The Special Care Nursery Flashcards
Primary purpose of the NICU neonatal intensive care unit
support of body temperature, control of infection, minimal hnadling,
Neonatal Care Levels
Level Basic Care: Evaluate and provide care for postnatal care to infants 35-to 37 weeks gestation, stablize infants infants less than 35 weeks gestation until transfer
Level II- Specialty Care
IIA: Provide care for the moderately ill infants greater than 32 weeks
IIB: provides mechanical ventilation:
Level III Subspeciality Care
IIIA: provides treatment that infants are 28 weeks young performs minor surgical procedures.
IIIB: Provides care for infants less than 28 weeks gestation, provides advancded respiratory support (high frequency ventilation) advanced imagining pediatric surgical specialists, access to pediatric medical subspeciliaties
IIIC: Provides extracorporeal membrane oxgenation (ECMO ) and complex cardiac surgery
How does Noise levels affect the infants
Nosies can put the babies at bradcardiac and hypoxic epidsodes and decibels up 45 should not exceed and max of 60 decibles.
What is consider a premature infant????
PREMATURE INFANTS – 7-10% of all births
Born before 37 weeks (relative to conception)
also known as premature infants
are at high risk for illness and death.
Birth-weight is a critical factor in determining the infants degree of risk….WHY?
Chance of a fetal survival increases if between how many weeks.
Chances of a fetus surviving greatly improve between 28 to 32 weeks. Rates shown are percentages of babies born in the US after specific lengths of gestation who survive the 1st year of life.
Whats the average birth weight for a baby
Whats the low birth rate for a baby
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The average newborn weighs 3,400 grams (7 1/2 pounds).
Range is between 5.5lbs (2500g)-9lbs (4100g)
LOW-BIRTHWEIGHT (LBW) INFANTS weigh less than 2,500 grams (5 1/2 pounds).
What is consider a VERY LOW birth weight and why don’t the infants survive??? before 30 weeks of age
Weight between 1501gms and 1,250 grams (2 1/4 pounds) and
Less than 30 weeks gestational age and are in grave danger because of the immaturity of their organ systems.
What size is a mircopremie what weight is consider Extremely Low Birth weight.
Weight below 1000g
Range of major medical complications
Micropremie < 750/800g
What is the average brith weight of a baby and weeks to develop
SGA: Problem affecting fetal growth – newborn infants weighing 90 percent or less than average weight of infants of the same gestational age.
EX: Average weight at 38 weeks 7.5 lbs
SGA babies weigh 6.8 lbs or less at 38 weeks
What happens to pre- mature birth weights where are they placed
What happens to infants with Respiratory Distress Syndrome
Are put in incubators,
— oxygen and temperature must be carefully monitored.
Easily chilled, susceptible to infection, sensitive to environment
Respiratory distress syndrome (RDS) may result due to poorly developed lungs (20%)
Surfactant replacement
Supplemental oxygen
What does research show about infants who receive
name some types of treatments
Research shows that children who receive more responsive, organized care in an appropriately stimulating environment, are apt to show more positive outcomes than children whose care was not as good.
- Neonatal Individualized Developmental Care
Assessment Program (NIDCAP)
- Infant massage
-Kangaroo care
Think of causes for low term birth
Multiple gestation
Teen (under age 15) and older mothers (over age 35)
Births too closely spaced
General health and nutrition of mother
drug & alcohol abuse
Fetal distress
g. Maternal chronic illness
h. Amniotic infection
Placental abruption/previa
j. Preeclampsia/toxemia
k. Uterine abnormalities
Whats the APGAR scale
First Assessment of the Newborn- Nurse
APGAR SCALE a standard measurement system that looks for a variety of indications of good health in newborns.
Developed by Virginia Apgar in 1953
What are the categories of the APGAR scale
think APGAR is an acronym
appearance (color) pulse (heart rate) grimace (reflex irritability) activity (muscle tone) respiration (respiratory effort)
Measured at 1 minute, 5 minutes,
10 minutes
Catagories to rate each one
Heart Rate 0 = absent 1= below 100 2= above 100
Respiratory Effect- 0 = absent 1= weak cry 2= strong cry
Muscle Tone- 0 = limp 1= weak flexion 2= strong
Body color= 0 = Entire body is blue 1= body is pink but extremities are blue 2= healthy pink
Reflex Response 0= absent 1= weak 2= strong
what do most babies score
What is life threathing
Scores under what reguire help to start breathing
Most babies score around 8.
Scores under 7 require help to start breathing
Scores under 4 need immediate life-saving intervention
Scores that stay between 0 and 3 after 20 minutes are an indicator that severe problems are likely to be precedeLow Apgar scores may indicate problems or birth defects that were already present in the fetus
Low Apgar scores may also result from difficulties during the birth process
-ANOXIA - a restriction of oxygen which can cause brain damage.
What are risks after the low birth weight
pregnancy which continues two weeks after the due date, associated with several risks.
placenta may begin to deteriorate
blood supply to baby’s brain may be decreased and cause brain damage
labor and delivery become more difficult
C - section what are some problems with this
Over a million babies in the U.S. today are born via a cesarean delivery
Several types of difficulties can lead to cesarean delivery
General fetal distress is most frequent. Position and size -breech position, -transverse position, -head is large. Risk of infection to mother
– Easy birth may deter release of certain stress hormones, such as catecholamines, which help prepare infant to deal with stress outside womb
What is defined as infant mortality
death at what age????
Defined as death within the first year of life.
U.S. ranks 22nd with 8.5 deaths per 1,000 live births.
Rate has been declining since 1960s.
How to find the corrected age of an infant born pre-term
Corrected age: subtract the estimated number of gestational weeks from 40 from the chronologic age
Subtract this value from chronological age
E.g. infant who is chronologically 24 weeks but born 8 weeks premature would have a corrected age of 16 weeks (done at least until 12 months, 18-24 months)
NICU Levels explained more explain all levels
Level 1. Newborn Nursery.
Well-baby nursery
Newborns who require minimal observation or care
Warming in an isolette, phototherapy, circumcision
Located in small community hospitals
Level 2a. Special Care Nursery.
Intermediate
Step-down from a Level III nursery
Intravenous medications, tube feedings, oxygen support
Neonatologists and neonatal nurses
Contained in regional or community hospitals
Level 2b. Special Care Nursery.
Can provide Level 2a care, and
Can provide mechanical ventilation for brief duration ( 28 weeks gestation and > 1000 grams birth weight.
Can provide sustained life support with conventional mechanical ventilation.
May perform minor surgical procedures, such as placement of central venous catheters or repair of inguinal hernias.
Level 3b. Neonatal Intensive Care Unit.
Can provide comprehensive care for infants < 28 weeks gestation and < 1000 grams birth weight.
Can provide advanced respiratory support such as high-frequency ventilation or inhaled nitric oxide.
Can perform major surgical procedures on neonates (excluding ECMO and repair of complex congenital heart defects requiring cardiopulmonary bypass).
Requires prompt and on-site access to a full range of pediatric subspecialty consultants, as well as pediatric surgical and anesthesia specialists.
Requires availability of advanced imaging support on an urgent basis, including CT, MRI, and echocardiography.
Level 3c. Neonatal Intensive Care Unit - CMC
Has the capabilities of a level 3b NICU
Can provide ECMO and surgical repair of complex congenital heart defects requiring cardiopulmonary bypass.
Synactive Model of Infant Behavior”
Hierarchical interaction of 4 subsystems- works to regulate responses to maintain homeostasis –balance
Autonomic- repiration, HR, digestion, thermoregulation
Motor- posture, tone, trunk /extremity activities
State- range of state/transitions/clearness available to the infant
Attentional/interactive- assume and maintain an alert state, respond to environment input-output
Review SLIDE 34 !!!! cant cut and paste it on here
Basis for Interation slide 35 what are the stages
think go from Autnomic, State of Consciousness,
Attention and interaction
Self Regulatory
Autonomic (physiologic functioning)
- Motor
- State (ranges of consciousness from sleep to wakefulness)
- Attention/interaction (attend and interact with caregivers)
- Self-regulatory (balanced, relaxed, and integrated functioning of all four subsystems)
What are some self - calming behaviors or assisted-calming behaviors?
Self calming Hand to face or mouth Sucking on hand, fingers, thumb, pacifier Maintaining flexed posture Hands or feet to midline Closing eyes Drowsy state Assisted calming
What are somethings that can wrong after birth
think like lack of blood flow to brain because of an underdeveloped heart
Hyperbilirubinemia – immature liver
Physiologic jaundice
Kernicterus – bilirubin deposits in the brain Basal ganglia CN nuclei Brainstem Treatment Phototherapy Transfusion Gastroesophageal reflux (GER) ? Relaxation of the esophageal sphincter Risk factors Premature birth Perinatal stress Neonatal stress Respiratory disease Tone of abdominal wall Treatment Positioning – prone, sitting Pharmacological management Changing formula
Neurologic Conditions
Asphyxia, inadequate exchange of oxygen & carbon dioxide
Hypoxic-ischemic encephalopathy, HIE
Cerebral ischemia, decreased blood flow to brain
Due to systemic hypotension, decreased cardiac output
Lesions associated with HIE
IVH
Most common brain lesion seen in infants < 32 weeks (40%)
Neurological status correlated with grade of IVH
Risk Factors
Hypoxemia, decreased arterial oxygen concentration- perinatal asphyxia, recurrent apnea, severe respiratory disease HIE Severe COMA/SEIZURES/ABSENT REFLEXES High mortality Ventilation Moderate Lethargic difficult to arouse (1st 12 hrs.) Often need ventilation Hypotonic Mild Affected infants usually recover Requires minimal ventilation
Respiratory issues after birth
Respiratory Conditions
Respiratory Distress Syndrome RDS: chest wall retraction, cyanosis, expiratory grunting, flaring of nares & tachypnea, apnea, hypotension, pulmonary edema, decreased surfactant levels < 37 weeks
Bronchopulmonary Dysplasia BPD: chronic lung disease < 25 weeks
Meconium Aspiration: airway obstruction (full term or post term)
Risk Factors for Viral infections to the fetus
Viral Infections of the Fetus and Neonate S-TORCH infections, Toxoplasmosis Other infections Syphilis Rubella Cytomegalovirus Herpes simplex Toxoplasmosis Human immunodeficiency virus (HIV)
In Utero substance abuse explain
In Utero Substance Exposure
Fetal Alcohol Syndrome (FAS)
Cocaine Exposure
Neonatal Drug Withdrawal Syndrome: jitteriness/stimulus sensitive, rhythmic, easily stopped by passive flexion
Whats retinopathy
Whats necrotizing Entercolitis
Necrotizing Enterocolitis (pathologic condition of the gastrointestinal tract) < 2000g during first 6 weeks of life
Retinopathy of Prematurity (ROP)
Abnormal vascular growth in the immature part of the retina: nearsightedness, strabismus, retinal scarring
What do as PT’s at Level 3 NICU patient
Individualized care guided by the infant’s physiological reactions, behavioral cues, and signs of stress in response to the immediate environment & events (VandenBerg, 1997)
Neonatal Individualized Developmental Care and Assessment Program (NIDCAP), approach based on observation of infants behavior in which the developmental specialist provided recommendations
Kangaroo care, encourages skin to skin holding- ^more rapid maturation of vagal tone, behavioral state organization, longer periods of quiet sleep and alert wakefulness with shorter periods of active sleep
Reduce Incidence of ImpairmentsProvide Handling & StimulationCalming Environment
Things to take down in a history
History: birth and medical Current medical status Precautions/contraindications Active movement/strength Muscle tone/reflexes Feeding Positioning and handling recommendations Recommend follow up care Discharge recommendations
Common Goals in the NICU among team members
Improve visual and auditory reactions
Prevent secondary/positional musculoskeletal abnormalities
Provide appropriate remediation of orthopedic complications
Provide consultation to team members
Facilitate transition to home
Interventions to the Baby
Therapeutic handling
Flexion, side-lying, Hammock, supported sitting, deep and rhythmic tactile sensation, deep proprioceptive input, deep stroking
Pacifiers
Gentle ROM
Therapeutic Positioning
Enhance flexor patterns Increase midline orientation Promote state organization Frequent changes Protect respiratory capacity
sex
Feeding
suck swallow reflex emerges at 28-30 weeks (33/35 weeks nippling)
Oral feeding – Effective Gag reflex Rooting Suckling Muscle tone
Tone configuration Coordination of suck Swallowing Breathing Jaw excursion
