physical assessment handout color 3 per pg

S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 1
© K. Karlsen 2006
Kristine A. Karlsen MSN, RNC, NNP
Author
National Program Director, Founder
The S.T.A.B.L.E. Program
Park City, Utah

Kristine A. Karlsen
Kristine A. Karlsen
MSN, RNC, NNP
MSN, RNC, NNP
Author
Author
National Program Director, Founder
National Program Director, Founder
The S.T.A.B.L.E. Program
The S.T.A.B.L.E. Program
Park City, Utah
Park City, Utah


PowerPoint
®
Design
Mary Puchalski MS, RNC, APN/CNS
Lombard, Illinois

Medical Illustrations

Marilou Kundmueller RN, BSN, MA
PowerPoint
PowerPoint
®
®
Design
Design
Mary Puchalski
Mary Puchalski
MS, RNC, APN/CNS
MS, RNC, APN/CNS
Lombard, Illinois
Lombard, Illinois


Medical Illustrations
Medical Illustrations
Marilou Kundmueller
Marilou Kundmueller
RN, BSN, MA
RN, BSN, MA
Physical and Gestational Age
Assessment of the Newborn
Physical and Gestational Age
Physical and Gestational Age
Assessment of the Newborn
Assessment of the Newborn
© K. Karlsen 2006
Principles of Physical Exam
Principles of Physical Exam

Review history
Review history
Prenatal
Prenatal
Labor/delivery
Labor/delivery
Presentation of illness
Presentation of illness
Use
Use
Consistent
Consistent
Organized
Organized
Gentle approach
Gentle approach
© K. Karlsen 2006
Wash hands, wear gloves
Wash hands, wear gloves
Use clean equipment
Use clean equipment
Keep infant warm
Keep infant warm
Perform while infant in quiet
Perform while infant in quiet
state whenever possible
state whenever possible
Shield infant
Shield infant
’

’
s eyes from
s eyes from
exam light
exam light
Comfort infant during and
Comfort infant during and
after exam
after exam
Change soiled diapers / redress following exam
Change soiled diapers / redress following exam
Principles of Physical Exam
Principles of Physical Exam
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 2
© K. Karlsen 2006
Principles of Physical Exam
Principles of Physical Exam
Observe before touching
Observe before touching
Auscultation before
Auscultation before
palpation
palpation
–
–
in quiet
in quiet
environment

environment
Gentle palpation
Gentle palpation
Avoid if acute abdomen
Avoid if acute abdomen
Extra care with
Extra care with
premature infants
premature infants
© K. Karlsen 2006
Infant Size
Infant Size
Measurement
Measurement
Weight
Weight
Length
Length
Head circumference
Head circumference
Appropriate size for age (AGA)
Appropriate size for age (AGA)
Well
Well
-
-
nourished appearance
nourished appearance
© K. Karlsen 2006
Infant Size

Infant Size
Small for gestational age (SGA)
Small for gestational age (SGA)
Weight less than10
Weight less than10
th
th
percentile for gestational age
percentile for gestational age
Symmetric
Symmetric
Asymmetric
Asymmetric
Appropriate size for age (AGA)
Appropriate size for age (AGA)
Large for gestational age (LGA)
Large for gestational age (LGA)
Weight greater than 90
Weight greater than 90
th
th
percentile for gestational age
percentile for gestational age
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 3
© K. Karlsen 2006
Infant Size
Infant Size
Use Ballard exam to

Use Ballard exam to
assess gestational age
assess gestational age
Gestational
age assessment
Gestational
Gestational
age assessment
age assessment
© K. Karlsen 2006
Infant Size
Infant Size
©
©
David A. Clark MD
David A. Clark MD
Discordant twins
Discordant twins
Discordant twins
© K. Karlsen 2006
Neurological Status
Neurological Status
Normal
Normal
Active, alert, good tone, moderate
Active, alert, good tone, moderate
flexion, symmetric strength
flexion, symmetric strength
and movement
and movement

Strong, symmetric cry
Strong, symmetric cry
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 4
© K. Karlsen 2006
Neurological Status
Neurological Status
Normal reflexes in term infant
Normal reflexes in term infant
Root and suck
Root and suck
© K. Karlsen 2006
Neurological Status
Neurological Status
Normal reflexes in term infant
Normal reflexes in term infant
Root and suck
Root and suck
Moro
Moro


arms extend, abduct, hands open
arms extend, abduct, hands open
, followed by
, followed by
flexion of arms and closing of hands
flexion of arms and closing of hands
© K. Karlsen 2006

Neurological Status
Neurological Status
Normal reflexes in term infant
Normal reflexes in term infant
Root and suck
Root and suck
Moro
Moro


arms extend, abduct, hands open
arms extend, abduct, hands open
, followed by
, followed by
flexion of arms and closing of hands
flexion of arms and closing of hands
Palmar and plantar grasp
Palmar and plantar grasp
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 5
© K. Karlsen 2006
Neurological Status
Neurological Status
Normal reflexes in term infant
Normal reflexes in term infant
Root and suck
Root and suck
Moro
Moro



arms extend, abduct, hands open
arms extend, abduct, hands open
, followed by
, followed by
flexion of arms and closing of hands
flexion of arms and closing of hands
Palmar and plantar grasp
Palmar and plantar grasp
Babinski
Babinski


extension or flexion of toes after stimulating
extension or flexion of toes after stimulating
sole of foot
sole of foot
© K. Karlsen 2006
Neurological Status
Neurological Status
Normal reflexes in term infant
Normal reflexes in term infant
Root and suck
Root and suck
Moro
Moro


arms extend, abduct, hands open

arms extend, abduct, hands open
, followed by
, followed by
flexion of arms and closing of hands
flexion of arms and closing of hands
Palmar and plantar grasp
Palmar and plantar grasp
Babinski
Babinski


extension or flexion of toes after stimulating
extension or flexion of toes after stimulating
sole of foot
sole of foot
Tonic neck (fencing position)
Tonic neck (fencing position)
Truncal incurvation (Galant reflex)
Truncal incurvation (Galant reflex)


pelvis moves toward
pelvis moves toward
side of stimulus
side of stimulus
© K. Karlsen 2006
Neurological Status
Neurological Status
Abnormal
Abnormal

Weak suck or poor feeding
Weak suck or poor feeding
pattern
pattern
Weak cry
Weak cry
Distressed facies
Distressed facies
Lethargy / hypotonia
Lethargy / hypotonia
Hyperreflexia
Hyperreflexia
/ hypertonia
/ hypertonia
Decreased or absent reflexes
Decreased or absent reflexes
Irritability
Irritability
Seizures
Seizures
Coma
Coma
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 6
© K. Karlsen 2006
Head
Head
Size
Size

Indication of normal brain growth
Indication of normal brain growth
Record largest measurement
Record largest measurement
Above ear and eyebrow ridges
Above ear and eyebrow ridges
Occipitofrontal circumference
Occipitofrontal circumference
(OFC)
(OFC)
Varies with molding and
Varies with molding and
scalp swelling
scalp swelling
© K. Karlsen 2006
Head
Head
Sutures
Sutures
Approximated
Approximated
Overlapping
Overlapping
Wide
Wide
-
-
spaced
spaced
Mobility

Mobility
Occipital
bone
Occipital
Occipital
bone
bone
Sagittal
suture
Sagittal
Sagittal
suture
suture
Posterior
Posterior
fontanel
fontanel
Lambdoidal
suture
Lambdoidal
Lambdoidal
suture
suture
Frontal
bone
Frontal
Frontal
bone
bone
Coronal

suture
Coronal
Coronal
suture
suture
Anterior
fontanel
Anterior
Anterior
fontanel
fontanel
Parietal
bone
Parietal
Parietal
bone
bone
Metopic
suture
Metopic
Metopic
suture
suture
Squamosal
suture
Squamosal
Squamosal
suture
suture
© K. Karlsen 2006

Head
Head
Shape
Shape
Molding
Molding
Symmetric
Symmetric
Asymmetric
Asymmetric
Size of fontanels
Size of fontanels
Anterior
Anterior
Posterior
Posterior
Scalp swellings
Scalp swellings
Location
Location
Characteristics
Characteristics
©
©
David A. Clark MD
David A. Clark MD
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 7
© K. Karlsen 2006

Skull bone
S
S kin
C
C onnective tissue (CT)
A
A poneurosis (galea)
L
L oose CT (subgaleal)
P
P eriosteum
Superior sagittal sinus
– drains blood from
scalp back to heart
Superior sagittal sinus
Superior sagittal sinus
–
–
drains blood from
drains blood from
scalp back to heart
scalp back to heart
 Scalp Anatomy
 Scalp Anatomy
Head
Head
© K. Karlsen 2006
Caput Succedaneum
Caput Succedaneum
Subgaleal Hemorrhage

Subgaleal Hemorrhage
Cephalohematoma
Cephalohematoma
Head
Head
 Scalp Swellings
 Scalp Swellings
© K. Karlsen 2006
Emissary
Emissary
vein
vein
Superior
Superior
sagittal sinus
sagittal sinus
DurationBlood lossPalpationLocation
Resolves in
48 – 72 hours
MinimalSoft and spongy
Pits on pressure
Edema of presenting
part of scalp – usually
crosses suture lines –
shifts with positioning
Accumulation of
serosanguineous
fluid in
subcutaneous
tissues of scalp

Accumulation of
Accumulation of
serosanguineous
serosanguineous
fluid in
fluid in
subcutaneous
subcutaneous
tissues of scalp
tissues of scalp
Head
Head
 Caput Succedaneum
 Caput Succedaneum
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 8
© K. Karlsen 2006
Head
Head
 Caput Succedaneum
 Caput Succedaneum
Vacuum edema
Vacuum edema
Vacuum edema
© K. Karlsen 2006
DurationBlood lossPalpationLocation
Resolves in
2 weeks to
3 months

Rarely severe
X-ray if skull
fracture suspected
Initially firm
More fluctuant
after 48 hrs
Stops at sutures
Parietal and occipital
bones
May be bilateral
Emissary
vein
Superior
sagittal sinus
Blood
accumulation
between skull bone
and periosteum
Blood
Blood
accumulation
accumulation
between skull bone
between skull bone
and periosteum
and periosteum
Emissary
Emissary
vein
vein

Superior
Superior
sagittal sinus
sagittal sinus
 Cephalohematoma
 Cephalohematoma
Head
Head
© K. Karlsen 2006
 Cephalohematoma
 Cephalohematoma
Head
Head
©
©
David A. Clark MD
David A. Clark MD
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 9
© K. Karlsen 2006
DurationBlood lossPalpationLocation
Resolves over
2 – 3 wks
High morbidity
& mortality
May lead to
severe anemia
and hypovolemic
shock

Firm to fluctuant –
“boggy”
Dependent swelling
Crosses suture
lines – may
extend from eyes
to nape of neck
Rupture of emissary
veins  subtle but
massive hemorrhage!
Rupture of emissary
Rupture of emissary
veins
veins


subtle but
subtle but
massive hemorrhage!
massive hemorrhage!
Superior
Superior
sagittal sinus
sagittal sinus
Subgaleal space –
holds up to 240 ml
of blood –
potentially entire
blood volume
Subgaleal space

Subgaleal space
–
–
holds up to 240 ml
holds up to 240 ml
of blood
of blood
–
–
potentially entire
potentially entire
blood volume
blood volume
 Subgaleal Hemorrhage
 Subgaleal Hemorrhage
Head
Head
© K. Karlsen 2006
DurationBlood lossPalpationLocation
Resolves over
2 – 3 wks
High morbidity
& mortality
May lead to
severe anemia
and hypovolemic
shock
Firm to fluctuant –
“boggy”
Dependent swelling

Crosses suture
lines – may
extend from eyes
to nape of neck
 Subgaleal Hemorrhage
 Subgaleal Hemorrhage
Head
Head
© K. Karlsen 2006
Video courtesy of Swiss
Video courtesy of Swiss
Society
Society
of Neonatology
of Neonatology
Infant with subgaleal hemorrhage
Infant with subgaleal hemorrhage
Note area of hemorrhage
Note area of hemorrhage
Note area of hemorrhage
Anterior
Note fluid waves,
tachypnea and retractions
Note fluid waves,
Note fluid waves,
tachypnea and retractions
tachypnea and retractions
 Subgaleal Hemorrhage
 Subgaleal Hemorrhage
Head

Head
Monitoring guidelines
Monitoring guidelines
Monitoring guidelines
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 10
© K. Karlsen 2006
Head
Head
Craniosynostosis
Craniosynostosis
Craniosynostosis
©
©
David A. Clark MD
David A. Clark MD
©
©
David A. Clark MD
David A. Clark MD
 Abnormal Findings
 Abnormal Findings
Apert syndrome
Apert syndrome
Crouzon syndrome
Crouzon syndrome
© K. Karlsen 2006
Congenital
hydrocephalus

Congenital
Congenital
hydrocephalus
hydrocephalus
©
©
David A. Clark MD
David A. Clark MD
Head
Head
 Abnormal Findings
 Abnormal Findings
© K. Karlsen 2006
Macrocephaly
Macrocephaly
Macrocephaly
©
©
Jack Dolcourt MD
Jack Dolcourt MD
©
©
Jack Dolcourt MD
Jack Dolcourt MD
Microcephaly
Microcephaly
Microcephaly
©
©
David A. Clark MD

David A. Clark MD
©
©
David A. Clark MD
David A. Clark MD
4 P syndrome
4 P syndrome
Head
Head
 Abnormal Findings
 Abnormal Findings
Holoprosencephaly
Holoprosencephaly
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 11
© K. Karlsen 2006
Scalp electrode
Scalp electrode
Scalp electrode
Head
Head
 Scalp Injuries
 Scalp Injuries
© K. Karlsen 2006
Head
Head
 Scalp Abnormalities
 Scalp Abnormalities
Cutis aplasia

Cutis aplasia
Cutis aplasia
©
©
David A. Clark MD
David A. Clark MD
© K. Karlsen 2006
Abnormally placed whorl
Abnormally placed whorl
Abnormally placed whorl
Hair  Abnormal Findings
Hair  Abnormal Findings
Low hairline
Low hairline
Low hairline
©
©
David A. Clark MD
David A. Clark MD
Trisomy 21
Trisomy 21
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 12
© K. Karlsen 2006
Congenital absence of
hair growth – bald patch
Congenital absence of
Congenital absence of
hair growth

hair growth
–
–
bald patch
bald patch
©
©
David A. Clark MD
David A. Clark MD
©
©
David A. Clark MD
David A. Clark MD
Alopecia
Alopecia
Alopecia
Hair  Abnormal Findings
Hair  Abnormal Findings
© K. Karlsen 2006
Long lashes, low hairline
Long lashes, low hairline
Long lashes, low hairline
©
©
David A. Clark MD
David A. Clark MD
Hair  Abnormal Findings
Hair  Abnormal Findings
Cornelia de Lange syndrome
Cornelia de Lange syndrome

© K. Karlsen 2006
Face
Face
Symmetry
Symmetry
Features
Features
Symmetric facies
Symmetric facies
Symmetric facies
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 13
© K. Karlsen 2006
Face
Face
 Normal Findings
 Normal Findings
Milia
Milia
Milia
Milia
Milia
Birthmarks
Birthmarks
Nevus simplex (
Nevus simplex (
‘
‘
stork bite

stork bite
’
’
)
)
Nevus flammeus (eyelids)
Nevus flammeus (eyelids)
Telangiectatic nevus (
Telangiectatic nevus (
‘
‘
salmon patch
salmon patch
’
’
)
)
© K. Karlsen 2006
Face
Face
©
©
David A. Clark MD
David A. Clark MD
Moebius syndrome
Moebius syndrome
Prominent telangiectasia
Prominent telangiectasia
Prominent telangiectasia
Goltz syndrome

Goltz syndrome
Congenital facial paralysis
(6
th
and 7
th
cranial nerves)
Congenital facial paralysis
Congenital facial paralysis
(6
(6
th
th
and 7
and 7
th
th
cranial nerves)
cranial nerves)
 Abnormal Findings
 Abnormal Findings
© K. Karlsen 2006
Face
Face
Fetal Alcohol Syndrome
Fetal Alcohol Syndrome
Flattened midface
Flattened midface
Broad nasal bridge
Broad nasal bridge

Short, up
Short, up
-
-
turned nose
turned nose
Smooth, long philtrum
Smooth, long philtrum
Thin upper lip
Thin upper lip
Hypoplastic maxilla
Hypoplastic maxilla
Philtrum
Philtrum
 Abnormal Findings
 Abnormal Findings
©
©
David A. Clark MD
David A. Clark MD
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 14
© K. Karlsen 2006
Trisomy 21
Trisomy 21
Short round head
Short round head
Flat facial profile
Flat facial profile

Epicanthal folds
Epicanthal folds
Brushfield
Brushfield
’
’
s spots
s spots
Up
Up
-
-
slanting palpebral fissures
slanting palpebral fissures
Short, flat nasal bridge
Short, flat nasal bridge
Protruding tongue
Protruding tongue
Short, narrow palate
Short, narrow palate
Small, low
Small, low
-
-
set ears
set ears
Short neck,
Short neck,
excess nuchal folds
excess nuchal folds

©
©
Jack Dolcourt MD
Jack Dolcourt MD
Face
Face
 Abnormal Findings
 Abnormal Findings
© K. Karlsen 2006
Trisomy 18
Trisomy 18
Prominent occiput
Prominent occiput
Triangular facies
Triangular facies
Small palpebral fissures
Small palpebral fissures
Ptosis
Ptosis
Pinched appearance of nose
Pinched appearance of nose
Low
Low
-
-
set, malformed ears
set, malformed ears
Micrognathia
Micrognathia
Small mouth

Small mouth
©
©
Jack Dolcourt MD
Jack Dolcourt MD
Face
Face
 Abnormal Findings
 Abnormal Findings
© K. Karlsen 2006
Trisomy 13
Trisomy 13
Microcephaly, sloping forehead
Microcephaly, sloping forehead
Wide sagittal sutures and fontanels
Wide sagittal sutures and fontanels
Holoprosencephaly
Holoprosencephaly
Central facial anomalies, midface hypoplasia
Central facial anomalies, midface hypoplasia
Anophthalmia, microphthalmia,
Anophthalmia, microphthalmia,
hypotelorism
hypotelorism
Cataracts, coloboma of iris
Cataracts, coloboma of iris
Broad, bulbous nose
Broad, bulbous nose
Cleft lip, palate
Cleft lip, palate

Low
Low
-
-
set, malformed ears
set, malformed ears
Scalp defects
Scalp defects


cutis aplasia
cutis aplasia
Face
Face
 Abnormal Findings
 Abnormal Findings
Microphthalmia
Microphthalmia
Microphthalmia
Anophthalmia,
holoprosencephaly
Anophthalmia,
Anophthalmia,
holoprosencephaly
holoprosencephaly
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 15
© K. Karlsen 2006
Face

Face
 Injury
 Injury
Asymmetric facies
following forceps
assist delivery
Asymmetric facies
Asymmetric facies
following forceps
following forceps
assist delivery
assist delivery
Location
Location
Extent of injury
Extent of injury
Eye involvement
Eye involvement


ophthalmology
ophthalmology
evaluation
evaluation
Assess for symmetry when crying
Assess for symmetry when crying
Asymmetry
Asymmetry



nerve injury
nerve injury
© K. Karlsen 2006
Face
Face
Forceps marks
Forceps marks
Forceps marks
 Injury
 Injury
© K. Karlsen 2006
Face
Face
Bruising
Bruising


face presentation
face presentation
 Injury
 Injury
©
©
David A. Clark MD
David A. Clark MD
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 16
© K. Karlsen 2006
Eyes  Position and Size

Eyes  Position and Size
Normal eye spacing
Normal eye spacing


inner canthal distance
inner canthal distance
= palpebral fissure length
= palpebral fissure length
Outer canthal distance
Outer canthal distance
Outer canthal distance
Palpebral fissure length (size of eye)
Palpebral fissure length (size of eye)
Palpebral fissure length (size of eye)
Interpupillary distance
Interpupillary distance
Interpupillary distance
Inner canthal distance
Inner canthal distance
Inner canthal distance
© K. Karlsen 2006
Eyes
Eyes
Hypertelorism
Hypertelorism
Hypertelorism
Microphthalmia
Microphthalmia
Microphthalmia

Epicanthal folds
Epicanthal folds
Epicanthal folds
Trisomy 21
Trisomy 21
Upward-slanting
palpebral fissures
Upward
Upward
-
-
slanting
slanting
palpebral fissures
palpebral fissures
©
©
David A. Clark MD
David A. Clark MD
Rubinstein
Rubinstein
-
-
Taybi syndrome
Taybi syndrome
Strabismus
Strabismus
Strabismus
©
©

David A. Clark MD
David A. Clark MD
 Abnormal Findings
 Abnormal Findings
© K. Karlsen 2006
Eyes
Eyes
©
©
Jack Dolcourt MD
Jack Dolcourt MD
©
©
Jack Dolcourt MD
Jack Dolcourt MD
©
©
Jack Dolcourt MD
Jack Dolcourt MD
Brushfield spots
Brushfield spots
Brushfield spots
 Abnormal Findings
 Abnormal Findings
©
©
David A. Clark MD
David A. Clark MD
Sclerocornea
Sclerocornea

Sclerocornea
Congenital cataracts
Congenital cataracts
Congenital cataracts
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 17
© K. Karlsen 2006
Eyes
Eyes
 Abnormal Findings
 Abnormal Findings
©
©
David A. Clark MD
David A. Clark MD
Blocked lacrimal duct
Blocked lacrimal duct
Blocked lacrimal duct
©
©
David A. Clark MD
David A. Clark MD
Epibulbar dermoid cyst
Epibulbar dermoid cyst
Epibulbar dermoid cyst
Coloboma
Coloboma
Coloboma
Goldenhar syndrome

Goldenhar syndrome
© K. Karlsen 2006
Ears
Ears
Helix
Helix
Helix
Triangular
fossa
Triangular
Triangular
fossa
fossa
Tragus
Tragus
Tragus
Lobule
Lobule
Lobule
Antitragus
Antitragus
Antitragus
Antihelix
Antihelix
Antihelix
Concha
Concha
Concha
© K. Karlsen 2006
Ears

Ears
Normal
Normal
Normal
Low set
Low set
Low set
 Position
 Position
©
©
David A. Clark MD
David A. Clark MD
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 18
© K. Karlsen 2006
Ears
Ears
Ear pits
Ear pits
Ear pits
 Minor Anomalies
 Minor Anomalies
Preauricular skin tags
Preauricular skin tags
Preauricular skin tags
© K. Karlsen 2006
Ears
Ears

Extra creases
Extra creases
Extra creases
 Abnormal Findings
 Abnormal Findings
©
©
Jack Dolcourt MD
Jack Dolcourt MD
©
©
David A. Clark MD
David A. Clark MD
Goldenhar syndrome
Goldenhar syndrome
Treacher Collins syndrome
Treacher Collins syndrome
Beckwith
Beckwith
-
-
Wiedemann
Wiedemann
syndrome
syndrome
Trisomy 13
Trisomy 13
© K. Karlsen 2006
Area of
Area of

obstruction
obstruction
Nose
Nose
Choanal Atresia
Choanal Atresia
One or both nares obstructed
One or both nares obstructed
Cyanotic at rest but
Cyanotic at rest but
‘
‘
pinks up
pinks up
’
’
with crying
with crying
If bilateral, may need
If bilateral, may need
oral airway or
oral airway or
endotracheal intubation
endotracheal intubation
Oral airway sizes
Oral airway sizes
00
00
–
–

small infants
small infants
0
0
–
–
term or large
term or large
infants
infants
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 19
© K. Karlsen 2006
Mouth
Mouth
Lips
Lips
Gums
Gums
Cheeks
Cheeks
Tongue
Tongue
Palate
Palate
–
–
hard, soft
hard, soft

©
©
Jack Dolcourt MD
Jack Dolcourt MD
Short frenulum
Short frenulum
Short frenulum
Cleft soft palate
Cleft soft palate
Cleft soft palate
Natal teeth
Natal teeth
Natal teeth
Macroglossia
Macroglossia
Macroglossia
© K. Karlsen 2006
©
©
David A. Clark MD
David A. Clark MD
Micrognathia
Micrognathia
Micrognathia
Mobius
Mobius
syndrome
syndrome
Treacher Collins syndrome
Treacher Collins syndrome

and Chin  Abnormal Findings
and Chin  Abnormal Findings
Mouth
Mouth
© K. Karlsen 2006
Pierre
Pierre
-
-
Robin Sequence
Robin Sequence
Very small jaw
Very small jaw
Tongue obstructs airway
Tongue obstructs airway
May have cleft palate
May have cleft palate
©
©
Jack Dolcourt MD
Jack Dolcourt MD
©
©
Jack Dolcourt MD
Jack Dolcourt MD
Cleft palate
Cleft palate
Cleft palate
Stabilization
Stabilization

Stabilization
and Chin  Abnormal Findings
and Chin  Abnormal Findings
Mouth
Mouth
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 20
© K. Karlsen 2006
Neck  Abnormal Findings
Neck  Abnormal Findings
Short
Short
Nuchal thickening
Nuchal thickening
Webbing
Webbing
Torticollis
Torticollis
Masses
Masses
©
©
Jack Dolcourt MD
Jack Dolcourt MD
©
©
David A. Clark MD
David A. Clark MD
© K. Karlsen 2006

Neck  Abnormal Findings
Neck  Abnormal Findings
Cystic hygroma  soft, fluctuant, transilluminates
Cystic hygroma
Cystic hygroma


soft, fluctuant, transilluminates
soft, fluctuant, transilluminates
© K. Karlsen 2006
Short sternum
Short sternum
Short sternum
©
©
David A. Clark MD
David A. Clark MD
Shape
Shape
Broad
Broad
Narrow
Narrow
Bell shaped
Bell shaped
Short
Short
Chest  Abnormal Findings
Chest  Abnormal Findings
Broad chest and wide

spaced nipples
Broad chest and wide
Broad chest and wide
spaced nipples
spaced nipples
©
©
David A. Clark MD
David A. Clark MD
Turner syndrome
Turner syndrome
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 21
© K. Karlsen 2006
Breasts and nipples
Breasts and nipples
Placement
Placement
Shape
Shape
Pigmentation
Pigmentation
Secretions
Secretions
Chest  Abnormal Findings
Chest  Abnormal Findings
Gynecomastia
Gynecomastia
Gynecomastia

©
©
David A. Clark MD
David A. Clark MD
Turner syndrome
Turner syndrome
Accessory nipple
Accessory nipple
Accessory nipple
Broad chest and wide
spaced nipples
Broad chest and wide
Broad chest and wide
spaced nipples
spaced nipples
© K. Karlsen 2006
Respiratory rate
Respiratory rate
Normal
Normal
30
30
–
–
60 breaths per minute
60 breaths per minute
Easy breathing effort
Easy breathing effort
Abnormal
Abnormal

R
R
espiratory
espiratory
rate > 60
rate > 60


‘
‘
tachypnea
tachypnea
’
’
Respiratory rate < 30 plus labored
Respiratory rate < 30 plus labored
breathing
breathing


sign of exhaustion
sign of exhaustion
!
!
Gasping
Gasping


sign of impending
sign of impending

cardiorespiratory arrest
cardiorespiratory arrest
Grunting
Grunting
Flaring
Flaring
Retractions
Retractions
Chest
Chest
and Airway
and Airway
© K. Karlsen 2006
Retractions
Retractions
Intercostal
Intercostal
–
–
between the ribs
between the ribs
Substernal
Substernal
–
–
under the sternum
under the sternum
Chest and Airway
Chest and Airway
S.T.A.B.L.E. - Physical Assessment

(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 22
© K. Karlsen 2006
Chest and Airway
Chest and Airway
Retractions
Retractions
Subcostal
Subcostal
–
–
below the rib cage
below the rib cage
Suprasternal
Suprasternal
–
–
above the sternum
above the sternum
© K. Karlsen 2006
Chest and Airway
Chest and Airway
Airway obstruction
Airway obstruction
Nose
Nose
Mouth and jaw
Mouth and jaw
Larynx or trachea
Larynx or trachea

Bronchii
Bronchii
© K. Karlsen 2006
Diaphragmatic hernia
Diaphragmatic hernia
Bowel in chest
Bowel in chest
UAC tip
UAC tip


aorta
aorta
shifted to right
shifted to right
Gastric tube tip
Gastric tube tip


stomach in chest
stomach in chest
Chest and Airway
Chest and Airway
CDH Stabilization
CDH Stabilization
CDH Stabilization
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 23
© K. Karlsen 2006

Type A
8%
Type A
8%
Type B
1%
Type B
1%
Type C
86%
Type C
86%
Type D
1%
Type D
1%
Type E
4%
Type E
4%
Chest and Airway
Chest and Airway
Tracheoesophageal fistula
Tracheoesophageal fistula
© K. Karlsen 2006
Tracheoesophageal fistula
Tracheoesophageal fistula
Assess for VATER / VACTERL association
Assess for VATER / VACTERL association
Vertebral

Vertebral
Anal atresia
Anal atresia
Cardiac
Cardiac
TE fistula
TE fistula
Renal
Renal
Radial
Radial
Limb
Limb
Chest and Airway
Chest and Airway
©
©
Jack Dolcourt MD
Jack Dolcourt MD
TEF stabilization
TEF stabilization
TEF stabilization
© K. Karlsen 2006
Abdomen  Normal findings
Abdomen  Normal findings
©
©
Jack Dolcourt MD
Jack Dolcourt MD
Full appearance

Full appearance
No discoloration
No discoloration
Active bowel sounds
Active bowel sounds
Soft and non
Soft and non
-
-
tender to palpation
tender to palpation
Normal abdomen
Normal abdomen
Normal abdomen
S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 24
© K. Karlsen 2006
Abdomen
Abdomen
©
©
Jack Dolcourt MD
Jack Dolcourt MD
Appearance
Appearance


scaphoid, distended, visible loops
scaphoid, distended, visible loops

Color
Color


erythema, bluish discoloration
erythema, bluish discoloration
Bowel sounds
Bowel sounds


hypo or hyperactive
hypo or hyperactive
Palpation
Palpation


firm, tender
firm, tender
 Abnormal Findings
 Abnormal Findings
Congenital diaphragmatic hernia
Congenital diaphragmatic hernia
© K. Karlsen 2006
©
©
Jack Dolcourt MD
Jack Dolcourt MD
Appearance
Appearance



scaphoid, distended, visible loops
scaphoid, distended, visible loops
Color
Color


erythema, bluish discoloration
erythema, bluish discoloration
Bowel sounds
Bowel sounds


hypo or hyperactive
hypo or hyperactive
Palpation
Palpation


firm, tender, masses
firm, tender, masses
Abdomen
Abdomen
 Abnormal Findings
 Abnormal Findings
© K. Karlsen 2006
Abdomen
Abdomen
Visible bowel loops
Bilious gastric drainage

Visible bowel loops
Visible bowel loops
Bilious gastric drainage
Bilious gastric drainage
 Abnormal Findings
 Abnormal Findings
Appearance
Appearance


scaphoid, distended, visible loops
scaphoid, distended, visible loops
Color
Color


erythema, bluish discoloration
erythema, bluish discoloration
Bowel sounds
Bowel sounds


hypo or hyperactive
hypo or hyperactive
Palpation
Palpation


firm, tender, masses
firm, tender, masses

S.T.A.B.L.E. - Physical Assessment
(c) Kristine A. Karlsen 2006. Handout
reproducible for eduational purposes. 25
© K. Karlsen 2006
Abdomen
Abdomen
©
©
David A. Clark MD
David A. Clark MD
Eagle
Eagle
-
-
Barrett syndrome
Barrett syndrome
(Prune belly syndrome)
(Prune belly syndrome)
 Abnormal Findings
 Abnormal Findings
Appearance
Appearance


scaphoid, distended, visible loops
scaphoid, distended, visible loops
Color
Color



erythema, bluish discoloration
erythema, bluish discoloration
Bowel sounds
Bowel sounds


hypo or hyperactive
hypo or hyperactive
Palpation
Palpation


firm, tender, masses
firm, tender, masses
© K. Karlsen 2006
Abdomen
Abdomen
©
©
David A. Clark MD
David A. Clark MD
Distended bladder
Distended bladder
Distended bladder
©
©
David A. Clark MD
David A. Clark MD
Bladder exstrophy
Bladder exstrophy

Bladder exstrophy
 Abnormal Findings
 Abnormal Findings
© K. Karlsen 2006
Umbilical cord
Umbilical cord
Abdomen
Abdomen
 Abnormal Findings
 Abnormal Findings
Two vessel cord
Two vessel cord
Two vessel cord