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Pediatrics > NICU considerations > Flashcards

NICU considerations Flashcards

1
Q

Signs of stress in an infant

A 
Skin: pale, cyanotic, gray, flushed
Eyes: glassy, gaze aversion, staring
Gasping for air
Grimacing, fussing, irregular breathing
fluctuating muscle tone (flaccidity or hyper-tonicity)
Frantic movements
*table 4.3, pg 112 in book*
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2
Q

Minimizing stress in NICU

A 
Decrease noise/light
Minimize handling
Protect sleep states
Help parents understand behavioral cues
Promote relationship-based care giving
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3
Q

Provide family-centered care by:

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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4
Q

Preterm is classified as:

A

37 weeks or before

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5
Q

Characteristics of preterm infant compared to full term

A

Hypotonia
Decreased flexor tone
Decreased extension and head control
Increased ROM
Increased reactivity and startle response
Former pre-terms may also demonstrate toe walking

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6
Q

Evolution of Tone, Reflexes, and Musculoskeletal development

A

Proceeds in orderly, sequential pattern: LE to UE, distal to proximal
20-26 wks: many changes quickly
By 32 wks: development slows, looks more like term infant

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7
Q

4 sensory components of tactile system:

A

Touch
Temperature
Pain
Proprioception

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8
Q

Tactile System at 7 wks

A

pain receptors first appear around mouth

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9
Q

Tactile System at 22 wks

A

pain pathways are myelinated

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10
Q

Pain reduction strategies

A 
*mimic environment of uterus*
Dim lights/shade eyes
Reduce noise
Reduce frequency of handling
Swaddle
Non-nutritive sucking
Kangaroo Care
Facilitated tucking
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11
Q

Common Neonatal Pain Assessment Scales

A

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

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12
Q

CRIES : characteristics assessed

A 
C*rying
R*equires additional O2
I*ncreased vital signs
E*xpression
S*leeplessness
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13
Q

Premature Infant Pain Profile (PIPP) : characteristics assessed

A 
Gestational age
Behavioral state
HR
O2 sat
Brow bulge
Eye squeeze
Nasolabial furrow
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14
Q

Neonatal Facial Coding Scale (NFCS) : characteristics assessed

A 
Brow bulge
Eye squeeze
Nasolabial furrow
Open lips
Stretched mouth
Lip purse
Taut tongue
Chin quiver
Tongue protrusion
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15
Q

Neonatal Infant Pain Scale (NIPS) : characteristics assessed

A 
Facial expression
Cry
Breathing patterns
Arms
Legs
State of arousal
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16
Q

Vestibular nerve is full-size and tracts are myelinating at ___ weeks

A

20

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17
Q

Vestibular stimulation enhances ______ __ _______

A

States of arousal

slow and rhythmic = calming, fast and erratic = stimulating

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18
Q

Olfactory and gustatory development: Smell at ___ ; Taste buds begin to mature at ___

A

28 weeks

13 weeks

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19
Q

Olfactory and gustatory development: Preterm infant lacks practice in _______

A

Swallowing (makes coordination of SSB difficult)

*from 24 weeks until term, fetus swallows 1L of amniotic fluid daily

20
Q

Auditory: ____ wks GA able to hear ___ dB consistently. Normal conversation = ___ dB

A

28 wks
40 dB
60 dB
*AAP recommends NICU should not exceed 45dB

21
Q

Visual: major eye structure and visual pathways are in place by ____ wks

A

23-24 GA

22
Q

Visual: retina and visual cortex undergo extensive maturation from _____ wks to _____

A

24 wks to term

23
Q

Visual: eyelids separate between ___-___ wks

A

24-28 wks

24
Q

Visual: pupillary reflex is present at ___ wks

A

34 wks

bright light causes lid closure without fatigue

25
Q

Brazelton- Neonatal behavioral assessment scale: State 1

A

Deep sleep, without movements, breathing regularly

26
Q

Brazelton- State 2

A

Light sleep, eyes closed, some corporal movement

27
Q

Brazelton- State 3

A

Sleepy, eyes opening and closing

28
Q

Brazelton- State 4

A

Awake, eyes open, minimal corporal movement

29
Q

Brazelton- State 5

A

Completely awake, strong corporal movement

30
Q

Requirements for COMPLETE neonatal neuromotor assessment: (3)

A

Able to tolerate gentle handling
Be in a calm alert state
On room air and in open crib

31
Q

Gestational age

A

length of time baby was in the womb

32
Q

AGA, LGA, or SGA

A

appropriate, large or small for gestational age

33
Q

APGAR

A 
A*ppearance (color)
P*ulse (HR)
G*rimace (reflex irritability) 
A*ctivity (muscle tone)
R*espiration (respiratory effort)
recorded at first and fifth minute of life
34
Q

Respiratory Distress Syndrome (RDS)

A

Insufficient surfactant production and structural lung immaturity
Symptoms: increased respiratory rate, interconstal retractions, nasal flaring, cyanosis

35
Q

Patent Ductus Arteriosus

A

Ductus arteriosus usually closes 10-15 hours after birth, when it does not close it is termed PDA.
Symptoms: murmur, increased HR, respiratory distress, failure to gain weight

36
Q

Hyperbilirubinemia (jaundice)

A

Immature liver function causes build up of bilirubin in the blood
Symptoms: decreased level of arousal and activity, lethargy, hypotonia, poor sucking ability, can also alter visual, social-interactive and neuromotor abilities

37
Q

Gastroesophageal Reflux

A

Movement of gastric contents into esophagus and above

Symptoms: irritability, extension and arching of trunk to the right (trying to get away from it)

38
Q

Necrotizing Enterocolitis

A

Acute inflammation of immature intestines causing necrosis (risk doubles in babies with prenatal cocaine exposure)
Symptoms: abdominal distension and vomiting

39
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 neurological issues (CP, mental retardation, seizures)

40
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, busual, and cognitive functions

41
Q

Retinopathy of Prematurity

A

Abnormal blood vessel development in retina of the eye

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

42
Q

Prenatal drug exposure

A

Symptoms: gongenital anomalies, abnormal sleep patterns, tremors, poor organized response, irritability and inability to be consoled

43
Q

Chorioamnionitis

A

Inflammatory response that occurs when cervicovaginal bacteria invades the amniotic cavity

44
Q

Bone disease of prematurity/osteopenia

A

Third trimester very important for bone development, 80% of bone is produced between 24-40 wks,
Preterm infants are missing mechanical stimulation of cramped uterus

45
Q

Bronchopulmonary Dysplasia (BPD)

A

Most common chronic lung disease associated with prematurity
Greatest factor is under-developed lungs
Symptoms: bluish skin, rapid breathing, shortness of breath

Pediatrics (8 decks)

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