00:01
Now, we're ready to talk about
the head to toe assessment.
00:04
We're going to move in a
cephalocaudal progression
so that we don't leave
anything out.
00:09
Let's begin with the head.
00:11
When we look at the head,
we want to observe the shape.
00:15
And we also want to make sure
that the eyes, the naris, the lips
are all evenly lined up.
00:20
If there are any abnormalities
in alignment
that may indicate that
there is some sort of neurologic
or other type of complication
that exists.
00:30
The nurse should also
observe and palpate
the anterior and posterior
fontanelle.
00:35
The anterior fontanelle
is shaped like a diamond.
00:38
Now, it should feel level.
00:40
If it's sunken in, it may be
an indication of dehydration,
or if it's bulging, that may
be an indication of bleeding
or increased
intracranial pressure.
00:49
You also should not feel a pulse
inside the anterior fontanelle.
00:53
The posterior fontanelle
is shaped like a triangle.
00:56
It's located a little bit
further back on the baby's head.
00:59
Again, this should be level should
not be sunk in, or even bulging.
01:05
Now, sometimes you may find that
these fontanelles are hard to feel
because of the overlapping bones.
And that's okay.
01:11
We just want to note if we feel it
and what they feel like.
01:15
You also want to palpate
the suture lines.
01:17
So you can see in this graphic,
our fontanelle
anterior and posterior
are present.
01:22
But there are also
some other lines.
01:24
So these lines are here because
that allowed the head to shape
in order to make its way
out of the vagina.
01:30
So you want to note that
the suture lines are either level,
that they're separated,
or that they're overriding.
01:37
Recognizing that
overriding suture lines
may be normal
the first few days after birth.
01:42
Reassure the parents however,
that over time,
the suture lines will line up,
they'll still have a soft spot,
but they will go together.
01:51
Next you want to palpate
and observe the scalp.
01:54
So knowing particularly if anything
has happened during the delivery.
01:58
So thinking about if a
vacuum extraction was used,
or a forcep,
or perhaps during labor,
and electronic fetal monitor
was placed,
a scalp electrode
on the baby's head,
you want to check and make sure that
they're not any lacerations there.
02:12
And this could be really important.
02:14
So you want
to not only look but to feel
all around the baby's head
for any lesions or lacerations.
02:22
Now, let's talk about
three additional conditions
that the nurse should assess
the head for
during the newborn assessment.
02:29
Caput succedaneum,
cephalohematoma
and subgaleal hematoma.
02:35
First, let's look at
caput succedaneum.
02:38
What I want you to notice
in this graphic
is that the fluid is collecting
underneath the skin layer
of the scalp.
02:45
You'll notice that the fluid is
able to cross the suture line.
02:49
Caput crosses the see.
Caput, Captain...
02:54
Get it?
Now, let's look at
cephalohematoma.
02:58
In this case,
you have a collection of blood
that is collected underneath
the periosteal layer of the scout.
03:05
In this particular case,
the blood is not able to
cross the suture line.
03:10
So it's contained and it creates
sort of like a bump,
a bump on the head.
03:17
Now, let's look at the
subgaleal hematoma.
03:20
Now, the subgaleal hematoma
is formed in a potential space.
03:24
So it's not encapsulated.
03:26
And the difficulty here is that
because there's not
an encapsulated space,
the baby can continue to
bleed, and bleed, and bleed.
03:35
And they can lose significant
amounts of their blood volume
in a very short amount of time.
03:40
So it's important that the nurse
is able to distinguish between
caput succadeneum, cephalohematoma,
and subgeleal hematoma.
03:51
Let's look at a picture to see
if we can notice
the difference between
a hematoma and a caput succadeneum.
03:59
What I want you to notice in
this picture is this small ridge.
04:02
Did you see that?
That's the suture line.
04:05
And adjacent to that suture line,
you'll notice that there's a hump.
04:09
Guess what type
of abnormality this is.
04:13
Exactly.
This is a Cephalohematoma.
04:16
And we know that because the fluid
does not cross the suture line.
04:21
Do you see that?
Now, let's look at
caput succedaneum.
04:25
So what you'll notice here
is that we still have
an abnormally shaped head,
but this fluid definitely
crosses the suture line.
04:34
Remember, caput crosses.
04:38
Here's another example of
caput succedaneum.
04:42
Again, we noticed the head
is abnormally shaped,
but the fluid definitely
crosses the suture line.
04:49
I hope you have those
differences down now.
04:54
Now, let's move on to the spine.
04:56
It's important to remember
that when we observe the spine
and when we palpate the spine,
we palpate down the
entire length of the spine
to make sure we don't miss
one single area.
05:05
What we're looking for is symmetry
to make sure
everything on the left and
the right are balanced.
05:10
We want to make sure the spine
doesn't curve to the right or left.
05:14
We're looking for any lesions that
may be along the link of the spine,
or palpate for any masses
that might be located there,
or any tags, any skin tags,
and they may look like
a pedunculated mole
somewhere down
the length of the spine.
05:28
Next we want to look at the neck.
05:30
So we'll position the baby
and make sure
that the head doesn't lean
to one side or the other.
05:36
And that may indicate
that there may be an issue
with birth or nerve damage.
05:40
So we want to hold the head midline
and make sure that it's possible
to keep the head that way.
05:45
We want to move through
a full range of motion of the head
from side to side,
and front to back.
05:51
We also want to check the clavicles
and so the nurse will palpate
the clavicles
and make sure that they do not feel
like crepitus.
05:58
And you may have learned about
crepitus in your adult assessment.
06:02
And it feels like rice krispies.
06:05
So rice crispy if you've ever had a
rice krispies treat, yummy, yummy,
but not yummy if you've
got it on your neck.
06:11
So we're going to feel
for any signs of crepitus,
which might indicate
a broken clavicle
or any lumps or any other masses.
06:19
Next for the eyes.
06:20
Again, we're looking for symmetry.
Are they even?
Are they evenly spaced?
Is the outer canthus of the eye
in line with the pinna
or the upper part of the ear?
These are all indicators that there
may be something neurologically,
or genetically abnormal
about the newborn.
06:40
The nurse should also make sure
that the red reflex is present.
06:44
So this may be using either
a penlight or an ophthalmoscope.
06:48
And we can actually
just shine a light
and make sure that the red
shows through from the retina.
06:53
So this is a very easy procedure.
06:55
And this is something
that the nurse can do.
06:59
Now, let's look at the nose.
07:01
So on the nose, we want to look for
any signs of drainage from the naris
or any signs of nasal flaring,
where you see the edges of the naris
sort of moving
as a result of difficulty
in breathing or respiration.
07:14
You may have also noticed
these little white spots
that are all over the baby
in this particular graphic.
07:20
Right on the nose, you see those?
Those are clogged sebaceous glands,
also known as Milia.
07:26
And you might find them
located on the nose or the chin
or the forehead.
07:30
They usually disappear
in about two to four weeks,
and they are completely benign.
07:35
So reassure the parents
that this is totally fine.
07:39
Now, as we look
inside the baby's mouth,
we may notice several things
that are different,
but completely normal.
07:46
One of the first things a nurse
might notice are Epstein's pearls,
and this is a result of
retained epithelial tissue
that's right on
the roof of the mouth.
07:55
And that can be found on the palate,
up at the roof,
could be have found
all along the gum lines.
08:01
So this is going to be something
that you might notice.
08:04
They might be white,
or they might look a little yellow,
but they're all the same.
08:08
These are Epstein's pearls.
08:10
And again, they are
completely benign and normal
and typically disappear
in two to four weeks.
08:15
They are not teeth, they are
just retained epithelial tissue.
08:20
These, however, are teeth.
08:23
These are natal teeth.
08:24
And so very rarely does happen that
babies are born with natal teeth.
08:29
These teeth are not baby teeth,
they will fall out.
08:32
They do pose a choking hazard.
08:34
So the nurse needs to make sure
that if natal teeth are present,
they let someone know.
08:41
Now, let's talk about
another variation called
the cleft lip or cleft palate.
08:46
If a newborn has a cleft lip,
this is something
the nurse will notice clearly
because this is going to be
an external abnormality.
08:53
And so they'll see an opening
between the lips and the mouth.
08:56
You'll be able to see
straight into the baby's mouth
when their lips are closed.
09:01
However, a cleft palate
can be something that's hidden.
09:04
You can have a cleft palate
of your hard palate,
which would be right on
the front of the mouth.
09:08
Or it could be a cleft that goes all
the way through to the soft palate,
which is in the very
back of the mouth.
09:14
So the nurse really needs to do
a thorough job of making sure
that they palpate all the way back
to the soft palate
in order to make sure
there's not a hole located there.
09:24
So hard or soft palate cleft,
or lip cleft
or baby could have a combination
of all of the above.
09:33
Now, let's look at the chest.
09:34
Again, looking for
shape, size, and symmetry.
09:38
This is going to be a theme as we go
through this assessment,
making sure that everything
on the left and the right
are exactly the same.
09:45
In addition for noticing
a diminished tissue
around the breast area,
the nurse should also notice
the position of the nipples.
09:52
Are they even?
Is one nipple higher than the other?
There's also the possibility
of supernumerary tissue.
09:59
So if the nurse examines down
the inframammary ridge,
they may notice additional tissue.
10:04
Now, the tissue might look
like a breast
or it may look like a small mole.
10:09
Any of those indications are
going to be supernumerary tissue.
10:13
So take a look.
10:15
We also want to notice on the chest
any signs of any sort
of respiratory distress.
10:21
So if there is any
accessory muscles use
if there any retractions
in the chest,
this is going to be something
that the nurse needs to note.
10:29
We want to make sure that the baby
is continuing to transition well.
10:35
Moving down to the abdomen.
10:36
Again, shape and symmetry.
10:39
Is the abdomen protuberant
meaning it's sticking out.
10:42
It's like a gravid uterus,
or is it sunken in.
10:46
So normally,
babies have a little bit of a PUJ.
10:48
But a tight abdomen is an indication
that there may be something
that is abnormal that's happening.
10:54
Or an abdomen that sunken in
may also be an indication that
something else is going on.
11:01
We want to make sure that if you
were asked to palpate for the liver,
which is not something
nurses really do anymore,
that you know how to do this
because you can cause damage.
11:11
But if you are to palpate,
then you want to make sure
you're palpating for the liver,
and the spleen,
and typically the kidneys.
11:18
Now again, if this is not something
that the nurse has been trained
or is expected to do,
this will not be part of
the normal assessment,
but you do need to make sure
that it is done by the provider.
11:30
While the provider is palpating
for the kidneys, and the liver,
and spleen,
they may also notice any tenderness
that the baby's feeling
during that assessment.
11:39
Now, when you assess the abdomen,
one of the things
you want to make sure
is that you're hearing bowel sounds
in all four quadrants.
11:46
So let's think back to when
we would do this assessment
before we palpate for the
liver, spleen, kidneys, or after?
Before, exactly right.
11:57
In fact, when you're listening
for respiratory sounds,
when you do your
vital sign assessment,
it's a good idea to go ahead
and listen to the bowel sounds
while you have your stethoscope
out and the baby's quiet.
12:08
So just as you would
listen for bowel sounds
in all four quadrants on an adult,
we'll do the same thing
for the baby.
12:15
Then we can look at the umbilicus.
12:17
So if we are able
to visualize the cord
and it's right after delivery,
you will still note
two arteries and a vein.
12:26
So you'll see
all three of those vessels.
12:28
Every now and then you'll notice
that there may only be
one artery and one vein.
12:32
This is an abnormality, and
you would want to chart that.