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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