1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 34 Child Health Assessment

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Health Assessment Assessment Nursing diagnosis Outcome identification, planning Implementation Outcome evaluation

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health History: Database Interview setting Types of questions –Closed-ended –Open-ended –Compound –Expansive –Leading

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health History: Database (cont’d) Health interview –Introduction, explanation –Demographic data –Chief concern –History of chief concern –Health, family profile

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health History: Database (cont’d) Health interview –Day history Play Sleep Hygiene Nutrition

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health History: Database (cont’d) Past health history Family health history Review of systems

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Physical Assessment Purpose, techniques Equipment, setting, approach Variations –Newborn –Infant –Toddler, preschooler –School age, adolescent

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination Vital signs General appearance Mental status

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Body measurements –Weight –Height –Head circumference –Chest, abdominal circumference –Skin

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Head –Newborn, infant –Toddler, preschooler, school age –Adolescent

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Eyes –Conjunctivitis –Hordeolum –Ptosis –Strabismus –Esotropia –Exotropia

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d)

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Eyes –Newborn, infant –Toddler, preschooler –School age, adolescent

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Nose –Newborn, infant –Older children Ears –Newborn, infant –Older children

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d)

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Mouth –Newborn, infant –Older children Neck –Newborn, infant –Adolescent

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Chest Breasts –Newborn –School age, adolescent Lungs –Newborn, infant

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d)

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Heart –PMI –Heart sounds –Rhythm –Newborn, infant, toddler –School age, adolescent

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d)

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Abdomen –Newborn, infant –Preschooler, school age Genitorectal area –Female –Male –Inguinal hernia

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Extremities Back Neurologic function –Motor, sensory

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) See Figure 34.21.

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Vision Assessment Vision screening Techniques –Snellen chart –Preschool E chart –National Association for the Prevention of Blindness Home Test –Allen cards

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Vision Assessment (cont’d) Techniques –Stycar cards –Titmus Vision tester –Color vision discrimination testing Vision referrals

26. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hearing Assessment Auditory screening –Newborn, infant –Older children Principles of audiometric assessment –Frequency –loudness

27. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hearing Assessment (cont’d) Hearing loss Acoustic impedance testing Conduction loss testing

28. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Speech Assessment Denver Articulation screening –Administration –Scoring

29. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Developmental Appraisal Developmental history Denver II Developmental screening –Administration –Scoring –Prescreening test

30. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Intelligence Goodenough-Harris Drawing test

31. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Temperament Child’s innate behavioral characteristics –Activity level –Rhythmicity –Tendency to approach or withdraw –Adaptability

32. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immunizations Types Available vaccines –Diphtheria, tetanus, pertussis (DTaP) –Polio –Measles, mumps, rubella (MMR) –Hepatitis

33. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immunizations (cont’d) Available vaccines –H. influenzae Type B –Varicella –Pneumococcal pneumonia –Human Papillomavirus –Meningococeal Vaccine

34. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immunizations (cont’d) Available vaccines –Lyme disease –Influenza –Anthrax, smallpox

35. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immunizations (cont’d) Administration Parental education

36. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which physical finding would best suggest that an infant is dehydrated? A.A depressed fontanelle B.A caput succedaneum C.Curved fingerbeds D.A listless appearance

37. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. A depressed fontanelle Rationale: With dehydration, the fontanelles of infants often appear sunken.

38. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question School-aged children run a high incidence of pediculosis. Of the following, which best suggests pediculosis? A.Dry, brittle hair B.Small white particles on the hair strands C.Patches of hair loss D.Weeping circular areas on the scalp

39. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Small white particles on the hair strands Rationale: The eggs of lice are revealed as small white particles on hair strands.

40. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question When assessing a child’s heart, which finding would be considered abnormal? A.Physiologic splitting with inspiration B.Presence of a fourth heart sound C.An observable PMI D.Dullness with percussion

41. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Presence of a fourth heart sound Rationale: Many children demonstrate physiologic splitting and an observable point of maximum impulse. A fourth heart sound suggests pathology.