Case 5: NICU Flashcards
APGAR
Test performed by the delivery medical team at 1, 5, and 10 min after birth; each of the five sections ( respiratory effort, heart rate, muscle tone, reflexes, skin color) is scored based on a scale of 0-2; the higher the score, the better the health of the infant
Group B Streptococcal Infection
Bacterial infection present in the woman’s vagina, rectum, or urinary bladder can be passed to the infant during delivery; although rare, infants who become infected are at a risk for pneumonia, sepsis, and meningitis
High flow nasal cannula
Oxygen delivery device that delivers heated and humidified air at higher fraction of inspired oxygen than room air
Incubator
Apparatus used to control environmental factors for infants who are ill or born preterm;
the primary purpose is to provide a thermal environment that helps infant maintain appropriate body temperature
Level IV neonatal intensive care unit
Neonatal unit that provides the highest level of comprehensive care for critically ill infants, including advanced respiratory support, 24 -hour on site neonatology team, advanced imaging, and urgent on site access to pediatric medical and surgical subspecialties
Post-conceptual age
gestational age + weeks since birth ( chronological age)
Preeclampsia
-one of the most common complications of pregnancy;
-marked by hypertension and proteinuria
-places the mother at increased risk for brain injury, blood clotting issues, and kidney and liver injury;
-it also decreases blood flow to the placenta, leading to IUGR or prematurely born infants
General PT plan of care/goals
-Facilitates typical developmental and achievement of developmental milestones from birth age to discharge
-prevent of minimize secondary impairments
-promotes appropriate muscle tone and movement pattern development
General PT plan of care/goals number 2
Encourage development of self regulaory skills and state of arousal
promotes infant role ( procuring, social interaction, exploratory day, feeding); educate caregivers on proper handling technique, positioning ad developmental activities; promote parental role
PT interventions
Determine and facilitate infants movement patterns, tone, posture, behavioral organization ( including stress signs), and physiological stability;
facilitate quite alert state and state transitions;
minimize stress; promote age-appropriate postural and movement activities;
facilitates proper handling techniques and positioning;
provide environmental modifications
nursing and caregiver education.
Precautions during PT interventions
Continuous monitoring of vital signs and behavioral cues throughout sessions
monitor medical lines and tubes
determine whether the physiological cost of the examinations/intervention outweighs the anticipated benefits
complications interfering with PT
Pain and stress
decline in physiological stability ( apnea, bradycardia)
fractures
Assessment of general movement (GMs) is valid and reliable in identifying infants at risk for developmental delay and cerebral palsy
Grade A: consistent, good quality patient-oriented evidence
which of the following increases the risk of positional plagiocephaly in pre-term infants
Diagnosis of chronic lung disease
( male sex and chronic lung disease are factors that increase the risk of positional plagiocephaly )
what are some recommended ways to decrease the risk of positional skull deformities
- Spending at least 30 minutes per day in supervised, awake tummy time
- reducing time spent in swing and infant seats
which of the following strategies promotes behavioral organization in pre-term infants during the PT session
Grading tactile input and allowing rest between positional changes
what are the factors that increase stress in premature infant?
- providing multimodal sensory input when the infant is stressed
- positioning the infant in side-lying without 3D boundaries or a nest ( lack of support/ boundaries)
Deep sleep is difficult for preterm infants to achieve in the NICU because?
Environmental factors and neurobehavioral immaturity, which limits the infants ability to self regulate
Deep sleep is vital —— and —- and therefore timing a therapy session during this time is not appropriate
development and growth
The therapist is at the bedside for the initial evaluation. List the following in the order that would promote optimal neurobehavioral organization during the PT session:
- Take notes of the vital signs at rest and all lines and tubes attached to the infant
- observe the infant’s state, position, and movement patterns
- open the incubator door softly
- provide a contained touch
Providing a contained touch is good for what?
it is a good way to grade tactile input and begin the hands-on portion of the eval and treatment
in infants requiring supplemental oxygen, the left lateral and prone position improves lung function and breathing strategies and result in fewer events of apnea and hypoxia compared to the supine position
Grade C: consensus, diesase oriented evidence, usual practice, expert opinion or case series
In the prone position, postural support nappy and support roll promotes flexed posture, midline orientation, MSK alignment, and neuromotor function in the LE of every low birth weight infants
Grade B: inconsistent or limited quality patient-oriented evidence
Education provided to parents is most effective when multiple methods are utilized, including observation of therapy, verbal instruction, and written handouts.
Grade C: consensus, disease-oriented evidence, usual practice, expert opinion, or case series.
