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
What are important components of identifying maternal data?
maternal age, race/ethnicity, marital status, occupation, highest education level and religion
What are important components of maternal general health status data?
1) hospitalizations, 2) surgeries, 3) injuries, 4) congenital conditions, 5) chronic health problems, 6) illnesses with current pregnancy, 7) general health habits, and 8) current medications
What conditions should be addressed when interviewing the mother concerning her chronic health problems?
allergies, hypertension, DM, respiratory problems, heart disease, thyroid fx, liver dz, kidney dz, blood dyscrasias, sz disorders, neurologic/muscloskeletal problems, mental illness/ depression
What conditions should be addressed when interviewing the mother concerning her illnesses with current pregnancy?
PIH, HELLP, GDM, UTIs and STDs
What conditions should be addressed when interviewing the mother concerning her health habits?
exercise, sleep, diet, caffeine, tobacco, alcohol, illicit drug use
What should be addressed when interviewing the mother concerning her family hx?
genetic problems- pedigree; chronic disorders or disabilities of household members
What should be addressed when interviewing the mother concerning her living accommodations?
apt/ house/ trailer/ homeless, water supply, electricity
What should be addressed when interviewing the mother concerning her social hx?
1) living situation, 2) other children (age, gender, problems), 3) health status of other household members, 4) access to transportation, 5) support systems/ friends/ extended family members, 6) financial support, 7) plan to return to work, 8) plan for infant care
How should OB history be assessed?
1) Gravidity 2) Parity 3) Spont AB 4) Elective AB 5) Preterm deliveries 6) Stillbirths 7) Neonatal deaths 8) multiple pregnancies 9) Types of deliveries 10) Complications with past pregnancies 11) BW of other children 12) GA at birth of other children 13) complications at birth with other children
How should the history of the current pregnancy be assessed?
1) immune status 2) due date 3) fertilization hx 4) # of prenatal visits 5) when prenatal care began 6) weight gain 7) drug use- Rx, herbal, OTC, ilicit 8) physical activity 9) infectious exposures 10) tests during pregnancy 11) high risk factors 12) medical complications 13) treatments
What are potential infectious risks during pregnancy that should be addressed?
TB, Hep A/B/C, STDs, TORCH
What are tests during pregnancy that should be addressed?
1) ultrasounds 2) serology/ blood type 3) glucose tolerance test 4) GBS status 5) Triple/Quad screen
What is included in the triple/quad screen?
1) alpha fetoprotein (AFP) 2) unconjugated estriol (UE3), 3) human chorionic gonadotropic (hCG), and 4) inhibin A
How should the history of the L&D be assessed?
1) onset of labor (spont v induction), 2) duration (length of stages 1&2), 3) fetal presentation, 4) ROM, 5) signs of fetal distress, 6) type of delivery, 7) forceps/vacuum, 8) nuchal cord, 9) shoulder dystocia, 10) meds/anesthesia
What should be noted as it pertains to ROM?
spontaneous v artificial, color, consistency, odor, length of time of ROM
What are the immediate concerns of assessment at the time of delivery?
1) Apgar scores, 2) resuscitation efforts, 3) response to resuscitation, 4) anomalies noted, 5) cord vessels, 6) voiding/ passing of mec
What are the concerns of assessment during the initial period after birth?
1) sex/weight/length, 2) GA/classification, 3) VS, 4) blood glucose >45mg/dL
Why is a good history vital to a newborn exam?
1) prevents missing important information that is critical to the exam, 2) allays parental anxiety- was there an abnormality during the pregnancy that needs to be addressed, 3) alerts you to potential problems, 4) prevents unnecessary testing, 5) enables cultural sensitivity
Why is observation an important technique for a newborn exam?
most important, gives immediate indication of wellness, thoughtful inspection- not just looking, continue through entire exam
How is color observed?
mucous membranes, tongue, nail beds, hands, feet, skin, perfusion, mec staining, jaundice, mottling, plethora and cyanosis
How is nutritional status observed?
subcutaneous fat, breast tissue, cord
How is hydration observed?
skin turgor, anterior fontanel
How is GA observed?
posture, skin, ear cartilage, areola & nipple formation, creases on feet, testes, rugae and labia
How is the head/hair observed?
distribution, amount, texture of hair, shape of head, scalp, fontanels, sutures, lesions
How is the face observed?
shape, symmetry of features/ movement, glabella tap
How are eyes observed?
placement of eyebrows/ eyes, eyelids, drainage, conjunctiva, sclera, iris, red reflex, PERRL, optic blink reflex, corneal blink reflex, eye movements and doll’s eye
How are ears observed?
placement, pits, sinuses, accessory tragi, auditory canal, recoil of pinna, response to sound
How is the nose observed?
size, shape, symmetry, secretions, congestion, patency, response to odor
How is the mouth observed?
philtrum, shape, symmetry, moisture, secretions, gums, palate, tongue, uvula, rooting, movement of tongue, suck, swallow, gag, jaw size
How is the neck observed?
clefts, sinuses, webbing, fat pad, ROM, asymmetric tonic neck reflex
How is the chest observed?
shape and symmetry, respiratory effort, nipples and breast tissue
How is the heart observed?
color, skin perfusion, precordial activity, visible PMI
How is the abdomen observed?
color, size, shape, distension, visible peristaltic waves/loops, cord, vessels, peri-umbilical area
How are the genitalia observed?
Male: scrotum, rugae, foreskin, urine stream, meatus, perineum, anus; Female: labia majora, labia minora, clitoris, vagina, perineum, anus
How are the musculoskeletal/neurologic systems observed?
posture, motor activity, palm and sole creases, # of digits, nails, palmar and plantar grasps, babinksi reflex, ankle clonus, length and symmetry of extremities, ROM, pull-to-sit, vertical/ventral suspensions, spine alignment, truncal incurvation, stepping reflex, Allis’ sign, Moro
How is the infant’s state observed?
facial expression, responsiveness
Why is the technique of palpation used?
to sense temp, turgor, texture, tension, tenderness, pulsation, depth, size, shape & location of structures not seen
Why is the technique of percussion used?
can help determine present of abnormal tympanicity or dullness in chest or abdomen
What should be considered as it pertains to the timing of the newborn exam?
1) not just after feeding: 30-60min prior to feed is best, 2) not when baby is irritable, 3) after transition, 4) within first 24h if possible, 5) GA assessment: of ELBW infants should be done <12h r/t skin changes that affect scoring
