History And Development Of The Peds Pt Flashcards
Your initial diagnosis can be made ____% of the time just based on history
75
What happens during the first week of pregnancy
Zygote/blastocyst implants into uterine wall
What happens during 2nd week of pregnancy
Trilaminar sic (neural tube, myotome, sclerotome, dermotome) is formed
- amniotic cavity is formed
What Happens during 3rd week of pregnancy
First week of organogenesis closure of the neural tube occurs
What happens during the 4th week of pregnancy
Limb bunds become recognizable
- dermatome becomes skin, myotome becomes muscle, sclerotome becomes bone
What happens during 5th week of pregnancy
Hand plate forms
What happens during 7th week of pregnancy
Notches in rays occurs from cell death
Failure - syndactylism
Limb rotation: upper lateral and lower medial
What happens during 8th week of pregnancy
Embryo assumes human appearance
Basic organ systems complete
What happens during the 9th - 12th weeks of pregnancy
First bone develops
Skelton develops cranial to causal
Upper limbs become proportionate but lower limbs do not
What happens during the 13the to 20th week of pregnancy
Rapid growth
Lower limbs catch up
Bones begin ossifying
What happens during the 20th to 40th week of pregnancy
Growth continues and body become more proportionate and infant-like
What is the first bone to develop
The clavicle
What is the embryonic period of the pregnancy
Up to week 10
- systems and organs being developed
- minor insults can be catastrophic
What is the fetal period
- growth and maturation
- less likely to be damages by environmental factors
- size is a factor due to compression forces
What does the teratogen, phenobarbitine and phenytoin cause
- TEV
- Polydactyly
- Met adductus/varus
- hypoplasia of distal phalanges
- mental disorders
What does the teratogen sodium valproate and carbamazepine cause
Neutral tube defects
What does the teratogen alcohol cause
- spontaneous abortion to intra uterine growth retardation to full fetal alcohol syndrome
What does the teratogen cocaine cause
Vasoconstriction,
Intrauterine growth retardation
CNS defects
What does the teratogen Cannabis cause
- intrauterine growth retardation
= Congentital anomalies like TEV, syndactyly, neurological behavior tics, startle reflex and tremors
What does the teratogen vitamin A cause
- increased intake increases risk of malformation
- avoid synthetic retinoids
What does the teratogen tobacco use cause
- retarded fetal growth
- premature birth in heavy smokers 2x as frequent
- nicotine decreases uterine blood flow lowering oxygen supply, impairs cell growth and has adverse effects on mental development
What are some infectious viruses during pregnancy/birth
- cytomegalovirus
- Rubella
- Toxoplasmosis
- Herpes simplex II
- HIV
What are some other deforming forces during pregnancy
- Rapid bone growth
- abnormal growth/excessive load
- oligohydramnios —> Potter syndrome
- position of feet and legs
- malformations
- multiple pregnancies
- prima gravies
What are some neonatal injuries
- dislocation of hip
- palsy of arms and legs
- edema of skull
- hematoma
- intraventricular hemorrhage
- subarachnoid hemorrhage
- compressional head injury with serious implications
- if brain is damaged the legs are held in marked extension
- asyphxia
What are the 4 ways a newborn is thought to start breathing
- the temperature change stimulates peripheral thermoreceptors which signal the hypothalamus
- the passage through the canal
- cord clamping - increases BP, decreases PO2, increases PCO2, hence the chemoreceptor respond and restore homeostasis
- Cathether Insertion - noxious stimulation `
What are the points on the APGAR scoring system
Color
Heart rate
Respiration
Muscle
Reflex irritability
What are the points for color on APGAR scoring system
Completely pink - 2
Pink with blue extremities - 1
Blue or white - 0
What are the points for Heart rate on APGAR scoring system
> 100 bpm - 2 points
< 100 bpm - 1
Absent - 0 points
What are the points for respiration on the APGAR scoring system
Crying lustily - 2
Shallow and irregular - 1
Absent - 0
What are the points for muscle on APGAR scoring system
active movement - 2
Some flexion of extremities - 1
Flaccid - 0
What are the points for reflex inability on APGAR scoring system
Cough - 2
Grimace - 1
Nil - 0
What is a 0-3 points on APGAR scoring system
Vigorous resuscitation
What is a 4-6 points on APGAR scoring system
Some assistance needed
What is 7-10 points on APGAR scoring system
No intervention
What are some postnatal influences on Peds development
- bones unwind and derotate
- positions of comfort - knee to chest, Reversed Tailors/W position
- Sleeping positions
- keep those feet out
What is the disadvantage of knee to chest when laying prone
Can lead to low tibial position
How does sleeping positions affect development
In toeing can be due to internal tibia torsion, ankle equinus, and an adducted forefoot when a child sleeps prone with hips in extension and feet INTERNALLY rotated
What is the effect of reversed tailors/W position
Prevents the unwinding of the femoral torsion and excessive force directed to the distal tibial epiphysis
What are some developmental landmarks at 3 months
- baby produces vigorous movements
- head bobs when baby held upright
- head help up when baby lies prone
- baby is able to hold toy
- baby smiles, follows and object
What are some developmental landmarks at 6 months
- baby is able to lift head up when lying supine
- baby can roll from supine to prone
- baby is able to support weight when in a standing position
- baby can transfer a toy from hand to hand
Developmental landmark at 9-10 months
Baby can pull self into an upright position
Developmental landmark at 12 months
- todder can stand unassisted
- toddler can walk when led
Developmental landmark at 15months
Toddler can walk with a broad base of gait
Developmental landmark at 18 months
- toddler can run with only occasional falls
Developmental landmark at 24 months
- toddler can run without falling, can walk up and down stairs, can rise from a squatting position
- toddler can walks on heels to test ankle dorsiflexers, can walk on toes to test Gastroc
- balance may be assessed with toddler’s feet together/cerebellar function may be assessed with toddlers eyes open
- join position asses with toddler;s eyes closed (Romberg)
Developmental landmark at 3 years
Balance on one foot
Developmental landmark at 4 years
Run and jump
Developmental landmark at 5 years old
- skin
- balance momentarily on one foot with eyes closed
