Newborn Health Assessment

  • View
    42.898

  • Download
    0

Embed Size (px)

DESCRIPTION

Newborn Physical Assessment

Text of Newborn Health Assessment

  • 1. New Born Health AssessmentGwen Sollestre Diana Rivera Chris Mach Abigail Krywry Ivette Sanchez

2. Objectives

  • Identify the purpose of components of the APGAR score
  • Describe the method for estimating the gestational age of a newborn
  • Identify the sequence to follow in assessment of the newborn
  • Recognize deviations from normal findings during examination of the newborn

3. Apgar Score

  • Rapid assessment for resuscitation based of five signs
    • 1. Heart rate
    • 2. Respiratory rate
    • 3. Muscle tone
    • 4. Reflex irritability
    • 5. Color
  • Scored 0, 1, or 2
    • 0-3 severe distress
    • 4-6 moderate difficulty
    • 7-10 no difficulty adjusting to life
  • Based on 1-5 min after birth

4. Apgar Score 5. Initial Assessment

  • External
    • Skin color, staining, peeling, wasting, birthmarks, length of nails, nasal patency
  • Chest
    • Palpate PMI, auscultate rate and quality of heart tones, murmurs, character of respirations, equality of breath sounds on each side of chest
  • Abdomen
    • Rounded abdomen, absenceof anomalies, number of vessels in cord
  • Neurological
    • Muscle tone, reflex reaction, Moro reflex, palpate anterior fontanel for fullness or bulge, presence of size of fontanels and sutures

6. Stabilization

  • If excess mucus is present, moth and nose may be suctioned with bulb syringe
  • Percussion over the chest wall using soft circular mark or percussion cup to aid in loosening secretions
  • If coughing and choking support with head to side

7. Thermoregulation

  • Cold stress is detrimental, increases need for oxygen and upset acid and base balance
  • Place infant on mother abdomen with warm blanket, drying and wrapping the newborn in warmed blankets right after birth, keeping head well covered,keep in nursery at 24 degrees Celsius
  • Baby warmer 36-37 degrees Celsius
  • Axillary temp every hour until stable

8. Therapeutic Interventions 9. Nursing Diagnoses

  • Ineffective airway clearance related to airway obstruction with mucus
  • Impaired gas exchange related to hypothermia
  • Ineffective thermoregulation related to heat loss to the environment
  • Risk for infection related to umbilical cord stump/fetal scalp electrode sites

10. Measurements

  • Assessing a newborn's weight:
  • The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs (3.2 kg).
  • In general, small babies and very large babies are more likely to have problems.
  • In most cases the metric system is used for weighing babies.

11. Measurements

  • Converting grams to pounds and ounces:
    • 1 lb. = 453.59237 grams
    • 1 oz. = 28.349523 grams
    • 1000 grams = 1 kg
    • Newborn Length:
    • Head circumference - the distance around the baby's head (head circumference is normally about 1/2 the baby's body length plus 10 cm).
    • abdominal circumference - the distance around the abdomen.
    • length - the measurement from crown of head to the heel.

12. Gestational Age

  • Head: normal measurements32-37 cm (12.5-14.5 in); should be 2cm larger than chest circumference
  • Length: normal measurements48-52 cm (18-22 in)
  • Weight: normal measurements2500-4000 g (5lbs 8oz-8lbs 13oz)
  • The Dubowitz/Ballard Examination
  • Points are given for each area of assessment:
    • Skin textures (sticky, smooth, peeling)
    • Lanugo (the soft downy hair on a baby's body) - is absent in immature babies
    • Plantar creases - range from absent to covering the entire foot
    • Breast - the thickness and size of breast tissue and areola
    • Eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue.
    • Genitals, male - presence of testes and appearance of scrotum, from smooth to wrinkled.
    • Genitals, female - appearance and size of the clitoris and the labia.

13. Physical Examination

  • Temperature normal axillary temperature 36.5- 37.2C in normal room environment; stabilized by 8-10 hours of age.
  • Pulse - normally 120 to160 beats per minute; listen for 1 FULL minute.
  • Blood pressure 80-90/40-50 mm Hg; use 2.5 cm wide cuff.
  • Respiration rate - normally 30 to 60 breaths per minute
  • Vital Signs

14. Physical Assessment

  • Skin: generally pink (varying with ethnic origin), no skin edema with vernix caseosa and lanugo, check for jaundice.
  • Face: characteristics normal & symmetrical, patency in orifices, imaginary line drawn through eyes reaching to top notch of ears.No tears.Responds to hearing voices & other sounds.Epsteins pearls. Has rooting, sucking and extrusion reflexes.
  • Head: of body length, molding.Check for abnormalities with the fonatels, sutures and hair.

15. Physical Examination

      • Head and Neck:
      • Appearance, shape, presence of molding (shaping of the head from passage through the birth canal)
      • Fontanels (the open "soft spots" between the bones of the baby's skull)
      • Clavicles (bones across the upper chest)

16. Physical Examination

  • General Appearance
  • Physical activity
  • Muscle tone
  • Posture
  • Level of consciousness
  • Skin
  • Color
  • Texture
  • Nails
  • Presence of rashes

17. Physical Examination

  • Face - eyes, ears, nose, cheeks
  • Mouth - palate, tongue, throat
  • Lungs - breath sounds, breathing pattern
  • Heart sounds and femoral (in the groin) pulses
  • Abdomen - presence of masses or hernias
  • Genitals and anus - for open passage of urine and stool
  • Arms and legs - movement and development

18. Physical Examination

  • Eyes
  • Ears

< Normal Ear Pinna Ear Deformity > 19. Physical Examination

  • Nose
  • Mouth

20. Physical Examination 21. Physical Examination Normal Umbilical CordUmbilical Hernia 22. Physical Examination Gastroschisis 23. Physical Examination

  • Normal
  • Abnormal Configuration

Female Genitalia 24. Physical Examination

  • Normal
  • Undescended Testes

Male Genitalia 25. Physical Examination

  • Ambiguous Genitalia
  • Closed Rectum

26. Neuromuscular Maturity

  • Neuromuscular system evaluation:
  • -Gestational maturity rating is measured after the baby is born by the Ballard Scale, it consists of six evaluation areas of Neuromuscular maturity and seven items of physical maturity
  • -A score is assigned to each area. The more neurologically mature the baby, the higher the score.

27. Neuromuscular Maturity

  • Neuromuscular system evaluation, includes:
    • Posture - how does the baby hold his/her arms and legs
    • Square window - how far the baby's hands can be flexed toward the wrist
    • Arm recoil - how far the baby's arms "spring back" to a flexed position
    • Popliteal angle - how far the baby's knees extend
    • Scarf sign - how far the elbows can be moved across the baby's chest
    • Heel to ear - how close the baby's feet can be moved to the ears.

28. Posture

  • Score 0 if all extremities are fully flexed
  • Score 1 if there is slight flexion of the legs only.
  • Score 2 if there is moderate flexion of the legs.
  • Score 3 if the legs are flexed and the arms are partially flexed.
  • Score 4 if all limbs are fully flexed against the body

29. Square Window

  • Score 1 if the wrist can be flexed to 60 degrees
  • Score 2 if the wrist can be flexed half way to the forearm.
  • Score 3 if the wris