Alecia Hollis, R.N., MSN SMCC Associate Degree Nursing Instructor

Performing Physical Exam Steps of the Physical exam Inspection Palpation Auscultation

Developmental Consideration Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

Performing Physical Exam General Appearance Measurement of Vital Signs Temperature Pulse Respiratory Rate Measuring Oxygen Saturation Blood Pressure Pain Assessment SYSTEMATIC APPROACH

Vital Signs Age Heart Rate (beats/min) Blood Pressure (mm Hg) Respiratory Rate (breaths/min) Prem ature *55-75/35-45†40-70† 0-3 mo *65-85/ mo / mo / yr / yr / yr /60/7514/22 12 > yr /65/

Blood pressure Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

Body Measurements Length or Height Weight Weight for Length Body Mass Index Monitoring Equipment

Weight Weight Status Category Percentile Range UnderweightLess than the 5th percentile Healthy weight5th percentile to less than the 85th percentile Overweight85th to less than the 95th percentile ObeseEqual to or greater than the 95th percentile

External Structures

Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

Strabismus

Vision Assessment Standardized Vision Chart Criteria for referral 3 to 4 years---20/50 or less in either eye 5 years old----20/40 or less in either eye 6 years old---20/30 or less in either eye A difference in vision between the eyes of two lines or more on the Snellen eye chart. Any problems with ocular alignment Data from American Academy of Opthalmology, Pediatric Opththalmology/Strabismus Panel, (2007). Preferred Practice Pattern Guidelines. Pediatric eye evaluations San Francisico, CA

Warning signs for Referrals Learning problems Frequent headaches Visual complaints (child frequently won’t recognize problem) Failed vision screen or concerns on eye exam Acute eye injury Worsening infection, pain, discharge

Corneal Abrasion en.wikipedia.org insighteyespecialists.com

Corneal Ulcer accesspediatrics.mhmedical.com

External Structures Inspect the Pinna (external ear) Inspect the external auditory canal for drainage sonoworld.com

External Structures clinicaladvisor.com

Internal structure quizlet.com anatomybox.com

Internal Structures webmd.com

Hearing Screening lathamcenterspws.blogs.

Hearing Loss Conductive hearing loss –Occurs due to problems in the outer or middle ear; normal bone conduction Sensorineural hearing loss--- Refers to nerve damage (VIII) in the inner ear (or 25) dbNORMAL dbMild dbModerate dbSevere >90 dbMay not hear a sound

Hearing loss Hearing Aids Cochlear Implants ww.medicalhomeportal.org/living-with-child/assistive- technology/hearing-aids

Nose

Assessment of Nose

Assessment of Mouth and Throat Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

Lips realmagick.com

Tongue

Mouth

Gums and Teeth

Neck

Cardiovascular Inspection Palpation Auscultation

Cardiovascular Atitesting.com

Auscultation

Listening Sites for Auscultation S2 S1 Kyle, T.& Ricci, S. (2009). Maternity and Pediatric Nursing. Philadelphia, PA: Lippincott Williams & Wilkins

Heart Sounds mediconweb.com

Listening Sites for Auscultation Heart SoundSites where heard bestSites where heard softly S1Apex of the heart Tricuspid and Mitral area Base of heart Aortic area and Pulmonic S2Base of the heart Aortic and Pulmonic area Apex of the heart Tricuspid and Mitral area Physiologic splittingPulmonic area S3Mitral London, Marcia (2014). Maternal & Child Nursing Care: New Jersey, Pearson.

Respiratory

Wheeze or Stridor Wheezes occur when air flows rapidly through bronchi that are narrowed nearly to the point of closure. Wheezes is lower airway Asthma = expiratory wheezes A stridor is upper airway Inflammation of upper airway or FB 42

Lung sounds

Possible Sites for Retractions Bowden & Greenberg

Respiratory Distress g