NICU Flashcards
How to assess small premie in nicu
Chart
Observation
Hands on, assessment
Subsystems: Autonomic and motor systems, state organization, attention/interaction, self reg balancing system
Stress and defense behaviors
Resp pauses Irregular resp Breath holding Bradycardia Skin color changes Seizure Tremoring/startling Visceral signs Sneezing Yawning Sighing
Visceral signs of autonomic distress
Gagging Spitting up Chocking Hiccoughing Straining as if having BM Gasping Coughing
Autonomic self regulatory and approach behavior
Stability Smooth respiration Stable or increasing O2 sat Pink, stable color Stable viscera
Motor stress - flaccidity “tuning out”
Trunk flaccid: extremity flaccid, facial facility - gape face
Hyperflexion of trunk, extremeties: fetal tuck, fisting
Frantic diffuse activity, squirming, twitching
Motor hypertonicity stress signal
Hyperextension of” Legs, arms, trunk (arching), finger splaying, facial grimace Tongue ext High guard arm position
Motor stability
Smooth, well modulated posture
Well regulated tone
Synchronous smooth movements w/ efficient motor strategies (motor stability)
Hand clasping Foot clasping Finger folding Hand to mouth maneuvers Grasping Suck searching Sucking Hand holding Tucking
State related stress signals
Diffuse sleep Awake w/ whimpering, facial twitches or discharge smiling Eye floating, roving Sustained fussing/crying/silent crying Frequently active averting Panicked/worried alertness/hyperalert Glassy-eyed, strained alertness, drowsy Rapid oscillations Irritability and prolonged diffuse arousal Frenzy and inconsolability Sleepless/restless
State stability
Clear robust sleep states Rhythmical robust crying Effective self coming Reliable consolability Robust, focused alertness w/ intent, animated facial features
Brazelton state organization
1 deep sleep 2 slight sleep 3 drowsy 4 alert and quiet 5 alters and active 6 crying
NICU active muscle strength developmental progression week 28
Active ankle movement
NICU active muscle strength developmental progression week 30
Knee and thigh movement
NICU active muscle strength developmental progression week 32
Hip
Lower ab
Finger movements
NICU active muscle strength developmental progression week 34
Mid trunk
Elbow movements
NICU active muscle strength developmental progression week 36
Upper trunk
Shoulder
NICU active muscle strength developmental progression week 38
Neck muscles tone present
Bobbing head control
Head turning
30 week gestation tx plan
Auditory stim Touch Vestibular Visual Oral motor Parent and caregiver training
32 week gestation tx plan
Auditory Calming and oral facilitation Alerting Visual stim Active movement facilitation Positioning Swaddling Parent/caregiver training 32wek infant on respirator
34 week gestation tx plan
Calming Altering Oral/feeding fascilitaiton Visual skills Active movement facilitation Positions Swaddling Parent/caregiver training 34 week on respirator
By 34 weeks gestation - feeding expectation
That infant can feed by nipple and eat enough to maintain weight gain and temperature as well as have enough energy for developmental activities
36-38 week infant tx
Calming Alerting Oral/feeding skills Visual skills Active movement facilitation Positioning Swaddling Parent/caregiver training 36-38wk on ventilator
Term infant tx
Calming Alerting Oral/feeding skills Visual skills Active movement facilitation Positioning Swaddling Parent/caregiver training Term infant on ventilator
When to test for follow up
4-6 mo corrected age
9-14 mo
18-36 mo
