NSB103 Lecture Notes - Lecture 3: Lanugo, Fremitus, Soft Palate
Week 3: Paediatric and Older Patient
Assessment of the Child
• treat like an individual
• Developmental stages
• Physical growth (predicts health)
-weight
-length
-head circumference
• Growth charts + rapid growth period
• WHO Child Growth Standards
• ALL same vital signs
• Child have problems regulating temperature - at risk of hyperthermia
• At 4 year they have temperature control
• Systolic BP = 80 + (2 x age)
• Diastolic BP = 2/3 of systolic
• Skin - Lanugo and Vernix casinos
• Depended nose breathing for 4 months
• Heart more horizontal
Planning
• Health History
• Evaluate subjective data
• Objective data
• Suitable environment
General Approach
• Assess pt in warm room
• Natural lightening
• Have familiar caregiver present during assessment to reduce anxiety and uncooperativeness
• Talk in soothing voice
• Explain all procedures and allow children to touch or manipulate medical equipment
• Allow infants to sit on caregiver's lap to promote security
• Maintain eye contract with caregiver until infant is comfortable
• If appropriate interview older school-age children separately from caregiver
• Respect modesty
• Warm equipment
• Avoid startling child
• If child is sleeping, perform simple procedures and assessment
• Perform invasive procedures last
• Provide comfort measures flowing pain
• To prevent falls, always keep one hand on infant who is being examined on examination table
• Provide opportunities for caregivers to ask questions
Anatomy and Physiology
• Neurological system
-incomplete at birth
-neurons become myelinated in 1st year
• Urinary System
-bladder control progressively
• female genitalia
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Document Summary
Assessment of the child treat like an individual: developmental stages, physical growth (predicts health) Systolic bp = 80 + (2 x age) Planning: health history, evaluate subjective data, objective data. If child is sleeping, perform simple procedures and assessment. Neurons become myelinated in 1st year: urinary system. Development of public hair (8-10yrs: male genitalia. Paediatric pain assessment: pain increases child"s sense of fear and vulnerability, no assessment tool is identified as best, age and developmental level should be considered, wong-baker faces rating scale. Physical examination: approaching a child vary for age group, basic principle is building trusting relationship. Always explain what will be done prior to each part of assessment. Show respect to child as an individual and allow expression of feelings. Inspect colour, lesions, palpate texture: hair, head: Inspect for symmetry, shape, head control, palate fontanelles, suture lines, surface characteristics: eyes:
