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Newborn Assessment Flashcards

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1
Q

when does the newborn assessment begin

A

before delivery

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2
Q

What to anticipate in prenatal history

A

what may have compromise the fetus in utero?

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3
Q

Prenatal history

A

maternal medical and prenatal history

  • blood type, lab values, GBS/HIV/HepB
  • DM or preecalmpsia
  • Smoking/substance abuse
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4
Q

what to think about intrapartum history

A

what happened during labor

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5
Q

intrapartum history

A
  • duration and course
  • maternal well being: analgesia or anesthesia
  • fetal well being:prolonged rupture of membranes, meconium stained amniotic fluid, nuchal cord, precipitous birth, use fo forceps of vacuum extraction, fetal distress
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6
Q

First assessment

A

transition to extrauterine life

  • ABC’s immediately at birth
  • thermoregulation
  • APGAR scoring
  • Incorporate data with brief physical assessment
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7
Q

What are APGAR scores

A
  • indication of extrauterine transition
  • assessed at 1-5 minutes
  • total score out of 0-10
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8
Q

Interpretation of APGAR score

A
  • 8-10: good prognosis
  • 4-7: active involvement/resuscitation efforts
  • 0-3: poor prognosis
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9
Q

what does APGAR stand for

A 
Appearance/ color
Pulse/heart rate
Reflex irritability/ grimace
Muscle tone/activity
Respiratory effort/respirations
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10
Q

APGAR: appearance

A

0- blue, pale
1-body pink, extremities blue
2- pink

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11
Q

APGAR: Pulse

A

0- absent
1- 60-100
2- over 100

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12
Q

APGAR: grimace

A

0- no response
1- grimace
2- vigorous cry

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13
Q

APGAR: activity

A

0- flaccid, limp
1- some upper extremity flexion
2- active motion of all extremities flexed

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14
Q

APGAR: respirations

A

0- apnea
1- slow, irregular, weak cry
2- lusty cry

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15
Q

Second assessment

A
  • physical examination of new born:
  • gestational age assessment if warranted
  • assessment of attachment
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16
Q

continuous process of assessing

A
  • progress of adaptation to extrauterine life
  • nutritional status and ability to feed
  • behavioral state/ organizational abilities
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17
Q

General measurement of newborn: weight

A
  • weight: 7lb 8oz

- 70-75% of weight is water

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18
Q

general measure of newborn: head circumference

A
  • 32-37 cm/ 12.5-14.5 inches
  • 2 cm/1 inch greater than chest circumference
  • measured above eyebrow at prominent part of the skull
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19
Q

general measurement of newborn: circumference

A

measured at nipple line

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20
Q

general measurement of newborn: abdominal circumference

A

measured just below umbilicus

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21
Q

general measurement of newborn: length

A

in USA, 20 inches

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22
Q

what does gestational age do? and when is it obtained

A
  • establish in first 4 hours after birth

- predict at risk infants and help keep alert for problems

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23
Q

Ballard tool

A
  • tool for estimating gestational age
  • each finding is given a point value
  • maternal condition may affect certain components
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24
Q

assessment of physical maturity characteristics

A
  • skin
  • languo
  • planar creases
  • areola/breast bud
  • eye/ear formation
  • genitalia
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25
Assessment of neuromuscular maturity
- posture - square window - arm recoil - popliteal angle - scarf sign - heel to ear
26
newborn classification based on gestational age and weight
- SGA: less than 2500g - AGA: 2500-3999g - LGA- 4000g
27
physical assessment
- complete with parent in systematic head to toe manner | - general appearance: head large for body and tend to stay in flexed position
28
Newborn assessment care plan: skin
- color: pallor, beefy red, jaundice, cyanosis - texture: cracked, peeling, absence of vernix - turgor: maintain tent shape - pigmentation: rashes, birth marks, petechiae
29
skin variations
- telangiectatic nevi: stork bites - Mongolian spots - nevus flames: port wine stains
30
Newborn assessment and care plan: head
- general appearance - proportion to ody - circumference - molding - fontanelles - sutures
31
head: general appearance and proportion
- piagiocephaly - brachycephaly - dolichocephaly
32
head shape in zika
microcephaly
33
head variations: molding
- caput succedaneum: edema, bruising of presenting part, crosses suture line - cephalohematoma: collection of blood within suture line
34
head: fontanelles
- anterior fontanelle: diamond shaped and closes around 18 months - posterior fontanelle: triangle shaped an closes around 8-12 weeks
35
head: sutures
no bulging and no depression
36
newborn assessment and care plan: eyes
- placement and appearance - eyelids and movement - color
37
new born eye assessment
- tearless crying - peripheral vision - can fixate on near objects - can perceive faces, shapes, and color - clink in response to bright light - pupillary reflex is present
38
eyelid variations
- ptosis | - epicanthal folds
39
newborn assessment and care plan: nose
- small and narrow | - must breath through nose
40
newborn assessment and care plan: mouth
- palate: soft and hard - tongue - lips pink - taste buds present
41
newborn assessment and care plan: ears
- appearance - cartilage/ recoil - hearing
42
newborn assessment and care plan: ears
- appearance: soft, pliable, - cartilage/ recoil: pinna parallel with inner and outer cants, ready to recoil - hearing
43
newborn assessment and care plan: neck
- appearance: short with skin folds, low muscle tone - movement - clavicles: intact, check for crepitus
44
newborn assessment and care plan: chest
- appearance: cylindrical and symmetrical - breast: engorged, whitish secretions - auscultation - circumference
45
newborn assessment and care plan: heart:
- auscultation: PMI located at 3-4 ICS, midclavicular line - rhythm/rate/murmurs: heart rate: 110-160 - xiphoid cartilage
46
signs of respiratory distress
- nasal flaring - intercostal or xiphoid retractions - expiratory grunting or sighing - seesaw respirations - tachypnea
47
newborn assessment and care plan: abdomen
- cylindrical and soft - bowel sounds present by 1 hr after brith - umbilical cord: initially white and gelatinous, two arteries, one vein
48
newborn assessment and care plan: genitalia
- female: labia majora covers labia minora | - male- testes descended, pendulous scrotum
49
female genitalia variations
- vaginal tag/ hymnal tag | - pseudomenstration
50
male genitalia variations
- hypospadias | - left hydrocele
51
newborn assessment and care plan: extremities
- short flexible, and move symmetrically | - leg are equal in length with symmetrical creases
52
variations in extremities
- gross deformities - extra digits - clubfoot - hip dislocation
53
newborn reflexes
- palmar and plantar grasp - rooting reflex - moro reflex - fencer reflex/ asymmetric tonic neck - babinski reflex - galant reflect: trunk incurvation
54
newborn protective reflexes
- blinking - yawn - cough - sneeze
55
behavioral sates of newborn
- deep sleep - light sleep - drowsiness - quiet alert - active alert - crying
56
behavioral response
- habituation - orienting response - motor organization - consolability - cuddliness
57
infant nutritional requirements
-calories: 100-120 cal/kg/day -protien for cell growth carbs for energy -fat for brain and CNS developement -fluid: 100-150 ml/kg/day -iron: reserves depleted by 6 most -vitamin D -Babies regain BW by 10-14 days
58
early nutritional assessment: growth
-lose weight in first 3-4day of life if formula feed: can lose 3.5% if breast fed should not lose more than 7% -no greater than 10% weight loss priorate discharge -weighed daily
59
weight changes in first yeasr
double weight by 5 months - tripe BW by 1 year - quad BW by 2 years
60
breastfeeding assessment
- let down response - nipple condition - maternal comfort during feeding - infant's weight
61
what to monitor for in breast assessment
-montior process of -anticipatory guidance/education -maternal repose to infant cues -latch on technique positioning
62
signs of effective breastfeeding
- infant nursing 8 or more time in 1 day - mother can hear infant swallow - mother's breast soften after feeding - number of wet diapers increases - infant stols besinning to lighten - characteristic output

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