newborn assessment : fine tuning your assessment skills kim mccullen, nnp-bc munson medical center

Newborn Assessment:Fine Tuning Your Assessment Skills

Kim McCullen, NNP-BCMunson Medical Center

Organizing the Newborn Exam

• The significance of OBSERVATION• Tools used to complete the Physical Exam (PE)– Auscultation– Palpation– Percussion – http://newborns.stanford.edu/PhotoGallery/

VSD4.html

Perinatal History

• Brief review of the Perinatal History for “clues” to potential pathology

• The newborn’s history begins with conception and includes events that occur throughout gestation, labor, and delivery.

• Categorization of High-Risk Pregnancy Factors -Socioeconomic Factors, Demographic Factors, Medical Factors, Current Maternal Obstetric Status, Habits

Basic Newborn Assessment of the Term Neonate

Skin

• PE of the skin, what does and can it mean?– Cutis Marmorata– Harlequin Color Change– Ecchymosis– Macule– Petechiae– Vesicle– Pustule

Cutis Marmorata

Harlequin Color Change

Ecchymosis (Bruising)Increases Risk for Jaundice

Macule

Petechiae

Vesicle

Pustule

Head to Toe Assessment!

Head

• Measurement: Microcephaly? Macrocephaly?• Shape: molding?

Skull: fontanels and sutures

Face

Ears

Eyes

Nose

Mouth

Chest

Heart

• Murmur?• 4 limb Blood Pressure• Pulses

Fetal Circulation

Normal Heart

PDA

Coarctation of the Aorta

Abdomen

• Size• Shape• Movement

Abdomen

Genitourinary

Hypospadius

Hymenal Tag

Musculoskeletal

Late Preterm Newborn

• Hypothermia• Hypoglycemia• Respiratory distress• Apnea• Hyperbilirubinemia• Feeding difficulties

Medications At Birth

Vitamin K

• http://www.cdc.gov/ncbddd/blooddisorders/documents/vitamin-k.pdf

Hepatitis B Vaccine

• http://www.cdc.gov/hepatitis/B/

Public Health Services

• Newborn Screen• CCHD Screen• Hearing Screen

Questions?

Newborn Assessment: Fine Tuning Your Assessment Skills

•Interactional reference for physical examination:

•http://newborns.stanford.edu/PhotoGallery/

•Vitamin K reference:

•http://www.cdc.gov/ncbddd/blooddisorders/doc uments/vitamin-k.pdf

•Hepatitis B Vaccine reference:

•http://www.cdc.gov/hepatitis/B/