NICU Exam Flashcards
why use adjusted age in NICU?
Allows us to keep track on how close to term they are, monitor growth and development, tells us about when we can start feeding them (should be at least 34 wks)
SLP Role: Infant communication
We read stress cues and respond to infant, aid in baths/procedures to respond to stress cues, give positive interactions and enhance neuroprotective growth
SLP Role: Feeding/swallowing
work with infant to help integrate sensory information for feeding (getting infant to handle sensations in mouth), help them practice SSB since infants usually get practice in the womb, give them positive feeding experiences, NICU babies are at a high risk for PFD, so want to set them up for success. We expect them to have feeding issues
SLP Role: Supporting families
Teach family how to read and respond to stress cues, how to feed their babies, want to build parent bonds with child, want them to be part of the team and be competent in caring for their baby (helps with infant and caregiver stress)
NICU healing environment
- lights
- can use cycled lighting, eye covers,
- its dark in the womb, want to try and replicate that - Sounds
- bells go off in nurses station
- rubber wheels
- sounds are muffled in the womb want to replicate that - smells/tastes
- mik drops to give infants taste of mom, good for positive oral feeding
- want to avoid strong procedural smells and lotions
- can give baby clothes of parent for familiar smell
- in womb, taste what mom eats and smell mom, want to replicate that
try to simulate the womb as much as possible to reduce infant stress
Synactive Theory
Helps us understand infant behavioral communication, helps us understand that autonomic, motor, state, attention/interaction, and self-regulation systems are all interdependent.
Autonomic system
want to see: pinkish all over, steady breathing, steady vitals,
dont want to see: pale or red color, unsteady vitals, burping, excessive drooling, diarrhea, yawning, hiccups, gagging, sneezing
motor system
want to see: smooth movements, flexed position (like in fetal position), holding hands to face, mouthing/sucking, adjusting posture
Dont want to see: jerky movements, flat or extended limbs
State System
want to see: smooth transitions between states, appropriate state for sitatuion (crying during needle pokes is fine), regular sleep pattern,
Dont want to see: inappropriate state for situation, rapid changes in state (deep sleep then awake),
Attention/Interaction State
want to see: baby being able to suck, swallow, and look at caregiver
Dont want to see: stress signals of other systems, not looking at caregiver
Self-regulation system
want to see: hands to mouth, sucking, change in position, visual locking
What to look for when entering room
stable vitals, appropriate positioning and state, quiet alert or drowsy (want to see them wake up more for feeding)
carefully and slowly pick them up, make sure they can handle being touched and moved, if good, do NNS assessment
Strategies to Calm Baby
sway and shoosh, hand hugs, bum pats (not for all babies, some get overwhelmed), swaddle
NNS assessment
want to see: rooting, accepting the pacfier, lingual cupping, sucking the pacifier, can gently tug on paci to see if they can keep it in, make sure they can handle their secretions, keep paci in mouth, stable vitals, no stress cues
If good, move to feeding assessment
NNS assessment strategies
stroke palate to engage sucking, stroke or press tongue to engage lingual cupping, can try paci dips to increase engagement/sucking
Feeding Assessment
want to see: rooting, baby accepting nipple, no drooling or anterior loss of bolus, gasping, SSB (no more than 4? sucks before breathing), look for stress cues
Pacing Strategy
Coregulated pacing - used for babies who are somewhat able to coordinate SSB, just do it when they need
Strict Pacing - pace every time, for those who need extra support with SSB
Can pace by putting nipple in cheek or by tilting the nipple up, can also remove nipple from mouth if necessary
Positioning strategy
side-lying - makes breathing easier by expanding lung compliance, doesn’t cause gravity to pull milk to back of throat, allows milk to fall out of mouth
used to help with anterior loss of bolus, SSB
Nipple flow rate
may need to slow flow rate if baby cannot coordinate SSB, anterior loss of bolus, gasping,
Infant thickening Liquids
Dont want to thicken until at least full term, want to try other pacing strategies first as thickened liquids can cause death to GI system, constipation, and excess calories (makes babies look obese)
HAVE TO HAVE an instrumental assessment first!
Readiness signs for feeding
can be on oxygen, if on high flow, need extra information
at least 34 wks gestation
stable vitals, calm
show interest/hunger cues
NNS ASSESSMENT
