CPC exam 4

• Muscle strength testing

  1. Performed symmetrically, simultaneously asking the patient to push against resistance (usually start with arms then legs)

  2. Scale: 0/5 = No muscle twitch with attempted movement

  3. 1/5 = The muscle can be seen to twitch but no movement at the joint is seen

  4. 2/5 = Movement occurs in the horizontal plane but not against gravity

  5. 3/5 = Movement against gravity but not resistance

  6. 4/5 = Movement against some resistance

  7. 5/5 = Movement against full resistance
• First Aid review sections

  • Shock
  • Amputation
  • Triage
• 1. A-B-C's

  Airway, breathing, circulation
• Major types of shock

  • Hypovolemic
  • Cardiogenic
  • Anaphylactic
  • Fainting
• Amputation management

  1. Manage A-B-C's & call 9-1-1

  2. Apply direct pressure to stump

  3. Wrap body part in a dry, clean cloth

  4. Place wrapped part into a plastic bag and seal

  5. Place sealed bag into icy cold water

  6. Do not put amputated part directly into water or on ice
• Triage


  The action of sorting victims of disaster in order to determine who needs immediate care and transportation to the hospital, or could be delayed
• Disaster


  Any situation that taxes emergency resources
• Screening for possible newborn sepsis

  1. Mother should undergo speculum exam during 34-36 weeks of gestation, that includes a group B beta (GBS) to assess maternal colonization

  2. Treat with intrapartum antibiotic prophylaxis (IAP) during labor

  3. Evaluate for sepsis to newborns who appear ill or asymptomatic newborns with high risk factors

  4. Start antibiotic treatment until the test result comes back
• Most common organism causing newborn sepsis

  Group B Streptococcus
• APGAR scoring

  1. Perform 1-5 minutes (immediately) after delivery

  2. 5 categories, each category scored 0,1,2

  3. Add all up

  4. APGAR total score 2 or less = newborn in poor condition

  5. APGAR total score 3-7 = in fair condition

  6. APGAR total score 8 or higher = in good condition
• Comprehensive history

  • Full maternal / Family/ Prenatal histories
• Exam component that should always be prepared to perform

  Cardiorespiratory - to assess congenital heart defect
• Skin findings on newborns

  • Central cyanosis
  • Acrocyanosis
  • Ecchymosis
  • Pallor
  • Jaundice
  • Vernix caseosa
  • Lanugo
  • Milia
  • Mongolian spots
  • Nevus simplex
  • Port-wine stains
• Central cyanosis

  Seen in mucosa of mouth & tongue
• Acrocyanosis

  Mild perioral cyanosis and cyanosis of hands/feet - common in first few days of life
• Ecchymosis

  Suggests trauma
• Pallor

  Indicates presence of anemia, erythema with polycythemia
• Vernix caseosa

  A waxy white coating most commonly in the flexure surfaces and skin creases composed of sebaceous material and skin exfoliation
• Lanugo


  Fine hair covering the body found in premature newborns and will shed in the weeks after delivery
• Milia

  White papules on the nose and cheeks, transient lesions made of keratin/sebaceous material in the pilaceous follicles, usually disappear in the first few weeks of life
• Mongolian spots

  Macules or patches of dermal melanocytes in blue or brown hues, typically on the back and buttocks, commonly seen in babies of African American and Asian ethnicity, resolve spontaneously
• Nevus simplex

  Erythematous macules composed of dilated capillaries that may be found on the face and the back of the neck, usually resolve by 18 months though neck lesions may persist

  
• Port-wine stains


  Dilated capillaries that do not resolve spontaneously and may be progressive, resulting in disfigurement or dysfunction if not treated, may indicate related syndromes such as Sturge-Weber or Klippel-Trenaunay-Weber
• Asymmetric tonic neck reflex

  1. Newborn supine - rotate the head to one side - extremities on chin side extend while those on the occiput side flex

  2. Persistence after 6 months may indicate cerebral palsy
• Moro reflex with palmar grasp response


  1. Place doctor's thumb pads into each of newborn's palms - palming grasping - tests for palmar grasp response

  2. Place supporting fingers behind the baby's hand, then lift the hands upward until the thorax barely lifts, and the head begins to flex but does not leave the table

  3. Suddenly release the hands imitating a fall

  4. Normal response = symmetrical; extension of the back, extension and abduction of the arms, and fanning of the digits, followed by flexion and adduction of the arms, and closing of the fingers as in a motion of trying to cling; the baby may cry as part of reflex

  5. Persistence after 6 months may indicate cerebral palsy or peripheral nerve injury
• Plantar grasp reflex

  1. Tap the plantar surfaces of the feet

  2. The feet should grasp

  3. Persistence of grasp reflexes after 1 year seen in birth injury and developmental delay
• Babinski reflex

  1. Stroke the bottom of each foot from the heel, laterally along the side and across the ball of the foot

  2. Normal = A positive Babinski reflex should be seen, with extension and fanning of the toes
• Walking reflex

  1. Lift the baby with the thumbs over the anterior chest, hands under each axilla, and fingers wrapped around the back

  2. Hold the baby over the table and lower until the feet are just above it

  3. Touch the feet lightly to the table

  4. Normal = The baby attempts to walk across the surface
• Placing reaction

  1. Hold the infant upright and touch the anterior distal tibia against the edge of the table, should cause the infant to lift the foot, flexing the hip and knee as if attempting to step up onto the table surface

  2. Absence at birth may indicate brain damage
• Caput succedaneum

  Swelling that crosses suture lines, caused by edema related to the presenting part of the head at delivery and self-resolves

  
• Cephalohematoma


  An area of subperiosteal bleeding that stops at suture lines, the collection of blood will be reabsorbed but takes several weeks or more
• The main difference between caput succedaneum and cephalohematoma is that lumps caused by bleeding under the scalp is cephalohematoma, whereas lumps caused by scalp swelling due to pressure is known as caput succedaneum

  
• The testicles should be fully descended into the scrotum by the age of 1 year
• Undescended testicles increase the risk of developing testicular cancer, and referral to a specialist should be made
• Vital signs for newborns

  • Temperature
  • Pulse
  • Respiration
  • Heart rate
  • Blood pressure
  • Weight
  • Length
  • Head circumference
• Blood pressure is not typically measured in the newborn unless cardiovascular or renal abnormalities are suspected
• Appropriate, large, or small for gestational age

  Classification of newborn weight
• Macrocephaly

  Seen in hydrocephalus

  Seen in neural tube defects or syndromic conditions, common in premature babies
• General assessment of newborns

  • Development deformities
  • Respiratory effort (paradoxical breathing is normal: watch for signs of respiratory distress)
  • Body positioning (reflects how the baby was positioned within the uterus)
  • General motor tone, positioning
  • Extremity movement
  • Asymmetry (suggests birth injury)

  
• Tanner staging - Female

  • Stage 1
  • Stage 2
  • Stage 3
  • Stage 4
  • Stage 5