Exam 1 Blueprint
Chapter 4- Communication, Physical, and Developmental Assessment
1. Perform a complete age-specific head-to-toe assessment
FIRST SUPINE POSITION: to examine heart, lungs, abdomen, & hips
NEXT PRONE POSITION: to examine spine, back, and sacrum
Auscultate, percuss, and palpate while quiet
Minimal physical contact first to establish that you’re not scary. Distract with play
In older children/adolescents: assess genitalia last
2. Identify how to obtain physiologic measures in the pediatric patient
VITALS: go from least to most invasive. In this order:
1) Count respiration
2) Count apical heart rate
Less than 2 yrs? Measure apical for FULL MINUTE
Compare redial and femoral pulses (coarctation of aorta)
Increasing age = decreasing heart rate
3) Blood pressure
Use correct cuff size
4) Temperature
Oral, axillary, tympanic, temporal.
Method based on facility, age, development, & illness severity
3. Review atraumatic care and how we incorporate that in a physical assessment
Atraumatic = going from least to most invasive.
Useful when palpating abdomen region
Minimizes physical and psychological stress that health promotion & illness can inflict
4. Identify birthmarks (e.g., café au lait, Mongolian spot)
Mongolian spot: bluish- bruise like spot on the back
Café au lait: note size and number. 5+ could mean neurofibromatosis
5. Review apical heart rate, location, and duration of assessment in pediatric patients and why
Apical heart rate = apex of heart (5th midclavicular space)
Duration of assessment: 1 whole minute if less than 2 yrs.
Why? In case you cant get radial pulse, and to assess heart sounds
Chapter 5- Pain Assessment and Management in Children
, 1. Identify influencing factors on pain assessment
Age
Developmental level (cognitive ability)
Cause and nature of pain
Ability to express pain
Cultural consideration
2. Understand how to appropriately assess pain in children based on age and cognitive
development.
Behavioral Pain Assessment tools:
CRIES (neonates): looks at physiological changes (O2, HR. BP) and listens to
the baby’s cry to understand if the baby is in pain. Helps to ask mother
about child’s cry and whether its normal because she know baby’s cry the
best.
FLACC (2mo-7yrs): face, legs, activity, cry, consolability
COMFORT: for children in critical care setting
CHEOPS: used in recovery room
For children w/ communication & cognitive impairment:
NCCPC: non-communicating children’s pain checklist (for cognitively
impaired)
PICIC: pain indicator for communicatively impaired children
Self-Report:
Numeric pain scale (8 yrs+): 0-10 scale
FACES (4-16 yrs): peds exam
3. Identify how and when to evaluate pain relief
HOW? Use OLDCARTS! (onset, location, duration, characteristics, aggravating &
relieving factors, timing, severity). Assess of treatment is effective
WHEN? 15-30 minutes after intervention
Chapter 22- Family Centered Care of the Child During Illness and Hospitalization
, 1. Understand the effects of hospitalization on the child and the family
ON INFANT/CHILD: goes through separation anxiety consisting of the following
stages:
Stage of protest: crying and screaming for parent
State of despair: depression, crying stops, withdrawals, less active
Detachment/denial: NOT COPING MECHANISM, but child accepts that parents are
gone & gets used to new environment
ADOLESCENTS
Loneliness & isolation
Fear of treatment, losing self-determination, and choices
Anger, sad, stress, regression
Special needs: more emotional consequences possible
FAMILIES
Parents feel loss of control and helplessness
Fam-centered care must also include siblings too
Siblings may feel hospitalization is their fault (siblings need support too and
parents may forget that)
Jealousy & anger may result
Chapter 10- Health Promotion of the Infant and Family
1. Describe the major physical, growth, and developmental milestones expected in the first year
as discussed in class
Fine/motor skills?
Locomotion:
o Walk alone: 12-13 motnhs
o Run clumsily: 18 months
o Walk up and down stairs: 2 years
Fine motor development: improved dexterity, scribble, and throw ball by ages 12 – 18
months
2. Discuss appropriate toys to choose to foster development and when they would be
appropriate (TABLE 10.2, page 428). * = both age groups can use
Birth to 6 mo.
o Nursery mobiles
o Unbreakable mirrors
o Music boxes*
o Rattles*
o Squeaky animals and dolls*
o Stuffed animals*
Chapter 4- Communication, Physical, and Developmental Assessment
1. Perform a complete age-specific head-to-toe assessment
FIRST SUPINE POSITION: to examine heart, lungs, abdomen, & hips
NEXT PRONE POSITION: to examine spine, back, and sacrum
Auscultate, percuss, and palpate while quiet
Minimal physical contact first to establish that you’re not scary. Distract with play
In older children/adolescents: assess genitalia last
2. Identify how to obtain physiologic measures in the pediatric patient
VITALS: go from least to most invasive. In this order:
1) Count respiration
2) Count apical heart rate
Less than 2 yrs? Measure apical for FULL MINUTE
Compare redial and femoral pulses (coarctation of aorta)
Increasing age = decreasing heart rate
3) Blood pressure
Use correct cuff size
4) Temperature
Oral, axillary, tympanic, temporal.
Method based on facility, age, development, & illness severity
3. Review atraumatic care and how we incorporate that in a physical assessment
Atraumatic = going from least to most invasive.
Useful when palpating abdomen region
Minimizes physical and psychological stress that health promotion & illness can inflict
4. Identify birthmarks (e.g., café au lait, Mongolian spot)
Mongolian spot: bluish- bruise like spot on the back
Café au lait: note size and number. 5+ could mean neurofibromatosis
5. Review apical heart rate, location, and duration of assessment in pediatric patients and why
Apical heart rate = apex of heart (5th midclavicular space)
Duration of assessment: 1 whole minute if less than 2 yrs.
Why? In case you cant get radial pulse, and to assess heart sounds
Chapter 5- Pain Assessment and Management in Children
, 1. Identify influencing factors on pain assessment
Age
Developmental level (cognitive ability)
Cause and nature of pain
Ability to express pain
Cultural consideration
2. Understand how to appropriately assess pain in children based on age and cognitive
development.
Behavioral Pain Assessment tools:
CRIES (neonates): looks at physiological changes (O2, HR. BP) and listens to
the baby’s cry to understand if the baby is in pain. Helps to ask mother
about child’s cry and whether its normal because she know baby’s cry the
best.
FLACC (2mo-7yrs): face, legs, activity, cry, consolability
COMFORT: for children in critical care setting
CHEOPS: used in recovery room
For children w/ communication & cognitive impairment:
NCCPC: non-communicating children’s pain checklist (for cognitively
impaired)
PICIC: pain indicator for communicatively impaired children
Self-Report:
Numeric pain scale (8 yrs+): 0-10 scale
FACES (4-16 yrs): peds exam
3. Identify how and when to evaluate pain relief
HOW? Use OLDCARTS! (onset, location, duration, characteristics, aggravating &
relieving factors, timing, severity). Assess of treatment is effective
WHEN? 15-30 minutes after intervention
Chapter 22- Family Centered Care of the Child During Illness and Hospitalization
, 1. Understand the effects of hospitalization on the child and the family
ON INFANT/CHILD: goes through separation anxiety consisting of the following
stages:
Stage of protest: crying and screaming for parent
State of despair: depression, crying stops, withdrawals, less active
Detachment/denial: NOT COPING MECHANISM, but child accepts that parents are
gone & gets used to new environment
ADOLESCENTS
Loneliness & isolation
Fear of treatment, losing self-determination, and choices
Anger, sad, stress, regression
Special needs: more emotional consequences possible
FAMILIES
Parents feel loss of control and helplessness
Fam-centered care must also include siblings too
Siblings may feel hospitalization is their fault (siblings need support too and
parents may forget that)
Jealousy & anger may result
Chapter 10- Health Promotion of the Infant and Family
1. Describe the major physical, growth, and developmental milestones expected in the first year
as discussed in class
Fine/motor skills?
Locomotion:
o Walk alone: 12-13 motnhs
o Run clumsily: 18 months
o Walk up and down stairs: 2 years
Fine motor development: improved dexterity, scribble, and throw ball by ages 12 – 18
months
2. Discuss appropriate toys to choose to foster development and when they would be
appropriate (TABLE 10.2, page 428). * = both age groups can use
Birth to 6 mo.
o Nursery mobiles
o Unbreakable mirrors
o Music boxes*
o Rattles*
o Squeaky animals and dolls*
o Stuffed animals*
