Paediatric Exam 1 Assessment

newborn age range - birth to 1 month Infant age range - Birth - 12 months toddler age range: - 1-3 years preschool age range: - 3-5 years school age range: - 6-12 years Adolescent age range - 12-18 years Older infants prefer to be ..... - undressed (EXCEPT DIAPER) Do ... wake a sleeping baby - NOT when should you auscultate heart, lungs & abdomen on an infant? - when they're quiet Goal during first year of life: - Focus on expected growth and developmental milestones Observations alone may be your most valuable tool in assessment by finding: - ▪ General level activity ▪ Overall mood ▪ Parent-child interaction ▪ Turning to Sound: Hearing Check ▪ Smiling at toy: Vision Check ▪ Developmental areas: rolling, crawling, etc. You should perform ..... .... 1st in kids & temperature last - respiratory rate Infants' temperature is taken .... - rectally To take rectal temperature: - 1. Position the child appropriately 2. Lubricate the end of the probe 3. Hold legs firmly 4. Place probe ▪ ½ inch for newborns ▪ ¾ inch for infants ▪ 1 inch for preschoolers & older DO NOT DO RECTAL if: - Rectal bleeding, profuse bleeding, immunocompromised, neutropenic precautions, and specific order saying no. Oral temperature not accurate until about ... years of age. - 5 what to look for in respiratory exam of infant? - Listen to child's respiratory rate for 1 full minute (irregular breathing) o Look at child's chest o Feel the child's chest o Listen w/ stethoscope Infants HR drops significantly during .... - sleep toddler age range: - 1 years old - 2-3 years old tips for toddler assessment? - Make examination into a game ▪ Use age-appropriate language ▪ Inspect body through play "tickle toes" ▪ Use minimal physical contact initially ▪ Avoid lying (painful or traumatic procedures last) ▪ Separation Anxiety ▪ Hints: this age can be fun or challenging due to developmental stage of stage of these children focus area for toddler assessment: - o Verbal skills o Motor skills o Speech pattern & Clarity o Hearing ability o Visual Acuity o Emerging independence (behavior) normal new born respiratory rate: - 30-55 normal 1 year respiratory rate - 25-40 normal 3 year respiratory rate - 20-30 normal 6 year respiratory rate - 16-22 normal 10 year respiratory rate - 16-20 normal 17 year respiratory rate: - 12-20 An apical pulse should be taken: - ▪ All children younger than 2 years ▪ All children with a cardiac condition (especially if taking digoxin) Radial pulse once .. years of age & older - 2 normal heart rate for new born: - 100-170 normal heart rate for infant to 2 years: - 80-130 normal heart rate for 2-6 years old: - 70-120 normal heart rate for 6-10 years old: - 70-110 normal heart rate for 10-16 years old: - 60-100 average SBP or DBP that is ≥95th percentile for gender, age, and height on at least 3 separate occasions -screening now recommended at birth - hypertension -Age 13 years & older, use adult guidelines blood pressure measured routinely starting at age .... - 3 Infant normal BP parameters: - 65-80 systolic, 40-50 systolic In children 1 year and older, estimated BP norms: - Systolic: 80 + (2 x age in years) Diastolic: 2/3 of systolic How can BP be altered? - Too small cuff: High pressure Too big cuff: Low pressure why is weight so important in kids? - Growth in children is monitored very closely, especially in infants & toddlers ▪ All medication in children is dosed based on their weight ▪ Children can get dehydrated very quickly how to measure child weight? - use the same scale each time you weigh a patient ▪ Weigh at the same time each day ▪ Weigh before the child has eaten (especially infants) Less then 2 years old, weigh .....: • If a diaper is left on, be sure it is dry and subtract the weight of the diaper Weigh on baby scale (unless cooperative to stand) - naked 2 years and over, weight ...... or .... only - dry diaper and gown only: • Weight on standing scal Age < 2 years, height should be measured in ..... position - measure recumbent (lying down) Age 2 years and above, height should be measured while child is .... ... - measure standing up Anterior fontanel close by .... to ... months of age - 12 to 18 Posterior fontanel close by the end of the .... .... - second month {6-8 weeks} The average head circumference of a newborn is about ... to ... cm, o 2 to 3 cm more than chest circumference. - 33 to 35 why should we measure head circumference? - An indication of brain growth o Infants and toddlers' brains are growing very fast o Rule out: Microcephaly and hydrocephalus • Measured up to 2 years of age • Be sure to measure around the largest part of the head, (middle of forehead and occipital) Most babies doubled their weight at the rate of 5 to 7 ounce weekly for ... ..... and tripled at ... .... - 6 months, 12 months. A growth of 1.5 to 2.5 cm is seen monthly from birth to age .. .... while a growth of 1 cm per month is expected from ages .. to ... .... - 6 months, 6 to 12 months. ..... front teeth normally appear by the age of 5 to 9 months while .... front teeth begin to appear by 8 to 12 months. - Lower, upper All deciduous teeth (20 in total) will erupt by the .... years of age - 2 1/2 normal skin observations include: - Normal: ▪ Mongolian Spots ▪ Port wine stain ▪ Tip of nose, external ear, lips, hands & feet are prominent areas for detecting ..... ▪ Sclera ▪ Conjunctiva ▪ Nail Beds ▪ Buccal mucosa - cyanosis