Newborn Assessment PDF

Newborn Assessment Chapter 18 Copyright © 2015 W olters Kluwer Health | Lippincott W illiam s & W ilkins 1 Objectives vDescribe the components of neonatal assessment and intervention. vIdentify key anatomical and physiological ch...

Newborn Assessment Chapter 18 Copyright © 2015 W olters Kluwer Health | Lippincott W illiam s & W ilkins 1 Objectives vDescribe the components of neonatal assessment and intervention. vIdentify key anatomical and physiological changes that occur as the neonate adapts to life outside the womb, as well as corresponding care considerations. vDescribe and prioritize the clinical assessments and care interventions needed for the neonate. vIdentify the aspects of normal physiological variation of the neonate. vDescribe neonate behavior and how to assess it. Copyright © 2019 W olters Kluwer All Rights Reserved 3 Vital Signs Respiratory Rate v30-60 bpm (Full min) vAuscultate for one full minute by visualizing chest and abdomen. Copyright © 2019 W olters Kluwer All Rights Reserved 4 1  Vital Signs Heart Rate v110-160 vListen for 1 full Min vListen for Murmurs o Typically, physiologic and resolve in early infancy o Further assessment of murmurs is rarely indicated in the absence of other cardiac or respiratory difficulties Copyright © 2019 W olters Kluwer All Rights Reserved 6 Vital Signs Temperature v97.7 - 100.4 º F (36.5 – 38.0 ºC) (Can vary on institution) Textbook: 97.7º – 99.3º vKeep baby warm during assessment vBathing Copyright © 2019 W olters Kluwer All Rights Reserved 7 Signs of Respiratory Distress Copyright © 2019 W olters Kluwer All Rights Reserved 8 2  APGAR Copyright © 2019 W olters Kluwer All Rights Reserved 11 Immediate Interventions Eye Prophylaxis vErythromycin Sulfate Ointment vMandatory in US (all state law) vPrecaution against ophthalmia neonatorum- inflammation of eyes resulting from gonorrheal or chlamydial infection Vitamin K Prophylaxis vPrevent hemorrhagic disease in newborn vVitamin K is not present in sterile intestine at birth Hepatitis B Vaccine vIM injections to newborns Hepatitis B Immunoglobulin Copyright © 2019 W olters Kluwer All Rights Reserved 12 Skin Assessment Throughout Exam vProduct of sebaceous glands vVernix Caseosa- white, cheese-like, creamy substance vProtective barrier of skin vCovers body after 35 weeks Copyright © 2019 W olters Kluwer All Rights Reserved 13 3  Skin Assessment Jaundice vBlanch Skin to assess vOccurs first in sclera and face then down chest, abdomen and extremeties vTranscutaneous bilirubin Copyright © 2019 W olters Kluwer All Rights Reserved 14 Skin Assessment Acrocyanosis vBluish coloring of extremities vNormal vTo preserve heat, newborn responds to cold with peripheral vasoconstriction Circumoral Cyanosis Copyright © 2019 W olters Kluwer All Rights Reserved 15 Skin Assessment Slate Grey Nevi vResemble bruising vDocument Café au lait spots vMay be normal depending on amount Copyright © 2019 W olters Kluwer All Rights Reserved 16 4  Skin Assessment Erythema Toxicum v“Newborn Rash” or “Newborn Acne” vBenign: Will resolve without treatment vErythematous macules, papules and small vesicles Copyright © 2019 W olters Kluwer All Rights Reserved 17 Skin Assessment Nevi Simplex vAka “Storks Bites” vCommon at -Nape of Neck -Eyelids -Glabella (between eyebrows) vUsually Fade within 2 yrs Copyright © 2019 W olters Kluwer All Rights Reserved 18 Skin Assessment vAka “port-wine stain” vA nonblanchable discoloration of the skin vNeck and Face vTypically, flat and pink at birth but darkens and becomes textured with time Copyright © 2019 W olters Kluwer All Rights Reserved 19 5  Skin Assessment Nevus vascularis vAka “strawberry hemangioma” vAn area of the skin that is raised and sharply demarcated vMay be present at birth or appear in the first several weeks postpartum Copyright © 2019 W olters Kluwer All Rights Reserved 20 Skin Assessment Lanugo vThin hair covers body between 20-28 weeks vOnly few patches present in term newborns vProtective barrier for skin in utero Copyright © 2019 W olters Kluwer All Rights Reserved 21 Skin Assessment Nevus Flammeus/Vascularis vFlammeus (Port –Wine Stain) o A nonblanchable discoloration of skin. o Falnt and pink at birth, but darkens and become textured with time. vVascularis (Strawberry Hemangioma) o A area of skin that is raised and sharply demarcated Copyright © 2019 W olters Kluwer All Rights Reserved 22 6  Skin Assessment Milia vDistended, small, white sebaceous glands vUsually around mouth, cheeks, nose and chin Copyright © 2019 W olters Kluwer All Rights Reserved 24 Copyright © 2019 W olters Kluwer All Rights Reserved 27 Caput Saccedaneum vs Cephalohematoma Copyright © 2019 W olters Kluwer All Rights Reserved 30 7  Head vHair should be fine and silky vFacial Symmetry Head Circumference vFullest part of occiput, just above the eyebrows Copyright © 2019 W olters Kluwer All Rights Reserved 31 Ears vLow placement of the ears could be associated with congenital abnormalities vIncomplete cartilage formation is associated with prematurity vFailure (Refer) of a hearing test in the early newborn period necessitates further assessment after discharge Copyright © 2019 W olters Kluwer All Rights Reserved 34 Mouth vAll structures should be symmetric, intact, moist and pink vEpstein pearls are a common benign finding vCleft lip and palate are neural tube defects vNatal teeth Copyright © 2019 W olters Kluwer All Rights Reserved 36 8  Neck vAssess for flexibility, movement and bruising vTorticollis is a condition in which the neck is twisted to the side. It typically resolves over a period of months vClavicles Intact -Crepitus Copyright © 2019 W olters Kluwer All Rights Reserved 37 Abdomen vBowel Sounds –present vSoft, round, and nondistended o Firm, distended should be reported vUmbilical stump should be white or gray, odorless o Drainage and redness around cord are concerns for infection vAbdomen should rise with chest when breathing Copyright © 2019 W olters Kluwer All Rights Reserved 40 Umbilical Cord May be green-tinged if meconium present 2 Arteries vMuscular, small & tight, thick walled 1 Vein vFlaccid walls, larger in size Copyright © 2019 W olters Kluwer All Rights Reserved 41 9  Genitalia - Male vAssess placement of urinary meatus o Hypospadias & epispadias may occur independently or with other congenital defects vBoth testes should be palpable within the scrotum vNote 1st void- should be within first 24 hrs. Copyright © 2019 W olters Kluwer All Rights Reserved 42 Genitalia - Female vLabia Majoria should cover labia minora and clitoris vMay see white or blood- tinged discharge “pseudo- menses” vUrethral placement above or on top of clitoris instead of beneath also suggests ambiguous genitalia Copyright © 2019 W olters Kluwer All Rights Reserved 43 Anus-Bowel Movement First Bowel Movement vExpected 24 hrs. Anal Patency vImperforate anus requires urgent evaluation Copyright © 2019 W olters Kluwer All Rights Reserved 44 10  Reflexes vRooting vSuck vExtrusion vPalmar grasp vPlantar grasp vTonic Neck (Fencing) vMoro or Startle vBabinski vStepping Copyright © 2019 W olters Kluwer All Rights Reserved 48 Discharge Tests vCritical Congenital Heart Disease (CCHD) Screening o 300 infants each year are discharged with unrecognized CCHD o Tested around 24 hours of age vNewborn Screen o Mandated by U.S Law Copyright © 2019 W olters Kluwer All Rights Reserved 49 Discharge Tests vHearing Screen vTranscutaneous Bilirubin Copyright © 2019 W olters Kluwer All Rights Reserved 50 11  Copyright © 2019 W olters Kluwer All Rights Reserved 51 Post Partum Assessment Competency Checklist Copyright © 2015 W olters Kluwer Health | Lippincott W illiam s & W ilkins 53 12