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

Preschoolers
School-age Children
Adolescents

Performing Physical Exam
 Steps of the Physical exam
 Inspection
 Palpation
 Auscultation

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

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

Vital Signs
Age
Heart Rate
(beats/min)
Prem ature
120-170 *
0-3 mo
100-150 *
3-6 mo
6-12 mo
90-120
80-120
1-3 yr 70-110
3-6 yr 65-110
6-12 yr
12 > yr
60-95
55-85
Blood Pressure
(mm Hg)
Respiratory Rate
(breaths/min)
55-75/35-45†
65-85/45-55
40-70†
35-55
70-90/50-65
80-100/55-65
90-105/55-70
95-110/60-75
100-120/60/75
110-135/65/85
30-45
25-40
20-30
20-25
14/22
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 Height
Weight
Weight for Length
Body Mass Index
Monitoring Equipment

Weight
 Weight Status Category Percentile Range
Underweight Less than the 5th percentile
 Healthy weight 5th percentile to less than the 85th percentile
 Overweight 85th to less than the 95th percentile
 Obese 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 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

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

Corneal Abrasion insighteyespecialists.com
en.wikipedia.org

Corneal Ulcer accesspediatrics.mhmedical.com

External Structures
 Inspect 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 Loss
Conductive hearing loss –Occurs due to problems in the outer or middle ear; normal bone conduction
0-20 (or 25) db
20-45 db
46-65 db
65-90 db
Sensorineural hearing loss---
Refers to nerve damage (VIII) in the inner ear.
>90 db
NORMAL
Mild
Moderate
Severe
May not hear a sound

Hearing loss
Hearing Aids Cochlear Implants ww.medicalhomeportal.org/living-with-child/assistivetechnology/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 realmagick.com
http://medicalpicturesinfo.com/wp-content/uploads/2011/08/Angular-Cheilitis-5.jpeg

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

Cardiovascular
 Inspection
 Palpation
 Auscultation

Cardiovascular
Atitesting.com

Auscultation

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

Heart Sounds mediconweb.com

Listening Sites for Auscultation
Heart Sound
S1
S2
Physiologic splitting
S3
Sites where heard best Sites where heard softly
Apex of the heart
Tricuspid and Mitral area
Base of the heart
Aortic and Pulmonic area
Pulmonic area
Mitral
Base of heart
Aortic area and Pulmonic
Apex of the heart
Tricuspid and Mitral area
London, 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 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

Lung sounds

Possible Sites for Retractions
Bowden & Greenberg

Respiratory Distress www.nationwidechildrens.or
g