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Chapter 25. The Pediatric Patient. Competencies. Differentiate the structural and physiological variations between pediatric patients and adults. Identify personal-social, language, and fine and gross motor findings when using the Denver II. (continues). Competencies.
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Chapter 25 The Pediatric Patient
Competencies • Differentiate the structural and physiological variations between pediatric patients and adults. • Identify personal-social, language, and fine and gross motor findings when using the Denver II. (continues)
Competencies • Elicit a complete health history from a patient or caregiver using standard components of a pediatric health history. (continues)
Competencies • Identify various techniques of approaching patients at different developmental levels before initiating the physical examination. (continues)
Competencies • Perform inspection, palpation, percussion, and auscultation in a head-to-toe examination of a pediatric patient.
Physical Growth • Weight • Length or height • Head circumference (continues)
Physical Growth • Average weight gain • Rapid growth periods • Infancy • Adolescence
Allaying Childhood FearsDuring Physical Exam • Infant • Toddler • Preschooler • School age • Adolescent
Anatomy and Physiology • Vital signs • Temperature regulation • Variations by age • Pulse • Respirations • Blood pressure (continues)
Anatomy and Physiology • Skin and hair • Lanugo • Vernix caseosa • Head • Closure of fontanels (continues)
Anatomy and Physiology • Eyes, ears, nose, mouth, and throat • Visual acuity • Variations in eustachian tube • Development of sinuses • Eruption of teeth (continues)
Anatomy and Physiology • Breasts • Breast tissue begins to develop at 8 to 10 years of age • Thorax and lungs • Infant • Chest development • Nose breathing • Abdominal breathing (continues)
Anatomy and Physiology • Heart and peripheral vasculature • Placement • Cardiac output • Abdomen • Musculoskeletal system • Bone growth ends at 20 years of age (continues)
Anatomy and Physiology • Neurological system • Incomplete at birth • Neurons become myelinated • Urinary system • Bladder location (continues)
Anatomy and Physiology • Female genitalia • Development of pubic hair • Male genitalia • Descent of the testes • Onset of puberty
Health History • Biographical data • Name • Contact information • Source of data (continues)
Health History • Chief complaint • Infants, toddlers, young preschoolers are unable to describe their health concerns; caregiver will describe • Older preschoolers, school-age children, and adolescents are able to describe their health concerns
Past Health History • Birth history • Prenatal • Labor and delivery • Postnatal • Medical history • Hospitalizations • Emergency department visits (continues)
Past Health History • Injuries and accidents • Childhood illnesses • Document exposure to measles, mumps, rubella, pertussis, chickenpox, RSV • Immunizations (continues)
Past Health History • Family health history • SIDS • ADHD • Congenital disorders • Mental retardation
Social History • School or day care environment • Academic performance (if applicable) • Home environment • Potential exposure to lead • Gun safety (continues)
Social History • Child’s personal habits • Activities child enjoys • How does child cope with stress? • Domestic and intimate partner violence • Adolescents may be at risk
Health Maintenance Activities • Sleep • Diet • Safety • Critical to assess childproofing the environment
Developmental Examination • Denver II • Personal-social • Fine motor-adaptive • Language • Gross motor
Physical Examination • Equipment • Appropriate child-sized equipment • Developmental examination tools • Ophthalmoscope, otoscope (continues)
Physical Examination • General approach • Warm environment • Methods to reduce anxiety and promote security • Respect patient’s modesty (continues)
Physical Examination • General approach (cont’d) • Interview older children and adolescents separate from caregiver • Perform uncomfortable procedures last
Examination • Vital signs • Blood pressure • Heart rate • Temperature • Respiratory rate (continues)
Examination • Physical growth • Weight • Height or length • Head circumference • Chest circumference • Apgar score (continues)
Examination • Skin • Inspect color, lesions • Palpate texture • Hair (continues)
Examination • Head • Inspect for symmetry, shape, head control • Palpate fontanels, suture lines, surface characteristics (continues)
Examination • Eyes • Assess eyes toward the end of the exam in children up to 10 years old • Vision screening • Tumbling E chart • Allen test (continues)
Examination • Eyes (cont’d) • Strabismus screening • Hirschberg test • Cover-uncover test • Color vision (continues)
Examination • Eyes (cont’d) • Inspect • Eyelids • Lacrimal apparatus • Sclera • Iris • Pupils • Lens (continues)
Examination • Eyes (cont’d) • Inspect • Red reflex • Retina • Optic disc (continues)
Examination • Ears • Auditory testing • External ear • Internal ear • Nose • Inspect mucosa, nasal septum, presence of drainage (continues)
Examination • Mouth and throat • Inspect lips, buccal mucosa, teeth, hard palate, soft palate, oropharynx (continues)
Examination • Neck • Palpate thyroid and lymph nodes • Breasts • Inspection • Assess sexual maturity rating (continues)
Examination • Thorax and lungs • Inspect shape of thorax, presence of retractions • Palpate for tactile fremitus • Percuss diaphragmatic excursion • Auscultate breath sounds (continues)
Examination • Heart and peripheral vasculature • Usually performed at beginning of exam • Inspect • Apical impulse, precordium • Palpate • Thrill • Peripheral pulses (continues)
Examination • Heart and peripheral vasculature (cont’d) • Auscultate • Heart sounds • Innocent murmurs (continues)
Examination • Abdomen • Calm child before proceeding • Inspect • Contour • Peristaltic wave • Auscultate • Bowel sounds • Palpate (continues)
Examination • Musculoskeletal system • General approach • Use of games to facilitate evaluation • Inspection • Muscles, joints, tibiofemoral bones • Palpation • Joints, feet, hip, femur
Neurological Examination • General approach • Infant • Toddler (continues)
Neurological Examination • Reflex mechanisms of the infant • Rooting • Sucking • Palmar grasp • Tonic neck • Stepping • Plantar grasp (continues)
Neurological Examination • Reflex mechanisms of the infant (cont’d) • Babinski • Moro • Galant • Placing • Landau (continues)
Neurological Examination • Cranial nerve testing • Infant • Toddler • School age • Adolescent
Genitalia Examination • Tanner sexual maturity rating • Female • Age-specific guidelines • Inspect perineal area (continues)
Genitalia Examination • Male • Age-specific guidelines • Inspect penis, scrotum • Palpate scrotum • Hernia
Anus Examination • Performed if problem detected or abuse suspected • Inspect for bleeding, fissures, prolapse, skin tags