Lungs and Respiration
Breath sounds should be clear; voice sounds heard through the lungs but
syllables should be indistinct (vocal resonance). Syllables clearly heard
when whispered (pectoriloquy), or sound increased in intensity or clarity
(bronchophony), diminished or absent vocal resonance, or decreased or
absent breath sounds could indicate lung congestion or consolidation.
Abnormal breath sounds should be described instead of labeled to promote
diagnosis and monitoring by various health-care providers.
Respiratory rates vary with age:- <1 year: 30 to 35 breaths/minute
- 2 to 3 years: 25 breaths/minute
- 4 to 6 years: 21 to 23 breaths/minute
- 8 to 12 years: 19 to 20 breaths/minute
- 14 to 18 years: 16 to 18 breaths/minute
Abdomen
Always auscultate before palpation or percussion of the abdomen to
avoid altering current bowel sound pattern with artificial stimulation of
bowel activity.
Gently palpate abdomen; do notpalpate abdomen if Wilms tumor is
present.
Examine all four quadrants of the abdomen.
Report visible peristaltic waves, which may indicate pathologic state.
Note absence or asymmetric abdominal reflex in infants and children
>1 year of age.
Have child cough, laugh, or blow up balloon to increase intraabdominal
pressure while inspecting for hernia.
Report hyperperistalsis indicated by hyperactive bowel sounds or an absence
of bowel sounds, both of which may indicate a gastrointestinal disorder.
Lack of tympany on percussion could indicate full stomach, or presence
of fluid or solid tumor; avoid assessment of stomach immediately after
meals.
Note guarding and tenderness, particularly rebound tenderness, or pain
that could indicate inflammation or infection.Genitourinary
Exam can be anxiety provoking for older child and adolescents, thus secure
privacy (ask preference for parental presence), preserve modesty, and
when possible offer same-sex examiner.
If complaint of burning, frequency or difficulty voiding, obtain urine
specimen for possible culture.
Note urinary and genital structures, size, and appearance; explain
anatomy for older child and caution that you will touch an area prior to
doing so to prepare the child.(^42) Pediatric Nursing Demystified