APGAR Newborn Assessment Score Scale Test Made Easy w/ NCLEX Practice Questions

Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video I'm going to be going over

APGAR scoring.

What I'm going to be doing is I'm going to explain to you how to figure out an APGAR

score, go over the interventions with you based on that score, and then do some practice

problems that you may encounter on the NCLEX or your maternity nursing lecture exams on

how to solve APGAR problems.

And this video is part of an NCLEX review series over maternity nursing, so if you're

studying this section, be sure to check out those other videos.

And as always, in the description below or at the end of this YouTube video, you can

access the quiz which will test you on APGAR.

So let's get started.

First, let's start out talking about what is APGAR.

APGAR is an easy and quick assessment tool used to assess the status of a newborn after

birth.

So what will happen is on the NCLEX exam or on your maternity nursing lecture exams,

you'll be given a scenario and it'll give you a detailed description of certain characteristics

found in that newborn.

And you'll have to know based on those characteristics that they give you what score that newborn

scores.

Or you'll be given the score and you'll have to select which of the following will be your

next nursing intervention.

Say the score was five.

You would have to know to provide some resuscitation to that infant based on that score.

So what is the word APGAR?

APGAR is a mnemonic and it actually stands for what you're going to be looking for.

The A stands for appearance, which is the skin color.

P stands for pulse, which is the heart rate.

G stands for grimace, which is the reflex irritability.

A stands for muscle tone.

R stands for respiratory effort.

And it's important to know that the APGAR scoring is performed at one minute and five

minutes after birth.

And then it may be reassessed at 10 minutes if the score is six or less.

Now let's look at the APGAR scoring in detail.

What are you looking for?

Now each category is scored from zero to two.

And higher the score, the better the baby is doing.

So 10 is great.

However, it is rare to get a perfect 10 in a baby because most babies have what's called

acrocyanosis.

And this is where they have the pink body, but they may have some blue in their hands

or in their feet.

So it's rare to have a 10.

Okay, so let's look at it.

Okay, A was appearance and scored from zero to two.

You would give a zero if the baby was pale all over or blue all over.

Give a one if there was that acrocyanosis.

Again, you have the pink body, but you have blue in the extremities like the hands and

legs or feet.

And two is pink all over.

Pink from head to toe, extremities included.

P, pulse.

Z, you would give a zero if the pulse was absent.

You would give a one if the heart rate was less than 100 beats per minute.

And you would give a two if it was greater than 100 beats per minute.

G was for grimace.

You would give a zero if there was no response to stimulation at all.

You stimulate the infant, it doesn't do anything.

You would give a one if there was a grimace, but no cry to stimulation.

And give a two if the infant cried and had active movement while you were stimulating

them.

Okay, A was activity.

You would give a zero if the baby doesn't move at all, none, it's flaccid, it's limp,

just laying there.

However, you would give a one if there was some flexion of the arms and legs.

And a two if the arms and legs were flexed and you go to extend them and they go right

back to the flexion position.

R was for respiratory.

Zero, your respiratory effort would be absent.

One, you would give a one if the newborn had a weak or irregular cry.

And you would give a two if it had a strong, regular, vigorous cry.

Now let's look at the interventions based on the score.

If the newborn scores a seven to ten, you would provide that routine post-delivery care.

Infant scored a four to six, it would need some resuscitation, maybe oxygen, suction,

stimulating the baby, rubbing the back, getting it to move.

Zero to three would be full-on, full resuscitation.

Now let's look at a typical scenario you may encounter on an exam.

This scenario says you're collecting the one minute APGAR on a newborn male.

You note the heart rate is 140 beats per minute, the baby's cry is strong and regular, and

the body is pink with slightly blue hands.

There is some flexion of arms and legs.

While assessing the newborn, it moves and cries.

What is the patient's APGAR score?

What I like to do is I like to just write out APGAR.

And I'm going to tally underneath it the score that it gets and then add it up.

So you're looking for five things in this scenario because there's five categories.

So A, A was for appearance.

How does this newborn look?

It tells us that the newborn is pink with slightly blue hands.

So that is a score of one.

B is for pulse.

What was the pulse?

Pulse was 140 beats per minute.

It's greater than 100, so we're going to give it two points.

G was for grimace, which is that reflex irritability.

And that, let's see, what does it say?

It says that the baby, while assessing the newborn, it moves and cries.

So the baby is active, it's moving, and it's crying.

It's not just grimacing and not crying.

So it gets a two for that.

Okay, the other A was for activity.

We're looking at the muscle tone.

So what does it tell us?

There's some flexion of the arms and legs.

Not total flexion, there's some.

So the baby will get a one for that.

It would get a two if it was totally flexed, had overall flexion.

And R, that's the respiratory effort, and it tells us that the baby's cry is regular

and strong.

So that would get a two.

And we've got all five, so let's add them up.

Two, four, six, seven, eight.

Our APGAR score is eight.

Now let's look at our next practice question.

Okay, this says, you're assessing the five-minute APGAR.

On assessment, you note the following.

Heart rate, 97, no response to stimulation, flaccid, absent respirations, cyanotic throughout.

What is the patient's APGAR score, and what is your nursing intervention based on the

score?

Okay, so just from looking at this, this baby is not doing good.

So we're going to write out APGAR, and we're looking for those five things.

So A for appearance, it says cyanotic throughout, so zero.

P for pulse, heart rate, 97.

So it's less than 100, but it's there, so we'll give it a one.

G for grimace, which is the reflex irritability.

It tells us that it's doing nothing, no response to stimulation at all, so zero.

A for activity, looking at the muscle tone, it says it's flaccid, there's no flexion at

all, so zero.

And then R for respiratory effort, it says absent respirations.

So this newborn has an APGAR of one.

And what are we going to do based on that?

We are going to provide full resuscitation efforts, and we will reassess the APGAR at

five minutes, which will put us at 10 minutes after birth.

Okay, so that is about APGAR scoring.

Now go to my website, registernurserin.com, and take the free quiz that will test you

on APGAR.

And please check out the other videos in this series, and please consider subscribing to

this YouTube channel.