daily examination of the newborn Flashcards
Intro- how would you begin and conduct your visit
introduce myself- name and student midwife
explain procedure- top/toe and look for signs of deviation
consent for doing procedure- including undressing Alfie
reason for- monitor newborn wellbeing, detect deviations, refer on to appropriate person, look for signs of infection, monitor weight gain against local guidelines, support parents in their new role (answer questions, give advice)
what would your initial observation on entering the area
Look at parents- stressed, tired, anything concerning
How are they handling alfie-, holding properly, any advice
Is environment too warm/cold, smoke,pets, (safely kept), visitors, proper hygiene and clean home
How would you prepare for daily physical exam of Alfie
Do it in a warm environment, if not warm minimise the exposure time
Good lightening
Wash hands- WHO guidance (5 moments of hand hygiene and 7 steps of hand washing, if visibly clean use hand gel) avoids cross infection
Hands are warm and non sterile gloves and apron
What information would be helpful to know prior to examining baby
What’s Alfie’s behaviour like- sleep pattern, feeding frequency of feeding, formula feeding( volumes they are giving), breast feeding (frequency, both breasts?, if Stephanie feels breasts are emptying)
Elimination- wet nappies (between 5-6 in 24 hours and heavier as progressing)
Change in stoll- colour (becoming lighter, minimum of 2 in 24 hours, size of £2, change in colour and consistency) Link urine and stoll output with feeding
Ask if they have concerns and address them if so
Look to see if alfie is over/underdressed
Positioned correctly in cot- Reduce chance of SIDS (feet to foot of cot, no hat, no toys or bumpers- leave parents with info)
Look for resp rate- 30-40 breaths per minute, if alfie is distressed 60
When undressed look for chest movement- symmetrical, no nostral flaring, no chest in drawing ( Signs alfie is working too hard)
Any signs of vomiting or positing
Make sure all four limbs are moving - no signs of discomfort
Demonstrate physical exam- what you are doing and why
systematic process- ensure covering all essential information
Weight alfie in line with local guidelines- normal for a baby to loose between 5-10% off birth weight within fist week, then an increase to birth weight by two weeks old
Ask if any signs of urice acid in wet nappies- this is a by product of a nucleotide breakdown (normal process and presents itself as red of orange crystals in nappy) if happens provide reassurance
Make sure baby is feeding well to clear this
Bowels movements- goes from tar- brown- yellow
Do temperature- digital to do under armpit ( 36.5-37.5 degrees)
Head- take off to not overheat, exam head for moulding (normal just reassure), trauma, whole head all the way round, bruising, cephalic haematoma, caput, indentation on fontanelles, can physically palpate sutures and fontanelles
Eyes- no signs of bloodshot, signs of discharge
Nose- no resp effort, no swelling
Mouth- use torch, look at mouth, tongue, roof- any signs of trauma, infection, thrush, sucking blisters
Neck- skin creases- no infection or excoriation, look at back of neck ( make sure advice on hygiene and cleaning after being sick)
Skin- open top- make sure skin colours is appropriate for ethnic group, birth marks, good peripheral perfusion, no cyanosis (pale), jaundice ( test as appropriate), rashes, spots, bruising or injection
Arms and legs- signs of paranekia, nails, poor hygiene
Umbilicus- signs of separation or challenges, give parents advice about keeping cleans and dry
Groin and buttock- front and both sides, signs of thrush or infection, rashes, nappy problems
Overall approach to care episode
Systematic approach
Handled baby gently
Communicated well with parents
Answered Questions
Not undressed for too long
Given opportunity to have dialogue about care
Share information
what will actions be following newborn exam
wash and dry hands
Get rid of PPE and single use equipment
Discuss finding with parents
Give any on going care advice
Any referrals
Contact phone numbers
Complete documentation- Date time and sign
Plan next visit
Say bye
