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

Copyright 2002, Delmar, A division of Thomson Learning 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)

Copyright 2002, Delmar, A division of Thomson Learning 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.

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

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

Copyright 2002, Delmar, A division of Thomson Learning 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)

Copyright 2002, Delmar, A division of Thomson Learning 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)

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

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

Copyright 2002, Delmar, A division of Thomson Learning 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

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

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

Copyright 2002, Delmar, A division of Thomson Learning 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

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

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

Copyright 2002, Delmar, A division of Thomson Learning 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

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

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

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

Copyright 2002, Delmar, A division of Thomson Learning 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

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 Ears  Auditory testing  External ear  Internal ear Mouth and throat  Inspect lips, buccal mucosa, teeth, hard palate, soft palate, oropharynx (continues)

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

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

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

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

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

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

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

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

Copyright 2002, Delmar, A division of Thomson Learning 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