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Newborn Care and Assessment

Newborn Care and Assessment

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Newborn Care and Assessment

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  1. Newborn Care and Assessment Kim Martin RN, MSN Nursing Instructor HACC, Pennsylvania’s Community College Nursing 101; Summer 2012

  2. Newborn Assessment • Begins immediately after birth • Continues throughout hospital stay • APGAR score at one minute and 5 minutes • Gestational age assessment within 2 hours • Complete assessment within 24 hours • Wear gloves until 1st bath

  3. Newborn Assessment • Health History • Physical Assessment • Hand washing and warm hands • Sleeping newborn

  4. Normal Axillary = 36.5 - 37.5° C (97.7 - 99.5° F) Rectal = 36.5 - 37.6° C (97.7 - 99.7° F) Axillaryis preferred Rectal done first in some institutions Abnormal Decreased Elevated Temperature

  5. Normal Heart rate = 120 - 160 BPM PMI 3rd- 4th intercostal space Brachial, femoral, and pedal pulses present and equal bilaterally Abnormal Tachycardia Bradycardia PMI to right Murmurs and arrhythmias Absent or unequal pulses Heart Rate and Pulses

  6. Normal Rate = 30 - 60 per minute Irregular, shallow, unlabored Chest movement symmetric Breath sounds present and clear in all lobes Abnormal Tachypnea after 1st hour Slow respirations Nasal flaring, grunting, retractions Apnea with color changes Asymmetric or decreased chest expansion Abnormal lung sounds Bowel sounds in chest Respirations

  7. Normal 2,500 to 4,000 grams (5 lbs 8 oz to 8 lbs 130z) Weight loss < 10% in first 2 weeks Abnormal LGA SGA LBW VLBW ELBW Weight loss > 10% Weight

  8. Weighing

  9. Normal 45 - 55 cm 17.75 - 21. 5 inches Measure from crown to heel Abnormal Below normal Above normal Length

  10. Normal 31 to 33.8 cm 12.2 to 15 inches Measured over prominent part of occiput and just above eyebrows Abnormal Small Large Head Circumference

  11. Characteristics of the Newborn

  12. Normal Skin Variations Vernix Vernix Acrocyanosis Lanugo

  13. Mottling Harlequin Sign

  14. Abnormal skin variations

  15. Excessive Vernix Cyanosis Jaundice

  16. Forceps Marks Petechiae

  17. Nevus flammeus Cafe’ au lait spots Nevus vascularis

  18. Head and face

  19. Molding

  20. Caput and Molding

  21. Cephalhematoma

  22. Ear Placement

  23. Think “Ears and Kidneys”

  24. ChoanalAtresia

  25. Mouth – Normal Precocious teeth Epstein’s pearls

  26. Cleft Lip and Palate

  27. Chest and abdomen

  28. Abnormal Asymmetrical Supernumerary nipples

  29. Umbilical Hernia

  30. Omphalocele

  31. Gastroschisis

  32. Bladder Exstrophy

  33. Ambiguous Genitalia

  34. Extremities

  35. Polydactyly

  36. Syndactyly

  37. Brachial Plexus Injury • Diminished movement of arm with extension and pronation of forearm • (Erb-Duchenne paralysis)

  38. Abnormal Lower Extremities • Ortolani and Barlow signs positive • unequal leg length • Malposition of feet = position in uterus, talipes equinovarus

  39. Newborn reflexes

  40. Moro/Startle Reflex