PEDIATRIC ASSESSMENT - PowerPoint PPT Presentation

View by Category
About This Presentation
Title:

PEDIATRIC ASSESSMENT

Description:

PEDIATRIC ASSESSMENT * * * * * * * * * * * * * * * * ADOLESCENT Privacy issues first consideration HEADS: home life, education, alcohol, drugs, sexual activity ... – PowerPoint PPT presentation

Number of Views:1594
Avg rating:3.0/5.0
Slides: 73
Provided by: 56861433
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: PEDIATRIC ASSESSMENT


1
  • PEDIATRIC ASSESSMENT

2
Essential Pediatric Nursing Skills
  • Knowledge of Growth and Development
  • Development of a Therapeutic Relationship
  • Communication with children and their parents
  • Understanding of family dynamics and parent-child
    relationships IDENTIFY KEY FAMILY MEMBERS
  • Knowledge of Health Promotion Disease
    Prevention
  • Patient Education and Anticipatory Guidance
  • Practice of Therapeutic and Atraumatic Care
  • Patient and Family Advocacy
  • Caring, Supportive Culturally Sensitive
    Interactions
  • Coordination and Collaboration
  • CRITICAL THINKING

3
Introduction
  • Key elements.
  • Times
  • Every month in the 1st year.
  • Every 3 month of the 2nd and 3rd year.
  • Each 6 month of 4th and 5th year.
  • Yearly after the 6th year.

4
Physical Exam
  • Avoid touching painful areas until confidence has
    been gained.
  • Begin exam without instruments.
  • Allow child to determine order of exam if
    practical.
  • Use the same format as adult physical exam.

5
Infant Exam
  • Examine on parent lap.
  • Leave diaper on.
  • Comfort measures such as pacifier or bottle.
  • Talk softly.
  • Start with heart and lung sounds.
  • Ear and throat exam last.

6
Toddler Exam
  • Examine on parent lap if uncooperative.
  • Use play therapy.
  • Distract with stories.
  • Let toddler play with equipment / BP.
  • Call by name.
  • Praise frequently.
  • Quickly do exam.

7
History
Personal Hx., Life styles, Health Hx. (past
and current), and Family Hx.
  • Bio-graphic Demographic
  • Name, Date of Birth, Age
  • Parents siblings info
  • Cultural practices
  • Religious practices
  • Parents occupations
  • Adolescent work info
  • Past Medical History
  • Allergies
  • Past illness
  • Trauma / hospitalizations
  • Surgeries
  • Birth history
  • Developmental
  • Family Medical/Genetics
  • Current Health Status
  • Immunization Status
  • Chronic illnesses or conditions
  • What concerns do you have today?

8
Equipment Whats in Your setting?
  • Stethoscope Sphygmomanometer
  • Pen Light
  • Otoscope / Opthalmoscope
  • Scale

9
Review of Systems
  • Ask questions about each system
  • Measurements weight, height, head circumference,
    growth chart, BMI
  • Nutrition breastfed, formula, favorite foods,
    beverages, eating habits
  • Growth and Development Milestones for each age
    group

10
Physical Exam Technique
  • Inspection- eye only.
  • Palpation- tip of finger.
  • Percussion- use. . .
  • Dullness (solid organ), resonance (over solid
    organ or filled air), tympanic (hollow organ).
  • Auscultation- stethoscope.

11
History Review of Systems
  • Skin
  • HEENT
  • Neck
  • Chest Lungs / Respiratory
  • Heart Cardiovascular
  • GI
  • GU GYN
  • Musculoskeletal Extremities
  • Neuro
  • Endocrine

12
  • Sleep Activity
  • Appetite
  • Bowel Bladder
  • In a time crunch, these three questions should
    give you enough insight into the childs general
    functioning
  • Can get more detailed if any () responses

13
Physical Assessment
  • The approach is
  • Orderly
  • Systematic
  • Head-to-toe
  • But FLEXIBILIY is essential
  • And be kind and gentle
  • but firm, direct and honest

14
Physical Assessment
General Appearance Behavior
  • Facial expression
  • Posture / movement
  • Hygiene
  • Behavior
  • Developmental Status

15
Vital Signs
  • Temperature rectal only when absolutely
    necessary
  • Pulse apical on all children under 1 year
  • Respirations infant use abdominal muscles
  • Blood pressure admission base line
  • And the Fifth Vital Sign is ____ ?

16
Pediatric Vital Signs Normal Ranges
Infant Toddler School-Age
Adolescent
  • Heart Rate
  • 80-150 70-110 60-110 60-100
  • Respiratory Rate
  • 24-38 22-30 14-22 12-22
  • Systolic blood pressure
  • 65-100 90-105 90-120 110-125
  • Diastolic blood pressure
  • 45 - 65 55-70 60-75 65-85

17
Physical Assessment
  • General
  • Skin, hair, nails
  • Head, neck, lymph nodes
  • Eyes, ears, nose, throat
  • Chest, Tanner Scale
  • Heart
  • Abdomen
  • Genitalia, Tanner Scale,
  • Rectal
  • Musculoskeletal feet, legs, back, gait

18
Palpation
  • Use of your fingers and palms to determine
  • Temperature
  • Hydration
  • Texture
  • Shape
  • Movement
  • Areas of Tenderness
  • Warm hands and short nails
  • Palpate areas of tenderness / pain last
  • Talk with the child during palpation to help
    him relax
  • Be observant of reactions to palpation
  • Move firmly without hesitation

19
H E E N T
  • Head
  • Eyes
  • Ears
  • Nose
  • Neck
  • Throat

20
HEENT Head Neck, Eyes, Ears, Nose, Face, Mouth
Throat
  • Head Symmetry of skull and face
  • Neck Structure, movement, trachea, thyroid,
    vessels and lymph nodes
  • Eyes Vision, placement, external and internal
    fundoscopic exam
  • Ears Hearing, external, ear canal and otoscopic
    exam of tympanic membrane
  • Nose Structure, exudate, sinuses
  • Mouth Structures of mouth, teeth and pharynx

21
Head
  • Shape
  • NormoCephalic ATraumatic
  • Lesions
  • ? Edema

22
Head Key Points
  • Head Circumference (HC
  • Fontannels/sutures Anterior closes at 10-18
    months, posterior by 2 months
  • Symmetry shape Face skull
  • Bruits Temporal bruits may be significant after
    5 yrs
  • Hair Patterns, loss, hygiene, pediculosis in
    school aged child
  • Sinuses Palpate for tenderness in older children
  • Facial expression Sadness, signs of abuse,
    allergy, fatigue
  • Abnormal facies Diagnostic facies of common
    syndromes or illnesses

23
(No Transcript)
24
(No Transcript)
25
Neuro Assessment
  • LOC / Glasgow coma scale
  • Pupil size
  • Vital Signs
  • Pain
  • Seizure Activity
  • Focal Deficits

26
Bacterial Meningitis
  • Clinical Manifestations in an Older Child
  • High fever
  • Headache
  • LOC Changes / GCS
  • Nuchal rigidity / stiff neck
  • Kernigs inability to extend legs
  • Brudzinski sign flexion of hips when neck is
    flexed
  • Purple rash (check for blanching)
  • Looks Sick

27
Eyes
  • PERRR
  • Red Reflex
  • Corneal Light Reflex
  • Strabismus
  • Alignment of eye important due to correlation
    with brain development
  • May need to corrected surgically
  • Preschoolers should have vision screening
  • Refer to ophthalmologist is there are concerns

o
28
Eyes Key Points
  • Vision Red reflex blink in neonate
  • Examine external structure of the
  • 1- Conjunctiva- glassy
  • 2- Sclera- clear
  • 3- Cornea- cover the iris and pupil
  • 4- pupils- compare for size, shape, test for
    reaction.
  • 5- Iris- color, size and clarity. 6-12 M.
  • Snellen chart for older children
  • Irritations infections
  • PERRL
  • Amblyopia (lazy eye) Corneal light reflex,
    binocular vision, cover-uncover test

29
Ears Key Points
  • Ask about hearing concerns
  • Inquire about infants response to
  • Observe an older infants/toddlers speech pattern
  • Inspect the ears
  • Assess the shape of the ears
  • Determine if both ears are well formed
  • Assess
  • External shape and size.
  • Pinna line, low set ear (retardation).
  • Internal structure.

30
Ear Exam
Pinna is pulled down and back to straighten ear
canal in children under 3 years.
31
Common Ear Infections
  • Otitis Media
  • Most common reason children come to the
    pediatrician or emergency room
  • Fever or tugging at ear
  • Often increases at night when they are sleeping
  • History of cold or congestion
  • Infection can lead to rupture of ear drum.
  • Chronic effusion can lead to hearing loss.
  • OM is often a contributing factor in more serious
    infections mastoiditis, cellulitis, meningitis,
    bacteremia.
  • Chronic ear effusion in the early years may lead
    to decreased hearing and speech problems.

32
Nose Throat / Mouth
  • Exudate
  • Pharynx
  • Tonsils
  • Signs Symptoms of Allerg
  • Assess for symmetry, deformity, skin lesion.
  • Palpate for septal deviation.
  • Smooth and moist, with pinkish color.
  • ic Rhinitis
  • Palate
  • Gums
  • Swallow
  • Oral Hygiene
  • Condition of teeth
  • Missing teeth
  • Orthodontic Appliances

33
Nose Key Points
  • Exam nose mouth after ears
  • Observe shape structural deviations
  • Nares (check patency, mucous membranes,
    discharge, turbinates, bleeding)
  • Septum (check for deviation)
  • Infants are obligate nose breathers
  • Nasal flaring is associated with respiratory
    distress

34
Nose and Throat
  • Sinusitis
  • Fever
  • Purulent rhinorrhea
  • Facial Pain cheeks, forehead
  • Breath odor
  • Chronic cough could be day and night
  • () Post-nasal drip

35
Mouth Pharynx Key Points
  • Lips color, symmetry, moisture, swelling, sores,
    fissures
  • Buccal mucosa, gingivae, tongue palate for
    moisture, color, intactness, bleeding, lesions.
  • Tongue frenulum - movement, size texture
  • Teeth - caries, malocclusion and loose teeth.
  • Uvula symmetrical movement or bifid uvula
  • Voice quality, Speech
  • Breath - halitosis

36
Ears, Nose and Throat
  • Sore Throats
  • Is it strept or is it viral or could
    it be mono?
  • Lymph nodes
  • ROM

37
Neck Key Points
  • v position, lymph nodes, masses, fistulas, clefts
  • Range of Motion (ROM)
  • Check clavicle in newborn
  • Head control in infant
  • Trachea thyroid in midline
  • Carotid arteries (bruits)
  • Meningeal irritation

38
Chest Assessment
  • How does the child look?
  • Color
  • Work of Breathing Effort used to breathe

Auscultation
  • All 4 quadrants
  • Front and back
  • Take the time to listen
  • Be sure about lungs CTAB
  • (clear to auscultation bilaterally)

39
Chest
  • Anatomy.
  • Inspection symmetry, movement of chest wall.
  • Breathing pattern- abdominal breathing.
  • Palpation
  • 1- light palpation in light circular motion to
    detect lesion and masses
  • 2- deep palpation palpate for internal organ
    like liver and spleen.

40
Lungs Respiratory Key Points
  • Clubbing
  • Snoring (expiratory) upper airway obstruction,
    allergy,
  • Dullness to percussion fluid or mass

Increased or Decreased Respirations Stridor Wheezi
ng
41
(No Transcript)
42
Chest Assessment
  • Auscultation
  • Wheezing
  • Retractions
  • Subcostal
  • Intercostal
  • Sub-sternal
  • Supra-clavicular
  • Red Flags
  • grunting
  • nasal flaring
  • stridor

43
All that Wheezes isnt always Asthma
  • Think
  • Infection
  • Foreign body aspiration
  • Anaphylaxis
  • Insect bites/stings, medications, food allergies

44
And all Asthma doesnt always Wheeze!
  • Cough
  • Fatigue
  • Reduced exercise tolerance

45
Cough - Characteristics
  • Dry, non-productive
  • Mucousy productive
  • Croupy
  • Acute less than 2-3 weeks
  • Chronic more than 2-3 weeks
  • Associating Symptoms

46
Auscultating Heart Sounds
Circulatory
The Auscultation Assistant Hear Heart Murmurs,
Heart Sounds, and Breath Sounds.
http//www.wilkes.med.ucla.edu/inex.htm
Pillitter
  • Perfusion capillary refill
  • Warm to touch

47
Abdominal Assessment
Gastro-Intestinal
Pillitteri
48
Abdomen
  • Use supine position with pillow under the head
    and knee flexed.
  • Divide abd. to 4 Quadrant, and examine from
    button to top.
  • Examination of the abdomen involve the
    inspection, auscultation, palpation and
    percussion.

49
Abdomen Key Points
  • Contour
  • Bowel Sounds Peristalsis
  • Skin color, veins
  • Umbilicus
  • Assess for Tenderness, Ridigity, Tympany,
    Dullness
  • Hernias umbilical, inguinal, femoral
  • Masses - size, shape, dullness, position,
    mobility
  • Liver, Spleen, Kidneys, Bladder

50
(No Transcript)
51
(No Transcript)
52
Abdominal Girth
Abdominal girth should be measured over the
umbilicus Whenever possible.
53
Bowel Sounds
  • Normal every 10 to 30 seconds.
  • Listen in each quadrant long enough to hear at
    least one bowel sound.
  • Absent
  • Hypoactive peritonitis, paralytic illeus
  • Normoactive
  • Hyperactive, GE, Intestestinal obs.

54
Stomachaches and Abdominal Pain
  • Excessive gas
  • Chronic constipation
  • Lactose intolerance
  • Viral gastroenteritis
  • Irritable bowel syndrome
  • Heartburn or indigestion
  • GERD
  • Food allergy
  • Parasite infections (Giardia)

What are we most concerned about?
55
Stomachaches and Abdominal Pain
  • Appendicitis
  • Bowel obstruction -- Cholecystitis with or
    without gallstones
  • Food poisoning (salmonella,
    shigella)
  • Inflammatory Bowel Disease
  • Ulcerative colitis
  • Hernia
  • Intussusception
  • Kidney stones
  • Pancreatitis
  • Sickle cell crisis
  • Ulcers
  • Urinary tract infections

56
Signs and Symptoms
  • Appearance color, facial, ROM, gait, position
  • Pain get your pain scales out
  • Nausea
  • Vomiting
  • Diarrhea
  • Bloating
  • Vomiting
  • Inability to pass gas or stool

57
Musculo-Skeletal
  • FROM, MAE - neck, shoulder, elbow, wrist, hip,
    knee, ankle, foot, digits
  • Alignment, contour, strength, weakness symmetry
  • Limb, joint mobility stiffness, contractures
  • Gait observe child walking without shoes
  • Spinal alignment - Scoliosis
  • Muscle Strength Tone
  • Hips O B
  • Reflexes

58
  • Bone, joints-cartilages, ligaments and muscles.
  • Inspect the joint for flexion and extension,
    abduction, adduction, rotation.
  • Inspect the symmetry and observe the edema.

59
(No Transcript)
60
Scoliosis
Lateral curvature of spine
  • Key Points
  • Barefoot
  • Feet Together
  • Bend Over Diving Of a Diving Board
  • Check Hips

Medline.com
61
Assessment
  • The Five Ps
  • Pain
  • Paresthesia
  • Passive stretch
  • Pressure
  • Pulse-less-ness

62
Skin, Nails Hair
  • Rashes
  • Lesions
  • Lacerations
  • Lumps
  • Bumps
  • Bruises
  • Bites
  • Infections

63
Common Skin Lesions
  • Macule
  • Papule
  • Vesicle, bulla
  • Pustule
  • Cyst
  • Patch
  • Plaque
  • Wheal
  • Striae
  • Scale
  • Crust
  • Keloid
  • Fissure
  • Ulcer
  • Petechiae
  • Purpura
  • Ecchymosis
  • Capillary bleeding Petichiae and purpura
  • usually indicate serious conditions

64
Skin Infections
  • Bacterial infections
  • Abscess formation
  • Severity varies with skin integrity, immune and
    cellular defenses
  • Examples
  • impetigo
  • cellulitis

65
The School-Age Child
  • Privacy and modesty.
  • Explain procedures and equipment.
  • Interact with child during exam.

66
Adolescent
  • Privacy issues first consideration
  • HEADS home life, education, alcohol, drugs,
    sexual activity / suicide
  • GAPS Guidelines for Adolescent Preventive
    Services
  • Bright Futures

67
Psychosocial Assessment
  • HEADS
  • Home life
  • Emotions / Depression or Education
  • Activities
  • Drugs / Alcohol / Substance Abuse
  • Sexuality activity or Suicide
  • SHADESS
  • School
  • Home
  • Activities
  • Drugs / Substance Abuse
  • Emotions / Depression
  • Sexuality
  • Safety

68
Common School HealthFocused Assessments
  • The I dont feel good where do I begin?
  • Behavioral / Mental Health Concerns
  • Chronic Conditions Special Needs
  • What Else?

69
The I dont feel good
Where do I begin ?
70
The Frequent Fliers
  • Headaches
  • Stomachaches
  • Nosebleeds
  • Chest Pain
  • Coughs
  • Fevers

71
QUESTIONS
72
The Power of Nursing
  • Never doubt how vitally important you are
  • never doubt how important your work is
  • and never expect anyone to acknowledge it
  • before you do.
  • Every moment, in everything you do,
  • you are making a difference.
  • In fact, you are in the business of making a
    difference in other peoples lives.
  • In that difference lies their healing
    and your power.
  • Never forget it.
  • Leah L. Curtin, RN, MS, MA, DSC, FAAN
About PowerShow.com