S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 1 © K. Karlsen 2006 Kristine A. Karlsen MSN, RNC, NNP Author National Program Director, Founder The S.T.A.B.L.E. Program Park City, Utah stable@stableprogram.org Kristine A. Karlsen Kristine A. Karlsen MSN, RNC, NNP MSN, RNC, NNP Author Author National Program Director, Founder National Program Director, Founder The S.T.A.B.L.E. Program The S.T.A.B.L.E. Program Park City, Utah Park City, Utah stable@stableprogram.org stable@stableprogram.org PowerPoint ® Design Mary Puchalski MS, RNC, APN/CNS Lombard, Illinois mary@stableprogram.org Medical Illustrations Marilou Kundmueller RN, BSN, MA PowerPoint PowerPoint ® ® Design Design Mary Puchalski Mary Puchalski MS, RNC, APN/CNS MS, RNC, APN/CNS Lombard, Illinois Lombard, Illinois mary@stableprogram.org mary@stableprogram.org Medical Illustrations Medical Illustrations Marilou Kundmueller Marilou Kundmueller RN, BSN, MA RN, BSN, MA Physical and Gestational Age Assessment of the Newborn Physical and Gestational Age Physical and Gestational Age Assessment of the Newborn Assessment of the Newborn © K. Karlsen 2006 Principles of Physical Exam Principles of Physical Exam Review history Review history Prenatal Prenatal Labor/delivery Labor/delivery Presentation of illness Presentation of illness Use Use Consistent Consistent Organized Organized Gentle approach Gentle approach © K. Karlsen 2006 Wash hands, wear gloves Wash hands, wear gloves Use clean equipment Use clean equipment Keep infant warm Keep infant warm Perform while infant in quiet Perform while infant in quiet state whenever possible state whenever possible Shield infant Shield infant ’ ’ s eyes from s eyes from exam light exam light Comfort infant during and Comfort infant during and after exam after exam Change soiled diapers / redress following exam Change soiled diapers / redress following exam Principles of Physical Exam Principles of Physical Exam © K. Karlsen 2006 Principles of Physical Exam Principles of Physical Exam Observe before touching Observe before touching Auscultation before Auscultation before palpation palpation – – in quiet in quiet environment environment Gentle palpation Gentle palpation Avoid if acute abdomen Avoid if acute abdomen Extra care with Extra care with premature infants premature infants © K. Karlsen 2006 Infant Size Infant Size Measurement Measurement Weight Weight Length Length Head circumference Head circumference Appropriate size for age (AGA) Appropriate size for age (AGA) Well Well - - nourished appearance nourished appearance © K. Karlsen 2006 Infant Size Infant Size Small for gestational age (SGA) Small for gestational age (SGA) Weight less than10 Weight less than10 th th percentile for gestational age percentile for gestational age Symmetric Symmetric Asymmetric Asymmetric Appropriate size for age (AGA) Appropriate size for age (AGA) Large for gestational age (LGA) Large for gestational age (LGA) Weight greater than 90 Weight greater than 90 th th percentile for gestational age percentile for gestational age S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 2 © K. Karlsen 2006 Infant Size Infant Size Use Ballard exam to Use Ballard exam to assess gestational age assess gestational age Gestational age assessment Gestational Gestational age assessment age assessment © K. Karlsen 2006 Infant Size Infant Size © © David A. Clark MD David A. Clark MD Discordant twins Discordant twins Discordant twins © K. Karlsen 2006 Neurological Status Neurological Status Normal Normal Active, alert, good tone, moderate Active, alert, good tone, moderate flexion, symmetric strength flexion, symmetric strength and movement and movement Strong, symmetric cry Strong, symmetric cry © K. Karlsen 2006 Neurological Status Neurological Status Normal reflexes in term infant Normal reflexes in term infant Root and suck Root and suck © K. Karlsen 2006 Neurological Status Neurological Status Normal reflexes in term infant Normal reflexes in term infant Root and suck Root and suck Moro Moro   arms extend, abduct, hands open arms extend, abduct, hands open , followed by , followed by flexion of arms and closing of hands flexion of arms and closing of hands © K. Karlsen 2006 Neurological Status Neurological Status Normal reflexes in term infant Normal reflexes in term infant Root and suck Root and suck Moro Moro   arms extend, abduct, hands open arms extend, abduct, hands open , followed by , followed by flexion of arms and closing of hands flexion of arms and closing of hands Palmar and plantar grasp Palmar and plantar grasp S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 3 © K. Karlsen 2006 Neurological Status Neurological Status Normal reflexes in term infant Normal reflexes in term infant Root and suck Root and suck Moro Moro   arms extend, abduct, hands open arms extend, abduct, hands open , followed by , followed by flexion of arms and closing of hands flexion of arms and closing of hands Palmar and plantar grasp Palmar and plantar grasp Babinski Babinski   extension or flexion of toes after stimulating extension or flexion of toes after stimulating sole of foot sole of foot © K. Karlsen 2006 Neurological Status Neurological Status Normal reflexes in term infant Normal reflexes in term infant Root and suck Root and suck Moro Moro   arms extend, abduct, hands open arms extend, abduct, hands open , followed by , followed by flexion of arms and closing of hands flexion of arms and closing of hands Palmar and plantar grasp Palmar and plantar grasp Babinski Babinski   extension or flexion of toes after stimulating extension or flexion of toes after stimulating sole of foot sole of foot Tonic neck (fencing position) Tonic neck (fencing position) Truncal incurvation (Galant reflex) Truncal incurvation (Galant reflex)   pelvis moves toward pelvis moves toward side of stimulus side of stimulus © K. Karlsen 2006 Neurological Status Neurological Status Abnormal Abnormal Weak suck or poor feeding Weak suck or poor feeding pattern pattern Weak cry Weak cry Distressed facies Distressed facies Lethargy / hypotonia Lethargy / hypotonia Hyperreflexia Hyperreflexia / hypertonia / hypertonia Decreased or absent reflexes Decreased or absent reflexes Irritability Irritability Seizures Seizures Coma Coma © K. Karlsen 2006 Head Head Size Size Indication of normal brain growth Indication of normal brain growth Record largest measurement Record largest measurement Above ear and eyebrow ridges Above ear and eyebrow ridges Occipitofrontal circumference Occipitofrontal circumference (OFC) (OFC) Varies with molding and Varies with molding and scalp swelling scalp swelling © K. Karlsen 2006 Head Head Sutures Sutures Approximated Approximated Overlapping Overlapping Wide Wide - - spaced spaced Mobility Mobility Occipital bone Occipital Occipital bone bone Sagittal suture Sagittal Sagittal suture suture Posterior Posterior fontanel fontanel Lambdoidal suture Lambdoidal Lambdoidal suture suture Frontal bone Frontal Frontal bone bone Coronal suture Coronal Coronal suture suture Anterior fontanel Anterior Anterior fontanel fontanel Parietal bone Parietal Parietal bone bone Metopic suture Metopic Metopic suture suture Squamosal suture Squamosal Squamosal suture suture © K. Karlsen 2006 Head Head Shape Shape Molding Molding Symmetric Symmetric Asymmetric Asymmetric Size of fontanels Size of fontanels Anterior Anterior Posterior Posterior Scalp swellings Scalp swellings Location Location Characteristics Characteristics © © David A. Clark MD David A. Clark MD S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 4 © K. Karlsen 2006 Skull bone S S kin C C onnective tissue (CT) A A poneurosis (galea) L L oose CT (subgaleal) P P eriosteum Superior sagittal sinus – drains blood from scalp back to heart Superior sagittal sinus Superior sagittal sinus – – drains blood from drains blood from scalp back to heart scalp back to heart  Scalp Anatomy  Scalp Anatomy Head Head © K. Karlsen 2006 Caput Succedaneum Caput Succedaneum Subgaleal Hemorrhage Subgaleal Hemorrhage Cephalohematoma Cephalohematoma Head Head  Scalp Swellings  Scalp Swellings © K. Karlsen 2006 Emissary Emissary vein vein Superior Superior sagittal sinus sagittal sinus DurationBlood lossPalpationLocation Resolves in 48 – 72 hours MinimalSoft and spongy Pits on pressure Edema of presenting part of scalp – usually crosses suture lines – shifts with positioning Accumulation of serosanguineous fluid in subcutaneous tissues of scalp Accumulation of Accumulation of serosanguineous serosanguineous fluid in fluid in subcutaneous subcutaneous tissues of scalp tissues of scalp Head Head  Caput Succedaneum  Caput Succedaneum © K. Karlsen 2006 Head Head  Caput Succedaneum  Caput Succedaneum Vacuum edema Vacuum edema Vacuum edema © K. Karlsen 2006 DurationBlood lossPalpationLocation Resolves in 2 weeks to 3 months Rarely severe X-ray if skull fracture suspected Initially firm More fluctuant after 48 hrs Stops at sutures Parietal and occipital bones May be bilateral Emissary vein Superior sagittal sinus Blood accumulation between skull bone and periosteum Blood Blood accumulation accumulation between skull bone between skull bone and periosteum and periosteum Emissary Emissary vein vein Superior Superior sagittal sinus sagittal sinus  Cephalohematoma  Cephalohematoma Head Head © K. Karlsen 2006  Cephalohematoma  Cephalohematoma Head Head © © David A. Clark MD David A. Clark MD S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 5 © K. Karlsen 2006 DurationBlood lossPalpationLocation Resolves over 2 – 3 wks High morbidity & mortality May lead to severe anemia and hypovolemic shock Firm to fluctuant – “boggy” Dependent swelling Crosses suture lines – may extend from eyes to nape of neck Rupture of emissary veins  subtle but massive hemorrhage! Rupture of emissary Rupture of emissary veins veins   subtle but subtle but massive hemorrhage! massive hemorrhage! Superior Superior sagittal sinus sagittal sinus Subgaleal space – holds up to 240 ml of blood – potentially entire blood volume Subgaleal space Subgaleal space – – holds up to 240 ml holds up to 240 ml of blood of blood – – potentially entire potentially entire blood volume blood volume  Subgaleal Hemorrhage  Subgaleal Hemorrhage Head Head © K. Karlsen 2006 DurationBlood lossPalpationLocation Resolves over 2 – 3 wks High morbidity & mortality May lead to severe anemia and hypovolemic shock Firm to fluctuant – “boggy” Dependent swelling Crosses suture lines – may extend from eyes to nape of neck  Subgaleal Hemorrhage  Subgaleal Hemorrhage Head Head © K. Karlsen 2006 Video courtesy of Swiss Video courtesy of Swiss Society Society of Neonatology of Neonatology Infant with subgaleal hemorrhage Infant with subgaleal hemorrhage Note area of hemorrhage Note area of hemorrhage Note area of hemorrhage Anterior Note fluid waves, tachypnea and retractions Note fluid waves, Note fluid waves, tachypnea and retractions tachypnea and retractions  Subgaleal Hemorrhage  Subgaleal Hemorrhage Head Head Monitoring guidelines Monitoring guidelines Monitoring guidelines © K. Karlsen 2006 Head Head Craniosynostosis Craniosynostosis Craniosynostosis © © David A. Clark MD David A. Clark MD © © David A. Clark MD David A. Clark MD  Abnormal Findings  Abnormal Findings Apert syndrome Apert syndrome Crouzon syndrome Crouzon syndrome © K. Karlsen 2006 Congenital hydrocephalus Congenital Congenital hydrocephalus hydrocephalus © © David A. Clark MD David A. Clark MD Head Head  Abnormal Findings  Abnormal Findings © K. Karlsen 2006 Macrocephaly Macrocephaly Macrocephaly © © Jack Dolcourt MD Jack Dolcourt MD © © Jack Dolcourt MD Jack Dolcourt MD Microcephaly Microcephaly Microcephaly © © David A. Clark MD David A. Clark MD © © David A. Clark MD David A. Clark MD 4 P syndrome 4 P syndrome Head Head  Abnormal Findings  Abnormal Findings Holoprosencephaly Holoprosencephaly S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 6 © K. Karlsen 2006 Scalp electrode Scalp electrode Scalp electrode Head Head  Scalp Injuries  Scalp Injuries © K. Karlsen 2006 Head Head  Scalp Abnormalities  Scalp Abnormalities Cutis aplasia Cutis aplasia Cutis aplasia © © David A. Clark MD David A. Clark MD © K. Karlsen 2006 Abnormally placed whorl Abnormally placed whorl Abnormally placed whorl Hair  Abnormal Findings Hair  Abnormal Findings Low hairline Low hairline Low hairline © © David A. Clark MD David A. Clark MD Trisomy 21 Trisomy 21 © K. Karlsen 2006 Congenital absence of hair growth – bald patch Congenital absence of Congenital absence of hair growth hair growth – – bald patch bald patch © © David A. Clark MD David A. Clark MD © © David A. Clark MD David A. Clark MD Alopecia Alopecia Alopecia Hair  Abnormal Findings Hair  Abnormal Findings © K. Karlsen 2006 Long lashes, low hairline Long lashes, low hairline Long lashes, low hairline © © David A. Clark MD David A. Clark MD Hair  Abnormal Findings Hair  Abnormal Findings Cornelia de Lange syndrome Cornelia de Lange syndrome © K. Karlsen 2006 Face Face Symmetry Symmetry Features Features Symmetric facies Symmetric facies Symmetric facies S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 7 © K. Karlsen 2006 Face Face  Normal Findings  Normal Findings Milia Milia Milia Milia Milia Birthmarks Birthmarks Nevus simplex ( Nevus simplex ( ‘ ‘ stork bite stork bite ’ ’ ) ) Nevus flammeus (eyelids) Nevus flammeus (eyelids) Telangiectatic nevus ( Telangiectatic nevus ( ‘ ‘ salmon patch salmon patch ’ ’ ) ) © K. Karlsen 2006 Face Face © © David A. Clark MD David A. Clark MD Moebius syndrome Moebius syndrome Prominent telangiectasia Prominent telangiectasia Prominent telangiectasia Goltz syndrome Goltz syndrome Congenital facial paralysis (6 th and 7 th cranial nerves) Congenital facial paralysis Congenital facial paralysis (6 (6 th th and 7 and 7 th th cranial nerves) cranial nerves)  Abnormal Findings  Abnormal Findings © K. Karlsen 2006 Face Face Fetal Alcohol Syndrome Fetal Alcohol Syndrome Flattened midface Flattened midface Broad nasal bridge Broad nasal bridge Short, up Short, up - - turned nose turned nose Smooth, long philtrum Smooth, long philtrum Thin upper lip Thin upper lip Hypoplastic maxilla Hypoplastic maxilla Philtrum Philtrum  Abnormal Findings  Abnormal Findings © © David A. Clark MD David A. Clark MD © K. Karlsen 2006 Trisomy 21 Trisomy 21 Short round head Short round head Flat facial profile Flat facial profile Epicanthal folds Epicanthal folds Brushfield Brushfield ’ ’ s spots s spots Up Up - - slanting palpebral fissures slanting palpebral fissures Short, flat nasal bridge Short, flat nasal bridge Protruding tongue Protruding tongue Short, narrow palate Short, narrow palate Small, low Small, low - - set ears set ears Short neck, Short neck, excess nuchal folds excess nuchal folds © © Jack Dolcourt MD Jack Dolcourt MD Face Face  Abnormal Findings  Abnormal Findings © K. Karlsen 2006 Trisomy 18 Trisomy 18 Prominent occiput Prominent occiput Triangular facies Triangular facies Small palpebral fissures Small palpebral fissures Ptosis Ptosis Pinched appearance of nose Pinched appearance of nose Low Low - - set, malformed ears set, malformed ears Micrognathia Micrognathia Small mouth Small mouth © © Jack Dolcourt MD Jack Dolcourt MD Face Face  Abnormal Findings  Abnormal Findings © K. Karlsen 2006 Trisomy 13 Trisomy 13 Microcephaly, sloping forehead Microcephaly, sloping forehead Wide sagittal sutures and fontanels Wide sagittal sutures and fontanels Holoprosencephaly Holoprosencephaly Central facial anomalies, midface hypoplasia Central facial anomalies, midface hypoplasia Anophthalmia, microphthalmia, Anophthalmia, microphthalmia, hypotelorism hypotelorism Cataracts, coloboma of iris Cataracts, coloboma of iris Broad, bulbous nose Broad, bulbous nose Cleft lip, palate Cleft lip, palate Low Low - - set, malformed ears set, malformed ears Scalp defects Scalp defects   cutis aplasia cutis aplasia Face Face  Abnormal Findings  Abnormal Findings Microphthalmia Microphthalmia Microphthalmia Anophthalmia, holoprosencephaly Anophthalmia, Anophthalmia, holoprosencephaly holoprosencephaly S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 8 © K. Karlsen 2006 Face Face  Injury  Injury Asymmetric facies following forceps assist delivery Asymmetric facies Asymmetric facies following forceps following forceps assist delivery assist delivery Location Location Extent of injury Extent of injury Eye involvement Eye involvement   ophthalmology ophthalmology evaluation evaluation Assess for symmetry when crying Assess for symmetry when crying Asymmetry Asymmetry   nerve injury nerve injury © K. Karlsen 2006 Face Face Forceps marks Forceps marks Forceps marks  Injury  Injury © K. Karlsen 2006 Face Face Bruising Bruising   face presentation face presentation  Injury  Injury © © David A. Clark MD David A. Clark MD © K. Karlsen 2006 Eyes  Position and Size Eyes  Position and Size Normal eye spacing Normal eye spacing   inner canthal distance inner canthal distance = palpebral fissure length = palpebral fissure length Outer canthal distance Outer canthal distance Outer canthal distance Palpebral fissure length (size of eye) Palpebral fissure length (size of eye) Palpebral fissure length (size of eye) Interpupillary distance Interpupillary distance Interpupillary distance Inner canthal distance Inner canthal distance Inner canthal distance © K. Karlsen 2006 Eyes Eyes Hypertelorism Hypertelorism Hypertelorism Microphthalmia Microphthalmia Microphthalmia Epicanthal folds Epicanthal folds Epicanthal folds Trisomy 21 Trisomy 21 Upward-slanting palpebral fissures Upward Upward - - slanting slanting palpebral fissures palpebral fissures © © David A. Clark MD David A. Clark MD Rubinstein Rubinstein - - Taybi syndrome Taybi syndrome Strabismus Strabismus Strabismus © © David A. Clark MD David A. Clark MD  Abnormal Findings  Abnormal Findings © K. Karlsen 2006 Eyes Eyes © © Jack Dolcourt MD Jack Dolcourt MD © © Jack Dolcourt MD Jack Dolcourt MD © © Jack Dolcourt MD Jack Dolcourt MD Brushfield spots Brushfield spots Brushfield spots  Abnormal Findings  Abnormal Findings © © David A. Clark MD David A. Clark MD Sclerocornea Sclerocornea Sclerocornea Congenital cataracts Congenital cataracts Congenital cataracts S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 9 © K. Karlsen 2006 Eyes Eyes  Abnormal Findings  Abnormal Findings © © David A. Clark MD David A. Clark MD Blocked lacrimal duct Blocked lacrimal duct Blocked lacrimal duct © © David A. Clark MD David A. Clark MD Epibulbar dermoid cyst Epibulbar dermoid cyst Epibulbar dermoid cyst Coloboma Coloboma Coloboma Goldenhar syndrome Goldenhar syndrome © K. Karlsen 2006 Ears Ears Helix Helix Helix Triangular fossa Triangular Triangular fossa fossa Tragus Tragus Tragus Lobule Lobule Lobule Antitragus Antitragus Antitragus Antihelix Antihelix Antihelix Concha Concha Concha © K. Karlsen 2006 Ears Ears Normal Normal Normal Low set Low set Low set  Position  Position © © David A. Clark MD David A. Clark MD © K. Karlsen 2006 Ears Ears Ear pits Ear pits Ear pits  Minor Anomalies  Minor Anomalies Preauricular skin tags Preauricular skin tags Preauricular skin tags © K. Karlsen 2006 Ears Ears Extra creases Extra creases Extra creases  Abnormal Findings  Abnormal Findings © © Jack Dolcourt MD Jack Dolcourt MD © © David A. Clark MD David A. Clark MD Goldenhar syndrome Goldenhar syndrome Treacher Collins syndrome Treacher Collins syndrome Beckwith Beckwith - - Wiedemann Wiedemann syndrome syndrome Trisomy 13 Trisomy 13 © K. Karlsen 2006 Area of Area of obstruction obstruction Nose Nose Choanal Atresia Choanal Atresia One or both nares obstructed One or both nares obstructed Cyanotic at rest but Cyanotic at rest but ‘ ‘ pinks up pinks up ’ ’ with crying with crying If bilateral, may need If bilateral, may need oral airway or oral airway or endotracheal intubation endotracheal intubation Oral airway sizes Oral airway sizes 00 00 – – small infants small infants 0 0 – – term or large term or large infants infants S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 2006. Handout reproducible for eduational purposes. 10 © K. Karlsen 2006 Mouth Mouth Lips Lips Gums Gums Cheeks Cheeks Tongue Tongue Palate Palate – – hard, soft hard, soft © © Jack Dolcourt MD Jack Dolcourt MD Short frenulum Short frenulum Short frenulum Cleft soft palate Cleft soft palate Cleft soft palate Natal teeth Natal teeth Natal teeth Macroglossia Macroglossia Macroglossia © K. Karlsen 2006 © © David A. Clark MD David A. Clark MD Micrognathia Micrognathia Micrognathia Mobius Mobius syndrome syndrome Treacher Collins syndrome Treacher Collins syndrome and Chin  Abnormal Findings and Chin  Abnormal Findings Mouth Mouth © K. Karlsen 2006 Pierre Pierre - - Robin Sequence Robin Sequence Very small jaw Very small jaw Tongue obstructs airway Tongue obstructs airway May have cleft palate May have cleft palate © © Jack Dolcourt MD Jack Dolcourt MD © © Jack Dolcourt MD Jack Dolcourt MD Cleft palate Cleft palate Cleft palate Stabilization Stabilization Stabilization and Chin  Abnormal Findings and Chin  Abnormal Findings Mouth Mouth © K. Karlsen 2006 Neck  Abnormal Findings Neck  Abnormal Findings Short Short Nuchal thickening Nuchal thickening Webbing Webbing Torticollis Torticollis Masses Masses © © Jack Dolcourt MD Jack Dolcourt MD © © David A. Clark MD David A. Clark MD © K. Karlsen 2006 Neck  Abnormal Findings Neck  Abnormal Findings Cystic hygroma  soft, fluctuant, transilluminates Cystic hygroma Cystic hygroma   soft, fluctuant, transilluminates soft, fluctuant, transilluminates © K. Karlsen 2006 Short sternum Short sternum Short sternum © © David A. Clark MD David A. Clark MD Shape Shape Broad Broad Narrow Narrow Bell shaped Bell shaped Short Short Chest  Abnormal Findings Chest  Abnormal Findings Broad chest and wide spaced nipples Broad chest and wide Broad chest and wide spaced nipples spaced nipples © © David A. Clark MD David A. Clark MD Turner syndrome Turner syndrome [...]... Substernal – under the sternum © K Karlsen 20 06 (c) Kristine A Karlsen 20 06 Handout reproducible for eduational purposes CDH Stabilization CDH Stabilization © K Karlsen 20 06 11 S.T.A.B.L.E - Physical Assessment Chest and Airway Abdomen  Abnormal Findings Appearance  scaphoid, distended, visible loops Color  erythema, bluish discoloration Bowel sounds  hypo or hyperactive Palpation  firm, tender Tracheoesophageal... Normal abdomen Normal abdomen © K Karlsen 20 06 © Jack Dolcourt MD (c) Kristine A Karlsen 20 06 Handout reproducible for eduational purposes © K Karlsen 20 06 12 S.T.A.B.L.E - Physical Assessment Abdomen  Abnormal Findings Abdomen  Abnormal Findings Appearance  scaphoid, distended, visible loops Color  erythema, bluish discoloration Bowel sounds  hypo or hyperactive Palpation  firm, tender, masses... K Karlsen 20 06 Compare upper Compare upper to lower body to lower body © K Karlsen 20 06 Skin Color  Abnormal Findings AAP hyperbilirubinemia and AAP hyperbilirubinemia and phototherapy nomograms phototherapy nomograms Jaundice Jaundice Skin Perfusion  Abnormal Findings Prolonged capillary refill time Pallor Cool extremities Mottling  abnormal if associated with other signs of poor perfusion Skin... musculoskeletal, central nervous system anomalies central nervous system anomalies Peritoneal sac protects Peritoneal sac protects herniated organs herniated organs Stabilization guidelines Stabilization guidelines © K Karlsen 20 06 (c) Kristine A Karlsen 20 06 Handout reproducible for eduational purposes © K Karlsen 20 06 13 S.T.A.B.L.E - Physical Assessment Abdomen  Abnormal Findings Abdomen  Abnormal Findings Gastroschisis... reduced hemoglobin Cutis marmorata Bluish marbling / mottling © K Karlsen 20 06 (c) Kristine A Karlsen 20 06 Handout reproducible for eduational purposes Caused by dilation of capillaries and venules in response to chilling or stress Persistent cutis marmorata with some trisomies or syndromes © K Karlsen 20 06 16 S.T.A.B.L.E - Physical Assessment Skin  Non-pathologic Findings Skin  Non-pathologic Findings... 20 06 © K Karlsen 20 06 Spine  Abnormal Findings Lipomeningocele Lipomeningocele © David A Clark MD Skin Color  Abnormal Findings Pallor Anemia © David A Clark MD © David A Clark MD Sacral dimple Sacral dimple Cutis aplasia Cutis aplasia © K Karlsen 20 06 (c) Kristine A Karlsen 20 06 Handout reproducible for eduational purposes Twin-to-twin transfusion Twin- toTwin-to-twin transfusion © K Karlsen 20 06. .. 20 06 Skin  Non-pathologic Findings © David A Clark MD Skin  Abnormal Findings Staphylococcal scalded skin Staphylococcal scalded skin © Jack Dolcourt MD Harlequin sign Harlequin sign © David A Clark MD Mongolian spots Mongolian spots Sucking blisters Sucking blisters © K Karlsen 20 06 (c) Kristine A Karlsen 20 06 Handout reproducible for eduational purposes © K Karlsen 20 06 17 S.T.A.B.L.E - Physical Assessment. .. © David A Clark MD © K Karlsen 20 06 Skin  Abnormal Findings © K Karlsen 20 06 © David A Clark MD Extremities  Fractures Humerus Humerus Congenital herpes lesions Congenital herpes lesions Femur Femur © David A Clark MD © K Karlsen 20 06 Skin  Abnormal Findings © K Karlsen 20 06 Extremities  Abnormal Findings Edema Edema © K Karlsen 20 06 (c) Kristine A Karlsen 20 06 Handout reproducible for eduational... Hypoplastic nails © K Karlsen 20 06 © K Karlsen 20 06 Extremities  Trisomy 13 Genitalia  Male Tapered, thin fingers Tapered, thin fingers Polydactyly Polydactyly © David A Clark MD Absent right testicle Absent right testicle © David A Clark MD Testicular torsion Testicular torsion © David A Clark MD Rocker-bottom feet RockerRocker-bottom feet © K Karlsen 20 06 (c) Kristine A Karlsen 20 06 Handout reproducible for...  firm, tender Tracheoesophageal fistula Type A 8% Type B 1% Type C 86% Type D 1% Type E 4% Congenital diaphragmatic hernia © K Karlsen 20 06 © K Karlsen 20 06 Chest and Airway © Jack Dolcourt MD Abdomen  Abnormal Findings Appearance  scaphoid, distended, visible loops Color  erythema, bluish discoloration Bowel sounds  hypo or hyperactive Palpation  firm, tender, masses Tracheoesophageal fistula . Abnormal Findings S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 20 06. Handout reproducible for eduational purposes. 16 © K. Karlsen 20 06 Skin Color Skin Color Plethora Plethora Polycythemia Polycythemia Normal. Stabilization S.T.A.B.L.E. - Physical Assessment (c) Kristine A. Karlsen 20 06. Handout reproducible for eduational purposes. 12 © K. Karlsen 20 06 Type A 8% Type A 8% Type B 1% Type B 1% Type C 86% Type C 86% Type. BSN, MA Physical and Gestational Age Assessment of the Newborn Physical and Gestational Age Physical and Gestational Age Assessment of the Newborn Assessment of the Newborn © K. Karlsen 20 06 Principles