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Copyright 2002, Delmar, A division of Thomson Learning Chapter 24 Pediatric Patient
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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)
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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.
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Copyright 2002, Delmar, A division of Thomson Learning Physical Growth Weight Height Head circumference Average weight gain Rapid growth periods Infancy Adolescence
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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)
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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)
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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)
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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)
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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
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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
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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)
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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)
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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
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Copyright 2002, Delmar, A division of Thomson Learning Developmental Assessment Denver II Personal-social Fine motor-adaptive Language Gross motor
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Copyright 2002, Delmar, A division of Thomson Learning Physical Assessment Equipment Appropriate child-size equipment Developmental assessment tools Otoscope (continues)
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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
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Copyright 2002, Delmar, A division of Thomson Learning Assessment Vital signs Temperature Blood pressure Heart rate Respiratory rate (continues)
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Copyright 2002, Delmar, A division of Thomson Learning Assessment Physical growth Height or length Weight Head circumference Growth charts Chest circumference Apgar score (continues)
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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)
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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
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Copyright 2002, Delmar, A division of Thomson Learning Eye Assessment Inspect Eyelids Lacrimal apparatus Sclera Iris Pupils Red reflex Retina Optic disc
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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)
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Copyright 2002, Delmar, A division of Thomson Learning Assessment Neck Palpate thyroid and lymph nodes Breasts (continues)
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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)
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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)
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Copyright 2002, Delmar, A division of Thomson Learning Assessment Abdomen Calm child before proceeding Inspect Contour Peristaltic wave Auscultate Bowel sounds Palpate (continues)
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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
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Copyright 2002, Delmar, A division of Thomson Learning Neurological Assessment General approach Infant Toddler (continues)
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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)
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Copyright 2002, Delmar, A division of Thomson Learning Neurological Assessment Cranial nerve testing Infant Toddler School age Adolescent
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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
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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
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