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Presentation on theme: "THE PEDIATRIC EXAMINATION"— Presentation transcript:


2 Introduction to the Pediatric Examination
Pediatrics deals with: Care and development of children Diagnosis and treatment of diseases in children Pediatrician: medical doctor who specializes in pediatrics

3 Well-child visit (health maintenance visit)
Components Evaluation of growth and development of child Physical examination To detect any abnormal conditions associated with child's stage of development Anticipatory guidance Provides parents with information to prepare for anticipated developmental events Assists parents in promoting child's well being Immunizations What should we say to the parent about the importance of a well-child visit?

4 Topics of a well-child Visit
Topics included are: safety nutrition sleep play exercise development discipline What are some safety tips to give to parents?

5 Typical schedule for well-child visits
1 month 2 months 4 months 6 months 9 months 15 months 18 months 24 months Yearly thereafter It is important for parents to stay with this schedule because immunizations are given to the child.

6 Sick-child visit Sick-child visit: child exhibits signs and symptoms of disease Physician evaluates patient's condition to arrive at a diagnosis and prescribe treatment Procedures performed by MA during pediatric office visits: Vital signs Weight Visual acuity Assisting with physical examination Give some examples of acute illnesses a child may have. 6

7 Developing a Rapport Important to establish rapport with child
If trust and confidence gained: Child more likely to cooperate during examination Requires special techniques (based on age) Explain procedure to children who are able to understand Approach child at his/her level of understanding Know what to expect from a child at a particular age Realize that a child may regress when ill How can you communicate to the child? 7

8 Developing a Rapport, cont.
Toddlers: respond well to making a game of the procedure School-age children: explain purpose of an instrument

9 Carrying the Infant Lift and carry infant in a manner that is safe and comfortable 1. Cradle position Infant is cradled with his/her body resting against MA's chest Patient teaching may be required for the family. 9

10 Carrying the Infant, cont.
2. Upright position Infant is held upright while resting against the MA's chest Cradling the head provides safety to the head and neck.

11 Growth Measurements One of the best methods to evaluate progress of child Measured at each office visit and plotted on growth chart: Weight Height (length) Head circumference (up to 3 years) The head circumference may be measured longer if disease is present. 11

12 Measuring Weight Use: Infants: measured in supine position
Determine nutritional needs Calculate proper med dosage Infants: measured in supine position Older children: measured in standing position What is the recumbent position? 12

13 Length Length and Height Length
Measured in children younger than 24 months Measured from vertex of head to heel in supine position Two people are needed to accurately determine length What is the vertex of the head? Why are two people needed to determine length? 13

14 Height b. Height (stature)
Older children: measured in standing position The extremities grow at a faster rate than the trunk.

15 Head Circumference (HC)
Infancy: period of rapid brain growth Important to measure HC in children under age 3 Plot on a growth chart Newborn HC range: 32 to 38 centimeters (12.5” to 15”) 4-inch (10-cm) increase in HC occurs in first year of life Important screening measure for: Macroencephaly Microencephaly How would you plot the head circumference? 15

16 Chest Circumference (CC)
At birth: HC is approximately 2 cm larger than CC Chest grows at faster rate than cranium Between 6 months and 2 years: measurements are about the same After age 2: CC is greater than HC CC not typically measured on routine basis Only when heart or lung abnormality is suspected The circumference is taken at the nipple line.

17 Growth Charts Should be part of child's record
Developed to determine if child's growth is normal Identifies children with growth or nutritional abnormalities MA responsible for plotting child's measurements on growth chart What is NCHS? 17

18 Purpose of Growth Charts
Compares child's weight and length (or height) with other children of same age Example: 18-month-old boy: Weight: 25th percentile; Height: 80th percentile Interpretation 75% of 18-month-old boys weigh more; 25% weigh less 20% of 18-month-old boys are taller; 80% are shorter Look at child's growth pattern (primary use) Physician investigates significant changes in growth pattern: Rapid rise or rapid drop 18

19 Growth Chart

20 Pediatric Blood Pressure Measurement
American Academy of Pediatrics recommends: Children 3 years of age and older: measure blood pressure (BP) annually Purpose Identify children at risk for developing hypertension as adults Identify children with kidney disease or heart disease Once treated: BP usually returns to normal Overweight children: usually have higher BP than those of normal weight To reduce BP: Weight loss through a prescribed diet and physical activity The patient should be relaxed and not anxious during the taking of a BP. 20

21 Blood Pressure Cuff Size
Cuff too small: BP may be falsely high Cuff too large: BP may be falsely low 3. Cuffs come in a variety of sizes Measured in centimeters Size of cuff: refers to inner inflatable bladder (not cloth cover) Name of cuff (child, adult) Does not necessarily imply that it's appropriate for that age 21

22 Determining Proper Cuff Size
Assess child's arm circumference: midpoint between shoulder and elbow Bladder of cuff should encircle 80% to 100% of arm 22

23 Pediatric Blood Pressure Measurement, cont.
Make sure child is relaxed Apprehension can cause BP to be falsely high To reduce anxiety: Explain procedure Allow child to handle equipment (if appropriate) Measure BP after child has been sitting quietly for 3 to 5 minutes What are some ways the MA could calm the child?

24 Blood Pressure Classifications
Pediatric BP varies depending on: Age Height Gender The stethoscope should not touch the cuff. 24

25 Blood Pressure Classifications, cont.
BP varies throughout the day due to normal fluctuations in: Physical activity Emotional stress If child's BP elevated: Two or more readings must be taken at different visits before diagnosis of hypertension can be made How long should you wait before taking a BP if the patient has been exercising? 25

26 Collection of a Urine Specimen
Purpose May be required as part of physical examination To perform a urinalysis to screen for disease Assist in diagnosis of pathologic condition Evaluate effectiveness of therapy Pediatric urine collector Used for infants or young children who cannot urinate voluntarily Consists of plastic disposable bag with adhesive around the opening What conditions may warrant a necessity for a urine specimen? 26

27 Pediatric Urine Collector
On a male, the penis and scrotum should be placed through the opening of the collection bag.

28 Pediatric Injections Experience child has with early injections influences his or her attitude toward later ones Explain procedure to children old enough Be honest and attempt to gain trust and cooperation Tell child it will hurt, but only for a short time Explain that the med will help child get better Another person should be present to: Help position child or divert or restrain child, if needed If child struggles/fights excessively: Delay injection and consult physician Parents may also need support during this procedure. 28

29 Types of Needles Intramuscular injection Subcutaneous injection
Gauge and length of needle based on: Consistency of med (Thick, oily medications = larger lumen) Size of child (Needle must reach muscle tissue) Length of needle range: ⅝ to 1 inch Gauge range: 22 to 25 Depends on viscosity of mediation Subcutaneous injection Length of needle range: ⅜ to ½ inch Gauge range: 23 to 25 Check the package insert of the immunization for injection site. 29

30 Intramuscular Injection Sites
Site varies based on age of child Injection site: indicated in package insert accompanying med Dorsogluteal site Until child is walking, gluteus muscle is: Small and not well-developed Covered with a thick layer of fat Injection may come close to sciatic nerve Danger increased: if child squirming or fighting Do not use gluteal site until child has been walking for at least 1 year This site is used frequently in adults. 30

31 Courtesy Wyeth Laboratories, Philadelphia, Penn
Dorsogluteal Site Courtesy Wyeth Laboratories, Philadelphia, Penn

32 Vastus Lateralis Site Vastus lateralis
Recommended for infants and young children Located on anterior surface of midlateral thigh Away from major nerves and blood vessels Muscle is large enough to accommodate the med The child should be restrained during injections. 32

33 Vastus Lateralis Site, cont.
Length of needle: depends on size of thigh 1 inch used most often To administer injection: Infant is placed on back Thigh is grasped in order to: Compress the muscle tissue Stabilize the extremity Injection is administered into the compressed tissue Most immunizations are given in this site. 33

34 Deltoid Site Deltoid muscle is shallow: To administer injection:
Can accommodate only very small amount of med To administer injection: Muscle is grasped between thumb and fingers Needle inserted pointing slightly upward toward shoulder The deltoid site is not used until a child is older and the deltoid muscle is better formed. 34

35 Immunizations Immunity: resistance of the body to effects of harmful agents such as pathogenic microorganisms and their toxins Active, artificial immunization: process of becoming immune through use of a vaccine or toxoid Vaccine: A suspension of attenuated (weakened) or killed microorganisms administered to an individual Toxoid: A toxin (poisonous substance produced by a bacterium) that has been treated by heat or chemicals to destroy its harmful properties Give an example of a vaccine. 35

36 Purpose of Childhood Immunizations
Build body's defenses Protect from certain infectious diseases Administered to infants and young children during well-child visits American Academy of Pediatrics: Publishes a recommended childhood immunization schedule annually ( How would you explain to a parent the importance of immunizations? 36

37 Immunization Schedule
From Department of Health and Human Services, Centers for Disease Control and Prevention, United States, 2007

38 Immunizations Be familiar with each immunization including: Use
Common side effects Route of administration Dose Method of storage What are some common side effects of immunizations? 38

39 Immunizations, cont. Package insert comes with each immunization: contains info about drug Physician’s Desk Reference (PDR) can also be used to locate information The MA should always refer to the PI (package insert) before administering an immunization. 39

40 Immunizations, cont. Immunizations administered to infants and children: Hep B: Hepatitis B vaccine (IM) DTaP: Diphtheria and tetanus toxoids and acellular pertussis vaccine (IM) Hib: Haemophilus influenzae type b (IM) IPV: Inactivated polio vaccine (IM or SC) MMR: Measles, mumps, and rubella vaccine (SC) Varicella: Chickenpox vaccine (SC) PCV: Pneumococcal conjugate vaccine (IM) The polio vaccine was once given orally. Another name for pertussis is whooping cough. 40

41 Immunizations, cont. Immunization record card provided to parents
Instruct parent to bring to well-child visits Child's immunizations can be recorded Instruct parents in: Normal side effects of immunizations What to do if side effects occur What should the MA do if the parent loses the immunization card? 41

42 National Childhood Vaccine Injury Act (NCVIA)
Requires parents be provided with: Information about benefits and risks of childhood immunization CDC developed vaccine information statements (VIS) Explains benefits and risks of immunizations in lay terms 3. Before a child receives an immunization: Appropriate VIS must be given to child's parent or guardian Parent must be given enough time to read VIS What does CDC stand for? These forms can be printed from the internet. 42

43 Vaccine Information Statement
Courtesy Centers for Disease Control and Prevention, Atlanta, GA

44 National Childhood Vaccine Injury Act (NCVIA), cont.
Information that must be charted in patient's medical record (required by NCVIA) Name and publication date of each VIS given to parent Date the VIS provided to parent Date of administration of vaccine Manufacturer and lot number of vaccine Signature/title of health care provider who administered vaccine Address of medical office where vaccine was administered Where do you locate the name and publication date on the VIS form? 44


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