Factors Affecting Infant Health: Sepsis, Limbic System Development, and Neonatal Care, Exams of Nursing

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Certified Extremely Low Birth Weight Study Questions and Answers 2024 GRADED A+ Definition of very low birth weight - SOLUTION infants between 1000- 1500g at birth Definition of extremely low birth weight - SOLUTION infants less than 1000g at birth Description of ELBW ears - SOLUTION flat pinna with no cartilage and will stay folded together when pressed Typical skin of ELBW infant - SOLUTION thin, sticky, transparent, visible vasculature typical plantar surfaces of the feet of an ELBW - SOLUTION smooth with no wrinkles Description of Lanugo in ELBW - SOLUTION sparse to none Description of the posture and tone of an ELBW infant - SOLUTION hypotonic, flexible, passive Team members that should be at an ELBW delivery - SOLUTION nnp/neonatologist, NICU nurse (2), respiratory therapist Temperature set up for a ELBW delivery - SOLUTION radiant warmer at 36.5, warming mattress, hat, plastic wrap, warmed sterile blanket Pulse ox placement at delivery - SOLUTION right wrist (pre-ductal) O2 target sats at 1,2,3,4,5,10 min of life for an ELBW infant - SOLUTION 1 min 60-65%, 2min 65-70%, 3min 70-75%, 4min 75-80%, 5min 80-85%, 10 min 85-95% Benefits of delayed cord clamping - SOLUTION improved hemodynamics, decreased IVH, decreased NEC, decreased need for blood, decreased mortality Length of time and infant position of delayed cord clamping in an ELBW - SOLUTION 30-60 seconds, infant must be below level of placenta Definition of Ballard Score - SOLUTION assesses gestational age based on physical and neuromuscular maturity Point in time when the Ballard score should be completed - SOLUTION physical assessment within 2 hours of birth, neuromuscular within 24 hours of birth Categories of the physical assessment of the Ballard Score - SOLUTION skin, lanugo, plantar surface, beast, eye/ear, genitalia Categories of the neuromuscular assessment of the Ballard Score - SOLUTION posture, square window, arm recoil, popliteal angle, scar sign, heel to ear Best type of vascular access in an ELBW infant - SOLUTION UAC and UVC Purpose of a UVC in an ELBW infant - SOLUTION admin fluids, meds, and blood products Purpose of a UAC in an ELBW infant - SOLUTION monitor blood pressure and draw labs Correct placement location of a UVC - SOLUTION just above the diaphragm, t9-t10 vertebrae Correct placement location of a UAC - SOLUTION just above the diaphragm, t6-t9 vertebrae Verification of correct placement of a UAC or UVC - SOLUTION x-ray fluid that should be given asap to an ELBW infant - SOLUTION dextrose 5% potential causes of hypermagnesemia in an ELBW infant - SOLUTION maternal admin of mag sulfate, status asthmaticus, enemas, renal failure antidote for hypermagnesemia - SOLUTION calcium gluconate potential causes for hypomagnesemia in an ELBW infant - SOLUTION increased urinary loss, malabsorption, short bowel syndrome, diarrhea clinical manifestations of hypomagnesemia in an ELBW infant - SOLUTION nausea, weakness, hyperreflexia, clonus difference between term and premature human milk - SOLUTION premature milk has higher concentrations of protein, sodium and chloride, has more lipids, trace elements, vitamins, and energy, has lower concentrations of phosphorus and calcium and has lower osmolality time frame when pumping should begin after delivery - SOLUTION within 6 hours when an ELBW can breastfeed - SOLUTION when there is a coordinated suck, swallow, breathe pattern contraindication for breastfeeding - SOLUTION galactosemia (can't digest breastmilk) advantages to pacifier (non-nutritive sucking) in an ELBW infant - SOLUTION sensory-motor-oral stimulation, earlier transition to BF or PO feeds, develops suck/swallow/breathe pattern oral care is preformed with ____ in an ELBW infant - SOLUTION colostrum definition of trophic feeds - SOLUTION less than 24ml/kg/day of human milk or preemie formula primary source of nutrition is TPN most common method of enteral feeding in the NICU - SOLUTION NG tube adequate weight gain for an ELBW at 24-32 weeks, 33-36 weeks, 37-40 weeks and 40 weeks to 3 months - SOLUTION 24-32 weeks = 15-20g/day 33-36 weeks = 14-15g/day 37-40 weeks = 7-9g/day 40 weeks -3 months = 30g/day Definition of blow by O2 - SOLUTION free flow O2 from bag mask or O2 tubing held near infants face indications of blow by O2 - SOLUTION used for short term O2 delivery in the DR or during cares potential complications of nasal cannula - SOLUTION skin injury to nose, varying O2 concentration, drying of nasal mucosa different methods of CPAP - SOLUTION mask, nasal, bilevel indications for CPAP - SOLUTION RDS, apnea, atelectasis, pulmonary edema advantages of CPAP - SOLUTION no intubation potential complications of CPAP - SOLUTION abdominal distention, air leaks, ineffective ventilation, nasal septal breakdown, variable pressures with mouth open indications of mechanical ventilation - SOLUTION respiratory failure, surfactant, severe apnea and bradys, CNS disease, surgery potential complications from mechanical ventilation - SOLUTION tube dislodgement, air leaks, BPD, ROP, IVH BPD - SOLUTION bronchopulmonary dysplasia different vent modes - SOLUTION intermittent mandatory, patient triggered, SIMV (synchronized intermittent mandatory), A/C (assist control), PSV (pressure support), NAVA (neutrally assisted), VT (volume triggered), jet, oscillator components of blood gas eval - SOLUTION pH, paCO2, HCO3 normal pH for a neonate - SOLUTION 7.35-7.45 normal paCO2 for a neonate - SOLUTION 35-45 normal HCO3 for a neonate - SOLUTION 22-26 respiratory acidosis - SOLUTION when there is an increase of CO2 with a normal HCO3 metabolic acidosis - SOLUTION when the CO2 is normal and the HCO3 is decreased respiratory alkalosis - SOLUTION when there is a decrease in CO2 and a normal HCO3 metabolic acidosis occurs when - SOLUTION when hydrogen ions are lost and the HCO3 is added, but the CO2 remains unchanged ELBW and VLBW infants have a more pronounced experience of pain due to - SOLUTION incomplete myelination of nerves, myelination serves as an insulator for the nerve fiber thus decreasing the pain experience most frequently occurring painful procedures in the NICU - SOLUTION heel sticks, adhesive removal, IV sticks, ET and nasal suctioning skin differences between an ELBW infant and a term infant - SOLUTION ELBW's have an immature epidermis and dermis, minimal subQ fat, and increased permeability techniques to prevent skin breakdown in an ELBW infant - SOLUTION no wrinkles in bedding, positioning devices, rotate medical devices, pad the IV hub, reposition q3-4 hours, hydrogels and gentle removal of adhesives definition of neonatal sepsis - SOLUTION systemic bacterial, viral or fungal infection that occurs in the first 28 days of life with hemodynamic changes that result in significant morbidity or mortality organisms most associated with neonatal sepsis - SOLUTION e. coli, GBS, CoNs, Hib early onset sepsis is usually associated with ______ transmission from mother to infant - SOLUTION vertical different types of diabetes in pregnancy - SOLUTION gestational, type I, type II gestational diabetes is diagnosed at _____ gestation - SOLUTION 24-28 weeks potential complications for infants of diabetic mothers - SOLUTION fetal death, macrosomia, shoulder dystocia, birth trauma, RDS, hypoglycemia, heart defects, open neural tube defects, childhood obesity different ways to deliver a baby - SOLUTION vag, operative (C-section, forceps, vacuum) VBAC PDA and it's significance - SOLUTION diverts fetal blood from pulmonary artery to aorta, post delivery shunt shifts to a left to right pattern, closure dependent on O2 tension and decreasing prostaglandins, hemodynamically significant if HR >170, RR >70, bounding pulses, hepatomegaly and O2 requirement definition of PPHN (persistent pulmonary hypertension of the newborn) - SOLUTION disruption of the normal transition to extrauterine circulation characterized by persistent increased PVR perinatal risk factors for PPHN - SOLUTION MAS, asphyxia, abnormal pulmonary development causes of PPHN - SOLUTION RDS, PDA, sepsis or pneumonia PPHN diagnostic test - SOLUTION ECHO management of PPHN - SOLUTION correct hypoxia and acidosis, pulmonary vasodilation with O2, HF vent to prevent barotrauma definition of cor pulmonale - SOLUTION right sided heart failure, an enlargement f the right ventricle due to high BP in the arteries of the lungs caused by chronic lung disease definition of apnea - SOLUTION absence of breathing for >20 seconds definition of apnea of prematurity - SOLUTION recurrent episodes starting in first week of life in preterm infants with no other abnormalities, usually resolves on its own definition of pulmonary hypoplasia - SOLUTION defective or inhibited growth of the lungs, unilateral or bilateral, results in decreased numbers of alveoli, bronchioles and arterioles, difficult to diagnose, ass. with conditions that compromise the lungs, results in oligohydramnios and or congenital malformations definition of RDS - SOLUTION surfactant deficiency and or structural immaturity s/s of RDS - SOLUTION tachypnea with grunting, flaring and retractions recommended prevention and treatment of RDS - SOLUTION antenatal corticosteroids, surfactant replacement, reducing hypoxemia, correcting acidemia, increasing functional capacity 4 areas where air leaks are ruptures in the alveoli - SOLUTION mediastinum, pleural space, space surrounding the heart, peritoneal cavity most common type of air leak - SOLUTION pneumothorax 2 most common pneumothorax's' - SOLUTION spontaneous and tension definition of spontaneous pneumothorax - SOLUTION isolated pocket of free air in pleural space, may be asymptomatic definition of tension pneumothorax - SOLUTION addition of new air through the rupture with each breath, resulting in lung collapse and compromised cardiac function s/s of a pneumothorax - SOLUTION increased resp distress, bradys, asymmetry in chest expansion, change in breath sounds, movement of heart's PMI diagnostic test for a pneumothorax - SOLUTION transillumination with a fiber optic light, chest x-ray definition of pulmonary hemorrhage - SOLUTION presence of red blood cells in the alveoli, interstitium, or both on pathologic exam treatments for BPD - SOLUTION prenatal steroids and early surfactant, restrict fluids and increase calories, bronchodilators, diuretics and corticosteroids potential complications of BPD - SOLUTION increased mortality, chronic resp infections, altered lung function, cor pulmonale, growth restrictions, fractures and rickets, neurodevelopmental sequelae definition of peritonitis - SOLUTION inflammation of the peritoneum, typically bacterial or fungal 3 mechanisms related to nec - SOLUTION intestinal ischemia, bacterial colonization, volume feedings s/s of nec - SOLUTION distention, visible loops, tenderness, discoloration, diminishing peristalsis, residuals, lethargy, apnea, bradys, blood in stool, temp instability, diminished urine output, poor perfusion definition of short gut syndrome - SOLUTION malabsorption and malnutrition resulting from a surgical bowel shortening, ass. with atresia, malrotation, abdominal wall defects, perforations definition of hematopoiesis - SOLUTION the formation, production and maintenance of blood cells difference between immature and mature neutrophils - SOLUTION immature neutrophils include promyelocyte, myelocyte, metamyelocyte, bands mature include polymorphonuclear neutrophils definition of thrombocytopenia - SOLUTION acquired disease with serious loss of platelets, platelet destruction can be autoimmune from mother, infection, asphyxia at birth or neonatal alloimmune management of thrombocytopenia - SOLUTION treat underlying problem, platelet transfusion, IVIG, steroids risk factors for IVH - SOLUTION prematurity, arterial blood pressure swings, low 5 min apgar, acidosis, rapid admin of sodium bicarb or volume expanders, RDS requiring ventilation incidence of IVH in ELBW infants - SOLUTION 10-60% clinical presentation of IVH` - SOLUTION sudden deterioration, O2 desats, bradys, metabolic acidosis, tense fontanelle, shock definition of post-hemorrhagic hydrocephalus - SOLUTION progressive dilation of the ventricles after IVH caused by injury to the periventricular white matter, in 50% of surviving IVH infants treatment options for post-hemorrhagic hydrocephalus - SOLUTION serial lumbar punctures, admin of lasix and diamox, VP shunt, family support definition of periventricular leukomalacia - SOLUTION ischemia and necrosis of periventricular white matter in the watershed area of the brain Barlow maneuver - SOLUTION pressure from front causes palpable dislocation of the femoral head Ortolani maneuver - SOLUTION when the femoral head is relocated to the hip joint an audible click confirms developmental dysplasia of the hip treatment of developmental dysplasia of the hip (DDH) - SOLUTION pavlik harness to immobilize infant in a flexed position definition of acute renal failure - SOLUTION abrupt and severe decrease in urine output, rise in BUN and creatinine management protocol of acute renal failure - SOLUTION Id and treat cause, strict I&O, daily weight, monitor BP, electrolytes and nutrition definition of syndrome of inappropriate antidiuretic hormone (SIADH) - SOLUTION impairment of free water clearance caused by an uncontrolled release of antidiuretic hormone (ADH) causes of SIADH - SOLUTION cns infections, birth asphyxia, intracranial hemorrhage, meningitis diagnostic tests for SIADH - SOLUTION finding an elevated circulating ADH level with low serum osmolality and hyponatremia clinical manifestations of SIADH - SOLUTION fluid retention, oliguria, hyponatremia, weight gain, edema causes of renal artery/vein thrombosis - SOLUTION vascular injury, decreased vascular flow, increased blood viscosity diagnostic test of a renal artery/vein thrombosis - SOLUTION renal venography tracheomalacia - SOLUTION occurs when the cartilage in the trachea is not developed, the airway is floppy instead of being rigid s/s of tracheomalacia - SOLUTION noisy, high pitched breathing diagnostic test for tracheomalacia - SOLUTION chest airway may show narrowing, confirmed with laryngoscopy treatment of tracheomalacia - SOLUTION humidified air, close monitoring for infection second most common cause of congenital airway obstruction presenting with neonatal stridor - SOLUTION vocal cord paralysis percentage of ELBW infants that get antibiotics in first 3 days of life - SOLUTION 85% reason why ELBW infants are given vit A - SOLUTION to reduce the duration of O2 therapy and thus reduce the risk for ROP best way to monitor BP when giving pressors - SOLUTION art line reason for indomethacin admin in ELBW infants - SOLUTION NSAID given in 1st 12 hours of life to promote closure of PDA definition of retinopathy of prematurity (ROP) - SOLUTION affects blood vessels in the retina, leading cause of blindness risk factors of ROP - SOLUTION prematurity, supplemental O2, PDA, vent support, hyperglycemia, male gender ROP exams done at point in life - SOLUTION 4 weeks of life or 31 weeks whichever is later, rpt every 2 weeks if no ROP, weekly if ROP, treatment of ROP - SOLUTION laser therapy, cryotherapy, meds autonomy - SOLUTION the ethical principal that protects the right of the patients to make decisions about their medical care without the healthcare provider trying to influence beneficence - SOLUTION healthcare providers must do all they can to benefit the patient in every situation non-maleficence - SOLUTION do no harm