Practical skills for State Exam

1. Measurement of blood pressure in children

Before staring BP measurement, the child should remain sited and relaxed for 3-5
min in a quiet and comfortably warm room. He/she should be sited with back
supported, the legs uncrossed, and feet flat against the floor. Supine position is not
recommended as may result in higher systolic BP. Common pitfalls including child
sitting in the bed with legs hanging and inability to hold without moving or speaking
as well as measuring BP in upsent, crying, unable to cooperate children should be
avoided.

Blood pressure is usually measured at the right arm. The arm should be supported at
heart level. Upper or lower position of the arm results in lower and higher BP,
respectively, due to changes in hydrostatic pressure.

Then, appropriate cuff for the arm of the child needs to be selected. A cuff that is too
small can overestimate the BP, and a larger cuff may give lower readings. The
bladder, that is the inflatable part of the cuff, determines the cuff size. The rule for
appropriate cuff size is to measure the arm circumference midway between
acromion and olecranon and select a cuff bladder length that would cover 80-100%
of the arm circumference. The cuff bladder width should be 40% of the arm
circumference. The branchial artery is palpated at the cubital fossa. The midline of
the cuff is placed in line with brachial artery 2-3 cm above the cubital fossa. The cuff
should fit around the arm but leave room for about 2-3 fingers.

Auscultation using a mercury, hybrid or aneroid sphygmomanometer is considered

the gold standard for office BP measurement. However, validated automated
(oscillometric) devices using an automated inflating cuff could be used pediatric
population. If auscultation is used a high-quality stethoscope is placed over the
palpating brachial artery at the cubital fossa. The cuff is inflated 20mmHg above the
disappearance of palpating pulse and then is deflated at a rate of 2-3 mmHg per sec.
The pressure at which the pulse sound appears is the Korotkoff phase 1 sound
representing systolic BP and the pressure at which pulse sounds disappears is
Korotkoff phase 4 sound and gives diastolic BP.

According to the European Society of Hypertension 2016 guidelines BP should be

measured three times in children and adolescents with an interval of 3 min apart,
and then evaluate the average of the last two readings to determine the child’s or
adolescent’s BP levels.
Norm AP- systolic 90+2n( n- age)
Diastolic 90 - n
2. Rules for taking an ECG
https://www.youtube.com/watch?v=9ZMygJcV850
Take off clothes from the chest, lay the child on the couch. Parents can be nearby, support and
reassure child. The doctor will fix 9-12 sensors on the baby's body - in the chest area, on the
wrists and ankles. In order not to injure the delicate baby skin, sensors of reduced sizes and a
special shape (depending on age) are used to conduct an ECG for a child.
A red electrode is applied to the right hand; A yellow electrode is attached to the left hand; A
green electrode is placed on the left leg; The right leg implies grounding and a black electrode
is attached to it.
3. Primary toilet of a newborn
Algorithm of Examination for a healthy newborn at Maternity Hall
1.Midwife.lays the baby on the mother's belly, dries the baby's head and body with
sterile, dry, preheated diapers.
2. After the end of the pulsation of the umbilical cord, but no later than 1 min. after the
birth, the midwife, replacing sterile gloves, pinches and cuts the umbilical cord and
transfers the baby to the mother's breast.
3. With the appearance of a search and sucking reflex, the midwife helps to carry out the
first early application of the child to the mother's breast.
4. After 30 min. after the birth of the child, the midwife uses an electronic thermometer
to measure the newborn body temperature in the axillary region.
5. After making eye-to-eye contact between the mother and child (but not later than the
first hour of the child's life), the midwife, after treating the hands, conducts ophthalmia
prophylaxis for the newborn using antibacterial drugs (eye drops, ointment.
6. Skin-to-skin contact is carried out for at least 2 hours in the delivery room, subject to
the satisfactory condition of the mother and child.
7. After the skin-to-skin contact is completed, the midwife transfers the child to a warm
changing table, processes and clamps the umbilical cord, measures growth,
circumscribes the head and chest, weighs, after which an initial medical examination is
carried out and the midwife puts on the child clean sliders, a shirt , cap, socks, gloves.
8. The child, together with the mother, is covered with a blanket and transferred to the
ward of joint stay in compliance with the conditions of the heating chain

4. Bladder catheterization in girls, boys

https://www.youtube.com/watch?v=nVldql6f79Q

5. Rules for conducting pulse oximetry in children of different ages

Children over 30kg- use an adult pulse oximeter for your child, as long as their finger
goes all the way to the end of the probe.
Children under 30kg need a child's pulse oximeter. This may be either an oximeter
that: clips
onto the finger with a child sized clip wraps around the finger with tape.
The best sites for performing pulse ox on infants are around the palm and the foot. An infant
pulseox probe (not an adult pulse ox clip) should always be used for infants.
Preparing
Wash child’s hands. Make sure it doesn't have any nail polish or glitter on it - the
sensor's light beams pass through the child's nail. Make sure child rests for at least 5
minutes before reading. If child’s hands are cold, warm them up by rubbing them
together. His arm should be at waist level - try resting your arm on a table or the arm of a
chair.

Taking the reading

 Switch the pulse oximeter ON and the display will light up.
 If using a pulse oximeter with a clip, squeeze to open and put your child's finger
in until their fingertip touches the end.
 If using a pulse oximeter with tape, make sure the two surfaces are on opposite
sides of the finger and keep them in place by wrapping the tape around.
 It works best on the middle or index finger of either hand.
 Keep your child's hand still and wait for 1 to 2 minutes until their pulse
(bpm/PRbpm) is steady and their oxygen saturation (SpO2%) number has not
changed for at least 5 seconds.
 If the numbers are not steady, try a different finger.