Physical Exam

Question 1

Least to most restrictive

Answer 1

General: temperament; interactions with parent; reactive; alert; distress

Respiratory: auscultate RR x1 minute; examine chest; WOB

Cardiac: auscultate apical x1 minute; BUE (brachial) /BLE pulses simultaneously; cap refills

Head: fontanels/sutures, clavicles
Eyes: blinking/red reflex
Ears: placement, pinning, dimple
Mouth: rooting, suck, pallate

Abdo: soft palpation; umbilical cord

Genu: femoral pulses; rashes

Musco: Ortolani/Barlow until 3 mo; full ROM of BUE/BLE
Bilateral babinski, plantar, palmar grasp reflexes

Skin: E tox, jaundice, milia, nevus simplex (stork bites), cafe au lait, mongolian spots, strawberry hemangioma, harlequin sign

Tonic neck bilaterally/ROM while …
caregiver distracts baby while attempting ear assess !

Assess head lag when pulling to supported seated, then lift to standing
Stepping reflex

BABY GOT BACK - assess tummy time, while checking back skin/sacral dimple/butt

FLIP back over and cradle/educate adult

MORO reflex

Swaddle or back to caregiver for comfort

Question 2

Neonatal growth in first 2 weeks

Answer 2

Expected to lost 7-10% of BW & regain by week 2

1. weight loss = birth weight - current weight
2. divide weight loss/birth weight

*FTT if not regained by week 3

Question 3

Periods of rapid neonatal growth

Answer 3

7-10 days & 3-6 weeks

Question 4

Normal newborn visual awareness + taste

Answer 4

Vision: range of 8-12 in

• tracks objects up to 180 deg by 2 mo
• color vision develops 4-6 mo

Prefers sweet taste at first

Question 5

Colic

Answer 5

Crying > 3 hours daily

Question 6

Maternal factors to SGA

Answer 6

High BP, diabetes, CKD
heart/respiratory distress
infection
malnutrition, anemia
substance use, cigarettes

Question 7

CBC with diff lab values

Answer 7

Hgb: 14-20%
Hct: 50-62%
Plts: 150,000-450,000

WBC: 9,000-34,000

Question 8

Neutrophils

Segs (segmented neutrophils)

Bands

Answer 8

Neutrophils: 6-23.5

Neutropenic: typhoid fever, brucelosis, many viral diseases (hepatitis, influenza, rubella, mumps)

Increased neutrophils: acute bacterial infection

Segs: 6-20

Bands: < 3.5
(immature neutrophils)

Question 9

Lymphocytes

Answer 9

Lymphs: 2.5-10.5 (main part of immune system)

Increased with viral infections or TB

Question 10

Monocytes

Answer 10

Monos: < 3.5

(largest cells in normal blood; act as phagocytes in inflammatory diseases; 2nd line of defense against infections; produce antiviral substance interferon

Monocytosis (elevated): (bacterial infections) TB, malaria, rocky mountain spotted fever, monocytic leukemia, UC, enteritis

Question 11

Eosinophils

Answer 11

Eos: < 2

(antigen-antibody reactions)

Decreased: corticosteroid use

Increased: allergic reactions, hay fever, asthma, or drug hypersensitivity

Question 12

Basophils

“mast cells”

Answer 12

Basos: < 0.4

(phagocytes with heparin, histamines, serotonin)

Decrease: corticosteroid use, allergic rxn, acute infections

Increased: bone marrow function (leukemia or hodgkins)

Question 13

Normal blood sugar

Answer 13

< 40

Question 14

UA

Answer 14

SPECIFIC GRAVITY: 1.005 and 1.030
Increased like 1.010 = mild dehydration
Decreased = excessive fluid intake, diabetes insipidus, pyelonephritis

pH: 4.6-8
< 6 = DKA, diarrhea
> 6 = UTI, vomiting, kidney failure

GLUCOSE: none

KETONES: none (build up when need to BD fats for energy because not enough sugar or CHO into cells)
(> 20 = DKA, abnormal food intake, anorexia, fasting, high protein/low CHO diets, prolonged vomiting, acute illness, burns, hyperthyroidism, fever, lactation, pregnancy

PROTEIN: none
(large amts = dehydration, nephrotoxic drugs, UTI, SLE, sepsis)

RBC: none
(> 4 = bladder infection, pyelonephritis, kidney stones, menstrual bleeding)

WBC: none

NITRITES: none

beets and blackberries may turn urine red

Question 15

Blood type & screen

Answer 15

type & Rh factor

> jaundice risk with ABO incompatibility

Question 16

Serology

Answer 16

special circumstances for HIV, HCV, HBV, syphilis