The document describes the Ballard scoring system used to assess gestational age in newborns. It involves examining neuromuscular and physical maturity through tests like posture, arm recoil, and skin appearance. Scores are assigned for each test and combined to give an overall score corresponding to a gestational age range. The updated Ballard method is more accurate for extremely preterm infants and includes an eye assessment. Assigning a Ballard score helps evaluate gestational age when maternal dates are uncertain or prenatal ultrasounds vary.
This document provides guidance on examining a newborn. It outlines assessing the newborn's vital signs such as temperature, heart rate, respiratory rate, and blood pressure. It also includes measuring the newborn's weight, length, and head circumference to plot on a growth chart. The physical examination section details examining the newborn's general appearance, skin, head, face, chest, abdomen, genitalia, limbs, back, and reflexes. The goal is to check for any abnormalities, jaundice, or signs of trauma or illness.
This document provides guidance on performing a newborn examination. It begins by classifying newborns by gestational age and birth weight. It then describes how to assess vital signs, growth measurements, and the different body systems. Key parts of the examination are classified including the skin, head, eyes, chest, heart, abdomen, genitals and nervous system. Important reflexes are outlined to assess neurological development. The document emphasizes the importance of estimating gestational age and recognizing normal and abnormal findings during the newborn examination.
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
The document provides guidance on conducting a thorough health assessment of newborns, including initial assessment using APGAR scoring, transitional assessment of vital signs, gestational age assessment, behavioral assessment using the NBAS scale, physical examination of each body system, and special screening tests for conditions like hearing, hypothyroidism, and eye diseases. The assessment aims to identify any abnormalities, evaluate maturity based on reflexes and muscle tone, and ensure newborns have properly adjusted to extrauterine life.
OBSTETRIC AND GYNAECILOGICAL PHYSICAL EXAMINATION.pptxmucunguziamos495
This document provides guidance on performing a physical examination. It begins by outlining examination of general appearance and vital signs. It then provides detailed instructions on examination of specific body systems including hands, fingers, pulse, face, eyes, mouth, neck, lymph nodes, breasts, abdomen, and obstetric assessment. The physical examination is thorough, with emphasis on inspection, palpation, and assessing relevant physical signs.
Newborn screening involves a head-to-toe examination of a newborn to check for any abnormalities and includes biochemical screening tests and special screenings like screening for retinopathy of prematurity, hearing, and echocardiograms. The examination involves measurements, vital signs checks, examination of skin, head, face, chest, heart, abdomen, genitals, extremities, spine, and hips as well as assessment of muscle tone, reflexes, and any other abnormalities. Biochemical screening checks for conditions like G6PD deficiency and congenital hypothyroidism to identify issues early to prevent intellectual disabilities or death. Special screenings include screening preterm infants for retinopathy of prematurity, hearing screening for those
The physical examination of a newborn baby aims to:
1. Identify any abnormalities or injuries at birth.
2. Ensure normal development by checking things like weight, body proportions, and reflexes.
3. Look for signs of conditions like Down syndrome by examining the face, eyes, and other features.
The assessment involves a full-body examination checking multiple areas like the head, chest, abdomen, genitals, back, and extremities to evaluate the baby's health and rule out any issues.
This document provides information on conducting a health examination, including definitions, indications, techniques, equipment, positioning, preparing the patient and environment, and assessing different body systems. A health examination involves systematically assessing the general physical and mental condition of the body through the senses of inspection, palpation, percussion, and auscultation. It is important to prepare the patient and environment, use the proper equipment and techniques, and document examination findings.
This document provides guidance on examining a newborn. It outlines assessing the newborn's vital signs such as temperature, heart rate, respiratory rate, and blood pressure. It also includes measuring the newborn's weight, length, and head circumference to plot on a growth chart. The physical examination section details examining the newborn's general appearance, skin, head, face, chest, abdomen, genitalia, limbs, back, and reflexes. The goal is to check for any abnormalities, jaundice, or signs of trauma or illness.
This document provides guidance on performing a newborn examination. It begins by classifying newborns by gestational age and birth weight. It then describes how to assess vital signs, growth measurements, and the different body systems. Key parts of the examination are classified including the skin, head, eyes, chest, heart, abdomen, genitals and nervous system. Important reflexes are outlined to assess neurological development. The document emphasizes the importance of estimating gestational age and recognizing normal and abnormal findings during the newborn examination.
Health Assessment of the Newborn
The newborn requires thorough skilled observation to ensure a satisfactory adjustment to extra uterine life.
Health assessment of newborn after delivery can be divided into:
1. Initial Assessment
2. Transitional Assessment
3. Assessment of gestational age
4. Behavioural asessment
5. Systemic physical examination
Initial Assessment:
Initial assessment is done by using the APGAR scoring system.
APGAR score: It is method use to assess the newborn’s immediate adjustment to extra uterine life.
• The score based on five signs
1. Appearance (colour)
2. Pulse (Heart rate)
3. Grimace (Reflex irritability )
4. Activity (Muscle tone)
5. Respiratory rate
• Each item is given a score 0, 1, or 2
• 0-3 severe distress
• 4-6 moderate difficulty
• 7-10 no difficulty adjusting to life
• Evaluations of all five categories are made on 1-5 min after birth.
APGAR score:
Sign 0 1 2
Appearance (colour) Blue or pale Body pink, Extrimities Blue Completely Pink
Pulse (Heart rate) Absent Slow (<100 /> 100/m
Grimace (Reflex irritability ) No response Grimace Cough Or Sneeze
Activity(Muscle tone Limp Some flexion Active movement
Respiratory rate Absent Slow, Irregular Good, Crying
Other initial assessment are-
• Stabilization
• Measuring weight.
Transitional Assessment during the period of reactivity
First period of reactivity (6- 8 hours after birth):
During the first 30 minutes the newborn is very alert, cries vigorously, may suck a first greedily, and appears very interested in the environment. Physiologically the respiratory rate can be as high as 80 breaths/ min, crackles may be heard, heart rate may reach 180 beats/min, bowel sound are active, mucus secretions are increased and temperature may decrease slightly.
Second period of reactivity:
Began when the newborn awake from the deep sleep, it lasts about 2-5 hours. The newborn is alert and responsive, heart and respiratory rate are increased, gastric and respiratory secretions are increased, and passage of meconium commonly occurs.
Following this stage is a period of stabilization of physiologic systems & vacillating patern of sleep & activity.
The document provides guidance on conducting a thorough health assessment of newborns, including initial assessment using APGAR scoring, transitional assessment of vital signs, gestational age assessment, behavioral assessment using the NBAS scale, physical examination of each body system, and special screening tests for conditions like hearing, hypothyroidism, and eye diseases. The assessment aims to identify any abnormalities, evaluate maturity based on reflexes and muscle tone, and ensure newborns have properly adjusted to extrauterine life.
OBSTETRIC AND GYNAECILOGICAL PHYSICAL EXAMINATION.pptxmucunguziamos495
This document provides guidance on performing a physical examination. It begins by outlining examination of general appearance and vital signs. It then provides detailed instructions on examination of specific body systems including hands, fingers, pulse, face, eyes, mouth, neck, lymph nodes, breasts, abdomen, and obstetric assessment. The physical examination is thorough, with emphasis on inspection, palpation, and assessing relevant physical signs.
Newborn screening involves a head-to-toe examination of a newborn to check for any abnormalities and includes biochemical screening tests and special screenings like screening for retinopathy of prematurity, hearing, and echocardiograms. The examination involves measurements, vital signs checks, examination of skin, head, face, chest, heart, abdomen, genitals, extremities, spine, and hips as well as assessment of muscle tone, reflexes, and any other abnormalities. Biochemical screening checks for conditions like G6PD deficiency and congenital hypothyroidism to identify issues early to prevent intellectual disabilities or death. Special screenings include screening preterm infants for retinopathy of prematurity, hearing screening for those
The physical examination of a newborn baby aims to:
1. Identify any abnormalities or injuries at birth.
2. Ensure normal development by checking things like weight, body proportions, and reflexes.
3. Look for signs of conditions like Down syndrome by examining the face, eyes, and other features.
The assessment involves a full-body examination checking multiple areas like the head, chest, abdomen, genitals, back, and extremities to evaluate the baby's health and rule out any issues.
This document provides information on conducting a health examination, including definitions, indications, techniques, equipment, positioning, preparing the patient and environment, and assessing different body systems. A health examination involves systematically assessing the general physical and mental condition of the body through the senses of inspection, palpation, percussion, and auscultation. It is important to prepare the patient and environment, use the proper equipment and techniques, and document examination findings.
This document outlines the purposes and procedures for a newborn examination. The goals are to identify any abnormalities, complications from delivery, or diseases in the newborn. The examination involves assessing vital signs, appearance, measurements, and examining each body system from head to toe. The APGAR score is also determined to evaluate the newborn's condition at 1 and 5 minutes after birth. A thorough physical exam is important for the health and survival of the newborn.
The document provides guidance on performing an abdominal assessment. It outlines key considerations for the assessment including ensuring the patient's bladder is empty and they are comfortably positioned. The abdominal region is divided into four quadrants that are examined. The assessment involves inspection, auscultation, percussion and palpation. During auscultation, normal bowel sounds between 5-35 per minute are listened for, along with any abnormal sounds that could indicate issues. The full sequence and components of the physical exam are described.
Physical examination abdomen, musculoskeletal and neurological systemArifa T N
This document provides guidance on performing a physical examination of the abdomen, musculoskeletal system, neurologic system, genital/inguinal areas, and rectum/anus. It describes inspection, palpation, percussion, and auscultation techniques for each body system and lists the specific assessments to perform, including examining the liver and bowel sounds for the abdomen, testing various reflexes and cranial nerves for neurologic function, and inspecting the genitalia and inguinal lymph nodes. Equipment needs and positions for rectal exams are also outlined.
Dr. Hossam Ala'a provides a detailed guide for taking a history from a patient presenting with ischemia. The history includes gathering information on the patient's personal history, current complaint, history of present illness, past medical history, family history, and review of symptoms in other body systems. The physical examination involves inspecting and palpating the affected limb to evaluate changes in skin, muscles, and temperature that may indicate ischemia.
The document provides guidance on performing a clinical examination of dogs. It outlines examining the dog's physical appearance, vital signs, and different body systems in a systematic manner from head to tail. Key steps include assessing the dog's demeanor, physical characteristics, medical history, and performing a hands-on examination of each region including eyes, ears, mouth, limbs, abdomen, heart, lungs, and rectum. Attention to detail, consistency in approach, and comparing both sides of the body are emphasized for a thorough physical exam.
This document provides an overview of the clinical examination of the spine. It discusses the anatomy of the spine and common spinal conditions. The examination involves obtaining a history, inspecting the spine, palpating for tenderness, and assessing range of motion. Special tests like the straight leg raise test help localize pain and diagnose conditions like herniated discs. A neurological exam evaluates muscle strength, sensation, and reflexes to identify abnormalities affecting the spinal cord or nerves. A thorough spinal exam provides important clues for diagnosing underlying spinal problems.
Assessing the Thorax and Lungs presentationsrslytrd
The document provides guidance on assessing the thorax, lungs, and peripheral vascular system. It describes preparing the client, inspecting various areas, palpating for sensations, and expected normal findings. Specific assessments include inspecting the chest wall, observing breathing patterns, palpating the lungs, assessing peripheral pulses, inspecting skin and veins in the extremities, and assessing arterial flow. When assessing the breasts, the client is positioned upright and instructed to expose one breast at a time for inspection and palpation while maintaining privacy. Teaching breast self-examination is also described.
This document provides guidance on performing a newborn examination. It discusses examining the baby's history, vital signs, appearance, major body systems and reflexes. The examination is conducted in a warm, well-lit room and includes assessing temperature, heart rate, respiratory rate, blood pressure, color, muscle tone, reflexes, measurements and a full physical exam from head to toe. The exam evaluates the skin, fontanelles, eyes, ears, heart, lungs, abdomen, genitals, limbs and neurological function through assessing tone and primitive reflexes. The goal is to identify any abnormalities and ensure healthy development.
This document provides guidelines for assessing the health of a newborn infant. It describes evaluating the infant's history including prenatal and delivery factors. Physical appearance is assessed including skin, tone, head size and overall appearance. Vital signs like temperature, heart rate, respiratory rate and status are examined. Laboratory tests including arterial and capillary blood samples are outlined. Gestational age assessment tools like the Dubowitz Scale and Ballard Scale are presented. Proper technique for obtaining capillary blood samples is also covered.
This document provides an overview of the clinical examination of the spine. It describes examining the patient's history, general examination including inspection of posture and deformities, and localized palpation of the cervical, thoracic, lumbar, and sacral spine. Specific tests are outlined to assess the range of motion and integrity of the spine as well as nerve root tension including the straight leg raise test. A neurological examination of motor function, sensation, and reflexes is also recommended to evaluate for any neurological deficits.
1. The document discusses growth and development in premature and small for gestational age infants. It provides guidelines for assessing growth based on intrauterine growth curves and comparing weights, lengths, and head circumferences to corrected ages.
2. For weights, lengths, and head circumferences, there is typically a period of catch-up growth where growth velocities exceed those of full-term infants. Maximum catch-up growth occurs from 36-44 postmenstrual weeks.
3. Guidelines are provided for how long to correct for gestational age when assessing weights, lengths, and head circumference, as well as typical growth velocities at different postnatal ages.
1. The Ballard Maturation Assessment provides a standardized method for assessing gestational age in newborns from 26-44 weeks gestation based on neuromuscular and physical signs of maturity.
2. Neuromuscular signs like posture, arm recoil, and heel-to-ear test assess the infant's increasing passive flexor tone as maturity progresses. Physical signs examined include skin, lanugo, breast development, and genital maturity.
3. Neurological signs are more reliable indicators of gestational age than physical signs alone, as physical development can be impacted by nutritional status while neurological development is genetically determined.
The document provides guidance on assessing the abdomen, anus, and rectum. It outlines the objectives of the assessment, including discussing pertinent health history questions, describing specific examination techniques, documenting findings, and listing age-related changes. It then provides detailed instructions on inspecting, auscultating, percussing, and palpating the abdomen, as well as examining the rectum. It describes how to assess for common abnormalities and conditions affecting different areas of the gastrointestinal system.
This document defines cephalopelvic disproportion and describes factors that can influence pelvic size. It discusses various types of contracted pelves, including developmental, metabolic, and traumatic causes. Methods for diagnosing a contracted pelvis are provided, including history, examination, and pelvimetry techniques. Degrees of disproportion and contracted pelvis are defined based on pelvic measurements.
This document provides guidance on performing a clinical examination of the abdomen, including inspection, auscultation, percussion, and palpation techniques. It describes how to evaluate the abdomen by listening for bowel sounds and vascular bruits, percussing to determine organ sizes and detect dullness or fluid, and palpating the liver, spleen, kidneys, and aorta. The document emphasizes performing auscultation before percussion or palpation, and outlines specific examination techniques and signs to evaluate for common abdominal conditions.
- A newborn examination is performed within 24 hours of birth to assess transition to extrauterine life and detect any malformations or diseases.
- The examination assesses measurements, vital signs, general appearance, skin, and a head-to-toe assessment of various body systems and reflexes.
- Key steps include preparing the environment, introducing oneself, ensuring privacy and comfort, proceeding systematically, and documenting findings to identify any issues requiring treatment.
This document presents the case of a 51-year-old male presenting with body malaise and flank pain. His history includes hypertension, smoking, and a poor diet. On examination, he was found to have elevated blood pressure and costovertebral angle tenderness. Differential diagnoses considered included cholecystitis, pyelonephritis, nephrolithiasis, and diverticulitis. Diagnostic workup included a urinalysis, blood tests, and CT scan. The primary diagnosis was determined to be acute renal colic caused by nephrolithiasis (calcium kidney stones).
This document outlines the purposes and procedures for a newborn examination. The goals are to identify any abnormalities, complications from delivery, or diseases in the newborn. The examination involves assessing vital signs, appearance, measurements, and examining each body system from head to toe. The APGAR score is also determined to evaluate the newborn's condition at 1 and 5 minutes after birth. A thorough physical exam is important for the health and survival of the newborn.
The document provides guidance on performing an abdominal assessment. It outlines key considerations for the assessment including ensuring the patient's bladder is empty and they are comfortably positioned. The abdominal region is divided into four quadrants that are examined. The assessment involves inspection, auscultation, percussion and palpation. During auscultation, normal bowel sounds between 5-35 per minute are listened for, along with any abnormal sounds that could indicate issues. The full sequence and components of the physical exam are described.
Physical examination abdomen, musculoskeletal and neurological systemArifa T N
This document provides guidance on performing a physical examination of the abdomen, musculoskeletal system, neurologic system, genital/inguinal areas, and rectum/anus. It describes inspection, palpation, percussion, and auscultation techniques for each body system and lists the specific assessments to perform, including examining the liver and bowel sounds for the abdomen, testing various reflexes and cranial nerves for neurologic function, and inspecting the genitalia and inguinal lymph nodes. Equipment needs and positions for rectal exams are also outlined.
Dr. Hossam Ala'a provides a detailed guide for taking a history from a patient presenting with ischemia. The history includes gathering information on the patient's personal history, current complaint, history of present illness, past medical history, family history, and review of symptoms in other body systems. The physical examination involves inspecting and palpating the affected limb to evaluate changes in skin, muscles, and temperature that may indicate ischemia.
The document provides guidance on performing a clinical examination of dogs. It outlines examining the dog's physical appearance, vital signs, and different body systems in a systematic manner from head to tail. Key steps include assessing the dog's demeanor, physical characteristics, medical history, and performing a hands-on examination of each region including eyes, ears, mouth, limbs, abdomen, heart, lungs, and rectum. Attention to detail, consistency in approach, and comparing both sides of the body are emphasized for a thorough physical exam.
This document provides an overview of the clinical examination of the spine. It discusses the anatomy of the spine and common spinal conditions. The examination involves obtaining a history, inspecting the spine, palpating for tenderness, and assessing range of motion. Special tests like the straight leg raise test help localize pain and diagnose conditions like herniated discs. A neurological exam evaluates muscle strength, sensation, and reflexes to identify abnormalities affecting the spinal cord or nerves. A thorough spinal exam provides important clues for diagnosing underlying spinal problems.
Assessing the Thorax and Lungs presentationsrslytrd
The document provides guidance on assessing the thorax, lungs, and peripheral vascular system. It describes preparing the client, inspecting various areas, palpating for sensations, and expected normal findings. Specific assessments include inspecting the chest wall, observing breathing patterns, palpating the lungs, assessing peripheral pulses, inspecting skin and veins in the extremities, and assessing arterial flow. When assessing the breasts, the client is positioned upright and instructed to expose one breast at a time for inspection and palpation while maintaining privacy. Teaching breast self-examination is also described.
This document provides guidance on performing a newborn examination. It discusses examining the baby's history, vital signs, appearance, major body systems and reflexes. The examination is conducted in a warm, well-lit room and includes assessing temperature, heart rate, respiratory rate, blood pressure, color, muscle tone, reflexes, measurements and a full physical exam from head to toe. The exam evaluates the skin, fontanelles, eyes, ears, heart, lungs, abdomen, genitals, limbs and neurological function through assessing tone and primitive reflexes. The goal is to identify any abnormalities and ensure healthy development.
This document provides guidelines for assessing the health of a newborn infant. It describes evaluating the infant's history including prenatal and delivery factors. Physical appearance is assessed including skin, tone, head size and overall appearance. Vital signs like temperature, heart rate, respiratory rate and status are examined. Laboratory tests including arterial and capillary blood samples are outlined. Gestational age assessment tools like the Dubowitz Scale and Ballard Scale are presented. Proper technique for obtaining capillary blood samples is also covered.
This document provides an overview of the clinical examination of the spine. It describes examining the patient's history, general examination including inspection of posture and deformities, and localized palpation of the cervical, thoracic, lumbar, and sacral spine. Specific tests are outlined to assess the range of motion and integrity of the spine as well as nerve root tension including the straight leg raise test. A neurological examination of motor function, sensation, and reflexes is also recommended to evaluate for any neurological deficits.
1. The document discusses growth and development in premature and small for gestational age infants. It provides guidelines for assessing growth based on intrauterine growth curves and comparing weights, lengths, and head circumferences to corrected ages.
2. For weights, lengths, and head circumferences, there is typically a period of catch-up growth where growth velocities exceed those of full-term infants. Maximum catch-up growth occurs from 36-44 postmenstrual weeks.
3. Guidelines are provided for how long to correct for gestational age when assessing weights, lengths, and head circumference, as well as typical growth velocities at different postnatal ages.
1. The Ballard Maturation Assessment provides a standardized method for assessing gestational age in newborns from 26-44 weeks gestation based on neuromuscular and physical signs of maturity.
2. Neuromuscular signs like posture, arm recoil, and heel-to-ear test assess the infant's increasing passive flexor tone as maturity progresses. Physical signs examined include skin, lanugo, breast development, and genital maturity.
3. Neurological signs are more reliable indicators of gestational age than physical signs alone, as physical development can be impacted by nutritional status while neurological development is genetically determined.
The document provides guidance on assessing the abdomen, anus, and rectum. It outlines the objectives of the assessment, including discussing pertinent health history questions, describing specific examination techniques, documenting findings, and listing age-related changes. It then provides detailed instructions on inspecting, auscultating, percussing, and palpating the abdomen, as well as examining the rectum. It describes how to assess for common abnormalities and conditions affecting different areas of the gastrointestinal system.
This document defines cephalopelvic disproportion and describes factors that can influence pelvic size. It discusses various types of contracted pelves, including developmental, metabolic, and traumatic causes. Methods for diagnosing a contracted pelvis are provided, including history, examination, and pelvimetry techniques. Degrees of disproportion and contracted pelvis are defined based on pelvic measurements.
This document provides guidance on performing a clinical examination of the abdomen, including inspection, auscultation, percussion, and palpation techniques. It describes how to evaluate the abdomen by listening for bowel sounds and vascular bruits, percussing to determine organ sizes and detect dullness or fluid, and palpating the liver, spleen, kidneys, and aorta. The document emphasizes performing auscultation before percussion or palpation, and outlines specific examination techniques and signs to evaluate for common abdominal conditions.
- A newborn examination is performed within 24 hours of birth to assess transition to extrauterine life and detect any malformations or diseases.
- The examination assesses measurements, vital signs, general appearance, skin, and a head-to-toe assessment of various body systems and reflexes.
- Key steps include preparing the environment, introducing oneself, ensuring privacy and comfort, proceeding systematically, and documenting findings to identify any issues requiring treatment.
This document presents the case of a 51-year-old male presenting with body malaise and flank pain. His history includes hypertension, smoking, and a poor diet. On examination, he was found to have elevated blood pressure and costovertebral angle tenderness. Differential diagnoses considered included cholecystitis, pyelonephritis, nephrolithiasis, and diverticulitis. Diagnostic workup included a urinalysis, blood tests, and CT scan. The primary diagnosis was determined to be acute renal colic caused by nephrolithiasis (calcium kidney stones).
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Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
8. Head
• Round and symmetry
• Abnormal swelling or bruises of the scalp
• Signs of trauma or laceration
• caput succedaneum
• cephalohaematoma
• subglial haematoma
• Fontanelle (bulging or sunken) –Anterior and Posterior fontanelle
• Soft, non bulging
• Suture:-
• 2 sutures palpable which are coronal and sagittal sutures.
• Separated or overidding
• Abnormal: macrocephaly/ microcephaly
9. Face
• Symmetry
• Dysmorphic features
• Ears:
• Both ears are present
• No low set ears
• External auditory meatus is patent
• periauricular tag/ pit
• Eyes:
• Sclera is white and not jaundice.
• Conjunctiva is pink and not anaemic.
• Red eye reflect- cataract,
retinoblastoma
• Nose: patency of each nostril to exclude
choanal atresia
• Mouth:
• Central cyanosis
• Cleft palate or cleft lips seen or not
• Natal teeth
• Rooting reflex present
• Suckling reflex present.
• Neck:
• Short neck
• Abnormal swelling such as cystic
hygroma.
• Clavicular fracture.
10. Upper Limb
• All the 5 digits are present
• Abnormalities:
• syndactyly (2 or more digits fused together)
• polydactyly (extra digit)
• bradydactyly (shortening of the digit) seen
• single palmar crease
• Pulse rate
• Check radio-radial delay and radio-femoral delay
• Palmar grasp reflex
11. Chest
• Respiratory rate
• Chest movement - symmetrical bilaterally
• Chest recession and audible grunting
• Chest deformity
- pectus excavatum or pectus carinatum
• Inspection of breast tissue
• Palpate for:
• Apex beat
• parasternal heave or thrill.
• Auscultate for breath sound and heart sound
12. Abdomen
• Move with respiration – abdomen breather
• Shape of abdomen, which normally cylindrical shape
• Scaphoid shape suggest diaphragmatic hernia
• Palpation:
• Soft, non- tender and no guarding
• No mass palpable
• Palpate for liver and spleen
• If distended – obstruction/ mass
• Umbilical cord
• Pink/ infected
• Any discharge or foul smelling
• 2 arteries and 1 vein (couldn’t be seen if cord is dry)
• Auscultate for bowel sound and renal bruit.
• Abnormal:
1. omphalocele ( defect of the abdominal belly wall )
2. gastroschisis(birth defect in which the baby's intestines extend outside of the abdomen through a hole next to the belly
button)
13.
14. Genitalia
• Male –
• Scrotum
• Urethral meatus is present at the tip of the penis.
• Testes
• No hypo/epispadias, hydrocoele/ undesended testis or hernia
• Female –
• Labia edematoes
• Clitoris enlarged
• May have discharge- pseudomensturation
• Anus patency
• Palpate for femoral pulse
15. Lower Limb
• Shortening of the limb
• Presence of 5 toes are present in each leg
• Any wide sandal gap
• Creases on soles of feet
• Premature < crease
• Check for DDH
• Barlow and Ortolani test
• Look for CTEV- inward turning of the foot
• Plantar grasp reflex
16.
17. • Back
• Stable spine
• Any hyperpigmented skin - mongolian spot
• Spina bifida - sacral dimple and no tuft of hair.
• Abnormalities - scoliosis and kyphosis.
• Moro reflex
Symerical abduction and extension of arm, then adduction of arm to embracing position and
returns to relaxed state
20. • Evaluation of gestational age
• Maternal menstrual history
• Prenatal USG
• Post natal assessment
• Methods of post natal assessment
• Dubowitz method
- difficult to administer due to its complexity (assessment of 34 parameters)
- over estimate GA in very preterm infants
• Ballard method
21.
22.
23. • Ballard method
Original New
Scores range from 5 to 50 (26w - 44w) Scores range from -0 to 50 (20w - 44w)
Score starts with 0 Score starts with -1
Inaccurate in extremely preterm More accurate
Not include eye assessment Include eye assessment
24. NEW BALLARD SCORE
• 2 major components
1. Neuromuscular maturity
• Posture
• Square window test
• Arm recoil
• Popliteal angle
• Scarf sign
• Heal to ear test
2. Physical maturity
• Skin texture, colour and opacity
• Lanugo
• Plantar surface
• Breast
• Eye/ear
• Genitals
25.
26. 1) POSTURE
• Observe in supine position at rest
• Score is assigned based on degree
2) SCARF SIGN
Grasp the hands and pull the arm
across the chest and around neck
The point on the chest which the
elbow moves
• full scarf (-1)
• contralateral axillary line(0)
• contralateral nipple line (1)
• xyphoid process (2)
• ipsilateral nipple line (3)
• ipsilateral axillary line (4)
27. 3) ARM RECOIL
• Flex the neonates arms for 5 sec
• Fully extend arms by pulling on the
hands and release
4) SQUARE WINDOW
• Fully flexed infants hands on the
wrist joint without rotating the
wrist
• Measured angle between forearm
and palm
28. 5) POPLITEAL ANGLE
• Holds the knee adjacent to the
chest and abdomen, extend the
leg with index finger
• Measure angle between lower leg,
thigh and posterior knee
6) HEEL TO EAR
Grasp one foot and draw foot as
near to head as possible
29.
30. 1) EYE/EAR
• Lids open and complete
eyelash develop at term
• <34w pinna stays folded
• Incurving upper pinna at 34w
• At 36w some cartilage present
and will spring back
31. 2) BREAST
• Areola raised by 34w
• A 1-2mm nodule palpable by 36w and
become 10mm by 40w
32. 3) SKIN
Less transparent and thicker with increasing
gestational age
4) LANUGO
Fine downy hair
covering fetus
from 20-28w
33. 6) GENITALIA
Male:
• Testes descend by 28w
• At 37w testes can be palpated high
in scrotum and completely
descended by 40w
Female:
Early gestation, clitoris prominent
and widely separated labia
34. 6) PLANTAR SURFACE
• 28-30w appear and cover anterior
portion of plantar surface
• Extend toward heels as GA increases
35. 20 w = -10
30 w = 15
40 w = 40
Score + 5 = GA + 2
Extremely preterm: <28w
Very preterm: 28-31w 6/7
Moderate preterm: 32-33w 6/7
Late preterm: 34-36w 6/7
Term: 37w
HC measurement:
From the most prominent part of occiput to just above the eyebrows/ frontal
Acceptable 33-38cm
HC >/= CC
Length crown to heel, acceptable 48-52cm
In full term baby:
-symmetric
-head turned to one side
-flexed extremities
-hand toghtly fisted with thumb covered by fingers
#special concerned if:
1.asymmetric
-fracture of clavice or humerus
-Nerve injuries
2. Breech presentation
-knee and legs straightened or tin FROG position
Birth mark
Mongolian spot
Blue –green or gray pigmentation
Lower back, sacrum & buttocks
Disappears by 4 y/o age
Port wine stain
Capillary malformation
Flat red to purple, sharply demarcated with dense area beneath the capillaries
Usually at face
a/w sturge-weber syndrome
Others:
Mottling ( cutis marmorata)
Reticulated pattern of constricted capillaries and venules
Due to vasomotor instability in inmature infant
Bluish mottling- in response to chilling, stress or overstimullation
Café au laif spot
Tan or light brown macules or pathcees
No pathological significant, if < 3cm in length and < 6 in number
If >3 and > 6 cutaneous neurofibromatosis
Abnormal swelling or bruises of the scalp
1.caput succedaneum (edematous swelling of presenting part)
-due to pressure against cevix during crowning
- Swelling subside within days
2. cephalohaematoma (subperiosteal haemorrhage)
due to plonged second stage / instrumental delivery
Resolve spontaneously within 4-6weeks
Limited by suture line
May complicated with:
Anemia, jaundice
Calcified( hard around edge but sof in centre- will resolve
Hypotension
Focus of infection:meningitis/ osteomyelitis
3. subglial haematoma (bleeding below epicranial aponeurosis, above the periosteum)
Diffused head swelling that shift with repositioning and indents on palpation
Swelling not limited by suture line-may extend to the orbits and the subcutaneous muscles of the neck
Since the Subgaleal space is capable of holding large volume of the baby's blood, it may result in haemorrhagic shock.
SAH- Subarachnoid hemorrhage
Prolonged labour, forcep or ventouse delivery
Presure exerted on baby head during labour +/- hematology disorder
Features: apnea, seizure, lethargy
Bulging of fontanelle, HC increase rapidly, lack of symmetric movement
Ix: FBC, coagulation profile, CT brain or USG ranium
Fontanelle –
-Anterior fontanelle is diamond in shape
Posterior fontanelle is triangular in shape
Abnormal: macrocephaly/ microcephaly
macrocephaly – hydrocephalus + dilated scalp veins, bulging anterior fontanelle, separation of suture lines, sun-setting eyes
#craniosynostosis- premature closure of the fontanelles
dysmorphic features
such as low set ears,
hypertelorism -distance between 2 medial canthi is > size of 1 eye
up slanting eyes
flat nasal bridge
Sucking/ rooting reflex:
-touch the lip. Cheeck or corner of the mouth= turn head toward
Palmar grasp reflex
Place finger in the palm of baby- curl or grasp the finger
Male –
Prepuce covers glans of penis- adherent to foreskin = phimosis
Scrotum – enlarged = hernia/ hydrocyele (illumation test)
Urethral meatus – ventral / dorsal = hypo/epispadias
Testes – undesended= cryptorchidism
Female –
Vaginal discharge is not seen/ seen.
Urethral meatus, vaginal opening ,clitoris, labia majora and labia minora are present.
Anus is patent.
Plantar reflex:
Place finger at the base of the toes = toes curls downward
Simple sacral dimple:
-solitary dimple
-<5mm in diameter, < 2.5 cm from the anus
-midline location
No visible drainage
-no associated cutaneous stigmata such as hemangioma, skin tag or tail
no need firther imaging eg. Xray or USG of the back
Maturational assessment of newborn
Ideally within first 24 hours
Neuromuscular signs more reliable than physical
Higher GA more brain growth neuro muscular more mature
Increase passive flexor tone, decrease joint laxity (in centripetal direction) higher score
In caudo cephalad : lower limb mature first then upper limb
1 sign = general
3 signs = upper limbs
2 signs = lower limbs
Popliteal angle = -1 to +5
Posture and arm recoil = 0 to +4
Others = -1 to +4
POSTURE: baby should be in well flexed, if more extended, flaccid – premature infant
SCARF SIGN: decrease distance pull of arm to contralateral side – higher score – more mature
ARM RECOIL: pull arm down, should recoil back
SQUARE WINDOW: wrist flexibility, prem cannot bend, term baby can bend wrist until hit the arm (max passive flexor tone, min passive extensor tone)
POPLITEAL ANGLE: flex hip joint, if can go to face, more premature
HEEL TO EAR: bend knee, try to extend the knee, if can go to ear, more premature
Eyes/ear
Breast bud
Skin
Lanugo
Genital male
Genital female
Plantar surface
Score
-1 to +4 for all
-1 to +5 for skin
Eye ear: thin and fused thick and stiff cartilage
Breast bud: imperceptible to developed with areolar
Skin: thin and friable leathery and wrinkled
Lanugo: in very premature no lanugo
Genitals:
smooth scrotum pendulous testes with rugae
prominent clitoris majora covering clitoris and minora