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Neonatal Nursing Care: Part2 Neonatal Assessment

Neonatal Nursing Care: Part2 Neonatal Assessment . Developed by D. Ann Currie, RN, MSN. Neonatal Assessment. Gestational Age Assessment: Physical Characteristics . Resting posture Preterm - extended Term - flexed Skin Preterm - thin and transparent with veins prominent

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Neonatal Nursing Care: Part2 Neonatal Assessment

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  1. Neonatal Nursing Care: Part2Neonatal Assessment Developed by D. Ann Currie, RN, MSN

  2. Neonatal Assessment

  3. Gestational Age Assessment: Physical Characteristics • Resting posture • Preterm - extended • Term - flexed • Skin • Preterm - thin and transparent with veins prominent • Term - opaque and disappearance of the vernix caseosa

  4. Newborn Assessments

  5. Newborn Measurements

  6. Cephalhematoma and Caput Succedaneum

  7. Newborn Vital Signs

  8. Common Reflexes of the Newborn

  9. Potential Birth Injuries

  10. Gestational Age Assessment: Physical Characteristics • Lanugo • Decreases as gestational age increases • Sole (plantar) creases • As gestation progresses, proceeds to the heel • Breast bud • Term: the tissue will measure between 0.5 and 1 cm

  11. Gestational Age Assessment: Physical Characteristics • Ear form and cartilage distribution • Preterm - relatively shapeless and flat, no recoil • Term - some cartilage and slight incurving of the upper pinna, good recoil • Male genitals • Preterm - small scrotum, few rugae, testes are palpable in the inguinal canal • Term - testes are generally in the lower scrotum, which is pendulous and covered with rugae

  12. Gestational Age Assessment: Physical Characteristics • Female genitals • Preterm - clitoris is prominent, labia majora are small and widely separated • Term - labia majora cover the labia minora and clitoris

  13. Assessment of Neuromuscular Characteristics • Square window • Recoil • Popliteal angle • Scarf sign • Heel to ear • Ankle dorsiflexion • Head lag • Ventral suspension

  14. Measurement and Appearance • Average weight of 3405 g at term • Average length is 50 cm (20 in) • Head circumference is 32-37 cm • Chest circumference is 30-35 cm • Skin – pink tinged

  15. Head • Proportionally larger than body • Fontanelles • Anterior • Posterior • Hair • Face

  16. Eyes • Tearless crying • Peripheral vision • Can fixate on near objects • Can perceive faces, shapes and colors • Blink in response to bright light • Pupillary reflex is present

  17. Ears and Neck • Ears • Soft and pliable • Ready recoil • Pinna parallel with inner and outer canthus • Neck • Short with skin folds

  18. Nose and Mouth • Nose • Small and narrow • Must breathe through nose • Mouth • Lips pink • Taste buds present

  19. Chest • Chest – cylindrical • Breasts – engorged, whitish secretion • Respirations • Diaphragmatic • 30-60 per minute • Heart rate 110-160 bpm

  20. Abdomen • Cylindrical and soft • Bowel sounds present by 1 hour after birth • Umbilical cord • Initially white and gelatinous • Two arteries, one vein

  21. Genitalia and Extremities • Genitalia • Female – labia majora covers labia minora • Male – testes descended, pendulous scrotum • Extremities • Short, flexible, and move symmetrically • Legs are equal in length with symmetrical creases

  22. Measurements • Weight • Length • Head circumference • Chest circumference • Abdominal girth • Temperature

  23. Skin Variations • Acrocyanosis • Mottling • Harlequin sign • Jaundice • Erythema toxicum • Milia

  24. Erythema toxicum.

  25. Facial milia.

  26. Skin Variations • Vernix Caseosa • Forceps marks • Telangiectatic nevi • Mongolian spots • Nevus flammeus • Nevus vasculosus

  27. Mongolian spots

  28. Head Variations • Molding • Cephalohematoma • Caput succedaneum

  29. Mouth Variations • Cleft lip and palate • Precocious teeth • Epstein’s Pearls • Thrush

  30. Ear and Eye Variations • Low set ears • Edema of the eyelids • Normal variations • Subconjunctival hemorrhage • Transient strabismus • Doll’s Eye

  31. Respiratory Variations • Signs of respiratory distress • Nasal flaring • Intercostal or xiphoid retractions • Expiratory grunting or sighing • Seesaw respirations • Tachypnea

  32. Cardiac Variations • Heart is large • Low pitched murmur • Decreased strength or absence of femoral pulses

  33. Female Genitalia Variations • Vaginal tag • Pseudomenstruation • Smegma

  34. Male Genitalia Variations • Hypospadias • Phimosis • Hydrocele • Cryptorchidism

  35. Variations in Extremities • Gross deformities • Extra digits or webbing • Clubfoot • Hip dislocation

  36. The asymmetry of gluteal and thigh fat folds seen in infant with left developmental of the hip. B, Barlow (dislocation) maneuver. Baby’s thigh is grasped and adducted (placed together) with gentle downward pressure. C, Dislocation is palpable as femoral head slips out of acetabulum. D, Ortolani’s maneuver puts downward pressure on the hip and then inward rotation. If the hip is dislocated, this maneuver will force the femoral head back into the acetabular rim with a noticeable “clunk

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