Ped- 244 final

Maternal history, biographic data, labor and delivery, present health status, and family history

Teaching need

• developmetnal readiness
• get acquainted time
• determine best exam place
• be systematic, yet flexible
• examine intrusive or painful areas last

• Newborn- birth to 28 days
• Pre- term: <37 weeks
• term: 37-42 weeks
• Post-term- >42 weeks

• Birth- 6 months: Immoblie, safety, comfort, sensory stimulation
• 6 months-12 months: Separation/stranger anxity, warm up play techniques, examine infant on parents lap if appropriate

age 1-3 years, parent's lap provide security, play, least inrusive assessment first, avoid no responses, offer choices, and let touch equipment

age 3- 5/6, keep parent close, exam table, protect modesty, consider magical thinking, use safe words, let touch equipment

age 6-10/12: Head to toe exam , address questions directly to child, give concrete explanations, answer questions honestly

• Pre- 10-12 years
• Adolescent: 13-18/21
• Confidentiality
• privacy (exam alone)
• Preventive services
• Issues: body issues, eating disorders, pregnancy, STD, violence

• Tachypnea: rapid breathing
• Retractions: intercostal retractions- trouble breathing
• Dyspnea: SOB
• Grunting
• Faring
• Anxiety & air hunger
• Inspriatory stridor
• Second hand smoke

It is higher and shorter so more respiratory problems

Restlessness, anxiety or agitation indicate hypoxia, increased HR and RR, stridor/retractions, pallor/xyanosis, avoid sedatives that deress repirations

• Higher than adults go to 12-20 a min b/w 10-18 years
• Respirations should be counted for a full minute
• Assess when child is calm
• Infants/children under 7 are abdominal breathers
• BV in lungs when younger

• Acute spasm of larynx resulting in partial airway obstruction
• Peak: 6 months-2 years, grow out of
• Cause: Viral
• Mild fever, inspiratory stridor, barking cough
• Give plenty of fluids

• Medical emergency
• Severe inflammation of eiglottis that progresses rapidly
• peak: 3-8 years
• Bacterial
• High fever, trouble swallowing, cherry red color, severe distress, upper airway obstruction, DO NOT examine throat

• Inflammation of larynx, trachea, and bronchi.
• Predominately in infacts and toddlers
• Viral
• Gradual onset
• Labored inspirations

• Inflammation of bronchioles and alveoli
• Retractions, tachypnea, labored resps
• percussion: dullness
• vesicular BS change to Bronchial or BV

• Higher HR than an adult
• In infants under 1 year take aprical pulse because radial pulse is difficult to palpate, count for a full minute

• Birth to 1 year: 80/50
• 1 to 5 years: 90/60
• 5 to 10 years: 100-110/60-70
• 10 to 16 years: 110-120/70-80
• Measure annaully at age 3 and up
• use dynamap in infants
• use appropraite pediatric cuff

• -Apical impulse at 4th ICS left of MCL, by age 7 reaches 5th ICS at MCL
• -Heart sounds louder and more high pitched
• -Some children have physiologic murmurs, does not indicate disease
• -Assess peripheral pulse, especially newborns

Growth patterns, clubbing, SOB, fatigue, suck reflex, having trouble keeping up with activity, murmurs, chest pain

• Infant history: breast or bottle fed, spitting up, response to new foods, bowel movements, food allergies.
• Infants have a soft, round abdoment with slight protrusion- bowel sounds in center of abdomen
• -Diastatis recti- when crying, muscle seperation
• -Umbilical cord: 2 arteries, 1 vein
• -Liver palpable .5-2.5 cm below right costal margin for newborns, 1-2 cm below for infants

• -24 hr diet recall, likes, dislikes, Pica- eating non-nutritional foods like stuffed animals
• -liver palpable 1-2 cm below right costal margin
• -Spleen 1-2 cm below left costal margin
• -Less palpable with age

• -Eatting patterns, 24 diet recall, weight loss or gain, level of activity
• -laxative use, vomiting
• -View self as thin or overweight
• -Same assessment as the adult
• -Privacy issues with exam

• Anorexia
• Bulimia
• OBessesd with food, weight, distorted body image
• Control issue
• Tooth decay, anemia, dry skin, hypotension, etc

• Cranial bones soft at birth (soft sport)
• Sutures ossify around age 6
• assess for congenital birth defects
• Bones arent fused at birth

• Children: Height, weight each visit, look at percentiles
• Assess gait, knees for alignment
• Toddlers have a wide stance which ends after 2.5 years

• Adolescents:
• Screen for scoliosis
• Injuries due to sports or trauma

• System develops at 20 weeks, very susceptible to infection due to inability to produce immunoglobulins
• Receive IgG from Mother through passive immunity

increase b/w ages 6-9, larger than adults, shotty nodes 3mm to 1 cm in cervical and inguinal areas, small nontender nodes

• Head: Symmetry of skull and face
• Neck: Structure, movment, trachea, thyroid, vessels, lymph nodes
• Eyes: vision, placement
• Ears: hearing, external ear, ear canal, and otoscopic exam of tympanic membrane
• Nose: nose and sinuses
• Mouth: Structures of mouth, teeth and phaynx

Head circumference: asses each visit for first 2 years of life Measure just above eyebrows, rapid increase in HC during first 3 months of life 34-35 cm at birth

Fontanels: Anterior 2.5-4 cm, close by 24 months. Sunken- dehydration, bulging: increased hemorrhage

Molding: cone head, overlapping of sutures due to pressure from birth. Resolves in a week

• Accumulation of fluid beneath scalp
• crosses the suture line
• Normal findings: resolves in 3-4 days after birth

• -Collection of blood and fluid beneath scalp, localized over one cranial bone, does not cross suture line
• Normal finding: take 3-4 weeks to resolve

• Assess for symmetry, twitching-should be none, tics, edema
• Assess expression

• Symmetry: outer canthus should align with pinna of ear
• Wide set or close eyes can indicate chromosomal problems
• Assess conjunctive for drainage
• 2-4 weeks: can focus on objects
• 3-4 months: coodination of EOM and follow objects
• 5-6 months: Follows peoples movements, plays with hands

• Gets to 20/20 at age 6
• Use E on snellen chart to assess vision until age 6
• Color vision age 4-8

• Turns head side to side by 2 weeks of age
• Steady head control at 3-5 months
• Assess for short neck (Down Syndrome) or webbing (turners Syndrome)
• Head lag (poor neck control) after 6 months may indicate CP
• Assess shape and size of thyroid

• Assess color, drainage, uvula size
• Tonsils
• Bed breath can indicate chronic sinusitis, infected tonsils
• Tonsils grow to maximum size between 2-6 years, can obstruct airway

• Assess nasal patency
• Infants are nose breathers
• Nasal flaring is respiratory distress
• watery discharge with allergies
• Yellor or green discharge: infection

• Maxillary and Ethmoid sinuses present at birth
• Frontal sinuse develops around age 7
• palpate and transilluminate

• Inspect mucosa, gingivae, tongue
• Assess for cleft palate
• Tongue movement
• Lips for color
• Salivary glands developed by 3 months

• 4-6 months- infant turns head to sound
• 6-10 months- responds to name and follows sounds
• Assess for hearing loss if decreased vocabulary
• Assess ears for abnormalities of auricle
• Low set ears- mental retardation
• Tragus and auricle pain: otitis externa
• To examine pull pinna down and back to straighten out until age 3
• hearing screenings at birth

• Primary concerns: Reflex, posture, tone
• closely tied with developmental tasks
• voluntary control will take over as brain develops
• Functions develop in orderly process

• Signs are vague and conroversial
• Clumsiness, language distrubances
• delay in child to perform age specific activites
• continued presnce is a developmental delay or lag

• Moro or startle
• Tonic: Head to one side, other side arm and leg up disappears 4- 6 months
• Palmer grasp: Disappers 3-4 months
• Step in place
• Babinski- Disappears at 18 months
• Rooting: disappears at 3 months

• Newborn red in color-decreased fat, vasomotor instability
• Covered with white wazy coating (Vernix Caseosa)
• Immediately after birth lips, nail beds, and feet may be cyanotic
• Temp regulation not develop
• Sub-Q fa layer is poorly developed
• Apocrine glands not active until adolescense-mid perspiration odor

• Storkbites, Angelkiss- Vascular birthmarks
• Strawberry Mark- Immature hemangioma, slightly raised sharp demarcation 2-3 cm in diameter, disappear by age 5
• Cavernous Hemangiomas- reddish round mass blood vessels, may continue to grow until 10-15 months, regularly reassess

• Lanuago- soft fine hair on ears, shoulds, and back-sheds 10-14 days after birth
• Postmature infants will have long nails
• Tufts of hair on back of spine- spina bifida

• Bruising-inconsistent brusing with development= suspicion
• Common lesions associated with communicable diseases
• Varicella-Chickenpox
• Rubella, Rubeola, Roseola
• Tinea corporis
• Impetigo
• Pediculosis
• Scabies

• Result of prolonged contact with urine and feces
• Can be fungal with lesions
• Treatment: If dry, wet it. If wet, dry it!
• Caldesene medicated powder or desitin cream

• Most common cause is Staphyloccus aureus, can be strptococcal.
• Predisposing factors; poor hygiene, antecednet lesions
• Occurs around the mouth and nose as oozing that becomes honey-crusted lesions
• Scratching will spread the infection
• Treatment: antiseptic soap/water, ATB

• Ringworm: superficial fungal infection that is most prevalent in hot, humid climates and children
• Transmitted by direct or indirect contact and is communicable as long as lesion is present
• Treatment: fungal cream or griseofulvin for systemic treatment
• Keep skin dry, avoid tight clothing

• Caued by mites that burrow under the skin to lay eggs
• Pruitus is caused by feces and ova
• Highly communicable and spread skin to skin
• Most common sites are the finger webs, wrists, and anticubial fossa
• Lesions are linear, threadlike, grayish burrows
• Treatment: Elimite cream applied and left on skin 8-14 hours head to toe

• Apocrine glands enlarge and become active
• Incresed sebaceous gland activity
• Have oiler skin

• Increased andrgoen levels
• Axillae adn pubic areas will develop coarse terminal hair
• Nails: same as adults

• Tanner Stages- developmental assessment
• Asymmtrically-normal may resolve
• Gynexomastia- normal, resolves

Yes, if not many injuries can occur

Aorta problems

The Denver developmental Screening Test- tests approproiate milestones for a child's gross motor, language, fine motor, and personal social development

• Cognitive and Language development (Piaget)- Sensorimotor stage
• Moral Development (Kolberg)- Love and affection of the parents, follows them
• Psychosocial Development (erikson)- Trust v. Mistrust
• Psychosexual Development (Freud)- Oral Stage

• Check at 1 and 5 minutes after birth
• Score less than 8 may indicate poor transiton from intrauterine to extrauterine life

• Stage 1-5 based on Tanner
• 1: none
• 5: highest

• Stage 1-5, based on Tanner
• Stage 1: No hair
• Stage 5: Adult configuration, adult pattern hair

• Stage 1-5, based on Tanner
• Stage 1: No hair
• Stage 5: Inverse Triangle

• Toddler- Sensorimotor to Preoperational Stage
• Preschoolers- Preoperational
• School-age children: Operational
• Adolescents: Formal Operations Stage

Toddler- precoventional stage, punishment and obedience

Preschooler- preconventional stage, 10 years, external control

School-age child- role conformity-please others

Adolscent- postconventional, individual conscience and defined set of moral values

• Toddler- Autonomy versus shame and doubt
• Preschooler- initiative v. guilt
• School-age child- industry v. inferiority
• Adolescent- identity v. role diffusion

• Toddler: Anal stage
• Preschooler: Phallic Stage
• School-age chld: Latency period
• Adolescent: Genital Stage