(2)
Penlight.
(3)
Tape measure.
(4)
Rectal thermometer.
(5)
Infant scale.
b. Wash hands for a full three minutes.
c. Approach and identify the infant.
d. Provide for a warm, well-lighted, draft-free area, keeping the infant undressed
for as short a time as possible.
e. Place the infant on a flat, protected surface.
f. Take the infant's temperature. The infant's temperature is taken rectally only
on admission. Subsequent temperatures are to be taken by the axillary method.
g. Determine the infant's apical heart rate. Count for a full minute.
h. Determine the infant's respiratory rate. Count for a full minute. Note any
signs of respiratory distress (retractions, grunting, nasal flaring) rate over 60 bpm, or
periods of apnea. Auscultate the infant's lungs.
i. Balance the scale.
j. Weigh the naked infant. Most newborns weigh between six to nine pounds
(2,700 and 4,000 grams). Record the weight in pounds and ounces, as well as in
grams.
k. Measure the infant's length from top of the head to the heel with the leg fully
extended and record measurements.
l. Measure the infant's head circumference and record measurements. The
normal head circumference is 13 to 14 inches (33 to 35 cm). Cranial molding from a
vaginal delivery may affect this measurement. The measurement should be repeated
on the second and third day after delivery.
m. Measure the infant's chest circumference at the nipple line and record the
measurement.
n. Observe the general contour of the infant's head. Gently palpate the sutures
and fontanelles. The anterior fontanelle is approximately two inches long and is
gem/diamond shaped. The posterior fontanelle is smaller than the anterior fontanelle.
MD0922
8-15