Newborn exam

Question 1

General observation

Answer 1

state : awake or alert 
tone -->flexed 
color : pink , acrocyanosis of hand and feet
respiration: respiratory effort 
- grunting ? retraction ? nasal flaring
skin : mark ? 
lanugo : hair 
vernix : how much ? 
genitalia 
ingrown anomaly 
asymmetry

Question 2

lungs (start first if baby is quite)

Answer 2

lungs field : right (near clavicle) 6 places
under axilary
turn over : 6 places

30-60 resp.

Question 3

Heart

Answer 3

diaphragm first then bell
aortic 
pulmonic 
tricuspid 
mitral 
noted: no erb point 
in baby PMI is at 5th intercostal area & apical pulse in the 4th midclavicle area 
(in adult PMI & apical pulse are the same place) 
noted: murmur normal w/in couple days

100-160 bpm

Question 4

abdomen

Answer 4

all 4 quadrants

Question 5

Head

Answer 5

feel shape of the head : caput (gone by next day)? hematoma (for several week - ?
anterior & posterior fontanel

Question 6

eyes

Answer 6

placement on the face

immediately compare to ear should be at the line or above the line

Question 7

nose

Answer 7

position of the nose
it is the bridge flat ?
use light look inside septum deviation turbinate
test for patency (finger inside mouth and block each nose )
palpate palate, gum, look at mucosa
tongue ? uvula (midline/raise?)

Question 8

neck

Answer 8

lift up head : shape ? webbing present ? lesion
palpate lympth node
ROM : turn side to side (elicit another reflex -fancing pose)
palpate clavicle (most common fx)

Question 9

upper extremity

Answer 9

palpate : humerus down to finger 
open up the finger (any extra digit? creases? ) 
palpate and rotate every single joint 
any crepitus 
brachial pulses 
femoral pulses

Question 10

chest

Answer 10

shape : round
breathing abdomen rise at the same time.
nipple : aligned ?
NOT to do Percussion

Question 11

abdomen

Answer 11

light palpation 
deep palpation 
liver on right : 1cm 
spleen: left side 
kidney : 4-5cm

Question 12

umbilicus

Answer 12

1 vein 2 arterie

herniation ?

Question 13

genitalia

Answer 13

penis: straight, urinary meatus (pull back too see meatus)
reflex: stroke at testicle scrotum rise up ?

girl: open majora look at vagina opening : any skin tag ?
anus wink ?

Question 14

lower extremities

Answer 14

palpate all the bone 
palpate all the joint 
ROM from toe up to the knee - then do the other side 
plantal grab 
bibinski -flare toes 
palmal grab 
go back to the hip:

Question 15

hip

Answer 15

bend knee
barlow manuver: bring knee up and inward
knee up and out ( malani manuver)

Question 16

back

Answer 16

curvature 
scapula : symmetrical 
back of neck 
each and every vertebrae 
open butt dimple - any tuff of hair ? 
manolian spot ? 
gluteal fold : equal ? 
stroke on the side : baby will arch on the side
foot on the surface: other foot flex 
startle/moro reflex : arm up

Question 17

reflexes

Answer 17

rooting reflex 
sucking reflex
tonic neck 
palmal
planta
bibinski 
steping
trunk curvation 
anal wink 
moro