[Exam 3] Chapter 32 – Health Assessment of Children Flashcards
(249 cards)
1
Q
Preparing for Health Hx: What should nurse take into account and consider?
A
Consider age and developmental stage and take into account family roles and values
2
Q
Preparing for Health Hx - Gathering Materials: What should be available?
A
Materials to record history data, private space with adequate lighting, chairs of adults, and bed or exam tiable for child
3
Q
Preparing for Health Hx - Approaching Parent/Caregiver: How to approach parent?
A
Use open-ended questions and avoid making judgemental comments. Demonstrate patience and help parent stay ont rack when there are several children in family
4
Q
Preparing for Health Hx - Approaching Child: What can nurse do to not scare child with uniform?
A
Can wear variety of professional-looking outfits, whether colorful uniform tops, aprons, or smocks worn over white unforms or everyday clothing
5
Q
Preparing for Health Hx - Approaching Child: How should you speak to child?
A
Make eye contact and address by name. Use slow deliberate gestures.
6
Q
Preparing for Health Hx - Approaching Child: How to get child to wamr up?
A
A joke, puppet, a silly story or even a simple magic trick
7
Q
Preparing for Health Hx - Approaching Child: How can you elicit a child’s cooperation?
A
By allowing them control over the pace and order of the health history, or anything else that the child can control while still allowing nurse to obtain information needed
8
Q
Preparing for Health Hx - Communicating with Child During Health Hx: How should you ask them where pain hurts?
A
Ask them to point to where it hurts and allow them to answer questions
9
Q
Preparing for Health Hx - Communicating with Child During Health Hx: How can you gain more trust with adolescent patients?
A
By asking them whether they would be more comfortable answering queestions alone in exam area or whether htey prefer their parents to be present.
10
Q
Preparing for Health Hx - Communicating with Child During Health Hx: How can you demonstrate an interest in teens?
A
By asking questions about school, work, hobbies, or activites and friendships.
11
Q
Preparing for Health Hx - Communicating with Child During Health Hx: What must nurse do if nurse receives indication that teen may be in danger?
A
Nurse must inform the teen that info will be shared with other providers and parent
12
Q
Preparing for Health Hx - Observing Parent/Child Interaction: When does this begin??
A
During focused conversation of health interview and continue throughout physical exam. Observe for behavioral cues.
13
Q
Preparing for Health Hx - Observing Parent/Child Interaction: What kind of behavioral cues should you look for?
A
Does parent make eye contact with infant?
Does parent anticipate and respond to infants needs?
Are parents ineffective when dealing with toddlers temper tantrums?
14
Q
Preparing for Health Hx - Observing Parent/Child Interaction: What behavioral cues should you look for with children?
A
Does child look at parent for answering?
Does the child seem relaxed with parent or stressed
15
Q
Preparing for Health Hx - Observing Parent/Child Interaction: What to observe in relationship between adolescent and parent?
A
Does parent allow adolescent to speak?
Does parent contradict what is being said?
Observe body language of adolescent, are they relaxed or tense
16
Q
Preparing for Health Hx - Observing Parent/Child Interaction: What kind of open-questions could be used to get adolescent to talk?
A
“Tell me about your…” or “What have you noticed about…”
17
Q
Preparing for Health Hx - Determining Type of Hx Needed: When would a complete and detailed history be compelted?
A
When the physician rarely sees the child, or if the child is critically ill
18
Q
Preparing for Health Hx - Determining Type of Hx Needed: When would a problem-focused history be conducted?
A
When the child who receives routine health care and presents with a mild illness.
19
Q
Preparing for Health Hx - Determining Type of Hx Needed: What kind of history would be confused on child in an emergent situation?
A
Health history that is focused on child’s most immediate need.
20
Q
Performing Health Hx: What is the foundation of an accurate health assessment?
A
Health interview
21
Q
Performing Health Hx: What are some therapeutic techniques that can be used when communicating?
A
Active listening, open-ended questions, and eliminating barriers to communication
22
Q
Performing Health Hx: What is collected at initial visit?
A
Large amounts of historical data. Having family fill out questionnaire can save time.
23
Q
Performing Health Hx - Demographics: What should first be obtained?
A
Data such as child’s name, nickname, birth date, and gender. Determine race or ethnicity. Record child’s address and home telephone number.
24
Q
Performing Health Hx - Demographics: What should you do with the historian
A
Identify who it is, and note how reliable this source of information is considered to be
25
Performing Health Hx - Demographics: What questions should be asked at person with the child?
Their relation to the child and determine the composition of the household.
26
Performing Health Hx - Chief Complaint and Hx of Present Illness: How can you ask about the chief complaint?
"What can I help you with today?" or "What did you notice in you rbaby/child that you wanted to have checked today?"
27
Performing Health Hx - Chief Complaint and Hx of Present Illness: What should you do when determined the history related to the preesent illness?
Determine its onset, duration, characteristics, and course (locations, s&s, exposures) along with episodes in family and tx done.
28
Performing Health Hx - Past Health Hx: What questions should you ask about pas for parent
Prenatal history (any problems with pregnancy), perinatal history (any problems with labor) or other health/developmental problems
29
Performing Health Hx - Past Health Hx: What should you document form the past for child?
Childs prior history of illness and any accidents or injnuries in past
30
Performing Health Hx - Past Health Hx: What should you do about allergies?
Determine all allergies, a long with the severity of the allergies. This can also be used to determine immunization status
31
Performing Health Hx - Past Health Hx: What to record about medication?
Record any medications child taking, dosage, and schedule, as well as when last dose was given.
32
Performing Health Hx - Family Health Hx: How can you inquire about family health hx?
Perform a three-generation family health hx. Identify if grandparents or parents have certainissues like coronary artery disease.
33
Performing Health Hx - Review of Systems: Inquire about problems related to what?
Growth/Development
Skin
Head/Neck
Eyes/Vision
Ears/Hearing
Mouth
Organ Systems
34
Performing Health Hx - Developmental Hx: What should you determine here?
Landmarks in gross motor control and when they were achieved such as sitting, standing, walkng, pedaling and so on.
35
Performing Health Hx - Developmental Hx: Ask whether child has attained fine motor skills such a
grapsing, releasing, pincer grasp, crayon or utensil use, adn handwriitng skills
36
Performing Health Hx - Developmental Hx: What should you ask about self-care ability?
Ability to tie shoes, dressing, brushing teeth, and how toilet training is progressing. This also includes feeding skills including how they handle cup or utensils.
37
Performing Health Hx - Functional Hx: This should contain information about child's daily routine, including..
Safety measures (car seats, seatbelts)
Routine health care and dental care
Nutrition, including 24-hour dietary recall
Physical activity
Television habits
Sleep patterns
Hearing/vision problems
38
Performing Health Hx - Family Composition, Resources, and Home Environment: What questions could you determine about parents?
Marital status of parents. Does child live with parents? Foster Care?
Determine employment status and occupations. May determine if they don't spend enough time with child
39
Performing Health Hx - Family Composition, Resources, and Home Environment: Why should y ou assess family income?
Can determine health insurance and supplemental nutrition assistance program
40
Physical Exam: Place to perform exam for newborn?
May lie on exam table or in caregivers lap
41
Physical Exam: Place to perform exam for infant
Caregivers lap or on exam table with caregiver right beside
42
Physical Exam: Place to perform exam for toddler?
Allow some freedom of movement when possible , and child may stand between caregivers legs
43
Physical Exam: Place to perform exam for preschool?
Some may be willing to sit on exam table with caregiver standing close by
44
Physical Exam: Place to perform exam for school-age
Sittin on exam table while they still have contact with caregiver
45
Physical Exam: Exam direction for newborn?
Keep up running dialog with the caregiver, explaining each step
46
Physical Exam: Exam direction for infant?
Contineu to explain each step to caregiver, and address child by name
47
Physical Exam: Exam direction for toddler?
Introduce yourself to caregiver, and child and explain most steps to the child and all steps to caregiver
48
Physical Exam: Exam direction for preschool?
Allow child to decide order of exam, and explain what the instruments do and let the child try them
49
Physical Exam: Exam direction for school-age?
Include the child in all parts of the exam using head-to-toe approach
50
Preparing for Physical Exam - Gathering Materials: What should be included in exam area?
Exam table or child's crib. Need light. Gather clean gloves, stethoscope, thermometer, tape measure, reflex hammer, pen light, tongue depressor, and cotton balls
51
Preparing for Physical Exam - Gathering Materials: What will be needed for taking measurement data?
Scale and a stadiometer.
52
Preparing for Physical Exam - Approaching the Child: If several children are to be seen at same time, who would be seen first?
The child who will be most cooperative. Allows other children to be more cooperative
53
Preparing for Physical Exam - Approaching the Child with Newborns/Infants: What to do if infant asleep?
Ausculate the heart, lungs, and abdomen first. Count HR and RR before undressing baby
54
Preparing for Physical Exam - Approaching the Child with Newborns/Infants: When is the best time to examine the infant?
1-2 hours before a feeding.
55
Preparing for Physical Exam - Approaching the Child with Newborns/Infants: How will the assessment be performed?
In a heat-to-toe manner, leaving the most traumatic procedures until the end
56
Preparing for Physical Exam - Approaching the Child with Newborns/Infants: When should the moro reflex be done?
At the end of the exam , as the startlign sensation may make the infant cry.
57
Preparing for Physical Exam - Approaching the Child with Toddler: How will toddlers feel about removing clothes?
Remove clothing one piece at a time. They may feel more comfortable replacing that item of clothing before removign another one.
58
Preparing for Physical Exam - Approaching the Child with Toddler: How should equipment be introduced?
Very slowly, and explain briefly what is going on. Let them touch the equipment whenever possible.
59
Preparing for Physical Exam - Approaching the Child with Toddler: Where will they prefer to sit?
On caregivers lap
60
Preparing for Physical Exam - Approaching the Child with Toddler: How to position child if they need to be supine?
Sit in chair knee-to-knee with caregiver so toddle rmay lie back on caregiver's and yours lap.
61
Preparing for Physical Exam - Approaching the Child with Preschooler: How should they be prepared here?
Use simple explanation to inform each step of exam. Allow them to help by holding stethoscope or pen light.
62
Preparing for Physical Exam - Approaching the Child with Preschooler: Preschoolers like to play games, meanign what should be done during assessmen?
Encourage deep breathing during lung ausculation, hold up a finger/penlight and instruct child to blow it out
63
Preparing for Physical Exam - Approaching the Child with School-Age Children: Problem with children here with laungage?
They may think phrases have a double meaning. BE direct by saying i want to listen to you breathe or lets see how warm you are
64
Preparing for Physical Exam - Approaching the Child with School-Age Children: How can comfort be provided with genitalia exam?
Allow them to wear their underpants under exam gown to provide a sense of security
65
Preparing for Physical Exam - Approaching the Child with Adolescents: How should assessment be performed?
In a head-to-toe manner, exposing only area to be examined.
66
Preparing for Physical Exam - Approaching the Child with Adolescents: We should allow time for what?
Allow opportunites for teen to ask questiosn without the caregiver being present.
67
Steps of Physical Exam: What is checked under systemic inspection?
Checking color, warmth, characteristics, adn texture visually and smelling for any odor
68
Steps of Physical Exam: Palpation follows what
inspection.
69
Performing Physical Exam: A complete examiniation includes assessment of what
general appearance, VS, body measures and pain, as well as examining every part of the body
70
Performing Physical Exam - General Appearance: What questions should we ask ourselves?
Does child give impression of being ill or well?
What is child's expression adn energy level?
Note lethargy, listlessness, excessive actviity, or inappropriate attention span
71
Performing Physical Exam - General Appearance: What shiuld be noted about posturing?
Newborns posture flexed, with arms/legs tucked in
Older infant should have head control
Preschool is slender and upright
School-age child and adolescent should demonstrate an upright posture
72
Performing Physical Exam - General Appearance: Questions to ask if child's development appears appropriate?
Is child active, moving around the room?
Does child speech seem appropriate for age?
Does child seem clean, cared for?
73
Performing Physical Exam - Measurement of VS: VS include what?
Temperature, pulse rate, respiratory rate, and blood pressure
74
Performing Physical Exam - Measurement of VS: What should be done if child is crying?
Document the fact
75
Performing Physical Exam - Measurement of VS with Temp: Routes for taking child's temperature include?
Tympanic, temporal, oral, axillary and rectal
76
Performing Physical Exam - Measurement of VS with Temp: What do tympanic temperature reflect?
The pulmonary artery temperature and can be measured within seconds.
77
Performing Physical Exam - Measurement of VS with Temp: Tympanic temperatures can be used in children how old?
Those 3 months of age or older.
78
Performing Physical Exam - Measurement of VS with Temp: How does temporal scanning work?
Uses infared scanning on the skin over temporal artery combined with mathematical computation to determine child's arterial temperature. Measure on exposed side of head
79
Performing Physical Exam - Measurement of VS with Temp: What age can a temporal scanning be used for?
Any age except those younger than 90 days who are ill or have a fever
80
Performing Physical Exam - Measurement of VS with Temp: How is a temporal scan performed?
Depress sensor button and slide the tip across child's forehead, midway between eyebrows and hairlines and ending in lateral hairline. Continue to depress and place on soft spot behind ear lobe.
81
Performing Physical Exam - Measurement of VS with Temp: If younger than 3, what to do for tympanic temperature?
Pul the earlobe back and down.
82
Performing Physical Exam - Measurement of VS with Temp: What may affect oral temperature?
Oral intake, oxygen administration, and nebulized medications or tx's.
83
Performing Physical Exam - Measurement of VS with Temp: Who may axillary method be used for?
THose who are uncooperative, neurologically impaired, or immunosuppressed or have injuries.
84
Performing Physical Exam - Measurement of VS with Temp: How to take rectal temperature?
Position infant supine with legs flexed. Older infant or child should be prone or side lying. Apply water soluble jelly and insert past anal sphincter no more than 1 inch
85
Performing Physical Exam - Measurement of VS with Temp: Who should the rectal route not be used on?
Immunosuppressed child, as well as those with diarrhea, bleeding disorder, or hx or rectal surgery
86
Performing Physical Exam - Measurement of VS with Pulse: Why is radial pulse difficult to palpate in those younger than 2?
Because the blood vessels lie close to the skin usrface and are easily obliterated.
87
Performing Physical Exam - Measurement of VS with Pulse: For those younger than 10, auscultation of apilcal pulse should be done how?
With stethoscope for a full minute.
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Performing Physical Exam - Measurement of VS with Pulse: What pulse is checked in older children?
Radial pulse.
89
Performing Physical Exam - Measurement of VS with RR: How are infants respirations primarily done?
Thorugh diaphragmatic movements, so count the abdominal movements.
90
Performing Physical Exam - Measurement of VS with RR: How to count respirations after 1 year of age?
Count the thoracic movements.
91
Performing Physical Exam - Measurement of VS with RR: For infant?
25-55
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Performing Physical Exam - Measurement of VS with RR: for toddler?
20-30
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Performing Physical Exam - Measurement of VS with RR: for preschooler?
20-25
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Performing Physical Exam - Measurement of VS with RR: for school-age child?
14-22
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Performing Physical Exam - Measurement of VS with RR: for adolescent?
12-18
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Performing Physical Exam - Measurement of VS with HR: for infant?
80-150
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Performing Physical Exam - Measurement of VS with HR: for toddler?
70-120
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Performing Physical Exam - Measurement of VS with HR: for preschooler?
65-110
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Performing Physical Exam - Measurement of VS with HR: for school-age?
60-100
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Performing Physical Exam - Measurement of VS with HR: for adolescent?
55-95
101
Performing Physical Exam - Measurement of VS with Measuring oxygen saturation: Guidelines to follow when using this?
Probe may be placed on finger, toe, ear, or foot. Don't place on same extremity with bp cuff.
Ensure probe not placed tight
Cover the sensory to prevent disruption from light
102
Performing Physical Exam - Measurement of VS with Measuring oxygen saturation: Potential courses or error in pulse ox readings?
Abnormal hemoglobin value, poor perfusion, motion artificat and skin breakdown
103
Performing Physical Exam - Measurement of VS with BP: At what age should this begun to be done?
For those older than 3
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Performing Physical Exam - Measurement of VS with BP: Children younger than 3 should have blood pressure measured if they have what risk factors?
History of prematurity, low birth weight
Congenital heart disease
REcurrent UTI, hematuria, and proteinuria.
Malignancy, bone marrow transplant
Tx of meds that raise bp
105
Performing Physical Exam - Measurement of VS with BP: Cufff bladder should be what percentage width of the circumference of the upper arm ?
At least 40%
106
Performing Physical Exam - Measurement of VS with BP: Cuff bladder length should cover what circumference of the upper arm?
80-100%
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Performing Physical Exam - Measurement of VS with BP: Where to measure blood pressure?
Upper arm, lower arm, thihg, or calf/ankle
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Performing Physical Exam - Measurement of VS with BP: How to obtain bp using upper arm?
Place limb at level of the heart, place cuff around upper arm, and ausculate brachail artery.
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Performing Physical Exam - Measurement of VS with BP: How do you document it is systolic blood pressure is herard to zero?
Document reading as systolic pressure over "P" for pulse
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Performing Physical Exam - Measurement of VS with BP: How does a doppler ultrasound method work?
Uses high-frequency sound waves that boune off body parts to obtain blood pressure. Apply gel and listen with device to where sounds would normally be ausculated
111
Performing Physical Exam - Measurement of VS with BP: What does oscillometric equipment do?
Measures the mean arterial pulse and then calculates the systolic and diastolci readings.
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Performing Physical Exam - Measurement of VS with BP: In children older than 1, systolic presesure in thigh tends to be how much higher than in arm?
10-40 mmHg higher
113
Performing Physical Exam - Measurement of VS with Pain Assess: What scale is used for those who are too young to verbally quantify their pain?
FLACC pains cale. Consisits of possible 10 points, wiht a 0,1,2 given for each of five clinical signs
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Performing Physical Exam - Measurement of VS with Pain Assess: For those who are older and can express their pain, what scale is used?
Pain Faces Scale. Each face represents a person who is happy or sad.
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Performing Physical Exam - Measurement of VS with Body Measurements: What body measurements are obtained here?
Height or length, Weight, and BMI
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Performing Physical Exam - Measurement of VS with Body Measurements: What will you measure in those younger than 2?
Head circumference
117
Performing Physical Exam - Measurement of VS with Body Measurements: What is a growth chart?
Screening tool for nutritional problems as well as chronic illness. Record each measurement in ink with small dot at correct location for child's age and date.
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Performing Physical Exam - Measurement of VS with Body Measurements: Children should fall in what range for the growth chart?
5-95th percentiles
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Performing Physical Exam - Body Measurements: Sudden or sustained chainges in percentile may indicate what?
Chronic disorder, emotional difficulty, or nutritional intake problem
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Performing Physical Exam - Body Measurements - Length/Height: Calculate length of toddler in lying position until how old
24 months
121
Performing Physical Exam - Body Measurements - Length/Height: How is height measured once they can stand?
Begin measuring the standing height using stadiometer.
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Performing Physical Exam - Body Measurements - Weight: How should infants and toddelrs be weighed?
On a platform-type electronic or balance scale, with exam paper placed between child and surface.
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Performing Physical Exam - Body Measurements - Weight: Infants weight should be weighted to the nearest what?
10 g (or half oz)
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Performing Physical Exam - Body Measurements - Weight: Toddler and older children should be rounded to the neares what?
100 g (or quarter-pound)
125
Performing Physical Exam - Body Measurements - Weight for Length: When is this used?
For those younger than 24 months. Plot weight on growth chart.
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Performing Physical Exam - Body Measurements - BMI: BMI less than 5th percentile, between 85th-95 percentile, adn greater than 95th percentile indicate what?
< 5th = Underweight
85th-95th = RF Overweight
>95th = OVerweight
127
Performing Physical Exam - Body Measurements - Head Circumference: How long is this done for?
Until third birthday , and than annually until 6th birthday.
128
Performing Physical Exam - Monitoring Equipment: What does an apnea monitor measure?
abnormal or irregular breathing in infants
129
Performing Physical Exam - Monitoring Equipment: Waht does a cardiopulmonary monitor measure?
heart rate and respiratory rate
130
Performing Physical Exam - Skin - Inspection: What do blueness of hands and feet indicate?
Acrocyanosis, and normal in babies up to several days of age
131
Performing Physical Exam - Skin - Inspection: Cooling or warming of newborn or young infant may produce what response
vasomotor response thqat causes a mottling of the skin
132
Performing Physical Exam - Skin - Inspection: What is lanugo?
(Soft, downy hair on body, particurly the face and back) .
133
Performing Physical Exam - Skin - Inspection: What are pigmented nevi indicated by?
a darker patch of skin and generally do not pade over time.
134
Performing Physical Exam - Skin - Inspection: What is salmon nevi?
Light pink macule usually on eyelids, nasal bridge, and back of neck (stork bite)
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Performing Physical Exam - Skin - Inspection: What is strawberry nevus?
Raised reddish papule made of blood vessels
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Performing Physical Exam - Skin - Inspection: What is nevus flameus
Dark purple-red flat patch, grows with the child
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Performing Physical Exam - Skin - Inspection: What is ecchymosis?
Purpuple discoloration, changing to blue, brown, black
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Performing Physical Exam - Skin - Inspection: What is petechiae?
Pinpoint reddish purple macules that do not blanch when pressed
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Performing Physical Exam - Skin - Inspection: What is purpura?
Larger purple macules that do not blanch when pressed
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Performing Physical Exam - Skin - Inspection: What should you do if rash present?
Describe in detail, noting types of lesions, distribution, drying, scrabbingn, scaling and any drainage
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Performing Physical Exam - Skin - Palpation: Palpate the skin for what?
Temperature, moisture, texture, turgor, and edema. Use back of hand to assess skin temperature.
142
Performing Physical Exam - Skin - Palpation: Skin dryness in well-hydrated child may occur with what?
Excess sun exposure, poor nutrition, or overbathing.
143
Performing Physical Exam - Skin - Palpation: How to assess skin tugor?
Elevating the skin on the abdomen in infant or on the back of the hand in the older child
144
Performing Physical Exam - Hair and Nails: What will you note about the hair and scalp?
Color, texture ,amount, and quality.
145
Performing Physical Exam - Hair and Nails: Corase, dry hair at any age may indicate what?
Thyroid disorder or nutritional deficiency
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Performing Physical Exam - Hair and Nails: Clubbing of nails may indicate what?
Chronic hypoxemia related to respiratory or cardiac disease.
147
Performing Physical Exam - Head - Inspection: How will you inspect an infants head?
Observe whether head appears centered or shifts to one side. Also note asymmetry.
148
Performing Physical Exam - Head - Inspection: What should you encourage parent to do if they have a flattened occiput?
Encourage parent to allow infant tummy time while awake.
149
Performing Physical Exam - Head - Palpation: What part is palpated?
Anterior and posterior fontanels, which are the soft areas on the skull that remain open that allows for rapid brain growth
150
Performing Physical Exam - Head - Palpation: Anterior fontanels size?
1-4 cm in either direction until it can no longer be felt by 9-18 months
151
Performing Physical Exam - Head - Palpation: What can dehydration cause to happen to the fontnels/
To be sunken
152
Performing Physical Exam - Head - Palpation: Palpate the jaw joints as child bites to assess which cranial nerve?
V (trigeminal)
153
Performing Physical Exam - Head - Palpation: Large fontanels may be associated with what?
Down syndrome or congenital hypothyroidism.
154
Performing Physical Exam - Head - Palpation: A fontanel that becomes larger over time indicates what
hydrocephalus
155
Performing Physical Exam - Neck: Webbing or excessive skin folds may be associated with?
Turner Syndrome
156
Performing Physical Exam - Neck: Lax neck skin may indicate what
Down syndrome
157
Performing Physical Exam - Neck: What should you assess in the neck?
Flexibility of neck.
158
Performing Physical Exam - Neck: How can you test cranial nerve XI?
by having child attempt to turn the head against resistance.
159
Performing Physical Exam - Neck: What should be done if infant or child has experienced trauma?
Should have cervical spine maintained and completely immobile until damage to spinal cord determined
160
Performing Physical Exam - Neck: Palpate the neck for what?
Masses and lymph nodes . Can show swelling, mobility, temperature, and tenderness.
161
Performing Physical Exam - Eyes: Assessment of eyes includes what?
Evaluation of external / internal structures as well as screening for visual acuity.
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Performing Physical Exam - Eyes: Internal structure assessment performed by who
advanced practitioner
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Performing Physical Exam - Eyes - External Structures: What will you observe for ?
Symmetry and spacing, and even distribution of eyelashed and eyelids, adn presence of epicanthal folds. Also note blinking
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Performing Physical Exam - Eyes - External Structures: When would epicanthal fold be present?
Asian descent, those with genetic abnormalites, and those with fetal alcohol syndrome.
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Performing Physical Exam - Eyes - External Structures: How can you test for accommodation?
Focusing at different differences but holding objects at different distances.
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Performing Physical Exam - Eyes - External Structures: Normal infant may display crossing of eyes until when
3 months of age.
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Performing Physical Exam - Eyes - External Structures: How can you assess extraocular muscle mobility and function of cranial nerves III and IV
By instructing child to follow the light through the six cardinal positions of gaze.
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Performing Physical Exam - Eyes - External Structures: How to test cranial nerve IV?
By instructing child to look downward and inward.
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Performing Physical Exam - Eyes - External Structures: How can you assess eye muscle strength?
Hirschberg test (bring penlight to middle of your face and direct the child to lok at it. Small dot should be placed symmetrically)
Cover Test (Cover one child's eye and instruct child to focus on an intersting object. Eye should not waver).
170
Performing Physical Exam - Eyes - External Structures: How to test peripheral vision?
Have child focus on specific point directly in front. Bring finer or small object from beyond range of vision into vision. When child sees object, they should say stop (tests cranial nerve II)
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Performing Physical Exam - Eyes - External Structures: Absence of red reflex in one or both eyes may indicate?
Presence of cataracts
172
Performing Physical Exam - Ears and External Structures: What level should they be at?
Placed no lower than the eyes.
173
Performing Physical Exam - Ears and External Structures: Protusion or flattening of ears may indicate
inflammation (protusion) or persistent side-lying (flattening)
174
Performing Physical Exam - Ears and External Structures: What should be done with the waxy cerumen that is soft and an orangish- brown color?
Should be left in place or washed gently away when bathing.
175
Performing Physical Exam - Ears and External Structures: What to do about drainage?
Note it, because it is abnormal
176
Performing Physical Exam - Ears and External Structures: How to palpate mastoid process?
Pull on the auricle,
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Performing Physical Exam - Ears and External Structures: How to soften impacted or dry cerumen?
Few drops of mineral or cooking oil and then gently irrigating from the canal with an ear syringe and warm water
178
Performing Physical Exam - Ears and Internal Structures: Howo can mobility of ear drum be assessed?
Typanometer. Reads air pressure.
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Performing Physical Exam - Ears and Internal Structures: How to straignten ear canal in infants adn toddlers? and older children?
Gently pull down on the ear lobe
up on the outer edge of the pinna for older children
180
Performing Physical Exam - Ears and Internal Structures: What is an otoscopic examination?
Usually performed near the end of hte physical assessment for infants and young children, as they are often quite resitant to this intrusive procedure.
181
Performing Physical Exam - Ears and Internal Structures: How should the canal look?
Pink, should have tiny ears , and should be free from scratches.
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Performing Physical Exam - Ears and Internal Structures: How should the typanic membrane look?
Pink or gray, and shuld be translucent
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Performing Physical Exam - Nose/Sinuses: How to ensure that nares provide unobstructed airflow?
By alternately occluding one nostril at a time and observing for air movement through other nostril
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Performing Physical Exam - Nose/Sinuses: How can cranial nerve I be tested?
By having child close their eyes and identify a familar scent as such as pepperiment
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Performing Physical Exam - Nose/Sinuses: Infants up to 3-6 months of age has thought to be what type of breathers?
Obligate nose breathers, because of their long soft palate and relatively large tongue.
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Performing Physical Exam - Inspection of Mouth: What will you observe for here with lips?
Color, symmetry, and absence of inflammation or edema.
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Performing Physical Exam - Inspection of Mouth: When does salivation in infants begin?
At about 3 months of age with drooling occuring because they do not learn to swallow salivia until several months later
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Performing Physical Exam - Inspection of Mouth: Tongue extrusion reflex is normal up until when?
Age of 6 months and allows infant to suckle easily from birth
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Performing Physical Exam - Inspection of Mouth: How to test cranial nerve XII?
Ask older child to touch the tongue to the roof of the mouth and then stick the to ngue out and move it from side-to-side
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Performing Physical Exam - Inspection of Mouth: What to do with natal (present at birth) or neonatal (erupting by 30 days of age) teeth?
Should be evaluated by a pediatric dentist for potential extraction
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Performing Physical Exam - Inspection of Throat: What would be inspected here?
Tonsils, uvula, and oropharynx
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Performing Physical Exam - Inspection of Throat: When will tonsils be seen?
Usually when they bcome a toddler. Then begin to decrease in size by 9th year
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Performing Physical Exam - Thorax: What should you determine here?
Size and shape as well as symmetry, movement and bony landmarks
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Performing Physical Exam - Thorax: What deformity should you assess for?
Pectus Excavatum (depressed sternum) or pectus carinatum (protuberant sternum)
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Performing Physical Exam - Thorax: Infants and younger children are primary what type of breathers?
Diaphragmatic breathers
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Performing Physical Exam - Thorax: What will you note with respirations?
Depth and regularity of respirations, noting the length of inspiratory and expiratory phases in relation to each other.
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Performing Physical Exam - Thorax: How to assess child's respiratory effort?
By first observing for nasal flaring.
Observe chest wall and shoulders for accessory muscle use.
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Performing Physical Exam - Thorax: Typical locations for retractions?
Intercostal, subcostal, substernal, suprasternal and clavicular regions
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Performing Physical Exam - Lungs - Palpation/Percussion: How will you palpate for symmetric respiratory excursion?
By placing the thumbs and fingers together along the costal margin on teh chest or back.
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Performing Physical Exam - Lungs - Auscultation: What position should child be in for this?
Sitting position for infant or child.
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Performing Physical Exam - Lungs - Auscultation: What games can encourage the child to breathe better?
Blowing a cotton ball up in the air, blowing a pinwheel, or blowing out the light of the penlight.
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Performing Physical Exam - Lungs - Auscultation: Child with respiratory disorder may exhibit what breath sounds?
Diminished, most often heard in bases. They are softer and quieter than lung sounds demonstrating adequate aeration
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Performing Physical Exam - Lungs - Auscultation: Note adventitiousu breath sounds such as?
Wheezes or crackles, documenting their location adn whether they are present on inspiration, expiration, or both
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Performing Physical Exam - Breasts - Inspection:Observe the breasts fo rwhat?
Position, shape, size, symetry, and color.
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Performing Physical Exam - Breasts - Inspection:Newborns of both genders may have swollen nipples why?
From the influence of maternal estrogen.
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Performing Physical Exam - Breasts - Inspection:Inspect the breasts for the current stage of development including
Widening of the areola
Elevation of the nipple
Increase in breast size.
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Performing Physical Exam - Breasts - Inspection: When can female breast development start?
As early as 8, but starts by 13 for most girls.
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Performing Physical Exam - Breasts - Inspection:What are the tanner stages?
The sexual maturity rating scale developed to describe breast development.
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Performing Physical Exam - Breasts - Inspection:Why may adolescent boys develop gynecomastia (enlargement of breast tissue)
due to hormonal pubertal changes.
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Performing Physical Exam - Breasts - Palpation: What under the nipple confirms pubertal changes?
A tender nodule
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Performing Physical Exam - Heart and Peripheral Perfusion - Inspection: What may indicate a cardiovascular problem?
Pallor, cyanosis, mottling, or edema
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Performing Physical Exam - Heart and Peripheral Perfusion - Inspection: Where does the apical impulse occur?
Point of maximum intensity (PMI) which is located right under the nipple
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Performing Physical Exam - Heart and Peripheral Perfusion - Palpation: Palpate the chest for what what are not normal?
Lifts, heaves, or thrills.
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Performing Physical Exam - Heart and Peripheral Perfusion - Palpation: How should you check for pulses?
Check both the upper body and lower body pulses.
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Performing Physical Exam - Heart and Peripheral Perfusion - Auscultation: Perform ausculation with child in what two different positions?
Upright and reclined.
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Performing Physical Exam - Heart and Peripheral Perfusion - Auscultation: When does sinus arrhythmia occur?
Common and normal finding in children adn adolescents. Results in an irregular heart rhythm, with heart rate increasing with inhalation and decreasing with exhalation
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Performing Physical Exam - Heart and Peripheral Perfusion - Auscultation: What should you note with murmurs?
Note hte location and timing of the murmur.
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Performing Physical Exam - Heart and Peripheral Perfusion - Auscultation: Systolic murmur associated with what position
S1
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Performing Physical Exam - Heart and Peripheral Perfusion - Auscultation: Diastolic murmur associated with what?
S2
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Performing Physical Exam - Heart and Peripheral Perfusion - Auscultation: How are heart murmurs graded?
On a scale from 1-6
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Performing Physical Exam - Heart and Peripheral Perfusion - Auscultation: Why do innocent murmurs occur frequently in children?
Because of child's more dynamic circulation , thin chest wall, and angulated vessels.
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Performing Physical Exam - Abdomen - Inspection: Inspect the abdomen for what?
Size, shape, and symmetry
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Performing Physical Exam - Abdomen - Inspection: How does abdomen appear for infant and toddler?
It is rounded and p rotuberant until abdominal musculature becomes well developed
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Performing Physical Exam - Abdomen - Inspection: WHat to do if visible peristaltic waves are seen?
They are abnormal and should be reported.
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Performing Physical Exam - Abdomen - Inspection: What to know about newborns umbilicus?
Assess color, bleeding, odor, and drainage. Should slowly dry becoming hard and black.
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Performing Physical Exam - Abdomen - Inspection: What to know for umbilical hernia?
Common to see this protrude through umbilicus and protrude through and become longer.
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Performing Physical Exam - Abdomen - Palpation: What to do if childs leg are small enough?
Knees brought up to flex the hips and relax the abdomen.
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Performing Physical Exam - Abdomen - Palpation: How to decrease ticklishness with abdominal palpation?
Place a warm, flat still hand on the abdomen while distracting child before palpation begins.
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Performing Physical Exam - Genitalia/Anus: Foreskin that canot be retracted in boy older than 3 may indicate what?
Phimosis
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Performing Physical Exam - Genitalia/Anus: What should you do when you first remove a male infant's diaper?
Asses force of urine stream and erection reflex as cool air may make the infant void and briefly experience an erection
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Performing Physical Exam - Genitalia/Anus: How to perform assessment for female?
First, determine the presence of pubic hair. may be present at birth
Then inspect labia major and minora for size, color, and skin integrity.
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Performing Physical Exam - Genitalia/Anus: How will labia minora look in newborn?
Will be swollen from the effects of maternal estrogen but will decrease in size.
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Performing Physical Exam - Musculoskeletal - Clavical/Shoulder: How to test cranial nerve XI?
REquest that the child shrug the shoulders while you apply downward pressure
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Performing Physical Exam - Musculoskeletal - Extremities: How to test for developmental dysplasia of the hip?
Ortolani and Barlow Maneuvers
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Performing Physical Exam - Musculoskeletal - Extremities: What is Genu Valgum (knock knee) present for?
Until child is 7. Observe them walking, noting any difficulty with leg position.
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Performing Physical Exam - Musculoskeletal - Extremities: Inability to strangten the foot to midline may indicate?
Clubfoot
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Performing Physical Exam - Musculoskeletal - Extremities: Counting the fingers and toes may indicate?
Polydactylyl (increased number of digits) or syndactyly (webbing of digits)
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Performing Physical Exam - Neurologic - Balance and Coordination: What contorls balance and coordination?
The cerebellum.
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Performing Physical Exam - Neurologic - Sensory Testing: How to test Cranial Nerve V?
By lightly touching the childs cheek with cotton ball. Will root toward that side
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Performing Physical Exam - Neurologic - Reflexes: What are primitive reflexes?
Involve whole-body response. This includes Moro, root, suck, asymmetric tonic neck, and plantar /palmar grasp.
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Performing Physical Exam - Neurologic - Reflexes: What are protective reflexes?
Motor responsnes related to maintenance of equilibrium. Necessary for appropriate motor development . Include righting and parachute reactions
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Performing Physical Exam - Neurologic - Reflexes: Strength of reflexes graded how?
From +0 to +4. Newborns are usually 3+ while children should stay at 2+
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A 5-year-old boy visits the pediatric office with an upper respiratory infection. Which approach would give the nurse the most information about the child’s developmental level?
Playing a game with the child.
Talking with the child about the teddy bear next to him.
Using a screening tool during a follow-up office visit.
Asking the 10-year-old sibling about the child.
Using a screening tool during a follow-up office visit.
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Which statement indicates the best sequence for the nurse to conduct an assessment in a nonemergency situation?
Introduce yourself, ask about any problems, take a history, and do the physical examination.
Perform the physical examination and then ask the family if there are any problems in the child’s life.
Do the physical examination while at the same time asking about the child’s previous illnesses; then talk about the family’s concerns.
Get a complete history of the family’s health beliefs and practices, and then assess the child.
Introduce yourself, ask about any problems, take a history, and do the physical examination.
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What approach by the nurse would most likely encourage a child to cooperate with an assessment of physical and developmental health?
Explain to the child what’s going to happen when the child asks questions.
Explain what is going to happen in words the child can understand.
Force the child to cooperate by having a parent hold him or her down.
Give the child a sticker before beginning the examination.
Explain what is going to happen in words the child can understand.
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A sleeping 5-month-old girl is being held by the mother when the nurse comes in to do a physical examination. What assessment should be done initially?
Listening to the bowel sounds
Counting the heart rate
Checking the temperature
Looking in the ears
Counting the heart rate
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Which assessment finding is considered normal in children?
Irregular respiratory rate and rhythm
Split S2 and sinus arrhythmia
Decreased heart rate with crying
Genu varum past the age of 5 years
Split S2 and sinus arrhythmia
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A child’s weight is 35 pounds, 7 ounces. Convert the weight to kilograms.
16.074
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A child’s height is 41 inches. Convert the height to centimeters.
104.14 cm
