PT Exam, Eval, and Intervention in NICU Flashcards
After taking the history you will be observing the baby. What 5 things are you looking for?
- Position of body, head, eyes, mouth, feet, etc
- Environment: lights, sounds, lines/tubes, diaper, blanket, temperature
- Restful or active?
- Self calming techniques
- Signs of stress
Describe what signs of stress you might see when examining a baby.
Observational signs Physiological changes HR change >40 bpm RR change >15 PO2 change >15
Give the signs that would tell you that a baby is engaged during your exam.
Babbling, smiling, pink skin, smooth movements, wide bright eyes, open and relaxed hands, reaching towards caregiver
If a baby is disengaged during your exam what would you expect to see?
Lip grimacing, fussing/crying, red or pale skin, arching back/tense UE & LE, Gaze aversion, fisting/splaying fingers, pushing away
What are 6 calming techniques? (not necessarily the ones from the video in lab.)
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)
The Neurological Assessment of Preterm and Full Term Newborn Infant assess what?
Good correlation with infants motor skills at 1 y/o
Takes <15 minutes to assess
How does the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) work?
No handling- all observation
PT educates NICU team and parents
Which test used by the PT/OT is the most popular for assessing 32 weeks GA -4 months?
Test of Infant Motor Performance (TIMP)
How would you assess pain of a newborn/infant?
Premature Infant Pain Profile (PIPP)
Neonatal Infant Pain Scale (PIPS)
CRIES
Crying, requires additional O2, increased vital signs, expressions, sleeplessness
What are the 6 interventions for the NICU baby?
- Minimize sounds
- Minimize light: tent over eyes, dim lights
- Increase skin to skin contact
- Therapeutic handling
- Proper positioning for motor development
- Kangaroo Care
What are two reasons you would use therapeutic handling as an intervention?
Facilitation of appropriate GMS and Developmental positioning
What is the purpose for proper positing for motor development? What are some guidelines to follow?
Purpose: comfort and development
Guidelines: Change positions regularly and provide boundaries
Describe the optimal alignment for proper positioning for motor development.
Head midline with chin tuck Shoulders protracted Hands midline Trunk flexion with posterior pelvic tilt LE flexion Hips in slight ER
The 3 consequences for poor positioning are?
- Musculoskeletal
- Cranial molding problems
- Odd head shapes
What can poor alignment of the the musculoskeletal system cause?
Poor alignment-> tight mm-> poor mm patterns-> decreased developmental skills or poor bone development
There are two factors that can lead to cranial molding problems. What are they?
Sutures open at birth
Constant pressure on one side of head will cause misshapen head
Give the 4 types of head shapes and their descriptions
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
Which of the 4 types of head shapes is life threatening?
Craniostenosis/Craniosynostosis
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?
Benefits baby
Benefits Mom and Dad
Improved neurodevelopment assessments at 6 months compared to non-kangaroo care babies
What are the benefits to baby and parents in Kangaroo Care?
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
What education does the healthcare provider need when discussing Kangaroo Care?
Proper positioning for routine care and procedures, positioning for development and self calming, and recommendations for smooth transition home with continued outpatient therapy
What kinds of education would you give parents in Kangaroo Care?
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.
