Question

A 10-year-old has a chief complaint of weakness. What are the key physical assessment points? Identify at least 3 differential diagnoses and provide a rationale for any tests or diagnostics needed to confirm or rule out a disease.

Answer 1

The nurse must be aware of the childs developmental stage to engage in effective communication .The use of both verbal and nonverbal communication should be appropriate to the developmental level.Non verbal behaviours vary in importance based on the childs developmental level and physical condition .Although the childs physical condition is a consideration ,developmental level is much more important.The presence of parents is important when communicating with young children but maybe detrimental when speaking with adolescents.The findings on the physical examination provide accurate information in determining the correct diagnosis.The blood tests,electrodiagnostic studies,muscle biopsy and molecular genetic studies play a confirmatory diagnostic role.Weakness is the most common symptom exhibited by a patient with muscle disease.Proximal muscle weakness is the most common distribution of weakness in a myopathic disorder such as myasthenia gravis.Information regarding the chief complaint should be obtained. In children,history regarding the acquisition of developmental milestones should be ascertained .History regarding mental development,school performance are important indicators of superimposed CNS involvement.

In children older than 5 strength measurement is more stable and reproducible in children .Quantitative strength measurements have been demonstrated to be far more sensitive than clinical strength tessting for detecting weakness in children.