Comprehensive NICU Nurse Core Exam Review: Key Concepts in Neonatal Care, Exams of Nursing

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COMPREHENSIVE NICU NURSE CORE EXAM REVIEW ductus arteriosus (what is it, what does it do, and why?) - CORRECT ANSWER -blood vessel in fetal heart between pulmonary artery and aorta; shunts blood from right to left due to high pulmonary vascular resistance allows most of blood coming from r. ventricle to bypass lungs (which are not functioning in fetus) foramen ovale - CORRECT ANSWER -hole connecting the atria in fetal heart; shunts blood from right to left (due to high pulmonary vascular resistance) acts as another route for blood to bypass the lungs (along with ductus arteriosis) purpose of surfactant in lungs - CORRECT ANSWER -reduces surface tension in the alveolar fluid - air (CO2/O2) has to travel through layer of fluid in order to diffuse oxygen saturation monitoring location for neonatal resuscitation & O2 sat %'s after birth (1, 2, 3, 4, 5, and 10 mins) - CORRECT ANSWER -upper right arm (preductal location) 1 min: 60-65% 2 min: 65-70% 3 min: 70-75% 4 min: 75-80% 5 min: 80-85% 10 min: 85-90% oxygen saturation monitoring location (long term NICU stay, not neonatal resuscitation) - CORRECT ANSWER -bottom of foot or fleshy part of palm of right hand most important FHR characteristic indicating fetal oxygenation status? - CORRECT ANSWER -variability accelerations are also important in reflecting normal autonomic regulation of FHR (oxygenation) FHR baseline range - CORRECT ANSWER -110-160 BPM two main causes of deccelerations - CORRECT ANSWER -1) autonomic slowing of FHR in response to to changes in blood pressure, blood gases, and other possible factors 2) direct FHR lowering resulting from disrupted oxygen disruption BPP (biophysical profile) 5 variables - CORRECT ANSWER -- fetal tone, fetal movement, fetal breathing, fetal reactivity (NST), and amniotic fluid volume Blood Gases of umbilical vasculature - CORRECT ANSWER -Umbilical veins carry oxygenated blood from placenta to fetus Umbilical arteries carry deoxygenated blood back to mothers circulation s/s of neonatal sepsis - CORRECT ANSWER -*present w/in 12 hrs of birth Seesaw respirations - CORRECT ANSWER -Present when the chest retracts and the abdomen expands during inspiration. During expiration, the movement revereses: chest exands and abdomen moves inward respiratory contraindication for oral feeding? - CORRECT ANSWER -if respiratory rate exceeds 60bpm (tachypnea), oral feedings are contraindicated due to inability to coordiate feeding with increased breaths Neonatal RDS; prognosis - CORRECT ANSWER -- Based on GA, birth weight, and severity of RDS - Prolonged use of mechanical ventilation is associated with negative long term outcomes; damaging to pulmonary structures Periodic Breathing - CORRECT ANSWER -- Cessation of breathing lasting 5 to 15 seconds - Followed by period of "rebound" tachypnea - Cessation for ~20 seconds or more is considered *true apnea* Neonatal Apnea - CORRECT ANSWER -- Cessation of beathing for more than 20 seconds - Apnea occuring in preterm infants is called AOP, apnea of prematurity IDM - CORRECT ANSWER -infant of diabetic mother neonate heart rate - CORRECT ANSWER -100-180 neonate axillary temperature - CORRECT ANSWER -36.5 - 37.5 C how to support milk production in the NICU mother - CORRECT ANSWER -- educate mothers on pumping techniques (manual, hand expression, electric pump) - initiate pumping within 6 hours after birth - skin to skin after birth - pump 8x / day - emotional support - initiate feeding at the breast before bottle feeding calories recommendations for premature infants - CORRECT ANSWER -110 - 135 cal/kg/day preterm infant weight loss - CORRECT ANSWER -10-20% of birth weight in first week (term infants lose 5-10%) trophic feedings - CORRECT ANSWER -the practice of feeding minute volumes of formula or breastmilk in order to stimulate the development of the immature gastrointestinal tract of the preterm infant PICC insertion locations - CORRECT ANSWER -*saphenous, antecubital* (most common two), axillary, basilic, cephalic, popliteal, posterior auricular, and external jugular veins PICC line indications - CORRECT ANSWER -long term antibiotics, TPN, chemotherapy PICC Line - CORRECT ANSWER -Peripherally Inserted Central Catheter (PICC) placed into a vein in your arm, and then guided into a larger vein in your chest. midline catheter - CORRECT ANSWER -shorter than a PICC line. The midline tube ends in a vein below your armpit. Infiltration - CORRECT ANSWER -when I.V. fluid or medications leak into the surrounding tissue. Infiltration can be caused by improper placement or dislodgment of the catheter. Patient movement can cause the catheter to slip out or through the blood vessel lumen. Extravasation - CORRECT ANSWER -if the fluid is a non-vesicant (does not irritate tissue), it is called an infiltration. if the fluid is a vesicant (a fluid that irritates tissue), it is called an extravasation. Kangaroo care - CORRECT ANSWER -Treatment for preterm infants that involves skin-to-skin contact Lanugo - CORRECT ANSWER -Fine downy hair that appears over the entire fetus at 20 weeks; begins to disappear around 28 weeks Vernix - CORRECT ANSWER -white cheeselike material on baby; produced at 20-24 weeks, begins to decrease at 36 weeks Normal birth weight - CORRECT ANSWER -2500-4000g Excessive birth weight - CORRECT ANSWER -4000g and up Low birth weight - CORRECT ANSWER -2500g or less Moderate low birth weight - CORRECT ANSWER -1500-2500g Very low birth weight - CORRECT ANSWER -1500g or less Extremely low birth weight - CORRECT ANSWER -1000g or less