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 Definition of very low birth weight - Correct answer infants between 1000- 1500g at birth Definition of extremely low birth weight - Correct answer infants less than 1000g at birth Description of ELBW ears - Correct answer flat pinna with no cartilage and will stay folded together when pressed Typical skin of ELBW infant - Correct answer thin, sticky, transparent, visible vasculature typical plantar surfaces of the feet of an ELBW - Correct answer smooth with no wrinkles Description of Lanugo in ELBW - Correct answer sparse to none Description of the posture and tone of an ELBW infant - Correct answer hypotonic, flexible, passive Team members that should be at an ELBW delivery - Correct answer nnp/neonatologist, NICU nurse (2), respiratory therapist Temperature set up for a ELBW delivery - Correct answer radiant warmer at 36.5, warming mattress, hat, plastic wrap, warmed sterile blanket Pulse ox placement at delivery - Correct answer right wrist (pre-ductal) O2 target sats at 1,2,3,4,5,10 min of life for an ELBW infant - Correct answer 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 - Correct answer 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 - Correct answer 30-60 seconds, infant must be below level of placenta Definition of Ballard Score - Correct answer assesses gestational age based on physical and neuromuscular maturity Point in time when the Ballard score should be completed - Correct answer physical assessment within 2 hours of birth, neuromuscular within 24 hours of birth Categories of the physical assessment of the Ballard Score - Correct answer skin, lanugo, plantar surface, beast, eye/ear, genitalia Categories of the neuromuscular assessment of the Ballard Score - Correct answer posture, square window, arm recoil, popliteal angle, scar sign, heel to ear Best type of vascular access in an ELBW infant - Correct answer UAC and UVC Purpose of a UVC in an ELBW infant - Correct answer admin fluids, meds, and blood products Purpose of a UAC in an ELBW infant - Correct answer monitor blood pressure and draw labs Correct placement location of a UVC - Correct answer just above the diaphragm, t9-t10 vertebrae Correct placement location of a UAC - Correct answer just above the diaphragm, t6-t9 vertebrae Verification of correct placement of a UAC or UVC - Correct answer x-ray fluid that should be given asap to an ELBW infant - Correct answer dextrose 5% clinical significance of magnesium - Correct answer important for hemoglobin formation, wound healing and host defenses potential causes of hypermagnesemia in an ELBW infant - Correct answer maternal admin of mag sulfate, status asthmaticus, enemas, renal failure antidote for hypermagnesemia - Correct answer calcium gluconate potential causes for hypomagnesemia in an ELBW infant - Correct answer increased urinary loss, malabsorption, short bowel syndrome, diarrhea clinical manifestations of hypomagnesemia in an ELBW infant - Correct answer nausea, weakness, hyperreflexia, clonus difference between term and premature human milk - Correct answer 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 - Correct answer within 6 hours when an ELBW can breastfeed - Correct answer when there is a coordinated suck, swallow, breathe pattern contraindication for breastfeeding - Correct answer galactosemia (can't digest breastmilk) advantages to pacifier (non-nutritive sucking) in an ELBW infant - Correct answer 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 - Correct answer colostrum definition of trophic feeds - Correct answer 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 - Correct answer NG tube adequate weight gain for an ELBW at 24-32 weeks, 33-36 weeks, 37-40 weeks and 40 weeks to 3 months - Correct answer 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 - Correct answer free flow O2 from bag mask or O2 tubing held near infants face indications of blow by O2 - Correct answer used for short term O2 delivery in the DR or during cares potential complications of nasal cannula - Correct answer skin injury to nose, varying O2 concentration, drying of nasal mucosa different methods of CPAP - Correct answer mask, nasal, bilevel indications for CPAP - Correct answer RDS, apnea, atelectasis, pulmonary edema advantages of CPAP - Correct answer no intubation potential complications of CPAP - Correct answer abdominal distention, air leaks, ineffective ventilation, nasal septal breakdown, variable pressures with mouth open indications of mechanical ventilation - Correct answer respiratory failure, surfactant, severe apnea and bradys, CNS disease, surgery potential complications from mechanical ventilation - Correct answer tube dislodgement, air leaks, BPD, ROP, IVH BPD - Correct answer bronchopulmonary dysplasia different vent modes - Correct answer 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 - Correct answer pH, paCO2, HCO3 normal pH for a neonate - Correct answer 7.35-7.45 normal paCO2 for a neonate - Correct answer 35-45 normal HCO3 for a neonate - Correct answer 22-26 respiratory acidosis - Correct answer when there is an increase of CO2 with a normal HCO3 metabolic acidosis - Correct answer when the CO2 is normal and the HCO3 is decreased respiratory alkalosis - Correct answer when there is a decrease in CO2 and a normal HCO3 metabolic acidosis occurs when - Correct answer 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 - Correct answer 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 - Correct answer heel sticks, adhesive removal, IV sticks, ET and nasal suctioning skin differences between an ELBW infant and a term infant - Correct answer ELBW's have an immature epidermis and dermis, minimal subQ fat, and increased permeability techniques to prevent skin breakdown in an ELBW infant - Correct answer no wrinkles in bedding, positioning devices, rotate medical devices, pad the IV hub, reposition q3-4 hours, hydrogels and gentle removal of adhesives timeframe in pregnancy when antenatal steroids can be administered - Correct answer 24-37 weeks reason why mag sulfate is given to mothers in preterm labor - Correct answer provides neuroprotection to premature infants to prevent CP reasons why a mother receives antibiotics while in labor - Correct answer GBS positive or unknown, PROM >18 hours, temp >100.4 different types of diabetes in pregnancy - Correct answer gestational, type I, type II gestational diabetes is diagnosed at _____ gestation - Correct answer 24- 28 weeks potential complications for infants of diabetic mothers - Correct answer fetal death, macrosomia, shoulder dystocia, birth trauma, RDS, hypoglycemia, heart defects, open neural tube defects, childhood obesity different ways to deliver a baby - Correct answer vag, operative (C- section, forceps, vacuum) VBAC PDA and it's significance - Correct answer 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) - Correct answer disruption of the normal transition to extrauterine circulation characterized by persistent increased PVR perinatal risk factors for PPHN - Correct answer MAS, asphyxia, abnormal pulmonary development causes of PPHN - Correct answer RDS, PDA, sepsis or pneumonia PPHN diagnostic test - Correct answer ECHO management of PPHN - Correct answer correct hypoxia and acidosis, pulmonary vasodilation with O2, HF vent to prevent barotrauma definition of cor pulmonale - Correct answer 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 - Correct answer absence of breathing for >20 seconds definition of apnea of prematurity - Correct answer recurrent episodes starting in first week of life in preterm infants with no other abnormalities, usually resolves on its own definition of pulmonary hypoplasia - Correct answer 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 - Correct answer surfactant deficiency and or structural immaturity s/s of RDS - Correct answer tachypnea with grunting, flaring and retractions recommended prevention and treatment of RDS - Correct answer antenatal corticosteroids, surfactant replacement, reducing hypoxemia, correcting acidemia, increasing functional capacity 4 areas where air leaks are ruptures in the alveoli - Correct answer mediastinum, pleural space, space surrounding the heart, peritoneal cavity most common type of air leak - Correct answer pneumothorax 2 most common pneumothorax's' - Correct answer spontaneous and tension definition of spontaneous pneumothorax - Correct answer isolated pocket of free air in pleural space, may be asymptomatic definition of tension pneumothorax - Correct answer addition of new air through the rupture with each breath, resulting in lung collapse and compromised cardiac function s/s of a pneumothorax - Correct answer increased resp distress, bradys, asymmetry in chest expansion, change in breath sounds, movement of heart's PMI diagnostic test for a pneumothorax - Correct answer transillumination with a fiber optic light, chest x-ray definition of pulmonary hemorrhage - Correct answer presence of red blood cells in the alveoli, interstitium, or both on pathologic exam treatments for BPD - Correct answer prenatal steroids and early surfactant, restrict fluids and increase calories, bronchodilators, diuretics and corticosteroids potential complications of BPD - Correct answer increased mortality, chronic resp infections, altered lung function, cor pulmonale, growth restrictions, fractures and rickets, neurodevelopmental sequelae definition of peritonitis - Correct answer inflammation of the peritoneum, typically bacterial or fungal 3 mechanisms related to nec - Correct answer intestinal ischemia, bacterial colonization, volume feedings s/s of nec - Correct answer 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 - Correct answer malabsorption and malnutrition resulting from a surgical bowel shortening, ass. with atresia, malrotation, abdominal wall defects, perforations definition of hematopoiesis - Correct answer the formation, production and maintenance of blood cells skin precautions for an ELBW infant - Correct answer adhesive remover, sterile saline to remove betadine or chlorhexidine to avoid risk of chemical burns, avoid emollient, baths in warm sterile water definition of hemangioma - Correct answer raised, soft, bright red tumor located on the head, beck, trunk or extremities, caused by proliferation of capillaries occupying the dermal and subdermal layers in ass. with endothelial proliferation definition of periventricular/intraventricular hemorrhage (IVH) - Correct answer occurs once subendymal germinal matrix hemorrhage extends into lateral ventricles risk factors for IVH - Correct answer 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 - Correct answer 10-60% clinical presentation of IVH` - Correct answer sudden deterioration, O2 desats, bradys, metabolic acidosis, tense fontanelle, shock definition of post-hemorrhagic hydrocephalus - Correct answer 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 - Correct answer serial lumbar punctures, admin of lasix and diamox, VP shunt, family support definition of periventricular leukomalacia - Correct answer ischemia and necrosis of periventricular white matter in the watershed area of the brain Barlow maneuver - Correct answer pressure from front causes palpable dislocation of the femoral head Ortolani maneuver - Correct answer 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) - Correct answer pavlik harness to immobilize infant in a flexed position definition of acute renal failure - Correct answer abrupt and severe decrease in urine output, rise in BUN and creatinine management protocol of acute renal failure - Correct answer Id and treat cause, strict I&O, daily weight, monitor BP, electrolytes and nutrition definition of syndrome of inappropriate antidiuretic hormone (SIADH) - Correct answer impairment of free water clearance caused by an uncontrolled release of antidiuretic hormone (ADH) causes of SIADH - Correct answer cns infections, birth asphyxia, intracranial hemorrhage, meningitis diagnostic tests for SIADH - Correct answer finding an elevated circulating ADH level with low serum osmolality and hyponatremia clinical manifestations of SIADH - Correct answer fluid retention, oliguria, hyponatremia, weight gain, edema causes of renal artery/vein thrombosis - Correct answer vascular injury, decreased vascular flow, increased blood viscosity diagnostic test of a renal artery/vein thrombosis - Correct answer renal venography tracheomalacia - Correct answer occurs when the cartilage in the trachea is not developed, the airway is floppy instead of being rigid s/s of tracheomalacia - Correct answer noisy, high pitched breathing diagnostic test for tracheomalacia - Correct answer chest airway may show narrowing, confirmed with laryngoscopy treatment of tracheomalacia - Correct answer humidified air, close monitoring for infection second most common cause of congenital airway obstruction presenting with neonatal stridor - Correct answer vocal cord paralysis percentage of ELBW infants that get antibiotics in first 3 days of life - Correct answer 85% reason why ELBW infants are given vit A - Correct answer to reduce the duration of O2 therapy and thus reduce the risk for ROP best way to monitor BP when giving pressors - Correct answer art line reason for indomethacin admin in ELBW infants - Correct answer NSAID given in 1st 12 hours of life to promote closure of PDA definition of retinopathy of prematurity (ROP) - Correct answer affects blood vessels in the retina, leading cause of blindness risk factors of ROP - Correct answer prematurity, supplemental O2, PDA, vent support, hyperglycemia, male gender ROP exams done at point in life - Correct answer 4 weeks of life or 31 weeks whichever is later, rpt every 2 weeks if no ROP, weekly if ROP, treatment of ROP - Correct answer laser therapy, cryotherapy, meds autonomy - Correct answer 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 - Correct answer healthcare providers must do all they can to benefit the patient in every situation non-maleficence - Correct answer do no harm