rashdecisions-emorydepartmentofpediatrics（13页）.docVIP

Physical Examination of the Newborn Linda L. McCollum, PhD, APRN, NNP-BC Regional Outreach Coordinator Emory Regional Perinatal Center Emory University School of Medicine 80 Jesse Hill Jr Drive, SE Atlanta, GA 30329 Office: 404-616-4219 Linda_McCollum@ Objectives: 1. Outline a systematic approach to the physical examination of the newborn. 2. Discuss the significance of multiple minor malformations. VITAL SIGNS MEASUREMENTS The following numbers are not absolutes, but merely general guidelines Temperature: axillary = 97.7-99.5OF (36.5-37.5OC); skin = 97.3-99.1OF (36.3-37.3OC) Respiratory rate: 40-60 breaths per minute (correlated with activity) Breath sounds: bilateral and equal; auscultate both the anterior and posterior chest as well as both axillae Heart rate: 120-160 beats per minute (correlated with activity) Heart sounds: murmurs may be innocent or pathologic and consequently must be considered within the context of the total exam; when a murmur is detected, it should be described by: location – usually in terms of the interspace and the sternal, midclavicular, or axillary lines timing – systolic, diastolic, or continuous intensity – grade I is barely audible or audible only after a period of careful auscultation grade II is soft, but audible immediately grade III is of moderate intensity, but not associated with a thrill grade IV is louder, and may be associated with a thrill grade V is very loud and can be heard with the stethoscope rim barely on the chest grade VI can be heard with the stethoscope just slightly removed from the chest radiation – transmission (for example, to the back) pitch – high, medium, or low quality – harsh, rumbling, or musical Capillary refill: 3 seconds Peripheral pulses: 3+/4 and equal; remember to compare upper/lower and left/right pulses and pressures 0 not palpable 1+ difficult to palpate, thready, weak, easily obliterated with pressure