Professional Documents
Culture Documents
9/6/2014 9:26 PM
Pediatric
Interview/Evaluation
Head-to-Toe
Assessment:
Infant
Sequence
of
examination
o Begin
the
examination
with
a
general
survey,
then
assessment
of
somatic
growth,
then
vital
signs,
skin,
head
and
neck,
eyes,
ears
and
nose,
mouth
and
pharynx,
thorax
and
lungs,
cardiovascular
system,
breasts,
abdomen,
genitalia
and
rectum,
musculoskeletal
system,
nervous
system,
otoscopic
examination
of
the
ears
Vital
Signs
o For
infants
you
measure
pulse,
respiratory
rate,
blood
pressure,
and
temperature
o Pulse
palpate
the
femoral
artery
or
brachial
artery
or
oscillate
the
heart
o Normal
respiratory
rate
in
infants
between
30-60
bpm
o Temperature
is
determine
in
infant
by
rectal
examination
The
Skin
o Notice
the
texture
(normally
soft
and
smooth
in
infants)
o Common
skin
conditions
and
rashes
include
Vernix
caseosa,
Edema,
Milia,
Miliaria
rubra
o In
well
hydrated
infants
the
skin
returns
to
its
original
form
instantly
(no
jaundice)
Eyes
o Use
less
lighting
so
they
dont
blink
o During
the
first
month,
some
babies
have
cross
eyes
o By
one
month
of
age,
an
infant
should
be
able
to
fix
on
objects
such
as
your
face
and
follow
a
bright
light,
provided
you
catch
the
baby
during
an
alert
period
Cardiovascular
System
o Notice
the
skin
for
cyanosis
o Palpate
the
peripheral
pulses
or
femoral
pulse
o The
point
of
maximal
impulses
is
often
not
palatable
in
infants
o Listen
to
the
S1,
S2,
S3,
and
sometimes
S4
o Listen
for
systolic
or
diastolic
murmurs
Musculoskeletal
System
o Much
of
it
is
to
notice
for
congenital
abnormalities
o With
a
little
practice,
you
will
be
able
to
combine
the
musculoskeletal
examination
with
the
developmental
and
nervous
system
examination
o
Some
normal
infants
exhibit
twisting
(torsion
of
the
tibia)
inwardly
or
outwardly
on
the
tibias
longitudinal
axis
Nervous
System
o The
examination
of
the
nervous
system
in
infants
includes
techniques
specific
to
their
particular
age
and
depending
on:
Internal
factors:
alertness
and
timing
with
respect
to
feeding
and
sleeping
External
factors:
presence
of
parents,
or
the
presence
of
fearful
stimuli
o Primitive
reflexes,
present
only
at
certain
age
and
then
disappear
o Neurologic
changes,
often
present
as
developmental
abnormalities
o Do
not
use
a
pin
to
test
for
pain!
Females
o This
is
false
because
only
1/5000
people
in
America
are
live
to
be
100
o We
are
not
programed
to
live
for
100
years
o To
live
for
100
years,
you
not
only
need
a
healthy
lifestyle
but
win
the
genetic
lottery
Note
o Your
ekiguy
reason
why
you
wake
up
in
the
morning
affects
how
long
you
live
ex.
A
102
year
old
fisherman
wakes
up
every
morning
to
provide
fish
3
times
a
day
for
his
family.
o Adventist
are
known
to
live
longer
in
certain
parts
of
the
world
o
Urology
o Groin
Pain
Muscle,
tendon
or
ligament
strain
Metabolic Syndrome
o Mexican/African/Asian
Americans
o Risk
factors
include
genetic
factor
South
Asians,
poor
diet
and
inadequate
exercise
o Adipose
tissue
dysfunction
o Insulin
resistance
is
the
primary
mediator
of
metabolic
syndrome
Clinical
Consequences
o Cardiovascular
disease
o Stroke
o Diabetes
o Fatty
liver
o Cancers
Diabetes
Mellitus
o Type
1
autoimmune
destruction
of
beta
islet
cells
o Type
2
Obesity
related
insulin
resistance
(defect
insulin
receptor)
o Type
3
Alzheimers
disease
Management
o Aggressive
therapeutic
life
style
changes
o Diet
rich
in
fruits,
veggies,
whole
grains,
avoid
sat/trans
fat
o Exercise
at
least
30mts
five
times
a
week
o Reduce
LDL
with
statins
<100
o Increase
HDL:
aerobic
exercise,
niacin
o Increase
insulin
sensitivity:
methformin
Polyunsaturated
Fats
o Omega
6
linoleic
acid
in
vegetable
oils
o Omega
3
Plant
source
alpha-linoleic
acid
(ALA)
walnuts,
flaxseeds,
canola
oil
Marine
Source
DHA
&
EPA,
wild
fish
(salmon),
tuna
mackerel
Chronic
Inflammation
o Current
Omega-6
to
Omega-3
ratio
is
15:1
o Rich
sources
of
omega
3
(flaxseeds,
fish)
are
both
anti-inflammatory
and
prevent
oxidative
stress
closes
linked
to
vascular
dysfunction