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Alecia Hollis, R.N., MSNSMCC Associate Degree Nursing Instructor
Performing Physical ExamSteps of the Physical exam
InspectionPalpationAuscultation
Developmental Consideration
Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens
Performing Physical ExamGeneral Appearance Measurement of Vital Signs
Temperature Pulse Respiratory Rate
Measuring Oxygen Saturation Blood Pressure Pain Assessment
SYSTEMATIC APPROACH
AgeHeart Rate (beats/min)
Blood Pressure (mm Hg)
Respiratory Rate (breaths/min)
Premature
120-170 * 55-75/35-45† 40-70†
0-3 mo
100-150 * 65-85/45-55 35-55
3-6 mo
90-120 70-90/50-65 30-45
6-12 mo
80-120 80-100/55-65 25-40
1-3 yr
70-110 90-105/55-70 20-30
3-6 yr
65-110 95-110/60-75 20-25
6-12 yr
60-95 100-120/60/75 14/22
12 > yr
55-85 110-135/65/85 12-18
http://www.emedicinehealth.com/pediatric_vital_signs/article_em.htm
Blood pressure
Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens
Body Measurements Length or HeightWeight
Weight for LengthBody Mass Index
Monitoring Equipment
WeightWeight Status Category Percentile Range
Underweight Less than the 5th percentileHealthy weight 5th percentile to less than
the 85th percentileOverweight 85th to less than the 95th
percentileObese Equal to or greater than the 95th
percentile
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
External Structures
Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens
Strabismus
http://www.uofmhealth.org/health-library/zm6098
Vision AssessmentStandardized Vision ChartCriteria for referral3 to 4 years---20/50 or less in
either eye5 years old----20/40 or less in
either eye6 years old---20/30 or less in
either eyeA difference in vision between
the eyes of two lines or more on the Snellen eye chart.
Any problems with ocular alignment
Data from American Academy of Opthalmology, Pediatric Opththalmology/Strabismus Panel, (2007). Preferred Practice Pattern Guidelines. Pediatric eye evaluations San Francisico, CA
Warning signs for ReferralsLearning problemsFrequent headachesVisual complaints (child frequently won’t
recognize problem)Failed vision screen or concerns on eye examAcute eye injury Worsening infection, pain, discharge
Corneal Abrasion
en.wikipedia.org insighteyespecialists.com
Corneal Ulcer
accesspediatrics.mhmedical.com
External StructuresInspect the Pinna
(external ear)Inspect the external
auditory canal for drainage
sonoworld.com
External Structures
clinicaladvisor.com
Internal structure
quizlet.com
anatomybox.com
http://www.webmd.com/cold-and-flu/ear-infection/middle-ear
Internal Structures
http://www.earcentergreensboro.com/medical-education/ear_tubes.php webmd.com
Hearing Screening
lathamcenterspws.blogs.
Hearing LossConductive hearing loss –Occurs due to problems in the outer or middle ear; normal bone conduction
Sensorineural hearing loss---Refers to nerve damage (VIII) in the inner ear.
0-20 (or 25) db NORMAL
20-45 db Mild
46-65 db Moderate
65-90 db Severe
>90 db May not hear a sound
Hearing lossHearing Aids Cochlear Implants
ww.medicalhomeportal.org/living-with-child/assistive-technology/hearing-aids
http://www.macrobusiness.com.au/2011/09/did-you-hear-about-cochlear/
Nose
http://training.seer.cancer.gov/anatomy/respiratory/passages/nose.html
Assessment of Nose
http://www.atitesting.com/ati_next_gen/skillsmodules/content/physical-assessment-child/equipment/ap_ear_nose_throat.html
Assessment of Mouth and Throat
Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens
Lips
http://medicalpicturesinfo.com/wp-content/uploads/2011/08/Angular-Cheilitis-5.jpeg
realmagick.com
Tongue
http://www.chicanol.com/heridas-en-la-lengua/
Mouth
http://sleepmedicineboardreview.wordpress.com/2011/10/25/tonsil-size-scoring/
Gums and Teeth
http://pediatricdentistrynorth.com/special-offers/tooth-eruption/
Neck
CardiovascularInspectionPalpationAuscultation
Cardiovascular
Atitesting.com
Auscultation
Listening Sites for Auscultation
S2S2
S1
Kyle, T.& Ricci, S. (2009). Maternity and Pediatric Nursing. Philadelphia, PA: Lippincott Williams & Wilkins
Heart Sounds
mediconweb.com
Listening Sites for AuscultationHeart Sound Sites where heard
bestSites where heard softly
S1 Apex of the heartTricuspid and Mitral area
Base of heartAortic area and Pulmonic
S2 Base of the heartAortic and Pulmonic area
Apex of the heartTricuspid and Mitral area
Physiologic splitting Pulmonic area
S3 MitralLondon, Marcia (2014). Maternal & Child Nursing Care: New Jersey, Pearson.
www.texasheart.org
Respiratory
http://vereburn.com/index.php?main_page=index&cPath=29_2672
Wheeze or StridorWheezes occur when air flows rapidly
through bronchi that are narrowed nearly to the point of closure.
Wheezes is lower airwayAsthma = expiratory wheezes
A stridor is upper airwayInflammation of upper airway or FB
42
Lung sounds
Possible Sites for Retractions
Bowden & Greenberg
Respiratory Distress
www.nationwidechildrens.org
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