Module 4: Austin Flashcards
1
Q
SGA
A
infant is below the 10th percentile on a standard growth chart
2
Q
IUGR
A
refers to the deviation and reduction in expected fetal growth pattern
3
Q
here are two types of IUGR:
A
symmetrical and asymmetrical
4
Q
symmetrical
A
- the type of growth restriction occurs early in pregnancy and is associated with a decreased number of fetal cells
- inadequate growth of the head, body and extremities
- infants are born with fewer brain cells and tend to have poorer outcomes
- etiologies include genetic or chromosomal causes, early gestational intrauterine infections (TORCH) and maternal alcohol use
5
Q
asymmetrical
A
- usually occurs early in the third trimester and is associated with impaired growth of the body, with normal growth of the head and extremities
- is the result of failure of the cells to increase in size resulting in less fat and smaller abdominal organs
- due to extrinsic influences that affect the fetus later in gestation, such as preeclampsia, chronic hypertension, and uterine anomalies
6
Q
Causes of Intrauterine Growth Restriction.
asymmetric
A
Placental insufficiency Pre-eclampsia Hypertension Renal disease Long-standing diabetes Smoking Altitude Multiple pregnancy
7
Q
Causes of Intrauterine Growth Restriction.
symmetric
A
Congenital infections Chromosomal abnormalities Skeletal abnormalities Fetal alcohol syndrome Constitutional short stature Low socio-economic status
8
Q
Steps in Resuscitation of the Infant with Perinatal Asphyxia.
A
A – airway B – breathing C – circulation D – drugs E – environment F – family
Assessment, clear Airway, Apgar score
ensure Breathing, positive pressure until HR > 100/min support Circulation if HR < 100/min, Cardiac massage HR < 60/min - give Drugs - epinephrine
Environment – keep warm
keep Family informed of progress and prognosis
9
Q
Using the growth chart provided, plot Austin’s percentiles for his weight.
A
Weight 900 grams — below 10th percentile
10
Q
Using the growth chart provided, plot Austin’s percentiles for his length.
A
Length 40 cm — below 50th percentile (approximately 30th percentile)
11
Q
Using the growth chart provided, plot Austin’s percentiles for his head circumference.
A
Head circumference 29 cm — 50th percentile
12
Q
What type of SGA infant is Austin?
A
Austin is an asymmetrical IUGR baby.
This means that while his body, particularly in terms of weight, is underdeveloped, his head is not. This combination suggests that the antenatal problems causing Austin’s decreased growth were not severe enough to affect brain growth. This is good news for Austin.
13
Q
What are some problems that Austin is at risk for by being IUGR/SGA?
A
Austin is at risk for:
hypoxia – due to placenta insufficiency
hypothermia – due to small size and reduced brown fat stores
hypoglycemia – reduced hepatic glycogen stores
polycythemia – due to increased erythropoiesis
14
Q
Based on what you know about fetal growth and development, and specifically the vulnerability associated with prematurity and SGA, suggest a plan for assessing Austin. What will you plan to assess and monitor (pulmonary, cardio, neuro, GI, renal, immune, and metabolic systems)?
A
At 31 weeks gestation, all of the organ systems are anatomically well developed. However, physiologically, their functional abilities are quite immature. This means that all of Austin’s organ systems are vulnerable and at risk for problems, and, because of this, require close monitoring. This is an overview of the assessment and monitoring Austin requires:
pulmonary, cardio, neuro, GI, renal, immune and metabolic system
15
Q
pulmonary
A
- assess RR and HR by monitor and auscultation
- assess air entry, indrawing, color, perfusion
- monitor blood gases
- pulse oximetry
16
Q
cardiovascular
A
- assess HR by monitor and auscultation
- assess for murmurs
- assess perfusion, blood pressure, pulses, color
17
Q
neurologic
A
-assess tone, movement, state, fontanelle, level of alertness
18
Q
gastrointestinal
A
-assess stools, bowel sounds, abdominal girth, abdominal tenderness
19
Q
renal
A
-assess urine output, weight, tissue turgor, serum electrolytes
20
Q
immune
A
- observe for infection/sepsis
- monitor temperature, vital signs, CBC
21
Q
metabolic
A
- assess temperature
- assess serum glucose
22
Q
Apnea
A
Apnea is defined as a as cessation of breathing that lasts for more than 20 seconds and/or is accompanied by hypoxia (↓ O2 sats) or bradycardia (↓ HR) (Walsh, 2010).
Apnea in infants differs from that of adults in that infants respond to hypoxemia with only a brief increase in respiratory rate followed by hypoventilation or apnea.
23
Q
There are two types of apnea:
A
primary apnea – is apnea that is not associated with any other diseases (eg: Apnea of Prematurity)
secondary apnea – may be associated with a particular disease or in response to a procedure
When referring to apnea in the context of neonatal resuscitation, primary apnea responds to the initial steps of NRP, whereas secondary apnea does not respond to stimulation, drying or suctioning and requires initiation of IPPV.
24
Q
Note that in Canada two differing practices occur than what is stated in the article:
A
When doing bag and mask ventilation on an infant who is experiencing apnea, your oxygen concentration to start should be approximately 10% higher than what the infant is already receiving (e.g., if they are on room air, 21%, then you should give them approximately 30% oxygen to start and titrate up if needed).
Caffeine citrate is the drug of choice to treat apneas.
25
Apnea of Prematurity
The exact causes of apnea of prematurity are still not known. Immaturity and/or depression of the central respiratory drive to the muscles of respiration have been accepted as key factors in the pathogenesis of apnea of prematurity.
The severity of apnea attacks in premature infants correlates with gestational age. The more premature an infant is, the more likely he or she is to have frequent, severe apneic spells.
Studies have shown that apnea occurs most frequently during the sleep state and is especially prevalent during active sleep. Active sleep, or REM sleep, is the predominant sleep state of premature infants, and infants less than 32 weeks spend 80% of their time asleep. These two characteristics of the sleep states of premature infants puts them at significantly higher risk for developing apnea.
Premature infants have a decreased amount of peripheral catecholamines (epinephrine and norepinephrine) and this has also been implicated as a cause of apnea. When infection is present, catecholamines stores are further depleted, putting infected premature infants at a very high risk for developing apnea.
Respiratory muscle fatigue may also be a contributing factor in apnea of prematurity. Premature infants have very compliant chest cages and less compliant lungs than full-term infants and this means increased work of breathing for premature infants (Walsh, 2010).
26
Secondary Apnea
Rather than being due to prematurity, apnea may be the first sign of an underlying disorder.
When an infant suddenly starts having apneic spells, it is important to investigate for possible underlying disorders before jumping to the diagnosis of apnea of prematurity and initiating drug therapy.
Apnea seldom occurs in first 24 hours of life, even in premature infants. Therefore, the appearance of apneic spells in the first 24 hours is usually a sign of an underlying disorder. Apnea is rare in infants of greater than 34 weeks gestation and needs to be promptly investigated.
27
Causes of Apnea
Infection- Pneumonia, sepsis, meningitis
Resp distress-immaturity of resp development, RDS, airway obstruction, CPAP application, postextubation, congenital anomalies of the upper airways
Cardiovascular disorders- PDA, CHF
GI disorders- NEC, vomitting, deglutition syncope
CNS- depressant drugs, IVH, seizure, increased bill levels, bili encephalopathy/kernicterus, infection, tutors/ischemia
metabolic- hypoglycemia, hypocalcemia, hyponatremia/hypernatremia
environmental-rapid increase of environmental temp, hypothermia, vigorous suctioning, feeding, storing, stretching/movement; fatigue/stress, prenatal exposure to maternal cigarette smoking, position, sleep state, pain, first immunizations (increase apnea, bradycardia and desalts within 72 hrs of immunizations
hematopoietic-polycythemia,anemia
28
Respiratory Support
Assessment and intervention should proceed in an orderly sequence:
LOOK AT THE INFANT
CHECK BREATHING
CHECK HEART RATE
CHECK COLOR
29
Look
When the monitor alarm rings, it is important to first look at the infant. The infant may be fine: breathing, with a normal heart rate, and satisfactory color. The problem may be the monitor, the leads, etc. If the infant is not fine, proceed with assessment and intervention, following the sequence: breathing, heart rate, and color.
30
Breathing
If an infant is apneic, provide gentle stimulation by rubbing the infant’s back or moving his or her foot. Often, this stimulation is all that is required for the infant to resume breathing.
Check the infant’s airway and position the infant to ensure a patent airway. This position is called the “sniffing position” and is achieved by gently lifting the chin to slightly extend the neck.
If stimulation and positioning do not solve the problem, provide intermittent positive pressure ventilation (IPPV) with a bag and mask.
31
Heart Rate
Once the infant is breathing continue your assessment and check the heart rate. If the infant is on a cardiorespiratory monitor, you have likely been noting the heart rate all along. Nevertheless, at this point, turn your attention specifically to heart rate. If it is below 100 beats per minute, continue with or start positive pressure ventilation with a bag and mask.
The majority of bradycardia in infants is pulmonary in origin. Therefore, the provision of ventilation will usually improve the heart rate.
32
Color
Once the infant is breathing and the heart rate is above 100, turn your attention to the infant’s color. If pale or cyanosed, provide oxygen (~10% higher than what the infant is receiving). As long as the heart rate is greater than 100 and the infant is breathing, bag and mask ventilation is no longer required.
We have given you an overview of the sequence of events for responding to an infant’s apnea and/or bradycardia. Most often, gentle stimulation is all that is required.
33
Develop a list of potential reasons for Austin’s apnea and bradycardia
Some potential reasons for Austin’s apnea and bradycardia include:
prematurity — CNS immaturity, sleep patterns, catecholamine deficiency, fatigue
positioning — sometimes infants obstruct their airways when their chin falls to their chest or when their necks are hyperextended
hypoxia —depresses the respiratory center
anemia — insufficient oxygen carrying capacity
sepsis — all premature infants have the potential to develop infections because of the immaturity of their immune systems
neurologic — depressed respiratory center
hypothermia — Austin is very small with very little ability to self-regulate his temperature
hypoglycemia — Austin will have low glycogen stores because of prematurity and because of his SGA
gastro-esophageal reflux — causes bronchospasm
I chose these because they are the most likely causes. However, you must look at all aspects of Austin’s history to rule out the cause of Austin’s apnea and bradycardia.
34
What would you assess further about Austin in order to determine the cause of his apnea?
oxygen — pulse oximetry, Hgb, and Hct
check Austin’s position
complete set of vital signs, especially temperature
blood work: blood cultures, CBC/differential, electrolytes, glucose
tone, level of alertness
35
Sam has just finished charting and is about to begin his handover report. Austin’s cardiorespiratory monitor alarm rings. Sam looks at Austin and immediately notes that he is not breathing. What should Sam do?
Write your answer in narrative format as a continuation of the case.
Here’s one possible course of action:
Sam quickly opens the porthole door and gently rubs Austin’s back. Austin doesn’t respond. Sam turns him over onto his back and places him in a sniff position. With this, Austin opens his eyes, gasps weakly, and begins breathing.
He notes that Austin’s heart rate and color are satisfactory and decides to turn Austin back on his stomach. He then charts the events.
36
Caffeine Citrate
Methylxanthine (caffeine citrate) is the primary treatment option for apnea of prematurity (AOP) due to its ability to stimulate the CNS system and increase respiratory output.
- increases minute ventilation
- improves CO2 sensitivity
- enhances diaphragmatic activity
- decreases periodic breathing
37
Theophylline (aminophylline)
Theophylline (aminophylline) is still used in some NICUs. However, caffeine citrate has been shown to have fewer side effects, is tolerated better, and once a day dosing has made it the drug of choice in the treatment of AOP.
38
Nursing care aimed at supporting and monitoring an infant’s respiratory status should include:
- Monitoring work of breathing, oxygen saturation, hemoglobin, ventilation, blood gases, color, HR, RR, air entry, chest movement.
- Monitor apnea: frequency, duration, stimulus required, oxygen saturation, and HR.
- Administer caffeine citrate and ensure correct dosage for weight.
- Maintain saturations between 88–95%.
- Ensure adequate volume and hemoglobin.
- Reduce pain, stress, and handling using comfort and medications.
39
Feeding Concerns
Although, at 31 weeks, Austin’s gastrointestinal system is not mature, keeping him NPO until he is full term is not an option. As is the case for many other aspects of neonatal care, the decision to feed preterm infants must consider the relative risks and benefits.
40
Can you explain how at 31 weeks gestation Austin’s GI tract is immature?
delayed gastric emptying
↓ enzyme activity
↓ peristaltic activity
↓ normal flora
41
Feeding decisions are not easy or straightforward. And yet they are critical to a vulnerable infant’s health. Some infants should be NPO and not fed at all. Those are infants who are:
- at high risk for NEC (prematurity, SGA, perinatal asphyxia, respiratory distress, feeding intolerance, sepsis, and formula feeding)
- CNS depressed
- have congenital anatomic GI anomalies
- may require surgery, especially GI surgery
42
Infants who are NPO or are not on full feeds require IV nutrition
D10W will provide sugar and water needs. Electrolytes such as sodium and potassium can be added for maintenance.
43
If an infant will be NPO for an extended period,
Total Parenteral Nutrition (TPN) should be given as it provides more complete nutrition, including minerals, protein and fat.
44
Some infants cannot nipple feed (breast or bottle) due to illness or immaturity, but can be fed by an oral or nasal gastric tube.
Infants fed by a gastric tube are at risk for intolerance because they have no control over the amount or frequency of feeding. They must be closely observed for tolerance of feeds.
45
Austin GI overview
In this module, we focus on IV therapy as an approach to infant nutrition. At 31 weeks, Austin’s immature gastrointestinal system may not tolerate oral feeds. Being stressed in utero means that his GI system may have experienced hypoxia, putting him at risk for necrotizing enterocolitis. In addition, he does not have adequate suck/swallow/breathe coordination as this does not develop before 33–36 weeks gestation. It may be several days or weeks before feeds can be started. In the meantime, infants like Austin require IV therapy for calories, fluid, and electrolytes.
46
There are several indications for initiating intravenous therapy in infants, and they include:
- to maintain fluid, electrolyte, and glucose balance when oral fluids are not tolerated or are contraindicated, or as an adjunct to intermittent feeding
- to provide adequate nutrition for growth (usually via TPN)
- to administer medications
- to administer blood or blood products
47
Extravasation
One of the most frequent complications associated with IV therapy in infants is extravasation or infiltration. Some of the reasons for this are the immaturity of the circulatory system and the immaturity of the skin. In premature infants the veins are very thin and friable with very little or no muscle support. They move easily and are very fragile. The skin is so thin that it is often described as “paper thin” and therefore is unable to lend support to the blood vessels. As the gestational age increases, so too does the maturity of the blood vessels and skin with a corresponding decrease in the likelihood of intravenous infiltration.
48
The infiltration of intravenous solution into the tissues is usually caused by
the dislodgement of the venipuncture needle or catheter. The signs include edema and/or blanching at the site. The site may be cool to touch and it may be painful for the infant when touched.
49
Prevention of infiltration includes
assessment of the IV site at least hourly, adequate taping of the device, and possibly restraining the limb. The singular most important treatment is to discontinue the IV at the earliest sign of infiltration. This is to prevent IV burns and scar formation that often results from infiltration.
50
Infection/Septicemia
This is one of the more serious complications of IV therapy, particularly for preterm infants given their immature immune systems. Infection or septicemia occurs when bacteria, fungus, or viruses invade the bloodstream through the IV site. Prevention includes proper handwashing, following unit procedures for skin preparation, and changing and accessing IV solutions as per unit policy.
The complications of IV therapy are not uncommon and when they occur, they cause pain and discomfort. The use of central lines and adherence to unit guidelines regarding the number of IV start attempts and pain relief may reduce the stress associated with extravasation in particular.
51
Total Fluids
Infants are ordered a certain amount of fluid per kilo per day (e.g. 80mls/kg/day) to meet their daily requirements of nutritional support. Close monitoring to ensure that the correct rate of IV fluid is infusing every hour is imperative. Excessive or insufficient fluid amounts will result in either fluid overload or dehydration and both will not meet the infant’s specific nutritional requirements.
Excessive or insufficient infusion of IV fluid can be a result of a malfunctioning infusion pump or an incorrectly set rate. Insufficient fluid rates can also be caused by an IV going interstitial.
Prevention includes checking the infusion pump at least hourly for the amount of fluid infused, ensuring the correct rate is set on the infusion pump, and checking the physician’s order for the hourly rate to be infused. In addition, it is important to ensure that the physician’s orders reflect the recommended guidelines for fluid administration for newborns.
52
Nursing care aimed at supporting and monitoring an infant’s nutritional requirements should include:
- Monitor serum glucose for all at risk infants: small for gestational age, perinatal asphyxia, RDS, hypoxia, infant of diabetic mother (IDM).
- Ensure accurate fluid requirements based on weight.
- Meet fluid and caloric needs with N/G or O/G and IV.
- Slowly increase feeds and decrease IV.
- Monitor tolerance of feeds closely.
- Monitor for signs of NEC.
- Monitor IV site, rate, and type of fluid.
- Minimize glucose utilization by minimizing pain, stress, and handling.
53
Premature infants of less than 32 weeks are likely to require 2–3 weeks of IV therapy in order to maintain their nutritional status. Explain why these infants require IV therapy.
Premature infants less than 32 weeks have immature gastrointestinal systems. While oral feeds (OG/NG) may be started, the progression to fully oral feeds in premature infants is generally quite slow. Therefore, IV fluids are used to supplement oral feeds, and, in this way, to help maintain fluid and nutritional status.
54
Describe what your assessment of Austin’s intravenous therapy would include. How often will you check his IV site?
check IV site for redness, swelling and blanching, pain, temperature, leaking
check around the site — looking at the tapes, the limb board, position
check physician’s order for total fluids for the day and calculate the IV rates accordingly
check for correct solutions, rates, and alarms on infusion pumps
check the IV site at least hourly and more often if concerned about its appearance
check the site frequently while administering medications
55
Calculate an hourly IV rate for Austin based on the following order: Total fluids 100 ml/kg/24 hr. Austin’s birth weight is 900 gm.
Note: Base fluid calculations on birth weight until the infant has surpassed his birth weight.
Formula for calculating total daily fluids is total fluids ordered × weight in kilograms. To calculate the hourly rate you then divide by 24.
100 ml/kg/day X 0.900 kg = 90 ml/day
90 mls/day /24hrs/day = 3.75 ml/hr
56
Austin's and is distended...
| Why is Sam concerned about Austin’s abdomen?
Sam is likely concerned about Austin’s abdomen because he knows that feeding Austin does carry some risk. Austin may not tolerate enteral feeds because he is premature. All premature infants being fed enterally must be closely monitored for tolerance
57
If Austin developed signs of feeding intolerance, what possible explanations could be made for this intolerance?
immaturity of the gastrointestinal system is the most common cause of intolerance
hypoxia
sepsis
necrotizing enterocolitis
side effect of caffeine citrate
congenital anomalies (although this is unlikely in Austin’s case)
58
Why is expressed breast milk the best choice for feeding Austin?
Breast milk is immunologically and nutritionally superior to formula and it is also easier to digest.
59
Austin is currently receiving 2cc of EBM every 4 hours; what is the purpose of trophic feeds?
Trophic feeding is the practice of feeding minute volumes of milk in order to stimulate the development of the immature gastrointestinal tract of the preterm infant.
60
Necrotizing Enterocolitis
Necrotizing enterocolitis (NEC) is a disease that primarily affects premature infants, but there is a small population of term infants who may be at risk.
In preterm infants, the development of NEC is very much related to vulnerability arising from prematurity. The gastrointestinal tract is not functionally prepared to handle food.
In full-term infants, the development of NEC is related to vulnerability arising from the transition to extrauterine life. Asphyxia decreases blood flow to the gut, and if severe enough, can lead to ischemia and necrosis.
NEC is characterized as a progressive disease of the gastrointestinal tract involving inflammation, infection, and necrosis of the bowel tissue.
61
What in Austin’s history places him at risk for NEC? In other words, why is he vulnerable?
Prematurity, SGA, history of apnea and bradycardia, and early feeding all place Austin at increased risk for NEC.
62
What other problems may mask NEC or mimic the signs and symptoms of NEC?
hypothermia
feeding intolerance related to immature gastrointestinal system
bowel obstruction
sepsis
63
What can be done to prevent NEC?
use of breast milk
closely monitor those infants identified as at risk
at-risk infants should be fed carefully and in slowly increasing amounts
any suspicions of NEC should be identified immediately
provide adequate oxygen
64
Generate an assessment tool for NEC.
Visual
observe abdomen for any ropiness or bowel loops, distension, discoloration; check gastric aspirates for color/consistency/amount; check stool for occult or frank blood
Palpation:
gently palpate abdomen to see if there is any tenderness, firmness, or areas which may indicate obstruction; check abdominal girth every other feed
Auscultation:
bowel sounds present or absent, hypoactive/hyperactive bowel sounds
Other:
monitor vital signs including watching for temperature instability and apnea/bradycardia; watch for lethargy or irritability; monitor blood work, especially for signs of sepsis
65
What stage of NEC do you believe Austin is experiencing? Is the management appropriate?
Would you recommend anything?
Austin is most likely in Stage 1 — suspected NEC. The management seems appropriate and nothing further is recommended at this time.
66
Critical Findings for NEC
- feeding intolerance
- abd distention
- bloody or hemoccult-positive stools
- thrombocytopenia, leukocytosis, leukopenia, and metabolic acidosis
- pneumatosis intestinalis on abd radiograph
- Free air on abd radiograph in the presence of perforated viscus.
67
Stage I: suspected NEC
A. Systemic signs are nonspecific, including apnea, brady- cardia, lethargy, and temperature instability.
B. Intestinal finding include feeding intolerance, recurrent gastric residuals, and guaiac-positive stools.
C. Radiographic findings are normal or nonspecific.
68
Stage IIA: mild NEC
A. Systemic signs are similar to those in stage I.
B. Intestinal findings include prominent abdominal disten- tion with or without tenderness, absent bowel sounds,
and gross blood in the stools.
C. Radiographic findings include ileus, with dilated loops
with focal areas of pneumatosis intestinalis.
69
Stage IIB: moderate NEC
A. System signs include stage I signs plus mild acidosis and thrombocytopenia.
B. Intestinal findings include increasing distention, abdom- inal wall edema, and tenderness with or without a palpable mass.
C. Radiographicfindingsincludeextensivepneumatosisand early ascites intrahepatic portal venous gas may be present.
70
Stage IIIA: advanced NEC
A. Systemic findings include respiratory and metabolic acidosis, assisted ventilation for apnea, decreasing blood pressure and urine output, neutropenia, and coagulopathy.
B. Intestinalfindingsincludespreadingedema,erythema,or discoloration, and induration of the abdominal wall.
C. Radiographic findings include prominent ascites, paucity
of bowel gas, and possibly a persistent sentinel loop.
71
Stage IIIB: advanced NEC
A. Systemic findings reveal generalized edema deteriorating vital signs and laboratory indices, refractory hypotension,shock syndrome, disseminated intravascular coagulation,
and electrolyte imbalance.
B. Intestinal findings reveal a tense, discolored abdomen
and ascites.
C. Radiographic findings commonly show absent bowel gas
and often evidence of intraperitoneal free air.
72
Management of NEC
- NPO
- TPN
- IV ABX
- ORAL gastric tube at low intermittent suction
- check VS
- assess abd girth
- give probiotics
73
How will you communicate and collaborate with both Austin and Lisa to develop a plan of care?
Take some time to hear Lisa’s story. She is expressing to you that it is difficult for her to get to the hospital. Explore further what would work for her. Listen to her concerns and needs. Also, be aware of your own assumptions and bias’ as you care for Lisa. As you cannot separate who you are as a person from who you are as a nurse, your past personal and profession experience may be influencing how you care for Austin and Lisa.
74
Skin-to-Skin Contact
Skin-to-skin contact or kangaroo care refer to the idea that infants and parents can benefit from close physical contact. First practiced in Latin America as a way of keeping small infants warm, it has since been studied and adopted as an appropriate way to facilitate warmth, attachment, and ultimately, infant stability. The readings from the following article and chapter are such important concepts to grasp. Understanding the relationship between the infant and their environment - and how this influences the development - are vital concepts to grasp when caring for these vulnerable newborns.
75
What are the benefits of kangaroo care for Austin?
improves self-regulation
reduces stress
facilitates neurodevelopmental maturation
stability of vital signs
76
What are the benefits of kangaroo care for Lisa?
maternal infant bonding
77
literature has shown that the neonatal intensive care unit environment and nursing staff can restrict the natural process of attachment for many mothers and their infants. The mother‐infant attachment process can be highly influenced by mother‐infant and mother‐nurse interactions. The key recommendations from this review are that nurses need to minimise mother and infant separation by promoting mother‐infant interaction through
kangaroo care, breastfeeding and participation in care. This review has also identi ed that promoting nurse‐mother interaction through psychosocial support and communication by establishing a trustful and caring relationship can enhance the mother‐infant attachment process.
78
Teen pregnancy
Teen mothers are considered to be at a higher risk because they are “biologically immature and their growing body is competing with the fetus for nutrient sources” (Kenner, pp. 651). They are more likely to deliver early due to inadequate nutrition and immature reproductive organs. In contrast to this increased risk teen mothers are also perfectly capable of having a healthy pregnancy and a healthy infant. With proper nutrition and early prenatal care potential problems can be decreased.
79
Apnea is often a sign of an underlying disorder
True
80
Asymmetrical IUGR usually occurs early in the third trimester and is associated with impaired growth of the body, with normal growth the head and extremities.
True
81
Apnea is never accompanied by bradycardia and desaturation.
False
82
An infant who has experienced asphyxia should be fed within a few hours of birth.
False
83
Gavage Feeding(NG or OG) is indicated in infants
- who are intubated
| - who have an absent suck, swallow or gag reflex
84
Jacob is two days old, his birth weight is 1450 gas, and he presently weighs 1380 gms. Which weight should his total fluids be calculated on?
1450 gms.
85
Some of the benefits of skin to skin cuddling (kangaroo care) in the infant are:
- reduce stress
- reduce painful procedures
- minimizes apneas and bradycardias
86
An infant who is receiving IV therapy should be monitored for:
- Accurate fluid intake
- accurate output
- IV patency hourly
87
NEC affects only preterm infants.
False
