1 / 40

Review

Review. I guide for studying…. Ground Rules. This review is not all-inclusive You are still responsible for: Extra notes, comments added in class to clarify a concept, etc…. “Wellness Care”. Fysh’s Wellness Schedule Developmental Surveillance (define)

denim
Download Presentation

Review

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. Review I guide for studying…

  2. Ground Rules • This review is not all-inclusive You are still responsible for: • Extra notes, comments added in class to clarify a concept, etc…

  3. “Wellness Care” • Fysh’s Wellness Schedule • Developmental Surveillance (define) • Why use screening tools vs. observation? • Are parent’s good judges of developmental delays? Why?

  4. Age Descriptors • Newborn birth to 2 months • Infant 0-1 year • Toddler 1-2 years • Child 2+ years

  5. History “Historian” • Name • Relationship to the patient • Reliability

  6. Infant Vitals • Pulse • Apical pulse – 5th intercostal space, midclavicular line • Compare brachial to femoral • Respiration • Look at abdomen • Signs of distress? • BP • Temp • Tympanum vs. axillary (newborn-don’t add 1) • *Height – recumbent (top of head to heel) • *Weight - oz

  7. Weight • Doubles by 6 months • Triples by 1 year Head & Chest Circumference • Where do you measure? • <2 years: approx. the same

  8. Large head = hydrocephalus • Small head = microcephaly (craniosynostosis) • Lack of growth, weight gain • Failure to thrive?

  9. Skin Variants (Pigment? Vessels? Temp? Etc?) • Acrocyanosis (transient) • Cutis marmorata • Mongolian spots • Telangiectatic nevi • Erythema toxicum • Milia/miliaria • Strawberry hemangioma

  10. Skin Findingsto Investigate Further… • Persistent acrocyanosis • Faun-tail nevus (spina bifida) • Café-au-lait (neurofibromatosis) • Port-wine stain (opthalmic CN V) • Jaundice

  11. Jaundice • Tips for examining… • Risk factors • Physiologic vs Pathological • Rh incompatibility?

  12. Immune/Lymph • Firm, discrete, moveable (visible) • <0.5cm “normal” Investigate further if: • Growing rapidly • Suspiciously large (>2-3 cm) • Fixed and immoveable

  13. Tonsils • Enlarged? • At what are do they “peak” in their “relative size”? • Possible complication: • ____________ • Grading +2

  14. Newborn Head & Neck • Molding and prominent ridges (birth) usually resolved within 1 week

  15. Fontanels • Post fontanel: ~2 months • Ant fontanel: by 24 months • Measure: transvere +AP 2 • Bulging • Infection? • Increased ICP? • Depressed • Dehydration? • other signs of dehydration

  16. Hydrocephalus Signs & Symptoms

  17. Eyes • Red reflex (newborn +) • Retinoblastoma • Cataracts • Strabismus (exo, eso) vs pseudostrabismus • Corneal light reflex • Cover-uncover • Cross Cover • Adult visual acuity is developed ~6 years (20/20)

  18. Nose • External • Internal • Shine a light • Tilt the nose tip up with thumb • Patency?

  19. Infant Mouth Exam • Avoid depressing the tongue • Stimulates reflex protrusion - unable to visalize • Tongue • Fits in mouth (macroglossia?) • Can protrude past gums (short frenulum?) • Strong suck; gag reflex • Palate well-formed • Thrush vs milk?

  20. Child Mouth Exam • To get a child’s mouth open: • May have to gag them • Grading Tonsils (1+ to 4+) • Peak size 2-6 years old

  21. Strep pharyngitis • S & S? • NO cough

  22. Child Ear Exam • Restraining? (red reflex) • Sit on parent’s lap • Pull ear down and back OR up and back (child) • Pneumatic otoscopy • Tympanometry • Acoustic reflectometry

  23. Hearing Note… Speech development and hearing go hand in hand • Toys, voice • Weber, Rinne, Schwabach • 3-4 years old

  24. Newborn Chest Exam • Periodic breathing • Prolonged? Cyanotic? Newborn • Cough – concern • Sneezing – normal

  25. Chest Exam • Crackles • Stridor • Grunting Increased Respiratory Effort • Retraction (ribs, supraclavicular notch) • Contraction of SCM’s • Flaring of nostrils • Paradoxic breathing

  26. Chest Exam (Child) • Breath sounds may be louder, harsher, and more bronchial • Hyperresonance is common • Easy to miss dullness (consolidation)

  27. Asthma • Hyperreactivity • COPD • Signs and symptoms: • Anxiety • Wheezing • Dyspnea • Cough • Prolonged expiratory phase

  28. For each condition… • Know typical signs & symptoms • Clinical presentation • Expected resolution? • Treatment?

  29. Infant Heart Exam • Heart function… • Skin • Lungs • Liver • Apical pulse (rate) • Brachial vs femoral • Weak, thin, bounding? • Capillary refill

  30. Most murmurs are innocent • Investigate if: • Persists beyond 2-3 days of life • Intense • Fills systole • Occupies diastole • Radiate widely • Cyanosis = referral

  31. Congenital Heart Defects • Which ones result in cyanosis? • Tetralogy of Fallot

  32. Abdominal Exam • Infant normal: soft & rounded • If distended? Why? • Tympany – gas • Dullness – fluid, solid mass • Umbilical hernia (umbilical ring) vs. • Diastasis recti (rectus abdominus)

  33. Detectable spleen • Can be common in well infants • Liver border • Newborn: just below R costal margin • Infants/toddlers: 1-3 cm below • Children: 1-2 cm below

  34. Note • Peristaltic waves • Pyloric stenosis? • Fixed solid mass… abdomen • Don’t palpate aggresively! • Wilm’s (nephroblastoma) • Neuroblastoma

  35. For each condition… • Know typical signs & symptoms • Clinical presentation • Significance? Referral? • Expected resolution? • Treatment?

  36. Exam Tips • To inspect the infant’s neck: • supine, elevate the upper back and let the head fall back into extension • To encourage an infant to open their eyes: • Dimly lit room • Hold infant upright, suspended, over a shoulder

  37. Exam Tips • Fundoscopic exam • Patient supine • Sit on parent’s lap? • Do not force eye open • Internal Ear Exam (infant) • Supine/prone, head turned • Rest ulnar surface of hand (otoscope) against face • Stabilize head • Pull auricle down

  38. Exam Tips • Auscultating lungs (need deep breaths) • Get them active • “blow out” pen light • Abdominal Exam • Bottle/pacifier/nursing • Supine on parent’s lap • If ticklish, place child’s hand under yours

  39. (There may be more than one answer for each…) • Clubbing (Schamroth technique) • Sign of _________? • Child with “barrel chest” • Sign of _________? • Skin turgor (abdomen) • Sign of _________?

More Related