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Neonatal Assessment Guide / Independent Study
Neonatal Assessment Guide / Independent Study
Nursing 370
Nursing students will perform the following newborn assessment with the clinical
instructor’s assistance during the clinical nursing experience. The purpose of this
assessment is to increase the student’s knowledge about newborn physical assessment
and to increase the student’s observational skills.
• The clinical instructor will assign students the week before this assignment is due.
• Students are required to complete the column entitled “Norms & Possible
Alterations” prior to meeting with the clinical instructor for the hands-on clinical
newborn assessment.
• Students will describe fully what they see, hear, and feel during the clinical
newborn assessment in the column entitled “Description of Findings” (this will
be handed in the week following the experience to the clinical instructor).
• References other than course textbooks must be listed.
• Grading will be O =outstanding, S = satisfactory, or U = unsatisfactory
3. Temperature
1
5. Chest Circumference 32.5 cm, 1-2 cm less than head
Wider than it is long
Posture: briefly describe Body usually flexed, hands
may be tightly clenched, and
neck appears short because
Skin chin rests on chest.
1. Color Consistent with race.
European- pink-tinged, African
or Native American pale pink
with yellow tinge, Asian –pink
2. Texture to rosy red, yellow tinge.
Smooth, soft, flexible, may
have dray, peeling hands and
feet.
3. Turgor Elastic, returns to normal
shape after pinching
5. Jaundice
2
4. Fontanels Palpation of juncture of cranial
A. Anterior bones
Fontanel 3-4cm long by 2-3 cm wide
diamond shaped
B. Posterior 1-2 cm at birth, triangle shaped
Fontanel
Hair
1. Texture Smooth with fine texture
variations, depends on ethnic
background
2. Distribution Scalp hair high over eyebrows
(Spanish-Mexican hairline
Face begins midforehead to neck)
1. Symmetry Symmetric movement of all
facial features, normal hairline,
eyebrows & eyelashes present
2. Spacing of features Eyes-ears at same level,
nostrils equal size, cheeks full,
and sucking pads present
3. Movement Makes facial grimaces
Symmetric when resting and
crying
Eyes
1. General placement and Bright and clear; even
appearance placement, slight nystagmus
(involuntary cyclic eye
movement)
2. Color Blue-gray or slate-blue-gray
Brown color at birth in dark-
skinned infants
3. Any tears? -
React to light by
accommodation, light reflex
demonstrated at birth or by 3
4. Pupils react to light? weeks of age
3
5. Subconjunctival Chemical conjunctivitis,
hemorrhage? Subconjunctival hemorrhage
Nose
1. General appearance May appear flattened as a
result of birth process
Mouth
1. Symmetry? Symmetry of movement and
strength
2. Symmetry?
4
Neck
1. Appearance Short, straight, creased with
skin folds, posterior neck lacks
loose extra folds of skin
2. Mobility Moro reflex elicitable
Clavicles
1. Appearance &size Straight and intact
5
Heart
1. Palpate for PMI & Usually lateral to
describe midclavicular line at third or
fourth intercostal space
Abdomen
1. Appearance Cylindric with some
protrusion, appears large in
relation to pelvis
2. Any Diastasis Recti? Common in infants of African
Americans
6
8. Describe voiding Emptied about 3 hours after
birth or time of birth,
inoffensive, mild odor
Genitals
Male
1. Penis Slender in appearance about
2.5 cm long 1 cm wide at birth
2. Pilonidal dimple -
7
3. Complete a ROM & All joints move spontaneously;
desribe good muscle tone, of flexor
type, birth to 2 months
8
Toes curl downward when sole of
5. Plantar grasp
foot is stimulated lessens by 8
months
Activity
1. Neonate cries when? Cries vary in length from 3-7
minutes after consoling
measures are used
2. Cry (pitch) Moderate tone and pitch,
strong and lusty
9
10