Physical and gestational age assessment of the newborn Flashcards Preview

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Flashcards in Physical and gestational age assessment of the newborn Deck (63):
1

White or Asian: pink, reddish, pale
Black: warmish brown tone
All babies: more ruddy if crying, acrocyanosis

Healthy, well-oxygenated, full term - Color Changes & Skin Characteristics

2

especially if cold
lacy pattern of dark & light areas
vasomotor fluctuations

Mottling

3

vasomotor disturbance; blood vessels on one side of body dilate (deep pink), other side constrict (pale)
Single or multiple episodes

Harlequin sign

4

first detectable on face & mucus membranes of mouth
Blanch tip of nose, gum line, forehead, sternum
Also examine sclera

Jaundice

5

Non-pathologic
Unknown etiology
Seen in first few days of life
“flea-bite” dermatitis
No Rx, peaks 24-48 hours of life, then disappears in hours or days

Erythema Neonatorum Toxicum (“normal newborn rash”)

6

Assess over abdomen
Should be elastic
Used to evaluate hydration, need to initiate feedings, presence of infectious process

Skin Turgor

7

Covers fetus in utero
Lubricates skin
White, cheeselike substance
Term or postterm: less present

Vernix Caseosa

8

Exposed sebaceous glands
Raised white spots on face, especially nose

Milia

9

Reddened areas over cheeks & jaws
Seen with difficult forceps delivery
Disappear in 1-2 days
Rare: facial paralysis

Forceps Marks

10

“Marked from birth”
Frequent cause of concern, anxiety, and blame
Cultural context

Birthmarks

11

Birthmark; Pale pink or red spots
Seen on eyelids, nose, lower occipital bone, nape of neck
Light-complected newborn; more noticeable if cries
Blanch, no clinical significance, disappear around age 2

Telangiectatic Nevi (“stork bites”, salmon patches)

12

Grey-blue pigmented areas
Lumbosacral or buttocks
Dark-skinned & Asian newborns
Disappear in late infancy or early childhood

Mongolian Spots

13

Flat, purple-red, sharply demarcated
Most often on face
Do not blanch, fade, or increase in size
Can be disfiguring

Nevus Flammeus (“port-wine stain”)

14

Dark red, rough-textured, sharply demarcated, raised
Usually head or face
Grow for several months, then shrink, but can take 7-10 years to disappear

Nevus Vasculosus (“strawberry marks”)

15

Flat, pigmented, sharply demarcated, “coffee with milk”
1 in 5 have them
1-3 spots okay, ># or > 5 mm linked to neurofibromatosis

Café au Lait Spots

16

Head 1/3 adult size
Circumference: 32-38 cm
Head circumference 2-3 cm > chest circumference
Measure from most prominent part of occiput to just above eyebrows

Head Circumference

17

Average: 30-36 cm
Lower edge of scapula, bring around anteriorly over nipple line

Chest Circumference

18

Large, ¼ total body size
Palpate suture lines: open sutures or overriding?
Identify fontanels
Evaluate symmetry
Evaluate molding

Newborn’s Head

19

Diamond-shaped, 2-3 cm wide x 3-4 cm long
Flat, but may swell with stooling, crying
Depressed = dehydration
Can feel pulsation of heart through it
Closes within 18 months

Fontanels: Anterior

20

Smaller, triangular in shape

May be almost closed at birth, but will be fully-closed by end of 2nd month

Fontanels: Posterior

21

Overriding of skull bones
Occurs as head accommodates to diameters of birth canal
Head seems elongated
Disappears spontaneously within few days

Asymmetry of Head: Molding

22

Diffuse, soft-tissue edema of scalp
Caused by pressure on head in L & D
Crosses suture lines
Scalp ecchymosis ( blood into tissue) may be present
Resolves in a few days

Asymmetry of Head: Caput Succadaneum (“caput”)

23

Collection of blood due to rupture of blood vessels between skull and periosteum
No ecchymosis
Doesn’t cross suture lines
Slow process
Resolves slowly; 2-6 weeks

Asymmetry of Head: Cephalohematoma

24

Closed much of time
Most often blue or slate-gray at birth
Darker eyes in darker-skinned
Permanent eye color can take up to 1 year
White spots (Brushfield’s) in periphery of iris
Lacrimal glands immature

Eyes

25

“cross-eyes”; Transient
Immature neuromuscular control
Disappears by 3-4 months

Strabismus

26

eye bleeding; (black filled)
Harmless
Due to pressure
Disappear in about a week

Subconjunctival Hemorrhages

27

Red reflex: pupil appears red-orange when ophthalmoscope directed on it
Blink reflex: response to shining bright light into eyes

Eyes: Reflexes

28

Pink, moist mucosa
Inspect lips, gums, palates
Epstein’s pearls - white or yellow cystic vesicles (fluid)
Precocious teeth - removed to orevent aspiration
Tongue: midline, mobile, normal short frenulum

Mouth

29

“Tongue-tied”; TX: frenotomy (ingual frenulum is cut)

Ankyloglossia

30

Short compared to abdomen
Round chest, thin chest wall with little musculature
Ribs soft & compliant
Tip of xiphoid may protrude

Thorax

31

Extra nipples, found along the “milk line” from upper, outer shoulders to middle of pubic
bone
Within normal limits

Thorax: Supernumerary Nipples

32

Males and females
Maternal hormones, crossed placenta
Persists 2-3 weeks
“Witch’s milk” - milk from newborn breast

Thorax: Breast Hypertrophy

33

Normal newborn cry

strong & lusty, medium pitch

34

High-pitched newborn cry

neurological disorders, hypoglycemia

35

Diaphragmatic, in synchrony with abdomen
Respiratory distress: G,F,R, seesaw respirations, sustained tachypnea, stridor on inspiration
Note abnormalities of AP diameter
Lung sounds: check anterior/posterior chest; noisy until lung fluid clears

Respirations

36

Auscultate entire cardiac region
Apical pulse for a full minute
120-150 BPM normal rate; no obvious irregularities in rhythm
S1: mitral & tricuspid valves closing
S2: aortic & pulmonary valves closing
Check peripheral pulses (brachial, femoral)

Heart Sounds

37

Becoming a routine measurement
Doppler or brachial cuff
Especially needed if distress, preterm, suspected cardiac anomaly
Normal BP range: 63-70/40-50

Blood Pressure Measurement

38

Round, symmetric contour, slightly protuberant, superficial veins often visible
Note bowel sounds
Palpation
Umbilical hernias

Abdomen

39

Note presence & size of labia majora/minora, clitoris, vaginal opening
Labia majora usually covers minora and vestibule
Clitoris large in neonatal period
Enlarged labia or vaginal discharge present due to maternal hormones
Pseudomenstruation: “withdrawal bleed”

Female Genitalia

40

Scrotum: relatively large, pigment
Testes palpable
Prepuce
Phimosis - foreskin cannot be fully retracted over the glans penis
Position of meatus
Hydrocele

Male Genitalia

41

Inspect area for patency, fissures
Note passage first meconium; 90% by 24 hours
R/O imperforate anus & rectal atresia with digital exam if no stool by 48 hours

Anus

42

Place NB prone, inspect, palpate
Normal spinal curvature is C-shaped
Pilonidal region: √ for tuft of hair or sinus
Perianal area: normal dimpling

Posterior Surface

43

Symmetry of size & movement, posture at rest, fractures, lacerations, bruising, functional deficiencies
Breech NB may have hips, knees extended
Moro Reflex: checks damage to structures and function of CNS
Hands & feet: normal # digits, with normal formation
Nails not meconium-stained; nail length
Single palmar crease = Simian line
Plantar creases cover entire sole at term
Check position of feet: neutral midline position

Extremities

44

Affected hip has limited abduction; femur appears shortened, deeper thigh creases
“Ortolani’s Maneuver” & “Barlow”s Maneuver”: puts hip through full ROM, “click” if hip
dislocation suspected

Congenital Hip Dislocation

45

a brace used mostly for babies who have a hip disorder.

Pavlik Harness

46

- Jitteriness or tremors: rhythmic movements equal in amplitude; provoked by external stimuli like noise or handling
- Seizures: fast & slow components and don’t stop when examiner holds down limb

Neurologic Assessment

47

Protective: blink, gag, sneeze
Primitive: Moro
Feeding: rooting, sucking
Human Interaction: palmar grasp

Reflexes

48

Gestational age calculated from mother’s LMP
Prenatally, assess fetal age by ultrasound
After birth, physical exam leads to more accurate assessment of maturity
1970: Dubowitz exam
1979, rev. 1991: Ballard exam

Gestational Age Assessment

49

Posture: NB undisturbed, flat surface
More mature = more flexed
34 weeks’: froglike posture
36-38 weeks’: all extremities flexed

Neuromuscular Evaluation: Posture

50

Flex hand towards ventral forearm; wrist flexion
28-32 weeks’: 90 degrees
38-40 weeks’: 30 degrees
40+: 0 degrees

Neuromuscular Evaluation: Square Window

51

Flex arms for 5 seconds, then extend for 30 seconds, release
36-37 weeks’: stay extended
term: prompt recoil with passive extension

Neuromuscular Evaluation: Arm Recoil

52

Degree of knee flexion; measure angle
Place NB supine, flex thigh against abdomen, then extend lower leg
Immature: no resistance
Term: resistance

Neuromuscular Evaluation: Popliteal Angle

53

Supine, draw arm across chest towards opposite shoulder & note location of elbow
Term: marked resistance

Neuromuscular Evaluation: Scarf Sign

54

Supine, draw foot towards ear until resistance met
Immature: leg stays straight, foot goes to ear or beyond
Term: marked resistance
Breech: allow leg positioning to resolve first or inaccurate

Neuromuscular Evaluation: Heel-to-Ear

55

Preterm: thin, transparent, veins prominent
Term: opaque
Postterm: little or no vernix, skin cracks and peels

Physical Characteristics: Skin

56

Fine, downy hair covering body
Decreases as gestational age increases
Greatest amount at 28-30 weeks’ gestation; then disappears from face first, then trunk,
then extremities

Physical Characteristics: Lanugo

57

Sole crease exam only reliable first 12 hours, then skin dries
Develop anterior to posterior
Peeling noted
Blacks have less-developed sole creases at term

Physical Characteristics: Plantar Creases

58

Palpate with forefinger and middle finger; don’t grasp nipple, avoid trauma
Measures 5-10 mm at term; areola raised and stippled
As gestational age increases, breast tissue and areola enlarge

Physical Characteristics: Areola/Breast Bud

59

Physical Characteristics: Ear Formation/Cartilage

60

<36 weeks’: scrotum few rugae, testes in inguinal canal
36-38 weeks’: rugae anteriorly, testes upper part scrotum
Term: both testes descended, rugae cover pendulous scrotum

Physical Characteristics: Male Genitalia

61

30-32 weeks’: clitoris prominent, labia majora small & widely separated
36-40 weeks’: labia majora nearly covers clitoris
40+ weeks’: labia majora covers minora and clitoris

Physical Characteristics: Female Genitalia

62

Growth Grids

Plot NB’s weight, head circumference, length
90th percentile = Large for Gestational Age (LGA)
Remainder = Accurate or Appropriate for Gestational Age (AGA)

63

G, F, R

Grunting, flaring, retractions