1. Chapter 32 Health Assessment
Part E

2. Performing a Physical Examination
Genitalia and anus
Male
Female
Anus

3. Genitalia:
Male: circumcised?, meatus, scrotum, testes (avoid cremasteric reflex; use of translumination), inguinal hernia, stage of development
Female: labia, clitoris, meatus, vaginal orifice, stage of development
Anus: may be examined for reflex and patency

4. male genitalia: full term newborn,
uncircumcised

5. Palpating Testes Normally felt as small
Palpating Testes Normally felt as small. Ovoid bodies in each scrotal sac. May take time to descend. in Figure    A, Preventing cremasteric reflex by having child sit in “tailor” position. B, Blocking inguinal canal during palpation of scrotum for descended testes. Circumcised male

6. To prevent the testes from retracting during the exam, place fingers over inguinal canal.

7. absence of the testicles in the scrotum
few rugae in the scrotum in the preterm newborn

8. Stages of development for male genitalia.

10. Stages of female development for pubic hair.

11. Female Genitalia

12. Anatomic structures of the female genital and perineal area

13. Sexual maturity rating:
These scales are used to rate sexual maturity in males and females.

14. Performing a Physical Examination
Musculoskeletal
Clavicles and shoulders
Spine
Extremities
Neurologic
Level of consciousness
Balance and coordination
Sensory testing
Reflexes

15. Back, Extremities and Joints
8 months: sits without support; spine is straight
Normal spine is straight
Marked curvatures, like scoliosis (lateral) are abnormal

16. Figure   Bowleg (genu varnum) Toddlers may be bowlegged after beginning to walk but will correct. If present beyond 2-3 years (space between knees greater than 2”/5cm) will need treatment with a brace.

17. Knock-knee (genu valgum) Normal in children 2-7 years.
Figure  
  Knock-knee
(genu valgum)
Normal in children 2-7 years.
May need treatment if persists
with correction braces worn day & night

18. Examining Hips of Infant
equal hip abduction with knees nearly touching exam table = normal

19. Joint Assessment
Ortolani-Barlow maneuver: position infant as shown, knees pressing together, downward pressure on one femur at a time
Allis Sign: flex the infant’s hips and knees heels close to buttocks, place feet on exam table a difference in knee height

20. Reflexes of the Newborn/Infant
Blinking: to bright lights or object coming close to eyes
Sneeze: present throughout life
Sucking: sucking movements of circumoral area to stimulation
Gag and rooting
Yawn and Cough
Grasp
Remember these reflexes in the newborn? When assessing the newborn/infant, check for these reflexes if appropriate for age.

21. More Newborn Reflexes
Plantar reflex:
Plantar flexion = normal
after 2 y.o.
Babinski response normal in children under 2 y.o., abnormal after.
Moro: extension and abduction of extremities with jarring
Startle: abduction of arms with elbow flexion with noise
Tonic Neck: when head turned to one side, arm and leg on that side extend, opposite arm and leg flex

22. Neurologic Assessment: Cerebellar Function and Reflexes
Test balance and coordination
Finger-to-nose test
Coordination tests: can be done with cooperative 6 y.o. and older
Finger-to-finger test
Heel-to-Shin test

23. stand with feet together, eyes
Romberg procedure:
stand with feet together, eyes
closed, arms by side
Remain close to child in case they fall
Overall Function
Watch for balance, coordination, gait and fine and gross motor skills as child moves

24. Reflexes as Child gets Older Figure 06-42. Testing for triceps reflex
Reflexes as Child gets Older Figure    Testing for triceps reflex. Child is placed supine, with forearm resting over chest, and triceps tendon is struck. Alternate procedure: child's arm is abducted, with upper arm supported and forearm allowed to hang freely. Triceps tendon is struck. Normal response is partial extension of forearm.

25. Figure 06-43. Testing for biceps reflex
Figure    Testing for biceps reflex. Hold child's partially flexed elbow in palm of hand with your thumb over antecubital space. Strike thumbnail with hammer. Normal response is partial flexion of forearm.

26. Figure    Testing for patellar (knee jerk) reflex using distraction. Child sits on edge of examining table (or on parent's lap) with lower legs flexed at knee and dangling freely. Patellar tendon is tapped just below kneecap. Normal response is partial extension of lower leg.

27. Figure 06-45. Testing for Achilles reflex
Figure    Testing for Achilles reflex. Use same position for eliciting knee jerk reflex. Support foot lightly in your hand and strike Achilles tendon. Normal response is plantar flexion of foot (foot pointing downward, or “planting” toward floor).

28. The ability to Assess our patients is one of the most important skills a nurse can develop. Nurses are with the patient more than any other health professional, so it is vital we know the normal parameters for the child based on age and recognize signs and symptoms that indicate the need for interventions and referral. Our goal is to keep children healthy and safe or return them to a state of maximum health. I LOVE pictures of children – can you tell!

29. The End