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NURS 501 > Exam 4 - Newborn Physical Exam > Flashcards

Exam 4 - Newborn Physical Exam Flashcards

1
Q

Normal head circumference for newborn

A

12-15 inches

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2
Q

Normal weight for newborn

A

5 lbs 8 oz - 8 lbs 13 oz

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3
Q

Normal length of newborn

A

18-22 inches

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4
Q

Normal temperature (axillary/rectal) of newborn

A

97.7-99.0 F

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5
Q

Normal HR for newborn

A

80-180 bpm (depending on infant state)

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6
Q

Normal RR for newborn

A

30-60 breaths per minute

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7
Q

Normal BP for newborn

A

Not routinely done in primary care unless there is an issue

  • Can be measured on arm or leg
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8
Q

What scale should be used to measure pain in a newborn?

A

FLACC scale

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9
Q

Respiratory assessment of newborn (what to look out for)

A
  • Chest excursion (symmetric and equal)
  • Use of accessory muscles
    • Retractions
    • Abdominal breathing
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10
Q

What is periodic breathing?

A

Rapid periods of breathing followed by slower periods of breathing

  • Normal, but begin to worry if there is constant fast breathing
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11
Q

What are the components of a newborn cardiac exam?

A
  • Check HR at PMI
  • Auscultate in all five areas: aortic, pulmonic, Erb’s point, tricuspid, mitral
  • Palpate for heaves, thrills, and PMI
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12
Q

Are murmurs common in newborns?

A

S1 and S2 are normal (along with S3 or S4)

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13
Q

How would the provider screen for congenital heart defects in a newborn?

A

Obtain pre and postductal pulsoxiemetery screening after 24 hours of age AND before discharge

  • Right hand - preductal
  • Either foot - postductal
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14
Q

How would the provider screen for congenital heart defects if the newborn was born at home or discharged before 24 hours of life?

A

Perform screening at first newborn visit

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15
Q

What are normal results after a pre and postductal pulsoxiemetery to screen for congenital heart defects?

A

Both hand and food >95% and less than a 3% difference between hand and foot saturations

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16
Q

What should the provider do if there are discrepancies with pulsoxiemetery readings when screening for congenital heart defects?

A

Urgent referral to cardiology

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17
Q

What are the four most common murmurs (congenital heart diseases) in newborns? What do they sound like?

A
  • PDA - machine-like sound
  • ASD - heard best in pulmonic area
  • VSD - harsh systolic murmur
  • Coarctation of aorta - systolic murmur
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18
Q

What are normal skin findings for a newborn in terms of appearance, cap refill, skin turgor, and mucus membranes?

A

Appearance - pink, well perfused

Capillary refill - <2 seconds

Skin turgor - elastic

Mucus membranes - pink, moist

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19
Q

What is acrocyanosis? Is this normal?

A

Bluish discoloration of hands and feet

  • Normal for first 24-48 hours of life d/t immature cardiac circulation
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20
Q

Can acrocyanosis be seen in older newborns?

A

Yes - d/t cold stress

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21
Q

Common skin finding: harlequin sign

A

Unilateral color change on one side of body d/t autonomic vasomotor instability

  • More common in low birth weight infants
  • Transcient, harmless, lasts for 10-20 minutes
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22
Q

Common skin finding: erythema toxicum

A

Yellow/white, 1-3 mm papules over erythematous base

  • Anywhere on body except palmar surfaces
  • Occurs abruptly; unknown cause
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23
Q

Common skin finding: milia

A

Exposed sebaceous glands that appear as whiteheads

  • Disappears within first month of life
  • No treatment needed
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24
Q

Common skin finding: mongolian spots

A

Bluish-grey pigmentation found on lower back, across shoulders, hips, legs

  • More common in darker-skinned newborns
  • Fades over time
  • ALWAYS DOCUMENT so that these are not confused with non-accidental trauma
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25
Q

Common skin finding: strawberry hemangioma

A

Raised capillary nevi that can occur anywhere on body

  • Can increase in size over first few months, but generally disapperas by age 10
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26
Q

When should the provider consider a referral with strawberry hemangiomas?

A

When there is an orbital hemangioma, very large hemangioma, or those with the potential to interfere with the airway

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27
Q

Common skin finding: stork bites

A

Pale pink or reddish discoloration of the skin

  • Location: nape of neck, lower axilla, nasal bridge, eyelids
  • More evident when newborn cries
  • Generally disappears by 2 years old
  • No treatment needed
28
Q

Common skin finding: lanugo

A

Fine, soft hair that covers the newborn’s back, shoulders, cheeks, forehead, and scalp

  • More common in premature infants
  • Disappears within first month of life
29
Q

Common skin finding: linea nigra

A

Line of increased pigmentation from umbilicus to genitalia

  • More common in darker-skinned infants
30
Q

Common skin finding: vervix caseosa

A

Cheesy, gray-white substance covering and protecting the skin during fetal life

  • Diminishes near term
31
Q

Common skin finding: neonatal acne

A

Caused by maternal hormone stimulation of sebaceous glands that appears at 3-4 weeks of life

  • More common in males
  • No treatment needed (topical lotions/creams make it worse)
  • Can occur anywhere on body
32
Q

Common skin finding: petechiae

A

Pinpoint-sized hemorrhage

  • Normal on presenting parts –> prescence anywhere else could indicate infection
33
Q

Common skin finding: jaundice

A

Yellowing of skin

  • Most visible after blanching
  • Progression is head to toe
  • Can be physiologic or pathologic
34
Q

Common skin finding: cyanosis

A

Bluish discoloration of the skin d/t fetal hgb with O2 sat <60% (hypoxemia), central cyanosis, or pathologic cyanosis

  • Location: periorbital, circumoral, chest, abdomen
  • Requires assessment for pathologic condition
35
Q

Common skin finding: cafe-au-lait spots

A

Hyperpigmented lesions (usually macules) that are irregular in shape and light brown in color

  • Usually benign but can be associated with pathologic conditions
  • Any newborn with 6+ lesions >1cm requires workup for neurofibromitosis
36
Q

Common skin finding: mottling

A

Marbling or spiderweb appearance of newborns skin d/t hypothermia or infection (concerning)

  • Cutis marmorata: occurs in healthy newborn and appears the same, but improves as skin is warmed
37
Q

Common skin finding: pallor

A

Paleness of skin that can occur with anemia or infection

  • In children with darker skin, evaluate in soles of feet, palms of hands, or circumorally
38
Q

How would the fontanels and sutures appear in newborns?

A

Fontanels: anterior (diamond shaped), posterior (triangle shaped)

Sutures: five total (open or overlapped)

39
Q

Cephalohematoma vs caput succedaneum: which one crosses suture lines?

A

Cephalohematoma - does NOT cross suture lines

Caput succedaneum - does cross suture lines

40
Q

What is a cephalohematoma?

A

Collection of blood under the periosteum caused by pressure during labor or operative measures

  • Resolves w/o intervention by 6-8 weeks
41
Q

What is a caput succedaneum?

A

Localized swelling of the soft tissues of the scalp caused by pressure during labor and birth

  • Resolves spontaneously within 24-48 hours after birth
42
Q

What should the provider assess for during an eye exam of a newborn?

A
  • Can the newborn fix and focus on an object 8-10 inches from the face?
  • Assess size, shape, and placement
  • Permanent eye color by 3-6 months
43
Q

Abnormal findings during newborn eye assessment

  • Placement - hypertelorism/hypotelorism
A

Placement problem - “third eye” should fit easily between the two eyes; if not, could indicate chromosomal anomaly or syndrome

  • Hypertelorism - eyes too widely spaced
  • Hypotelorism - eyes too closely spaced
44
Q

Abnormal findings during newborn eye assessment

  • Corneal abnormalities
A

Haziness could indicate glaucoma

45
Q

Abnormal findings during newborn eye assessment

  • Red reflex
A

Absence can indicate infection or cataracts

Grey or white pupil could indicate retinoblastoma

46
Q

Abnormal findings during newborn eye assessment

  • Palpebral fissure
A

Eye openings too small –> could indicate chromosomal anomaly or syndrome

47
Q

Abnormal findings during newborn eye assessment

  • Epicanthal folds
A

Slanting of eyes –> could indicate chromosomal anomaly or syndrome

48
Q

Normal presentation during ear assessment

A
  • Full term infant should have firm, flexible cartilage; recoil should be brisk
  • Line from inner canthus to outer canthus of eye should lead to occiput (top of pinna should touch line)
  • Angle of placement of ear should be vertical or no more than 10 degrees from vertical
49
Q

Abnormal ear findings during newborn assessment

A
  • Malformed/malpositioned ears - congenital or chromosomal anomaly
  • Preauricular sinus/tag - outer ear and renal tissues formed at the same time
    • Consider renal abnormalities
    • Requires repeat hearing screen at 6 months
50
Q

True/false: Newborns are obligate nose breathers

A

True

  • Become upset or have difficulty feeding when nasal passagways are obstructed
51
Q

Abnormal throat/mouth findings during newborn assessment

A
  • Macroglossia - congenital/chromosomal anomaly
  • Ankyloglossia - difficuty feeding/latching
  • Palpate cleft palates, submucous cleft, high arched palate
52
Q

When do the anterior and posterior fontanels close?

A

Anterior - 18 months

Posterior - 4 months

53
Q

What should the provider look for during a newborn chest/thorax assessment?

A
  • Cylindrical
  • 1:1 AP ratio
  • Chest circumference is 33cm or 2cm less than head circumference
  • Breast engorgement and “witches milk” are normal
  • Inspect clavicles for crepitus
54
Q

What should the provider look for during a newborn abdominal assessment?

A
  • Rounded and domed
  • Umbilical cord should have two arteries, one vein
  • Cord falls off between 7-10 days
55
Q

What should the provider look for during a male newborn genital assessment?

A
  • Placement of urethral opening should be at the tip
  • Both testes should be descended and palpable
56
Q

What should the provider do when a hydrocele is present during a male genitalia exam?

A

Check to see if it transluminates

  • Will spontaneously resolve
57
Q

What should the provider look for during a female genitalia assessment?

A
  • Assess size of labia majora/minora and clitoris
  • Milky vaginal discharge is normal
  • Blood tinged mucus/vaginal discharge is normal
58
Q

What should the provider assess for during a spine examination of a newborn?

A
  • Should be straight and flexible
  • Observe for pilonidal dimple (be sure base is visible)
59
Q

What should the provider assess for during an upper extremity examination?

A
  • Full ROM
  • Symmetry
  • Brachial pulses
60
Q

What should the provider assess for during a lower extremity examination?

A
  • Femoral pulses
  • Barlow and Ortolani’s maneuvers
  • Symmetry of skin folds (gluteal and femoral areas)
  • Size, shape, symmetry of newborns feet
61
Q

Eight newborn reflexes

A
  • Rooting
  • Sucking
  • Tonic neck reflex (fencing)
  • Palmar grasp
  • Galant
  • Moro (startle)
  • Plantar grasp
  • Babinski
62
Q

How would the provider assess cranial nerve I (olfactory)?

A

Alcohol wipe under nose to ellicit grimmace

63
Q

How would the provider assess cranial nerve II (optic), III (oculomotor), IV (trochlear), VI (abducens)?

A
  • Light in eyes should cause rapid eye closure
  • Baby’s head should follow your face when 8-10 inches away
64
Q

How would the provider assess cranial nerves V (trigeminal), IX (glossopharyngeal), and XII (hypoglossal)?

A
  • Rooting and sucking reflexes
  • Swallowing assessed by observing latch
65
Q

How would the provider assess cranial nerve VII (facial)?

A

Glabella tap assessed for blinking

66
Q

How would the provider assess for cranial nerve VIII (auditory)?

A

Assess infant in a quiet room to observe their reaction to sound

NURS 501 (66 decks)

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