Circulatory System Heart Inspection Precordial activity Shape and symmetry Heave: an obvious lifting of the chest wall during contraction, may indicate an enlarged heart Palpation

Chest and Lungs Chest shape Infants: Shape is almost circular with anteroposterior diameter equaling the transverse or lateral diameter Children and adolescents: The transverse diameter

Ears During the tympanic membrane exam: In infants – Pull pinna down and back In children older than 3 – Pull pinna up and back

Hair and scalp Hair should be evenly distributed, smooth, and strong Manifestations of nutritional deficiencies include hair that is stringy, dull, brittle, and dry Hair

General Appearance Appears undistressed, clean, well-kept, and without body odors Muscle tone: Erect head posture is expected in infants after 4 months of age Make

Pulse Rate Grading of Pulses Grade Description 0 Not palpable +1 Difficult to palpate, thready, weak, easily obliterated with pressure +2 Difficult to palpate, may

Temperature measurement in pediatrics Ask the Question PICOT Question: In infants and children, what is the most accurate method for measuring temperature in febrile children?

Physical Assessment Anthropometric Measurements Height, weight, and circumference Weigh the child, taking two measurements and averaging them Calculate BMI BMI under the 5th percentile indicated

Performing Pediatric Physical Examination Perform the examination in an appropriate, nonthreatening area: Have room well-lit and decorated with neutral colors. Have room temperature comfortably warm.

Sequence of examination Infant Before able to sit alone — supine or prone, preferably in parent’s lap; before 4 to 6 months, can place on

Clinical Assessment of Nutritional Status Evidence of Adequate Nutrition Evidence of Deficient or Excessive Nutrition Deficiency or Excess General Growth Normal weight gain, growth velocity,

Nutrition Dietary intake Dietary Reference Intakes (DRI) are a set of four evidence-based nutrient reference values that provide quantitative estimates of nutrient intakes for use