Newborn Assessment/Care Flashcards
list signs of respiratory distress (6)
- nasal flaring
- grunting
- tachypnea
- substernal retractions
- seesaw respirations
- cyanosis
what is the first sign of respiratory distress?
nasal flaring
when the baby is experiencing nasal flaring, what are they trying to do?
get more air in this way
why do we see grunting?
it natures CPAP → baby is trying to force more air down deep
what rate is considered tachypneic?
> 60 respirations per minute
When a baby is in respiratory distress, what does tachypnea indicate?
they are trying to take in faster breaths to compensate for not getting enough O2
how would substernal retractions present?
They don’t gasp for breath → but will see pulling at the rib cage
how would seesaw respirations present? how should they breathe normally?
pulling at the chest that goes down to the abdomen
they should be belly breathers
what is a late sign of respiratory distress?
cyanosis
are milia normal?
yes & they go away on their own
what does milia result from?
exposure to mom’s hormone’s & the baby’s being sensitive
are stork bites normal?
yes
where are stork bites typically seen?
on eyelids and nape of the neck
who are Mongolian spots seen the most in?
babies of color
when do Mongolian spots usually dissapear?
somewhere in preschool age
What does Caput Succedaneum indicate?
swelling or fluid under the skin → diffuse swelling does NOT have a border
where can meconium staining be seen? what does this indicate?
staining of the umbilical cord or vernix
it means that the baby had their first meconium passage in utero
what newborn assessment finding looks like an infection but is normal?
Newborn rash or Erythema toxicum
are cafe au lait spots normal?
they are normal but if there is 9 or more, should be evaluated by pediatrician
is congenital pigmented nevus normal?
they are normal changes that may not go away but they should be watched for changes related to skin cancer
if there is mottling right away after birth, what does this mean?
their vasomotor changes are happening
if mottling is seen after they get pink, what can this mean?
could mean they are cold, stressed, or septic
what newborn assessment finding is when one half of the body is red and the other half is normal color?
harlequin sign
is harlequin sign common?
no it is not seen often
if harlequin sign does not persist what does this mean? how does it resolve?
it means it was just vasomotor changes
usually resolves on its own
when there is lots of vernix at birth what does this mean?
it is a preterm baby
what does leathering & cracking of the skin mean at birth?
it is a post dates baby
What newborn assessment finding is common & can look like cyanosis?
facial bruising
what should the nurse do if there is facial bruising at birth? (4)
- Determine by blanching to see color underneath & be sure to pass off in report
- Look at mucous membranes
- observe the baby breathing
- may even check pulse ox
if a baby who was born using a vacuum has vacuum marks on head, what can be applied to it?
bacitracin
what finding presents with hairy shoulders, arms & back? who is it seen in?
lanugo; seen in preterm babies
is nevus vasculitis or strawberry hemangioma common?
yes very common
where do nevus vasculitis or strawberry hemangioma appear?
on head and face
when does nevus vasculitis or strawberry hemangioma disappear? what happens?
by age 5
it turns silvery/white first then disappears
why should nevus vasculitis or strawberry hemangioma not be surgically removed?
it causes scarring
does nevus flammeus or port wine stain go away?
no it does not and it can be very distressing
what assessment finding is a pathologic lesion that is very serious & more than just skin deep?
varicella (chicken pox)
what assessment finding is a pathologic lesion consisting of fluid filled vesicles?
HSV
what is the worry with HSV lesions?
child is highly contagious & may become septic
Be really careful with this → baby would have to be on isolation
what fontanelle is diamond shaped? what one is smaller & triangle shape?
anterior fontanelle is diamond shaped
posterior fontanelle is smaller & triangle shaped
when should anterior fontanelle close?
at 18 mos
when should posterior fontanelle close?
by 3-4 mos
what could sunken fontanelle indicate? What should we worry about?
child is dehydrated → worry about ineffective breastfeeding or baby has a virus and is vomiting
what does a bulging fontanelle indicate?
fluid on the brain
is molding or cone head normal? why or why not? what can you feel?
normal → they were in birth canal for a while
can feel bones under skin
what newborn assessment finding is on one side and does not cross suture line? should you be alarmed?
Goose egg
Not to be alarmed, it is just under the scalp (which is very vascular)
when might a goose egg be seen?
if vacuum was used
as goose egg goes away, what is the child at higher risk for?
jaundice
what indicates a healthy baby cry?
both sides of face move equally
when do most cases of facial palsy resolve? what can it disrupt?
most resolve in a few days
can disrupt feeding
what does recess jaw indicate?
part of a syndrome
what will baby with recess jaw have extreme difficulty with?
extreme difficulty with feeding & be in NICU
most babies are fairly __________ in their eyes
edematous
what might you have to do if there is eyelid edema?
Might have to pry eyeball open to ensure the eyeball is present
*Could have congenital defect where eyeball is absent
if the baby has gonorrhea infection in the eyes, what do we tx it with? what can this infection lead to?
erythromycin ointment
can lead to blindness
if you detect a subconjunctival hemorrhage, is this alarming?
no not very alarming & usually goes away in a week or two
why is it very important to look at newborn ears?
Ears develop at same time as kidneys but we cannot see the kidneys
if a baby’s ear has a skin tag on it, does this correlate to kidney damage?
no
if a newborn’s ears have dimpling/little holes what can this indicate?
some kind of hearing loss if they travel to CNVIII
how do you measure low set ears?
measure from inner canthus of eye
what are low set ears markers for?
Marker for different syndromes → such as trisomies
a normal baby mouth should have what?
pink moist mucous membranes
what are epstein’s pearls?
a variation of normal; little cysts that look like teeth but go away
what should you do if you see that the newborn as a tongue tie?
refer to pediatrician to be able to breastfeed more effectively
if a baby has circumoral cyanosis where else would you see cyanosis?
inside mouth if you were to open it
how should you assess cleft palate?
when baby’s mouth is open with light
then take gloved finger and assess (feel) all the way back to the soft palate
the severity of gap in palate can vary so it is important to do what?
use a good light to look
what can cleft palate lead to? why?
Can lead to aspiration when feeding bc of abnormal opening between trachea & esophagus
when a baby has a cleft lip, parents can sometimes get info where/when?
from ultrasound before baby is born
what are abnormal findings when assessing baby’s clavicles? what should you do and why?
bubbles popping or grating sensation (crepitus)
should STOP palpating & call dr
can actually cause pneumothorax if you drag bone fragment into the lungs
if you had a baby with shoulder dystocia, you may see what?
asymmetrical movement in arms
what should you see regarding extremity movements? if not what could this indicate?
Should have symmetrical movements → could indicate fractured clavicle or brachial plexus
what is a pretty common finding that can look like little nubs of dangling skin or full finger/toe? what does this come from?
Polydactyly → recessive gene that runs in family
what is syndactyly? when does it happen?
fingers/toes are fused together; happens pretty early in development
how many creases should the baby have on their hands?
two distinct creases across the palm
what is simian crease? what is it a marker of?
one crease across the palm
marker for down syndrome & other developmental disability
If B/L → much stronger marker
