that is not smiling could indicate...
    Visual deficit, attachment issue
  60. Warning sign of primitive reflex persistence in a child of 6 months or older could indicate?
    Neurologic dysfunction
  61. A child 6 months or older that is not babbling could indicate the developmental concern of
    Hearing deficit
  62. No reciprocal vocalizations or facial expressions in a child 9 months or older is a warning sign for
    Autism spectrum disorders
  63. No spoon or crayon use by a child age 12 months or older is warning sign for?
    Fine motor delay
  64. A child who is not walking by 15-18 months is considered to be experiencing what?
    Gross motor delay
  65. No imitative play by a child 18 months or older is a warning sign for ?
    Autism spectrum disorders
  66. If a child shows hand dominance present prior to 18 months, this would indicate a possible...?
    hemiplegia in opposite upper extremity
  67. A child 18 months or older without having spoken a first word may have a possible ...?
    hearing deficit, expressive language deficit
  68. Echolalia (repetitive speech) or inability to follow simple commands in a child 24 months or older is a warning sign for ...
    Social delay or autism spectrum disorders
  69. Any child who loses a developmental milestone such as a child who was able to sit without support and now can not needs a full evaluation. Indicates a significant neurologic problem.
  70. High sensitivity means:
    a high false-positive rate
  71. low specificity
    a low false negative rate
  72. Risk assessment determines ...
    liklehood of developing a condition
  73. universal screening
    entire population is screened regardless of individual risk
  74. selective screening
    done when a risk assessment indicates the client has one or more risk factors for the disorder
  75. Amino acid metabolism disorders
    • phenylketonuria
    • maple syrup urine disease
    • homocystinuria
    • citrullinemia
    • argininosuccinic acidemia
    • tyrosinemia type I
  76. Metabolic Screening consists of
    • Amino acid metabolism disorders
    • Organic acid metabolism disorders
    • Fatty acid oxidation disorders
    • Hemoglobinopathies
    • Others
  77. Organic acid metabolism disorders consist of
    • isovaleric acidemia
    • glutaric acidemia type I
    • hydroxymethylglutaric aciduria
    • multiple carboxylase deficiency
    • methylmalonic acidemia due to mutase deficiency
    • methylmalonic acidemia cblA and cblB forms
    • 3-methylcrotonyl-CoA carboxylase deficiency
    • propionic acidemia
    • beta-ketothiolase defiency
  78. Fatty acid oxidation disorders:
    • medium-chain acyl-CoA dehydrogenase deficiency
    • very-long-chain acyl-CoAdehydrogenase deficiency
    • long-chain 3-OH acyl-CoA dehydrogenase deficiency
    • trifunctional protein deficiency
    • carnitine uptake defect
  79. Hemoglobinopathies:
    • sickle cell anemia
    • HbS/beta-thalassemia
    • HbS/C disease
  80. Others:
    • congenital hypothyroidism
    • biotinidase deficiency
    • congenital adrenal hyperplasia
    • classical galactosemia
    • cystic fibrosis
  81. Screening tools:
    • Denver II
    • Denver PRQ
    • Child Development Inventory (CDI)
    • Ages and Stages Questionnaire (ASQ)
    • Parents' Evaluation of Developmental Status (PEDS)
    • Batelle Developmental Inventory Screening Tool
    • Bayley Scales of Infant Development II
    • Early Language Milestone Scale
    • Denver Articulation Screening
    • Goodenough-Harris Drawing Test
  82. Denver II
    Birth - 6 years---Assesses personal - social, fine motor-adaptive, language, and gross motor skills
  83. Denver PRQ Screening tool

    Parental report
    Birth-6 years--Assesses personal - social, fine motor-adaptive, language, and gross motor skills
  84. Child development Inventory (CDI)

    Parental report
    Birth -6 years---Simple questions about infant, toddler, or preschooler behaviors.Measures social, self-help, gross motor, fine motor, expressive language, language comprehension, letter, numbers, and general development as appropriate
  85. Ages and Stages Questionarre

    Parental report
    Birth -6 years---Assesses communication, gross motor, fine motor, personal-social, and problem solving skills
  86. Parent's evaluation of developmental status screening tool

    Parental report
    Birth -8 years ---Screens for a wide range of developmental, behavioral, and family issues
  87. Batelle developmental inventory screening test

    Direct elicitation (special training)
    12-96 months---Assesses fine and gross motor, adaptive, personal -social, receptive and expressive language, and cognitive skills
  88. Bayley Scales of Infant Development II
    • 1-42 months
    • Direct elicitaion
    • Requires special Training
    • Thorough
  89. Early Language Milestone Scale
    • Birth - 3 years
    • Requires standarized kit
  90. Denver Articulation Screening
    • 2.5 -7 years
    • 5 minutes to administer
    • Does not evaluate language ability
  91. Goodenough-Harris Drawing Test
    • 5-17 years
    • Child draws a person,which is analyzed for body parts, clothing, proportion, and perspective
  92. Child needs a metabolic screening after 48 hours old even if one was done with the first 48 hours.
  93. Need to identify hearing loss by 3 months of age
  94. Vision Screening for Neonates
    • hold object 10-12 inches from the face
    • after fixation, infant should follow to midline
    • by 2 months of age- should be able to follow object to 180 degrees
  95. Photoscreening can help identify problems such as ocular malalignment, refractive error, lens and retinal problems
  96. Use black and white patterns to perform vision screening on infants less than 6 months of age.
  97. Steps to follow when using a vision screening chart
    • place the chart at the child's eye level
    • place a mark on the floor 20 feet from the chart
    • align the child's heels on the mark
    • have the child read each line with one eye covered and then with the other eye covered
    • have the child read each line with both eyes
  98. Hearing Screening Methods
    • Auditory brain stem response (ABR)
    • Evoked otoacoustic emissions (EOAE)
    • visual reinforcement audiometry (VRA)
    • Tympanometry
    • Conditioned play audiometry (CPA)
    • Pure-tone (conventional) audiometry
    • Whisper test
    • Weber Test
    • Rinne Test
  99. Auditory brain stem response (ABR)
    • Newborn-6 months
    • Measures electroencephalographic waves
    • Results could be affected by ear debris
    • Infant must be quiet
    • sedation may be needed
  100. evoked otoacoustic emissions (EOAE)
    • newborn-6 monthsor developmentally delayed children at the infant's level of functioning
    • machine produces clicks that stimualtes cilia in the cochlea and measures the response
    • infant must be quiet
    • results may be inaccurate in first 24 hours of life
  101. Infants should have how many teeth by 1 year of age?
  102. How many teeth should children and adolescents have?
    20 deciduous and 32 permanent
  103. Chest shape of infants should be?
    circular with anteroposterior diameter equaling the transverse or lateral diameter
  104. chest shape of children and adolescents should be ?
    transverse diameter to anteroposterior diameter changes to 2:1.
  105. Breath sounds in children and adolescent are vesicular heard over lung fields
  106. Heart sounds for children
    • Clear and crisp
    • s1 louder at the apex of heart
    • s2 louder near the base of heart
    • sinus arrhythmias associated with respirations are common
    • physiologic splitting of s2 and s3 heart sounds are expected findings in children
  107. Infant pulses
    Brachial, temporal and femoral should be palpable full and localized
  108. Bowel sounds should be heard how often?
    5-30 seconds
  109. Descending colon-cylindric mass that is possibly palpable in the lower left quadrant due to presence of stool
  110. Infant spines should be?
    without dimples or tuft of hair and midline with an overall C-Shaped lateral curve
  111. Sucking and rooting reflexes
    • Birth -4 months-
    • elicited by stroking cheek or edge of mouth
  112. Palmar grasp
    • birth to 6 months
    • elicited by placing object in palm
    • infant should grasp
  113. Plantar grasp
    • birth to 8 months
    • elicited by touching the sole of foot
    • toes curl downward
  114. Moro reflex (startle)
    • birth to 4 months
    • elicited by striking a flat surface an infant is lying on or by allowing the head and trunk in a semi sitting position to fall backward to an angle of at least 30 degrees
    • infants arms and legs symmetrically extend and then abduct while her fingers spread to form a c shape
  115. tonic neck reflex (fencer postion)
    • birth to 3 to 4 months
    • elicited by turning head to one side
    • infant extends the arm and leg on that side and flexes arm and leg on opposite side
  116. babinski reflex
    • birth to 1 year
    • elicited by stroking the outer edge of the sole of foot up toward the toes
    • toes fan upward and out
  117. Stepping reflex
    • Birth to 4 weeks
    • elicited by holding an infant upright with his feet touching a flat surface.
    • infant makes stepping movements
  118. Cranial nerves
    • 1 olfactory
    • II optic
    • III oculomotor
    • IV trochlear
    • V trigeminal
    • VI abducens
    • VII facial
    • VIII acoustic
    • IX glossopharyngeal
    • X Vagus
    • XI Spinal Accessory
    • XII Hypoglossal
  119. Cranial Nerve- I olfactory

    expected findings in infants and children/adolescents
    • infants- difficult to test
    • c/a- identifies smells through each nostril individually
  120. Cranial nerve- II optic

    expected findings in infants and children/adolscents
    • infant- looks at facce and tracks with eyes
    • c/a- has intact visual acuity, peripheral vision, and color vision
  121. Cranial Nerve- III oculomotor

    expected findings of infants and children/adolscents
    • Infants- Blinks in response to light and Has pupils that are reactive to light
    • C/A- Has no nystagmus and PERRLA is intact
  122. Cranial nerve - IV Trochlear

    Expected fingings in infants and children and adolscents
    • Infant- looks at face and tracks with eyes
    • C/A- has the ability to look down and in with eyes
  123. Cranial Nerve - V Trigeminal

    Expected findings in infants and children/adolscents
    • Infant - Has rooting and sucking reflexes
    • C/A - Is able to clench teeth together and detects touch on face with eyes closed
  124. Cranial Nerve - VI Abducens

    Expected findings in infants and children/adolescents
    • Infant - looks at thave and tracks with eyes
    • C/A - Is able to see laterally
    • with eyes
  125. Cranial Nerve - VII Facial

    Expected finding in infants and children/adolescents
    • Infants- Has symmetric facial movements
    • C/A - has the ability to differentiate between salty and sweet on tongue and has symmetric facial movements
  126. Cranial Nerve- VIII Acoustic

    Expected findings in infants and children/adolescents
    • Infants - tracks a sound and blinks in response to a loud noise
    • C/A - Doeks not experience vertigo and has intact hearing
  127. Cranial nerve- IX Glossopharyngeal

    Expected findings in infants and children/adolescents
    • Infants - has an intact gag reflex
    • C/A - has an intact gag reflex and is able to taste sour sensations on back of tongue
  128. Cranial Nerve- X Vagus

    Expected findings in infants and children/adolescents
    • Infant - has no difficulties swallowing
    • C/A - Speech clear, no difficulties swallowing
  129. Cranial Nerve - XI Spinal Accessory

    Expected fingings in infants and children/adolescents
    • infants - moves shoulder symmetrically
    • C/A - has equal strength of shoulder shrug against examiner's hands
  130. Cranial nerve - XII Hypoglossal

    Expected findings in infants and children/adolescents
    • infants - has no difficulties swallowing and opens mouth when nares are occluded
    • C/A - Has a tongue that is midline and is able to move tongue in all directions with equal strength against tongue blade resistance
  131. Deep tendon reflexes in pediatric patients
    • Partial flexion of lower arm at biceps tendon
    • Partial extension of lower arm at triceps tendon
    • Partial extension of lower leg at patellar tendon
    • Plantar fexion of foot at Achilles tendon
  132. Cerebellar function assessment for children and adolscents
    • Finger to nose test - Rapid coordinated movements
    • Heel to shin test- able to run the heel of one foot down the shin of the other leg while standing
    • Romberg test- Able to stand with slight swaying while eyes closed