Clinical Assessment of Nutritional Status : Sequence of examination

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 examining table
    • After able to sit alone — sitting in parent’s lap whenever possible; if on table, place with parent in full view
      • If quiet, auscultate heart, lungs, and abdomen.
      • Record heart and respiratory rates.
      • Palpate and percuss same areas.
      • Proceed in usual head-to-toe direction.
      • Perform traumatic procedures last (eyes, ears, mouth [while crying]).
      • Elicit reflexes as body part is examined.
      • Elicit Moro reflex last.
        • Completely undress if room temperature permits.
        • Leave diaper on male infant.
        • Gain cooperation with distraction, bright objects, rattles, talking.
        • Smile at infant; use soft, gentle voice.
        • Pacify with bottle of sugar water or feeding.
        • Enlist parent’s aid for restraining to examine ears, mouth.
        • Avoid abrupt, jerky movements.
  • Toddler
    • Sitting or standing on or near parent 
    • Prone or supine in parent’s lap
      • Inspect body area through play: “Count fingers,” “tickle toes.”
      • Use minimum physical contact initially.
      • Introduce equipment slowly.
      • Auscultate, percuss, palpate whenever quiet.
      • Perform traumatic procedures last (same as for infant).
        • Have parent remove outer clothing.
        • Remove underwear as body part is examined.
        • Allow toddler to inspect equipment; demonstrating use of equipment is usually ineffective.
        • If uncooperative, perform procedures quickly.
        • Use restraint when appropriate, request parent’s assistance.
        • Talk about examination if cooperative; use short phrases.
        • Praise for cooperative behavior.
  • School-Age Child
    • Prefer sitting
    • Cooperative in most positions
    • Younger child prefers parent’s presence
    • Older child may prefer privacy
      • Proceed in head-to-toe direction.
      • May examine genitalia last in older child
        • Respect need for privacy.
        • Request self-undressing.
        • Allow to wear underpants.
        • Give gown to wear.
        • Explain purpose of equipment and significance of procedure, such as otoscope to see eardrum, which is necessary for hearing.
        • Teach about body function and care.
  • Adolescent
    • Same as for school-age child
    • Offer option of parent’s presence
      • Same as older school-age child.
      • May examine genitalia last
        • Allow to undress in private.
        • Give gown.
        • Expose only area to be examined.
        • Respect need for privacy.
        • Explain findings during examination e.g., “Your muscles are firm and strong”).
        • Matter-of-factly comment about sexual development (e.g., “Your breasts are developing as they should be”).
        • Emphasize normalcy of development.
        • Examine genitalia as any other body part; may leave to end.
  • Goal of assessment
    • Minimize anxiety and foster trust
    • Preserve security of parent-child relationship
    • Prep child as much as possible

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