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Medically Based Pediatrics > NICU > Flashcards

NICU Flashcards

1
Q

What are competencies of a NICU OT?

A
  • Understanding of pediatric practice
  • Must know about medical conditions associated with prematurity and vulnerabilities associated with neonates
  • Understand family needs and stressors due to NICU environment and prematurity
  • Understanding of pre-term infant neuromotor and neurobehavioral development
  • Must be collaborative member of NICU team
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2
Q

What is the role of OT in the NICU?

A
  • Developmentally individualized supportive care
  • Promotes physiologic stability, decreased stress above all
  • Environmental modifications and education based on sensory processing
  • Family education and collaboration training caregivers and families about calming strategies
  • Neurodevelopmental intervention
  • Positioning
  • Splinting
  • Feeding evaluation and training
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3
Q

What is a radiant warmer?

A
  • An open bed with an overhead heat source
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4
Q

What is an incubator?

A
  • A clear, plastic heated box that encloses the mattress and infant
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5
Q

What is an open crib?

A
  • A basinet style bed with no external heat source provided. The infant is dressed in clothes and swaddled in blankets
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6
Q

What is bag and mask ventilation and continuous positive airway pressure (CPAP) and ECMO?

A
  • Oxygen assisted ventilation
  • Bag and mask: a bag attached to a face mask is rhythmically squeezed to deliver positive pressure and oxygen
  • CPAP: steady stream of pressurized air given through endotrachial tube, nasopharyngeal tube, nasal prongs, or a small nasa mask
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7
Q

What is mechanical ventilation?

A
  • Machine controls or assists breathing by mechanically inflating the lungs, increasing alveolar ventilation, and improving gas exchange
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8
Q

What is Extracorporeal Membrane Oxygenation (ECMO)?

A
  • Sophisticated life support system that uses modified heart-lung bypass to provide nearly total lung rest and minimize barotraumas (lung damage from prolonged ventilation)
  • Similar to a lung heart bybass
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9
Q

What are examples are oxygen therapy without assisted ventilation?

A
  • Vapotherm, oxygen hood, nasal cannula
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10
Q

What is Vapotherm?

A
  • Respiratory therapy device attached to a nasal cannula that allows very high nasal flows of warmed and moist air
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11
Q

What is an oxygen hood?

A
  • Plastic hood that provides a flow of warm, humidified oxygen placed over infant’s head
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12
Q

What is a nasal cannula?

A
  • Humidified oxygen delivered by flexible NC with small prongs that fit into the nares
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13
Q

What is the intrauterine environment like?

A
  • TACTILE: constant proprioceptive input, smooth, wet, comfortable, boundaries
  • VESTIBULAR: maternal movements, dinural cycle, amniotic fluid creates gentle oscillating environment, flexed posture
  • AUDITORY: biological sounds, muffled environmental sounds
  • VISUAL: dark, occasional red dim spectrum light
  • THERMAL: constant warmth and consistent temperature
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14
Q

What is the extrauterine environment like?

A
  • TACTILE: painful and invasive, dry cool air, medical touching, some social touching
  • VESTIBULAR: flat postures, rapid position changes, influence of gravity, restraints due to equipment
  • AUDITORY: loud, non-contingent, mechanical frequent harsh intermittent impulse noise
  • VISUAL: bright lights, eyes unprotected, often no dinural rhythm
  • THERMAL: environmental temperature variations, high risk of neonatal heat loss from thin skin and lack of subcutaneous fat
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15
Q

What does light exposure in the NICU consist of?

A
  • Fluorescent light exposure can lead to:
    1) Chromosomal damage
    2) Disruption of dinural rhythms
    3) Over stimulation leading to physiological distress
  • Pre 30 week infants are unable to close eyelids tightly or filter light properly
  • Constant lighting affects development of natural circadian rhythms
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16
Q

What are environmental light modifications that can be made?

A
  • Dimmed light especially at night
  • Use of moderate light only
  • Shield infant eyes with bedside draping or phototherapy eye mask or isolette cover
  • Focused lighting for procedures that require more light
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17
Q

What is sound like in the NICU?

A
  • Constant environmental noise usually 50-90 dB (same as street traffic with light machinery)
  • Noise increases arousal and can increase physiological distress
  • Auditory processing development is most active in the 3rd trimester. It may lead to auditory sensitivity and auditory processing problems if pre-term infants are bombarded with noise
18
Q

What sound modifications can be made to the environment?

A
  • Sound proof materials to construct new NICUs
  • Pods or individual rooms for infants to reduce noise
  • Strict noise level policies: pagers turned to vibrate, only low levels of talking permitted, phones that flash and do not ring
  • Sound blocking isolette covers for cribs
19
Q

What is tactile exposure like in the NICU?

A
  • Frequent medical touch for procedures including ventilation, tube adjustments, and suctioning
  • Increased pain response in pre-term infants leads to increased physiological distress
  • Fixed schedules for procedures leads to decreased efforts of infants to express aversion to touch and problems with attachment
  • Sleep deprivation due to frequent interruptions
  • Decreased opportunities for parent/infant tactile interaction to early preemies due to temperature regulation issues
  • Uncomfortable bedding
20
Q

What modifications can be made to touch in the NICU environment?

A
  • Let infant determine schedule
  • Avoid unnecessary touching-bathe every other day, check vitals from monitors, suction PRN not on schedule
  • Speak softly to infant prior to physical handling
  • Swaddling during painful procedures and baths
21
Q

What are calming strategies for a pre-term infant?

A
  • Containment
  • Kangaroo Care
  • Swaddling
  • Infant Massage
22
Q

What is containment?

A
  • A calming strategy

- Use of materials or humans to provide physical boundaries for the infant (i.e. Z-flo fluidized positioners)

23
Q

What is Kangaroo Care?

A
  • A calming strategy
  • Involves skin to skin contact with parent (better for non-ventilated infants); yields increased feeding time, reduction of physiological stress, and improved attachment
24
Q

What is swaddling?

A
  • A calming strategy
  • A type of containment that provides the infant deep pressure and simulation of womb positioning through the wrapping of a blanket around the baby
25
Q

What is infant massage?

A
  • A calming strategy
  • A technique in which the parent provides gentle tactile stimulation or prolonged placement of the hands WITH the infant (best for children 32 PCA)
26
Q

What are common stressors for families in the NICU?

A
  • Family crisis mode
  • Many stressors
    • Health of infant
    • Unfamiliar environment/technology
    • Financial burdens
    • Transportation issues
    • Return to work
    • Feelings of helplessness
    • Depression and possible post-partum
    • Care and time away from other children
    • Decreased competence “I can’t care for them because I don’t know about all their medical issues”
27
Q

How is Vygotsky’s scaffolding helpful in training families in the NICU?

A

Vygotsky’s scaffolding helps:

  • Detect physiological signs of stress
  • Reduce aversive sensory stimuli
  • Perform calming techniques
  • Position the baby therapeutically
  • Provide feeding instruction and support
28
Q

What does NICU family education include?

A
  • Ask family what are major stressors and goals?
  • Collaborate with NICU team to develop a POC that is meeting infant’s medical needs and parents’ goals
  • Provide resources for networking/support systems
  • Provide education on Shaken Baby Syndrome. There is a peak of crying at 6 months
  • Prepare family for life after NICU
29
Q

What does the OT neuromotor and neurobehavioral evaluation and intervention consist of?

A
  • Gather chart information
  • Use clinical observation
  • Co-assess with other disciplines to limit handling time
  • Perform evaluation based on infant’s sleep cycle
  • Be familiar and flexible with evaluation
  • NEVER stress an infant over completing an assessment
  • ## Over interpretation and mistaking immaturity for pathology are frequent errors made by NICU therapists
30
Q

What are common standardized assessments used in the NICU for pre-term infants?
*do not memorize

A
  • It’s important to keep in mind that pre-term infant’s haven’t developed many reflexes or milestones
  • Naturalistic Observations of Newborn Behavior (NONB)
  • Assessment of Pre-term Infant Behavior (NIDCAO Level II)
  • Neonatal Behavioral Assessment Scale (NBAS)
  • NICU Network Neurobehavioral Scale (NNNS)
  • Infant Behavioral Assessment (IBA)
  • Neonatal Oral Motor Assessment Scale (NOMAS)
  • Bayley Infant Toddler Developmental Motor Assessment
31
Q

What are things to remember with preemie neurodevelopment when implementing interventions in the NICU?

A
  • Muscle tone: hypotonia is typical for preemie; may be affected by arousal state or medication
  • Therapeutic positioning: without positioning infant presents with W-posturing of arms, frog-like posturing of legs, and asymmetrical head position
32
Q

Why is therapeutic positioning important in the NICU?

A
  • Without proper positioning pre-term infants can develop iatrogenic conditions affecting head shape
33
Q

What is plagiocephaly?

A
  • Development of abnormal head shape in infants resulting from externally enforced molding surfaces (prolonged position of head towards one direction)
34
Q

What is brachycephaly?

A
  • Flattening of the back of the head due to prolonged supine position
35
Q

What is scaphocephaly?

A
  • Narrowing of the head along the sides due to progressive time spent with head turned to one side while in prone position (preemies lack the musculature to extend neck and freely move head so it remains in this position)
36
Q

What is important to remember for therapeutic positioning in the NICU?

A
  • Increase flexion position (fetal position)
  • Sidelying position: supported with snuggle wraps and blanket rolls
  • Sleeping position: use safe sleep position to avoid SIDS. Safe sleep position is supine but can also put baby at risk of brachycephaly
  • Watch for extensor tone in neck due to trach and vent tubing. Eventually work on neck flexion as these are removed
  • Nesting: place infant in flexed position inside a concave space made by blankets and towel rolls with high, steep boundaries
  • Gel mattress to relieve pressure creates a soft, secure surface
  • Snuggle Ups are an example of commercial products that reduce positioning errors by different caregivers
  • Avoid extremities being unconfined because it leads to the infant feeling unorganized
  • Provide opportunities for prone and sidelying positions
  • Change position every 2-4 hours or when infant gives cues
  • Avoid oversize diapers to avoid abnormal hip development
37
Q

When is PROM necessary in the NICU?

A
  • Congenital malformations

- Hypertonicity

38
Q

Is splinting used often in the NICU?

A
  • Rarely because of skin integrity issues

- Splints must be made using alternative molding forms and soft splinting material

39
Q

Why do a lot of feeding problems develop in the NICU?

A

Because of underdeveloped:

  • Oral motor skills
  • Respiratory skills
  • Endurance
  • Gastro-intestinal system
40
Q

What can an OT educate a NICU parent on in order to increase breast or bottle feeding?

A
  • Supportive positioning
  • Nipple selection
  • Oral motor stimulation for the older preemie
  • Complications of feeding: reflux, suck/swallow/breathe develops at 34 wks gestation
41
Q

What must the baby be able to do in order to discharge from the NICU?

A
  • Baby must breathe independently or the caregiver must be independent in vent care
  • Baby must feed well by bottle/breast or be independent with tube placement and feedings
  • Baby must maintain adequate temperature and weight
  • Premature infants are at risk for developmental delay and other health complications
  • Discharge planning should begin with parents on day of admission
  • Referrals can be made to early intervention or medically-based pediatric services and follow-up NICU clinic
42
Q

What frames of reference are used in the NICU?

A
  • Biomechanical: therapeutic positioning and splints
  • Sensory processing: modifying the sensory environment of NICU
  • Sensory integration: sensory calming and regulation to facilitate attachment
  • Coping: helping families learn to manage stress related to child being in NICU and educate families on stressors that may occur
  • NDT: used sparingly and only if baby is at developmental preemie state to handle strengthening (i.e. oral motor strengthening for feeding)

Medically Based Pediatrics (12 decks)

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