Assessment of Newborns and Recognizing Abnormal Findings

QUESTION

1. Which findings in a newborn are considered abnormal and should be reported to the health care provider (HCP)? Select all that apply.

1. Cyanosis of the hands and feet
2. Decreased muscle tone
3. Heart rate of 150/min
4. Sacral dimple
5. Single artery in the umbilical cord

A. State your rational.
B. What’s spina bifida and acrocyanosis?
C. Included physiological findings during the first assessment in a newborn.
IMPORTANT POINTS: *You must use Saunders book as a reference.

PART B
2. When assessing a preterm newborn for cold stress, a graduate nurse in the newborn nursery needs further teaching when stating the need to assess for which finding?

1. Irritability
2. Poor feeding
3. Shivering
4. Week cry
D. State your rational.
E. Include clinical manifestations of cold stress.

ANSWER

Assessment of Newborns and Recognizing Abnormal Findings

Introduction

Accurate and thorough assessment of newborns is crucial to identify any abnormal findings that may require immediate attention from healthcare providers. This essay addresses abnormal findings in a newborn that should be reported to the healthcare provider, provides rationales for each finding, explains spina bifida and acrocyanosis, lists physiological findings during the first assessment of a newborn, and discusses the clinical manifestations of cold stress in preterm newborns.

Abnormal Findings in a Newborn

The following findings in a newborn are considered abnormal and should be reported to the healthcare provider:

Cyanosis of the hands and feet

Rationale: Cyanosis of the extremities may indicate inadequate oxygenation and potential respiratory or circulatory problems, necessitating immediate medical evaluation.

Decreased muscle tone

Rationale: Decreased muscle tone may be a sign of hypotonia or neuromuscular dysfunction, which requires further investigation by the healthcare provider to rule out any underlying conditions.

Sacral dimple

Rationale: A sacral dimple may be a sign of an underlying spinal cord abnormality, such as spina bifida. The healthcare provider needs to assess the dimple to determine its significance and order appropriate diagnostic tests if necessary.

Single artery in the umbilical cord

Rationale: Normally, the umbilical cord contains two arteries and one vein. The presence of a single artery in the umbilical cord, known as a single umbilical artery, may be associated with renal or cardiovascular abnormalities. Further evaluation by the healthcare provider is necessary to ensure the newborn’s well-being.

Spina Bifida and Acrocyanosis

Spina Bifida: Spina bifida is a congenital neural tube defect characterized by incomplete closure of the spinal cord and surrounding structures during fetal development. It can lead to various neurological complications and physical disabilities.

Acrocyanosis: Acrocyanosis refers to the bluish discoloration of the hands and feet in newborns. It is a benign condition caused by immature peripheral circulation and is not considered abnormal or concerning.

Physiological Findings during the First Assessment in a Newborn

During the first assessment of a newborn, the following physiological findings may be observed:
Heart rate around 120-160 beats per minute.
Respiratory rate between 30-60 breaths per minute.
Presence of fine, crackling sounds in the lungs (due to retained amniotic fluid).
Soft and non-distended abdomen.
Presence of vernix caseosa (a white, cheese-like substance covering the skin).
Passage of meconium within the first 24-48 hours after birth.

Clinical Manifestations of Cold Stress

Cold stress occurs when a newborn’s body loses heat faster than it can produce, resulting in potential complications. The graduate nurse needs further teaching if stating the need to assess for the following finding:

Shivering

Rationale: Shivering is not a clinical manifestation of cold stress in newborns. Unlike adults, newborns rely on non-shivering thermogenesis to generate heat. Shivering indicates a response to cold in older children and adults but is not present in newborns.

Clinical Manifestations of Cold Stress

Clinical manifestations of cold stress in preterm newborns include:
Hypothermia (low body temperature)
Poor feeding or sucking
Lethargy or decreased activity level
Tachypnea (rapid breathing)
Respiratory distress
Bradycardia (slow heart rate)
Mottled skin or cool extremities

Conclusion

Thorough assessment of newborns is essential to identify any abnormal findings that may require immediate attention from healthcare providers. Cyanosis of the hands and feet, decreased muscle tone, sacral dimple, and a single artery in the umbilical cord are abnormal findings that should be reported. Understanding spina bifida, acrocyanosis, physiological findings in newborns, and clinical manifestations of cold stress helps nurses provide safe and effective care to newborns.