2019_Newborn Assessment Outline.docx - NEWBORN PHYSICAL...

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NEWBORN PHYSICAL ASSESSMENT OUTLINE Assessment begins before delivery - baby’s history is MOTHER’S history PRENATAL HISTORY ANTICIPATE: what may have compromised the fetus in utero? - maternal medical and prenatal history - blood type, lab values, GBS (group B strep)/HIV/HepB status - Diabetes and preeclampsia - Smoking/substance abuse/alcohol consumption - illicit and prescribed medication - Diabetes/cardiovascular issues - if the mother is diabetic, would be concerned about the baby's blood sugar dropping - psychological issues INTRAPARTUM HISTORY ANTICIPATE: What occurred in Labor? o Duration and course o Maternal well being analgesia and anesthesia complications of labor or birth o Fetal well being prolonged rupture of membranes meconium-stained amniotic fluid sometimes the baby will breathe the meconium into the pharynx and then into the bronchi and then will have sticky alveoli that will not open nuchal cord cord wrapped around neck → baby is becoming hypoxic → constriction of the cord precipitous birth (rapid birth) worry of babies getting a concussion use of forceps or vacuum extraction bruising fetal distress abnormal HR indicates that baby is already at risk prior to delivery FIRST ASSESSMENT First Assessment/Transition to Extrauterine Life o A-B-C’s immediately at birth airway, breathing, circulation o Thermoregulation cold = acidotic o Apgar Scoring 1
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NEWBORN PHYSICAL ASSESSMENT OUTLINE o Incorporate data with brief physical assessment APGAR SCORES Assessed at 1 and 5 minutes Indication of Extrauterine Transition Total Score: 0-10 o 8-10: Good prognosis; o 4-7: active involvement/resuscitation efforts o 0-3: poor prognosis What’s Important? o You should be able to calculate Apgar score o Given a specific score/information, determine infant’s well being o Implications for continued assessment/ re-evaluation Apgar Scoring Color ( A ppearance): 0=Blue/pale, 1= body pink, extremities blue, 2=pink Heart Rate ( P ulse) 0=Absent, 1=60-100, 2=>100 Reflex Irritability ( G rimace) 0=No response, 1= Grimace, 2=vigorous cry Muscle Tone ( A ctivity) 0=Flaccid, limp 1= some upper (or lower) extremity flexion, 2=Active motion or all extremities flexed Respiratory Effort ( R espirations) 0=Apnea, 1= Slow, irregular, weak cry 2= lusty cry CASE STUDY Michael was born by vaginal delivery. Assessment at birth reflects: Heart rate 120, respiratory effort good with strong cry, cries again when his nose is suctioned, color: pink with blue hands and feet, actively kicking his feet. He’s 6lbs and 21 inches long. o What is the apgar score for Michael? 9 Newborn girl screaming and kicking at 5 minutes of age with a heart rate of 140. You note that her hands and feet are blue. o Apgar is… 9 34 week male with a heart rate of 120, good respiratory effort, makes a face when his back is rubbed, slight flexion of upper extremities, blue hands and feet.
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