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General
- Position patient and drape
- Use the correct terminology for locations on the abdomen
- Ask patient to point to areas of pain and examine that area last
Observation
- Observe patient's general appearance:
- Comfort, wellbeing, activity level, grooming, temperament, body habitus, nutritional status
General Considerations
- Patient should be gowned
- Examine on the table
- Respect the adolescent's need for privacy and modesty
- Give the patient the option of asking the parent to leave the room during the physical exam
- Always have a chaperone for breast and GU exams
- Describe what you will be doing step-by-step
- Vital Signs Normal Reference Range
Blood Pressure
- Measure blood pressure in both arms
- Use appropriately sized cuff
Eyes
- Note position and spacing of eyes, palpebral fissures, color, sclera and conjunctiva, eyelids, papillary size, and discharge
- Corneal Light Reflex
- Red Reflex
- Fundoscopic Exam
- Visual Tracking/Extraocular movements
- Formally assess visual acuity starting at 3 yrs of age
Mouth
- Inspect teeth, tonsils, oropharnyx
- Assess cranial nerves IX, X, and XII
Ears
- Observe appearance and placement
- Palpate pinnae, tragus, mastoid
- Otoscopic exam
- Pneumatic otoscopy if suspect otitis media
Lymph Nodes
- Palpate occipital, post auricular, pre auricular, anterior cervical, submandibular, submental, supraclavicular, axillary, and inguinal chains
Respiratory
- Note breathing pattern, skin color, signs of distress, use of accessory muscles
- Percuss
- Auscultate
Cardiovascular
- Measure blood pressure in both arms in children >3 yrs
- Compare radial pulses and dorsalis pedis pulses bilaterally
- Palpate PMI
- Auscultate with diaphragm and bell with patient lying at 30 degrees
Abdominal
- Observe shape, contour, presence of hernias
- Auscultate bowel sounds in 4 quadrants
- Percuss
- Palpate, note size of liver and spleen
Neurologic Exam
- Attempt to elicit deep tendon reflexes
- Assess strength and muscle tone
- Assess cranial nerves II-XII
- Assess Gait
Back
- Observe for scoliosis, spinal defects, or lesions
Genitals
- Have chaperone present for GU exam
- Visualize external genitalia to confirm Tanner Staging
- Males: examine in standing position, observe, gently retract foreskin to visualize urethral meatus, confirm bilaterally descended testicles, palpate for inguinal/femoral hernias
- Females: visual inspection of external genitalia sufficient
- Pelvic and breast exams are not performed until the patient reaches 21 years of age or 3 years after the onset of sexual activity
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