Transcript Pediatric Assessment - Mississippi School Nurse Association

Alecia Hollis, R.N., MSN
SMCC Associate Degree Nursing Instructor
Preschoolers
School-age Children
Adolescents
Performing Physical Exam
 Steps of the Physical exam
 Inspection
 Palpation
 Auscultation
Developmental Consideration
Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens
Performing Physical Exam
 General Appearance
 Measurement of Vital Signs
 Temperature
 Pulse
 Respiratory Rate

Measuring Oxygen Saturation
 Blood Pressure
 Pain Assessment
 SYSTEMATIC APPROACH
Vital Signs
Blood Pressure
(mm Hg)
Respiratory Rate
(breaths/min)
Prem
120-170 *
ature
55-75/35-45†
40-70†
0-3
mo
100-150 *
65-85/45-55
35-55
3-6
mo
90-120
70-90/50-65
30-45
6-12
mo
80-120
80-100/55-65
25-40
1-3 yr 70-110
90-105/55-70
20-30
3-6 yr 65-110
95-110/60-75
20-25
6-12
yr
60-95
100-120/60/75
14/22
12 >
yr
55-85
110-135/65/85
12-18
Age
Heart Rate
(beats/min)
http://www.emedicinehealth.com/pediatric_vital_signs/article_em.htm
Blood pressure
Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens
Body Measurements
Length or Height
Weight
Weight for Length
Body Mass Index
Monitoring Equipment
Weight
 Weight Status Category Percentile Range
Underweight
Less than the 5th percentile
 Healthy weight 5th percentile to less than the 85th
percentile
 Overweight
85th to less than the 95th percentile
 Obese
Equal to or greater than the 95th percentile
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html
External Structures
Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens
Strabismus
http://www.uofmhealth.org/health-library/zm6098
Vision Assessment
 Standardized Vision Chart
Criteria for referral
3 to 4 years---20/50 or less in either
eye
5 years old----20/40 or less in
either eye
6 years old---20/30 or less in either
eye
A difference in vision between the
eyes of two lines or more on the
Snellen eye chart.
Any problems with ocular
alignment
Data from American Academy of Opthalmology, Pediatric Opththalmology/Strabismus Panel, (2007).
Preferred Practice Pattern Guidelines. Pediatric eye evaluations San Francisico, CA
Warning signs for Referrals
 Learning problems
 Frequent headaches
 Visual complaints (child frequently won’t recognize
problem)
 Failed vision screen or concerns on eye exam
 Acute eye injury
 Worsening infection, pain, discharge
Corneal Abrasion
insighteyespecialists.com
en.wikipedia.org
Corneal Ulcer
accesspediatrics.mhmedical.com
External Structures
 Inspect the Pinna
(external ear)
 Inspect the external
auditory canal for
drainage
sonoworld.com
External Structures
clinicaladvisor.com
Internal structure
quizlet.com
anatomybox.com
http://www.webmd.com/cold-and-flu/ear-infection/middle-ear
Internal Structures
http://www.earcentergreensboro.com/medical-education/ear_tubes.php
webmd.com
Hearing Screening
lathamcenterspws.blogs
.
Hearing Loss
Conductive hearing
loss –Occurs due to
problems in the
outer or middle ear;
normal bone
conduction
Sensorineural
hearing loss--Refers to nerve
damage (VIII) in the
inner ear.
0-20 (or 25) db
NORMAL
20-45 db
Mild
46-65 db
Moderate
65-90 db
Severe
>90 db
May not hear a sound
Hearing loss
Hearing Aids
Cochlear Implants
ww.medicalhomeportal.org/living-with-child/assistivetechnology/hearing-aids
http://www.macrobusiness.com.au/2011/09/did-you-hear-about-cochlear/
Nose
http://training.seer.cancer.gov/anatomy/respiratory/passages/nose.html
Assessment of Nose
http://www.atitesting.com/ati_next_gen/skillsmodules/content/physical-assessment-child/equipment/ap_ear_nose_throat.html
Assessment of Mouth and Throat
Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens
Lips
http://medicalpicturesinfo.com/wp-content/uploads/2011/08/Angular-Cheilitis-5.jpeg
realmagick.com
Tongue
http://www.chicanol.com/heridas-en-la-lengua/
Mouth
http://sleepmedicineboardreview.wordpress.com/2011/10/25/tonsil-size-scoring/
Gums and Teeth
http://pediatricdentistrynorth.com/special-offers/tooth-eruption/
Neck
Cardiovascular
 Inspection
 Palpation
 Auscultation
Cardiovascular
Atitesting.com
Auscultation
Listening Sites for Auscultation
S2
S2
S1
Kyle, T.& Ricci, S. (2009). Maternity and Pediatric Nursing. Philadelphia, PA:
Lippincott Williams & Wilkins
Heart Sounds
mediconweb.com
Listening Sites for Auscultation
Heart Sound
Sites where heard best
Sites where heard softly
S1
Apex of the heart
Tricuspid and Mitral area
Base of heart
Aortic area and Pulmonic
S2
Base of the heart
Aortic and Pulmonic area
Apex of the heart
Tricuspid and Mitral area
Physiologic splitting
Pulmonic area
S3
Mitral
London, Marcia (2014). Maternal & Child Nursing Care: New Jersey, Pearson.
www.texasheart.org
Respiratory
http://vereburn.com/index.php?main_page=index&cPath=29_2672
Wheeze or Stridor
 Wheezes occur when air flows rapidly through bronchi
that are narrowed nearly to the point of closure.
 Wheezes is lower airway
 Asthma = expiratory wheezes
 A stridor is upper airway
 Inflammation of upper airway or FB
42
Lung sounds
Possible Sites for Retractions
Bowden & Greenberg
Respiratory Distress
www.nationwidechildrens.org