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Neonatal Nursing Care: Part2 Neonatal Assessment

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Presentation on theme: "Neonatal Nursing Care: Part2 Neonatal Assessment"— Presentation transcript:

1 Neonatal Nursing Care: Part2 Neonatal Assessment
Developed by D. Ann Currie, RN, MSN

2 Neonatal Assessment

3 Gestational Age Assessment: Physical Characteristics
Resting posture Preterm - extended Term - flexed Skin Preterm - thin and transparent with veins prominent Term - opaque and disappearance of the vernix caseosa

4 Newborn Assessments

5 Newborn Measurements

6 Cephalhematoma and Caput Succedaneum

7 Newborn Vital Signs

8 Common Reflexes of the Newborn

9 Potential Birth Injuries

10 Gestational Age Assessment: Physical Characteristics
Lanugo Decreases as gestational age increases Sole (plantar) creases As gestation progresses, proceeds to the heel Breast bud Term: the tissue will measure between 0.5 and 1 cm

11 Gestational Age Assessment: Physical Characteristics
Ear form and cartilage distribution Preterm - relatively shapeless and flat, no recoil Term - some cartilage and slight incurving of the upper pinna, good recoil Male genitals Preterm - small scrotum, few rugae, testes are palpable in the inguinal canal Term - testes are generally in the lower scrotum, which is pendulous and covered with rugae

12 Gestational Age Assessment: Physical Characteristics
Female genitals Preterm - clitoris is prominent, labia majora are small and widely separated Term - labia majora cover the labia minora and clitoris

13 Assessment of Neuromuscular Characteristics
Square window Recoil Popliteal angle Scarf sign Heel to ear Ankle dorsiflexion Head lag Ventral suspension

14 Measurement and Appearance
Average weight of 3405 g at term Average length is 50 cm (20 in) Head circumference is cm Chest circumference is cm Skin – pink tinged




18 Head Proportionally larger than body Fontanelles Hair Face Anterior
Posterior Hair Face

19 Eyes Tearless crying Peripheral vision Can fixate on near objects
Can perceive faces, shapes and colors Blink in response to bright light Pupillary reflex is present

20 Ears and Neck Ears Neck Soft and pliable Ready recoil
Pinna parallel with inner and outer canthus Neck Short with skin folds


22 Nose and Mouth Nose Mouth Small and narrow Must breathe through nose
Lips pink Taste buds present

23 Chest Chest – cylindrical Breasts – engorged, whitish secretion
Respirations Diaphragmatic 30-60 per minute Heart rate bpm

24 Abdomen Cylindrical and soft
Bowel sounds present by 1 hour after birth Umbilical cord Initially white and gelatinous Two arteries, one vein

25 Genitalia and Extremities
Female – labia majora covers labia minora Male – testes descended, pendulous scrotum Extremities Short, flexible, and move symmetrically Legs are equal in length with symmetrical creases

26 Measurements Weight Length Head circumference Chest circumference
Abdominal girth Temperature

27 Skin Variations Acrocyanosis Mottling Harlequin sign Jaundice
Erythema toxicum Milia

28 Erythema toxicum.

29 Facial milia.

30 Skin Variations Vernix Caseosa Forceps marks Telangiectatic nevi
Mongolian spots Nevus flammeus Nevus vasculosus

31 Mongolian spots


33 Head Variations Molding Cephalohematoma Caput succedaneum





38 Mouth Variations Cleft lip and palate Precocious teeth
Epstein’s Pearls Thrush

39 Ear and Eye Variations Low set ears Edema of the eyelids
Normal variations Subconjunctival hemorrhage Transient strabismus Doll’s Eye

40 Respiratory Variations
Signs of respiratory distress Nasal flaring Intercostal or xiphoid retractions Expiratory grunting or sighing Seesaw respirations Tachypnea



43 Cardiac Variations Heart is large Low pitched murmur
Decreased strength or absence of femoral pulses


45 Female Genitalia Variations
Vaginal tag Pseudomenstruation Smegma

46 Male Genitalia Variations
Hypospadias Phimosis Hydrocele Cryptorchidism

47 Variations in Extremities
Gross deformities Extra digits or webbing Clubfoot Hip dislocation


49 The asymmetry of gluteal and thigh fat folds seen in infant with left developmental of the hip. B, Barlow (dislocation) maneuver. Baby’s thigh is grasped and adducted (placed together) with gentle downward pressure. C, Dislocation is palpable as femoral head slips out of acetabulum. D, Ortolani’s maneuver puts downward pressure on the hip and then inward rotation. If the hip is dislocated, this maneuver will force the femoral head back into the acetabular rim with a noticeable “clunk




53 Reflexes Tonic-neck Moro Grasping Rooting Sucking Babinski
Trunk incurvation

54 Protective reflexes Blink Yawn Cough Sneeze

55 Brazelton’s Neonatal Behavioral Assessment Scale
Habituation Orientation to inanimate and animate visual and auditory assessment stimuli Motor activity Variations Self-quieting activity Cuddliness or social behaviors

56 The End of Part 2

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