This document provides guidelines for performing a comprehensive physical examination of children. It describes how to assess various body systems and structures including height, weight, temperature, skin, eyes, ears, nose, mouth, heart, lungs, abdomen, genitals, musculoskeletal system and nervous system. Physical examination is an important part of the nursing process as it provides data to identify any abnormalities and guide nursing diagnosis, care, and evaluation. The examination should be performed thoroughly but also make the child comfortable.
definition and normal values and all if more info. needed comment below.
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Nosebleeds are very common in young children, affecting most at some time or another. From the outset, it is important to be aware that nosebleeds will often settle down on their own, sometimes requiring medical treatment, but that major underlying causes (blood clotting problems or abnormalities in the nose) are very rare.
Neonatal Intensive Care Unit: Definition, objectives, major components, requirements, physical setup, admission criteria, space, location, baby care area, electrical outlet, ventilation, counselling, handwashing area, acoustic characteristics, personnel, equipments available in the NICU, services, levels of NICU
definition and normal values and all if more info. needed comment below.
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Nosebleeds are very common in young children, affecting most at some time or another. From the outset, it is important to be aware that nosebleeds will often settle down on their own, sometimes requiring medical treatment, but that major underlying causes (blood clotting problems or abnormalities in the nose) are very rare.
Neonatal Intensive Care Unit: Definition, objectives, major components, requirements, physical setup, admission criteria, space, location, baby care area, electrical outlet, ventilation, counselling, handwashing area, acoustic characteristics, personnel, equipments available in the NICU, services, levels of NICU
Anthropometric measurements are a series of quantitative measurements of the muscle, bone, and adipose tissue used to assess the composition of the body. The core elements of anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip, and limbs), and skinfold thickness
Assessment of the child's health from birth to adolescence, methods of assessment of both physical ad psychological status of child, psychological tests etc.
A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history.
HEALTH ASSESSMENT OR EXAMINATION OF SKIN, HAIR AND NAILS WITH THE HELP OF METHODS OF HEALTH ASSESSMENT: INSPECTION, ASCULTATION, PALPATION AND PERCUSSION TECHNIQUES.
Anthropometric measurements are a series of quantitative measurements of the muscle, bone, and adipose tissue used to assess the composition of the body. The core elements of anthropometry are height, weight, body mass index (BMI), body circumferences (waist, hip, and limbs), and skinfold thickness
Assessment of the child's health from birth to adolescence, methods of assessment of both physical ad psychological status of child, psychological tests etc.
A health assessment is a plan of care that identifies the specific needs of a person and how those needs will be addressed by the healthcare system or skilled nursing facility. Health assessment is the evaluation of the health status by performing a physical exam after taking a health history.
HEALTH ASSESSMENT OR EXAMINATION OF SKIN, HAIR AND NAILS WITH THE HELP OF METHODS OF HEALTH ASSESSMENT: INSPECTION, ASCULTATION, PALPATION AND PERCUSSION TECHNIQUES.
how to examine sick baby , approach to child medical examination , diagnosis of sick child , evaluation of sick baby , medical examination of children , child medical history and examination , care of children
TIME OF ASSESSMENT
At place of birth
Postnatal assessment- done 3 times
Institutional Delivery
24hrs or next day
At time of discharge
Within 4-6 weeks age of baby
Home Delivery
Within 3 days
Other two assessments are same as institutional delivery.
INITIAL ASSESSMENT
Immediate after birth
APGAR Scoring
Review of maternal and perinatal history
Assessment of gestational age
Anthropometric Measurement
Detailed head to foot examination
APGAR SCORING
Given by Dr. Virginia Apgar
It contains 5 objective criteria and done twice , one minute after birth and five minute are birth.
If APGAR score is
10= best possible conditions
7-10 = no difficulty in adjustment in extrauterine life
4-6 = moderate difficulty or mild depression
Equal to or less than 3 = severe depression
At 5 min, APGAR correlates more closely with infants' neurologic status at one year of age
ASSESSMENT OF GESTATIONAL AGE AT BIRTH
last menstrual period is clue for calculation of gestational age but the mother may forget the last menstrual period or may suffer from menstrual irregularities.
physical characteristics is reliable to assess maturity but limited value in less than 36 weeks of maturity due to chances are intrauterine growth retardation.
neurologic characteristics are more reliable
FIRST DAY EXAMINATION
vital signs
general behavior
feeding behavior
pattern of elimination
anthropometric measurement
gestational assessment
skin
head
Face
Eyes
Nose
ears
Mouth
Nick
Chest
abdomen
Genitalia
back
Buttocks
hips
extremities
neurological
special senses
REFLEXES
Vital signs
Temperature is recorded usually by axillary method.
Temperature: 36.5 to 37.5 degree Celsius
Respiration: 30 - 60 breaths per minute
Blood pressure: 80/40- 60/25 mmHg
Pulse: 120 – 160 beat per minute
General behavior
posture , position, general alertness ,activity, crying ,response to stimulation, sleeping pattern , etc. should be assessed carefully.
Feeding behavior
suckling and swallowing reflex, vomiting regurgitation, choking, frothiness (which may be due to tracheoesophageal fistula) should be evaluated to detect associated problems.
Pattern of elimination
passage of meconium and urine should be observed and S for presence of any anomalies. the new unit passes urine and meconium within 24 hours and afterwards for first few days, the baby voids 10 to 15 times and average 6 stools per day.
Anthropometric measurement
head circumference : 35 – 37 cm
chest circumference :33- 35 cm
weight : 2.5- Well 3 kg
length : 48 – 53 cm (avg. 50 cm)
Gestational assessment
It can also be done on first day if it is not done on the day of delivery or if the baby is having any problem on that day.
Skin
detect cyanosis, jaundice, pallor and plethora. lanugo hair, vernix , skin turgor, edema, ecchymosis, petechiae, erythema toxicum (rash), dryness or peeling hemangiomas, Mongolian spot, etc. should we look for. presence of any abrasions.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
2. INTRODUCTION
Physical assessment is an important part of the
nursing process, because it provides the data for
which nurse can make a nursing diagnosis and plan,
implement and evaluate nursing care.
Measurement of physical growth in children is a key
element in evaluating their health status.
Physical assessment uses four skills; inspection or
observation , palpation, percussion and auscultation.
4. HEIGHT
Until the child can stand steadily , generally before the age of 5
years, the height is taken as length while the child is lying on a
firm table.
The length is obtained by placing the feet against a fixed upright
surface at the zero mark of the rule and measuring from that
point to the vertex ,against which a flat movable surface placed.
The child’s body is fully extended by flattening the knees and
maintaining the head in a midline position.
Assistance can be needed to obtain an accurate measurement.
If the child stands straights and tall and hold the head so that the
line of vision parallels the floor surface , a standing height can be
measured.
5.
6. WEIGHT
The infant is weighed on an
infant scale , the older child
on a upright platform scale.
Either type of scale is
balanced before the weight
is read.
7.
8.
9.
10. TEMPERATURE
Normal temperature runs around 99 degrees until > 36
months.
A variance of 1-2 degrees is OK.
A temperature <97 degrees in an infant and > 100.5
degrees is indicative of a problem and should be noted.
Temperatures are taken commonly either axillary or
tympanic.
Be sure to document how taken.
11.
12. PULSE RATE
Apical pulse rates are most
commonly taken in children;
especially in those under 2.
Assess based on limits for age
and norms for that child.
13.
14.
15. RESPIRATORY RATE
Assess the rate, depth, and ease of respiration in the
child. Varies with age of child.
Respirations should be quiet and effortless
Infants are abdominal breathers / nose breathers 4 weeks
to 4 months.
By age 7 – costal breathers
19. SKIN AND LYMPHATICS
INSPECTION : SKIN
Describe any variation in colour, particularly in children with increased pigmentation ,birth marks
,bruises or unusual marks , scars , wounds or insect bites , to ascertain suspected jaundice, scaliness ,
vernix caeseosa , Mongolian sot , Malia etc.
PALPATION
Check the tension of the skin by pinching up a fold of skin, normal skin quickly falls back , but
dehydrated skin remains in pinched position .
Skin examined for texture , moisture , temperature , colour and lesions .
The skin of young child is usually smooth , slightly dry and uniform temperature.
Skin is oily; cradle cap or ezema present.
Skin is too dry; child may bathed too and deficiency in vitamins .
Clammy skin ; heart disease
If the arms are warm and legs are cooler : coartation of aorta
20.
21. The skin is observed for pallor and cyanosis ; increased
deoxygenated haemoglobin .
Erythema and jaundice
Ecchymosis –haemorrhage of blood into skin .
Petechia
Presence of simian crease ; down syndrome
Skin turgor
Poor skin turgor : dehydration and in oedema , sign of kidney
disease.
ACCESSORY STRUCTURES
HAIR
Hair is examined for colour, texture , elasticity , distribution ,
cleanliness and infestation .
22. Alopecia : tinea capitis ,pyoderma and seboric dermatitis or side effects of
radiation and certain drugs such as chemotherapeutic agents, protein
deprivation and celiac disease.
Hair is dull, dry , brittle and depigmented : malnourished
Hypertrichosis
Hair growth from midforehead and excessive : cretinism
Excessive hair over the spine : spina bifida
NAIL
Inspected for shape , texture , flexibility and colour.
Normal nails are usually convex , translucent, smooth and firm but flexible.
Colour abnormalities may include blueness ;cyanosis
Yellow tint :jaundice
Dark colouration indicates haemorrhage
23. White opacity of the nail; benign hereditary defect or trauma
Clubbing in the base of the nail and becomes swollen : tetralogy of Fallot.
Micronychia : trisomy 18 and foetal alcohol syndrome.
HEAD AND NECK
head control
Presence of wry neck or torticollis
Opisthotonas : meningeal irritation
Nuchal rigidity
Inspection and palpation of skull
Symmetry, size, and general appearance
Asymmetry of the skull : craniosynostosis ,infants remained in one position for long period
Posterior fontanelles anterior fontanelles
Late closure of fontanelles : rickets , cretinism
Bulging and depressed fontanelle.: raised intracranial tension
Prominent scalp veins and crack pot sign : hydrocephalus
24. EYE
Alignment and placement on the face.
The eyes are inspected for shape , size , colour , movement and symmetry.
Epicanthal folds : Caucasian children .
Ptosis or drooping of eyelids.
Edema of eyelids : kidney diseases.
Ambylopia
Exophthalmos : hyperthyroidism
Setting sun sign
EYE LASHES
Inspected for position ,presence or absence of eyelashes
Assess for blepharospasm , blepharitis , hordeolum and chalazion
LACRIMALAPPARATU
position and patency and possibility of infection
25. Epiphora or excessive tearing ,plugged lacrimal duct, alacrimia , corneal
ulceration and scarring.
ORBIT
Sunken eyes : dehydration
Macrothalmia : toxoplasmosis
CONJUNTIVA
Normally glossy and pink
Assess for conjunctivitis
Pale conjunctiva : anemia in child
SCLERA
Inspected for discolouration
PUPILS
Inspected for shape ,size ,movement and the ability to accommodate and react
to light.
anisocoria
26. OCCULAR MUSCLES
Strabismus and nystagmus
TESTING FOR VISUAL ACQUITY
Snellen's chart is used
Snellen alphabet
Snellen’ E’ charts
Denver eye screening test is used for children over 2 ½ years of age.
TESTING FOR VISUAL FIELD
Peripheral vision ; child look at the nurse at a distance of 3 feet.
TESTING FOR COLOUR VISION
Colour blindness
Red green defect and blue yellow defects
27.
28. EAR
Inspection for alignment and placement on the head
Assess auricle or pinna ( helix, antihelix ,concha, tragus and lobule )
Assess for any anomalies
EAR CANAL : inspection is done with otoscope.
1. 2.5 cm
2. Pink in colour
3. Thin
4. Presence of ear cerumen
5. Inspected for discharge
TYMPANIC MEMBRANE
Transparent tissue of a grey coloured
Examined for loss of any bony land marks
Examine middle ear , inner ear and auditory or eustachian tube
29. Examination of mastoid area for any infection (mastoiditis)
TESTING FOR HEARING ACUITY
Crib-o-Gram is used to test the hearing of the new-born and infant.
Audiometer is an electric instrument that measure pure tone , frequencies and
loudness of voice.
NOSE
It is a framework of bone and cartilage covered with skin and lined with
mucus membrane.
Assess the external triangular structure of the nose.
Insect type and amount of watery , purulent and crusty discharge if any , are
noted.
Patency of nose
Observe for “Allergic salute” : rhinitis , rhinorrhoea or itching .
Assess for nasal cavities , mucus membrane and small hairs.
30. Assess for nasal septum deviation and perforated septum.
Assess olfactory areas , sinuses( palpate frontal sinus)
MOUTH
Assess for lips for shape, colour ,inflammation, fissuring and lesion.
Anaemia : pale lips
Cherry red lips : heart lesion
Cyanosis or grey colour : congenital heart lesion.
Cheilitis
Assess for oral or buccal cavity , gag reflex ,oral thrush.
Assess salivary glands , tonsils
31. THORAX AND CHEST
Palpate thorax area(rachitic rosary) , clavicle( fracture)
Assess deformities in the bones of chest
Harrisons groove , barrel chest
Assess inspiration and expiration and non symmetrical
movements of chest.
Auscultation of breath sounds.
Abnormal lung sounds: rales , rhonchi , wheezing etc
HEART
To inspect and palpate heart child lies flat on the back with chest
elevated at a 45 angle.
Both sides of anterior chest wall should be symmetric.
32.
33. Auscultation of heart sounds
ABDOMEN
Abdomen is inspected for skin abnormalities , contour , symmetry , size , muscle
tone , masses.
Examined Convexity and concavity.
Inspect Scaphoid abdomen ,distended abdomen protruding abdomen.
Auscultation is done to determine presence or absence of peristaltic waves.
Each quadrants is heard for 5 mins
Soft friction rubs ; peritoneal obstruction or inflamed spleen
Splashing noise ; presence of fluid in the stomach.
Palpate abdomen for degree of distention , edge of liver , spleen , femoral pulse
and skin turgor
Deep palpation to feel abdominal organs.
34. ANUS AND RECTUM
Observe anal sphincter , firmness of buttocks muscle.
Inspect for any signs of inflammation , redness , scars , marks , rashes and anal
fissures.
Observe pin worm around the anus.
Palpation ; determine the presence of fistulas , sinuses , strictures and abscess .
GENETALIA
Examination male genetalia
The scrotum is inspected and palpated for possible inguinal hernia , oedema ,
colour and masses .
If red and shiny skin – orchitis
Assess for hydrocele
Spermatic cords are traced and examined for swelling or masses
Both testes are examined for descended and undescended testes
Assess prostrate gland. Its position and shape
35. The shaft of penis is examined for its size .
Micropenis (2.5cm)
Balanitis and venereal warts
URETHRA
The meatus is examined for an ulceration
Assess for hypospadias's and epispadiasis
Observe for priapism
EXAMINATION OF FEMALE GENETALIA
Mons pubis is inspected for skin discolouration , pubic lice or crabs and palpated for
masses.
The skin of labia is inspected for abrasion and ulceration.
Assess vulvitis , gonorrhoea , labio inguinal hernia
Check for any adhesion
Assess for abnormally large clitoris to investigate virilization
36. URINARY MEATUS
Assess for prolapse of urethra , hematuria , dysuria ,urethritis
Examine vaginal opening and hymen , congenital absence of vagina
Assess for vulvoginitis , unpleasant odour , abnormal colour of discharge.
MUSCULOSKELETAL SYSTEM
Knock – kneed appearance
In Pre-schoolers ; assess eversion of extremities .
Assess range of motion , congenital dislocation , tenderness , heat , swelling over joints;
infection.
Inspect atrophy, hypertrophy , spasticity , flaccidity , tone, rigidity of muscles .
Examine vertebral column for spina bifida , abnormal curvatures , meningomyelocele, tenderness
or note areas of mass.
Upper extremities assessed for fractures any deformity , length and shape of fingers , extra digits.
Lower extremities ; assess fracture , joint pain , arthritis , equality of length , complete range of
motion at the hip , knees , ankles and toes , abnormal hip dislocation and tibial torsion or bowing
of tibia.
37. CENTRAL NERVOUS SYSTEM
It is done to note orientation , level of consciousness, intellectual ability
and behaviour .
Assess any disorientation , hyperactive problems , cerebral palsy ,
cerebral dysfunction any injury or trauma , tumor to the brain.
Assess for language ability , cry , senses.
Assessing the milestones.
Assessing the reflexes
Biceps tendon reflex
Triceps tendon reflex
Patellar deep tendon reflex
Achilles deep tendon reflex
38.
39.
40. CONCLUSION
Physical examination of a child should be done
to rule out the distinguish between normal and
abnormality of body parts. It should be done in
the presence of his or her to parents to reduce
anxiety. It helps a nurse and a physician to know
that all the organs are functioning normally or
not.