Kamis, 26 Februari 2009

Gestational and Child Assessment

Gestational and Child Assessment
PSIK B
Stikes Ngudi Waluyo Ungaran 

bu puji

Gestational Assessment

Physical characteristics of the newborn
Reflexes
Physical exam
Brazelton Neonatal Behavioral Assessment Scale
New Ballard Scale by Ballard, Novack and Driver

Pre-term Newborns
Preterm is born before 37 weeks
7% of all pregnancies (higher in blacks & LSE)
LBW = 5% of infants <2500g (5#8oz) - ~36 weeks
VLBW <1500g (3#5oz) - ~32 weeks
http://www.neonatology.org/index.html

Post-term Newborn
Post-term is born after 42 weeks
Mean wt. of full-term infant~3200g (7lbs)
Weight does not necessarily correlate to GA
SGA <10% of appropriate weight for GA
LGA >90% of appropriate weight for GA

Newborn (Primitive) reflexes
  Onset Gone
Moro 28w 5m  
Palmar grasp 28-32w 2-3m  
Rooting 28w 6th wk
Stepping 35-36w 3m 
Tonic neck 35w 2-3m
*see pages 636-638 in Pillitteri 
Physical Exam of Newborn
Infant easily stimulated by noise, touch, temperature changes or other environmental stimuli
Always keep infant warm 
Inspection, auscultation, palpation, percussion order (warm stethoscope and hands)
Brazelton Neonatal Behavioral Assessment Scale
Workshop training program required to administered-RN use parts of tool to assess infants and increase parental understanding
Habituation
Orientation
Motor performance
Range of state
Regulation of state
Autonomic regulation
Reflexes
Ballard Scale
Neuromuscular Maturity Physical Maturity
Posture -Skin
Square window -Lanugo
Arm recoil -Plantar surface
Popliteal angle -Breast
Scarf sign -Eye/ear
Heel to ear -Genitals (M/F)
Posture 0 to 4
Arms & legs extended
Slight-moderate flexion of hips/knees
Moderate-strong flexion of hips/knees
Legs flexed & abducted, arms slightly flexed
Full flexion arms & legs
Square Window -1 to 4
>90 degrees
90 degrees
60 degrees
45 degrees
30 degrees
0 degrees
Arm Recoil 0 to 4
Extended 180 degrees or random movements
Minimal flexion 140-180 degrees
Small amount flexion, 110-140 degrees
Moderate flexion, 90-100 degrees
Brisk return to full flexion, <90 degrees
Popliteal Angle -1 to 5
180 degrees
160 degrees
140 degrees
120 degrees
100 degrees
90 degrees
<90 degrees
Thigh held in knee chest position and leg is gently extended from behind the ankle. Measure the angle behind the knee.
Scarf Sign -1 to 1
Elbow reaches/nears level of opposite shoulder
Elbow crosses opposite anterior axillary line
Elbow reaches opposite anterior axillary line
Scarf Sign 2 to 4
Elbow at midline
Elbow does not reach midline
Elbow does not cross proximate axillary line

Heel to Ear -1 to 4
Pull foot to ear without force
Physical Maturity
Skin (-1 to 5)
Lanugo (-1 to 4)
Plantar (Sole) Creases (-2 to 4)
< 36 weeks: 1-2 transverse creases on anterior 1/3 of sole
by 40 weeks: complex criss-crossing of creases over entire sole
Physical Maturity
Breast (-1 to 4)
<34 weeks: not generally palpable
at 36weeks: diameter does not usually exceed 3mm
Eye/Ear (-2 to 4)
appears mainly after 36 weeks
Genitals M/F (-1 to 4)
<36 weeks: few anterior, inferior scrotal rugae
40 weeks: rugae cover entire scrotum
Maturity Rating (20-44 weeks)
TS GA TS GA TS GA
-10 20 20 32 50 44
-5 22 25 34
0 24 30 36
5 26 35 38
10 28 40 40
15 30 45 42
Child Assessment
Denver II or DDST-R (Revised Denver Developmental Screening Test)
Personal-social
Fine motor-adaptive
Language
Gross motor
see Appendix H in Pillitteri
Description of Denver II
Not an IQ test, not diagnostic, not predictive
Designed for apparently well children Birth-6yrs
Start with low items and work up
Need 3 items completely below age line 
Need every item that age line intersects
Calculate Child’s Age
Current date minus birth date
Work right to left (days, months, years)
To borrow
Take 30 days from one month
Take 12 months from one year

Practice Calculations
Example 1 Year Month Day
Current date 2006 1 18
  (2005) (0+12 =12) (18+30=48)
Birth date 2004 4 20

Age of child 1 8 28  

Practice Calculations 2
Example 2 Year Month Day
Current date 2007 3 30
Birth date 2006 6 14
Age of child
Answer
0 years
9 months
16 days
Adjusting for Prematurity
Example 3 Year Month Day
Current date 2006 1 18
Birth date 2005 3 10
Age of child 0 10 8
6 weeks of premature -1 -14
Adjusted age of child 8 24

Personal-Social
Getting along with people
Caring for personal needs
Fine motor-Adaptive
Hand-eye coordination
Manipulation of small objects
Problem-solving 
Language
Hearing
Understanding
Using language
Gross Motor
Sitting
Walking
Jumping
Overall large muscle movement
Interpretation of test results
Normal
No delays with max of one caution
Suspect
Two or more cautions &/or one or more delays
Rescreen 1-2 weeks
Untestable
Refusal on one item on or completely to left of age line in 75-90% area

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