Newborn Physical Exam Checklist

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  Keep your fingertips on the greater trochanter laterally and your thumb on the medial proximal thigh. Gently push the hip posteriorly in the line of the shaft of the femur. A positive test causes the femoral head to slip out of the acetabulum which...

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  Dark spots in the red reflex can be due to cataracts , corneal abnormalities , or opacities in the vitreous. The parents should be asked if there is a family history of visual disorders, particularly retinoblastoma or congenital cataract. Parents...

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• Newborn Baby Assessment (NIPE) – OSCE Guide

  Ask parents if their child can see and hear. Most parents will have noticed that their baby will 'still' to sudden noise and will follow a face with their eyes. Socially, most babies will be spontaneously smiling by six weeks. Also, they will have a range of sounds - coos, glugs, cries - which indicate mood. Ask the parents whether they have any other concerns. Health promotion Immunisations. Breastfeeding and other advice on feeding and weaning. If ankyloglossia tongue tie is causing problems with feeding, it has usually been dealt with by the six-week stage. If not, refer for division of tongue tie, which has been approved by NICE[ 9 ].

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• Interactive Tools

  Reducing the risk of sudden infant death syndrome. The following reduce the risk[ 10 ]: Not smoking. Putting the baby to sleep on their back. Avoiding falling asleep in the same bed as the baby, or on the sofa together. Avoiding overheating. Avoiding bulky or loose items of bedding, such as pillows and duvets. Car safety and other injury prevention strategies. Dental health; sugar-free medicines, avoiding sugary drinks or sugar on dummies[ 11 ]. Give written advice where appropriate.

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• A Comprehensive Newborn Examination: Part I. General, Head And Neck, Cardiopulmonary

  Also consider maternal health and whether there is evidence of postnatal depression [ 12 ]. Consider the involvement of the father and use the opportunity to involve him in the care of the child[ 2 ].

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• Physical Examination Of The Newborn

  Dislocated or dislocatable. Limited abduction. Note The Moro reflex was described by Ernst Moro in He was professor of paediatrics in Heidelberg, Germany. The infant is examined lying supine back on the bed with the hips flexed to a right angle and knees flexed. Barlows test demonstrates both a dislocated and a dislocatable unstable hip: One hand immobilises the pelvis thumb over pubic ramus, fingers over sacrum while the other hand moves the opposite thigh into mid-abduction. If the hip is dislocatable, backward pressure on the inner side of the thigh with the thumb causes the femoral head to slip backwards out of the acetabulum.

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• Newborn Care: Well Child Visit Schedule

  Conversely forward pressure on the outer side of the thigh with the fingers would tend to cause the head to spring forwards, back into the acetabulum. The same procedure is then carried out for the opposite side. Both thighs are then abducted. Usually the gross placental weight is measured and recorded placenta, membranes and umbilical cord. As gestation progresses the weight of the placenta increases. An infant of g usually has a placenta weighing about g between g and g. Therefore, at term the gross placental weight is about a fifth that of the fetus.

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• Assessment Of Congenital Anomalies In Infants Born To Pregnant Women Enrolled In Clinical Trials

  Infants who are underweight for gestational age have both an absolutely and relatively small placenta. In contrast, infants of poorly controlled diabetics, and infants who have suffered a chronic intrauterine infection e. There are three layers to the placental membranes. The amnion on the inside prevents the fetus sticking to the membranes , the chorion in the middle to provide strength , and the decidua on the outside. The amnion is usually smooth and shiny. If the healthy amnion is peeled away from the rest of the membranes, it is completely clear and transparent. A cloudy or opaque amnion suggests infection chorioamnionitis while a granular surface amnion nodosum suggests too little amniotic fluid oligohydramnios. The membranes should not smell offensive. The umbilical cord normally has one large vein and two thick walled arteries.

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• Complete Head-to-Toe Physical Assessment Cheat Sheet

  The more the pull e. A short cord suggests very poor fetal movement. The cord becomes stained green once the amniotic fluid has been contaminated with meconium for a few hours. A single umbilical artery is associated with congenital malformations. A true knot may kill the fetus. The shape of the placenta is not important. Most are oval. Usually the umbilical cord is inserted into the centre of the placenta with arteries and veins radiating out in all directions over the chorionic plate. A peripheral insertion is of no clinical importance. However, insertion into the membranes in a low-lying placenta can result is severe haemorrhage from a fetal vessel when the membranes rupture vasa praevia. Arteries always cross over veins. Fetal vessels torn off at the placental edge indicate that an extra piece of placenta has been retained accessory lobe. Pale patches on the fetal surface are due to fibrin deposits and are not clinically important. The maternal surface of the placenta is dark maroon in preterm infants but becomes grey towards term.

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• The Newborn Examination

  A pale placenta suggests anaemia. Calcification is not important and reflects a good maternal calcium intake. The maternal surface is divided into lobes cotyledons. Make sure that the placenta is complete as a retained lobe can result in postpartum haemorrhage or infection. Firmly attached blood clot, especially if it lies over an area of compressed placenta, suggest placental abruption. Fresh infarcts are best identified on palpation as they form a hard lump. Old infarcts are yellow or grey and easily seen, especially if the placenta is sliced. It is particularly important to examine the placentas of twins. Unlike-sexed boy and girl twins are always non-identical dizygous.

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• Assessments For Newborn Babies

  Liked-sex twins are definitely identical monozygous if they share a single placenta monochorionic twins. Monochorionic placentas always have fetal blood vessels on the chorionic place which run from one umbilical cord to the other. Monochorionic placentas have one chorion and usually two amniotic sacs. Two placentas fused together dichorionic placentas may be mistaken for a single placenta. However, there are never fetal blood vessels linking the two umbilical cords. Dichorionic placentas can be seen in both identical and non-identical twins. The separating membranes of dichorionic twins always include both amnion and chorion.

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• Template For Notes And Presentations

  Pathological examination with histology should be requested if an abnormality of the placenta is identified. Placental ischaemia, chronic intrauterine infection and chorioamnionitis are easily identified on histology. The road-to-health booklet Use of the road-to-health booklet preschool health booklet is advocated by the World Health Organisation as one of the main methods of improving child health, especially in a developing country. The booklet is widely used throughout southern Africa. After delivery each newborn infant is issued with a road-to-health booklet which forms the primary health-care record until the infant starts school by the age of 6 years. The details which are usually entered in the booklet are: Maternal information:.

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• Six-week Baby Check

  Template for Notes and Presentations Clinical Rotations for Students Although the official medical record is now entirely electronic, students may choose to write admission and follow-up notes on lined progress note paper. Whether notes are done electronically or on paper, it is important that the information is recorded and verbally presented in a logical, coherent manner and that a succinct assessment and plan is provided. Our suggested format for both admit and progress notes is presented on this page. Pregnancy was complicated by PIH, treated with Mag. ROM was 7 hours prior to delivery with clear fluid. Delivery was complicated by tight nuchal cord, cut before delivery. Apgars 3 and 9. Baby received PPV for 30 seconds to improve color and tone. Baby has been doing well since birth, breastfed x3, stool x 1 and void x 1, VSS.

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• A Comprehensive Newborn Examination: Part II. Skin, Trunk, Extremities, Neurologic

  Mom states that feeding are going well, but she complains of sore nipples. FH: sibling under bili lights for 2 days in newborn nursery, negative for congenital diseases, childhood deaths, or atopic diseases. SH: intact family, 3 yo sib; has all baby needs including car seat. Plans to receive care at LPCH clinic. PE: wt - g, length - Mom with soreness during feeds. Expect spontaneous resolution of rash within 1 -2 weeks Expect spontaneous resolution of cephalohematoma, but follow clinically for jaundice, TBili to be drawn at 24 hours of life with newborn screen. Discussed with mom expectations for feedings, RN to help with latch technique and position, recommended BF class.

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• Complete Head-to-Toe Physical Assessment Cheat Sheet - Nurseslabs

  Hair: The hair of the client is thick, silky hair is evenly distributed and has a variable amount of body hair. There are also no signs of infection and infestation observed. Nails: The client has a light brown nails and has the shape of convex curve. It is smooth and is intact with the epidermis. When nails pressed between the fingers Blanch Test , the nails return to usual color in less than 4 seconds.

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• Newborn Examination

  Head Head: The head of the client is rounded; normocephalic and symmetrical. Skull: There are no nodules or masses and depressions when palpated. Face: The face of the client appeared smooth and has uniform consistency and with no presence of nodules or masses. Eyes and Vision Eyebrows: Hair is evenly distributed. Eyelashes: Eyelashes appeared to be equally distributed and curled slightly outward. Eyelids: There were no presence of discharges, no discoloration and lids close symmetrically with involuntary blinks approximately times per minute. Eyes The Bulbar conjunctiva appeared transparent with few capillaries evident. The sclera appeared white. The palpebral conjunctiva appeared shiny, smooth and pink. There is no edema or tearing of the lacrimal gland. Cornea is transparent, smooth and shiny and the details of the iris are visible.

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  The client blinks when the cornea was touched. The pupils of the eyes are black and equal in size. The iris is flat and round. PERRLA pupils equally round respond to light accommodation , illuminated and non-illuminated pupils constricts. Pupils constrict when looking at near object and dilate at far object. Pupils converge when object is moved towards the nose. When assessing the peripheral visual field, the client can see objects in the periphery when looking straight ahead. When testing for the Extraocular Muscle, both eyes of the client coordinately moved in unison with parallel alignment. The client was able to read the newsprint held at a distance of 14 inches. Ears and Hearing Ears: The Auricles are symmetrical and has the same color with his facial skin.

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• Physical Examination Of The Newborn - Children's Health Issues - MSD Manual Consumer Version

  The auricles are aligned with the outer canthus of eye. When palpating for the texture, the auricles are mobile, firm and not tender. The pinna recoils when folded. During the assessment of Watch tick test, the client was able to hear ticking in both ears. Nose and Sinus Nose: The nose appeared symmetric, straight and uniform in color. There was no presence of discharge or flaring. When lightly palpated, there were no tenderness and lesions Mouth: The lips of the client are uniformly pink; moist, symmetric and have a smooth texture. The client was able to purse his lips when asked to whistle. Teeth and Gums: There are no discoloration of the enamels, no retraction of gums, pinkish in color of gums The buccal mucosa of the client appeared as uniformly pink; moist, soft, glistening and with elastic texture.

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• Well-Child Care: Promoting Health And Development

  The tongue of the client is centrally positioned. It is pink in color, moist and slightly rough. There is a presence of thin whitish coating. The smooth palates are light pink and smooth while the hard palate has a more irregular texture. The uvula of the client is positioned in the midline of the soft palate. Neck: The neck muscles are equal in size. The client showed coordinated, smooth head movement with no discomfort. The lymph nodes of the client are not palpable. The trachea is placed in the midline of the neck. The thyroid gland is not visible on inspection and the glands ascend during swallowing but are not visible.

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• Central Mississippi Down Syndrome Society

  The client manifested quiet, rhythmic and effortless respirations. The spine is vertically aligned. The right and left shoulders and hips are of the same height. Heart: There were no visible pulsations on the aortic and pulmonic areas. There is no presence of heaves or lifts. Abdomen: The abdomen of the client has an unblemished skin and is uniform in color. The abdomen has a symmetric contour.

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• Newborn Exam | Learn Pediatrics

  The jugular veins are not visible. Extremities The extremities are symmetrical in size and length. Muscles: The muscles are not palpable with the absence of tremors. They are normally firm and showed smooth, coordinated movements. Bones: There were no presence of bone deformities, tenderness and swelling. Joints: There were no swelling, tenderness and joints move smoothly. Nursing Assessment in Tabular Form Assessment.

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• Pediatrics: History And Physical Examination

  This infant has a normal pink color, normal flexed posture and strength, good activity and resposiveness to the exam, relatively large size over 9 pounds , physical findings consistent with term gestational age skin, ears, etc , and a nice strong cry. Bruising is visible on this infant's head. Scalp edema caput succedaneum is a very common finding. Cephalohematoma sub-periosteal bleed is occasionally noted. Gentle but firm palpation will help distinguish these two entities from each other and from molding. Suture frequently overlap each other "over-riding" and fontanelle size varies. Within 24 hours, edema and molding will already show improvement. Infants have very short necks, but they should have full range of motion from side to side, and the neck should appear symmetric. To palpate clavicles, use a firm, steady pressure along the enitre length of the bone, from shoulder to sternum, to detect crepitus, edema, or step-offs that indicate clavicular fracture.

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• Physical Assessment Of The Newborn | Duquesne University

  The infant above has swelling over the left clavicle as a result of a fracture. Eyes should be symmetric and in a normal position. Eyelid edema is common after birth and resolves a a few days. Slight yellow discharge in a normal eye may be benign, but injection in the conjunctiva seen above in the baby's right eye is abnormal. Red light reflexes can be seen by looking at the pupils through an ophthalmoscope; they may appear orange-yellow in darker skinned infants. Ears should not appear low or posteriorly rotated. Although nasal congestion can be present in newborns, there should not be nostril flaring or respiratory distress. Palate should be intact visibly and by palpation submucosal clefts occur. Tongue should be freely mobile. In the photo above, the lingual frenulum under the tongue is restricting tongue elevation when the baby cries.

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• AAP Schedule Of Well-Child Care Visits

  Chest should have a normal contour with nipples near the mid-clavicular line. Small breast buds are present in term infants. Breathing should appear easy. The infant in the photo above has unusually prominent ribs as a result of intercostal retractions, a sign of respiratory distress. Lung sounds should be clear and equal. Normal respiratory rate is 40 - 60 bpm. Normal heart rate is - bpm. Quality and location of murmurs should be noted. Femoral pulses are best obtained when the infant is quiet.

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• Newborn Baby Examination

  They should feel strong and equal. Bowel sounds should be present and the abdomen soft. A liver edge in nornally palpable 1 - 2 cm below the right costal margin. A spleen should not be detected on physical exam. Kidneys may be palpated by an experienced examiner, but are likely enlarged if easily felt. The cord should be clean and dry. If fresh, the umbilical vessels may be assesssed also. There should be two arteries and one vein. For girls, both labia majora and minora should be seen. Normal hymenal tissue is light pink with a central orifice between the labia minora. White or mucoid disharge as in the photo is normal. For boys, the penile shaft should appear straight with an intact foreskin. Testicles should be palpable bilaterally as small 1 cm symmetric masses.

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• Your Child's Checkup: 1 Month

  The anus should have a visible orifice within the sphincter. Stool in the diaper is notevidence of patency. Back should appear symmetric and spine should be palpable all along its length. Unusual skin lesions, tags, or masses should be noted as these may indicate underlying spinal dysraphism. Fingers and toes should be counted and evaluated for evidence of malformation. Arms and legs should appear symmetric bilaterally and have normal position and good tone. Ortolani and Barlow maneuvers are used to evaluate hips for subluxation or dislocation. This newborn has bilateral clubfeet.

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• Neonatal Examination

  Genetic testing If prenatal testing gave a diagnosis of Down syndrome and if the exam after birth agrees, then no further testing is probably needed in the newborn period. If the physical examination after birth raises the possibility of Down syndrome, testing by rapid FISH confirmation and a complete chromosome analysis are needed. A complete chromosome analysis is needed to provide full information, but to ensure prompt results, both should be obtained unless the complete analysis can be done as quickly as the rapid analysis. Counseling The prenatal or newborn diagnosis of Down syndrome can cause many concerns for parents. Feeding Infants with Down syndrome sometimes have low muscle control, which can cause feeding problems. For this reason, infants should be closely watched for slow feeding or choking and for good weight gain. Breastfeeding is strongly encouraged, but extra attention may need to be given to positioning and to keeping the baby awake or alert.

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• Newborn Baby Examination · Paediatric · OSCE Skills · Medistudents

  Heart An echocardiogram an ultrasound picture of the heart is needed to check for any evidence of heart disease. This should be done even if a prenatal echocardiogram was done. If issues exist, it is very important to act early. Breathing that is too fast or cyanosis a bluish color of the skin are signs for possible concern. Hearing and Vision Infants with Down syndrome are at risk for sensory issues, such as eye problems leading to vision loss or ear problems leading to hearing loss. It is important to have both vision and hearing checked by specialists ophthalmology and ENT.

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• Six-week Baby Check. About The Six-week Baby Check | Patient

  Thyroid Thyroid hormone levels can be too low in newborns and need to be checked a TSH test. Thyroid hormone imbalance can cause a variety of problems that might not be easy to detect without a blood test. Blood test After birth, white and red blood counts can be unusually high in infants with Down syndrome. These blood counts need to be checked. Spitting up, stomach swelling, or an abnormal stool pattern can be signs that there is an issue.

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