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PNP: Physical Assessment > Newborn Skin Assessment > Flashcards

Newborn Skin Assessment Flashcards

1
Q

Basic Functions of Newborn Skin (5)

A
  1. Physical protection
  2. Immunologic protection
  3. Heat regulation
  4. Sense perception
  5. Self cleaning
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2
Q

How is newborn skin different? (8)

A
  1. Basic structure is the same but skin is thinner
  2. Functionally immature (functionality decreases with GA)
  3. Increased fragility of the skin
  4. Fewer fibrils connecting the dermis and the epidermis
  5. Increased permeability with decreasing GA until 2 weeks of life –> Increased absorption and evaporation
  6. Decreased elasticity
    - Decreased collagen deposits in the dermis
  7. Skin appearance changes dramatically in the first few
    hours, days of life (Rapidly matures so that by 2 weeks of life preterm skin will resemble that of full term skin)
  8. Sweat glands are present at birth but do not function
    like an adult until 2-3 years of age (important for temperature regulation of newborn; can overheat)
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3
Q

Thinner epidermis of newborns leads to…

A

increased risk of skin injury (adhesive, tape, monitor leads, handling)

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4
Q

Less pigmented skin of newborn leads too..

A

Responds rapidly to environmental changes and internal processes

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5
Q

Newborn Skin pH (6)

A
  1. Mean pH 6.4 at birth
  2. Decreases to 4.9 within first weeks
  3. pH less than 5.0 is considered beneficial for antimicrobial defense
  4. Maintenance of normal skin pH is difficult
  5. Easy to disrupt – exposure to alkali solutions
  6. Frequent bathing, soaps, topical substances, exposures
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6
Q

Newborn Skin: Immune System (4)

A
  1. Inadequate immune system
  2. Invasive treatments (sick or preterm)
  3. Frequent use of antibiotics (sick or preterm)
  4. Skin disruptions create portal of entry for infection
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7
Q

Transepidermal Water Loss (TEWL)

A

Increased in premature infants (less than 32 weeks)

Influenced by…

  1. Skin integrity
  2. Ambient temperature and humidity
  3. Postnatal age
  4. Infant weight
  5. Activity
  6. Body temperature
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8
Q

TEWL can lead to… (6)

A
  1. Dehydration
  2. Weight loss
  3. Electrolyte imbalance
  4. Shock
  5. Renal failure
  6. Death
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9
Q

What to look for when assessing newborn skin (7)

A
  1. Skin assessment surface head-to-toe
  2. Color
  3. Examine underlying dermis
  4. Assess thickness of the skin
  5. Assess amounts of subcutaneous fat
  6. Irregularities in texture or consistency (turgor,edema,moisture)
  7. Temperature
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10
Q

What can newborn skin assessment determine? (5)

A
  1. Gestational age
  2. Nutritional status
  3. Functioning of organ systems
  4. Presence of cutaneous or systemic disease
  5. Note risk factors in the environment
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11
Q

Vernix (5)

A
  1. Fetal skin; protects fetus in utero and externally protects against organisms that can penetrate teh skin
  2. Greasy, white or yellow material
  3. Sebaceous gland secretions and exfoliated skin cells
  4. Water, lipids and protein
  5. Present during the third trimester (peaks at 33-37 weeks)
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12
Q

Lanugo (4)

A
  1. In utero
  2. A soft, downy, hair
  3. First appears at 20 weeks
  4. Covers entire body-including face
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13
Q

Acrocyanosis (4)

A
  1. Bluish discoloration of the palms and feet
  2. Presents at birth and lasts up to 48 hours – should go away by time baby leaves hospital otherwise bring back
  3. Exacerbated by low temperatures
  4. Benign in the normal, healthy infant
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14
Q

Plethoric (4)

A
  1. Ruddy or red appearance (cherry red)
  2. Indicative of a high level of RBCs
    * May be due to chronic fetal hypoxic state compensation; body procudes more RBCs and baby comes out very red
  3. Do CBC
    * Polycytehmia –> increased RBCs leads to risk for clotting, stroke, and hyperbilirubenemia
  4. Assess symptoms
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15
Q

Jaundice (5)

A
  1. Yellow coloring of the skin and sclera
  2. Check age of infant; considered physiological in first 72 hours
  3. Head to toe progression; always starts at top
  4. Bilirubin indirect / direct
  5. Very important to have right temperature in lighting in room when assessing
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16
Q

Curtis Marmorata (5)

A
  1. Bluish mottling or marbling of the skin
  2. In response to chilling, stress, overstimulation
    * Resolves when they feel better
  3. Caused by dilatation of the capillaries
  4. Disappear when the infant is warmed
  5. Persistent C.M. may be seen with Trisomy 21, trisomy 18, and Cornelia de Lange syndrome
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17
Q

Harlequin Color Change (7)

A
  1. Seen only in the newborn period
  2. Common in LBW infants (but can happen with AGA)
  3. Lying on one side-sharply demarcated red color on the
    dependent half of the body
  4. Pale appearing opposite side (side facing upward)
  5. When rotated the color reverses
  6. No pathologic significance**
  7. Temporary imbalance of the autonomic regulatory
    mechanism of the cutaneous vessels (ex: when breast-feeding the baby)
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18
Q

Erythema Toxicum (7)

A
  1. Benign rash 70% of newborns
  2. Small, white or yellow papules, macules, pustules or
    vesicles with an erythematous base
  3. Most common on the face, trunk, extremities
  4. Disappears and reappears on a different part of the
    body (hallmark is that it comes and goes)
  5. Peak incidence is from 24-48 hours
  6. Cause unknown
  7. Definitive diagnosis – smear shows numerous
    eosinophils
    *If it doesn’t classically look like ET, check if it’s herpes because it’s lots of clusters to point of vesicular
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19
Q

Milia (5)

A
  1. Multiple yellow or pearly white papules ~1mm in size
  2. Found on the brow, cheeks, nose
  3. In mouth = Epstein’s pearls
4. Epidermal cysts caused by accumulation of sebaceous
gland secretions (from maternal hormones)
  1. Resolve spontaneously during 1st weeks
    * Don’t play with them or they can get infected
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20
Q

Sebaceous gland Hyperplasia (3)

A
  1. Numerous tiny (less than .5mm) white/yellow papules on the nose, cheeks, upper lip
  2. Caused by maternal hormones
  3. No treatment required
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21
Q

Miliaria (5 including 3 types)

A
  1. Obstruction on sweat ducts
  2. Forehead, scalp, creases most common – can be all
    over
  3. Three types-depending on severity
    - Crystallina-clear, thin vesicles 1-2mm
    - Rubra-Appear as small erythematous papules
    - Profunda-secondary infection, rare
  4. It is prickly heat / heat rash***
  5. Different from erythematous toxicum because it is not on an erythematous base
22
Q

Treatment of Milaria

A

Eliminating precipitating factors
 Excessive heat, humidity
 Keep clean and dry
 Resolve within a few hours

*No barrier creams!! Leave open and air dry because it’s due to excessive heat

23
Q

Sebaceous Nevus (7)

A
  1. Small yellow papule or plaque
    * Smooth, yellow, orange hairless
  2. Scalp and face - will have hairless area
  3. Immature hair follicles, sebaceous glands
  4. Devoid of hair on the scalp
  5. Changes at puberty-enlarges and raised
    * More pronounced in adolesence
  6. Small percentage transform into basal cell epithelioma
    * Needs to be followed, refer to dermatology
  7. Surgical removal
24
Q

Neonatal Acne (6)

A
  1. Neonatal cephalic pustulosis
  2. Benign
  3. Typically presents 2nd-3rd week of life
  4. Inflammatory papules and pustules
  5. Forehead, cheeks and nose
  6. Can last for 6-12 months
25
Q

Erythema Toxicum Neonatarum (onset, morphology, distribution, duration)

A

Onset: 24-48 hours

Morphology: Erythematous macules, papules and pustules on erythematous base

Distribution: face, trunk, buttocks, proximal extremities

Duration: 5-7 days

26
Q

Benign Cephalic Pustulosis (onset, morphology, distribution, duration)

A

Onset: 2nd and 3rd week of life

Morphology: inflammatory papules and pustules; no true comendones

Distribution: forehead, nose, and cheeks

Duration: 6-12 months old

27
Q

Transient Neonatal Pustular Melanosis (onset, morphology, distribution, duration)

A

Onset: Present at birth

Morphology: Vesicles, superficial pustules and pigmented macules, rim of scales

Distribution: Chin, neck, forehead, chest, buttocks, and less often palms and soles

Duration: Few days, pigmentation 3-6 months

28
Q

Miliaria (onset, morphology, distribution, duration)

A

Onset: Days to weeks

Morphology: small vesicles, vesicles with surrounding erythema, papules, small pustules

Distribution: forehead, neck, upper trunk

Duration: Few days

29
Q

Sebhorric Dermatitis (onset, morphology, distribution, duration)

A

Onset: 3 weeks-12 months

Morphology: erythema, greasy scales, and salmon-colored oval patches

Distribution: scalp, face, forehead, eyebrows, trunk, interdiginous and flexural areas

Duration: weeks to months

30
Q

Mongolian Spots (8)

A

Dermal melanocytes (dermal melanocytosis)

  1. Hyperpigmented macule
  2. Most common pigmented lesion
  3. 90% of AA, Asian, and Hispanic infants
  4. Buttocks, flank, shoulders
  5. Gray, bluish-green in color
  6. “bruises” (but you can tell them apart because they don’t change color like bruises)
  7. Melanocytes that infiltrate the dermis
  8. Fade over the first 3 years of life
31
Q

Transient Neonatal Pustural Melanosis (7)

A
  1. Superficial, vesiculopustular lesions
  2. Rupture within 12-48 hours
  3. Leaving small pigmented macules
  4. Surrounded by white scales
  5. Remain up to 3 mths
  6. Benign
  7. Aspiration reveals neutrophils and and almost no
    eosinophils
32
Q

Congenital Melanocyte Nevi (7)

A
  1. Dark brown or black macules
  2. Proliferation of melanocytes
  3. Lower back and buttocks most common
  4. 1cm-20cm range
  5. 20cm malignant changes
  6. Observe carefully – laser or surgical excision
    * Risk of melanoma in large/deep CMN
  7. Can be +/- hair
33
Q

Cafe Au Lait (4)

A
  1. Tan or light brown macules or patches
  2. Well defined borders
  3. 5 = NF risk
34
Q

Tuberous Sclerosis (7)

A
  1. Hereditary disorder
  2. Cutaneous and central nervous tumors
  3. Seizures, delays and behavioral
  4. Hypopigmented, white macules
  5. Ash leaf macules “leaf” shaped
  6. Trunk and buttocks
  7. Very light in color!
35
Q

Cutis Aplasia (7)

A
  1. Congenital abnormality
  2. Absence of some layers of skin
  3. Scalp
  4. Trisomy 13 (Patau’s syndrome)
  5. RX: surgery
  6. Presents as superficial erosion, ulceration or scar
  7. Atypical/large or hair collar sign indicate need for imaging
36
Q

Forceps Marks (3)

A
  1. On Cheeks, scalp, face
  2. Red or bruised
  3. Assess facial palsy, fractured clavicles or skull
    fractures
37
Q

Subcutaneous Fat Necrosis (4)

A
  1. Nodule that is hard, nonpitting and sharply circumscribed
  2. Red or purplish in color
  3. Trauma at delivery
  4. Grows larger over first days-resolves
38
Q

Sucking Blisters (3)

A
  1. Vesicles on the lips, fingers or hands
  2. In utero – could be from sucking thumb in utero
  3. No treatment
39
Q

Scalp Lesions (4)

A
  1. Abrasions or lacerations
  2. Scalp electrode
  3. Vacuum extraction
  4. RX: clean, dry and observe for infection
40
Q

Nevus Simplex (6)

A 
1. Vascular Lesion
“stork bite”
2. Most common (50%)
3. Irregularly bordered pink macule
4. Dilated, distended capillaries
5. Blanch with pressure, more prominent with
crying
6. Fade by year 2
41
Q

Port Wine Nevus (12)

A

Vascular Lesion

  1. Nevus flammeus
  2. Flat, pink or reddish purple lesion
  3. Dilated, congested capillaries
  4. Sharply delineated edges-
  5. Does not blanch
  6. Does not grow or resolve
  7. Usually unilateral
  8. RX: flashlamp pulse dyed laser therapy
  9. Branches to Trigeminal nerves may be associated
  10. Seizures, MR, hemiparesis
  11. Cause is unknown
  12. Rare congenital disorder
42
Q

Strawberry Hemangioma (7)

A

Vascular Lesion

  1. Infantile hemangiomas
  2. Bright, red, raised tumor
  3. Head, neck, trunk or extremities
  4. Soft and compressible
  5. 10% newborns – girls>boys
  6. Dilated capillaries
  7. Complications-bleeding, ulceration, infection or
    compression of vital organs
43
Q

Infantile Hemangiomas (8)

A
  1. Start out as a small ‘dot’
  2. IH proliferate during the first 2-3months of life
  3. Period of rapid growth is between 5-7 weeks of age
  4. Growth stabilizes 4-6 months
  5. Followed by involution (years)
  6. Larger take longer to involute-refer before 3 months
    of age for best outcome
  7. Superficial v Deep (bright red v bluish)
  8. Occur anywhere on the body-can be focal or
    segmental
44
Q

Why location of hemangioma is important….(4)

A
  1. Observe placement for possible underlying organ
    involvement
  2. Visual or airway impairment based on location
  3. Multi-focal (>5) can be associated with hepatic
    involvement – abdominal US recommended
  4. Segmental (spine) more likely to have underlying
    structural anomalies
45
Q

Cavernous Hemangioma (6)

A
  1. Larger more mature vascular lesion
  2. Involves the dermis
  3. Bluish, red in color
  4. Soft, compressible
  5. Poorly defined borders
  6. Associated with: Kasabach Merritt syndrome, Platelet sequestration, Thrombocytopenia, Hemorrhage risk
46
Q

Klippel-Trenaunay-Weber syndrome (5)

A
  1. Triad of: Hemangioma,varicose veins, limbs
  2. Vascular nevus with hypertrophy of the bone
  3. Course depends on limb involvement
  4. Rare congenital anomaly / ? cause
  5. Males>females
47
Q

Thrush (4)

A

Type of infectious lesion

  1. Oral fungal infection
  2. Candida albicans
  3. White patches tongue and mucous membranes
  4. RX: oral Nystatin
48
Q

Candida Diaper Derm (5)

A

Infectious lesion

  1. Candida albicans
  2. Moist, erythematous eruptions
  3. Small white or yellow pustules
  4. Clean and dry
  5. RX: nystatin cream and/or oral
49
Q

STAPHYLOCCAL SCALDED SKIN (5)

A

Infectious lesion

1. Tender erythema, followed by bullous eruption and
peeling epidermis
2. Staph Aureus infection
3. Toxin damages the epidermal cells
4. RX: abx and isolation
5. Increased IWL possible
50
Q

Rubella (3)

A

Infectious lesions

  1. Petechiae or purpura
  2. “blueberry muffin” spots
  3. Thrombocytopenia

PNP: Physical Assessment (21 decks)

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