Eval

components of eval

• subjective

• medical history

• social history

• objective measures

• assessment

What is a key difference between gen pop and peds evals

mother and patient history is taken

What are goals based off of

subjective/ parent concerns

Parts of subjective

• why Dr referred them

• caregiver concerns

parts of medical history

• medical history during pregnancy, labor, and delivery

• mother

• patient

most common complications during pregnancy

• high BP

• gestational DM

• pre-eclampsia

• infections

• mental health

high BP affect on pregnancy

at risk for pre-term labor

when does high BP in pregnancy typically occur

during 2nd half of pregnancy and resolves after delivery

describe gestational DM

occurs when a woman who did not have DM prior to pregnancy develops it during pregnancy

how is gestational DM managed

diet and medications

affects of gestational DM on pregnancy

if uncontrolled, increases risk of having a large infant → increased risk for c-section

describe preclampsia

high BP and protein in urine without a known cause

when does preclampsia typically develop

after 20th week

risk factors for preclampsia

• first pregnancy

• existing conditions

• > 35 y/o

• carrying multiples

• obesity

How can infections affect pregnancy

• may or may not pass to child during birth/pregnancy

• preterm labor

• low birth weight

• birth defects

• maternal health complications

how are infections typically treated

many treated with medications

prevalence of depression during pregnancy

15%

prevalence of anxiety in pregnancy

43%

affects of mental health during pregnancy

can lead to significant effects on both fetus and newborn baby

timeline for a full term pregnancy

39-40 weeks

timeline for a early term pregnancy

37-38 weeks

timeline for a late term pregnancy

41-42 weeks

age of viability

24 weeks

when does corrected age start

36 weeks

Why do we use corrected age

knowing when milestones are expected

When does corrected age stop being used

2 y/o

possible concerns during labor and delivery

• labor that does not progress

• umbilical cord issues

• abnormal HR of baby

• water breaking early

testing measures for patients in Utero

• US

• blood tests (genetic carrier screenings)

• amniocentesis

• chronic villus sampling (CVS)

When are USs performed

8-13 weeks, 18-21 weeks, and potentially at the end of term

purpose of US at 8-13 weeks

• establish viability

• due date

• number of fetuses

• assess pelvic anatomy

purpose of US at 18-21 weeks

anatomy scan

purpose of anatomy scans

• measures baby’s weight and length

• gender

• assess organs

• placenta health

what is an anatomy scan of the lips looking for

cleft lip

what is an anatomy scan of the brain looking for

• anencephaly

• ventricle size

• etc

what is an anatomy scan of the spine looking for

neural tube closure/spina bifida

what is an anatomy scan of the heart looking for

• 4 chambers

• HR between 120-160

what is an anatomy scan of the kidneyslooking for

• 2

• normal size

what is an anatomy scan of the limbs looking for

normal development

types of blood testing

• Pregnancy-associated plasma protein screening (PAPP-A)

• Human chorionic gonadotropin (hCG)

• Alpha-fetoprotein screening (AFP)

What is PAPP-A

protein produced by the placenta in early pregnancy

what does abnormal levels of PAPP-A indicate

higher risk of chromosome problems

What is hCG

hormone made by placenta in early pregnancy

what does abnormal levels of hCG indicate

higher risk for chromosome problems

What is AFP screening

mother’s blood test to indicate twins, ONTD, and chromosome problems

what is ONTD

open neural tube defect (spina bifida)

Describe an amniocentesis

small sample of amniotic fluid taken by putting a long, thin needle through abdomen into amniotic sac

When can an amniocentesis be done

16-22 weeks

what does abnormal findings on amniocentesis dx

• chromosomal abnormalities

• neural tube defects

• other genetic dxs

How is it that amniocentesis can diagnose

can directly test the baby’s DNA

When is a CVS performed

10-13 weeks

purpose of CVS

prenatal genetic testing done to confirm or rule out genetic conditions

What diagnosis is not dx with CVS

ONTD

What is a CVS

sample of placental tissue by transcervical or transabdominal extraction

Why is CVS not always suggested

higher rate of miscarriage due to samples taken during early gestation

reasons to perform prenatal tests

• age >35 at time of delivery

• abnormal 1st trimester screening results

• hx of genetic or chromosomal disorders

• abnormal US results

describe Apgar score

assessment of infants immediately after birth to estabilish needs for intervention

When is apgar taken

1 and 5 mins after birth

What is a normal score on apgar

>7

What does apgar assess

appearance (color)

pulse (HR)

grimace (reflexes)

activity (muscle tone)

respiration

scale for apgar

10 points

apgar chart

parts of social history

• lives with…

• siblings

• school/daycare/daily routine

• concerns/barriers in home environment

• behaviors and interactions with peers

objective measures to be taken

• pain

• strength/ROM

• tone

• visual appearance

• reflex integration

• posture

• gross motor skills

pain scales used for peds

FLACC score

Wong Baker faces scale

Faces pain scale- revised

numeric pain rating scale

Categories in a FLACC score

face, legs, activity, cry, consolability

age range for FLACC

2 mo - 3 years

scale for FLACC score

10

What patients is the FLACC useful for

non-verbal or pre-verbal patients

FLACC score chart

age range for Wong Baker faces scale

3 y/o and older

describe faces pain scale - reviseed

self report measure of pain intensity for children with more realistic faces

age range for faces pain scale- revides

4-16 y/o

WB faces pain scale

faces pain scale - revised

age range for numeric pain rating scale

>7 y/o

numeric pain rating scale

ways of taking ROM

• goniometer

• functional movement

When are specific ROM measurements helpful

surgical, traumatic, or paitent’s with ROM goals

types of strength assessments

MMT

observation/functional skill

when can MMT be used

3+ y/o (but not typically doable until 5)

When are MMT taken

yearly measurements

who is appropriate for observation strength measurements

those who cannot follow directions

how is observation used for strength assessments

asymmetries in functional movements, posture, etc

advanced strength measurements

• sit ups

• push ups

• wall sits

• V-ups

• supine flexion and prone extension

how long is prone ext held for

60 sec

how long is supine flex held for

90 sec

how long is wall sit held for

60 sec

define tone

amount of resting tension or resistance to movement in a muscle

purpose of tone

assists in maintaining posture

how is tone affected after birth

usually does not change

What are exceptions to tone changes

CP and premies

when does tone normalize

12-15 mo

when does flexor tone develop

legs: 30-32 weeks

UE: 36 weeks

what disorders cause muscle tone irregs

dysfunction in brain, spinal cord, muscle spindles, or neural circuits

What are the tone classifications

hypotonia and hypertonia

define hypotonia

decreased ability to generate muscle force(diminished resting)

define hypertonia

abnormal increase in resistance to an external force (increased resting)

common causes of hypotonia

pre-term

prenatal drug exposure

neurological disorders

genetic

scale for tone

modified ashworth scale

mod ashworth chart

Grade	Description
0	No increase in muscle tone
1	Slight increase in muscle tone, with a catch and release or minimal resistance at the end of the range of motion when an affected part(s) is moved in flexion or extension
1+	1+: Slight increase in muscle tone, manifested as a catch, followed by minimal resistance through the remainder (less than half) of the range of motion
2	A marked increase in muscle tone throughout most of the range of motion, but affected part(s) are still easily moved
3	Considerable increase in muscle tone, passive movement difficult
4	Affected part(s) rigid in flexion or extension