Pediatric Assessment

TIP 10: DIAPER CHECK

PEDIATRIC ASSESSMENT - Do GU exams on all patients wearing
TIPS AND TECHNIQUES diapers to make sure there aren’t any
TIP 1: FEELING SAFE AND SECURE unexpected findings hiding under the
- Establish trust with patient diaper such as rashes or signs of abuse
- Try to make a good first
impression TIP 11: LOCALIZING INJURIES
TIP 2: PREPARE FOR EXAM - If you think your patient has a
- Always have materials ready and easily musculoskeletal injury that they may be
accessible before starting the exam guarding, asked the parent to press
- EXAMPLE: lightly on that suspicious area before
- Have ophthalmoscope, you try
otoscope, and tongue depressor - This will help give an idea on the
close and ready to use location of the injury
TIP 3: GIVING CHOICES TIP 12: EAR EXAM
- Never asked kids permission to examine - POSITIONING is the key
them, instead give them choices - Have the parent hold their child
- EXAMPLE on their lap in an upright posture
- When examining the ears, ask the the parent can use their forearms
child patient what ear they want to stabilize the head and arms in
to be examined first a bear hug like position have the
TIP 4: BE FLEXIBLE parent relax the han holding the
- Start examination with less invasive head so you can check the other
portions of the exam like the heart and ear
lungs
TIP 5: TONGUE DEPRESSOR
- Always use tongue depressor when
examining the posterior oropharynx
- Lesions at the posterior
oropharynx can be difficult to see
unless you use a tongue
depressor
TIP 6: INSTRUMENT CHECK
- In cases where the child patient gets
too nervous or scare of being
examined, let them examine the
equipment first by letting them briefly
hold it or play with it
TIP 7: MOCK EXAM
- Perform examination on someone to
demonstrate to the child patient that
the exam is easy and harmless
TIP 8: STETHOSCOPE TRICK
- After listening to the heart and lungs you
can use the stethoscope to palpate the
abdomen but your patient may have
already gotten used to it by now
TIP 9: MALES WITH ABDOMINAL PAIN
- always perform a genital exam in all
male patients presenting with
abdominal pain, nausea or vomiting
- You don’t wanna miss testicular
torsion or hernia
 Pediatric Assessment
PEDIATRIC ASSESSMENT
- The pediatric physical examination differs from COLLECTING OBJECTIVE DATA
the adult physical examination in that the - Collection of information through observations
approach differs according to age and - Includes the nurse doing a baseline
developmental level. measurement
- Together, the health history and physical - These measurements are the child's
examination provide information that leads to height, weight, blood pressure,
the child's diagnosis and forms the basis for the temperature and respiration
nursing care plan. GENERAL STATUS ASSESSMENT
- Refers to the branch of medicine dealing with - Observing general appearance
children and their disease - The face of an infant should be
PEDIATRIC HEALTH HISTORY TAKING symmetrical, observe for nutritional
COLLECTING SUBJECTIVE DATA status, hygiene, mental alertness and
- Are collected through interviewing the family body posture and movement; Examine
caregiver and the child the skin color for lesions, bruises, scars,
- Why interview? birthmark, observe hair texture
- Helps establish relationship - Noting psychological status and behavior
between the nurse, child, and - Observations of behavior should include
family factors that influence the behavior and
- Listen and communicate. Introduce and how often the behavior is repeated
explain your purpose - Physically, as well as, emotional and
- Help promote a good interview intellectual responses should be noted
- Establish rapport - Consider the child’s age and
developmental level
INTERVIEWING FAMILY CAREGIVERS
- A family caregiver provides most of the DEVELOPMENTAL STAGES
information needed in caring for the child, INFANCY
especially the infant or the toddler - A period of rapid growth in which the head,
- Rather than simply asking the caregiver to fill out especially the brain grows faster than others
a form the nurse may ask a question and write TODDLER
down answer - Preschool age
- Ask questions and note them - A period of slow growth in which the trunk grows
- Avoid being judgmental faster
INTERVIEWING THE CHILD SCHOOL AGE
- Important that the preschool child and the older - A period of slow growth in which the limbs grow
child be included in the interview faster
- Be age appropriate ADOLESCENT
- Use age appropriate toys and - A period of rapid growth for the trunk, including
questions the gonads and other tissues
- Establish rapport
CHECKS IN AN INFANT ASSESSMENT
- By being honest by answering
Head and chest circumference in neonates are
questions
relatively equal
- Listen
Neonates behavior is controlled by reflexes
- Listen attentively and make the
At age 1-4 months posterior fontanel closes
patient feel important during the
At age 5-6 months, birth weight doubles and
interview
infant voluntarily grasps and releases objects and
INTERVIEWING THE ADOLESCENT
exhibits signs of attachment to parent
- Adolescents can provide information about
At 7-9 months infant searches objects outside his
themselves
perceptual fields
- Interview in private
At 10-12 months, birth weight triples and birth
OBTAINING A CLIENT HISTORY length increases about 50%
- When a child is brought to any healthcare setting
WHAT TO EXPECT IN A TODDLER
- It is important to gather information regarding the
child’s current condition, as well as medical - Gains 4-6 lbs per year
history - Exhibits egocentric behavior
- Biographical data - Demonstrates separates anxiety
- Chief complaint - Exhibits appropriate cognitive
- History of present health concern
development
- Health history
- Family health history - Climbs stairs at age 21 months, runs and
HOW TO OBTAIN CLIENT HEALTH HISTORY? jumps by age 2, and rides a tricycle by
- Review of systems for current health problems age 3
- Allergies, medications, and substance abuse - Has first molars
- Lifestyle
- Say four to five word sentences and is
- Developmental level
75% intelligible by age 3
- Begins toilet training
 -
NORMAL FINDINGS IN A PRESCHOOL HOW TO MEASURE HEIGHT
- Pulse rate ranges from 90-100 bpm - The child who can stand usually is measuredd for
- Respiratory rate 25 breaths/minute height while standing at the same time at the
- Blood pressure ranges from 85/60 to 70/90 mmhg same time
MOTOR SKILL MILESTONES FOR PRESCHOOLERS - A child who is still not able to stand alone
steadily, the child will be put flat with knees put
● Dresses without help ● Alternates feet on step
● Builds towers or blocks ● Hops on one foot
flat on an examining table and then measure the
● Copies circles and lines ● Skips (At age 5) child’s height by straightening the body from the
● Uses scissors ● Develops hand top of the head to footnees put flat on an
● Strings large beads dominance
examining table and then measure the child’s
● Throws a ball over ● Enjoys the sandbox,
head water play, blocks, height by straightening the body from the top of
crayons, clay, and the head to foot
finger paint
MEASURING HEAD CIRCUMFERENCE
- The head circumference routinely
COGNITIVE DEVELOPMENT IN ADOLESCENT measured in children to the age 2 or 3
- Abstract thinking years or in any child with a neurologic
- Increased ability to analyze, synthesize and use
concern
logic
- Solve problem - You should measure a child’s head
MALE SECONDARY CHARACTERISTICS circumference until hes 36 months old
- Testicular enlargement - Head needs to be measured to
- Increase in muscle mass measure the development of the brain
- Broadening of the chest
HOW TO MEASURE
- Increase in facial and body hair
- Voice deepens
- Measure the head. Around the
- Pubic hair growth widest point, from the frontal
- Increase in sweat gland an sebaceous gland bone, around the occipital bone
activity VITAL SIGN
- Increase in body odor
- is taken at each visit and cmpared with
- Increase in acne
- Nocturnal emissions the normal values for children at the
- Masturbation with ejaculation same age
MALE SECONDARY CHARACTERISTICS INCLUDES:
- Breast development - Temperature
- Increase fatty tissues in the thighs, hips, and
- Pulse
breast
- Broadening of the hips
- Respiration
- Onset of menses - Blood pressure
- Pubic hair growth TEMPERATURE
- Increased in sweat and sebaceous gland activity - Can be measured by the oral, rectal, axillary, or
- Increase in body odor tympanic method
- Increase in acne - Temperature are recorded in celcius or
MEASURING HEIGHT AND WEIGHT fahrenheit
WHEN TO MEASURE: - According to the policy of the healthcare facility
- Normal oral temperature range is 36.4ºC
- Height and weight should be measured and
to 37.4ºC(97.6ºF-9.3ºF)
recorded each time the child has a routine
- Normal rectal temperature usually 0.5-1.0
physical examination, as well as at other
degree higher than the oral
healthcare visits
measurement
HOW TO MEASURE WEIGHT
- An axillary temperature usually measures
- An infant is weighed nude, there should be no
o.5 degrees to 1.0 degrees lower than
clothes, lying on an infant scale
oral temperature
- If a child is young enough to hve his length
measured while he’s lying down, you’ll most likely
PULSE
weigh him on an infant scale - The apical pulse should be counted
- To prevent injury, never turn away from a before the child is isturbed for other
child on a scale or never leave him procedures
unattended
- The stethoscope is placed between the
- You can usually use an adult scale to weigh
children oler than age 2 or 3 child’s left nipple and sternum
- If a child is young enough to hve his length - A radial pulse may be taken on an older
measured while he’s lying down, you’ll most likely child
weigh him on an infant scale
- Pulse rates vary with age: from
- To prevent injury, never turn away from a
child on a scale or never leave him
100-180bpm for a neonate to 50-95bpm
unattended for the 14-18 year old adolescent
- You can usually use an adult scale to weigh
children oler than age 2 or 3
RESPIRATION
- The child can be observed while lying or
sitting; infants are abdominal breather;
therfore the movement of the infant’s
abdomen is observed to count
respirations
- OLDER CHILD: same with adilts
- The infant’s respirations must be
counted for a full minute
because of normal irregularity
- Retractions are noted as
substernal, subcostal, intercostal,
suprasternal, or supraclavicular
BLOOD PRESSURE
- For children 3 years of age and older,
blood pressure monitoring is a part of
routine and ongoing data collection
- The most common sites used to obtain a
blood ressure reading in chilren are the
upper arm, lower arm or fore arm, thigh,
and calf or ankle
- The blood pressure is taken by
auscultation, palpation, or doppler or
electronic method
PEDIATRIC PHYSICAL EXAMINATION
- Data are also collecte by examining the
body systems of the child
PEDIATRIC SKIN
NEONATES AND INFANTS
- Bacterial and candida infections may
occur with diaper rash
PRESCHOOL AND SCHOOL-AGED CHILDREN
- Younger children are susceptible too
common disorders
- Allergic dermatitis, atopic
dermatitis, warts, ringworms,
cabis, and skin reaction to food
allergies
- They typically have bruises on
their lower extremities resulting
from active play
ADOLESCENTS
- At puberty hormonal changes affect
the child’s skin and hair
- Androgen levels increase causing
sebaceous glands to produce more
sebum which cn clog hair follicles on
scalp
- Common dermatosis
- Acne, contact dermatitis, some
fungal infections
SYMMETRY OR A BALANCE IS NOTED IN THE
FEATURES OF THE FCE AND IN THE HEAD
- Assess the ROM
- Assess the fontanels (infants)
- Swelling - infection
- Depression - dehydration
- Assess the eyes
- Assess the ears
- Assess the nose, mouth, and throat
- Check for head and facial symmetry
- Note shape and symmetry of the head;
note for craniosyptosis; premature
closure of fontanels
PEDIATRIC NECK
- Assess the child's head and neck
muscles
- Neck mobility is important
indication of neurological
disorders:
- Meningitis
CEREBRAL FUNCTION
To assess level of consciousness in a
young child use motor cues
- Observe for lethargy, drowsiness, and
stupor
- Observe for hyperactivity
PEDIATRIC EYES AND VISION
- Behavior problems or poor performance
in school may be related to difficulty in
seeing the chalkboard
HISTORY QUESTIONS
1. Look for clues to familial eye isorders
such as:
a. Refractive errors
b. Retinoblastoma
2. Ask the parent of the child holds
reading materials close to his face to
read; a sign of myopia or
nearsightedness
PHYSICAL EXAMINATION
- Includes tests for visual acuity and
inspection for strabismus; lazy eye (libat)
Because visual acuity and depth perception
develop fully by age 7, you can test vision in a
school-aged child as you would in adult
TEST A CHILD AGED 4 WITH A CHART
- E-CHART: This chart is made up entirely of capital
e’s , their legs pointing up, down, right, or left
- The child identifies what he sees with his hands or
fingers the position of each e
- NO METHOD ACCURATELY MEASURES VISUAL
ACUITY IN CHILDREN YOUNGER THAN AGE 4; But
testing with allen cards may provide useful ata
- ALLEN CARD: Each card contains an illustration of
a familiar object such as christmas tree, birthday
cake, or horse
PEDIATRIC EARS AND HEARING AUSCULTATION SIGNIFICANT FINDINGS
An infant younger than 6 months should respond ABDOMINAL MURMUR
to a spoken voice
- May indicate coarctation of the aorta
- By 6 months a infant can localize the
HIGH-PITCHED ABDOMINAL SOUND
direction of sound, and by age 5 a
- may indicate abdominal obstruction or
child’s hearing is fully developed
gastroenteritis
1. Investigate a child’s speech development by
VENOUS HUM
listening to him carefully, speech development
- may indicate portal hypertension
reflects hearing acuity during childhood
SPLENIC OR HEPATIC FRICTION RUB
2. Observe behaviors for possible signs of ear
- may indicate inflammation
disorders
DOUBLE SOUND IN THE FEMORAL ARTERY
PEDIATRIC CHEST AND LUNGS - may indicate aortic insufficiency
- Chest measurements are done on infants and ABSENCE OF BOWEL SOUNDS
children to determine normal growth rate - may indicate paralytic ileus or peritonitis
HOW TO MEASURE CHEST CLUES TO PEDIATRIC ABDOMINAL PAIN
- nipple level with tape measure, circumferential ● GUARDING
ADOLESCENTS ● GRIMACING
- In the older school age child, adolescent note ● CHANGE IN PITCH OF CRY
evidence of breast development PEDIATRIC GENITALIA AND RECTUM
ASSESS RESPIRATORY CHARACTERISTICS Important to respect the child’s privacy and take
- Evaluate respiratory rate, rhythm, and depth into account the child’s age and stage of growth
- Report any noisy or grunting respirations development
HOW TO ASSESS BREATH SOUNDS - While wearing gloves observe any area of sores,
- Use stethoscope to assess wheezing lesions, swelling, and discharges
- FOR MALE CHILDREN
PEDIATRIC HEART ASSESSMENT
- Assess the testes
In some infants and children, a pulsation
PEDIATRIC URINARY SYSTEM
can be seen in the chest that indicates the Impact the skin for anemic pallor
heartbeat which is called the point of Palpate for bladder distention and kidney
maximum impulse enlargement
- ASSESS CAUSE OF BEDWETTING
- Heart rate and rhythms - Bladder irritation
- The nurse listens for the rhythm of - Urethral irritation
the heart sounds and counts the - Emotional difficulties
rate per minute PEDIATRIC BACK AND EXTREMETIES
- Heart abnormalities - The back and extremities should also be assessed
- Unusual heat sounds might for abnormalities
indicate heart murmur, ASSESS THE BACK
abnormality that should be OBSERVE
reported - Symmetry and curvature of the spine
- Heart function and effectiveness INFANTS
- The nurses asses the pulses in - Spine is rounded and flexible; as the child grows
different parts of the body and develops motor skills the spine further
PEDIATRIC ABDOMEN develops
ASSESS GAIT AND POSTURE
- The abdomen may protrude slightly in
- Note gait an posture when the chil enters or is
infant and small children walking in a room
- Because their abdomen is not yet - Note ROM, joint movement and muscle
fully developed strength
ASSESS THE EXTREMITIES
DIVIDING THE ABDOMEN
- The extremities should be warm, have a good
ASSESS BOWEL SOUNDS color, and symmetrical
- To describe the abdomen, divide the area into PEDIATRIC NEUROLOGIC STATUS
four sections and label sections with the terms left - Assessing the neurological status of the infant
upper quadrant (LUQ), left lower quadrant (LLQ), and child is the most complex aspect of the
right lower quadrant (RLQ), right upper quadrant physical exam
(RUQ) INCLUDES:
- Using a stethoscope, the nurse listens for bowel - Neurologic Exam
sounds or evidence of peristalsis in each section - Reflexes, Cranial Nerve Function
of the abdomen nd records what is heard - Neurologic Assessment Tools
- Glasgow Coma Scale
FUNCTIONAL ASSESSMENT TEST
NEWBORN ASSESSMENT INCLUDES INFANTS AND CHILREN - MMDST
MMDST
- Initial and ongoing assessments
METRO MANILA DEVELOPMENTAL SCREENING TEST
- A Head-to-toe examination - A screening test to note for normalcy of the
- Neurologic and behavioral assessments child’s developmental and to determine any
APGAR SCORING SYSTEM delays as well in children 61/2 years old and
WHAT IS THE APGAR SCORE? below
- adopted from DENVER development test
- A test given to newborns soon after birth
- A measurement that should be taken at
- Usually one minute and five a regular interval in order to observe
minute after birth reliable trend
- This test checks a baby’s heart rate, - Recommendations for measurement intervals
include
muscle tone, and other signs to see if
- Infants (0-12 months); every 2 months
extra medical care or emergency care - Young Children; 15, 18, 24, an 30 months
is needed - 3+; every year
WHAT DOES “APGAR” MEAN?
STANDS FOR: ADULTS
Appearance Pulse Grimace Activity KATZ INDEX OF INDEPENDENCE IN ACTIVITIES OF DAILY
LIVING SCALE (Katz. ADL)
Respiration
- a widely used tool to assess the level of
- Five things are used to check a baby’s independency in older adults
health. Each is scored on a scale of 0-2. BARTHEL INDEX
2 being the best score: - Assesses functional independence, generally in
stroke patients
APPEARANCE
-
- Skin color of the child is assessed
- Pinkish, Bluish,
PULSE
- Heart rate is assessed
GRIMACE RESPONSE
- Reflexes of the baby is assessed
ACTIVITY
- Muscle tone is assessed
asd
RESPIRATION
- Breathing rate and effort

- A baby who scores 7 or above on the test is

considered. In good health
- A lower score - means that your baby need some
immediate medical care such as suctioning of
the airways or oxygen to help him or her breathe
better
- A slightly low score (Especially at 1-minute) is
common, especially in babies born:
- After a high-risk pregnancy
- Through c-section
- After a complicated labor and delivery
- If the baby is born premature