Newborn Assessment Flashcards
How to promote physical well-being of newborn
Nursing care - Keep baby warm, wash after 24 hours, swaddle,
Physical assessment - reflexes, vitals
Nutrition - get them breastfeeding or on formula
How to promote and establish a functioning family?
we must educate and support both parents and grandparents
What are respiratory changes from fetus to newborn?
Respirations initiate
Chemically - surfactant reduces tension to reduce O2 concentration
Thermally - Moist infant is cold from exposed air
Mechanical - think vaginal compression or fetal chest during vaginal delivery
Apgar scoring. Scoring the Activity
0 - Absent
1 - Flexed arms and legs
2 - Active and moving around
APGAR - Pulse scoring
0 - No pulse
1 - Less than 100 bpm
2 - More than 100 bpm
APGAR Grimace scoring (Reflex)
0 - Floppy
1 - Minimal response to stimulation
2 - Prompt to respond
APGAR Appearance scoring
0 - Blue/pale
1 - Pink body with acrycyanosis
2 - Pink all over
APGAR - Respiration scoring
0 - No breathing
1- Slow & Irregular
2- Vigorous cry
When to assess APGAR
1 minute of birth
5 Minutes
Again at 10 min is the first two readings were low
Assess and intervene then reassess after interventions are done
Methods of heat loss - Evaporation
Wet surface exposed to air = loses heat
Baby comes out wet and water evaporates so baby loses heat
Conduction
Newborn comes into direct contact with object cooler than skin
Warm blankets and stethoscopes before placing on the baby
Convection
Heat is transferred to air that surrounds he newborn
Losing heat through airflow - try to decrease airflow in room to maintain babys temperature
Radiation
Transfer of heat to colder objects that arents in contact with infant.
What are the effects of cold stress?
Increased metabolic rate
Non-shivering thermogenesis-metabolism of brown fat
Vasoconstriction
How does increased metabolic rate in cold stress effect the baby?
Increase use of glucose and low production of surfactant hypoglycemia with respiratory distress
How non-shivering thermogenesis metabolism of brown fat effects the baby?
Increased production of free fatty acids leading to metabolic acidosis and jaundice
How does vasoconstriction of cold stress effect the baby?
Pale mottled skin leading to fetal circulatory patterns
What are kennel and klaus’ theory on bonding?
Must bond within the first hour of life or it will effect baby for the next 20 years
How to encourage bonding with parents?
En face -babies can see 6-8 in in front of them
Encourage breastfeeding asap after delivery
Skin to skin
Periods of reactivity
First period
30-60 Min
Vitals - eyes are the most open
Encourage bonding
APGAR
Radiant warming
Meds - Vit K & arithromycin
What are the periods of reactivity?
First period - 30 - 60 min
Sleep phase - 1 to 4 hours
Second period - 4 to 12 hours
What happens in the second period
4 to 12 hours after birth
Increased sensitivity to internal and external stimuly
Voiding and meconium
Mucus, apnea, emesis
Most active in this phase
Risk of not giving vit K injection to newborns
Neonatal hemorrhaging
Normal weight in pounds and gms for newborns
2500-4000gms
5.5 - 8lbs
SGA
less than 10% SGA
LGA
More than 90% LGA
Normal length of newborn
18-22 inches
48-52cm
Head circumfrence
measure above eyebrow
13-14INCHES
32-36CM
Chest circumfrence
Measure nipple line
12-13 Inches
30-34 cm
Temp of newborns
Pulse
97.5-99.5
110-160 bpm
Crying - 180 bpm
Sleeping -100 bpm
Blood pressure of newborns
Only taken with suspected cardiac issues
Measure at the thigh
Falls around 70/40 as normal
Normal Fontanelles
Dehydrated
ICP
Flat & pulsing
Bulging - ICP
Sunken - dehydration
Molding
Cone head normal
Overrided sutures
Resolves quickly
Caput Succedenum
Crosses suture line like a cap
Cap Swelling
Goes away without treatment
Cephalohematoma
Over a particular bone
Does not cross suture line
Bleeding, blood clot
What will we see when cephalohematoma begins to resolve?
Jaundice that starts from head and spreads to the rest of the body
Skin of the newborn?
Reddish in color, ruddy and smooth
Edema - resolves but causes weight loss as they lose water
Turgor- look for dehydration
What to look for in the eyes of newborn?
Color and red reflex
Subconjunctival hemorrhage from birth trauma
Chemical conjunctivities from reaction to eye prophylaxis
What to look for with ears in newborns
Eyes and top of ear should line up - if not possible down syndrom or chromosome abnormalities
Loud noise = startle reflex
Moro reflex - abduct, adduct, cry (Away at 3mos)
Flexible pinna with cartilage - it snaps back
What to look for in the nose with newborns
They are nose breathers look for patency
Normal sneezing and no bridge
Problems:
Nasal flaring that lasts longer than a few moments after birth
Check for retractions & listen to lungs
Mouth and throat assessment in newborn
Reflexes: Sucking, Rooting, Gag, Extrusion reflexes
Extrusion usually lost at 4-6mos when solids are introduced
Place finger in mouth and see if sucking reflex is available check for cleft palate at same time
Abdominal assessment of the newborn?
Dome shaped belly
Soft on palpation
Liver is palpable 2-3cm below right costal margin
Bowel sounds 2 hours post delivery
When will be first void and meconium of newborn?
Void - within 24 hours
Meconium - Within 24-48 hours
Female genitalia of the newborn
Edematous at labia and clitoris with vernix between the labia
Moms hormones may have the baby spotting within the first week this is normal!
Male genitalia of the newborn
Palpable testes - if not palpable may be testicular cancer later in life
Rugae should be formed
Do not clean Smega
Do not retract the foreskin it will not return if you do.
Assessment of extremities
Normal posture
Equal bilateral movement and tone of all four extremities
Flat feet- will develop the arch later
All creases should be present
Look for simean crease - if coupled with downset ears can be a down syndrome case.
Hip dislocation assessment
Use ortolani’s maneuver - push knee up and rotate
Look for clicking - can also be r/t breech birth
If not breech baby
check for:
-Clicking
-Unequal leg length
-Asymmetrical skin creases on back of thigh
Neuromuscular system assessment of the newborn?
-Maintains flexion
-Can hold head erect for few seconds
-When prone turns head to side to breath
Troubling signs of the neuromuscular assessment?
No movement
Jerking
Quivering
Clonic jerking -Possible Neonatal abstinence syndrome - check urine tox
Behavioral assessment
Soothed to cuddles - if cannot be soothed look into NAS
Sleeps for at least 16-20 hours a day
Brazelton behavioral assessment - test for ADD
Additional care of newborn - Bulb suctioning and sleeping
Parent teaching to suction - Bubl suctions - Depress bulb and suction mouth first to avoid aspiration.
Back to sleep - Avoid SIDS
Additional care of newborn - Circumcision & PKU
Keep clean and dry
Monitor newborn voiding
wrap with ointment
PKU - Must be breast and bottle fed before wait 24-48 hours
When to call MD
Fever
Blue or color changing
Crying incessantly
No urination
Car seat safety
Rear face seat until 2 years old
Front face until 40 pounds
Booster up to 7-8 years old
Normal skin assessment
Milia - Clogged sebaceous glands
Mottling - happens when they’re cold
Vernix
Rashes and marks
Erythema toxicum (Newborn rash) - Starts are trunk and goes away on its own
Forceps mark - assess symmetry (Neuro check)
Mongolian spots - common in any race by white. Purple ecchymotic skin
Goes away in few weeks/months
Birthmarks
Port wine stain - more permanent birthmark
Stork bite/ Nevi - Normal - goes away in its own, Found on neck/lips
If blanches will go away quickly
Strawberry hemangioma - Not uncommon and can be found on lower back
Cafe au lait
Petechiae
Reflexes - Babkin reflex
Stimulated by:
Press, stroke both palms
Mouth opens, eyes close, head tilts forward
Disappears: 3 mos
Grasping reflex
Stimulated: Place object in palm
Holds it tightly
Disappears: 4 mos
Babinski reflex
Stimulated: Stroke sole of foot
Foot twists and toes fan out
Disappears: 8 mos
Stepping reflex
Stimulated: Hold baby under arms not on floor
Stepping motion
Disappears: 2 mos
Difference between physiologic and pathologic jaundice in the newborn?
Pathological jaundice happens within the first 24 hours
Physiological jaundice occurs 2nd or 3rd day. Not associated with hemolytic disease or other pathologies.
(6-10mg/dl & resolves in 5-7 days)
