Physical Assessment Of Newborn

Front 1

How do you do Physical assessment for newborn

Back 1

- provide care
- maintain a quite environment(appropriate for gestational age)
-observe/inspect (look for clues)
-palpate
-auscultate

Front 2

What are the things to assess in gestational age

Back 2

-last menstrual cycle
-prenatal ultrasound
-postnatal assessment (physical/neuro)

Front 3

what are the two scale used in assessing gestational age

Back 3

- dubowitz scale
-ballard score (simplified)

Front 4

How many physical and neurological signs does Dubowitz scale has

Back 4

- 11 physical signs
-10 neurological signs

Front 5

How many physical and neurological signs does Ballard score have

Back 5

- 6 physical signs
- 6 neurological signs

Front 6

What are the six physical signs of Ballard score

Back 6

- skin

- lanugo

- plantar surface

- breast

- eye/ear

- Genitalia

Front 7

What are the six Neurological signs of Ballard score

Back 7

- posture
- square window (wrist)
- arm recoil
- popliteal angle
- scarf sign
- heel to ear

Front 8

What is Lanugo

Back 8

Fine downy hair covering fetus from 20-28 weeks

Front 9

Where and when does lanugo disappear?

Back 9

Disappears around face and anterior trunk around ~28 weeks

Front 10

plantar surface

What happened during 28-30 weeks on plantar surface?

Back 10

Creases appears and cover the anterior portion of the plantar surface of the foot

Front 11

Breast

What should breast look like in a newborn?

Back 11

- imperceptible

- size of areola and bud

- areola raised by 34 weeks

Front 12

When does areola of the breast raised in newborn?

Back 12

By 34 weeks

Front 13

Eyes/Ear

Back 13

- Eyes fused = extreme prematurity

- floppy ears= cartilage not develop

Front 14

If eyes are fused together what does that indicates?

Back 14

Extreme prematurity

Front 15

If the ears are floppy what does that indicates or mean?

Back 15

Cartilage not developed

Front 16

Gestational Age

Back 16

- Once gestational age is determined, plot on weight vs gestational age chart ( percentile)

- Used to determine intra- uterine growth retardation. (IUGR)

Front 17

What does percentile used for?

Back 17

Used to determine intra- uterine growth retardation.

Front 18

What is the percentile of small gestational age ( SGA) ?

Back 18

Less than 10th percentile

Front 19

What percentile is appropriate for gestational age (AGA)

Back 19

10 - 90th percentile

Front 20

What percentile is large for gestational age (LGA)

Back 20

Greater than 90th percentile

Front 21

What are signs of respiratory distress in newborn?

Back 21

- Nasal flaring

- Grunting

- Retractions

- Cyanosis ( late sign of distress)

- Tachypnea

- Paradoxical breathing(see- saw , severe distress)

Front 22

What does nasal flaring does to newborn?

Back 22

It decrease resistance

Front 23

What does grunting create for a newborn during distress?

Back 23

- Creating CPAP/PEEP

- Valsalva manuever

Front 24

What does retractions cause to newborn during distress?

Back 24

- Increases WOB

- Poor compliance

Front 25

What is considered periodic breathing in nweborn

Back 25

Pauses for 5-10 secs

Front 26

True or False: Periodic breathing is considered common in newborn?

Back 26

True

Front 27

How is periodic breathing resolved?

Back 27

Resolves w/o intervention i.e on its own

Front 28

What is Apnea of prematurity?

Back 28

Cessation of breathing greater than 20 secs

Its shorter if accompanied by:

- Bradycardia

- Cyanosis/pallor

- Desats

Front 29

What percentage of infants does Apnea of prematurity affects?

Back 29

Affects 85% infants less than 34 weeks

Front 30

When does Apnea of prematurity resolves?

Back 30

Usually 37 weeks +

Front 31

What are treatments/ management of Apnea of prematurity

Back 31

- Tactile stimulation
- Respiratory stimulants ( caffeine/ theophylline)
- Oxygen
- Cpap
- Mechanical ventilation
- Apnea monitor

Front 32

Auscultation of breath sounds in newborn

Back 32

- Listen in quiet environment

- Difficult to hear

- symmetric sounds

- Crackles ( fluids/recruitment)

Front 33

What is the normal infant HR ?

Back 33

120 - 160

- less than 100 = Bradycardia

Front 34

What is bradycardia in an infant

Back 34

Less than 100

Front 35

When do you start CPR in infant?

Back 35

when is less than 60

Front 36

When would you see and infant HR increases to 200+

Back 36

Common when infant is agitation / crying

Front 37

Where is the most accurate place to take infant pulse?

Back 37

Auscultate apical pulse

Front 38

Where can can you take infant pulse?

Back 38

- Brachial

- Femoral

- Umbilical

Front 39

How does the infant heart sounds?

Back 39

Mumur

Front 40

What are some of the Neuro checks?

Back 40

- pupils

- Crying

- Reflex appropriate

- Muscle tone

Front 41

What area do you inspect during full assessment?

Back 41

- Genitals

- Rectum

- Mouth/Nose

- 10 fingers/toes

Front 42

What is the normal infant Blood Pressure?

Back 42

= 60-90 / 30-60 mmHg
- Varies based on gestational age/weight

Front 43

What are the ways we can invasively monitors BP?

Back 43

- UAC- umbilical artery catheter

- Peripheral arterial line

Front 44

What is the hemoglobin of a newborn?

Back 44

16-19

Front 45

What is the hemoglobin level of newborn @ 2 wks?

Back 45

13-15

Front 46

What is the hematocrit of a newborn?

Back 46

55 - 60 %

Front 47

What is the hematocrit of newborn @ 2 weeks

Back 47

40 - 45 %

Front 48

Why does the newborn H & H changes @ 2 weeks?

Back 48

Because the affinity for the oxygen changes

Front 49

How do you obtain ABG for newborn?

Back 49

- Heel sticks ( CGB- capillary gas)

the best indicator of oxygenation

- UAC/ Peripheral line

- Arterial stick

Front 50

What are the normal ABG values at birth?

Back 50

pH = 7.25 - 7.35

PCO2 = 45 - 55

PO2= 50 - 60

Front 51

How long does newborn ABG normalizes to adult values?

Back 51

48 hours