Physical Assessment of the Newborn: A Comprehensive Approach to the Art of Physical Examination

Description

“The text is… a core text for any program preparing individuals for advanced practice roles in perinatal and neonatal care, and it should be a resource in every setting providing care to neonates. At all levels of practice, it serves as a convenient reference to normal parameters, common variations, and less commonly seen abnormalities.” --Susan Tucker Blackburn, RN, PhD, FAAN Author of Maternal, Fetal, and Neonatal Physiology: A Clinical Perspective From the Foreword The newly revised, 25th Anniversary Edition of this definitive publication on neonatal care continues to illustrate how to systematically and accurately gather assessment data and interpret results. Because even normal newborns feature a tremendous range of physical variation, subtle signs that indicate internal malformations or syndromes may escape notice without a proper assessment. Many problems in the neonate can be noticed early by an astute nurse, nurse practitioner, or physician with honed assessment skills, long before electronic monitors or other equipment can detect them. Physical Assessment of the Newborn, Sixth Edition addresses the physical, physiologic, neurologic, and behavioral implications of a thorough assessment, and explains how healthcare providers can reduce the risks associated with the transition to extrauterine life and the neonatal period. Grounded with a scientific basis and rationale, each system assessment represents the most up-to-date clinical content. Because assessment skills are such an integral aspect of practice, many individuals take them for granted, yet all health professionals who perform newborn examinations, including nurses, neonatal and pediatric nurse practitioners, nurse-midwives, physicians, and therapists can benefit from the essential content presented in this book, as well as students preparing for advanced practice roles in neonatal care. New to the Sixth Edition: Provides clinical updates throughout Presents an Enhanced Art Program Offers an all-new chapter on the Opioid-Dependent Neonate Includes an Image Bank and Power Points Key Features: Addresses all key aspects of newborn assessment Provides a well-organized evaluation of individual body systems Assist practitioners in identifying infant state, behavioral clues, and signs of pain Examines the tremendous range of variation among newborns of different gestational ages Provides Antepartum Tests and Intrapartum Monitoring Written in an easy-to-read, user-friendly style Contains tables, figures, and numerous full color photos and illustrations Cover......Page 1 Title......Page 2 Copyright......Page 3 Contents......Page 4 Contributors......Page 6 Foreword......Page 8 Preface......Page 10 Acknowledgments......Page 12 Share Physical Assessment of the Newborn: A Comprehensive Approach to the Art of Physical Examination, Sixth Edition......Page 13 Observation......Page 14 Percussion......Page 15 Transillumination......Page 17 Basics of Physical Assessment......Page 18 Palpation......Page 19 Ophthalmoscope......Page 20 References......Page 21 Importance of the History......Page 22 The Supplemental Interview......Page 23 Interim History......Page 24 Intrapartum History......Page 25 Maternal Medical History......Page 29 Family Medical History......Page 32 Remaining Elements......Page 33 References......Page 34 Chapter 3: Gestational Age Assessment......Page 36 Historical Perspective......Page 39 Anterior Vascular Capsule of the Lens......Page 40 Neuromuscular and Physical Criteria......Page 42 Timing of the Physical Examination......Page 49 Evaluation of Growth Indices......Page 50 Summary......Page 53 References......Page 54 Anatomy and Physiology......Page 58 Beginning the Examination......Page 59 Color Variations......Page 61 Common Newborn Skin Lesions......Page 62 Common Pigmented Skin Lesions......Page 63 Skin Lesions Secondary to Trauma ......Page 65 Vascular Skin Lesions......Page 66 Inspecting the Nails......Page 70 References......Page 71 Skull......Page 74 Head Size......Page 79 Face......Page 80 Ears......Page 81 Eyes......Page 83 Nose......Page 85 References......Page 89 History......Page 92 General......Page 93 Respirations......Page 94 Components of the Chest and Respiratory System Airways......Page 96 Normal Breath Sounds......Page 98 Adventitious Sounds......Page 99 Overall Structure......Page 101 Patient-Triggered Ventilation......Page 102 References......Page 103 Reviewing Maternal, Family, and Birth Histories......Page 106 Observing Appearance and Behavior......Page 107 Pallor/Mottling/Perfusion......Page 109 Palpating Peripheral Pulses......Page 110 Precordium......Page 111 Apical Impulse......Page 112 Heart Rate......Page 113 Cardiac Rhythm and Regularity......Page 114 Heart Sounds......Page 115 Murmurs......Page 116 Evaluating Blood Pressure......Page 118 Normal Values......Page 119 Screening for CHD With Pulse Oximetry......Page 121 References......Page 122 Skin......Page 124 Shape and Movement......Page 125 Umbilical Cord......Page 126 Abdominal-Wall Defects......Page 127 Perianal Area......Page 128 Auscultation......Page 129 Organs......Page 130 Masses......Page 131 Groin and Femoral Area......Page 132 References......Page 133 Related Findings......Page 134 Abdomen......Page 135 Male Genitalia......Page 136 Female Genitalia......Page 138 Abdominal Distention......Page 139 Abdominal-Wall Defects......Page 140 The Penis......Page 141 The Scrotum......Page 144 Abnormalities of the Female Genitalia......Page 146 Disorders of Sexual Development......Page 147 References......Page 148 Prenatal History......Page 152 General Survey......Page 153 Length......Page 154 Observation......Page 155 Hand......Page 157 Spine......Page 159 Hips......Page 160 Legs......Page 163 Anomalies of the Neck......Page 165 Upper Extremity Anomalies......Page 167 Lower Extremity Anomalies......Page 170 Conditions Affecting Upper and/or Lower Extremities......Page 173 References......Page 177 Observation......Page 180 Examination of the Head......Page 184 Postural Tone......Page 185 Assessment of Developmental Reflexes......Page 187 Moro Reflex......Page 188 Assessment of Sensory Function......Page 190 Assessment of the Autonomic Nervous System......Page 191 Trigeminal—Cranial Nerve V......Page 192 Hypoglossal—Cranial Nerve XII......Page 193 Neonatal Encephalopathy......Page 194 Maternal Drug Use......Page 195 Defects in Closure of the Anterior Neural Tube......Page 196 Defects in Closure of the Posterior Neural Tube......Page 197 Primary Subarachnoid Hemorrhage......Page 199 Subdural Hemorrhage......Page 200 Periventricular–Intraventricular Hemorrhage......Page 201 Extracranial Hemorrhage......Page 202 Seizures......Page 203 References......Page 204 Chapter 12: Behavioral Assessment......Page 206 Approach to Behavioral Assessment......Page 208 Identifying States of Consciousness......Page 209 Sleep States......Page 210 Awake States......Page 211 Organization......Page 213 Recognizing the Sensory Threshold......Page 214 Observing Behavioral Cues......Page 215 Habituation......Page 216 Evaluating Consolability......Page 217 Identifying Temperament......Page 218 Term Newborn Behavioral Assessment......Page 219 Case Assessment of a Full-Term Infant......Page 221 Preterm Infant Behavior Assessment......Page 222 Case Assessment of a Healthy Preterm Infant......Page 223 Case Assessments of Immature Preterm Infants......Page 225 Other Emerging Infant Assessment Tools......Page 227 References......Page 228 Maternal and Family Histories......Page 232 Head......Page 233 Nose and Mouth......Page 234 Genitalia......Page 235 Trunk and Spine......Page 236 Problems in Morphogenesis......Page 237 Genetics......Page 238 Syndromes......Page 239 Trisomy 18 (Edwards Syndrome)......Page 240 45,X (Turner Syndrome)......Page 241 Charge Syndrome......Page 242 Potter Oligohydramnios Sequence......Page 243 Arthrogryposis (Multiple Joint Fixations)......Page 244 Anticonvulsants......Page 245 Infants of Diabetic Mothers......Page 248 References......Page 249 Data Collection......Page 252 Systematic Approach to Evaluation......Page 254 Assessment of Pain......Page 255 Assessment Tools......Page 256 Elga Infants......Page 259 Neurologically Impaired Infants......Page 260 Infants With Persistent or Chronic Pain......Page 261 Infants at End of Life......Page 262 Infants With Diseases or Conditions Warranting Pain Assessment......Page 263 Parents’ Views on Pain......Page 264 References......Page 265 Chapter 15: Assessment of the Newborn With Antenatal Exposure to Drugs......Page 268 Biologic Specimens......Page 269 Cocaine......Page 270 Opioids......Page 271 Clinical Presentation......Page 272 Assessment Tools......Page 273 References......Page 274 Biophysical Profile......Page 276 Doppler Velocimetry......Page 277 Fetal Fibronectin Levels......Page 278 Maternal Serum Estriol Levels......Page 279 Ultrasound......Page 280 FHR Monitoring......Page 281 References......Page 282 Glossary of Terms......Page 284 Glossary Compiled and Verified Using the Following Sources......Page 306 Index......Page 308