National Institute of Nursing Education

PGIMER, CHANDIGARH

Lesson Plan on Neonatal Assessment

Submitted to: Submitted by:

Dr.V.Venkadalakshmi Garima Sharma
Associate Professor M. Sc (N)2ND Year
NINE, PGIMER NINE, PGIMER
Chandigarh Chandigarh
SUBJECT - Obstetric Nursing and Midwifery.

TOPIC - Neonatal assessment

GROUP OF STUDENTS -

NO. OF STUDENT -

METHOD OF TEACHING - Demonstration

TIME OF TEACHING - .

DURATION - 40-45 minute

VENUE -

SUPERVISOR - Mrs. V. Venkadalakshmi

PREVIOUS KNOWLEDGE - Student have some previous knowledge about Neonatal assessment.

GENERAL OBJECTIVE - At the end of the class student will have knowledge regarding Neonatal assessment.

SPECIFIC OBJECTIVE - At the end of the class the student will be able to:

 Introduce the topic.

 Define Neonatal assessment.
 Explain the purposes of Neonatal assessment.
 Enumerate the articles used in Neonatal assessment.
 Discuss the steps of procedure in Neonatal assessment.
S.No Specific Time Content Teaching Learning Evaluation
Method
Objective

1. At the end of Introduction Teaching A.V. Aids

the class Method
student will 2 min Newborn or neonatal period is from birth till 28 days of life during
be able to this period, each neonate should be carefully checked for any sign Lecture PowerPoint
of problems or complications. The main purpose of this assessment cum presentation What is Neonatal
introduce the assessment?
topic. is to assess baby's transition from intrauterine to extrauterine discussion
environment

Definition
2. Define
Neonatal It is the assessment of health of neonate (i.e., from birth till 28 days
2min of life) to know about the well-being of baby, any congenital
assessment.
abnormalities, teach the parents about the child's body and current Lecture What is the definition
status of health, as well as measures to ensure health in the future. PowerPoint Neonatal assessment?
cum presentation
discussion

Purpose

Enumerate  To determine the normalcy of different body system forhealthy

3. the purpose of 1min adaptation to extrauterine life
Neonatal
assessment.  To detect significant health problems for immediate Lecture
management cum PowerPoint
 To know about the well-being of baby discussion presentation What are the purpose of
neonatal assessment?
 To note down any congenital anomalies

 To teach parents about child's body and current status of health

  To ensure measures for neonate's health in future

 To check baby's adjustment to environment

Articles

4. Enlist the 2min  Measuring tape

articles used  Thermometer
for Neonatal Demonstrati PowerPoint Whatare the articles used
assessment.  Stethoscope on presentation in Neonatal assessment?

 Newspaper to measure the height of neonate

 Pen and diary to note down the finding
 Weighing machine (Digital).

Steps of Procedure
5. Explain the 15min Pre-procedural Steps
steps of
procedure for  Arrange the articles (for easy access)
Neonatal Demonstrati PowerPoint What are the steps of
 Wash hands with soap and water. Dry the hands with towel to on presentation procedure for Neonatal
assessment.
avoid touching the baby with wet hands (to maintain asepsisand
assessment?
prevent infection)
 Review the mother's obstetric history, number of pregnancies,
history of previous pregnancies, and health during the
pregnancy, complications during and after the pregnancy,
history of any drug she has taken and her Rh typing (to
collectcorrect data information)

 Review the health history of newborn child: Date of birth, place

of birth, the type of delivery, any problem experienced by the
 child after delivery, immunization status of the child, the
weight and length. The infants color and cry at birth, the
breastfeeding practice (to gather information)
Intraprocedural Steps
 Check the vital signs of neonate
 Normal findings
a. Respiration (average)- 40 respirations/min
b. Heart rate (apical)-120-160 beats/min
c. Temperature- 90.0°-99.5°F (35.6°-37.5°C)
d. Blood pressure (average)- 75/42 mm Hg
e. Systolic pressure- 60-80 mm Hg
f. Diastolic pressure- 40-50 mm Hg
 Checking Temperature
Temperature of neonate may be taken either by axilla or rectum.
Axillary method is preferred because there is less chance of injuring
the neonate. Initial temperature may be as low as 36°C. By the 12th
hour temperature stabilized to 36°C. By the fourth weak it is
maintained at 36.5°-37°C.
 Taking Heart Rate
a. The average resting heart rate for full-term newborns is 120-
160 beats/min (when the newborn cries, the heart rate may
exceed 180 beats/min).
b. Apical pulses should be obtained by auscultation using
stethoscope for a full minute, preferably while the newborn is
asleep.
c. The heart rate should be evaluated for abnormal rhythms or
 beats. The maximal impulse of heart should be felt just lateral
to midclavicular line in the third or fourth intercostal space
(lower left sternal border).
d. Normal heart rate range: 120-160 beats/min.
 Head to Foot Assessment
Head
 Observe the shape of the head. Check for the birth injuries like
cephalohematoma, caput sucedaneum
 Measure head circumference: Normal limits are 33-35 cm
 Palate the anterior and posterior fontanels to determine whether
they are open, closed, depressed or bulging. The anterior
fontanel is diamond shaped and closes at 12-18 months.
Posterior fontanel is triangular in shape and closes at one and
half month after birth.
Eye
 The eyes are blue or gray at birth changing to the permanent
color in 3-6 months
 Observe for redness, swelling and discharge or yellow
discoloration, hypertelorism which may be indicative of
infection, jaundice or syndrome respectively.
Ears
 Doere any on seres (ow set ears are indicative of Downs
syndrome)
Nose
 Observe for mucous accumulation inside the nares which may
cause nasal faring
 Check for any bleeding and deviated nasal septum (DNS).
Mouth and Throat
 Observe for cleft lip and cleft palate.
Neck
 Observe the creases of neck for the accumulation of dirt,
redness and excoriation
 Check for webbed neck.
Chest
 It is bell shaped and approximately the same circumference as
abdomen and about 1 inch less than the head circumference.
 Its normal circumference ranges from 31 cm to 33 cm
 Look for chest indrawing.
Abdomen
 On inspection, the normal neonates abdomen appears rounded,
slightly protuberant. Normal abdominal circumference is 29-31
cm
 Observe the umbilical cord for redness, pus and bleeding. After
birth cord begins to shrink. It changes in color from yellow-
brown to black and slough off by 6-10 days after the birth,
leaving a granulating area that heals in another week.
Upper Extremities
 The arm should move symmetrically and equally well. If an
arm does not move, normally, the baby may have sustained a
birth injury. In mature neonates, the hands are plump
 Assess for syndactyly and polydactyly.
Lower Extremities
 Watch and inspect for range of motion and symmetry
 Assess for hip dislocation, clubfoot, polydactyly or syndactyly
of feet
 Hip- Inspect the hip area carefully for signs of either hip
instability or dislocation by performing the Ortolani and
Barlow test.
Procedure for Ortolani and Barlow Test
 Lay the infant in a supine position and flex the knee to 90° at
the hips (proper position of the infant ensures accurate results)
 Hold the infant's pelvis with one hand to stabilize it during
manipulation
 Using the other hand place the middle fingers over the great
trochanter of the femur and the thumb on the internal side of
the thigh over the lesser trochanter (placing the fingers in this
manner allows easy abduction of the hips).
 Slowly and gently abduct the hips while applying pressure over
the greater trochanter. The femur is pulled forward while the
greater trochanter is used as a furculum.
 Listen for a clicking or clunking sound while performing step
number four. Normally, no sound is heard. A clicking or
clunking sound is a positive Ortolani's sign and it happens
when the femoral head is re-entering the acetabulum
 With the fingers in the same position, assess the infant for
Barlow's sign. Hold the hips and knees at 90° flexion while
exerting a backward pressure (down and laterally)
 Slowly and gently abduct (bringing the thigh towards the
midline) the hip. Note any feeling of the femoral head slipping.
Normally the hip joint is stable. The feeling of the hip joint
 slipping out of the socket posteriolaterally is a positive
Barlow's sign.
Back
 Inspect the back for spina bifida
 Observe for Mongolian spot at the back.
Anogenital Area
 Buttocks are plump and firm. In the anal region, there should
be no redness or fistulas. The newborn infant passes meconium
within 24 hours and check for patent rectum.
Female Genitalia
 The female genitalia may be slightly swollen from the action of
the maternal hormones
 There can be signs of pseudomenstruation.
Male Genitalia
 Assess for descended testes
 Assess for hypospadiasis and epispadiasis.
Urine
 Urine is passed frequently. Urination may be delayed until the
second day
 Note down the frequency, color and amount of urine.
Neurological Assessment
 Nervous system is strikingly immature when compared with the
child or adult. The bodily functions and responses to external
stimuli are carried on chiefly by the midbrain and reflexes of
spinal cord. Certain reflexes are absolutely essential and
protective to the life of newborn. Successful use of the reflex
 mechanism is evidence of normal functioning of nervous
system.
Ballard's scoring system for assessing neuromuscular maturity
In this following aspect regarding neuromuscular activity are
checked:
 Posture: How does the baby hold his/her arms and legs
 Square window: How far the baby's hands can be flexed toward
the wrist
 Arm recoil: How far the baby's arms 'spring back' to a flexed
position
 Popliteal angle: How far the baby's knees extend
 Scarf sign: How far the elbows can be moved across the baby's
chest
 Heel to ear: How close the baby's feet can be moved to the ears.

6 Describe 10min
different
Reflexes
types of
neonatal Neonatal reflexes are inborn reflexes which are present at birth and Demonstrati PowerPoint Describe different types
reflexes occur at a predictable fashion. A normal developing newborn
on presentation of neonatal reflexes.
should respond to certain stimuli with these reflexes, which
eventually become inhibited as the child matures.

Moro Reflex
Response to sudden movement or loud noise should be one of the
symmetric extension and abduction of the extremities and fanning
of index finger and thumb forming a C shape. It is present up to age
of 3-4 months

Rooting reflex
Touching or stroking the cheek alongside of mouth causes neonate
to turn head toward that side and begin sucking.

Sucking Reflex
Begins strong sucking movement in response to stimulation.

Palmar Grasp
Grasps finger when palm is stimulated and held momentarily.

Plantar Grasp
Toes curl downward when sole of foot is stimulated.

Babinski Reflex
Fanning and extension of all toes when one side of sole is stroked
from heel upward.

Tonic Neck Reflex

When head is turned to one side, extremities on same side extend
and on opposite side flex.

Glabellar Reflex
Tapping briskly on glabella causes eyes to close tightly

Doll's Eye
As head is moved toward right or left, eyes lag behind and do not
immediately adjust to new position
Measurement of Height and Weight
Weight
 Uncover the baby
 Place the baby on infant weighing machine
  Record the weight
 Normal weight of neonate is 2.5-3 kg
Height
 Place the child in supine position over the newspaper
 Slide a scale over the head to the newspaper and make a mark
 Hold the infant's leg straight and make a mark, where the
infants rub touches the newspaper
 Measure the distance between 2 marks in centimeter
 Normal height is 49-50 cm.

Postprocedural Steps
 Any abnormality, inform to physician
 Handover the baby to mother
 Remove all the articles
 Wash and dry

7. Summarize 2min
 Definition of Neonatal assessment.
 Purpose of Neonatal assessment.
 Articles required for Neonatal assessment.
 Steps of Neonatal assessment.
 Different types of neonatal reflexes
8. Evaluation 2min  Define Neonatal assessment.
 What are the purposes of Neonatal assessment?
 Describe different types of neonatal reflexes.

Newborn or neonatal period is from birth till 28 days of life during

9. Conclusion 2min this period, each neonate should be carefully checked for any sign
of problems or complications. The main purpose of this assessment
is to assess baby's transition from intrauterine to extrauterine
environment

10. References  Ghai. S.Clinical Nursing Procedures.3rd edition, CBS

publishers and distributors pvt. Ltd..New Delhi, p- 788-793
 Dutta DC, Konar H. Textbook of Obstetrics, 7th edition. Jaypee
Brothers Medical publisher Pvt. Ltd. 2013
 TNAI manual, clinical procedures
 www.lippincotts nursing centre.com.
 RamanAV.MaternityNursing,19thedition.WoltersKluwer(india)
Pvt.ltd. Delhi;2011