Assessing

Newborn
Using Apgar
Scoring
 DEFINITION
Apgar Scoring - is a tool for quick
and accurate assessment of the
condition of the newborn at birth.
It was devised by dr. Virginia
Apgar in 1952.
 RATIONALE
1. The first-minute Apgar scoring is done to
assess the well-being of the newborn and
to determine if there is a need for
immediate resuscitation.
2. The five-minute Apgar scoring is done to:
 Assess the capacity of the newborn to
adjust to the extra uterine environment.
 Evaluate the effectiveness of
resuscitation measures, if done.
 Enable the nurse to formulate a plan of
care for the newborn.
 EQUIPMENT
 Stethoscope
 Nasogastric tube Fr 8
 Clean linen or layette
 Apgar Score Chart
 PLANNING & IMPLEMENTATION
ACTION RATIONALE
1. Place the newborn in a To protect the newborn
crib or table lined with a from contamination and
blanket or linen. injury.
2. Evaluate the heart rate. A significant index to
cardiovascular functioning.
– Observe the pulsation
of the cord at the
abdomen if the cord is
still uncut.
– Listen to the heart
beat using a
 PLANNING & IMPLEMENTATION
ACTION RATIONALE
3. Observe for respiratory To determine if the
effort. Is the cry newborn is responding
vigorous? well or has respiratory
difficulty.
– Is there difficulty of
breathing?
– Is there any presence
of external retraction
or nasal flaring?
– Is the respiration
“regular”?
 PLANNING & IMPLEMENTATION
ACTION RATIONALE
4. Observe for muscular To assess for muscular
tonicity. tonicity.

– Are the extremities

well-flexed?

– Do they resist effort to

extend them?

– Are they flaccid or

limp?
 PLANNING & IMPLEMENTATION
ACTION RATIONALE
5. Evaluate the reflex To check for reflex
irritability. irritability.
– How does the baby
respond to gentle
slapping of the sole
of the feet? To
suctioning?
– Is there no response
at all?
– Is the cry weak or
merely makes a
grimace?
 PLANNING & IMPLEMENTATION
ACTION RATIONALE
6. Inspect the newborn’s To evaluate the
entire body for color. cardiovascular
functioning. Color is an
index to tissue perfusion
and oxygenation of
blood.
ADAPTATION 0 1 2 1 min 5 min

HEART RATE Less than Over

Absent
100 bpm 100 bpm
Slow,
RESPIRATORY Absent Good,
regular,
EFFORT strong cry
weak cry

MUSCLE Some
Flaccid, flexion of Well-flexed
TONE Limp extremities
extremities

REFLEX No Weak cry, Vigorous

IRRITABILITY Response grimace cry
Body pink, Completely
COLOR Blue, Pale extremities Pink
blue

TOTAL
EVALUATION & DOCUMENTATION
1. Evaluation of the newborn based on the five
adaptation areas following any sequence.
2. Score for each adaptation area.
3. Use of the Apgar Scoring chart for one
minute and five minutes.
– A score of 7 to 10 indicates good condition
with minimal special precaution to be taken.
– A score of 4 to 6 means the baby is in fair
condition and certain recommended
procedures are to be followed.
– A score of 0 to 3 means the newborn is in
extremely poor condition and resuscitation is
needed immediately