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APGAR Score

Virginia Apgar
Picmonic
The APGAR score is a rapid assessment tool to evaluate the neonate's overall health. Five criteria are examined and a score of 0, 1, or 2 is assigned. These five values (Appearance, Pulse, Grimace, Activity and Respiration) are totaled for the APGAR score. Scores are affected by many factors including genetic defects, gestational age, or pregnancy related complications including hypoxia and trauma.
9 KEY FACTS
1 and 5 Minutes
(1)-Wand to (5)-Hand Minutes-clock

The neonate is assessed using this score at intervals of 1 and 5 minutes after birth. The APGAR score may not be completed if the neonate requires resuscitation.

Appearance
Appearance-in-mirror

Assess skin coloration.0 = Blue or pale1 = Body pink, extremities blue2 = Completely pink

Pulse
Heart-timer

Assess heart rate.0 = Absent1 = Slow (<100 bpm)2 = Normal (>100 bpm)Remember that a neonate's normal heart rate lies between 120-160 bpm. 

Grimace
Grimacing

Asses reflex irritability and crying.0 = No response1 = Grimace2 = Grimace with Cough, Sneeze, or Cry

Activity and Muscle Tone
Active with Muscle Tone

Assess flexion of the extremities.0 = Flaccid1 = Some flexion2 = Good flexion

Respiration
Respiration

Assess breathing rate and effort.0 = Absent1 = Slow or Irregular2 = Regular respiration or Crying

Total Scores
Total Scoreboard

The total of each of the 5 areas are added together for the final APGAR Score. These scores indicate 0-3 = Severe Distress, 4-6 = Moderate Distress, 7-10 = Minimal to no Distress

Gentle Stimulation
Gently Stimulating

Neonates in moderate distress at 1 minute often improve with gentle stimulation. This stimulation includes tactile methods, such as touching or rubbing the neonates back.

Oxygen
O2-tank

A neonate who is initially cyanotic may have an indication for oxygen therapy. Oxygen therapy should be initiated using the blow by method and should not be continued long term per the physician's orders.

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