Pediatric Assessment PDF

1/6/2025 Pediatric Physical Assessment Nursing 220 M. Woodroof, FNP-C Rev 8/24 MW 1 Rule #1 CHILDREN ARE NOT SMALL ADULTS!!! 2 1 ...

1/6/2025 Pediatric Physical Assessment Nursing 220 M. Woodroof, FNP-C Rev 8/24 MW 1 Rule #1 CHILDREN ARE NOT SMALL ADULTS!!! 2 1  1/6/2025 Growth and Development Expected and sequential pattern Growth= adjustments in the size of the child Development= ongoing process of adapting throughout the lifespan 3 Growth in Infancy Weight Height 0.5-1 ounce per day 1 inch per month for the 1.5 pounds per month first 6 months Double birth weight by 6 months Triple birth weight by 9 months 4 2  1/6/2025 Growth in Toddler (1-3 yr.) Weight Height Weight gain of 3-5 3 inches per year pounds per year Growth in Pre-schooler (3-6 yr.) Weight gain of 5 pounds 2.5- 3 inches per year per year 5 Growth in School-Age (6-12 yr.) Weight Height Weight gain of 4-6 2 inches per year pounds per year Growth in Adolescence (12-19 yr.) Girls: 15-55 pounds Girls: 2-8 inches weight gain Boys: 4-12 inches Boys: 15-66 pounds weight gain 6 3  1/6/2025 Children are Unique Communicate honestly with the child about what to expect before you do anything to them! Explain about meds & procedures! Use: Developmentally appropriate stories, puppets, + interaction... Give praise Allow choices and involvement in care Provide distractions- Toy box of med related objects (syringes, med cups, droppers…) for therapeutic play & familiarization. 7 Child Life Specialists 8 4  1/6/2025 Approach Build rapport w/ child & family before you give meds or do any procedure See & talk to you so child & family can acclimate (Never “hit & run!”) Assess & respect cultural difference Talk to child as well as parents Always give TLC after intervention 9 History Housing/ family composition Family medical history Personal medical/ surgical history Medications/ allergies Vaccination status Developmental milestones Daily Activities (SODA) 10 5  1/6/2025 Adolescent HEADS Assessment Home Education/ Employment Eating Activities Drugs Sexuality/ SI/ Safety 11 Physical Exam Always go prepared Have all supplies on hand Move quickly (borrowed time) Least to most invasive not necessarily head to toe 12 6  1/6/2025 Toddlers & Preschoolers like to imitate & help 13 Explain what you are doing to school aged kids 14 7  1/6/2025 Measuring weight NEVER take your hand off an infant/ toddler! 15 Measuring height Infants/ Toddlers: Older children: Head- to- toe standing height 16 8  1/6/2025 Head circumference until 36 months* 17 The “Growth Chart” Weight, height and head circumference are plotted Values compare child’s growth relative to others of the same age Range= 5th to 95th percentile 18 9  1/6/2025 Fontanelles Posterior fontanelle closes between 2 and 3 months Anterior fontanelle may be palpable until 18 months 19 Ear Exams/ Ear medications Children ≤3 y/o Pinna down and back if under age 3 Pinna up and back if over age 3 Children > 3 y/o 20 10  1/6/2025 Dental Issues During school-aged years, children begin to lose their ‘baby’ teeth; remember that when assessing your 5-12-year-olds *Do not need to memorize this 21 Pediatric Heart Location of the heart in the child PMI can be between 3rd-5th ICS at Left MCL (infant-school) 22 11  1/6/2025 Physical Chest Deformities Pectus excavatum Pectus carinatum (funnel chest) (pigeon chest) 23 Common Sites of Retractions If a child has respiratory distress, these are common sites of retractions 24 12  1/6/2025 Abdomen- Umbilical Hernia 25 Testicular Assessment- Descended? 26 13  1/6/2025 Pubertal Development 27 Newborn Reflexes Grasping Moro Rooting Babinski Sucking 28 14  1/6/2025 Vital Signs Temperature Heart Rate Respirations Blood pressure I/Os Pain 29 Vital Signs Heart Rate Blood pressure Respiratory Rate Age (beats/min) (mmHg) (breaths/min SBP 65-100 Infant 80-150 25-55 DBP 45-65 SBP 90-105 Toddler 70-110 22-30 DBP 55-70 SBP 95-110 Preschool 65-110 20-25 DBP 60-75 SBP 100-120 School-Age 60-95 14-22 DBP 60-75 SBP 110-125 Adolescent 55-85 12-18 DBP 65-85 30 15  1/6/2025 Selected BP Sites 31 PEWS: Pediatric Early Warning System 0 1 2 3 Playing Fussy but Any Neuro concern Lethargic Appropriate consolable different from Confused At baseline baseline Difficult to Arouse Behavior Irritable and NOT Decreased pain consolable response Pink Tachycardia of 20 Tachycardia of 30 Tachycardia of 40 Capillary refill 1-2 above normal above normal above normal rate seconds rate rate Bradycardia of Pale greater than 5 Capillary refill below normal rate Cardiovascular > 3 seconds Grey Mottled Capillary refill above or equal to 5 seconds Within normal parameters >10 above normal >20 above normal >30 above normal parameters parameters parameters or No retractions Retractions 40% FiO2 via mask below normal Respiratory 30o/+ FiO2 via mask 02 via HFNC parameters 02 via NC Grunting Tracheostomy with/ > 40% Fi02 via mask without vent 32 16  1/6/2025 Hypotension in children is determined by age and systolic blood pressure (BP), measured in mmHg. Term neonates (0 to 28 days): The systolic BP is < 60 mmHg. Infants (1 to 12 months): Systolic BP is < 70 mmHg. Children (1 to 10 years): Systolic BP is < 70 mmHg + (age in years x 2). Children > 10 years: Systolic BP is < 90 mmHg. *For example, you use the following calculation to determine hypotension by systolic blood pressure for a 7-year-old: 70 mmHg + (7 years of age x 2) 70 mmHg + (14) =84 mmHg Therefore, a 7-year-old child is hypotensive when the systolic blood pressure is less than 84 mmHg. 33 Pain Scales FLACC Wong- Baker Faces Numeric 34 17  1/6/2025 Pain Scale (FACES) 35 Always use “9” Rights of Med Administration… Right child Right medication Right dose Right time Right route Right documentation Right approach (G & D) Right to be educated Right to refuse 36 18  1/6/2025 Medication Administration Tips To identify child ask “What is your name?” and ALWAYS check ID band Never say “Are you Susie Jones?” Child may say yes to authority figure or be confused, drowsy or wanting to avoid their own therapy (may even switch beds!) 37 Intramuscular injections Pediatric Intramuscular Injection Guidelines Site Infant Toddler Child- Adolescent Needle: 5/8 inch Needle: 5/8 - 1 inch Needle: 1 inch Vastus Lateralis Gauge: 23-25 Gauge: 22-25 Gauge: 22-25 Volume: 0.5 – 1 ml Volume: 0.5 – 2 ml Volume: 1 – 2 ml Needle: 5/8 – 1 inch Needle: 1 inch Ventrogluteal NOT RECOMMENDED Gauge: 22-25 Gauge: 22-25 Volume: 1 - 2 ml Volume: 2 – 5 ml Needle: 5/8 – 1 inch Needle: 5/8 – 1 inch Deltoid NOT RECOMMENDED Gauge: 22-25 Gauge: 22-25 Volume: 0.5 ml Volume: 1 – 1.5 ml Needle: 0.5- 1.5 inches Dorsogluteal NOT RECOMMENDED NOT RECOMMENDED Gauge: 22-25 Volume: 1.5 - 2 mls 38 19  1/6/2025 A. Vastus lateralis B. Dorsogluteal C. Deltoid D. Ventrogluteal 39 Subcutaneous injections One ml is maximum for all subcutaneous injections. Preferred sites in children are the anterolateral thigh (under 12 months) or the subcutaneous tissue over the triceps muscle (over 12 months). 40 20  1/6/2025 Calculating Pediatric Fluid Requirements Formula to calculate child’s 24 hr fluid maintenance requirements: 100 ml/kg for 1st 10 kg of body wt 50 ml/kg for 11-20 kg of body wt 20 ml/kg for each additional kg of body wt over 20 kg 41 21