Physical Examination Across Age Groups

Developmental Considerations in Physical Exam

• Learning Outcome: Integrate concepts, principles, and techniques of physical examination to assess client health using appropriate tools, considering growth and development variations.

Content

• Developmental Variations in Physical Assessment/Examination
  • The Infant
  • The Toddler
  • The Preschool Child
  • The School Age
  • The Adolescent
  • The Aging Adult
  • The Ill/Sick Person
  • Standard Precautions for All Patients

Examining an Infant

Position

• The parent should be present for the infant's security.
• Place the infant flat on a padded examination table.
• For some steps, the infant can be held against the parent.
• If the infant can sit without support (around 6 months), the examination should be performed in the parent's lap.
• By 9–12 months, the parent must remain in the infant's full view.

Preparation

• Examine the infant 1–2 hours after feeding.
• Maintain a warm environment.
• Warm hands and stethoscope.
• Use a soft voice.
• Maintain eye contact with the infant.
• Smile.
• Use a pacifier for crying.
• Offer toys for distraction when fussy.

Sequence

• Listen to heart, lungs, and abdomen sounds in a sleeping infant first.
• Perform less distressing steps first, then the invasive ones (eye, ear, nose, and throat).
• Sequence includes vital signs, measurement (weight, height, head circumference), and general appearance (head to toe).

Examining a Toddler

Position

• The toddler should sit on the parent's lap for the entire examination.
• Parents should help position the toddler during invasive procedures.

Preparation

• A security object, like a blanket or teddy bear, may be helpful.
• Toddlers often resist removing clothing.
• Use clear, firm instructions using a tone that expects cooperation.
• Toddlers like to make choices; allow limited options.
• Praise cooperation.

Sequence

• Start with non-threatening areas.
• Save more stressful procedures (head, ear, nose, throat) for later.

Examining a Preschooler

Position

• 3-year-olds: Parents hold on lap;
• 4-5-year-olds: Comfortable on a table with parents present.

Preparation

• Preschoolers can communicate verbally, but their understanding is still limited.
• Use short, simple explanations.
• Allow the child to play with equipment to reduce fears.
• Let the child hold the stethoscope.
• Compliment cooperation.

Examining a School-Age Child

Position

• The child sits on the examination table.
• Has a sense of modesty.
• The older child (11-12 yrs) can decide on presence of parents/siblings.

Preparation

• Divert attention with casual conversation (family, school, friends, hobbies).
• Show how the equipment works.
• Comment on the body and how it functions.
• Enthusiasm at heart sounds is rewarding.

Sequence

• As with an adult, progress from head to toe.

Assessing an Adolescent

Position

• The adolescent sits upright on the examination table.
• Examine alone.

Preparation

• Provide feedback that the adolescent's body is developing normally.
• Communicate with care, do not overestimate or underestimate.
• Provide health teachings to promote wellness and positive attitudes.

Sequence

• Use the head-to-toe approach.
• Examine genitalia last and quickly.

Assessing Older Adults

Position

• Sit on an examination table;
• Frail patients may need to be supine.
• Sequence minimizes position changes to prevent postural hypotension.
• Allow rest periods to avoid exhaustion.

Preparation

• Adjust examination pace for slower pace.
• Physical touch is appreciated.
• Do not mistake decreased hearing/vision as confusion.

Sequence

• Use the head-to-toe approach like younger adults.

References

• Weber and Kelly (2018): Health Assessment in Nursing (6th ed.)
• Udan (2009): Health Assessment and Physical Examination (1st ed.)

This quiz explores key concepts related to physical examinations for different age groups, including infants, toddlers, preschoolers, and older adults. Test your knowledge on Erik Erikson's theories and the appropriate examination techniques for each stage of life.