Exam 1 Flashcards
1
Q
What all is part of the Cognitive-Affective Domain?
A
Level of consciousness Communication Orientation Attention Memory Perception/Judgment Mood and Pain
2
Q
Alert
A
Eyes open, interacting with their environment
3
Q
Lethargic
A
Drowsy, in and out of consciousness, not attending to tasks
4
Q
Glasgow Coma Scale
A
Level of consciousness and severity of injury with trauma to head/brain
Assessed by MD in ER/ICU
5
Q
What levels of consciousness may PT be done?
A
Active participation in alert and lethargic states
PROM and positioning if unconscious
6
Q
Difference between Orientation x3 and Orientation x4
A
x3: Person, place, and time
x4: Person, place, time, and diagnosis
7
Q
Aphasia
A
Inability to comprehend written or spoken language, formulate written or spoken language, or use written or spoken language
8
Q
Expressive Aphasia
A
Non-fluent Broca's Aphasia Limited vocabulary Slow, hesitant speech with good auditory/reading comprehension (communication board) May have impaired written skills
9
Q
Receptive Aphasia
A
Fluent
Wernicke’s Aphasia
No problem speaking, no comprehension
10
Q
Global Aphasia
A
Inability to produce or comprehend language
11
Q
Dysarthria
A
Lesion in brain that mediates speech production
Labored speaking skills, but understand communication and can express in written
12
Q
Aphonia
A
Inability to produce speech due to paralysis of vocal cords or diaphragm
13
Q
Broca’s Aphasia Physiology
A
Lesion of frontal lobe (anterior motor association - inferior frontal gyrus)
Usually seen with CVA/TBI
Refer to SLP for assessment
14
Q
Wernicke’s Aphasia Physiology
A
Lesion in posterior portion of temporal lobe and part of parietal lobe
Reading and writing are impaired
15
Q
Dysarthria Physiology
A
Acquired
Impairment of speech production from damage to the PNS/CNS causing weakness of the motor/speech system (respiration, phonation, articulation, resonance)
Production is not altered, but melody and rhythm changed
CP, TBI, CVA, MS, PD, ALS
May coexist with aphasia in CVA/TBI
16
Q
Attention
A
Ability to select and attend to a specific stimulus while suppressing extraneous stimuli
Ability to remain on task
17
Q
Amnesia
A
State of memory dysfunction
18
Q
Perception
A
Ability of an individual to recognize and interpret sensory information, high order function as it requires the individual to integrate auditory, sensory, visual, and somatosensory information
Should be screened for any type of brain injury
19
Q
Clinical indicators of perceptual difficulty
A
Brain Damage Unable to perform self ADLs/simple tasks Difficulty initiation/completing a task Unable to identify common onbjects Unable to follow simple directions
20
Q
Unilateral Neglect
A
Not aware of one half of their body/plate/environment
Typically right-sided brain injury that impairs left side
Brain damage over eye damage
Lesion located in Right parietal lobe (parietal sensory association cortex)
Often right middle cerebral artery CVA
21
Q
Clinical measures of neglect
A
Line Bisection: draw horizontal line and ask to draw line bisecting (bisect line to the right of the center in neglect)
Cancellation tests: cross out all objects they see on piece of paper
22
Q
Hemianopia
A
Defective vision in half of the visual field
Lesion in optic pathway or tract
Check visual fields
May present with hemianopia and neglect
23
Q
Apraxia
A
Movement disorder resulting in inability to perform movements without underlying cause
Cognitive deficit that interferes with motor planning
Lesion in frontal and posterior parietal lobes
i.e. when given scissors, try to use as a comb
24
Q
Types of Apraxia
A
Ideomotor
Ideational
Constructional
Childhood apraxia of speech
25
Ideomotor Apraxia
Disconnect between idea of a movement and the execution
Knows what to do but can't
Can't walk on command, but can get up and get a coffee
Lesion in frontal and/or posterior parietal lobe
26
Ideational Apraxia
Inability to figure out how to perform a task
Given a hairbrush and told brush hair, but doesn't know how to
Lesion in parietal lobe
27
Constructional Apraxia
Faulty spatial analysis and conceptualization of task
Unable to understand relationship of parts to whole
Can't put sandwich together even though they are given the ingredients; all parts of clock are there but not correct
Lesion in posterior parietal lobe
28
Childhood Apraxia of speech
Developmental challenge in the brain and can't form speech correctly
2-4 years: issues getting the wrong sounds/words
Won't just grow out, refer to SLP
29
Judgment
Part of executive function
Impairments lead to impulsiveness, socially inappropriate behavior
Assess executive function if they can figure out how to fold/open a walker, find number in phone book, differentiate photos
30
Mood
Affects participation and treatment
31
What are the emotional states?
```
Fatigue
Anxiety
Depression - impacts recovery
Delusion
Disinhibition - inappropriate expression of emotion
Aggressiveness
Apathy
```
32
Components of Musculoskeletal Domain
Strength: need at least 3/5 for most functional activities
ROM: visual screening followed by goni in limited range (AROM and PROM)
Posture: sitting and standing
33
Pressure Sores
Most common preventable secondary condition PTs need to assess for in neurologic dysfunction
34
Bony prominences at risk for pressure ulcers
Calcaneus
External Occipital Meatus
Sacrum
35
Causes of Ulcer
```
Immobility
Moisture
Lack of Sensation
Poor Oxygenation
Poor Nutrition
Shearing Force
```
36
Trophic skin exam changes
Skin color: venous stasis (bluish/purple in LE)
Skin texture: smooth and shiny, absence of hair
Skin Temp: cool = impaired; hot=infected
Edema
Calf pain + increased temp + edema may = DVT
Braden scale: administered by nursing to determine risk
37
Upper Motor Neuron Lesions (cortex, brainstem, corticospinal tracts, spinal cord)
```
Spasticity/Hypertonia
Exaggerated reflexes
Babinski and Clonus
Synergy
Weakness
Disuse Atrophy
```
38
Lower Motor Neuron Lesions (cranial nerves/nuclei, spinal cord - AHC, spinal root, peripheral nerve)
```
Flaccidity/Hypotonia
Decreased or absent reflexes
No primitive reflexes
Weakness
Atrophy due to lack of innervation (severe wasting)
```
39
Reflexes
Muscle
Developmental: ATNR; STNR; postural synergy patterns: observed muscle hypertonicity and gross movement patterns
Primitive Reflexes: babinski, clonus
Cranial Nerve Testing
40
UE Synergy Patterns
Flexor component: elbow, wrist, and finger
| Extensor component: shoulder ADD and IR, and forearm pronation
41
LE Synergy Patterns
Extensor component: Hip IR and ADD, knee extension, plantarflexion and inversion
42
Tonal Abnormalities
```
Flaccidity
Hypotonia
Normal
Spasticity
Dystonia
Rigidity
```
43
Spasticity
Resistance to external stretch increases with increasing speed of stretch and varies with direction of movement
Resistance to external stretch rises above threshold speed
44
Dystonia
Involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both
45
Rigidity
Resistance to external stretch is present at very low speeds of movement, does not depend on speed, and doesn't exhibit speed or angle threshold
46
Spasticity Physiology
Injury to pyramidal tracts (corticospinal)
CVA, CP, TBI
UMN Syndrome (babinski and clonus)
Chronic spasticity leads to contractures, deformity, activity limitations
Clasp knife response: feeling of letting go of resistance when stretching spastic muscle (autogenic inhibition)
47
Modified Ashworth Scale
Grades tone from:
0 (no increased tone)
4: Extremely stiff
48
Rigidity Physiology
Basal Ganglia lesion
| Leads to contractures and activity limitations
49
Types of Rigidity
Cogwheel: alternating letting go and increased resistance (PD)
Leadpipe: constant
Decorticate: UE flexed and LE extended; above superior colliculus, reduce stimuli and position (TBI)
Decerebrate: UE and LE extended; between vestibular nucleus and superior colliculus; reduce stimuli and posture (TBI)
50
Positions that affect tone
UE: antigravity: UE flexed, adducted, wrist flexed = spasticity
LE: antigravity: LE extended, adducted, plantarflexed: spasticity
51
Dynamic components of tone
```
Volitional effort
Arousal
Stress
Position
Medications
Temperature
```
52
Functional Balance Tests
```
Berg/PBS
Tinetti
TUG and TUDS
Dynamic Gait Index; Functional Gait Assessment
BOT-2
Pediatric Functional Reach
```
53
Coordination
Ability to execute smooth, accurate, controlled motor responses
Based on intact and functioning nervous system
Fluidity of movement
54
Coordination characterized by:
```
Appropriate speed
Distance (dysmetria)
Direction
Timing
Accuracy
```
55
Dysdiadochokinesia
Problems with alternating pronation/supination
56
Dysmetria
Problem with pointing and past pointing
57
Tremor
Either a resting tremor or intention worsens
58
Bradykinesia
Slowed gross and fine motor movement
59
Sensation Testing
Results from sensory testing => clinical judgments about diagnosis, prognosis, and outcomes
Sensory input impacts motor output
60
Sensory Testing Principles
```
Position Patient: informal with supine
Socks off
Strict about eyes closed
Simple instructions
Remove clothing
Obscure vision
```
61
Sensory System classification
Receptors
| Spinal Pathways
62
Receptors
Mechano, thermo, chemo, and pain
Cutaneous: nociceptors, Meissner's corpuscles (touch), Pacinian corpuscles (deep pressure); Merkel's disks (light pressure, 2 point discrimination)
Deep Sensory: Ruffini corpuscles (muscle and joint receptor)
63
Spinal Pathway
Spinothalamic: pain and temperature
| Dorsal Column: discriminative touch
64
Spinothalamic
Nondiscriminative
Small, slow conduction
Skin origin
From dorsal root horn, cross in spinal cord, lower brainstem, thalamus
65
Dorsal Column
Discriminative
Large, fast conduction
Skin, joint, tendon origin
Dorsal column, cross in medulla to contra thalamus, sensory cortex
66
Dermatome Testing
Cutaneous area supplied by single dorsal root
| Less likely to be dermatomal and more likely to to homunculus, but still test
67
Sensory Exam
Light touch (sharp/dull)
2 point: dorsal column
Kinesthesia/proprioception: dorsal column
Vibration: early screening in diabetic cases
Pain and temperature: lateral spinothalamic tract
Cranial nerve screening
68
Cranial Nerve Testing
```
CN I: Smell
CN II: Read nametag and check visual fields
CN II, IV, and VI: eye movement and pupillary reflexes; Ptosis, diplopia, and strabismus
CN V: Open and close jaw
CN VII: Smile
CN VIII: hearing and scratch test
CN XI: MMT of SCM and trap
CN XII: stick tongue out
```
69
Cerebellum Function
Regulates coordinated movements
Rapid movement
Maintain posture, muscle tone, and equilibrium
70
Cerebellar Dysfunctions
Ataxia: uncoordinated
Hypotonia: Gamma input determined by cerebellum, so less function
Dysmetria: can't judge distance or range
Dysdiadochokinesia: can't perform rapid alternating movements
Tremor
71
Cerebellar Dysfunction Features
Movement decomposition: inability to perform smooth, coordinated movements
Gait Disorder: wide BOS, high guard
Rebound: loss of check reflex
Dysarthria: inability to perform motor component of speech articulation
72
Coordination Exams
Nonequilibrium: finger to nose, pronation/supination, tapping, heel to toe, heel on shin
Equilibrium: standing, feet together, tandem, perturbations, eyes open/closed
73
Basal Ganglia Function
Regulates initiation of movement, planning of complex motor tasks, automatic and postural adjustments
74
Basal Ganglia Dysfunctions
Bradykinesia
Rigidity: lesion in basal ganglion and extrapyramidal tracts
Resting Tremor
Akinesia
Chorea: ongoing, involuntary, discrete movements, rapid, jerky motions
Athetosis: continuous, flowing motions, writhing, twisting
75
Hyperkinetic Disorders
Unwanted excess movement (involuntary or voluntary)
Chorea
Athetosis
Dystonia
76
Cerebral Cortex Function
Perceiving and interpreting sensory information
Controlling voluntary movement
Controlling co-contraction
77
Cerebral Cortex Dysfunction
Spasticity
78
Activity Limitations Domain
Bed Mobility
Transfers
Locomotion
MOST IMPORTANT ASPECT OF EXAM
79
What are the core dimensions of PT Expert Practice?
Knowledge
Clinical Reasoning
Movement
Virtues
80
Knowledge
Multidimensional
| Patient-Centered
81
Clinical Reasoning
Collaborative Process
| Reflection-in-action
82
Movement
Central Focus
| Centered on Function
83
Virtues
Caring
| Commitment
84
Clinical Reasoning
Sum of the thinking and decision-making processes associated with clinical practice
Process of reflective inquiry, in collaboration with a patient or family, which seeks to promote a deep and contextually relevant understanding of the clinical problem to provide a sound basis for clinical intervention
85
Clinical reasoning is...
a continuous reflective activity
engages the patient and family in a collaborative decision-making process
acknowledges key contextual factors that will impact clinical interventions and patient outcomes
86
Types of reflection
Reflection-on-Action: after the experience
Reflection-in-Action: make changes in real time
Reflection-for-Action: anticipate change for future interactions
87
Types of clinical reasoning
```
Hypothetico-deductive (Deductive Reasoning)
Pattern Recognition (Inductive Reasoning)
```
88
Hypothetico-Deductive Reasoning
Generation of a hypothesis based on results of tests/measures and testing that hypothesis
Used by novices in all situations and experts in challenging/unfamiliar situations
89
Pattern Recognition
Quick retrieval of info from a well-structured knowledge base contrived upon previous clinical experience
Frequently used by experts during familiar situations as they recognize patterns previously encountered
90
Deductive Reasoning Process
```
ICF Framework
Patient Management Model
Clinical Practice Guidelines
Clinical Prediction Rules
Algorithms
```
91
Inductive Reasoning Process
```
Requires previous experience
Involves recognition of familiar clinical patterns
Reflection
Open-Ended questions
Writing clinical narrative
```
92
Clinical Reasoning Framework
Cognitive Knowledge/Experiences
Analytical Skills/Critical Thinking
Situational Awareness/Context/Reflection/Frames of Reference
93
Normal Newborn Behaviors
Flexion contractures at hips and knees
Flexion for everything in order to fit inside
Respond to auditory stimuli
94
Abnormal Newborn Behaviors
Less flexion/resting extension
Shine light and disgusted/not alert/not crying
Cognition correlates to motor performance
95
Normal Newborn Tone
Constant flexion
96
Abnormal Newborn Tone
Passive motion easier to perform
| More flaccid
97
Normal Newborn Head
Little neck flexion, but keep chin off chest and keep head up a few seconds
98
Abnormal Newborn Head
Zero flexion in UEs and neck
| Can't keep head up in sitting
99
Components of pediatric PT Exam
Child/Family History
Systems Review
Tests and Measures
100
Pediatric Exam
Developmental milestones: have they always been delayed or are there certain things they are behind in
Re-evaluation/roles in growth: expect to get better as they age
Culture/Family dynamics/Environment: some populations don't let kids lay on ground, less motion in extremities, less neck muscles, decreased strength
101
History-Parent/Child Interview
```
Major Concerns
Developmental Goals
Start asking child around age 5
Important people in child's life
Typical day
```
102
School, Behavioral, Psycho-social history
MH, LD, ADHD/ADD, TBI
Behaviors: sleeping and eating habits, activity level, temperament, drive/motivation, compliance/motivation, discipline, interests
Time spent in school/daycare, transport, play
103
Cardiopulmonary Systems Review (Peds)
Heart Defects
Cystic Fibrosis
Muscular Dystrophy
Quieter voice, can't breathe as deep, won't be as physically active
104
Musculoskeletal Systems Review (Peds)
Decreased strength on that side of body
| Contractures
105
Integumentary Systems Review (Peds)
Pressure Ulcers
106
Neuromuscular Systems Review (Peds)
```
Tone
Synergy patterns
Bed mobility
Transfers
Locomotion
Balance
```
107
Cognitive-Affective Domain
Cognition: what toys they use, ask questions if older
Communication: hearing, vision, and ability to verbalize
Reflexes: differentiate UMN and normalcy
108
Integumentary Domain
Visual tracking/attending
Auditory attending/Orienting
Sensory processing (body awareness, proprioception, motor planning, tactile input)
109
Musculoskeletal Domain
```
Observation
Palpation (soft tissue, bony)
Assessment of static/dynamic posture
AROM/PROM
Postural Alignment: thigh folds, leg length, pelvic height, genu varus/valgus, ankle/foot position
```
110
Neuromuscular Domain
```
Reflexes (developmental and MSR)
Coordination and balance
Tone
Functional Strength
Sensory Testing
```
111
Activity Limitations/Gross Motor Skills Domain
Knowledge of age appropriate gross motor skills
| Determine where child is in relation to norms
112
Pediatric HOP-FA
Clinical framework designed to guide clinical reasoning in peds PT practice
Provides systematic, stepwise guide to the patient/client management process where the PT is asked to consider factors and issues that may affect clinical reasoning for the child and family
113
Examination for infants and young children
```
Observation!
Establish rapport in a relaxed atmosphere
Interactive play
Undress if appropriate
"Hands on" may be last to assess
Arena/play-based assessments
Change your agenda as you go
```
114
Exam for preschool
```
Observation
Play
Explain what you're doing
Arena/play-based
Self-care and ADL's
```
115
Exam for School-aged children, adolescents, and adults with developmental delays
Custom techniques
Talk with patient
Approach cognitive age, not chronological
116
Functional exam of motor function
```
Playground, school, home, and community
Fine motor skills
Language skills
Receptive/Expressive
Self help-adaptive skills
Social/behavioral skills
```
117
Purpose for Tests and Outcome Measures
Discriminative Measure: identify gross motor delay from "norm"
Predictive measure: prognosis - GMFCS
Evaluative Measure: detect progress over time
Baseline Measures: diagnosis and prognosis
Measure effectiveness of intervention
Research
118
Construction of Peds Tests
Screening vs outcome measures
| Norm vs criterion-referenced
119
Norm-Referenced Tests
Utilize normal subject tests results as standards for interpreting scores
Not needed if given a diagnosis
Compare to typically developing children
Tests: AIMS, PDMS-2, PEDI, BOT-2
120
Criterion-Referenced Tests
Scores interpreted on absolute criteria
Scores based on number of items performed correctly
Tests: GMFM, PBS
121
Standardization of Tests
Process of systemization of the methods used to obtain a measurement
Reliability
Validity
MCID
122
Screening Tools
```
Purpose: identify developmental delays
Quick and cost effect
Identify need for outcome measure
Overview of child's development
Don't establish diagnosis
Milani-Comparetti Motor Development, Denver, AIMS, BINS
```
123
Outcome Measures
Purpose: in-depth view of gross motor development
Help provide diagnosis or school placement
More time consuming and costlier
AIMS, PDMS-2, PEDI, GMFM, BOT-2, SFA, Wee-FIM
124
Selection of Peds Tests
```
Child and family goals
Disability domain
Test purpose
Age criteria
Norm vs criterion-referenced
Sensitivity vs specificity
MCID
```
125
Domain of Disability: Body Structure/Function
PBS
| Milani-Comparetti
126
Domain of Disability: Activity
```
AIMS
Denver II
PDMS-2
PEDI
BOT-2
SFA
Wee-FIM
```
127
Domain of Disability: Participation
PEDI
| SFA
128
Scoring and Score Interpretation
Raw Score
| Standard Score: expressed as deviation from mean; needed for norm-referenced
129
Percentile Score
of children of same age expected to score lower than child tested
130
Age Equivalent Score
Chronological age for which a certain score represents the average performance
131
Scaled Score
Performance along a continuum
Not related to age
Don't report, but helps you get deviation
132
PDMS-2
Purpose: Gross and fine motor development by direct observation
Age: Birth - 6 years
Areas tested: reflexes (0 - 12 months), stationary, locomotion, object manipulation, grasping, visual-motor
Norm Referenced
Entire: 45 min
GM portion: 30 min
133
PDMS-2 Scoring
```
Must directly observe action
Scored "0", "1", or "2"
Basal Level: 3 "2's"
Ceiling Level: 3 "0's"
12 months or less: reflexes last
```
134
PEDI
Purpose: Children with disability (physically or cognitively) and measures functional skills vs normality
Age: 6 months - 7.5 years
Areas: self-care, mobility, and social function
Norm-referenced
Time: 30-60 minutes
135
PEDI Scoring
0 or 1
| Caregiver assistance and modification 0 - 5
136
SNAPPS
```
Advanced clinical reasoning process
Summarize the most important aspects
Determine 2-3 appropriate tests
Compare and contrast tests to determine most appropriate
Ask about areas of uncertainty
Select areas to review and study
```
137
BOT-2
Purpose: Assess gross and fine motor skills
Age: 4-21 years; higher level balance and coordination
Areas: fine manual control, manual coordination, body coordination, strength, and agility
Norm-referenced
OT and PT both use
138
BOT-2 Administration
Must observe child performing
| Used in school systems with children who are mildly involved due to high level coordination and balance required
139
GMFM
Purpose: measure change in gross motor function over time in kids with CP
Age: 5 months to 16 years
Areas: GM function (lying, rolling, sitting, crawling, kneeling, standing, walking, running, and jumping)
Typically developing 5 yo should get 100%
Criterion-referenced with norm values using GMFCS for CP and DS
45-60 min
140
GMFCS - CP
Purpose: Classification for children with CP looking at trunk control and walking to describe the level of involvement/severity
Age: 6 - 12 years
Levels I - V based on severity of involvement
141
GMFCS General Classifications
Level I: walks without limitations
Level II: walks with limitations
Level III: walks using a hand-held mobility device
Level IV: self-mobility with limitations, may use power mobility
Level V: transported via manual chair
142
GMFCS Level I
Walk at home/school/outdoors/community
Climb stairs without using railing
Perform running and jumping, but speed, balance, and coordination are limited
143
GMFCS Level II
Children walk in most settings and climb stairs holding rail
Difficulty walking long distances and balancing uneven terrains/inclines/confined spaces
Walk with physical assistance, hand-held mobility device, or used wheeled mobility over long distances
Minimal ability to perform gross motor skills (running and jumping)
144
GMFCS Level III
Walk using hand-held device in most indoor settings
May climb stairs holding rail with supervision/assistance
Use wheeled mobility when traveling long distances and may self-propel for shorter distances
145
GMFCS Level IV
Use methods of mobility that require physical assistance or powered mobility in most settings
May walk for short distances at home with physical assistance or use powered mobility or body support walker when positioned
Manual wheelchair or powered mobility at school/outdoors/community
146
GMFCS Level V
Transported in manual wheelchair in all settings
| Limited in their ability to maintain antigravity head and trunk postures and control leg/arm movements
147
Level I vs Level II
Level II - limitations walking long distances and balancing; may need a hand-held mobility device when first learning to walk
May use wheeled mobility when traveling long distances outdoors and in the community
Requires use of a railing to walk up and down stairs, and are not as capable of running and jumping
148
Level II vs Level III
Level II: can walk without a device after age 4 (but may choose to use it)
Level III: need handheld device to walk indoors and use wheeled mobility in community
149
Level III vs Level IV
Level III: sit on own, but require limited support; slightly independent in standing transfers, walk with handheld device
Level IV: supported sitting but self-mobility is limited; more likely to use manual or powered mobility in community
150
Level IV vs Level V
Level V: severe limitations in head/trunk control, require extensive assisted technology and physical assistance; self-mobility achieved if child/youth can learn to operate power wheelchair
151
MACS
Purpose: Describes how children with CP use their hands to handle objects in home/school/community
Age: 4-18 years
152
MACS Level I
Handles objects independently and successfully
153
MACS Level II
Handles most objects but with reduced quality and/or speed
154
MACS Level III
Handles objects with difficulty; need help to prepare/modify environment
155
MACS Level IV
Handles a limited selection of easily managed objects in adopted situations
156
MACS Level V
Does not handle objects and has severely limited ability to perform simple actions
157
Pediatric Balance Scale
```
Purpose: assess balance in children; pediatric version of Berg
Age: Any age
Areas: Balance
Criterion-referenced
Time: 20 min
```
158
PBS Bottom Line
Use with caution if not normalizing for age and gender, as they can't determine delays in balance if not
159
SFA
Purpose: assess function and guide planning for students in school
Age: K-6th grade
Areas: participation, task supports, activity performance, physical tasks, cognitive tasks
Criterion-referenced
Time: up to 2 hours
160
Wee-FIM
Pediatric version of the FIM
Locomotion and transfers
Appropriate for child in inpatient rehab to observe functional abilities
161
GMFM Scoring
Section C: crawling and kneeling
Section D: standing
Section E: walking, running, and jumping
162
When does suck, swallow, and breathing on their own begin?
35 weeks
163
Neural tube is formed at...
4 weeks
164
Divisions of thigh, knee, calf, and foot; forming of umbilical forms...
8-9 weeks
165
Eyes are almost fully formed...
9-12 weeks
166
Inspiratory movements at the head/neck occur; ossification of skeleton, very active...
16 weeks
167
Initial CNS/PNS myelination...
22 weeks
168
Lungs mature to potentially viable state and begin to secrete surfactant... usually administer in addition to, but can breathe on their own...
24 weeks
169
Generalized avoidance reflexes at lips and nose to light touch...
8-9 weeks
170
Palmar grasp starts to emerge; mouth opening (without sucking) can be elicited; global flex/ext movements occur...
9-12 weeks
171
Sucking reflex emerges...
17 weeks
172
Head and extremities can move in isolated fashion; sucking/swallowing both present...
20 weeks
173
Alert state, random movements, overall hypotonia...
28 weeks
174
State differentiation more pronounced, movement dominated by trunk; hand to mouth movement begin; hypotonia decreases some but UE > LE...
32 weeks
175
Vigorous; sustained cry; behavioral states clear; visually fixates and can briefly follow movement; hip knee and ankle flexion contractures are minimally present; well-coordinated suck-swallow-breathe...
36 weeks
176
Physiologic flexion for UEs and LEs; more organized and coordinated movement; brief but sustained behavioral states; hand to mouth well establish; able to regulate systems better...
40 weeks
177
Birth weight classifications
Extremely Low Body Weight < 2.2 lbs
Very Low Body Weight < 3.3 lbs
Low Body Weight: 3.3 - 5.5 lbs
Small for Gestational Age < 10%
178
Maternal malnutrition vs gestational diabetes
Shoulder problems, brachial plexus injuries, hypotonic
179
Cigarette smoking problems
Decreased circulation
180
Alcohol use problems
Impacts Nervous System
181
Illicit Drug Use
Impacts Nervous System
182
HIV problems
Prophylactic medications reduce transmission
183
Multiple Pregnancy
Twins => conditions, smaller, one may take more nutrition
184
Hyperbilirubinemia (jaundice)
Liver function is immature; RBC differences present
Treatment: prevent kernicterus (unconjugated bilirubin at basal ganglia and hippocampus)
Phototherapy or exchange transfusion
185
Gastroesophageal Reflux
Immature sphincters
Correlated to apnea events in premature and term infants
Treatment: smaller more frequent feedings; thick feedings; elevated head/upright; left sidelying, medication
186
Necrotizing Enterocolitis
First 6 weeks of life and <2000 g
Factors: intestinal ischemia, infectious gents, poor formula tolerance
s/s: vomiting, abdominal distention, bloody stools, retention of stool, lethargy, decreased urine, respiratory status change
MEDICAL EMERGENCY
Treatment: withhold oral feeding, antibiotics, remove intestine
187
Patent Ductus Arteriosus, Atrial Septal Defective, Ventricular Septal Defect
May close with or without medication, surgery perhaps
188
PDA
May give medication and catheter with rubber band, but may need surgery
Usually close fairly easily
189
Respiratory Distress Syndrome (hyaline membrane disease)
Most common cause of distress (lungs last to mature)
Pulmonary immaturity and lack of surfactant
Steroid pharmacologic management is common
Ventilator or ECMO may be needed
Surfactant may be administered if <30 weeks
190
Patent Ductus Arteriosus Physiology
Ductus Arteriosus connect the pulmonary artery to the aorta
Usually closes soon after birth
High incidence in premature infants
Mixing of deoxygenated and oxygenated blood, so inadequate amounts of oxygenated blood to all extremities (feeding and breathing are intertwined in young infants)
191
Ventricularseptal Defect
Similar to PDA in mixing of oxygenated and deoxygenated blood, but on a larger scale
192
Bronchopulmonary Dysplasia
> 28 days chronological age and still need O2, as well as abnormal physical exam
Chronic diuretic medications may be needed
Monitor closely for infections
193
Chronic Lung Disease
> 36 weeks and still need O2, as well as abnormal physical and radiographic exams
194
NICU Musculoskeletal Conditions
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Club foot
General Asymmetry
Arthrogryposis
Plagiocephaly: flat spot
Congenital torticollis: birthing process
Congenital hip dysplasia
Tibial Torsion
Brachial Plexus Injury
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195
Myelomeningocele
High levels of alpha feto- protein (screened in pregnancy with prenatal care)
Surgery to close open back area often done 1-2 days after being born (C-section)
196
Periventricular Leukomalacia
Associated with IVH
Symmetric, ischemic lesion of the brain (dying tissue)
With cysts: lots of problems, brain tissue not really there
Without cysts: less neurological issues
Need to try and minimize sequelae and monitor closely for seizures
197
Retinopathy of Prematurity
Higher risk when on ventilator (can detach retina)
Ischemic event at retinal vessels
5 stages/zones
Contributions: BPD, VLBW, extreme prematurity, hyperoxemia, shock, hypothermia, vitamin E deficiency, light exposure
198
Hypoxic-Ischemic Encephalopathy
Decreased oxygenation and blood flow: not always death, but deceleration of activity (usually larger term babies with cord wrapped around)
Low APGAR
Therapy = blanket
Seizures and abnormal tone/reflexes/behavioral state
Impairments may present in pulmonary, cardiovascular, hepatic, and renal function
199
Intraventricular Hemorrhage
Common when <32 weeks and/or <1500 g
Blood filling in ventricles and tissue death along ventricles
Risk factor for CP
Most occur within first 72 hours of birth
Grades I-IV
200
Failure to Thrive
Nonspecific diagnosis when infant is below 5th percentile on growth charts for height, weight, and head circumference
Can be related to feeding intolerance, cardiac or pulmonary compromise, etc.
201
Lead Poisoning
Can cause mental retardation, neural tube defects, general risk for neurologic insults
Old homes tend to have lead paint (mouthing infants can ingest)
202
Maternal Drug Use
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May lead to intrauterine growth restriction/retardation (cigarettes, alcohol, heroin, cocaine)
Growth Deformities
Neonatal Withdrawal syndrome
CNS injuries
Premature labor
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