Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 34 Child Health Assessment

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process: Health Assessment Assessment Nursing diagnosis Outcome identification, planning Implementation Outcome evaluation

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health History: Database Interview setting Types of questions –Closed-ended –Open-ended –Compound –Expansive –Leading

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health History: Database (cont’d) Health interview –Introduction, explanation –Demographic data –Chief concern –History of chief concern –Health, family profile

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health History: Database (cont’d) Health interview –Day history Play Sleep Hygiene Nutrition

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Health History: Database (cont’d) Past health history Family health history Review of systems

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Physical Assessment Purpose, techniques Equipment, setting, approach Variations –Newborn –Infant –Toddler, preschooler –School age, adolescent

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination Vital signs General appearance Mental status

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Body measurements –Weight –Height –Head circumference –Chest, abdominal circumference –Skin

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Head –Newborn, infant –Toddler, preschooler, school age –Adolescent

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Eyes –Conjunctivitis –Hordeolum –Ptosis –Strabismus –Esotropia –Exotropia

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Eyes –Newborn, infant –Toddler, preschooler –School age, adolescent

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Nose –Newborn, infant –Older children Ears –Newborn, infant –Older children

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Mouth –Newborn, infant –Older children Neck –Newborn, infant –Adolescent

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Chest Breasts –Newborn –School age, adolescent Lungs –Newborn, infant

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Heart –PMI –Heart sounds –Rhythm –Newborn, infant, toddler –School age, adolescent

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Abdomen –Newborn, infant –Preschooler, school age Genitorectal area –Female –Male –Inguinal hernia

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) Extremities Back Neurologic function –Motor, sensory

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Components of Physical Examination (cont’d) See Figure

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Vision Assessment Vision screening Techniques –Snellen chart –Preschool E chart –National Association for the Prevention of Blindness Home Test –Allen cards

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Vision Assessment (cont’d) Techniques –Stycar cards –Titmus Vision tester –Color vision discrimination testing Vision referrals

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hearing Assessment Auditory screening –Newborn, infant –Older children Principles of audiometric assessment –Frequency –loudness

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Hearing Assessment (cont’d) Hearing loss Acoustic impedance testing Conduction loss testing

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Speech Assessment Denver Articulation screening –Administration –Scoring

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Developmental Appraisal Developmental history Denver II Developmental screening –Administration –Scoring –Prescreening test

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Intelligence Goodenough-Harris Drawing test

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Temperament Child’s innate behavioral characteristics –Activity level –Rhythmicity –Tendency to approach or withdraw –Adaptability

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immunizations Types Available vaccines –Diphtheria, tetanus, pertussis (DTaP) –Polio –Measles, mumps, rubella (MMR) –Hepatitis

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immunizations (cont’d) Available vaccines –H. influenzae Type B –Varicella –Pneumococcal pneumonia –Human Papillomavirus –Meningococeal Vaccine

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immunizations (cont’d) Available vaccines –Lyme disease –Influenza –Anthrax, smallpox

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Immunizations (cont’d) Administration Parental education

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which physical finding would best suggest that an infant is dehydrated? A.A depressed fontanelle B.A caput succedaneum C.Curved fingerbeds D.A listless appearance

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. A depressed fontanelle Rationale: With dehydration, the fontanelles of infants often appear sunken.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question School-aged children run a high incidence of pediculosis. Of the following, which best suggests pediculosis? A.Dry, brittle hair B.Small white particles on the hair strands C.Patches of hair loss D.Weeping circular areas on the scalp

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Small white particles on the hair strands Rationale: The eggs of lice are revealed as small white particles on hair strands.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question When assessing a child’s heart, which finding would be considered abnormal? A.Physiologic splitting with inspiration B.Presence of a fourth heart sound C.An observable PMI D.Dullness with percussion

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Presence of a fourth heart sound Rationale: Many children demonstrate physiologic splitting and an observable point of maximum impulse. A fourth heart sound suggests pathology.