Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Maternal Exam 4 > Premature infant & High risk infants > Flashcards

Premature infant & High risk infants Flashcards

1
Q

Late preterm age

A

34-36.6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Early term age

A

37-38.6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Full term

A

39 - 40.6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Late term

A

41.7 - 41.6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Post term

A

42 - beyond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What will a preterm infant flexion be like?

A

There will be a lack of flexion which indicates the immaturity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How much vernix will a preterm infant have?

A

Vernix or the white coating is produced at 20-24 weeks but goes away around the 36 week mark.
So young or early babies will have more if they are before 36 weeks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How much vernix will a pst term baby have?

A

No vernix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What will the skin of a preterm infant look like?

Why is this?

A

Thin & transparent with veins that are easy to see and an overall reddish tone to them bc of it

The fat deposits on a fetus don’t develop until 36 weeks and the vessels only begin to form at 37 weeks. So if you’re born early you won’t have these fully formed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What will skin look like in post term infants?

A

Wrinkled dry and cracked or desquamation from the the fluid disappearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What will the presence of lanugo or body hair be like in a preterm infant?

A

The baby will have more of it. It covers the entire body at 20 weeks, is greatest at 28-30 ish weeks and thins closer to term leaving bald spots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What will hair such as eyelashes, brows, and on head be like for a preterm?

A

The hair, eyebrows and eyelashes develop at 20-23 weeks and so they should have it if they aren’t super early.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What will sole creases look like in preterm infants?

A

They develop from toes to heals , so if they are preterm they’ll be high.
If term they’ll be all the way down to heel.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When do eyes open?

A

26 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What will ears look like if you are a preterm infant?

A

If early, the pinna will be paper thin. As the fetus ages it should have thickened

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What will nipple tissue be like if you are a premature infant?

A

Smaller than 5mm .

  • should be 5-10 mm in term babies
  • either gender
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Gestational age where testes begin process of descent from the abdomen

A

28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Testes high in the scrotum gestational age

A

37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Testes completely descended and scrotum covered in rugae gestational age

A

full term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What happens to scrotum as fetus gets older gestational wise

A

Becomes more pendulous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What if the testes are undescended at term

A

Urology consultant needed for risk of infertility concerns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why are respiratory complications common in premature infants?

A

The lungs are one of the last organs to develop and function due to the need for surfactant
- which lubricates alveoli and allows them to open

Pulmonary vessels are also very immature and can rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When does surfactant start to develop?

What can no surfactant cause?

A

Surfactant starts to develop around the 28 weeks but it is the 35-36 weeks where they have enough to actually breathe on their own and replace old surfactant

Atelecatasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Small ways to improve respiratory function in infants?

A

Position w shoulder roll

Suctioning their nasal area and airway

Prone positioning or on tummy to allow the mattress to help them breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

tool to assess respiratory functioning?

A

Silverman Anderson index tool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When and who does RSD or respiratory distress syndrome only occur in?

A

Premature infants due to it having to develop within 6 hours of birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

RDS signs

RR
Muscle tone
Breathing
Skin

A

RR - tachypnea so over 60

Hypotonia muscles

Retractions, grunting, nasal flaring, apnea, and even obvious decreased air entry

Pallor skin early on
Cyanosis if late

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why can’t you tell if infant has RDS right away?

A

The infant may have surfactant at birth but once they use it up, they have none and that is when they show symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What effects does RDS have on the lungs?

A

Can cause atelectasis in lungs

Loss of residual lung capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does RDS effect the body systemically?

What state(s) can the body go in?

A

Hypoxemia and cyanosis

Respiratory acidosis followed by metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does RDS effects the heart?

A

It can cause the ductus arteriosus and former vale to reopen due to stress of being hypoxic

An increase in pulmonary vascular resistance and right to left shunting occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What does RDS do to perfusion?

A

Perfusion isn’t able to be balanced and so the ventilation distribution is uneven to the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How do they diagnose RDS?

What about the chest diameter?

A

Clinical signs but also a patchy atelectasis from radiology

Increased AP diameter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is RDS treatment like for prevention?

A

They want to start with prevention with maternal corticosteroids at 24-34 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How will they treat infants who have RDS already?

A

They’ll do oxygen therapy

Can do exogenous surfactant phospholipids with an endotracheal tube

Nitric oxide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Exogenous surfactant phospolopids requires ___ .

Where do they get the surfactant?

A

parental consent

porcine or bovine
pig or cow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does the manual bagging do during an Exogenous surfactant phospholipids?

How will the infant respond to the treatment?

A

Helps distribute the surfactant med

The infant will be coughing and they won’t like it bc we are putting fluid in their lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When an infant has RSD, what can be used to open pulmonary field

A

Nitric oxide due to its vasodilation ability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

If giving O2 for RDS, what does the o2 sat need to be in infants

How do we keep the o2 sat low and avoid ROP eye damage?

How do they decide the mode to give O2 by for RDS?

A

88-93%
- also monitor blood gases too

Oxygen blenders (blends room air and o2 together)

Depends on the need

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How do they decide the mode to give O2 by for RDS

methods:
Blow by

Nasal cannula

Oxyhood

Nasal or ETT CPAP

Ventilator
- what frequencies?

A

Depends on the need

Blow by - blowing air directly to face

w og tube

oxyhood - clear plastic hood to blow in the face

nasal etT cpap -cpap machine idk what this is exactly tho

Ventilation on high frequency of 480–1200
or
low frequency 250 -900.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why do we do sepsis evaluation in RSD ?

A

Due to risk of infection from invasiveness of lab draws and procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Why do we give give antibiotics in RSD?

A

Based off culture results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Type of nutrition for RSD?

What sort of things will we monitor for RSD that are super important??

A

TPN (in IV)

I&O
Daily weights

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is ECMO that is done for RSD?

How old do you have to be? and why?

A

Extra-corporal membrane oxygenation but its really when you shunt blood from heart to pump and back to ease breathing so that the lungs can rest and have time to mature.

34 weeks and older due to anticoagulant use and risk of iVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Can a term baby have RDS??

A

They have be in respiratory distress but they won’t have the syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is PDA or patent ductus arteriosus?

How soon does it close?

What is is it triggered by?

A

A hole between the left pulmonary artery and ascending aorta that shunts blood from lungs to placenta for gas exchange that is meant to close

Should close within 48 hours

Triggered by first breath o2 rising

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

So what cause the PDA to reopen?

What if the PDA is small?

A

It open when there’s stress from hypoxia

May not show symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Common PDA histories?

A

Prematurity *
FAS
Amphetamine exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is seen on chest X-ray with pda?

A

Left ventricle volume overload
Pulmonary edema
Chronic heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

PDA symptoms:

tachypnea w crackles or bradypnea wo crackles?

systolic murmur or diastolic murmur?

What will pulse be like?

A

PDA

tachypnea w crackles

systolic murmur left sternum 2-3 IC spaces

femoral and peripheral pulses will be bounding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

PDA symptoms

What will blood pressure be like? HR?

organs?

skin?

A

hypotension and tachycardia

hepatomegaly of liver

mottling and cyanosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

PDA blood gases

A

Hypercapnia or elevated CO2

Metabolic acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

PDA diagnosis?

A

Echo to measure blood shunt amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Treatment of PDA

HF symptoms -

Oxygenation -

Patency -

A 
Restrict fluids
Diuretics 
Respiratory support w ventilator
Prostaglandin synthesis inhibitors 
Surgical ligation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Why do we restrict fluids and give diuretics for PDA?

A

Due to the heart failure going on with LV overland and pulmonary edema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Why do we give respiratory support for PDA treatment

A

In order to help the perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Why do we give prostaglandin synthesis inhibitors?

Which meds?

A

It can cause the PDA to constrict

Indomethacin

Neoprofen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Indomethacin risks

When giving Indeomethacin what are the requirements for the patient?

how many doses?

A

intestinal perforations, decreased urine output, decreased blood flow to gut, and IVH

NPO

3 doses maximum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Neoprofen

Why use it over Indomethacin?

Average dose

A

this is pediatric IV ibuprofen

Lesser effect on kidneys but not as effective

Average dose is 500-1500 g less than 32 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

When will they do surgical ligation for PDA?

A

With drug failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Transient Tachypnea is what?

A

Usually is when a schedule c section baby gets fluid in their lungs and can’t clear them
- must be c section schedule bc the fluid has to be there or it can’t be pushed out by going down the birth canal

so failure to clear lung fluid, mucus, debris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Other reasons besides scheduled c section that have transient tachypnea of the newborn or TTN?

A

TTN can be from LGA, diabetes infants, near term infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What will happen to baby shortly after birth if they are TTN or transient Tachypnea?
Symptoms?

A

They will show signs of distress due to fluid in the lungs

  • grunting, nasal flaring
  • subcostal retractions
  • slight cyanosis
  • tachypnea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How is TTN or transient tachypnea diagnosed?

You may see hyper-aeration of the alveoli. what does this mean?

A

On xray

  • you will see a flattened counter of diaphragm
  • dense streaking pattern known as patchy Atelectasis

over expansion of the lungs but it clears overtime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

TTN nursing care priorities ?

what will nutrition look like?

What do we provide to the family?

A

Maintain respiratory status and nutrition
- will have to be on TPN first then bottle feeding

Support and educate family bc it is a quick recovery really

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is PPHN or Persistent Pulmonary Hypertension?

What type of infants is it seen in?

A

When the pulmonary vascular bed doesn’t relax but instead vasoconstricts

Term or post term infants with tachycardia and cyanosis

67
Q

What happen to the heart in Persistent pulmonary hypertension

How does the PPHN occur?

A

The increased pulmonary resistance from constriction then causes the right Ventricle hypertension and the foramen oval and ductus arteriosus are used again.

Response to a trigger of some sort

68
Q

Persistent pulmonary hypertension

A

Pulmonary hypertension due to the lack of blood staying moving

Hypoxia , tachycardia, cyanosis

Acidemia

69
Q

Diagnosis of Persistent pulmonary hypertension?

how is confirmed?

A

O2 sat in right arm and leg at 24 hrs of age
- should be equal or nearly the same
preductal will be higher than post ductal

confirmed on echo

70
Q

Firs thing to do with Persistent pulmonary hypertension?

When does assessment happen?

A

Review the mom and baby’s health history

Assess within 24 hours of life

71
Q

T/F

Baby’s with persistent pulmonary hypertension will have RDS symptoms

A

true but they won’t respond to oxygen

72
Q

Meds for Persistent pulmonary hypertension

A

IV
Meds

O2 and nitric oxide both will vasodilate to decrease PVR
Vasopressor Dopamine will increase SVR

73
Q

What can they place with a Persistent pulmonary hypertension ?

What can they do to address oxygen and compliance for PPHN?

Is stimulation ok with PPHN?

What if baby isn’t responding to treatment?

A

Place a umbilical catheter

ventilator with sedation and paralyzing agent s

It is best not to allow stimulation or keep it minimal

They will need ECMO

74
Q

Wha tis Bronchopulmonary dysplasia?

A

Lung field problems due to baby being born premature to the point they require O2 therapy for up to 28 days or longer
- remember o2 just needs to be around the 89-93 mark

75
Q

What is the cause of bronco pulmonary dysplasia tho?

How do we keep this from happening now?

A

The premature baby has no surfactant and so they need O2. But that O2 is causing scarring and a bad cycle of damage.

Keep this from happening by keeping O2 levels lower

76
Q

Main symptoms of BPD or bronchopulmonary dysplasia?

Care for ventilator?

A

Resp symptoms but the main part is they NEED that ventilator to the point that you can’t even wean them off of it

Infection risk from ventilation use so be aware of pseudomonas

77
Q

How are pulmonary fluid levels controlled in BPD or BPD or bronchopulmonary dysplasia?

What electrolyte replacements can counteract diuretics?

A

Diuretics and fluids

Potassium to keep fluids from being pulled from lungs

78
Q

Meds for BPD or bronchopulmonary dysplasia??

A

Bronchodilators
- albuterol

Long term steroids d/t chronic lung disease

79
Q

Why do serial echos for BPD or bronchopulmonary dysplasia??

Exercises therapy for BPD or bronchopulmonary dysplasia??
But what can suctioning lead to ?

A

Evaluate affect on heart

Chest physiotherapy and suctioning

negative oral sensations bc the baby doesn’t want anything in their mouth meaning they dont want to nipple so may need speech therapy too

80
Q

What do infants with BPD or bronchopulmonary dysplasia have higher risk of once discharged?

the key to preventing BPD?

A

Respiratory infection risk

prevent the premature brith in the first place

81
Q

What is ROP?

A

Retinopathy of Premature meaning infants get oxygen therapy they can damage their eyes in premature infants under 30 weeks
- again 30 weeks is important here

82
Q

Why is ROP more common in premature infants less than 30 weeks?

A

More common due to retina not being vascularized and vessels develop abnormally

83
Q

What does the ROP cause in the eye?

A

Abnormal vascularization w bleeding

Fluid leakage that results in hemorrhages , scar tissue, and disruption of retina and macula

84
Q

Dreaded potential of ROP?

A

retinal detachment due to impaired vision/blindness

85
Q

How to prevent ROP?

A

Keep oxygen on lowest O2 possible 89-93 or just prevent the prematurity that caused the need for oxygen in the first place

  • it is a multi factor cause tho
  • really make sure to monitor the oxygen to make sure no accidents happen too
86
Q

So just to make things clear - the need for o2 after birth can damage what two organs?

A

Eyes & Lungs

87
Q

How is it that we can keep o2 levels at a lower level in infants?

A

1) In utero the oxygenation was not at 100% so they don’t really need it that high
2) their RBC’s have higher affinity for oxygen

88
Q

What can be used to help make suer O2 levels aren’t too high in infants?

A

Oxygen blenders

89
Q

What will the ophthalmologist notice on exam ? And when is this exam done?

How many exams will there be?

A

They will notice retinal changes
Exam is 4-6 weeks after birth

Just do repeat exams if there’s any issues in order to monitor progression

90
Q

What happens to most ROP cases?

A

They regress spontanesouly

91
Q

ROP treatment that stops growth of blood vessels

A

Avastin

92
Q

ROP treatment that is considered to be more permanent suppression of blood vessel growth

A

Laser Therapy

93
Q

All treatments for ROP?

main goal of tx?

A

Avastin Injection
Laser Therapy
Cryotherapy

Just prevent vision loss

94
Q

Why are infants/newborns at risk of alteration in thermoregulation that they can’t control?

A

Higher ration of body surface to body weight

Less SQ fat

Thin skin

Immature temp regulation in brain

Decreased ability to constrict vessels

95
Q

How does posture flexion affect thermoregulation?

A

Flexion keeps you warm where by decreasing surface area

And if you’re extended and not flexed, heat can be lost quicker

96
Q

How does the higher ratio of body surface to weight cause heat loss?

A

Bc there’s more body surface, its more opportunity for heat to get out but the smaller weight means the heat loss affects them more

97
Q

How does thin skin cause heat loss

A

There is a greater amount of insensible water loss and heat loss

98
Q

What type of environment is needed to address temp-control?
What is the state we are wanting to prevent?

How to prevent cold stress?
Hypothermia is an early sign of ____.

A

Neutral thermal environment

Preventing hypoglycemia
as well as cold stress.

Monitor baby’s temp

early sign of sepsis

99
Q

Oxygen intervention for thermal regulation

A

Provide warm and humidified oxygen

100
Q

Incubator intervention for thermal regulation

A

Double walled incubator

101
Q

How can you help temp regulation as far as using scales and x rays?

A

Pre-warm them

102
Q

What state do you want baby’s skin in for temp regulation?

What can you have them wear?

A

Keep the skin dry bc if they’re wet they lose more heat

Wear a cap for temp regulation

103
Q

How should you monitor the baby’s temp for thermoregulation?

A

Use temp probe bed set on servo control

104
Q

What temp should feedings be before you give them and why?

A

Warm bc if cold, it can affect baby’s temp.

105
Q

What lighting equipment can be used for thermoregulation of infants?

Micro premies tent ?

A

Heat lamps

For micro premies - use plastic tents for insensible water loss
bc plastic keeps temp in

106
Q

What can cause an increased risk of aspiration in infants?

A

Poor gag reflex, suck swallow reflex, esophageal sphincter that doesn’t work

107
Q

How does an infants small stomach capacity affect GI?

A

Means they may not be able to get all calories needs met.

- may have to add more calories and protein to food for nutrition with fortified bread milk or formulas

108
Q

Deficiency of calcium and phosphorus is due to ? Why do we need these?

A

They both are deposited in last semester so can happen in premature infants.
They prevent rickets and osteopenia (so for bone growth)

109
Q

Feeding intolerance —

How is max feeding volume found?

How long is nipple feeding ok to do?

What is done with the remained of food?

A

Adequate nutrition based by weight gain of 10-20 grams/kg/day

30 min per feeding

Gavage feed

110
Q

What is feeding Progresso normally like?

A

Infants are NPO due to an admit diagnosis for feeding intolerance rt respiratory distress, poor feedings, hypovolemia etc
and kept on IV fluids

Then enteral feedings are started at small volumes until l they tolerance is established
- can increase feeding volume gradually

111
Q

What to monitor with feeding intolerances?

A

Abdominal girth
Residual w tube feedings
Bowel sounds

112
Q

Signs of a feeding intolerance

A 
Residual is increased, blood in stools
abdominal distention w visible bowel loops
lactose in stools
n/v
Waterless stools
113
Q

When do infants develop their suck swallow reflex?

A

34 weeks so if they’re born before this, you can have a lack of oral readiness

114
Q

What does the gag reflex need to be like for oral readiness to be achieved

What is an example of non-nutritive sucking?

A

Gag reflex needs to be strong

pacifier

115
Q

What does skin to skin encourage as far as nutrition?

A

It encourages the rooting. and sucking reflex onto the nipple for feedings

116
Q

How should oral attempts be attempted for feedings?
What to provide ?

position for oral readiness?

A

Low and slow
quality over quantity

Cheek/chin support ad pacing

upright position

117
Q

You’re starting oral feeds and you notice weight loss. is this bad?

A

No it is to be expected

- if it gets too bad fortifier can be added to increase calories

118
Q

What is meconium aspiration?

What happens?

A

Meconium aspiration is when the fetus swallows their own meconium – but the meconium is from a asphyxia in utero

  • increased intestinal peristalsis w anal sphincter relaxing to relate meconium and it enters lungs
119
Q

What positioning is meconium aspiration common in?

A

Breech since the butt is squeezed with contractions

- but we do c sections remember

120
Q

What if they discover meconium on exam?

Will they do an amnioinfusion?

What treatment/management will they do for meconium aspiration?

A

Increase in assessments

no it won’t help

Suction once the head is in sight

121
Q

Exam needed once born if baby to check for meconium aspiration

A

Laryngoscopic exam that checks to see if vocal cord are meconium stained bc if so, that means risk of aspiration in lungs

122
Q

If an infant has meconium aspiration and is in respiratory distress what is done?

A

Tracheal incubation w suctioning

After that transfer to NICU

123
Q

Diagnosis of Meconium aspiration

A

Lugn x rays
Blood gases
O2 sats

124
Q

What pressure will oxygen be on with meconium aspiration

What meds can be given for meconium aspiration?

A

high pressure

Nitric Oxide to vasodilate
Antibiotics

125
Q

Why do we do bicarbonate infusion with meconium aspiration?

A

Treats metabolic acidosis

126
Q

Other nursing care interventions for meconium aspiration

A

pulmonary hygiene w suctioning

nutrition

neutral temp

supportive care

127
Q

Necrotizing Enterocolitis description

Who is for the majority at risk?

A

Inflammation disease of the bowels that can lead to ischemia with potential for necrosis and perforation that premature infants are at risk for most of the time

128
Q

How did the sequence happen of Enterocolitis?

A

Lack of oxygen or asphyxia insult occurs >

blood shunts from gut/bowel due to stress > bowel damage > ischemia > necrosis > perforation

129
Q

Best treatment for Necrotizing Enterocolitis?

A

Early prevention. Bc if you feed them formula without knowing it, then you can make them septic not breastfeeding)
- probiotics and breastfeeding can reduce the risk

130
Q

How can you tell Necrotizing Enterocolitis is going on generally?

Abdominal distention ?

A

Can take days to week for it to develop but you might see a generalized sick changing, coloring is poor, apnea episodes, bradycardia, hypotonia, temp instability.
just not alert

Abdominal distention with erythema and tenderness and increased residual

131
Q

What happens to abdominal wall in Enterocolitis?

A

Erythema of abdominal wall can occur that can present as tender abdomen and guarding

132
Q

Urine specific gravity trend of necrotizing enterocolitis?

What to check stool for?

A

Rising w oliguria or less pee

Blood or diarrhea

133
Q

Necrotizing enterocolitis critical status characteristics?

A 
Hypotension later on with
metabolic acidosis, 
abdominal wall cellulitis,
bleeding disorder (causes bleeding from gut)

all bc of critical status

134
Q

Necrotizing enterocolitis diagnosis

A

Radiologic studies of the bowel w dilated and thickened bowel loop ileum from air in bowels

Pneumatosis intestinal loop on x ray = bacterial invasion

clinical picture + labs + sepsis

135
Q

Why do we give NPO w IV feedings for Necrotizing endocarditis?

A

to rest the GI tract

136
Q

What should the OG or NG tube suctioning be on /gastric compression for necrotizing enterocolitis

A

low settings for necrotizing enterocolitis

137
Q

In a necrotizing enterocolitis, what if there is a bowel perforation/obstruction?

What can necrotizing enterocolitis lead to that can cause death?

A

Surgery will have to be done

  • partial colectomy
  • peritoneal drain

sepsis

138
Q

What happens due to alteration in renal physiology?

And the implications?

A

Takes longer to excrete

Monitor drugs closely
Do smaller doses
Longer dose intervals in between too

139
Q

Dehydration signs

A 
Sunken fontanelle
Loss of weight
Poor skin turgor 
Dry oral mucous membranes
Decreased urine output 
Increased urine social gravity
140
Q

How to monitor I&O

A

weight diapers
keep track of IVF rates , meds, and UO
daily weights
monitor labs

141
Q

What does having an immature liver due to prematurity /infancy mean

A

You will have decreased glycogen store and increased risk of hypoglycemia

142
Q

What does having low iron stores mean

A

Iron is stored in liver in 3rd trimester but if you have either a hemorrhage or something that causes decreased iron then you may have anemia of prematurity

143
Q

In anemia of prematurity rt the liver, for how long can you remain low on hub/hct

A

3-6 months but most premies go home on oral iron supplements

144
Q

Anemia of prematurity treatment

A

Transfusion of PRBC, oral iron , Erythropoetin (to stimulate rbc production although it is not as common as iron)

145
Q

What does an impaired conjugation of bilirubin in liver do the infant?

A

Increases risk of jaundice or hyperbilirubemia

146
Q

When is most immunity acquired ?

What does this mean for premies?

A

3rd trimeter from mom igG

- so if they are born before this, they are at higher risk of infection

147
Q

Is skin a good barrier to infection in premies?

Why is infection risk higher?

A

No it is fragile

premature poses more procedures and just the fact you may not have igG from mom.

148
Q

best defense against infection

A

hand washing
limit visitations
aseptic/sterile technique
Keep the same nurse so they know what to look for

149
Q

Signs & symptoms of sepsis

A 
Subtle change in behavior 
Lethargy or irritability
Hypotonia 
Hypotension 
Pale, cyanosis
Clammy skin
\+ Cultures
Elevated C reactive protein to protect against inflammatory response

WBC low or high with elevated bands

Elevated IGM level s(due to initial infection)

150
Q

What will temp be like in sepsis?

A

Unstable often low but can be hyperthermic or high

151
Q

Feeding intolerance signs of sepsis?

A

Decreased intake, abdominal distention, vomiting

Poor sucking and lack of interest in feeding

152
Q

Other trends of sepsis

A

Hyerpbilirubemia

tachycardia

153
Q

With sepsis, when do you give antibiotics

what if cultures are negative? and symptoms go away with normal CRP?

A

Before you even get culture results

  • gentamicin and ampicillin
  • you can change the drug if needed

You discontinue abx after 48 hours

154
Q

What is main cause if IVH or intraventricular hemorrhage?

A

Fragile blood vessels in germinal matrix which leads to fluctuations in blood pressure and they can become hypoxic

155
Q

Increased risk of IVH occurs when

A

Before 34 weeks or at 1500 grams

156
Q

Ototoxic drugs that can cause hearing loss/neurotoxic effects?

What should be screened for in relation to neuro?

A

Gentamicin and Lasix so don’t use them for too long

Meningitis
Hyperbilirubemia

157
Q

Intraventricular Hemorrhage prevention

how do we provide neuro protection

A

Steroids to mom 24 hours before birth

postnatal surfactant

magnesium sulfate

  • both are given to mo mom help baby
158
Q

Intraventricular Hemorrhage diagnosis?

A

ventricular cranial sonogram 90% bleeds occur happen before 4 days of life

159
Q

Intraventricular hemorrhage treatment?

A

HOB elevated
Prevent hydrocephaly
Lumbar taps done periodically for pressure removal and
V/P shunt to drain the fluid

160
Q

Pharm ways to prevent pain

A

morphine

fantayl

161
Q

Nonpharm ways to prevent pain

A

swaddle, cuddle, rock
music, oral
sucrose and pacifiers

162
Q

Why do premature infants need reduced light , less noise, and quiet?

How should you space care?

what position should infant be swaddled in?

A

Bc they can’t handle heavy stimuli

clustered care

flexed positioning

163
Q

T/F

an infant will never lose sucking ability

A

false they definitely can

164
Q

Signs of overstimulation

A

Cross sign
mottling
bradycardia

Maternal Exam 4 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions