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2010-03-02 20:45:57

basic assessment
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  1. Adolescent assessment, including immunizations
    • -provide privacy.
    • - physical exam= assess puberty changes, ht, wt, vs, & growth done yearly.
    • -vaccines = meningococcal, pneumococcal, flu & varicella booster tetanus & diptheria (done 10 yr after pre-k dose). Hep B
    • -screen for scoliosis & goiter
  2. Preschooler assessment
    • -physical exam, ht, wt, vision, hearing & bp yearly
    • -immunizations: boosters for dtap, polio & mmr
    • -tb required before school
    • -lead testing if indicated
  3. Preschooler development
    • -discipline w time outs, consistency, firm limits, & short explanations
    • -consistent routines, allow imaginative play, limit tv
    • -read to child daily, teach proper hand washing
    • -usu gain 5 lb/yr, grows abt 3" /yr (by age 5 at 1/2 expected adult ht)
    • -by age 3: vocab 300-500 words, use 3-4 word sentences, can walk run and jump well, climb stairs, ride 3 wheel bike, balance on 1 foot briefly. stacks 9-10 blocks, copy circles, draw a cross.
    • -by age 4: use abt 1500 words, ask why a lot, make up stories, can learn songs, catch a ball w both arms, skip, walk downstairs, hop on 1 foot, climb playground, lace shoes, use scissors, copy a square, trace a diamond, draw a stick figure w 3 parts.
    • -by age 5: vocab of 2100 words, rec& names abt 4 colors, days and months, can tie shoes, copy diamond & triangle, skip usuing alternate feet, jump rope, and more parts to stick figure, print numbers & letters. can enjoy sports.
  4. School age child assessment
    • -every 2 yrs from 6 to 10, then yearly. physical exam, dietary intake, ht, wt, hearing, vision, bp, hr,rr
    • -inquire alchol, drug, tobacco pt & family
    • -assess home & family dynamics, extracurricular activies, changes in thoughts, academics, sexuality
    • -screeen for tb
    • -tetanus booster age 11 or 12
  5. Normal motor development of infant up to 1 yr
    • birth- full head lag when pulled by arms,
    • 1 mo- when prone can lift head & turn side to side, grasp sm objects
    • 3 mo- lose grasp reflex & will grasp obj put in hand, hold it then release it
    • 4 mo - minimal head lag & can sit w support
    • 5 mo- roll from front to back, grasp obj placed in front of him & pass them to other hand
    • 6mo- c sit up while using hands to support self, can stand bearing his own wt while being held
    • 7&8mo- c sit wo support, uses thumb & forfinger to grasp
    • 8 mo- bear his own wt while standing wo being held, crawling on belly
    • 10 mo- can crawl, pull self up to standing position, cruises while holding furniture, pincher grasp, can hold crayons
    • 12mo- walking while holding someones hand
  6. normal motor dev of toddler 1 to 3
    • 15 mo- walking alone, builds tower w 2 blocks, scribble w crayons
    • 18 mo- stacks 3-4 blocks, walks up stairs w help
    • 24 mo- walk up stairs holding rail one step at time
    • 30 mo- stacks 8 blocks, kick a ball, jump w both feet, dress self, brush teeth, hold crayons, draw cross, ride tricycle
    • 36 mo- gross & fine motor control much steadier
  7. Normal growth patterns of toddler (1-3yrs)
    • -Ht: grow 3"ea year
    • -wt: gain abt 5lb per yr. 2.5yr quadrupled birth wt.
    • -HC: 1-2yr old hc and chest circ will be same, increasing by abt 1".
    • -lg abdomens
    • -bow legs
    • -poor muscle tone
  8. Normal growth patterns school age child (6-12 yr)
    • -ht: grow abt 2" per yr
    • -wt: gain 5 to 6 lb per yr
    • -boys slightly taller and weigh more
    • -age 12 girls usu taller and weigh more
  9. normal growth patterns adolescent (12 -21yr)
    • -growth spurt
    • -females grow 2-8" and gain 15-55lbs.
    • -males grow 4-12" and gain 15-65lb
    • -puberty for girls lasts abt 3 years
    • -puberty for boys starts btwn 9&16 and is over by 19
    • -females: menarche begins abt 2.5yrs after puberty begins (breast buds & pubic hair)
    • -male puberty: inc muscle mass, penis size & testicle size, appearance of body & facial hair & deep voice
  10. normal vitals for children
    • newborns: hr 100-180; rr 30-50; temp 99.4-99.7
    • infant to 2 yr: hr 80-130; rr 20-30; bp-age +90 sys (if 1-7yrold) +56dia (if 1-5yrold)
    • -2 to 10yr: hr 70-110, rr 20-28, bp (2xage in yrs)+83 (sys 8-18yrs) & age in yrs +52 (dia 6-18yr), temp 98.6 to 99 (3-5 yrs) and 98.1-98.3 (7-9 yrs)
    • 10 yr-adult: hr 60-100, rr 12-20, temp 97.8 to 98.3
  11. normal growth patterns of infant to 1 yr
    • length: birth to 6 mo, 1"per mo. from 6 to mo, an increase of 50% of length is normal
    • weight: birth to 6 mo, gain of 1.5lb per mo. birth wt doubles by 5 mo. avg wt by 6 mo is 16lb. from 6 to 12 mo wt gain slows to 3/4lb /mo. by 12 mo the infant should have tripled his birth wt & weigh avg of 21.5 lb
    • HC: inc 1.5cm ea mo thru 6 mo, avg size 17", from 6-12 a gain of 1/2cm per mo to avg of 18"
    • Chest circumference: avg 1" smaller than HC
    • Teeth: primary teeth erupt around 6 mo.
    • Fontanel: anterior fontanel at birth 2" wide & posterior fontanel will be 1/2" wide. anterior fontanel closes btwn 12 & 18 mo, posterior fontanel is closed by 2mo
  12. newborn reflexes of eyes, nose and throat
    • blinking reflex: blink at obj near eye or sudden bright light; persist thru adulthood
    • pupillary reflex: contract at bright light, persists thru adulthood
    • dolls eye reflex: when head moved one side to other eyes will lag behind & adjust slowly to new position of head. disappears as infant dev ability to fixate on objects
    • sneeze reflex: sneeze in response to obsstruction or irriatation to nose, persists thru adulthood
    • glabellar reflex: when tapped on bridge of nose child will close eyes tightly
    • yawn reflex: lack of sufficient o2 will cause baby to yawn, persist thru adulthood
  13. Mass reflexes of newborn
    • Placing Reflex: when held upright & top of foot is against edge of table, baby will lift his foot onto table top. fades by 4mo of age.
    • Tonic neck reflex: when supine & head is turned to 1 side, arm & leg on that side will extend & arm & leg on opposite side will flex. fades by 3-4 months
    • Trunk incurvation reflex: when back stroked along one side of the spine, body will curve in that direction. fades by 4wk old
    • Moro rreflex: changing position suddenly wil cause to extend extremities, form a c w thumb & forefinger, then draw extremities towrd midline: may cause crying; fades after 3-4 mo
    • Crawl reflex: when on abd will make crawling motion w arms & legs. gone by abt 6 wks
    • Startle reflex: sudden loud noise will result in arms flailing outward w elbows flexed & hands clenched. fades by 4 mo old
    • Dance reflex: when held upright & bottom of foot placed on flat surface legs will flex up & down as if walking. fades after 3-4 wks
    • Perez reflex: when prone & stroked along spine from tailbone to neck, infant will cry, flex arms & legs & lift head and pelvis off table; may urinate or defecate. fades by 4-6 mo
  14. localized newborn reflexes
    • Grasp reflex: if palms of feet or hands are touched near base of fingers or toes, they will flex; palmar grasp fades after 3 mo, plantar grasp fades after 8 mo
    • Babinski reflex: if outside of sole of foot is stroked upward & across ball of foot, toes will extend, flare outward & big toe will hyperextend. disappears after 1 yr
    • Ankle clonus- while holding knee in flex position, foot is rapidly flexed w toes towrd knees, 2 beats of foot will be felt; grad disappears.
    • sucking reflex: obj placed on lips will attempt to suck, persists thru infancy
    • gag reflex: posterior pharynx stimulated will gag, persists thru adulthood
    • cough reflex: laryngeal or tracheobronchial mucous mem are irritated, will cough. persist thru adult
    • extrusion reflex: tongue pressed on will force tongue outward. persist 1st 3 mo of life
    • rooting reflex: outside of cheek is touched will turn head toward and try to suck. disappears by 3-4 mo
  15. immunizations
    • birth: opthalmic drops(prevent blindness from gonorrhea) and vit k (prevent hemorrhagic dz)
    • phenylkeotnuria, hypothyroid testing before dc
    • HEP B: birth, 1-2 mo and 6-18 mo
    • DTAP: 2,4,6, and 15-18 mo
    • HIB: 2,4 and after 12 mo
    • POLIO: 2,4 and between 6 and 18 mo
    • MMR: 12 to 18 months
    • VARICELLA: 12 months