newborn assessment Essay

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Pages: 13
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Vital Signs and Measurements
Temperature - Range 36.5 to 37 axillary
Common variations:
Crying may elevate temperature
Stabilizes in 8 to 10 hours after delivery
Signs of potential distress or deviations from expected findings:
Temperature is not reliable indicator of infection
A temperature less than 36.5
Heart rate - Range 120 to 160 beats per minute
Common variations:
Heart rate range to 100 when sleeping to 180 when crying
Color pink with acrocyanosis
Heart rate may be irregular with crying
Signs of potential distress or deviations from expected findings:
Although murmurs may be due to transitional circulation-all murmurs should be followed-up and referred for medical evaluation
Deviation from range
Faint sound
Respiration - Range 30 to 60 breaths per minute
Common variations:
Bilateral bronchial breath sounds
Moist breath sounds may be present shortly after birth
Signs of potential distress or deviations from expected findings:
Asymmetrical chest movements
Apnea >15 seconds
Diminished breath sounds
Seesaw respirations
Grunting
Nasal flaring
Retractions
Deep sighing
Tachypnea - respirations > 60
Persistent irregular breathing
Excessive mucus
Persistant fine crackles
Stridor (Crowing respiratory sound)
Blood Pressure - not done routinely
Factors to consider:
Varies with change in activity level
Appropriate cuff size important for accurate reading
Average newborn (1 to 3 days) oscillometry pressure value: 65/41 in both upper and lower extremities
Sign of potential distress or deviations from expected findings:
Calf systolic pressure 6 to 9 mm Hg less than systolic pressure in upper extremities may be indicative of coarctation of the aorta
General Measurements
Head Circumference - 33 to 35 cm
Expected findings:
Head should be 2 to 3 cms larger than the chest
Chest circumference - 30.5 to 33 cm
Common variations:
Molding* of head may result in a lower head circumference measurement
Head and chest circumference may be equal for the first 24 to 48 hours of life
*Molding refers to the process by which the neonates head is shaped during labor as it passes through the birth canal. The head may become elongated due to the overlapping of the cranial bones at the suture lines.
Weight range - 2500 - 4000 gms (5 lbs. 8oz. - 8 lbs. 13 oz.)
Length range - 48 to 53 cms (19 - 21 inches)

Skin
Expected Findings:

Skin reddish in color, smooth and puffy at birth
At 24 - 36 hours of age, skin flaky, dry and pink in color
Edema around eyes, feet, and genitals
Turgor good with quick recoil
Cord with one vein and two arteries
Cord clamp tight and cord drying

Photo used with permission*
Hair silky and soft with individual strands
Nipples present and in expected locations
Nails to end of fingers and often extend slightly beyond
Vernix caseosa - The white, cheesy substance covering the newborn's body. Often present only in the skin folds.
Lanugo - Fine downy body hair usually distributed over shoulders, sacral area, and back of newborns. Usually disappears before birth or shortly after birth.
Common variations:

ACROCYANOSIS
The result of sluggish peripheral circulation.

Photo used with permission*
MONGOLIAN SPOTS
Patch of purple-black or blue-black color distributed over coccygeal and sacral regions of infants of African-American or Asian descent. Not malignant. Resolves in time.

Photo used with permission*
MOTTLING
Generalized red and white discoloration of skin of chilled infants with fair complexion.

Photo used with permission*
PHYSIOLOGICJAUNDICE
Hyperbilirubinemia not associated with hemolytic disease or other pathology in the newborn. Jaundice that appears in full term newborns 24 hours after birth and peaks at 72 hours. Bilirubin may reach 6 to 10 mg/dl and resolve in 5 to 7 days.

Photo used with permission*
MILIA
Tiny white papules (plugged sebaceous glands) located over nose, cheek, and chin.

Photo used with
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