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

3. Performing Physical Exam Steps of the Physical exam Inspection Palpation Auscultation

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

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

6. Vital Signs Age Heart Rate (beats/min) Blood Pressure (mm Hg) Respiratory Rate (breaths/min) Prem ature 120-170 *55-75/35-45†40-70† 0-3 mo 100-150 *65-85/45-5535-55 3-6 mo 90-12070-90/50-6530-45 6-12 mo 80-12080-100/55-6525-40 1-3 yr70-11090-105/55-7020-30 3-6 yr65-11095-110/60-7520-25 6-12 yr 60-95100-120/60/7514/22 12 > yr 55-85110-135/65/8512-18 http://www.emedicinehealth.com/pediatric_vital_signs/article_em.htm

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

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

9. 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 http://www.cdc.gov/healthyweight/assessing/bmi/childrens_bmi/about_childrens_bmi.html

11. External Structures

12. Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

13. Strabismus http://www.uofmhealth.org/health-library/zm6098

14. 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

15. 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

16. Corneal Abrasion en.wikipedia.org insighteyespecialists.com

17. Corneal Ulcer accesspediatrics.mhmedical.com

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

19. External Structures clinicaladvisor.com

20. Internal structure quizlet.com anatomybox.com

21. http://www.webmd.com/cold-and-flu/ear-infection/middle-ear

22. Internal Structures http://www.earcentergreensboro.com/medical-education/ear_tubes.php webmd.com

23. Hearing Screening lathamcenterspws.blogs.

24. 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. 0-20 (or 25) dbNORMAL 20-45 dbMild 46-65 dbModerate 65-90 dbSevere >90 dbMay not hear a sound

25. Hearing loss Hearing Aids Cochlear Implants ww.medicalhomeportal.org/living-with-child/assistive- technology/hearing-aids http://www.macrobusiness.com.au/2011/09/did-you-hear-about-cochlear/

26. Nose http://training.seer.cancer.gov/anatomy/respiratory/passages/nose.html

27. Assessment of Nose http://www.atitesting.com/ati_next_gen/skillsmodules/content/physical-assessment-child/equipment/ap_ear_nose_throat.html

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

29. Lips http://medicalpicturesinfo.com/wp-content/uploads/2011/08/Angular-Cheilitis-5.jpeg realmagick.com

30. Tongue http://www.chicanol.com/heridas-en-la-lengua/

31. Mouth http://sleepmedicineboardreview.wordpress.com/2011/10/25/tonsil-size-scoring/

32. Gums and Teeth http://pediatricdentistrynorth.com/special-offers/tooth-eruption/

33. Neck

34. Cardiovascular Inspection Palpation Auscultation

35. Cardiovascular Atitesting.com

36. Auscultation

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

38. Heart Sounds mediconweb.com

39. 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.

40. www.texasheart.org

41. Respiratory http://vereburn.com/index.php?main_page=index&cPath=29_2672

42. 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

43. Lung sounds

44. Possible Sites for Retractions Bowden & Greenberg

45. Respiratory Distress www.nationwidechildrens.or g