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Physical Assessment

The Biophysical Profile uses Ultrasound to determine fetal well being. These five parameters are assessed: Amniotic Fluid Tone Respiratory Movement Body Movement Non Stress Test. Physical Assessment.

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Physical Assessment

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  1. The Biophysical Profile uses Ultrasound to determine fetal well being. These five parameters are assessed: Amniotic FluidTone Respiratory Movement Body Movement Non Stress Test

  2. Physical Assessment • Caput Succedaneum- crosses the suture lines, can occur with a vertex delivery, hemorrhagic edema. • Cephalohematoma- will not cross the suture lines, due to traumatic delivery and is contained to one area.

  3. PHYSICAL ASSESSMENT • A FULL TERM INFANT THAT IS SGA IS AT RISK FOR POLYCYTHEMIA DUE TO CHRONIC HYPOXIA IN UTERO: MORE RBC’S ARE PRODUCED TO COMPENSATE FOR LACK OF OXYGEN.

  4. PHYSICAL ASSESSMENT • ERYTHEMA TOXICUM- YELLOW OR WHITE MACULAR PAPULAR RASH. THIS IS A NORMAL NEWBORN RASH WHICH WILL RESOLVE SPONTANEOUSLY. • THIS RASH WOULD NEVER BE FOUND ON THE PALMS OF HANDS OR SOLES OF FEET (THIS TYPE OF RASH CAN BE INDICATIVE OF SYPHYLLIS)

  5. Alpha-fetoprotein (AFP) • THE CONCENTRATION IS LOW IN DOWN SYNDROME BUT ELEVATED IN NEURAL TUBE DEFECTS.

  6. LATE DECELERATIONS- A FALL IN HEART RATE AT THE BEGINNING OF THE UTERINE CONTRACTION, AND RETURNING TO BASELINE AFTER THE CONTRACTION HAS ENDED. • * ASSOCIATED WITH INCREASED INCIDENCE OF FETAL COMPROMISE.

  7. THERMOREGULATION • NEONATES CONSERVE HEAT THROUGH –NON-SHIVERING THERMOGENESIS, WHICH CONSISTS OF THE METABOLISM OF BROWN ADIPOSE TISSUE. • BROWN ADIPOSE TISSUE BEGINS FORMING AT 26-28 WEEKS GESTATION.

  8. THERMOREGULATION • INSENSIBLE WATER LOSS IS WHAT IS LOST THROUGH THE SKIN AND RESPIRATORY SYSTEM, AND WE ARE UNABLE TO MEASURE. • THE MORE PRETERM THE NEONATE IS THE MORE WATER THEY LOSE IN THIS MANNER.

  9. FLUID AND ELECTROLYTES • INFANTS WITH RDS AND BPD TEND TO HAVE THIRD SPACING OF FLUID WITH EDEMA DUE TO INJURY TO THE CELLS WHICH CAUSE FLUID TO LEAK. • THE INJURY IS DUE TO EXPOSURE TO OXYGEN AND POSITIVE PRESSURE VENTILATION.

  10. DEVELOPMENTAL • SELF REGULATION IS WHEN A NEONATE ATTEMPTS TO MAINTAIN A BALANCED STABLE STATE: EXAMPLES OF SELF REGULATORY STRATEGIES INCLUDE- • 1. FOOT BRACING AGAINST A BOUNDARY • 2. GRASPING HANDS TOGETHER OR HAND TO MOUTH OR HAND TO FACE • 3. SUCKING • 4. GRASPING BLANKET OR TUBING

  11. DEVELOPMENTAL • THERE ARE TWO DIFFERENT STATES THE NEONATE CAN BE IN: SLEEP AND AWAKESTATE: THE AWAKE STATE CONSISTS OF THE INFANT BEING - ACTIVE ALERT, QUIET ALERT AND CRYING. • THE BEST TIME TO INTERACT WITH THE NEONATE IS WHEN THEY ARE IN THE QUIET ALERT STATE.

  12. NUTRITION • NEONATES DEVELOP THE ABILITY TO COORDINATE SUCKING, SWALLOWING AND BREATHING AT 31-34 WEEKS.

  13. CARDIAC CONGENITAL HEART DEFECTS THAT HAVE AN INCREASE IN PULMONARY BLOOD FLOW ARE: PDA VSD ASD AV CANAL

  14. CARDIAC • OBSTRUCTIVE DEFECTS THAT CAUSE PULMONARY VENOUS CONGESTION ARE: • COARCTATION OF THE AORTA • AORTIC STENOSIS

  15. CARDIAC • MATERNAL FACTORS THAT PREDISPOSE NEONATES TO CONGENITAL HEART DEFECTS ARE: • LUPUS • MATERNAL DIABETES • RUBELLA

  16. LINE PLACEMENT • UMBILICAL ARTERY CATHETERIZATION – IF PLACEMENT IS LOW CATHETR SHOULD BE BETWEEN THE 3RD AND 4TH LUMBAR SPACE. • IF PLACEMENT IS HIGH CATHETER SHOULD BE BETWEEN THE 6TH -10TH THORACIC SPACE.

  17. X-RAYS • DUODENAL ATRESIA IS ASSOCIATED WITH DOWN SYNDROME. • CLASSIC APPEARANCE ON ABDOMINAL X-RAY WILL REVEAL A “DOUBLE BUBBLE”.

  18. PHARMACOLOGY • TOLERANCE TO A MEDICATION IS WHEN THE INFANT REQUIRES AN INCREASE IN DOSE TO ACHIEVE THE DESIRED EFFECT. • DEPENDANCE TO A MEDICATION IS WHEN THE INFANT NEEDS REGULAR ADMINISTRATION OF THE MEDICATION FOR PHYSIOLOGICAL WELL BEING.

  19. GI SYSTEM • OMPHALOCELE- HERNIATION THROUGH THE UMBILICUS, COVERED BY A SAC. ASSOCIATED WITH OTHER ANOMALIES SUCH AS SGA, SKELETAL OR CHROMOSOMAL. • GASTROSCHISIS- HERNIATION OCURS TO THE RIGHT OF THE UMBILICUS AND IS NOT USUALLY ASSOCIATED WITH OTHER ANOMALIES.

  20. BILIRUBIN • INDIRECT BILIRUBIN ALSO KNOWN AS UNCONJUGATED IS FAT SOLUBLE AND MUST BE BROUGHT TO THE LIVER TO BE CHANGED TO WATER SOLUBLE. • DIRECT BILIRUBIN ALSO KNOWN AS CONJUGATED IS WATER SOLUBLE AND IS READY TO BE EXCRETED IN THE BILE AND INTO THE STOOL.

  21. GI SYSTEM • AT BIRTH THE ABDOMEN IS FLUID FILLED, WITHIN 30 MINUTES IT BEGINS TO FILL WITH AIR. • WITHIN 8 HOURS THE LARGE INTESTINE SHOLD BE FILLED WITH AIR, IF NOT THIS COULD INDICATE AND OBSTRUCTION.

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