Infant’s first nursing assessment //NCLEX 3

Remember, a lot of babies after birth go through a transitional period for six to eight hours as their bodies slowly get used to doing all the jobs that the placenta and the uterus and the mummy were doing before the baby was born. So often babies are born, for example, breathing really rapidly, trying to kind of get the fluid out of their lungs, and this will slowly slow down over the first few hours of life. So your exam can change a lot within the first few hours of life. Remember, it's really important that the baby stays warm during the physical exam, even as you're unwrapping the baby. But even before you do that, take a really good look at the baby and just assess the baby's activity, the baby's breathing pattern, and the baby's general color. As you get used to seeing more and more babies, you'll become much better at estimating the gestational age that the baby was born at. But there is also a scoring system called the Ballard score, which basically gives points for different aspects of the baby, and if you add up the points, it will kind of estimate the gestational age for you. Generally, the floppier the baby, the more immature the baby. So obviously they'll get a lower score on the Ballard score. The other findings in the Ballard score are dependent on kind of skin findings and other physical exam findings. So obviously like the thinner the skin, the more prominent the veins are, then the younger the gestational age of the baby. As part of your assessment, it's also very important to ascertain and then document the vital signs. So remember, the temperature in a newborn baby is pretty similar to an adult, whereas the heart rate and the respiratory rate are much faster in term babies than even older kids. But the blood pressure, as you can imagine, is much lower in babies as compared to older kids and adults. Start your assessment by listening to the heart rate as well as to the respiratory rate with your stethoscope, and it's recommended that you listen to up to about a minute for each one, just to make sure that you're not missing anything. A normal heart rate is anywhere between 100 and 200. It's kind of on the lower end if the baby is sleeping and on the upper end if the baby is crying or really agitated. A normal respiratory rate is between 30 and 60. Remember, like I said, it can be a lot faster when they're first born, and then that can kind of slow down after the first few hours. And the temperature, which is the auxiliary temperature, is normally 97.7 to 99.5 Fahrenheit, which is 36.5 to 37.5 Celsius. Remember, it is really bad for babies to either get too hot or too cold. So really go out of your way to make sure that babies are always at the perfect temperature. And then the blood pressure. So the blood pressure isn't always measured in newborn babies, but generally a good rule of thumb is that the mean blood pressure, which is kind of the weighted average between the systolic and the diastolic blood pressure, should equal about the gestational age. So for example, if you have a 38-weeker, then the mean blood pressure may be 40, and the systolic may be 55, with a diastolic of 35. What about body measurements? Obviously, the younger the gestational age of the baby, the smaller the weight, the length, and the head circumference are going to be on that baby. It is important that all those parameters are measured on all babies, and all of those parameters are plotted on the curves to see if they're big or small for the gestational age of the baby. Sometimes the baby may be a good weight or good length for their gestational age, but their head circumference might be tiny. This would be really concerning for something abnormal going on with the brain, which is why it's always important to plot everything out. The weight should be measured with the baby completely naked, and for a term baby, remember an average of about 3.5 kilograms. The head circumference should be measured with a tape measure right above the eyebrows, all the way around the head, so kind of like almost the largest diameter of the head. This is crucial that everybody measures it the same way. For a term baby, it's about 35 centimeters, and the length of a baby is ideally measured on a length board. Babies wiggle around a lot, so it's really difficult to get an accurate length, but generally, in a term baby, it's about 50 centimeters. Just kind of remember that as an average, right? Now, go watch the exam of the neonatal head.