normal peds assessment?

  1. I'm doing my peds rotation and am wondering about peds assessments. I haven't been able to find what a "normal" assessment would be like. My patient is 7 months, bowel obstruction, exploratory lap scheduled tomorrow (second time for this surgery) with possible colostomy placement. She is pretty sedated from pain. How do assess neuro in an infant? I know you check pupil dilation, but you can't assess AAO like you would in an adult. I guess you can decide if they are alert, drowsy, sedated, etc.
    Your cardiac, respiratory, etc evaluations should be similar except that the vitals will be higher, correct? What would you be looking for on the fontanels?
    Any help would be appreciated. I did a search on here for this but didn't come up with anything.
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  2. 3 Comments

  3. by   ElvishDNP
    Mosby's Guide to Physical Assessment is a good resource. It gives "normal" assessment criteria for adults as well as children/infants. Your peds book should have an appendix for normal VS according to age. If yours doesn't, Whaley and Wong's peds textbook does.

    Neuro assessment of infants is a little different than adults. You check the fontanels for depression or bulging. Bulging fontanels can be a sign of increased intracranial pressure. Fontanels should be soft and flat. Posterior fontanel will probably be gone by now. You look to see if they are posturing -- decorticate or decerebrate. Hopefully neither. If they are sedated, do they respond to auditory stimuli? Tactile? Do they respond only to painful stimuli? What about reflexes? Are hers appropriate for her age?

    I do newborn nursery; it has been over a year since I assessed any kids over a few days old. Any chiming in from more experienced peds nurses??
  4. by   PEDSOBRN
    Quote from LanaBanana
    I'm doing my peds rotation and am wondering about peds assessments. I haven't been able to find what a "normal" assessment would be like. My patient is 7 months, bowel obstruction, exploratory lap scheduled tomorrow (second time for this surgery) with possible colostomy placement. She is pretty sedated from pain. How do assess neuro in an infant? I know you check pupil dilation, but you can't assess AAO like you would in an adult. I guess you can decide if they are alert, drowsy, sedated, etc.
    Your cardiac, respiratory, etc evaluations should be similar except that the vitals will be higher, correct? What would you be looking for on the fontanels?
    Any help would be appreciated. I did a search on here for this but didn't come up with anything.
    Well, as far as the neuro assessment....you want to note wether the babe is alert, sedated, lethargic, active, sleepy, note whatever the babe is doing. Also note whether the babe moves all extremities. The posterior fontanels close at 2-3 months and the anterior fontanels close at 12-18 months. The fontanels should be soft and flat when open. Bulging fontanels can mean increased intracranial pressure and depressed fontanels can mean dehydration. I hope that that all helps you with neuro assessment.
  5. by   NotReady4PrimeTime
    Quote from PEDSOBRN
    Well, as far as the neuro assessment....you want to note wether the babe is alert, sedated, lethargic, active, sleepy, note whatever the babe is doing. Also note whether the babe moves all extremities. The posterior fontanels close at 2-3 months and the anterior fontanels close at 12-18 months. The fontanels should be soft and flat when open. Bulging fontanels can mean increased intracranial pressure and depressed fontanels can mean dehydration. I hope that that all helps you with neuro assessment.
    Don't forget temperature. In infants temperature instability is often neurologically mediated, although hypothermia can also indicate sepsis. The pitch of an infant's cry often indicates something out-of-the-ordinary upstairs too. High pitched shrieks are never normal. Are they fixing on objects? Do they follow your face when you move your head? What do their eyes do when you're stimulating them? Cross-eyed appearance can be normal, but sunset eyes, nystagmus or dysconjugate gaze aren't. There are lots of other things I could add, but they are things I wouldn't expect to see outside the PICU.

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