Finals Lecture notes

INFANTS AND CHILDREN

1. Denver Developmental Screening Test (DDST-II)
▪ Use to evaluate children from birth to 6 years to estimate their abilities as compared to those of an
average group of children of the same age.
▪ Device for detecting developmental delays in infancy and preschool years.

▪ Direct observation on what the child can do and on reports by parents

Four Areas of Competency

▪ Personal-Social

▪ Fine Motor Adaptive

▪ Gross Motor

▪ Language
2. Metro Manila Developmental Screening Test (MMDST)
▪ Developed by DR. Phoebe Williams

▪ Designed to detect developmental delays in children 2 weeks to 61/2 years old

▪ Administered using the MMDST kit which includes the manual, sample test form, test materials and the
MMDST bag which consists of:
A bright red yarn pom-pom, a rattle with a narrow handle, eight 1 inch colored wooden blocks (red, blue,
yellow, green), a small clear glass or bottle with 5/8 inch opening, a small bell with 2 ½ inch diameter
mouth, a rubber ball 12 ½ inches in circumference, cheese curls, a pencil, bond paper
▪ Four Aspects of Development
Personal-Social (tasks which indicate the child’s ability to get along with people and to take care of himself)
Fine Motor Adaptive (tasks which indicate the child’s ability to see and to use his hands to pick up objects
and to draw)
Language (tasks which indicate the child’s ability to hear, follow directions and to speak)
Gross Motor Behavior (tasks which indicate the child’s ability to sit, walk and jump)
MMDST – 4 Areas of Competency

Personal- Social Fine Motor Adaptive Gross Motor Behavior Language

Regards face Follows to midline Stomach lefts head Responds to bell
Smiles responsively Equal Movements Stomach head up 45 Vocalizes – not crying
Smiles spontaneously Follows past midline degrees Laughs
Feeds self cracker Follows 180 Stomach head up 90 Squeals/ makes high
Resists toy pull Hands together degrees pitched sounds
Plays peek-a-boo Grasp rattle Stomach chest up, arm Turns to voice
Works for toy out of Regards cheese curl support Dada or mama
reach Reaches for object Sit head steady Specific
Initially shy with Sit, looks for yarn Rolls over 3 words other than
strangers Sit, takes 2 cubes Pull to sit, no head lag mama/ dada
Plays pat-a-cake/ wave Rakes cheese curls Bear some weights on Combines 2 different
bye bye Passes cubes hand to legs words
Plays ball with examiner hand Sits without support Names one picture
Indicates Wants Bangs 2 cubes held in Stands momentarily Follows direction
Drinks from cup hands Stands alone well Uses plurals EX: Birds,
 Removes garments Thumb-finger grasp Stoops and recovers chicken
Imitates housework Neat pincer grasp of Walks well Gives first and last name
Uses spoon, spilling little cheese curl Walks backward Comprehends cold, tired
Helps in house-simple Scribbles spontaneously Walks up steps ,hungry
tasks Tower of 2 cubes Kicks ball forward Comprehends
Puts on clothing Tower of 4 cubes Throws ball overhead prepositions ( on under
Washes and dries hand Tower of 8 cubes Balance on 1 foot 1 ,behind)
Plays interactive games Imitates vertical line second Recognizes colors
Separates from mother Dumps cheese curl from Jumps in place Opposite analogies EX:
easily bottle spontaneously Pedals tricycle Fire is hot
Dresses with supervision Imitates bridge Broad jump Ice is cold
Buttons up Picks longer lines Balance on 1 foot 5 Defines words
Dresses without Copies circle seconds Composition of (shoe
supervision Imitates demonstrated Balance on 1 foot 10 etc)
picture seconds
Copies + Hops on 1 foot
Draws man 3 / 6 parts Heel to toe walk
Copies square Catches bounced ball

Scoring:
P –Pass
F- Failure
R- Refusal
No – No opportunity

I. GENERAL SURVEY
A. GENERAL APPEARANCE
1) Apparent age, nutrition, voice quality and actions consistent to sex and observed or stated age.
2) Stature and body build
3) Body posture, gait and movement
4) General skin color, texture, moisture and hair distribution
5) Dressing, grooming and personal hygiene
6) Mental alertness
7) Manner, affect, relationship
8) Speech pattern

B. MEASURE VITAL SIGNS

1) Weight and height
2) TPR
3) Blood pressure

FRAMEWORKS/ MODELS OF ASSESSMENT:

A. REVIEW OF SYSTEM (ROS)
⮚ Patient’s subjective response to a series of body system – related questions, and serves as a double check
that vital information is not overlooked.
Systems Approach
1) Integument ( skin, hair, nails)
2) Head and Neck
3) Eyes
 4) Ears Nose, Mouth and Throat
5) Thorax and lungs
6) Cardiovascular and Peripheral Vascular System
7) Abdomen
8) Musculoskeletal System
9) Neurologic System
10) Genitourinary System

Review of System
General Health
▪ Perception of general state of health

▪ Specific symptoms or problems

▪ Difference from usual state

▪ Body odors

▪ Fever, chills, night sweats

▪ Impaired ability to carry out ADL

Skin, Hair and Nails

▪ Known skin disease

▪ Itching

▪ Skin reaction to hot or cold weather

▪ Presence and location of scars, sores or ulcers

▪ Presence and location of skin growths such as warts, moles, tumors and masses

▪ Color changer in any of the above lesions

▪ Change in amount, texture or character of hair

▪ Presence of development of baldness

▪ Hair care practices, including frequency of shampooing, permanent or hair coloring

▪ Changes in nail color or texture

▪ Excessive nail splitting, cracking or breaking

Head and Neck

▪ Lumps, bumps or scars from old injuries

▪ Headaches

▪ Recent head trauma, injury or surgery

▪ Concussion or unconsciousness fro head injury

▪ Dizzy spells or masses

▪ Enlarged lymph nodes or glands

Nose and Sinuses
▪ History of frequent nosebleed

▪ History of allergies

▪ Postnasal drip

▪ Frequent sneezing

▪ Frequent nasal drainage

▪ Impaired ability to smell

▪ Pain over the sinuses

▪ History of nasal trauma or fracture

▪ Difficulty of breathing

Mouth and Throat

▪ History of frequent sore throats

▪ Current or past mouth lesions, such as abscesses, ulcers and sores

▪ History of oral herpes infections

▪ Date and results of last dental examination

▪ Overall description of dental examination

▪ Bleeding gums

▪ History of hoarseness

▪ Changes in voice quality

▪ Difficulty or chewing or swallowing

Eyes
▪ Date and result of last visual examination

▪ History of eye infection

▪ Use of corrective lenses

▪ Blurred or double vision

▪ Itching, excessive tearing or discharges

▪ Eye pain, spots or floaters in visual field

▪ History or glaucoma or cataracts

▪ Unusual sensation such as twitching

▪ Photosensitivity

▪ Swelling around eyes or eyelids

 ▪ Visual disturbances, such as rainbows around lights, flashing lights

▪ History of retinal detachment

▪ History of strabismus or amblyopia

Ears
▪ Date and results of last hearing evaluation

▪ Abnormal sensitivity to noise

▪ Ear pain

▪ Ringing or crackling in the ears

▪ Recent changes in hearing ability

▪ Use of hearing aids

▪ History of ear infection

▪ History of vertigo

▪ Feeling of fullness in the ear

▪ Ear care habits

▪ Number of ear infections per year (pediatric patients)

Respiratory System
▪ History of asthma or other breathing problem

▪ Chronic cough

▪ History of coughing up blood

▪ Breathing problems after physical exertion

▪ Sputum production (note color, odor and amount)

▪ Wheezing or noisy respirations

▪ History of pneumonia or bronchitis

Cardiovascular System
▪ History of chest pain

▪ History of palpitations

▪ History of heart murmurs

▪ History of irregular pulses

▪ Hypertension

▪ Color changes in fingers or toes

▪ Swelling or edema in extremities

 ▪ Leg pain when walking, relived by rest

Breasts
▪ Date and results of last breast examination (including mammography for women over 40y/o)

▪ Pattern of breast self – examination

▪ Brest pain, tenderness or swelling

▪ History of nipple changes or discharges

▪ History of breastfeeding

Gastrointestinal System
▪ Change in appetite

▪ Indigestion or pain associated with eating

▪ History of ulcers

▪ History of vomiting blood

▪ Burning sensation in esophagus

▪ Frequent nausea and vomiting

▪ History of liver or gallbladder disease

▪ History of jaundice

▪ Abdominal swelling or ascites

▪ Change in defecation pattern

▪ Stool characteristics

▪ History of diarrhea or constipation

▪ History of hemorrhoids

▪ Use of digestive aids or laxatives

Urinary System
▪ Painful urination

▪ Characteristics of urine

▪ Pattern of urination

▪ Hesitancy in starting urine stream

▪ Changes in urine system

▪ History of renal calculi

▪ History of flank pain

▪ Hematuria
 ▪ History of decreased or excessive urine output

▪ Dribbling, incontinence or stress incontinence

▪ Frequent urination at night

▪ Difficulty with toilet training (for children)

▪ Bed – wetting (for children)

▪ History of bladder or kidney infections

▪ History of urinary tract infections

Female Reproductive System

▪ Menarche including duration and amount of flow

▪ Date of LMP

▪ Painful menstruation, PMS

▪ History of excessive menstrual bleeding

▪ History of missed periods

▪ History of bleeding between periods.

▪ Paps smear result if any

▪ Obstetrical history

▪ Satisfaction with sexual performance

▪ History of painful intercourse

▪ Contraceptive practices

▪ History of STD

▪ Problems with infertility

Male Reproductive System

▪ Presence of penile lesions/scrotal lesions

▪ Prostate problems

▪ Pattern of testicular self – examination

▪ Satisfaction with sexual performance/ change in libido

▪ History of venereal disease

▪ Contraceptive practices

▪ Knowledge of how to prevent STD

▪ Concern about impotence

▪ Concern about sterility

Nutrition
▪ Present weight

▪ Usual weight, desired weight

▪ Food intolerances

▪ Food likes and dislikes

Endocrine Lymph Nodes

▪ Exopthalmus - enlargement, tenderness

▪ Fatigue

▪ Change in size of hands, or feet

▪ Heat and cold intolerances

▪ Excessive sweating Hematological

▪ Polydipsia, polyphagia, polyuria - easy bruising / bleeding

▪ Increased hunger, DM - anemia, sickle cell anemia

▪ Change in body hair distribution - blood type

B. Head-to Toe (Cephalocaudal)

1. Head
● Hair, scalp, cranium, face – size, symmetry, shape, contour, parasites present
● Eyes and vision – visual acuity (CN 2 or optic nerve), symmetry, closure and symmetry
● Ears and hearing - color, size, symmetry, Acoustic nerve (CN 8) , otoscopic examination
● Nose and sinuses – symmetry, patency and tenderness, Olfactory nerve (CN 1)
● Mouth and oropharynx – teeth and gums, palate, tonsils, tongue
● Cranial nerves
1. Neck
● Muscles - symmetry
● Lymph nodes
● Trachea
● Thyroid glands
● Carotid arteries
● Neck veins

2. Upper extremities
o Skin and nails
o Muscle strength and tone
o Joint range of motion
o Brachial and radial pulse
o Biceps tendon reflexes
o Tendon reflexes
o Sensation

3. Chest and Thorax

 - Skin
- Chest shape and size
- Lungs
- Heart
- Spinal column
- Breast and axillae – 4 quadrants, tail of Spence, lymph nodes

4. Abdomen (IAPerPa)
- Skin – color, integrity
- Abdominal sounds
- Specific organs (e.g. liver, bladder)
- Femoral Pulses

6. Genitals
- Testicles
- Vagina
- Urethra

7. Anus and rectum

8. Lower extremities
- Skin and toenails
- Gait and balance
- Joint range of motion
- Popliteal, posterior tibial, and pedal pulses
- Tendon and plantar reflexes