Care of Mother, Child and Adolescent (Well-

Clients)
STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR
Session # 18

Materials:
Book, pen, notebook and SAS
LESSON TITLE: NURSING CARE OF A FAMILY WITH A
NEWBORN

LEARNING OUTCOMES:
Reference:
At the end of the lesson, the student nurse can:
1. Describe the normal characteristics of a term newborn
Pilliteri, Adele and Silbert-Flagg, JoAnne (2018)
2. Assess a newborn for normal growth and development
Maternal and Child Health Nursing, 8th Edition.
3. Implement nursing care for a newborn, such as
USA: Lippincott Williams and Wilkins
instructing parents on the care of a newborn

LESSON REVIEW/PREVIEW (5 minutes)

MAIN LESSON (45 minutes)

Please refer to refer to Chapter 18: Nursing Care of a Family with a Newborn p. 425
VITAL STATISTICS
Weight. Length
 Weight depends on racial, nutritional, intrauterine  Average matured female newborn is 53 cm (20.9
& genetic factors in); matured male newborn is 54 cm (21.3 in)
 Weight in relation to gestational age should be
plotted on a standard neonatal graph Head Circumference
 Birth weight increases with each succeeding child  Ave: 34 to 35 cm (13.5 to 14 in)
in a family  A mature newborn with circumference <33 cm or
 Average birth weight of a matured female > 37 cm should be investigated
newborn 3.4 kg (7.5 lbs) and a matured male  HC is measured with a tape measure drawn
newborn is 3.5 kg (7.7 lbs) across the center of the forehead & around the
 A newborn loses more than 5% to 10% of birth most prominent portion of the posterior head
st
weight (6 to 10 oz) during the 1 few days after
birth since the newborn is no longer under the Chest Circumference
influence of salt and fluid-retaining maternal
nd rd
 Chest circumference is usually 2 cm (0.75 to 1 in) less
hormones and diuresis begins on the 2 to 3 than head circumference
day of life, voiding and the passing of stool also
reduces the weight.
 After the initial weight loss, the newborn has 1
day of stable weight then begins to gain weight
 Breastfed newborn regains birthweight within 10
days; formula-fed newborn within 7 days. After
this, weight gain is 2 lbs/month

VITAL SIGNS
Temperature Pulse
 It is about 99°F (37.2°C) at birth because they have  In utero, PR = 120 to 160 bpm; immediately after
been confined in an internal body organ; temperature birth, as rapid as 180 bpm; within 1 hour, the NB
falls almost immediately because of immature settles down to sleep & the pulse rate stabilizes to
temperature-regulating mechanisms an average of 120 to 140 bpm

4 Mechanisms of Heat Loss:  HR is slightly irregular due to immature cardiac

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1. CONVECTION- flow of heat from the NB’s body
surface to cooler surrounding air; avoid drafts such as
windows and air conditioners
2. CONDUCTION- is the transfer of body heat to a cooler
solid object IN CONTACT with the baby (e.g. placing baby
on a cold surface); to avoid heat loss, cover baby with a
warmed blanket or towel
3. RADIATION- transfer of body heat to a cooler solid
object NOT IN CONTACT with the baby such as a cold
window or air conditioner; move infant as far from the cold
surface as possible
4. EVAPORATION- loss of heat through conversion of a
liquid to vapor; newborn’s lose heat as amniotic fluid on
their skin evaporates; dry newborn’s as soon as possible
especially their face & hair which will not be covered with
clothing
 Newborn’s lose heat easily because they lack
subcutaneous fat; also, shivering is rarely seen in
NB’s
 Newborn’s conserve heat by constricting blood
vessels & moving blood away from the skin
 BROWN FAT, a special tissue found in mature
Newborn’s, helps to conserve heat by increasing
metabolism
 Brown fat is found in the intrascapular region, thorax
& perirenal area.
 Mechanical measures to conserve heat: drying &
wrapping the newborn’s, placing them in a warmed
crib, or drying them & placing them under radiant
warmers
 KANGAROO CARE- placing a newborn against the
mother’s skin which helps transfer heat from the
mother to the newborn
 Newborn’s temperature stabilizes at 98.6°F within 4
hours after birth
 A newborn with a bacterial infection may run a
subnormal temperature unlike adults
PHYSIOLOGIC FUNCTION
Cardiovascular System Gastrointestinal System
 Clamping of the umbilical cord forces the neonate
to take in O2 through the lungs→ ↓pressure in the
chest promoting closure of the ductus arteriosus;
↑pressure on the left side of the heart closes the
foramen ovale.
 Umbilical vein ductus venosus and u. arteries no
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regulatory centers in the medulla
 Transient murmurs are common due to the
incomplete closure of the fetal circulation shunts
 Femoral pulses may be palpated but radial &
temporal pulses are difficult to palpate
 Absence of femoral pulses suggests possible
coarctation of the aorta
 Heart rate is always determined by listening for n
apical heartbeat for 1 full minute
Respiration
st
 Respiratory rate in the 1 few minutes after birth
may be as high as 80 breaths/min. As
respirations stabilize, it settles to 30 to 60 breaths
per minute at rest.
 Respirations are likely to be irregular, with short
periods of apnea (without cyanosis) sometimes
called PERIODIC RESPIRATIONS
 Breathing primarily involves the diaphragm and
abdominal muscles
 Coughing & sneezing reflexes are present at birth
to clear the airway
 Newborn’s are obligate nose breathers
Blood Pressure
 Blood pressure is about 80/46 mm Hg at birth; by
th
the 10 day, it rises to 100/50 mm Hg though
readings are usually inaccurate
 Blood pressure cuff width must be no more than
2/3 the length of the upper arm or thigh
 It is usually sterile at birth but within 24 hours,
bacteria are present from airborne sources,
vaginal secretions at birth, hospital linens, or from
contact with the mother’s breast
 Normal flora in the intestines are necessary for the
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 longer receive blood, the blood within them clots
& the vessels atrophy within the next few weeks
st
 Peripheral circulation remains sluggish for the 1
24 hours; acrocyanosis (cyanosis in the hands &
feet) and cold feet are common
 BLOOD VOLUME= 80 to 110 ml/kg or about 300
ml
 RBC COUNT= 6 million/ cu mm
 HGB= 17 to 18 g/ 100 ml
 HCT= 45% TO 50%
 Indirect bilirubin at birth = 1 to 4 mg/ 100 ml
 WBC= 15,000 to 30,000 cells/mm3; as high as
40,000 if the birth was stressful
 Prolonged coagulation or prothrombin time due to
low levels of Vitamin K(necessary for synthesis of
Factors II, VII IX and X)
 It takes 24 hours for flora to accumulate in the
intestines & for Vitamin K to be synthesized
 Vitamin K (AQUAMEPHYTON) is administered
into the vastus lateralis muscle immediately after
birth
Respiratory System
 Initial breath is initiated by a combination of cold
receptors, lowered partial pressure of O2 (pO2),
INCREASED Pco2 as high as70 mm Hg before
st
the 1 breath
 Within 10 minutes after birth, good residual
volume is established
 10 to 12 hours after birth, vital capacity is
established
Urinary System
 The average newborn voids within 24 hours after
birth; otherwise, should be examined for urethral
stenosis or absent kidneys or ureters
 Males should void with enough force to produce a
small projected arc; females should produce a
steady stream.
 NB kidneys do not concentrate urine well,
producing light-colored & odorless urine
 NB single voiding is only about 15 ml, specific
gravity ranges from 1.008 to 1.010
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synthesis of Vitamin K
 Stomach capacity is about 60 to 90 ml
 A newborn has limited ability to digest starch & fat
because pancreatic enzymes, lipase & amylase
st
remain deficient for the 1 few months
 Newborn regurgitates easily because of an
immature cardiac sphincter.
 Immature liver function leads to lowered glucose &
serum protein levels
st
 MECONIUM- 1 stool of NB & is usually passed
within 24 hours after birth; it is tarlike, sticky,
blackish green and odorless formed from mucus,
vernix, lanugo, hormones & carbohydrates
accumulated in utero
 If (-) stool passage by 24 to 48 hours, suspect
meconium ileus, imperforate anus, bowel
obstruction
nd rd
 2 to 3 day, TRANSITIONAL STOOL which is
green & loose, is passed; it resembles diarrhea
th
 4 day, breast-fed babies pass 3 to 4 light yellow
stools per day which are sweet-smelling because
breast milk is high in lactic acid
 Formula-fed babies pass 2 to 3 bright yellow,
more odorous, stools
 Newborn under phototherapy light have bright
green stools due to increased bilirubin secretions
 Clay-colored (gray) stools are associated with bile
duct obstruction
 Blood-flecked stools usually indicate anal fissure
 If mucus is mixed with stool or the stool is watery
& loose, a milk allergy, lactose intolerance, or
some other condition is suspected
Immune System
 Newborn’s have difficulty producing antibodies
against antigens until about 2 months of age & are
therefore prone to infection. Thus, immunizations
are not given t infants younger than 2 months of
age
 Newborn’s are born with passive antibodies (Ig G)
from the mother that crossed the placenta (
antibodies vs polio, measles, diphtheria, pertussis,
chickenpox, rubella & tetanus
 Newborn’s are routinely given Hepatitis B vaccine
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st
 Daily urine output for the 1 1 or 2 days is about
st
30 to 60 ml. 1 voiding may be pink or dusky
because of uric acid crystals formed in the
bladder in utero
 Diapers can be weighed to determine the amount
and timing of voiding
Neuromuscular System
 Newborn exhibits neuromuscular function by
moving their extremities, attempting head control,
strong cry, & newborn reflexes since the nervous
system is still immature
Newborn Reflexes:
1. Blink Reflex.
Purpose: to protect the eyes
Stimulus: shining a strong light on an eye, sudden
movement toward the eye
Reaction: rapid eye closure
2. Rooting Reflex.
Purpose: to help the newborn find food; for nourishment
Stimulus: cheek is brushed or stroked near the mouth
Reaction: the newborn will turn the head in the direction
of the stimulus
th
*Disappears at about the 6 week of life when the eyes
focus steadily
3. Sucking Reflex.
Purpose: to help the newborn find food
Stimulus: When the newborn’s lips touch the mother’s
breast or a bottle
Reaction: the baby sucks to take in food
*Diminishes in 6 months
*Disappears immediately if never stimulated (eg. TEF);
maintained by offering non-nutritive sucking such as a
pacifier
4. Swallowing Reflex.
Purpose: for nourishment
Stimulus: food that reaches the posterior portion of the
tongue is automatically swallowed
*Gag, cough, sneeze reflexes are also present to maintain
a clear airway
when normal swallowing does not keep the pharynx free
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during the 1 12 hours after birth
 Any Health Care Practitioner with Herpes simplex
eruptions should not care for newborns until the
lesions have crusted
11. Moro Reflex/Startle Reflex.
Stimulus: loud noise or by jarring of the bassinet or by
holding newborn in a supine position & allow the head
drop backward 1 inch
Response: Newborn abducts & extends arms & legs,
fingers assume a “C” position; finally swinging the arms
into an embrace position & pull up the legs against the
abdomen (adduction)
Purpose: like trying to ward off an attacker then covering
up to protect himself
st
*it is strong for the 1 8 weeks & fades by the end of the
th th
4 or 5 month at the same time as the infant can roll
away from danger
12. Babinski Reflex.
Stimulus: the side of the sole of the foot is stroked in an
inverted “J” curve from the heel upward
Response: Newborn fans the toes (+ Babinski sign)
*in adults, the opposite response is normal (flexing of the
toes)
*It remains positive (toes fan) until at least 3 months then
replaced by the adult response
13. Magnet Reflex.
Stimulus: pressure is applied to the soles of the feet of a
newborn lying in a supine position
Response: Newborn pushes back against the pressure.
*Magnet, Crossed Extension & Trunk Incurvation reflexes
are tests of spinal cord integrity.
14. Crossed Extension Reflex.
Stimulus: 1 leg of newborn lying supine is extended & the
sole of the foot irritated by rubbing with a sharp object
such as a thumbnail
Response: Newborn raises the other leg & extends it, as
st
if trying to push away the hand irritating the 1 leg.
15. Trunk Incurvation Reflex.
Stimulus: Newborn lies in a prone position & touched
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of obstructing mucus along the paravertebral area by a finger

5. Extrusion Reflex. Response: Newborn flexes the trunk & swing the pelvis
Purpose: prevents swallowing of inedible substances towards the touch

Stimulus: substance placed on the anterior portion of the 16. Landau Reflex.
tongues
Stimulus: Newborn is held in a prone position with a hand
Reaction: Newborn pushes away the substance with the underneath, supporting the trunk
tongue
Response: Newborn must demonstrate some muscle
*disappears at 4 months of age tone; may not be able to lift the head or arch the back but
must not sag into an inverted “U” position (poor muscle
6. Palmar Grasp Reflex tone)
Newborn grasps an object placed in their palm by closing
their fingers on it 17. Deep tendon Reflex.

*Disappears at about 6 weeks to 3 months of age; grasps Stimulus: patellar reflex is stimulated by tapping the
meaningfully at 3 months of age patellar tendon with the tip of the finger.

7. Step (Walk)-in-Place Reflex.
Newborn is held in a vertical position with their feet
touching a hard surface will take a few, quick, alternating
steps.
*disappears by 3 months; by 4 months, babies can bear a
good portion of their weight unhindered by this reflex
8. Placing Reflex.
Similar to step-in-place but it is elicited by touching the
anterior surface of the newborn’s leg against a hard
surface such as the edge of a bassinet or table.
Response: lower leg moves perceptively if the reflex is
intact; test for spinal nerves L2 through L4
18. Biceps Reflex
Stimulus: biceps reflex is stimulated by placing the thumb
of your left hand on the tendon of the biceps muscles on
the inner surface of the elbow; tap the thumb as it rests on
the tendon.
Response: The tendon may be felt contracting rather than
being observed; test for spinal nerves C5 & C6

The newborn makes a few quick, lifting motions, as if to

step onto the table, because of the reflex

9. Plantar Grasp Reflex.

When an object touches the sole of the newborn’s foot at
the base of the toes, the toes grasp n the same manner
as the fingers do.

* it disappears by 9 mos. in preparation for walking

10. Tonic Neck Reflex/Boxer Reflex/Fencing Reflex .

In a supine position, the head is usually turned to 1 side;
the arm & the leg on the side toward which the head turns
extend , and the opposite arm & leg contracts.

Purpose: stimulates eye coordination since the extended

arm moves in front of the face.

*may signify handedness

nd rd
*disappears on the 2 to 3 months of life
The Senses- already developed at birth TASTE.
HEARING. -Newborns has the ability to discriminate taste, since

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-A newborn is able to hear even in utero tastebuds are developed & functioning even before birth

VISION.
-May have been seeing light & dark in utero for the last
few mos. of pregnancy as the as the uterus & abdominal
wall were stretched thin.
-demonstrates sight by blinking at a strong light or
following a bright light or toy a short distance with their
eyes; cannot follow past midline & lose track of objects
easily
-Newborn’s focus on black or white objects best at a
distance of 9 to 12 inches
- In utero, the fetus will swallow amniotic fluid more rapidly
if sweetened by glucose & less if bitter flavor is added.
SMELL.
-present in newborn’s as soon as the nose is clear of
mucus & amniotic fluid
- Newborn’s turn toward their mother’s breast partly
because of recognition of the smell of breast milk & partly
as a manifestation of the rooting reflex.

-pupillary reflex or the ability to contract the pupil is

present from birth

TOUCH.
-well developed at birth; demonstrated by quieting at a
soothing touch & by positive rooting & sucking reflex & by
reaction to painful stimuli.

PHYSIOLOGIC ADJUSTMENT TO EXTRAUTERINE LIFE

st
Periods of reactivity- periods of irregular adjustment in the 1 6 hours of life (Desmond)
st st
1. 1 Period of reactivity- 1 phase lasting for about 30 minutes; baby is alert & exhibits exploring, searching activity,
often making sounds; HR & RR are rapid

2. Next is a quiet, resting period- heart rate and respiratory rate are slow, the newborn typically sleeps for about 90
minutes.
nd nd th
3. 2 period of reactivity- between the 2 & 6 weeks of life, when the baby wakes, often gagging or choking on mucus
that accumulated in the mouth; alert & responsive to the environment.

 Periods of reactivity indicates that the Nb is healthy & adjusting well to the extrauterine life.

APPEARANCE OF A NEWBORN
SKIN Birthmarks
Color  HEMANGIOMA- vascular tumor of the skin
 Most have a ruddy complexion due to increased
circulation of RBC’s in blood vessels & decreased a. Nevus Flammeus- macular purple or dark-red lesion
subcutaneous fat (sometimes called port-wine stain) usually appearing on
 Pale & cyanotic- infants with poor CNS control the face or thighs
 Gray color- indicates infection
 Generalized mottling of the skin, bluish -those above the nose bridge tend to fade,
appearance of the lips, hands & feet is common -can be removed by laser therapy though they may
from immature peripheral circulation reappear

ACROCYANOSIS- blueness of hands & feet is normal in -Stork’s beak mark- lighter pink patches at the nape of the
st
the 1 24 to 48 hours after birth neck which do not fade
b. Strawberry Hemangiomas- elevated areas formed by
Central Cyanosis- or cyanosis of the trunk indicates immature capillaries & endothelial cells; some are present
decreased oxygenation at birth while some appear up to 2 weeks after birth
 Suction the mouth of a newborn(if the newborn
st
does not cry or cyanotic)1 before the nose,
st -associated with high Estrogen levels of pregnancy
because suctioning the nose 1 may trigger a

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 reflex gasp, possibly leading to aspiration if there
is mucus in the posterior throat -may increase in size up to 1 year of age, then they tend
to be absorbed & shrink in size; by 7 years old, 50% to
HYPERBILIRUBINEMI A- leads to jaundice & occurs on 75% have disappeared
nd rd
the 2 to the 3 day of life due to breakdown of fetal
RBC’s (PHYSIOLOGIC JAUNDICE) -hydrocortisone ointment may speed the disappearance of
the lesions
CEPHALHEMATOMA- collection of blood under the
periosteum of the skull bone; also causes release of
Indirect Bilirubin -surgery is rarely recommended because it may lead to
 Intestinal obstruction prevents evacuation of stool secondary infection
& intestinal flora breaks down bile into its basic
components leading to release of Indirect c. Cavernous hemangioma- dilated vascular spaces,
Bilirubin; early feeding of newborn promotes usually raised, resembling strawberry hemangiomas but
intestinal movement & excretion of meconium & do not disappear with time
helps prevent Indirect Bilirubin build up.
MONGOLIAN SPOTS- collections of pigment cells
 Treatment for physiologic jaundice is rarely (melanocytes) that appear as slate-gray patches across
necessary except for early feeding to speed the sacrum or buttocks & possibly n the arms or the legs
passage of stool
-common in Asians, S. Europeans, or Africans
 Some breast-fed babies may have more difficulty
converting IB because breast milk contains -disappear by school age
PREGNANEDIOL ( metabolite of progesterone)
which depresses action of glucoronyl transferase

PALLOR- usually the result of anemia caused by:

(1) excessive blood loss when the cord was cut
(2) Inadequate flow of blood from the cord to the infant at
birth
(3) fetal-maternal transfusion
(4) low iron stores due to poor maternal nutrition
(5) blood incompatibility

 HARLEQUIN SIGN- due to immature circulation,

a newborn lying on his or her side appears red on
the dependent side of the body & pale on the
upper side; transient only & fades with change of
position, kicking or crying vigorously

Vernix Caseosa HEAD

 White, cream cheese-like substance that serves
as a skin lubricant, noticeable on the skin of a
newborn
 Yellow vernix- due to bilirubin
 Newborn’s head is ¼ of the total body length; in
an adult, 1/8 of the total height
 The fore head is large & prominent, the chin
appears to recede & quivers easily.

 Green vernix- meconium staining Fontanelles

st
 Anterior fontanelle is found at the juncture of the
 Before the 1 bath, wear gloves when handling frontal & parietal bones; diamond-shaped,
the NB to prevent exposure to body fluids measures 2 to 3 cm in width & 3 to 4 cm in length

Lanugo  Anterior Fontanelle is felt as a soft spot, neither

 Fine, downy hair that covers the shoulders, back, indented nor bulging
upper arms, forehead & ears of the newborn
 Anterior Fontanelle normally closes at 12 to 18
 Post-mature infants rarely have lanugo months of age

 It is rubbed away by the friction of bedding &  Posterior fontanelle is found at the junction of the

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 clothes against the skin; by 2 weeks of age, it has
disappeared
Desquamation
 Within 24 h after birth, skin becomes extremely
dry especially on the palms & soles resulting to
areas of peeling similar to sunburn
 It usually needs no treatment
Milia
 Plugged or unopened sebaceous gland appearing
as pinpoint white papules appear on the cheeks
or across the bridge of the nose
 Disappear by 2 to 4 weeks of age as the
sebaceous glands mature & drain
 Teach parents to avoid squeezing or scratching to
prevent infection
Erythema Toxicum/ Flea-bite rash
st th
 Newborn rash usually appearing in the 1 to 4
day of life, some up to 2 weeks of age.
 It begins with a papule, increases in severity to
nd
become erythema by the 2 day & disappears by
rd
the 3 day
 It is caused by the newborn’s eosinophils reacting
to the environment as the immune system
matures.
 It requires no treatment
Forceps marks
 Circular or linear contusions matching the rim of
the forceps blades n the infant’s cheek;
disappears in 1 to 2 days along with the edema
 Closely asses the facial nerve to determine any
potential nerve compression
Skin Turgor
 Newborn skin should feel resilient if the
underlying tissue s well-hydrated
 If a fold of the skin is grasped between the thumb
& fingers, it should feel elastic; when released,
should fall back to form a smooth surface
 Poor turgor is seen in those who suffered severe
malnutrition in utero, those with difficulty sucking
at birth or those with metabolic disorders such as
adrenogenital syndrome
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parietal bones & the occipital bone; triangular in
shape & measures 1 cm in length
nd
 Posterior Fontanelle closes by the end of the 2
month
Sutures
 They are the separating lines of the skull and may
override during passage through the birth canal.
 Molding subsides in 24 to 48 hours
 Wide separation of suture lines suggest increased
ICP, hydrocephalus, subdural hemorrhage
 Fused suture lines prevent head from expanding
with growth
Molding
 Molding may be so extreme the head appears like
a dunce cap but shape will be restored in a few
days
Caput Succedaneum
 It is the edema of the scalp at the presenting part
of the head
 The edema crosses suture lines & is gradually
rd
absorbed & disappears about the 3 day of life &
requires no treatment
Cephalhematoma
 It is a collection of blood between the periosteum
of a skull bone & the bone itself
 It is caused by the rupture of periosteal capillaries
due to pressure at birth
 It usually appears 24 hours after birth
 The swelling is usually severe, well-outlined as an
egg shape; may be discolored (black & blue)
because of the presence of coagulated blood
 It is confined to an individual bone so the swelling
stops at the suture line
 It sometimes takes weeks for the
cephalhematoma to be reabsorbed
Craniotabes
 It is a localized softening of the cranial bones
caused by pressure of the fetal skull against the
mother’s pelvic bone in utero
st
 it is common in 1 -born infants because of the
lower position of the fetal head in the pelvis during
the last 2 weeks of pregnancy in the primiparous
women
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EYES
 Lacrimal ducts are not fully mature until 3 months
of age; therefore, crying is initially tearless
 Irises are gray or blue, sclera appears blue due to
its thinness; eyes assume permanent color
between 3 & 12 months of age
 Small subconjunctival hemorrhage sometimes
appears due to pressure during childbirth,
appearing as a red spot on the sclera usually in
the inner aspect of the eye or as a red ring around
the cornea
 Bleeding is slight, requires no treatment & is
completely absorbed within 2 to 3 weeks
st
 Edema around the orbit remains for the 1 2 to 3
days until the kidneys are capable of evacuating
fluid more efficiently
 White pupil suggests congenital cataract
MOUTH
 NB’s mouth should move evenly; otherwise,
check for cranial nerve injury
 EPSTEIN’S CYST- 1 or 2 small, round,
glistening, well-circumscribed cysts on the
palate, a result of the extra load of Calcium
deposited in utero; require no treatment &
disappear spontaneously within 1 week
 THRUSH- a Candida albicans infection
appearing as white or gray patches on the
tongue & sides of cheeks
 NATAL TEETH- evaluate for stability; all teeth
not covered by gum membrane should be
removed because they can loosen & may be
aspirated
NECK
 It is short, chubby, with creased skin folds & head
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 the skull is so soft that the pressure of the
examining finger can indent it; bone returns to its
normal shape after pressure is removed
 The condition resolves after a few months
EARS
 Pinna tends to bend easily but strong enough to
recoil
 The level of the top part of the external ear
should be on a line drawn from the inner canthus
to the outer canthus of the eye & back across the
side of the head; ears set lower are found in
infants with trisomy 18 & 13
 Skin tags in front of the ear may be associated
with kidney or chromosomal abnormalities or of
no reason at all; may be removed with ligation
when the child is 1-week old
 Preauricular dermal sinus appear as pinpoint-size
opening directly in front of the ear; may be
removed surgically when the child is near school
age
 Test hearing by ringing a bell held 6 in from each
ear; newborn blink, stop crying, be startled in
response.
NOSE
 Test for CHOANAL ATRESIA by closing the
mouth & compressing 1 naris at a time with the
fingers. Note any discomfort or distress with
breathing.
ABDOMEN
 It is normally slightly protuberant
 If scaphoid or sunken, it suggests missing
abdominal contents or diaphragmatic hernia
 Bowel sounds should be present within 1 hour
after birth
 Edge of the liver is usually palpable 1 to 2 cm
below the right costal margin; the spleen 1 to 2 cm
below the left costal margin
 After cord cutting, count the cord (AVA); 1 artery is
associated with a congenital heart or renal
abnormality
st
 After the 1 hour, umbilical stump begins to dry &
nd rd
shrink, turning brown; 2 to 3 day, black
 Stump falls off by day 6 to 10 leaving a
granulating area that heals in 1 week
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 should rotate freely
 CONGENITAL TORTICOLLIS- caused by injury
to the sternocleidomastoid muscle during birth
manifested by rigidity of the neck
 In newborn’s whose membranes were ruptured >
24h before birth, nuchal rigidity suggests
meningitis
 Thymus gland will triple in size by 3 yrs of age &
remains the same size till 10yo then shrinks
CHEST
 When 2 years old, the chest measurement will
exceed that of the head
 WITCH’S MILK- breasts secrete a thin, watery
fluid as an influence of the mother’s hormones but
these hormones clear in about 1 week
 Chest circumference is approximately 2 inches
smaller than the head
 RR- 30 to 60 breaths per minute
 SUPERNUMERARY NIPPLES- extra nipples
usually found below & in line with the normal
nipple
 Grunting suggests respiratory distress syndrome
 A high crowing sound on inspiration suggests
stridor or immature tracheal development
ANOGENITAL AREA
 Anal patency is tested by gently inserting the tip
of the little finger, gloved & lubricated
st
 If newborn does not pass meconium within the 1
24 hours, suspect meconium ileus or imperforate
anus
Male Genitalia
 The scrotum is edematous & has rugae, deeply
pigmented in dark-skinned newborn’s
 If 1 or both testicles are missing, suspect
cryptorchidism; may be caused by agenesis,
ectopic testes (testes cannot enter closed scrotal
sac) or undescended testes (vas deferens or
artery is too short to allow testes to descend)
 CREMASTERIC REFLEX- elicited by stroking the
internal side of the thigh causing the testis on that
side to move up upward (absent in NB’s < 10
days old)
 The penis appears small, approximately 2 cm
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Education (Department of Nursing)
 Moist or odorous cord suggests infection; treat to
prevent septicemia
 PATENT URACHUS- a canal that connects the
bladder to the umbilicus as manifested by
moistness at the base of the cord caused by urine
flow
 Check for umbilical hernia; if < 2 cm, it closes on
its own by school age
 Newborn kidneys are the size of a walnut; right
kidney is lower than the left
 ABDOMINAL REFLEX- stroke each quadrant of
the abdomen to cause the umbilicus to wink in
th
that direction (not demonstrable before the 10
day of life)
BACK
 Spine appears flat in the lumbar & sacral areas;
curves appear only after the child is able to sit &
walk
 SPINA BIFIDA OCCULTA or DERMAL SINUS-
pinpoint opening, dimpling or sinus tract in the
skin
 NB typically assumes its position in utero
EXTREMITIES
 Arms & legs appear short, hands are plump
 Fingernails are soft & smooth, sometimes extend
over the fingertips
 Test upper extremities for muscle tone by
unflexing the arm for 5 seconds. If tone is good,
arm immediately returns to its flexed position.
 When the arms are at the sides, the fingertips
should cover the proximal thigh; unusually short
arms may signify ACHONDROPLASTIC
DWARFISM
 SIMIAN CREASE- a single crease on the palm
(normally 3 creases) plus unusual curvature of the
little finger are associated with Down syndrome
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 long
EPISPADIAS- urethral opening is at the dorsal side
HYPOSPADIAS- urethral opening is at the ventral side
 Circumcision should not be done if epispadias or
hypospadias is present (foreskin may be used in
the repair)
Female Genitalia
 Vulva may be swollen due to maternal hormones
 PSEUDOMENSTRUATION- mucus vaginal
secretion, sometimes blood-tinged
 If arm hangs limp or is unmoving, it suggests birth
injury (to a clavicle, brachial or cervical plexus or
fracture of a long bone)
 SYNDACTYLY- webbing of fingers or toes
 POLYDACTYLY- extra digits
 Soles of the feet are covered approximately 2/3 by
creases; if less, suspect immaturity
 In a supine position, both hips can flexed &
abducted (180°) that the knees touch or nearly
touch the surface of the bed
 If hip joint locks 160 to 170°, hip subluxation
(shallow, poorly-formed acetabulum) is suggested
 Hold the infant’s leg with fingers on the greater &
lesser trochanters then abduct the hip; if
subluxation is present, a “clunk” of the femur head
striking the shallow acetabulum CAN BE HEARD
(ORTOLANI’S SIGN).
 If the hip can be felt slipping from the socket, this
is BARLOW’S SIGN

CHECK FOR UNDERSTANDING (25 minutes)

You will answer and rationalize this by pair. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.

Multiple Choice

1. Which of the following would the nurse identify as a goal of newborn care in the postpartum period?
A. To facilitate development of a close parent-newborn relationship
B. To assist parents in developing healthy attitudes about childbearing practices
C. To identify actual or potential problems requiring immediate or emergency attention
D. To provide the parents of the newborn with information about well-baby programs
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________ _______________________

2. After birth, which of the following structures receives blood only from the left ventricle?
A. Aorta
B. Inferior vena cava
C. Pulmonary arteries
D. Ductus arteriosus
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________ _______________________

3. When assessing the newborn’s heart rate, which of the following would be considered normal if the baby were
sleeping?
A. 80 bpm
B. 100 bpm
C. 120 bpm
D. 140 bpm
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________ _______________________

4. The initial respirations of the newborn are a result from which of the following?
A. A rise in temperature

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Education (Department of Nursing) 11 of 14
 B. A change in pressure gradients
C. Increased blood pH
D. Decreased blood CO2 level
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________ _______________________

5.Which of the following would the nurse identify as correct about the newborn’s immune system?
A. The risk of infection in the newborn is relatively low
B. Phagocytosis occurs fairly rapidly in the newborn
C. The newborn is unable to limit the invading organisms at their point of entry.
D. Immunoglobulin A is present in their GI and respiratory tract.
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________

6. Which of the following is true regarding the fontanels of the newborn?

A. The anterior is triangle-shaped, the posterior is diamond-shaped
B. The posterior closes at 18 months, the anterior closes at 8 to 12 weeks
C. The anterior is larger in size when compared to the posterior.
D. The anterior is bulging and the posterior is sunken
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________

7. The first period of reactivity begins at birth. Which of the following is characteristic of this period?
A. This period lasts about 30 minutes
B. The infant is asleep.
C. A poor suck is present.
D. Respirations may be increased to 110cpm
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________

8. Which of the following groups of reflexes are present at birth and remains unchanged through adulthood?
A. Blink, cough, rooting and gag
B. Blink, cough, sneeze and gag
C. Rooting, sneeze, swallowing and cough
D. Stepping, blink, cough and sneeze
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________ _______________________

9. Which of the following when present in the urine may cause a reddish stain on the diaper of a newborn?
A. Mucus
B. Uric acid crystals
C. Bilirubin
D. Excess iron
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________ _______________________

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Education (Department of Nursing) 12 of 14
10. Before birth, which of the following structures connects the left and right atria of the heart?
A. Umbilical vein
B. Foramen ovale
C. Ductus arteriosus
D. Ductus venosus
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________ _______________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________ ________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
7. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
8. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
9. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
10. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________ ________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

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Education (Department of Nursing) 13 of 14
You are done with the session! Let’s track your progress.

Period 1 Period 2 Period 3

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

AL STRATEGY: CAT 3-2-1

This closure activity is to evaluate what you had learned after the discussion and the activity .

3-2-1
Three things you learned:
1. __________________________________________________
2. __________________________________________________
3. __________________________________________________

Two things that you’d like to learn more about:

1. __________________________________________________
2. __________________________________________________

One question you still have:

1. ___________________________________________

For next session: Kindly read Chapter 28: Principle of Growth and Development p.755

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Education (Department of Nursing) 14 of 14