[17] MIDTERMS | PROFILE OF THE NEWBORN Flashcards

Question 1

Q

VITAL STATISTICS

Weight- Average birth weight:

Answer

A

2.5 to 3.5 kg (7.7 lbs)

Question 2

Q

VITAL STATISTICS

Length: The average birth length of a mature female neonate is ____. For male, is ____

Answer

A

Length: The average birth length of a mature female neonate is 49 cm (19.2 in). For male, is 50 cm (19.6 in)

Question 3

Q

VITAL STATISTICS

Head Circumference

Answer

A

34-35 cm (13.5-14 in)

Question 4

Q

VITAL STATISTICS

Chest Circumference

Answer

A

About 2cm less than the head circumference

Question 5

Q

VITAL STATISTICS

Abdominal Circumference

Answer

A

Same as chest circumference

Question 6

Q

VITAL SIGNS

Temperature

Answer

A

37.2 C at birth

Baby is bathed 6 hours after birth (Unang Yakap)

Question 7

Q

VITAL SIGNS

Pulse

Answer

A

Average of 120 to 140 bpm or as low as 90 to 110 bpm

Question 8

Q

VITAL SIGNS

Respiration

Answer

A

Average of 30-60 breaths per min

Question 9

Q

VITAL SIGNS

Blood Pressure

Answer

A

Approximately 80/46 mmHg at birth.
By the 10th day, it rises to about 100/50 mmHg

Question 10

Q

CARDIOVASCULAR SYSTEM

The peripheral circulation of a newborn remains ____ for at least the first ____ hours after birth
Cyanosis in the NB’s feet & hands ( ____ )
Feet feel ____ to touch at this time
NB’s blood volume is ____ ml per kilogram of bodyweight, or about ____ in total.

Answer

A

The peripheral circulation of a newborn remains sluggish for at least the first 24 hours after birth
Cyanosis in the NB’s feet & hands (acrocyanosis)
Feet feel warm to touch at this time
NB’s blood volume is 80-110 ml per kilogram of bodyweight, or about 300ml in total.

Question 11

Q

CARDIOVASCULAR SYSTEM

RBC of ____ million cells/cubic millimeter, Hgb level ave. ____ g/100 ml of blood. Hct count ____
Indirect bilirubin level at birth is ____ mg/100ml.
WBC count, ____ cells/mm3 at birth
Lower than normal level of Vit ____

Answer

A

RBC of 6 million cells/cubic millimeter, Hgb level ave. 17-18 g/100 ml of blood. Hct count 45%-50%
Indirect bilirubin level at birth is 1-4 mg/100ml.
WBC count, 15,000-30,000 cells/mm3 at birth
Lower than normal level of Vit K

Question 12

Q

RESPIRATORY SYSTEM

All NB have ____ in the lungs from intrauterine life
A baby born by ____ birth does not have as much lung fluid expelled at birth
Premature babies, whose alveoli collapse each time they exhale (lack ____ ) have difficulty establishing effective ____ & respiration.

Answer

A

All NB have some fluid in the lungs from intrauterine life
A baby born by caesarean birth does not have as much lung fluid expelled at birth
Premature babies, whose alveoli collapse each time they exhale (lack lung surfactant) have difficulty establishing effective residual capacity & respiration.

Question 13

Q

GASTROINTESTINAL SYSTEM

____ at birth
Bacterial source may be ____; vaginal secretions during birth, ____, & from contact at the ____.
Accumulation of bacteria in the GIT is necessary for digestion & ____ synthesis.
NB stomach holds ____ ml.

Answer

A

Sterile at birth
Bacterial source may be airborne; vaginal secretions during birth, hospital bedding, & from contact at the breast.
Accumulation of bacteria in the GIT is necessary for digestion & vit k synthesis.
NB stomach holds 60-90 ml.

Question 14

Q

GASTROINTESTINAL SYSTEM

____ easily
Immature liver function can lead to a tendency toward lowered ____ and ____ levels.
____, first stool usually passed within 24hrs
____ stool, green & loose stool on the 2nd or 3rd day of life.
____ stools are noticed for babies receiving phototherapy. (Treatment for ____ )

Answer

A

Regurgitates easily
Immature liver function can lead to a tendency toward lowered glucose and protein serum levels.
Meconium, first stool usually passed within 24hrs
Transitional stool, green & loose stool on the 2nd or 3rd day of life.
Bright green stools are noticed for babies receiving phototherapy. (Treatment for jaundice)

Question 15

Q

URINARY SYSTEM

Immature - decreased ability to remove waste products from the blood.
NB voids within 24 hrs after birth, ____ & ____. About ____ ml in single voiding.
Males should be assessed to void with enough force to produce a small ____; females should produce a ____, not just continuous dribbling.
The first voiding may be ____ or ____
Specific gravity ranges from ____ to ____.
The daily urinary output for the first 1 or 2 days is about ____ to ____ ml total.
Diapers can be weighed to determine amount & timings of voiding.

Answer

A

Immature - decreased ability to remove waste products from the blood.
NB voids within 24 hrs after birth, light-colored & odorless. About 15ml in single voiding.
Males should be assessed to void with enough force to produce a small projected arc; females should produce a steady stream, not just continuous dribbling.
The first voiding may be pink or dusky
Specific gravity ranges from 1.008 to 1.010.
The daily urinary output for the first 1 or 2 days is about 30 to 60 ml total.
Diapers can be weighed to determine amount & timings of voiding.

Question 16

Q

IMMUNE SYSTEM

With passive antibodies ( ____ ) from mother that crossed the placenta.
Difficulty of forming antibodies against invading antigens until about ____ months of age
____ is highly advised.

Answer

A

With passive antibodies (Immunoglobulin G) from mother that crossed the placenta.
Difficulty of forming antibodies against invading antigens until about 2 months of age
Breastfeeding is highly advised.

Question 17

Q

NEUROMUSCULAR SYSTEM

Term neonates demonstrate neuromuscular function by moving their extremities attempting to control the ____ movement, exhibiting a strong ____, and demonstrating newborn ____.
Limpness or total absence of muscular response to manipulation is never normal & suggests ____, ____ or ____

Answer

A

Term neonates demonstrate neuromuscular function by moving their extremities attempting to control the head movement, exhibiting a strong cry, and demonstrating newborn reflexes.
Limpness or total absence of muscular response to manipulation is never normal & suggests narcosis, shock or cerebral injury

Question 18

Q

REFLEXES SEEN IN NEWBORNS

R____ reflex
S____ reflex
S____ reflex
E____ reflex
M____ reflex
T____ reflex
P____ reflex
S____ reflex
P____ reflex
B____ reflex
Other reflexes

Answer

A

Rooting reflex
Sucking reflex
Swallowing reflex
Extrusion reflex
Moro / Startle reflex
Tonic neck / Fencing reflex
Palmar grasp reflex
Stepping, placing or dancing reflex
Plantar grasp reflex
Babinski reflex
Other reflexes

Question 19

Q

SENSES

The senses in newborn are ____ at birth.

HEARING
VISION
TOUCH
TASTE
SMELL

Answer

A

The senses in newborn are already developed at birth.

HEARING
VISION
TOUCH
TASTE
SMELL

Question 20

Q

PHYSICAL EXAMINATION

SKIN COLOR & LESIONS

Assess for ____, cyanosis, ____, & jaundice
General inspection of a newborn’s skin includes the color, ____, and general appearance

Answer

A

SKIN COLOR & LESIONS

Assess for pallor, cyanosis, plethora, & jaundice
General inspection of a newborn’s skin includes the color, any birthmarks, and general appearance

Question 21

Q

PHYSICAL EXAMINATION

SKIN COLOR & LESIONS - FINDINGS

COLOR

Normal color: cyanosis, acrocyanosis, ____, ____, ____

BIRTHMARKS: - Hemangioas
1. ____ or Port Wine Stain
2. ____ Hemangiomas
3. ____ Heamangiomas
4. ____

Answer

A

SKIN COLOR & LESIONS - FINDINGS

COLOR

Normal color: cyanosis, acrocyanosis, jaundice, pallor, Harlequin sign

BIRTHMARKS: - Hemangiomas
1. Nevus Flammeus or Port Wine Stain
2. Strawberry Hemangiomas
3. Cavernous Heamangiomas
4. Mongolian Spots

Question 22

Q

PHYSICAL EXAMINATION

SKIN COLOR & LESIONS - FINDINGS

GENERAL APPEARANCE

VERNIX CASEOSA

White, cream cheese-like substance that serves as a ____. Usually, it is noticeable on a term newborn’s skin.
Document the color of the vernix because it takes on the color of the ____.
____ vernix indicates meconium was present in the amniotic fluid. ____ vernix implies that the amniotic fluid was ____ from bilirubin.

Answer

A

SKIN COLOR & LESIONS - FINDINGS

GENERAL APPEARANCE

VERNIX CASEOSA

White, cream cheese-like substance that serves as a skin lubricant. Usually, it is noticeable on a term newborn’s skin.
Document the color of the vernix because it takes on the color of the amniotic fluid.
Green vernix indicates meconium was present in the amniotic fluid. Yellow vernix implies that the amniotic fluid was yellow from bilirubin.

Question 23

Q

PHYSICAL EXAMINATION

LANUGO

Fine, ____ hair that covers a newborn’s shoulders, back & upper arms.
A baby born after ____ wks of gestation has more lanugo than ____ wks AOG.
By ____ wks of age it has disappeared

Answer

A

LANUGO

Fine, downy hair that covers a newborn’s shoulders, back & upper arms.
A baby born after 37-39 wks of gestation has more lanugo than 40 wks AOG.
By 2 wks of age it has disappeared

Question 24

Q

PHYSICAL EXAMINATION

DESQUAMATION

Within ____ hrs after birth, skin of most NB has become extremely dry. Dryness is particularly evident on the ____ & ____.
Newborns who are ____ and have suffered ____ may have such extremely dry skin that it has a leathery appearance and there are actual cracks in the skin folds.
This should be differentiated from normal desquamation because it helps to diagnose the newborn as ____

Answer

A

DESQUAMATION

Within 24 hrs after birth, skin of most NB has become extremely dry. Dryness is particularly evident on the palms of the hands & soles of the feet.
Newborns who are postterm and have suffered intrauterine malnutrition may have such extremely dry skin that it has a leathery appearance and there are actual cracks in the skin folds.
This should be differentiated from normal desquamation because it helps to diagnose the newborn as postterm

Question 25

Q

PHYSICAL EXAMINATION

MILIA

All NB sebaceous glands are immature. A ____ can be found on the cheek or across the bridge of the nose.
Disappear by ____ weeks of age as the sebaceous glands mature and the plugged ones drain.

Answer

A

MILIA

All NB sebaceous glands are immature. A white pinpoint white papulae can be found on the cheek or across the bridge of the nose.
Disappear by 3 to 4 weeks of age as the sebaceous glands mature and the plugged ones drain.

Question 26

Q

PHYSICAL EXAMINATION

ERYTHEMA TOXICUM

A newborn rash; usually appears on the ____ day of life, may appear up to ____ weeks of age. Rash has no pattern. It is caused by a NB’s ____ reacting to the environment as the immune system matures.

Answer

A

ERYTHEMA TOXICUM

A newborn rash; usually appears on the 1st to 4th day of life,may appear up to 2 weeks of age. Rash has no pattern. It is caused by a NB’s eosinophils reacting to the environment as the immune system matures.

Question 27

Q

PHYSICAL EXAMINATION

FORCEP MARKS

If forceps were used for birth, there maybe a circular or linear contusion matching the rim of the blade of the forceps on the infants’ cheek. Disappear in ____ days, along with the ____ that accompanies it.

Answer

A

FORCEP MARKS

If forceps were used for birth, there maybe a circular or linear contusion matching the rim of the blade of the forceps on the infants’ cheek. Disappear in 1-2 days, along with the edema that accompanies it.

Question 28

Q

PHYSICAL EXAMINATION

HEAD

Check for ____ sutures, abnormal shape & size of the head, ____ & ____
Also measure the head ____. Take note that during infancy the head is the largest area in the body, and it remain disproportionate to the body until ____ years old

Answer

A

HEAD

Check for overriding sutures, abnormal shape & size of the head, posterior & anterior fontanel
Also measure the head circumference. Take note that during infancy the head is the largest area in the body, and it remain disproportionate to the body until 5 years old

Question 29

Q

PHYSICAL EXAMINATION

HEAD - FINDINGS

appears ____
____ large & prominent
____ appears to be receding

Answer

A

HEAD - FINDINGS

appears disproportionately large
Forehead large & prominent
Chin appears to be receding

Question 30

Q

PHYSICAL EXAMINATION

spaces or openings where the skull bones join.
anterior
posterior

Question 31

Q

PHYSICAL EXAMINATION

separates the line of the skull

Question 32

Q

PHYSICAL EXAMINATION

part of the NB’s head that engages the cervix is molded to fit the cervix contours.
appears to be prominent & asymmetric

Question 33

Q

PHYSICAL EXAMINATION

Edema of the scalp at the presenting part of the head.
Absorbs & disappears about the 3rd day.

Answer

A

CAPUT SUCCEDANEUM

Question 34

Q

PHYSICAL EXAMINATION

collection of blood between the periosteum of a skull bone & itself;
caused by rupture of a periostal capillary due to pressure of birth

Answer

A

CEPHALHEMATOMA

Question 35

Q

PHYSICAL EXAMINATION

Localized softening of cranial bones probably caused by pressure of fetal skull against the mother’s pelvic bone in utero.

Answer

A

CRANIOTABES

Question 36

Q

PHYSICAL EXAMINATION

EYES

Lay the infant in a ____ position and lift the head.
Inspect the eyes color, size, symmetry, ____ and ____.

Application of Terramycin Opthalmic Ointment to avoid Opthalmia Neonatorum

Answer

A

EYES

Lay the infant in a supine position and lift the head.
Inspect the eyes color, size, symmetry, swelling and discharge.

Question 37

Q

PHYSICAL EXAMINATION

EYES - FINDINGS

NB cry ____
____ hemorrhage
Irises are usually ____ or ____

Answer

A

EYES - FINDINGS

NB cry tearlessly
Subconjunctival hemorrhage
Irises are usually gray or blue

Question 38

Q

PHYSICAL EXAMINATION

EYES - FINDINGS

Sclera maybe ____ due to its thinness.
Assume permanent color between ____ & ____ mos of age.
Edema often present around the ____ or on the ____.
____ should appear round & proportionate in size.
Pupils should be ____

Answer

A

EYES - FINDINGS

Sclera maybe blue due to its thinness.
Assume permanent color between 3 & 12 mos of age.
Edema often present around the orbit or on the eyelids.
Cornea should appear round & proportionate in size.
Pupils should be dark

Question 39

Q

PHYSICAL EXAMINATION

EARS - FINDINGS

Not completely formed
____ tends to bend easily
level of the top part of external ear should be on a line drawn from the ____ to the ____ of the eye & back across the side of the head.
Visualization of the ____ of the NB is usually not attempted.
hearing test is done by ringing a bell held about ____ inches away from each ear

Answer

A

EARS - FINDINGS

Not completely formed
Pinna tends to bend easily
level of the top part of external ear should be on a line drawn from the inner canthus to the outer canthus of the eye & back across the side of the head.
Visualization of the tympanic membrane of the NB is usually not attempted.
hearing test is done by ringing a bell held about 6 inches away from each ear

Question 40

Q

PHYSICAL EXAMINATION

NOSE

Look for flaring of the ____, which is a sign of increased respiratory effort
Check for ____
Check for defects such as ____

Answer

A

NOSE

Look for flaring of the alae nasi, which is a sign of increased respiratory effort
Check for choanal atresia
Check for defects such as cleft lip & palate

Question 41

Q

PHYSICAL EXAMINATION

NOSE - FINDINGS

Appear large for the face
Note for any discomfort or distress with breathing.
Record presence of ____ on the nose.
Test for ____ (blockage of the rear of the nose)
(+) ____

Answer

A

NOSE - FINDINGS

Appear large for the face
Note for any discomfort or distress with breathing.
Record presence of milia on the nose.
Test for choanal atresia (blockage of the rear of the nose)
(+) cleft lip & palate

Question 42

Q

PHYSICAL EXAMINATION

MOUTH

Inspect the mouth for size, shape and color
Note also if there is a ____ present
Inspect the ____ for intactness.

Answer

A

MOUTH

Inspect the mouth for size, shape and color
Note also if there is a tooth/teeth present
Inspect the palate for intactness.

Question 43

Q

PHYSICAL EXAMINATION

MOUTH - FINDINGS

Open evenly when NB cries.
Tongue appears large & prominent in the mouth.
Tongue is short creating an impression of ____.
____ should be intact.
One or two small round glistening, well circumscribed cysts are present on the palate, ____.
Sometimes natal teeth will have erupted.
____ can also be seen on the tongue and sides of the cheeks as white or gray patches and requires antifungal treatment.

Answer

A

MOUTH - FINDINGS

Open evenly when NB cries.
Tongue appears large & prominent in the mouth.
Tongue is short creating an impression of “tongue tied”.
Palate should be intact.
One or two small round glistening, well circumscribed cysts are present on the palate, Epstein’s pearls.
Sometimes natal teeth will have erupted.
Thrush can also be seen on the tongue and sides of the cheeks as white or gray patches and requires antifungal treatment.

Question 44

Q

PHYSICAL EXAMINATION

NECK

Inspect for symmetry of shape of the neck, its alignment; ____ & possible ____; ____
Assess infant’s ability to ____

Answer

A

NECK

Inspect for symmetry of shape of the neck, its alignment; lumps & possible fracture; lymph nodes
Assess infant’s ability to control head

Question 45

Q

PHYSICAL EXAMINATION

NECK - FINDINGS

Short & often ____, with increased skin folds
(-) rigidity of neck ( ____ )
Not strong enough to support total weight of head

Answer

A

NECK - FINDINGS

Short & often chubby, with increased skin folds
(-) rigidity of neck (Congenital torticollis)
Not strong enough to support total weight of head

Question 46

Q

PHYSICAL EXAMINATION

CHEST

Assess for the ____ and pattern and observe chest movement for symmetry and ____
Inspect the ____ for appearance and presence of symmetry
Palpate the ____ for swelling and edema
Breast may be slightly ____ secondary to presence of maternal hormones
Auscultate for breath sounds, noting the inspiratory to expiratory ratio and the presence of ____
____ is of little clinical benefit and should be avoided especially in low-birth-weight or preterm infants as it may cause injury

Answer

A

CHEST

Assess for the respiratory rate and pattern and observe chest movement for symmetry and retractions
Inspect the clavicles for appearance and presence of symmetry
Palpate the breast for swelling and edema
Breast may be slightly enlarged secondary to presence of maternal hormones
Auscultate for breath sounds, noting the inspiratory to expiratory ratio and the presence of adventitious sounds
Percussion is of little clinical benefit and should be avoided especially in low-birth-weight or preterm infants as it may cause injury

Question 47

Q

PHYSICAL EXAMINATION

CHEST - FINDINGS

Breast maybe engorged.
May appear small
____ milk
Clavicles should be straight, should appear symmetric side by side
RR: ____ bpm
(-) chest ____

Answer

A

CHEST

Breast maybe engorged.
May appear small
Witch’s milk
Clavicles should be straight, should appear symmetric side by side
RR: 30-60 bpm
(-) chest retractions

Question 48

Q

PHYSICAL EXAMINATION

ABDOMEN

Inspect for the shape; contour & note any abdominal ____, masses, visible peristalsis, ____, & obvious malformations
Assess umbilical cord & count the ____; auscultate for bowel sounds.
Inspect anal area for patency & for presence of ____ or ____.
Palpate for the kidneys

Answer

A

ABDOMEN

Inspect for the shape; contour & note any abdominal distension, masses, visible peristalsis, diastasis recti, & obvious malformations
Assess umbilical cord & count the vessels; auscultate for bowel sounds.
Inspect anal area for patency & for presence of fistulas or skin tags.
Palpate for the kidneys

Question 49

Q

PHYSICAL EXAMINATION

ABDOMEN - FINDINGS

Looks slightly ____
Bowel sound should be present within ____ hr after birth.
Edge of the liver should be palpable 1-2 cm below the ____ margin
Edge of the spleen should be palpable 1-2 cm below the ____ margin

Answer

A

ABDOMEN - FINDINGS

Looks slightly protuberant
Bowel sound should be present within 1hr after birth.
Edge of the liver should be palpable 1-2 cm below the right costal margin
Edge of the spleen should be palpable 1-2 cm below the left costal margin

Question 50

Q

PHYSICAL EXAMINATION

ABDOMEN -FINDINGS

Umbilical cord appears bluish white, gelatinous structure; moist; marked with the red & blue streaks of umbilical vein & 2 arteries during the ____ hr.
After clamping: begins to dry & appears dull & ____, then turns ____

Answer

A

ABDOMEN -FINDINGS

Umbilical cord appears bluish white, gelatinous structure; moist; marked with the red & blue streaks of umbilical vein & 2 arteries during the 1st hr.
After clamping: begins to dry & appears dull & yellowish brown, then turns greenish black

Question 51

Q

PHYSICAL EXAMINATION

ABDOMEN - FINDINGS

single artery = ____ or ____
Hematoma / ____
Draining & ____ at the base

Answer

A

ABDOMEN - FINDINGS

single artery = congenital heart or renal abnormality
Hematoma / omphalocele
Draining & erythematous at the base

Question 52

Q

PHYSICAL EXAMINATION

ANOGENITAL AREA

____ anus; not covered by a membrane
Check for ____ anus
Note for the time after which the infant first passes ____

Answer

A

ANOGENITAL AREA

Patent anus; not covered by a membrane
Check for imperforate anus
Note for the time after which the infant first passes meconium

Question 53

Q

PHYSICAL EXAMINATION

ANOGENITAL AREA - FINDINGS

____ - The opening to the anus is missing or blocked.
____ may exist wherein stool is evacuated via the vagina, scrotum, or raphe.

Answer

A

ANOGENITAL AREA - FINDINGS

Imperforate anus - The opening to the anus is missing or blocked.
Fistula may exist wherein stool is evacuated via the vagina, scrotum, or raphe.

Question 54

Q

PHYSICAL EXAMINATION

MALE GENITALIA

Assess any malformation, abnormalities or ____.
Inspect glans, urethral opening, foreskin or the prepuce, & the scrotum; palpate for the testes & ensure that both testicles are descended into ____.
Elicit ____ reflex by stroking the internal side of the thigh.

Answer

A

MALE GENITALIA

Assess any malformation, abnormalities or sexual ambiguity.
Inspect glans, urethral opening, foreskin or the prepuce, & the scrotum; palpate for the testes & ensure that both testicles are descended into scrotum.
Elicit cremasteric reflex by stroking the internal side of the thigh.

Question 55

Q

PHYSICAL EXAMINATION

FEMALE GENITALIA

Check the labia, clitoris, urethral opening & ____

Answer

A

FEMALE GENITALIA

Check the labia, clitoris, urethral opening & external vaginal vault

Question 56

Q

PHYSICAL EXAMINATION

MALE GENITALIA - FINDINGS

Scrotum edematous & has ____
Both ____ should be present in the scrotum
(+) cremasteric reflex, elicited by stroking ____ of thigh
____ - penis is absent
____ - urethra ends in the upper part of penis
____ - urethra ends in the underside of penis

Answer

A

MALE GENITALIA - FINDINGS

Scrotum edematous & has rugae
Both testes should be present in the scrotum
(+) cremasteric reflex, elicited by stroking internal side of thigh
Agenesis - penis is absent
Epispadias - urethra ends in the upper part of penis
Hypospadias - urethra ends on the underside of penis

Question 57

Q

PHYSICAL EXAMINATION

FEMALE GENITALIA - FINDINGS

Vulva may be ____ (effect of maternal hormones)
Sometimes with mucus vaginal secretion, ____ if blood tinged. This ____ is a manifestation of the abrupt decrease in maternal hormones and usually disappears by ____ weeks of age.

Answer

A

FEMALE GENITALIA - FINDINGS

Vulva may be swollen (effect of maternal hormones)
Sometimes with mucus vaginal secretion, pseudomenstruation if blood tinged. This pseudomenstruation is a manifestation of the abrupt decrease in maternal hormones and usually disappears by 2 to 4 weeks of age.

Question 58

Q

PHYSICAL EXAMINATION

BACK

Inspect the back and base of the newborn’s spine for opening, ____, or ____ in the skin

Answer

A

BACK

Inspect the back and base of the newborn’s spine for opening, dimpling, or sinus tract in the skin

Question 59

Q

PHYSICAL EXAMINATION

BACK - FINDINGS

Flat in the ____ & ____ areas.
(-) dimpling, (-) sinus tract (suggest ____ )
A ____ anywhere along the spine, but most commonly in the sacral area, indicates some type of spina bifida.
A ____ may indicate the existence of spina bifida occulta or be a portal of entry into the spinal column.

Answer

A

BACK - FINDINGS

Flat in the lumbar & sacral areas.
(-) dimpling, (-) sinus tract (suggest spinal bifida)
A protruding sac anywhere along the spine, but most commonly in the sacral area, indicates some type of spina bifida.
A pilonidal cyst may indicate the existence of spina bifida occulta or be a portal of entry into the spinal column.

Question 60

Q

PHYSICAL EXAMINATION

EXTREMITIES

Test the upper extremities for ____
Assess shoulder girdle for injury & clavicles for fracture (shoulder ____ ).
Assess mobility of the ____ & extension of ____. Inspect ____ for assessment of gestational age & count the fingers.
Assess the feet & ankles for deformity, mobility & count the toes.
Test for ____
Examine the ____ last, using the ____.
Check for ____

Answer

A

EXTREMITIES

Test the upper extremities for muscle tone
Assess shoulder girdle for injury & clavicles for fracture (shoulder dystocia).
Assess mobility of the shoulder & extension of elbow. Inspect palmar creases for assessment of gestational age & count the fingers.
Assess the feet & ankles for deformity, mobility & count the toes.
Test for capillary refill
Examine the hips last, using the Ortolani-Barlow maneuver.
Check for ankle clonus

Question 61

Q

PHYSICAL EXAMINATION

EXTREMITIES - FINDINGS

The arms and legs of the newborn appear ____ in proportion to the trunk.
The hands seem plump and clenched.
Short arms would signify ____
____
The legs appear ____ and short
The sole of the foot is ____
Feet turned in ( ____ deviation).
A foot does not align readily or will not turn to midline position ( ____ ).

Answer

A

EXTREMITIES - FINDINGS

The arms and legs of the newborn appear short in proportion to the trunk.
The hands seem plump and clenched.
Short arms would signify achondroplasia (dwarfism)
Simian crease
The legs appear bowed and short
The sole of the foot is flat
Feet turned in (Varus deviation).
A foot does not align readily or will not turn to midline position (clubfoot).

Question 62

Q

BALLARD SCORE

Also know as ____
It allows clinicians to estimate ____
It is based on the neonate’s physical and neuromuscular maturity and can be used up to ____ days after birth
The ____ components are more consistent over time because the ____ components mature quickly after birth

Answer

A

Also know as “Dubowitz”
It allows clinicians to estimamate gestational age
It is based on the neonate’s physical and neuromuscular maturity and can be used up to 4 days after birth
The neuromusuclar components are more consistent over time because the physical components mature quickly after birth

Question 63

Q

BALLARD SCORE

Because the Ballard score is accurate only within plus or minus ____ weeks, it should be used to assign gestational age only when there is ____ about the estimated date of confinement or there is a major discrepancy between the obstetrically defined gestational age and the findings on physical examination.
Scores from neuromuscular and physical domains are added to obtain total score.

Answer

A

Because the Ballard score is accurate only within plus or minus 2 weeks, it should be used to assign gestational age only when there is no reliable obstetrical information about the estimated date of confinement or there is a major discrepancy between the obstetrically defined gestational age and the findings on physical examination.
Scores from neuromuscular and physical domains are added to obtain total score.

Question 64

Q

BALLARD SCORE

Premature: < 34 weeks gestation
Late pre-term: 34 to < 37 weeks
Early term: 37 0/7 weeks through 38 6/7 weeks
Full term: 39 0/7 weeks through 40 6/7 weeks
Late term: 41 0/7 weeks through 41 6/7 weeks
Post term: 42 0/7 weeks and beyond
Postmature: > 42 weeks

Answer

A

Premature: < 34 weeks gestation
Late pre-term: 34 to < 37 weeks
Early term: 37 0/7 weeks through 38 6/7 weeks
Full term: 39 0/7 weeks through 40 6/7 weeks
Late term: 41 0/7 weeks through 41 6/7 weeks
Post term: 42 0/7 weeks and beyond
Postmature: > 42 weeks

Answer 62

A

SILVERMAN-ANDERSEN INDEX

Answer 63

A

APGAR SCORING

Answer 64

A

The 1-minute score determines how well the baby tolerated the birthing process.
The 5-minute score tells the health care provider how well the baby is doing outside the mother’s womb.
The newborn is considered to be “vigorous” if the initial scores are 7 and above. If the five-minute score is less than 7, scoring is done every five minutes thereafter until the score reaches 7.
It may be repeated at 10, 15, and 20 minutes if the score is low.

Answer 65

A

Virginia Apgar, MD (1909-1974) introduced the Apgar score in 1952.
It is done by a doctor, midwife, or nurse
The provider examines the baby’s:
-> Respiratory effort
-> Heart rate
-> Muscle tone
-> Reflex Irritability
-> Skin color
Each category is scored with 0, 1, or 2, depending on the observed condition.
Acrocyanosis is common in newborns that a score of 1 can be thought as normal.

Answer 66

A

A - ACTIVITY
P - PULSE
G - GRIMACE
A - APPEARANCE
R - RESPIRATION

Answer 67

A

Apgar scores of 0-3 are critically low, especially in term and late-preterm infants
Apgar scores of 4-6 are below normal, and indicate that the baby likely requires medical intervention
Apgar scores of 7+ are considered normal (1, 3)

A baby with a low Apgar score may need:
* Oxygen and clearing out the airway to help with breathing
* Physical stimulation to get the heart beating at a healthy rate
* Most of the time, a low score at 1 minute is near-normal by 5 minutes.