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NS7920 > Module 4: Max > Flashcards

Module 4: Max Flashcards

1
Q

What is a main cause of brain injury in newborn?

A

Hypoxic-Ischemic Encephalopathy (HIE)

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2
Q

What is Hypoxic-Ischemic Encephalopath (HIE) caused by (2)?

A

HIE is damage to the brain caused by:
- hypoxia and/or
- ischemia.

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3
Q

What are lifelong consequences of Hypoxic-Ischemic Encephalopathy HIE (3)?

A

varying from
- mild behavioural deficits to
- severe seizures,
- motor and cognitive delay
- cerebral palsy in the newborn.

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4
Q

What are 2 primary physiological processes that leads to Hypoxic-Ischemic Encephalopathy (HIE)?

A

Brain hypoxia and ischemia is due to:
- systemic hypoxemia
- reduced cerebral blood flow (CBF),
- or both

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5
Q

What are the two phases of Hypoxic-Ischemic Encephalopathy (HIE)?

A
  • initial insult
  • reperfusion injury
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6
Q

How is Hypoxic-Ischemic Encephalopathy (HIE) characterized by?

A

It is characterized
- by an initial insult such as asphyxia at birth and
- a reperfusion injury which occurs 6-15 hours post initial insult
*** reperfusion injury is where the irreversible cell death occurs.

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7
Q

What happens during the initial insult of Hypoxic-Ischemic Encephalopathy (HIE)?

A
  • Hypoxemia and/or ischemia cause a deprivation of glucose and oxygen supply to the brain, which causes a primary energy failure and initiates a cascade of biochemical events leading to cell dysfunction and ultimately to cell death.
  • The sympathetic nervous system is stimulated, resulting in shunting of blood to vital organs (brain, heart and adrenals) to maintain adequate cardiac output and cerebral perfusion.
  • As the hypoxic ischemic event progresses, there is a decrease in cardiac output and cerebral perfusion, which leads to anaerobic metabolism.
  • As the brain reverts to anaerobic metabolism, it causes a rapid depletion of high-energy phosphate reserves (ATP).
  • Cellular function is compromised, resulting in an increase of intracellular sodium, calcium and water, tissue acidosis, and electrical failure of neural tissue.
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8
Q

What happens during the reperfusion injury of Hypoxic-Ischemic Encephalopathy (HIE)?

A

*** This phase is where irreversible cell death begins (6–15 hours after initial insult).
- The phase begins with a brief period of restored cellular function (normal vital signs, pH, absence of seizures).
- Clinical deterioration quickly follows because of mitochondrial dysfunction as a result of the initial insult;
- continued cell injury and cell death can occur.

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9
Q

What are supportive intensive care should be included for infants with Hypoxic-Ischemic Encephalopathy HIE (3)?

A
  • correction of hemodynamic and pulmonary disturbances (hypotension, metabolic acidosis, and maintenance of adequate ventilation);
  • correction of metabolic disturbances of glucose, calcium, magnesium, and electrolytes;
  • treatment of seizures if present;
  • monitoring for other organ system dysfunctions, such as acute renal failure.
    ***Maintenance of adequate ventilation and adequate perfusion is a central aspect of supportive care.
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10
Q

What should be included to help with the control of seizures for infants with Hypoxic-Ischemic Encephalopathy (HIE)?

A

The presence of seizures occurring within the first hours predicates a poor outcome of HIE.
- Therefore, antiepileptic drugs are among the medications most commonly used in perinatal HIE.

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11
Q

What is the neuroprotective strategy should be included for infants with Hypoxic-Ischemic Encephalopathy (HIE)?

A
  • Therapeutic hypothermia has become a standard practice for term to near-term infants with moderate to severe HIE.
  • The beneficial effects of mild hypothermia occur at multiple areas in the cascade to cell death.
  • Therapeutic hypothermia must be commenced within six hours of age because induced hypothermia targets the second phase to prevent reperfusion injury to the brain.
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12
Q

Which type of therapeutic hypothermia treatment is currently recommended treatment to reduce brain injury for infants with Hypoxic-Ischemic Encephalopathy (HIE)?

A
  • Whole body cooling is currently the recommended treatment to reduce brain injury and promote better long-term neurodevelopmental outcomes
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13
Q

What is therapeutic hypothermia?

A
  • is a medical treatment that lowers a patient’s body temperature
  • in order to help reduce the risk of ischemic injury to tissue following a period of insufficient blood flow.
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14
Q

What are some neuroprotective mechanisms of therapeutic cooling (4)?

A
  • reduced metabolic rate and energy depletion
  • decreased excitatory transmitter release
  • decreased free radical production
  • reduced alterations in ion flux
  • reduced apoptosis (cell death) due to HIE
  • reduced vascular permeability,
  • reduced edema,
  • reduced disruptions of blood–brain barrier functions
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15
Q

What are three methods of therpeutic hypotermia?

A
  • Selective Head Cooling
  • Whole Body Cooling
  • Ice Packs
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16
Q

What is selective head cooling therapeutic hypothermia method?

A
  • A cap (CoolCap) with channels for circulating cold water is placed over the infant’s head, and a pumping device facilitates continuous circulation of cold water.
  • Nasopharyngeal or rectal temperature is maintained at 33–34°C for 72 hours.
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17
Q

What is whole body cooling therapeutic hypothermia method?

A
  • The infant is placed on a cooling blanket, through which circulating cold water flows, so that the desired level of hypothermia is reached quickly and maintained for 72 hours.
  • Nasopharyngeal or rectal temperature is maintained at 33–34°C for 72 hours.
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18
Q

What is ice packs therapeutic hypothermia method?

A
  • Ice packs are applied to the armpits, head and neck, and groin of the infant.
  • This technique is used when neither of the first two methods are available, such as in a smaller outlying hospital, as the infant is prepared for transport to a higher-level NICU.
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19
Q

What is the process of therapeutic hypothermia?

A
  • using a cooling cap or blanket,
  • a newborns body temperature is lowered to 35.5 degrees celsius
  • newborns body temperature is lowered for 72hours
  • decreased body temperature slows the babys metabolic rate
  • cells are able to recover, preventing the spread, severity, permanence of brain damage
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20
Q

How does the rewarming of the infant begin? Why done gradually?

A
  • Once the infant has completed 72 hours of induced hypothermia, the rewarming process begins.
  • The process can take anywhere from 8–10 hours as rapid warming can cause vasodilatory shock and rebound seizures.

***done gradually to prevent changes in BP, skin damage due to rapid rewarming of tissue

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21
Q

What is amplitude-Integrated Electroencephalography (aEEG)?

A
  • aEEG is a method for continuous monitoring of brain function that is used increasingly in NICUs.
  • Amplitude-integrated electroencephalography (aEEG) technology provides continuous brain function data over a period of days in order to detect seizures and monitor the effect of anticonvulsant drugs.
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22
Q

What is the difference between aEEG vs EEG?

A
  • amplitude-integrated electroencephalography (aEEG) technology provides continuous brain function data over a period of days
  • electroencephalography (EEG) monitoring has involved a periodic “snap-shot” of brain function
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23
Q

How is amplitude-Integrated Electroencephalography (aEEG) monitoring done?

A

aEEG monitoring is done by
- putting electrodes (needle, hydrogel, EEG cap) on both sides of the infant’s scalp
- attaching them to a monitor (Brainz or CFM) that will provide a continuous readout of activity.

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24
Q

Who can Brainz monitoring be used on (3)?

A
  • diagnosed with moderate to severe HIE
  • having definite or questionable seizures
  • muscle-relaxed and at risk of seizures that may not be clinically apparent
  • having unexplained apneas
  • diagnosed with significant neurological disorders (for example, congenital brain malformations, vascular lesions)
  • post cardiac arrest
  • diagnosed with an inborn error of metabolism (for example, urea cycle disorders, hypoglycemia, hypocalcaemia)
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25
Q

Cooling needs to be initiated within how many hours of birth?

A

Within 6hrs on birth

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26
Q

Therapeutic cooling thought to?
a. Decrease rate of cell death
b. Prevent cardiovascular instability
c. Reduce energy depletion
d. Reduce cellular edema
e. Stop the initial brain injury

A
  • a. Decrease rate of cell death
  • c. Reduce energy depletion
  • d. Reduce cellular edema
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27
Q

What are 4 of the adverse effects associated with therapeutic cooling?

A
  • bradycardia
  • hypotension
  • thrombocytopenia
  • coagulopathy
  • renal impairment
  • overcooling (particularly <28°C) can increase the risk of dysrhythmias and bradycardia
28
Q

What is Multiple Organ Dysfunction Syndrome (MODS)?

A
  • Multiple organ dysfunction syndrome (MODS) is the presence of altered organ function in acutely ill patients such that homeostasis cannot be maintained without intervention.
  • It usually involves two or more organ systems.
  • Alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure.
29
Q

If infant is experiencing therapeutic hypothermia and end-organ damage. What blood products would be ordered if Max had petechiae, bruising, prolonged PT, and low platelets?

A
  • Fresh frozen plasma q 8 hours
  • Cryoprecipitate infusion x 1
  • Platelet infusion x 1
30
Q

What is albumin?

A

Albumin is the most abundant
- protein in blood plasma and is
- mainly produced in the liver.

31
Q

What is the main function of albumin?

A
  • The main function of serum albumin is the maintenance of blood volume.
  • Albumin helps to maintain the volume of blood by maintaining the oncotic pressure, as it helps to pull interstitial fluid into the circulatory system and, thus, maintains the volume of blood.
32
Q

What happens if the level of albumin decreases?

A
  • When the level of albumin decreases, the oncotic pressure also reduces,
  • which in turn results in greater fluid leakage from the capillaries.
  • This can eventually cause accumulation of fluid or water in the tissues (edema).
33
Q

What are the two different concentrations of albummin?

A

Albumin 5%
- used to expand the circulating blood volume
- expands volume 1:1

Albumin 25%
- expands circulating blood volume by drawing fluid from interstitial spaces
- expands volume 3-4:1

34
Q

pRBCs is used to treat ____

It contains ____(fluid) and ______s

A
  • treat anemia
  • contain plasma, red blood cell (RBC)
35
Q

Platelets is essential for _____of blood

It also contain ______, some RBCs and some WBCs

A
  • for coagulation
  • contains plasma
36
Q

Fresh frozen plasma (FFP) used to control _____ due to ________ levels of clotting factors

It contains all coagulation factors and no RBCs, leukocytes or_______

A
  • control bleeding due to low
  • contains platelets
37
Q

_________ made from FFP and contains specific clotting factors

A

Cryoprecipitate

38
Q

An infant has approximately 80-100 mL/kg of total circulating blood volume

term infants = approximately
mL/kg of blood

preterm infants = approximately
mL/kg of blood

A
  • term = 80
  • preterm = 100
39
Q

Blood products can be given through ______s and peripheral IVs but are not infused through PICC (peripherally inserted central catheter) lines because they are very small-gauge, which makes them prone to _______ and thrombosis.

A
  • given through UVC
  • prone to clotting
40
Q

What does packed red blood cells transport? When to use it?

A
  • Transports oxygen and carbon dioxide to and from the tissues
  • uses when: Hemorrhage, anemia and improve oxygen delivery
41
Q

What does platelets do? When to uses?

A
  • Promotes blood clotting and wound healing
  • uses when: Hemorrhage
42
Q

What does fresh frozen plasma contain? When to uses?

A
  • Contains all coagulation factors
  • uses when: Active bleeding
43
Q

What does cryoprecipitate do? When to uses?

A
  • Percipitate recovered from thawing frozen plasma
  • uses when: Consumptive coagulopathy or massive bleeding
44
Q

Blood pressure increases for infants with advancing (3)?

A

depends on various factors, including
- gestational age,
- postnatal age, and
- birth weight.

45
Q

Why is the recognition and treatment of hypotension important (to avoid)?

A

To avoid complications such as
- cerebral ischemic injury or
- intraventricular hemorrhage IVH

46
Q

Why is the recognition and treatment of hypertension important?

A

hypertension in the newborn is increasingly seen as a complication in infants who have
- bronchopulmonary dysplasia BPD and
- are receiving steroid treatment.

47
Q

What are 2 arterial blood pressure determined by?

A
  • cardiac output
  • peripheral vascular resistance
48
Q

When are 3 infants blood pressure generally considered adequate in clinical practice?

A

generally considered to be adequate as long as
- urine output (> 1 mL/kg/hr) and
- capillary refill (< 3 seconds) are within normal limits and
- there is no metabolic acidosis.

49
Q

What is hydrocortisone?

A

Hydrocortisone is a corticosteroid hormone

50
Q

What does hydrocortisone do?

A

Hydrocortisone
- increases the sensitivity of the vasculature to epinephrine and norepinephrine,
—> thereby increasing blood pressure.

51
Q

What is neonatal cardiac output dependent on? Select all that apply.
a. Stroke volume
b. Urine output
c. CO2 levels
d. Heart rate
e. Coronary perfusion

A
  • a. Stroke volume
  • d. Heart rate
52
Q

What are the 3 stroke volume is affected by?

A
  • contractility,
  • preload, and
  • afterload
53
Q

The correct size of cuff to measure an infant’s BP is:
a. one-third the length of the extremity
b. half the length of the extremity
c. two-thirds the length of the extremity
d. one-quarter the length of the extremity

A

c. two-thirds the length of the extremity

54
Q

What does family centred care involve as per Callister (2015)

A
  • family care taking
  • equal family participation
  • collaboration
  • maintaining families’ respect and dignity
  • knowledge transformation
55
Q

What does it mean by nurse enters into the relationship as a servant leader?

A
  • entering into a relationship that is based on caring, empowering and relating to one another.
  • Adapting this position of servant leader, the nurse acts as a visionary, humble, accountable leader who facilities families in directing their own care.
  • This kind of relating involves presence and awareness.
    **This is when we stop “doing” and simply “be with” the family, exploring what this experience is like for them.
56
Q

What is a key theme identified by many families in the literature?

A
  • a strong need for communication and knowledge-sharing between parents and nurses.
  • Parents need support to provide appropriate care to their infant and this requires being educated on all aspects of their infant’s medical condition and behaviours.
  • This education and encouragement, especially from nurses, can facilitate parent–infant bonding and will also provide the foundation for successful and trusting relationships between parents and healthcare providers.
57
Q

What is the second theme identified by many families in the literature?

A
  • was their need to be encouraged to participate in their infant’s care.
  • It is critical for nurses to recognize parents’ need to be supported and to encourage them to touch and care for their infant as appropriate.
  • Facilitating attachment through touching and providing care is often important to families and this can be disrupted when an ill infant is admitted to NICU.
58
Q

What is the third theme identified by many families in the literature?

A
  • Many parents of ill infants in the NICU articulated a need for effective and caring relationships with the nurses providing care for their infant
  • opportunity for nurses to develop equal partnerships with parents and recognize the value in including parents as partners in their infant’s care. I
59
Q

What is the forth theme identified by many families in the literature?

A
  • is the creation of a welcoming unit
  • Many parents identified two needs in particular to feeling welcome in the NICU: not having restrictions on visiting hours and the ability to make the unit homey
  • Contextual components can be inclusion of families during rounds, removing the concept of visiting hours, and welcoming families to participate in discussions.
60
Q

How is the Creation of a welcoming unit can be linked to two facets of FCC?

A
  • coalition between healthcare team and the family and
  • encouragement of open communication
61
Q

What are some causes of hypotension (3)?

A
  • PDA
  • sepsis
  • NEC
  • Hypovolemia
  • Delayed transition from intrauterine to extrauterine life
  • Chorioamnionitis
  • Perinatal asphyixa
62
Q

What are some signs of inadequate perfusion (3)?

A
  • Cap refill >3
  • Weak pulse
  • Mottled skin
  • Oliguria
  • Tachycardia
  • Metabolic acidosis
  • Lethargy
63
Q

Is hypovolemia a common cause of hypotension in term and preterm newborn?

A

It’s uncommon

64
Q

What are some nursing care for Hypoxic-Ischemic Encephalopathy (HIE)

A

deliver room: resuscitation and stabilization

Therapeutic hypothermia

Establish ventilation
Support adequate perfusion
Prevent hypotension, hypoxia, acidosis
UAC: continuous Blood pressure monitored
Maintain quiet, darkened environment, minimal handling, DSC
Seizure Meds: phenobarbital
Sedation meds: morphine
Inotropes: dopamine to maintain BP
Neurologic status: aEEG, brainz monitoring, seizures monitoring
EEG and MRI, neurology consult
Fluid management: strict in and out
NPO

65
Q

What can Hypoxic-Ischemic Encephalopathy (HIE) be caused by? Leads to?

A
  • Perinatal asphyxia and
  • can lead to hypoxia, hypercarbia and metabolic acidosis
66
Q

How to approach each family as unique individuals with unique needs?

A
  • simply being with them
  • asking them what this experience is like for them
  • guiding them through this journey to support them
  • can’t assume ALL parents will experience having a sick infant the same
  • do NOT want to assume that one member of the family defines the rest of the family

NS7920 (5 decks)

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