Initial Newborn Assessment Flashcards
When does the standard of practice dictate than an infant should be assessed?
1) time of birth 2) during transition @1st 6hrs 3) general newborn exam @24-48h 4) daily when hospitalized 5) prior to dc
What should be assessed in the initial examination while the infant is still in the delivery room?
HR, respiratory effort, tone, reflex, color, observe for gross anomalies, check for vessels in cord, temperature and determine sex
What measurements should be taken immediately?
length, OFC, chest circumference
What are the categories of classification that must be completed with assessment?
AGA, SGA, LGA and GA
What components of CV system should be addressed in the initial examination?
count apical HR, listen for murmurs, check pulses
What components of respiratory system should be addressed in the initial examination?
count RR, listen to breath sounds/ aeration, check patency of nares, assess effort and WOB
What are acceptable ranges of RR commonly found in the initial assessment?
RR 60-90 s/p CSX, may exhibit mild G/F/R up to 1h post birth, normal term infant RR should decrease to 50-60 by end of transition
What components of neurologic system should be addressed in the initial examination?
listen to quality of cry, observe overall state and vigor
What might cause depression in the newborn?
maternal medications, MgSo4, analgesics/anesthetics, illict drugs, hypoglycemia or hypothermia
How much amniotic fluid does a normal infant every day in utero?
200-300mL/kg/d; equivalent to our swallowing 5 gal of fluid every day
What should be noted about gastric contents?
if gastric contents are suctioned, observe color and amount- up to 15cc is normal
When is the general newborn exam best completed?
after transition in a quiet, alert state
What is the intention of completing a general newborn exam?
it examines the well-being and physical normalcy of the infant; take advantage of the opportunities presented by the infant and family, take infant behavior into account
What is the intention of completing a discharge newborn exam and what is included?
to assess ability to go home; assess VS, temp stability, feeding: check wt since birth, amount and frequency of feeds, voiding and stooling, CV status- murmurs, pulmonary status, condition of the cord, hip stability, normal state behavior, eye & hearing exam and color- how old is this baby in hrs?
Why are late preterm infants (34-37 weeks) at increased risk for jaundice?
1) immature liver 2) less than optimal feeding
When are jaundice levels expected to peak in term infants?
3-5 days post birth
When are jaundice levels expected to peak in preterm infants?
5-7 days post birth
What is an important assessment r/t jaundice and discharge preparation?
essential to determine risk of jaundice prior to dc home and to provide for f/u with PCP
What should be added to the dc exam if an infant has been hospitalized for a longer period of time?
1) neuro exam 2) review of complications 3) assessment of maternal competence 4) f/u plans
What should be considered when attempting to determine if an infant is displaying signs of illness?
1) maternal indications, 2) gross observation, 3) changes in activity 4) temp instability, 5) changes in physiologic parameters, and 6) changes in feeding patterns
What components of gross observation should be considering when determining illness in a newborn?
posture, tone, abdominal distension, changes in color/perfusion
What components of temp instability should be considering when determining illness in a newborn?
increased temp = viral; decreased temp = bacterial
What components of physiologic parameters should be considering when determining illness in a newborn?
SpO2, HR, RR and BP
What should be included in the history taking portion of the newborn exam?
1) maternal hx: prerequisite for adequate newborn exam, 2) maternal record: if complete and accessible at time of exam, and 3) maternal interview
What are techniques to utilize to optimize a maternal interview?
1) introduce yourself, 2) give reason for questions, 3) maintain a normal conversation distance, 4) do not interrupt, 5) make eye contact, 6) allow time for response, 7) avoid technical language, 8) request clarification