Chapter 24 Pediatric Patient Copyright 2002 Delmar A

Chapter 24 Pediatric Patient Copyright 2002, Delmar, A division of Thomson Learning

Competencies l l Differentiate the structural and physiological variations of pediatric patients and adults. Identify the personal-social, language, fine and gross motor findings when using the Denver II. (continues) Copyright 2002, Delmar, A division of Thomson Learning

Competencies l l l Elicit a complete health history from a patient or caregiver using standard components of a pediatric health history. Identify various techniques of approaching patients at different developmental levels before initiating physical assessment. Perform inspection, palpation, percussion, and auscultation in a head-to-toe assessment of a pediatric patient. Copyright 2002, Delmar, A division of Thomson Learning

Physical Growth l l l Weight Head circumference Average weight gain Rapid growth periods Infancy £ Adolescence £ Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology l Vital signs Temperature regulation £ Variations by age £ l Skin and hair Lanugo £ Vernix caseosa £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology l Head £ l Closure of fontanels Eyes, ears, nose, mouth Production of tears £ Variations in eustachian tube £ Development of sinuses £ Eruption of teeth £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology l Breasts £ l Breast tissue develops between 8 and 13 years of age Thorax and lungs £ Infant Chest development Nose breathing Abdominal breathing (continues) Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology l Heart and peripheral vasculature Placement £ Cardiac output £ l l Abdomen Musculoskeletal system £ Bone growth ends at 20 years of age (continues) Copyright 2002, Delmar, A division of Thomson Learning

Anatomy and Physiology l Neurological system £ l Female genitalia £ l Development of pubic hair Male genitalia Descent of the testes £ Onset of puberty £ Copyright 2002, Delmar, A division of Thomson Learning

Health History l Biographical data Name £ Contact information £ Source of data £ l Chief complaint £ Older preschooler, school-age child, and adolescent are able to describe own health concerns Copyright 2002, Delmar, A division of Thomson Learning

Past Health History l Birth history Prenatal £ Labor and delivery £ Postnatal £ l Medical history Hospitalizations £ Emergency department visits £ Chronic disease £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Past Health History l l Injuries/accidents Childhood illnesses £ l Document exposure to measles, mumps, rubella, pertussis, and chickenpox Immunizations (continues) Copyright 2002, Delmar, A division of Thomson Learning

Past Health History l l Family health history Social history Sexual practices £ School/home environment £ Child’s personal habits £ l Health maintenance activities Sleep £ Diet £ Safety—key area for assessment £ Copyright 2002, Delmar, A division of Thomson Learning

Developmental Assessment l Denver II Personal-social £ Fine motor-adaptive £ Language £ Gross motor £ Copyright 2002, Delmar, A division of Thomson Learning

Physical Assessment l Equipment Appropriate child-size equipment £ Developmental assessment tools £ Otoscope £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Physical Assessment l General approach Warm environment £ Methods to decrease anxiety and promote security £ Ensure modesty £ Interview older children and adolescents separate from caregiver £ Perform uncomfortable procedures last £ Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Vital signs Temperature £ Blood pressure £ Heart rate £ Respiratory rate £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Physical growth Height or length £ Weight £ Head circumference £ Growth charts £ Chest circumference £ Apgar score £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Skin Inspect color, lesions £ Palpate texture £ l l Hair Head Inspect for symmetry, shape, head control £ Palpate fontanels, suture lines, surface characteristics (continues) £ Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Eyes Test vision first in children up to 10 years old £ Vision screening £ £ Snellen E chart Allen test Strabismus screening Hirschberg test Cover-uncover test Copyright 2002, Delmar, A division of Thomson Learning

Eye Assessment £ Inspect Eyelids Lacrimal apparatus Sclera Iris Pupils Red reflex Retina Optic disc Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Ears Auditory testing £ External ear £ Internal ear £ l Mouth and throat £ Inspect lips, buccal mucosa, teeth, hard palate, soft palate, oropharynx (continues) Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Neck £ l Palpate thyroid and lymph nodes Breasts (continues) Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Thorax and lungs Inspect shape of thorax, presence of retractions £ Palpate for tactile fremitus £ Percuss diaphragmatic excursion £ Auscultate breath sounds £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Assessment l Heart and peripheral vasculature Usually performed at beginning of exam £ Inspect £ £ Palpate £ Apical impulse, precordium Thrill Peripheral pulses Auscultate Heart sounds Innocent murmurs Copyright 2002, Delmar, A division of Thomson Learning (continues)

Assessment l Abdomen Calm child before proceeding £ Inspect £ £ Auscultate £ Contour Peristaltic wave Bowel sounds Palpate (continues) Copyright 2002, Delmar, A division of Thomson Learning

Assessment l General approach £ l Inspection £ l Use of games to facilitate evaluation Muscles, joints, tibiofemoral bones Palpation £ Joints, feet, hip, femur Copyright 2002, Delmar, A division of Thomson Learning

Neurological Assessment l General approach Infant £ Toddler £ (continues) Copyright 2002, Delmar, A division of Thomson Learning

Neurological Assessment l Reflex mechanisms of the infant Rooting £ Sucking £ Palmar grasp £ Tonic neck £ Stepping £ Plantar grasp £ Babinski £ Moro £ Copyright 2002, Delmar, A division of Thomson Learning (continues)

Neurological Assessment l Cranial nerve testing Infant £ Toddler £ School age £ Adolescent £ Copyright 2002, Delmar, A division of Thomson Learning

Genitalia Assessment l l Tanner sexual maturity rating Female Age-specific guidelines £ Inspect perineal area £ l Male Age-specific guidelines £ Inspect penis, scrotum £ Palpate scrotum £ Copyright 2002, Delmar, A division of Thomson Learning

Signs of Sexual Abuse in Children l l l Strong fear of examination Presence of STD Anorectal tears, ecchymosis, pruritis, scarring, or bleeding Absent or delayed anal reflex Broken hymen, vaginal tears Copyright 2002, Delmar, A division of Thomson Learning