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10 - rehabilitation > 10-12 Neonatal > Flashcards

10-12 Neonatal Flashcards

1
Q

Very low birth weight

A
  • Equal or less than 3 lb 5 oz (1500 g)
  • 23-24 wks gestation
  • Increases incidence in birth defects
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2
Q

Gestational Age (GA)

A
  • Length of time in utero
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3
Q

Chronological Age (CA)

A
  • Age based on birthday
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4
Q

Corrected/Adjusted Age (AA)

A
  • Considers age baby is from due date
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5
Q

Post-Conceptual Age

A
  • AA prior to achieving term age

- GA + CA

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6
Q

Term Adjusted Age

A
  • CA - #weeks missed in utero
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7
Q

NICU Levels

A
  • Level 1: Minimal observation or care; small community hospital; “Well-baby nursery”
  • Level 2: Step down from Level III; continued care from Level III, IV meds or alimentation, tube feedings, O2; regional or community hospitals
  • Level 3: Highly specialized services for sickest and most fragile infants - complex, medical interventions, advanced diagnostic testing, surgery, resp. support; Teaching hospitals and affiliated with medical schools
  • Level 4: Level III plus ECMO (extracorporeal membrane oxygenation)
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8
Q

Family-Centered Care

A
  • Parents, children, significant others

- The “constant” in an infant’s life

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9
Q

Coping and Grief

A
  • Stages of grieving: Shock, Denial, Anger, Guilt, Adjustment, Acceptance
  • May interfere with bonding
  • Staff facilitates bonding, provides empathy
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10
Q

Basic requirements for survival

A
  • Physiological: breathing, feeding, growing
  • Sensorimotor: rooting, sucking, grasping, clearing the airway in prone, horizontal and vertical tracking
  • Affective/Communications: crying, self-consoling, eye contact, facial animation, eye aversion
  • Complex: auditory preferences, taste preferences, visual preferences, imitative capacities
  • Primary “work”: feeding (sucking + swallowing + breathing requires skill as well as energy
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11
Q

Failure in Feeding in Pre-Term or Sick Full-Term Babies

A
  • Learned oral aversion resulting from NICU care
  • Lack of flex/ext balance and chin tuck to assist with sucking, swallowing, breathing
  • Residual lung disease may cause tachynea; interferes with sucking and swallowing
  • Lack of self-regulation; unable to calm self with environmental stressors
  • Apnea
  • Bradycardia
  • Unable to coordinate sucking, swallowing, breathing, and becomes physiologically unstable
  • Immature GI Tract
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12
Q

PM: Respiratory Distress Syndrome

A
  • Pulmonary immaturity, inadequate pulmonary surfactant

- Surfactant lowers the surface tension and allows the alveoli to maintain its shape

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13
Q

PM: Patent Ductus Arteriosus

A
  • Structure bypasses circulation to lungs pre-birth
  • Normal fetal circulation: Hole in R ventricle and L pulmonary artery allows blood to circulate in utero
  • Closes within 10-15 hours after delivery
  • If does not close, prevents oxygenation of blood, results in hypotension, poor perfusion, CHF
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14
Q

PM: Hyperbilirubinemia

A
  • Accumulation of bilirubin (liver enzyme) in the blood
  • Caused by immature hepatic function
  • Bilirubin can accumulate in the brain and cause neuronal damage - must be addresed right away
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15
Q

PM: Gastroesophageal Reflux (GER)

A
  • Some degree is normal, asymptomatic
  • Frequent episodes can damage esophageal lining - inflammation, dysmotility, pain
  • Leads to poor oral feeding patterns, oral aversion and excessive crying due to pain
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16
Q

PM: Necrotizing Enterocolitis (NEC)

A
  • Acute inflammation of the immature intestine causes acute intestinal necrosis
  • Cause: Injury to intestinal mucosal lining
  • Doubled in those exposed to cocaine (vasoconstrictive effects in intestine)
17
Q

PM: Germinal Matrix-Intraventricular Hemorrhage (GM-IVH)

A
  • Occurs in those less than 32 weeks gestation
  • Most common brain lesion in premature infants
  • Hemorrhage in brain extends to the area between lateral ventricles
18
Q

PM: Periventricular Leukomalacia (PVL)

A
  • Areas of white matter adjacent to the lateral ventricles become necrotic
19
Q

PM: Retinopathy of Prematurity

A
  • Retinopathy: Vasoproliferative disease of immature retina
  • Cause: Alteration in normal development of blood vessels in eye
  • Higher risk in those born less than 30 weeks gestation
20
Q

PM: Prenatal Cocaine Exposure

A
  • Defects: Dependency, malnutrition, retarded intrauterine growth
  • Infant may go through withdrawal
  • Can cause placental vasoconstriction and decreased uterine blood flow
21
Q

PM: Chorioamnionitis

A
  • Cervicovaginal bacteria invades amniotic cavity, causing inflammatory response in membranes of the developing fetus
  • Most common cause of preterm labor
  • Infant more susceptible to brain damage and intestinal abnormalities
22
Q

PM: Osteopenia

A
  • Decrease in bone density
  • Occurs because of immature bone development
  • 80% of bone formed between 24 and 40 weeks; 3rd semester essential for bone formation
23
Q

PM: Bronchopulmonary Dysplasia (BPD)

A
  • Most common chronic lung disease associated with prematurity
  • Causes: Effects of O2 toxicity, barotrauma, volutrauma from mechanical ventilation on immature infant lungs
  • Alternatives: Continuous positive airway pressure (CPAP), inhaled nitric oxide (iNO), high frequency ventilation (HFV)
24
Q

Meconium Aspiration Syndrome

A
  • During delivery, fetus may pass BM into amniotic fluid; as infant gasps for first breath, may aspirate meconium-tainted fluid
  • Meconium particles obstruct airway, interfere with gas exchange; leads to respiratory distress
25
Q

Toxoplasmosis

A
  • Hydocephalus
  • Seizures
  • Intracranial calcifications
  • Ophthalamic disease
  • Located in cat feces, undercooked meat
26
Q

Rubella

A
  • Hearing loss
  • Mental retardation (MR)
  • Cardiac malformations
  • Ophthalamic defects
  • Will affect younger than 20 wks if mother contracts
27
Q

Cytomegalovirus (CMV)

A
  • Microcephaly
  • Periventricular calcification
  • Congenital cataracts
  • Hepato-splenomegaly
  • Jaundice
  • Profound mental retardation
  • Deafness
  • Blindness
  • Cerebral Palsy
  • Transferred in utero via placenta, breast milk, birth canal
28
Q

Herpes Simplex Virus (HSV)

A
  • Local skin infection
  • Encephalitis
  • Multiple organ involvement
  • Seizures
  • Temperature instability
  • Hypotonia
  • Microencephaly
  • Hydroencephalus
  • Porencephalic cysts
  • CP
  • blindness
  • cog deficits
  • 80% Type 1, 20% Type 2
29
Q

HIV

A
  • Meds have decreased passing this
30
Q

Streptococci Group B

A
  • Respiratory distress
  • Vomiting
  • Diarrhea
  • Abdominal Distention
  • Ileus
  • Poor feeding
  • Temperature instability
  • Hypotension
  • Hyperglycemia
  • Seizures
  • Petecchia
31
Q

Fetal Alcohol Syndrome (FAS)

A
  • Physical, behavorial, cog abnormalities
  • Dysmorphic facial characteristics
  • Pre- and post-natal growth deficits
  • Mental retardation
32
Q

Brachial Plexus Injury

A
  • Caused by difficult delivery
  • Brachial plexus nerves stretched or avulsed
  • “Waiter’s Tip” position
  • Recovery: Spontaneous within 2 months (average); Long term impairments if not recovered after 6 months
  • Treatment: Gentle PROM 7-10 days (decrease hemorrhage and edema, splinting, activities to promote movement, motor learning, strengthening, developmental appropriate skills, early surgical intervention if indicated
33
Q

Torticollis

A
  • Neck muscles contract voluntarily on one side causing the neck and head to rotate on one side
  • Unilateral shortening of the SCM with limited cervical ROM
  • Treatment: stretching, don’t only breast feed to one side, rotate head to opposite side, tummy time
34
Q

Metatarsus Adductus (MTA)

A
  • Most common foot deformity
  • Tranverse deformit of talometatarsal joints with medial deviation of the MT, slight hindfoot valgus, full DF
  • Can be flexible or fixed
  • INterventions: Prolonged passive stretching, therapeutic taping, serial casting, corrective shoes, bracing, surgery
35
Q

Talipes Equinovarus

A
  • Clubfoot
  • 3-4 components
  • Equinus (upward bending limited
  • Cavus (high arch)
  • Varus (of hind foot)
  • forefoot adduction
36
Q

Arthrogryposis

A
  • “Curved, hooked joint”
  • Multiple congenital joint contractures
  • Occurs in 2 or more joints in different body areas
  • Caused by loss of movement in utero
  • Amyoplasia: classic form - no joint crease, everything cylindrical, featureless; symmretic involvement; all 4 extremities
37
Q

Ortho INterventions

A
  • ROM
  • Serial Casting
  • Taping
  • Splinting
  • Surgery
  • Family Education
38
Q

CRIES

A
  • Crying, Oxygen requirement, INcreased vital signs, Facial Expressions, Sleep
  • 0-2 for each parameter based on changes from baseline

10 - rehabilitation (25 decks)

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