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Samenvatting Blok 3 - Kind in ontwikkeling
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,Table of ContentsEmbryologie – (vóór) De Bevruchting .............................................................................................................................................................................................................. 9
De Mitose & Meiose ........................................................................................................................................................................................................................................................................ 9
De Gametogenese (globaal) ........................................................................................................................................................................................................................................................... 10
De Oögenese & Ovulatie ................................................................................................................................................................................................................................................................ 10
De Bevruchting ............................................................................................................................................................................................................................................................................... 13
Embryologie – De Embryonale Periode ......................................................................................................................................................................................................... 15
Week 1 – De Mitotische Celdelingen ............................................................................................................................................................................................................................................. 15
Week 2 – De Aanhechting & Vorming tweelagige kiemschijf ........................................................................................................................................................................................................ 17
Week 3 – De Gastrulatie ................................................................................................................................................................................................................................................................ 19
Week 3 – De aanleg van de bloedsomloop .................................................................................................................................................................................................................................... 22
Week 4 – De Neurulatie ................................................................................................................................................................................................................................................................. 22
Week 4 – Plooivorming .................................................................................................................................................................................................................................................................. 23
De Globale Organogenese ............................................................................................................................................................................................................................................................. 24
De Globale Organogenese – Tijdlijnen ........................................................................................................................................................................................................................................... 25
Embryologie – De Organogenese .................................................................................................................................................................................................................. 26
Tractus Respiratorius ..................................................................................................................................................................................................................................................................... 26
Tractus Circulatorius – Het Hart ..................................................................................................................................................................................................................................................... 27
Tractus Digestivus .......................................................................................................................................................................................................................................................................... 27
Het Centrale Zenuwstelsel ............................................................................................................................................................................................................................................................. 30
Het Endocriene stelsel – Bijnieren ................................................................................................................................................................................................................................................. 31
Het Endocriene stelsel – Hypofyse & Hypothalamus ..................................................................................................................................................................................................................... 31
De Ledematen ................................................................................................................................................................................................................................................................................ 32
De Zintuigen – Ogen....................................................................................................................................................................................................................................................................... 32
De Zintuigen – Oren ....................................................................................................................................................................................................................................................................... 33
Tractus Uropoeticus ....................................................................................................................................................................................................................................................................... 33
De Geslachtsorganen – Indifferente Fase ...................................................................................................................................................................................................................................... 34
, De Inwendige Geslachtsorganen – Mannelijk ................................................................................................................................................................................................................................ 37
De Uitwendige Geslachtsorganen – Mannelijk .............................................................................................................................................................................................................................. 38
De Inwendige Geslachtsorganen – Vrouwelijk............................................................................................................................................................................................................................... 39
De Uitwendige Geslachtsorganen – Vrouwelijk ............................................................................................................................................................................................................................. 40
Embryologie – Afwijkingen ........................................................................................................................................................................................................................... 41
Gemelli ........................................................................................................................................................................................................................................................................................... 41
Een Miskraam ................................................................................................................................................................................................................................................................................ 42
Neurale buisdefecten ..................................................................................................................................................................................................................................................................... 43
Afwijkende Geslachtsorganen ....................................................................................................................................................................................................................................................... 44
Beïnvloedende factoren – Organogenese...................................................................................................................................................................................................................................... 45
Embryologie – De Placenta & De Vruchtzak .................................................................................................................................................................................................. 46
De Nidatie ...................................................................................................................................................................................................................................................................................... 46
De (vroege) ontwikkeling van de placenta ..................................................................................................................................................................................................................................... 48
De (late) ontwikkeling van de placenta en vruchtzak .................................................................................................................................................................................................................... 50
De Placenta – Anatomie ................................................................................................................................................................................................................................................................. 51
De Placenta – Afwijkingen.............................................................................................................................................................................................................................................................. 52
Fysiologie – De Placentaire Circulatie & Gasuitwisseling ............................................................................................................................................................................................................... 53
Fysiologie – Transportmechanismen ............................................................................................................................................................................................................................................. 54
Fysiologie – De Endocriene werking .............................................................................................................................................................................................................................................. 55
De Vruchtzak .................................................................................................................................................................................................................................................................................. 56
Het Vruchtwater ............................................................................................................................................................................................................................................................................ 57
Beïnvloedende factoren – De Placenta .......................................................................................................................................................................................................................................... 57
De Foetale Groei ........................................................................................................................................................................................................................................... 58
De Fysiologische Foetale Groei ...................................................................................................................................................................................................................................................... 58
De Afwijkende Foetale Groei – Foetale Groei Vertraging .............................................................................................................................................................................................................. 59
De Afwijkende Foetale Groei – Small / Large for Gestational Age ................................................................................................................................................................................................. 61
(Afwijkende) Foetale Groei – Beïnvloedende Factoren / Oorzaken .............................................................................................................................................................................................. 62
De Afwijkende Foetale Groei – Hoeveelheid Vruchtwater ............................................................................................................................................................................................................ 63
,De Foetale Groei – Monitoren ....................................................................................................................................................................................................................... 64
Uitwendig Zwangeren Onderzoek ................................................................................................................................................................................................................................................. 64
Echoscopie – Basisprincipes ........................................................................................................................................................................................................................................................... 65
Echoscopie – Biometrie.................................................................................................................................................................................................................................................................. 66
Groeicurves .................................................................................................................................................................................................................................................................................... 68
De Foetale Conditie ...................................................................................................................................................................................................................................... 68
De Foetale Hartfrequentie ............................................................................................................................................................................................................................................................. 68
De Foetale Hartfrequentie – Beïnvloedende factoren ................................................................................................................................................................................................................... 69
De Foetale Hartfrequentie – Beïnvloedende factoren – Baring ..................................................................................................................................................................................................... 70
Fysiologie – Zuur-Base Evenwichten .............................................................................................................................................................................................................................................. 72
Foetale nood .................................................................................................................................................................................................................................................................................. 73
De Foetale Conditie – Monitoren .................................................................................................................................................................................................................. 75
Foetale Bewaking ........................................................................................................................................................................................................................................................................... 75
Intermitterende Auscultatie (IA) .................................................................................................................................................................................................................................................... 75
Cardiotocografie (CTG)................................................................................................................................................................................................................................................................... 75
Cardiotocografie (CTG) – Beoordelen ............................................................................................................................................................................................................................................ 77
Microbloedonderzoek (MBO) ........................................................................................................................................................................................................................................................ 79
De Foetus → De Neonaat ........................................................................................................................................................................................................................ 80
Tractus Respiratorius – Foetaal...................................................................................................................................................................................................................................................... 80
Tractus Respiratorius – Neonataal ................................................................................................................................................................................................................................................. 81
Tractus Circulatorius – Foetaal....................................................................................................................................................................................................................................................... 82
Tractus Circulatorius – Neonataal .................................................................................................................................................................................................................................................. 84
Bloed / Hemoglobine – Foetaal & Neonataal ................................................................................................................................................................................................................................ 85
Tractus Digestivus – Foetaal & Neonataal ..................................................................................................................................................................................................................................... 86
Glucosehuishouding – Foetaal & Neonataal .................................................................................................................................................................................................................................. 87
Thermoregulatie – Foetaal & Neonataal........................................................................................................................................................................................................................................ 87
Immuunsysteem – Foetaal & Neonataal........................................................................................................................................................................................................................................ 90
,Het Onderzoek Neonaat (VT) ........................................................................................................................................................................................................................ 91
Het Onderzoek Neonaat ................................................................................................................................................................................................................................................................ 91
Algemeen lichamelijk onderzoek ................................................................................................................................................................................................................................................... 91
De Huid .......................................................................................................................................................................................................................................................................................... 92
Het Caput ....................................................................................................................................................................................................................................................................................... 92
De Ogen ......................................................................................................................................................................................................................................................................................... 93
De Oren .......................................................................................................................................................................................................................................................................................... 94
De Neus .......................................................................................................................................................................................................................................................................................... 94
De Mond en kin .............................................................................................................................................................................................................................................................................. 94
De Hals en clavicula........................................................................................................................................................................................................................................................................ 95
De Thorax ....................................................................................................................................................................................................................................................................................... 95
Het Abdomen ................................................................................................................................................................................................................................................................................. 95
De Genitalia – Meisjes.................................................................................................................................................................................................................................................................... 96
De Genitalia – Jongens ................................................................................................................................................................................................................................................................... 96
De Anus .......................................................................................................................................................................................................................................................................................... 97
De Extremiteiten ............................................................................................................................................................................................................................................................................ 97
De Rug, wervelkolom en heupen ................................................................................................................................................................................................................................................... 97
Neurologisch onderzoek ................................................................................................................................................................................................................................................................ 98
Medicatie ....................................................................................................................................................................................................................................................................................... 98
De Kraamweek ............................................................................................................................................................................................................................................. 99
Controles Neonaat (door kraamverzorgende) ............................................................................................................................................................................................................................... 99
Beleid – Temperatuurregulatie ....................................................................................................................................................................................................................................................100
Huidafwijkingen ...........................................................................................................................................................................................................................................................................101
Huidafwijkingen – Verslaglegging ................................................................................................................................................................................................................................................106
Huilgedrag ....................................................................................................................................................................................................................................................................................106
Shaken Baby Syndroom ...............................................................................................................................................................................................................................................................107
Wiegendood .................................................................................................................................................................................................................................................................................108
Neonatale Screening – De Hielprik & Gehoortest ........................................................................................................................................................................................................................109
, De Geboorte – Wetten & Regelgeving .........................................................................................................................................................................................................................................111
Voeding – Neonaat ..................................................................................................................................................................................................................................... 112
Voedingspatronen........................................................................................................................................................................................................................................................................112
Defecatiepatronen .......................................................................................................................................................................................................................................................................112
Gewichtsverloop ..........................................................................................................................................................................................................................................................................113
Complicaties – Hypoglykemie ......................................................................................................................................................................................................................................................114
Complicaties – Reflux ...................................................................................................................................................................................................................................................................115
Complicaties – Darmkrampjes .....................................................................................................................................................................................................................................................116
Bilirubine Stofwisseling – Neonaat ............................................................................................................................................................................................................. 117
Fysiologie – Bilirubine Stofwisseling ............................................................................................................................................................................................................................................117
Icterus Neonatorum – Soorten ....................................................................................................................................................................................................................................................118
Icterus Neonatorum – Monitoren & Beoordelen.........................................................................................................................................................................................................................120
Icterus Neonatorum – Diagnostiek & Behandeling ......................................................................................................................................................................................................................121
Borstvoeding – Flesvoeding ........................................................................................................................................................................................................................ 122
Melk bewaren ..............................................................................................................................................................................................................................................................................122
Kolven & Tepelhoedje ..................................................................................................................................................................................................................................................................123
Voeding & Leefstijl – Kraamvrouw ...............................................................................................................................................................................................................................................123
Wetgeving Borstvoeding ..............................................................................................................................................................................................................................................................124
De Eerste Levensjaren................................................................................................................................................................................................................................. 124
Zorgoverdracht ............................................................................................................................................................................................................................................................................124
Het Rijksvaccinatieprogramma ....................................................................................................................................................................................................................................................125
De ontwikkeling van het kind .......................................................................................................................................................................................................................................................126
Ouderschap & Hechting .............................................................................................................................................................................................................................. 126
Gehechtheid .................................................................................................................................................................................................................................................................................126
Gehechtheid – Soorten ................................................................................................................................................................................................................................................................127
Transitie naar het ouderschap .....................................................................................................................................................................................................................................................128
Het Ouderschapsmodel ...............................................................................................................................................................................................................................................................128
, Transitie naar ouderschap ...........................................................................................................................................................................................................................................................129
Stress ......................................................................................................................................................................................................................................................... 129
Stressreacties ...............................................................................................................................................................................................................................................................................129
Omgaan met stress – Coping Mechanismen ................................................................................................................................................................................................................................131
Farmacologie ............................................................................................................................................................................................................................................. 131
Farmacokinetiek...........................................................................................................................................................................................................................................................................131
Farmacodynamiek ........................................................................................................................................................................................................................................................................133
“Optimal Drug Therapy” ..............................................................................................................................................................................................................................................................134
De Verloskundige – Medicatie toedienen ....................................................................................................................................................................................................................................135
Farmacologie – Zwangerschap & Lactatie................................................................................................................................................................................................... 141
Zwangerschap – veranderde farmacokinetiek .............................................................................................................................................................................................................................141
Zwangerschap – invloed geneesmiddel op vrucht .......................................................................................................................................................................................................................142
Lactatie – overgang in moedermelk .............................................................................................................................................................................................................................................143
Lactatie – invloed geneesmiddel op zuigeling en lactatie ............................................................................................................................................................................................................143
Lactatie – geneesmiddelgebruik ..................................................................................................................................................................................................................................................144
Immunologie .............................................................................................................................................................................................................................................. 145
Lymfocytopoëse ...........................................................................................................................................................................................................................................................................145
Het Immuunsysteem ....................................................................................................................................................................................................................................................................146
Fysiologie – Aspecifieke / Aangeboren Immuniteit .....................................................................................................................................................................................................................147
Fysiologie – Specifieke / Adaptieve Immuniteit ...........................................................................................................................................................................................................................149
Fysiologie – Antistoffen................................................................................................................................................................................................................................................................151
Evidence Based Midwifery .......................................................................................................................................................................................................................... 152
Levels of Evidence ........................................................................................................................................................................................................................................................................152
Onderzoeksdesigns – Soorten ......................................................................................................................................................................................................................................................153
Onderzoeksdesigns – Kapstokvragen ...........................................................................................................................................................................................................................................156
Clinical Irritations .........................................................................................................................................................................................................................................................................157
,Communicatie Trainingen – Blok 3.............................................................................................................................................................................................................. 157
Motiverende Gespreksvoering.....................................................................................................................................................................................................................................................158
Shared Decision Making ...............................................................................................................................................................................................................................................................158
Het Slecht-Nieuws-Gesprek .........................................................................................................................................................................................................................................................158
,Embryologie – (vóór) De Bevruchting
De Mitose & Meiose
Profase 1 De chromosoomparen verzamelen en de centriolen (met microtubuli) verschijnen
Crossing-over (uitwisseling van allelen tussen homologe chromosomenparen) vindt hier plaats
Metafase 1 De chromosoomparen liggen in het midden van de cel en hechten aan het spoelfiguur dmv de centriolen
Anafase 1 De chromosoomparen worden losgetrokken naar de tegenoverliggende kanten van de cel
Telofase 1 Het spoelfiguur verdwijnt en nieuwe kernmembranen vormen zich om de chromosomen
Cytokinese 1 De rest van de cel (organellen, celmembraan) splitst en vormt 2 dochtercellen
Profase 2 Chromatiden paren verzamelen en de centriolen (met microtubuli) verschijnen
Metafase 2 De chromatiden liggen in het midden van de cel en hechten aan het spoelfiguur dmv de centriolen
Anafase 2 De chromatiden worden losgetrokken naar de tegenoverliggende kanten van de cel
Telofase 2 Het spoelfiguur verdwijnt en nieuwe kernmembranen vormen zich om de chromosomen die zich weer ontwinden
Cytokinese 2 De rest van de cel (organellen, celmembraan) splits en vormen 2 dochtercellen
, De Gametogenese (globaal)
De Oögenese & Ovulatie
Maand 1 – 3 van zwangerschap mitotische celdelingen van de primordiale kiemcellen
→ Öogonium
Maand 3 – 7 van zwangerschap meiose 1 ontwikkelt tot profase 1
de ontwikkelende öocyt word omgeven door een één-cellaag-dikke wand van afgeplatte follikelcellen
de follikelcellen produceren “oocyte maturation inhibitor” waardoor verdere ontwikkeling van meiose geremd word
→ Primaire öocyt in Primordiaal ovariumfollikel
Maandelijks vanaf puberteit primaire öocyt groeit en wordt omgeven door een één-cellaag-dikke wand van granulosacellen
• granulosacellen = groeiende, kubusvormige follikelcellen die oestrogeen produceren
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