Universidad de Sta.

Isabel Vincentian Learning Module

College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

MODULE ON THE NEWBORN 2

(Physical appearance - Nursing Diagnoses)

Overview
You’re finished with the discussion of the lessons in PART 1 involving the profile of
the newborn until the appearance of the newborn on the skin. Did you appreciate the
beauty of the newborn? How great is our God for doing this “Miracle of Life”!
This next part will enlighten and help you understand more the concept of the
NEWBORN about his/her physical appearance from the head down to the feet. We will
also discuss nursing considerations and interventions that we must consider and be able
to formulate nursing diagnoses in the care of this amazing God’s creation.

Learning Outcomes
At the end of this Module, you will:

1. Describe the appearance of the newborn from the head to the feet.

2. Illustrate the concepts about the Care of the Newborn through a map.

3. Formulate nursing diagnoses on the Care of the Newborn

Learning Experience and Self-Assessment Activity

Do you know
that...
The HEAD of the
baby enlarges after it
goes out completely
in the vaginal opening
of the mother.
www.canva.com/design

With this quick fact, we will start this module as continuation of the
concept on the care of the newborn with the appearance of the head.

The discussion will be followed with the appearance of the face,

abdomen, extremities until the feet of the newborn. So, let’s start...

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

2. HEAD
What to assess:
 We have to assess for the symmetry, shape, swelling, and movement
 Commonly the newborn’s head is soft, pliable, and moves easily
 With some molding (if Spontaneous Vaginal Delivery); round & well-shaped (if
through Cesarean Section)
 Large – ¼ of the total body length
 Forehead – large and prominent
 Chin – appears to be receding – quivers if an infant is startled or cries
 Full-bodied hair – well-nourished newborn
 Thin lifeless hair – poorly nourished and preterm infants

*Fontanelles (“soft spot”)

- These are spaces or openings where the skull bones join.
> BAD (12-18 mos)

> LPT (2-3 mos or 8-12 wks)

> Can be a bulging or sunken

Head lag
 Common when pulling newborn
to a sitting position

 When prone, NB should be able to lift

the head slightly and turn head from side to side

Word Blitz
Craniosynostosis
 > Premature closure of the fontanelles
fontanelles.

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

*Sutures
- These are separating lines of the skull. They may override or separate from each
other. The overriding at birth may be due to extreme pressure exerted on the head
during passage through the birth canal. It subsides in 24 to 48 hours.

TAKE NOTE!
If any of the sutures close too early (fuse prematurely), there may be no growth in that
area. This may force growth to happen in another area or direction. This results in an
abnormal head shape (craniosynostosis). (https://www.stanfordchildrens.org/en/topic/default?
id=anatomy-of-the-newborn-skull-90-P01840)

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

*MOLDING – This is the overlapping of skull bones due to compression during labor
and delivery. Disappears in few days after birth.

*CAPUT SUCCEDANEUM – This is the edema or swelling of the soft tissues of the
scalp at the presenting part of the head. This maybe due to prolonged delivery time or
difficulty in delivering the head of the baby. May disappear on the third day after birth.

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

*CEPHALOHEMATOMA – This a collection of blood between the periosteum of the

skull bone and bone itself, caused by rupture of a periosteal capillary maybe due to the
pressure during delivery. It appears 24 hours after birth.

> It is also associated with the use of birth-

assisting tools such as forceps or vacuum

extractors. It usually heals without any

major interventions, but if improperly

Treated, it can cause serious problems.

(www.abclawcenters.com, )

*CRANIOTABES – This is a localized softening of the cranial bones due to the

pressure of the fetal skull against the mother’s pelvic bone in utero. When you press the
head of the newborn it will indent and feel like a “PING-PONG” ball. This MOST common
among 1st born babies and can be pathological in older child maybe due to metabolic
disorder.

ABNORMAL FINDINGS OF THE HEAD:

 Large head – Can be a sign of HYDROCEPHALUS – there is an increased

intracranial pressure and there are widely separated sutures.
 Small head or MICROCEPHALY
 Missing parts of the brain and skull - ANENCEPHALY
 Anterior fontanel depressed – can be a sign of dehydration, molding
 Full or bulging at rest – can be a sign of increased Intra-Cranial Pressure
 Woolly, bunchy hair – indicative of prematurity
 Unusual hair growth – may indicate genetic abnormalities (ex. Hirsutism)

HYDROCEPHALY MICROCEPHALY ANENCEPHALY

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

We are done with the appearance of the head of the newborn, now we
will go to the first thing you want to see after the delivery of the newborn, it
is his/her FACE, right? Oftentimes relatives would ask after the delivery, who
resembles the face of the baby? the father or the mother? or the other
members of the family?
Let’s us now continue...

3. Face/Eyes/Ears/Nose /Mouth
What to Assess:
 Facial movement & symmetry
 Symmetry, size, shape and spacing of eyes, nose and ears

*EYES

Color:

 white sclera (if it is BLUE there is thinness)

 Slate gray, brown or dark blue
 Final eye color: after 6-12 months
 Symmetrical
 Pupils equal, round, reactive to light
 (+) Blink reflex
 (+) transient strabismus due to weak extraocular movements
 Able to move and fixate momentarily
 (+) Red reflex – if (-), cataract
 (+) Edema on eyelids r/t pressure during delivery or effects of medication
 (-) Tear formation (begins @ 2-3 mos.
 Cries tearlessly because the lacrimal ducts are immature until 3 months of age.
 Iris – gray or blue
 Alerts to interesting sights
 Follows objects across midline
 DOLL’S EYE SIGN – can be done by turning the NB head side to side while on
supine position. The eyes will remain stationary. It will disappear between 3 to 4
months of age.

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

Nursing Considerations:

 Administer eye medication within 1 hr. after birth to prevent Ophthalmia

neonatorum/Neonatal Blindness/Gonorrheal conjunctivitis
 Drugs of Choice: Erythromycin 0.5% / Tetracycline 1% / Silver Nitrate 1%
 Application of medicine must be from inner to outer canthus of the eye
(conjunctival sac)

SUNCONJUNCTIVAL HEMORRHAGE:

 Red spot on the sclera – inner aspect of the eye (red ring around the cornea).
Caused by pressure during birth which ruptures a conjunctival capillary of the
eye.

ABNORMAL FINDINGS OF THE EYES:

 If there’s constant tearing there might be a plugged lacrimal duct

 Unequal pupils – may indicate ANISOCORIA
 Setting sun’s eyes – may be due to increased intracranial pressure
 Failure to follow objects – can be attributed to blindness
 White areas over pupils – can be a sign of cataract
 Yellow sclera – is an indication of jaundice
 Blue sclera – can be a sign of Osteogenesis imperfecta

*EARS
> Ears are well formed and complete
> Area where upper ear meets head even with imaginary line drawn from inner and
outer canthus of eye
 Startle response to loud noises
 Alerts to high-pitched voices

ABNORMAL FINDINGS OF THE EARS:

 Low-set ears may indicate Chromosomal disorders (ex. Trisomy 21-Down

Syndrome)
 Skin tags, preauricular sinuses, dimples may be signs of kidney or other
anomalies

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

 No response to sound - deafness

*NOSE
> Appears large for the face
> Both nostrils open to air flow

> May have slight flattening from pressure during birth

> Small & narrow; maybe flattened at midline

> Newborns are nasal breathers; they experience (+) Periodic sneezing

> Reactive to strong odors

ABNORMAL FINDINGS ON THE NOSE

 Blockage of one of both nasal passages – may indicate CHOANAL ATRESIA

 Malformations – congenital conditions
 Flaring mucus – respiratory distress
 (+) Low nasal bridge = Down’s syndrome

*Mouth, gums, tongue

> The mouth is pinkish in color; with moist gums; with intact soft & hard palates

> The uvula is on the midline

> Tongue normal in size and moves freely; with symmetrical frenulum

> Lips and palate are intact

> Reflexes are present like Extrusion and Gag reflexes

EPSTEIN PEARLS – present on the palate, a result of extra calcium deposited in utero

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

PRECOCIOUS TEETH – small, white epithelial pearls present on gum margins.

EPSTEIN PEARLS PRECOCIOUS TEETH

ABNORMAL FINDINGS:
 Small mouth or large tongue = chromosomal problems (Down Syndrome)
 (+) white patches on tongue or side of the cheek = Oral thrush (Candidiasis)

4. NECK
 Short and often chubby with creased skin folds
 Head rotates freely
 Neck = not strong enough to support total weight – makes a momentary
effort at head control – sitting position
 Lying prone – can raise head slight
 Thyroid gland not palpable
 Intact clavicle
 Trachea – prominent on the front of the neck
 Thymus gland – enlarged- rapid growth of glandular tissue early in life
 3 years thymus – triples in size – 10 years – shrink

Neck rigidity – is indicative of congenital torticollis; Injury to the sternocleidomastoid

muscle during birth
Nuchal rigidity – suggest meningitis; newborns whose membranes were ruptured
more than 24 hours before birth.

5. CHEST
> Chest is symmetric side to side
> Respirations are rapid but not distressed
> Both males and females – breast maybe engorged
> (+) Bronchial sounds

Lung alveoli – open slowly over the first 24 to 48 hours and baby has mucus in back
of
throat – RHONCHI – heard – harsh innocent sound of air passing over

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

mucus.

GRUNTING – suggests respiratory distress; High, crowing sound on inspiration maybe

due to immature tracheal development.

> (+) Breast engorgement, subsides after 2 wks

> (+) Prominent/ edematous nipple
> (+) Accessory nipples
> (+) “Witch Milk”

WITCH’s MILK
Do you know that...
Is a thin, watery fluid secreted by
the breasts of newborns which is a re-
sult of retained maternal hormones
The newborn’s breasts are also
engorged because of maternal
hormones.

6. ABDOMEN
> slightly protuberant
SCAPHOID OR SUNKEN APPEARANCE – indicate missing abdominal contents or
DIAPHRAGMATIC HERNIA
 Bowel sounds – should be present within 1 hour after birth

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

 Edge of liver – palpable 1 to 2 cm below the right coastal margin

 Edge of spleen – palpable 1 to 2 cm below the left coastal margin
 During the 1st hour the stump of the umbilical cord must be white,
gelatinous structure and with blue and red streaks of the umbilical vein and
arteries
 Meconium should be passed within 24 to 48 hours
 Urine – passed within 12 to 24 hours
Umbilical Cord
 2 arteries; 1 vein
 White & gelatinous immediately after birth
 Begins to DRY between 1-2 hrs following birth
 Blackened or shriveled between 2-3 days
 Dried & gradually falls off by 7 days
Daily Cord Care:
 Keep cord dry and clean & clamp secured
 Apply 70% isopropyl alcohol to the cord with each diaper change and at
least 2-3x a day.
 DO NOT cover with diaper
 Note for any signs of bleeding or drainage from the cord and other
abnormalities
 Do a sponge bath until the cord falls off.

7. GASTRO-INTESTINAL TRACT
> Capacity: 90 ml, with rapid intestinal peristalsis (2 ½ to 3 hrs)
> Bowels sounds; (+) within 1-2 hrs after birth
> Presence of mass, distention depression or protrusion
> (+) Scaphoid = diaphragmatic hernia
> (+) Distention = LOWER GASTROINTESTINAL TRACT obstruction/ mass

8. ANOGENITAL AREA
*MALE GENITALIA:
 Scrotum is edematous and has rugae

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

 Testes should within scrotal sac

 Penis appears small – 2cm long
 Urethral opening should be at the tip of the glans penis

UNCIRCUMCISED CIRCUMCISED
ABNORMAL FINDINGS:
 Prepuce covers glans penis
 (+) adherent foreskin = Phimosis
 Scrotum: edematous
 (+) enlarged = Hernia
 Meatus: central
 (+) ventral/ dorsal = Hypo/epispadias
 Testes: descended
 (+) undescended = Cryptorchidism
*FEMALE GENITALIA:
 Vulva maybe swollen due to the effect of retained maternal hormones
 PSEUDOMENSTRUATION – blood tinged mucus vaginal secretion also
due to the action of retained maternal hormones
 Labia: edematous
 Clitoris: enlarged; with visible “hymen tag”
 There’s a presence of Smegma (a cheese-like vaginal discharge)
 First voiding within 24 hrs

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

A NEWBORN FEMALE’S VAGINA

*ANUS
> Check patency
> First stool (Meconium) – within 1st 24 hrs
> Sticky, tarlike, blackish-green, odorless material

We are now down to the last part of the physical appearance of the
newborn which are the back and the extremities.
Let us see what are the normal and abnormal characteristics of the
newborn’s back and extremities…

9. BACK
> Spine appears flat in lumbar and sacral areas
> Assumes position maintained in utero – back rounded and arms and
legs flexed on abdomen and chest (fetal position)
*SPINE
> Straight, posture flexed
> Supports head momentarily
> Arms & legs flexed
> Chin flexed on upper chest

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

> Check for protrusion, excessive or poor muscle contractions this might indicate
a Central Nervous System damage.

10. EXTREMITIES
> Arms and legs – short – moves symmetrically
> Hands – plump and clenched into fists
> Clenched fists; flat soles; Fingernails – soft and smooth
> Legs are bowed and short
> Sole of foot – appears flat – extra pad of fat in longitudinal arch
> Flexed, full ROM, symmetrical
> With 10 fingers and toes in each hand
> (+) Creases on soles of feet

ABNORMAL FINDINGS:
> (-) Creases = prematurity
> Check for hip fractures or dysplasia
> (+) Ortolani’s click & uneven gluteal folds = Hip dysplasia

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

PALM CREASES SOLE CREASES ORTOLANI’S SIGN

 (+) inward turning of the foot = club foot or talipes equinovarus

 (+) extra digits = Polydactyly

 (+) web fingers = Syndactyly

Polydactyly Syndactyly

As student nurses who will be taking care of these cute God’s creations,
you have to bear in mind that some problems may arise during the course of
delivery and even after the delivery of the newborn. As you assess the
newborn/s, you can make Nursing Diagnoses in order to have a good and
organized plan of care for them.
Here are some examples of Nursing Diagnoses for the newborn:
1. Ineffective breathing pattern related to accumulation of mucus in the airway.
2. Ineffective thermoregulation related to heat loss from exposure in an
airconditioned room
3. Imbalanced nutrition, less than body requirements related to poor sucking reflex
4. Altered sleep pattern related to a noisy environment
5. Immobility related to body structural defect.

You have just finished the module. I would just like to emphasize
some important points on the discussions of the topics.

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

Key Points

 We must be aware that we have to document and report all abnormal findings we
discovered when caring for the newborn.

 Parents must know what should be expected normally on their newborn child

 Pregnancy visits, activities and nutritional status must be considered in defining the
reasons of birth defects on the newborns.

 Let us not forget that as nurses we have a great role in the teaching of good care
to be given by the mother and her family to the newborn child

References
Books and Online Sources:
Books:
 Silbert-Flagg, Joanne & Pilliteri, Adele (2018); Maternal & Child Health Nursing,
Care of the Childbearing & Childrearing Family (8 th edition)/ Wolter & Kluwer

 Pilliteri, Adele (2010); Maternal & Child Health Nursing, Care of the Childbearing
& Childrearing Family (6th edition)/ Lippincott Williams & Wilkins

Pictures/Images:

Cephalohematoma: https://www.contemporarypediatrics.com/view/cephalhematoma?
url=cephalhematoma (
Sutures: https://www.stanfordchildrens.org/en/topic/default?id=anatomy-of-the-newborn-
skull-90-P01840
Anencephaly: https://www.researchgate.net/figure/Anencephaly-newborn-girl-case-
60_fig2_273870643
Hydrocephalus: https://www.researchgate.net/figure/Hydrocephalus-with-increased-head-
circumference-in-a-3-month-old-child_fig4_234071019
Microcephaly: https://www.usnews.com/news/articles/2016-04-13/babies-with-microcephaly-
from-zika-also-have-brain-damage
Eyes: https://www.aoa.org/patients-and-public/good-vision-throughout-life/childrens-vision/
infant-vision-birth-to-24-months-of-age
Ears: https://www.kidspot.com.au/health/baby-health/newborn-care/ear-care-for-newborns/
news-story/d08bb2f3b5a40b9401342bde2e34cd38
Nose: https://www.workingmother.com/momlife/13647648/how-to-get-boogers-out-of-a-
newborns-nose/
Breasts: https://medlineplus.gov/ency/imagepages/9415.htm
Abdomen: https://www.ecoparent.ca/eco-parenting/umbilical-cord-care-happy-belly-buttons
Penis: https://theotherbabybook.wordpress.com/category/bloggers/molly/
Vagina: https://www.dshs.texas.gov/newborn/hand_cah.shtm

Other images are taken from:

Book:

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Universidad de Sta. Isabel Vincentian Learning Module
College of Health Sciences MATERNAL AND CHILD HEALTH NURSING
Nursing Program Mr. Rhandy V. Salvani, MAN, RN

Pilliteri, Adele (2010) (2018); Maternal & Child Health Nursing, Care of the
Childbearing & Childrearing Family (6th edition)/ Lippincott Williams & Wilkins
Online source:
www.adam.com
Videos:
Video (Head) - https://www.youtube.com/watch?v=uQWNCadPG5Y
Video (Face) - https://www.youtube.com/watch?v=bHSifjHnTnY
Video (Chest) -https://www.youtube.com/watch?v=lMxVSwxsSt0
Video (Abdomen) - https://www.youtube.com/watch?v=Uto5Kn_5Gx8
Video (Anogenital) - https://www.youtube.com/watch?v=6c3cCqxnNL0
Video (Reflexes) - https://www.youtube.com/watch?v=UlzroiZ1Sv8

CONGRATULATIONS FOR FINISHING THIS MODULE!

Pause for a moment and PRAY... Thank God for giving you
this wonderful “GIFT OF LIFE”. If you have a baby brother,
sister, cousin or nephew/niece, cuddle him/her and let
him/her feel your care, that this wonderful little human
being is in the warmth of the LOVE of a FAMILY.

Thank you!!!
- Sir
Rhandy

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