OSCE Checklist Flashcards
preperation of NIPE
- Looks at case history and identifies at least 3 significant findings from the maternal, family and perinatal histories correctly.
- Gather and checks equipment.
- Introduce yourself to parents, name and role., Offer congratulations.
Briefly explain the procedure: - Top to toe examination
- Optional
- Repeated at 6 weeks by GP
Explains the limitations: - Snapshot in time
- Problems may arise
- Screening not diagnostic
- Confirm with mum any significant history or clarify anything identified from notes.
- Confirm baby name and date of birth
Seek and gain consent
NIPE observation?
Ascertain any carers anxieties and observe interaction with the baby
Observe baby’s general condition while settled and undisturbed:
* Colour
* Breathing
* Behaviour
* Activity
* Tone
* Cry
Confirm urine and stool output
Establish feeding method and any concerns
Perform hand hygiene and don PPE if appropriate
Undress baby as required, keep warm throughout
head to toe NIPE
- skin
-head and scalp - eyes
-nose
-mouth
-ears - neck and clavicles
-upper limbs
-chest
-heart
-abdomen
-genitalia
-lower limbs
-hips
-spine
-reflex
assessment of skin
- Colour
- Integrity
- Birthmarks
- Trauma/bruising
- Rashes
assessment of head and scalp
- Shape
- Size
- Sutures/fontanelles
- Measures head circumference
- Injury
assessment of eyes
- Normal structures
- Shape
- Position
- Clarity/discharge
- Red reflexes – present, equal, red-magnolia/blue
assessment of nose
- Patency
- Philtrum
assessment of mouth
- Visual & digital inspection of the hard and soft palate to uvula for cleft
- Tongue – shape/size/tongue tie
- Gums/teeth
- Presence of suck reflex
- Presence of rooting reflex
- Jaw
assessment of ears
- Size
- Shape
- Position
- Abnormalities in structures
- Hearing test
assessment of neck and clavicles
check for tumours, skin tags, folds making sure head can freely move
checking for any fractures
assessment of upper limbs
- Equal movement
- Proportion
- Symmetry
- Brachial pulses
- Palmer creases
- Digits
- Grasp reflex
assessment of chest
- Respiratory rate
- Respiratory effort
- Listens for chest sounds
nipples also
assessment of heart
- Capillary refill
- Heart rate
- Heart rhythm
- Heart sound - heart auscultation x5 points 1min, mitral also with bell
- Heaves
- Thrills
- Pulse oximetry
assessment of abdomen
- General inspection
- Palpate rolling through four corners shallow then deeper
- Umbilical cord
assessment of genitalia
- Appearance of structures
- Positioning
- Completeness
- Patency
assessment of lower limbs
- Femoral pulses
- Symmetry
- Movement & tone
- Length
- Plantar creases
- Digits
- Plantar reflex
assessment of hips
- Knee height position
- Leg/buttock creases
- Barlow’s test
- Ortolani’s test
STABILISE HIP
assessment of spine
- Skin appearance of head/neck
- Spine bony structure
- Sacrum/sacral dimple
- Buttock cleft
reflex
moro
post NIPE
Dress and wrap baby – back to parents
Doff PPE if appropriate and perform hand hygiene
Communicate findings to parents and inform parents of future proposals or plans
Time given to parents for questions.
Complete documentation
Complete referrals needed
What would you do as an examiner for a breech baby at birth?
- be aware when performing hip exam
- send a orthopaedic USS referral
Component of assessment infant feeding?
- Women centred approach demonstrated throughout
- Observing and listening during conversations
- Discusses hands off approach
- Clear relevant information shared
- Mentions use of leaflets, analogies, props
Identify signs of instinctive behaviour in baby: - Rooting
- Head bobbing
- Mouthing the nipple
- …and helps mother to recognise them
components of positioning
Baby held close
Baby held/supported with head and body inline
Baby’s head free to tilt back
Baby held with nose opposite nipple
component of attachment
- Watch for baby to have a wide open mouth
- Mother moves her baby to her breast with head tilted back, chin leading
- Bottom lip touches breast well away from the base of the nipple
- Nipple aimed towards the rear of the roof of the baby’s mouth
