Infant Skin and Eye Development Quiz

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Questions and Answers

What is the nature of the marks mentioned in the content?

They are indicative of mental retardation.

They are normally seen in infants.

They are not bruise marks. (correct)

They appear as permanent bruises.

During which stage of development do these marks typically disappear?

Infancy

Adolescence

Toddler years

Preschool years (correct)

Which of the following statements is true regarding the treatment of the marks?

They need specific treatments to fade.

They typically disappear naturally. (correct)

They require immediate medical intervention.

They worsen over time without treatment.

Which of the following is NOT associated with the marks referenced?

Mental retardation Signup and view all the answers

What can be concluded about the long-term effects of the marks?

They have no lasting impact after preschool years. Signup and view all the answers

What is Harlequin Coloring associated with?

Immature vasomotor reflex system Signup and view all the answers

What does desquamation refer to in this context?

Peeling of the skin Signup and view all the answers

When does desquamation typically occur in infants?

Within 2-4 weeks of life Signup and view all the answers

What causes desquamation during infancy?

Pressure and erosion of sheets Signup and view all the answers

Which of the following descriptions is most accurate about skin desquamation in newborns?

Is significant around bony prominences Signup and view all the answers

What is a characteristic feature observed in a healthy eye during examination?

Distinct eyebrows Signup and view all the answers

Which reflexes are important indicators of eye functionality?

Red reflex and blink reflex Signup and view all the answers

In terms of vision, what is a common variation observed in some individuals?

Myopic vision, seeing best at 7 to 10 inches Signup and view all the answers

Which observation is NOT typically associated with healthy eye function?

Edematous eyelids Signup and view all the answers

What does fixation with the ability to follow objects to midline indicate?

Normal visual tracking abilities Signup and view all the answers

What does the persistence of the Doll's Eyes Reflex indicate?

Possible neurologic damage Signup and view all the answers

Under what condition should the Doll's Eyes Reflex not be elicited?

Once fixation is present Signup and view all the answers

Which statement about the Doll's Eyes Reflex is true?

It should disappear if fixation is achieved. Signup and view all the answers

What could be inferred if the Doll's Eyes Reflex is still active in a patient?

There may be an issue with the brainstem. Signup and view all the answers

What is the primary role of fixation in relation to the Doll's Eyes Reflex?

Inhibiting reflex elicitation Signup and view all the answers

At what age does the cough reflex typically become present after birth?

By 1-2 days postnatal Signup and view all the answers

What is one of the common variations in the chest of newborns?

Witch's milk Signup and view all the answers

Which of the following statements accurately describes the xiphesternal process in newborns?

It is evident at birth. Signup and view all the answers

What phenomenon related to breastfeeding can occur in newborns?

Swollen breasts Signup and view all the answers

Which metabolic condition is NOT typically included in screening?

Vitamin D deficiency Signup and view all the answers

Which condition is included in the screening process?

Cystic fibrosis Signup and view all the answers

How far apart are the structures mentioned in the content?

8 cm Signup and view all the answers

Which aspect of hearing is addressed during the screening?

General hearing ability Signup and view all the answers

Which of the following screenings specifically assesses a condition related to the endocrine system?

Thyroid function tests Signup and view all the answers

What type of imaging is utilized in newborn screening?

Hip ultrasound Signup and view all the answers

Study Notes

Newborn Physical Assessment

Introduction: After immediate intervention, babies requiring additional care are transferred to a normal newborn nursery or maternity floor.
Gestational Age Classification:
Early-term: 37 to < 39 weeks
Full-term: 39 to < 41 weeks
Late-term: 41 to < 42 weeks
Post-term: 42 weeks and beyond
Role of Neonatal Nurse and Physician: In the normal newborn nursery or maternity floor, neonatal nurses and physicians are responsible for follow up and stabilization of the newborn.

Stabilization of the Newborn

Mnemonic: Sugar, Temperature, Artificial breathing, Blood Pressure, Labs, and Emotional support for the family

Admission Care (Nurse's Role)

Interpersonal communication: Good communication is key.
Maternal and Neonatal history: A complete history is taken about the mother and newborn.
Identification band: Ensure newborns have an identification band.
Physical Assessment: Comprehensive physical assessment, including general appearance, vital signs, and gestational age assessment.
Hemorrhage prevention: Administer vitamin K if not given during delivery.
Documentation: Proper documentation is important.

Assessment: APGAR Scoring System

Purpose: To assess the newborn's adjustment to extrauterine life and their initial condition.
Scoring: 10 points possible. Scores reflect no depression (7-10), mild depression (4-6), and severe depression (0-3).

Apgar Scoring System (Detailed)

Component	2 points	1 point	0 points
Appearance (A)	Pink body and face (complete)	Pink body, blue limbs/pale body and face	Pale or blue body and face
Pulse (P)	More than 100 bpm	100 bpm or less; but responding to stimulation	No response, or respiratory rate is not identifiable
Grimace (G)	Cry, cough, or sneeze	Grimace or puckering of face	No response
Activity (A)	Active movement with waving arms and legs	Some response to stimulation of arms and legs	No movement of legs or arms, body not reactive to stimulation
Respiration (R)	Strong cry, and clear respiratory rate	Slow, irregular/weak cry; if difficulty breathing; respiratory rate not clear	No cry or no respiratory rate/breathing

Normal Newborn General Appearance

Posture: Well-flexed, full range of motion. Spontaneously moves. Possible variation in legs are extended in breech.
Findings related to distress: Posture limp, asymmetrical movement, persistent tremor, twitching.

Vital Signs

Normal Temperature range: 36.5 to 37 degrees Celsius axillary.
Temperature Variations: Crying may elevate temperature for 8 to 10 hours after birth. Stabilizes afterward.
Temperature Distress: A temperature less than 36.5°C is not a reliable indicator for infection.
Heart Rate: 120 to 160 beats per minute. listen for 1 minute. Variations include 100 bpm when sleeping and 180 bpm when crying. Color is pink with acrocyanosis. Possible irregular rates during crying. Murmurs might occur due to transitional circulation, needing follow-up.
Respiration: 30 to 60 breaths per minute. Possible variations include bilateral broncial breath sounds; possibly moist breath sounds shortly after birth. Distress signs include asymmetrical chest movements, apnea (> 15 seconds), seesaw respirations, nasal flaring, persistent irregular breathing, deep sighing, persistent fine crackles (all are potential warning signs).
Blood Pressure: Not routinely performed. Factors like activity level and cuff size affect measurements. The average newborn oscillometry pressure value is 65/41 in both upper and lower extremities.

General Measurements

Head Circumference: 33 to 35 cm
Chest circumference: 30.5 to 33 cm
Expected findings: Head should be 2-3cm larger than chest. Possible head and chest circumference measurements may be even for 24-48 hours after birth).
Common variations: Molding of the head causing lower head circumference. Possible equality of head & chest circumference for the first 24-48 hours after birth
Weight range: 2500 to 4000 grams

Weight & Length

Weight gain: Healthy term babies gain about 30 grams per day in the first month of life, 20 grams in the second month of life and 10gr/day afterwards during the first year.
Length: Average range is 18-22 inches (46-56 cm). From top of the head to the heel with the leg fully extended.

Skin

Expected findings: Reddish, smooth, and puffy at birth. At 24-36 hours, it becomes flaky, and dry, and pinkish in color. Edema is common around the eyes, feet, and genitals.
Vernix Caseosa: White and cheesy substance on the newborn's body; primarily found in skin folds and creases.
Lanugo: Fine downy body hair; frequently found on the shoulders, sacral area, and back of newborns. It typically disappears before or within the first few weeks of life.
Turgor: Good with quick recoil.
Hair: Silky, soft, strands discernible.
Nipples: Present and in the correct locations.
Cord: One vein and two arteries. Clamp tight and cord drying.
Nails: Reach the end of fingers and sometimes extend slightly.
Additional variations: Acrosyanosis (sluggish peripheral circulation)
Mongolian spots: Dark bluish/black areas on the lower back, buttocks, anterior trunk, or around wrists/ankles. Usually disappear during preschool ages and are not associated with medical issues.
Physiologic jaundice: Skin discoloration that happens within 24 hours after birth.
Milia: Small white or yellow papules on cheeks, forehead, chin, and nose; resolve in 1-2 weeks and doesn't require any treatment.
Erythema toxicum: Pink papular rash (within 24-48 hours) often with superimposed vesicles on thorax, back and abdomen. Resolves within days.
Petechiae/Bruises: Pinpoint, flat hemorrhages on the presenting parts (head, face, and chest) appearing after pressure from birth process.
Harlequin Color Change: Half the body is red and the other half is pale, usually appearing with vigorous crying . This is usually transient.
Desquamation: Skin peeling over bony prominences; occurs routinely within 2-4 weeks of life due to pressure or erosion of skin layers.
Signs of distress related to skin: Jaundice within 24 hours of life. General and circumoral cyanosis. Rashes (excluding erythema toxicum). Pigmented Nevi, Yellow Vernix, Hemangioma, Pallor, Forceps marks.

Head

Anterior fontanel: Diamond-shaped, located at the junction of parietal and frontal bones. 2-3cm wide; 3-4 cm length, closing between 12-18 months.
Posterior fontanel: Triangular, 0.5-1 cm, located between parietal and occipital bones, closes by the 2nd month.
Fontanels: Soft, firm, or flat.
Sutures: Palpable, slightly separated.
Common Variations: Molding of fontanels and sutures
Caput succedaneum: Localized soft area on the scalp, result from difficult labor or vacuum extraction; resolves within days; not concerning.
Signs of distress related to the head: Bulging or depressed fontanels, Hydrocephalus, Macrocephaly, Cephalhematoma, Closed sutures, craniostenosis (early closure)

Eyes

Expected findings: Initially slate gray or blue; true color develops by 3-6 months. No tears. Fixation (following objects to midline); red reflex; distinct eyebrows; bright shiny cornea; pupils equal and reactive to light.
Common variations: Edematous eyelids, myopia (best vision at 7-10 inches), uncoordinated movements, may focus only for a few seconds.
Signs of distress related to eyes: Discharge (chemical conjunctivitis), subconjunctival hemorrhage, Opaque lenses, absence of the red reflex, Epicanthal folds (not present in babies from Orient descent), Doll's eyes reflex (after 10 days), congenital cataracts, glaucoma

Ears

Expected findings: Pinna top on horizontal line with outer canthus of eye; established hearing after first sneeze; loud noise elicits startle reflex; flexible pinna with cartilage.
Common variations: Skin tags on or around ears
Signs of distress related to ears: Low ear placement (possible chromosomal or kidney problem), preauricular sinus, ear malformations, cartilage absence.

Nose

Expected findings: Nostrils patent bilaterally; obligate nose breathers; no nasal discharge.
Common variations: Sneezes to clear nostrils; bridge absent; thin white discharge (nasal mucus).
Signs of distress related to nose: Choanal atresia, choanal discharge, nose malformations, nasal flaring beyond first few moments after birth, displaced nasal septum

Mouth and Throat

Expected findings: Moist mucosa; high-arched palate; midline uvula; minimal or absent salivation; tongue freely moving/not protruded; developed fat pads; present rooting, sucking, gag, and extrusion reflexes.
Epstein's Pearls: Brittle, white, shiny spots on hard palate; normal and resolves.
Common variations: Cleft lip or palate, Circumoral pallor (pale around mouth), Lip movement asymmetrical, Absent/incomplete reflexes, protruding tongue, diminished movement, Candida Albicans, precocious teeth.

Neck

Expected findings: Short and thick neck; turns easily side to side; clavicles intact; tonic neck reflex present; neck-righting reflex present. Possible some head control.
Common variations: Torticollis; stiff neck drawing head to one side; resistance to flexion; large fat pad on back of neck; palpable crepitus, movement with palpation of clavicle.

Chest

Expected findings: Evident xiphoid process; bilateral synchronous chest movement; symmetrical nipples (8cm apart); absence of cough reflex at birth, present by 1-2 days postnatal. Xiphesternal process evident
Common variations: Witch's milk; swollen breasts (3rd day, lasts 2-3 weeks, resolves naturally; N.B: do not express); accessory nipples.
Signs of distress related to the chest: Asymmetrical chest movement; sternum depressed; marked retractions; absent breast tissue; flattened chest ; supernumerary nipples; nipples are widely spaced; bowel sounds auscultated

Abdomen

Expected findings: Dome-shaped abdomen; abdominal respirations; soft to palpation; well-formed umbilical cord with three vessels; cord dry at birth; stump falls off 7-9 days; palpable liver below right costal margin; bilateral equal femoral pulses; bowel sounds audible within 2 hours; voiding within 24 hours; meconium within 24-48 hours after birth.
Expected appearance (Abdomen): Cylindrical in shape. Bluish white with two arteries and one vein.
Common Variations: Small umbilical hernia
Signs of distress related to the abdomen: Absent bowel sounds; visible peristaltic waves; abdominal distension; palpable masses; scaphoid-shaped abdomen; omphalocele; cord redness or drainage; presence of two vessels. Gastroschisis, omphalocele.

Female and Male Genitalia

Female Genitalia (Expected Findings): Edema (labia and clitoris); labia majora larger than surrounding labia minora; urethral meatus behind the clitoris; presence of vernix between the labia.)
Female genitalia Variations: Hymenal tag; Pseudomenstruation; increased pigmentation; ecchymosis and edema after breech birth; "Red brick"- pink stained urine due to uric acid crystals.
Female genitalia Distress Signs: Labia fused; fecal discharge from vaginal opening; imperforate hymen; ambiguous genitalia; widely separated labia.
Male Genitalia (Expected Findings): Urinary meatus at the tip of the glans penis; large, edematous, pendulous scrotum with rugae; usually pigmented; palpable testes in scrotum; absence of testes, needs to check for the hernia; smegma beneath the prepuce; stream adequate on voiding.
Male genitalia Variations: Prepuce covering urinary meatus; erections; increased pigmentation; edema and ecchymosis after breech delivery.
Male genitalia Distress Signs: Nonpalpable testes; phimosis (foreskin adhered to glans penis); hypospadias or epispadias (urinary meatus on abnormal position); smooth scrotum; ambiguous genitalia.

Back and Rectum

Expected findings: Intact spine (no masses or openings); trunk incurvature reflex; patent anal opening.
Common Variations: Limitation of movement, fusion of vertebrae, spina bifida, tuft of hair.
Possible findings related to distress: Perforate anus; anal fissures; pilonidal cyst

Extremities

Expected findings: Maintains a flexed posture; shows equal and bilateral movement and tone; full range of joint's motion. Pink nail beds; flat appearance of the feet; present palmar and sole creases.
Common Variations: Unequal tone; asymmetrical movement; polydactyly (extra digits); syndactyly (digit webbing).
Distress Signs: Unequal leg length; asymmetrical skin creases on posterior thigh; simean crease (presence of only 3 creases); persistent cyanosis; nail beds; clubfeet; marked metatarsus varus.
Expected findings related to neuromuscular system: Maintains posture of flexion; Turns head side-to-side while prone; Holds head and back horizontally when prone; Ability to erect head momentarily

Neuro-muscular System

Possible findings related to distress: Hypotonia; straightening of extremities; clonic jerking; paralysis

Reflexes

Reflexes: Successful use of reflex mechanisms is indication of normal Central Nervous system function.

Behavioral Assessment

Reactivity phases: Newborn's reactivity phases occur during the first 6 to 8 hours after birth.
Behavioral States: Different sleep states and awake states are observed.
Quiet sleep; active sleep; drowsiness; awake states (quiet alert and active alert); crying.
Newborn Interaction: Methods used to encourage interaction with parent. The difference in newborn needs to interact vs. to end interaction.
Place hand near mouth to satisfy hunger.
Turn head away when they are full

Screening

Purpose: Detect abnormal conditions before symptoms appear; to enable early interventions. Usually state funded. Screen for conditions such as PKU & others.
Screening may include: Endocrine conditions, organic acid metabolism, fatty acid metabolism, Amino Acid metabolism, Hearing, Cystic Fibrosis, Hip Ultrasound.

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Description

Test your knowledge about the skin and eye development in infants. This quiz covers topics such as marks seen at birth, desquamation, and eye functionality. Assess your understanding of normal developmental milestones and variations in infants.