special populations newborn exam

what exam precautions should be taken before examining a newborn

hand washing

thermal environment

light and noise

brief exam time

when does the newborn exam take place

immediately after birth

before discharge from maternity unit

whenever there is any concern about the infants progress

what is included in the initial care of a newborn 

apgar score

2 drops of silver nitrate in each eye

mom can hold her baby and breastfeed

nurse proceeds with exam 

vitamin K1 is administered 

the nurse puts on an antibiotic on the cut of the cord and umbilical area 

what needs to happen immediately after childbirth 

newborn breathes spontaneously 

airway cleared of mucus by bulb suction

cord clamped and cut

newborn dried and placed on warm blanket 

critical to maintain body temp 

who created the apgar score

Dr. Virginia Apgar in 1953

what does the APGAR score

provides an organized method quickly assessing the status of a newborn at 1 minute and 5 minutes of age

help staff to determine short term interventions if needed

does apgar score determine long term well being 

no 

what does the apgar score determine

activity and muscle tone

pulse (heart rate)

grimace (reflex irritability)

appearance (color)

respiration (rate and effort)

what is the numerical value scale that the apgar score is based on 

0-2 

what does the A in apgar stand for

activity and muscle tone

what does 0 activity and muscle tone mean in an apgar score

limp and flaccid

no movement

what does a 1 activity and muscle tone mean in an apgar score

some bending and flexing

what does a 2 activity and muscle tone mean in an apgar score 

active spontaneous movement 

what does the p mean in apgar score

pulse

what does a 0 pulse score mean in an apgar score

absent heartbeat

what does a 1 pulse score mean in an apgar score 

slow heartbeat (less than 100 bpm)

what do we expect a newborns heart rate to be

about 100

what does a 2 pulse score mean in an apgar score

adequate heartbeat (more than 100 bpm)

what does a 0 grimace score mean in an apgar score 

no response to stimulation 

what does a 1 grimace score mean in an apgar score

facial movement only with stimulation

what does a 2 grimace score mean in an apgar score 

vigorous cry

pulls away with stimulation 

what does a 0 appearance score mean in an apgar score

pale or blue

what does a 1 appearance score mean in an apgar score

normal body color but blue extremities 

what does a 2 appearance score mean in an apgar score

normal color

completely pink

what does a 0 respiratory score in an apgar score mean

no breathing

what does a 1 respiratory score mean in an apgar score 

weak cry 

irregular breathing 

what does a 2 respiratory score mean in an apgar score

strong cry

regular breathing with normal effort

what is a normal 1 minute apgar score

8-10

what 1 minute apgar score indicated some nervous system depression 

5-7 

what 1 minute apgar score shows severe depression requiring immediate resuscitation

0-4

what 5 minute apgar score shows high risk for subsequent central nervous system and other organ dysfunction

0-7

what is a normal 5 minute apgar score

8-10

what does the apgar score rate

respiration 

crying

reflexes

irritability

pulse

heart rate

skin color of body and extremities

muscle tone 

what are the general growth parameters

weight (naked)

length (stright)

head circumference

what is a normal weight range for a newborn

2500-4000g

what is a normal length for a newborn

45-56 cm 

18-22 in

what is a normal head circumference for a newborn

32-37 cm

what is a normal heart rate for a newborn

100-160

what is a normal respiratory rate for a newborn

30-60

what is a normal axilla temperature for a newborn

97.7 to 98.9 degrees farenheit

what is a normal blood rpessure for a newborn

50-80mmHg systolic

40-50 mmHg diastolic

during general imspection what are some obvious dimorphism or malformations we should look for 

cleft palate

down syndrome 

what do we check when doing general inspection of the skin on a newborn

vernix caseosa

lanugo

acrocyanosis

cyanosis

bruising

mongolian spots

jaundice

when is acrocyanosis normal

up to 12 hours after birth

what is lanugo 

fine body hair in preemies 

describe mongolian spots

dermal melanosis

MC on buttock or back

50-70% african american newborns

benign

describe meconium staining

fetal distress

meconium aspiration syndrome

describe erythema toxicum

papules of 2-3 mm in diameter

etiology unknown

first 2-4 days of life

benign and self limted

describe miliaria

superficial grouped vesicles without erythema

obstruction of sweat glands

describe miliaria rubra

erythematous papules

when does physiological jaundice appear 

2-3 days

normal reaction, gone within a week 

what is the major cause of physiological jaundice

increased bilirubin production due to increased hemoglobin levels at birth and a shortened red cell lifespan

describe pathological jaundice

Rh disease

infections

what is normal occipital frontal circumference

32-37 cm

how can a newborns head appear

molding

overlapping sutures

when does a newborns head return to normal shape

within 24 hours

which fintanelle is palpable 

anterior 

how big is the anterior fontanelle

1-4 cm

when does the anterior fontanelle close

2 years of age

how large is the posterior fontanelle 

1cm

when does the posterior fontanelle close

3 months of age

what does a depressed fontanelle mean

dehydration

what does a bulging fontanelle mean 

increased intracranial pressure 

describe cephalohematoma

subperiosteal hematoma

does not cross suture lines

prolonged or difficult delivery with instruments

weeks to resolve

what is caput succedaneum

boggy edema presenting part of the head

blood under skin

crosses suture lines

disappear in a few days

prolonged or difficult delivery

vacuum extraction

describe plagiocephaly 

diagonal asymmetry 

flattening of the head

what treatments can be done to help with plagiocephaly

reposition baby during sleep

helmet

craniosacral therapy

how can a newborn get bell’s palsy

birth trauma

describe how bell’s palsy will present 

eyelid not close on affected side

lower face uneven during crying

no movement on affected side of the face 

which cranial nerve is affected in bell’s palsy

CN VII

what do we need to check a newborns eyes for

papillary light reflex

red reflex

subconjunctival hemorrhage

what do we need to assess newborns nose for 

nasal obstruction (patency)

purulent nasal discharge (syphilis)

how should we assess the ears for abnormalities

ears at eye level

if the ears are lower than eye level what does this indicate

chromosomal abnormalities

downs syndrome

what are the s/s of a tongue tie 

digestive issues

colic

hear shaped tongue

pulls off breast/bottle crying, hitting, tugging, fussy while feeding 

trouble lifting tongue from side to side

dribbles milk down side of mouth 

unable to latch deeply

what should a newborns chest circumference be

30-35cm

what are respiratory distress signs for an infant

grunting

tachypnea

nasal flaring

asymmetric chest rise

retraction sign

what can cause tachypnea in a newborn 

born before 38 weeks 

c-section delivery

born to mother with diabetes 

describe pectus excavatum

chest curves inward d

describe pectus carinatum

chest curves outward

what are the most common congenital heart defects in a newborn 

ventricular septal defect 

atrial septal defect

pulmonary valve stenosis 

patent ductus arteriosus 

tetralogy of fallot 

what are s/s of heart issues in a newborn

heart murmur

abnormal heart sounds

fast breathing

poor feeding

very less weight gain

excessive sweating

cyanosis

fatigue

what is included in the tetrology of fallot

ventricular heart defect

pulmonary valve stenosis

right ventricular hypertrophy

misplaced aorta

what are we inspecting with abdomen inspection 

distention 

scaphoid abdomen

diaphragmatic hernia 

what are we palpating during abdomen exam

kidney, liver, spleen all palpable

what kind of hernias can a newborn have

umbilical

inguinal

what is galezzi sign 

unilateral dislocated hip

what is DDH

developmental dysplasia of the hip

posterior displacement in developmentally dysplastic hip

how can we assess for DDH

symmetry of anterior thigh crease

symmetry of gluteal folds

what does the barlow maneuver assess 

instability or dislocation of the hip 

how do you conduct barlow maneuver

infant supine

hips flexed to 90

index and middle finger along greater trochanter

apply downward pressure

lisen for clunk

what is the ortolani maneuver assessing

reducible dislocation with a positive test

how do you perform ortolani maneuver 

flex hip to 90 

index and middle finger along greater trochanter 

apply downward pressure 

adduct hip and lift leg anteriorly  

listen for clunk

what does ortolani maneuver do

reduce already dislocated hi[p

what is syndactyly

fusion of digits

what is polydactyl 

extra digits 

what is a single transverse palmar crease common with

trisomy 21

what should we suspect with a newborn if there is decreased movement of one limb

fracture

brachial plexus injury

erbs palsy

duchennes

what causes club foot 

unusual position of the feet 

is club foot painful

no