RNC Assessment of newborn Questions And Answers

RNC Assessment of newborn Questions And Answers Abnormal assessment of skin - ANS 1. Cyanotic. 2. Pale. 3. Mottled. 4. Cool to touch. 5. Poor perfusion. Abnormal assessment of respiratory - ANS 1. Poor color. 2. Tachypnea. 3. Decreased air entry. 4. Increased work of breathing: grunting, flaring, and retracting. 5. Apnea. 6. Unequal breath sounds. 7. Oxygen requirement. Abnormal assessment of cardiovascular - ANS 1. Abnormal heart sounds such as murmur. 2. Weak, absent, or unequal pulses. 3. Hepatosplenomegaly. Abnormal assessment of CNS - ANS 1. Hypertonic or hypotonic. 2. Jitteriness, tremors. 3. Lethargy. 4. Bulging fontanelle (record baseline head circumference). 5. Seizures. 6. Irritability, high-pitched cry. Morphologic features - ANS 1. Congenital anomalies (e.g., abdominal wall defects, imperforate anus). 2. Severe birth trauma. 3. Absent or decreased limb movement. 4. Asymmetry. Abnormal GI assessment - ANS 1. Abdominal distention (measure baseline abdominal girth). 2. Increased gastric contents on aspiration. 3. Inability to pass an orogastric tube. 4. Excessive mucus. 5. Emesis soon after birth or after first feeding. Diagnostic tools - ANS A. Pulse oximetry (peripheral monitoring of oxygen saturation). 1. Oxygen saturation (Sao2) of blood is that percentage of the total hemoglobin concentration that is chemically combined with oxygen. 2. A baseline Pao2 value should be obtained to confirm the infant's oxygen level. 3. For hyperoxic study, administer 100% oxygen to differentiate between pulmonary and cardiac disease. (In infants with pulmonary disease, saturation will improve, whereas in infants with cyanotic heart disease, little or no change will occur. Use caution to avoid exposing the ductus arteriosus to high oxygen levels in ductal-dependent cardiac lesions.) B. Arterial blood gas determinations. If oxygen requirement persists, pulse oximetry saturations in room air are decreased and cyanosis is present. C. Chest x-ray examination. Anteroposterior and lateral views are needed if respiratory distress is present or cardiac disease is suspected. D. Transillumination. Use a high-intensity light placed over the side of the chest in question if pneumothorax or pneumomediastinum is suspected. E. Whole-blood glucose screening test or serum glucose determination if indicated by history or assessment results (see Routine Care Considerations in the Transition Nursery, item D: Glucose Needs/First Feeding, on p. 80). F. Hematocrit determination. 1. History of blood loss. 2. Plethoric or pale infant. 3. Twins (to rule out twin-to-twin transfusion). 4. Heel-stick (capillary) samples tend to have higher results of approximately 10%. 5. Hematocrit variations. Highest hematocrit is at 2 to 4 hours of age and then progressively falls as a result of the beginning of red blood cell breakdown and the cessation of erythropoiesis in response to a comparatively oxygen-enriched environment. G. Complete blood cell count with differential examinat Comprehensive Assessment - ANS Within 12 to 18 hours of life: evaluation of size, growth, and GA; transition to extrauterine life; and congenital anomalies. b. Discharge examination: focus on problem(s) during hospitalization, problems with feeding and weight gain, and ability of parent(s) to meet infant's needs. Assessment of color - ANS Color (Sniderman and Taeusch, 2005). a. Most reliable indicator of color: mucous membranes. Other areas include conjunctiva, nail beds, lips, buccal mucosa, earlobes, and soles of feet. b. Lighting and color of blankets can affect perception of color. c. Central cyanosis; always abnormal (1) Recognition influenced by hematocrit, temperature, and environmental factors. (2) Central cyanosis: superficial capillaries exceed 5 g/dl unsaturated hemoglobin (Roberton, 2000). (3) Variety of etiologies: cardiac, pulmonary, infection, metabolic, neurologic, and hematologic. d. Acrocyanosis. (1) Suggests instability of peripheral circulation. (2) Cyanosis limited to hands, feet, and circumoral area (lips). (3) May be a result of cold, stress, shock, and polycythemia. (4) Normal finding for 24 to 48 hours after birth. e. Pallor: pale, white appearance. (1) Reflects poor perfusion and circulatory failure or acidosis. (2) With bradycardia indicates anoxia or vasoconstriction found in shock, sepsis, or severe respiratory distress. (3) With tachycardia can indicate anemia. f. Plethora: ruddy or red appearance. (1) May indicate polycythemia. g. Jaundice: yellow pigmentation in skin or conjunctiva due to deposition of bilirubin. (1) Abnormal in the first 24 hours of life. Needs immediate investigation. (2) Cephalocaudal progression. h. Mottling: checkerboard red and white pattern. (1) May be normal in neonatal period, especially in preterm infants. Reflects vasomotor instability and unequal capillary blood to cutaneous tissue. (2) May be seen in cold stress, hypovolemia, and sepsis. (3) Cutis marmorata: exaggerated marbling greatest on extremities but also present on trunk (Fletcher, 1998). i. Harlequin sign: distinct midline demarcation. (1) Pale on one side and red on the opposite side. (2) Ow Assessment of Respiratory system - ANS Respiratory effort. a. Rate. (1) Normal 40 to 60 respi