PEDIATRIC ASSESSMENT

Prepared by: Puan Kurniati Solehan

 Objectives
• Understand the importance of Assessment and
Triage and how they interplay in the Health Care
Setting
• Identify essential components of a “focused”
Pediatric Assessment
• Utilize the assessment information to differentiate
between minor and more serious conditions (Triage)
• Identify and implement nursing interventions based
on the assessment and triage provided
Sound
Essential Pediatric Nursing Skills
• Knowledge of Growth and Development
• Development of a Therapeutic Relationship
• Communication with children and their parents
• Understanding of family dynamics and parent-child
relationships: IDENTIFY KEY FAMILY MEMBERS
• Knowledge of Health Promotion & Disease Prevention
• Patient Education and Anticipatory Guidance
• Practice of Therapeutic and Atraumatic Care
• Patient and Family Advocacy
• Caring, Supportive & Culturally Sensitive Interactions
• Coordination and Collaboration
• CRITICAL THINKING
 Equipment
What’s in Your setting?

• Airway support
equipment, Ambu-bags
• Stethoscope &
Sphygmomanometer
• Pen Light
• Pulse Ox & Cardiac
Monitor
• Nebulizer
• Otoscope /
Opthalmoscope
• O2
The single most important part of
thehealth assessment is……

th
e
 History
Bio-graphic Demographic Past Medical History
• Name, Date of Birth, Age • Allergies
• Past illness
• Parents & siblings info
• Trauma / hospitalizations
• Cultural practices • Surgeries
• Religious practices • Birth history
• Parents’ occupations • Developmental
• Family Medical/Genetics
• Adolescent – work info
Current Health Status
• Immunization Status
• Chronic illnesses or conditions
• What concerns do you have today?
Review of Systems

• Ask questions about each system

• Measurements: weight, height, head
circumference, growth chart, BMI
• Nutrition: breastfed, formula, favorite
foods, beverages, eating habits
• Growth and Development: Milestones
for each age group
History: Review of Systems

• Skin • GI
• HEENT • GU & GYN
• Neck • Musculoskeletal
• Chest & Lungs / & Extremities
Respiratory • Neuro
• Heart & • Endocrine
Cardiovascular
 THIS OLD CART
O_
L
D
C
A
R
T
 Patti’s Nitty Gritty Trio

• Sleep & Activity

• Appetite
• Bowel & Bladder

• In a time crunch, these three questions

should give you enough insight into
the child’s general functioning –
• Can get more detailed if any (+)
responses
 Components of a
Focused Pediatric
Assessment
• Always ABCs!
Appearance
• PAT: Pediatric Includes
Assessment LOC &
Behavior
Triangle
• Ongoing Triage –
PAT
• Minor vs.
• Serious vs.
Life-Threatening Breathing Changes Skin Circulation

• Problem- Focused
Examination
 PAT
General Appearance
Work of Breathing
Circulation to the Skin
APPEARANCE

Tone
Interactiveness
Consolability
Look/gaze
Speech/cry
Work of Breathing

• Increased or
Decreased
Respirations
• Stridor
• Wheezing
Circulation to the Skin

• Inadequate perfusion
of vital organs
• Leads to
compensatory
mechanisms in non-
essential functions
• Ex: vasoconstriction in
the skin.
Initial Assessment (s)

• Primary • Secondary
• A = Airway • E = Exposure
• B = Breathing • F = Full Set of Vitals
• G = Give Comfort
• C = Circulation Measures including Pain
• D = Disability Assessment & Tx.
• H = Head –to-Toe
assessment & history
• I = Inspect posterior
surfaces – rashes,
bruising
Physical Assessment
• The approach is:
• Orderly
• Systematic
• Head-to-toe

• But FLEXIBILIY is essential

• And be kind and gentle
• but firm, direct and honest
Physical Assessment

General Appearance & Behavior

• Facial expression
• Posture / movement
• Hygiene
• Behavior
• Developmental Status
Vital Signs

• Temperature: rectal only when

absolutely necessary
• Pulse: apical on all children under 1
year
• Respirations: infant use abdominal
muscles
• Blood pressure: admission base
line
• And the “Fifth” Vital Sign is
?
Pediatric Vital Signs – Normal
Ranges
Infant Toddler School-Age Adolescent
• Heart Rate
80-150 70-110 60-110 60-100

• Respiratory Rate
24-38 22-30 14-22 12-22

• Systolic blood pressure

65-100 90-105 90-120 110-125

• Diastolic blood pressure

45 - 65 55-70 60-75 65-85
 Physical Assessment

• General • Heart
• Skin, hair, nails • Abdomen
• Head, neck, • Genitalia, Tanner Scale,
lymph nodes • Rectal
• Eyes, ears, nose, • Musculoskeletal: feet,
throat legs, back, gait
• Chest, Tanner
Scale
Physical Assessment
• Four Basic Skills:
1. Inspection
2. Palpation
3. Percussion
4. Auscultation

• Sequence for abdominal:

1.inspection,
2.auscultation,
3.percussion, 4.palpation
Inspection

• Use all your

senses
• The essential
First Step of the
Physical Exam
Palpation
• Use of your fingers • Warm hands and
and palms to short nails
determine: • Palpate areas of
tenderness / pain last
• Temperature
• Talk with the child
• Hydration during palpation
• Texture to help him relax
• Shape • Be observant of
• Movement reactions to palpation
• Move firmly without
• Areas of hesitation
Tenderness
Palpation
• For the ticklish child: place her hands over
your hands and have the child do the
pressing down.
Percussion
Use of tapping to
produce sounds that
are characterized
according to:
• Intensity
• Pitch
• Duration
• Quality
Direct vs.
Indirect
Auscultation
• Listening for body sounds
• Bell: low-pitched
• - heart
• Diaphragm: high-pitched
• – lung & bowel

LUNGS:
Listen to all lung fields
FRONT AND BACK!
auscultate for breath sounds and
 “I P P A”
• Practice, Practice, Practice
• by knowing what the norm is, you’ll be able
to pick up on the abnormal, even if
you
can’t diagnose it….
• The important thing is to be able to say
“This is not right”
• and refer appropriately!
 H E E N T

Head
Eyes
Ears
Nose
Neck
Throat
 HEENT: Head & Neck, Eyes, Ears,
Nose, Face, Mouth & Throat
• Head: Symmetry of skull and face
• Neck: Structure, movement, trachea, thyroid,
vessels and lymph nodes
• Eyes: Vision, placement, external and internal
fundoscopic exam
• Ears: Hearing, external, ear canal and
otoscopic exam of tympanic membrane
• Nose: Structure, exudate, sinuses
• Mouth: Structures of mouth, teeth and
pharynx
Head

• Shape:
“NormoCephalic –
ATraumatic”
• Lesions
• ? Edema
 Head: Key Points

• Head Circumference (HC

• Fontannels/sutures: Anterior closes at 10-18
months, posterior by 2 months
• Symmetry & shape: Face & skull
• Bruits: Temporal bruits may be significant after 5
yrs
• Hair: Patterns, loss, hygiene, pediculosis in school
aged child
• Sinuses: Palpate for tenderness in older children
• Facial expression: Sadness, signs of abuse,
allergy, fatigue
• Abnormal facies: “Diagnostic facies” of common
syndromes or illnesses
Neuro Assessment

• LOC / Glasgow coma scale

• Confusion, Delirium, Stupor, Coma
• Pupil size
• CNS grossly intact: II – XII
• Vital Signs
• Pain
• Seizure Activity
• Focal Deficits
Neurological Key Points
• Cranial Nerves
• Cerebral Function:
• Mental status, appearance, behavior, cooperation
• LOC, language, emotional status, social response,
attention span
• Cerebellar Function
• Balance, gait & leg coordination, ataxia, posture, tremors
• Finger to nose (fingers to thumb) 3-4 yrs
• Finger to examiner's finger 4-6 yrs
• Ability to stand with eyes closed (Romberg) 3-4 yrs
• Rapid alternations of hands (prone, supine) school age
• Tandum walk 4-6 yrs
• Walk on toes, heels school age
• Stand on one foot 3-6 yrs
• Motor Function: Gross motor & Fine motor movements
• Sensory function
• Reflexes
Cranial Nerves

C1 - Smell
C2 - Visual acuity, visual fields, fundus
C3, 4, 6 - EOM, 6 fields of gaze
C5 - Sensory to face: Motor--clench teeth,
C5 & C7 - Corneal reflex
C7 - Raise eyebrows, frown, close eyes tight, show
teeth, smile, puff cheeks, taste--anterior 2/3 tongue
C8 - Hearing & equilibrium
C9 – say "ah," equal movement of soft palate & uvula
C10 - Gag, Taste, posterior 1/3 tongue
C11 - Shoulder shrug & head turn with resistance
C12 - Tongue movement
 Reflexes
Deep tendon:
• Biceps C5, C6
• Triceps C6, C7, C8
• Brachioradialis C5, C6
• Patellar L2, L3, L4
• Achilles S1, S2

Superficial:
• Cremasteric T12, L1, L2
• Abdominal T7, T8, T9, T10, T11

Infant Automatisms:
• Primitive Reflexes
 Glasgow Coma Scale
The lowest possible GCS is 3 (deep coma or death) while the
highest is 15 (fully awake person).

1 2 3 4 5 6
EYES Does not Opens eyes Opens Opens eyes N/A N/A
open eyes in eyes in spontaneously
response response
to painful to voice
stimuli

N/A
VERBAL Makes no Incomprehen Utters Confused, Oriented,
sounds sible sounds inappropri disorientated converses
ate normally
words

MOTOR Makes no Extension to Abnormal Flexion / Localizes Obeys

movements painful stimuli flexion to Withdrawal to painful commands
painful painful stimuli
stimuli stimuli

Source :Wikipedia
Bacterial Meningitis
Clinical Manifestations in an Older Child
• High fever
• Headache
• LOC Changes / GCS
• Nuchal rigidity / stiff neck

• + Kernigs = inability to extend legs

• + Brudzinski sign = flexion of hips when neck is

flexed
• Purple rash (check for blanching)
• “Looks Sick”
HEAD INJURY
• Very common in pediatrics
• Most often not serious
• requires observation only
• Symptoms
- headache
- vomiting
- lethargy
- altered behavior
•Altered mental status: GCS
 HEAD INJURY - Physical
Findings
• PUPILS
• PAPILLEDEMA
• CUSHING TRIAD:
• bradycardia, irregular respirations and
hypertention

• Look for signs of alcohol/drug abuse in

adolescents
• Lack of external signs of head trauma
does not rule out significant brain injury
CONCUSSION

• Traumatic alteration in mental status

- disturbance of vision
- loss of equilibrium
- amnesia
- headache
- cognitive function
- LOC (not necessary for diagnosis)
• Needs complete neurological exam
• Second-impact syndrome
• MRI
 Guidelines st
Grading &1 Concussion
Guidelines

Minimum time
Grade Confusion Amnesia LOC to return Time
to play asymptomatic

I Yes No No 20 min When

examined

II Yes Yes No 1 week 1 week

III Yes Yes Yes 1month 1

week
 sports after repeat
concussion

Grade Minimum time to Time

return to play asymptomatic

I (2nd time) 2 weeks 1 week

II (2nd time) 1month 1 week

III (2nd time) Season over

I,II (3rd time)
 Eyes

• PERRL & EOM

• Red Reflex
• Corneal Light Reflex
• Strabismus:
• Alignment of eye important due
to correlation with brain
development
• May need to corrected
surgically
• Preschoolers should have
o
vision screening
• Refer to ophthalmologist is there
are concerns
 Eyes: Key Points
• Vision: Red reflex & blink in neonate
• Visual following at 5-6 weeks
• 180 degree tracking at 4 months
• Pictures or Tumbling E charts & strabismus check
for preschool child
• Snellen chart for older children
• Irritations & infections
• PERRL
• Amblyopia (lazy eye): Corneal light reflex, binocular
vision, cover-uncover test
• EOMs: tracking 6 fields of vision
• Fundoscopic exam of internal eye & retina
 Conjunctivitis
Viral – most common cause Bacterial – more common in
• Very contagious school-age children
• 8 day incubation period Symptoms:
• Pinkish-red eyes • Red eyes
• Watery or serous discharge • Purulent or mucopurulent
• Crusty eyelids on awakening discharge, matted eyelids
• c/o “gritty sensation in eye upon awakening
• • c/o “gritty” sensation
May c/o URI symptoms
• Usually starts unilaterally
• Can be either unilateral or
bilateral and then progresses to
• bilateral
Vesicles around eye could • Often concurrent otitis
be media
herpes lesions • Culture if < 1 month of
Immediate referral to
Conjunctivitis
Allergic
• Often seasonal
• Erythema due to dilated vessels
• Itching, burning
• May be seasonal
• Tearing, watery eyes
• Eyelid swelling
• Clear or stringy eye discharge
• bilateral
 Ears: Key Points
• Ask about hearing concerns
• Inquire about infant’s response to
• Observe an older infant’s/toddlers speech
pattern
• Inspect the ears
• •Assess the shape of the ears
• Determine if both ears are well formed
• •Assess
Common Ear Infections

Otitis Media Otitis Externa

• Most common reason • Pain –especially
children come to the when pinna is slightly
pediatrician or tugged at
emergency room • Discharge
• Fever or tugging at (sometimes odorous)
• ear • “Swimmer’s Ear”
Often increases at night
• when they are sleeping
History of cold or
congestion
 Nose & Throat / Mouth
• Turbinates • Palate
• Exudate • Gums
• Pharynx • Swallow
• Tonsils • Oral Hygiene
• Signs & Symptoms of • Condition of teeth
Allergic Rhinitis • Missing teeth
• Streaking
• Cobble stoning
• Orthodontic
• Post-Nasal Drip Appliances
• Injection
• Erythema
Or is it infection?
Nose: Key Points

• Exam nose & mouth after ears

• Observe shape & structural deviations
• Nares: (check patency, mucous
membranes, discharge, turbinates,
bleeding)
• Septum: (check for deviation)
• Infants are obligate nose breathers
• Nasal flaring is associated with
respiratory distress
Nose: Variations

• Allergy: “allergic salute” - line

across nose.
• Infection
• Foreign body:
• Foul odor or unilateral discharge
• Structure variations
• Bell’s palsy
Nose and Throat

Sinusitis:
• Fever
• Purulent rhinorrhea
• Facial Pain – cheeks, forehead
• Breath odor
• Chronic cough – could be day and night
• (+) Post-nasal drip
Mouth & Pharynx: Key
Points
• Lips: color, symmetry, moisture, swelling, sores,
fissures
• Buccal mucosa, gingivae, tongue & palate for
moisture, color, intactness, bleeding, lesions.
• Tongue & frenulum - movement, size & texture
• Teeth - caries, malocclusion and loose teeth.
• Uvula: symmetrical movement or bifid uvula
• Voice quality, Speech
• Breath - halitosis
Ears, Nose and Throat

Sore Throats

Is it strept or is it viral
or could it be mono?

Lymph nodes
& ROM
Neck: Key Points
• √ position, lymph nodes, masses, fistulas,
clefts
• Suppleness & Range of Motion (ROM)
• Check clavicle in newborn
• Head control in infant
• Trachea & thyroid in midline
• Carotid arteries (bruits)
• Torticollis
• Webbing
• Meningeal irritation
 Chest Assessment
•How does the child look?
•Color
•Work of Breathing: Effort
used to breathe
Auscultatio
n• All 4
quadrants
• Front and back
• Take the time
to listen
 Lungs & Respiratory: Key
Points
• Quality of Respirations:
• Symmetry, Expansion, Effort, Dyspnea
• S & S Respiratory Distress:
• Color: cyanosis, pallor, circumoral cyanosis,
mottling
• Tachypnea
• Retractions
• Nasal flaring
• Grunting (expiratory)
• Stridor - inspiratory: croup
• Adventitious sounds:
• Crackles / Rales
• Rhonchi - course breath sounds
• Wheeze – inspiratory vs. expiratory
Lungs & Respiratory: Key Points

• Clubbing
• Snoring (expiratory): upper airway
obstruction, allergy,
• Fremitus:
• Increased in pneumonia, atelectasis,
mass
• Decreased in asthma,
pneumothorax or FB
• Dullness to percussion: fluid or
mass
Work of Breathing

• Increased or
Decreased
Respirations
• Stridor
• Wheezing
 Chest Assessment
• Auscultation
• Wheezing
• Retractions
• Subcostal
• Intercostal
• Sub-sternal
• Supra-clavicular
Red Flags:
• grunting
• nasal flaring
• stridor
 All that Wheezes
isn’t always Asthma…
Think:
• Infection
• Foreign body aspiration
• Anaphylaxis
• Insect bites/stings,
medications, food
allergies
 And all Asthma
doesn’t always Wheeze!

• Cough
• Fatigue
• Reduced
exercise

tolerance
 Coughs

• Allergies
• Asthma
• Infections – pneumonia, bronchitis,
bronchiolitis
• Sinusitis – Post-nasal drip
• GERD
• Cigarette smoking
• Exposure to secondhand smoke,
• Other pollutants
 Cough - Characteristics

• Dry, non-productive
• Mucousy – productive
• Croupy
• Acute – less than 2-3 weeks
• Chronic – more than 2-3 weeks
• Associating Symptoms
Chest Pain
• Call 911 if severe, acute, unremitting
– needs immediate attention - very
rare
• Non-cardiac – most common
• Musculoskeletal: costochondritis
• Pulmonary
• Gastrointestinal e.g. GERD
• Psychogenic
• Often no significant physical findings
• Must rule out Cardiac origin – refer to PCP or
pedi cardiologist
 Circulatory
•Auscultating Heart Sounds
The Auscultation Assistant – Hear Heart Murmurs, Heart Sounds,
and Breath Sounds. http://www.wilkes.med.ucla.edu/inex.htm

Pillitt
er

•Perfusion – capillary refill

•“Warm to touch”
 Murmurs:
• may be systolic, diastolic or continuous
• timing, location, quality -course, harsh, blowing, high pitched
• GRADE:
• I - faint, may not be heard sitting
• II - readily heard with stethoscope
• III - loud, no thrill
• IV - loud with stethoscope, thrill
• V - loud with stethoscope barely to chest, thrill
• VI - loud with stethoscope not touching chest, thrill
• Functional Murmurs:
• Change or disappear with position change (usually loudest supine)
• Low grade, soft or musical
• Intensity range from I-III/VI
• Systolic (never diastolic)
• Do not radiate
• Occur in absence of significant heart disease or structural
abnormality
 Gastro-Intestinal
Abdominal Assessment

Pillitt
eri
Abdomen: Key Points

• Contour
• Bowel Sounds & Peristalsis
• Skin: color, veins
• Umbilicus
• Assess for Tenderness, Ridigity, Tympany,
Dullness
• Hernias: umbilical, inguinal, femoral
• Masses - size, shape, dullness, position,
mobility
• Liver, Spleen, Kidneys, Bladder
 Bowel Sounds
• Normal: every 10 to 30 seconds.
• Listen in each quadrant long enough to
hear at least one bowel sound.
• Absent
• Hypoactive
• Normoactive
• Hyperactive
 Stomachaches and
Abdominal Pain
• Excessive gas • Heartburn or
• Chronic constipation indigestion
• Lactose intolerance • GERD
• Viral gastroenteritis • Food allergy
• Irritable bowel • Parasite infections
syndrome (Giardia)

What are we most concerned about?

Stomachaches and Abdominal
Pain
• Appendicitis
• Bowel obstruction --
Cholecystitis with or without
gallstones
• Food poisoning
(salmonella, shigella)
• Inflammatory Bowel
Disease –
• Crohn's disease
• Ulcerative colitis
• Hernia
• Intussusception
• Kidney stones
• Pancreatitis
• Sickle cell crisis
• Ulcers
• Urinary tract
infections
 Signs and Symptoms

• Appearance –color, facial, ROM, gait, position

• Pain – get your pain scales out
• Nausea
• Vomiting
• Diarrhea
• Bloating
• Vomiting
• Inability to pass gas or stool
 Diagnostic breakdown of one year's admissions for
abdominal pain in a district general hospital.

Davenport, M. BMJ 1996;312:498-501

Copyright ©1996 BMJ Publishing Group Ltd.

Bottom Line: Acute or Not

Soft, non-tender,
non-distended
no rebound, no HSM,
no mass,
BS NA x 4Q

Can the child hop?

Ball &
Bindler
 Musculo-Skeletal
• FROM, MAE - neck, shoulder, elbow, wrist, hip,
knee, ankle, foot, digits
• Alignment, contour, strength, weakness &
symmetry
• Limb, joint mobility: stiffness,
contractures
• Gait – observe child walking without
shoes
• Spinal alignment - Scoliosis
• Muscle Strength & Tone
• Hips – O & B
• Reflexes
• Pre-Participation Sports P.E. –
 Scoliosis

Lateral curvature of spine

Key Points:

•Barefoot
Medline.co
•Feet Together m
•Bend Over –”Diving Of a Diving Board”
•Check Hips
Assessment

• The Five P’s:

• Pain
• Paresthesia
• Passive stretch
• Pressure
• Pulse-less-ness
Skin, Nails & Hair
• Rashes
• Lesions
• Lacerations
• Lumps
• Bumps
• Bruises
• Bites
• Infections
Common Skin Lesions
• Macule • Scale
• Papule • Crust
• Vesicle, bulla • Keloid
• Pustule • Fissure
• Cyst • Ulcer
• Patch • Petechiae
• Plaque • Purpura
• Wheal • Ecchymosis
• Striae  Capillary bleeding: Petichiae and purpura
usually indicate serious conditions
Skin Infections

• Bacterial infections
• Abscess formation
• Severity varies with skin integrity,
immune and cellular defenses
• Examples:
• impetigo
• cellulitis
Viral Skin Infections

• Most communicable diseases of

childhood have characteristic rash
• Examples: verruca, herpes simplex
types I and II, varicella zoster,
molluscum contagiosum
Fungal Skin
Infections
• Superficial infections that live on the
skin
• Also known as dermatophytoses,
tinea
• Transmission from person to person or
from infected animal to human
• Examples: tinea capitis, tinea corporis,
tinea pedis, candidiasis
 Contact Dermatitis
• Inflammatory reaction of skin to chemical
• Initial reaction in the exposed region
• Characteristic sharp delineation between
inflamed and normal skin
• Primary irritant
• Sensitizing agent
• Examples: diaper dermatitis, reaction to
wool, reaction to specific chemical
• Poison Ivy, Oak, and Sumac - urushiol
Miscellaneous Skin Disorders

• Urticaria
• Psoriasis
• Alopecia
• Intertrigo
• Stevens-Johnson syndrome
• Neurofibromatosis
Atopic Dermatitis

• A type of pruritic • Three forms:

eczema that begins • Infantile eczema:
during infancy begins at age 2-
• Hereditary 6 months
• Childhood eczema:
tendency
may follow
• Often associated infantile form
with history of food • Preadolescent and
allergies, allergic adolescent: 12 years
rhinitis, and asthma to early adult age
Therapeutic Management of
Atopic Dermatitis

Goals:
• Relieve pruritus
• Hydrate skin
• Reduce inflammation
• Prevent or control secondary infection
WOUND CLASIFICATION
CLINICAL NON-TETANUS- TETANUS-PRONE
FEATURES PRONE WOUNDS WOUNDS
Age of wound <6 hours >6 hours
Linear wounds, Stellate, avulsion
abrasions
configuration
depth <1cm >1cm
s
Mechanism of injury Sharp surface Crush, burn, missile
Sings of infection absent present
Devitalized tissue present
Contaminants (dirt, absent present
feces, soil, saliva )
Denervated/ischemic absent
absent present
tissue
The School-Age Child

• Privacy and
modesty.
• Explain procedures
and equipment.
• Interact with child
during exam.
Adolescent
• Privacy issues – first
consideration
• HEADS: home life,
education,
alcohol, drugs,
sexual activity /
suicide
• GAPS Guidelines for
Adolescent
Preventive Services
• Bright Futures
Psychosocial Assessment
HEADS SHADESS
• Home life •School
• Emotions / •Home
Depression or •Activities
Education
•Drugs / Substance
• Activities
• Drugs / Alcohol / Abuse
Substance •Emotions /
Abuse Depression
• Sexuality •Sexuality
activity or •Safety
Suicid
Common School Health
Focused Assessments

• The “I don’t feel good”

– where do I begin?
• Behavioral / Mental
Health Concerns
• Chronic Conditions &
Special Needs
• What Else?
The “I don’t feel
good”
 Appearance
PAT Includes LOC &
Behavior

PAT

and
Breathing Changes Skin Circulation

This OLD CART

Common School Health
Focused Assessments
• Emergencies & Trauma
– Allergic Reactions,
Asthma, Head, Abdomen,
Limb, Other
• Skin – Rashes,
Lacerations, Lumps,
Bumps & Bruises
• The Frequent Fliers –
Headaches, Stomachaches,
Chest Pain, Coughs &
Fevers
• Other HEENT
Emergencies & Trauma

• Allergic
Reactions
• Asthma
• Head
• Abdomen
• Limb
• Other
 The Frequent Fliers

• Headaches
• Stomachaches
• Nosebleeds
• Chest Pain
• Coughs
• & Fevers
 Frequent Fliers

If only you could cash in on those miles!

Behavioral / Mental Health
Concerns

• Developmental Delays
• Depression
• Aggressive Behaviors
• Suicide Risks
• Other Mental Health
Issues
Chronic Conditions &
Special Needs

• Asthma
• Diabetes
• Neuro – seizures
• Sickle Cell Anemia
• Cerebral Palsy
• ADHD
Additional “To – Do’s”

• Documentation
• –SOAP Notes
• Quality Improvement
– - chart reviews
• Confidentiality –
seriously!
Resources and References
• Jan Chandler RN, MSN, CNS, PNP Pediatric Nursing: Nursing Care of
Children and Young Adults: Pediatric Physical Assessment
• Colyar, M. Well Child Assessment for Primary Care Providers.
Philadelphia, PA: F.A. Davis Company.
• Duderstadt, K. Pediatric Physical Examination.
St. Louis, MO: Mosby, Inc.
• Engel, J. Pediatric Assessment 5th. Ed. St.
Louis, MO: Mosby, Inc.
• Wong’s Essentials of Pediatric Nursing 8th ed.
• AAP Preparticipation Physical Evaluation.
Available @ www.aap.org
• Resource Manual for the Nurse in the School Setting
http://www.ems-c.org/school/frameschool.htm
• American Medical Association Guidelines for Adolescent Preventive
Services (GAPS) http://www.ama-assn.org/ama/pub/category/2280.html
• American School Health Association http://www.ashaweb.org
• The Auscultation Assistant @
http://www.wilkes.med.ucla.edu/intro.html
• BMI Calculator: http://www.cdc.gov/nccdphp/dnpa/bmi /
• 2007 Asthma Guidelines:
http://www.nhlbi.nih.gov/guidelines/asthma/index.htm
 We Know
It’s a Jungle Out
There!
 The Power of Nursing

Never doubt how vitally important you are;

never doubt how important your work is –
and never expect anyone to acknowledge it
before you do.
Every moment, in everything you do,
you are making a difference.
In fact, you are in the business of making a
difference in other people’s lives.
In that difference lies their healing
and your power.
Never forget it.