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high risk OB > high risk infant > Flashcards

high risk infant Flashcards

1
Q

what is included on the ballard score?

A

-posture
-square window
-arm recoil
-popliteal angle
-scarf sign
-heel to ear

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2
Q

supplies checklist for preterm delivery

A

-radiant warmer preheated
-room temp at 80
-suction
-cracked heat pad
-plastic wrap/bag
-hats/blankets
-intubation kit
-ventilator/CPAP/nasal O2/ambu bag
-pulse ox, stethoscope
-emergency meds: epi and saline
-supplies for umbilical lines
-warmed transport isolette

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3
Q

methods of O2 therapy

A

-hood therapy
-nasal cannula
-CPAP
-manual ventilation
-nitric oxide therapy (“INO”)
-extracorporeal membrane oxygenation (ECMO)

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4
Q

what is adverse effect of too much oxygen in preterm infants

A

blindness
*oxygen L/min and O2%
(above 36 weeks it doesn’t matter as much)

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5
Q

-clear plastic hood over infants head
-nurse controls O2 conc

A

hood therapy

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6
Q

-delivers set pressure in spontaneously breathing infants
-keeps alveoli open
-measured by centimeters 5-10

A

CPAP (continuous positive airway pressure)

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7
Q

what number CPAP can result in a pneumothorax

A

8 cm

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8
Q

-delivers some breaths in spontaneously breathing infants on CPAP
-no ET tube

A

NIPPV
(non-invasive positive pressure ventilation)

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9
Q

-oxygen delivery needed for hypoxemia, hypercapnia, or persistent apnea
-set to provide a predetermined amount oxygen during spontaneous respirations and in absence of spontaneous respirations

A

mechanical ventilation

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10
Q

3 functional modes ventilation
-pressure ventilation
-volume ventilation
-high frequency ventilation

A

-pressure ventilation: constant flow
-volume ventilation: predetermined volume of inspiratory pressure
-high frequency ventilation: smaller volumes of O2 at more rapid rate (>300/min, jet/oscillator)

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11
Q

-oxygen delivery device
-vasodilator, decreases pulmonary vascular resistance
-used for persistent pulmonary HTN, meconium aspiration, congenital heart disease

A

nitric oxide therapy
“INO”

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12
Q

risk with nitric oxide therapy

A

nitric oxide binds to Hgb resulting in production of methemoglobin which can’t bind to O2 (methemoglobinemia)

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13
Q

what is emergency drug given for methemoglobinemia (from nitric oxide therapy)

A

methylene blue

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14
Q

PPHN

A

pulmonary HTN of the newborn

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15
Q

-treatment for pts with life threatening heart/lung problems
-long term breathing and support support
-adds O2 to blood and remove CO2 and return it to infant

A

ECMO
extracorporeal membrane oxygenation

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16
Q

can preterm infants receive ECMO

A

no
increases risk brain bleeds

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17
Q

S+S pain in newborn

A

-increased HR
-increased BP
-rapid and shallow respirations
-decreased O2
-pallor and sweating
-increased muscle tone, dilated pupils, increased ICP, metabolic and endocrine changes
-crying, grimacing

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18
Q

N-PASS

A

neonatal pain, agitation and sedation scale

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19
Q

what is included in NPASS

A

-cry/irritability
-behavioral state
-facial expression
-extremities tone
-VS
-premature pain assessment

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20
Q

highest score on NPASS

A

10
(+1 if <30 wks EGA)

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21
Q

pain management meds used in NICU

A

-morphine
-fentanyl
-methadone
-precedex
-midazolam (versed)
-lorazepam (ativan)

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22
Q

when should babies be back to their birthweight after birth

A

2 weeks

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23
Q

equivalent between grams and mL

A

1 g = 1 mL
mostly weigh diapers for babies on IV fluids

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24
Q

when does suck-swallow-breath develop

A

32-34 wks

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25
Q

limit time for PO feeding babies

A

30 mins

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26
Q

how much milk should babies get per day (formula)

A

150-160mL/kg/day

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27
Q

risk with long term (1 yr+) TPN

A

liver failure

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28
Q

IDM issues

A

RDS
hypoglycemia
hyperbilirubinemia

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29
Q

potential problems in LGA infants

A

-hypoglycemia
-birth trauma
-pulmonary HTN
-poor feeding

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30
Q

can preterm babies be cooled

A

no. have to be full term

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31
Q

potential problems in IUGR infants (<10% for gestational age)

A

-hypoglycemia
-hypothermia
-polycythemia
-infection (increased risk NEC)

32
Q

potential problems in postterm infants

A

-meconium aspiration
-asphyxia
-shoulder dystocia

33
Q

syndrome caused by lack of pulmonary surfactant which prevents the alveoli from collapsing

A

respiratory distress syndrome
RDS

34
Q

S+S RDS

A

-crackles
-poor air exchange
-color changes: pallor/cyanosis/mottling
-increased work breathing: tachypnea, nasal flaring, grunting, retractions
-apnea

35
Q

when might babies not need surfactant administered

A

moms who received steroids before birth

36
Q

Tx RDS

A

give surfactant
O2 therapy

37
Q

-very low lung volumes
-stiff and difficult to ventilate

A

hypoplastic lung

38
Q

what are babies with hypoplastic lungs at high risk for

A

pneumothorax

39
Q

what babies might have hypoplastic lungs

A

-moms water broke early (around 20 wks)
-congenital diaphragmatic hernia

40
Q

-chronic lung disease
-develops when premature infants with RDS need mechanical ventilation for long time, causing inflammation and scarring in lungs making it difficult to extubate

A

bronchopulmonary dysplasia (BPD)

41
Q

S+S BPD

A

-increased work breathing
-tachypnea
-retractions
-nasal flaring
-tachycardia
-intolerance to stimuli and feeds

42
Q

Tx BPD

A

-O2 therapy
-nutrition
-fluid restriction
-meds (diuretics, steroids, bronchodilators)
-time for lungs to heal

43
Q

classic signs congenital diaphragmatic hernia

A

-resp distress
-scaphoid abdomen
-bowel sounds in chest

44
Q

Tx congenital diaphragmatic hernia

A

-ET intubation
-OG tube placement
-often ECMO
-minimize bag mask ventilation
-surgery to correct

45
Q

intestines are outside stomach through hole in abdomen

A

gastroschisis

46
Q

intestines, liver and other organs remain outside stomach in sac

A

omphalocele

47
Q

-open defect of spinal cord
-failure of closure of neural tube

A

mylomeningocele

48
Q

how should babies with mylomeningoceles be positioned

A

on the stomach (decubitus positioning)
sterile plastic covering over it

49
Q

risk factors for retinopathy of prematurity (ROP)

A

preterm birth when vessels aren’t fully developed and require supplementary oxygen

50
Q

Tx ROP

A

-sometimes self resolve
-avastin injection
-laser therapy

51
Q

S+S PDA

A

-murmur
-active precordium
-bounding pulses
-tachycardia
-tachypnea
-crackles
-hepatomegaly
-wide pulse pressures
-high O2 requirement
-unable to wean off resp support

52
Q

what do you give to keep PDA open

A

prostaglandins

53
Q

Tx PDA

A

-vent support
-fluid restriction and diuretics (decrease CV volume overload)
-indomethacin, ibuprofen or tylenol causes PDA to constrict
-surgical ligation

54
Q

side effect use of indomethacin to treat PDA

A

NEC

55
Q

tissue in small or large intestines is injured or dying causing it to become inflamed or even perforate

A

necrotizing enterocolitis (NEC)

56
Q

risk factors NEC

A

-premature birth
-decreased blood flow to intestines
-infection
-umbilical lines
-congenital heart disease

57
Q

S+S NEC

A

-distended and discolored abdomen
-bilious residuals
-feeding intolerance
-no stool and/or dark/bloody stools
-lethargic
-increased apnea and bradycardia

58
Q

Tx NEC

A

-NPO
-give fluids
-NG suction decompression (repogle)
-surgery

59
Q

maternal risks for NN sepsis

A

-untreated GBS
-STDs
-chorio
-prolonged ROM

60
Q

risk factors intraventricular hemorrhage (IVH)

A

premature
hypoxia
ischemia
unstable BP

61
Q

S+S IVH

A

apnea
bradycardia
frequent transfusions
boggy head/full fontanels
lethargy

62
Q

consequences of IVH

A

midline shift
hydrocephalus requiring shunt
cerebral palsy
developmental delays

63
Q

4 criteria for whole body cooling

A

-infant >36 wks and <6 hrs old
-need for resuscitation at birth or Dx of encephalopathy
-moderate to severe encephalopathy
-1 of 3: (pH <7 or base deficit >16, acute event and assisted ventilation at birth >10 mins, acute perinatal event and 10 min apgars at 5 or below)

64
Q

what is temp lowered to during body cooling

A

33.5 C (95 F)

65
Q

how long is baby cooled for

A

72 hrs

66
Q

S+S neonatal abstinence syndrome

A

-tremors
-seizures possible
-overactive reflexes and hypertonia
-excessive crying
-poor feeding
-tachypnea
-fever and sweating
-diarrhea
-inability to sleep for prolonged periods

67
Q

neck muscles contract causing head to be turned to one side

A

torticollis

68
Q

criteria for cooling therapy in newborn

A

-infant >36 wks EGA and <6 hrs old
-need for resuscitation at birth secondary to poor resp effort or Dx of encephalopathy
-moderate to severe encephalopathy
-one of following 3: (pH <7 or base deficit >16; acute event and assisted ventilation at birth for 10+ mins; acute perinatal event and 10 min apgar score <5)

69
Q

why would nitrous oxide be given to newborn

A

vasodilator: relaxes pulmonary smooth muscle and decreases pulmonary resistance

70
Q

Tissue in the small or large intestines is injured or dying causing it to become inflamed or even perforate

A

NEC

71
Q

S+S NEC

A

-distended and discolored abdomen
-visible bowel loops
-bilious residuals and feeding intolerance
-no stool and/or dark or bloody stools
-lethargic
-increase in apnea and bradycardia

72
Q

Tx NEC

A

-NPO
-give fluids
-repogle for gastric decompression
-Abx
-x-rays
-surgery

73
Q

S+S PDA

A

-murmur
-active precordium
-bounding peripheral pulses
-tachycardia
-tachypnea
-crackles
-hepatomegaly
-wide pulse pressures
-high oxygen requirement
-unable to wean off respiratory support

74
Q

Tx PDA

A

-ventilatory support
-fluid restriction and diuretics to decrease cardiovascular volume overload
- Indomethacin, ibuprofen, acetaminophen which causes the PDA to constrict
-surgical ligation

75
Q

S+S RDS

A

-crackles
-poor air exchange
-color changes (pallor/cyanosis/mottling)
-increased work breathing (tachypnea, nasal flaring, grunting, retractions)
-apnea

76
Q

Tx RDS

A

-adequate ventilation
-admin surfactant
-oxygen therapy

high risk OB (14 decks)

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