Neonatal Care: Preterm Infant Development and Common Diagnoses, Exams of Nursing

Download Neonatal Care: Preterm Infant Development and Common Diagnoses and more Exams Nursing in PDF only on Docsity! Developmental Therapy in the NICU Exam Questions with Verified Answers Latest Update-Success Guaranteed Objectives - Correct answer -understand the theoretic concept of Developmental Care and its importance in the NICU -identify 3 unique treatment strategies within the NICU to facilitate newborn development -Discuss the importance for early intervention with high-risk newborns and refer to appropriate services Newborn Intensive Care Unit Levels 1-4 - Correct answer Level 1: normal newborn nursery Level 2: special care nursery Level 3: newborn intensive care -->respiratory -->neonatal surgery -->special diagnostics -->very preterm infants Level 4: Newborn intensive care -->cardiac surgery Infants admitted to Intensive Care - Correct answer Multiple diagnosis -prematurity -Respiratory distress -Surgical (GI, cardiac, renal) -Neurological problems -Congenital anomalies -Infection -Metabolic Definition by Gestational Age - Correct answer 23-26 wks: very preterm infant 27-33 wks: moderately preterm infant 34-36 wks: late preterm infant Definition by Birth Weight 500 g= 1 lb 30 ml =1 0z - Correct answer >2500 g: Normal Birth Weight 1500-2500: Low Birth Weight 1000-1500 g: Very Low Birth Weight <1000 g: Extremely Low Birth Weight Size for Dates - Correct answer -Appropriate for Gestational age (AGA) -Small for Gestational age (SGA) -Large for Gestational age (LGA) Intrauterine Growth Restriction ( = mom's placenta unable to give baby nutrition in utero) -baby almost always SGA and have difficulty growing when older.. and typically have ADHD -Perinatal Data Base: 6.9 point IQ deficit at 7 yrs of age -Preterm infants: with and without postnatal nutrition -8 point deficit on one year MDI if> 2 wks post natal malnutrition Common Diagnosis of the Preterm infant - Correct answer -Respiratory Distress Syndrome (RDS) -Chronic Lung Disease (CLD) or Bronchopulmonary Dysplasia (BPD) -Sepsis -Necrotizing Enterocolitis (NEC)= related to GI system; babies born before 31-32 wks have immature stomach, small intestine, and large intestine, have not developed GI motility yet and don't have flora(good bacteria) to help them digest food. Thus they can't gain weight. Thus fed via fluid IV (once stable on fluids they MUST be fed human breastmilk) - NEC is scary and common -Retinopathy of Prematurity (ROP)= eyes should not be exposed to outside environment before 37 weeks (too much O2 in air can pull retina off and baby becomes blind) -Intraventricular hemorrhage (IVH)= bleeding in the brain that later results in CP. Incidence of Prematurity - Correct answer In US in 2012: -11.5% of infants born premature c) stage 3 (severe): stupor, flaccidity, small to mid position pupils which react poorly to light, decreased stretch reflexes, hypothermia, and absent Moro. Relatively new therapy: *Body and head cooling* -(blanket that pumps cold water to bring down the baby's body temp, decrease the significant edema that follows after lack of o2, trying to prevent a secondary brain injury from occurring) -HIE= a term baby with small mother and baby gets stuck in labor, lack of O2 during delivery process. Very different than PVL bc this is a GLOBAL injury, depending on how diffuse /deep into brain tissue injury was- these kids can either have very poor outcomes or very good outcomes. Neonatal Seizures causes - Correct answer -Metabolic -Infection -Bleeding -HIE Neonatal Seizures Signs - Correct answer Abnormal movements Apnea Staring Sucking, Chewing Need to differentiate from jitteriness Neonatal Seizures Treatment - Correct answer Determine and treat underlying cause Anticonvulsants Neonatal Seizures Outcome - Correct answer often dependent on cause of seizure Retinopathy of Prematurity - Correct answer At risk infants require eye exams at 4-6 weeks of age until retinal mature <1500 g <30 wks gestation The youngest, smallest, sickest infants at greatest risk Retinal maturity described as zones (location) as goes out from the optic nerve Outcomes: -need for glasses -Strabismus -Blindness CStages of ROP (tells you the severity of disease) - Correct answer Stage 1: is a faint demarcation line Stage 2: is an elevated ridge Stage 3: is extra retinal fibrovascular tissue Stage 4: is sub-total retinal detachment Stage 5: is total retinal detachment Treatment: -laser surgery or injection of Avastin Criteria for discharge - Correct answer -parental education -completion of appropriate elements of primary care in the hospital -Development of a management plan for unresolved medical problems -Development of comprehensive home care plan -Identification and involvement of support services -Determination and designation of follow-up care Discharge planning - Correct answer -Resolution of medical and surgical probs that required hospitalization -Adequate weight gain on oral feedings -Thermal stability -Education and comfort of parents -Predischarge health maintenance: -->appropriate screening (metabolic screening, hearing test, eye exams, head ultrasounds, at 1 week and 36 wks corrected age) -Post discharge environment -Support and Follow-up -->primary care provider -->NICU follow-up clinic -->other specialty clinic appt. -->Community Resources (early intervention, home health care) Factors Influencing Long Term Outcome of Premature Infants - Correct answer 1. Degree of prematurity 2. Size for Dates (SGA) 3. Intraventricular Hemorrhage 4. Periventricular Leukomalacia 5. Socio-economic Status 6. Postnatal Nutrition Risk Factors - Correct answer -Extreme prematurity -Intraventricular Hemorrhage (IVH) -Periventricular Leukomalacia (PVL) -Severe bronchopulmonary dysplasia -Intrauterine Growth Restriction Criteria for NICU Follow-Up clinic - Correct answer -Birth weight<1500 g (3 lbs) -GA <32 weeks -Required more than 4 days on ventilator or has persistent pulmonary problems (BPD) -Intrauterine growth retardation (>2 S.D. below the mean in two growth parameters) -ECMO patients -Neonatal seizures, intraventricular hemorrhage (any grade), periventricular leukomalacia, hydrocephalus, perinatal asphyxia, or other neurological abnormality -Elevated bilirubin levels requiring an exchange transfusion -IDM with symptomatic hypoglycemia -Congenital or acquired infection (meningitis or positive blood cultures assoc. with pulmonary compromise, DIC, or shock) Goals of NICU Follow-up Clinic - Correct answer -Identification of concerns related to health, growth, and development -Early identification of problems related to development -Responding to parent concerns, remaining questions from NICU course -Recommendations for care -Appropriate referrals -Reassurance At Each follow-up Clinic Visit - Correct answer -History and Physical exam -Growth and Nutrition assessment -Health status -Development and muscle tone -Referrals if needed -Summary of visit to primary care provider -Anticipatory guidance Routine NICU Follow-up visits - Correct answer -4 months corrected age -12 months corrected age -24 months corrected age -4 years of age Additional Clinic Visits - Correct answer -Infants with Chronic Lung Disease -*NICU infant requires 20-22 hrs of sleep per day compared to term infant requiring 17- 20 hrs of sleep per day* -Monitoring signs of stress and overstimulation for the infant Additional Treatment - Correct answer Kangaroo Care Joint compression -->last trimester of preg. is when baby's have skeletal elongation. WB in utero is kicking and punching mom- this is difficult to replicate in utero environment for WB -Osteopenia prematurity is common in baby's who don't get enough WB- monitor for alkaline phosphate levels.. if they are high (600-1800) it means baby is at high risk for fractures - alk phosphates are enzyme in bony matrix allowing baby to grow long. Supplement with Vit D and joint compression at ankle, knee, hip, elbow, wrist, shoulder 1x/day to help skeletal elongation/growth PROM to all extremities Increase handling tolerance Facilitate vestibular development Monitor potential movement disorders Oral motor development and feeding Cranial molding Musculoskeletal development support Oral motor development and Feeding - Correct answer Goal is for each infant to have a positive feeding experience and avoid oral aversion development Feeding a NICU baby is complex, challenging, and risky as the infant is learning to coordinate SSB and high probability for aspiration Requires advanced training: AOTA recommends minimal of 2 years pediatric experience before NICU placement Oral Motor Development - Correct answer Initial sucking and swallowing of amniotic fluid at 9 wks gestation Coordination of SSB at 28 wks gestation Fully maturation to allow for fluid introduction at 32-34 weeks Protective cough at 36 weeks Oral Motor Progression - Correct answer NNS program at 28 weeks gestation -supplemental Oxygen allows orbicularis oris muscle to turn up- and prevents baby from getting adequate lip seal Feeding - Correct answer Discuss with family their preferred feeding plan for home discharge -breast -bottle Coordinated plan to reduce risk of over-fatigue of oral motor musculature -Breastfeeding starts around 32 weeks, bottle feeding at 34 weeks Bottle feeding NICU baby - Correct answer Considerations -anatomical: frenulum length, tone of tongue, hard/soft palate structure -O2 needs -Organization of suck pattern with NNS -Historical considerations Bottling Techniques - Correct answer -Positioning infant -Pacing infant -Oral motor control -Musculoskeletal support Aspiration risk - Correct answer -Common for infants with history of IVH, oral motor anatomical anomalies -Vido Fluoroscopy Swallow Study (VFSS) with radiologist to confirm swallow safety -Alter liquid consistency for safe swallow or may need G-tube for home feeding Specialized infant feeding - Correct answer Cleft palate -floor of nasal cavity is gone btw 6-9 mo: ENT repairs lip btw 12-18 mo: repairs palate Kinesiotaping in the NICU - Correct answer -Neuro-motor facilitation -Functional correction -Edema management -Orthopedic correction Manual Edema Management - Correct answer Critically ill infants will have fluid imbalance with significant acute/chronic edema. Immature lymphatic system that needs facilitation for maturation. Manual Edema mobilization, kinesiotaping, clear/flow PROM program, weight bearing with joint compression Splinting - Correct answer Soft splint: wrist/finger anomalies Thermoplastic splinting: clubfoot deformity, wrist flexion contracture Amniotic banding of extremities Visceral Manipulation and Abdominal Strengthening - Correct answer -Utilized with infants with significant reflux -Rectus abdominus home program to increase GI motility, reduce constipation, and increase gastric emptying -Visceral Manipulation: mobilization of abdominal viscera to support GI motility Caregiver Education - Correct answer Joint compression, PROM Tummy Time Back to Sleep Flexion swaddling Feeding techniques, including use of home bottles while in NICU Abdominal development Visual development Referral to Early intervention KT/Splinting education as needed Expected development Developmental Education to parents of children with special needs - Correct answer Trisomy 21 Cardiac complications Genetic syndromes Orthopedic anomalies Referral to appropriate out-pt services -->rehabilitation -->specialized physician -->VFSS -->NICU follow-up clinic NICU Follow-up clinic - Correct answer Corrected GA: corrected until 2 yrs of age, education to parents on developmental expectations (ie. at 34 wks baby should sleep on back, can't sleep on tummy unless on a monitor and written physician order)