Health

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Health Physical Assessment in NursingFirst
Edition
Donita DAmicoandColleen Barbarito
Chapter 25 Assessment of Infants, Children, and
Adolescents
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LEARNING OBJECTIVE ONE
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LEARNING OBJECTIVE ONE

• Child and Adult Variations
• Integument
• Head, eyes, ears, nose, and throat
• Vital signs
• Respiratory
• Cardiovascular

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LEARNING OBJECTIVE ONE

• Child and Adult Variations
• Breasts
• Abdomen
• Genitourinary and reproductive
• Musculoskeletal
• Neurologic

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LEARNING OBJECTIVE ONE

• Physical Variants in the Integument System
• Increased risk of heat and water loss
• Decreased heat tolerance
• Presence of milia, lanugo, salmon patches,
  Mongolian spots, acrocyanosis, and vernix caseosa

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LEARNING OBJECTIVE ONE

• Physical Variants in the Head, Eyes, Ears, Nose,
  and Throat
• Presence of fontanels and cranial sutures, caput
  succedaneum, cephalohematomas, and head
  disproportionate to body
• Growth of lymph tissue
• Smaller sinuses

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LEARNING OBJECTIVE ONE

• Physical Variants in the Head, Eyes, Ears, Nose,
  and Throat
• Smaller external ear canals with shorter,
  straighter eustachian tubes
• Teeth eruption and loss of primary teeth
• Shorter neck and nonpalpable thyroid gland
• Decreased visual acuity until age seven

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LEARNING OBJECTIVE ONE

• Physical Variants in the Vital Signs
• Irregular breathing patterns
• Age-dependent blood pressures

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LEARNING OBJECTIVE ONE

• Physical Variants in the Respiratory System
• Thinner chest wall
• Louder and harsher breath sounds
• Abdominal breathing
• Pliant airways
• Increased oxygen needs

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LEARNING OBJECTIVE ONE

• Physical Variants in the Cardiovascular System
• Closure of ductus venosus, ductus arteriosus, and
  foramen ovale
• Sinus arrhythmias
• Louder heart sounds
• Physiological S2 split with inspiration
• Functional murmurs

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LEARNING OBJECTIVE ONE

• Physical Variants in the Breasts
• Inverted nipples
• Breast discharge
• Thelarche
• Gynecomastia

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LEARNING OBJECTIVE ONE

• Physical Variants in the Abdomen
• Presence/removal of umbilical cord
• Palpable liver edge

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LEARNING OBJECTIVE ONE

• Physical Variants in the Genitourinary and
  Reproductive Systems
• Smaller bladder capacities
• Development of sphincter control
• Genital growth
• Infant vaginal discharge as a result of maternal
  hormones

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LEARNING OBJECTIVE ONE

• Physical Variants in the Musculoskeletal System
• Ossification of skeletal bones
• Bone growth

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LEARNING OBJECTIVE ONE

• Physical Variants in the Neurologic System
• Growth of myelin sheath
• Presence of primitive reflexes
• Development of gross and fine motor skills
• Need for increased sleep

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LEARNING OBJECTIVE TWO
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LEARNING OBJECTIVE TWO

• Physical Assessment of Infants and Children
• Techniques
• Inspection
• Palpation
• Auscultation

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LEARNING OBJECTIVE TWO

• Specific Areas of Infants and Childrens
  Assessment
• Growth and development
• Skin, hair, and nails
• Head and neck
• Eyes and vision
• Ears and hearing
• Nose and sinuses
• Mouth and throat

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LEARNING OBJECTIVE TWO

• Specific Areas of Infants and Childrens
  Assessment
• Chest and lungs
• Cardiovascular system
• Abdomen
• Genitourinary system
• Musculoskeletal system
• Neurological system

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LEARNING OBJECTIVE TWO

• Growth and Development
• Measurement of height, weight, and head
  circumference (on children under age two)
• Vital signs

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LEARNING OBJECTIVE TWO

• Integument System
• Inspection of the skin for the presence of
  lesions, birthmarks, or discolorations
• Inspection of the hair and nails for texture,
  distribution, and moisture

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LEARNING OBJECTIVE TWO

• Head and Neck
• Inspection and palpation of the skull for
  deformities
• Palpation of the lymph nodes

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LEARNING OBJECTIVE TWO

• Eyes and Vision
• Inspection of the inner and outer structures for
  symmetry, position, movement, and appearance
• Measurement of visual acuity

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LEARNING OBJECTIVE TWO

• Ears and Hearing
• Inspection of the structures
• Evaluation of hearing

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LEARNING OBJECTIVE TWO

• Nose and Sinuses
• Inspection of the structures

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LEARNING OBJECTIVE TWO

• Mouth and Throat
• Inspection of the structures

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LEARNING OBJECTIVE TWO

• Chest and Lungs
• Inspection of the chest
• Auscultation of lung fields

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LEARNING OBJECTIVE TWO

• Cardiovascular System
• Inspection for cyanosis, chest pulsations, and
  PMI
• Palpation of pulses
• Auscultation of heart sounds

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LEARNING OBJECTIVE TWO

• Abdomen
• Inspection, auscultation, and palpation of the
  structures

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LEARNING OBJECTIVE TWO

• Genitourinary System
• Inspection and palpation of the structures

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LEARNING OBJECTIVE TWO

• Musculoskeletal System
• Observation of gait and movements
• Inspection of the upper and lower extremities,
  hips, and spine

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LEARNING OBJECTIVE TWO

• Neurological System
• Evaluation of mental status
• Evaluation of reflexes
• Evaluation of cranial nerves
• Evaluation of coordination, sensation, and
  movement

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LEARNING OBJECTIVE THREE
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LEARNING OBJECTIVE THREE

• Child Compliance and Safety During Physical
  Assessment
• Protection of modesty and privacy

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LEARNING OBJECTIVE THREE

• Nursing Approaches
• Caring, supportive, yet firm
• Play should be incorporated into nursing
  procedures

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LEARNING OBJECTIVE THREE

• Head - to - Toe Approach
• May not work with young children
• Threatening parts of the examination should be
  performed last

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LEARNING OBJECTIVE FOUR
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LEARNING OBJECTIVE FOUR

• Health Assessment of Children
• Physical, cognitive, and emotional development

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LEARNING OBJECTIVE FOUR

• Scoliosis Treatments
• Strengthening
• Stretching
• Bracing
• Surgery

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LEARNING OBJECTIVE FOUR

• Understandings of Health and Illness
• Understanding of health risks
• Relate illness to bad thoughts or behaviors

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LEARNING OBJECTIVE FOUR

• Approaches with Children
• Caring, supportive, firm
• Play and nursing procedures
• Painful procedures

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LEARNING OBJECTIVE FOUR

• Parents and Stress

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LEARNING OBJECTIVE FIVE
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LEARNING OBJECTIVE FIVE

• Focus Areas for Infant and Child Health Outlined
  in Healthy People 2010
• Fetal and infant deaths
• Child deaths
• Adolescent deaths

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LEARNING OBJECTIVE FIVE

• Key Objectives for Fetal and Infant Deaths
• Reduce the number of fetal and infant deaths,
  including all deaths, neonatal deaths,
  postneonatal deaths, deaths related to birth
  defects, deaths related to congenital heart
  defects, and deaths caused by SIDS

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LEARNING OBJECTIVE FIVE

• Key Objectives for Child Deaths
• Reduce the numbers of deaths in children between
  the ages of one and nine

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LEARNING OBJECTIVE FIVE

• Key Objectives for Adolescent Deaths
• Reduce the number of preventable deaths in
  adolescents ages 10 through 19

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LEARNING OBJECTIVE SIX
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LEARNING OBJECTIVE SIX

• Critical Thinking and the Nursing Process