E X A M I N I N G T H E P E D I A T R I C P A T I E N T

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E X A M I N I N G T H E P E D I A T R I C P A T I E N T

  1. 1. EXAMINING THE PEDIATRIC PATIENT<br />
  2. 2. Guidelines on examining pediatric patients<br />A keen observation of the child from the beginning to the end of the consultation <br />Wash hands before and after examining the patient<br />Spend a little time winning the child’s confidence by starting on friendly terms<br />Examine the child on the examining table or on a position that suits the child<br />In an infant remove all clothing but in adolescents a thorough examination should be conducted with due respect to the patient’s privacy and sensitivities<br />
  3. 3. Examining patients: 4 developmental levels<br />Infancy- (0-2 yrs- newborn)<br />Preschool-(2-5 yrs)<br />School-age-(5-10 yrs)<br />Adolescent-(10 yrs &gt;)<br />
  4. 4. Newborn<br />APGAR score immoreextensivemediately after birth<br />Do a general survey ; insert tube passing thru nose,aspirate gastric content<br />Extensive examination at 12th-24h hour of life- Dubowitz scoring<br />Observe baby’s breathing, color,cry,size,body proportion and nutritional state and movements of the head and extremities.Responsiveness is bet noted 2-3 hours after feeding<br />Auscultation and palpation should be done when the baby is quiet<br />
  5. 5. Preschool<br />Mobile patients<br />Communicate with patients at their own level;observe speech<br />During communication process observe the child<br />Get anthropometric measurements<br />Observe the child for behavioral features<br />
  6. 6. School Age<br />Deal with the child as an increasingly independent individual<br />Communication is vital<br />Antrhpometric measurements, screen for auditory and visual problems<br />Check for vaccinations<br />Dental and discipline concerns<br />
  7. 7. Adolescents<br />There should be respect for privacy<br />Examination done privately and make sure that they are covered properly<br />Examine for changes and appropriateness of secondary sexual characteristics; emphasis on body concerns<br />Confidentiality- ethical right to health care<br />Information and explanation on what needs to be done should be given in a straightforward fashion<br />Transition to care to a non- pediatrician can be facilitated<br />
  8. 8. Physical Examination-GeneralSurvey<br />Gen survey-wt,hght-temp-rectal,PR-pulsations of carotidmoral or brachial,RR-greater range,BP<br />Head<br />Shape,headcircumference,sutures,<br />anterior fontanel,bruits,transillumination<br />Ears-position and shape,tympanicmembrane,impairment of hearing<br />Eyes-doll’s eye maneuver,uprightposition,redreflex,pupils,cornea,funduscopy<br />Nose-patency, alarflaring,nasal septum deviation,nasal speculum examination<br />Mouth, tongue and throat-color of lips,teeth,oralsigns;tongue-shape, thickness,lesions;throat-tonsils,epiglottis<br />
  9. 9. Physical Examination-Head<br />Head<br /><ul><li>Shape,headcircumference,sutures,
  10. 10. anterior fontanel,bruits,transillumination
  11. 11. Ears-position and shape,tympanicmembrane,impairment of hearing
  12. 12. Eyes-doll’s eye maneuver,uprightposition,redreflex,pupils,cornea,funduscopy
  13. 13. Nose-patency, alarflaring,nasal septum deviation,nasal speculum examination
  14. 14. Mouth, tongue and throat-color of lips,teeth,oralsigns;tongue-shape, thickness,lesions;throat-tonsils,epiglottis</li></li></ul><li>Physical Examination-Chest<br />Chest-examined ahead of other regions-inspect,auscultate,palpate and percuss;<br />shape and circumference-barrel shaped in infancy then becomes elliptical, relationship of head and chest circumference;<br />RESPIRATORY SYSTEM<br />rate and depth of respiration-30-60/min-NB and infancy;6yrs and&gt; 20-25/min;deep and shallow breathing;irregularity<br />Palpation-vocal fremitus,pericardial or pleural friction rub<br />
  15. 15. Physical Examination-Chest <br />Percussion –child’s chest more resonant-chest wall thinner and muscles smaller; <br />Posteriorly- change in percussion note from 8th-10th ribs<br />Anteriorly-decreased percussion note over diaphragm, liver and heart; top of libver dullness-6th rib from midaxillary line to the sternum; lower edge of lung or top of the diaphragm is percussed to the level of the 8th-10th ribs<br />
  16. 16. Physical Examination-Chest<br />Mediastinum-cardiac dullness-2nd-5th rib extending on the right sternalborder;from left sternal border-2nd rib to midclavicular line at the 5th rib<br />Impaired resonance over a fixed area indicates consolidation, collapse or massive atelectasis<br />Shifting dullness- hydothorax<br />Hyperresonance-emphysema<br />Auscultation-decreased breath sounds, rales,wheezing<br />
  17. 17. Physical Examination-Chest<br />CARDIOVASCULAR SYSTEM<br />Femoral pulses and BP<br />Inspection-precordialbulging,signs of RVH,cardiac impulse-4thinterspace<br />Auscultation-quality of the heart sounds-clear and sharp, gallop rhythm, pericardial friction rub, murmurs<br />
  18. 18. Physical Examination-Abdomen<br />Inspection-flat when in supine,potbelly,distention-gas, fluids, mass, peristalsis<br />Palpation-inspiration and expiration, soft or hard, tenderness, masses, spleen- 1 cm below the left costal margin, liver-1-2 cm below the right costal margin, congenital renal anomalies, bimanual deep palpation for deeper masses<br />Percussion-tympanitic-gas,fixed dullness-masses,<br /> shifting dullness-fluid<br />Ausculation-decrease or absence of peristaltic sounds- paralytic ileus<br />
  19. 19. Physical Examination-Genitalia<br />Inspection<br />Female-vaginal discharge,imperforatehymen,size of clitoris, fusion of labia, ambiguous genitalia<br />Male-position of urethral orifice,size of penis, undescendedtestes,hernia or hydrocoele<br />
  20. 20. Physical Examination-Anus and Rectum<br />Anal fissures- bleeding and constipation<br />Prolapse of the rectal mucosa<br />Rectal examination<br />
  21. 21. Physical Examination-Musculoskeletal System<br />Range of motion of all joints is greatest in infancy <br />Position of feet at birth-fetal position<br />Hips examine for dislocation<br />

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