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RNC Review > Comprehensive Assessment of the Newborn > Flashcards

Comprehensive Assessment of the Newborn Flashcards

(73 cards)

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1
Q

An intial comprehensive assessment includes:

A

Medical history, gestational age and a physical exam

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2
Q

What should be included in the medical history?

A

Maternal medical history, social history, obstetric history, and current obstetric status

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3
Q

How do you deteremine estimated date of delivery (EDD)?

A

First day of last menstrual period + 280 days

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4
Q

What is the most commonlu used tool to determine gestational age?

A

The New Ballard Score

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5
Q

Newborn Classification: Gestational Age

A

Preterm <34wks
Late Preterm 34-37wks
Term 37-42wks
Post Term >42wks

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6
Q

Newborn Classification: Weight for Age

A

SGA <10th Percentile
AGA 10-90th Percentile
LGA >90th Percentile

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7
Q

Newborn Classification: Birth Weight

A

LBW <2500g
VLBW <1500g
ELBE <1000g

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8
Q

Comprehensive Management of a Preterm baby includes:

A

Respiratory support
Fluid/Eletrolyte balance
Infection prevention
Skin Integrity
Neuroprotective Care
Thermoregulation

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9
Q

Post Term management includes assessing for:

A

Birth injury
Mec aspiration
Hypoxia/Asphyxia
Macrosomia >4500g
Signs of muscle wasting
Hypoglycemia

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10
Q

What are two possible indications for placental insufficieny that would be present during an assessment?

A

Hypoxia/Asphyxia
Signs of muscle wasting

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11
Q

What are the 4 types of assessment techniques?

A

Observation
Auscultation
Palpation
Transillumination

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12
Q

Heat to Toe Assessment Possible Findings: Skull

A

Caput
Cephalohematoma
Subgaleal Hemorrhage
Microcephalic
Macrocephalic
Craniosynostosis
Cutis Aplasia

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13
Q

Craniosynostosis

A

congenital ossification of the cranial sutures that can lead to restricted brain growth

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14
Q

Cutis Aplasia

A

localized congenital absense of skin, usually a single medline posterior scalp defect

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15
Q

Heat to Toe Assessment Possible Findings: Eyes

A

Eye movement
Pupil constriction
Drainage
Iris can be dark blue for up to 3-6 months
Coloboma
Palpebral Fissure
Hypertelorism
Red reflex
Nasolacrimal duct drainage

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16
Q

Coloboma

A

Condition that presents with missing eye tissue; keyhole appearance in iris

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17
Q

Hypertelorism

A

Wide spaced eyes

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18
Q

Absent Red Reflex

A

Could indicate congenital cataracts

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19
Q

Heat to Toe Assessment Possible Findings: Ears and Nose

A

Low-Set ears
Skin tags
Angled nasal septum
Choanal atresia

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20
Q

Low set ears are often associated with?

A

Various choromosomal abnormalities

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21
Q

When would finding a skin tag be of concern?

A

If there are other abnormalities present. If the skin tags are an isolated finding, then it is benign.

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22
Q

Angled nasal septum could be associated with

A

Congenital anomalies

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23
Q

Choanal Atresia

A

Congenital failure of nares to oepn during fetal development

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24
Q

How does a baby with a choanal atresia look physically?

A

Cyanotic at rest (due to obstruction for nose breather) and pink when crying (breathing in thru mouth)

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25
Why is choanal atresia possibly dangerous?
Babies are nose breathers
26
Heat to Toe Assessment Possible Findings: Mouth
Cleft palate/lip Thrush Macrostomia Microstomia Natal Teeth Epstein's pearls Asymmetrical lip movement
27
Macrostomia
An unusally wide mouth
28
What is macrostomia usually associated with?
Mucopolysaccharidosis - metabolism defect
29
Mucopolysaccharidosis
Metabolism defect caused by the absence of enzymes that break down glycosaminoglycans
30
Microstomia
An unsually small mouth
31
What is microstomia often associated with?
T18
32
Epstein's Pearls
Small, white, benign keratin cysts on the palate and gums
33
Do Epstein's pearls go away?
Typically they go away within a few weeks but sometimes can persist longer
34
What could cause asymmetrical lip movements in a neonate?
Possible sign of injury to the facial nerve
35
Heat to Toe Assessment Possible Findings: Jaw and Neck
Cystic hygroma Fractured clavicle Goiter Micrognathia Webbing Torticollis
36
Cystic Hygroma
Cyst caused by lymph challe
37
What is one dangerous complications of cystic hygroma?
Can cause an airway obstruction
38
How does a fractured clavicle present?
Limited same side arm movement Pain Crepitus
39
Goiter
Enlarged throid gland
40
Micrognathia
Small jaw associated with Pierre Robin Sequence, Treacher Collins Syndrome or DeLange's Syndrome
41
What is neck webbing often associated with?
Turner Syndrome Noonan Syndrome Down Syndrome
42
Torticollis
Presents as a head tipped to one side and the chin pointing to the opposite side.
43
What causes torticollis?
A hematoma of the sternocleidomastoid muscle
44
Heat to Toe Assessment Possible Findings: Chest
Look for physical signs of respiratory distress related to chest movement
45
Signs of a Pneumothorax
Sudden onset of desats or bradys A narrowed pulse pressure Inc anterior/posterior diameter chest unequal chest expansion Shift in heart sounds
46
Heat to Toe Assessment Possible Findings: Breast and Nipples
Enlarged breast tissue or milky discharge Red firm nipples with purulent discharge Supernumerary nipples Widespread nipples
47
What may cause enlarged breast tissue or milky discharge from nipples in neonates?
Maternal estrogen still in the baby
48
How long does maternal estrogen typically linger in the baby?
Up to two weeks
49
What could red firm nipples with purulent discharge be a sign of?
Sepsis and/or mastitis
50
Widespread nipples are associated with?
Turner Syndrome
51
Heat to Toe Assessment Possible Findings: Cardiac
Heart Sound Precordial Activity Pulses
52
Abnormal heart sounds might indicate:
a pneumothorax, dextrocardia or diaphragmatic hernia
53
Is precordial activity normal in term infants?
No - can reflect congenital heart defects, fluid overload or heart failure
54
Bounding pulses can be a sign of?
PDA
55
Absent or dec pulses in the lower extremities may indicate what?
Coarctation of the aorta
56
Heat to Toe Assessment Possible Findings: Abdomen
Scaphoid abdomen Flabby wrinkled abdomen Abdominal distention Gastroschisis Omphalocele Single Umbilical Artery Diastasis Recti Omphalitis Patent Urachus Umbilical hernia
57
Scaphoid abdomen can be a sign of
Congenital diaphragmatic hernia
58
Prune Belly Syndrome
Flabby, wrinkled abdomen due to a lack of abdominal muscles
59
Gastroschisis
Abdominal wall defect where a portion of bowel is outside of the body
60
Omphalocele
Herniation of bowel into the umbilical cord as a translucent sac
61
What might a single umbilical artery be associated with?
Chromosomal abnormalities including T18, T13, triploidy
62
Omphalitis
Redness, warmth, swelling and/or pain around the umbilicus due to infection of the stump
63
Patent Urachus
Redness, foul odor of the cord or leaking fluid caused by a remnant of a connection between the bladder and the umbilicus
64
Umbilical Hernia
Intestines protrude through the abdominal muscles leading to an outward belly button
65
Do umbilical hernias require intervention?
Most hernias resolve on their own by age 1 but some cares may require surgical intervention
66
What is the most common sign of anal fistula?
If stool passes thru vagina or perineum
67
How might neural tube defects present in relation to the anus?
Dribbling stool and absent anal wink
68
Bilateral nonpalpable testes in a phenotypical male at term may represent:
A virilized female with congenital adrenal hyperplasia or intersex
69
Congenital Adrenal Hyperplasia
A genetic disorder that affects the adrenal gland which is reponsible for the production of hormones like cortisol, aldosterone and androgens
70
How should a normal glans penis look?
Completely covered by foreskin
71
Hypospadias
Urethral opening is located on the dorsal (posterior) surface
72
Epispadias
Urethral opening is located on the ventral (anterior) surface
73
Simian Crease
Single palmar crease that presents in 40% of infants with T21

RNC Review (3 decks)

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