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Newborn Assessment

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Heart rate- absent- below 100 above 100. Resp effort- absent- slow- irreg ... Note size of labia majora and minora. May have pseudomenstruation. Hymenal skin tag ... – PowerPoint PPT presentation

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Title: Newborn Assessment


1
Newborn Assessment
  • Chapter 18

2
Assessment
  • Consider maternal and prenatal hx
  • Birthing hx
  • Analgesia and Anesthesia
  • Wgt and gest age
  • Complications of birth
  • Examination results

3
Timing of Assessment
  • In birthing area- Evaluate airway and transition
  • Within 4 hours
  • Prior to discharge home
  • Determine gestational age within 4 hours

4
Apgars
  • Heart rate- absent- below 100 above 100
  • Resp effort- absent- slow- irreg
  • Tone- flaccid some flexion- active motion
  • Reflex irritability- none- grimace- vigorous cry
  • Color-pale- body pink- ext. blue- completely pink
  • Given at 1 minute and 5

5
Weights and Measurements
  • Average weight-3400 gms
  • Fluid shift causes weight loss
  • Average length 20 inch
  • Head larger than abdomen
  • Temp. control

6
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7
Heart
  • 120-160- influenced by activity
  • Auscultate, L axilla, scapula
  • 90 of murmurs transient
  • Assess pulses- femoral brachial- pedal

8
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9
Ballard Dubowitz
  • Tool to assess gestational age
  • Optimal accuracy within 12 hours
  • Most accurate 28 wks and under 43 wks
  • Physical more accurate than neurological
  • GA effected by PIH, DM, meds

10
Physical Characteristic
  • Resting posture
  • Skin
  • Lanugo
  • Plantar creases
  • Areola
  • Ear
  • Genitalia

11
Neuromuscular
  • Develops from lower to upper
  • Square window
  • Recoil- posture
  • Popliteal angle
  • Scarf sign
  • Heal to ear

12
Plotting Gestational Age
  • Upper 10 LGA, bottom 10 SGA
  • Length
  • Head
  • Weight
  • Complete exam from head to toe

13
Skin
  • Acrocyanosis
  • Mottling
  • Harlequin
  • Jaundice
  • Erythema toxicum
  • Milia
  • Turgor

14
Birthmarks
  • Stork bites
  • Mongolian spots- dark skin, resolve 1-2 yrs
  • Port wine stain- eval. for seizures
  • Nevus vasculosus
  • Educate parents

15
Head
  • Molding- over-riding sutures
  • Palpate fontanelles
  • Cephalahematoma- does not cross suture
  • Caput succedaneum-crosses suture line

16
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17
Face-Nose
  • Evaluate for symmetry and movement
  • Ability to smell
  • Obligate nose breathers

18
Mouth
  • Ability to discriminate
  • Assess suck
  • Check palate
  • Precocious teeth
  • Epstein's Pearls-disappear
  • Thrush
  • Teach hand washing

19
Eyes
  • Bluish white sclera
  • Erythro.-for gonorrhea and Chlamydia
  • Conjuctival hemorrhages
  • Check reflexes
  • Doll eyes- move in opposite direction
  • Tearless
  • Some visual acuity
  • Strabismus

20
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21
Ears
  • Symmetry
  • Low set r/t Downs, mental retardation, renal
    problems
  • Respond to sound
  • Habituation
  • Term vs. preterm
  • Hearing Test

22
Neck
  • Lacks tone
  • Provide support
  • Evaluate for masses
  • Check clavicles

23
Chest-Respirations
  • Xiphoid cartilage visible
  • Breast engorged due to mat. hormones
  • Do not squeeze
  • Assess for grunting- retracting- flaring
  • NSVD vs. C/S

24
Cry
  • Should be lusty, medium pitched
  • Piercing cry from
  • Hypoglycemia
  • Neurological disorders
  • Sepsis
  • Withdrawal

25
Abdomen
  • Slightly distended
  • Assess for tenderness and masses
  • Bowel sounds
  • NSVD vs. C/S

26
Genitalia
  • Note size of labia majora and minora
  • May have pseudomenstruation
  • Hymenal skin tag
  • Clean gently

27
Male genitalia
  • Hypospadias- meatus on ventral side
  • Phimosos-foreskin cannot be retracted
  • Cryptotorchidism-testes not descended
  • Hydrocele- excess fluid
  • Dusky or solid- think torsion

28
Extremities
  • Count fingers and toes
  • Polydactyly-Syndactyly
  • Simian crease- associated with Downs
  • Brachial palsy trauma
  • Erbs entire arm
  • Teach parents passive motion exercises

29
Legs and Feet
  • Evaluate skin folds
  • Check for hip click
  • Keep fingers over greater trochanter
  • Evaluate for clubfeet

30
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31
Back
  • Evaluate spine
  • Straight, flat, no curves
  • Visualize bottom of dimple
  • Hair associated with spina bifida

32
Umbilical cord
  • 2 arteries-1 vein
  • Begins to dry within 1-3 hours
  • Falls off 7-10 days
  • Note bleeding or discharge
  • Wash hands- do not apply alcohol

33
Newborn Reflexes
  • Protective reflexes
  • Moro- startle until 6 months
  • Tonic clonic- fencing
  • Grasp
  • Rooting
  • Babinski
  • Sucking

34
Newborn Behaviors
  • Habituation-decreasing response to stimuli
  • Attention to auditory and visual stimuli
  • Motor activity- response to being held
  • Alert, state, color changes
  • Self quieting behavior
  • Cuddliness
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