OMED 1401 - Advanced Patient Assessment (NEWBORN AND NEONATES) Flashcards
What is the Difference Between a Newborn, a Neonate, Infant, Child or Adolscent?
What is a Newborn?
- Placenta in the Room
What is a Neonate?
- Up to 28 Days old.
What is an Infant?
- One Month to 2 Year old.
What is a Child?
- 2 Years old to 12 Year Old.
What is an Adolescent?
- 12 Years to 18 Years Old.
How to Assess a Newborn in a Newborn Assessment?
First Step - Know how to Complete Newborn Life Support.
Understand the Reasons why a Newborn may be in Arrest:
Hypoxia:
- Umbilical Cord Complications
- Prolonged Delivery
- Placenta Issues
Fetal Compromise:
- Pre Term <35 Weeks
- Breech
- Maternal Infection
Other:
- Infection
- SIDS.
What is Newborn Life Support and the Steps?
Intended to Provide this Help and Compromises the Following Elements:
Enabling Placental Transfusion (When able to do so) by Delaying the Clamping of the Umbilical Cord.
Drying and Covering the Newborn Infant, and where Necessary Taking Additional Steps to Maintain a Normal Body Temperature (I.e. Between 36.5 and 37.5)
Assessing the Infant’s Condition and the Need for Any Intervention.
Maintaining an Open Airway (CONSIDER POSITIONING)
If the Infant is not Breathing, Aerating the Lungs with Inflation Breaths (Air, not O2. 2-3 Seconds)
Continue Ventilating Apnoeic Infants until Respiration is Established.
If the Heart Remains less than 60 min-1 after 5 Effective Breaths and 30 Seconds Effective Ventilation. Start Chest Compressions. Circle Chest 3:1 (120bpm)
Administration of Drugs (Rarely)
How to Approach a Newborn Assessment?
Check Danger, Response, Airway. Confirm no Arrest.
Correct any ABC Issues, otherwise Continue the ‘Hands off’ Approach.
Paediatric Triangle
Confirm no ABCDE Issues - OK to Approach the Patient.
History Taking - General History
Then Begin Assessment of the Newborn.
What is the Assessment of a Newborn?
Approach in the Same way as Paediatric Initially (Taking only a General History of Presenting Complaint).
2. Immediate Assessment
- Colour
- Tone
- Heart Rate (With Heart Sounds through Stethoscope)
- Respiratory Rate.
Ensure Newborn is Warm.
APGAR Assessment:
Appearance - Skin Colour
Pulse - Heart Rate
Grimace Response (Reflexes)
Activity (Muscle Tone)
Respiration (Breathing Rate and Effort)
Check RED FLAGS - Meconium, Sepsis, Dehydration
What is the Immediate Assessment for a Newborn?
Healthy Neonate:
Tone - Good
Colour - Initially Blue but will become Pink within First 90 Seconds.
Heart Rate - Good (120-150 Beats per Minute)
RR - Cries within a Few Seconds of Delivery.
Ill Neonate
Tone - Floppy
Colour - Pale
Heart Rate - Very Slow (Start CPR if <60)
RR - Not Breathing.
How to Ensure a Neonate is Warm?
Ensure Neonate is WARM.
- Close the Windows
- Warms the Room/Ambulance
- Dry the Baby with the Towel in your Maternity Kit. Dry them Again - Make sure they are Completely dry.
Wrap them in a New Clean Dry Towel.
Put the Hat on them.
What is the APGAR SCORE?
Appearance (Skin Colour)
0 - Cyanotic/Pale all Over
1 - Peripheral Cyanosis Only
2 - Pink
Pulse (Heart Rate)
0 - 0
1 - <100
2 - 100-140
Grimace (Reflex Irritability)
0 - No Response to Stimulation
1 - Grimace (Facial Movement)/Weak Cry when Stimulated.
2 - Cry when Stimulated.
Activity (Tone)
0 - Floppy
1 - Some Flexion
2 - Well Flexed and Resisting Extension
Respiration
0 - Apnoeic
1 - Slow, Irregular Breathing.
2 - Strong Cry.
CARRIED OUT AT 1 MINUTE, THEN AT 5 MINUTES POST BIRTH.
SCORES NEED TO BE RECORDED.
What are the Red Flags in the Assessment of a Newborn?
Meconium Aspiration.
Symptoms of Neonatal Sepsis
- Respiratory Distress/Grunting
- Lethargy
- Irritability
- Hypothermia
- Hypoglycaemia
- Hypotonia
Dehydration in the Newborn
- Sunken Fontanelle
- Sunken Eyes
- Lack of Tears
- Decreased Urine Output (No Wet Nappies in 6-8 hour Periods)
- Rapid Breathing
- Increased HR
- Restlessness
How to Safeguard a Newborn?
ALL CONCERNS NEED TO BE REPORTED TO THE MIDWIFE.
If in Doubt, and no Midwife Available, Convey to Hospital (Common Reason to Give: Baby is a Bit Cold).
Atmosphere in the Room at Birth
Consider Men Present (Not if they are Baby’s Father or not)
Note how other Children may Appear/Behave
How to Assess a Neonate?
Approach in the Same Way as Paediatric Initially (taking only a General History of Presenting Complaint).
2. Take History, Discuss Concerns, Investigate Antenatal and Intrapartum Care.
- Assess Feeding
- Consider Position
- Check RED FLAGS: Sepsis, Dehydration, Hypoglycaemia.
- Consider Safeguarding: NAI, Shaken Baby, SIDS.
What are the Handheld Antenatal Records?
Pt’s Name, Hospital No., NHS No.
Current and Past Medical History
Surgical History
Health and Family Support Assessment
Antenatal Appointments & Clinical Assessment
Individual Care Plans
Antenatal in-Patient Records
INTRAPARTUM NOTES:
- All Care in Labour, Including Foetal Loss must be Documented.
How to Assess Feeding?
Is the Baby Feeding Well?
- Interested when Offered Breast? or Sleepy?
- Attaches at the Breast?
- Attaches well for a Sustained Period with Long Rhythmical Sucking and Swallowing?
Feed Frequency?
- Should be 8-10 Feeds in 24 Hours.
- Babies are Expected to Feed every 3 Hours. Preterm Babies may not be able to Feed Responsively and may need to be Woken for a Feed.
Wet Nappies?
- Should be at Least 5 Heavy, Wet Nappies is 24 HRS.
Soiled Nappies?
- Minimum of 2 Dirty Nappies in 24 Hours.
(Except in Days 1 & 2, where only 1 is OK).
What is a Volvulus?
Caused by a Defect at Birth - the Bowel becomes Misaligned during Development.
The Bowel is not Attached as Normal to the Abdominal Wall, making it possible for the Bowel to Twist on itself.
This Causes an Obstruction within the Bowel. It can also lead to Obstruction of the Blood Supply to the Intestine, causing Tissue Death.
Symptoms:
- Vomiting (Looks like Bile)
- Abdominal Pain/Tenderness
- Bloody or Dark Red Stool
- Constipation
- Diarrhoea
CAN LEAD TO SHOCK.
What is Intussusception?
Condition where the Bowel ‘Telescopes’ is on itself. This Causes the Bowel Walls to Press on one Another, Blocking the Bowel.
This can Lead to Reduced Blood Flow to that Part of the Bowel. It is a Bit like a Getting a Sock turned inside Itself’. (Great Ormond Street Hospital for Children).
Symptoms:
- Initially, Intermittent Severe Abdominal Pain, Lasting 2-3 Minutes. In between Intervals, the Child looks Pale, Tired, Floppy.
- Possible to Palpate an Abdominal Mass.
- Red Current Jelly Stools
- Biles Stained Vomit is a Late Sign.
- May Present as Hypovalaemic Shock.
Causes:
Unknown - Potentially Linked with Infections and Swelling within the Bowel Itself.
