1. diagnostic decision
1.1. down syndrom with ventricular defect with congestive heart failure
2. step4: hypothesis organization
2.1. GI
2.2. cardiopulmonary system
3. step5: learning objectives
3.1. 1- to define down syndrome, genetic basis, manifestation, risk factors, and complication( gi and cvs).
3.2. 2- to describe the normal process of breastfeeding and abnormalities related to down syndrome.
3.3. 3- to know the normal developmetl structure of the heart.
4. Step 6 Review of Last Session
4.1. dwon syndrom patient
4.1.1. Long duration of feeding
4.1.2. extra effort for breastfeeding
4.2. heart development
4.2.1. develop in cardiogenic area
4.2.2. placental circulation
4.2.2.1. two art and one vein the blood eighter come from svc or from an area to join to the the ivc
4.3. step6
4.3.1. difintion:
4.3.1.1. most common genetic problem with a problem in chromosome 21
4.3.2. cause
4.3.2.1. translocation to other chromosom
4.3.2.2. problem in the chromosome
4.3.3. charactersitics
4.3.3.1. amternal myotic dysfuntion: problem in the second stage.
4.3.3.2. most of the problem in the mental retardation
4.3.4. clinical prsentation
4.3.4.1. congenital heart disease
4.3.4.1.1. Atrioventricular defect
4.3.4.2. tetralogy of falop
4.3.4.3. gi problem
4.3.4.3.1. dudenal atresia
4.3.4.3.2. vomoting
4.3.4.4. dysmorphic feature
4.3.4.4.1. flat face
4.3.4.4.2. slant palpaular fissure
4.3.4.4.3. ear and eye proble
4.3.4.4.4. short neck
4.3.4.4.5. problem in the extremeties
4.3.4.5. neurological defect
4.3.4.5.1. alzahaimar disease
4.3.4.5.2. speach difficulty
4.3.4.5.3. loss of hear
4.3.4.5.4. vision problem
4.3.4.6. hematological
4.3.4.6.1. anemia
4.3.4.7. psychiatric
4.3.4.7.1. autism
4.4. breast feeding problem
4.4.1. duration of 20 to 35
4.4.2. frequency is 8 of 12 a day
4.4.3. improves the immunity
5. Step 7 Inquiry Plan
5.1. history
5.1.1. problem in feeding
5.1.2. any baby has previous problem
5.1.3. pregnancy is normal
5.1.4. us: no abnormality detected
5.1.5. vaginal delivery
5.1.6. weight:
5.1.7. family history
5.1.8. parents: no smoking
5.2. physical examination
5.2.1. wt; 3.5
5.2.2. pulse: 140
5.2.3. bp: 90 \ 60
5.2.4. respirtory rate
5.2.4.1. 42
6. Step 9 REview
7. Step 10 Management
7.1. GOAL
7.1.1. TO increase theheart.
7.2. medication
7.2.1. to keep the heart rater in nomral rat
7.2.1.1. digixon
7.2.1.2. ace
7.2.1.3. dirutics
7.2.1.3.1. increase the na+ and water lose in the body
7.2.1.4. gaba receptor
7.2.1.4.1. Improve learning
7.2.1.5. antioxidant
7.2.1.5.1. zinc
7.3. surgery
7.3.1. goal
7.3.1.1. pulmonary vascular resistance
7.3.1.1.1. assement
7.3.1.2. refractory congestive heart failure
7.3.1.3. failure to thrive
7.3.1.3.1. we give them calori
7.3.2. dependant on the size
7.3.2.1. open heart surgery
7.3.2.1.1. it is the best
7.3.2.2. cathetarization
7.3.2.2.1. through femoral artery
7.3.2.2.2. ventricles
7.3.3. be careful from the infection
7.3.3.1. give antibiotic eve
7.3.4. vsd
7.3.4.1. sometime benefatial
7.3.4.1.1. Preventing the closure
7.4. guidlines
7.4.1. diurtic and ace ( low doses)
7.4.2. beta blocker
7.4.2.1. contraindication
7.4.2.1.1. if it decrease the heart rate more than the normal
7.5. non drug related
7.5.1. education of the family
7.5.2. family support
7.6. refer him
7.6.1. pediatric cardiologist
7.6.1.1. avoid cyanosis
7.6.1.2. and murmar
8. Step Feedack
8.1. resource
8.1.1. uptodate
8.1.2. e-mdecine
8.1.3. medicine.net
8.1.4. WHO
8.1.5. medscape
8.1.6. divitson
8.1.7. cdc
8.1.8. american heart association
9. step 1: identify and difficult words
9.1. difficult words
9.1.1. Sluggish: slow
9.2. kews
9.2.1. newborn baby
9.2.2. trouple in feeding
9.2.3. diagnosed with down syndrom
9.2.4. 8 week age
9.2.5. breastfeeding difficulty
9.2.6. slow weight gain
9.2.7. sweating and shortness of breath ( about 5 - 10 min) and spend 1 hour during feeding