Posted: 25 Jan 2011 05:56 PM PST

CAPUT SUCCEDANEUM

Definition

A caput succedaneum is an edema of the scalp at the neonate's presenting part of the head. It often appears over the vertex of the newborn's head as a result of pressure against the mother's cervix during labor. The edema in caput succedaneum crosses the suture lines. It may involve wide areas of the head or it may just be a size of a large egg.

Causes

Mechanical trauma of the initial portion of scalp pushing through a narrowed cervix
Prolonged or difficult delivery
Vacuum extraction

The pressure (at birth) interferes with blood flow from the area causing a localized edema. The edematous area crosses the suture lines and is soft. Caput Succedaneum also occurs when a vacuum extractor is used. In this case, the caput corresponds to the area where the extractor is used to hasten the second stage of labor.

Signs and Symptoms

Scalp swelling that extends across the midline and over suture lines
Soft and puffy swelling of part of a scalp in a newborn's head
May be associated with increased molding of the head
The swelling may or may not have some degree of discoloration or bruising

Management

Needs no treatment. The edema is gradually absorbed and disappears about the third day of life.

Complication

Jaundice – results as the bruise breaks down into bilirubin.

CEPHALHEMATOMA

Definition

Cephalhematoma is a collection of blood between the periosteum of a skull bone and the bone itself. It occurs in one or both sides of the head. It occasionally forms over the occipital bone. The swelling with cephalhematoma is not present at birth rather it develops within the first 24 to 48 hours after birth.

Causes

Rupture of a periostal capillary due to the pressure of birth
Instrumental delivery

Signs and Symptoms

Swelling of the infant's head 24-48 hours after birth
Discoloration of the swollen site due to presence of coagulated blood
Has clear edges that end at the suture lines

Management

Observation and support of the affected part.
Transfusion and phototherapy may be necessary if blood accumulation is significant

Complication

Jaundice

Difference between a Caput Succedaneum and Cephalhematoma
INDICATORS	CAPUT SUCCEDANEUM	CEPHALHEMATOMA
Location	Presenting part of the head	Periosteum of skull bone and bone
Extent of Involvement	Both hemispheres; CROSSES the suture lines	Individual bone; DOES NOT CROSS the suture lines
Period of Absorption	3 to 4 days	Few weeks to months
Treatment	None	Support

image from emedicine.medscape.com

Exercises During Pregnancy

Posted: 25 Jan 2011 05:31 PM PST

Goal of Performing Prenatal Exercises: To strengthen the muscle that will be used in labor and delivery.

squatting

Guidelines in Performing Exercises during pregnancy:

Exercise should be done in moderation. Recommend that moderate exercise should be done 30 or more minutes daily.
The pregnant woman should avoid strenuous activity or intensifying training.
Exercises where there is a risk of falling or abdominal trauma should be avoided.
Pre-natal exercises should NOT be done during a hot or humid weather.
All exercises in supine position after the first trimester of pregnancy should not be done by the pregnant woman as this position increases the risk of supine hypotensive syndrome.
Tailor-sitting
Should be individualized. Meaning the exercises recommended for each pregnant woman should be according to ones age, physical condition, customary amount of exercise and the stage of pregnancy.
Adequate fluid intake before and after exercise should be practiced by the pregnant woman.
Exercises that cause fatigue should be stopped.
It is important to follow the health care provider's advice about taking the pulse rate during the exercise and keeping it within a certain range.
The pregnant woman should stop the exercise and seek medical advice if she experiences the following:

Chest pain
Dizziness
Headache
Decreased fetal movement
Signs of labor

Squatting and tailor sitting

Strengthen perineal muscle
Increase perineal circulation
Make more pelvic joints pliable

Pelvic Rock

Maintains good posture
Relieves abdominal pressure and low backaches
Strengthen abdominal muscles following delivery
modified knee-chest position

Modified knee-chest position

Relieves pelvic pressure and cramps in thighs or buttocks
Relieves discomfort from hemorrhoids

Shoulder circling

Strengthens muscles of the chest

Walking

shoulder circling

Best exercise
Promotes circulation

Kegel's

10 seconds contraction, 10 seconds relaxation (30 times a day)
Relieves congestion and discomfort in pelvic region
Tones up pelvic floor muscles

images from pregnancy.gemzies.com, medindia.net, moondragon.org, albertrotella.robopeoples.com, pregnancyatoz.com

Hearing Tests

Posted: 25 Jan 2011 05:05 PM PST

Rinne's Test
rinne test

Definition

Rinne's test is a hearing test that compares the perception of sounds as it compares the patient's ability to hear a tone conducted via air and bone through the mastoid process. It should always be accompanied by a Weber's test that is used to detect a sensorineural hearing loss, confirming the nature of hearing problem.

Purpose

To evaluate a patient’s hearing ability by air conduction compared to that of bone conduction.

Equipment: Tuning fork

Procedure

Explain the procedure to the patient to promote cooperation.
Sit the patient in a chair comfortably.
Strike a 512 Hz tuning fork softly (knees or elbows slightly not the table) otherwise the vibrations will be excessive and cause the patient discomfort.
Place the vibrating tuning fork on the base of the mastoid bone. Hold the fork for 2-3 seconds to allow sufficient time to make a mental note of the stimulus intensity.
Ask the client to tell you when the sound is no longer heard.
After the sound is no longer appreciated the vibrating top is held one inch from the external auditory meatus.
The patient is asked whether the sound is louder behind or in front – referring to bone and air conduction respectively.

Interpretation of Results

Normal: A patient with normal hearing will hear the tone of the vibration longer and louder when the tuning fork is held next to the ear than that against the mastoid bone.

Positive Hearing Loss or "Reversed Rinne": When a patient hears a louder and longer tone when the vibrating tuning fork is held against the mastoid bone than when it is held next to the ear.

Weber's Test

Definition

Weber's test is a quick hearing test that is performed with Rinne's test.

Purpose

The Weber test is used to determine a patient's hearing ability by bone conduction and is useful in detecting a unilateral (one-sided or asymmetrical) conductive hearing loss and unilateral sensorineural hearing loss.

Equipment: Tuning Fork

Procedure

Explain the procedure to the patient to promote cooperation.
Sit the patient in a chair comfortably.
Strike a 512 Hz tuning fork softly (knees or elbows slightly not the table) otherwise the vibrations will be excessive and cause the patient discomfort.
Place the vibrating tuning fork on the middle of the patient's head. Hold the fork for 2-3 seconds to allow sufficient time to make a mental note of the stimulus intensity.
Ask client if the sound is heard better in one ear or the same in both ears.

Interpretation of Results

Normal Response: sound is heard equally at both ears.

Sensorineural Hearing Loss: loudest sound in unaffected ear. This is because the affected ear is less effective at picking up sound even if it is transmitted directly by conduction into the inner ear.

Conductive Hearing Loss: Loudest sound in affected ear (hears vibrations only). This is because the conduction problem masks the ambient noise of the room, whilst the well-functioning inner ear picks the sound up via the bones of the skull causing it to be perceived as a louder sound than in the unaffected ear.

Watch a video on rinne and weber's test courtesy of Youtube.com

http://www.youtube.com/watch?v=FNy7dgOwu30

images from drdavidson.ucsd.edu, drdavidson.ucsd.edu