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NU2101 > OSCE Checklist > Flashcards

OSCE Checklist Flashcards

1
Q

preperation of NIPE

A
  • Looks at case history and identifies at least 3 significant findings from the maternal, family and perinatal histories correctly.
  • Gather and checks equipment.
  • Introduce yourself to parents, name and role., Offer congratulations.
    Briefly explain the procedure:
  • Top to toe examination
  • Optional
  • Repeated at 6 weeks by GP
    Explains the limitations:
  • Snapshot in time
  • Problems may arise
  • Screening not diagnostic
  • Confirm with mum any significant history or clarify anything identified from notes.
  • Confirm baby name and date of birth
    Seek and gain consent
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2
Q

NIPE observation?

A

Ascertain any carers anxieties and observe interaction with the baby
Observe baby’s general condition while settled and undisturbed:
* Colour
* Breathing
* Behaviour
* Activity
* Tone
* Cry
Confirm urine and stool output
Establish feeding method and any concerns
Perform hand hygiene and don PPE if appropriate
Undress baby as required, keep warm throughout

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3
Q

head to toe NIPE

A
  • skin
    -head and scalp
  • eyes
    -nose
    -mouth
    -ears
  • neck and clavicles
    -upper limbs
    -chest
    -heart
    -abdomen
    -genitalia
    -lower limbs
    -hips
    -spine
    -reflex
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4
Q

assessment of skin

A
  • Colour
  • Integrity
  • Birthmarks
  • Trauma/bruising
  • Rashes
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5
Q

assessment of head and scalp

A
  • Shape
  • Size
  • Sutures/fontanelles
  • Measures head circumference
  • Injury
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6
Q

assessment of eyes

A
  • Normal structures
  • Shape
  • Position
  • Clarity/discharge
  • Red reflexes – present, equal, red-magnolia/blue
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7
Q

assessment of nose

A
  • Patency
  • Philtrum
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8
Q

assessment of mouth

A
  • Visual & digital inspection of the hard and soft palate to uvula for cleft
  • Tongue – shape/size/tongue tie
  • Gums/teeth
  • Presence of suck reflex
  • Presence of rooting reflex
  • Jaw
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9
Q

assessment of ears

A
  • Size
  • Shape
  • Position
  • Abnormalities in structures
  • Hearing test
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10
Q

assessment of neck and clavicles

A

check for tumours, skin tags, folds making sure head can freely move
checking for any fractures

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11
Q

assessment of upper limbs

A
  • Equal movement
  • Proportion
  • Symmetry
  • Brachial pulses
  • Palmer creases
  • Digits
  • Grasp reflex
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12
Q

assessment of chest

A
  • Respiratory rate
  • Respiratory effort
  • Listens for chest sounds
    nipples also
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13
Q

assessment of heart

A
  • Capillary refill
  • Heart rate
  • Heart rhythm
  • Heart sound - heart auscultation x5 points 1min, mitral also with bell
  • Heaves
  • Thrills
  • Pulse oximetry
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14
Q

assessment of abdomen

A
  • General inspection
  • Palpate rolling through four corners shallow then deeper
  • Umbilical cord
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15
Q

assessment of genitalia

A
  • Appearance of structures
  • Positioning
  • Completeness
  • Patency
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16
Q

assessment of lower limbs

A
  • Femoral pulses
  • Symmetry
  • Movement & tone
  • Length
  • Plantar creases
  • Digits
  • Plantar reflex
17
Q

assessment of hips

A
  • Knee height position
  • Leg/buttock creases
  • Barlow’s test
  • Ortolani’s test
    STABILISE HIP
18
Q

assessment of spine

A
  • Skin appearance of head/neck
  • Spine bony structure
  • Sacrum/sacral dimple
  • Buttock cleft
19
Q

reflex

A

moro

20
Q

post NIPE

A

Dress and wrap baby – back to parents
Doff PPE if appropriate and perform hand hygiene
Communicate findings to parents and inform parents of future proposals or plans
Time given to parents for questions.
Complete documentation
Complete referrals needed

21
Q

What would you do as an examiner for a breech baby at birth?

A
  • be aware when performing hip exam
  • send a orthopaedic USS referral
22
Q

Component of assessment infant feeding?

A
  • Women centred approach demonstrated throughout
  • Observing and listening during conversations
  • Discusses hands off approach
  • Clear relevant information shared
  • Mentions use of leaflets, analogies, props
    Identify signs of instinctive behaviour in baby:
  • Rooting
  • Head bobbing
  • Mouthing the nipple
  • …and helps mother to recognise them
23
Q

components of positioning

A

Baby held close
Baby held/supported with head and body inline
Baby’s head free to tilt back
Baby held with nose opposite nipple

24
Q

component of attachment

A
  • Watch for baby to have a wide open mouth
  • Mother moves her baby to her breast with head tilted back, chin leading
  • Bottom lip touches breast well away from the base of the nipple
  • Nipple aimed towards the rear of the roof of the baby’s mouth
25
Q

components of effective feeding

A

Mother comfortable/pain free during feed
Baby’s mouth is wide open
Baby’s chin indents the breast
Baby’s cheeks are full and round
Nipple aimed towards the rear of the roof of the baby’s mouth
Suckling is appropriate to age of baby:
* Usually rapid initially, then deep
* Rhythmic with pauses
* Audible swallows
Areola: If any is visible, then more will be visible above the baby’s top lip
The baby is contented and stays on the breast

26
Q

components of hand expression

A

Explains why hand expressing might be useful
Describes an approach to teaching the practical skills of hand expressing which demonstrates a woman centred approach
Describes skill using a diagram or model of the relevant anatomy
Explains important of oxytocin

Explain to a mother how to express milk:
* Place fingers 2-3 cm back from the base of the nipple
* Shifting her fingers position when needed
* Thumb in C shape
* Compress and release in a steady rhythm (+/- pressing back first)
* Avoid sliding fingers on skin
* Move round breast once flow slows
* Once flow slows/ceases, move to other breast

27
Q

what things can help with oxytocin

A

Suggests things that will help with oxytocin:
* Having baby near
* Gentle breast massage
* Use of something to remind mother of baby
Overall comfortable environment

28
Q

what is the importance of oxytocin?

A
  • Responsible for milk delivery
    • Oxytocin then acts on the myoepithelial cells around the lacocytes which caused these cells to contract.
    • This contraction then injects the milk through the lactiferous ducts.
      This action is commonly referred to as the ‘let down reflex’
      let down reflex is initially controlled by the baby suckling at the breast as well as by the mother seeing, touching, hearing and smelling her baby.
29
Q

why might hand expression be helpful?

A

stimulates the hormone oxytocin, which helps to trigger the let-down reflex.

can help collect ebm

practice hand expression and to offer the breast as the smell and the taste of the milk may encourage baby to feed

might be useful to decreased engorged breasts or if the breast has mastitis

NU2101 (33 decks)

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