Pediatric Physical Exams Discussion 12.1

Pediatric Physical Exams Discussion 12.1

Pediatric Physical Exams Discussion 12.1

Discussion Guidelines

Initial Post

Discuss one approach of the physical exam for each pediatric age group—newborn, infant, and school-age child—that differs from that for the adult patient.

Then, using Chapter 18 of your Goolsby and Grubbs text, select one common diagnosis and one less-common diagnosis for the pediatric patient. Describe how you would be able to differentiate them from each other on exam.

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Response Post

Reply to the initial posts of at least two classmates.

Submission

Post your initial and follow up responses and review full grading criteria on the Discussion 12.1: Pediatric Physical Exams page.

Week 12: The Comprehensive Physical Exam of Children

Welcome to the twelfth week of Advanced Physical Assessment. During this week, you will continue coordinating the comprehensive physical exam. The focus of this week is performing physical exams of the newborn, infant, and young school-aged child. Please keep in mind that because there is a pediatric nurse practitioner specialty degree, this unit will provide only a brief overview of the pediatric assessment, as family nurse practitioners do not typically perform this focused exam in detail. You will learn how to identify those normal typical landmarks. Remember, this will help you identify the abnormal findings. Then you will continue to review the proper terminology for identifying and then appropriately documenting those subjective and objective findings. Finally, you will utilize your differential diagnoses book to help you recognize the similarities, yet uniqueness, of diagnoses specific to your week’s system of focus.

Review a list of all items due this week in your course syllabus.

Lesson 1: Assessing Children: Infancy Through Adolescence

During this lesson, you will continue coordinating the comprehensive exam, focusing on the newborn, infant, and young school-age child. You will also look at different exam techniques and review proper terminology for objective findings. Please note that this is just a brief summary of pediatric health. This topic requires far more attention from specialists and will only be covered in a general sense in this course.

Learning Outcomes

At the end of this lesson, you will be able to:

Begin the practice of sequencing and coordinating the comprehensive physical exam of the adolescent and child patient.

Identify the anatomical landmarks of the human body of children and adolescents.

Correlate examination techniques of the adolescent body systems using the correct sequence and anatomical landmarks in an adolescent patient.

Use correct terminology to record objective components of the physical examination findings.

Before attempting to complete your learning activities for this week, review the following learning materials:

Learning Materials

Read the following in your Bates’ Guide to Physical Examination and History Taking textbook:

Chapter 25, “Children: Infancy through Adolescence”

These readings will help you perform a newborn, infant, and young school-age child assessment, recognize pertinent positives and negatives related to that system, and also document appropriately.

Pediatric Head-to-Toe Physical Exam

The following video will give specific information regarding the steps taken during a pediatric physical exam.

Pediatric Head-to-Toe Physical Exam Transcript

Transcript—Pediatric Head-to-Toe Physical Exam (NUR 600, Week 12)

Woman: This is Ally Houstis for my physical assessment and here is my notes. Hi. How are you? What is your name?

Boy: Jackson

Woman: Jackson. Well my name is Ally. Can I do your assessment today? Good. I’m going to wash my hands okay?

You want to wash your hands? Okay. No. Are you sure? You do want to. Well let me get you some. Here you go. Rub, rub, rub. There you go. Good job. It’s important to have clean hands. Alright, well I’m going to start my head-to-toe assessment. I’m going to look at your hair, look at your scalp and make sure it’s not too dry and there’s nothing crawling around in there. Right? Feels nice and good. Your fontanelles are closed. How old are you? You’re four. Wow. Yeah your fontanelles would be closed. Look at me.

Boy: I want to look at the sea.

Woman: Okay you can look at the sea. I’m going to feel your lymph nodes. I can feel those occipitals, and then pre and post arcuate. There we go, good job. The posterior cervical, and the anterior, good. I’m going to the submental, right here. And the submandibular, right here. I don’t feel any big, swollen glands or any what we call lymphadenopathy. Here put your shoulders down. There you go. The supraclavicular, they all feel nice and supple and not swollen at all. There we go. Good job. You’re doing good.

Alright. I’m going to look at your eyes. Your conjunctiva is nice and pink. It’s not red or inflamed. You want me to do this text next? Alright. I’m going to look into your eyes, okay? Ready. Okay. There we go. It’s going to be a bright light. Just look at my nose. Right here. Good. And this side, keep looking at my nose. Good job. Good. Pupils react nicely, they’re equal. Okay. One more time. Now look there, right there see that green butterfly up there? Can you look at that green butterfly? You ready? Keep looking. Keep looking at the green butterfly. Look, look, look. Red reflex [0:2:48 inaudible]. Keep looking at the green butterfly. Good job. Over here.

Boy: Mommy can I spit my gum out?

Woman: Yes you may. Hold on just a moment. Keep looking at the green butterfly. Open, open open. Good job. That’s limited due to his age.

I’m going to pause it just for a second. Sorry about that.

Okay sit up for me. Okay, look straight ahead. Keep your head very still. Let me hold your chin so you keep your head very still. Can you look at this, just with your eyes? Are you ready? Good job. Oh you’re doing so good. Awesome!

Now, I’m going to show you how to use this. Here let me see your hand. Ready turn it over. I’m going to stick it on your head. Do you hear it?

Boy: Yeah

Woman: Do you hear it in one ear or both ears?

Boy: Both ears.

Woman: Both ears. Good job. Did it stop? Alright. Can you hear it? Tell me when it stops okay? When you can’t hear it anymore. Did it stop? Can you still hear it? Good job that’s how it’s supposed to work? You’re supposed to do it that way.

Now, you want me to look in your ears. Awesome. Here sit up for me. Alright. Now look in your ears, can I see if there are any bunny rabbits in there or any kitty cats? Nope, no bunny rabbits or kitty cats, just a nice tympanic membrane all intact. Yes. It is pearly gray, there’s no redness or erythema. Oh you want me to look in this ear too. Let me see if I see any kitty cats in this ear. No bunny rabbits or kitty cats, but I do see a nice ball of wax in there. Ha you’ve got a ball of wax in your ear.

Boy: No I don’t.

Woman: You don’t? Well let me see your nose. Up, up, up. Yup there we go. No septum deviation. It’s nice and pink in there. It’s not red or excoriated. Okay now I need to see your tongue.

Boy: Ahhhh.

Woman: Let me get a tongue depressor okay? Here we go. You ready. Say ah.

Boy: Ah.

Woman: Keep saying ah.

Boy: Ah.

Woman: Ah good job. Good job. You did exactly what I needed you to do. Check your 0:5:50 inaudible] reflex. Let me see if your teeth are intact. Do this for me. Perfect, perfect. Can you stick your tongue out at me? Can you stick it to the side? What about the other side? Up?

Down? Good job.

Alright, we’re done with these toys for a minute.

Boy: They’re not toys.

Woman: No they’re not toys. Alright let me feel your neck, okay? Your trachea is nice and midline, where it needs to be. Very good. Let’s turn around for me. Good job. Okay. Can you swallow for me? Good. Lift your head up a little bit more. Now swallow. Good deal. Alright. Your thyroid is nice and small, where it’s supposed to be. I don’t feel any goiters, equal on both sides. Alright, are you ready for me to, what should I do next? Are you ready? Okay. I need to look, I need to feel one, two more lymph nodes. Can I do that real fast? They’re right here. I don’t feel any in lymph nodes in there. Alright. How about your elbow? I don’t feel it. Nope I don’t feel it at all. You’re doing so good.

Okay, can you lift your shoulders for me? Don’t let me push them down. You’re so strong. Good job. Yeah your strength is very good. Can you squeeze my fingers? Hard, hard as you can, hard as you can. Oh man, you’re strong, you’re equal on both sides. Nice strength for me. Okay do this. Hold your fists like this, don’t let me pull them back. Oh wow. Okay, push against me. You’re knocking me back. You’re so strong. Well let’s check the strength in your knees. Don’t let me push your legs down. Oh you’re strong. Now you push my hands down, push, push, push, push. There you go good job. Lift your feet up, toes up, toes to the sky, toes to the sky. Push your toes down, push, push, push your toes down. Good job. Alright.

Hey while were here let’s go ahead and check your reflexes. You ready? Okay. Nope put your knees down.

Boy: Can I please hear my…?

Woman: Yes you can hear your heart in a minute. Put your knees down. Let them relax. There you go, you ready? There that was a good one. Ready? Do it again. Relax your leg. Good job. Okay let me see this a sec. Hold on. Turn over. Ready? Okay. Let me do this side. Oops. Let me see your arm. There we go. Let me see your hand. There you go. Perfect. Good. Good job.

Boy: Mommy can you check my heart?

Woman: Just a minute we’re almost ready. Sit up for me. Okay, now I’m ready to listen…nope let me check your pulses. Let me see your hands. Those are strong pulses there, they’re equal and regular. Let me see down here, and your legs feel nice and warm, good circulation. I’m looking at your skin too. Oh goodness, you’ve got some nice skin. Let’s see your toes. Cap refill is good, it’s less than two seconds on his lower extremities; less than two seconds on his upper extremities, both sides.

Hey, you’ve got a little booboo right here. What happened?

Boy: John did that.

Woman: Oh man. Who’s John. Is that your friend at school?

Boy: Uh huh. And then I kicked him and hugged him.

Woman: Yes. We’re supposed to be nice to our friends.

Can you put your arms like this? Good job.

Let me see, but you have to always be careful. Okay sit down. Actually, while you’re standing there, turn around and look at that butterfly. Do me a favor? I feel your iliac crest. Does that tickle? Stand up real straight. Good, can you bend over for me and touch your toes? Remember touch your toes. Good. Good. I don’t see any curvature of the spine. It looks nice and straight. Okay sit down and stare at the pretty butterfly, okay? Good job. Don’t try to get it. Are you ready? Say ninety-nine.

Boy: Ninety-nine.

Woman: Again.

Boy: Ninety-nine.

Woman: Again.

Boy: Ninety-nine.

Woman: Good job.

Boy: One hundred.

Woman: One hundred. Sit down. You ready?

Boy: Uh huh.

Woman: Okay, I’m going to tap on your back, you’re going to hear funny noises.

Boy: Somebody’s on the door. Mommy somebody’s on the door.

Woman: Really?

Boy: Uh huh. Listen.

Woman: Good. There’s your diaphragm. I hear it. I hear where your lungs stop. I’m not going to measure it, just for the sake of his age. I’m going to listen to your back really fast, okay? You’re going to have to take deep breaths. Are you ready? Sit down on your bottom. Deep breath. Deep breath. I’m going bilaterally, listening for any wheezing or any bronchi, poor sounds, [0:12:57 abnormal] breath sounds. Oh did that make you cough? All right lungs clear auscultation. One more. This way. Sit up for me. Turn around. Sit down on your bottom. Real straight. Now I’m going to listen to your heart. Okay? Let’s see. Alright. I’m going to listen to…

Boy: Can I hear too?

Woman: You can hear it after Mommy, okay?

Boy: Okay.

Woman: Listening for the aortic, the pulmonic. Bubble in your mouth, ready. 1, 2, 3 bubble. No sounds, sit up please. Good. Oh, there’s the tricuspid and the mitral. Let me listen under your gown. Let’s take that down for a minute. Let me see your big muscles. You’ve got an airplane or a motorcycle?

Boy: Motorcycle. It does everything.

Woman: Okay. Let’s not talk just for a minute. There we go. There’s your atrial. I’m sorry. Aortic, sorry, and your pulmonic. You’re tricuspid and you’re mitral, and check an [0:14:48 ankle] pulse. It’s nice and regular. I don’t hear any murmurs. I don’t hear any S3. All I hear is S1 and S2. Do you know what I hear? Bum, bum, bum, bum. Do you want to hear it?

Boy: Uh huh.

Woman: Very quickly and then I need it back, okay? Good job. Good job.

Now, we’ve got to do the E test. Are you ready for the E test? Okay, every time I put my stethoscope down say E.

Boy: E. E, E, E, E.

Woman: Just one time.

Boy: E.

Woman: E.

Boy: E.

Boy: E.

Woman: Again.

Boy: E.

Woman: Again.

Boy: E.

Woman: Again.

Boy: E.

Woman: Good job. Let’s lay down. Lay your head on your blanket for me. Okay, I’m going to look at his abdomen. I’m going to inspect it and see if I see any masses or any unusual bulges. He does have a few freckles, but other than that we’re good. I’m going to listen to all four quadrants. Your belly’s talking to me. You know what it’s saying?

Boy: What?

Woman: It’s saying I had doughnuts for breakfast. I’m going to listen for the renal arteries. I hear them. I’m going on to listen for the aortic. Good, I hear that too. Great job. Alright now I need to push on your belly? Are you ready? Are you ready? Okay. I’m going to palpate your belly, feeling for any masses. Does that tickle a little bit? Put your arms down. Now I’m going to do deeper palpation. Does anything have any owies? Tell me if you have any owies, okay? Does that have any owies or are you just silly? Where does it hurt? Show me.

Boy: When you push on it.

Woman: When I push really hard? I’m so sorry. I need to tap on your belly again. Here, put your legs straight, like this. One. Okay.

I’m going to pause it again.

Okay. I need to feel your liver. Are you ready? Do you hear it?

Boy: Uh huh.

Woman: Can you be very, very still? Still as a statue. Still as a statue, are you ready? There we go. Okay. There it is. There’s your spleen. Okay, now take a deep breath and hold it. Hold it. Now blow it out slow. Good job.

Boy: I blew it out fast.

No, hepatomegaly. Everything feels really good. Let’s see if I can feel your kidneys. I don’t think, I’ll try to feel them. Nope I can’t feel them. Okay sit up for me. Let’s check. Do you have any tenderness, any owies?

Boy: It hurt.

Woman: Where?

Boy: When you pat on my back.

Woman: It hurts it I pat on your back right here, like a little owie or a big owie?

Boy: A big owie.

Woman: Really. My goodness. I’m so sorry. Show me exactly where it hurts.

Boy: All around.

Woman: All around. So if I do that?

Boy: You did it right here and it hurt.

Woman: Oh. On the bone? Yeah. I’m so sorry

Lay back down, I have two more things to do. Let’s feel some more pulses. You know you have some pluses right here. Sorry. They’re nice and strong. And you have some pulses right behind your knee. Good popliteal pulses. Nice and regular. Good job. Dorsalis pedis are perfectly normal. We checked those earlier. Now, let’s check your flexion.

Boy: My blanket.

Woman: I’ll get your blanket. Do you want me to get it right now? Yes please. It really fell down there good, didn’t it? Hold on. Let me pause it.

Turn over, let’s see your hips. Are you ready? Bend your knee. Let me bend your knee. Good. Straight up. Ah, look at you. Okay, let me bend it. Let’s turn your hip out. Ligament is nice and strong. Are you ready? Knee up. Bend your knee towards me. Good job. That feels nice and good. Okay let me check my notes and see if I missed anything. I think we’re good.

Boy: Hey Mommy.

Woman: You’re a healthy little boy. Yeah healthy little boy.

Boy: Did I get a reward?

Woman: Quite possibly.

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Let’s inspect your skin. All over and make sure I didn’t miss any owies. I see a freckle right there. You kind of have a little bit of an umbilical hernia. A little bit of an owie. Any owies on your leg or just tickles? Turn around, let me see. I see no owies on there. Looks like you have a little bit of dry skin, but other than that.

Boy: Here’s a boo-boo.

Woman: I see that boo-boo. Let me see.

Let’s play with this, again. I’m going to put it right here and you tell me when it stops working, okay? Close your eyes. What do you fell?

Boy: Ow, ow.

Woman: It hurts? I’m sorry. Here, real soft, are you ready? Do you feel it?

Boy: Why does it hurt?

Woman: I don’t know.

Yes? I’m done.

Thank you so much for letting me interview you and do your assessment. You did so good.

Say bye. Have a good day.

Thank you.