Newborn Assessment/Care

Question 1

list signs of respiratory distress (6)

Answer 1

• nasal flaring
• grunting
• tachypnea
• substernal retractions
• seesaw respirations
• cyanosis

Question 2

what is the first sign of respiratory distress?

Answer 2

nasal flaring

Question 3

when the baby is experiencing nasal flaring, what are they trying to do?

Answer 3

get more air in this way

Question 4

why do we see grunting?

Answer 4

it natures CPAP → baby is trying to force more air down deep

Question 5

what rate is considered tachypneic?

Answer 5

> 60 respirations per minute

Question 6

When a baby is in respiratory distress, what does tachypnea indicate?

Answer 6

they are trying to take in faster breaths to compensate for not getting enough O2

Question 7

how would substernal retractions present?

Answer 7

They don’t gasp for breath → but will see pulling at the rib cage

Question 8

how would seesaw respirations present? how should they breathe normally?

Answer 8

pulling at the chest that goes down to the abdomen

they should be belly breathers

Question 9

what is a late sign of respiratory distress?

Answer 9

cyanosis

Question 10

are milia normal?

Answer 10

yes & they go away on their own

Question 11

what does milia result from?

Answer 11

exposure to mom’s hormone’s & the baby’s being sensitive

Question 12

are stork bites normal?

Answer 12

yes

Question 13

where are stork bites typically seen?

Answer 13

on eyelids and nape of the neck

Question 14

who are Mongolian spots seen the most in?

Answer 14

babies of color

Question 15

when do Mongolian spots usually dissapear?

Answer 15

somewhere in preschool age

Question 16

What does Caput Succedaneum indicate?

Answer 16

swelling or fluid under the skin → diffuse swelling does NOT have a border

Question 17

where can meconium staining be seen? what does this indicate?

Answer 17

staining of the umbilical cord or vernix
it means that the baby had their first meconium passage in utero

Question 18

what newborn assessment finding looks like an infection but is normal?

Answer 18

Newborn rash or Erythema toxicum

Question 19

are cafe au lait spots normal?

Answer 19

they are normal but if there is 9 or more, should be evaluated by pediatrician

Question 20

is congenital pigmented nevus normal?

Answer 20

they are normal changes that may not go away but they should be watched for changes related to skin cancer

Question 21

if there is mottling right away after birth, what does this mean?

Answer 21

their vasomotor changes are happening

Question 22

if mottling is seen after they get pink, what can this mean?

Answer 22

could mean they are cold, stressed, or septic

Question 23

what newborn assessment finding is when one half of the body is red and the other half is normal color?

Answer 23

harlequin sign

Question 24

is harlequin sign common?

Answer 24

no it is not seen often

Question 25

if harlequin sign does not persist what does this mean? how does it resolve?

Answer 25

it means it was just vasomotor changes usually resolves on its own

Question 26

when there is lots of vernix at birth what does this mean?

Answer 26

it is a preterm baby

Question 27

what does leathering & cracking of the skin mean at birth?

Answer 27

it is a post dates baby

Question 28

What newborn assessment finding is common & can look like cyanosis?

Answer 28

facial bruising

Question 29

what should the nurse do if there is facial bruising at birth? (4)

Answer 29

- Determine by blanching to see color underneath & be sure to pass off in report - Look at mucous membranes - observe the baby breathing - may even check pulse ox

Question 30

if a baby who was born using a vacuum has vacuum marks on head, what can be applied to it?

Answer 30

bacitracin

Question 31

what finding presents with hairy shoulders, arms & back? who is it seen in?

Answer 31

lanugo; seen in preterm babies

Question 32

is nevus vasculitis or strawberry hemangioma common?

Answer 32

yes very common

Question 33

where do nevus vasculitis or strawberry hemangioma appear?

Answer 33

on head and face

Question 34

when does nevus vasculitis or strawberry hemangioma disappear? what happens?

Answer 34

by age 5 it turns silvery/white first then disappears

Question 35

why should nevus vasculitis or strawberry hemangioma not be surgically removed?

Answer 35

it causes scarring

Question 36

does nevus flammeus or port wine stain go away?

Answer 36

no it does not and it can be very distressing

Question 37

what assessment finding is a pathologic lesion that is very serious & more than just skin deep?

Answer 37

varicella (chicken pox)

Question 38

what assessment finding is a pathologic lesion consisting of fluid filled vesicles?

Answer 38

HSV

Question 39

what is the worry with HSV lesions?

Answer 39

child is highly contagious & may become septic Be really careful with this → baby would have to be on isolation

Question 40

what fontanelle is diamond shaped? what one is smaller & triangle shape?

Answer 40

anterior fontanelle is diamond shaped posterior fontanelle is smaller & triangle shaped

Question 41

when should anterior fontanelle close?

Answer 41

at 18 mos

Question 42

when should posterior fontanelle close?

Answer 42

by 3-4 mos

Question 43

what could sunken fontanelle indicate? What should we worry about?

Answer 43

child is dehydrated → worry about ineffective breastfeeding or baby has a virus and is vomiting

Question 44

what does a bulging fontanelle indicate?

Answer 44

fluid on the brain

Question 45

is molding or cone head normal? why or why not? what can you feel?

Answer 45

normal → they were in birth canal for a while can feel bones under skin

Question 46

what newborn assessment finding is on one side and does not cross suture line? should you be alarmed?

Answer 46

Goose egg Not to be alarmed, it is just under the scalp (which is very vascular)

Question 47

when might a goose egg be seen?

Answer 47

if vacuum was used

Question 48

as goose egg goes away, what is the child at higher risk for?

Answer 48

jaundice

Question 49

what indicates a healthy baby cry?

Answer 49

both sides of face move equally

Question 50

when do most cases of facial palsy resolve? what can it disrupt?

Answer 50

most resolve in a few days can disrupt feeding

Question 51

what does recess jaw indicate?

Answer 51

part of a syndrome

Question 52

what will baby with recess jaw have extreme difficulty with?

Answer 52

extreme difficulty with feeding & be in NICU

Question 53

most babies are fairly __________ in their eyes

Answer 53

edematous

Question 54

what might you have to do if there is eyelid edema?

Answer 54

Might have to pry eyeball open to ensure the eyeball is present *Could have congenital defect where eyeball is absent

Question 55

if the baby has gonorrhea infection in the eyes, what do we tx it with? what can this infection lead to?

Answer 55

erythromycin ointment can lead to blindness

Question 56

if you detect a subconjunctival hemorrhage, is this alarming?

Answer 56

no not very alarming & usually goes away in a week or two

Question 57

why is it very important to look at newborn ears?

Answer 57

Ears develop at same time as kidneys but we cannot see the kidneys

Question 58

if a baby's ear has a skin tag on it, does this correlate to kidney damage?

Answer 58

no

Question 59

if a newborn's ears have dimpling/little holes what can this indicate?

Answer 59

some kind of hearing loss if they travel to CNVIII

Question 60

how do you measure low set ears?

Answer 60

measure from inner canthus of eye

Question 61

what are low set ears markers for?

Answer 61

Marker for different syndromes → such as trisomies

Question 62

a normal baby mouth should have what?

Answer 62

pink moist mucous membranes

Question 63

what are epstein's pearls?

Answer 63

a variation of normal; little cysts that look like teeth but go away

Question 64

what should you do if you see that the newborn as a tongue tie?

Answer 64

refer to pediatrician to be able to breastfeed more effectively

Question 65

if a baby has circumoral cyanosis where else would you see cyanosis?

Answer 65

inside mouth if you were to open it

Question 66

how should you assess cleft palate?

Answer 66

when baby's mouth is open with light then take gloved finger and assess (feel) all the way back to the soft palate

Question 67

the severity of gap in palate can vary so it is important to do what?

Answer 67

use a good light to look

Question 68

what can cleft palate lead to? why?

Answer 68

Can lead to aspiration when feeding bc of abnormal opening between trachea & esophagus

Question 69

when a baby has a cleft lip, parents can sometimes get info where/when?

Answer 69

from ultrasound before baby is born

Question 70

what are abnormal findings when assessing baby's clavicles? what should you do and why?

Answer 70

bubbles popping or grating sensation (crepitus) should STOP palpating & call dr can actually cause pneumothorax if you drag bone fragment into the lungs

Question 71

if you had a baby with shoulder dystocia, you may see what?

Answer 71

asymmetrical movement in arms

Question 72

what should you see regarding extremity movements? if not what could this indicate?

Answer 72

Should have symmetrical movements → could indicate fractured clavicle or brachial plexus

Question 73

what is a pretty common finding that can look like little nubs of dangling skin or full finger/toe? what does this come from?

Answer 73

Polydactyly → recessive gene that runs in family

Question 74

what is syndactyly? when does it happen?

Answer 74

fingers/toes are fused together; happens pretty early in development

Question 75

how many creases should the baby have on their hands?

Answer 75

two distinct creases across the palm

Question 76

what is simian crease? what is it a marker of?

Answer 76

one crease across the palm marker for down syndrome & other developmental disability If B/L → much stronger marker