PT in NICU Flashcards
Give the progressions of natural labor.
Stretching of uterus and vagina–> Sends impulse to hypothalamus–> Stimulates post. pituitary to produce oxytocin–> Uterus contracts and cervix dilates
What are the two non-medically induced reasons for premature babies?
Multiple babies (premature stretching) Trauma causing placenta to separate from wall of uterus
There are 4 medical reasons to induce labor with a premature baby. Name those 4.
- Pre-eclampsia (High BP)
- Mom is at risk
- Baby with poor vitals
- Intrauterine Growth Restriction (IUGR)
Baby in <10th percentile for wt and length for gestational age
Risk factors for preemies are what?
- Previous preemies
- Inadequate prenatal care (#1 reason)
- Younger than 16 y/o
- Drug or alcohol use during pregnancy
- High stress
- Waited less than a year since last birth
A baby born before what age is considered a preemie?
Before 37 weeks
Give the percentiles for: small for gestational age (SGA), large for gestational age (LGA), and appropriate for gestational age (AGA).
SGA: 90th percentile
AGA: 10-90th percentile
What are the values for low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW)?
LBW: 1501-2500 g
VLBW: <1000 g
Give the definition for gravida and para.
Gravida: # of pregnancies
Para: # delivered alive
What are full term and pre term babies labeled as in their chart?
Full Term= Term
Pre Term= PR
The letters “Ab” and “LC” stand for what?
Ab= abortions (spontaneous or voluntary) LC= Living children
If you saw G5 P3 T1 Pr2 Ab2 LC3 on a mothers chart what would that mean?
G5= 5 pregnancies P3= 3 delivered alive T1= 1 full term birth Pr= 2 pre-term births Ab= 2 abortions LC= 3 living children
What does APGAR stand for?
Appearance Pulse Grimace Respiration Activity
The APGAR is scored out of ____ points. After ___ points resuscitation begins.
10; 6/10
At what intervals is the APGAR taken for a baby and what trend do you want to see?
1, 5, 10, and 20 minutes
Want to see an increase in the score
Which nursery level has ECMO, a long term heart/lung machine for babies?
Level 4
Which nursery level is in regional hospitals where they can provide IV meds, tube feedings, O2 support, and neonatologists/neonatal nurses?
Level 2
Level 1 nurseries in small community hospitals include what?
Well baby nursery, minimal observation, warming isolette phototherapy, and circumcision
A level 3 nursery is equipped to handle what kinds of babies?
NICU; specialists beyond neonatologist; provides complex medical interventions, advanced diagnostic testing, sx, and therapies
What is RDS?
Respiratory distress syndrome; condition due to pulmonary immaturity and inadequate pulmonary surfactant.
A decrease in surfactant causes a chain reaction leading to RDS. What is the chain of events after a decrease in surfactant?
Increased surface tension–> collapse of alveoli–> Atelectasis–> decreased lung function
Give 4 factors that lead to RDS.
1) Decreased surfactant
2) Maternal diabetes (dictates how much surfactant baby makes)
3) Thoracic malformation (decreased surfactant)
4) Genetic factors
At ___ weeks type II alveolar cells are produced; ___weeks is when they start producing surfactant; and ___ weeks is when the baby should have enough surfactant to be adequate.
23 weeks; 28 weeks; 32 weeks
What are the S/S of RDS?
Increased respirations Expiratory grunting Nasal Flaring Cyanosis Hypoxia, hypercarbia Sternal and intercostal mm retractions
How would you treat RDS?
- Oxygen (might work at 32-34 weeks)
- Mechanical ventilation
- Surfactant Administration
- ECMO
What are the requirements for babies being allowed to start ECMO?
Must 4.5 lbs and 34 weeks
How does the ECMO machine work?
Deoxygenated blood is drained from the heart to an external pump. The pump then pushes blood through a membrane gas oxygenator and the oxygenated blood is then pushed to the baby.
What is commonly the maximum numbers of days a baby is allowed to stay on ECMO?
21 days
T/F It is not necessary to have any medications while the baby is on ECMO.
False, they need heparin to decrease blood clots since they are not moving and blood is being taken out of the body.
Give some of the complications that can arise with ECMO.
CNS damage, Sepsis, Seizures, cardiac complications, and renal failure.
What are some of the complications that can be seen with RDS?
Increased risk for: ROP, NEC, IVH
With prolonged mechanical ventilation the baby could suffer from chronic lung disease (at 9 months) or BPD.
