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FAMILY EXAM #2
Newborn Postpartum Assessments #1
| Question | Answer |
|---|---|
| An apgar score of zero includes | Absent HR, RR, Limp or flaccip muscle tone, no response of reflexes, cyanotic or pale skin |
| An apgar score of 1 includes | bradycardia, slow, irregular, shallow breaths, some flexion, limited resistance to extension, grimace or frowns when reflexes are irritated, appropriate body color, with blue extremities, termed acrocyanosis |
| An apgar score of 2 includes | Appropriate skin color, pink on body and extremities, sneezes, coughs, or cries during reflex irritability, tight flexion, good resistance to extension, return to flexion, respirations usually 30 to 60 breaths per minute, with a good cry, and a heart rate above 100 bpm. |
| The A in Apgar stands for | appearance, color |
| The P in Apgar stands for | Pulse, heart rate |
| The P in Apgar stands for | Grimace, reflex irritability |
| The second A in Apgar stands for | Activity, Muscle Tone |
| The R in Apgar stands for | Respiratory (Effort) |
| The Apgar is assessed | at one minute and five minutes following birth. An additional assessment is done at ten minutes if the 5 minute score is less than 7. Each category is scored from lowest at a zero, and highest at a two, with the highest posssible points being ten |
| An Apgar score of 7-10 | indicates the newborn is adapting well |
| An Apgar score of 4-6 | indicates moderate difficulty to adaptation |
| An Apgar score below 3 | indicates severe distress |
| Small for Gestational Age | Weight less than the 10th percentile (usually < 5.5 lbs) |
| Large for Gestational Age | Weight more than the 90th percentile (usually > 9lbs) |
| Appropriate for Gestatinal Age | Weight between the 10th and 90th Percentile |
| Term | Born between 38 and 42 weeks gestations |
| Post-Mature | Born after 42 weeks and demonstrating signs of placental aging |
| Pre-term or Premature | Born prior to 37 completed weeks, gestation, regardless of birth weight |
| Post-term or Post-Dates | Born after completion of week 42 of gestation |
| Newborn Head Assessment | Average is 32-38 cm (13-15 inches). It should be approximately one fourth the newborn's length or about half the infant's body plus 10 cm. |
| Newborn Length Assessment | Average is between 50 cm (20in) but can range from 44-55 cm (17-22in) |
| Newborn Weight Assessment | Average is 3,400 g (7.5 lbs.) but normal can range from 5 lbs. 8 oz to 8 lbs., 13 oz. They usually lose about 6% of their weight within the first days of life, but regain it in approximately 10 days |
| Newborn Chest Assessment | Average is 30-36 cm (12-14 inches) is generally equal or about 2-3 cm less than head circumference. Usually barrel shaped, with equal anteroposterior and lateral diameters, and is symmetric. Nipples may engorge and may secrete white discharge. Xiphoid process may be prominent at birth. |
| A large head may indicate | Hydrocephalus or increased intracranial pressure. |
| A small head may indicate | Microcephaly caused by rubella, toxoplasmosis or SGA |
| Newborn Heart and Lung Assessment | Lungs may still have fine crackles heard on inspiration due to amniotic fluid. Murmurs are common during the first few hours as the foramen ovale is closing |
| Newborn Neck Assessment | Creases are usually noted. Should move freely in all directions with the ability to hold the head in a midline position. Should have enough head control to be able to hold it up briefly without support. Also note clavicles which should be straight and intact. |
| Newborn Abdomen Assessment | Typically is protuberant but not distended. Contour is a result of the immaturity of the abdominal muscles. Movements are synchronous with respirations because newborns are at times, abdominal breathers. Auscultate all four quadrants and palpate abdomen for consistency, masses, and tenderness. |
| Newborn Male Genitalia Assessment | Inspect scrotum for size, symmetry, color, presence of rugae, and location of testes. Scrotum is usually large and well-formed rugae that should cover the scrotal sac. Testes should be palpated scrotal sac. They should feel firm and smooth, and should be equal in size on both sides. |
| Newborn Female Genitalia Assessment | Urethral meatus is located below the clitoris and is midline. May be engorged, and the labia majora and minora may both be edematous. Clitoris is large and hymen is thick. Vaginal discharge is composed of mucus mixed with blood may also be present the first few weeks of life. A labial bulge may indicate inguinal hernia, ambiguous genitalia, a rectovaginal fistula with feces present in the vagina, and an imperforate hymen. |
| Newborn Female and Male Genitalia Assessment | Inspect the anus for position and patency. Passage of meconium indicates patency. If it is not passed, a lubricated rectal thermometer can be inserted for digital examination. Abnormal findings would include anal fissures, or fistulas, and no meconium passed within 24 hours after birth |
| Cryptorchidism | the Undescended testes might be palpated in the inguinal canal in preterm infants. |
| Pseudomenstruation | Mucus mixed with blood during the first few weeks of life in female newborns. This discharge requires no treatment. |
| Sickle Cell Anemia Screening & Treatment | Bloodspot obtained at the same time of other newborn screening tests or prior to 3 months of age. Maintenance of hydration and hemodilution, rest, electrolyte replacement, pain management, blood replacement, and antibiotics |
| Galactosemia Screening & Treatment | First test done on discharge from the hospital with a follow-up test within 1 month. Eliminate milk from diet. Substitute soy milk. Breast feeding is not advised |
| Congenital Hypothyroidism Screen & Treatment | Testing (measures thyroxin [T4] and TSH) and is done between days 4-6 days of life. Lifelong thyroid replacement therapy |
| PKU Screening & Treatment | Universally screen in the US between 24-28 after protein feeding (PKU). includes lifetime diet of foods low in phenylalanine (low protein) and monitoring of blood levels. Special newborn formulas are available (Phenex and Lofenalac) |
| Newborn Assessment Danger Signs | Nasal flaring, chest restractions, grunting on exhalation, labored breathing, generalized cyanosis, extreme tachypnea or bradypnea, flaccid body, pallor, severe tachycardia or bradycardia |
| Neonatal Period | the first 28 days of life as the newborn adapts to life after birth |
| Mandation Newborn Screening | PKU, Congenital Hypothyroidism, Galactosemia, Sickle Cell Anemia |
| PKU | Autosomal recessive inherited deficiency in one of the enzymes necessary for the metabolism of phenylalanine to tyrosine, an essential amino acid found in most foods. If not treated leads to vomiting of protein feedings, and musty odor to the skin or body secretions of the newborn. If not treated mental and motor retardation, seizures, microcephaly, and poor growth and development |
| Congential Hypothyroidism | Deficiency of the thyroid hormone necessary for normal brain growth, calorie metabolism and development. May result from maternal hypothyroidism. Increased risk in newborns with birth weight < 2,000 g or > 4,500 g. Those of Hispanic and Asian Ethnic Groups. Feeding problems, growth and breathing problems. If not treated can cause irreversible brain damage and intellectual disability before age 1 |
| Galactosemia | Absence of the enzyme needed for the conversion of the milk sugar galactose to glucose. Poor weight gain, vomiting, jaundice, mood changes, loss of eyesight, seizures, and intellectually disability. If untreated galactose buildup causes permanent damage to the brain, eyes, and liver, and eventually leads to death |
| Sickle Cell Anemia | Recessively inherited abnormality in hemoglobin structure. Most commonly found in African American Newborns. Anemia developing shortly after birth. Increased risk for infection, growth restriction, vaso-occlusive crisis |
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