Newborn Exam Flashcards
four parts to the newborn hx
relevant maternal hx
pregnancy hx- past and if current
delivery hx
newborn hx (birth to time of exam)
what are the 4 components of the maternal hx
1) . family hx: newborn deaths (most isn’t pertinent)
2) . preexisting medical conditions (diabetes, HTN, Rheumatoid dz, hypo-hyperthyroidism) PLUS MEDS mom was on/is on
3) . Hx of previous pregnancies
4) . social hx
components of pregnancy hx (8)
1). LMP
2). Due date
3). hx of prenatal care
4). risk factors for pregnancy
5). maternal complications developed during
pregnancy
6). maternal lab data
7). maternal meds
8). fetal complications during pregnancy
what are three things that are maternal complications developed during pregnancy?
gestational diabetes, preterm labor, HTN/pre-eclampsia
what three lab tests do the baby and mom have to be cleared from before being discharged home?
syphilis, Hep B and HIV screen
components of labor hx (7)
1) . gestational age
2) . type of labor
3) . type of anesthesia
4) . rupture of the membranes and fluid characteristics
5) . maternal complications during labor
6) . fetal complications during labor
7) . meds given during labor
which type of anesthesia doesn’t affect the baby as much as general anesthesia?
spinal epidural (PLUS natural births)
if patient’s water broke more than 24 hours ago, what are you concerned about for the baby?
infection
components of delivery hx (4)
1) . type of delivery (I.e surgical assist?)
2) . complications during delivery
3) . Apgar scores
4) . resuscitation
3 examples of complications during delivery
1) . shoulder dystocia- can occur in overweight baby (overweight maybe bc mom had uncontrolled diabetes)
2) . Nuchal cord- caused by baby having a period of hypoxia while in the womb (think of true knot vs looser knot in umbilical cord that could cause this hypoxia)
3) . malpresentation- tells you how difficult the delivery was
what is the apgar score used for? what 2 time periods after birth is this score calculated?
its a marker of what condition the baby is in after delivery; after 1 and 5 minutes (can do 10 and 20 minutes as well)
what is a normal apgar score?
> 7 is considered normal for a term infant
5 things you are evaluating during a apgar score?
respiration, reflexes, heart rate, color, and tone
what is secondary apnea? what is tx for it?
baby was breathing once born but then suddenly stopped; tx is pressure ventilation with valve mask
when is the newborn exam first done?
within the first 12 hours of age
what are the 5 components of the initial assessment?
1) . vital signs
2) . anthropomorphic measurements
3) . color
4) . tone
5) . evidence of distress
overall: is this infant sick or well
what does anthropomorphic measurements tell you?
the size of the baby
HEENT exam (8 and some things to look for)
1) . head size- normal, big, small
2) . head shape- molding, caput, cephalohematoma
3) . sutures- split, open, fused
4) . ears- position/features, pts, tags, dimples (NO otoscopic exam)
5) . eyes- red reflex (retinoblastoma)
6) . nose- patency
7) . mouth-palate (see if smooth and intact), teeth, tongue tie
8) . neck- masses, pits, dimples
is tongue tie always corrected?
no, if baby is latching fine and mom isn’t complaining of pain, then tongue tie is fine (a lot of babies outgrow it)
what do you suspect if there is a wave of fluid under the baby’s scalp?
subgaleal hematoma (babies can bleed into space and die)
what is skull bossing?
a protrusion on the forehead with heavy brow ridge
what is important to remember about midline defects?
if you have two or more midline defects then look for a genetic cause
things to evaluate on chest exam (6)
1) . symmetry
2) . nipple spacing
3) . signs of distress
4) . breath sounds
5) . crepitus of clavicle
6) . breast tissue
what are four signs of distress?
1) . grunting- one of the most common things (baby trying to keep positive pressure inside lungs)
2) . nasal flaring
3) . retractions
4) . tachypnea
what are two things to evaluate for breath sounds?
symmetry and character
