G. Adolescence is a
J. The size of the approaches the size as the teen pro-
gresses through , and is
to the adolescent’s .
2.
List the principles of child development.
A.
B.
C.
D.
3.
List the developmental tasks during middle childhood.
A.
B.
C.
D.
E.
F.
G.
Activity B MATCHING
4.
Match the common childhood lesions with their description.
Answer Common Childhood Lesions Description
Insect bites A. Annular lesion that has central clearing and papules along the border
Urticaria (hives) B. Scaling, crusting, and hair loss Tinea corporis C. Intensely pruritic, red, distinct papules
Tinea capitis D. Pruritic, allergic sensitivity reaction that changes shape quickly
5.
Match the developmental task of adolescence with its characteristic (tasks will have more than one characteristic dependent on the stage of adolescence).
Answer Characteristic Task
Peers increasingly important A. Physical Females more comfortable, males awkward B. Cognitive
“Formal operational” C. Identity
Sexuality D. Independence
Separation from family Adult appearance Global issues Puberty Ambivalence Limit testing
Transition; many ideas
“Concrete operational”
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6.
Match the primitive refl ex to its description.
Answer Primitive Refl ex Description
Palmar grasp refl ex A. The arm/leg on side to which head is turned extends while the opposite arm/leg fl exes.
Plantar grasp refl ex B. The mouth will open and baby will turn the head toward the stimulated side and suck.
Moro refl ex C. The toes curl Asymmetric tonic neck
refl ex
D. The spine will curve toward the stimulated side.
Positive support refl ex E. The hip and knee of that foot will fl ex and the other foot will step forward. Alternate stepping will occur.
Rooting refl ex F. The arms and legs will extend in a protective fashion.
Galant refl ex G. The hips, knees, and ankles extend; the baby stands up, partially bearing weight, and sags after 20–30 seconds.
Placing and stepping refl exes
H. The head will lift up, and the spine will straighten.
Landau refl ex I. The arms abduct and extend, hands open, and legs fl ex.
Baby may cry.
Parachute refl ex J. The baby will fl ex all fi ngers to grasp your fi ngers
Activity D NCLEX STYLE QUESTIONS
11.
What does laxity of the soft-tissue structures of the foot cause in young children?
a.
Pronation
b.Pes planus
c.
Metatarsus adductus
d.Talipes calcaneovalgus
12.
After the age of 2 years, how much do toddlers grow per year?
a.
About 5 cm
b.About 6 cm
c.About 7 cm
d.About 8 cm
13.
You are examining a 3-year-old female patient who becomes very distressed during the examination. What should you tell the parents?
a.
“This behavior shows a lack of discipline.”
b.
“This behavior shows inability to adjust.”
c.
“This behavior is developmentally appro- priate.”
d.
“This behavior is socially inappropriate.”
Activity C SHORT ANSWER
7.
Discuss the test for scoliosis in the adolescent.
8.
Discuss the principles of child development.
9.
Discuss social and emotional development during middle childhood.
10.
Discuss tips for examining 1- to 4-year-olds.
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14.
You are speaking to a local PTO about child- hood obesity. What would you cite as the consequences of childhood obesity?
a.
Hepatic disease
b.Hypertension
c.Metabolic syndrome
d.Poor self-esteem
e.Pulmonary disease
15.
When examining visual acuity on a 30-month- old child, you should assess for what?
a.
Fixation preference
b.“Lazy eye”
c.
Hyperopia
d.Myopia
16.
You detect a pulmonary fl ow murmur that is accompanied by a fi xed split-second heart sound. What does this suggest?
a.
Aortic insuffi ciency
b.Tricuspid valve prolapse
c.Left-heart volume load
d.Right-heart volume load
17.
Your patient is a 15-year-old male. His testes and scrotum are enlarged and the scrotal skin is darkened. His pubic hair is coarse and curly but does not extend to the thighs. What Tan- ner stage would you assign to this patient?
a.
Stage 2
b.Stage 3
c.Stage 4
d.Stage 5
18.
Mrs. Mendellson has brought 14-year-old Lucretia to the clinic because of her weight.
When weighed, Lucretia falls below the 5th percentile for her height. The nurse notes that Lucretia is so thin that her bony skeleton is readily observable. She has delayed sexual development. What would the nurse suspect?
a.
Bulimia nervosa
b.Anorexia nervosa
c.Cystic fi brosis
d.AIDS
19.
What is helpful in measuring older children, especially if the child is suspected of having endocrine disorders?
a.
Age:weight comparison
b.WHO child growth standards
c.
Symphysiofundal height growth curve
d.Velocity growth curves
20.
What is the most frequent cause of an ele- vated blood pressure in children?
a.
Obesity
b.
An improperly performed examination
c.Diabetes
d.
An improperly calibrated sphygmoma- nometer
SECTION III: CASE STUDY
Activity E
Eighteen-year-old George Kristus comes to the clinic for a sports physical.
a.
Describe a physical examination of this patient.
b.
Explain what you would pay special attention to with this patient and why.
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SECTION IV: DOCUMENTATION
FORM FOR USE IN PRACTICE
PEDIATRIC HEALTH HISTORY AND PHYSICAL EXAMINATION
Patient Name Date/Time
Overview Referral
Source and Reliability Chief Complaint Present Illness Medications Past History Pregnancy Newborn period Illnesses Accidents Preventive Care Family history Developmental history Personal and social history Environmental exposures Review of Systems General Skin
Head, eyes, ears, nose, and throat (HEENT) Head
Eyes Ears Nose Mouth Neck Respiratory Cardiovascular Gastrointestinal Urinary
Genital
Musculoskeletal Neurologic Psychiatric Physical Examination Vital signs Skin HEENT Head Eyes Ears Nose Mouth
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Neck
Lymph nodes Lungs
Cardiovascular Breasts Abdomen Genitalia Musculoskeletal Neurologic Mental status
Developmental (DDST) Cranial nerves
Cerebellar
Deep tendon refl exes (DTRs) Sensory
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120
CHAPTER 24
SECTION I: LEARNING OBJECTIVES
Learning Objectives The student will:
1.
Determine how to best facilitate the health history and physical examination of the older adult.
2.
Identify areas of focus during the health history specifi c to the older adult.
3.
Recognize normal physiologic changes in the older adult.
4.
Address areas of health promotion and coun- seling specifi c to the older adult.
5.
Utilize screening tools in the assessment of older adults.
6.
Perform a health history and physical assess- ment on an older adult.
7.
Document the older adult assessment fi ndings.
SECTION II: STUDY GUIDE
Activity A FILL IN THE BLANK 1.
Complete the following statements:
A.