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. What would you like to do?
what are the guidlines for doing a newborn assessment?
- 1. takes 15 mins so keep newborn warm
- 2. use a soft voice,slow movements, warm hands/stethscope
- 3. always go head to toe
- 4. do it the same every time
what type of things do you need to know about mom prior to doing newborn assessment?
- 1. moms general and prenatal history
- 2. delivery type and if any delivery complications
- 3. medications taken by mom
- 4. any resuscitation needed
- 5. whether meconium was passed or not
- 6. apgars score
whats a normal axillary temp?
37 degrees celsius/98.6 degrees
what is a normal heart rate? how long you listen for?
100-160 for a min
What is the normal respiratory rate?
30-60 for one min
True/False. An irregular rate and rhythm is not normal.
False it is normal for an irregular rate and rhythm
what is a normal BP? and when is it done?
60-80/40-50 only done if suspected problems
What is thermoregulation?
maintenance of balance between heat loss and heat production.
What puts an infant at risk for heat loss?
- 1. thin layer of subcutaneous fat
- 2. blood vessels are closer to skin
- 3. larger body surface to body mass ratios
what is the most important goal for a newborn?
neutral thermal environment
what are the four ways heat loss can occur?
- 1. convection
- 2. radiation
- 3. evaporation
- 4. conduction
What is convection and how can you protect infant from it?
Flow of heat from body surface to cooler ambient air. Keep room temp at 24*C or higher and keep infant covereed/wrapped
What is radiation and how can you protect infant from it?
Loss of heat from the body surface to cooler solid surface not in direct contact but in relative proximity. Prevent drafts by keeping cribs and exam tables away from outside windows and air vents.
What is evaporation and how can you protect infant from it?
Loss of heat that occurs when a liquid is converted to vapor. Dry infant well and in a timely fashion.
What is conduction and how can you protect infant from it?
Loss of heat from body surface to cooler surfaces in direct contact. Pre warm the crib, scale, etc.
Which heat loss causes the most significant heat loss in the first few days of life?
What is the normal for a head circumference?
What is the normal for a chest circumference?
30-33 cm should be 2-3 cm < than head
What is the normal length?
Is it normal or abnormal to see soft smooth, deep cracks on abdomen; blood vessels faintly visible, skin turgor snaps back on a full term?
Acrocyanosis seen in the first 24 hours is normal or abnormal in a full term?
Increased vernix caseosa in neck, axilla & groin is normal or abnormal in a full term?
Abnormal. only few seen on the full term is normal
What is milia and is it normal or abnormal?
milia is small white, distended dots around nose, chin, and cheeks. NORMAL
What does the skin of a preterm baby look like?
thin, fragile skin with very visble vessels
Lanugo is fine downy hairs with some bald spots and is seen on a full term or preterm baby?
Full term. Preterm baby will have lots of lanugo.
Mongolian spot on butt and back and newborn rash will you tell mom to be worried about it or that it is normal?
it is normal
Is it normal or abnormal to see skin tags, ulcers, hematomas, bruising, petechiae, ecchymosis, hemangiomas, and pustules on a full term baby?
What are the two types of head appearances?
Caput succedaneum and cephalohematoma
what is a caput succedaneum?
collection of fluid under scalp it CROSSES sutur line resolves in 24-48 hrs
what is a cephalohematoma?
collection of blood between bone & periosteum. Does NOT cross suture line. resolves in 24-48 hrs.
What is normal for eyes in a full term?
- Iris deep blue/grey
- sclera bluish white
- hemorrhage in sclera
What is normal for ears in full term?
- pinna at line
- well curved pinna & similar shapes
- firm ear cartilage
- baby startles to loud sound
what do you look for when assessing the mouth?
rooting and sucking reflex, gums, no teeth, hard and soft palate are intact, lips/mucus membranes pink and moist, uvula
webbing and large folds of fat on back of neck are seen on a normal or abnormal infant?
if the breast tissue is full & 5-10 mm tissue bud is it normal or abnormal?
what are signs of respiratory distress?
- central cyanosis
- nasal flaring
- increase/decrease in respiratory rate
- audible grunting
Why might you hear a murmurs?
NORMAL heard loud as baby is in recovery of foramen ovale and ductus arteriosus still closing.
what are you looking for in the umbilicall cord?
2 arteries and 1 vein
Coarctation of aorta is abnormal or normal in the pulses?
When looking at a male genitial what normal findings are you looking for?
lots of Rugae over all surfaces, pendulous scrotum, testes fully descended, visible urinary meatus in center of penis
if testes seem to be swollen a little what could that mean?
hydroceles which is caused by an accumulation of fluid around testes.
When looking at a female genitial what normal findings are you looking for?
labia major covers the labia minora & clitoris, vaginal or hymenal tags, white/blood tinged mucus discharged.
In a preterm baby clitoris and labia majora looks like what?
clitoris is prominent and labia majora is small and widely separated.
What is the Barlow test checking for?
hip dysplasia or dislocation of hip
When checking the Barlow test you place your middle finger on ____ of each leg and thumbs on ____. Flex hip ____ degree and _____ use gentle _____ pushing of femoral head.
greater trochanter/inner midthigh/90/adduct/downward
what will indicate a positive test to the Barlow test?
a "clunk" sound
When performing the Ortolani Maneuver you flex thigh on hip and ____ the hips and apply ____ leverage to return dislocated hip with another ____.
What does tufting of hair at sacral area may indicate? Is it normal or abnormal?
Indicate spina bifida. Abnormal
If you see scapula even, spine palpable & straight, dimple at base of spine closed & gluteal folds symmetric are you looking at a abnormal or normal findings?
What are ways to check if anal is patent?
- BM within 24-48 hrs
- wink reflex (stroking the skin next to anus and anus should contract)
What resting posture & resistance to would expect to see in a normal full term infant?
resting posture is flexion of elbows;hips and knees. Resistance to extension of arms & legs.
How do you check for palmar grasp reflex?
Place finger in palm of hand and infant curls finger around fingers
How do you check for plantar grasp reflex?
Place finger at base of toes and infant toes curl downward.
How do you check for Babinski reflex?
Stroke finger from sole of infant foot upward and across ball of foot infant toes should hyperextend.
How do you check for Moro reflex?
hold infants hands and pull up and let go really quickly and startle infant. Infant should keep hands up.
How do you check for stepping reflex?
Hold infant vertically allowing one foot to touch table and infant will stimulat walking.
How do you check for fencing reflex?
While infant asleep turn infants head quickly to one side and one arm & leg extend and other flex
How do you check for extrusion reflex?
Touch infants tip of tongue and forces tongue outward
How do you check for sucking/rooting reflex?
Touch infants lip, cheek, or corner of mouth infant turns head toward stimulus.
What are the reasons to bathe an infant?
- 1. completely clean infant
- 2. observe infants condition
- 3. promote comfort
- 4. parent-child-family socializing
What places of the infant should you clean daily?
- 1.face around/behind ears
- 2. creases and skin folds
How many times a week should you bathe an infant?and clean the perineum?
bathe 2-3 times a week. clean perineum after every diaper change.
When should you NOT use soap on the infant? And what type of soap is NOT okay to use?
Dont use soap on face/creases/skin fold. Not okay to use Ivory soap.
Whats the difference of when you can give a sponge bath vs. a tub bath?
sponge bath until cord falls off & umbilicus heals. Tub bath after heailng of umbilicus or if baby is stable.
What are some general things you should make sure are done before giving a bath?
- Baby is awake
- Baby has not eaten yet
- Room temp 75* & free of drafts
- Temp of bath water 98-99*
What are saftey measures you should NEVER do when giving a baby a bath?
- 1. leave infant alone
- 2. hold infant under running water
- 3. cut finger/toe nails immediately post birth
- 4. use hair drier to dry infant
- 5. use cotton tipped swabs to clean ears or nose
how long should you keep infant warm and wrapped up after bath?
When is it okay to apply loosely fitted mitts on babys hands?
As a last resort when baby keeps scratching themselves
What and when do you assess for inregard to circumcision care?
assess for bleeding, infection, and urination after circumcision. Assess with each diaper change and Q30 min for 1 hour for first 5-6 hours.
how should you care for the cirumcision?
wash gently with warm water initially and the soap after healed in 5-6 days
what do you assess for in umbilical cord?
Assess for edema, redness, and purulent drainage
How should you clean the umbilical cord?
cleanse around base of cord where it joins skin with soap and water with every diaper change.
What you should tell patient what to look for when its time to notify doctor about umbilical cord?
Notify MD of any odor, discharge, or skin inflammation around the cord.
What would you like to do?
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