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Vitals

Vitals. Adapted from Mosby’s Guide to Physical Examination, 5 th Ed. Ch. 3 . Vitals . Pulse Respiration Blood pressure Temp Height & weight (infants and children). Pulse. Apical pulse 5 th intercostal space in the midclavicular line Femoral pulse

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Vitals

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  1. Vitals Adapted from Mosby’s Guide to Physical Examination, 5th Ed. Ch. 3

  2. Vitals • Pulse • Respiration • Blood pressure • Temp • Height & weight (infants and children)

  3. Pulse • Apical pulse • 5th intercostal space in the midclavicular line • Femoral pulse • use a point halfway from the pubic tubercle to ASIS as a guide

  4. Pulse

  5. Respiration • Infants – rise and fall of the abdomen facilitates counting • Rate • Regularity and rhythm • Depth • Difficulty; use of accessory muscles

  6. Respiration

  7. Blood Pressure • Cuff size (children) • Width should cover ~2/3 of the upper arm or thigh Too wide - underestimate BP Too narrow - artificially high BP http://store.datascope.com/Assets/product_images/0998-00-0003-21,22_s164_jpg.jpg

  8. Temperature • Tympanic thermometers are becoming increasingly popular • Accuracy depends on correct technique • Must read tympanic membrane which shares blood supply with the hypothalamus

  9. Temperature – Young Infants • Traditional routes may be more accurate NOTE: axillary temp correlates well with core temp of newborns • due to the infant’s small body mass and uniform skin blood flow

  10. Height - Infant Infant measuring mat OR Mark on a sheet of headrest paper

  11. Height - Child “Stature measuring device” (or height chart) • child is able to stand without support • approx. 24 months old

  12. Weight • Infant platform scale • More accurate (ounces or grams) • Child may sit or lie • Place paper or blanket under the child • “weigh it out”

  13. Growth and Measurement Adapted from Mosby’s Guide to Physical Examination, 5th Ed. Ch. 5 MacGregor, 2000

  14. Newborn • Most babies born to the same parents weigh within 6oz of each other at birth • Lower birth weight: consider an undisclosed congenital abnormality or intrauterine growth retardation

  15. Average Weight • 5 lb, 8 oz – 8 lb, 13oz (term newborn) Expected growth • Double birth weight by 4-5 months • Triple birth weight by 12 months NOTE: on average formula-fed babies are heavier after the 1st 6 months than breast-fed babies

  16. Average Length • 18-22 in (45-55cm) long at birth Expected Growth • Length increases by 50%in the 1st year of life

  17. Growth • Infancy • Growth of the trunk predominates • Fat increases until 9 months of age • What happens at 9 months? • Childhood • Legs are the fastest growing body part • Weight is gained at a steady rate • Fat increases slowly until 7 yrs of age when a prepubertal fat spurt occurs before the true growth spurt

  18. Growth • Adolescence • Trunk and legs elongate • About 50% of the ideal weight is gained • Skeletal mass and organ systems double in size

  19. Gender Differences

  20. Measurement Infant • Length • Weight • Head circumference • Chest circumference Child • Height • Weight

  21. Recumbent Length • Measurement of choice for infants birth to 24-36 months

  22. Recumbent Length • Tear a length of headrest paper • Lay the child on top of the paper • Mark the top of the child’s head • Ask mother to hold child in place • Extend leg and mark under the heel (foot dorsiflexed)

  23. Recumbent Length • Measure to the nearest 0.5 cm or ¼ in. • Chart on appropriate growth curve for sex and age • Identify the infant’s percentile • Note any change or variation from the population standard or the child’s norm

  24. Standing Height • Child stands erect • Heels, buttocks and shoulders against the wall • Looking straight ahead • Outer canthus of the eye should line up with the external auditory canal • Slide the headpiece onto the crown

  25. Standing Height • Use once the child is walking well • Usually about 24-36 months • Stature is recorded to the nearest ¼ in (0.5 cm)

  26. Infant scale (oz or g) • Distract the infant and balance the scale • Read the weight to the nearest ½ oz (10g) when the infant is most still • Chart on appropriate growth curve for sex and age • Identify the infant’s percentile • Note any change or variation from the population standard or the child’s norm

  27. Head Circumference • Measure the infant’s head at every “health visit” until 2 years of age • Yearly from 2-6 years of age Newborn: 13-14 in (33-35 cm) NOTE: By 2, the head is 2/3 its adult size

  28. Head Circumference • Measure the largest circumference with the tape snug • Occipital protuberance to the supraorbital prominence

  29. Head Circumference • Nearest 1/4 in (0.5 cm) • Repeat to check the accuracy of your measurement • Chart on appropriate growth curve for sex and age • Identify the infant’s percentile • Note any change or variation from the population standard or the child’s norm

  30. What if…? • Head circumference increases rapidly • Rises above percentile curves ~> Increased intracranial pressure • Head circumference grows slowly • Falls off percentile curves ~> Microcephaly

  31. Chest Circumference • Measure around the nipple line to the nearest 1/4 in (0.5 cm) • Firmly but not tight enough to cause an indentation in the skin

  32. Head vs. Chest Circumference Newborn to 5 months • Head may be equal or exceed the chest by 2 cm 5 months to 2 years • Chest should closely approximate the head circumference 2 years + • Chest should exceed head circumference

  33. Growth/ Development Abnormalities What might you detect by recording height, weight, head & chest circumference? • Failure to thrive • Craniosynostosis • Hydrocephalus • Turner’s syndrome etc.

  34. Failure to Thrive • Failure of an infant to grow at “normal rates” • May be related to: • Chronic disease • Congenital disorder (brain, heart, kidney) • Inadequate calories and protein • Improper feeding methods • Intrauterine growth retardation • Emotional deprivation

  35. Failure to Thrive • An emotionally deprived infant will not grow • Growth hormone levels will be low Once the child is given attention, growth hormone will be produced and the child will grow.

  36. Craniosynostosis www.emedicine.com/neuro/topic80.htm Early closure of suture(s) Associated with: • small head circumference (microcephaly) • rigid sutures www.emedicine.com/neuro/topic80.htm

  37. Hydrocephalus Excess CSF accumulates between the brain and the dura or within the ventricular system Resultant increased ICP leads to: • head enlargement • widening of sutures and fontanels • lethargy, irritability, weakness • “setting sun eyes”

  38. Turner Syndrome • Abnormality of sex chromosomes • Characteristics include: • Short stature • Absence of sexual development • Webbed neck • Shield-shaped chest • Hypoplastic axillary nipples • Increased carrying angle • Congenital abnormalities or heart or urinary tract

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