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PHYSICAL ASSESSMENT III.

NECK ▪Special Tests


▪Inspect -visual acuity—Rosenbaum, Snellen’s, Jaeger, E chart (CN II)
I. INTEGUMENTARY -Neck structure and symmetry - visual fields ( confrontation test)
▪Inspect -Skin color and integrity -cover and position test
-skin integrity for color variations, lesions, etc. -Appearance of lesions, masses, swelling -extraocular movements--- H
-scalp -Tested range of motion (rom) – flexion, extension, -convergence test (test for accommodation)
-corneal light reflex blink / corneal reflex (CN V)
-hair (color, quantity, distribution) hyperextension, lateral flexion, rotation
-direct and consensual light reflex
-nails -Carotid pulse
-note smell/odors u -Jugular venous pattern and pulsations
▪Visual Function Test
-edema (if appropriate) -position of trachea
exture -thyroid gland (visible enlargement or mass)
-light perception
-hand movements
▪Palpate
-counting fingers
-temperature ▪Palpate
-texture and moisture -neck (sternocleidomastoid &trapezius muscles)
▪CN Testing
-mobility and turgor -trachea (alignment & deviation)
-VII (Facial expressions- strength of eyebrows &eyelids)
-edema (if appropriate) -thyroid gland for size, irregularity, masses
- lymph nodes (pre-auricular, posterior auricular, V. EARS
submental, submaxillary, submandibular, tonsilar, ▪Inspect
II. HEAD AND FACE superficial cervical nodes, anterior deep cervical -position of ears in relation to eye
▪Inspect chain, supraclavicular, occipital, posterior cervical) -auricles, tragus, lobule of shape, position, lesions,
-head/skull size, shape, configuration discolorations & discharges
-face for symmetry, facial features, expressions & ▪CN Testing -maneuver for appropriate for amembranege
condition -XI (spinal accessory)
-consistency, distribution & color of hair ▪Using Penlight
IV. EYES
-auditory canal (color, consistency, discharge)
▪Palpate ▪Inspect
-checked auditory canal for color & cerumen
-head for size, shape & configuration -position and alignment
-tympanic membrane (ear drum) for color, shape,
-temporal arteries for elasticity and tenderness -eyelashes, bony orbits and brows
consistency and landmarks
-temporomandibular joints (TMJ) when client opens & -lacrimal apparatus
closes mouth -lids
▪Palpated
-sclera
-auricles for texture, elasticity, areas of tenderness
▪Auscultate -conjunctiva (bulbar/ palpebral)
-mastoid process for tenderness
-bilateral temporal artery -iris
-cornea and lens
▪CN Testing
▪CN Testing - pupil
-voice- whisper test
-V (Trigeminal- sharp and dull sensation) -watch tick test
-VII (Facial expressions- smile, frown, show teeth, blow ▪Palpate
Tuning fork test
out cheeks, raise eyebrows, tightly close eyes) -bony orbit
-Weber’s test for diminished hearing in one ear
-eyelids / eyeballs
-Rinne’s test to compare cone & air conduction (tuning
-lacrimal apparatus
on mastoid; then in front of the ears)

VI. NOSE AND SINUSES ▪Palpate *POSTERIOR AND LATERAL CHEST


▪Inspect -lips and gums ▪Inspect
- external nose for color, shape, size & consistency -salivary glands -color of chest
-tongue -configuration & shape of scapulae & chest wall
▪Using Penlight -hard(ant)/ soft(post) palates -use of accessory muscles when breathing
-septum alignment or deviation
-mucosa for swelling, discharge, bleeding, foreign bodies ▪CN Testing ▪Palpate
-V (Trigeminal- ability to chew aneal- ngd masticate) -tactile fremitus
▪Transillumination test -VII and XII (Facial & Glossophary –and taste) -tenderness, sensation, crepitus, masses, lesions
-frontal sinuses -IX & X ( Glosspharyngeal & Vagus – speech, swallow, -determined diaphragmatic excursions
-maxillary sinuses gag reflex)
-XII (Hypoglossal – tongue strength) ▪Percuss
▪Palpate -tone at posterior intercostals spaces (bilaterally)
-checked patency of nares VIII. LUNGS AND THORAX
-external nose for masses, tenderness, smoothness, *ANTERIOR CHEST ▪Auscultate
consistency ▪Inspect -posterior breath sounds and adventitious breath
-frontal sinuses -color of chest sounds
-maxillary sinuses -level of clavicles, sternum and costal angle -posterior voice sounds – bronchophony (
-shape of chest 99), egophony (eee) , whispered pectoriloquy (1,2,3)
▪Percuss -respiratory quality & pattern of respirationsn (rate, -noted & describe cough & sputum, if present
-frontal sinuses rhythm, depth)
-maxillary sinuses -intercostal spaces for bulging & retractions IX. BREAST AND AXILLAE
-use of accessory muscles for respirations ▪Inspect
▪CN Testing -retractions or dimpling of nipples, through specific
-I (olfactory—smell test) ▪Palpate functioning or maneuvers instructed to client
-tactile fremitus -color of breast
VII. MOUTH AND THROAT -tenderness, sensation, crepitus, masses, lesions -size, symmetry, texture & superficial venous pattern of
▪Inspect -determined anterior chest expansion/ excursion breasts
-lips for color, symmetry, consistency, contour, lesions -color of areola & nipples
-mucosa and gums for color, integrity, adherence, ▪Percuss -position of areola & nipples
lesions -tone at apices above clavicles then at intercostals -montgromery tubercles, discharges, nipple inversion (if
-salivary glands --- Wharton’s / Stensen’s duct spaces (comparing bilaterally) any)
-teeth for number, condition (oral hygiene), dental works -tone at anterior intercostals spaces
-tongue for color, moisture, size, texture, coating, ▪Palpate
vessels ▪Auscultate -breast according to recommend method (concentric,
-labial and lingual frenulums -anterior breath sounds and adventitious breath sounds vertical, radial/pie)
-hard(ant)/ soft(post) palates for color, integrity -anterior voice sounds – bronchophony (99), egophony -tail of Spence
-breath and breath sounds (eee) , whispered pectoriloquy (1,2,3) -areola & nipples for discharge
-uvula and tonsils (color, continuity, integrity, lesions, -noted & describe cough & sputum, if present
inflammation, size)
-posterior pharyngeal wall
▪Axillae XI. ABDOMEN XII. NUTRITION
-noted position for axilla palpation -empty bladder --24 hour diet recall
-noted axilla condition ▪Inspect - Identified current order diet
-palpates axillae for rashes, infection & anterior, central -overall abdominal skin color -assessed appetite basing on the meal percentage
& posterior lymph nodes -vascularity; striae, lesions, rashes charting
-taught breast self examination (BSE) -hair distributions -identify body built (ectomorph, endomorpg,
-symmetry & contour of abdomen mesomorph)
X. HEART -surface movements (peristaltic waves or any pulsation) --wrist size
▪Inspect -location, contour & color of umbilicus -- wrist circumference ( height to wrist ration[HWHR])
-precordium movement @MCL, 5 th ICS -measured abdominal girth -checked height
-jugular veins -checked weight
-heart landmarks (pulmonic, aortic, Erb’s point, ▪Auscultate -Determined ideal body weight
tricuspid, mitral) -bowel sounds over four quadrants -calculate body mass index (BMI)
-measure weight circumference
▪Palpate ▪Percuss -calculate waist-to-hip ratio (WHR)
-carotid pulse one at a time -tone over 4 quadrants
-precodium -liver location, size &span ▪Hydration status
-apex, left sterna border, & base of the heart for any -spleen location & size -intake and output
abnormalities -kidneys -skin moisture
▪Auscultate -bladder -skin turgor
-carotid artery -perform shifting dullness (test for ascites), if needed of -identified s/sx of fluid volume deficit (dehydration) and
-utilized correct positioning for the auscultation (left side- indicated fluid volume excess (fluid overload/ overhydration)
lying, leaning forward)
-traditional heart landmarks (pulmonic, aortic, Erb’s point, ▪Light Palpate XIII. MUSCULOSKELETAL
tricuspid, mitral) -4 quadrants to identify tenderness & muscular ▪Inspect
-note heart rate & rhythm resistance - Posture
--- S1 & S2 sound -Spine alignment
--- identify irregular/ abnormal heart sounds (murmur, ▪Deep Palpate
-4 quadrants for masses -gait
atrial/ventricular gallops.)
-umbilicus -Tested Range of Motion (ROM) of joints to upper and lower
-liver extremities
▪Special Test - Performed "nudge test' for the elderly or handicap
-Hepatojugular reflex -spleen
-kidneys - Muscle size, shape, symmetry
-Pulse deficit
-bladder
▪Graded Muscle strength
*PERIPHRAL CIRCULATION - Left upper extremity
▪IDENTIFY,PAgLPATE & GRADE ▪Special Tests
-blumberg’s tets (rebound tenderness) - Right upper extremity
- temporal, carotid, radial, brachial,ulnar, femoral, - Left lower extremity
popliteal, dorsalis pedis(pedal) posterior tibial. -iliopsoas
- Right lower extremity
-obturator
- Enumerated at least 5 Activities of Daily Living (ADLs)
▪special test -hypersensitivity affected(with limitations) basing on client's condition ---
-allen, burger, trendelenburg, manual compression test, -inspiratory arrest (murphy’s) bed mobility, eating, toy, transfer, walk in room, walk in
capillary refill, homan’s & edema (grade if present) -ballotement (w/ variations, either single-hand/ bimanual corridor, locomotion on/off unit, dressing, toilet use,
method) personal hygiene, bathing

- Enumerated at least 3 Instrumental Activities of Daily -Epididymis ▪Palpate


Living(IADLs) affected (with limitations) basing on -Spermatic cord - labia (masses, tenderness)
client's condition---housekeeping, use of telephone, -Inguinal and femoral areas -Bartholin's glands, urethra, and Skene's glands
-while client shifted weight to each corresponding side, - Size of vagina, and vaginal musculature
managing money, preparing meals, driving/traveling,
palpated for inguinal hernia - Femoral and inguinal hernia
shopping, taking medication, laundry, taking out -taught testicular self-examination (TSE)
garbage ▪Bimanual Palpate
*ANUS & RECTUM - Cervix for contour, consistency, mobility, and tenderness
▪Palpate ▪Inspect - Uterus for size, position, shape, and consistency
- Joints for mobility, smoothness, symmetry. Noted - Perianal area for lumps, ulcer, lesions, hemorrhoids, - Ovaries for size and shape
edema, heat, tenderness, pain, nodules, or crepitus. rashes, redness, fissures, or thickening of epithelium
- Sacrococcygeal area for swelling, redness, dimpling, *ANUS & RECTUM
▪Special test or hair ▪Inspect
-Straight Leg Raising (LaSegue's Test) - Instructed client to bear down or perform Valsalva - Perianal area for lumps, ulcer, lesions, hemorrhoids,
-Length Discrepancy maneuver, and inspected for bulges or lesions rashes, redness, fissures, or thickening of epithelium
- Ballottement - Sacrococcygeal area for swelling, redness, dimpling,
-Bulge sign/ milking ▪Palpate or hair
- Balloon Sign - External sphincter for tenderness, nodules, and - Instructed client to bear down or perform Valsalva
hardness maneuver, and inspected for bulges or lesions
XIV. MALE GENITOUNRINARY - Rectum for tenderness, irregularities, nodules, and
▪Inspect hardness ▪Palpate
- Pubic hair distribution (amount, texture/ cleanliness/ - Prostate for size, shape, tenderness, and consistency - External sphincter for tenderness, nodules, and
foreign, body) - Inspected and described characteristics of stool, if hardness
-Penis (circumcised/uncircumcised)base of penis any - Rectum for tenderness, irregularities, nodules, and
-Skin and shaft of penis for rashes, lesions, lumps, - Collected and/or tested feces for occult blood, if hardness
hardened or tender areas noted, or needed - Inspected and described characteristics of stool, if
- Glans for size, shape, lesions, or redness and location any
of urinary meatus, and discharge XV. FEMALE GENITOUNRINARY - Collected and/or tested feces for occult blood, if
-Scrotal skin for color, integrity and lesions ▪Inspect noted, or needed
- Scrotum for size, shape, and position - Pubic hair distribution, density, growth
- Transilluminated scrotal contents for red glow, - Mons pubis, labia majora, and perineum for vascularity,
swelling, or masses, if a mass is found during inspection moisture, symmetry, lesions, swelling, excoriations, and
and palpation. discharge
- Identified sexual maturity according to Tanner's Sexual - Labia minora, clitoris, urethral meatus, and vaginal
Maturity Rating Scale opening for lesions, swelling or discharge
- With client standing, instructed to bears down, - Identified sexual maturity according to Tanner's Sexual
inspected for bulges in inguinal and femoral areas Maturity Rating

▪Palpate ▪With speculum>


- Shaft of penis - Vagina for color, consistency, and discharge
-Urethral discharge by gently squeezing the glans - Cervix for lesions and discharge
-scrotom - Collects specimen as indicated or appropriate
- Bilateral testes
XVI. NEUROLOGIC - Checked at least 3 superficial reflexes relevant to Differences of a Pediatric History Compared to an Adult
client's condition History:
- Checked and determined LOC -abdominal I. Content Differences
-Performed GCS -cremasteric (male clx) A. Prenatal and birth history
- Checked and determined pupillary reaction and size -bulbocavernosus (male clx) B. Developmental history
- Checked and graded bilateral hand grasp strength -plantar/ babinski C. Social history of family - environmental risks
-Romberg's test, as indicated or appropriate -anal D. Immunization history
- Performed at least 3 cerebellar testing relevant to client s -Checked and graded at least 3 deep tendon reflexes
condition relevant to client's condition II. Parent as Historian
-gait -biceps A. Parent’s interpretation of signs, symptoms
-heel to toe (tandem walking) -triceps 1. Children above the age of 4 may be able to provide
- walk on tip toes -brachioraadialis some of their own history
- walk on heels -patellar 2. Reliability of parents’ observations varies
- hop on one foot (then with the other) -ankle jerk (achilles’) 3. Adjust wording of questions - “When did you first
- Performed at least 3 test tor coordination relevant to Others: notice Johnny was limping”? instead of “When did
client's condition -brudzinski Johnny’s hip pain start”?
- Finger to nose -kernig’s sign B. Observation of parent-child interactions
- Finger to nose and to the nurse’s finger 1. Distractions to parents may interfere with history
- Finger to fingers - Performed other neurologic tests relevant to client's taking
- Rapid afternating hand movements (RAHM) condition; 2. Quality of relationship
-heel to shin C. Parental behaviors/emotions are important
-draw a circle or figure of 8 with each foot on the
1. Parental guilt - nonjudgmental/reassurance
ground or air
- rapidly flex and extend each foot XVII. MENTAL STATUS 2. The irate parent: causes
- touch the finger of the nurse with the large toe of Assessed for the following:
each foot Outline of the Pediatric History:
- Checked at least 3 sensory testing relevant to client's 1. Mood and emotional state (affect)
condition 2. Facial expressions I. Chief Complaint
-pain (sharp/dull) 3. Speech and language abilities - Brief statement of primary problem (including
-temperature 4. Orientation to person, time, place duration) that caused family to seek medical attention
-light touch 5. Concentration, ability to focus and follow directions
-vibration 6. Recall of unrelated information in 5 or 10 minute period II. History of Present Illness
-position, joint mobility(kinesthesia) 7. Recent memory of happenings today  - Initial statement identifying the historian, that person’s
-tactile discrimination (streogenesis) 8. Remote memory relationship to patient and their reliability
-number identification (graphethesia) 9. Calculation (Digit Span)  Age
-2 point discrimination 10. Thought content and process  sex
-extinction 11. Visual perception and constructional ability  race
-point location 12, Judgment and abstract reasoning  other important identifying information about patient
 Concise chronological account of the illness, including
any previous treatment with full description of
symptoms (pertinent positives) and pertinent negatives.
It belongs here if it is relates to the differential diagnosis
for the chief complaint.

III. Past Medical History  HEENT - headaches, concussions, unusual head shape, Differences in Performing A Pediatric Physical
 Major medical illnesses strabismus, conjunctivitis, visual problems, hearing, ear Examination Compared to an Adult:
 Major surgical illnesses-list operations and dates infections, draining ears, cold and sore throats, tonsillitis, I. General Approach
 Trauma-fractures, lacerations mouth breathing, snoring, apnea, oral thrush, epistaxis,  Gather as much data as possible by observation first
 Previous hospital admissions with dates and diagnoses caries  Position of child: parent’s lap vs. exam table
 Current medications  Cardiac - cyanosis and dyspnea, heart murmurs,  Stay at the child’s level as much as possible. Do not
 Known allergies (not just drugs) exercise tolerance, squatting, chest pain, palpitations tower!!
 Immunization status - be specific, not just up to date  Respiratory - pneumonia, bronchiolitis, wheezing,  Order of exam: least distressing to most distressing
chronic cough, sputum, hemoptysis, TB  Rapport with child
IV. Pregnancy and Birth History  GI - stool color and character, diarrhea, constipation, 1. Include child - explain to the child’s level
 Maternal health during pregnancy: bleeding, trauma, vomiting, hematemesis, jaundice, abdominal pain, 2. Distraction is a valuable tool
hypertension, fevers, infectious illnesses, medications, colic, appetite  Examine painful area last-get general impression of
drugs, alcohol, smoking, rupture of membranes  GU - frequency, dysuria, hematuria, discharge, overall attitude
 Gestational age at delivery abdominal pains, quality of urinary stream, polyuria,  Be honest. If something is going to hurt, tell them that in
 Labor and delivery - length of labor, fetal distress, type previous infections, facial edema a calm fashion. Don’t lie or you lose credibility!
of delivery (vaginal, cesarean section), use of forceps,  Musculoskeletal - joint pains or swelling, fevers, scoliosis,  Understand developmental stages’ impact on child’s
anesthesia, breech delivery myalgia or weakness, injuries, gait changes response. For example, stranger anxiety is a normal
 Neonatal period - Apgar scores, breathing problems,  Pubertal - secondary sexual characteristics, menses stage of development, which tends to make examining
use of oxygen, need for intensive care, and menstrual problems, pregnancies, sexual activity a previously cooperative child more difficult.
hyperbilirubinemia, birth injuries, feeding problems,  Allergy - urticaria, hay fever, allergic rhinitis, asthma,
length of stay, birth weight eczema, drug reactions II. Vital signs
A. Normals differ from adults, and vary according to
V. Developmental History VIII. Family History age
 Ages at which milestones were achieved and current - Illnesses - cardiac disease, hypertension, stroke, 1. See “code card” for charts of age-adjusted normals
developmental abilities - smiling, rolling, sitting alone, diabetes, cancer, abnormal bleeding, allergy and B. Temperature
crawling, walking, running, 1st word, toilet training, asthma, epilepsy 1. Tympanic vs. oral vs. axillary vs. rectal
riding tricycle, etc (see developmental charts) - Mental retardation, congenital anomalies, C. Heart rate
 School-present grade, specific problems, interaction chromosomal problems, growth problems, 1. Auscultate or palpate apical pulse or palpate
with peers consanguinity, ethnic background femoral pulse in infant
 Behavior - enuresis, temper tantrums, thumb sucking, 2. Palpate antecubital or radial pulse in older child
pica, nightmares etc. IX. Social D. Respiratory rate -Observe for a minute. Infants
- Living situation and conditions - daycare, safety issues normally have periodic breathing so that observing for
VI. Feeding History - Composition of family only 15 seconds will result in a skewed number.
 -Breast or bottle fed, types of formula, frequency and - Occupation of parents E. Blood pressure
amount, reasons for any changes in formula 1. Appropriate size cuff - 2/3 width of upper arm
 Solids - when introduced, problems created by specific 2. Site
types F. Growth parameters - must plot on appropriate
 Fluoride use VII. Review of Systems: (usually very growth curve
abbreviated for infants and younger children) 1. Weight
o Weight - recent changes, weight at birth 2. Height/length
o Skin and Lymph - rashes, adenopathy, lumps, bruising 3. OFC: Across frontal-occipital prominence so
and bleeding, pigmentation changes greatest diameter (Occipital Frontal Circumference)
III. Unique findings in pediatric patients (See outline VI. Ears  Auscultation
below  Position of ears 1. Equality of breath sounds
- Observe from front and draw line from inner canthi to 2. Rales, wheezes, rhochi
Outline of a Pediatric Physical Examination occiput 3. Upper airway noise
 Tympanic membranes  Percussion and palpation often not possible and rarely
I. Vitals - see above  Hearing - Gross assessment only usually helpful

II. General V. Nose IX. Cardiovascular


 Statement about striking and/or important features.  Nasal septum  Auscultation
Nutritional status, level of consciousness, toxic or  Mucosa (color, polyps) 1. Rhythm
distressed, cyanosis, cooperation, hydration,  Sinus tenderness 2. Murmurs
dysmorphology, mental state  Discharge 3. Quality of heart sounds
 Obtain accurate weight, height and OFC  Pulses
VI. Mouth and Throat
1. Quality in upper and lower extremities
 Lips (colors, fissures)
III. Skin and Lymphatics
 Buccal mucosa (color, vesicles, moist or dry)
 Birthmarks - nevi, hemangiomas, mongolian spots etc X. Abdomen
 Tongue (color, papillae, position, tremors)
 Rashes, petechiae, desquamation, pigmentation,  Inspection
 Teeth and gums (number, condition)
jaundice, texture, turgor 1. Shape
 Palate (intact, arch)
 Lymph node enlargement, location, mobility, a. Infants usually have protuberant abdomens
 Tonsils (size, color, exudates)
consistency b. Becomes more scaphoid as child matures
 Posterior pharyngeal wall (color, lymph hyperplasia,
 Scars or injuries, especially in patterns suggestive of 2. Umbilicus (infection, hernias)
bulging)
abuse 3. Muscular integrity (diasthasis recti)
 Gag reflex
 Auscultation
IV. Head VII. Neck  Palpation
 Size and shape  Thyroid 1. Tenderness - avoid tender area until end of exam
 Fontanelle(s)  Trachea position 2. Liver, spleen, kidneys
1. Size  Masses (cysts, nodes) a. May be palpable in normal newborn
2. Tension - calm and in the sitting up position  Presence or absence of nuchal rigidity 3. Rebound, guarding
 Sutures - overriding a. Have child blow up belly to touch your hand
 Scalp and hair VIII. Lungs/Thorax
A. Inspection XI. Musculoskeletal
V. Eyes 1. Pattern of breathing  Back
 General a. Abdominal breathing is normal in infants 1. Sacral dimple
1. Strabismus b. Period breathing is normal in infants (pause < 15 2. Kyphosis, lordosis or scoliosis
2. Slant of palpebral fissures seconds)  Joints (motion, stability, swelling, tenderness)
3. Hypertelorism or telecanthus 2. Respiratory rate  Muscles
 EOM 3. Use of accessory muscles: retraction location,  Extremities
 Pupils degree/flaring 1. Deformity
 Conjunctiva, sclera, cornea 4. Chest wall configuration 2. Symmetry
 Plugging of nasolacrimal ducts 3. Edema
 Red reflex 4. Clubbing
 Visual fields - gross exam

 Gait Introductory information Immunization history


1. In-toeing, out-toeing  Introduce, establish rapport.  See Immunization Schedule Reference.
2. Bow legs, knock knee  Name, age, gender.  Get dates of each.
a. “Physiologic” bowing is frequently seen under 2  Person giving the history (parent, etc).
years of age and will spontaneously resolve  Origin. 3 days 12-18 months
3. Limp Presenting complaint  BCG  MMR
 Hips  Description of the presenting complaint, in 2 months 3-5 years
1. Ortolani’s and Barlow’s signs chronological order.  DTP  MMR
 Including whether came in through casualty or  Live polio  Live polio booster
XII. Neurologic - most accomplished through admitted by GP.  Hib  Diphtheria booster
observation alone 3 months  Tetanus booster
A. Cranial nerves History of presenting complaint  DTP 10-14 years
B. Sensation  SOCRATES:  Live polio  Rubella [girls]
C. Cerebellum  Time course: seasonal or diurnal fluctuation.  Hib  BCG [sometimes]
D. Muscle tone and strength  Exacerbating factors: foods. 4 months 15-18 years
E. Reflexes  Referral by GP vs. came in through casualty.  DTP  Live polio booster
1. DTR  Relevant negatives.  Live polio  Diphtheria
2. Superficial (abdominal and cremasteric)  If using slang, ask for clarification.  Hib booster
3. Neonatal primitive  Tetanus booster
Past medical, surgical history,
Illnesses and operations
XII. GU Birth history
 Past illnesses, operations.
A. External genitalia  Length of gestation.  Childhood illness, obs/gyn.
B. Hernias and Hydrocoeles  Age and parity of mother at delivery. o Tests and treatment prescribed for these.
1. Almost all hernias are indirect  Any maternal insults [alcohol, smoking] or illnesses o Problems with the anesthetic insurgery.
2. Can gently palpate; do not poke finger into the during gestation.
inguinal canal  Where born: city, hospital. Developmental history
C. Cryptorchidism  Birth weight, mode of delivery, difficulties in delivery.  Gross motor.
1. Distinguish from hyper-retractile testis  Resuscitation, intensive care requirement at birth.  Fine motor.
 Cyanosis, pallor, jaundice, convulsions, birthmarks,  Vision, speech, hearing.
2. Most will spontaneously descend by several months
malformations, feeding or respiratory difficulties.  Social.
of life
 Apgar score at birth if known.  See Developmental Milestones Reference.
D. Tanner staging in adolescents - See Tanner Staging
handouts  How baby was fed in first few days.
Education history
E. Rectal and pelvic exam not done routinely - special  Whether child went home with mother.
 Start of school attendance.
indications may exist  Where attend school.
Nutritional history
 Special needs requirements.
 Breast-fed vs. bottle-fed
 Impact of symptoms: absent school days.
o When breast started, stopped.
o If formula: type, amount, pre-mixed vs concentrate Family history
[and dilution used].  The current complaint in parents/ siblings: health, cause of
 Vitamin supplements. death, age of onset, age of death.
 Age when beikost started.  Parents/siblings: age, health, where living.
 Appetite and growth.  Height and weight of parents.
 Current diet.  Hereditary dz suspected: do a family tree.