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.
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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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Physical Growth Weight Height Head circumference Average weight gain Rapid growth periods
Infancy Adolescence
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Anatomy and Physiology Vital signs
Temperature regulation Variations by age
Skin and hair Lanugo Vernix caseosa
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Anatomy and Physiology Head
Closure of fontanels Eyes, ears, nose, mouth
Production of tears Variations in eustachian tube Development of sinuses Eruption of teeth
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Anatomy and Physiology Breasts
Breast tissue develops between 8 and 13 years of age
Thorax and lungs Infant
Chest development Nose breathing Abdominal breathing
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Anatomy and Physiology Heart and peripheral vasculature
Placement Cardiac output
Abdomen Musculoskeletal system
Bone growth ends at 20 years of age
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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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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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Past Health History Birth history
Prenatal Labor and delivery Postnatal
Medical history Hospitalizations Emergency department visits Chronic disease
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Past Health History Injuries/accidents Childhood illnesses
Document exposure to measles, mumps, rubella, pertussis, and chickenpox
Immunizations
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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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Developmental Assessment Denver II
Personal-social Fine motor-adaptive Language Gross motor
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Physical Assessment Equipment
Appropriate child-size equipment Developmental assessment tools Otoscope
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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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Assessment Vital signs
Temperature Blood pressure Heart rate Respiratory rate
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Assessment Physical growth
Height or length Weight Head circumference Growth charts Chest circumference Apgar score
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Assessment Skin
Inspect color, lesions Palpate texture
Hair Head
Inspect for symmetry, shape, head control
Palpate fontanels, suture lines, surface characteristics
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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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Eye Assessment Inspect
Eyelids Lacrimal apparatus Sclera Iris Pupils Red reflex Retina Optic disc
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Assessment Ears
Auditory testing External ear Internal ear
Mouth and throat Inspect lips, buccal mucosa, teeth, hard
palate, soft palate, oropharynx
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Assessment Neck
Palpate thyroid and lymph nodes Breasts
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Assessment Thorax and lungs
Inspect shape of thorax, presence of retractions
Palpate for tactile fremitus Percuss diaphragmatic excursion Auscultate breath sounds
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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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Assessment Abdomen
Calm child before proceeding Inspect
Contour Peristaltic wave
Auscultate Bowel sounds
Palpate
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Assessment General approach
Use of games to facilitate evaluation Inspection
Muscles, joints, tibiofemoral bones Palpation
Joints, feet, hip, femur
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Neurological Assessment General approach
Infant Toddler
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Neurological Assessment Reflex mechanisms of the infant
Rooting Sucking Palmar grasp Tonic neck Stepping Plantar grasp Babinski Moro
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Neurological Assessment Cranial nerve testing
Infant Toddler School age Adolescent
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Genitalia Assessment Tanner sexual maturity rating Female
Age-specific guidelines Inspect perineal area
Male Age-specific guidelines Inspect penis, scrotum Palpate scrotum