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

Copyright 2002, Delmar, A division of Thomson Learning

Chapter 24

Pediatric Patient


Competencies 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)


Competencies 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.


Physical Growth Weight Height Head circumference Average weight gain Rapid growth periods

Infancy Adolescence


Anatomy and Physiology Vital signs

Temperature regulation Variations by age

Skin and hair Lanugo Vernix caseosa

(continues)


Anatomy and Physiology Head

Closure of fontanels Eyes, ears, nose, mouth

Production of tears Variations in eustachian tube Development of sinuses Eruption of teeth

(continues)


Anatomy and Physiology Breasts

Breast tissue develops between 8 and 13 years of age

Thorax and lungs Infant

Chest development Nose breathing Abdominal breathing

(continues)


Anatomy and Physiology Heart and peripheral vasculature

Placement Cardiac output

Abdomen Musculoskeletal system

Bone growth ends at 20 years of age

(continues)


Anatomy and Physiology Neurological system

Development Female genitalia

Development of pubic hair Male genitalia

Descent of the testes Onset of puberty


Health History Biographical data

Name Contact information Source of data

Chief complaint Older preschooler, school-age

child, and adolescent are able to describe own health concerns


Past Health History Birth history

Prenatal Labor and delivery Postnatal

Medical history Hospitalizations Emergency department visits Chronic disease

(continues)


Past Health History Injuries/accidents Childhood illnesses

Document exposure to measles, mumps, rubella, pertussis, and chickenpox

Immunizations

(continues)


Past Health History Family health history Social history

Sexual practices School/home environment Child’s personal habits

Health maintenance activities Sleep Diet Safety—key area for assessment


Developmental Assessment Denver II

Personal-social Fine motor-adaptive Language Gross motor


Physical Assessment Equipment

Appropriate child-size equipment Developmental assessment tools Otoscope

(continues)


Physical Assessment 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


Assessment Vital signs

Temperature Blood pressure Heart rate Respiratory rate

(continues)


Assessment Physical growth

Height or length Weight Head circumference Growth charts Chest circumference Apgar score

(continues)


Assessment Skin

Inspect color, lesions Palpate texture

Hair Head

Inspect for symmetry, shape, head control

Palpate fontanels, suture lines, surface characteristics

(continues)


Assessment 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


Eye Assessment Inspect

Eyelids Lacrimal apparatus Sclera Iris Pupils Red reflex Retina Optic disc


Assessment Ears

Auditory testing External ear Internal ear

Mouth and throat Inspect lips, buccal mucosa, teeth, hard

palate, soft palate, oropharynx

(continues)


Assessment Neck

Palpate thyroid and lymph nodes Breasts

(continues)


Assessment Thorax and lungs

Inspect shape of thorax, presence of retractions

Palpate for tactile fremitus Percuss diaphragmatic excursion Auscultate breath sounds

(continues)


Assessment Heart and peripheral vasculature

Usually performed at beginning of exam Inspect

Apical impulse, precordium Palpate

Thrill Peripheral pulses

Auscultate Heart sounds Innocent murmurs (continues)


Assessment Abdomen

Calm child before proceeding Inspect

Contour Peristaltic wave

Auscultate Bowel sounds

Palpate

(continues)


Assessment General approach

Use of games to facilitate evaluation Inspection

Muscles, joints, tibiofemoral bones Palpation

Joints, feet, hip, femur


Neurological Assessment General approach

Infant Toddler

(continues)


Neurological Assessment Reflex mechanisms of the infant

Rooting Sucking Palmar grasp Tonic neck Stepping Plantar grasp Babinski Moro

(continues)


Neurological Assessment Cranial nerve testing

Infant Toddler School age Adolescent


Genitalia Assessment Tanner sexual maturity rating Female

Age-specific guidelines Inspect perineal area

Male Age-specific guidelines Inspect penis, scrotum Palpate scrotum


Signs of Sexual Abuse in Children Strong fear of examination Presence of STD Anorectal tears, ecchymosis,

pruritis, scarring, or bleeding Absent or delayed anal reflex Broken hymen, vaginal tears

Documents

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