NICU Service and Delivery - Test 1 Flashcards
Competencies of NICU OT?
Good understanding of pediatric practice
Must be knowledgeable about medical conditions associated with prematurity and the vulnerabilities associated with neonates
Good understanding of family needs and stressors due to NICU environment and prematurity circumstances
Understanding of pre-term infant neuromotor and neurobehavioral development
Must be a collaborative, competent member of NICU team
OT Role in NICU
Individualized developmentally supportive care
Promote 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
Vapotherm
Respiratory therapy device attached to a nasal cannula that allows very high nasal flows of warmed and moist air
oxygen hood
Plastic hood that provides a flow of warm, humidified oxygen placed over infant’s head
Intrauterine environment
Intrauterine
TACTILE- constant proprioceptive input; smooth, wet, comfortable, boundaries
VESTIBULAR- maternal movements, dinural cycle, amniotic fluid creates gentle oscillating environment, flexed posture
AUDITORY- biological sounds, muffed environmental sounds
VISUAL- Dark; occasional red dim spectrum light
THERMAL- constant warmth consistent temperature
Extrauterine environment
Extrauterine
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 diurnal rhythm
THERMAL- environmental temperature variations, high risk of neonatal heat loss from thin skin and lack of subcutaneous fat
What can fluorescent light exposure lead to?
Chromosomal damage
Disruption of dinural rhythms
Over stimulation leading to physiological distress
At what age can pre-term babies tightly close eyelids?
post-30 weeks
Environmental lighting should be:
Dimmed especially during night
Only use moderate lighting
Shield infant eyes with bedside draping or phototherapy eye mask or isolette cover
Focused lighting for procedures needing more light
Sound in the NICU should be:
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 not ring
Sound-blocking isolette covers for cribs
Touch in NICU should be:
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
containment?
The use of materials or humans to provide physical boundaries for the infant . I.e.: Z-flo fluidized positioners
kangaroo care?
Involves skin to skin contact with parent (better for non-ventilated infants); yields increased feeding time, reduction of physiological stress, and improved attachment
Vygotsky’s Scaffolding
Recruitment: get attention and adherence to demands of the task (this can be a road block)
Decrease degrees of freedom: only attends to part of the demands of the task
Direction maintenance: Try the next steps
Marking critical features – pointing out key elements
Frustration Control – Only give the just right challenges (this can be hard –grade it appropriately)
Demonstrate – demonstrate the ideal solution
