![]() ![]() During palpation, the tips, palmar, and lateral surfaces of the fingers of both hands are used to assess external structures (e.g., skin, hair texture), vibrations (e.g., peripheral pulses, precordial activity, point of maximal impulse of the heart against the chest wall), and internal structures (e.g., liver, spleen, kidneys). Palpation is a technique in which the examiner uses the sense of touch to assess both superficial and deeper body characteristics. The practitioner can collect most of the information needed for a complete physical assessment solely through observation ( Table 1.1). This finding may lead the examiner to palpate the precordium and peripheral pulses and obtain four extremity blood pressures, actions that are not normally part of the examination of an otherwise healthy-appearing newborn. For example, the observation of an active precordium (visual cardiac pulsations) directs the examiner to careful cardiovascular assessment. A specific observation may alert the examiner to assess a particular system more thoroughly. Using the visual and auditory senses, the practitioner observes the infant, assesses, and makes decisions about what has been seen or heard. If you cannot get the habit of observation one way or other, you better give up…, for it is not your calling, however kind and anxious you may be. For it may safely be said, not that the habit of ready and correct observation will by itself make us useful…, but that without it we shall be useless with all our devotion…. In the case of infants, everything must depend upon the accurate observation of the nurse or mother…. Consistency-performing the newborn physical assessment in the same organized manner every time-maximizes information gained from each examination performed, thus adding to the clinician’s knowledge base and ensuring that portions of any individual examination will not be inadvertently forgotten. The sequence of how the examination is performed is not as important as developing a consistent and organized approach. With experience, each clinician develops her or his own unique approach to newborn physical assessment. For example, if a previously quiet infant begins to cry during palpation of the abdomen, the experienced examiner continues the abdominal examination but also notes the quality of the cry, the infant’s color while crying, respiratory effort, facial movements, the tongue, intactness of the palate, and movement of the extremities.Ĭlinical expertise develops throughout a practitioner’s career. Repetition and experience help the examiner learn to see the newborn as a whole and process multiple observations while examining individual systems. In fact, the student often views the infant as a series of systems to be examined. Lack of familiarity with essential tools and limited practice with basic techniques both slow assessment. Initially, the inexperienced examiner finds physical assessment time-consuming. When the examiner views this responsibility as a diagnostic challenge, newborn physical assessment provides both personal and professional satisfaction, even though most infants examined are normal. The newborn’s inability to provide verbal information tests the acuity of the examiner’s skills. Seeing each infant as a mystery to be unraveled requires mindful curiosity from the examining clinician. This first examination offers a unique opportunity for early recognition of any problems the infant may have. The importance of approaching newborn physical examination with a sense of anticipation cannot be overemphasized. Other assessment techniques include auscultation, palpation, bimanual inspection of the kidneys, percussion, transillumination, and head-to-toe examination. Observation is the most important physical assessment technique for practitioners to master. The basic principles of physical assessment include: review the perinatal history for clues to potential pathology, assess the infant’s color for clues to potential pathology, auscultate only in a quiet environment, keep the infant warm during examination, have the necessary tools at hand, calm the infant before beginning the examination, handle the infant gently, and complete the examination. ![]() This chapter provides brief discussion on techniques of physical assessment, observation for physical assessment, timing of the examination, basics of physical assessment, a sample approach and the equipments used. With experience, each clinician develops their own unique approach to newborn physical assessment. This examination offers unique opportunity for early recognition of any problems the infant may have. This chapter deals with newborn physical assessment. ![]()
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