Heent Physical Assessment

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1. Discuss how HEENT physical assessment techniques would differ for a toddler and an older adult. What are some strategies that could be used to make it easier for the toddler, and what would you have to be especially careful about with the older adult. Pediatric patients are not small adults. Children require special care and attention. It is also a good idea to adjust your exam to the needs of each child. Making a child feel as comfortable as possible is key to your exam. The child should be in a position of comfort, most of the time in the arms or lap of their parent. Often demonstrating a procedure on the parent or stuffed animal is very helpful and less fearful for the child. You can also have the child assist in the exam by holding certain equipment. Different variations of tools are often used in an exam. For example, adults use a Snellen E chart for an eye exam and a picture chart is better suited for the preschooler to 6 years of age. When the child is more familiar with reading and identifying letters, then you can use the E chart. Children have shorter and wider ear canals than adults and are also positioned more horizontally. Because of this, bacteria can more easily travel to the middle ear. As you age, the Eustachian tube elongates and slopes. Cilia, microscopic hair like structures, line the ear canal and become more coarse and stiff as a person ages. As this happens, earwax builds up which can become impacted and reduces a persons hearing. When examining the inner ear on an adult or older child you should pull the pinna up and back which will help straighten the “S” shape of the canal. With an infant or young child, you will pull the pinna downwards. For the most part, adults are cooperative for evaluation and will follow directions, such as “open your mouth and stick out your tongue”. Some young children will be cooperative and you can make a
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