Vitals

1
Vitals

• Adapted from Mosbys Guide to Physical
  Examination, 5th Ed.
• Ch. 3

2
Vitals

• Pulse
• Respiration
• Blood pressure
• Temp
• Height weight (infants and children)

3
Pulse

• Apical pulse
• 5th intercostal space in the midclavicular line
• Femoral pulse
• use a point halfway from the pubic tubercle to
  ASIS as a guide

4
Pulse
5
Respiration

• Infants rise and fall of the abdomen
  facilitates counting
• Rate
• Regularity and rhythm
• Depth
• Difficulty use of accessory muscles

6
Respiration
7
Blood Pressure

• Cuff size (children)
• Width should cover 2/3 of the upper arm or thigh
• Too wide - underestimate BP
• Too narrow - artificially high BP

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8
Temperature

• Tympanic thermometers are becoming increasingly
  popular
• Accuracy depends on correct technique
• Must read tympanic membrane which shares blood
  supply with the hypothalamus

9
Temperature Young Infants

• Traditional routes may be more accurate
• NOTE axillary temp correlates well with core
  temp of newborns
• due to the infants small body mass and uniform
  skin blood flow

10
Height - Infant

• Infant measuring mat
• OR
• Mark on a sheet of headrest paper

11
Height - Child

• Stature measuring device
• (or height chart)
• child is able to stand without support
• approx. 24 months old

12
Weight

• Infant platform scale
• More accurate
• (ounces or grams)
• Child may sit or lie
• Place paper or blanket under the child
• weigh it out

13
Growth and Measurement

• Adapted from Mosbys Guide to Physical
  Examination, 5th Ed. Ch. 5

MacGregor, 2000
14
Newborn

• Most babies born to the same parents weigh within
  6oz of each other at birth
• Lower birth weight consider an undisclosed
  congenital abnormality or intrauterine growth
  retardation

15

• Average Weight
• 5 lb, 8 oz 8 lb, 13oz (term newborn)
• Expected growth
• Double birth weight by 4-5 months
• Triple birth weight by 12 months
• NOTE on average formula-fed babies are heavier
  after the 1st 6 months than breast-fed babies

16

• Average Length
• 18-22 in (45-55cm) long at birth
• Expected Growth
• Length increases by 50in the 1st year of life

17
Growth

• Infancy
• Growth of the trunk predominates
• Fat increases until 9 months of age
• What happens at 9 months?
• Childhood
• Legs are the fastest growing body part
• Weight is gained at a steady rate
• Fat increases slowly until 7 yrs of age when a
  prepubertal fat spurt occurs before the true
  growth spurt

18
Growth

• Adolescence
• Trunk and legs elongate
• About 50 of the ideal weight is gained
• Skeletal mass and organ systems double in size

19
Gender Differences
20
Measurement

• Infant
• Length
• Weight
• Head circumference
• Chest circumference
• Child
• Height
• Weight

21
Recumbent Length

• Measurement of choice for infants birth to 24-36
  months

22
Recumbent Length

• Tear a length of headrest paper
• Lay the child on top of the paper
• Mark the top of the childs head
• Ask mother to hold child in place
• Extend leg and mark under the heel (foot
  dorsiflexed)

23
Recumbent Length

• Measure to the nearest 0.5 cm or ¼ in.
• Chart on appropriate growth curve for sex and
  age
• Identify the infants percentile
• Note any change or variation from the population
  standard or the childs norm

24
Standing Height

• Child stands erect
• Heels, buttocks and shoulders against the wall
• Looking straight ahead
• Outer canthus of the eye should line up with the
  external auditory canal
• Slide the headpiece onto the crown

25
Standing Height

• Use once the child is walking well
• Usually about 24-36 months
• Stature is recorded to the nearest ¼ in (0.5 cm)

26
Infant scale (oz or g)

• Distract the infant and balance the scale
• Read the weight to the nearest ½ oz (10g) when
  the infant is most still
• Chart on appropriate growth curve for sex and age
• Identify the infants percentile
• Note any change or variation from the population
  standard or the childs norm

27
Head Circumference

• Measure the infants head at every health visit
  until 2 years of age
• Yearly from 2-6 years of age
• Newborn 13-14 in (33-35 cm)
• NOTE By 2, the head is 2/3 its adult size

28
Head Circumference

• Measure the largest circumference with the tape
  snug
• Occipital protuberance
  to the supraorbital
  prominence

29
Head Circumference

• Nearest 1/4 in (0.5 cm)
• Repeat to check the accuracy of your measurement
• Chart on appropriate growth curve for sex and age
• Identify the infants percentile
• Note any change or variation from the population
  standard or the childs norm

30
What if?

• Head circumference increases rapidly
• Rises above percentile curves
• Increased intracranial pressure
• Head circumference grows slowly
• Falls off percentile curves
• Microcephaly

31
Chest Circumference

• Measure around the nipple line to the nearest 1/4
  in (0.5 cm)
• Firmly but not tight
• enough to cause
• an indentation in
  the skin

32
Head vs. Chest Circumference

• Newborn to 5 months
• Head may be equal or exceed the chest by 2 cm
• 5 months to 2 years
• Chest should closely approximate the head
  circumference
• 2 years
• Chest should exceed head circumference

33
Growth/ Development Abnormalities

• What might you detect by recording height,
  weight, head chest circumference?
• Failure to thrive
• Craniosynostosis
• Hydrocephalus
• Turners syndrome etc.

34
Failure to Thrive

• Failure of an infant to grow at normal rates
• May be related to
• Chronic disease
• Congenital disorder (brain, heart, kidney)
• Inadequate calories and protein
• Improper feeding methods
• Intrauterine growth retardation
• Emotional deprivation

35
Failure to Thrive

• An emotionally deprived infant will not grow
• Growth hormone levels will be low
• Once the child is given attention, growth
  hormone will be produced and the child will grow.

36
Craniosynostosis
www.emedicine.com/neuro/topic80.htm

• Early closure of suture(s)
• Associated with
• small head circumference (microcephaly)
• rigid sutures

www.emedicine.com/neuro/topic80.htm
37
Hydrocephalus

• Excess CSF accumulates between the brain and the
  dura or within the ventricular system
• Resultant increased ICP leads to
• head enlargement
• widening of sutures and fontanels
• lethargy, irritability, weakness
• setting sun eyes

38
Turner Syndrome

• Abnormality of sex chromosomes
• Characteristics include
• Short stature
• Absence of sexual development
• Webbed neck
• Shield-shaped chest
• Hypoplastic axillary nipples
• Increased carrying angle
• Congenital abnormalities or heart or urinary tract