NURS 225 Lecture Notes - Lecture 1: Capillary Refill, Hypernatremia, Infant
University of Pennsylvania School of Nursing
N 225 Pediatric Nursing
Helene Fuld Pavilion for Innovative Learning and Simulation
Fall 2016/ Week I/ Student Guide
MODULE I: Why are children so different?
Point values for each response to the objectives are in parenthesis
Total number of points: 100
LEARNING OBJECTIVES: Upon completion of this module, the student will:
Neurologic System:
1. List 5 critical components of the neurological exam specific to a pediatric patient
(Hazinski (posted to Canvas). (1 point each- 5 points total)
Critical Components of
Neurological Exam
QUESTION # 2
Why is this component critical to
evaluate when conducting a
neurological exam?
Head circumference of infant
To ensure that intracranial volume
is increasing as to prevent increased
intracranial pressure when cranial
enlargement is occurring
Palpation of the fontanelles
To assess for normal intracranial
pressure and intracranial volume. If
a fontanelle is bulging, it may
indicate an increase in superior
vena caval pressure. If a fontanelle
is sunken, it can indicate significant
dehydration.
Muscle tone
Dominance of the flexor muscles is
normal in infants and children and
hypotonia/paralysis is abnormal
Level of consciousness by
evaluating infant’s alertness,
response to the environment, level
of activity and cry
Extreme sensitivity to stimuli can
indicate irritability. Extreme
irritability or lethargy is abnormal
during infancy. A high-pitched
abnormal cry may indicate
neurologic disease. A critically ill
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infant will not respond to bright
objects or faces, as normal infants
would.
All reflexes, especially Babinkski
reflex
If Babinski reflex is positive after
infant begins to walk then this may
indicate pyramidal tract disease.
2. Explain why each of the 5 components identified above are evaluated in pediatric
patients. (2 point each- 10 points total) USE TABLE IN #1 TO LIST YOUR ANSWERS
Cardiovascular System:
3. Identify the sites you would use to check the blood pressure in a child with a suspected heart
condition (Ball, Bindler, & Cowen, Chapter 5)? (4 points)
A BP should be taken in both the arm and the leg. These values should be compared and
the BP in the leg should be 10 to 20 mmHg higher than the arm reading.
4. Name 3 ideal locations where you could assess an infant’s pulse. (Ball, Bindler, &
Cowen, Chapter 5)? (3 points)
1.Brachial artery
2.Popliteal artery
3.Femoral artery
Respiratory System:
5. Name three specific physical assessment findings in an infant that indicate respiratory
distress (Ball, Bindler, & Cowen, Chapter 5 and Chapter 20)? (3 points)
1.use of accessory thoracic muscles
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2.Retractions-visible depression of tissue between ribs of
chest wall with each inspiration
3.Sustained respiratory rate higher than normal for age
6. Explain (in no more than 2 sentences), why infants have decreased lung aeration.
Describe (in no more than 2 sentences) the position infants should be placed in to
improve lung aeration (Hazinski, posted to Canvas and Why Pediatrics PowerPoint for
week 1 didactic)(2 points total for a 2 part question)
Infants have decreased aeration because they have narrower airways, smaller nostrils, a thinner
pharynx and larynx, a slenderer nasopharynx and a shorter turbinate region. Infants should be
placed in the upright position to improve lung aeration. When infants are supine, the abdominal
contents tend to press against the diaphragm, limiting diaphragmatic excursion.
Gastrointestinal System:
7. Describe why abdominal distention from gas is a common finding in infants (Ball,
Bindler, & Cowen, Chapter 25) (1 point).
Several enzymes, such as amylase, lipase, and trypsin are not present in sufficient quantities to
aid digestion until 4 to 6 months of age.
8. Complete the table below by describing 1 specific physical characteristic unique to the
gastrointestinal assessment system in a pediatric patient (Ball, Bindler, & Cowenm
Chapter 5 and 25) (1 point each- 7 points total)
Elements of GI Assessment
Specific components within that
assessment parameter
Abdominal inspection
Inspect umbilicus in infants and
toddlers because an umbilical
hernia is possible through an open
umbilical muscle ring.
Abdominal auscultation
Bowel sounds are normally high-
pitched, tinkling, and metallic
quality.
Abdominal palpation
Lower edge of liver is palpable on
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Document Summary
Helene fuld pavilion for innovative learning and simulation. Point values for each response to the objectives are in parenthesis. Learning objectives: upon completion of this module, the student will: Neurologic system: list 5 critical components of the neurological exam specific to a pediatric patient (hazinski (posted to canvas). (1 point each- 5 points total) Level of consciousness by evaluating infant"s alertness, response to the environment, level of activity and cry. To ensure that intracranial volume is increasing as to prevent increased intracranial pressure when cranial enlargement is occurring. To assess for normal intracranial pressure and intracranial volume. If a fontanelle is bulging, it may indicate an increase in superior vena caval pressure. If a fontanelle is sunken, it can indicate significant dehydration. Dominance of the flexor muscles is normal in infants and children and hypotonia/paralysis is abnormal. Extreme irritability or lethargy is abnormal during infancy. A high-pitched abnormal cry may indicate neurologic disease.
