Pediatric Assessment PDF

Pediatric Assessment Health Assessment Pediatric Overview Pediatric patients are not small adults Very different anesthesia management and anesthesia priorities for pediatric patients There is a difference between a “healthy kid” and a “chronic kid” Approach to assessment of a pediatric patient is c...

Pediatric Assessment Health Assessment Pediatric Overview Pediatric patients are not small adults Very different anesthesia management and anesthesia priorities for pediatric patients There is a difference between a “healthy kid” and a “chronic kid” Approach to assessment of a pediatric patient is complex and challenging Always include the parent/caregiver and be careful of which person can legally consent for the care of the patient Some Definitions Preterm infant is born before 37 weeks’ gestation Postmature infant is born after 42 weeks’ gestation Any infant < 2500g is low-birth-weight infant Three categories for infant weight Small for gestational age Appropriate for gestational age Large for gestational age Small and large for gestational age infants are more prone to comorbidities impacting anesthesia Pediatric Growth Chart Plotting birth weigh against gestational age determines categories In the weeks following birth, head circumference, length and weight are predictive of degree of physiological insult Consult the growth chart in infants less than 60 weeks Neonatal Period Generally defined as the first 28 days of extra uterine life No longer accepted that neonates do not respond to pain or do not need anesthesia Focus in the neonatal period is on assessment of the respiratory and cardiovascular systems; others as necessary based on history and diagnosis Physical exam to rule out congenital abnormalities Common Problems in Neonates SGA INFANTS LGA INFANTS Congenital abnormalities Chromosomal abnormalities Chronic intrauterine infection Heat loss Asphyxia Metabolic abnormalities Polycythemia Birth injuries Asphyxia Meconium aspiration Metabolic abnormalities Polycythemia Respiratory System Problems Respiratory Distress Syndrome (RDS) and Bronchopulmonary Dysplasia (BPD) inversely related to gestational age at birth RDS onset as early as 6 hours post birth Tachypnea, retractions, grunting, oxygen desaturation BPD Need for supplemental oxygen, lower airway obstruction, air trapping, carbon dioxide retention, atelectasis, bronchiolitis Risk for barotrauma Cardiovascular System Problems Direction of blood flow through any shunt Baseline oxygenation Dependence of the systemic or pulmonary circulation on flow through the ductus arteriosus Obstruction to blood flow Heart failure High output Low output Hypoxic Former Preterm Infants High incidence of postoperative apnea in former preterm infants (