Newborn Assessment Flashcards
when does the newborn assessment begin
before delivery
What to anticipate in prenatal history
what may have compromise the fetus in utero?
Prenatal history
maternal medical and prenatal history
- blood type, lab values, GBS/HIV/HepB
- DM or preecalmpsia
- Smoking/substance abuse
what to think about intrapartum history
what happened during labor
intrapartum history
- duration and course
- maternal well being: analgesia or anesthesia
- fetal well being:prolonged rupture of membranes, meconium stained amniotic fluid, nuchal cord, precipitous birth, use fo forceps of vacuum extraction, fetal distress
First assessment
transition to extrauterine life
- ABC’s immediately at birth
- thermoregulation
- APGAR scoring
- Incorporate data with brief physical assessment
What are APGAR scores
- indication of extrauterine transition
- assessed at 1-5 minutes
- total score out of 0-10
Interpretation of APGAR score
- 8-10: good prognosis
- 4-7: active involvement/resuscitation efforts
- 0-3: poor prognosis
what does APGAR stand for
Appearance/ color Pulse/heart rate Reflex irritability/ grimace Muscle tone/activity Respiratory effort/respirations
APGAR: appearance
0- blue, pale
1-body pink, extremities blue
2- pink
APGAR: Pulse
0- absent
1- 60-100
2- over 100
APGAR: grimace
0- no response
1- grimace
2- vigorous cry
APGAR: activity
0- flaccid, limp
1- some upper extremity flexion
2- active motion of all extremities flexed
APGAR: respirations
0- apnea
1- slow, irregular, weak cry
2- lusty cry
Second assessment
- physical examination of new born:
- gestational age assessment if warranted
- assessment of attachment
continuous process of assessing
- progress of adaptation to extrauterine life
- nutritional status and ability to feed
- behavioral state/ organizational abilities
General measurement of newborn: weight
- weight: 7lb 8oz
- 70-75% of weight is water
general measure of newborn: head circumference
- 32-37 cm/ 12.5-14.5 inches
- 2 cm/1 inch greater than chest circumference
- measured above eyebrow at prominent part of the skull
general measurement of newborn: circumference
measured at nipple line
general measurement of newborn: abdominal circumference
measured just below umbilicus
general measurement of newborn: length
in USA, 20 inches
what does gestational age do? and when is it obtained
- establish in first 4 hours after birth
- predict at risk infants and help keep alert for problems
Ballard tool
- tool for estimating gestational age
- each finding is given a point value
- maternal condition may affect certain components
assessment of physical maturity characteristics
- skin
- languo
- planar creases
- areola/breast bud
- eye/ear formation
- genitalia
Assessment of neuromuscular maturity
- posture
- square window
- arm recoil
- popliteal angle
- scarf sign
- heel to ear
newborn classification based on gestational age and weight
- SGA: less than 2500g
- AGA: 2500-3999g
- LGA- 4000g
physical assessment
- complete with parent in systematic head to toe manner
- general appearance: head large for body and tend to stay in flexed position
Newborn assessment care plan: skin
- color: pallor, beefy red, jaundice, cyanosis
- texture: cracked, peeling, absence of vernix
- turgor: maintain tent shape
- pigmentation: rashes, birth marks, petechiae
skin variations
- telangiectatic nevi: stork bites
- Mongolian spots
- nevus flames: port wine stains
Newborn assessment and care plan: head
- general appearance
- proportion to ody
- circumference
- molding
- fontanelles
- sutures
head: general appearance and proportion
- piagiocephaly
- brachycephaly
- dolichocephaly
head shape in zika
microcephaly
head variations: molding
- caput succedaneum: edema, bruising of presenting part, crosses suture line
- cephalohematoma: collection of blood within suture line
head: fontanelles
- anterior fontanelle: diamond shaped and closes around 18 months
- posterior fontanelle: triangle shaped an closes around 8-12 weeks
head: sutures
no bulging and no depression
newborn assessment and care plan: eyes
- placement and appearance
- eyelids and movement
- color
new born eye assessment
- tearless crying
- peripheral vision
- can fixate on near objects
- can perceive faces, shapes, and color
- clink in response to bright light
- pupillary reflex is present
eyelid variations
- ptosis
- epicanthal folds
newborn assessment and care plan: nose
- small and narrow
- must breath through nose
newborn assessment and care plan: mouth
- palate: soft and hard
- tongue
- lips pink
- taste buds present
newborn assessment and care plan: ears
- appearance
- cartilage/ recoil
- hearing
newborn assessment and care plan: ears
- appearance: soft, pliable,
- cartilage/ recoil: pinna parallel with inner and outer cants, ready to recoil
- hearing
newborn assessment and care plan: neck
- appearance: short with skin folds, low muscle tone
- movement
- clavicles: intact, check for crepitus
newborn assessment and care plan: chest
- appearance: cylindrical and symmetrical
- breast: engorged, whitish secretions
- auscultation
- circumference
newborn assessment and care plan: heart:
- auscultation: PMI located at 3-4 ICS, midclavicular line
- rhythm/rate/murmurs: heart rate: 110-160
- xiphoid cartilage
signs of respiratory distress
- nasal flaring
- intercostal or xiphoid retractions
- expiratory grunting or sighing
- seesaw respirations
- tachypnea
newborn assessment and care plan: abdomen
- cylindrical and soft
- bowel sounds present by 1 hr after brith
- umbilical cord: initially white and gelatinous, two arteries, one vein
newborn assessment and care plan: genitalia
- female: labia majora covers labia minora
- male- testes descended, pendulous scrotum
female genitalia variations
- vaginal tag/ hymnal tag
- pseudomenstration
male genitalia variations
- hypospadias
- left hydrocele
newborn assessment and care plan: extremities
- short flexible, and move symmetrically
- leg are equal in length with symmetrical creases
variations in extremities
- gross deformities
- extra digits
- clubfoot
- hip dislocation
newborn reflexes
- palmar and plantar grasp
- rooting reflex
- moro reflex
- fencer reflex/ asymmetric tonic neck
- babinski reflex
- galant reflect: trunk incurvation
newborn protective reflexes
- blinking
- yawn
- cough
- sneeze
behavioral sates of newborn
- deep sleep
- light sleep
- drowsiness
- quiet alert
- active alert
- crying
behavioral response
- habituation
- orienting response
- motor organization
- consolability
- cuddliness
infant nutritional requirements
-calories: 100-120 cal/kg/day
-protien for cell growth
carbs for energy
-fat for brain and CNS developement
-fluid: 100-150 ml/kg/day
-iron: reserves depleted by 6 most
-vitamin D
-Babies regain BW by 10-14 days
early nutritional assessment: growth
-lose weight in first 3-4day of life
if formula feed: can lose 3.5%
if breast fed should not lose more than 7%
-no greater than 10% weight loss priorate discharge
-weighed daily
weight changes in first yeasr
double weight by 5 months
- tripe BW by 1 year
- quad BW by 2 years
breastfeeding assessment
- let down response
- nipple condition
- maternal comfort during feeding
- infant’s weight
what to monitor for in breast assessment
-montior process of
-anticipatory guidance/education
-maternal repose to infant cues
-latch on technique
positioning
signs of effective breastfeeding
- infant nursing 8 or more time in 1 day
- mother can hear infant swallow
- mother’s breast soften after feeding
- number of wet diapers increases
- infant stols besinning to lighten
- characteristic output
