Neck, clavicles, chest, abdomen

Question 1

Rubric

Answer 1

Neck – 4 points
Shape – webbing  (1)
Lesions/masses (1)
Nodes (1)
ROM (1)

Chest - 22 points
Clavicles – symmetry, masses (calcification), crepitus (2)
Thorax Shape – rounded (1)
Symmetry of movement (1)
Nipples – number, placement, shape, pigmentation (1)

Question 2

Neck

Answer 2

An infant’s neck is very short.

• -Is the shape of the neck normal? Is there any bleeding? Look for masses and lessions.
• -Must lift up baby’s head and separate folds of neck, note any masses or lesions.
• -Palpate the lymph nodes - shouldn’t feel any.
• -Assess ROM by manually turning head side to side. This elicits the fencing reflex. The side the head is facing will extend (arm and leg). The opposite side will flex.

Question 3

Clavicles

Answer 3

• -Palpate the clavicles, looking for calcification or crepitus. A broken clavicle is the most common fracture in a newborn.
• -Confirm symmetry

Question 4

Chest and abdomen

Answer 4

• -When looking at the chest and abdomen, look for shape (should be rounded), breathing patterns, should be regular, both chest and abdomen should rise, symmetrically,
• • Assess the breast buds and nipples. They should be in line with each other. There should only be 2.
• -Breast buds can be enlarged and can leak milk. Normal. It is caused by hormones and will go away.

-Abdomen - do light palpation all over the abdomen. This is followed by deep palpation. In a newborn, the liver is palpable.

Spleen - near the costal margin, may be able to feel the liver border. Sometimes the spleen can be palpated in the baby.

Kidneys - may be able to find the kidneys. Per text - feel like large olives, about 4 - 5 cm. If larger, consult MD.

Umbilicus - there should be three vessels: one vein, two arteries. Is there any herniation? Is there any redness, swelling, or discharge? Look for herniation in the inguinal area as well. Can check for this when the baby is crying.