PT Exam, Eval, and Intervention in NICU

Question 1

After taking the history you will be observing the baby. What 5 things are you looking for?

Answer 1

1. Position of body, head, eyes, mouth, feet, etc
2. Environment: lights, sounds, lines/tubes, diaper, blanket, temperature
3. Restful or active?
4. Self calming techniques
5. Signs of stress

Question 2

Describe what signs of stress you might see when examining a baby.

Answer 2

Observational signs 
Physiological changes 
   HR change >40 bpm
   RR change >15
   PO2 change >15

Question 3

Give the signs that would tell you that a baby is engaged during your exam.

Answer 3

Babbling, smiling, pink skin, smooth movements, wide bright eyes, open and relaxed hands, reaching towards caregiver

Question 4

If a baby is disengaged during your exam what would you expect to see?

Answer 4

Lip grimacing, fussing/crying, red or pale skin, arching back/tense UE & LE, Gaze aversion, fisting/splaying fingers, pushing away

Question 5

What are 6 calming techniques? (not necessarily the ones from the video in lab.)

Answer 5

Swaddling 
Quiet shushing 
Sidelying
Midline orientation or body and UE
Skin to Skin (usually just parents) 
Facilitated tucking (provides boundaries, leave out part being looked at)

Question 6

The Neurological Assessment of Preterm and Full Term Newborn Infant assess what?

Answer 6

Good correlation with infants motor skills at 1 y/o

Takes <15 minutes to assess

Question 7

How does the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) work?

Answer 7

No handling- all observation

PT educates NICU team and parents

Question 8

Which test used by the PT/OT is the most popular for assessing 32 weeks GA -4 months?

Answer 8

Test of Infant Motor Performance (TIMP)

Question 9

How would you assess pain of a newborn/infant?

Answer 9

Premature Infant Pain Profile (PIPP)
Neonatal Infant Pain Scale (PIPS)
CRIES
Crying, requires additional O2, increased vital signs, expressions, sleeplessness

Question 10

What are the 6 interventions for the NICU baby?

Answer 10

1. Minimize sounds
2. Minimize light: tent over eyes, dim lights
3. Increase skin to skin contact
4. Therapeutic handling
5. Proper positioning for motor development
6. Kangaroo Care

Question 11

What are two reasons you would use therapeutic handling as an intervention?

Answer 11

Facilitation of appropriate GMS and Developmental positioning

Question 12

What is the purpose for proper positing for motor development? What are some guidelines to follow?

Answer 12

Purpose: comfort and development
Guidelines: Change positions regularly and provide boundaries

Question 13

Describe the optimal alignment for proper positioning for motor development.

Answer 13

Head midline with chin tuck
Shoulders protracted
Hands midline 
Trunk flexion with posterior pelvic tilt 
LE flexion 
Hips in slight ER

Question 14

The 3 consequences for poor positioning are?

Answer 14

1. Musculoskeletal
2. Cranial molding problems
3. Odd head shapes

Question 15

What can poor alignment of the the musculoskeletal system cause?

Answer 15

Poor alignment-> tight mm-> poor mm patterns-> decreased developmental skills or poor bone development

Question 16

There are two factors that can lead to cranial molding problems. What are they?

Answer 16

Sutures open at birth

Constant pressure on one side of head will cause misshapen head

Question 17

Give the 4 types of head shapes and their descriptions

Answer 17

1) Scaphocephaly/Dolicephaly: Increased A/P diameter; typical in NICU due to sidelying positions
2) Plagiocephaly: Unilat. posterioloateral head flattening; typical with torticollis or supine with cervical rotation
3) Brachycephaly: Increased R-L diameter; flatness on back of head due to supine position
4) Craniostenosis/Craniosynostosis: Premature fusion of one or more sutures which increases ICP; no ear shift, and treated with sx to unfuse suture

Question 18

Which of the 4 types of head shapes is life threatening?

Answer 18

Craniostenosis/Craniosynostosis

Question 19

In a program called “Kangaroo Care” skin to skin holding with parents is encouraged. Give the 3 reasons that it is important to have that contact?

Answer 19

Benefits baby
Benefits Mom and Dad
Improved neurodevelopment assessments at 6 months compared to non-kangaroo care babies

Question 20

What are the benefits to baby and parents in Kangaroo Care?

Answer 20

Baby: Improved thermoregulation, respiratory patterns, and O2 saturation; calmed behavior states; decreased apnea, bradycardia, and length of hospital stay

Parents: Increased maternal milk and breast feeding success, positive way to view baby, and more sensitive to baby’s movements/needs

Question 21

What education does the healthcare provider need when discussing Kangaroo Care?

Answer 21

Proper positioning for routine care and procedures, positioning for development and self calming, and recommendations for smooth transition home with continued outpatient therapy

Question 22

What kinds of education would you give parents in Kangaroo Care?

Answer 22

Address their increased guilt, fear, resentment, anger, helplessness, grief, or lack of confidence; encourage them to be active in child’s care; teach parents baby’s cues; teach parents how to help baby self-comfort, regulate, and organize; empower parents EARLY and DAILY in becoming partners in their baby’s care.