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Maternal and Child Health Home VisitingNursing Standards and Competencies

Guide for Newborn Physical Assessment,Anticipatory Guidance and Health Teaching

Developed by the following Healthy Babies Providers:

Vermont Assembly of Home Health AgenciesVermont Department of Health

Vermont Regional Perinatal Program

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Purpose

The purpose of the Guide for Newborn Physical Assessment, Anticipatory Guidance andHealth Teaching is to describe in detail the competency demonstrates newborn physicalassessment and compares data with norms as stated in Maternal and Child HealthHomeVisiting Nursing Standards and Competencies, Postpartum Maternal and NewbornNursingCare Competency, Vermont Department of Health, January 1997.It is important to note that only when physical assessment of the newborn is combined withthepsychosocial and environmental assessment of the newborn as well as the physical,psychosocial and environmental assessment of the postpartum woman and her family willeffective nursing interventions and positive client outcomes take place. The competenciesrelated to the psychosocial and environmental assessment of the newborn and postpartumwoman are described in the Postpartum Maternal and the Newborn Nursing CareCompetency,Maternal and Child Health Home Visiting Nursing Standards and Competencies, January1997.

A Guide for Postpartum Maternal Physical Assessment, Anticipatory Guidance and Health Teaching is under development.Priority Areas for Home Visits to Newborns Less Than 48 Hours of Age

Because important changes (e.g. jaundice) occur during the second and third days afterbirth,the following components of the physical assessment must be completed upon the firstvisit of all newborns less than 48 hours of age: parent(s) - infant interaction general health

sleepfeedingelimination

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Communication with Medical Care Provider and Other Healthy Babies Providers

It is expected that communication between the MCH Home Visiting nurse and thepostpartumwoman's and newborn's medical care provider and other Healthy Babies providers (e.g.nutritionist or lactation consultant) takes place on an ongoing basis and includes normalandabnormal findings, assessment items not addressed, nursing interventions and clientoutcomes.In the case of home visits to newborns less than 48 hours of age, it is expected that theMCHHome Visiting nurse will contact the newborn's medical care provider immediately if anyabnormalities are noted.

The physical assessment of the newborn may be adapted to meet the needs of thepostpartumwoman and newborn. For example, if the newborn had a physical assessment by theirmedicalcare provider on the day of the home visit, then the complete physical assessment asoutlinedin this guide may not be necessary. Discussing the findings of the physical assessment bythemedical care provider and its impact on nursing interventions is more appropriate.Applying this Guide Locally

There may be variations in local medical practice regarding anticipatory guidance andhealthteaching. For example, some medical providers request parents to take a rectal ratherthanaxillary temperature. It is important that MCH Home Visiting nurses know these localvariations and incorporate, as appropriate, this information in their anticipatory guidance

andhealth teaching so that parents receive consistent health teaching. Methods of communicationbetween MCH Home Visiting nurses, medical care providers and other Healthy Babies

d ll l h l l l l h k f h d f

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This guide articulates physical assessment of the newborn by MCH Home Visiting nurseswithin the context of maternal and child health nursing; community health nursing; home

visiting of newborns less than 48 hours of age as well as newborns over 48 hours of age;andnursing care that complements, rather than substitutes for the newborn's primary medicalcare.

The contributors to this guide are listed below; many thanks for your expertise andtime.Clinical Review Team

Nancy Kennedy, RN - VNA of Vermont and New HampshireLynn Metheny-Leib, RN, BSN, MPA - VNA of Chittenden, Grand IsleDell McDonough, RN BSN, IBCLC - Barre District Office, Dept of HealthHelen Woodard, RNC - Bennington Area Home Health

MCH Home Visiting Nursing Competency Workgroup

Betty Allen, RN, BSN - VNA Chittenden & Grand Isle

Martha Grady, RN, MSN - Vermont Regional Perinatal ProgramEllen Leff, RN, MS - Franklin County Home HealthMargaret Luce, RN, MSN - Central VT Home Health & HospiceKathleen Paterson, RN, MPH - Division of Community Public Health, Dept of Health

Healthy Babies Program

Sally Bellew, RN, BSN - Burlington District Office, Dept of HealthPaula Duncan, MD - Division of Health Improvement, Dept of Health

Toni Harbison, RN, BSN - Burlington District Office, Dept of HealthCindy Ingham, RN, BSN - Division of Community Public Health, Dept of HealthJane Jackson RN MS - Division of Community Public Health Dept of Health

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References

AWHONN. (1994). Didactic content and clinical skills verification for professional nurseproviders of perinatal home care. Washington, D.C.: author.

AWHONN. (1996). Compendium of postpartum care. Skillman: Johnson and JohnsonConsumer Products, Inc.

ANA. (1985). Code for nurses with interpretive statements. Kansas City: author.

ANA, Council of Community Health Nurses. (1986). Standards of community health nursingpractice. Kansas City: author.

Cardenas, B.D.B. (1989). Essential skills: Physical and developmental assessment.InStewart, M., J. Innes, S. Searl and C. Smillie. (Eds.), Community health nursing in Canada(pp. 496-530). Toronto: Gage Educational Publishing Company.

Olds, S.B., M. L. London and P. W. Ladewig. (Eds.). (1996). Maternal newborn nursing (5thed.). California: Addison-Wesley Nursing.

Simpson, K.R. and P. A. Creehan. (1996). AWHONN perinatal nursing. Philadelphia:Lippincott.

Tappeeo, E. and M.E. Honeyfield. (1996). Physical assessment of the newborn.California:NICUInk Book Publishers.

Thilo, E. H. and S. F. Townsend. Early newborn discharge: Have we gone too far?C di i il 996 29 6

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GUIDE FOR NEWBORN PHYSICAL ASSESSMENT, ANTICIPATORY GUIDANCE AND) HEALTH TEACHING

Assessment Items Norms Abnormalities Anticipatory Guidance and HealthTeaching

Priority Areas for Home Visits toNewborns

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Assessment Items Norms Abnormalities Anticipatory Guidance and HealthTeaching

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Assessment Items Norms Abnormalities Anticipatory Guidance and HealthTeaching

Priority Areas for Home Visits toNewborns 15% -assure that the same calibratedscale is used if the newbornsweight requires monitoring

-teach parents re: axillary temp

when signs of illness are present

-reinforce that newborns have littlefat & cant at first readily regulatetheir own temp. Avoid excessivelayers of clothing when surroundingtemp. is warm. A rule of thumb is todress infant 1 extra thin layer morethan parent(s) is wearing

-Assess temperature, refer to medical

care provider if abnormality observed

-weight(if monitoring needed)

-tactile stimulation -continuous irritability or irritability on tactilestimulation

3 REVISED 8/11/97DANCER(MEDs.BMOREAU.PHN) newbornassess.doc

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