Lect 1 - Physical Assessment and Assessment of Pain in the Pediatric Patient.docx

Physical Assessment and Assessment of Pain in the Pediatric
Patient
General Approach to Assessment
 Head to Toe?
o Generally, don’t do – little kids do least invasive – do
less invasive first then move to more invasive
 Obtain VS at same time?
o Listen to lungs, heart, do everything all at same time
 Often an observation of behavior, rather than following
commands
Vital Signs: Respiratory Rate
 Obtain first and while listening to lung and heart sounds
 One of the more important VS in children
 Auscultate for one minute
o Place hand on chest, listen, watch
 Do not use the RR on the monitor (this is unreliable is
generally just an apnea alarm (20s Ø chest wall movement)
 highly inaccurate (snapshot)
 RR is higher , the younger the child
o Newborns breathe about 30-60 times per minute , for
example
o Infants and young children have irregular breathing
patterns
 Ø labored breathing, but breathe very quickly then
slow or stop, then speed up, then slowdown –
cyclic = inaccurate monitor
Vital Signs: Heart Rate
 Auscultate apical heart rate for one full minute
 Can switch to radial pulse for HR at about 2 years old
o Brachial (under age 2), radial (over 2)
 Obtain while listening to lung sounds
 Try to do this first
 The younger the child, the higher the heart rate
 Infants’ heart rates are 90-120 bpm , for example

Vital Signs: Blood Pressure
 Try to obtain while child is calm
 Cuff can be applied to upper or lower extremity
o Avoid lower in children who are able to walk
 Normal SBP: 70 + (age in years x2)
o 2yo x2 = 4 + 70 = 74
 Be careful with wording “ Take ” your Blood Pressure implies
you are going to take something away from them 
measure?
 Ensure numbers stay consistent – look at trends, not always
accurate
 As with adults, proper size is important
o Too small, false high
o Too large, false low
Vital Signs: Temperature
 measured in Celsius using a temporal thermometer
o across forehead & behind ear – hold button
 Infants 2 months and younger will get an axillary temp
with a digital thermometer
o place thermometer parallel with body
 No rectal temps !
 Don’t add a degree or subtract a degree, just report the
temp
 and route
 98.6 F = 37 C
 What is a fever?
o 38.5 C or higher – flagged in chart (blue triangle for
low temp.)
 Always alert nurse or instructor if altered
temp.
o Do we treat every fever? No. but not your call – always
report!
o Can children under 6 months have Ibuprofen/motrin?
NO!
 Tx children with Tylenol ( under 6mo ) or motrin.
 Hypothermia?

o Acetaminophen 10-15 mg/kg/dose q4-6 hours
o Ibuprofen 10 mg/kg/dose q6 hours
Vitals Signs: SpO2 – O ₂ sats.
 Usually want kids >92%, some variation for kids with
respiratory or cardiac disease (Please NOTE: it is not >95%
(adults)!!)
o Asthma, other dz will affect needed SpO₂
 Fingers, toes, sometimes more well tolerated!