2.3 Developmental Assessment - Newborn Flashcards
What does APGAR stand for
- Activity (muscle tone)
- Pulse
- Grimace- reflex irritability in response to skin stimulation to feet
- Appearance - skin color
- Respiration- resp effort
Immediate evaluation of the newborn at 1 and
5 minutes of age is a valuable routine
The 1-minute
score reflects the newborn’s transition to extrauterine life.
* APGAR score: 8 to 10
* Vigorous, pink, and crying
* Requires only warming, drying, gentle stimulation
* Occasionally requires oxygen for a short period
* APGAR score: 5 to 7
* Cyanotic
* Slow, irregular respirations
* Good muscle tone and reflexes
* Responds to bag-and-mask ventilation
* APGAR score: 4 or less
* Limp, pale, or blue
* Apneic, slow heart rate
- Maximal resuscitative efforts with bag and mask, chest compres-
sions, intravenous (IV) volume expansion, and drug therapy
How can lungs be impacted by vaginal vs C section
Vag- the squeezing action on a
newborn’s chest as it passes through the pelvis and vagina assists in expulsion of amniotic fluid from the lungs.
C-section - does not
experience the squeezing action of a vaginal birth and requires
respiratory efforts and appropriate bulb suctioning to adequately
clear the amniotic fluid.
Are there benefits to delayed umbilical cord clamping
yes- 30-60 sec delayed clamping improves iron stores to prevent anemia
What does Vit K injection prevent in newborns
hemorrhage
How should the umbilical cord stump be cared for
left open to air
place diaper below cord
do not apply alcohol
slighly bloody discharge when falls off in 10-14 days is normal
Do not cover
if turns red, foul smelling, hot seek care
What are normal HR and RR of a newborn
HR 100-190
RR 30-60
Lanugo, vernix, dry and cracked skin are normal in the newborn.
What are lanugo and vernix
Lanugo- A fine, soft hair that covers a baby’s body, including the scalp, forehead, cheeks, shoulders, and back. Helps keep warm and protect skin
Vernix- waxy, cheese substsance that covers the fetus when delivered
languo helps vernix stick to skin
What type of eye movements are normal in newborns
- Intermittent uncoordinated eye movements (disconjugate gaze) during the first weeks after birth are common
- improving by 2-4 months old
- resolving by 6 months old.
What is important to check for the eyes of a newborn
red reflex
What is a typical size for HC in newborns
33cm
What is a normal finding for newborn nipples
3
- milky discharge from nipples secondary to maternal hormones
- supernumerary or inverted nipples are common
What is a common cardiac finding in newborns
cardiac murmurs
Match the type of murmur to its description and implications
Name of Murmur:
* Peripheral Pulmonary Stenosis (PPS)
* Transient Tricuspid Regurgitation
* Ventricular Septal Defect (VSD)
* Atrial Septal Defect (ASD)
* Patent Ductus Arteriosus (PDA)
* Tetralogy of Fallot (TOF)
* Coarctation of the Aorta
* Still’s Murmur
* Innocent Flow Murmur
Description:
* Soft systolic murmur at the upper left sternal border with a wide, fixed split of S2.
* Soft, blowing murmur heard at the upper left sternal border, often louder when supine.
* Harsh, systolic murmur at the left upper sternal border due to pulmonary stenosis.
* Vibratory or musical low-frequency systolic murmur heard at the mid or lower left sternal border.
* Harsh, holosystolic murmur at the left lower sternal border, may be associated with signs of heart failure.
* Continuous “machinery-like” murmur heard at the left infraclavicular area, may have bounding pulses.
* Soft, blowing, systolic murmur heard at the axillae or back, resolves as pulmonary arteries grow.
* Systolic murmur heard between the scapulae, weak femoral pulses, blood pressure discrepancy in limbs.
* Soft, systolic murmur at the left lower sternal border due to high pulmonary pressures, resolves quickly.
Implication:
* Pathological
* Physiological
* Physiological
* Pathological
* Pathological
* Physiological
* Pathological
* Physiological
* Pathological
Compare and constrast innocent and pathological murmurs
What are red flags for murmurs in infants
5
- Cyanosis or pallor
- Respiratory distress or grunting.=
- Poor feeding or lethargy
- Pulse oximetry reading <95% on the right hand or foot
- Persistent murmur beyond neonatal period (first 28 days)
Match the following newborn reflexes to their descriptions
Primitive reflexes:
* Asymmetric Tonic Neck Reflex (ATNR)
* Rooting Reflex
* Ankle Clonus
* Truncal Incurvation (Galant Reflex)
* Suck/Swallow Reflex
* Moro Reflex (Startle)
* Stepping and Placing Reflex
* Palmar Grasp Reflex
Descriptions:
* When the infant’s cheek is stroked, they turn their head and open their mouth toward the stimulus.
* When something touches the roof of the infant’s mouth, they begin sucking and swallowing.
* When the palm is touched, the infant closes their hand tightly around the object.
* In response to a sudden noise or movement, the infant extends arms, arches the back, and then brings arms in.
* A rhythmic jerking movement of the ankle when the foot is dorsiflexed. Three or four beats can be normal.
* When the soles of the feet touch a flat surface, the infant lifts their feet as if walking or stepping.
* Stroking the infant’s back near the spine causes them to curve their body toward the stimulus.
* When the infant’s head is turned to one side, the arm on that side stretches out, and the opposite arm bends.
