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Primary > The Newborn Assessment: History > Flashcards

The Newborn Assessment: History Flashcards

1
Q

A comprehensive history of the newborn should include a detailed assessment of the ___ ___ ____ course

A

Pre/ Peri/ Postnatal course

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2
Q

________ history

a) course of prenatal care
b) xenobiotic used during the gestational period
c) health problems during pregnancy
d) Intrauterine fetal health problems in utero
e) How does the mother feel about this pregnancy?

A

Prenatal History

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3
Q

Preinatal History

1) ______ Process
a) vaginal delivery vs C-section
b) planned vs emergent c- section
c) induced labor
d) analgesia/ anesthesia

A

Delivery process

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4
Q

Preinatal History

2) __________
a) placenta previa/abruption
b) meconium
c) forceps/ vacuum

A

Complications

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5
Q

Perinatal History

3) __________
a) Low birth weight < 2500 g
b) very low birth weight < 1500 g
c) extremetly low birth weight < 1000 g

A

Birth size/ weight

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6
Q

Perinatal History

4) ____________
a) appropriate for gestational age: between the 10th and 90th percentile

A

Assessment of weight for gestational age

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7
Q

______________: weight 90th associated with maternal diabetes

A

large for gestational age

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8
Q

_________________: weight < 10th percentile; symmetric vs asymmetric

A

Small for gestational age

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9
Q 
\_\_\_\_\_\_\_ scores (five areas of assessment for a toat of 10 points): Appearance, pulse, grimace, activity, and respiration
a) Maximum score at 1 and 5 minutes = 10; however, there are 3 points possible for each 0, 1, 2
A

APGAR

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10
Q

APGAR: Normal color all over (hands and feet are pink)

A

2

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11
Q

APGAR: Normla color (but hands and feet are bluish)

A

1

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12
Q

APGAR: Bluish-gray or pale all over

A

0

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13
Q

APGAR: Normal (above 100 beats per minute)

A

2

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14
Q

APGAR: Below 100 beats per minute

A

1

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15
Q

APGAR: Absent (no pulse)

A

0

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16
Q

APGAR: Pull away. sneezes, or coughs with stimulation

A

2

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17
Q

APGAR: Facial movement only (grimace) with stimulation

A

1

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18
Q

APGAR: Absent ( no response to simulation)

A

0

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19
Q

APGAR: Active, spontaneous movement

A

2

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20
Q

APGAR: Arms and legs flexed with little movment

A

1

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21
Q

APGAR: No movment, “floppy” tone

A

0

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22
Q

APGAR: Normal rate and effort, good cry

A

2

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23
Q

APGAR: Slow or irregular breathing, weak cry

A

1

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24
Q

APGAR: Absent (no breathing)

A

0

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25
Q

Maternal problem

a) _______
b) volume problems
c) response to anesthesia
d) breastfeeding
e) depression
f) fever/infection

A

bleeding

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26
Q

Infant problems

a) ABO/Rh incompatibilities
b) ______________
c) hip dysplasia
d) murmurs
e) talipes equinovarus congenita (club feet)
f) genetic syndromes

A

hyperbilirubinemia

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27
Q

The average length of a newborn is?

A

20 to 21 inches (51 cm)

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28
Q

The average weight of a newborn is?

A

7 lbs (3.1 kg)

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29
Q

The average head circumference is?

A

13 to 14 inches (33 to 35 cm)

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30
Q

Ethnic ________ in weight

A

difference

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31
Q

Assessment of gestational age: Length of gestation also has an ________ variation

A

ethnic

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32
Q

Infants born at gestational period _____ weeks have the best health outcomes

A

37 to 41

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33
Q

Those born prior to ____ weeks of gestation are premature and those born after 41 weeks of gestation are post-term

A

37

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34
Q

SGA: Symmetric IUGR (____% of SGA infants)

A

33%

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35
Q

Head circumference, weight, and length are all ____ percentile

A

< 10th

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36
Q

This usually suggests a long-term compromise to the fetus or the presence of an intrinsic problem

a) ______: Congenital or chromosomal abnormalities
b) Intrauterine infection: viral, bacterial, protozoal, the spirochete
c) Inborn errors of metabolism
d) Environment: Drugs, nicotine, x-ray exposure

A

Genetic

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37
Q

SGA: Asymmetric IUGR (55% of SGA infants)

a) head circumference and length _____
b) weight less than 10th percentile
c) May be due to acute extra fetal compromise (usually occur greater than 24 weeks)
1) chronic hypertension
2) pre-eclampsia
3) renal disease
4) cyanotic heart disease
5) hemoglobinopathies
6) abruptio placentae
7) Multiple gestations
8) altitude

A

normal limits

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38
Q

LGA: Weight is (____ percentile)

A

greater 90th

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39
Q

LGA:

a) ________ diabetes
b) Beckwith- Wiedemann syndrome: Congenital growth disorder; hemihypertrophy, large organs and other symptoms
c) ______ fetalis: fatal condition defined as an abnormla accumulation of fluid in two or more fetal compartments
d) large mother

A

a) Maternal

c) Hydrops

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40
Q

Temperature > ____ considered a fever in newborn?

A

> 100.4

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41
Q

Pulse variant is ____ beats per minute

A

120 to 170

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42
Q

Respiration _____ to as high as ___ breaths per minute

A

30 to 80

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43
Q

Blood pressure < _______

A

<112/74 mmHg

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44
Q

In newborns, this is a pinpoint white papules on the face, prominent on cheeks, nose, chin, and forehead.

a) Spontaneously disappear within 3 to 4 weeks of life
b) If persistent or widespread distribution may indicate a genetic syndrome

A

Miliaria

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45
Q

Most common newborn rash, usually appears between days 2 to 5 after birth; characterized by blotchy red spots on the skin with overlying white or yellow papules on pustules; resolves by the 14th day

A

Erythema toxicum

46
Q

Typically a subtle shade discoloration located on either flank; may not be present at birth but likely to increase in size with age; suspect neurofibromatosis if there are many large spots or if more than six spots in a child older than 5 years of age.

A

Cafe au lait spots

47
Q

If present in large numbers, suspect tuberous sclerosis, xeroderma pigmentosus, or generalized neurofibromatosis.

A

Junctional nevi

48
Q

Benign, flat, congenital birthmark with wavy borders and irregular shape; common color is blue; may last up to 3 to 5 years after birth, almost always disappear by puberty

A

Mongolian spots

49
Q

Vascular birthmark consisting of superficial and deep dilated capillaries in the skin; produce a reddish to purplish discoloration of the skin; permanent. Rule out Sturge- Webber: serious neuro condition with seizures- Ocular (glaucoma) characteristics.

A

Port Wine Stain

50
Q

Affects 2% or more of babies, raised, soft red lumps on the skin, more common in premature babies; hypo/hyperpigmented; after 6 months of age, the strawberry marks usually begin to shrink and fade.

A

Strawberry mark ( Hemangiomas)

51
Q

Posture: Hips should be _______ and partially flexed with knees flexed, arms adducted, elbows flexed, and fists clenched

A

abducted

52
Q

Head in a newborn should stay in line for 3 seconds all this is called muscle _____.

A

Tone

53
Q

____ should be symmetrical

A

Reflexes

54
Q

Rooting in newborns disappears in ____ months

A

3 to 4 months

55
Q

Sucking reflex in newborns disappears in ___ months

A

3 to 4 months

56
Q

Moro reflex in newborns disappears in ____ months

A

3 to 4 months

57
Q

Grasp (Palmar; Plantar) reflex in newborns disappears in ____ months

A

3 to 6 months; 4 months

58
Q

Placing/ stepping reflex in newborns disappears in ____ months

A

1 to 2 months

59
Q

Tonic neck reflex in newborns disappears in ____ months

A

3 months

60
Q

Babinski reflex in newborns disappears in ____ months

A

12 months or when walking

61
Q

Head and neck of the newborn:

_____ _______ crosses midline (fluid under the skin, simple swelling); resolves in 2 to 3 days

A

Head shape/ size variations

62
Q

Head and neck of the newborn:

Does not cross the midline (blood under periosteum); requires closer examination

A

Cephalohematoma

63
Q

Head and neck of the newborn:

Rickets, prematurity

A

Bossing

64
Q

Head and neck of the newborn:

Head circumference smaller than two standard deviations (SD); small brain

A

Microcephaly

65
Q

Head and neck of the newborn:

Head circumference large than two SD, hydrocephalus

A

macrocephaly

66
Q

Hair pattern in the newborn:

____ _____ with other anomalies are sometimes associated with deafness and retardation (Waardenburg syndrome)

A

White Forelocks

67
Q

More than ____ hair could mean poor brain growth

A

one

68
Q

_____ hair with unusual facies, SGA, and microcephaly are found in Down syndrome

A

Unruly

69
Q

Fontanels:

______ fontanel is the largest (2 to 5 cm); closes by ruffly 18 months

A

Anterior

70
Q

Fontanels:

______ fontanel may not be palpable at birth; closed by 2 to 3 months

A

Posterior

71
Q

Common causes of wide fontanels:

a) Prematurity
b) _____
c) Hydrocephalus
d) Down Syndrome
e) Hypothyroidism

A

IUGR

72
Q

___ ____ replaced by a black spot means there is no clear pathway from the lens to the retina

A

Red reflex

73
Q

Red Reflex:
If replaced by a whitish color, this may suggest
a) ___________ or congenital cataracts; the sclera is normally white and may appear bluish in preemies; if the sclera is deep blue, b) _________ ______ should be ruled out

A

a) retinoblastoma

b) osteogenesis imperfecta

74
Q

_______ (embryonic fissure defect): Mild forms only affect the iris; in more severe cases, the choroid and optic nerve can be involved with suspicion for central nervous system midline defects such as optic nerve hypoplasia

A

Colobomas

75
Q

_____ ___ _____ (Brushfield spots of the iris) is associated with Down Syndrome

A

Salt- and - pepper

76
Q

____ ____ (narrowing or blockage of the nasal airway by tissue, present at birth)

A

Choanal atresia

77
Q

_________ (small mouth) is observed in trisomy 13 and 18

A

Microstomia

78
Q

___________ (large mouth) is present in micropolysaccharidoses; fish mouth is seen in fetal alcohol syndrome

A

Macrostomia

79
Q

______ due to hypothyroidism, mucopolysaccharidoses

A

Macroglossia

80
Q

________

a) Epstein pearls
b) natal teeth

A

Teeth

81
Q

_____ newborn assessment

a) Micrognathia in Pierre- Robin syndrome
b) Treacher- Collins syndrome
c) Hallermann Streiff syndrome

A

Chin

82
Q

_____ newborn assessment

a) Clavicular fractures
b) webbed neck
c) lymph nodes

A

Neck

83
Q

___________/_______

a) Respiratory rate/Pattern: Abdominal breathing
b) Retractions
c) Grunting
d) Breast enlargement

A

Pulmonary/Chest

84
Q

____________

a) Capillary refill
b) Radio femoral pulse delay: Consider coarctation, pulse oximeter reading of all 4 extremities
c) Character of pulses
d) Note the location and size of the point of maximum impulse (PMI): 3rd and 4th intercostal space (ICS)/ left midclavicular line (LMCL)
e) Murmurs: 85% of newborns have murmurs

A

Cardiovascular

85
Q

_______

a) Contour: Flat abdomen is abnormal
b) Umbilical cord/ number of vessels ( two arteries and one vein)/ color
c) Hernias
d) Anal patency

A

Abdomen

86
Q

__________

a) Inspect glans, urethral meatus (hypo/ epispadias)
b) note ability to retract the foreskin in uncircumcised penis
c) Note presence of tests: 97% of full-term males have descended testes at birth

A

Male genitalia

87
Q

__________

a) discharge/ small amount of bleeding may be present

A

Female genitalia

88
Q

____________

a) Scoliosis
b) Kyphosis
c) Lordosis
d) Spinal defects
e) Meningomyeloceles
f) Clavical fracture
g) Fingers/creases
h) Developmental Dysplasia of the hip (DDH).

A

Spine

89
Q

With hips flexed at 90 degrees and knees together, begin by abducting, then adduct while the examiner’s fingers are over the greater trochanter

A

Developmental dysplasia of the hip (DDH)

90
Q

A “click” is heard or felt as dislocation is related

A

Ortolani’s click

91
Q

Feeling of a slip as the femoral head slips away from the acetabulum causing the dislocation

A

Barlow’s Maneuver

92
Q

Screening has low false positive/false negative results

a) Sensitivity: + = ____
b) Specificity: - = ____

A

a) +

b) -

93
Q

With screening test for over ____ conditions

A

50

94
Q

Mandatory Screening Program Goal is?

A

Early identification of specific metabolic disorders

95
Q

Do all 50 states require mandatory screening?

a) _____
b) galactosemia
c) hemoglobinopathies
d) congenital
e) hypothyroidism

A

a) PKU

96
Q

A re-screen is mandatory for newborns tested at ____ hours of age

A

< 24 hours

97
Q

_______ for newborn infants who appear symptomatic

A

Re-screen

98
Q

Cogenital cyanotic heart diseases (_________)

A

hyperoxygenation

99
Q

_____ reflex is observed the response to loud noise/voice

A

Stratel reflex

100
Q

Hearing test brain stem auditory evoked response (____) test

A

BSAER (Brainstem Auditory Evoked Response)

101
Q

Hearing screening should be identified but no later than ___ months and treated by 6 months

A

3 months

102
Q

_________

a) Occurrence: 1: 10,000 to 25,000
b) Developmental delay
c) severe retardation
d) seizures
e) aggressive
f) Autism
g) Hyperactivity

A

Phenylketonuria (PKU)

103
Q

_________: Liver dysfunction, coagulopathies

a) Occurrence: 1: 60,000 to 80,000
b) Special Consideration: 25% of unrecognized infants develop sepsis

A

Galactosemia

104
Q

_______

a) Sick cell disease, thalassemia
b) Occurrence: 1: 400 African- Americans
c) Anemia
d) Sepsis

A

Hemoglobinopathies

105
Q

_______

a) occurrence: 1: 3,600 to 5000
b) mental retardation
c) Neurological abnormalities
d) Metabolic abnormalities
e) Special consideration: Presents with a late onset in 10% of cases

A

Hypothyroidism

106
Q

The disorder that may be present at birth: Cardiovascular, ophthalmic complications that may be present at birth are ________?

A

Rubella

107
Q

The disorder that may be present at birth: Microcephaly, sensorineural hearing loss, chorioretinitis

A

CMV (Cytomegalovirus)

108
Q

The disorder that may be present at birth: Skin, mouth, ophthalmic, CNS, Pulmonary manifestations

A

Herpes

109
Q

The disorder that may be present at birth: Hepatitis, hemolytic anemia, nephrosis, myocarditis, bony findings

A

Congenital syphilis

110
Q

The disorder that may be present at birth: Pulmonary disease, pancreatic insufficiency, cirrhosis, FTT; has a range of severity

A

Cystic fibrosis

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