k.p 7.7 pem fisik bbl.ppt

1

2

Newborn: complete physical exam within 24 hours of birth

Listen to heart and lung first when the infant is quiet

Warming the statescope before using

3

VITAL SIGN

Temperature

Respirations: normal rate is 40-60 breaths/min

Blood Pressure

Pulse rate: normal rate is 100-180 beats/min

4

HEAD CIRCUMFERENCE, LENGTH, WEIGHT, AND GESTATIONAL AGE

Head circumference and percentile: place the measuring tape around the front of the head (above the brow) and the occipital area, the tape should be above the ears, normally 32-37 cm at term.Length and percentileWeight and percentileAssessment of gestational age

5

GENERAL APPEARANCE

Activity

Skin color

Obvious congenital abnormality

6

SKIN

1. COLORPlethora (deep, rosy red color)- common in polycytemia- can be seen in overoxygenation and

overheated infant- Erythema neonatorum: normal

phenomenon in transition period and can occur when the infant has been stimulated

7

JaundicePallor (washed-out, whitish appearance)Cyanosis - Central cyanosis: bluish skin

including the tongue and lips- Peripheral cyanosis: bluish skin with

pink lips and tongue- Acrocyanosis: bluish hands and feet only

SKIN

8

Polycytemia and Pallor

9

Cyanosis

10

SKINExtensive bruising (ecchymoses): prolonged and difficult delivery‘Blue on pink’ or ‘pink on blue’: poor perfusion, inadequate oxygenation, inadequate ventilation, or polycytemia.Harlequin coloration (clear line of demarcation between an area of redness and an area of normal coloration)Mottling (lacy red pattern): maybe seen in healthy infants and in those with cold stress, hypovolemia, or sepsis. Persistent mottling (cutis marmorata) found in infants with Down syndrome, trisomy 13 or trisomy 18.

11

Persistent mottling (cutis marmorata)

12

Vernix caseosa: substance that covers the skin until 38th week of gestationCollodion infant: skin resembles parchment, restriction in growth of the nose and ears.Dry skin: postdate or postmature infant, congenital syphillis, and candidiasis

SKIN

13

2. RASHESMilia: withish, pinhead-sized on chin, nose, forehead, and cheeks.Erythema toxicum: small areas of red skin with a yellow-white papule in the center.Candida albicans rash: erythematous plaques with sharply demarcated edges.Transient neonatal pustular melanosis: pustules, ruptured vesicupustules, and hiperpigmented macules.

SKIN

14

Acne neonatorum: comedones and papules over the cheeks, chin, and forehead.

Herpes simplex: pustular vesicular rash, vesicles, bullae, or denuded skin.

SKIN

15

SKIN

3. Nevi Macular hemangioma (‘stork bites’): dissappear spontaneously within 1st year of life.Port-wine stain (nevus flammeus): does not blanch with pressure and not disappear with time. Mongolian spot: dark blue or purple bruise-like makular spots, most common birthmark

16

SKIN

Cavernous hemangioma: large, red, cyst-like, firm, ill-defined mass. If associated with thrombocytopenia (Kasabach-Merrit syndrome)Strawberry hemangioma (macular hemangioma): flat, bright red, sharply demarcated lesions.

17

HEAD

Anterior and posterior fontanelles- anterior fontanelle usually closes at 9-12 mo and the posterior at 2-4 moMolding: temporary asymmetry of the skull resulting from the birth process.Caput succedaneumCephalhematomaSubgaleal hematoma

18

Increased intracranial pressure:

- bulging anterior fontanelle

- separated sutures

- paralysis of upward gaze (setting-sun

sign)

- prominent veins of the skalp

- increasing macrocephaly

HEAD

19

Bulging of fontanelle

20

Craniosynostosis: premature closure of one or more sutures

Craniotabes: softening of the skull

Plagiocephaly: oblique shape of a head, asymmetric and flattened.

HEAD

21

NECK

Eliciting the rooting reflex

Palpate the sternocleidomastoid

Short neck: Turner’s, Noonan’s, and Klippel-Feil syndromes

22

FACE

Note the general shape of the nose, mouth, and chinNote the presence of hypertelorism (eyes widely separated)Note the presence of low-set earsFacial nerve injury: unilateral branches of the facial nerve

23

EARS

Look for unusual shape or positionLow-set ears: congenital anomaliesPreauricular skin tags (papillomas): benignHairy ears: infants of a diabetic mothersGross hearing: when infant blinks in response to loud noises

24

EYESCheck the red reflex with an ophthalmoscopeOpacification of the lens: cataractSclera bluish tint: prematureSclera deep blue: osteogenesis imperfectaBrushfield’s spots (salt-and-pepper specling of the iris): Down syndromeSubconjunctival hemorrhage: 5% newborn infant.Conjunctivitis

25

NOSE

Nasal flaring: respiratory distress

Sniffing and discharge: congenital syphilis

Sneezing: response to bright or drug withdrawal.

26

MOUTH

Ranula: cystic swelling in the floor of the mouth.Epstein’s pearls: keratin-containing cystsMucocele: small lesion on the oral mucosaNatal teeth:- Predeciduous teeth: supernumerary teeth- True deciduous teeth: true teeth that erupt

early.

27

Macroglossia: enlargement of the tongue, can be seen in Beckwith’s syndr and Pompe’s disease

Frothy or copious saliva: esophageal atresia with tracheoesophageal fistula.

Thrush: sign of infection C. albicans.

MOUTH

28

Drooling

of saliva

29

CHEST

Observation Breath soundPectus excavatumBreast in a newborn: - usually 1cm in diameter in term- abnormally 3-4 cm: effects of maternal

estrogens- witch’s milk: white discharge

30

HEART

Murmur: VSD, PDA, Coarctatio aorta, PS, PA, TA, TGA, etc

Palpate the pulses (femoral, pedal, radial, and brachial)

Check for signs of CHF: gallop, tachypnea, hepatomegaly, wheezes and rales, tachycardia, and abnormal pulses.

31

ABDOMEN

Observation: omphalochele, gastroschisis, scaphoid abdomen.

Auscultation

Palpation: check for distention, tenderness, or masses.

32

Scaphoid abdomen Abdomen distention

Gastroschisis Omphalocele

33

UMBILICUS

Two arteries and one vein

Normal cord: translucent

Greenish-yellow color: meconium staining

34

GENITALIA

Male- check dorsal hood, hypospadias,

epispadias, and chordee.- normal penile leghth at birth is > 2 cm- Determine site of meatus, verife the

testicles and the color of scrotumFemale- examine the labia and clitoris

35

LYMPH NODES

Palpable lymph nodes usually in the inguinal and cervical 33% of normal neonates.

36

ANUS AND RECTUM

Check for patency of the anus

Check the position of the anus

Meconium should pass within 48 h

37

Imperforate anal membrane

Atresia ani

38

EXTREMITIES

Syndactyly : abnormal fusion of the digitsPolydactyly: supernumerary digitsSimian crease: a single transverse palmar crease (Down syndrome)Talipes equinovarus (clubfoot): foot is turn downward and inward and the sole is directed mediallyMetatarsus varus: adduction of the forefoot

39

TRUNK AND SPINE

Check for

- any gross defect of the spine

- abnormal pigmentation

- hairy patches over the lower back

- sacral or pilonidal dimple: small

meningocele

40

Fetal Phenytoin syndrome Hirsutism

41

HIPSCongenital hip dislocationOrtolani and Barlow maneuvers:- place in the frog position- abduct the hips by using middle finger to apply

gentle inward and upward pressure over the greater trochanter (Ortolani’s sign)

- adduct the hips by using the thumb to apply outward and backward pressure over the inner thigh (Barlow’s sign)

- a click of reduction and a click of dislocation: hip dislocation.

42

NERVOUS SYSTEM

Observe for abnormal movement or excessive irritabilityMuscle tone: hypotonia, hypertoniaReflexes: rooting, glabellar, grasp, neck-righting, and moroCranial nervesMovementPeriveral nerves: Erb-Duchenne paralysis, Klumpke’s paralysis

43

General sign of neurologic disorder:- Symptom of increased ICP- Hypotonia or hypertonia- Irritability or hyperexcitability- Poor sucking and swallowing reflexes- Shallow, irregular respirations- Apnea- Apathy- Staring- Seizure activity- Asymmteric reflexes

NERVOUS SYSTEM

44