Chapter 20: Assessment Of The Normal Newborn Flashcards
Labor and birth history includes:
- Type of delivery (vacuum assist, c-section, vaginal?)
- Infections during delivery
- Conditions at delivery (HTN, diabetes, amniotic fluid, PROM, etc.)
- Length and course of labor
- Any medications given during labor
- EDB
- Prenatal lab results (prenatal care/no prenatal care, folic acid deficiency, drug use, etc.)
What is a normal respiratory rate of a newborn?
30-60 breaths per minute
Frequency of respiration assessments
- The nurse assesses respiration’s at least once every 30 minutes until infant has been stable for 2 hours after birth.
- If abnormalities are noted, respiration’s are assessed more often.
In what case may infants breathe faster?
- Immediately after birth
- During crying
- During the first and second periods of reactivity
In order to attain an accurate respiratory rate, what should you do?
Count for a full minute.
Normal qualities of respiration in a newborn
Nonlabored
Symmetric chest movements
Periodic breathing
- Pauses in breathing lasting 5-10 seconds without other changes followed by rapid respiration’s for 10-15 seconds.
- Occurs in some full-term infants but is more common in preterm infants.
Newborns first gasp of air is
Exaggerated
Crackles in Newborns
Crackles during the first hour or two after birth is normal
What breath sounds should be reported?
-Wheezes
-Crackles
-Rhonchi
-Stridor
-Diminished
That persists should be reported.
Bowel sounds in chest may be a sign of
Diaphragmatic hernia
Signs of Respiratory Distress includes:
- Tachypnea
- Retractions
- Seesaw or paradoxical respiration’s
- Cyanosis
- Grunting/Flaring
- Asymmetry
When is tachypnea in a newborn normal?
- During first hour after birth.
- During periods of reactivity.
Retractions include
- Xiphoid
- Intercostal
- Supraclavicular
Seesaw or Paradoxical Respiration’s
- Chest falls when the abdomen rises (vise versa)
- Normal chest should rise and fall together
Cyanosis
Purplish blue discoloration indicating the infant is not getting enough oxygen.
Central cyanosis involves the
- lips
- tongue
- mucous membranes
- trunk
Central cyanosis indicates
- True hypoxia.
- This means inadequate oxygenation to the vital organs and requires immediate attention.
Bruising of the face
May occur from a tight unchallenged cord or pressure during birth and may look like central cyanosis.
How can you differentiate bruising from cyanosis?
- By applying pressure to the area.
- Cyanosis area will blanch, but a bruised area remains blue.
How can cyanosis in infants with dark skin tones be checked?
- Looking at the color of the mucous membranes
- Pulse oximeter may be used to determine oxygen saturation in infants with cyanosis
Peripheral cyanosis (acrocyanosis)
- Cyanosis only involving the extremities.
- Results from poor perfusion of blood to the periphery of the body.
Cyanosis at birth
It is normal to see a cyanosis infant at birth whose color quickly turns pink as the infant begins to breathe.
Cyanosis can occur whenever the
Occurs when the infant’s breathing is impaired such as during feedings d/t difficulty in coordinating sucking, swallowing and breathing.
Infants who become cyanosis on exertion or when crying may have
A congenital heart defect
Pallor in an infant
Can indicate the infant is slightly hypoxic or anemic
A ruddy color in some infants may indicate
Polycythemia (an excessive number of RBC’s)
What hematocrit levels indicates polycythemia?
> 65%**
Increased hematocrit levels can increase the risk for what?
Jaundice
Nasal Flaring
A reflex widening of the nostrils that occurs when the infant is receiving insufficient oxygen.
How does nasal flaring help the infant breathe?
Helps decrease airway resistance and increase the amount of air entering the lungs.
Intermittent nasal flaring may occur
In the first hour after birth
Continued nasal flaring can indicate
A more serious respiratory problem
Grunting
Noise made on expiration when air crosses partially closed vocal cords.
How can grunting help an infant with respirations?
Increases the pressure within the alveoli, which keeps the alveoli open and enhances exchange of gases in the lungs.
Grunting that is loud enough to be heard unaided in an infant can indicate
An infant having severe respiratory difficulty
Persistent grunting in an infant is a common sign of
Respiratory distress syndrome and necessitates expanded assessment and referral for treatment.
Choanal Stresia
- Blockage/narrowing of one or both nasal passages by bone or tissue.
- Requires surgery.
- Infant becomes cyanosis when quiet and pink when crying (draws air in mouth)
What method of breathing do newborns use for 4-6 weeks of life?
Newborns are nose breathers for 4-6 weeks of life (except when crying)
What is a normal temperature in a newborn?
97.7 F to 99.5 F
Lecture: 97.8 - 99.8 F
What is the normal axillary temperature in a newborn?
97.7 F to 99.8 F
How do you assess for respiratory distress?
- First, pulse ox (see if above or below 90%)
- Check warmth (cold stress will cause exacerbations)
Interventions for respiratory distress
- Free flow of oxygen is available to assist in the infant’s transition
- Warm them up
Interventions for fluid in the lungs of an infant
- Stimulate their back (rub-makes them cry and get the fluid out or resolves RR distress issues)
- Suction secretions with bulb or suction catheter
Assessment of cardiorespiratory status includes
- Assess and maintain airway
- Heart rate and rhythm: evaluate murmur (location, timing, duration)
- Examine appearance of size of chest
- Note if there is a funnel chest, barrel chest, or unequal chest expansion
- Assess breath sounds and respiratory efforts
- Evaluate color for pallor or cyanosis
The apical pulse should be counted for
One full minute
How often should the infant heart rate be assessed?
- Once every 30 minutes until the infant is stable for 2 hours after birth.
- Once stable: once every 8 hours according to hospital policy unless a reason for more frequent assessment develops.
Where is the point of maximum impulse found in an infant?
3-4 intercostal space, midclavicular line
What are conditions that affect the position of the heart?
Pneumothorax
Dextrocardia (right to left reversal from normal heart position)
Heart rhythm in infants
- Rhythm should be regular and first and second heart sounds heard clearly.
- Abnormalities should be noted.
Murmurs in infants
- May indicate openings in the septum of the heart or problems with blood flow through the valves.
- Most murmurs are temporary.
A murmur is common until what happens?
The ductus arteriosus is functionally close.
Brachial and femoral pulses in infants
Should be present and equal bilaterally and rates should be the same.
Femoral pulses that are weaker than brachial pulses may result from
-Impaired blood flow in coarctation of the aorta. (A narrowed area of the aorta impedes blood flow to the lower part of the body and causes weaker pulses in the lower extremities)
What systolic BP may indicate a coarction of the aorta?
A systolic BP >20 mm hg higher than lower extremities may indicate a coarction of the aorta.
Blood Pressure in a newborn
Not a necessary part of a routine assessment of the newborn.
An average blood pressure for full term newborns is
65 to 95 mm Hg systolic
30 to 60 mm Hg diastolic
When is blood pressure taken in a newborn?
BP is taken on all extremities if the infant has unequal pulse rates, murmurs or other signs of cardiac complications
What should be done to obtain an accurate blood pressure measurement in an infant?
- Use of Doppler ultrasonography or other electronic measurement techniques
- Infant should be quiet when BP is taken (crying elevates BP)
- Width of BP cuff should cover the upper arm and leg without encroaching on the joints.
How much does BP in an infant rise in the first 3-8 days?
1 to 3 mm Hg daily
How much does BP in an infant rise in the first 5-7 weeks?
1 mg Hg weekly
When does an infants blood pressure reach a value that will remain stable for the first year?
2 months
Blood pressure of the lower extremities should be what in relation to the upper extremities?
Should the same of slightly higher than that of the upper extremities.
Capillary Refill in infants
- Should be less than 2-3 seconds. (Book says 3-4 seconds)
- Checked by depressing the skin over the chest, abdomen or extremity until the area blanches.
What route is used for the first temperature measurement in an infant?
Rectal route. (Axillary is preferred afterward)
Temperature instability in an infant often indicates what?
Infection
When is the neonates temperature taken?
-Soon after birth while infant is being held by mother or is in a radiant warmer with a skin probe attached to the abdomen.
Skin Probe
- Should not be attached over bony prominences.
- Allows the warmer to measure and sip lay infants skin temperature continuously.
How often should an infants temperature be taken?
- Should be assessed at least once every 30 minutes until the infant is stable for 2 hours after birth.
- Often checked again at 4 hours and then once every 8 hours or according to facility policy as long as it remains stable.
Why should a thermometer never be forced into the rectum?
Because of the possible presence of an imperforate anus (closed anus)
The normal rectal temperature in a newborn is
36.5 C - 37.7 C (97.7 to 99.8 F)
Asymmetry of the head of a newborn can be caused by
- Molding
- Type of birth
- Cephalhematoma
Molding
Changes in the shape of the head to allow it to pass through the birth canal.
What causes molding?
- It is caused by overriding of the cranial bones at the sutures. (The parietal bones often override the occipital and frontal bones and a ridge can be felt at those areas)
- Is common, especially after a long second stage of labor.
How long does it take for molding to resolve?
- Resolves within a few days to 1 week after birth **
- Often, dramatic improvement is seen by the end of the first day of life.
What is the usual shape of the head of an infant born via c-section?
Round
What is the usual shape of the head of an infant born via vaginal birth?
Molding
What is the usual shape of the head of an infant born via breech position?
Flat head
Newborn Head Assessment: Hair
- Hair should be fine with a consistent pattern.
- Abnormal hair growth patterns may indicate genetic abnormalities.
A newborn head assessment includes:
- Shape
- Hair
- Fontanels
- Sutures
What would indicate that a fetal monitor electrode was inserted into the skin of the scalp?
- A small, red mark.
- Later,a small scab forms (this area occasionally becomes infected and topical antibiotic is applied)
Newborn Head Assessment: Sutures
All sutures should be palpated.
What can cause a separation of the sutures in a newborn?
- May be a temporary result of molding.
- If it persists or widens, may indicate increased intracranial pressure.
What can cause no space to be found between suture lines in a newborn?
-May be a result of molding and overriding bones.
Craniosynostosis
Define + it may impair brain growth and the shape of the head and requires surgery
A hard, ridged area not resulting from molding may indicate
Premature closure of sutures called craniosynostosis.
Fontanels
Areas of the head where sutures between the bones meet.
Fontanels in a newborn
- Areas are not calcified but are covered by membrane.
- This allows space for the brain to grow
Newborn Assessment of the Head: Fontanels
Palpate and note the position in relation to other bones in the skull
Palpation of the Fontanel Procedure
- Infants head is elevated during palpation for accurate assessment
- Infant may be placed in a semi sitting position or held in an upright position
- Fontanel should be palpated when the infant is quiet, because crying may cause it to protrude.
The anterior fontanel
Is a diamond-shaped area where the frontal and parietal bones meet*
Assessment of the eyes
- Examined for abnormalities and signs of inflammation.
- Eyes should be symmetric and same size.
- Sclera
- Conjuctiva
- Eye color
- Pupils
- Tearing
- Visual acuity
- Response to visual stimuli
Slanting of epicanthal folds in a non-Asian infant may be a sign of what?
Down syndrome or other abnormal conditions
How can pressure on the head during birth affect the eyes?
- Causes capillary rupture in the sclera -> edema of the eyelids and subconjunctival hemorrhage’s (reddened areas of the sclera)
- Edema usually resolves in a few days; hemorrhage resolves in a week.
What color should the sclera be in a newborn?
White or bluish white
A sclera that appears yellow, indicates
Jaundice
A sclera that is blue occurs in what condition?
Osteogenesis imperfecta (a congenital bone condition)
What are abnormalities that can be found in the eyes of a newborn?
- Yellow or blue color of the sclera
- Conjunctivitis
- Setting-sun sign
- Cataracts
- Excessive tearing
- No response to visual stimuli
Conjunctivitis
- May result from infection or chemical reaction to medications.
- Staphylococcus Chlamydia and Neisseria gonorrhoege are common organisms that cause the infection
- Can result in ophthalmia neonatorum
Ophthalmia Neonatorum
- Can lead to blindness
- To prevent, prophylactic antibiotics are administers to the eyes. (Any discharge from eyes is reported for possible culture and treatment)
Transient Strabismus
Cross eyes
-is common for the first 3-4 months after birth because infants have poor control of their eye muscles.
Doll’s Eye Sign
Normal finding in the newborn
The Setting-Sun sign
The iris appears low in the eye and part of the sclera can be seen above the iris.
The setting-sun sign may indicate
Hydrocephalus
Cataracts
(Opacities of the lens)
Appears as white area over the pupils.
What can cause cataracts in infants?
Infants may develop in infants of mothers who had rubella or other infections during pregnancy.
Tears in a newborn
Are scant or absent for the first 2 months.
Excessive tearing in a newborn can indicate
A plugged lacrimal duct, which is treated with massage or surgery.
What is normal visual acuity in a newborn?
20/400
Newborn Vision: Characteristics
- eyes cannot accommodate for distance, but newborns should show visual response to environment.
- should make eye contact when held in cradle position during a period of alertness
- should respond well to human faces and geometric patterns of black and white or medium bright colors, but show little interest in pastel colors.
Infants focus best on objects at what distance?
- Objects that are 20-30 cm (8-12 inches)
- But can see objects to a distance of 76 cm (2.5 feet).
How should newborns respond to visual stimuli?
Should blink or close eyes in response to bright light.
Newborn Assessment of the Ears: Assess for
Placement
Overall appearance
Maturity
Normal Placement of the Ears in a Newborn
An imaginary horizontal line drawn from the outer canthus of the eye should be even with the area where the upper ear joins the head
What are abnormal findings of the ears in newborns?
- Low set ears may indicated chromosomal abnormalities (ears should be almost vertical in placement on head)
- An angle greater than 10 degrees is abnormal
Abnormalities of the ear may indicate:
- Chromosomal abnormalities
- Hearing problems
- Kidney defects
What parts of the assessment of the ear are used as a part of gestational age assessment?
The stiffness of the cartilage and degree of incurving of the pinnacle.
Hearing in Newborns
- Can hear by last trimester of pregnancy.
- Hearing is very good after birth
How is hearing assessed in an infant?
-Hearing is assessed by noting the infant’s reaction to sudden loud noises, which should cause a startle response.
- A hearing screening is performed before discharge from most birth facilities
Infant Responses to Sound
- Infants should respond to the sound of voices.
- Prefer a high-pitched tone of voice and rhythmic sounds.
- They will turn toward the sound of the mother’s voice or another interesting sound.
Sense of Smell in Newborns is developed by what weeks?
29-32 weeks of gestation**
Sense of smell in infants gives the the ability to
- Distinguish taste as shown by their increased suck when given sweet liquids and rejection of bitter or salty liquids
- Differentiate between breast pads soaked with mother’s milk from pads soaked in water.
Assessment of other neurologic signs in a newborn
- Assessed for tremors or jitteriness. (If present, blood glucose levels should be checked; hypoglycemia is most common cause)
- If blood glucose level is within normal range, the cause may below calcium levels or prenatal exposure to drugs.
Epstein’s Pearls
- May be present on the hard palate and gums.
- Small, white hard, inclusion cysts are accumulations of epithelial cells.
- Disappears without treatments within a few weeks.
Newborn Assessment of the Mouth includes
- Teeth
- Palate
- Gums
- Tongue
- Suck reflex
- Lip
Abnormalities in the mouth of a newborn include
- Epstein’s pearls
- candidiasis
- cleft lip or palate
- large protruding tongue
Examination of the tongue
-Examine for size and movement.
A large protruding tongue can be present in what conditions?
Down syndrome
Hypothyroidism
What can affect the movement of the tongue?
Paralysis of the facial nerve
The tongue may appear to be tongue-tied d/t the short frenulum, but
This is normal and usually has no effect on the infant’s ability to feed.
True tongue-tie
- There is limited tongue movement.
- Clipping the frenulum seldom is practiced d/t potential for infection.
Candidiasis in the newborn
- Not apparent in the mouth immediately after birth and may appear 1-2 days later.
- Lesions resemble milk curds on the tongue and cheeks that bleed if attempts are made to wipe them away.
How is candidiasis treated in a newborn?
Nystatin suspension
How can newborns be infected with Candida albicans?
Can be infected during passage through the birth canal if the mother has a Candida vaginal infection.
A cleft lip or palate
- Results if the palate or lip fails to close.
- Cleft palate may involve the hard, soft or both palates and may appear alone or with a cleft lip.
How its a cleft palate assessed?
- Assessed when infant cries.
- A gloved finger is inserted into the mouth to palpate the hard and soft palate.
Suck Reflex
- Elicited when the lips or palate is stimulated.
- Normal full-term infant should have a strong suck reflex.
- Reflex is weaker in a neonate who is preterm, ill or has just been fed.
Newborn Assessment of the Neck
- Visually assess and note the ease of which the head turns form side to side.
- Neck is very short
- When lying in a prone position, the newborn should be able to raise the head briefly and turn it to the side.
What are abnormal findings in the neck of an infant?
- Webbing
- An unusually large fat pad between the occipital and the shoulders
- Masses
Webbing in the neck may indicate what conditions?
Turner’s syndrome
Down syndrome
An unusually large fat pad between the occiput and the shoulders may indicate what?
a chromosomal anomaly
Assessment of a Fracture Clavicle
- Sliding the fingers along each clavicle while moving the infant’s arm helps identify a fractured clavicle.
- If a fracture is present, a lump, swelling or tenderness over the area of the fracture may be observed.
- Crepitus and movement of the bone may be felt during palpation.
- Decreased movement of the arm on the affected side may also occur.
If a fractured clavicle causes damage to the brachial plexus, what can happen?
Paralysis of the arm on the side of the fracture can occur.
How is a fracture treated?
Immobilization of the affected arm for a short time.
The fracture heals quickly.
Newborn Assessment of the Breasts
- Note placement of nipples and look for extra nipples which may appear on chest or axilla.
- Breasts can become engorged and secrete a small amount of white fluid. (Caused by maternal hormones and resolves within a few weeks without treatment)
- Breasts should not be expressed or manipulated as this could cause infection.
Newborn Assessment of the Abdomen: Normal findings
- Should be soft, rounded and protrude slightly. (Should not be distended)
- Loops of bowel should not be visible through abdominal wall
Abnormal Findings in the Newborn Assessment of the Abdomen
- Distention
- Loops of bowel visible through abdominal wall
- Sunken or scaphoid appearance of the abdomen
- Umbilical hernia
- Masses
What can cause distention of the abdomen in newborns?
Mucus, blood, and amniotic fluid swallowed during birth
How can distention be treated?
Stomach may be emptied through feeding tube, if necessary.
An abdomen so distended that the skin is stretched and shiny can indicate what?
- Obstruction.
- If distended, nurse should measure abdominal circumference periodically to note changes. (Should be recorded and reported to HCP)
What can cause the bowel to be visible through the abdominal wall?
Indicates that air and meconium are not passing through the intestines normally.
A sunken or scaphoid appearance of the abdomen occurs when?
In diaphragmatic hernia, in which intestines are located in the chest cavity instead of the abdomen.
(Also indicated if bowel sounds are heard in chest)
How can a diaphragmatic hernia affect the condition of a newborn?
Interferes with development of the lungs, resulting in respiratory difficulty at birth.
Umbilical Hernia
Occurs when the intestinal muscles fail to close around the umbilicus, allowing the intestines to protrude through the weak area.
Umbilical Hernias are common in
Low-birth-weight, male and black infants*
Umbilical Hernia Treatment
- By the time infant is walking well, the muscles are usually strong enough that the hernia is no longer present.
- Surgery may be required in some cases
Palpation of the Abdomen in a Newborn
Easiest when the infant is relaxed and quiet.
Masses in the abdomen can indicate what?
Tumor of the kidneys
The infants liver is normally found where?
1-2 cm below the right costal margin.
If the liver of an infant seems large, what should be done?
It should be reported to the physician to nurse practitioner because it may be a sign of CHF or congenital infection**
Two Vessel Umbilical Cord
Is associated with chromosomal and renal defects.
Assessment of Umbilical Cord
- Two arteries are small and may stand up at the end
- Single vein is larger than arteries and resembles a slit because its walls are more easily compressed.
- The amount of Wharton’s jelly in the cord is noted.
If the umbilical cord appears thin, this could indicate what?
Infant may have been poorly nourished in the utero
A yellow-brown or green tinge to the cord indicates what?
That meconium was released at some time before birth, perhaps as a result of fetal compromise.
Newborn Measurements
Provide information about the infants growth in the utero.
What is apart of the initial measurement assessment?
- the weight
- the length
- the head and chest circumferences
What is a normal weight for a newborn?
Ranges between 2500-4000 g (5lb 8oz and 8lb 13 oz) **
What are factors that can affect fetal weight?
- gestational age
- placental functioning
- genetic factors (i.e race)
- parental size
- maternal diabetes
- HTN
- substance abuse
Why are infants expected to lose up to 10% of their birth weight during the first few days of life?
Could be d/t
- Excretion of meconium from bowel
- Loss of extracellular fluid
- Inadequate intake of calories to maintain their weight during the first few days
How fast do infants gain weight by their 14th day of life?
They regain or exceed their birth weight by 14 days.
Gain approximately 30 g per day during the earlier months.
What is the average length of a newborn?
45-55 cm (18-22 inches)**
What is the normal range of head circumference in a newborn?
32-38 cm (13-15 inches)
How can the measurement of the head of a newborn be affected?
- Can be affected by molding of the skull during the birthing process.
- If a large amount of molding occurred, the head is remeasured when it regains normal shape.
Small head in a newborn can indicate
Poor brain growth and microcephaly
Large head can indicate what in a new born?
Hydrocephalus
What is the normal circumference of the chest in a newborn?
30-36 cm (12-14 inches)**
Asymmetric responses may indicate what?
-Trauma during birth caused by nerve damage, paralysis or fracture.
How can you differentiate between tremors and seizures in newborns?
- The infants extremities are held in a relaxed position
- This causes tremors to stop but a seizure continues.
Cries that are shrill, high-pitched, hoarse and catlike
- Are abnormal
- May indicate a neurologic Disorder or other problem
Redness in a full-term infant may indicate
Polycythemia
Blanching over the skin over the nose or chest shows the presence of what?
Jaundice
In newborns, jaundice is abnormal when?
During the first day of life but common during the first week.
A thick covering of vernix may indicate what?
A preterm infant.
No vernix at all can be found in what kind of infants?
Postterm infants
Yellow-tinged vernix may indicate what?
Elevated bilirubin levels in the utero
Green-tinged vernix is caused by
Meconium staining
Milia
White cysts, 1-2 mm in size, that disappear without treatment.
Occurs over forehead, nose, cheeks and chin.
Erythema toxica
Red, blotchy areas that may have white or yellow papules of vesicles in the center.
Mongolian Spots
Bluish-black marks that resemble bruises.
Usually occur in sacral area but may appear on the buttocks, arms, shoulders and other areas.
Mongolian Spots occur most frequently in infants with what?
Dark skin
A nervus simplex aka salmon patch, “stork bite” or telangiectatic nervus
- Flat, pink or reddish discoloration from dilated capillaries that occurs over the eyelids, just above the bridge of the nose or at the nape of the neck.
- Blanches when area is pressed.
- More prominent during crying.
When do stork bites tend to disappear?
Disappear by 2 years of age; those at the nape of the neck may persist.
Nevus flammeus (port-wine stain)
- A permanent, flat, pink to dark reddish-purple mark that varies in size and location.
- May darken and may become modular as the child gets older.
Nevus Vasculosus (Strawberry hemangioma)
- Consists of enlarged capillaries in the outer layers of the skin.
- Is dark red and raised with a rough surface, giving a strawberry like appearance.
- Usually located on head.
- May grow larger for 5-6 months but usually disappears by early school years.
Cafe-au-lait spots
- Are permanent, light-brown areas that may occur anywhere on the body.
- Although they are harmless, the number and size are important.
Six or more cafe-au-lait spots or spots > 0.5 cm are associated with what?
Neurofibromatosis, a Genetic condition of neural tissue**
Petechiae
Pinpoint bruises that resemble a rash, may appear over areas such as the back, face and groin as a result of increased intravascular pressure during the birth process.
Widespread or continued formation of petechiae may indicate what?
Infection or low platelet count.
Generalized edema in newborns can indicate what?
More serious conditions such are heart failure
Peeling in newborns
- Peeling of the skin is normal in full-term newborns
- Excessive amounts of peeling may indicate a post-term infant.
Normal findings found in the extremities of term infants
-Extremities should be sharply flexed and resist extension during examination
Poor muscle tone in infants
- Results in a limp or “floppy infant”.
- May be from inadequate oxygen during birth, but should resolve within minutes as oxygen intake increases.
Continued poor muscle tone in newborns may result from
Prematurity or neurological damage.
Infants with previously good muscle tone may show decreased flexion if what happens?
If the infant becomes hypoglycemic or experiences respiratory difficulty.
All extremities are examined for what?
signs of fracture such as crepitus, redness, lumps or swelling and lack of use.
Injury to the brachial nerve plexus may result in
Erb’s Palsy - paralysis of the shoulder and arm muscles.
What can be found in a baby with erb’s palsy?
- Affected arm is extended at the infants side with the forearm prone.
- Movement of this arm is diminished during the Moro reflex.
Syndactyly
Webbing between digits.
Simian crease or line
A single crease parallel with the base of the fingers that crosses the palm without a break.
Club foot
…
Ortolani maneuver
Checks for developmental dysplasia of the hip
Developmental dysplasia
- Instability of the hip joint occurs and the head of the femur can be moved in and out of the acetabulum.
- Partial dislocation and inadequate development of the acetabulum may occur.
Identifying a hip problem early is important to
Prevent permanent damage to the joint.
Barlow Test
…
Normal findings of the hips
legs should abduct equally
Findings in a dislocated hip
- When comparing the height of the knees, the knee on the affected side is lower. (Observed by bending the infant’s knees with feet flat on the bed)
- Legs are extended while infant is in prone position, the leg on the affected side is shorter and the creases are asymmetric.
Treatment of developmental dysplasia of the hip
- Involves immobilizing the leg in a flexed, abducted position, usually with a harness.
- May involve traction, casting or surgery.
An indentation in the vertebral column of a newborn may be a sign of
Spina bifida occulta (failed closing of a vertebra)
Meningoceles
Protrusions of spinal fluid and meninges on the spinal cord, or both through the defect in the vertebrae.
Be sure to note a head lag of
Less than 45 degrees
When does a newborn pass meconium?
Within 48 hours
Meconium: Characteristics
Dark green - black; thick
Transitional stool
Thin brown to green
Occurs 2 days later
Breastfed stools
Mustard-yellow to pasty green.
Very soft, seedy
When should newborns void after birth?
95% should void by 24 hours after birth and 100% by 48 hours after birth.
If the newborn doesn’t void within 24 hours, what should the nurse do?
- Assess the adequacy of intake
- Bladder distention
- Restlessness
- Symptoms of pain
Formula-fed infants stool characteristics
Excrete stools that are more solid and pale yellow to light brown
A “water ring” around stool
Should never be present around the solid part of any stool.
What is a water ring?
Wet, stained area on the diaper where water stool has been absorbed into the diaper.
What may cause a water ring?
May be caused by formula intolerance or infection.
Dubowitz Scoring System
In-depth, detailed assessment tool that includes examination of physical, neurologic and behavioral characteristics.
Gestational Age Assessment
Examination of the newborn’s physical and neurological characteristics to determine the number of weeks from conception to birth.
The New Ballard Score
- A simplified adaptation of the dubowitz tool that has been revised to include characteristics of very preterm infants.
- Can be performed quickly, yet provides accurate information within 2 weeks.
When is the Ballard Score most accurate?
Within 12 hours of birth
The Ballard tool focuses on what characteristics?
Physical and neuromuscular, eliminating behavioral characteristics.
Review last three pages of notes for Billard Score
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Gestational Assessment Tools includes the following characteristics
- Skin
- Lanugo
- Sole (planar) creases
- Breast tissue
- Ear form and cartilage distribution
- Evaluation of genitals
Apnea in newborns
pause in breathing lasting 20 seconds or more, or accompanied by cyanosis, pallor, bradycardia, or decreased muscle tone
Periodic breathing
pauses in breathing lasting 5 to 10 seconds without other changes followed by rapid respirations for 10 to 15 seconds
