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731 Pediatrics > Neonatal ICU and Assessment Lecture > Flashcards

Neonatal ICU and Assessment Lecture Flashcards

1
Q

Standard Error of Measurement Definition

A

indicates precision of test scores

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2
Q

Standard Scores Definition

A

expressed as deviations from the mean

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3
Q

Positive Predictive Value Definition

A

the proportion of true negatives among those that have negative screening results

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4
Q

NICU Level I

A

Basic care facility for healthy newborns

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5
Q

NICU Level II

A

additional personnel, able to care for infants from 32 weeks, short-term respiratory assistance, some mechanical ventilation

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6
Q

NICU Level III

A

full range of subspecialties and surgical services

  • A: > 1000 g or > 28 weeks
  • B:
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7
Q

NICU Level IV

A

highest level of care

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8
Q

Signs of Stress in an Infant

A
  • 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
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9
Q

Minimizing stress in the NICU

A
  • 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
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10
Q

Family centered care in the NICU

A
  • facilitate bonding process
  • reflect family’s and child’s strengths
  • use baby’s name
  • provide info that is consistent and sensitive
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11
Q

Pre-term Infant has …

A
  • 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
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12
Q

Environmental and Behavioral Strategies for Pain Reduction

A
  • dim lights/shade eyes
  • reduce noise
  • reduce frequency of handling
  • swaddle
  • non-nutritive sucking
  • kangaroo care (skin to skin)
  • facilitated tucking
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13
Q

Tactile System

A
  • skin is one of the biggest sensory organs

- pain, touch, temperature and proprioception

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14
Q

Vestibular System

A
  • womb provides constant vestibular stimulation
  • vestibular stimulation is known to enhance states of arousal
  • slow and rhythmic = calming
  • fast and erratic = stimulating
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15
Q

Olfactory and Gustatory Development After Birth

A
  • Preterm infant has g-tube and no practice swallowing making coordination of SSB difficult
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16
Q

Auditory Development

A
  • normal conversation = 60 dB
  • AAP recommends NICU noise shouldn’t exceed 45 dB
  • noisy NICU may cause cochlear damage & sleep disturbances
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17
Q

Visual Development at 23-24 weeks

A

major eye structure and visual pathways in place

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18
Q

Brazelton State 1

A

deep sleep, without movements, breathing regularly

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19
Q

Brazelton State 2

A

light sleep, closed eyes, some corporal movement

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20
Q

Brazelton State 3

A

Sleepy, eyes opening and closing

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21
Q

Brazelton State 4

A

Awake, opened eyes, minimum corporal movement

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22
Q

Brazelton State 5

A

Completely awake, strong corporal movement

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23
Q

Brazelton State 6

A

Cry

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24
Q

Gestational Age Definition

A

length of time baby was in the womb

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25
Q

AGA, LGA, SGA

A

appropriate, small, or large for gestational age

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26
Q

NBL, LBW, MLBW, VLBW, ELBW

A

normal, low, moderately low, very low, and extremely low birth weight

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27
Q

APGAR

A

Appearance, Pulse, Grimace, Activity, Respiration; recorded at minute 1 and 5, higher number is better (8-10 is typical for healthy newborns)

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28
Q

Radiant Warmer

A

type of incubator used for babies who are very unstable or extremely premature to keep them warm

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29
Q

Isolette

A

an enclosed incubator where you can access infant through side port holes

30
Q

Nasal Cannula

A

humidified gas delivered via flexible tubing inserted into nose

31
Q

CPAP

A

used to prevent alveolar and airway collapse

- used to treat respiratory distress syndrome

32
Q

ECMO

A

heart and lung bypass machine

33
Q

Pulse Oximeter

A

measures oxygen concentration in the peripheral circulation with a bandage-type light sensor attached to arm or leg

34
Q

Phototherapy

A

used to reduce jaundice

35
Q

Gavage Tube (G-Tube)

A
  • oral or nasogastric tube used for feeding directly into the stomach
  • transpyloric (belly) tubes used when infants at risk for aspiration
36
Q

PICC

A
  • long catheter inserted into peripheral vein and threaded to superior vena cava
  • used for prolonged parental feeding, antibiotics, or to draw blood
37
Q

Respiratory Distress Syndrome

A
  • lack of surfactant production
  • surfactant helps prevent collapse of air space
  • Symptoms: increased RR, intercostal retractions, nasal flaring, cyanosis
38
Q

Patent Ductus Arteriosus

A
  • 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
39
Q

Gastroesophageal Reflux

A
  • 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
40
Q

Necrotizing Enterocolitis

A
  • acute inflammation of immature intestines causing necrosis
  • risk of developing NEC doubles with prenatal cocaine exposure
  • symptoms: abdominal distension and vomiting
41
Q

Germinal Matrix-Intraventricular Hemorrhage (GM-IVH)

A
  • 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
42
Q

Periventricular Leukomalacia (PVL)

A
  • 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
43
Q

Retinopathy Prematurity

A
  • abnormal blood vessel development in the retina of the eye

- symptoms: abnormal eye movements, crossed eyes, severe nearsightedness, white-looking pupils

44
Q

Prenatal Drug Exposure

A
  • 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
45
Q

Choriomanionitis

A
  • bacteria invades amniotic cavity causing an inflammatory response
  • most common cause of preterm labor
  • babies are at risk for neuro impairment and brain damage
46
Q

Bone Disease of Prematurity/Osteopenia

A
  • 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
47
Q

Bronchopulmonary Dysplasia (BPD)

A
  • most common chronic lung disease associated with prematurity
  • greatest contributing factor is under-developed lungs
  • symptoms: bluish skin, rapid breathing, SOB
48
Q

Assessment/Intervention for BPD

A
  • 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
49
Q

Congenital Diaphragmatic Hernia

A
  • requires surgery
  • congenital malformation of the diaphragm
  • high incidence of sensorineural hearing loss, GER, failure to thrive, feeding problems, developmental delay, seizure and scoliosis
50
Q

Omphalocele

A
  • 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
51
Q

Gastroschisis

A
  • requires surgery
  • birth defect
  • intestines stick out of body through a defect on one side of the umbilical cord
52
Q

Tracheal Esophogeal Fistula (TEF)

A
  • requires surgery
  • abnormal connection between the esophagus and trachea
  • need g-tubes during healing after the surgery
53
Q

Asphyxia

A
  • lack of oxygen to organs

- babies should be handled with care with intent to minimize stress and avoid sensory overload

54
Q

Seizures

A
  • difficult to recognize and diagnose

- in infants, usually manifests as chewing, lip smacking, sucking, apnea, gaze abnormalities

55
Q

Medical Issues in the Term/Near Term Infant

A
  • 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
56
Q

Brachial Plexus Injury

A
  • “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
57
Q

Congenital Hip Dysplasia

A
  • 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
58
Q

Metarsus Adductus

A
  • 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
59
Q

Talipes Equinovarus “Club Foot”

A
  • 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
60
Q

Arhrogrposis

A
  • describes congenital joint contractures in two or more areas of the body
  • goal of functional ROM
  • treatment includes serial casting, splinting, stretching, and surgery
61
Q

Infant Pain Scales

A

CRIES, Premature Infant Pain Profile (PIPP), Neonatal Facial Coding Scale (NFCS), Neonatal Infant Pain Scale (NIPS)

62
Q

CRIES Pain scale

A 
Crying
Requires additional O2
Increased Vital Signs
Expression
Sleeplessness
63
Q

PIPP

A 
Gestational AGe
Behavioral state
HR
O2 saturation
Brow Bulge
Eye Squeeze
Nasolabial furrow
64
Q

NFCS

A 
Brow bulge
eye squeeze
nasolabial furrow
open lips
stretched mouth
lip purse
taut tongue
chin quiver
tongue protrusion
65
Q

NIPS

A 
facial expression
Cry
breathing patterns
arms
legs
state of arousal
66
Q

Normal Birth Weight (NBW)

A

5 lb 8 oz to 8 lb 13 oz

67
Q

LBW

A
  • low birth weight

5 lb 8 oz

68
Q

MLBW

A
  • moderately low birth weight

3 lb 5 oz to 5 lb 8 oz

69
Q

VLBW

A
  • very low birth weight

3 lb 5 oz

70
Q

ELBW

A

Extremely low birth weight

less than 2 lb 3 oz

71
Q

The tactile system at 7 weeks

A

pain receptors appear around mouth

72
Q

Tactile system at 22 weeks

A

pain pathways are myelinated

731 Pediatrics (9 decks)

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