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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