How do NICU nurses assess their babies? What are the elements of a routine physical exam in the NICU?
These were the top questions asked during my latest and greatest Insta poll!
Every newborn is carefully examined after birth for problems or complications indicating that he/she may need NICU care. A complete and thorough physical assessment is performed that involves every body system. Throughout the baby’s hospital stay, we continually assess his health and observe for any deviations from his progression through his plan of care.
During a 12-hour shift, every baby is assessed 3-4 times. On average, a NICU nurse can have 1-3 babies. Meaning we might be assessing twelves times a shift! Needless to say our physical assessments must be QUICK but also THOROUGH! Below is a list of the many things that we are checking during our routine physical exam.
A NICU NURSE’S ASSESSMENT INCLUDES ALL OF THE FOLLOWING:
1. General appearance. Physical activity, tone, posture, and level of consciousness.
2. Skin. Color, texture, integrity, nails, presence of rashes, scaling/dryness, erythema, bruising, breakdown, Mongolian spots, sacral dimples.
3. Head and neck. Appearance, shape, presence of molding (shaping of the head from passage through the birth canal).
Fontanels (the open "soft spots" between the bones of the baby's skull)
Clavicles (any fractures?)
4. Face. Eyes, ears, nose, cheeks.
5. Mouth. Palate, lips, tongue, throat.
6. Lungs. Breath sounds, breathing pattern.
7. Heart sounds. Regularity, rate, rhythm.
8. Capillary Refill. Normal/abnormal.
9. Pulses. Radial, brachial, femoral, popliteal, etc.
10. Edema. Pitting or non-pitting, location.
11. Abdomen. Presence of masses, hernias, bruising, bowel loops.
12. GI. For open passage of stool as well as characteristics of stool.
Bowel sounds, loops, pattern.
Abdominal distention, bloating, tenderness, bruising.
13. GU. For open passage of urine as well as color and quantity.
14. Arms and legs. Movement and development.
Weight
A baby's birth weight is an important indicator of health. The average weight for term babies is about 7 pounds (3.2 kg). In general, small babies and large babies are at the greatest risk for postnatal problems. Babies are weighed daily in the NICU to assess growth, fluid, and nutritional needs. Newborns often lose “water weight” after birth and may hangout below their birth weight for a while. This is a completely normal occurrence. Babies will usually gain this weight back by the second week of life. Premature and sick babies may not begin to gain weight right away.
Most hospitals use the metric system for weighing babies. These charts below will help you convert grams to pounds & ounces…
GESTATIONAL ASSESSMENT
The Dubowitz/Ballard Scoring for Gestational Age is an exam often used to evaluate a baby’s appearance, skin texture, motor function, and reflexes. A baby's gestational age often can be closely estimated using this tool. The physical maturity aspect is performed within the first two hours of birth, and the neuromuscular maturity portion is completed within 24 hours after delivery. Assessing a baby's physical maturity is an important part of care. Maturity assessment is helpful in meeting a baby's needs if the dates of a pregnancy are uncertain. For example, a very small baby may actually be more mature than he appears by size. This means that he may need different care than a premature infant.
OTHER MEASUREMENTS
Other measurements are also taken of every baby in the NICU. These include the following:
Head circumference. The distance around the baby's head.
Abdominal circumference (Girth). The distance around the belly.
Length. The measurement from crown of head to the heel.