2 - Physical Assessment Findings (2) Flashcards
(41 cards)
Physical Assessment:
Ears…what do you look for?
- ALIGNMENT (top of the auricles even with outer canthus)
- EXTERNAL EAR (free of lesions, nontender, ear canal clear, normal cerumen)
- INTERNAL EAR (ear canal pink with fine hairs, tympanic membrane pearly pink or gray, light reflex visible, umbo and manubrium visible)
- HEARING (infants have blink reflex to sound, turn toward sounds, older children use whisper test)
Infants and toddlers, pull pinna ____ and back.
Children older than 3 years, pull pinna ____ and back.
down
up
Physical Assessment:
Nose…what do you look for?
- midline
- patency present w/o excessive flaring
- internal structures (septum midline and intact; mucosa pink, moist, no discharge)
- smell assessed in older children
Physical Assessment:
Mouth and throat
(don’t memorize…just read over and be familiar with this)
LIPS - lips (darker than facial skin) - smooth, soft, moist, and symmetric GUMS - coral pink - tight against teeth MUCOUS MEMBRANES - no lesions - moist, pink, smooth, glistening TONGUE - infants may have white coating on their tongues from milk that is easily removed...oral candidiasis coating is not easily removed - pink, symmetric tongues that can be moved beyond the lips TEETH - infants have 6-8 teeth by age 1 yr - 20 deciduous teeth...32 permanent teeth HARD AND SOFT PALATE - intact, firm, concave UVULA - intact, moves with vocalization TONSILS - infants...may not visualize - children...barely visual to prominent, same color, deep crevices that hold food particles SPEECH - infants...strong cry - children and adolescents...clear and articulate
Physical Assessment:
Thorax and lungs
- CHEST SHAPE (infant, almost circular; child/adol, 2:1 AP to transverse diameter)
- RIBS AND STERNUM (infants flexible, symmetric and smooth, no protrusions or bulges)
- MOVEMENT - symmetric, no retractions (infants, irregular rhythms common; children younger than 7, more abd. movement seen during respirations)
- BREATH SOUNDS (inspiration longer/louder than expiration; vesicular or soft, swishing sounds heard over most of the lungs)
- BREASTS (newborns breasts may be enlarged during first few days; child/adol - nipples and areolas darker pigmented and symmetric)
Females develop breasts between ___ and ___ years of age. They can be _____, with no masses and be palpable.
10 to 14 years
asymmetric
Males may develop breasts during puberty, this is called _____. They may be unilateral or bilateral.
gynocomastia
Physical Assessment:
Heart sounds
S1 S2 are clear and crisp
S1 is louder at the ____ of the heart.
S2 is louder at the ____ of the heart.
apex
base
T/F: Physiologic splitting of S2 and S3 heart sounds are expected findings in some children.
True
Which pulses are palpable, full, and localized in INFANTS?
brachial
temporal
femoral
Children and adolescents have the same palpable pulses as _____.
Adults
Physical Assessment:
Abdomen
- No tenderness or guarding
- Peristaltic waves may be visible in thinner children
- Symmetric, no protrusions around the umbilicus
What shape abdomens do infants and toddlers have?
What shape do child/adol have?
round
flat
Bowel sounds should be heard every ____ to ____ seconds.
5 to 30
Physical Assessment:
Genitalia (male)
- hair distribution is diamond shaped after puberty
- penis straight
- urethral meatus at the tip of the penis
- foreskin may not be retractable in infants and small children
- enlargement of penis occurs during adolescence
- the penis may look abnormally small in males who are obese b/c of skin folds partially covering the base
- scrotum hangs separately from penis
- skin on the scrotum has a rugated appearance and is loose
- left testicle hangs slighter lower than the right
- the inguinal canal should be absent of swelling
- during puberty, the testes and scrotum enlarge with darker scrotal skin
Physical Assessment:
Genitalia (Female)
- hair distribution over mons pubis should be documented in terms of amount and location during puberty
- hair in inverted triangle
- labia symmetric, w/o lesions, moist on inner aspects
- clitoris small w/o bruising or edema
- urethral meatus slit-like appearance w/ no discharge
- vaginal orifice hymen absent, or covers the vaginal opening prior to sexual intercourse
Physical Assessment:
Anus
surrounding skin intact with sphincter tightening noted if the anus is touched.
T/F: Routine rectal exams are always done with the pediatric population.
False
RARELY done
Physical Assessment:
Musculoskeletal system
- length, position, and size are symmetric
- joints are stable and symmetric with full ROM, no crepitus or redness
- spine: infants should be w/o dimples or tufts of hair, midline with an overall C-shaped lateral curve
- toddlers appear squat w/ short legs and protuberant abdomens
- preschoolers more erect than toddlers
- children develop cervical, thoracic, and lumbar curvatures like adults
- adol remain midline, no scoliosis noted
- gait, toddlers and young children - bowlegged or knock-knee appearance is common; feet face forward while walking
- older child/adol - steady gait noted with even wear on the soles of shoes
Physical Assessment: Neurologic System (What are the 8 infant reflexes)
1) Sucking and rooting
2) Palmar grasp
3) Plantar grasp
4) Moro
5) Startle
6) Tonic neck
7) Babinski
8) Stepping
Name the infant reflex:
Elicited by stroking an infant’s cheek or the edge of an infant’s mouth –> the infant turns head toward the side that is touched and starts to suck.
Sucking and rooting
birth to 4 mo
Name the infant reflex:
Elicited by placing an object in an infant’s palm –> the infant grasps the object.
Palmar grasp
birth to 3 mo
Name the infant reflex:
Elicited by touching the sole of an infant’s foot –> the infant’s toes curl downward
Plantar grasp
birth to 8 mo
