Physical Examination

• Normal Temperature: 36.5 to 37.2 celsius
• Temperature

  Most common used site: axillary
• Temperature

  Babies are prone to hypothermia because they cannot shiver
• Normal heart rate: 120 to 160 bpm

  • 1 full minute
  • Best site: apical or brachial
• Heart Rate

  N: (-) radial pulse

  N: (+) femoral pulse

  PDA: (+) radial pulse

  COA: (-) femoral pulse
• Normal Respiratory Rate: 30 to 60 cpm

  • 1 full minute
  • Observe abdomen (diaphragmatic breather)
  • obligatory nasal breathers
• Respiratory Rate

  Physiologic apnea: Shallow, irregular, periods of apnea <15 secs

  Pathologic apnea: periods of apnea >20 secs
• Head Circumference - normal: 33 to 35 cm
• Fontanelles


  Soft spots of the head
• Anterior fontanelle

  Aka: bregma

  Shape: diamond

  Closes at: 12 to 18 months

  Easy to palpate

  (+) large surface area
• Posterior fontanelle

  Aka: Lambda

  Shape: triangle

  Closes at: 2 to 3 months

  Hard to palpate

  (+) smaller surface area
• Fontanelle: Normal or abnormal

  Pulsates - normal
• Fontanelle: Normal or abnormal

  Firm - normal
• Fontanelle: Normal or abnormal

  Bulge - abnormal
• Fontanelle: Normal or abnormal

  Soft - normal
• Fontanelle: Normal or abnormal

  Sunken - abnormal
• Caput Succedaneum 


  Edema of the skull
• Cephal hematoma


  Collection of blood due to increase pressure to the rupture of periosteum
• Caput succedaneum vs. Cephal hematoma

  It crosses the suture line - caput succedaneum
• Caput succedaneum vs. Cephal hematoma

  Subsides by 3 to 5 days - caput succedaneum
• Caput succedaneum vs. Cephal hematoma

  Does no cross the suture line - cephal hematoma
• Caput succedaneum vs. Cephal hematoma

  Disappears by 6 weeks - cephal hematoma
• Skin

  Acrocyanosis

  • trunk - pink; extremities - blue: dt compromised peripheral circulation
• Skin

  Acrocyanosis

  • occurs within 24 to 48 hours
  • if >48 hours = TOF
• Skin

  Jaundice

  • yellowish discoloration of the skin and sclera
• Physiologic Jaundice aka icterus neonatorum
• Physiologic Jaundice occurs after 24 hours (2nd to 3rd day)
• Physiologic Jaundice occurs due to liver immaturity
• Pathologic Jaundice aka Icterus gravis
• Pathologic Jaundice occurs within 24 hours after birth
• Pathologic Jaundice occurs due to Rh incompatibility (baby rh +; mother -)
• Physiologic Jaundice

  Management:

  1. Early Breastfeeding - to excrete meconium dt colostrum's laxative effect
  2. Exposure to morning sunlight (15-30 minutes; 6-9 am; 10 am = contains UV rays; increases rf melanoma)
  3. Phototherapy - 18 inches

  Nursing Interventions:

  • cover the eyes (prevent blindness)
  • cover the genitals (prevent priapism = painful erection can lead to sterility)
  • increase OFI or IV rate
  • Frequent position (turn)
  • Avoid baby oils and lotion = burn
• Vernix Caseosa 


  Cheese-like substance in the skin
• Milia


  Tiny white papules at the nose, chin, cheeks, forehead due to distended sebaceous glands
• Miliaria aka sudamina
• Miliaria - prickly heat (bungang araw) due to distention of sweat glands


  NI: bathing with baking soda
• Lanugo 


  Fine downy hair
• Harlequin's Sign 


  Common in SL position; dependent side = pink; due to immaturity of circulation; NORMAL
• Epstein's pearls 


  Small, white cysts in the mouth
• Mongolian Spots


  Bluish black marks in the sacrum, buttocks, arms, shoulders