How To Do Newborn Physical Examination?

A complete physical examination is an important part of newborn care within the first 12 hours of life. Each body system is carefully examined for signs of health and normal function. The physician also looks for any signs of illness or birth defects. Physical examination of a newborn often includes assessment or examination of the following:

A. Vital Signs (normal readings):

• Axillary temperature - 96°F to 99°F or 35.6°C to 37.2°C 
• Pulse - 120 - 160 bpm, normally irregular 
• Respiration - 30 - 60 per minute, irregular, abdominal 
• Blood Pressure - 60 - 90mmHg (systolic) , 40 - 90 mmHg (diastolic) 

B. Measurements:

• Length - 18 - 22 in. or 45 - 55 cm., average - 20 in. 
• Head circumference - 13 - 14 in. or 33 - 35 cm 
• Chest circumference - 12 - 13 in. or 30 - 33 cm 
• Weight - average is 7 pounds or or 3.2 kilogram 

C. Skin

• The skin is usually reddish, although the fingers and toes may have a bluish tinge because of poor blood circulation during the first few hours.
• Presence of vernix caeseosa (is the waxy or cheese-like white substance found coating the skin of human babies.)
• Some cracking and peeling of skin
• Presence of Milia (tiny cysts and appear as whitish pinhead-sized spots mainly on and around the nose which usually disappear within a few weeks.
• Occasionally, the skin has several hard lumps (subcutaneous fat necrosis) due pressure from bones destroyed some fatty tissue. Most common on the head, cheek, and neck, particularly if forceps were used during delivery. May break through to the skin surface, releasing a clear yellow fluid, but they usually heal fairly quickly.

D. Head

• Presence of moulding (shaping of the head from passage through the birth canal)
• Sutures are palpable with small separation
• Presence of anterior fontanelle (diamond shaped, soft and flat and has 2-4 cm in size) and posterior fontanelle (triangular shape and has 0.5 - 1 cm in size)
• Caput succedaneum presents as a scalp swelling that extends across the midline and over suture lines and is associated with head moulding. It does not usually cause complications and usually resolves over the first few days.
• Hair are silky and soft

E. Face

• Symmetric in appearance and movement
• parts are proportional and appropriately placed

     1.  Ears

• Well formed and complete
• Startle response to loud noises
• Upper ear must be about same level with the outer canthus of the eye

     2.  Eyes

• Symmetric and clear
• Scant or absence of tears
• Pupils equal and react to light
• Follow objects across midline
• May have subconjunctiva haemorrhage
• Edema of eyelids from pressure during birth

     3.  Nose

• Both nostril open to air flow
• May have slight flattening from pressure during birth

     4.  Mouth

• Mouth, gums, and tongue are pink
• Lips and palate intact
• Presence of sucking, rooting, swallowing and gag reflexes

     5.  Neck and Clavicles

• Short neck turns head easily from side to side
• Presence of clavicles (bones across the upper chest)

     6.  Chest

• Cylindric.  Xyphoid process may be prominent
• Symmetric
• Nipples present and located properly
• May have engorgement with white discharge

     7.  Abdomen

• Usually distended
• Check for masses and hernias
• Umbilical cord clumped securely.  Cord must have 2 arteries and 1 vein    

     8.  Genital
          
      Female

• Labia  are prominent because of exposure to the mother's hormones, and they remain swollen for the first few weeks
• Small amount of vaginal discharge white mucous in color
• Urethra is open and vagina present 

      Male

• Testes should be present in the scrotum
• Rogue on scrotum
• Urethra open at the tip of penis

     9.  Extremities (both upper and lower)

• Equal and bilateral movement of extremities
• Correct number and formation of fingers and toes
• Good muscle tone and flexion
• Legs equal in length
• Normal position of feet

     10.  Back

• No opening observed or felt in the vertebral column to exclude spina bifida  (is a developmental congenital disorder caused by the incomplete closing of the embryonic neural tube)
• Anus patent
• Sphincter tightly closed

     11. Reflexes

• Grasp reflex
• Press finger against base of fingers or toes
• Fingers curl tightly and toes curl forward
• Plantar creases - these creases on the soles of the feet range from absent to covering the entire foot, depending on the maturity.

• Sucking reflex - when an object is placed in their mouth, newborns begin sucking immediately

• Rooting reflex - when either side of their mouth is touched, newborns turn their head toward that side. This reflex enables newborns to find the nipples.

• Moro Reflex - when newborns are startled, their arms and legs swing out and forward in a slow movement with fingers outstretched. This disappears in 6 months.

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24 Ways To Loose Weight Without Dieting (Part III)

Here is the last part on how to loose weight without deiting.

16: Chew Strong Mint Gum
Chew sugarless gum with a strong flavor when you're at risk for a snack attack. Making dinner after work, at a party, watching TV, or surfing the Internet are a few dangerous scenarios for mindless snacking. Gum with a big flavor punch overpowers other foods so they don't taste good.

17: Shrink Your Dishes

Chose a 10" lunch plate instead of a 12" dinner plate to automatically eat less. Cornell's Brian Wansink, PhD, found in test after test that people serve more and eat more food with larger dishes. Shrink your plate or bowl to cut out 100-200 calories a day – and 10-20 pounds in a year. In Wansink's tests, no one felt hungry or even noticed when tricks of the eye shaved 200 calories off their daily intake.

18 : Get Food Portions Right

The top habit of slim people is to stick with modest food portions at every meal, five days a week or more. "Always slim" people do it and successful losers do it, too, according to a Consumer Reports survey. After measuring portions a few times, it can become automatic. Make it easier with small "snack" packs and by keeping serving dishes off the table at meal time.

19: Try the 80-20 Rule

Americans are conditioned to keep eating until they're stuffed, but residents of Okinawa eat until they're 80% full. or named it as hara hachi bu. Try to adopt this healthy habit by consuming out 20% less food, according to researcher Brian Wansink, PhD, where his studies show most people don't miss it.

20: Choose for the Red Sauce

The tomato-based sauces tend to have fewer calories and much less fat than cream-based sauces. But remember, portion size still counts. A serving of pasta is one cup or roughly the size of a tennis ball.

21: Less Meat is Better

Eating vegetarian meals more often is a slimming habit, according to WebMD's "recipe doctor," Elaine Magee, MPH, RD. Vegetarians weigh up to 20% less than meat eaters. While there are several reasons for this, legumes play an important role. Bean burgers, lentil soup, and other tasty legume-based foods are simply packed with fiber. Most Americans get only half of this important nutrient, which fills you up with fewer calories.

22: Burn 100 Calories More

Lose 10 pounds in a year without dieting by burning an extra 100 calories every day. Try one of these activities:

• Pull weeds or plant flowers  - 20 minutes.
• Mow the lawn - 20 minutes.
• Clean house - 30 minutes.
• Jog - 10 minutes.
• Walk 1 mile - 20 minutes 

23: Celebrate

When you've kicked the soda habit or made through the day without overeating, pat yourself and say we made closer to a slimming lifestyle. Phone a friend, get a pedicure, buy new clothes -- or on occasion, indulge in a small slice of cheesecake.

24: Manage Stress without Food

Many people eat in response to stress. Unfortunately, food does not help you cope with stress; it simply adds calories to your daily total. Find more effective alternatives: exercise, take a bath, call a friend, surf the internet. Just steer clear of the kitchen!

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How Does Haemodialysis Works?

Hemodialysis is a type of dialysis that uses a machine with an artificial filter to remove wastes and extra fluids from the blood. This treatment also helps control the chemical balance in your body and helps control blood pressure. Each treatment takes about 4 hours and is done 3 times each week.

A dialysis machine pumps small amounts of blood out of the body and through a filter called an artificial kidney or dialyzer. This kidney filters extra fluid and wastes from the blood. The blood is then pumped back into your body. Medicine will be given to you to prevent your blood from clotting. Fluid, called dialysate, is added to the dialysis machine to: 

1. Help filter out extra fluid and wastes that have built up
2. Add chemicals that your body uses The dialysate is a mixture of water and chemicals that are present in your blood. This fluid can be adjusted, based on your lab values, to give you the best filtering with fewer side effects.

For your safety, the machine has pumps, sensors, monitors and alarms to let the staff know if there is any problem.                  

Access Site

For this treatment, there needs to be a site where the blood is taken out of the body and then returned to the blood stream. This is called an access. After the access is made and healed, 2 needles connected to tubing are inserted into the access. One needle draws a small volume of blood out and pumps it through to the dialysis machine and filter. After the blood is filtered, it is return to the body through the other needle. 

There are three main types of access sites:

1. Fistula – With minor surgery, an artery is joined to a vein under the skin. This is most often done in an arm. This increases the amount of blood that flows through the vein, and makes it bigger. This is the best access because it has fewer complications and lasts longer.
2. Graft – With minor surgery a soft plastic tube is used to join the artery and vein under the skin.
3. Catheter – There are two kinds of catheters, temporary and permanent. The temporary catheter is used for 1 to 2 weeks. This catheter is used until a more permanent access is placed. A permanent catheter is placed in the neck vein and tunneled under the skin. It is good for about a year. The catheter has a risk for infection and is used only until a fistula or graft can be placed. Both the fistula and graft need 2 to 6 weeks to heal and mature before they are able to be used.

Side Effects of Hemodialysis

During treatment:

• Feel tired and sleepy
• Feel dizzy
• Be cold
• Have muscle cramps
• Have nausea

Complication

• Hypotension
• Painful muscle cramps
• dialysis diequillibrium
• chest pain
• dysrythmias
• air embolism (through the line)
• haemorrhage (due to heparin)

Let the staff know how you are feeling so that they can help you be more comfortable.

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The Secret To Surviving Nursing School

Always remember these! 

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What Are The Nursing Care Given To Haemodialysis Patients

When your kidneys do not work well, dialysis is needed to remove extra fluid and waste products such as creatinine and urea, as well as free water from the blood in your body.  It can be done either by haemodialysis or peritoneal dialysis, where the former is the most common choice among patients.

Hemodialysis is a type of dialysis that uses a machine with an artificial filter to remove wastes and extra fluids from the blood. This treatment also helps control the chemical balance in your body and helps control blood pressure. Each treatment takes about 4 hours and is done 3 times each week. 

The need for dialysis may be acute (when there is high and increasing level of serum potassium, fluid overload-impending pulmonary edema, increasing acidosis, pericarditis and severe confusion) or chronic (e.g., End Stage Renal Failure, presence of uremic sign and symptoms affecting all body systems, hyperkalemia, fluid overload not responsive to diuretics and fluid restriction, and a general lack of well-being).

Nursing Care

Pre dialysis care

• assess vital sign as a baseline information to help evaluate the effects of haemodialysis
• weigh and record patient's weight
• assess vascular access site for palpable pulsation or vibration and for signs of inflammation.  Absence of pulsation/vibration should be reported to doctors and dialysis can no longer be done in the assessed access site.
• no procedure should be done on the extremities with vascular access site to avoid damage of blood vessels leading to the failure of the arteriovenous fistula.

Post dialysis care

• assess and document vital signs, weight and vascular access site condition
• rapid fluid and solute removal during dialysis may lead to hypotension, cardiopulmonary changes and weight loss
• assess client general condition for dialysis disequillibrium
• rapid changes in BUN (Blood Urea Nitrogen), pH and electrolyte level during dialysis may lead to cerebral edema and increase intracranial pressure
• assess for bleeding at the access site
• heparinization during dialysis increase the risk of bleeding
• provide psychological support; listen actively, address concerns and explain about the dialysis

Haemodialysis can be an outpatient or inpatient therapy.

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Prenatal Pesticide Exposure Linked With Lower IQ

Babies exposed to pesticides before birth may have significantly lower intelligence scores by age 7 than children who were not exposed, three separate studies published on Thursday said.

Results from the studies — two in New York and one in an agricultural community in California — suggest prenatal exposure to pesticides can have a lasting effect on intelligence.

In one study, a team at the University of California Berkeley found that every tenfold increase in prenatal exposure to organophosphate pesticides corresponded with a 5.5 point drop in overall IQ scores in children by age 7.

“That difference could mean, on average, more kids being shifted into the lower end of the spectrum of learning, and more kids needing special services in school,” Berkeley’s Brenda Eskenazi, who led one of the three studies published online in Environmental Health Perspectives, said in a statement.

The two other studies — one at Mount Sinai Medical Center and the other at Columbia University — also examined prenatal exposure to pesticides and IQ in children at age 7.

The teams at Berkeley and Mount Sinai sampled pesticide residues in maternal urine, while the team at Columbia tested umbilical cord blood levels of chlorpyrifos, part of a class of pesticides known as organophosphates that are known to be toxic to brain cells.

Until it was banned for indoor residential use by the U.S. Environmental Protection Agency in 2001, chlorpyrifos was one of the most widely used insecticides for residential pest control.

In the Columbia study, researchers sampled 265 New York City minority children born before the ban. The higher levels of chlorpyrifos in the babies’ umbilical cord blood were linked with lower performance on two different IQ tests.

Children who were in the highest 25 percent of exposure levels scored 2.7 points lower on IQ tests than children whose exposures were in the lowest quarter of the study.

The UC Berkeley study involved 329 children whose mothers enrolled when they were pregnant.

Urine samples were taken twice during pregnancy from the mothers and after birth from the children at regular intervals between ages 6 months and 5 years.

The team said while prenatal exposure to pesticides were significantly linked with childhood IQ, pesticide exposure after birth was not, suggesting exposure during fetal brain development was a more critical period than childhood exposure.

Children in the UC Berkeley study were exposed to pesticides in 1999 through 2000. Since the 2001 ban, use of organophosphates in the United States has fallen by more than 50 percent, but agricultural use of chlorpyrifos is still permitted.

“It is vitally important that we continue to monitor the levels of exposure in potentially vulnerable populations, especially in pregnant women in agricultural communities, as their infants may continue to be at risk,” Dr. Robin Whyatt of Columbia said in a statement.

(Source: Reuters, April 17th, 2011)

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Tips on How To Survive As A Student Nurse

My first day as a student nurse was frightening.  I can fell the ball rolling down my tummy and wanting to go to bathroom every now and then.  There were so many things questions in my mind. Will i make friends or will they like an older classmate.  Can i cope up with the lessons being out of education for over 10 years?  Can i really put into practice what i will learn in the class?  The worst is can i keep my promise to my husband that i can manage my time as a student, a wife and a mother!  For over a year now, i would say YES. In fact i am 1 of the deans list in the class and i have conquered all my fears during clinical posting time.  Though you fell scared on your first days on new hospital setting but definitely you be able to cope up once you are familiar with the new environment and the people around.

If you’re feeling nervous, let me reassure you. You are about to start the most amazing adventure. The next few years will be the most rewarding of your life.

Being a student nurse is a privilege and a wonderful experience. Yes it can be hard, yes you may struggle, but every moment is worth it. As you learn, you will acquire valuable memories that will stay with you throughout your career.  You will make friends who will stay with you for the rest of your life. Hold on to those special people who encourage and support you.

So what’s the most important thing to do as you embrace this new stage of your life? Enjoy it! All the best to guys!


A. STUDIES

• Don’t put too much pressure on yourself, but try your hardest and be proud of your achievements.
• Listen, understand and relate the lesson.  You can score even for twisted and tricky question.
• Ask if you have any doubts. 
• Learn to laugh at yourself. You will make mistakes, but that is how you learn.
• Manage your time for your studies, extra curricular activities, houseworks, exercise and others carefully.  Nursing needs ample time to study.
• Practice procedures many times and if you are not sure of the steps and proper ways to do it, ask your tutor, lecturer, or Clinical Instructor.  Remember practice makes perfect!

B. CLINICAL POSTING

• Be ready for your clinical posting.  Read and refresh your new and old notes.  Clinical Instructors (CI) loves to ask question every technical words you say and make sure you know the rationale.
• Be confident in every procedures you do with your CI.  This builds trust with the patient.
• Never try and do something if you are unclear about what you’ve been asked to do. It is always better to ask even 10 times if needed to fully understand rather make mistakes.
• Learn to laugh at yourself. Everyone make mistakes but learn from it.
• Keep a diary and/or write reflective accounts of your experiences. This may seem like a chore but when you read it, you’ll realise just how far you’ve come. It’s also a good way of venting emotions and putting things in perspective.
• Don’t refer to patients by their condition or bed number rather learn their names! That and a kind word can work wonders.
• Don't get disappointed when you are address as "the student" instead of your name.
• Be ready for criticism.  Don't be discouraged no matter how well you think you are doing.  Take it positively.
• Get used to assessment and appraisal.  It is part of the training.  Remember every CI has their own assessment and some has prejudices, don't be discouraged and accept it with good grace.
• Respect healthcare assistants. They know the wards inside and out. If you’re looking for something, they will know where to find things. Form good relationships with them and they will support you.
• Don’t be afraid to cry. I wouldn’t recommend you do it on the ward, but it is perfectly OK to cry. We all have awful days as student nurses and it’s important to deal with them. And then it’s time to move on - tomorrow will bring new challenges and new people.

DO WHAT YOU HAVE LEARN and WRITE WHAT YOU HAVE DONE!!!

This is the favorite saying our head of the nursing school will always remind us...

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