Alecia Hollis, R.N., MSNSMCC Associate Degree Nursing Instructor

Performing Physical ExamSteps of the Physical exam

InspectionPalpationAuscultation

Developmental Consideration

Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

Performing Physical ExamGeneral Appearance Measurement of Vital Signs

Temperature Pulse Respiratory Rate

Measuring Oxygen Saturation Blood Pressure Pain Assessment

SYSTEMATIC APPROACH

AgeHeart Rate (beats/min)

Blood Pressure (mm Hg)

Respiratory Rate (breaths/min)

Premature

120-170 * 55-75/35-45† 40-70†

0-3 mo

100-150 * 65-85/45-55 35-55

3-6 mo

90-120 70-90/50-65 30-45

6-12 mo

80-120 80-100/55-65 25-40

1-3 yr

70-110 90-105/55-70 20-30

3-6 yr

65-110 95-110/60-75 20-25

6-12 yr

60-95 100-120/60/75 14/22

12 > yr

55-85 110-135/65/85 12-18

http://www.emedicinehealth.com/pediatric_vital_signs/article_em.htm

Blood pressure

Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

Body Measurements Length or HeightWeight

Weight for LengthBody Mass Index

Monitoring Equipment

WeightWeight Status Category Percentile Range

Underweight Less than the 5th percentileHealthy weight 5th percentile to less than

the 85th percentileOverweight 85th to less than the 95th

percentileObese Equal to or greater than the 95th

percentile

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

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

External Structures

Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

Strabismus

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

Vision AssessmentStandardized Vision ChartCriteria for referral3 to 4 years---20/50 or less in

either eye5 years old----20/40 or less in

either eye6 years old---20/30 or less in

either eyeA 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 ReferralsLearning problemsFrequent headachesVisual complaints (child frequently won’t

recognize problem)Failed vision screen or concerns on eye examAcute eye injury Worsening infection, pain, discharge

Corneal Abrasion

en.wikipedia.org insighteyespecialists.com

Corneal Ulcer

accesspediatrics.mhmedical.com

External StructuresInspect the Pinna

(external ear)Inspect the external

auditory canal for drainage

sonoworld.com

External Structures

clinicaladvisor.com

Internal structure

quizlet.com

anatomybox.com

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

Internal Structures

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

Hearing Screening

lathamcenterspws.blogs.

Hearing LossConductive 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) db NORMAL

20-45 db Mild

46-65 db Moderate

65-90 db Severe

>90 db May not hear a sound

Hearing lossHearing 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/

Nose

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

Assessment of Nose

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

Assessment of Mouth and Throat

Copyright ©2009 Wolters Kluwer Health/Lippincott Williams & Wilkens

Lips

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

realmagick.com

Tongue

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

Mouth

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

Gums and Teeth

http://pediatricdentistrynorth.com/special-offers/tooth-eruption/

Neck

CardiovascularInspectionPalpationAuscultation

Cardiovascular

Atitesting.com

Auscultation

Listening Sites for Auscultation

S2S2

S1

Kyle, T.& Ricci, S. (2009). Maternity and Pediatric Nursing. Philadelphia, PA: Lippincott Williams & Wilkins

Heart Sounds

mediconweb.com

Listening Sites for AuscultationHeart Sound Sites where heard

bestSites where heard softly

S1 Apex of the heartTricuspid and Mitral area

Base of heartAortic area and Pulmonic

S2 Base of the heartAortic and Pulmonic area

Apex of the heartTricuspid and Mitral area

Physiologic splitting Pulmonic area

S3 MitralLondon, Marcia (2014). Maternal & Child Nursing Care: New Jersey, Pearson.

www.texasheart.org

Respiratory

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

Wheeze or StridorWheezes occur when air flows rapidly

through bronchi that are narrowed nearly to the point of closure.

Wheezes is lower airwayAsthma = expiratory wheezes

A stridor is upper airwayInflammation of upper airway or FB

42

Lung sounds

Possible Sites for Retractions

Bowden & Greenberg

Respiratory Distress

www.nationwidechildrens.org