Newborn Health Assessment

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Newborn Physical Assessment

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<ul><li> 1. New Born Health AssessmentGwen Sollestre Diana Rivera Chris Mach Abigail Krywry Ivette Sanchez </li></ul> <p> 2. Objectives</p> <ul><li>Identify the purpose of components of the APGAR score </li></ul> <ul><li>Describe the method for estimating the gestational age of a newborn </li></ul> <ul><li>Identify the sequence to follow in assessment of the newborn </li></ul> <ul><li>Recognize deviations from normal findings during examination of the newborn </li></ul> <p> 3. Apgar Score</p> <ul><li>Rapid assessment for resuscitation based of five signs </li></ul> <ul><li><ul><li>1. Heart rate </li></ul></li></ul> <ul><li><ul><li>2. Respiratory rate </li></ul></li></ul> <ul><li><ul><li>3. Muscle tone </li></ul></li></ul> <ul><li><ul><li>4. Reflex irritability </li></ul></li></ul> <ul><li><ul><li>5. Color </li></ul></li></ul> <ul><li>Scored 0, 1, or 2</li></ul> <ul><li><ul><li>0-3 severe distress </li></ul></li></ul> <ul><li><ul><li>4-6 moderate difficulty </li></ul></li></ul> <ul><li><ul><li>7-10 no difficulty adjusting to life </li></ul></li></ul> <ul><li>Based on 1-5 min after birth </li></ul> <p> 4. Apgar Score 5. Initial Assessment </p> <ul><li>External </li></ul> <ul><li><ul><li>Skin color, staining, peeling, wasting, birthmarks, length of nails, nasal patency </li></ul></li></ul> <ul><li>Chest </li></ul> <ul><li><ul><li>Palpate PMI, auscultate rate and quality of heart tones, murmurs, character of respirations, equality of breath sounds on each side of chest </li></ul></li></ul> <ul><li>Abdomen </li></ul> <ul><li><ul><li>Rounded abdomen, absenceof anomalies, number of vessels in cord </li></ul></li></ul> <ul><li>Neurological</li></ul> <ul><li><ul><li>Muscle tone, reflex reaction, Moro reflex, palpate anterior fontanel for fullness or bulge, presence of size of fontanels and sutures</li></ul></li></ul> <p> 6. Stabilization </p> <ul><li>If excess mucus is present, moth and nose may be suctioned with bulb syringe </li></ul> <ul><li>Percussion over the chest wall using soft circular mark or percussion cup to aid in loosening secretions </li></ul> <ul><li>If coughing and choking support with head to side </li></ul> <p> 7. Thermoregulation </p> <ul><li>Cold stress is detrimental, increases need for oxygen and upset acid and base balance </li></ul> <ul><li>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 </li></ul> <ul><li>Baby warmer 36-37 degrees Celsius </li></ul> <ul><li>Axillary temp every hour until stable </li></ul> <p> 8. Therapeutic Interventions 9. Nursing Diagnoses </p> <ul><li>Ineffective airway clearance related to airway obstruction with mucus </li></ul> <ul><li>Impaired gas exchange related to hypothermia </li></ul> <ul><li>Ineffective thermoregulation related to heat loss to the environment </li></ul> <ul><li>Risk for infection related to umbilical cord stump/fetal scalp electrode sites</li></ul> <p> 10. Measurements </p> <ul><li>Assessing a newborn's weight: </li></ul> <ul><li>The average weight for term babies (born between 37 and 41 weeks gestation) is about 7 lbs (3.2 kg).</li></ul> <ul><li>In general, small babies and very large babies are more likely to have problems.</li></ul> <ul><li>In most cases the metric system is used for weighing babies.</li></ul> <p> 11. Measurements </p> <ul><li>Converting grams to pounds and ounces: </li></ul> <ul><li><ul><li>1 lb. = 453.59237 grams</li></ul></li></ul> <ul><li><ul><li>1 oz. = 28.349523 grams</li></ul></li></ul> <ul><li><ul><li>1000 grams = 1 kg </li></ul></li></ul> <ul><li><ul><li>Newborn Length:</li></ul></li></ul> <ul><li><ul><li>Head circumference - the distance around the baby's head (head circumference is normally about 1/2 the baby's body length plus 10 cm). </li></ul></li></ul> <ul><li><ul><li>abdominal circumference - the distance around the abdomen. </li></ul></li></ul> <ul><li><ul><li>length - the measurement from crown of head to the heel. </li></ul></li></ul> <p> 12. Gestational Age </p> <ul><li>Head: normal measurements32-37 cm (12.5-14.5 in); should be 2cm larger than chest circumference </li></ul> <ul><li>Length: normal measurements48-52 cm (18-22 in) </li></ul> <ul><li>Weight: normal measurements2500-4000 g (5lbs 8oz-8lbs 13oz) </li></ul> <ul><li>The Dubowitz/Ballard Examination </li></ul> <ul><li>Points are given for each area of assessment: </li></ul> <ul><li><ul><li>Skin textures (sticky, smooth, peeling) </li></ul></li></ul> <ul><li><ul><li>Lanugo (the soft downy hair on a baby's body) - is absent in immature babies </li></ul></li></ul> <ul><li><ul><li>Plantar creases - range from absent to covering the entire foot </li></ul></li></ul> <ul><li><ul><li>Breast - the thickness and size of breast tissue and areola</li></ul></li></ul> <ul><li><ul><li>Eyes and ears - eyes fused or open and amount of cartilage and stiffness of the ear tissue. </li></ul></li></ul> <ul><li><ul><li>Genitals, male - presence of testes and appearance of scrotum, from smooth to wrinkled. </li></ul></li></ul> <ul><li><ul><li>Genitals, female - appearance and size of the clitoris and the labia. </li></ul></li></ul> <p> 13. Physical Examination </p> <ul><li>Temperature normal axillary temperature 36.5- 37.2C in normal room environment; stabilized by 8-10 hours of age. </li></ul> <ul><li>Pulse - normally 120 to160 beats per minute; listen for 1 FULL minute. </li></ul> <ul><li>Blood pressure 80-90/40-50 mm Hg; use 2.5 cm wide cuff. </li></ul> <ul><li>Respiration rate - normally 30 to 60 breaths per minute </li></ul> <ul><li>Vital Signs </li></ul> <p> 14. Physical Assessment </p> <ul><li>Skin: generally pink (varying with ethnic origin), no skin edema with vernix caseosa and lanugo, check for jaundice. </li></ul> <ul><li>Face: characteristics normal &amp; symmetrical, patency in orifices, imaginary line drawn through eyes reaching to top notch of ears.No tears.Responds to hearing voices &amp; other sounds.Epsteins pearls. Has rooting, sucking and extrusion reflexes. </li></ul> <ul><li>Head: of body length, molding.Check for abnormalities with the fonatels, sutures and hair.</li></ul> <p> 15. Physical Examination </p> <ul><li><ul><li><ul><li>Head and Neck: </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Appearance, shape, presence of molding (shaping of the head from passage through the birth canal) </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Fontanels (the open "soft spots" between the bones of the baby's skull) </li></ul></li></ul></li></ul> <ul><li><ul><li><ul><li>Clavicles (bones across the upper chest) </li></ul></li></ul></li></ul> <p> 16. Physical Examination </p> <ul><li>General Appearance </li></ul> <ul><li>Physical activity </li></ul> <ul><li>Muscle tone </li></ul> <ul><li>Posture</li></ul> <ul><li>Level of consciousness </li></ul> <ul><li>Skin </li></ul> <ul><li>Color</li></ul> <ul><li>Texture</li></ul> <ul><li>Nails</li></ul> <ul><li>Presence of rashes </li></ul> <p> 17. Physical Examination </p> <ul><li>Face - eyes, ears, nose, cheeks </li></ul> <ul><li>Mouth - palate, tongue, throat </li></ul> <ul><li>Lungs - breath sounds, breathing pattern </li></ul> <ul><li>Heart sounds and femoral (in the groin) pulses </li></ul> <ul><li>Abdomen - presence of masses or hernias </li></ul> <ul><li>Genitals and anus - for open passage of urine and stool </li></ul> <ul><li>Arms and legs - movement and development </li></ul> <p> 18. Physical Examination </p> <ul><li>Eyes </li></ul> <ul><li>Ears </li></ul> <p>&lt; Normal Ear Pinna Ear Deformity &gt; 19. Physical Examination </p> <ul><li>Nose</li></ul> <ul><li>Mouth </li></ul> <p> 20. Physical Examination 21. Physical Examination Normal Umbilical CordUmbilical Hernia 22. Physical Examination Gastroschisis 23. Physical Examination </p> <ul><li>Normal</li></ul> <ul><li>Abnormal Configuration </li></ul> <p>Female Genitalia 24. Physical Examination </p> <ul><li>Normal</li></ul> <ul><li>Undescended Testes </li></ul> <p>Male Genitalia 25. Physical Examination </p> <ul><li>Ambiguous Genitalia </li></ul> <ul><li>Closed Rectum </li></ul> <p> 26. Neuromuscular Maturity </p> <ul><li>Neuromuscular system evaluation:</li></ul> <ul><li>-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 </li></ul> <ul><li>-A score is assigned to each area. The more neurologically mature the baby, the higher the score. </li></ul> <p> 27. Neuromuscular Maturity </p> <ul><li>Neuromuscular system evaluation, includes: </li></ul> <ul><li><ul><li>Posture - how does the baby hold his/her arms and legs </li></ul></li></ul> <ul><li><ul><li>Square window - how far the baby's hands can be flexed toward the wrist </li></ul></li></ul> <ul><li><ul><li>Arm recoil - how far the baby's arms "spring back" to a flexed position </li></ul></li></ul> <ul><li><ul><li>Popliteal angle - how far the baby's knees extend </li></ul></li></ul> <ul><li><ul><li>Scarf sign - how far the elbows can be moved across the baby's chest </li></ul></li></ul> <ul><li><ul><li>Heel to ear - how close the baby's feet can be moved to the ears. </li></ul></li></ul> <p> 28. Posture </p> <ul><li>Score 0 if all extremities are fully flexed </li></ul> <ul><li>Score 1 if there is slight flexion of the legs only.</li></ul> <ul><li>Score 2 if there is moderate flexion of the legs.</li></ul> <ul><li>Score 3 if the legs are flexed and the arms are partially flexed.</li></ul> <ul><li>Score 4 if all limbs are fully flexed against the body </li></ul> <p> 29. Square Window </p> <ul><li>Score 1 if the wrist can be flexed to 60 degrees </li></ul> <ul><li>Score 2 if the wrist can be flexed half way to the forearm.</li></ul> <ul><li>Score 3 if the wrist can be flexed to 30.</li></ul> <ul><li>Score 4 if the palm of the hand can be pressed against the arm </li></ul> <p> 30. Arm Recoil </p> <ul><li>Score </li></ul> <ul><li>0- there is no arm recoil at all </li></ul> <ul><li>2 - there is some arm recoil.</li></ul> <ul><li>3 - the arm recoil is good and the arm is flexed half way back to </li></ul> <ul><li>the shoulder </li></ul> <ul><li>4- a brisk arm recoil and the infant pulls the arm back almost to </li></ul> <ul><li>the shoulder. </li></ul> <p> 31. Popitleal Angle </p> <ul><li>0 if the leg can be fully extended to form an angle of 180.</li></ul> <ul><li>1 if there is some limitation to full extension of the leg.</li></ul> <ul><li>2 if the knee can only be extended to 140.</li></ul> <ul><li>3 if the knee can be extended just beyond 90.</li></ul> <ul><li>4 if the knee can be extended to 90.</li></ul> <ul><li>5 if the knee cannot be extended to 90 </li></ul> <p> 32. Scarf Sign </p> <ul><li>0 if arm can be wrapped around neck like a scarf </li></ul> <ul><li>1 if elbow can be pulled across chest, not fully around neck </li></ul> <ul><li>2 if elbow reaches other side of chest, but not around neck </li></ul> <ul><li>3 if elbow only reaches midline of chest </li></ul> <ul><li>4 if elbow cannot be pulled as far as the midline </li></ul> <p> 33. Heel to ear </p> <ul><li>0 if he heel can easily be pulled to ear </li></ul> <ul><li>1 if h heel doesnt reach ear </li></ul> <ul><li>2 if heel can be pulled most of the way </li></ul> <ul><li>3 if heel can be pulled half way to ear </li></ul> <ul><li>4 if heel cannot be pulled half way to ear </li></ul> <p> 34. Assessment of Reflexes </p> <ul><li>Rooting &amp; Sucking: touch infants lip, cheek or corner of mouth with pacifier </li></ul> <ul><li><ul><li>-Infant turns head toward stimulus, opens mouth, takes hold and sucks </li></ul></li></ul> <ul><li><ul><li>Grasp: </li></ul></li></ul> <ul><li><ul><li>Palmar - (between 3-4 months) Place finger in palm of hand </li></ul></li></ul> <ul><li><ul><li>-Infants finger curl around examiners fingers </li></ul></li></ul> <ul><li><ul><li>Plantar- ( lessens by 8 months) Place finger at base of toes </li></ul></li></ul> <ul><li><ul><li>-infants toes curl downward </li></ul></li></ul> <p> 35. Assessment of Reflexes </p> <ul><li>Glabellar: tap forehead, bridge of nose, or maxilla </li></ul> <ul><li>-Newborn blinks for first 4 or 5 taps (continuos blinking means extrapyramidal disorder) </li></ul> <ul><li>Babinski Sign: stroke upward along lateral aspect of sole, then move finger across ball of foot </li></ul> <ul><li><ul><li>-All toes hyperextend, big toe will dorsiflex </li></ul></li></ul> <ul><li><ul><li>(record as a positive sign) </li></ul></li></ul> <ul><li><ul><li>-Absence requires neurological evaluation </li></ul></li></ul> <ul><li><ul><li>-This should disappear after 1 yr. of age </li></ul></li></ul> <p> 36. Assessment of Reflexes </p> <ul><li>Stepping or Walking: Hold infant vertically allowing one foot to touch table surface </li></ul> <ul><li>-Infant will simulate walking, term infant walk on soles of feet &amp; preterm walk on their toes </li></ul> <ul><li>Crawling: place newborn on abdomen </li></ul> <ul><li>-newborn makes crawling movements with arms and legs (disappears at 6 wk of age) </li></ul> <p> 37. Nutrition </p> <ul><li>An Infant may be put to breast feed shortly after birth or at least within 4 hours of birth. </li></ul> <ul><li>Most infants are on demand feeding schedules and are allowed to fed when they awaken </li></ul> <ul><li>Usually mothers are encouraged to feed their children every 3 to 4 hours during the day, and only when the when the infant awakens during the night for the first few days after work </li></ul> <ul><li>Formula fed infants usually eat every 3 to 4 hours </li></ul> <ul><li>Water supplements are not recommended </li></ul> <p> 38. Diagnostic Tests </p> <ul><li>Blood glucose levels</li></ul> <ul><li>Urinalysis</li></ul> <ul><li>Bilirubin levels</li></ul> <ul><li>CBC </li></ul> <ul><li>Methods:heel-stick blood sample is obtained to detect a variety of congenital conditions. </li></ul> <ul><li>Screening mandated by law, all states screen forphenylketonuria(PKU) and hypothyroidism, but each state determines which test is administered. </li></ul> <p> 39. References </p> <ul><li>Assessment of Growth of Infants Fed a New Formula - Full Text View - ClinicalTrials.gov."Home - ClinicalTrials.gov. Web. 07 May 2010. . </li></ul> <ul><li>Excellent Care from the Moment of Birth. Web. 07 May 2010. . </li></ul> <ul><li>HMHB - Home. Web. 07 May 2010. . </li></ul> <ul><li>Olds, Sally B.,Maternal-newborn Nursing &amp; Women's Healthcare. Upper Saddle River, N.J.: Pearson/Prentice Hall, 2004. Print </li></ul>