Eval Newborn Flashcards
Obstetric hx
GBS (+ PNC given at delivery)
Syphilis/HIV serology
ETOH, smoking, IVDU
HTN, DM, chronic health issues
Coombs (increase jaudice) and Rh testing
Gestation age, LNMP, GTPAL, prenatal care
APGAR timing
1 min, 5min - scoring q5 min until 20 min or score +7
APGAR scoring
8 pts - mild risk
6-8 pts - impaired
APGAR components
0-2 for each category
A - appearance (cynotic, hands/feet cynotic, pink)
P - pulse (absent, 100)
G -grimace/reflex (nothing, grimace, cry
A - activity/muscle tone (limp, extreme flexion, active motion)
R - respiration rate (absent, gasping, good)
PE of newborn
gestational age, vitals, fonanelles, clavicales, sacral dimple, hearing test, anal patency, urethral opening red reflexes,
pulse ox > 5% BP > 15mmHg diff. btw arm/leg -> ductal dependent lesion
Neonate resusitation
Thermoreg - warmer or skin to skin
Stimulate - soles or rub back for beathing
Suction - clear airway
Initiate resp - bag mask, compressions
Delivery care
cut cord, dry w/ warm clothes, assess ABC, chest, abd, skin, genitalia, APGAR
wipe mouth/nose, suction as needed, skin to skin,
tonic neck
gone by 2 mo
jaw held to one side - leg and arm on turned side will extend and opposite will flex
Rooting
gone by 4 mo
stroking face -> head turned toward stimulus
DTR
should be present at birth
Palmar grasp
gone by 4 mo
finger in infant palm -> grasp
Startle (Moro)
gone by 4 mo
Drop head suddenly -> ABduction shoulders/elbows, spreading/extending fingers followed by ADDuction
Sucking
offered a nip and suck away
Placing
gone by 4 mo
dangle feet - w/ minimal touching of surface -> flexion or stepping response
Traction
pulled to sitting position, intial head lag -> midline -> head falls forward
Prophylactic Tx w/in 48 hr birth
erythromycin in eyes (gonococcal) Vit K - prevent hemorrhagic dz Hep B vaccination Cord blood - Coombs testing Hypoglycemic - glucose Hct - anemia Test for PKU, galactosemia, sickle cell, hypothyroid, congeintal adrenal hyperplasia, CF
Male circumcision
Prevents - phimosis, paraphimosis, balanoposthitis and UTI’s, reduces risk of penile CA, STI’s, cervical CA
Risk - local infxn, bleeding, surgical error, urethral injury
Circumcision precedure
dorsal nerve block
Mogen - blind approach, not prefered (amputation)
Plastibell - suture looped around and tied to cut off blood supply w/in 7-10 days
Gomco - traps foreskin and scalpel run around upper surface
neonatal jaundice - Eti
increased bilirubin w/in 1 wk d/t physiologic jaundice, prematurity, breastfeeding jaudice. excess production of bilirubin or decreased rate of conjugation
neonatal jaundice - S/Sx
starts head -> chest -> extremities w/ rising levels - juandice, scleral icterus, orange mucosa, splenomegaly
neonatal jaundice - W/u
transcutaneous bili screen w/in 24 hrs
prenatal maternal blood type, Rh, antibody
direct/indirect bilirubin level
neonatal jaudice - Tx
transfusion, phototherapy, supplement w/ formula
common newborn resp distress
● Bronchiolitis (RSV) ● Diaphragmatic hernia ● Prematurity ● Aspiration PNA (esp. meconium) ● Other Infection cardiac vs. non-cardiac vs. resp. tract bronchopulmonary dysplasia persistent pulmonary hypertension respiratory distress syndrome (lack surfactant)
common birth trauma
soft tissue bruising, fractures (clavicle, humerus, femur) cerival plexus palsies
