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Midwifery Pratical Exam January 2021 > Examination Of A Newborn > Flashcards

Examination Of A Newborn Flashcards

1
Q

What are the two components to assessing the baby at birth?

A

1) The APGAR score

2) Top to toe physical examination

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2
Q

Why is the APGAR score carried out?

A

Apgar should be recorded routinely for all births (NICE)

So that the midwife can determine how well the baby is adjusting from intrauterine to extrauterine life.

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3
Q

Why do we carry out a top to toe physical examination?

A
  • It looks to confirm normality and detect any deviations from the normal so that a referral can be made.
  • To reassure parents

According to NICE 2014 midwives undertake the APGAR and top to toe as part of the care of the baby at birth.

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4
Q

When is the APGAR assessed?

A

It is assessed at:

1 minute 
5 minute 
10 minute 
Although these can be repeated at different time frames and are based on whether the baby is breathing effectively at birth.
The scores are given out of 10
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5
Q

What does APGAR stand for?

A 
A- Appearance (Colour) 
P- Pulse (Heart rate)
G- Grimace (Response to stimuli)
A- Activity (Muscle tone)
R- Respiratory effort
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6
Q

What is the scoring system for APGAR?

A

0,1 and 2 with a total score out of 10.

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7
Q

What is the procedure to carrying out the APGAR score?

A

1) Ensure good effective lighting, as this will give a good visualisation of colour of the baby
2) Note the time of delivery, wait 1 minute then undertake the first assessment assessing the five variables quickly and simultaneously, totally the score and recovering the baby
3) Act promptly and appropriately according to the score e.g a baby scoring 0-3 requires immediate resuscitation
4) Repeat at 5 minutes, the score should increase if previously eight or below
5) Document findings and act accordingly

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8
Q

When should the birth examination take place?

A

Within the first 72 hours of birth

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9
Q

How many wet nappies should a newborn have within 24 hours?

A

4-6

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10
Q

Why do we offer an IM injection of vitamin K to newborns?

A

Babies do not get enough Vitamin K from their mothers during pregnancy or when breastfeeding. vitamin K decreases the risk of a vitamin K deficiency bleeding. This is also known as Haemorrhagic Disease of the Newborn.

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11
Q

What is jaundice and why is it so common?

A

Jaundice is caused by the (completely normal) buildup of bilirubin in the blood.

Jaundice is common in newborn babies because babies have a high number if red blood cells in their blood which are broken down and frequently replaced.

Also, a newborn baby’s liver is not fully developed, so it’s less effective at removing the bilirubin from the blood.

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12
Q

When conducting the top to toe check, what are you looking for when examining the neck and clavicles?

A

Neck- Movement/shape/weakness

Clavicles- Inability to move arms/irritability/symmetry/pain

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13
Q

Why do we treat babies with a high level of jaundice?

A

This is because there’s a small risk the bilirubin could pass into the brain and cause brain damage.

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14
Q

When conducting the top to toe check, what are you looking for when examining the face, eyes and mouth?

A

Mouth- tongue tie, lips and palate (formed correctly?) sucking reflex, teeth, signs of thrush (redness, white spots or white coating)

Eyes- symmetry, stickiness, redness, discharge, swelling, cataracts, heamorrhages

Face- symmetry, any deformities or abnormalities

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15
Q

When conducting the top to toe check, what are you looking for when examining the cord and abdomen?

A

Chest- symmetrical, two nipples

Cord- intact, knots, clamped (unless lotus birth)

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16
Q

When conducting the top to toe check what are you looking for when examining the spine?

A
  • Curvature (scoliosis)
  • Gaps in the vertebrae
  • Fat pads
  • Dense tufts of hair
  • Birth marks
  • Spina bifida
  • Ensure sacral dimple is skin lined
17
Q

When conducting the top to toe check what are you looking for when examining the hands and feet?

A
  • Ensure there is x10 fingers and toes
  • Single palmar crease (sign of Down’s syndrome)
  • Clubbed foot
  • Polydactyly (extra digits)
  • Syndactyly (webbing)
18
Q

What is vernix?

A

A bio-film layer consisting of anti-microbial proteins and fatty acids. It provides a layer of protection.

19
Q

When conducting the top to toe check what are you looking for when examining the head?

A
  • Shape (Excessive moulding)
  • Size
  • Symmetry to the rest of the body
  • Bruises/trauma (particularly in an assisted delivery)
20
Q

What is the size of the head in a full term infant?

A

32-36cm

21
Q

When conducting the top to toe check what are you looking for when examining the genitals?

A
  • Check the sex of the baby
  • Check boys testicles have descended into the scrotum
  • Ensure urethra is open in and in the correct place
  • Vaginal skin tags
22
Q

When conducting the top to toe check what are you looking for when examining the anus and stool?

A
  • Ensure anus is present and ensure the stool comes from the correct place
  • Document the colour of the stool
23
Q

What is the correct procedure for carrying out a top to toe check on the newborn?

A

1) Wash hands and don PPE
2) Confirm infants name and DOB
3) Obtain informed consent from parents
4) Ensure at least one parent is present at the assessment
5) Adequately expose infant for assessment (down to the nappy)
6) Work systematically from top to toe checking each feature
7) Wash hands and document findings

24
Q

What percentage of a babies weight can we expect them to lose in the first few days of birth?

A

10% of their total birth weight

25
Q

When should we conduct a newborn blood spot test?

A

Day 5

26
Q

What conditions does the newborn blood spot test screen for?

A
  • Sickle cell disease
  • Cystic fibrosis
  • Congenital hypothyroidism
  • Inherited metabolic diseases
27
Q

How long is the neonatal period?

A

From birth to 28 days

28
Q

What key issues should be considered before carrying out the examination?

A

History-antenatal, medical and intrapartum.

Birth outcome- mode of delivery

Informed consent-ensuring enough info is given to parents to make informed decisions

Room temp- needs to be ambient, 26 degrees. This is because babies loose heat through conduction, convection, evaporation and radiation

29
Q

What temperature would we want a babies to be?

A

36.5-37.5

30
Q

What should a babies heart rate be?

A

110-160 beats per minute at rest. Usually 90-140 if they are asleep.

31
Q

What should a babies breathing be like?

A

Should be quiet 40-60 breaths per minute

32
Q

What is the normal range for a full term baby’s bead circumference?

A

34-35cm (Baston and Dunward 2017)

33
Q

What is a Caput Succedaneum?

A

Swelling caused by pressure at birth. It may be present with or without bruising and crosses the suture line.
It is a benign finding that wjll resolve quickly, parents should be informed that it should settle down within a few days

34
Q

What is a Cephalhaematoma?

A

Firm swelling or bump, and is caused by bleeding below the periosteum and results in swelling therefor does not cross the suture line. It is a benign finding that will gradually resolve. The swelling should not increase in size significantly after birth

Midwifery Pratical Exam January 2021 (7 decks)

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