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23.1 Physical Assessment of the Newborn

It is important for the nurse to know how to complete a comprehensive and accurate physical assessment on a newborn. Performing the physical assessment with the new parents in the room is a good opportunity for the nurse to educate the parents on safety issues in handling and caring for their newborn. New parents and even experienced ones will look to the nurse for guidance before discharge about how to integrate the newborn into their family, how to feed and soothe their newborn, and how to recognize when their newborn needs help. The nurse’s assessment should always work from the least invasive to the more invasive to avoid irritating the newborn and to maintain thermoregulation. Assessment begins with passive observations, then moves into a hands-on physical examination. The nurse should have a broad knowledge base of expected findings in a newborn, including weights and measurements, vital signs, commonly elicited reflexes, and expected and unexpected variations to look out for. Nurses are the experts in newborn care and should advocate for safe, timely discharge home for the newborn and their family.

23.2 Estimation of Gestational Age of the Newborn and Newborn Behavioral Assessment

A complete newborn assessment must consider the gestational age of a newborn. While that can be obtained by the date of a pregnant person’s last menstrual period, there are times when that is not accurate or is unknown. At those times, the nurse can utilize the Ballard scoring tool to determine the newborn’s approximate gestational age, allowing the clinical team to be prepared for any age-related issues that the newborn may experience. One of the greatest responsibilities of the nurse in caring for a newborn and their family is health promotion and risk reduction, which is the purpose of estimating gestational age.

The Brazelton Neonatal Behavioral Assessment gives nurses an opportunity to assess the newborn’s personality but also to assess the bonding that is (or is not) occurring between the parents and the newborn. Early intervention and a referral to a social worker is key if there is a problem, and providing resources before the couplet leaves the hospital is best practice. Additionally, this assessment gives the parents time to observe and interact with their newborn’s personality for the first time, while allowing the nurse one more chance for anticipatory guidance and discharge education.

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