1 / 15

Putting it all together… Pediatric Exam

Putting it all together… Pediatric Exam. Modified from Mosby’s Guide to Physical Exam, 6th Ed., Ch. 24. Getting Started. Offer a toy or paper & pencil while taking the patient history draw shapes (developmental assessment) ask them questions too (mental status)

kaiyo
Download Presentation

Putting it all together… Pediatric Exam

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Putting it all together…Pediatric Exam Modified from Mosby’s Guide to Physical Exam, 6th Ed., Ch. 24

  2. Getting Started • Offer a toy or paper & pencil while taking the patient history • draw shapes (developmental assessment) • ask them questions too (mental status) • General inspection can be done in the waiting room • less apprehensive • Vitals are often done first • make it fun, build rapport

  3. Child Playing Musculoskeletal & neurological exam • Observe spontaneous activities • Ask them to demonstrate skills • Building blocks, drawing shapes, etc. • Evaluate gait, jumping, hopping, ROM • Muscle strength • Climbing on parent’s lap, stooping, etc.

  4. Benefit of parent’s lap… • Often feel more secure • Observe parent/child relationship *Please have child undressed except for diaper/underpants • use gown if age appropriate

  5. On Parent’s Lap Upper Extremities • Inspect arms • Movement, size, shape • Observe use of hands • Number of fingers, palmar creases • Palpate radial pulses • Biceps & triceps reflex • Blood pressure

  6. On Parent’s Lap(may need to have child stand) Lower Extremities • Inspect legs • Movement, size, shape, alignment, lesions • Inspect feet • Alignment, longitudinal arch, number of toes • Dorsal pedis pulse • Plantar reflex • Achilles and patellar reflexes

  7. On Parent’s Lap Head and Neck • Inspect head • shape, alignment with neck, hairline, position of auricles • Palpate fontanels, sutures, depressions • Measure head circumference • Inspect neck • voluntary movement, webbing • Palpate neck • Trachea, thyroid, muscle tone, lymph nodes

  8. On Parent’s Lap Chest, Heart, & Lungs • Inspect chest • size, shape, deformity, nipple & breast development • respiratory movement, precordial movement • Palpate anterior chest • maximal impulse, tactile fremitus • Auscultate lungs & count respirations • Auscultate heart • murmurs • count apical pulse

  9. “Supine” – Still on Lap (diaper loosened) • Abdomen • Inspect • Bowel sounds • Palpate (liver size, etc.) • Percuss • Femoral pulse (vs. radial) • Lymph nodes • External genitalia

  10. Standing • Observe posture • Adam’s test • Gait

  11. Fundoscopic & Otoscopic Exams Restrain a child only as a last resort! Lessen fear… • child may handle the instrument (carefully) • “blow out” the light • perform the test on a doll or parent

  12. Return to Parent’s Lap • Inspect eyes • Extraocular movements • Pupillary light reflex, red reflex, funduscopic exam • Otoscopic exam • Inspect nasal mucosa • Inspect mouth and pharynx

  13. Tips • Tell a story OR ask them to tell one • Attract attention or distract… • Be patient; get down on their level • Use specific, polite directions rather than asking permission “Please open your mouth” vs. “Do you want to open your mouth?”

  14. Tips • Too many adults “looming” over them will make the child less cooperative • If ticklish, place your hand on top of theirs • If using a tongue blade, moistening it will help decrease the tendency to gag

  15. When assessing an ill child… • Is there a smile? • Playful, alert, responsive? • or dullness and apathy • Do they respond to soothing behavior? • Show interest in environment, toys? *These matter just as much as temperature, pulse and respirations!

More Related