Paeds Flashcards
What factors might contribute to fertility issues?
Age Smoking BMI Exercise Drugs Folate Alcohol.
Beyond what age is IVF least effective?
Over 40.
What weeks are in the first, second and third trimester of pregnancy?
0-12 weeks
13-28 weeks
29-40 weeks.
After 36 weeks when does the baby move down into the pelvis?
After 36 weeks.s
What are the different types of changes that occur to a women during pregnancy?
Physical Hormonal Haematological Cardiovascular Coagulation.
Why is a woman’s circulation larger during pregnancy?
Incase of blood loss during delivery/
What are the hormonal changes in pregnancy and what do these hormones d?
Increased oestrogen and progesteron. These act on the kidney to increase renin secretion. They increase salt and water retention and plasma volume (plasma volume by 45%)
Lower oesophageal sphincter relaxes (with increased abdominal pressure gives increased GORD)
Hormonal changes increase reduce insulin sensitivity.
What are the haematological changes during pregnancy?
Increased production of rc, wc, platelets
20% increase in red blood cell ass
Increased platelet consumption makes platelets normal to low
Increased wc makes diagnosing infections difficult.
What are the vascular changes during pregnancy?
Relaxation of smooth vascular muscle
- reduced peripheral resistance
- reduced systolic and diastolic blood pressure
- compensatory increase in heart rate by 25%
Vascular compression by the uterus
- vena cava and aorta
- difficulty with venous return when supine
Positioning of vessels of vena cava and aorta behind uterus- pressure of baby can cause significant vascular compression.
What happens to the coagulation system during pregnancy?
Increased fibrinolysis
Clotting factor production increases
Increased system sensitivity with increased DVT risk.
What can you not eat during pregnancy?
Raw/slightly cooked meat and raw fish (danger of infection with toxoplasmosis)
Raw eggs (salmonella)
Non-pasteurised milk and milk cheese (listeria)
Spicy/grilled and fried food (dyspesia)
Marlin/tuna and shark (mercury toxicity)
Internal organs of an animal is not advised during the first three months of pregnancy.
When does development of the embryo start?
4 weeks.
What happens during week 6 of pregnancy?
Start of embryonic development and growth.
When does the embryo stages stop?
10 weeks.
When the the baby known as the foetus (during what weeks)?
10-14 weeks.
What trimester is miscarriage rate highest in?
First trimester.
During what trimester may movement be felt and hair/toenails and eyelids start to form?
During the second trimester.
During what weeks do brain development and body fat increase occur?
20-26 weeks.
What happens during week 27 of pregnancy?
Growth and nervous system maturation.
Describe the linkage of blood vessels between mother and baby.
Interlinking blood vessels so maternal and fetal blood vessels don’t mix- close together so nutrients can diffuse, toxins can diffuse here too- like HIV will be caught at time of birth- Caesarean less risky for these individuals.
Why is screening completed during weeks 18-20?
To confirm pregnancy dates
To determine the number of foetuses and examine the placental structures
To assist in prenatal tests such as amniocentesis
To examine the foetal anatomy for presence of abnormalities
To check the amount of amniotic fluid
TO examine blood flow patterns
To observe foetal behaviour and activity
To examine the placenta
To measure the length of the cervix
To monitor foetal growth.
What is FAST?
Foetal abnormality screening programme.
When does FAST take place and what does it test for?
11-14 weeks Neuchal translucency (ultrasound) Maternal hCG (blood) PAPP-P (blood) Combined results can suggest chromosome abnormality.
What is the screening called during second trimester?
AFP
Abnormality follow up-
CVS and amniocentisis (genetic changes)
Ultrasound (spina bifida).
What testing do they do to the child after birth?
Physical examination
Hearing test
Blood spot (PKU, hypothyroidism, cystic fibrosis, sickle cell disease, MCADD).
What does APGAR stand for?
Activity Pulse Grimace Appearance Respiration Taken at 1 and 5 minutes and there should be a rise in score between the two.
Why is dentistry relevant during pregnancy?
Cost of dental care Drugs in pregnancy Pregnancy gingivitis Periodontal health in pregnancy Position of the mother.
What should a one month old be able to do?
Able to raise head from surface when lying on tummy
Pays attention to someone’s face in their direct line of vision
Moves arms and legs in an energetic manner
Likes to be held and rocked.
What should a two month year old be able to do?
Smiles and coos
Rolls part way to side when lying on back
Grunts and sighs.
What should a three month year old be able to do?
Eyes follow a moving object
Able to hold head erect
Grasps objects when placed in their hand
Babbles.
What should a four month year old be able to do?
Holds a rattle for an extended period of time
Laughs out loud
Sits supported for short periods of time
Recognises bottle and familiar faces.
What should a five month year old be able to do?
Reaches for and holds objects
Stands firmly when held
Stretches our arms to be picked up
Likes to play peek-a-boo.
What should a six month year old be able to do?
Turns over from back to stomach
Turns towards sounds
Sits with a little support (1 hand breaching)
Persistently reaches for objects out of their reach
Listens to own voice
Crows and squeals
Reaches for and grasps objects and brings them to mouth
Holds, sucks, bites cookie or cracker begins chewing.
What should a seven month year old be able to do?
Can transfer object from one hand to the other
Can sit for a few minutes without support
Pats and smiles at image in mirror
Creeps (pulling body with arms and leg kicks)
is shy at first with strangers.
What should an eight month year old be able to do?
Can sit steadily for about 5 minutes
Crawls on hands and knees
Grasps things with thumb and first two fingers
Likes to be near parent.
What should a 9 month year old be able to do?
Says mama or dada Responds to name Can stand for a short time Able to fit two objects together on their own Copies sounds.
What should a ten month year old be able to do?
Able to pull self up at the side of crib or playpen
Can drink from a cup when it is held.
What should an eleven month year old be able to do?
Can walk holding onto furniture
Can find an object placed under another object.
What should a one year old be able to do?
Waves bye bye Can walk with one hand held Says two words besides mama and dada Enjoys some solid foods Finger feeds self Likes to have an audience.
What should a 15 month year old be able to do?
Walks by self, stops creeping Shows desires by pointing and gesturing Scribbles on paper after shown Begins using a spoon Cooperates with dressing.
What should an 18 month year old be able to do?
Can build a tower with three blocks Likes to climb and takes things apart Can say 6 words Tries to put on shoes Drinks from cup held in both hands Likes to help a parent.
What should a two year old be able to do?
Able to run Walks up and down stairs using alternative feet Says about 50 words Sometimes uses 2 word sentences Points to objects in a book.
What should a three year old be able to do?
Can repeat two numbers in a row Knows their own gender Dresses self except for buttoning Can copy a circle Can follow 2 commands of on, under, behind Knows most parts of the body Jumps lifting both feet off ground Can build a tower with nine blocks.
What should a four year old be able to do?
Can repeat a simple 6 word sentence Can wash hands and face without help Can copy a cross Can stand on one foot Can catch a tossed ball.
What can a five year old be able to do?
Can follow 3 commands
Can copy a square
Can skip.
Why are childhood vaccinations provided?
To prevent infectious diseases where the risk of vaccination are lower than the risks of the disease
Reduce or eliminate infectious diseases from the community by reducing the number of susceptible vectors
Risks are POPULATION risks- difficult to apply to an individual.
What is the recent change to the polio vaccine?
Previously oral polio vaccine
Now inactivated polio vaccine.
What is the recent change to the meningitis vaccine?
Haemophilius influenza B
Meninncococcus B.
THE UK STANDARD VACCINATION PROTOCOL IN AVAILABLE TO VIEW ON THESE SLIDES.
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What are the two variations of vaccines that are not always given in the UK?
BCG (can be given shortly after birth if high risk) Hepatitis B (not a normal UK vaccine, normal in some other countries (3 doses from 6 weeks of age, live cancer protection).
Why might someone refuse a childhood vaccination?
Religious or philosophical grounds
Prevent a “painful” assault on the child
Benefits don’t outweigh the risks.
What do we do when someone refuses a childhood vaccination?
Does refusal put the child at extreme personal risk (neglect)?
Does refusal put others at risk sufficient to warrant intervention on public health grounds.
What can school screening allow us to assess?
School entry provides opportunity
- Personal social and emotional development
- Physical development
- Communication skills (includes hearing and vision assessment).
