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Pediatric Assessment and Fetal Development With Selected Pediatric Conditions

Pediatric Assessment and Fetal Development With Selected Pediatric Conditions

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Published by Dark Avenz

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Published by: Dark Avenz on Feb 04, 2010
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07/12/2013

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Pediatric Assessment and Fetal Development with Selected Pediatric Conditions
 Developmental Approach to the Physical Examination
Three rules in the examination of children and adolescents:
 flexibility ,safety,
and
organisation
Allow the child's age and developmental level to guide your history and physicalexamination
Atmosphere and environment are important
Incorporate health education and growth and development anticipatory guidance intothe examination
Move from the easy/simple -> more distressing; use positive reinforcement and'prizes'
Use demonstration and play to your advantage (play equipment or 'spares', paper dolltechnique, crayons, blocks)
Expect an age-appropriate level of cooperation; explain what will be involved in the physical examination and tell the child what she needs to do
 Infants
• Keep parent in view• Before 6 months examination on table; after 6 months examination in parent's lap• Undress fully in warm room• Careful with nappyremoval• Distract with bright objects/rattles. Soft manner; avoid loud noises and abruptmovements• Have bottle, dummy or breast handy• Vary examination sequence with activity level (if asleep/quietauscultate heart, lungs, abdomen first)• Usually able to proceed in cephalocaudal sequence• Distressing procedures last (ears and temperature)
Toddlers
• Most difficult group to examine• Approach gradually and minimise initial physical contact• Leave with parent (sitting or standing if possible)• Allow to inspect equipment (demonstration usually not helpful)• Start examination distally through play (toes, fingers)• Praise, praise, praise• Parent removes clothes• Save ears, mouth and anything lying down for last• Use restraint (with parent)
 Pre-schoolers
Allow close proximity to parent• Usually cooperative; able to proceed head to toe• Request self-undressing (bit by bit exposure modesty important)• Expect cooperation• Allow for choice when possible• If uncooperative, start distally with play
 
• Allow brief inspection of equipment with brief demonstration and explanation• Use games/stories for cooperation• Paper doll technique very effective• Praise, reward and positive reinforcement
 School-agers
• Usually cooperative• Child should undress self; privacy important; provide drape/gown if possible• Explain function of equipment; use of 'spares' helpful• Examination can be important teaching exercise• Head-toe sequence• Praise and feedback regarding normalcy is important
 Adolescents
• Give the option of parental presence• Undress in private; provide gown• Expose one area at a time• Physical examination can be an important teaching exercise• Head-toe sequence• Feedback regarding normalcy is important• Anticipatory guidance regarding sexual development (use Tanner staging)• Matter-of-fact approach to examination (and history)• Encourage appropriate decision-making skills
 
FETAL DEVELOPMENT WITH SELECTED PEDIATRIC CONDITIONSDIVISIONS OF UTERINE DECIDUA
Decidua basalis
Directly under the embryo
Portion of trophoblasts establishing communication with maternal bloodvessels
Decidua Capsularis
Stretches and encapsulates the trophoblasts
Decidua vera
Remaining portion of the uterine lining

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