Newborn Assessment: APGAR scoring. Part 4



so Apgar scoring probably one of the biggest topics with newborn and ob/gyn so let's go into what an Apgar is and how we assess your little baby now Apgar helps us to do L ask head-to-toe assessment on your newborn babies so let's just say you get a test question the RN is is assessing a newborn who has a heart rate of 198 a strong cry who resists staff when touched and has blue hands and defeats now you as the nurse have to classify those into these categories it's like a scoring chart and we're going to go through exactly what Apgar means and how we classify a newborn baby so just like everything else there's a good medium and then a band like a small medium large problem so for Apgar except we have appearance how does the baby look we have a pulse we have activity as well as respiratory rate now we can only score a maximum of two in each category that means you're the higher the score the better you can only score a maximum of ten points but let's go through each one here so for appearance if you have a blue core any time you guys think blue blue you have to think low oxygen low oxygen aka cyanotic cyanosis that's not good if you guys remember any of my lectures oxygen is the money of the body so a blue cord back a blue arms and legs blue arms and extremities that's okay that's better because a lot of the blood needs time to circulate throughout the extremities all of your core vital organs are right here if your baby is pink you want your babies to be pink that is a – so our baby can score – ah our next one our pulse if there's zero pulse it's not a good sign guys if it's less than 100 they score a 1 if it's greater than 100 it doesn't even matter if it's in the 200s we don't really classify Apgar greater than you know tachycardia or whatever we just say greater than 100 that's normal so in our question here we're assessing a newborn with a 198 pulse that's great they get a score – next is our grimace is your patient movie does your patient cry automatically and pull away because it's normal for when you stimulate a newborn they're going to pull away and retract or extend or even move if they're not doing any of that naturally we're going to stimulate them and if they cry with stimuli that's a 1 normal babies usually need some stimulation in order to crack some really active babies cry and pull away automatically but about 6 times out of 10 you're going to get that crying baby with stimuli you got to rub their feet rub their back and then look rocking 40 for your activity of 0 not given anything in the 0 category guys is not good and we're going to talk about exactly what we do when we classify our good kind of ok and then you better rush to the crash card because your baby is going down so we're going to get to that but for your activity 0 it's not good obviously number 1 is minor flexion minor flexion they're going to flex with minor it's not going to be a full-on flexion extension your baby's not going to be moving around that much it's going to be kind of sluggish and the more you see newborn babies inside your clinical rotation easier it's going to be for you guys so don't worry if it's kind of of them is that you know to active is that under active you'll know so for reflection and extension your baby's going crazy it's like a normal baby so the baby's moving without having to imply stimulus respiratory rate does your baby have a strong cry is it hmm is it a strong cry or is it more of a weak cry or even weak irregular gasps if it is you probably need a suction with the weak irregular gasps and you have to do like even deep suction into the baby's mouth all the way down because they might have aspirated some of the amniotic fluid inside that that uterus when they're coming out and the water is breaking definitely we want to suck out any type of amniotic fluid or if they had defecated inside the uterus meconium staining big big problem for brain damage so we're going to be suction out their mouth so strong crying it's a good thing so how do you know if your baby's bad how do you know if your baby's good or how do you know if your baby is doing okay well if you get a score of a 10 to 7 here you're going to be happy normal babies do not score tens I mean I shouldn't say normal but about eight is average eight is terms of like you know that's the average for your apt or scoring six to four the baby's doing okay I'm definitely going to monitor them if they score less than a seven we're going to do the Apgar scoring right after birth like we always do but then we're going to do it five minutes after birth and see if they bump up into this level if we do not get a better scoring after five minutes we're going to have to do it in another five minutes to see if it's going down or if your baby's getting better now if it's a three we're doing it one minute after birth guys if it's a three we are going to call the doctor get the crash cart get more people because that baby is going down and that might be a test question your baby comes out you're assessing them they have an Apgar scoring of three what is the first nursing intervention you call for help you call for the doctor you call a crash cart okay what's the first nursing intervention if your baby scores at eight warm up because they're good they're fine you don't have to reassess them if you're maybe scores a five reassess them in five minutes if they score the same probably going to reassess them in another five minutes because pediatrics specially newborns they go down very very quick anything's wrong with your newborns they usually spiral very very quick I've had a few patients um there were a few months old like nine months came in breathing little pale and it would try to triage them in the triage room and it didn't even take more than I believe less than 10 minutes and the baby was already not breathing no responsive so babies go down very very fast so in terms of our question here you're the RN who is assessing the newborn who has a heart rate of 198 fantastic it's greater than 100 198 that's great you have a strong cry here strong tried cool that's a total of two four we have four points over your baby resist staff when touched resisting the staff one touched cry with stimuli pull away cool so that's six theory and has blue hands and feet blue hands and feet let's see here is able to resist AB with flexion so we'll do flexion extension so it's going to be a two four six eight and one what the m9 honor Apgar scoring so that's how we score apgar's guides and remember this is done one minute after birth if we get a bad reading we're going to do it again in five minutes and we're going to do it every five minutes to monitor our patients once we score good we're going to basically just monitor the patient as normal but this would be a good one to write down like a little chart like this and carry it around with you okay so next one we're going to do Rh factor

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