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NURS 501 > Exam 4 - Newborn Physical Exam > Flashcards

Exam 4 - Newborn Physical Exam Flashcards

(66 cards)

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1
Q

Normal head circumference for newborn

A

12-15 inches

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2
Q

Normal weight for newborn

A

5 lbs 8 oz - 8 lbs 13 oz

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3
Q

Normal length of newborn

A

18-22 inches

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4
Q

Normal temperature (axillary/rectal) of newborn

A

97.7-99.0 F

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5
Q

Normal HR for newborn

A

80-180 bpm (depending on infant state)

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6
Q

Normal RR for newborn

A

30-60 breaths per minute

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7
Q

Normal BP for newborn

A

Not routinely done in primary care unless there is an issue

  • Can be measured on arm or leg
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8
Q

What scale should be used to measure pain in a newborn?

A

FLACC scale

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9
Q

Respiratory assessment of newborn (what to look out for)

A
  • Chest excursion (symmetric and equal)
  • Use of accessory muscles
    • Retractions
    • Abdominal breathing
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10
Q

What is periodic breathing?

A

Rapid periods of breathing followed by slower periods of breathing

  • Normal, but begin to worry if there is constant fast breathing
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11
Q

What are the components of a newborn cardiac exam?

A
  • Check HR at PMI
  • Auscultate in all five areas: aortic, pulmonic, Erb’s point, tricuspid, mitral
  • Palpate for heaves, thrills, and PMI
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12
Q

Are murmurs common in newborns?

A

S1 and S2 are normal (along with S3 or S4)

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13
Q

How would the provider screen for congenital heart defects in a newborn?

A

Obtain pre and postductal pulsoxiemetery screening after 24 hours of age AND before discharge

  • Right hand - preductal
  • Either foot - postductal
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14
Q

How would the provider screen for congenital heart defects if the newborn was born at home or discharged before 24 hours of life?

A

Perform screening at first newborn visit

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15
Q

What are normal results after a pre and postductal pulsoxiemetery to screen for congenital heart defects?

A

Both hand and food >95% and less than a 3% difference between hand and foot saturations

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16
Q

What should the provider do if there are discrepancies with pulsoxiemetery readings when screening for congenital heart defects?

A

Urgent referral to cardiology

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17
Q

What are the four most common murmurs (congenital heart diseases) in newborns? What do they sound like?

A
  • PDA - machine-like sound
  • ASD - heard best in pulmonic area
  • VSD - harsh systolic murmur
  • Coarctation of aorta - systolic murmur
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18
Q

What are normal skin findings for a newborn in terms of appearance, cap refill, skin turgor, and mucus membranes?

A

Appearance - pink, well perfused

Capillary refill - <2 seconds

Skin turgor - elastic

Mucus membranes - pink, moist

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19
Q

What is acrocyanosis? Is this normal?

A

Bluish discoloration of hands and feet

  • Normal for first 24-48 hours of life d/t immature cardiac circulation
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20
Q

Can acrocyanosis be seen in older newborns?

A

Yes - d/t cold stress

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21
Q

Common skin finding: harlequin sign

A

Unilateral color change on one side of body d/t autonomic vasomotor instability

  • More common in low birth weight infants
  • Transcient, harmless, lasts for 10-20 minutes
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22
Q

Common skin finding: erythema toxicum

A

Yellow/white, 1-3 mm papules over erythematous base

  • Anywhere on body except palmar surfaces
  • Occurs abruptly; unknown cause
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23
Q

Common skin finding: milia

A

Exposed sebaceous glands that appear as whiteheads

  • Disappears within first month of life
  • No treatment needed
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24
Q

Common skin finding: mongolian spots

A

Bluish-grey pigmentation found on lower back, across shoulders, hips, legs

  • More common in darker-skinned newborns
  • Fades over time
  • ALWAYS DOCUMENT so that these are not confused with non-accidental trauma
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25
Common skin finding: strawberry hemangioma
Raised capillary nevi that can occur anywhere on body * Can increase in size over first few months, but generally disapperas by age 10
26
When should the provider consider a referral with strawberry hemangiomas?
When there is an orbital hemangioma, very large hemangioma, or those with the potential to interfere with the airway
27
Common skin finding: stork bites
Pale pink or reddish discoloration of the skin * Location: nape of neck, lower axilla, nasal bridge, eyelids * More evident when newborn cries * Generally disappears by 2 years old * No treatment needed
28
Common skin finding: lanugo
Fine, soft hair that covers the newborn's back, shoulders, cheeks, forehead, and scalp * More common in premature infants * Disappears within first month of life
29
Common skin finding: linea nigra
Line of increased pigmentation from umbilicus to genitalia * More common in darker-skinned infants
30
Common skin finding: vervix caseosa
Cheesy, gray-white substance covering and protecting the skin during fetal life * Diminishes near term
31
Common skin finding: neonatal acne
Caused by maternal hormone stimulation of sebaceous glands that appears at 3-4 weeks of life * More common in males * No treatment needed (topical lotions/creams make it worse) * Can occur anywhere on body
32
Common skin finding: petechiae
Pinpoint-sized hemorrhage * Normal on presenting parts --\> prescence anywhere else could indicate infection
33
Common skin finding: jaundice
Yellowing of skin * Most visible after blanching * Progression is head to toe * Can be physiologic or pathologic
34
Common skin finding: cyanosis
Bluish discoloration of the skin d/t fetal hgb with O2 sat \<60% (hypoxemia), central cyanosis, or pathologic cyanosis * Location: periorbital, circumoral, chest, abdomen * Requires assessment for pathologic condition
35
Common skin finding: cafe-au-lait spots
Hyperpigmented lesions (usually macules) that are irregular in shape and light brown in color * Usually benign but can be associated with pathologic conditions * Any newborn with 6+ lesions \>1cm requires workup for **neurofibromitosis**
36
Common skin finding: mottling
Marbling or spiderweb appearance of newborns skin d/t hypothermia or infection (concerning) * _Cutis marmorata_: occurs in *healthy* newborn and appears the same, but improves as skin is warmed
37
Common skin finding: pallor
Paleness of skin that can occur with anemia or infection * In children with darker skin, evaluate in soles of feet, palms of hands, or circumorally
38
How would the fontanels and sutures appear in newborns?
Fontanels: anterior (diamond shaped), posterior (triangle shaped) Sutures: five total (open or overlapped)
39
Cephalohematoma vs caput succedaneum: which one crosses suture lines?
Cephalohematoma - does NOT cross suture lines Caput succedaneum - does cross suture lines
40
What is a cephalohematoma?
Collection of blood under the periosteum caused by pressure during labor or operative measures * Resolves w/o intervention by 6-8 weeks
41
What is a caput succedaneum?
Localized swelling of the soft tissues of the scalp caused by pressure during labor and birth * Resolves spontaneously within 24-48 hours after birth
42
What should the provider assess for during an eye exam of a newborn?
* Can the newborn fix and focus on an object 8-10 inches from the face? * Assess size, shape, and placement * Permanent eye color by 3-6 months
43
Abnormal findings during newborn eye assessment * Placement - hypertelorism/hypotelorism
Placement problem - "third eye" should fit easily between the two eyes; if not, could indicate chromosomal anomaly or syndrome * Hypertelorism - eyes too widely spaced * Hypotelorism - eyes too closely spaced
44
Abnormal findings during newborn eye assessment * Corneal abnormalities
Haziness could indicate glaucoma
45
Abnormal findings during newborn eye assessment * Red reflex
Absence can indicate infection or cataracts Grey or white pupil could indicate retinoblastoma
46
Abnormal findings during newborn eye assessment * Palpebral fissure
Eye openings too small --\> could indicate chromosomal anomaly or syndrome
47
Abnormal findings during newborn eye assessment * Epicanthal folds
Slanting of eyes --\> could indicate chromosomal anomaly or syndrome
48
Normal presentation during ear assessment
* Full term infant should have firm, flexible cartilage; recoil should be brisk * Line from inner canthus to outer canthus of eye should lead to occiput (top of pinna should touch line) * Angle of placement of ear should be vertical or no more than 10 degrees from vertical
49
Abnormal ear findings during newborn assessment
* Malformed/malpositioned ears - congenital or chromosomal anomaly * Preauricular sinus/tag - outer ear and renal tissues formed at the same time * Consider renal abnormalities * Requires repeat hearing screen at 6 months
50
True/false: Newborns are obligate nose breathers
True * Become upset or have difficulty feeding when nasal passagways are obstructed
51
Abnormal throat/mouth findings during newborn assessment
* Macroglossia - congenital/chromosomal anomaly * Ankyloglossia - difficuty feeding/latching * Palpate cleft palates, submucous cleft, high arched palate
52
When do the anterior and posterior fontanels close?
Anterior - 18 months Posterior - 4 months
53
What should the provider look for during a newborn chest/thorax assessment?
* Cylindrical * 1:1 AP ratio * Chest circumference is 33cm or 2cm less than head circumference * Breast engorgement and "witches milk" are normal * Inspect clavicles for crepitus
54
What should the provider look for during a newborn abdominal assessment?
* Rounded and domed * Umbilical cord should have two arteries, one vein * Cord falls off between 7-10 days
55
What should the provider look for during a male newborn genital assessment?
* Placement of urethral opening should be at the tip * Both testes should be descended and palpable
56
What should the provider do when a hydrocele is present during a male genitalia exam?
Check to see if it transluminates * Will spontaneously resolve
57
What should the provider look for during a female genitalia assessment?
* Assess size of labia majora/minora and clitoris * Milky vaginal discharge is normal * Blood tinged mucus/vaginal discharge is normal
58
What should the provider assess for during a spine examination of a newborn?
* Should be straight and flexible * Observe for pilonidal dimple (be sure base is visible)
59
What should the provider assess for during an upper extremity examination?
* Full ROM * Symmetry * Brachial pulses
60
What should the provider assess for during a lower extremity examination?
* Femoral pulses * Barlow and Ortolani's maneuvers * Symmetry of skin folds (gluteal and femoral areas) * Size, shape, symmetry of newborns feet
61
Eight newborn reflexes
* Rooting * Sucking * Tonic neck reflex (fencing) * Palmar grasp * Galant * Moro (startle) * Plantar grasp * Babinski
62
How would the provider assess cranial nerve I (olfactory)?
Alcohol wipe under nose to ellicit grimmace
63
How would the provider assess cranial nerve II (optic), III (oculomotor), IV (trochlear), VI (abducens)?
* Light in eyes should cause rapid eye closure * Baby's head should follow your face when 8-10 inches away
64
How would the provider assess cranial nerves V (trigeminal), IX (glossopharyngeal), and XII (hypoglossal)?
* Rooting and sucking reflexes * Swallowing assessed by observing latch
65
How would the provider assess cranial nerve VII (facial)?
Glabella tap assessed for blinking
66
How would the provider assess for cranial nerve VIII (auditory)?
Assess infant in a quiet room to observe their reaction to sound

NURS 501 (66 decks)

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