1229 Exam 4: RDS, Prematurity, NEC, and Septicemia

Question 1

Infants born before 37 weeks

Answer 1

Premature

Question 2

1 in 8 over, 1/2 million per year. Newborns 5.5 lbs or less makeup 50-60% of the NICU beds and account for 70% of neonatal deaths. 55,000 babies/year are born less than 1500 grams (3 lbs 5 oz)

Answer 2

Incidences of premature birth

Question 3

23 weeks - 20% survive, 90% handicap

25 weeks - 75% survive, 10% handicap

Answer 3

Mortality

Question 4

Infection, adequate nutrition, multiple gestation, pre-eclampsia

Answer 4

Etiology

Question 5

Physical signs: Skin, Lanugo, Plantar Surface, Breast, Eye/Ear, Genitals
Neuromuscular Signs: Posture, Square Window, Arm Recoil, Popliteal Angle, Scarf Sign, Heel to Ear

Answer 5

New Ballard Scale (Page 645 of Perry)

Question 6

Number one problem

Answer 6

Airway/Breathing

Question 7

Rarely observed in infants beyond 35 weeks
Caused by lack of surfactant leading to atelectasis, loss of functional residual capacity and ventilation perfusion imbalance
Usually presents within 6 hours of birth

Answer 7

Respiratory Distress Syndrome (RDS)

Question 8

Signs and Symptoms of RDS

Answer 8

Tachypnea
Grunting
Nasal Flaring
Retractions
Hypercapnia
Respiratory/Mixed Acidosis
Hypotension
Shock

Question 9

Treatment for RDS

Answer 9

Surfactant: Survanta or Exosurf; by ET tube; 4 mL/kg

Question 10

Occurs in 50% of infants less than 1500 grams (3.3 lbs)
Many with few clinical s/s will close
VLBW and some larger infants with serious respiratory disease will have CHF

Answer 10

Patent Ductus Arteriosus

Question 11

Signs and Symptoms of Patent Ductus Arteriosus

Answer 11

Tachycardia
Full bounding peripheral pulses
Widened pulse pressure
Hyperdynamic pansystolic murmur heard

Question 12

Treatment for PDA

Answer 12

First Line Therapy: Fluid Restriction & Diuretics
Then drugs (Idocin/Ibuprophen) or surgery

Question 13

Assess Heart Rate
Rhythm 
Color
Blood Pressure
Perfusion
Pulses
O2 Sat
Acid/Base Imbalance

Answer 13

Hypovolemia and Shock

Question 14

S/S of Hypovolemia and Shock

Answer 14

Hypotension
Cap refill > 3 sec
Tachycardia then Bradycardia
Continued respiratory distress despite O2 and ventilation

Question 15

May be due to pulmonary insufficiency, lung disease, maternal drug/analgesia, CNS disease from hypoxia or hemorrhage, cold stress or early onset sepsis
Two Types:
Central
Obstructive

Answer 15

Apnea

Question 16

Achrocyanosis is normal in a well baby

Central cyanosis is abnormal

Answer 16

Exhausted when trying to breath, it’s why they get on a ventilator. After 90 sec add supplemental O2. Wait to see if they respond to normal air by CPR or mask vent. The O2 made them cold.

Question 17

Complications of Oxygen Therapy

Answer 17

Retinopathy of Prematurity (ROP)
Affects retinal vessels before 42-43 weeks
Usually occurs less than 28 weeks
10-30% will get but only a few will be blind
Nearsightedness and lazy eye (Strabismus) are common
Takes as long as 5 months to evolve
Prevention; Early Detection
Chronic Lung Disease (BPD)
Pneumothorax

Question 18

Acute inflammatory disease characterized by perforation

Answer 18

Necrotizing Enterocolitis

Question 19

S/S of Necrotizing Enterocolitis

Answer 19

GI distention
Air in abdomen
Vomiting bile and blood
Tenderness
ileus

Question 20

Jaundice

Answer 20

Observe for jaundice in the first 24 hours or persistent after day 7-pathologic; greater than 24 hours- physiologic

Question 21

Phototherapy

Answer 21

Undressed
Covered eyes and genitalia
Avoid lotions or ointments
Remove every 4 hours, turn every 2 hours
Assess for s/s dehydration: dry mm, decreased UO, depressed fontanels
Monitor elimination
Feed every 3-4 hours