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Rose Anne L.

Magtoto Newborn Screening

BSN 2 1

Description: Newborn Screening is the process of testing newborn babies for testable genetic, endocrinologic, metabolic, and hematologic diseases. The test is done through a blood test when a baby is between 12 hours and 6 days of age. It is usually done while your baby is still in the hospital. The blood sample from the heel of the baby is sent to a State-approved lab for testing. Indication: To detect presence of treatable genetic, endocrinologic, metabolic, and hematologic diseases like earlier CH (Congenital hypothyroidism), CAH (Congenital adrenal hyperplasia), GAL (Galactosemia), PKU (Phenylketonuria), and G6PD (Glucose 6 Phosphate Dehydrogenase) Deficiency. Normal Results: A negative screen means that the result of the test is normal and the baby is not suffering from any of the disorders being screened. Newborn screening results are available within three weeks after the NBS Lab receives and tests the samples sent by the institutions. History: Robert Guthrie is given much of the credit for pioneering the earliest screening for phenylketonuria in the late 1960s using blood samples on filter paper obtained by pricking a newborn baby's heel on the second day of life to get a few drops of blood. Congenital hypothyroidism was the second disease widely added in the 1970s. The development of tandem mass spectrometry screening by Edwin Naylor and others in the early 1990s led to a large expansion of potentially detectable congenital metabolic diseases that affect blood levels of organic acids. Additional tests have been added to many screening programs over the last two decades.

Heel Prick Method Heel blood on a filter paper card for the newborn screening Review of Vital Signs

VITAL SIGNS Are signs that reflect the bodys physiologic status and ability to regulate and maintain local and systemic flow and oxygenate tissues. Recently, many agencies such as Veterans Administration consider PAIN as the 5th vital sign.

Guidelines for taking Vital Signs 1. The health care worker caring for the client measures the vital signs. 2. Equipment should be functional and appropriate. 3. Know the normal range for all vital signs. 4. Know the clients normal range of vital signs. 5. Know the clients medical history and any therapies or medication prescribed. 6. Control or minimize any therapies or medication prescribed. 7. Use an organized, systematic approach when taking vital signs. 8. Decide the frequency of vital signs assessment on the basis of the clients condition. 9. Analyze the results of vital signs measurement. 10.Verify and communicate significant changes in vital signs. When to take vital signs: 1. On admission 2. According to institutions policy and physicians order 3. Before and after administration of any medication that affects the cardiovascular system 4. Before and after any invasive procedure such as surgery 5. When a client complains of any changes in conditions, e.g. dizziness, headache 6. When the clients condition worsens, as in sudden increase in pain There are primary four vital signs which are standard in most medical settings:

1. 2. 3. 4.

Body temperature Pulse rate (or heart rate) Respiratory rate Blood pressure

The equipments needed are a thermometer, a sphygmomanometer, and a watch. Though a pulse can often be taken by hand, a stethoscope may be required for a patient with a very weak pulse. A. Temperature is the balance between heat produced and heat lost by the body 2 Types:

1. Core Temperature the temperature of the deep tissues of the body such
as abdominal cavity and pelvic cavity. The normal core body temperature is between 36.5C and 37.7C or between 36.7C (98F) and 37C (98.6F).

2. Surface Temperature the temperature of the skin, subcutaneous tissue,

and fat. Body heat is primarily produced by metabolism. Hypothalamus considered as the bodys thermostat; controls and maintains the bodys core temperature; maintain normal body temperature by balancing heat production and heat loss. Thermoregulation is the bodys physiologic function of heat regulation to maintain a constant internal body temperature. The heat of the body is measured in units called degrees. Factors that affect the bodys heat production/ temperature maintenance and regulation: 1. 2. 3. 4. 5. Environmental temperature Diurnal variations circadian rhythm Exercises Specific Dynamic Action (SDA) of foods Hormonal activity a. Progesterone b. Estrogen c. Thyroxine d. Norepinephrine and epinephrine Sex and age factors Basal Metabolic Rate (BMR) Muscle Activity Increased temperature of body cells (fever) Factors affecting

6. 7. 8. 9.

HEAT LOSS It is the release of heat from the body through the skin, the lungs and through the bodys waste products. Processes involved in HEAT LOSS:

a. Radiation without contact e.g. x-ray, sunrays b. Conduction with contact e.g. ice pack, TSB, body immersion to cold

c. Convection air currents e.g. electric fan, air condition d. Evaporation water is converted into steam e.g. perspiration
Alterations in Body Temperature:

a. Pyrexia a.k.a. hyperthermia, fever, febrile b. Hyperpyrexia very high fever, 41C (105.8F) and above c. Hypothermia subnormal temperature in the body to the pint that there
is an inability to maintain normal cell functioning. Physiologic process in order to increase body temperature: When the body heat decreases, the hypothalamus transmits impulses to stimulate heat production through: 1. Shivering

produced during shivering or feeling cold (hair standing on ends). 2. Sweating inhibition 3. Vasoconstriction (narrowing of blood vessels)

o Horripilation or Piloerection goose pimples and bumps

Physiologic process in order to decrease body temperature: When the body heat rises, the hypothalamus transmits impulses to reduce heat by triggering: 1. Perspiration 2. Inhibition of heat production 3. Vasodilation (widening of blood vessels) AFEBRILE absence of an elevated body temperature Types of Fever: 1. Intermittent fever 2. Remittent fever 3. Relapsing fever 4. Constant fever 5. Fever spikes Decline of Fever: 1. Crisis/Flush/Defervescent stage sudden decline of fever. 2. Lysis gradual decline of fever. The body is able to maintain homeostasis. Measurement of Temperature: Gabriel Daniel Fahrenheit Fahrenheit Scale measures that water freezes at 32F and boils at 212F. Anders Celcius Celcius Scale measures freezing point of water and boiling point at 100C. It is also known as CENTIGRADE. CONVERSION: F = (C x 9/5) + 32 C = (F 32) x 5/9 Normal Average Temperatures: Oral Temperature 37C (98.6F) Rectal Temperature 37.5C (99.5F) Axillary Temperature 36.7C (98F) Normal Ranges: Oral Temperature 36.1C to 37.2 C (97-99F) Rectal Temperature 36.7C to 37.8C (98-100F)

Axillary Temperature 35.6C to 36.7C (96-98F) B. Pulse is the wave of blood created by the contraction of the left ventricle of the heart. The pulse rate is regulated by the autonomic nervous system (ANS). It is the wave felt when the finger is placed over an artery. It is felt peripherally or heard each time the heart (left ventricle) contracts and forces the blood into the arterial circulation. Cardiac Output is the volume of blood pumped into the arteries by the heart. - equals STROKE VOLUME x HEART RATE Apical Pulse pulse located at the apex of the heart Peripheral Pulse pulse located in the periphery of the body; located away from the heart. PULSE CHARACTERISTICS: 1. Pulse Quality refers to the feel of the pulse, its rhythm, and forcefulness 2. Pulse Rate a normal pulse rate for adults is between 60 to 100 beats per minute. 3. Pulse Rhythm regularity of the heartbeat a. Regular beats are evenly spaced b. Irregular beats are not evenly spaced c. Dysrhythmia/ Arrhythmia caused by an early, late, or missed heart beat 4. Pulse Volume amplitude of force exerted by ejected blood against the arterial wall with each contraction a. Strong (+3) bounding pulse b. Normal Pulse (+2) full easily palpable c. Weak (+1) feebie, thread pulse 5. Elasticity of Arterial Wall reflect expansibility or its deformities; normal: feels smooth, straight, and soft; older: feels twisted and irregular 6. Bilateral Equality normal: bilaterally equal Factors that may alter pulse rate: 1. Age 2. Sex/ Gender 3. Exercise 4. Fever/ Changes in body temperature 5. Medications 6. Hemorrhage 7. Stress/ Emotions 8. Position changes 9. Application of heat and cold 10.Heart Disease a. Atherosclerosis fat deposition within blood vessels b. Arteriosclerosis hardening and thickening of blood vessels

Pulse Sites/ Location: 1. Apical Pulse 2. Radial Pulse 3. Temporal Pulse 4. Carotid Pulse 5. Brachial Pulse 6. Femoral Pulse 7. Popliteal Pulse 8. Dorsalis Pedis 9. Posterior Tibial Pulse Terms used to describe the characteristics of the pulse: a. Arrhythmias refers to the irregularities of rhythm b. Bradycardia very slow pulse rate (less than 60/min) c. Tachycardia pulse rate above normal (more than 100/min) d. Bounding strong pulse volume e. Thready or Weak a pulse of diminished strength f. Dicrotic one heart beat gives a sensation of a double beat g. Intermittent Pulse on and off pulsation h. Pulse Deficit difference between apical and radial counts taken simultaneously C. Respiration it refers to the act of breathing and involves the exchange of gasses between an organism and its environment. Kinds of Respiration:

1. External/ Pulmonary Respiration takes place in the lungs where

carbon dioxide is eliminated and oxygen is absorbed by the blood.

2. Internal/ Cellular Respiration takes place between the blood and the
tissues; involves oxygenation of the cells for heat production and liberation of water waste products. Phases of External Respiration: 1. Breathing-In Process/ Inspiration 2. Breathing-Out Process/ Expiration Types of Breathing: 1. Costal (thoracic) breathing involves the external intercostal muscles and other accessory muscles, such as sternocleidomatoid muscles. It can be observed by the movement of the chest upward and outward.

2. Diaphragmatic (abdominal) breathing involves the contraction and

the relaxation of the diaphragm, and it is observed by the movement of the abdomen, which occurs as a result of the diaphragms contraction and downward movement.

Ventilation refers to the movement of air in and out of the lungs Respiratory Rate Number of ventilation per minute Normal breathing carried automatically and effortless; controlled by respiratory centers Factors 1. 2. 3. 4. 5. 6. 7. Affecting Respiratory Rate and Depth: Emotional status/ Stress Drugs Exercise Mechanical Interference or distress condition Body Position Changes in altitude Exposure to extreme temperature

Before assessing a clients respiration, a nurse should assess: The clients normal breathing pattern The influence of the clients health problems on respiration Any medications or therapies that might affect respirations The relationship of the clients respiration to cardiovascular function ASSESSING RESPIRATION: 1. Respiratory Rate normally described in breaths per minute a. NORMAL i. Eupnea normal in rate and depth (12-20 breaths per minute) b. ABNORMAL i. Tachynea quick shallow breaths (>20 breaths per minute) ii. Apnea absence or cessation of breathing 2. Depth volume of air that is inhaled and exhaled; observed by the movement of the chest a. Normal Respirations take about 500ml of air during inspiration and expiration (tidal volume) b. ABNORMAL i. Deep Respirations large volume of air is inhaled and exhaled 1. Hyperventilation very deep, rapid respirations ii. Shallow Respirations exchange of a small volume of air and often the minimal use of lung tissue 1. Hypoventilation very shallow respirations

3. Rhythm observed for regularity of exhalations and inhalations

a. NORMAL i. Regular respirations are evenly spaced b. ABNORMAL i. Irregular unevenly spaced respirations ii. Cheyne-Strokes breathing rhythmic waxing and waning of respirations, from very deep to very shallow breathing and temporary apnea

iii. Kussmaul Breathing very deep and slightly rapid, usually

accompanied by a sigh

4. Quality or character respiratory effort and sound of breathing a. NORMAL quiet, effortless breathing
b. ABNORMAL i. Dyspnea difficult labored breathing ii. Orthopnea ability to breathe only in upright sitting or standing positions D. Blood Pressure is the measurement of pressure pulsations exerted against the blood vessel walls during systole and diastole. It is measured in terms of millimeters of mercury (mmHg). The body has hemodynamic regulators for blood pressure control: 1. Pumping action of the heart (cardiac output) the major factor that influences systolic pressure. When the pumping action of the heart is weak, less blood is pumped into arteries (lower cardiac output and the blood pressure decreases).

2. Peripheral vascular resistance (PVR) the size and distensibility of the

arteries, which is the most important determinant of diastolic pressure; = BP. PVR

3. Blood Volume the volume of blood in the circulatory system. Blood

pressure is proportional to the blood volume. Hemorrhage causes a loss in blood volume that in turn, lowers the blood pressure. Rapid infusion of intravenous fluids causes an increase in volume and subsequent rise in pressure.

4. Viscosity the thickness of the blood based on the ratio of proteins and cells

to the liquid portion of blood. The greater the viscosity, the harder the heart must work to pump blood, with a resultant increase in BP. blood vessels decreases thereby increasing BP.

5. Elasticity or compliance of blood vessels In older people, elasticity of

Blood Pressure is a result of the cardiac output and peripheral vascular resistance. Normal arteries expand during systole and contract during diastole, creating 2 distinct pressure phases: 1. Systolic Blood Pressure is a measurement of the maximal pressure exerted against arterial wall during systole, primarily a reflection of cardiac output.

2. Diastolic Blood Pressure is a measurement of pressure

remaining in the arterial system during diastole, primarily a reflection of peripheral vascular resistance. Pulse Pressure the difference between the systolic and diastolic pressure; normal is 30-40 mmHg.

Terms used to describe blood pressure:

1. Sphygmomanometer instrument used for direct measurement of blood 2. 3. 4. 5.

pressure Korotkoffs sound sounds that indicate systolic and diastolic pressure when determining blood pressure Hypertension abnormally high blood pressure; higher than 140/90 mmHg a. Essential Hypertension with no known cause b. Secondary Hypertension caused by known pathology e.g. stroke Hypotension abnormally low pressure. A systolic pressure below 100 mmHg. Orthostatic Hypotension low blood pressure associated with weakness and fainting when rising to an erect position

NORMAL VALUES: Normal Ranges 110/60 to 140/90 mmHg Average 120/80 mmHg Factors affecting blood pressure: A. Can cause a rise in BP a. Age b. Exercise c. Stress d. Race e. Obesity f. Diet g. Sex/ Gender h. Medications i. Diurnal Variations j. Disease process B. Can cause a fall in BP a. Blood Loss b. Dilation of blood vessels c. Postural or orthostatic hypotension ASSESSING BLOOD PRESSURE 1. Measured with a blood pressure cuff, sphygmomanometer, and a stethoscope * TYPES OF SPHYGMAMONOMETER a. Aneroid b. Mercury c. Electronic 2. Bladder 3. Blood pressure sites Arm (Brachial Artery) most common site Assessing BP on the thigh is indicated on the following:

1. The BP cannot be measured on either arm (because of burns or other trauma). 2. The BP in 1 thigh is to be compared with the BP of the other thigh. BP assessment on the arm or thigh is contraindicated when: 1. The shoulder, arm, or hand, (or the hip, knee, or ankle) is injured or diseased. 2. A cast or bulky bandage is on any part of the limb. 3. The client has had removal of axilla (or hip) lymph node on that side. 4. THE CLIENT HAS INTRAVENOUS INFUSION IN THAT LIMB. 5. The client has an arteriovenous fistula in that limb. Common causes of BP assessment errors: 1. Inaccurate manometer calibration falsely high or low reading 2. Loosely applied cuff high reading 3. Cuff too small for extremity high reading 4. Cuff too large for extremity low reading 5. Cuff applied over clothing creates noises or interferes with sound perception 6. Tubing that leaks rapid loss of pressure 7. Improper positioning of the ear tips poor sound conduction 8. Improper hearing altered sound perception 9. Loud environmental noise interferes with sound perception 10. Impaired vision inaccurate observation of the gauge 11. Rapid cuff deflation inappropriate observation of the gauge FIVE PHASES OF KOROTKOFFS SOUNDS: 1. Phase I faint, clear, TAPPING sounds 2. Phase II murmur or SWISHING sound is heard 3. Phase III KNOCKING sounds 4. Phase IV distinct, abrupt, MUFFLING of sound 5. Phase V sounds DISAPPEARS VARIATIONS IN NORMAL VITAL SIGNS BY AGE AGE ORAL TEMP PULSE RESPIRATION S Newborn 36.8 (98.2) 130 (80-180) 35 (30- 80) axillary 1 y/o 36.8 (98.2) 120 (80- 140) 30 (20- 40) axillary 5-6 y/o 37 (98.6) 100 (75-120) 20 (15- 25) 10 y/o 37 (98.6) 70 (50-90) 19 (15- 25) Teen 37 (98.6) 75 (50- 90) 18 (15- 20) Adult 37 (98.6) 80 (60- 100) 16 (12- 20) Older Adult 37 (98.6) 70 (60- 100) 16 (15- 20) BLOOD PRESSURE 73/55 90/55 95/57 102/62 120/80 120/80 Possible increased diastolic