Neonatal ICU and Assessment Lecture Flashcards
Standard Error of Measurement Definition
indicates precision of test scores
Standard Scores Definition
expressed as deviations from the mean
Positive Predictive Value Definition
the proportion of true negatives among those that have negative screening results
NICU Level I
Basic care facility for healthy newborns
NICU Level II
additional personnel, able to care for infants from 32 weeks, short-term respiratory assistance, some mechanical ventilation
NICU Level III
full range of subspecialties and surgical services
- A: > 1000 g or > 28 weeks
- B:
NICU Level IV
highest level of care
Signs of Stress in an Infant
- skin is pale, mottled, cyanotic, gray, flushed
- glassy eyes, gaze aversion, staring
- gasping for air
- grimacing, fussing, irregular breathing
- fluctuating muscle tone
- flaccidity or hyper-tonicity
- frantic movements
Minimizing stress in the NICU
- decrease noise/light
- minimize handling
- protect sleep states
- help parents understand behavioral cues
- promote relationship-based care giving
- autonomic and motor subsets are foundation for ability to achieve state and attention
Family centered care in the NICU
- facilitate bonding process
- reflect family’s and child’s strengths
- use baby’s name
- provide info that is consistent and sensitive
Pre-term Infant has …
- hypotonia
- decreased flexor tone
- decreased extension and head control
- increased PROM and AROM
- increased reactivity and startle response
- former pre-terms may also demonstrate toe walking
Environmental and Behavioral Strategies for Pain Reduction
- dim lights/shade eyes
- reduce noise
- reduce frequency of handling
- swaddle
- non-nutritive sucking
- kangaroo care (skin to skin)
- facilitated tucking
Tactile System
- skin is one of the biggest sensory organs
- pain, touch, temperature and proprioception
Vestibular System
- womb provides constant vestibular stimulation
- vestibular stimulation is known to enhance states of arousal
- slow and rhythmic = calming
- fast and erratic = stimulating
Olfactory and Gustatory Development After Birth
- Preterm infant has g-tube and no practice swallowing making coordination of SSB difficult
Auditory Development
- normal conversation = 60 dB
- AAP recommends NICU noise shouldn’t exceed 45 dB
- noisy NICU may cause cochlear damage & sleep disturbances
Visual Development at 23-24 weeks
major eye structure and visual pathways in place
Brazelton State 1
deep sleep, without movements, breathing regularly
Brazelton State 2
light sleep, closed eyes, some corporal movement
Brazelton State 3
Sleepy, eyes opening and closing
Brazelton State 4
Awake, opened eyes, minimum corporal movement
Brazelton State 5
Completely awake, strong corporal movement
Brazelton State 6
Cry
Gestational Age Definition
length of time baby was in the womb
AGA, LGA, SGA
appropriate, small, or large for gestational age
NBL, LBW, MLBW, VLBW, ELBW
normal, low, moderately low, very low, and extremely low birth weight
APGAR
Appearance, Pulse, Grimace, Activity, Respiration; recorded at minute 1 and 5, higher number is better (8-10 is typical for healthy newborns)
Radiant Warmer
type of incubator used for babies who are very unstable or extremely premature to keep them warm
Isolette
an enclosed incubator where you can access infant through side port holes
Nasal Cannula
humidified gas delivered via flexible tubing inserted into nose
CPAP
used to prevent alveolar and airway collapse
- used to treat respiratory distress syndrome
ECMO
heart and lung bypass machine
Pulse Oximeter
measures oxygen concentration in the peripheral circulation with a bandage-type light sensor attached to arm or leg
Phototherapy
used to reduce jaundice
Gavage Tube (G-Tube)
- oral or nasogastric tube used for feeding directly into the stomach
- transpyloric (belly) tubes used when infants at risk for aspiration
PICC
- long catheter inserted into peripheral vein and threaded to superior vena cava
- used for prolonged parental feeding, antibiotics, or to draw blood
Respiratory Distress Syndrome
- lack of surfactant production
- surfactant helps prevent collapse of air space
- Symptoms: increased RR, intercostal retractions, nasal flaring, cyanosis
Patent Ductus Arteriosus
- Ductus arteriosus usually closes 10-15 hours after birth
- this is when it DOESN’T close
- symptoms: murmur, increased HR, respirator distress, failure to gain weight
Gastroesophageal Reflux
- movement of gastric contents into esophagus
- can cause inflammation of esophagus and lead to poor oral feeding patterns
- Symptoms: irritability, extension and arching trunk to the right
- at risk for aspiration
Necrotizing Enterocolitis
- acute inflammation of immature intestines causing necrosis
- risk of developing NEC doubles with prenatal cocaine exposure
- symptoms: abdominal distension and vomiting
Germinal Matrix-Intraventricular Hemorrhage (GM-IVH)
- most common type of brain lesion in premature infants
- damage can extend to periventricular white matter, resulting in significant neuro issues
- CP, mental retardation, seizures
Periventricular Leukomalacia (PVL)
- death of small areas of brain tissue around ventricles
- damage creates “holes” in the brain
- high risk for developing problems with motor, visual and cognitive functions, spastic diplegia, hydrocephalus
Retinopathy Prematurity
- abnormal blood vessel development in the retina of the eye
- symptoms: abnormal eye movements, crossed eyes, severe nearsightedness, white-looking pupils
Prenatal Drug Exposure
- cocaine causes uterine contractility, maternal HTN, placental vasoconstriction and decreased uterine blood flow
- symptoms: congenital anomalies, abnormal sleep patterns, tremor, poor organized response, irritability and inability to be consoled
Choriomanionitis
- bacteria invades amniotic cavity causing an inflammatory response
- most common cause of preterm labor
- babies are at risk for neuro impairment and brain damage
Bone Disease of Prematurity/Osteopenia
- 80% of bone is produced between 24-40 wks
- large amounts of calcium magnesium and phosphates delivered in last trimester
- mechanical stimulation of bones in cramped uterus
Bronchopulmonary Dysplasia (BPD)
- most common chronic lung disease associated with prematurity
- greatest contributing factor is under-developed lungs
- symptoms: bluish skin, rapid breathing, SOB
Assessment/Intervention for BPD
- be cautious of symptoms of distress during assessment
- breathing is always the 1st priority
- decrease stimulation in environment
- position child to support respiration
- use gentle handling and mobilization techniques
- may need to provide scar massage
- develop activities into routines and play times
Congenital Diaphragmatic Hernia
- requires surgery
- congenital malformation of the diaphragm
- high incidence of sensorineural hearing loss, GER, failure to thrive, feeding problems, developmental delay, seizure and scoliosis
Omphalocele
- requires surgery
- birth defect in which the infant’s intestine or other abdominal organs stick out of belly button
- intestines are covered only by a thin layer of tissue and can be easily seen
Gastroschisis
- requires surgery
- birth defect
- intestines stick out of body through a defect on one side of the umbilical cord
Tracheal Esophogeal Fistula (TEF)
- requires surgery
- abnormal connection between the esophagus and trachea
- need g-tubes during healing after the surgery
Asphyxia
- lack of oxygen to organs
- babies should be handled with care with intent to minimize stress and avoid sensory overload
Seizures
- difficult to recognize and diagnose
- in infants, usually manifests as chewing, lip smacking, sucking, apnea, gaze abnormalities
Medical Issues in the Term/Near Term Infant
- Meconium Aspiration Syndrome
- Persistent Pulmonary Hypertension of the Newborn
- Infections
- Toxoplasmosis
- Rubella
- Cytomegalovirus
- Herpes Simplex Virus
- HIV
- Group B Strep
- Fetal Alcohol Syndrome
- Neonatal Abstinence Syndrome
Brachial Plexus Injury
- “waiter’s tip” position: shoulder add. and IR with elbow extension, pronation of forearm and flexion of wrist and fingers
- occurs when nerves are stretched during birth process
- 80% recover spontaneously in 1st 2 months after injury
- Treatment: PROM, prevent contracture, promote AROM, strengthening
Congenital Hip Dysplasia
- unstable hip due to abnormal formation of hip joint
- Ortalani Test: involves upward force while hip is abducted
- Barlow Test: downward force while hip is adducted
- 95% success rate using Pavlik harness if started before age of 7 wks
Metarsus Adductus
- front of foot is bent or angled in toward middle of foot, back of foot and ankles are normal
- treat with passive stretching, taping, corrective shoes, bracing or serial casting
Talipes Equinovarus “Club Foot”
- Affected foot appears to have been rotated internally at the ankle
- Without treatment, people with club feet often appear to walk on their ankles or on the sides of their feet
- With treatment, most recover completely during early childhood
- Treatment involves serial taping and casting
Arhrogrposis
- describes congenital joint contractures in two or more areas of the body
- goal of functional ROM
- treatment includes serial casting, splinting, stretching, and surgery
Infant Pain Scales
CRIES, Premature Infant Pain Profile (PIPP), Neonatal Facial Coding Scale (NFCS), Neonatal Infant Pain Scale (NIPS)
CRIES Pain scale
Crying Requires additional O2 Increased Vital Signs Expression Sleeplessness
PIPP
Gestational AGe Behavioral state HR O2 saturation Brow Bulge Eye Squeeze Nasolabial furrow
NFCS
Brow bulge eye squeeze nasolabial furrow open lips stretched mouth lip purse taut tongue chin quiver tongue protrusion
NIPS
facial expression Cry breathing patterns arms legs state of arousal
Normal Birth Weight (NBW)
5 lb 8 oz to 8 lb 13 oz
LBW
- low birth weight
5 lb 8 oz
MLBW
- moderately low birth weight
3 lb 5 oz to 5 lb 8 oz
VLBW
- very low birth weight
3 lb 5 oz
ELBW
Extremely low birth weight
less than 2 lb 3 oz
The tactile system at 7 weeks
pain receptors appear around mouth
Tactile system at 22 weeks
pain pathways are myelinated
