1. Step 1
1.1. Identify terms and cues
1.2. New terms
1.2.1. sluggish
1.2.1.1. slow
1.2.1.2. lack of energy
1.3. cues
1.3.1. newborn
1.3.1.1. baby with down syndrome
1.3.2. sluggish fedding behaviour
1.3.2.1. in day 2
1.3.3. facial changes
1.3.4. active with slow weight gain
1.3.4.1. after 8 weeks
1.3.5. sweaty and breathless with feeding
1.3.5.1. after 5-10 min
1.3.6. complete breastfeeding for 1 hour
1.3.7. pauses between feeding
1.3.7.1. due to breathlessness
1.4. 10 minutes
2. Step 4
2.1. Hypothesis organization (tentative solution)
2.1.1. down's syndrome
2.1.1.1. congenital heart diseases
2.1.1.1.1. congenital septal defects
2.1.1.2. GIT
2.1.1.2.1. dysphagia
2.1.1.3. respiratory
2.1.1.4. low muscle tone
2.1.1.5. endocrine system
2.1.1.5.1. hyperthyroidism / hypothyroidism
2.1.1.6. hematological
2.1.1.6.1. anemia?
2.2. 20 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. embryological heart development
3.1.1.1. patent ductus arterioles?
3.1.2. down's syndrome
3.1.2.1. risk factors
3.1.2.2. pathophysiology
3.1.2.3. complication
3.1.2.3.1. CVS?
3.1.2.3.2. hypotonia?
3.1.2.4. clinical features and diagnosis
3.2. 10 minutes
4. Step 2
4.1. Problem formulation (put it in a senates)
4.1.1. 8-weeks down syndrome boy presented with slow weight gain, sluggish feeding, sweating and breathlessness during breastfeeding causes him to pause.
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. down's syndrome
5.1.1.1. slow weight gain
5.1.1.1.1. growth delay
5.1.1.1.2. cardicac induced, as the body doesn't get its needs
5.1.1.1.3. hormonal abnormalities
5.1.1.1.4. absorption issues leading to low nutrition
5.1.1.2. feeding pattern
5.1.1.2.1. sweaty
5.1.1.2.2. breathlessness
5.1.1.3. Sluggish feeding
5.1.1.3.1. CNS not stimulating the heart and muscles
5.1.1.3.2. as a complication of down's
5.1.1.3.3. allergic to his mom's milk?
5.1.1.3.4. mother nutrition leads to low quality
5.1.1.3.5. he won't to be fed due to pain or something else