Normal Newborn Assessment Flashcards
Golden Minute
dry baby while on maternal abd
suction mouth, nose
stimulate breath - rub back/feet ( asses resp.)
assess HR
bag/mask ventilation
Lungs are filled with Aminotic fluid, baby should start breat upon birth. Increase CO2 in baby
Respiratory System
adaption to extrauterine life
Sulfactant redness surface tension of alveoli
Hypoxia, hypercapnia & acidosis ( all norm in labor) stimulate breathing
Increase tidal volume (inspiration)
Periodic breathing common
30-60 bpm, count full min
* Apnea > 20 sec w/ cyanosis & HR changes need futher eval
Assess grunting, retractions, stridor, nasal flaring (resp distress)
Transient Tachypnea of Newborn (TTN)
* RR > 60
* C/S, Sedation
* Due to more secretions
breathing should be even, symmetric
Heart
Same rate as in utero
* 110-160
BP: 60-80/ 40-50
Murmur ( transient) = normal
Crying increases HR
Danger signs
* Tachycardia from volume depletino, cardic disease, drug withdrawl, hypothyroidism
more toward the sternum, mital 4th intercostal space, after 24 hrs cyanosis concerning
Thermoregulation
Hypothermia risk w/ birth (cold, wet)
Normal temp: 36.5 -37.5 C
Heat Loss
* Low fat, cannot shiver, cannot move
Heat Loss
Covection, Radiation, Evaporation, Conduction
Cold Stress: Excessive heat loss -> compensatory mechanism
* Lethargy, high pitch cry
* Can lead to: Decrease brown fat, Increase O2 need, Decrease BG, Met. Acidosis, hypoxia
* Prevention: warm clothing/blanket, dry baby, skin to skin, NICU transfer, early breastfeeding, delay bathing until stable temp
Heat Loss
Convection
Flow of heat to cooler air
* Wrap in blanket
Example:
Baby is placed in a crib near window or air vent where there is a draft. Cooler air flowing around the baby’s body would carry heat away from baby skin.
Heat Loss
Radiation
Loss of heat to cooler solid surface (object)
* Cribs away from windows and doors
Example:
Place baby near a cold surface, such as windows,
Heat Loss
Evaporation
Heat loss liquid to vapor
* Dry newborn
Example:
Baby ‘s skin is wet after birth or a bath, liquid evaporates ; carrying heat away
Conduction
Heat loss to cooler surface in direct contact
* Warm stethecope, warm bed
Example:
Baby is placed on cold surface
Hypoglycemia
Risk Factors: Pre/post maturity, IUGR, big or small for gestional age, asphyxia, Cold Stress, Maternal diabetes, mom tocolytics (terbutaline)
Mani: Jitters, tremors, tachypnea, poor suck, drecease temp (some asymptomatic)
Nursing: By Heel stick (BG) side of foot, b/c they have vessel that can harm them
* Norm: 40-80
* < 40, notfiy HCP
Treat: early feeds, maybe IV D5W
GI System
Bacterial colonization necessary for Vit.K production
Stomach size of walnut
5-10% birth weight loss -> normal
Meconium 12-24 hrs
* transitional stool ( greenish/seedy)
* milk stool
Breastfeeding (q2hr) Formula (q3hrs)
Hepatic System
Iron Storage
Carb metabolism
Bilirubin conjugation (RBC breakdown)
Bilirubin is toxic and must need to be exreted
2 forms
* Unconjugated (indirect): fat soluble
* Conjugated (direct): water soluble
Ieterus (Jaundice) ( looks yellow, sclera)
* Kernicterus: Permanent brain damage
Poop it out, window, then last photo therapy (protect baby eyes)
Analogy: Imagine a dirty dish (unconjugated bilirubin). The dishwasher (liver) cleans it and makes it ready for storage or disposal (conjugated bilirubin).
Physiologic Jaundice
Not Present 1st 24hr
**Tranisent state, normal **
Appear day 2 or day 3 of life
Nonphysiologic (Hyperbilirubinemia)
Abnormal
First appears b/4 24hrs
blood incompatibilites w/ mom
Delay feeds, trauma cold stress
Req treatment
Intake and Output
Day 1-2 of life: At least 1 to 2 voids daily
After: 6-8 voids/day
Neuro Development
Hear well - turns to mom
Taste: Sweet/ sour distinction by day 3
Touch: typical for pain response
Cry: Loud + lusty
* high pitch = ABN (CNS damage, decrease BG, drugs)
Behavorial Adaptations
Feed w/i first 30 min
Sleepy 30 min - 2hrs PP
Active hours 2-8 ( last 10 mins to several hrs)
Early Assessments
ABC’s
APGAR 0,1,2 (Done @ min. 1 &5)
* Appearence ( hands/feet pink (2), bluish-gray or pale all over (0) )
* Pluse 100 bpm cutoff ( > 100bpm (2), absent (0) )
* Grimace/Relfex (pulls away, sneeze, cough (2), Facial movement only (1) )
* Activity/Muscle Tone (Arms/ Legs flexed with little movement (1), no movement “floopy” (0) )
* Resp. Effort ( good cry (2), weak cry (1), absent (0) )
Immediate Newborn Care
Airway: Suction mouth then nose
ID baby: Bands, prints, tags
Meds:
* Erythromycin: inner to outer
* Vit. K: 0.5-1 mg IM, Vast. Lat, 25 g, 5/8 in. needle
Thermoreg: prevent cold stress
* no bath until stable temp
Measurement + Vitals
HC: 13-14 in
Chest: 12-13 in
Weight: 6-9 lbs
Vitals: Q30 x 2hr, 1 hr post bath
HR: 110-160
Temp: 36.5-37.5
RR: 30-60
BP: 60-80/ 40-50
Skin
Color, texture, tugor, intergrity
Common Variations:
* Acrocyanosis, erythema toxicum (newborn rash) -> Do not put anything on this, will dry up
- Stork Bite: back of head (telangiectatic hevi), lanugo, vernix (cheeselike, whitish sub-
stance), milia (Epstein pearls in the mouth), mongolian spot (buttocks), Nevus flammeus (port wine stain) -> This is flat and permanent around face or neck
Eyes
Symmetrical, clear corneas
Pseudostrabismus
Ears
Pinna @ eye outer canthus
hearing screen 1-2 days of life
Nose
Center, symmetrical
Obligatory nose breather !!!!
Reflexes
Most reflexes last 3-4 mos.
* Suck, moro, rooting, blink, sneezing, gagging, coughing, grasp
Babinski last 18-24 mos
Head
Shape + Symmetry
Variations:
* Caput succedaneum: crosses suture line
* Cephalhematoma: does not cross suture line (blood d/t trauma) resolve w/in 2-8 wks
Palpate/inspect fontanels
* Bulging: increase ICP
* Sunken: dehydration
* wide sutures: Hydrocephalus
* Premature Closure: Genetic
Genitalia
Patent anus for meconium
Female:
* Engorgement=normal
* Vag. discharge = normal
* Enlarged clit = normal
Male:
* Foreskin intact
* Meatus midline @ glans tips
* Decrease testes
Infection Prevention
- Handwash
- Cord Care
- Cover circ w/ vasline, changes guaze w/ diaper
- No ill visitors
- Antibody breastfeeding ( passive immunity)
Before Discharge
Flu w/ Pediatrician 1-2 dys
Newborn blood > 24hrs
* PKU, TSH, T4
Hearing test
Car Seat Test
Birth certif.
Newborn ID paperwork
Cord clamp removed
S/S Needing Immediate Medical Attention
Lethargy, difficult walking
Temp > 100 F
Projectile Vom.
Green liquid stools
Refusing x2 feedings in a row
Infant should gain 1oz/dy
Preterms
Apperance: poor tone, little brown fat, thin skin, immautre labia, undescended testes
Behavior: Limited energy, easy echaustion, weak cry
Critical ! (constant temp probe)
* Thin skin, large BSA, little fat
* Immature hypothalamus = poor temp control
* Open body posture = more exposure
Hypoglycemia/ Resp. Distress
* Poor feeds
* irritable
* lethargic
* cool skin
* Cold Stress increase
Care: Radiant warmer, incubator, saran wrap, cluster care !!!, decrease stress/ stimuli, slow wean to crib, protect skin/prevent breakdown
Cord Clamps
Cord Abnorm ( i.e 2-vessel cord) may indicate cardio or renal abnorm
