HEART, RESPIRATORY, ABDOMEN ASSESSMENT
Heart and Respiratory
The heart and respiratory assessment were described under the initial exam and vital signs (slide 3).
- It is best to do these exams when the infant is quiet. If the infant is crying, you may insert a clean gloved finger into the infant's mouth to initiate sucking. This may quiet the infant while listening to the heart and lung sounds and counting the rates. If this does not work, you may swaddle the infant in a blanket and cradle or rock it in your arms as this will soothe him/her. Don't forget to wipe the stethoscope with an alcohol wipe between infants. Warming the bell will prevent a startle reflex from the infant.
- Observe the chest for evenness of respirations. Respirations are diaphragmatic, so that abdominal and chest movement are synchronous.
- Observe for intercostal and substernal retractions or see-saw respirations which indicate respiratory distress.
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Intercostal Retractions |
Subcostal Retractions |
Supernumerary Nipple Under Infant's Left Nipple
Pictures by Janelle Aby, MD, Stanford Medical School
- Assess for nipple/breast tissue for size and symmetry. Breast buds are the amount of areola
raised off the chest. This tissue measures about 6mm in the term infant, smaller in the premature infant. Fuller areola and greater breast tissue occurs in full term infants. Additional nipples or supernumerary nipples may be located along the nipple line. These findings are noted but no intervention taken. - Palpate the brachial artery on the inside of each upper arm. This is the pulse that is palpated during resuscitation.
- Auscultate heart sounds. Because the heart rate of the infant is rapid, it takes a lot of practice. Be patient. You will learn!
- Count the heart rate first for a full minute.
- If you are musical, set a metronome at a rate of 140 or 150 and count the rate for a full minute.
- Then listen to one element at a time, 1st heart sound then the 2nd heart sound. Do you hear a single sound or two sounds with each sound (split heart sound).
- Then listen to the systolic interval and diastolic interval. Is there a murmur? Systolic murmurs are not uncommon in infants. They are usually due to shunting through the patent ductus arteriosus (PDA) and disappear in a few days. A diastolic murmur is an unusual finding. If the infant is symptomatic (cyanotic, rapid respirations, poor feeding), the physician may order blood pressures on all four extremities to rule out coarctation of the aorta (COA). Click here to listen to the heart rate at each of the four locations of this infant's heart.
- Auscultate breath sounds. Auscultate front and sides, then the back. Sounds should be clear bilaterally. Click here for normal breath sounds. Click here to listen to tachypnea. Click again.
- After a c-section, the infant may have some crackles in the bases. Crying and movement will help to clear the lungs. Click here to listen to crackles in the lungs. If the crackles are combined with nasal flaring, retractions and grunting, the infant may be transported to the NICU for closer observation.
Abdomen
- Observe the abdomen for symmetry of shape and movement. The abdomen is rounded and soft. It may be mildly distended if overfed.Marked distension can be due to gastrointestinal malformations.
- Auscultate the abomen. If the infant has had a bowel movement and there is no distension, it is not necessary to ausculate all four quadrants. Bowel sounds become active 1-2 hours after birth.
- Palpate to determine the softness of the abdomen. The pediatrician or nurse practitioner will palpate for the liver, spleen or kidneys..Palpate the femoral pulses. This is a difficult part of the examination, so be patient. Place the tip of your index fingers in the groins. It is helpful to remember from anatomy where the femoral artery ought to be! Slowly move the position of the tips of your fingers until you feel the pulse. Compare the strength of the pulse on each side at the same time. A weak/thready pulse may suggest coarctation of the aorta (COA). Note that if your pressure is too light or too heavy, you may not feel the pulse! In rare cases, congenital defects of the abdominal wall occur (see side panel).
Umbilical Cord
After birth, the cord is cut and clamped. Note any redness, discharge or odor which may indicate an infection. If these symptoms are present, the physician will need to be notified to determine if laboratory tests are needed.
- The umbilical cord is whitish gray, gelatinous, and odorless. The two arteries and one vein can be viewed soon after birth.
- The pulse can be felt from the umbilical cord right after birth.
- The cord clamp remains in place for 24 hours, at which time the cord is dry, shriveled and black.
- See right sidebar for teaching instructions to parents.
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Cord after birth. 2 arteries on left and one vein on right. |
Umbilical cord on Day 2 after birth. Reddness from irritation by cord. |
Umbilical cord fell off on Day 8 after birth. Normal. Monitor for drainage. |
Pictures used with permission Dr. Janelle Aby, Stanford Medical School, Palo Alto, CA
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Drag the items from the bottom to the slots on the right. | |
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