[17] MIDTERMS | PROFILE OF THE NEWBORN

Question 1

VITAL STATISTICS

Weight- Average birth weight:

Answer 1

2.5 to 3.5 kg (7.7 lbs)

Question 2

VITAL STATISTICS

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

Answer 2

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

VITAL STATISTICS

Head Circumference

Answer 3

34-35 cm (13.5-14 in)

Question 4

VITAL STATISTICS

Chest Circumference

Answer 4

About 2cm less than the head circumference

Question 5

VITAL STATISTICS

Abdominal Circumference

Answer 5

Same as chest circumference

Question 6

VITAL SIGNS

Temperature

Answer 6

37.2 C at birth

Baby is bathed 6 hours after birth (Unang Yakap)

Question 7

VITAL SIGNS

Pulse

Answer 7

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

Question 8

VITAL SIGNS

Respiration

Answer 8

Average of 30-60 breaths per min

Question 9

VITAL SIGNS

Blood Pressure

Answer 9

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

Question 10

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 10

• 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

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 11

• 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

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 12

• 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

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 13

• 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

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 14

• 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

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 15

• 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

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 16

• 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

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 17

• 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

REFLEXES SEEN IN NEWBORNS

1. R____ reflex
2. S____ reflex
3. S____ reflex
4. E____ reflex
5. M____ reflex
6. T____ reflex
7. P____ reflex
8. S____ reflex
9. P____ reflex
10. B____ reflex
11. Other reflexes

Answer 18

1. Rooting reflex
2. Sucking reflex
3. Swallowing reflex
4. Extrusion reflex
5. Moro / Startle reflex
6. Tonic neck / Fencing reflex
7. Palmar grasp reflex
8. Stepping, placing or dancing reflex
9. Plantar grasp reflex
10. Babinski reflex
11. Other reflexes

Question 19

SENSES

The senses in newborn are ____ at birth.

• HEARING
• VISION
• TOUCH
• TASTE
• SMELL

Answer 19

The senses in newborn are already developed at birth.

• HEARING
• VISION
• TOUCH
• TASTE
• SMELL

Question 20

PHYSICAL EXAMINATION

SKIN COLOR & LESIONS

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

Answer 20

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

PHYSICAL EXAMINATION

SKIN COLOR & LESIONS - FINDINGS

COLOR
* Normal color: cyanosis, acrocyanosis, ____, ____, ____

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

Answer 21

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

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 22

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

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 23

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

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 24

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

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 25

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

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 26

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

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 27

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

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 28

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

PHYSICAL EXAMINATION

HEAD - FINDINGS

• appears ____
• ____ large & prominent
• ____ appears to be receding

Answer 29

HEAD - FINDINGS

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

Question 30

PHYSICAL EXAMINATION

• spaces or openings where the skull bones join.
  anterior
  posterior

Answer 30

FONTANEL

Question 31

PHYSICAL EXAMINATION

• separates the line of the skull

Answer 31

SUTURES

Question 32

PHYSICAL EXAMINATION

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

Answer 32

MOLDING

Question 33

PHYSICAL EXAMINATION

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

Answer 33

CAPUT SUCCEDANEUM

Question 34

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 34

CEPHALHEMATOMA

Question 35

PHYSICAL EXAMINATION

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

Answer 35

CRANIOTABES

Question 36

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 36

EYES

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

Question 37

PHYSICAL EXAMINATION

EYES - FINDINGS

• NB cry ____
• ____ hemorrhage
• Irises are usually ____ or ____

Answer 37

EYES - FINDINGS

• NB cry tearlessly
• Subconjunctival hemorrhage
• Irises are usually gray or blue

Question 38

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 38

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

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 39

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

PHYSICAL EXAMINATION

NOSE

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

Answer 40

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

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 41

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

PHYSICAL EXAMINATION

MOUTH

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

Answer 42

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

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 43

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

PHYSICAL EXAMINATION

NECK

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

Answer 44

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

PHYSICAL EXAMINATION

NECK - FINDINGS

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

Answer 45

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

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 46

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

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 47

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

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 48

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

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 49

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

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 50

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

PHYSICAL EXAMINATION

ABDOMEN - FINDINGS

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

Answer 51

ABDOMEN - FINDINGS

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

Question 52

PHYSICAL EXAMINATION

ANOGENITAL AREA

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

Answer 52

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

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 53

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

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 54

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

PHYSICAL EXAMINATION

FEMALE GENITALIA

• Check the labia, clitoris, urethral opening & ____

Answer 55

FEMALE GENITALIA

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

Question 56

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 56

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

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 57

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

PHYSICAL EXAMINATION

BACK

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

Answer 58

BACK

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

Question 59

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 59

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

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 60

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

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 61

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

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 62

• 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

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 63

• 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

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 64

• 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

Question 65

• It is used to assess the degree of respiratory distress in neonates
• Evaluates five parameters and assigns a numerical score for each parameter.
  -> Chest movement
  -> Intercostal retraction
  -> Xiphoid retraction
  -> Nares dilatation
  -> Expiratory grunt

Answer 65

SILVERMAN-ANDERSEN INDEX

Question 66

It is a quick test performed on a baby at 1 and 5 minutes after birth

Answer 66

APGAR SCORING

Question 67

APGAR SCORING

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

Answer 67

• 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.

Question 68

APGAR SCORE

• ____ (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 ____, depending on the observed condition.
• ____ is common in newborns that a score of 1 can be thought as normal.

Answer 68

• 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.

Question 69

• A - ____
• P - ____
• G - ____
• A - ____
• R - ____

Answer 69

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

Question 70

APGAR SCORE - INTERPRETATION

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

A baby with a low Apgar score may need:
* ____ and clearing out the airway to help with breathing
* ____ 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.

Answer 70

• 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.