Download Pediatric History and Physical Examination Hiba Abujaradeh

Pediatric History and Physical Examination
Hiba Abujaradeh
Introduction
Obtaining the Child's History
Interview is a very personal conversation with a parent, caretaker, and child/ adolescent
.during which private concerns and feelings are shared
Communication Strategies
Careful listening
Strategies to Build a Rapport with the Family
Make a self- introduction
)Explain the purpose of the interview (NCP
Provide privacy and remove as many distractions as possible during the interview
Direct the focus of the interview with open-ended questions. Use close-ended questions or
directing statement to clarify information
Ask one question at a time
Involve the child in the interview by asking age appropriate questions
Be honest with the child when answering questions or when giving information about what
.will happen. Children need to learn they can trust their nurse
Careful Listening
Complete attention is necessary to "hear" and accurately interpret information the parents
and child give during the nursing history
pay attention to the parent's attitude or tone of voice when the child's problems are
discussed the tone of voice can reveal anxiety, anger, or lack of concern
Observe the parent's nonverbal behavior (posture, gestures, body movements, eye contact,
)and facial expression
)History taking Outline (Subjective Data
Identifying data/ Chief Complain
Present illness
Past Medical History
Birth history, childhood illnesses, immunizations, hospitalizations and surgeries, allergies,
and medications
Family Medical History
Social History
Habits/ Activities of daily living (Nutrition, dental, sleep, elimination pattern (toilet training),
)safety/ injury prevention, activity and exercise, Discipline
)cognitive/ perception ( value and believe, pain
Developmental behavior
)Review of Systems (ROS
Case Study
Group work
Read the case study and find
Identifying data
Chief complain
Past medical history
)Family medical history (draw a genogram
Social history
Habits/ Activities of daily living
Mile stones that Maria achieved
ROS
Physical examination
Sequence of the examination
The sequence of children examination follows head-to-toe direction. The main function of
such systemic approach is to provide a general guidelines for assessment of each body area
.to minimize omitting segments of the examination
Holding toddler for mouth exam
Pediatric physical Examination
Outline
Physical Growth measurement
Physiologic measurements
General appearance
Skin - head and neck -eyes – ears- nose, mouth and throat - lungs-heart – abdomen genitalia- back and extremities - neurologic assessment
CDC Growth Charts
:The available clinical charts include the following
:Infants, birth to 36 months
Length-for-age and Weight-for-age percentiles
Head circumference-for-age and Weight-for-length percentiles
Children and adolescents, 2 to 20 years
Stature-for-age and Weight-for-age percentiles
BMI-for-age percentiles
Preschoolers, 2 to 5 years
Weight-for-stature
www.cdc.gov
??Is Ameena growing normally
.Ameena is nine-month-old girl
.Ameena’s length= 69 cm, weight =9 kg, and Head circumference = 45 cm
The mother asks you if Ameena’s length, weight, and head circumference are normal for her
age or not?? Explain
??Is Ahmad growing Normally
Ahmad is 5-year-old boy
Height = 112 cm
Weight = 23 kg
?Find Ahmad’s BMI and if he is growing normally
Physiological parameters
Temperature: can be easily measured at several body sites via oral, rectal , axillary, ear canal
.or skin
Substitutes for the no-longer-used mercury glass thermometer are electronic thermometers,
infrared ear-based thermometers, chemical indicator thermometers, skin plastic strips, and
.digital thermometers
All of which offer advantages: rapid temp taking, minimal intrusion, and reduced cross
.contamination
Recommendation based on research vary
*From 2-3 min for oral. Normal 37.0c
)min for rectal. 1 degree higher than oral (subtract 2-1
)min for an axillary reading. 0.5 degree lower than oral (add 7-5
Physiological parameters
Respiration count in the same manner as for the adult patient
.In infant observe abdominal movements because respiration are primarily diaphragmatic
Count respiration for 1 full min for accuracy
:Pulse
.Can be taken radially in children older than 2 years
In infant and young children the apical impulse (heard through a stethoscope) is more
reliable
Count the pulse for 1 full minute in infant and young children because of possible
. irregularities in rhythm
.For greater accuracy, measure the apical rate while the child is a sleep
Compare brachial and femoral pulses at least once during infancy to check for coarctation of
.aorta
:Blood pressure
Measure using noninvasive method
BP should be measured annually in children 3 years of age through adolescence
.Use an appropriate cuff size
Position limb at level of heart
Rapidly inflate cuff to about 20 mm hg above blood pressure baseline
.BP is classified by systolic BP and diastolic BP percentiles for age/sex/height
???Is my child BP Normal
Nagham is 4-year-old girl with a height of 103 cm and BP of 100/65. Nagham’s mom ask you
?if her child BP is normal
:Nagham BP
According to BP levels for girls by age and height percentile normal BP is between
52/92 -71/110
This means that Nagham has Normal BP
)Pain (the fifth vital signs- Subjective
)Pain (the fifth vital signs- objective
Skin
)Skin Color (Mongolian spot, erythema toxicum, acrocynosis, jaundice
Texture
Thickness
)Hair (lanugo
Palpate the skull for patent sutures, fontanels (anterior closed at 12-18m, posterior closed at
.2nd- 3rd m), fracture and swelling
.Observe the face for symmetry, movement and general appearance
Inspect the neck for size and palpate it for associated structures: normally short with
.skinfolds between the head and shoulders during infancy, it lengthens during next 3-4 years
Eyes : red reflex. Absence of red reflex can indicate retinoblastoma
:Ears
Ear abnormalities are commonly associated with renal anomalies. Low set ear can be
associated with down syndrome
:Examination of the tympanic membrane
Pull pinna down and backward in children younger than 3 years old and Up and backward in
.children older than 3 years old
Nose, mouth, and throat: Encouraging opening the mouth to Inspect the teeth, gum, tongue,
.hard and soft palate and tonsils
.Examine paranasal sinuses: only the maxillary and ethmoid sinuses are present at birth
Chest
Inspect the chest for size, shape, symmetry, movement, breast development and the
presence of bony landmarks formed by ribs and sternum
During infancy the chest normal to be rounded (By 2 years of age the lateral diameter is
)greater than the anteroposterior diameter
.Costal angle 45-50 degree
.Assess breathing sound
Child rib cage
Auscultate the breathing sound
Heart
:Position
: Use palpation to determine the location of the apical pulse
.Just lateral to the left MCL and fourth ICS in children younger than 7 years of age
.At the left MCL and fifth ICS in children older than 7 years of age
.Auscultate origin and differentiating of heart sound
Infant apical pulse
Child apical pulse
Direction of heart sounds for anatomic valve sites and areas (circled) for auscultation
Assess heart sound
Abdomen
.Examination orders: inspection, auscultation, percussion and palpation
.)Inspect for abdominal hernia (umbilical, internal or external inguinal canal, femoral hernia
Male genitalia: examine the penis, glans and shaft, urethral meatus (hypospadias), scrotum
.)(undescended tests
.)Female genitalia: examine for external structure (ambiguous genitalia
Infant's Abdominal palpation
Umbilical hernia
Back and extremities
.)Spine: examine for curvature (scoliosis
.Inspect the back for any tufts of hair
.Inspect the extremity for symmetry of length and size
)Count the fingers and toes to be certain of normal number ( polydactyly, synductyly
Back and extremities
.Joints: palpate for heat, tenderness, swelling, and range of motion
.Note symmetry and quality of muscle development, tone, and strength
Spina bifida
THANK YOU