Vital Signs – Initial Assessment of the Newborn (Nursing)

00:01 Now, it's time to talk about the normal newborn assessment that happens about two hours after delivery.

00:07 So we're going to talk about vital signs and how we take those.

00:11 A general survey, what we look for in the newborn, and then a complete head to toe assessment.

00:16 So we can put it all together.

00:18 Let's start with vital signs.

00:20 Well, because we always start with vital signs.

00:23 But it's particularly important for the newborn, because usually at the beginning of the assessment, the baby is quiet.

00:29 It is really difficult to count respiration’s and heart rate on a newborn when they're crying, and asking them to hold their breath or stop crying for a few minutes doesn't usually work really well.

00:41 So if you start on your vital signs before you unwrap the baby, you might actually be able to hear them.

00:47 Let's start with respirations.

00:49 So one thing that's important to remember with a newborn is that their respiratory rate is very irregular.

00:54 So you have to count respirations for a full minute.

00:58 You can't cheat. So 60 seconds.

01:01 It's also helpful to listen over the lung fields.

01:03 So you can actually hear the respirations.

01:06 And in normal rate for respirations for a newborn is anywhere between 30 and 60 breaths per minute.

01:13 So it's a lot of quick counting, and you've got to listen over the lung fields for a full minute. Don't forget.

01:20 Now in the next minute, you can also count the heart rate.

01:23 Again, this rate must be counted for a full minute.

01:26 The heart rate may be slightly irregular.

01:29 And oh my goodness, the heart rate is very challenging to count.

01:32 This is one of the most difficult skills for my nursing students.

01:37 Because the heart rate is beating still at the rate of 110 to 160 beats per minute, just like it was in utero.

01:44 So if you can imagine trying to count that, it goes by really quickly.

01:48 I'm gonna give you a couple hints though.

01:50 You can either tap your foot, sort of like tapping your foot to the beat of the music, or you can tap your finger over the stethoscope.

01:58 I have no idea why that works. But it will help you keep count.

02:01 So give it a try. But remember, a full minute.

02:05 So when I have a nursing student, that gives me vital signs on a newborn, and it hasn't been at least two minutes, I know they haven't quite checked it exactly like they should.

02:14 So remember that.

02:17 The other thing I want to remind you of when you're checking heart rate is the murmurs.

02:21 So if you go back and listen to the lecture, where we talked about the newborn assessment, and we talked about normal fetal circulation and the closure of our ductus and closure of our foramen ovale now those valves are still going to be moving.

02:34 So that is going to create a sound and that sound is going to be murmurs.

02:38 So know that hearing murmurs on a newborn is completely normal.

02:42 It's what we would expect. But you always want to report it, just to make sure that there's not a complication that we're missing.

02:48 So murmurs are expected but should be reported.

02:52 Now let's talk about the temperature.

02:54 So typical temperature for a newborn is anywhere between 97.7 and 99.7 degrees Fahrenheit, that translates to 36.5 or 37.5 degrees Celsius.

03:07 We're typically going to also take the vital signs axillary.

03:11 Now, maybe you remember from back in the day, we used to always take a rectal temperature, but we found out through evidence that we didn't really need to do that.

03:19 So now, the only time you're going to get an order for a rectal temp is if the vital sign is abnormal.

03:25 So if you find that you've taken an axillary temp, and it's particularly low, or particularly high, you may have an order for a rectal temperature.

03:33 Otherwise, an axillary temperature is completely fine.

03:38 Now let's talk about blood pressure.

03:40 This is another vital sign that we don't check on every baby every time.

03:44 We used to, a long time ago, check all four quadrants.

03:47 So we did both arms and both legs, and we checked blood pressure on every single baby.

03:52 But we realized that that wasn't necessary unless the baby was experiencing some difficulty.

03:56 However, if you have an order to check a blood pressure, you can expect the range to be anywhere from 50 to 75 systolic over 30 to 45 diastolic.