KCH BN BI GING: CHC D DCH NO TY

K NNG KHM THP TRCThs. Thanh HngMc tiu hc tp

Sau khi hc bi ny, hc vin c kh nng:

1. Trnh by c ngha ca vic khm thp trc2. Thc hin ng cc bc khm thp trc3. Bit cch nhn nh kt qu khm thp trc 4. Lit k c cc nguyn nhn thp rng, thp nh, thp lm v thp phng1. i cng

Thp trc l t chc lin kt, l khong trng gia cc xng s. Thp trc c hnh thoi c gii hn bi 2 xng nh v 2 xng trn. Cc rnh lin khp s v thp tn ti gip vng u ca tr tng dn song song vi s tng th tch ca no.

Khm thp tr em nh gi tnh trng dinh dng, pht hin sm cc du hiu bnh l v gin tip nh gi s pht trin ca no. Tt c cc bc s khi khm tr em nh nn nh gi thp ca tr.Khi khm thp cn o kch thc thp, xem b thp cng hay mm, thp c cng, thp phng hay lm, thp kn sm hay mun.

S bt thng ca thp lin quan n s pht trin xng, cc yu t lm tng p lc ni s v lin quan n mt s hi chng bnh l.

Thp trc ca tr mi sinh trung bnh l 2,1cm (dao ng 0,6cm - 3,6cm). Trong vng 1 thng sau sinh thp ca tr c th tng so vi lc mi sinh v mt s tr b chng khp s do qu trnh chuyn d hoc hin tng st cn sinh l trong my ngy u sau sinh.Tui trung bnh kn thp l 13,8 thng (dao ng 3 thng - 24 thng). Thp trc kn trc 3 thng gi l sm; thp kn sau 24 thng gi l mun.2.Cc yu t lin quan n s bt thng ca thp trc

2.1. Nguyn nhn thp trc rng hay thp kn mun Suy gip

Ri lon pht trin xng: gim phospho mu, ci xng thiu vitamin D, thiu canxi, khuyt xng nh, cc bnh bm sinh ri lon pht trin sn v xng Mt s bnh t bin gen: hi chng Russell - Silver, hi chng Beckwith-Wiedermann, th t bin 3 nhim sc th 13, 18, 21

Nhim trng bm sinh: giang mai, Rubella

M dng thuc trong thi k mang thai: thuc c ch angiotensin, primidone, methotrexate, fluconazole, hydantoin

2. 2. Nguyn nhn thp nh hay thp kn sm Tt u nh nguyn pht

u nh th pht sau mt s bnh l ca h thn kinh: di chng xut huyt no, di chng ngt chu sinh, nhim trng bm sinh

Cng gip Chng khp s bo thai

2.3. Nguyn nhn thp phng Tng p lc ni s

No ng thy

Nhim trng thn kinh cp tnh: vim no, vim mng no, p xe no

Chy mu trong s

Hi chng gi u no, gi thp phng (khi tr ang khc to, gng sc hoc khm t th nm). Ng c ch, ng c thuc (Itadixic)2.4. Nguyn nhn thp lm

Tnh trng mt nc ton thn Bnh nhn sau t dn lu no tht - bng

3. Cc bc khm thp trc3.1. Chun b bnh nhn Cho hi bnh nhn v b m, bc s t gii thiu tn

Hi h tn, ngy sinh ca bnh nhn Gii thch mc ch ca vic o thp cho b m3.2. Chun b dng c Mt thc c chia vch milimet 3.3. Yu cu b m b m hoc vt khc trn u tr (nu c) 3.4. Yu cu b m b tr t th u thng ng 3.5. nh gi b thp mm hay bnh thng, xc nh xem thp phng hay phng hay lm so vi b mt xng xung quanh khi tr khng gng sc (vut nh thp ca tr t sau ra trc)

3.6. Xc nh thp trc vi 4 im A, B, C, D (dng ngn tr ca bn tay phi xc nh: a ngn tay t gia thp ra xung quanh cho n khi chm cc cnh xng s gii hn thp). Xc nh im gia cc cnh hnh thoi ABCD3.7. Thao tc o: o ng ni trung im 2 cnh i din (a v b)

3.8. c kt qu vi 1 s l sau du phy (on thng c chiu di a v b), nhn nh kt qu.3.9. Kt thc thao tc khm. Cm n b m. 4. Bng kim dy-hcSTTNi dung tng bc ngha ca tng bcTiu chun phi t

1Cho hi, gii thiu tn bc s. Hi tn v ngy sinh ca v tnh tui ca bnh nhnLm quen vi bnh nhn v b m

Xc nh ng tn, tui ca bnh nhn. Bnh nhn v b m hp tc vi bc s.

Xc nh ng tn, tui bnh nhn

2Gii thch mc ch ca vic khm thp trcGip b m hiu mc ch ca o thp trcDng c y , chnh xc

3Yu cu b m b tr t th u thng ng v b m ca tr (nu tr i m) thao tc o tin hnh thun li v chnh xcB m hp tc

4nh gi xem thp cng, phng, phng hay lmNhn nh chnh xcNhn nh chnh xc

5S v nh gi b thpNhn nh chnh xcNhn nh chnh xc

6Xc nh v tr o thp trco chnh xcXc nh chnh xc

7o kch thc thpo chnh xco chnh xc

9Kt thc thao tc khm. Cm n b m.B m hi lngB m hi lng

10Trnh by kt qu vi gio vin

Ti liu tham kho

1. Nguyn Gia Khnh (2009). c im da c xng tr em. Bi ging Nhi khoa Tp 1. Nh xut bn y hc: 2042. John Gilroy (1982). Basic Neurology: 217-219.

3. Mayo Clinic Family Health Book. 4th edition.4. William E. DeMyer (1994). Technique of the Neurologic examination:14-22.5. Richard S. Snell (1997). Clinical Neuroanatomy. 6. C V Uzukwu-Edeani (2013). Normal anterior fontanelle sizes in newborn Igbo babies in south-eastern Nigeria. South African Journal of Child Health,Vol 7, No 2

7. Joseph Kiesler . The abnormal fontanelle. American Family Physical, Vol 67, No 12.8. Emily R Gallagher (2013). Evaluating fontanels in the newborn skull. Contemporary Pediatrics.9. Hall JG, Allanson JE, Gripp KW, Slavotinek AM (2006). Handbook of Physical Measurements. 2nd ed. New York: Oxford University Press , 84-190.C

A

D

B

b

a

A

D

B

C

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