Chapter 34
Child Health Assessment
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Nursing Process: Health Assessment
• Assessment
• Nursing diagnosis
• Outcome identification, planning
• Implementation
• Outcome evaluation
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Health History: Database
• Interview setting
• Types of questions
– Closed-ended
– Open-ended
– Compound
– Expansive
– Leading
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Health History: Database (cont’d)
• Health interview
– Introduction, explanation
– Demographic data
– Chief concern
– History of chief concern
– Health, family profile
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Health History: Database (cont’d)
• Health interview
– Day history
• Play
• Sleep
• Hygiene
• Nutrition
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Health History: Database (cont’d)
• Past health history
• Family health history
• Review of systems
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Physical Assessment
• Purpose, techniques
• Equipment, setting, approach
• Variations
– Newborn
– Infant
– Toddler, preschooler
– School age, adolescent
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Components of Physical Examination
• Vital signs
• General appearance
• Mental status
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Components of Physical Examination
(cont’d)
• Body measurements
– Weight
– Height
– Head circumference
– Chest, abdominal circumference
– Skin
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Components of Physical Examination
(cont’d)
• Head
– Newborn, infant
– Toddler, preschooler, school age
– Adolescent
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Components of Physical Examination
(cont’d)
• Eyes
– Conjunctivitis
– Hordeolum
– Ptosis
– Strabismus
– Esotropia
– Exotropia
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Components of Physical Examination
(cont’d)
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Components of Physical Examination
(cont’d)
• Eyes
– Newborn, infant
– Toddler, preschooler
– School age, adolescent
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Components of Physical Examination
(cont’d)
• Nose
– Newborn, infant
– Older children
• Ears
– Newborn, infant
– Older children
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Components of Physical Examination
(cont’d)
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Components of Physical Examination
(cont’d)
• Mouth
– Newborn, infant
– Older children
• Neck
– Newborn, infant
– Adolescent
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Components of Physical Examination
(cont’d)
• Chest
• Breasts
– Newborn
– School age, adolescent
• Lungs
– Newborn, infant
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Components of Physical Examination
(cont’d)
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Components of Physical Examination
(cont’d)
• Heart
– PMI
– Heart sounds
– Rhythm
– Newborn, infant, toddler
– School age, adolescent
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Components of Physical Examination
(cont’d)
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Components of Physical Examination
(cont’d)
• Abdomen
– Newborn, infant
– Preschooler, school age
• Genitorectal area
– Female
– Male
– Inguinal hernia
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Components of Physical Examination
(cont’d)
• Extremities
• Back
• Neurologic function
– Motor, sensory
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Components of Physical Examination
(cont’d)
See Figure 34.21.
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Vision Assessment
• Vision screening
• Techniques
– Snellen chart
– Preschool E chart
– National Association for the Prevention of
Blindness Home Test
– Allen cards
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Vision Assessment (cont’d)
• Techniques
– Stycar cards
– Titmus Vision tester
– Color vision discrimination testing
• Vision referrals
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Hearing Assessment
• Auditory screening
– Newborn, infant
– Older children
• Principles of audiometric assessment
– Frequency
– loudness
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Hearing Assessment (cont’d)
• Hearing loss
• Acoustic impedance testing
• Conduction loss testing
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Speech Assessment
• Denver Articulation screening
– Administration
– Scoring
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Developmental Appraisal
• Developmental history
• Denver II Developmental screening
– Administration
– Scoring
– Prescreening test
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Intelligence
• Goodenough-Harris Drawing test
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Temperament
• Child’s innate behavioral characteristics
– Activity level
– Rhythmicity
– Tendency to approach or withdraw
– Adaptability
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Immunizations
• Types
• Available vaccines
– Diphtheria, tetanus, pertussis (DTaP)
– Polio
– Measles, mumps, rubella (MMR)
– Hepatitis
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Immunizations (cont’d)
• Available vaccines
– H. influenzae Type B
– Varicella
– Pneumococcal pneumonia
– Human Papillomavirus
– Meningococeal Vaccine
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Immunizations (cont’d)
• Available vaccines
– Lyme disease
– Influenza
– Anthrax, smallpox
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Immunizations (cont’d)
• Administration
• Parental education
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Question
• Which physical finding would best suggest
that an infant is dehydrated?
A. A depressed fontanelle
B. A caput succedaneum
C. Curved fingerbeds
D. A listless appearance
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Answer
• A. A depressed fontanelle
• Rationale: With dehydration, the fontanelles
of infants often appear sunken.
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Question
• School-aged children run a high incidence of
pediculosis. Of the following, which best
suggests pediculosis?
A. Dry, brittle hair
B. Small white particles on the hair strands
C. Patches of hair loss
D. Weeping circular areas on the scalp
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Answer
• B. Small white particles on the hair strands
• Rationale: The eggs of lice are revealed as
small white particles on hair strands.
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Question
• When assessing a child’s heart, which finding
would be considered abnormal?
A. Physiologic splitting with inspiration
B. Presence of a fourth heart sound
C. An observable PMI
D. Dullness with percussion
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Answer
• B. Presence of a fourth heart sound
• Rationale: Many children demonstrate
physiologic splitting and an observable point
of maximum impulse. A fourth heart sound
suggests pathology.
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