1. Clinical Application for Child Health Nursing NUR 327 Newborn Assessment Lecture 1-B +Lecture 2

2. 15/01/1437 2 Definitions Lab 3

3. Definitions Health a state of complete physical, mental and social wellbeing and not merely absence of disease. (WHO) 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment3

4. Definitions Mortality :Rate of occurrence death. Morbidity: a specific illness in the population 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment4

5. Mortality of infancy: -Low birth weight <2500mg (Lower birth weight = Higher mortality) -Short or long gestational. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment5

6. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment6 Essential Newborn Care Interventions Clean the baby’s nose & mouth Suctioning the baby’s nose & mouth The baby’s breathing Tying the umbilical cord Thermal protection Prevent and manage newborn hypo/hyperthermia Early and exclusive breastfeeding Started within 1 hour after childbirth

7. 15/01/1437 7 APGAR SCORE Lab 3

8. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment8 APGAR EXPANSION A for Appearance (Color) P for Pulse Rate (Heart rate) G for Grimace (Reflex irritability) A for Activity (Muscle tone) R for Respiration

9. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment9 The time for judging the five objective signs were sixty seconds after the complete birth of the baby APGAR Score

10. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment10 Apgar Scoring system Meaning of an Apgar score APGAR Score

11. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment11 The newborn with special needs Weight-related gestational conditions 1- Small for gestational age infant (SGA) 2-Large for gestational age infant (LGA) Age-related gestational condition 1-Premature infant 2-Postmature infant

12. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment12 1- Small for gestational age infant (SGA) Characteristics: Thin & wasted infant Little s/c fat The head looks really big

13. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment13 1- Small for gestational age infant (SGA) The following conditions occur more frequently in SGA Asphyxia Hypoglycemia Hypothermia Congenital anomalies

14. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment14 2-Large for gestational age infant (LGA) The following conditions occur more frequently in LGA Hypoglycemia Hypocalcemia Hyperbilirubinemia Respiratory distress syndrome Congenital anomalies

15. 15/01/1437 15 Vital Signs Lab 3

16. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment16 Vital Signs Temperature Heart rate Respiration Blood pressure Oxygen Saturation

17. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment17 Temperature - range 36.5 to 37 C axillary -range 35.6 to 37.5 C Rectally Common variations -Crying may elevate temperature -Stabilizes in 8 to 10 hours after delivery

18. 15/01/143718 Temperature Position for taking axillary temperature.

19. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment19

20. Ear (Tympanic) Temperature Can also be affected by: Impacted ear wax & ear infections Should NOT be used if child had ear surgery

21. Ear (Tympanic) Temperature What Patients Think About Ear Temperatures Parents like them! Fast, easy, clean, and safe Children react better! Faster measurement  No holding or restraining  No positioning

22. 15/01/143722 Temperature Oral temperature for children over 5 to 6 years. Rectal temperatures are contraindicated if the child has had anal surgery, diarrhea, or rectal irritation.

23. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment23 Heart rate - range 120 to 180 beats per minute Common variations -Heart rate range to 120 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 -All murmurs should be followed-up and referred for medical evaluation -Deviation from range -Faint sound

24. 15/01/143724 Pulse Apical pulse for infants and toddlers under 2 years Count for 1 full minute Will be increased with: crying, anxiety, fever, and pain

25. 15/01/143725 Pulse rates Neonate: 100 – 180 1-year: 100 – 160 3 years: 80- 110 14 years 60 - 100

26. Pulse - Brachial Used for infants and small children Place fingertips of first 2 or middle 3 fingers over the brachial pulse area Inside of the elbow Lightly press your fingertips on the pulse area

27. 15/01/143727 Heart Sounds

28. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment28 Respiration - range 30 to 60 breaths per minute Common variations Bilateral bronchial breath sounds Signs of potential distress or deviations from expected findings -Asymmetrical chest movements -Apnea >15 seconds -Diminished breath sounds -Nasal flaring -Tachypnea

29. 15/01/143729 Respiratory Count for one full minute May want to do before you wake the infant up Rate will be elevated with crying / fever Newborn: 30 – 60 Toddler: 25- 40 School-age: 18 - 30 Adolescent: 16- 20

30. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment30 Blood pressure –systolic: 60 to 80 mmHg -diastolic: 40 to 50 mmHg Factors to consider -Appropriate cuff size important for accurate reading -Average newborn: 75/42 mmHg in both upper and lower extremities

31. Oxygen Saturation Oxygen Saturation provide important information about cardio- pulmonary dysfunction and is considered by many to be a fifth vital sign.

32. For those suffering from either acute or chronic cardio-pulmonary disorders, Oxygen Saturation can help quantify the degree of impairment. Oxygen Saturation

33. 15/01/1437 33 Growth Measurements Lab 3

34. 15/01/143734 1. Weight 2. Height / length 3. Head circumferences 4. Chest circumferences Physical growth parameter:

35. 15/01/143735 Weight

36. 15/01/143736 Needs to be recorded on a growth chart Newborn may lose up to 10% of birth weight in 3-4 days. Too much or too little weight gain needs to be further investigated. Double birth weigh by 5-6 months Triple birth weight by 1 year Nutritional counseling The normal birth weight is 2500- 4000g. Weight

37. 15/01/143737 Weight Weight-for-age percentiles, boys 0 to 24 months, WHO growth standards

38. 15/01/143738

39. 15/01/143739 Infants head is against end point and legs fully extended. Height / length Measurement

40. 15/01/143740 Length-for-age percentiles, boys birth to 24 months, WHO growth standards Height / length Measurement Length range - 48 to 53 cm

41. 15/01/143741

42. 15/01/143742 Child is measured while standing in stocking or bare feet with the heels back and shoulders touching the wall. Height / length Measurement

43. 15/01/143743 Stature-for-age percentiles, boys, 2 to 20 years, CDC growth charts: United States Height / length Measurement

44. 15/01/143744

45. 15/01/143745 Head Circumference - 33 to 35 cm Head circumference is measured by wrapping the paper tape over the eyebrows and the around the occipital prominence.

46. 15/01/143746 Head circumference-for-age percentiles, boys 0 to 24 months, WHO growth standards Head Circumference

47. 15/01/143747

48. 15/01/143748 Head circumference is measured in children from birth to 3 years of age because this is the period of rapid brain growth. Head circumference also should be measured in older children with abnormal growth because it may be helpful in determining the etiology. Head Circumference

49. 15/01/143749 Head, chest, and abdominal circumference.

50. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment50. Chest circumference - 30.5 to 33 cm Head should be 2 to 3 cm larger than the chest Head and chest circumference may be equal for the first 24 to 48 hours of life

51. 15/01/1437 51 Physical Assessment Lab 3

52. General appearance General appearance and behavior of new born. Flexion position Head flexed, chin resting on the upper chest, arm flexed with hand clenched and the feet dorsiflexed. Tiers easily with feeding or activity. Fever Sleep pattern 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment52

53. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment53 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 Nipples present and in expected locations Cord with one vein and two arteries

54. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment54 Vernix caseosa The white, cheesy substance covering the newborn's body. Often present only in the skin folds.

55. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment55 Lanugo Fine downy body hair usually distributed over shoulders, sacral area, and back of newborns. Usually disappears before birth or shortly after birth

56. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment56 Common variations Acrocyanosis - result of sluggish peripheral circulation

57. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment57 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.

58. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment58 Mottling: Generalized red and white discoloration of skin of chilled infants with fair complexion

59. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment59 Jaundice Physiologic Jaundice: 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. It may caused by the inability of the infant’s immature liver to modify bilirubin

60. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment60 Milia: Tiny white papules (plugged sebaceous glands) located over nose, cheek, and chin.

61. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment61 Petechiae: Pinpoint, flat hemorrhages often visualized on head, face, and chest. Associated with rapid onset of pressure followed by immediate release of pressure during birthing process. Bruises/ Ecchymoses: Larger than petechia, hemorrhagic areas associated with rapid delivery or breech birth.

62. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment62 Signs of potential distress or deviations from normal findings Pathologic Jaundice: Jaundice occurs before the baby is 24 hours of age It may caused by metabolic disorders

63. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment63 Head Expected findings Anterior fontanel diamond shaped 2-3 - 3-4 cm Posterior fontanel triangular 0.5 - 1 cm Fontanels soft, firm and flat Sutures palpable with small separation between each

64. Head Expected findings Check fontanels: Anterior: 12 to 18 months Posterior: closes by 2-3 months head control usually establish by 6 month 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment64

65. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment65

66. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment66 Common variations Caput succedaneum: Swelling of the soft tissue of the scalp caused by pressure of the fetal head on a cervix that is not fully dilated. Swelling crosses suture line and decreases rapidly in a few days after birth.

67. MoldingMolding of head may result in a lower head circumference measurement 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. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment67 Common variations

68. CEPHALHEMATOMA Sub periosteal extravasation of blood due rupture of vessels. Swelling increases in size on second and third day after delivery. Often associated with delivery by forceps. Swelling does not cross suture line and may take several weeks after birth. Jaundice may occur as blood cells are broken down as the swelling resolves. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment68

70. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment70 Eyes Expected findings Slate gray or blue eye color No tears Fixation at times - with ability to follow objects to midline Distinct eyebrows Cornea bright and shiny Pupils equal and reactive to light

71. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment71 Common variations Edematous eyelids

72. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment72 Uncoordinated movements

73. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment73 Signs of potential distress or deviations from expected findings Discharges Conjunctivitis

74. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment74. Doll's Eyes Reflex: When the head is moved slowly to the right or left, the eyes do not follow nor adjust immediately to the position of the head.

75. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment75. Reflexes absent Subconjunctival hemorrhage

76. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment76 Ears Expected findings Pinna top on horizontal line with outer canthus of eye Loud noise elicits Startle Reflex Flexible pinna with cartilage present

77. . pulled down and back to straighten ear canal in children under 3 years Ear Exam

78. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment78 Common variations Skin tags on or around ears

79. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment79 Signs of potential distress or deviations from expected findings -Ear placement low -Clefts present -Malformations

80. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment80 Nose Expected findings -Nostrils patent bilaterally -Obligate nose breathers -No nasal discharge Common variations -Sneezes to clear nostrils -Bridge appears absent -Thin white nasal mucus discharge

81. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment81 Signs of potential distress or deviations from expected findings -Other discharge -Malformation -Nasal flaring beyond first few moments after birth

82. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment82 Mouth and Throat Expected findings Mucosa moist. Shortly after birth may visualize sucking calluses on central portions of lips.

83. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment83. Palate high arched

84. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment84. Uvula midline Minimal or absent salivation Tongue moves freely and does not protrude Sucking reflex Gag reflex

85. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment85 Common variations Epstein's pearls on ridges of gums

86. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment86 Signs of potential distress or deviations from expected findings -Cleft lip or cleft palate -Lip movement asymmetrical -Reflexes absent or incomplete -Protruding tongue -Diminished tongue movement -Candida Albicans

87. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment87 Neck Expected findings -Short and thick -Turns easily side to side -Clavicles intact -Some head control

88. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment88 Signs of potential distress or deviations from expected findings -Torticollis -stiff neck drawing head to one side -Resistance to flexion -Large fat pad on back of neck -Movement with palpation of clavicle

89. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment89 Chest Expected findings -Evident xiphoid process -Equal anteroposterior and lateral diameter -Bilateral synchronous chest movement -Symmetrical nipples

90. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment90 Common variations -Enlarged breasts -Accessory nipples

91. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment91 Signs of potential distress or deviations from expected findings -Asymmetrical chest movements -Sternum depressed -Marked retractions -Absent breast tissue -Flattened chest -Supernumerary nipples- -Nipples widely spaced -Bowel sounds auscultated

92. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment92 Abdomen Expected findings Dome-shaped abdomen Abdominal respirations Soft to palpation Well formed umbilical cord Three vessels in cord Cord dry at base Liver palpable 2 - 3 cm below right costal margin Bilaterally equal femoral pulses Bowel sounds auscultated within two hours of birth Voiding within 24 hours of birth Meconium within 24 - 48 hours of birth

93. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment93 Common variations Small umbilical hernia

94. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment94 Signs of potential distress or deviations from expected findings -Bowel sounds absent -Abdominal distention -Palpable masses -Base of cord with redness or drainage -Cord with two vessels

95. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment95 Female Genitalia Expected findings -Edematous labia and clitoris -Labia majora are larger and surrounding labia minora -Vernix between labia Common variations Pseudomenstruation Increased pigmentation Ecchymosis and edema after breech birth

96. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment96 Signs of potential distress or deviations from expected findings Labia fused Fecal discharge from vaginal opening Ambiguous genitalia Widely separated labia

97. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment97 Male Genitalia Expected findings -Urinary meatus at tip of glans penis -Palpable testes in scrotum -Large, edematous, pendulous scrotum. -Stream adequate on voiding Common variations -Prepuce covering urinary meatus -Erections -Increased pigmentation -Edema and ecchymosis after breech delivery

98. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment98 Signs of potential distress or deviations from expected findings Non palpable testes Scrotum smooth Ambiguous genitalia

99. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment99 Back and Rectum Expected findings Intact spine without masses or openings Patent anal opening

100. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment100 Signs of potential distress or deviations from expected findings Limitation of movement Fusion of vertebrae Imperforate anus Anal fissures

101. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment101 Extremities Expected findings -Maintains posture of flexion -Equal and bilateral movement and tone -Full range of motion all joints -Ten fingers and ten toes -Legs appear bowed -Feet appear flat

102. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment102 Palmar creases present

103. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment103 Sole creases present

104. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment104 Signs of potential distress or deviations from expected findings -Asymmetrical movement of extremities -Polydactyly

105. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment105. Unequal leg length Asymmetrical skin creases posterior thigh

106. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment106. -Dislocation of hip -Persistent cyanosis of nail beds -Marked metatarsus varus

107. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment107 Neuromuscular System Expected findings -Maintains position of flexion -When prone, turns head side to side -Holds head and back in horizontal plane when held prone -Ability to hold head momentarily erect

108. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment108 Signs of potential distress or deviations from expected findings -Quivering -Limp extremities or straightening of extremities -Clonic jerking -Paralysis

109. 15/01/1437 109 Nutritional needs of the Neonate Lab 3

110. Feeding the Infant Good nutrition is essential for the growth and development that occurs during an infant’s first year of life. When developing infants are fed, the appropriate types and amounts of foods, their health is promoted. Early nutrition affects later development, and early feedings establish eating habits that influence nutrition throughout life. 10/28/2015110

111. 111 SFCC: Figure 14.14 10/28/2015

112. Why Is Breast Milk So Good for Babies? 10/28/2015112

113. Why Is Breast Milk So Good for Babies? Breastfeeding is a natural extension of pregnancy – the mother’s body continues to nourish the infant. The American Dietetic Association (ADA) and American Association of Pediatrics recognize exclusive breastfeeding for 6 months, and breastfeeding with complementary foods for at least 12 months, as an optimal feeding pattern for infants.

114. Breast milk is more easily and completely digested than infant formula, so breastfed infants usually need to eat more frequently than formula-fed infants do. During the first few weeks, the newborn will need approximately 8 to 12 feedings a day, on demand. As the infant gets older, there are longer intervals between feedings. 10/28/2015114

115. During the first two or three days of lactation, the breasts produce colostrum, a premilk substance containing antibodies and white cells from the mother’s blood. 10/28/2015115 Immune Factors in Breast Milk

116. Breastfed infants may have: Less allergies Lower blood cholesterol Less ear and respiratory infections May protect against obesity in childhood and later years. May have a positive effect on later intelligence. 28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 م28/10/2015 06:57 مNewborn Assessment116

117. Infant formulas are designed to resemble breast milk. Special formulas are available for premature infants, allergic infants, and others. 10/28/2015117 Formula Feeding

118. 10/28/2015118 Complementary feeding practices Different reasons to start complementary food can be highlighted: Breast milk is not enough in quantity: this is the main reason for the huge majority of the mothers. Breast milk is not sufficient to cover the infant’s nutritional needs for growing. The mother has to go to work, so the child must be partially weaned.

119. 119 Lactation Nutrient Needs Energy Intake Exercise intense may raise lactic acid concentration of breast milk and baby may not like the taste Vitamin and Minerals maintained in breast milk at expense of maternal stores if poor po intake; B6, B12, A, D; 10/28/2015

120. 120 Water need plenty of fluids to prevent dehydration drink a glass of fluid at each meal Nutrient Supplements iron to replace stores often continue prenatal vitamins Particular Foods foods with strong or spicy flavors may alter flavor of breast milk. some infants may be sensitive to particular foods that mom eats 10/28/2015 Lactation Nutrient Needs

121. 121 During Lactation Don’t: Don’t drink alcohol Don’t take medications unless OK by Medical Provider Don’t take illegal drugs Don’t smoke Don’t get into environmental contaminants Don’t have caffeine 10/28/2015

122. Consumer Corner: Formula’s Advertising Advantage 10/28/2015122

123. The End