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APGAR-Scoring a new baby

NSG 651 Activity Based Learning
by

Gail Elliott

on 28 May 2013

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Transcript of APGAR-Scoring a new baby

The
APGAR
score Conclusion Thank you for your attention! "Nobody, but nobody is going to stop breathing on me." -Dr. Virgina Apgar And one more thing... This is standard practice following every delivery, prepare to participate in this process during your maternal fetal rotation. Invented by Dr. Virginia Apgar in 1949.

Used to quickly assess infants at 1 minute (not before) & 5 minutes after birth. If the infant scores low on either of these exams, more APGAR scores may be preformed at 10 & 15 minutes.

Preformed by physicians, RNs, and midwives.

Score is done on a 0-10 scale.

7-10 is generally considered normal. Now that you've seen an example lets discuss HOW to assess a newborn for it's 1 minute APGAR What is an AGPAR Calculating an APGAR Clinical Assessment Use your senses
Listen to the HR for 6 seconds, multiply this number by 10 to provide BPM (beats per minute).
Observe for chest rise & fall to see respiratory effort, you will also listen for breath sounds.
Feel for muscle tone, when you lift the infants arm does it fall back on the warmer or do you feel some resistance?
Look at the color of the skin, is the infant blue, or are they exhibiting acrocyanosis.
Listen and watch for a cry to assess for reflex. What score would you give this baby? APGAR: 10
Heart Rate: indeterminable from video, assume it is >100 =2
Respiration: Unable to auscultate but good cry and rise & fall of chest noted = 2
Muscle tone: Strong movement noted, spontaneous flexion of arms and legs = 2
Reflexes: This can be thought of as irritability too, cry is a good measurement, good strong cry = 2
Color: Mostly pink =2 Did you arrive at the same APGAR score? Try to score this infant, what interventions do you see the nurses using? We don't know if this is the 1 or 5 minute APGAR however lets assume it is after the one minute because you can see the staff preforming interventions. Review Interventions Include
Tactile Stimulation: see RN rubbing spinal column
Blow by Oxygen (RN holding up tubing w/ green piece near infants mouth)
Warming & drying infant with blankets
Repositioning infant for optimal airway position APGAR SCORING Heart Rate: Assume 2 as unable to assess from video
Respiration: Initially this infant probably scored low as they are administering blow by O2 but we see the infant successfully transitioning from a 1 to a 2 here.
Muscle Tone: We see tone increasing as well into a good strong 2. Reflexes: We see improvement in cry and reflexes throughout video = 2.
Color: Throughout the video you can see the infant pinking up, notice how the feet are still a little blue. Score = 1. 8 or 9 Is it possible for different providers to come up with different scores? Questions for Discussion Are there any parts of the assessment that are subjective? If so which ones? What type of infant behaviors might you see together? For example, if an infant is blue could you assume compromised respiratory status? Do you feel like this is a helpful assessment tool? Why or Why not? In closing...assess quickly and thoroughly for timely interventions Suggestions: Example of cyanosis Memorize the APGAR scoring table

Practice thinking through an assessment in the same order. You can do multiple steps at once by putting all your senses to work. What is it, and
how do I do it? by: Gail Elliott Objectives:

Upon Completion of the Module the learner will:

1. Verbalize the Apgar scoring process.
2. Predict Apgar scores of newborns. References

American Academy of Pediatrics. (2006). The Apgar Score. Pediatrics, 117 (4), 1444-1447. doi: 10.1542/peds/2006-0325
Lasater, K., & Nielsen, A. (2009). The influence of concept-based learning activities on students' clinical judgment development. Journal Of Nursing Education, 48(8), 441-446. doi:10.3928/01484834-20090518-04
Ladewing, P., London, M. L., & Davidson, M. R. (2005). Contemporary Maternal-Newborn Nursing Care (6th ed.). Upper Saddle River, N.J: Pearson Prentice Hall.
Prezi. (2012). About Prezi. Retrieved from: http://prezi.com/about/ What is the APGAR for this term infant at 1 minute of age? Heart Rate 110
Weak Cry
Acrocyanosis
Grimacing
Some flexion of extremities 6 Heart Rate 110 =2
Weak Cry =1
Acrocyanosis =1
Grimacing =1
Some flexion of extremities =1
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