NEWBORN PHYSICAL ASSESSMENT

• What is the purpose of the immediate assessment of a newborn?

  To evaluate the infant’s transition to extrauterine life
• When should a complete physical examination of the newborn be performed?

  Within 24 hours after birth, once the newborn’s temperature stabilizes
• What conditions should the area used for newborn examination meet?

  The area should be well-lighted, warm, and free from drafts
• How should the infant be positioned during the physical assessment?

  The infant should be undressed as needed and placed on a firm, warm, flat surface
• What should be reviewed before starting the physical assessment of the newborn?

  The maternal history and prenatal/intrapartal records
• What are the nursing care responsibilities for a newborn during the first day of life?

  1. Initiation and maintenance of respirations
  2. Establishment of extrauterine circulation
  3. Control of body temperature
  4. Adequate nourishment
  5. Waste elimination
  6. Prevention of infection
  7. Infant-parent relationship
  8. Development care
• How much heat loss occurs from evaporation in newborns?

  200 kcal/kg/min
• Why does the newborn's temperature fall almost immediately after birth?

  Due to heat loss through different external mechanisms and the infant’s immature temperature regulating mechanism
• When is the newborn's temperature typically stabilized?

  By 8-10 hours of age
• How can heat loss by radiation be prevented?

  By placing the infant under radiant heat
• What is radiation in the context of newborn heat loss?


  Transfer of body heat to a cooler solid object not in contact with the baby
• What is conduction in terms of heat loss for newborns?


  Transfer of body heat to a cooler solid object in contact with the baby
• How can evaporation heat loss be reduced in newborns?


  By drying the infant’s body, especially the face and hair
• How can conduction heat loss be minimized during a newborn assessment?


  By covering surfaces with a warmed blanket or towel
• What is evaporation in the context of newborn heat loss?


  Loss of heat through conversion of a liquid to a vapor
• What is the normal apical pulse rate range for newborns?

  100-160 beats per minute (bpm)
• Where should the apical pulse be obtained in newborns?

  In the fourth intercostal space
• How does the heart rate of a newborn change when sleeping versus crying?

  Heart rate is usually 80-100 bpm when sleeping and can rise to 180 bpm when crying
• What is the range of heart rate for a newborn after birth when the condition has stabilized?

  120 to 140 bpm
• What should be assessed regarding brachial and femoral pulses in newborns?


  They should be assessed for equality and strength
• How does the respiratory rate of a newborn vary after birth?

  The respiratory rate varies with the state of alertness and activity
• What is the nature of newborn respirations?

  Respirations are abdominal in nature
• What is the nature of breath sounds in a newborn?

  Breath sounds are bronchial in nature
• What happens to the respiratory rate as respiratory activity is established in a newborn?

  The rate will settle to an average of 30 to 60 breaths/min
• What is normal for the respiratory rate of a newborn in the first few minutes of life?

  It may be as high as 90 beats/min
• When should blood pressure be assessed in a newborn?

  As a baseline unless cardiac problems are suspected
• What is the normal blood pressure range for a newborn at birth?

  80-60/45-40 mmHg
• What is the blood pressure of a newborn at day 10?

  100/50 mmHg
• What is essential for accurate blood pressure measurement in newborns?

  An appropriately sized cuff with a width-to-arm or calf ratio of 0.45 to 0.70
• How can the neonate's maturity level be gauged?

  By assessing the general appearance
• What features should be assessed to gauge the general appearance of a neonate?

  1. Posture
  2. Activity
  3. Overt signs of anomalies
  4. State of alertness
• What is the normal resting position of a newborn?

  The normal resting position is general flexion with arms and legs in moderate flexion
• How do normal spontaneous movements appear in a newborn?

  They are bilaterally asynchronous with legs moving in a bicycle fashion
• What are the states of alertness in a newborn?

  1. Deep sleep
  2. Active (light) sleep
  3. Drowsy state
  4. Awake alert state
  5. Alert fussy state
  6. Crying
• What changes occur in the skin of a newborn by the second to third day?

  The skin becomes pink, flaky, dry, with possible acrocyanosis and edema
• What does the skin of a newborn look like at birth?

  The skin may be sticky, smooth, bright red, and puffy
• What should be checked for on the newborn's skin?

  Presence of birthmarks or bruises
• How can dehydration be assessed in a newborn?

  By checking if the fold of skin persists after a pinch test
• What is the normal weight loss after birth for a newborn?

  Up to 10 percent of the baby’s birth weight
• What is vernix caseosa?

  A white, creamy biofilm covering the skin of the fetus during the last trimester