#1 Flashcards
APGAR Score assesses ___ from birth and ___ to extrauterine life.
- -neurologic recovery
- -immediate adaptation
When should APGAR Scores be taken?
1 and 5 minutes
What does APGAR stand for?
Activity Pulse Grimace Appearance Respirations
What is the APGAR Score for heart rate?
0 = absent 1 = <100 2 = >100
What is the APGAR Score for respiratory effort?
0 = absent 1 = slow and irregular 2 = easy; good crying
What is the APGAR Score for muscle tone?
0 = limp/flaccid 1 = some flexion 2 = active motion
What is the APGAR Score for Reflex irritability?
0 = no response 1 = grimace 2 = vigorous cry
What is the APGAR Score for color?
0 = blue/pale 1 = acrocyanosis 2 = pink
What is a normal 1-minute APGAR score?
8-10
What 1-minute APGAR score is associated w/ some nervous system depression?
5-7
What 1-minute APGAR score is associated w/ severe depression, requiring immediate resuscitation?
0-4
What is a normal 5-minute APGAR Score?
8-10
What 5-minute APGAR Score indicates organ failure?
0-7
Estimates gestational age based on specific neuromuscular signs and physical characteristics
Ballard scoring system
Ballard Scoring System:
–Preterm = ?wks
Preterm = < 37 wks
Term = 37-42 wks
Postterm = > 42 wks
What are the birthweight classifications for:
- -Low birth weight
- -Normal birth weight
Low birth weight = < 2500 g
Normal birth weight = > 2500 g
What is the newborn classifications for:
- -Small for gestational age
- -Appropriate for gestational age
- -Larger for gestational age
SGA = < 10th percentile
AGA = 10-90th percentile
LGA = > 90th percentile
Preterm AGA infants are more prone to what 4 pathologies?
- -Respiratory distress syndrome
- -Apnea
- -Patent ductus arteriosus
- -Infection
What is believed to be a big cause of Preterm AGA infants?
Maternal smoking
Larger for gestational age may present w/ what pathology shortly after birth?
Metabolic abnormalities
When examining a newborn and having difficulty inspecting the eyes, what is a tip?
Dim lights and rock newborn
What are 7 things of appearance to note during the newborn exam sequence?
- -Newborn’s color
- -Size
- -Body proportions
- -Nutritional status
- -Posture
- -Respirations
- -Head/extremities movements
Most normal term newborns lie in what position?
Symmetric position, w/ limbs semi-flexed (frog leg)
Where is the Apical pulse palpated?
3rd-5th IC space in the Midcalvicular line
Where is the Femoral pulse palpated at?
Halfway from the pubic tubercle to ASIS
What is a normal pulse for a newborn?
120-170
What is a normal pulse for a 1 year old?
80-160
What is a normal pulse for a 3 year old?
80-120
What is a normal pulse for a 6 year old?
75-115
What is a normal pulse for a 10 year old?
70-110
During respiration what body part will rise and fall for an infant?
Abdomen
During respiration what body part will rise and fall for a child?
Chest
What is the normal respiration rate for a newborn?
30-80
What is the normal respiration rate for a 1 year old?
20-40
What is the normal respiration rate for a 3 year old?
20-30
What is the normal respiration rate for a 6 year old?
16-22
What is the normal respiration rate for a 10 year old?
16-20
What technique is used to take blood pressure on infants?
Flush technique
When using the flush technique gradually diminish pressure until..
You see a sudden “flush” and return to usual color
At what age should take blood pressure in a child the same as you would in an adult?
After 2 years
To make sure you are using the correct cuff size, the width should cover how much of the upper arm?
2/3
What will happen to your reading if your cuff size is too wide?
Underestimate BP
What will happen to your reading if your cuff size is too narrow?
Artificially high BP
What are the 2 best spots to take temperature for an infant?
Rectal or axillary
When measuring infants heigh (birth to 24-36 months) what distances are you measuring?
Top of head to heel (dorsiflexed)
What tools are recommended to measure infant height?
Infant measuring mat or headrest paper
At what development state is it ok to measuring a child’s height standing?
If able to stand w/out support
When measuring child height standing, what body parts should touch the wall?
Heels
Buttocks
Shoulders
When measuring a child’s height, the outer Can thus of the eye should line up w/…
External auditory canal
What is the most accurate tool to measure infant weight?
Infant platform scale
What is the pp for the infant platform scale?
Sit or lie
Before placing infant on scale what should you do?
Place paper or blank under the infant and weight it out
When should head circumference measurements be taken?
Done at every health visit
Where should head circumference be taken at?
Occipital protuberance to Supra orbital prominence
Where should chest circumference measurements be taken at?
Around the nipple line
When recording measurements, you should chart appropriately for what 2 things?
Sex and age
What are average birth weights?
5.8 lbs - 8.13 lbs
What is the average length at birth?
18-22 inches
What is the average head circumference at birth?
13-14 inches
Most babies born to the same parents weight w/in how many ounces of each other at birth?
6 oz
If there is a lower birth weight what are 2 things to suspect?
- -Congenital abnormality
- -Intrauterine growth retardation
What is the expected length growth in the 1st year of life?
50%
When should infant weight double and triple?
2x = 6 months 3x = 1 year
When should infant head be equal or exceed the chest by 2 cm?
Newborn to 5 months
When should the chest closely approximate the head circumference?
5 months to 2 years
When should the chest exceed head circumference?
> 2 years
What is the fastest growing body part during infancy?
Trunk
During infancy, fat increases until what age?
9 months of age
What is the fastest growing body part in children?
Legs
During childhood, fat increases slowly until what age?
7, then prepubertal fat spurt occurs
What is the fastest growing body part during adolescence?
Trunk and legs
What % of the ideal weight is gained during adolescence?
50%
What organ systems double in size during adolescence?
Skeletal mass and organ systems
What if head circumference increases rapidly or rises above percentile cureves?
Increased intracranial pressure
–Hydrocephalus, etc.
What if head circumference grows slowly or falls off percentile curves?
Microcephaly
–craniosynostosis, etc.
What are 3 physical manifestations associated w/ Turner syndrome?
- -Webbed neck w/ low hairline
- -Shield chest w/ widespread nipples
- -Abnormal ears
Transient puffiness of the hands, feet, eyelids, legs pubis or sacrum occurs in some newborns is not a concern if it disappears w/in how many days?
2-3 days
Some newborns are bald while other are born w/ an inordinate amount of head hair, when should it shed and be replaced w/ permanent hair?
2-3 months
Dark-skinned newborns do not always manifest the intensity of melanosis that will be readily evident in 2-3 months. What are 2 exceptions?
Nail beds and skin of the scrotum
What is transient mottling when infant is exposed to decreased temperature?
Curtis marmorata
What is cyanosis of hands and feet?
Acrocyanosis
Acrocyanosis is a common response to cold, and underlying cardiac defect if more persistent in…
In the feet than hands
Whitish, moist cheese like substance that covers the infants body at birth?
Vernix caseosa
Vernix caseosa is a mixture of what 2 things?
Sebum and skin cells
Fine, silky hair covering the newborn shoulders and back?
Lanugo
Lanugo should be shed w/in how many days?
10-14 days
Flat, deep pink, localized areas usually seen in back of neck?
Telangiectatic nevi
Irregular areas of blue/blue-gray pigmentation. Usually in sacral and gluteal regions.
Dermal melanocytosis “Mongolian spots”
Mongolian spots are seen predominantly in what 4 populations?
Africans, native Americans, asians, latins
Pink popular rash w/ vesicles superimposed on the thorax, back, buttocks, and abdomen?
Erythema toxicum
When do erythema toxicum spots appear and resolve
24-48 hrs after birth and resolves after several days
What 2 things should be examined in newborns for hyperbilirubinemia?
Oral mucosa and sclera
Hyperbilirubinemia starts where and becomes worrisome if?
Starts at face and worrisome if descends below the nipples
What are 5 risk factors for hyperbilirubinemia?
- -Breast feeding
- -Hemolytic disease
- -Infection
- -Cephalhematoma
- -Cutaneous or subcutaneous bleeds
Physiologic jaundice starts and usually disappears when?
Starts first day of life and disappears in 8-10 days
–(may persist for up to 3-4 weeks)
If jaundice is present in the first 24 hours or it is intense and/or persistent, you must consider..
Pathological jaundice
What 4 infections cause pathological jaundice?
Toxoplasmosis
Rubella
Herpes
Syphillis
What are 2 things to look at when examining skin creases?
- -Asymmetrical creases on thighs
- -simian line
What does asymmetrical creases on thighs indicate?
Possible hip dysplasia
Skin turner is best evaluated by gently pinching a fold of ____ skin.
Abdominal skin
What does tenting indicate?
Dehydration or malnutrition
What are 5 causes of clubbing of the nails?
Respiratory disease CVD Thyroid disease Cirrhosis Colitis
Place nail surface of corresponding fingers together to measure for clubbing?
Schamroth Technique
Small white discrete papules on the face and bridge of the nose?
Milia
What causes milia?
Plugged sebaceous glands
Milia is common during what age?
First 2-3 months
Heat rash is caused by…
Occlusion of sweat glands during periods of head and high humidity
What is miliaria?
Heat rash
What are common locations for eczamatous rash in young children?
Face, elbow, knees
What is seborrheic dermatitis?
Cradle cap
Scalp lesions are scaling, adherent, thick, yellow, and crusted?
Seborrheic dermatitis
When do strawberry hemangioma become noticeable?
1-2 months after birth
When do strawberry hemangioma’s grow most rapidly?
1-6 months after birth
When do you expect strawberry hemangioma’s to begin shrinking?
12-18 months
What is trichotillomania?
Pulling hair out
Tuft of hair overlying the spinal column usually in the lumbosacral area?
Faun tail nexus
What pathology is associated w/ faun tail nevus?
Spina bifida occulta
What are evenly pigmented patches present at birth or shortly thereafter?
Cafe au lait spots
If you note > 5 patches w/ diameters > 1 cm in a child under 5, what pathology is it?
Neurofibromatosis
Axillary freckling or inguinal freckling is associated w/ what pathology?
Neurofibromatosis
When a port-wine stain involves the opthalmic division of the trigeminal nerve it may be associated w/ what 2 things?
- -Sturge-Weber syndrome (seizures)
- -Occular defects
Supernumerary nipples are associated w/ what organ abnormalities?
Renal abnormalities
What lymph nodes in the neonate react quickly to any mild stimulus?
Cervical and postauricular chains
Is the enlargement of the tonsils in children an indication of a problem?
No
