Nursing Care for the Newborn

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• Nursing Care for the Newborn
• (( The Assessment ))
• p. 201- 206
• By Mohammad Abuadas RN, MSN

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The Initial Assessment

• APGAR scoring
• The most frequently used method to assess the
  newborns immediate adjustment to extrauterine
  life is the APGAR scoring system.
• The score is based on observation to heart rate,
  respiratory effort, muscle tone, reflex
  irritability, and color, items measured 0,1,2
  grades.
• The APGAR scoring is taken 1 5 minutes after
  birth, and repeated after newborns condition
  stabilizes.
• It assesses the physical neurological status.

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APGAR SCORE
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APGAR Score Interpretation
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Example

• A newborn assessed using APGAR scoring system,
  found with heart rate 120 bpm, slow and weak
  cry, well flexed, the newborn found crying and
  sneezing as a response , and pale .. how much in
  APGAR? And what will be your intervention ????.

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Answer
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Assessment for gestational age(Ballard scale)

• Posture
• With infant quite and in supine position,
  observe degree of flexion in arms and legs.
  Muscle tone and degree of flexion increase with
  maturity . Full flexion of the arms and legs 4.

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• Square window
• with thumb supporting back of the arm below
  wrist , apply gentle pressure with index and
  third fingers of dorsum of hand without rotating
  infants wrist. Measure angle between base of
  thumb and forearm4

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• Arm recoil
• with infants supine, fully flex both forearms
  on upper arms, hold for 5 minutes pull down on
  hands to fully extend and rapidly release arms.
  Observe rapidity and intensity to of recoil to a
  state of flexion. A brisk return to flexion 4

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• Popliteal angle
• With infant supine and pelvis flat on a firm
  surface, flex lower leg on thigh and then flex
  thigh on abdomen. While holding knee with thumb
  and the index finger, extend lower leg with index
  finger of other hand . Measure degree of angle
  behind knee. An angle of less than 90 degrees
  5.

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• Scarf sign
• With infant supine , support hand in midline
  with one hand use other hand to pull infants
  arm across the shoulder so that infants hand
  touches shoulder. Determine location of elbow in
  relation to midline . Elbow doesn't reach midline
  4

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• Heal to ear sign
• With infant supine, and pelvis flat on a firm
  surface, pull foot as far as possible up toward
  ear on same side. Measure distance of foot from
  ear and degrees of knee flexion ( same popliteal
  angle). Knees flexed with a popliteal angle of
  less than 90 degree 4

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Weight related to gestational age

• Appropriate for gestational age 10th-90th .
• Small for gestational age lt 10th .
• Large for gestational age gt 90th .
• The normal birth weight is 2700- 4000g .

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Growth measures

• Head circumference 33- 35.5 cm
• Chest circumference 30.5- 33 cm, 2 cm less than
  head circumference.
• Abdominal circumference.
• Length head (cephalic) to heal 48- 53 cm
• Body weight 2700- 4000 g. ( loses 10 of weight
  in the first 3 to 4 days after birth).

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Vital signs

• Axillary temperature 36.5- 36.6 . Avoid rectal
  in the first day .
• Pulse 120- 140 bpm
• Respiration 30- 60 bpm
• Blood pressure 65/41 mmHg in the first 3 days.
  Compared with lower extremities.
• Vital signs must be checked every hour for 2
  hours, then once every 8 hours until discharge.