Pemeriksaan fisis pada bayi baru lahir

Pendahuluan
BBL rawan penyesuain fisiologik
Organ 2 mulai berfungsi Angka kematian & kesakitan tinggi

Sebelum PF, perlu riw kel, kehamilan,

persalinan

Maternal history/labor data indicating potential problems with new Findings of brief physical examination performed in the delivery room

Pemeriksaan Fisik
Telanjang
lampu terang, pemanas Tangan, alat bersih, hangat

Dilakukan min 3 x

Saat lahir Dalam 24 jam di ruang perawatan Waktu pulang

http://www.southcoast.org/pi x/quality-wash-me-big.gif

Examination precaution
Hand washing,hand washing ,hand

washing Thermal environment Light and noise Brief examination time

 Immediately dry infant under a

radiant warmer or skin to skin contact with the mother Keep neonates head covered

 Infant temperature should

be above 36.4C.
Infants lose heat through

evaporation, radiation, conduction and convection.

The Four modalities by which the infant lost his/ her body temperature: 1Evaporation: Heat loss that resulted from expenditure of internal thermal energy to convert liquid on an exposed surface to gases, e.g.: amniotic fluid, sweat. Prevention: Carefully dry the infant after delivery or after bathing.
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2- Conduction: Heat loss occurred from direct contact between body surface and cooler solid object. Prevention: Warm all objects before the infant comes into contact with them.

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3- Convection: Heat loss is resulted from exposure of an infant to direct source of air draft. Prevention: Keep infant out of drafts Close one end of heat shield in incubator to reduce velocity of air.

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4- Radiation:
It occurred from body surface

to relatively distant objects that are cooler

than skin temperature.

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Vernix Caseosa

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Tujuan
Pemeriksaan awal, kamar bersalin

Menilai ggn adaptasi NA prognosis Cacat bawaan yg perlu tindakan segera Keputusan RG, ruang perawatan khusus, intensif atau segera operasi Menemukan pemeriksaan yg luput pertama Kelainan yg blm hilang Penyakit yg dpt di RS

Pemeriksaan ke dua

Pemeriksaan ke tiga

Cephalhematoma

Cephalhematoma

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Caput succedaneum

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Newborn Scalp Hematomata

Cephalohematoma

From Pediatrics 2005, Mosby, Inc. p17 &1262

Examination precaution
Hand washing,hand washing ,hand

washing Thermal environment Light and noise Brief examination time

Examination precaution
Hand washing,hand washing ,hand

washing Thermal environment Light and noise Brief examination time

Acrocyanosis

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Pemeriksaan awal
Amnion, plasenta, TP BBL, usia kehamilan

Mulut: labio-gnato-palatoskisis,

hipersalivasi Anus: anus imperforatus, fistulorektovaginal Kelainan pd garis tengah : spinabifida, meningomielokel, ambigus genital,dll Jenis kelamin: pembesaran klitoris, hipospadia

Subconjunctival Hemorrhage

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Mongolian spots

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Mongolian spots

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Primitive reflexes

Suck
Onset: ~28weeks GA
Well-established: 32-34 weeks GA Disappears: around 12 months

Elicited by the examiner stroking the lips

of the infant; the infants mouth opens and the examiner introduces their gloved finger and sucking starts.

Sucking reflex

Rooting
Onset: 28 weeks GA

Well-established: 32-34 weeks

GA Disappears: 3-4 months Elicited by the examiner stroking the cheek or corner of the infants mouth. The infants head turns toward the stimulus and opens its mouth.

Rooting reflex

Palmar grasp
Onset: 28 weeks GA

Well-established: 32 weeks GA
Disappears: 2 months Elicited by the examiner placing

his finger on the palmar surface of the infants hand and the infants hand grasps the finger. Attempts to remove the finger result in the infant tightening the grasp.

Grasp reflex

Grasp reflex

Tonic neck (Fencing posture)

Onset: 35 weeks GA Well-established: 4 weeks PCA Disappearance: 7 months Elicited by rotating the infants

head from midline to one side. The infant should respond by extending the arm on the side to which the head is turned and flexing the opposite arm. The lower extremities respond similarly.

Moro
Onset: 28-32 weeks GA

Well-established: 37 weeks GA
Disappearance: 6 months
The examiner holds the infant so that one hand

supports the head and the other supports the buttocks. The reflex is elicited by the sudden dropping of the head in her hand. The response is a series of movements: the infants hands open and there is extension and abduction of the upper extremities. This is followed by anterior flexion of the upper extremities and and audible cry.

Moro

Moro reflex

Stepping
Onset: 35-36 weeks GA Well-established: 37 weeks GA Disappearance: 3-4 months

PCA Elicited by touching the top of the infants foot to the edge of a table while the infant is held upright. The infant makes movements that resemble stepping.

Galant (Trunk incurvation)

Onset: 28 weeks GA Well-established: 40 weeks GA

Disappearance: 3-4 months

The infant is held in ventral

suspension with the chest in the palm of the examiners hand. Firm pressure is applied to the infants side parallel to the spine in the thoracic area. The response consists of flexion of the pelvis toward the side of the stimulus.

Babinski
Onset: 34-36 weeks GA Well-established: 38 weeks Disappearance: 12 months

PCA Elicited by stimulus applied to the outer edge of the sole of the foot. The infant responds by plantar flexion and either flexion or extension of the toes.

Anthropometric Measurements
Measure weight, length, and head

circumference

helps determine if a baby's weight and measurements are normal for the number of weeks of pregnancy. Small or underweight babies, as well as very large babies, may need special attention and care.

Length (from top of head to the heel with the leg fully extended

Normal Length
Average range:
18-22

inches (46-56 cm)

Measured from crown to rump and

rump to heel or from crown to heel at birth

Head circumference (repeat after molding and caput succedaneum are resolved)

Head Circumference

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Head circumference
Average range:
33

to 35 cm (13-14 inches) Normally, 2 cm larger than chest circumference

Place tape measure above eyebrows

and stretch around fullest part of occiput at posterior fontanele

Chest circumference (at the nipple line)

Chest Circumference
Average range:

30-33 cm (12-13 inches) Normally, 2 cm smaller than head circumference

Stretch tape measure around scapulae

and over nipple line

Weight Measurement

Pemeriksaan di Ruang rawat Aktivitas fisik Tangisan bayi

Melengking kel neurologis Lemah, merintih kesulitan pernafasan

Wajah ; down sind, dll Keadaan gizi: BB & PB, tebal lapisan

sub kutis, kerutan pd kulit, edema ( hipoproteinemia, premature, SN kongenital) Suhu : axilla : 36,5 37,5

Cleft Palate

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Demam : dehidrasi, ggn serebral,infeksi, kenaikan suhu lingkungan

Pemeriksaan secara rinci Kulit

Akrosianosis: kedinginan Cutis marmorata/mottling: ggn sirkulasi Ikterus Warna harlequin Pucat Vernik kaseosa Hemangioma kapiler Mongolian spot Mekonium staining lanugo

 Kepala & laher

Bentuk kepala, fontanel ( menonjol & tegang peningkatan TIK Kaput suksedaneum, hematom sefal,perdarahan subaponeurotik Dismorfik, sindrom, kelumpuhan saraf, hipoplasi otot depresor sudut mulut

Trauma lahir pd kepala

Wajah

Mata ; perdarahan retina & konjuntiva,

kel kongenital

Cleft Lip

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 Telinga: ukuran, bentuk, kertilago, low

set aers. Hidung; nasal brigde, jarak antar kantus medial 2,5 cm max,atresia koana, fraktur Mulut; kista,lidh besar,tanda foote (lidah keluar masuk, pe TIK), reflek hisap Leher; kelainan tulang, tumor, hemangioma, higroma kistik, trauma, perdarahan m sternokleidomastoideus Dada; N spt tong, pektus ekskavatus, karinatum payudara

Natal Tooth

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 Paru: frekuensi nafas, retraksi, merintih. Down score (evaluasi gawat nafas)

Frekuensi, retraksi, sianosis, air entri, merintih 1-3 : ringan 4-5 : sedang > 6: berat

Kardiovaskuler: denyut nadi, bising

jantung,TD, Abdomen: dinding abd, hati & limpa, ginjal

Downes score

 Genitalia eksterna: labia mayor minor,

uretra, withdrawal bleeding, fimosis, hipospadia, epispadia,skrotum Anus Tulang belakang & ekstremitas; skoliosis, meningokel, spina bifida, fraktur, trauma saraf, sindaktili, polidaktili, simian,dislokasi tulang panggul,tonus.

Hydrocele

Inguinal hernia

Hypospadias

From Pediatrics 2005, Mosby, Inc. p13531354

Bifida scrotum with hypospadias

Anus
Check the position of

the anus and anal tone By spreading the buttocks apart as a superficial dimple may resemble an anus
Imperforated anus with fistula

 Pemeriksan usia kehamilan;

HPHT USG Dubowitz : 11 kriteria klinis, 10 neurologis Ballard : 6 kriteria klinis, 6 neurologis

Ballard

Dubowitz

Lubchenco curve ( pertumbuhan janin)

 Pemeriksaan pulang

SSP; aktivitas bayi, ubun-ubun Kulit: ikterus Jantung;bising yg baru timbul kemudian Abdomen; tumor Talipusat: infeksi ASI, menyusu

Pemeriksaan Fisik Anak

Dr.Bambang Mulyawan SpA Fak.Kedokteran Universitas Muhammadiyah Malang

Apa yang dimaksud Pemeriksaan Fisik ?

Physical examination is a fundamental examining method, it is proceeded by the sense organs such as eyes, ears, nose and hands or simple tools stethoscope and plexor.

Empat (4) prinsip utama Pemeriksaan Fisik

Inspection
Palpation Percussion

Auscultation

teach the eye to see, the finger to feel, and the ear to hear What is the fifth? Smelling

Persiapan dalam Pemeriksaan Fisik

Wash your hands, preferably while the patient is watching Washing with soap and water is an effective way to reduce the transmission of disease

Yang harus diperhatikan untuk pasien anak

Remain calm and appear confident.

You are caring for a whole family.

Honesty is important. Inform caregiver and child often. Keep the family together. Provide hope and reassurance to all.

Pendekatan dlm pemeriksaan fisik anak

.URUTAN JALANNYA PEMERIKSAAN

SEDIKIT BANYAK DITENTUKAN OLEH ANAK (PASIEN) DAN BUKAN OLEH DOKTER YANG MEMERIKSA

Pelaksanaan Pemeriksaan fisik :

Keadaan Umum Pem.fisis dimulai dg cara yg mudah, tidak

membuat anak takut/merasakan sakit, namun pencatatannya logis dan berurutan ( dari kepala kaki ; inspeksi,palpasi, perkusi, auskultasi ). Sebaiknya tidak diawali dg penggunaan alat bantu.

PENTING UNTUK DIPERHATIKAN

Tujuan pemeriksaan fisik adl. memperoleh informasi yang akurat tentang tentang keadaan fisis pasien. Karena sifat alamiah bayi dan anak, urutan pemeriksaan tidak harus ikut sistematika yg lazim pd or. dewasa. Pada bayi dan anak kecil, auskultasi abdomen dan jantung didahulukan, diikuti dg pemeriksaan lain, dan diakhiri dg pemeriksaan yg menggunakan alat. Dalam melaporkan hasil pemeriksaan mulailah dengan identitas ( umur dan jenis kelamin), diikuti dengan keadaan umum, kesadaran, tanda vital, baru disusul dg hasil pemeriksaan sistemik. Selalu gunakanlah kedua sisi stetoskop, dahulukan sisi sungkup ( untuk suara bernada rendah dan sedang ) kemudian sisi diafragma untuk suara bernada tinggi.

Rumple-Leede Test (1)

Tourniquet Test
Rumple-Leede Capillary Fragility Test

Rumple-Leede Test (2)

Suatu metode diagnostik klinis untuk

mengetahui tendensi/kecenderungan adanya perdarahan pada seorang pasien. Test ini menilai fragilitas dinding kapiler dan digunakan untuk mengidentifikasi adanya trombositopeni. WHO : salah satu alat yg diperlukan untuk diagnostik DHF.

Rumple-Leede Test (3)

Cara : Cuff/manset tensimeter dipasang

dan dipertahankan pada posisi tekanan darah antara diastolik dan sistolik selama 5 menit. Hasil positif : terdapat 20 petechiae pada daerah volar lengan seluas diameter 1 inch ( +/- seluas uang logam Rp.100,lama )

Thanks for your attention !