Clinical Reasoning and Newborn Exam I Flashcards Preview

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Flashcards in Clinical Reasoning and Newborn Exam I Deck (29):
1

critical thinking

tying ones medical knowledge with clinical encounter
-and formulating a diagnosis with therapeutic strategy

2

steps in clinical reasoning

patient story
data acquisition
problem presentation
hypothesis
select a script for illness (acquire more data if need)
diagnosis

3

signalment

who and what it is
-the patient identifying information

4

chief complaint

health issue of patient

5

history

what has happened

6

proper history

should give you diagnosis 80-90% of the time

7

miss more diagnosis

by not looking
-not doing good physical exam

8

ptyalism

excessive salivation

9

conformation bias

tendency to search for or interpret info in a way that confirms ones preconceptions

10

umbilical vein

carry oxygenated blood to the liver or IVC (via ductus venosus)

11

ductus venosus

allow oxygenated blood in umbilical vein to pass to the inferior vena cava

12

semi-oxygenated blood in right atrium

1- can go to right ventricle
> to pulmonary artery
-lungs have air sacs full of fluid
-hypoxic pulmonary vasoconstriction
-increased resistance
-high pressure to lungs
-less likely to flow this way
-also high P in right heart
-higher than P in left atrium

2- blood flows foramen ovale - right atrium to left atrium
-blood to left ventricle
-then to aorta
-distributes to body

13

foramen ovale

allows blood from right atrium to left atrium

14

lung blood flow before birth

high resistance

15

ductus arteriosus

connection between pulmonary artery and aorta

-allows blood from pulmonary artery to aorta
-this direction because high lung R

16

internal iliac arteries

branches to umbilical artery (2x)

-brings deoxygenated blood to placenta
-placenta has low R so blood is directed here

17

after birth changes

-placenta removed
-lung bring in air

cause lots of changes

18

placenta removed

whartons jelly contraction
-natural clamp
- to very high R

19

whartons jelly

contracts around vessels as temperature falls

20

lung changes

fluid replaced by air
-oxygen levels rise
-stops the hypoxic pulmoanry vasoconstriction

-results in dilation
-causes decreased R in lungs
-right heart pressure falls
-oxygenated blood to left atrium
-increases pressure in left side of heart
-causes close of foramen ovale (first few minutes)

21

ductus arteriosus changes

-first few hours of life
-constriction of ductus arteriousus
-sense high oxygen levels
-also senses placenta removed - prostaglandin decrease

22

umbilical artery changes

high resistance
-no blood that way
-have smooth muscle that contracts

over course of few hours

23

umbilical vein changes

no blood flow after placenta removed
-blood clots off

24

ductus venosus changes

no blood flow after placenta removed
-blood clots off

25

newborn exam

first day of life

observation
vital signs
head to toe exam

keep baby warm and clean everything

26

observation of baby

color
skin (bluish on back normal)
jaundice
pallor (anemia)

muscle tone and activity

27

vital signs of baby

temp (36.5-37.5)
breathing (30-60, irregular normal)
heart rate (100-160 bpm)

28

breathing problem

nasal flaring

29

head to to exam of baby

fontanelles (A/P)
uneven head shape normal
-goes away 2-3 days

eye discharge
-blood on white of eye - from birth - goes away

finger in mouth - sucking
-cleft lip/palate - can't suck

swollen breasts - normal

swollen belly - obstruction or infection

umbilical hernia - usually goes away

spinal defects

anus - first stool passage - should be first 24 hours

genitals - urethra opening
-two testes
-females -white or blood discharge

normal weight 2.4 - 4 kilos