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PNP: Physical Assessment > Newborn Assessment > Flashcards

Newborn Assessment Flashcards

1
Q

Terms (6)

A
  1. Preterm: less than 37 weeks
  2. Late preterm: 34-36 weeks
  3. Early term: 37-38 weeks
  4. Full term: 39-40 weeks
  5. Late term: 41 weeks
  6. Post term: 42 weeks and beyond
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2
Q

Assessment of Anterior Vascular Capsule of Lens (5)

A
  1. Use ophthalmoscope and focus on lens not retina
    * Within 6-10 inches –vascular will come into view
  2. The hyaloid system and tunica vascullosa lentis are TRANSIENT embryologic vascular systems that invade the eye during active growth and are seen at 27 weeks
  3. Gone after 34 weeks
  4. More vessels = younger GA, Less vessels = older
  5. Must be done within first 24-48 hours because atrophy is rapid
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3
Q

Ballard Exam for GAA (5)

A
  1. Includes extremely premature neonates
  2. Overestimates by 2-4 days = less 37 weeks
  3. 1-2 weeks = less than 28 weeks
  4. Perform with premature neonates postnatal age less than 12 hours
  5. Perform with full term neonates within first 48 hours
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4
Q

Caput Succedaneum (5)

A
  1. Edematous swelling of the soft tissues of the scalp that extends across the suture lines
    - Poorly demarcated soft tissue swelling
  2. Cause: pressure that restricts the return of venous and lymph flow during labor
  3. May be associated with petechiae or ecchymosis
  4. Pitting when palpated
  5. Resolves within days (3-5 days)
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5
Q

Cephalhematoma (6)

A
  1. Collection of blood between the periosteum and the skull (subperiosteal hemorrhage)
  2. May occur after traumatic delivery or instrumentation
  3. Well DEMARCATED edges confined by sutures
  4. Fluctuant SWELLING Does not CROSS SUTURE LINES
  5. Resolves in weeks (3-5) to months completely
  6. Most common location – parietal bones
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6
Q

Asymmetrical Crying Face (4)

A
  1. This condition can be differentiated from facial nerve palsy in that THE EYE AND FOREHEAD MUSCES ARE UNAFFECTED
  2. The etiology is a congenital deficiency or absence of the depressor anguli oris muscle (which controls the downward motion of the lip)
  3. In rare cases, this anomaly has been associated with cardiac or renal abnormalities or 22q11 deletion
  4. Can close both eyes; only involvement is the muscles of the mouth; nasolabial folds will be equal
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7
Q

Newborn breathing (4)

A
  1. Infants are obligatory nasal breathers
  2. Nasal flaring – an attempt to decrease resistance to airflow by increasing the size of the nostrils
  3. Grunting: attempts to clear fetal lung fluid from the lungs, created by exhalation against a partially closed glottis in attempt to increase the FRC and stabilize alveoli
  4. Suprasternal retractions are rare and indicative of upper airway obstruction
    - Laryngeal webs
    - Vascular ring
    - Usually with stridor or gasping
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8
Q

Precordium (4)

A
  1. In the first hours of life, the precordium of a term neonate may show a visible impulse along the left lower sternal border
  2. Right ventricular predominance common to transitional circulation
  3. As transition occurs this sign will disappear – normal newborn
    * If it persists after first hours of life – think heart disease, defects with increased ventricular volume…PDA, VSD
  4. PRETERM INFANTS- have an active precordium because they have less subcutaneous tissue than the term newborn
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9
Q

Newborn PMI

A

PMI is stronger than the apical impulse during the first hours to days of life at the 5th ICS/LSB
*Normal for newborn because of right ventricular predominance

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10
Q

Newborn Apical Impulse (2)

A
  1. In the neonate is usually seen in the 4th intercostal space; at or to the left of the midclavicular line
  2. Can be displaced – think pneumothorax, diaphragmatic hernia or dextrocardia
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11
Q

Volume Scale of Pulses (4)

A
  1. 0= absent
  2. 1+ = thready/weak
  3. 2+ = normally palpated
  4. +3 = full or bounding
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12
Q

Palpating brachial and femoral pulses

A

Right brachial + one femoral should be palpated at the same time
*Right side - because the right subclavian artery is always preductal – but left may not be…

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13
Q

What could diminished/absent femoral pulse indicate? (3)

A
  1. Decreased aortic blood flow
  2. Coarctation of the aorta
  3. Aortic stenosis
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14
Q

Critical Congenital Heart Defect Screening (3)

A

In first 24 hours check right hand and right foot

  1. Pulse ox > 95% - either extremity or less than 3% difference – normal newborn care
  2. Pulse ox 90-94% - or > 4% difference – repeat hourly x2, if there are 3 abnormal = REFER
  3. Less than 90% pulse ox - examine and notify - possible transfer
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15
Q

Abdominal Inspection (6)

A
  1. Skin of the abdomen should be pink
  2. Blue or grey = necrosis of the bowel
  3. A few veins may be visible – especially on lighter skinned and preterm infants
  4. Shape should be symmetric, without obvious swellings or depressions
  5. Fullness may be present if just fed
  6. Marked distention should not be present
    - In a preterm infant the abdomen may appear distended due overall size and GA
    - True Distention is never normal
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16
Q

Abdominal Circumference Assessment

A
  1. Measured just above the umbilicus = the greatest diameter
  2. Less than the head circumference = normal up until 30-32 weeks gestation
  3. 32-36 weeks - abdomen and head are equal
  4. After 36 weeks – abdominal circumference greater than the head
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17
Q

Scaphoid Abdomen

A
  1. Sunken
  2. May indicate diaphragmatic hernia – displacement of contents up into the chest
    - Contents have shifted up and are now in the lungs
    - Need to establish an airway; can’t blow air in because it will go into the intestines
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18
Q

Abdominal Distention

A
  1. Markedly distended abdomen warrants further evaluation

2. Bowel obstruction, necrotizing enterocolitis (NEC) or masses need to be ruled out

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19
Q

Diastasis Recti

A
  1. Midline separation of the rectus abdominus muscles
  2. Can be easily seen as a midline, elevated ridge extending from below the sternum to the umbilicus
  3. Exaggerated when crying
  4. Normal finding – will resolve without intervention
20
Q

Omphalocele (4)

A
  1. Herniation of the abdominal contents into the umbilical cord; directly over umbilical cord, protrusion can be large or small
  2. Contained in a translucent sac touching the umbilical cord
  3. Failure of the bowel to reenter the abdominal cavity after normal extrusion into the cord at 10 weeks gestation…faulty migration embryologically
  4. Frequently associated with Beckwith-Wiedeman syndrome, Trisomy 13 and 18. (other anomalies)
21
Q

Gastrochisis (5)

A
  1. Viscera protrudes through abdominal wall; usually right lateral
  2. No sac covering this defect (lies to right of an intact umbilical cord w/o a sac)
  3. Umbilical cord is separate from it
  4. Usually to the right of midline
  5. Intestines are exposed in the amniotic fluid; large amounts of bowel may lie in the amniotic fluid
22
Q

Polyhydramnios (2)

A
  1. AFI greater than 20-24cm (normal is 8-18cm)

2. Excessive fluid – preterm labor/placental abruption

23
Q

Oligohydramnios (2)

A
  1. AFI less than 5-6cm less than 500 ml of AF at term or 50%of normal at any time
  2. Compression due to lack of cushion
24
Q

Palpating Kidney

A
  1. The neonates kidneys are in a lower position in the abdomen than they will be in later life
  2. Normally the inferior poles of the kidneys can be palpated…right kidney is lower than the left
  3. Can be palpated in the flank areas above the level of the umbilicus
  4. Normal sized kidneys; Term = 4.5-5cm in length
25
Q

GA and Appearance of Male Genitalia (3)

A
  1. Rugae develop on the ventral surface of the scrotum at 36 weeks gestation
  2. Term – the scrotum is fully rugated and deeply pigmented
  3. Preterm – little to no rugae and no difference in pigmentation
26
Q

Scrotal Sac and GA (3)

A
  1. Less than 28 week GA, tetes are in abdomen
  2. 28-30 weeks GA, testes are in inguinal canal (begin to descend)
  3. Term GA - well situated in the scrotum
27
Q

Hypospadias

A

Abnormal location of the urethral opening on the ventral surface of the penis

28
Q

Epispadias

A

Abnormal location on the dorsal surface

*Associated with extrophy of the bladder and chordee

29
Q

Hydrocele (6)

A
  1. Result of a patent processus vaginalis = fluid around the testicle
  2. A Nontender, fluid-filled scrotal mass
  3. Presents as scrotal swelling caused by passage of peritoneal fluid through the patent processus vaginalis into the scrotum
  4. More common in preterm males
  5. May be associated with an inguinal hernia
  6. Most resolve within 1st year of life; Repair if they persist
30
Q

Inguinal Hernia (4)

A
  1. Presents as bulge swelling in the groin or scrotum that comes and goes
  2. Incidence is inversely proportional to gestational age
  3. Intestine in the scrotal sac renders the testi impalpable (different than hydrocele)
  4. Reducible, appear and disappear with straining or crying
31
Q

Testicular Torsion (6)

A
  1. Twisting of the testis on its spermatic cord
  2. May occur prenatally so look at first exam
  3. Usually unilateral
  4. Presents as: hard, swollen scrotum that is red to blue in color and does not transilluminate
  5. Ischemia of >4-6 hours = irreversible damage and loss of the gonad
  6. Painful in older boys but not noted in neonates…so may not be tender but still needs evaluation!
32
Q

States of consciousness (4)

A
  1. Refer to the level of consciousness exhibited by the infant
  2. Determined by level of arousal and ability to respond to stimuli
  3. The ‘state’ effects the infant’s behavior, function, and reaction to the environment
  4. Healthy Term infants can use STATE to exert control over environmental input – this is limited in the preterm infant
33
Q

Easy Temperament (4)

A
  1. The easy baby demonstrates regularity
  2. Positive approaches to new situation
  3. Adaptability to change
  4. Overall positive mood
34
Q

Difficult Temperament (4)

A
  1. Irregular schedule
  2. Trouble adapting to new situations
  3. Low threshold for stimuli
  4. Intense moods
35
Q

Slow to Warm Temperament (4)

A
  1. Mild intensity
  2. Positive or negative moods
  3. Slow adaptation to new situations/people
  4. Need repeated, slow exposure to a situation before they will respond positively
36
Q

Characteristics of Pre-Term Infants (10)

A
  1. Lack of muscle tone and subcutaneous fat so appear weak and frail
  2. Underdeveloped flexor muscles and muscle tone
  3. Head is larger in comparison to rest of body
  4. Lack of subcutaneous fat (white fat)
  5. Skin appear thin and translucent
  6. Barely apparent small flat nipples
  7. Plantar creases are absent (less than 32 weeks GA)
  8. Pinna of the ear is soft and flat
  9. Active precordium visible
  10. Reflexes are present and CNs intact
37
Q

Anterior Vascular Capsule of Lens Grading (4)

A

Grade 4: 27-28 weeks GA

Grade 3: 29-30 weeks GA

Grade 2: 31-32 weeks GA

Grade 1: 33-34 weeks GA

38
Q

CN 7 Palsy (5)

A
  1. Causes paralysis to the affected side (drooping of muscles on the affected side)
  2. Loss of forehead wrinkling
  3. No nasolabial folds
  4. Partial closing of the eye on the affected side
  5. Drooping mouth appearance
39
Q

Minor Malformations of the Ear (4)

A
  1. Pits or skin tags
  2. Anterior to the tragus
  3. Embryologic remnants of the first brachial cleft (arch)
  4. Preauricular sinus may be blind or communicate; assess for drainage or infection
40
Q

Female Genitalia (2)

A
  1. Urethral meatus should be ventral to vaginal opening
    - Deviation may indicate ambiguous genitalia
  2. Inguinal hernia may produce a reducible swelling of the labia
41
Q

Deep sleep state (3)

A
  1. No eye movement
  2. No activity
  3. Regular breathing
42
Q

Light sleep state (2)

A
  1. Low levels of activity

2. Rapid eye movement possible

43
Q

Drowsiness state (2)

A
  1. Variable activity levels

2. Dull, heavey-lided eyes that open and close

44
Q

Quiet Alert State (2)

A
  1. Wide, bright eyes

2. Attention focused on stimulus

45
Q

Active alert state (3)

A
  1. Increased motor activity
  2. Periods of fussiness
  3. Irregular respirations
46
Q

Crying state (2)

A
  1. Increased motor activity

2. color changes

PNP: Physical Assessment (21 decks)

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