Module 3A: Sarah Flashcards
What are some common multi-system effects of prematurity (3)?
- intraventricular hemorrhage (IVH),
- patent ductus arteriosus (PDA),
- respiratory distress syndrome (RDS): most worrisome
- necrotizing enterocolitis (NEC),
- acute kidney injury (AKI),
- sepsis,
- hyperbilirubinemia,
- hypothermia,
- hypoglycemia, and
- apnea
Of all the common multi-system effects on prematurity, which one is particularly worrisome?
- respiratory distress syndrome (RDS)
- RDS is the most common cause of respiratory distress for preterm infants
What are 3 possible causes of respiratory distress?
- RDS
- TTN
- Sepsis
What is respiratory distress syndrome (RDS)?
- a potentially life-threatening problem,
- common breathing disorder
- largely because of the pathophysiology that results from immature pulmonary structure and function
What are some pathophysiology of respiratory distress syndrome (3)?
- Immature lungs and lack of surfactant are the major causes of RDS.
- Other contributing factors are poorly developed/few units of gas exchange and increased distance between alveolar-capillary units due to immature pulmonary vasculature.
- preterm infants have weak respiratory muscles, compliant rib cages, and non-compliant lungs.
- Alveoli collapse due to increased surface tension and hypercarbia, hypoxia, and respiratory acidosis result.
- Pulmonary vasoconstriction and worsening mixed acidosis occur.
- Intervention is aimed at improving oxygenation/ventilation through mechanical ventilation and artificial surfactant.
How is RDS different from respiratory distress?
- The clinical picture of RDS will include respiratory distress, which is a response to a variety of causative factors.
- Respiratory distress is increased work of breathing, this can include tachypnea, retractions, tracheal tug, nasal flaring, and grunting.
- Respiratory distress is a symptom of RDS but can also be a symptom of many other common health challenges such as transient tachypnea of the newborn, sepsis, cold stress, among many others.
- respiratory distress is a common manifestation of many potential problems
What other pulmonary disorders may present respiratory distress in preterm infants (3)?
- pneumonia,
- transient tachypnea of the newborn (TTN),
- pneumothorax,
- pulmonary edema,
- pulmonary hemorrhage,
- hypoplastic lung, and
- congenital diaphragmatic hernia (CDH).
What are some non-pulmonary disorders that may present with respiratory distress in preterm infants (3)?
- necrotizing enterocolitis (NEC),
- sepsis,
- congenital heart disease,
- patent ductus arteriosus (PDA),
- hypothermia
What is Trauma-informed care?
- a concept that is widely used in mental health to describe the understanding that traumatic events such as abuse and neglect can lead to long-term physical and psychological effects.
What is “age-appropriate care”?
- introduced in order to assist caregivers in recognizing that patient needs over the different stages of life change, requiring care that adjusts with his or her developmental, biological, and socioemotional needs
What is the concept of Trauma-informed, age-appropriate care?
- developmental concept that recognizes the physiological, neurobiological, and psychoemotional sequelae of trauma in early life and
- aims to mitigate the deleterious effects associated with the trauma experience through the provision of evidence-based, age-appropriate caring strategies
What are some experiences infants are frequently exposed to in NICU environment that can be traumatic to contribute to psychological and emotional damage ?
- maternal separation,
- pain,
- stress,
- isolation,
- sleep deprivation,
- anxiety, and fear
What are the 5 core measures for age-appropriate care in the NICU?
- The Healing Environment (Physical, Human, Systems)
- Family-Centred Care (Define, Assess, Empower, and Educate)
- Age-Appropriate Activities of Daily Living (Feeding, Positioning, Hygiene)
- Pain and Stress Assessment and Management (Assess, Manage, Mitigate)
- Protected Sleep (Assess, Protect, Support)
What is the “healing environment” of the five core measures for age-appropriate care in the NICU?
- A soothing, spacious, and aesthetically pleasing environment conducive to rest, healing, and recovery.
The healing environment also includes: - the infant’s sensory environment: tactile (touch), vestibular (movement, proprioception, and balance), gustatory (taste), olfactory (smell), auditory (noise), and visual (light) systems
- a collaborative health care team that demonstrates collaboration, caring, and communication
What is the “fammily-centred care” of the five core measures for age-appropriate care in the NICU?
- A trauma-informed approach to family-centred care in the NICU is a commitment to supporting families in crisis, protecting infant–parent attachment, and supporting parental-role development to foster short- and long-term family unity
What is the “age-appropriate activities of daily living” of the five core measures for age-appropriate care in the NICU?
- Activities of daily living (ADLs) in the context of the NICU refer to everyday tasks, such as bathing, feeding, postural support, skin care, and diapering.
- These tasks are especially important in infants because it is also their initial contact with parents and caregivers; these activities teach the infant trust, caring, compassion, and social interaction. Many of the early experiences of preterm infants are associated with caregiving tasks such as feeding, positioning, and skin care.
- If these experiences are unpleasant, stressful, or painful, they set the stage to jeopardize future behaviour and development.
- Social and emotional behaviour are modified by experience; and stress and early life adversity have long-lasting consequences
What is the “pain and stress assessment and management” of the five core measures for age-appropriate care in the NICU?
- Prevention and management of pain and stress are exceptionally important core measures for age-appropriate care in the NICU.
- Pain is usually associated with tissue damage, such as heel pokes, whereas stress is an experience that is perceived by the brain as a threat.
- Painful procedures are obviously stressful for preterm infants, but it is important to be aware of other stressors in the NICU environment, such as bright lights, sounds, parental separation, and procedures such as temperature taking and diaper changes.
- Unmanaged pain and stress can have a strong influence on the developing brain and lead to significant life-long consequences
What is the “protected sleep” of the five core measures for age-appropriate care in the NICU?
- Protected sleep as a core measure incorporates assessing sleep–wake states, supporting sleep, and educating families about the importance of sleep.
- Well-organized sleep is associated with improved cognitive and psychomotor development, as well as stress reduction, increased immune function, improved growth, stable oxygenation, and autonomic stability
What is family-centred care?
- Family-centred care is not about using a set of pre-established rules to provide care.
- It is about putting parents in the centre of the picture, working to establish a partnership with them, and providing care and making decisions that reflect their individual needs.
- I appreciated how Selina offered Brooke a few minutes of skin-to-skin contact with Sarah prior to transport to the NICU, and Terry offered some specific information about why Sarah required closer monitoring than could be provided in the delivery room.
What is the difference of hypoxia and hypoxemia?
- Hypoxia: a deficiency in the amount of oxygen reaching the tissues
- Hypoxemia: a deficiency in the amount of oxygen in the blood
What are 4 early signs/ responses to hypoxia?
- tachypnea: reflects efforts to increase oxygen intake
- tachycardia: reflects efforts to increase cardiac output, thereby increasing delivery of oxygen to cells
- pallor and mottling: reflects redistribution of blood away from non-vital organs such as skin, toward vital organs such as the heart and brain (often referred to as the “diving reflex”); other organs that receive less blood are skeletal muscles, liver, lungs, kidneys, and gut
- air hunger: reflects efforts to increase oxygen intake
What are 4 late signs/responses to hypoxia?
- apnea: reflects central nervous system hypoxia and depression
- bradycardia: reflects cardiac hypoxia
- cyanosis: reflects increased amounts of deoxygenated hemoglobin reaching the cells
- lethargy: reflects generalized hypoxia, central nervous system depression, and tiring
What is the “diving reflex”?
- redistributes blood away from the liver, lungs, skin, skeletal muscle, gut, and kidneys to the heart and brain, causing the non-vital organs to become hypoxic and ischemic
What are some assessment of oxygenation include?
Monitoring for early and late signs of hypoxia:
- Respiratory rates,
- heart rates,
- skin colour,
- perfusion, and
-level of consciousness and
- activity all reflect how well an infant is oxygenated.
How can hypoxemia be assessed?
- assessed by looking at pO2 and SaO2 saturation
- SaO2 measured by pulse oximetry is denoted as SpO2
- p02 is a measurement of the amount of 02 dissolved in the blood
What are the 2 ways oxygen is carried in blood?
- Dissolved in plasma:
- attached to hemoglobin
How are oxygen in dissolved plasma measure?
Oxygen carried in blood by Dissolved in Plasma:
- accounts for only 2%–3% of the total oxygen content of blood
- measured by pO2
- pO2 values, arterial = 50–80, capillary = 40–60
- arterial pO2 values are more accurate than capillary pO2 values
How are oxygen being attached to hemoglobin measured?
- accounts for 97%–98% of the total oxygen content of blood
- is measured by SaO2 via pulse oximetry (SpO2)
- SaO2 is the oxygen saturation of arterial blood, while SpO2 is the oxygen saturation as detected by the pulse oximeter
What is pulse oximetry?
- a way of assessing oxygenation
- non-invasive, continuous, reliable, and easy to use
- a mainstay in the management of respiratory distress
- tells us about the oxygen attached to hemoglobin, which is the bulk of the oxygen available
- measures the extent to which hemoglobin is saturated with oxygen molecules
- oxygen bound to Hbg is measured as oxygen saturation and measured by pulse oximetry
- normal Sp02 range for infant receiving oxygen88-95%
Where can oxygen saturation probe be placed and where can it not be placed on infant?
- placed on foot, hand, wrist
- cant be placed on ear
- normal Sp02 range for infant receiving oxygen: 88-95%
What is pO2?
pO2 (Partial Pressure of Oxygen):
- a measurement of the amount of oxygen dissolved in the blood, done by a capillary or arterial blood sample
What is the difference between anemia and polycythemia?
- Anemia (decreased hemoglobin): Hgb = 90
- polycythemia (excess hemoglobin): Hgb = 200
Both affect oxygen saturation interpretation:
- whenever you are using pulse oximetry to assess oxygenation, you need to be aware of an infant’s hemoglobin. If it is normal, your oximeter readings are valid.
-If the hemoglobin is elevated, oximeter readings are falsely low.
- If the hemoglobin is low, oximeter readings are falsely high
What is low HCO3- a reflection of?
- low HCO3- is a reflection of excess lactic acid that has combined with HCO3-.
- This buildup of lactic acid is due to anaerobic metabolism, which is the result of hypoxia.
- This lactic acidosis is contributing to the metabolic component of Sarah’s mixed acidosis.
What can having poor blood gases have on infants body system? GI? Renal? Pulmonary?
- compromise her gastrointestinal functioning, putting her at risk for NEC.
- Hypoxia initially increases cerebral blood flow, which can lead to IVH in a preterm infant.
- Reduced renal blood flow will disrupt urine output, and therefore fluid and electrolyte imbalance.
- Reduced blood flow to the lungs interferes with surfactant production.
What are some nursing care to monitor S&S of sepsis and prevention of sepsis?
- monitor CBC, CRP, blood gas, vitals, work of breathing, colour, perfusion
- administer IV antibiotics
- maintain incubator isolation and clean and aseptic techniques
- limit handling and procedures
What are some risk factors that make infant vulnerable to infection (3)?
- preterm: immune system is both immature and inexperienced
- maternal infection (UTI)
- maternal fever/not feeling well: passing microorganisms to infant during delivery
- being handled since birth (by nurses, parents)
- Health care professionals’ hands, equipment, and invasive procedures all increase the risk of introducing microorganisms into infants environment
What are the main signs of infection in an infant (3)?
- Hypothermia, or temperature instability, is one of the main signs of sepsis.
- Apnea is a major sign of sepsis
- Lethargy is another main sign.
- Hyper- and hypoglycemia
- Poor feeding
- Abdominal distention
- Unexplained bradycardia
- rashes or petechiae.
- Laboured respirations and
- tachypnea
What is the most common metabolic disturbance occur in neonatal period?
- hypoglycemia
When should blood sugar be screened for at risk infants?
- screening at-risk infants and the management of low blood glucose levels in the first hours to days of life is a frequent issue in the care of the newborn infant
What is the the threshold blood glucose value for infant in first 72hours? after 72hours?
- If an infant is at-risk or unwell, a blood glucose of less than 2.6 mmol/L in the first 72 hours of life indicates the need for active management and ongoing surveillance.
- Beyond 72 hours of age the threshhold for treatment increases to 3.3 mmol/L.
- In well term infants routine glucose monitoring is not recommended
Infants experiencing hypoxia, do they shift from aerobic metabolism to anaerobic metabolism?
yes
- Glycolysis is the major pathway of glucose metabolism
- during anaerobic metabolism, the rate of glucose formation (through glycolysis) is significantly reduced
- anaerobic glycolysis produces only two molecules of the energy molecule (ATP) per molecule of glucose, as compared to 36 molecules during aerobic oxidation
- both aerobic and anaerobic metabolism burn the same major intermediary substrate (pyruvic acid),
- anaerobic metabolism converts pyruvic acid to lactic acid.
- Aerobic metabolism further metabolizes pyruvic acid for extra energy
What are two ways that glycolysis occurs?
- aerobic metabolism
- anaerobic metabolism
What are the byproducts of aerobic metabolism? anaerobic metabolism?
- aerobic metabolism: CO2 and H2O
- anaerobic metabolism: lactic acid
What does product is converted from pyruvic acid from aerobic metabolism? anaerobic metabolism?
- aerobic metabolism: further metabolize pyruvic acid for extra enegy
- anaerobic metabolism converts pyruvic acid to lactic acid
