a nurse is assessing a newborn who has a weak cry and is grimacing This is a topic that many people are looking for. bluevelvetrestaurant.com is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, bluevelvetrestaurant.com would like to introduce to you NEWBORN ASSESSMENT | FNP Health Assessment & Education. Following along are instructions in the video below:
Todays video. I wanted to show you how to do a basic newborn assessment. Assessment.
It very conveniently have a five day old volunteer here this is my daughter shes going to be helping us with this exam. I am going to leave her clothes on a lot of these exams you would do with obviously the baby ingested diaper. But its the internet.
Were not gonna get fiber naked oh she just one moment shes nervous shes a big internet debut my baby so i just wanted to throw that disclaimer in there real quick. She wont be naked you can look up pictures somewhere else on the internet. If you need that but i will go over reflexes things that you should be looking for in your newborn exam.
Well also go over some basic education and anticipatory guidance that you should offer caregivers of your newborn. If youre new here welcome. Im liz.
Im a family nurse practitioner. This is piper shes our newest family member and i make videos just like this on nursing and p content on tuesdays and on saturdays. I have a vlog documenting my life inside and out of work as an fnp.
So if that sounds fun consider subscribing. Id love to have you lets get on with this assessment alright. So the very first part of the physical assessment of a newborn is to get their weight their length and the circumference of their head.
So how big theyre not goodness and then when you walk into the room. The other thing youre gonna want to immediately just kind of look for is its okay how the baby looks so you want to see their color make sure they dont look jaundiced. Which is that yellow color make sure that their tone.
Looks okay theyre not super floppy. But at the same time theyre not super tight that they are not absolutely losing their mind and unable to be consoled and youre gonna want to inspect their skin and see if they have any lesions if they have any birthmarks anything going on piper its hard to see in this light. But she has erythema toxic immune a tourim which is a very very common rash in newborns you can kind of see it a little bit there on her arm.
Itll go away between five and 14 days. And she has a few birthmarks. So those are all things youre just gonna want to kind of note and reassure.
The parents on and make note of them that way they can be monitored. But the basic idea here is to just get a general overview of the infant one last thing. I would make sure to check.
While youre doing that assessment is check their umbilical cord. Make sure it doesnt look infected that its drying out well. I ate the parents at that point too.
You know dont put an think on the umbilical cord. Leave the diaper below the umbilical cord. Dont give them a bath until they fall.
Its fallen off and dont encourage it to fall off it will fall off on its own within a week or two the next thing you can do which im already kind of doing with my finger in her mouth is you can assess for their palate. So youre gonna want to assess for cleft lip and cleft palate that you can do by just sticking a gloved finger into their mouth. And feeling the roof of their mouth.
Making sure. Thats intact and you can visualize here that she doesnt have a cleft lip and while you have their finger in their mouth. Its also a good time to assess their suck swallow breathe reflex and coordination.
So you can just kind of wiggle your pinky around like im doing and see do they a strong suck do they have a weak suck. Does it seem to be somewhat coordinated. You know are they choking on your finger anything like that youll want to assess that while your fingers in there.
Im going to leave my finger in there just for now. Because thats gonna soothe her while i do the rest of this assessment. This is a good time to look at your ears.
You can see her sore a little bit bent from being in utero. But her eyelids look intact. You can see she kind of has a little bit more of that rash over here this year looks good.
And its a good time to feel her fontanel. So the fontanelles are going to be the gaps in the skull and newborns will have an anterior fontanelle. If you can see thats right here.
And its an open area and you want that to be flat. If its depressed it could indicate dehydration and then they have one right here in the back. The one in the back is usually much much smaller than thats gonna close up within the first few weeks of life.
Whereas the anterior. The one in the front front now thats going to be open for at least nine months until 18 months. And i usually educate parents you know dont press on that thats a delicate area.
But its also okay. Its not something that they need to be totally afraid of i know its i know its kind of unnerving sure like oh my gosh thats their brain. And its a good education point to remind them if this ever gets really sunk in and doesnt feel flat.
Ill have them feel it with me that could mean baby is getting dehydrated look at the shape of their head at this point. Make sure it looks pretty symmetrical. Remind parents offer reassurance if their head is a little bit in a cone shape thats just from feeding in the birth canal and that will shape out.
But its something to monitor. And i encourage parents to take pictures of their head from the top down and from the sides that way in case their head doesnt really show get back into that round shape. We know we can kind of monitor.
It and they can always go for cranial molding. If thats needed later next. We will take a peek inside of their mouth and in the mouth.
Youre just gonna want to note. Any epstein curls piper. Actually does have an epstein pro.
Which is a really white small cyst you dont have to do anything about them its in the back of her mouth. And thats again just offer. Parents reassurance check her lips.
And make sure that they can flange out. Okay. She might not cooperate with us there we go and then you want to make sure that her tongue.
Also when she sticks her tongue out you can kind of play with their mouth a little bit. And see if shell do it you want her their tongue. You want to be able to if you can visualize their tongue coming at least past their lip line and thats gonna help ensure that theyre gonna have an effective suck swallow and usually you do that by just playing with her lip.
Im not gonna do it because shes sleeping for this video thats actually perfect no the one other assessment. I did not do on this girls noggin was the red light reflex and im probably not going to do it because i dont want to wake her up. But what you would do for the red light reflex is thats to assess you want to assess their eyes.
Which we really didnt talk about you want to make sure that their eye does not look yellowed because again that could indicate jaundice. You want that to be pretty white and you want to make sure that the red reflex is present. So you do that by using your up selma scope going in holding it a little bit of an angle.
And just shining. The light on the back of the eyeball back and forth. You want to see a red circle of light in their eye on both sides and that would indicate a red reflex.
If they do not have it that could indicate some kind of a corneal problem or retinal blastoma. Which is hes the huge thing you do not want them to have so if they do not have the red reflex present that is an emergency referral. One thing.
I do want to point out before we go any further is i as a parent and as a provider really prefer to educate parents about what im looking for as im looking for it i think as a parent. Its very reassuring. Its weird when someones just touching your kid all over and youre like what are you even looking for so.
I usually talk through my assessment. Kind of like im doing with you and say what im seeing you know im seeing the rash. We talked about earlier.
Id let them know thatll go away the milea. The little white spots. You know those will thats just trapped keratin or skin cells.
Under the skin. Dont pick at them. Its a really great opportunity to let reassure parents that everything youre seeing is normal let them kind of get to know their baby and then make them feel included in the process.
Because ive had assessments before where someone was just looking my daughter over and it was just really uncomfortable excels like i dont know if this is good or bad or what youre looking for and especially for parents who arent in the health care field that would be especially worrying so just a little side note there all right next. Were gonna take a peek at their chest. Just make sure that their chest cavity looks okay again that its symmetrical.
Were gonna take a quick listen to their heart and their youre checking for the rhythm. Making sure. Theres no murmurs listen into their lungs.
A little bit their belly. Remember to listen to their belly.
Before you feel it we can roll her over and get a better listen to those back lungs. And if youre using a regular adult size stethoscope just flip. It over so youre on the bell rather than the diaphragm because thats gonna be a little bit too big next.
If you havent looked at their bill accord. Yet you can do that now just feel their belly. You dont want it to be hard you want it to be nice and soft next.
We move down to the diaper area and just pull their diaper down. If its a little boy make sure both of the testes are descended and on both little girls and boys youre just going to want to assess the general area and make sure that theres no obvious abnormalities present the next thing. Were gonna do is were going to assess for any hyssop dysplasia in the newborn.
So the first test. Were gonna do two tests to do this the barlow and the ortolani test so the first test youre gonna want to do is the barlow and that you just start with their legs out. And youre going to bring them in the middle and push down bringing them to center lets let it relax applying a little bit of downward pressure and like to the middle.
If it was positive youd hear a pop and for the ortolani you start with their legs together in the middle bent 90 degrees. And you kind of pull towards you and out to the sides and again if it was positive when you move them out that would kind of create another pop and if that was positive you would send the infant for an ultrasound of their hips to see if they are having any hip dysplasia and the next thing. Were gonna do before we move on to the reflexes with baby is just make sure that their extremities have arent floppy.
But they also dont have too much tone and tone is what would be if they were really really tense. So with her you can see you know you can pull her limbs out. And shell bring them back.
And youre able to stretch everything out and again she just curls up and thats the type of tone. You would like in the newborn. And then obviously just do a once over and make sure we have ten adorable fingers and ten adorable toes.
One other thing i do mention to parents a lot that can be concerning is the hands and the feet in a newborn. Its not abnormal for them to get a little bit of this like purplish hue. You can see here especially if they are chilly or if theyve been crying as long as the color does return and the baby doesnt seem to be in distress.
That is okay. And i just remind parents of that because that can be kind of distressing. If you look at your babys feet and they look a little bit bluish purple.
But as long as the color returns once theyre all toasty. And there doesnt seem to be any other obvious problem then thats totally fine okay so the last thing i wanted to talk about here. Which are kind of fun are the reflexes that your newborn will have so there are five primitive reflexes and we assess these because if their baby is lacking them it could be a problem with the central nervous system.
So the first is the rooting reflex and thats if i stroked the corner of her mouth. You see over here she turns her head to where im stroking and this reflex will last until shes about four months old the next. One is the suck reflex sucking reflex is just if you stick something inside babys mouth.
Shes going to want to suck it the next reflex. Were gonna look at is the tonic reflex this one doesnt work like all the time. But if you turn their head baby should stick this arm out like shes doing and turned that one here.
Its kind of hard to see this. Oh everything is okay everything is okay like i said that one doesnt always work. But this one will usually go out and this one goes up.
But shes hungry. So its not working sorry friends and that neck reflex should last until about five to seven months next is the grasp reflex and that is when you put your hands. Always okay in babys hands.
She should grab them just like shes doing so thats when you feel like babies are holding your hands. Thats their grasp reflex next is kind of fun. This is the stepping reflex if you hold a baby up and put their feet touching solid ground.
Theyre going to walk for you and shes doing that on your own dont bring them up and down up and down. It kind of looks like dancing and then the very last one which i guess we can do because shes kind of mad is the moro reflex where if you put them backwards really quick or startle them to a loud noise. Theyre gonna fly out all of their limbs.
So well see if we can get her to do it nope. So shes obviously not in a very startling mood right now and shes starting to get kind of cranky. But you can always ask the parents have you ever noticed her splay her arms out really quick and theyll usually be able to tell you yes or no.
And thats a good way to assess that one one that is not a primitive reflex. But thats just fun is the babinski so if you stroke their feet their toes are gonna do that this in newborns is totally normal if its in adults. Its actually a really big problem and indicative that there is something not good going on with your poor brain.
One other last fun reflex you can do and this is a good time to examine babys back as well lets put them over your arm like this and stroke. The side and theyre gonna curve to that side there we go and the other one. I shall wiggle or booty back to this side and then over here and thats all of our reflexes.
Thanks girlfriend. You did a great job. What a good job.
Shes like i am a hungry leave. Me alone. Oh.
You look happy there you look happy and that pretty much wraps up the physical exam of your newborn. The other huge part of a newborn visit and assessment is the education you can provide to the parents now. Im not going to go crazy in depth on this but things you definitely want to cover.
It is just to assess how the parents are coping and assess for safety. So the big thing here is youre gonna ask them if they have any questions especially first time parents were going to have a lot of questions youre gonna want to spend time answering them educating them on anything they need education on giving them any resources and tools that could be helpful for them youre gonna want to make sure that the baby has access to a safe environment and food. So making sure that the parents have formula if their formula feeding.
If mom has any questions about breastfeeding offering lactation consultant resources. If thats something that si did go over how many wet and poopy diapers baby should be having what they should be concerned for you know so if babys superduper. Tired wont wake up doesnt want to eat drink has a fever and then assess for general safety.
Things you know is your to have water. Do you have electricity or their firearms in the home is there because anyones smoke in the home assess for all of those things real quick or have it on your questionnaire. When they come in another thing.
Thats good to do in an initial newborn. Visit is just make sure that mom is aware of signs and symptoms of postpartum depression it like it would not be setting in at this point. But moms probably not going to be seen.
If she had a vaginal delivery for six weeks. So its good to just kind of touch on that here just so its something thats maybe in the back of their minds in case. Mom is not feeling so good in the next few weeks in order to keep track of feedings and poopy diapers.
I usually recommend an app called baby tracker. It is free on your smartphone and keeps track of everything. Thats an awesome resource to help keep track of all the ins and outs in the early days.
And the last big thing. I usually touch on is car seat safety. So my background is in pediatric nursing and we sell lots and lots of car accidents where babies were injured due to encouraged place car seats so this is like my personal mission in life so i usually have the parent you know i will show them a picture of what proper car.
Seat and clip placement looks like go over that baby definitely needs to be rear. Facing do not leave baby in the car seat if its not in the car take them out as soon as you get home. Because of the recliner.
They can suffocate and then go over safe sleep. So on a flat surface nothing. In the crib.
Or the bassinet with baby un dressing. Them in one more layer than youre wearing. Because they obviously dont want any blankets in the crib and those are my main teaching points with parents i think i said that is not an all encompassing thing and for second time.
Parents you can kind of touch on some things more sometimes less. I highly recommend if youre going to be seeing pediatric patients for an assessment to get the bright futures pocket guide. Ill leave it link down below they go over all the anticipatory guidance you need to do they go over the physical exams.
You need to do for children from birth until they are no until theyre 18. So highly recommend that and thatll have all the anticipatory guidance that you can kind of cover and you can insert that into your appointment. However you feel you need to but those are the big kind of talking points.
I definitely like to hit on in my appointments with newborns okay guys and that is your basic newborn assessment like i said its not the most like in depth. Detailed thing in case you found something that you were nervous about. But its a good baseline and should give you a good idea of kind of what youre looking for at that first appointment at a few days of life special thanks to our baby model.
You did a great job good job honey again if this video was helpful and you like to see more like it consider subscribing also head over to instagram where i post lots of pictures of this one. And her sister. What im learning at work.
What im seeing at work q. And as all that good stuff question of the day is what is your favorite baby reflex. I personally i like the moro one guys it makes me laugh.
Its really mean to do it to them. But it makes me giggle with their little arms flopping all out so let me know what your reason is down below. I hope you have a fabulous rest of your week.
And ill see you again next time bye bye. Im hungry lets go music. .
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