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NURS 372~ > W10c - Newborn Assessment > Flashcards

W10c - Newborn Assessment Flashcards

1
Q

Components of the newborn physical assessment: Vitals

A

Heart rate

Respiratory rate

Temperature (axillary)

Oxygen saturation

Blood pressure (if indicated)

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2
Q

Newborn Assessment: Measurements

A

Weight

Length

Head circumference

Abdominal girth (if needed)

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3
Q

Newborn Assessment: Systems Review

A

Cardiovascular

Respiratory
Gastrointestinal

Genitourinary

Neurological

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4
Q

Newborn Assessment: Growth and Development

A

Gestational age assessment

Feeding ability

Tone and reflexes

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5
Q

Newborn Assessment: Head-to-Toe

A

Skin: Color, lesions, rashes, birthmarks

Head & Neck: Fontanelles, sutures, swelling, clavicles
Eyes/Ears/Nose/Mouth: Red reflex, palate, nasal patency, ear position

Chest: Symmetry, breath sounds, heart sounds, murmurs

Abdomen: Cord, bowel sounds, organomegaly

Genitalia: Patent anus, descended testes, normal labia

Musculoskeletal: Limb movement, hip abduction, spine

Neurological: Tone, reflexes (Moro, grasp, rooting, sucking)

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6
Q

What does a normal general appearance look like in a newborn?

A

Well flexed, pink, active, appropriate weight, no signs of respiratory distress.

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7
Q

Why might a newborn appear more pink if the mother had gestational diabetes?

A

Increased red blood cell production (polycythemia).

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8
Q

What birth weight defines a low birth weight newborn?

A

Less than 5.5 pounds (approx. 2500 grams).

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9
Q

What is considered a high birth weight newborn?

A

Greater than 8.8–9.9 pounds (approx. 4000–4500 grams).

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10
Q

Do neonates feel pain?

A

Yes

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11
Q

What are some physiological signs of pain in a neonate?

A

Increased heart rate and blood pressure, grimacing, clenched fists.

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12
Q

What are behavioral signs of neonatal pain?

A

Crying, turning away from stimulus, red face, grimace, clenched extremities.

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13
Q

What pain assessment tools are used in neonates?

A

PIPP (Premature Infant Pain Profile) and NIPS (Neonatal Infant Pain Scale).

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14
Q

What comfort measures can reduce pain in neonates?

A

Skin-to-skin contact, breastfeeding, sucrose, swaddling, pharmacological pain relief.

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15
Q

When should comfort measures be applied?

A

Before, during, and after painful procedures.

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16
Q

What is the average BW?

A

2500 g - 4000 g

5.5 to 8 lbs

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17
Q

What percentage of birth weight loss is acceptable for term infants?

A

Up to 10% in the first few days

Regained in the first two weeks

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18
Q

What is the average head circumference of a term infant?

A

34 cm (normal range: 32–36.8 cm)

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19
Q

What is the normal length range for term infants?

A

45 to 55 cm

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20
Q

What’s the difference between quiet alert and active alert states in a newborn?

A

Quiet alert: Still, focused, best state for bonding and feeding

Active alert: Increased motor activity, may be fussy or less attentive to stimuli

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21
Q

Name the finding

A

Erythema Toxicum

A common newborn rash that:

Appears between 24 to 72 hours of life

Typically resolves within a few weeks

Causes no discomfort and needs no treatment

Occurs as baby’s skin adjusts to the environment

Can look concerning to parents but is normal

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22
Q

Name the finding

A

Milia

Small white papules on the face

Caused by keratin-filled cysts

Common and benign

Exfoliate on their own within the first few weeks of life

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23
Q

Name the finding

A

Congenital Dermal Melanocytosis (Formerly “Mongolian Spot”)

Blue or slate-grey pigmentation present at birth

Commonly found on the back or buttocks

Benign and flat, may resemble a bruise

Fades within the first few years

Important to document to avoid mistaken suspicion of abuse

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24
Q

Name the finding

A

Lanugo

Fine, soft hair found on newborn’s face, shoulders, and back

More common in preterm infants

Helps with thermoregulation

Sheds spontaneously in the first few weeks of life

Normal finding, no treatment needed

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25
Name the finding
Normal Skin Peeling Due to skin drying out post-amniotic fluid exposure Common in post-date infants No treatment needed, but moisturizing is okay Allow vernix to absorb naturally Breastmilk can be applied as a gentle moisturizer
26
Name the finding
Facial Bruising Often related to facial or occiput posterior (OP) presentation Can occur with nuchal cord or difficult delivery Breakdown of red blood cells increases risk of jaundice or hyperbilirubinemia **Monitor for signs of elevated bilirubin**
27
Name the finding
Nevus Simplex ( "Nevi" or "Stork Bite") Red, flat, patch-like appearance Typically located on back of neck, eyelids, or forehead Benign and usually fades with time
28
What is the term given to the cheese like, whitish substance that fuses with the epidermis and serves as a protective coating for the fetus?   Vernix caseosa    Surfactant Caput succedaneum Acrocyanosis
Vernix caseosa Made of shed skin cells, sebum, and lanugo Fuses with the epidermis and serves as a barrier Protective: antimicrobial, waterproof, and prevents fluid loss Helps with thermoregulation and reduces skin trauma at birth Often left intact after birth to support skin health
29
What marks on a baby’s skin may indicate an underlying problem that requires notification of a physician?   Congenital Dermal Melanocytosis on the back  Telangiectatic nevi on the nose or nape of the neck  Petechiae scattered over the infant’s body  Erythema toxicum anywhere on the body
 Petechiae scattered over the infant’s body If localized (e.g., on face), may be due to birth trauma If widespread, it may indicate sepsis, thrombocytopenia, or a coagulopathy Requires urgent evaluation to rule out serious underlying causes Other options listed are typically benign and do not require immediate medical attention
30
Where does jaundice typically appear first in a newborn?
Face and sclera (eyes)
31
What type of bilirubin causes jaundice in newborns?
Unconjugated (indirect) bilirubin
32
Why are newborns prone to jaundice?
Immature liver can’t conjugate bilirubin efficiently
33
How is bilirubin formed?
Hemoglobin → heme + globin → heme becomes bilirubin
34
What happens to bilirubin in circulation?
It binds to albumin
35
What happens to bilirubin if it doesn't bind to albumin?
Kernicterus (bilirubin encephalopathy)
36
What is the visible sign of jaundice?
Yellow discoloration of skin, sclera, and mucous membranes
37
Overriding sutures
- Visually you will see a ridge and riding over of sutures **Normal finding** that self-resolves
38
Name the finding
Head moulding Temporary overlapping of a newborn’s cranial bones during passage through the birth canal. It allows the head to change shape and fit through the maternal pelvis. It’s a normal finding after vaginal delivery and typically resolves within a few days postpartum.
39
Name the finding
Cephalhematoma Collection of blood between skull bone and periosteum Does not cross suture lines Localized to one side Appears hours after birth Associated with prolonged labor or birth trauma Takes weeks to resolve Increases risk of jaundice due to RBC breakdown
40
What is the key feature of a cephalhematoma?
Does not cross suture lines
41
Risk associated with cephalhematoma
Jaundice due to RBC breakdown
42
How does caput succedaneum differ from cephalhematoma?
Present at birth Crosses suture lines Resolves in a few days Does not increase risk of jaundice
43
Name the finding
Bruising of the vertex Probably a vacuum used Bruising on the head with small lacerations Likely used an internal monitor to measure fetal HR
44
How does a cephalhematoma form?
Pressure during delivery causes rupture of blood vessels between the periosteum (the membrane covering the skull) and the skull bone itself. Blood accumulates in the subperiosteal space Because the periosteum is tightly attached at suture lines, the swelling is restricted to one bone and does not cross suture lines The hematoma is not visible immediately at birth but becomes apparent over several hours As the blood breaks down over days to weeks, the infant is at increased risk for jaundice due to bilirubin release from red blood cells in the hematoma
45
How does a caput succedaneum form?
Oedematous fluid collects in the soft tissues of the scalp, usually due to **pressure against the cervix during labor**. During a vaginal delivery, the baby’s head presses against the dilating cervix This pressure **slows venous and lymphatic return**, allowing fluid to accumulate in the scalp’s soft tissue The swelling is present at birth and crosses suture lines (because it’s superficial, above the periosteum) It’s soft, sometimes bruised, but resolves within a few days It does not increase the risk of jaundice because it’s **just fluid**, not pooled blood
46
Subgleal Hemorrhage
Rare but potentially life-threatening condition where blood collects in the subaponeurotic space (area between the scalp and the skull bone).
47
How does a subgleal hemorrhage form?
Shearing of emissary veins during vacuum-assisted or traumatic deliveries causes bleeding into the subgaleal space Area is large and not limited by suture lines, so blood can spread over the entire scalp, even down to the neck Bleeding may not be obvious right away, but swelling increases over hours, becoming fluctuant and boggy Can lead to hypovolemic shock. Baby can lose up to 40% of total blood volume into this space
48
S/S of Subgleal Hemorrhage
tachycardia pallor hypotonia progressive head circumference increase jaundice from RBC breakdown
49
Name the finding
Eyelid edema -normal -may not open eyes completely, especially in the presence of bright light
50
Potential cause of eyelid edema
Use of erythromycin topical ointment (Very rare, but she mentioned it in class) Local irritation of the conjunctiva
51
Name the finding
-low set ears -below eye line -baby also looks hypotonic - poor tone in facial features
52
Name the finding
Skin tag -normal, often benign -ears form at same time as kidneys, so if you see a lots of skin tags on ears, look at kidneys due to timing of gestation
53
Name the finding
Tight Frenulum -heart shape appearance -impacts ability to feed
54
Name the finding
Epstein Pearl -normal, benign -spontaneously resolve
55
Name the finding
Yeast infection/Oral Thrush -doesn’t wipe away -if breastfeeding - also chance that breastfeeding individual has infection
56
What are the normal features of a newborn umbilical cord?
Contains 2 arteries (smaller, more erect) and 1 vein (larger, flatter) Dark color is normal due to blood coagulation Can be meconium stained (entirely dark) without being pathologic Cord clamp is applied to prevent bleeding
57
Umbilical Cord Care Considerations
Watch for signs of infection, bleeding Teach parents to keep it outside of the diaper so it doesn't become contaminated
58
Name the finding
Umbilical hernia Observe for 1 year, will likely resolve Beyond one year, intervention
59
How many voids should a newborn have per day in the first 5 days?
Day 1 = 1 void Day 2 = 2 voids Day 3 = 3 voids Day 4 = 4 voids Day 5 = 5–6 wet diapers per day
60
What are peach-colored crystals in a newborn’s diaper?
Uric acid crystals – normal finding in first few days
61
When should a newborn pass their first stool?
Within the first 24 hours (up to 48 max)
62
What does meconium look like?
Thick, tarry, dark brown/black
63
What should stool look like after meconium in a breastfed baby?
Pasty, mustard yellow
64
What should stool look like after meconium in a formula-fed baby?
Clay, grey/yellow, green or brown
65
By when should all meconium be passed?
By day 5 of life
66
What is meconium?
First stool composed of: - Amniotic fluid - Intestinal secretions - Shed mucosal cells - Possibly ingested maternal blood
67
When should meconium be passed in healthy vs LBW infants?
Healthy: 12 - 24 hours, up to 48 LBW: Delayed (?)
68
A dyad is attending their first well baby visit with their primary HCP. The infant is 6 days old. When the diaper is removed, meconium is noted. Is this normal or abnormal?
Abnormal After day 5 Should be passing transitional stool at this point
69
What does transitional stool look like?
Greenish brown to yellowish brown
70
When does transitional stool appear?
Usually appears by the THIRD day AFTER initiation of feeding
71
How does transitional stool compare to meconium?
Thinner and less sticky compared to meconium
72
What does milk stool look like in breastfed infants?
Yellow to golden Pasty consistency Odour similar to sour milk **Thinner than transitional stool**
73
When is milk stool usually observed?
Usually appears by the fourth day
74
What does milk stool look like in formula-fed infants?
Pale yellow to light brown FIRMER consistency Odour like normal stool
75
A nurse notes the following characteristics in a diaper of a male born 18 hours ago Is this normal or abnormal?
Normal Uric acid crystals Not concerning in the first few days of life This WOULD be concerning after the first week -- sign of dehydration
76
Diaper of a female born 18 hours ago Normal or abnormal?
Normal Pseudo menses Withdrawing from maternal hormones
77
What is pseudomenses in a newborn?
A small amount of vaginal bleeding in newborn females
78
What causes pseudomenses in newborns?
Withdrawal of maternal estrogen after birth
79
Name the finding
Facial Nerve Palsy Unilateral facial weakness due to trauma of the 7th cranial nerve, often from pressure during birth or forceps use. Often resolves spontaneously within days to weeks if due to birth trauma.
80
Name the finding
Sacral Dimple Concern for neural tube defects How open is it? If it’s deep, large, located above the gluteal cleft, has discharge, or is associated with a skin tag or tuft of hair it **may indicate spinal abnormality**.
81
What are common risk factors for developmental hip dysplasia?
Family history, female sex, breech presentation
82
What is the Ortolani test?
A maneuver used to detect hip dislocation: hips are flexed to 90° then abducted. A ‘click’ may indicate a dislocated hip being reduced into the socket.
83
What is the Galeazzi (Allis) sign?
Knees are flexed with feet flat on the table. Unequal knee height suggests femoral shortening—possible hip dysplasia.
84
What are visual signs of hip dysplasia in infants?
Asymmetric thigh or gluteal folds, shortened leg on affected side, limited abduction.
85
What is the rooting reflex?
Infant turns head toward stimulus and opens mouth when cheek is stroked.
86
What is the sucking reflex?
Infant opens mouth and begins to suck when object touches lips or mouth.
87
What is the Moro reflex?
Startle reflex: symmetrical abduction and extension of arms, then return to flexion.
88
What is the grasp reflex?
Infant’s fingers curl around examiner’s finger (palmer), toes curl down (plantar).
89
What is the tonic neck reflex?
"Jousting Reflex" When infant’s head is turned to one side, the arm and leg on that side extend; the opposite side flexes.
90
What is the Babinski reflex in infants?
Stroke sole of foot → toes fan out and big toe dorsiflexes (normal in infants).
91
Why is vitamin K given at birth?
To prevent hemorrhagic disease of the newborn due to low vitamin K levels at birth.
92
Where is the vitamin K injection given?
In the vastus lateralis (thigh muscle), intramuscularly.
93
When should vitamin K be given after birth?
Within the first few hours, up to 6 hours after birth.
94
What is the vitamin K dose for newborns ≥1500g?
1 mg IM injection.
95
What is the vitamin K dose for newborns <1500g?
0.5 mg IM injection.
96
Why don’t newborns have enough vitamin K?
GI flora that synthesizes vitamin K is not present at birth.
97
What gauge and length is used for IM injections in newborns?
25 gauge, 5/8 inch (16 mm) to 7/8 inch (22 mm)
98
Preferred IM injection site in newborns?
Vastus lateralis
99
Maximum volume per IM injection in newborns?
0.5 mL
100
What angle is used for newborn IM injections?
90 degrees
101
What should be considered with IM injections in newborns?
Pain management strategies (e.g., skin-to-skin, sucrose)
102
When should the first newborn bath occur?
Delay until at least 24 hours after birth (WHO); if not possible, wait at least 6 hours
103
Why delay the first newborn bath?
Allows time for physiological stabilization and transition to extrauterine life
104
Preferred method of bathing newborns?
Immersion bath (reduces heat loss better than sponge bath)
105
Daily hygiene for newborns without full bath?
Wipe hands, face, and buttocks with warm water
106
Bathing precautions if cord still intact?
Ensure the cord is dried well after bath to prevent infection
107
Should drying agents be used on newborn skin?
No—avoid products that dry out the skin

NURS 372~ (7 decks)

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