Pediatric Assessment ppt (up to but not including Health Supervision)

Question 1

Health assessment components in pediatrics

Answer 1

Health interview and history.

Observation of the parent–child interaction.

Assessment of the child’s emotional, physiologic, cognitive, and social development.

Physical assessment.

Question 2

What is crucial for proper assessment of the family’s needs?

Answer 2

*Behavioral observations are crucial to proper assessment of the family’s needs.

Question 3

Nurse role when assessing a pediatric patient

Answer 3

Establish rapport and trust.
Demonstrate respect for the child and parent/caregiver.
Approach child in a developmentally appropriate manner.
Communicate effectively by listening actively, demonstrating empathy, and providing feedback.
Observe systematically.
Obtain accurate data.
Validate and interpret data accurately.

Question 4

Therapeutic communication

Answer 4

Active listening.
Using open-ended questions.
Identifying and eliminating barriers to communication.
Establishing rapport.

Question 5

What is the foundation of an accurate health assessment

Answer 5

Health interview

Question 6

Health history includes:

Answer 6

Demographics
Chief complaint
History of present illness
Past health history
Review of systems
Family health history
Developmental history
Functional history
Family composition
Resources
Home environment

Question 7

Demographics

Answer 7

simple, non-intrusive; never assume who parent is

Question 8

Chief complaint

Answer 8

Reason for the visit

Question 9

History of present illness

Answer 9

Onset, duration, characteristics, and course (location, signs, symptoms, exposures, etc.).

Previous episodes in the child or family members.

Any changes in environment/daily routine.

Previous testing or therapies; what makes it better or worse.

What the concern means to the child and family.

Inquiry about any exposure to infectious/toxic agents.

Question 10

Past health history

Answer 10

Prenatal or perinatal history, past illnesses, other developmental concerns.

Prior history of illnesses, accidents, or injuries.
Any operations or hospitalizations.

Diet (specifics) and allergies (type and reactions).
Immunization status.

Any OTC or prescription medications child is taking.
Menstrual history in adolescent females.

Question 11

Health history: Development

Answer 11

Developmental: meeting milestones

Question 12

Health history: Functional

Answer 12

Functional: Daily Routine; Sleep, safety, Dental, Physical play, nutrition, etc.

Question 13

Assessment

Answer 13

General appearance, vital signs [PAIN – FLACC or Pain Faces], body measurements (height, weight, head circumference, BMI on appropriate growth charts), activity level, orientation, mood, and pain assessment.

Question 14

Physical examination- what is the technique?

Answer 14

Inspection

Palpation

Percussion

*Auscultation

Question 15

What is the largest body organ?

Answer 15

Skin

Question 16

What does the skin reveal?

Answer 16

reveals nutrition, respiratory, cardiac, endocrine, and hydration status at a glance.

Question 17

Inspecting variations in skin color and causes:

Answer 17

Pallor, central and peripheral cyanosis, jaundice, redness, etc.

Descriptive about lesions

Question 18

Hair and Nails: What can dry brittle nails indicate?

Answer 18

Nutritional difficiency

Question 19

Coarse dry hair can indicate what?

Answer 19

Thyroid or nutritional deficiency

Question 20

In children, what you you assess about a child’s head?

Answer 20

Always assess symmetry (face and muscle movement)

Question 21

What are the two fontanels

Answer 21

1. Anterior
2. Posterior

Question 22

Anterior Fontanels

Answer 22

closed between 9-18 months

Question 23

Posterior Fontanels

Answer 23

Posterior: smaller; closes between shortly after birth and 2 months

Question 24

What are you checking for with the necks of babies?

Answer 24

Symmetry, webbing, ROM, lymph nodes

Question 25

What are you checking for with the ears of the babies?

Answer 25

EARS: Symmetry, placed no lower than the eyes, skin tags

Question 26

How to check inner ear of young infant/child

Answer 26

*Pull down earlobe of young infant/child

Question 27

How to check inner ear of young older child

Answer 27

*Pull up on outer edge of pinna in older child

Question 28

What are you assessing for eyes of babies?

Answer 28

EYES: Symmetry, spacing, epicanthal folds, accommodation (focusing at different distances), PERRLA (pupils equal round reactive to light and accommodation), extraocular motility (tracking), Hirschberg test (small dot in reflected eye symmetrically in each eye)

Question 29

Hirschberg test

Answer 29

(small dot in reflected eye symmetrically in each eye)

Question 30

For nose, what are you checking for?

Answer 30

symmetry, patency, drainage, piercings

Question 31

For Mouth and Throat, what are you checking for?

Answer 31

Lips for inflammation, lesions, edema; teeth; tonsils pink, uvula midline, no exudate

Question 32

For the Thorax and Lung assessment what do you start with?

Answer 32

Begin assessment by observing shape and contour and determining work of breathing.

Question 33

For thorax and lungs, what else are you assessing?

Answer 33

Observe rate and respiratory effort—easy, labored? Note retractions or use of accessory muscles to breathe. Listen for unusual sounds—wheezing, stridor, crackles, or diminished Describe cough if present—dry, hacking, wet, productive. Play games to get child to cooperate with deep breathing!

Question 34

For breasts, what are you assessing?

Answer 34

Breasts: Assess based on Tanner Stage 1-5

Question 35

When observing a child's heart what do you assess?

Answer 35

Observe posture, color, symmetry, clubbing, vein distention, apical impulse (can be visible) at point of maximum intensity (PMI) Pulses, warmth, cap refillWh

Question 36

What is a common finding in children (having to do with the heart)

Answer 36

Murmur: common finding in children.

Question 37

How is a heart murmur graded?

Answer 37

Grading is based upon how loud the murmur is: Grade I (soft and intermittent) to Grade VI (loud, can be heard without the stethoscope touching chest).

Question 38

When assessing a murmur, what should you note?

Answer 38

Note the anatomic location where the murmur is best heard. Note where and if murmur radiates to other parts of the chest.

Question 39

In children, how should you divide the abdomen?

Answer 39

Divide into 4 quadrants as in adult.

Question 40

In children, what are you assessing for in the abdomen

Answer 40

Inspect for size, shape, symmetry; infant and toddler will be rounded, check cord in infants.

Question 41

In the abdomen, what are you auscultating for?

Answer 41

Auscultate bowel sounds

Question 42

What is the order of operations of assessing the abdomen?

Answer 42

1. Inspect 2. auscultate 3. Percuss 4. Palpate

Question 43

How do you palpate the abdomen?

Answer 43

first light and then deep. Monitor pain, organs (liver, spleen, kidneys rarely palpated)

Question 44

When palpating the abdomen, what is expected?

Answer 44

Should be soft, nontender, nondistended Report firmness, tenderness, or masses

Question 45

When assessing the musculoskeletal, what does that include?

Answer 45

Includes clavicles, shoulders, spine, extremities, joints and hips. Determining range of motion. Tone.

Question 46

Assessing the clavicle and shoulder, what are you checking for?

Answer 46

Clavicles & Shoulders: tenderness, crepitus, strength

Question 47

Assessing the spine, what are you checking for?

Answer 47

Spine: posture, alignment, scoliosis

Question 48

When assessing extremities what are you checking?

Answer 48

Extremities: move spontaneously , gait

Question 49

Genu varum

Answer 49

bow legs

Question 50

How long does genu varum last?

Answer 50

until 2-3 years

Question 51

Genu valqum

Answer 51

knock knee

Question 52

How long does Genu valqum last?

Answer 52

until 7 years old

Question 53

Neurologically, what are you assessing?

Answer 53

Level of Consciousness: Balance and Coordination: Sensory: Reflexes Developmental:

Question 54

Level of consciousness

Answer 54

alertness and attentiveness

Question 55

Balance and Coordination

Answer 55

controlled by cerebellum: Gait, Romberg, heel to shin, rapid alternating movements, finger to finger, finger to nose

Question 56

Sensory is assessing

Answer 56

Sensory: cranial nerves, vision, hearing, tasting, smelling, sharp and dull

Question 57

Reflexes are assessing

Answer 57

Reflexes: primitive and protective reflexes. Deep tendon reflexes

Question 58

Development, what should be done?

Answer 58

utilize screening tools

Question 59

What assessment should you leave until the end

Answer 59

Genitalia/anus

Question 60

What scale is used to assess genitalia and anus?

Answer 60

Tanner scale

Question 61

Tanner scale

Answer 61

used for girls and boys to categorize degree of pubertal development.

Question 62

How is the Tanner Scale recorded?

Answer 62

Recorded as Tanner Stages I–IV.

Question 63

What is included in the tanner scale?

Answer 63

breast and pubic hair distribution for girls. pubic hair, penis and scrotum size for boys.

Question 64

When assessing anus, what is being checked?

Answer 64

Anus: assess for fissures, rash, hemorrhoids, skin tags