Neonatal Care and Resuscitation, Exams of Nursing

Download Neonatal Care and Resuscitation and more Exams Nursing in PDF only on Docsity! NICU NURSING EXAM 2024 WITH 100% ACCURATE SOLUTIONS What is the high risk neonate defined as? - correct answer✔✔ A newborn, regardless of gestational age or birth weight, who has greater than average chance of morbidity or mortality d/t conditions associated with birth and the transition to extrauterine life. How is a high risk neonate classified by weight? - correct answer✔✔ -Low birth weight: <2500g -Very low birth weight: <1500g -Extremely low birth weight: <1000g How is a high risk neonate classified by growth? - correct answer✔✔ -Intrauterine growth restriction -Small for gestational age -Large for gestational age How is a high risk neonate classified by gestational age? - correct answer✔✔ -Premature infant: </= 36 6/7 weeks -Term infant: >/= 37 0/7 weeks -Postmature infant: >42 weeks What are risk factors that increase the likelihood of NICU admission? - correct answer✔✔ -Prematurity -Low birth weight -Birth depression -High risk pregnancy -Congenital anomalies What are risk factors for prematurity? - correct answer✔✔ -Teen pregnancy -Adavanced maternal age (>35y) -Low SES -Drug/tobacco use -Hx of preterm birth -Multiple gestation -Obesity -DM -HTN -Maternal infection -Infertility tx What should the nurse understand about the neonatal resuscitation program? - correct answer✔✔ - Geared towards deliveries and birth interventions, as many newborns require some assistance to begin breathing at birth -A smaller percentage require extensive resuscitative measures (compressions or meds) What are important questions to ask in terms of neonatal resuscitation? - correct answer✔✔ -Are they term? -Good tone? -Breathing/crying independently? -How big? What is included in post-resuscitation care in the NICU? - correct answer✔✔ -Thermoregulation -Glucose monitoring -Labs -X-ray -IVF -Management of lines and tubes -Monitor VS -Support family -Sepsis -CNS disorders -Drugs What should the nurse understand about apnea of prematurity? - correct answer✔✔ -Immature central respiratory center -Respiratory depression occurs predominantly during transitional sleep (neonates sleep 80% of the day) What are nursing considerations for apnea of prematurity? - correct answer✔✔ -Evaluate for infection or respiratory compromise that may be causing apnea, not just prematurity -Tx: Respiratory support and caffeine -Nursing documentation of events is important What should the nurse understand about ECMO? - correct answer✔✔ -Extracoporeal membrane oxygenation -Prolonged cardiopulmonary bypass that provides cardiorespiratory support for infants in REVERSIBLE (key for candidacy), profound respiratory and/or cardiac failure -Associated conditions: RDS, MAS, PPHN, CDH, sepsis What are the two different types of ECMO? - correct answer✔✔ -Venoarterial (VA) -Venvenous (VV) What are contraindications for ECMO? - correct answer✔✔ -Gestational age <34 weeks -Weight <2kg -Severe IVH -Irreversible lung disease -Irreversible severe neuro abnormally (i.e. severe head bleed, as ECMO is heparinized) -Severe congenital anomalies What are acyanotic congenital heart abnormalities? - correct answer✔✔ -PDA -VSD -ASD -A-V canal -Coarctation of the aorta -Hypoplastic left heart What are cyanotic congenital heart abnormalities? - correct answer✔✔ -Transposition of the greater vessels -Tetralogy of Fallot -Pulmonary stenosis -Truncus arteriosus How is critical congenital heart disease (CCHD) measured? - correct answer✔✔ -Pulse ox on upper and lower extremities and looking for a gradient -Mandatory for all nurseries What is a PDA and the sx? - correct answer✔✔ -Patent ductus arteriosus after birth -Sx: Murmur, cardiomegaly, bounding pulses, active precordium, widened pulse pressure What are complications of PDA? - correct answer✔✔ -Congestive heart failure -Feeding intolerance (not enough oxygenation for increased energy demand) -Respiratory distress (poor oxygenation) What is the management of a PDA? - correct answer✔✔ -Fluid restriction -PEEP -Indomethacin and ibuprofen to vasoconstrict and close up PDA -Surgical ligation if meds are unsuccessful What should the nurse understand about gastroschisis? - correct answer✔✔ -Abdominal wall defect -Defect placed to the right of the umbilicus -NOT covered by a sac -May include stomach and small and large intestines -Bowel is thickened, edmatous, and inflamed -Not usually associated with other anomalies -Slowly pushed back in What should the nurse understand about omphaloceles? - correct answer✔✔ -Abdominal wall defect -Herniation of abdominal viscera into umbilical cord and usually covered with peritoneal sac -May include stomach, liver, spleen, and intestine -Associated with cardiac, neuro, GU, skeletal, and chromosome anomalies -Often left to granulate over and fix when child is older What should the nurse understand about necrotizing enterocolitis? - correct answer✔✔ -Disease process leading to bowel necrosis What are the risk factors of necrotizing enterocolitis? - correct answer✔✔ -Perinatal hypoxemia -Polycythemia -Prematurity -Formula or hyperosmolar feeds -Abnormal bacterial colonization -Congenital heart defect What are the sx of necrotizing enterocolitis? - correct answer✔✔ -Apnea -Lethargy -Abdominal distention -Feeding intolerance -Emesis -Bloody stools What should the nurse understand about perinatal asphyxia? - correct answer✔✔ Cause of hypoxic ischemic encephalopathy -Profound umbilical artery acidosis <7 -5 minute APGAR <3 -Neuro sequelae: Seizures, hypotonia, coma -Multiple organ dysfunction What are risk factors for hypoxic ischemic encephalopathy? - correct answer✔✔ -Cord compression -Placental abruption -Difficult delivery What is the management of HIE? - correct answer✔✔ -Therapeutic hypothermia (full body and started within first 6 hours to decrease inflammation in brain to decrease cell death) -Seizure management -Maintain normal electrolytes and glucose -Monitor intake and output closely d/t potential renal impairment -MRI -Educate and support family What are the different types of intracranial hemorrhages? - correct answer✔✔ -Subdural -Subarachnoid -Cerebellar -Intraventricular (most common) What should the nurse understand about intraventricular hemorrhages? - correct answer✔✔ -Germinal matrix hemorrhage: Collection of blood vessels for neuron growth. As brain develops, no longer necessary so not as perfused --> Premature babies more at risk bc brains have not developed as much. Term babies may not even have it anymore -Graded 1-4 -90% of hemorrhage occurs in first 72 hours of life (screen at 3 and 7 days of age) What should the nurse understand about fetal anomalies? - correct answer✔✔ -An abnormality of structure, function, or metabolism whether genetically determined or a result of environmental interference during embryonic or fetal life -Trisomies (13, 18, 21) -Cleft lip and palate -VATER association What should the nurse understand about neurodevelopmental issues? - correct answer✔✔ - Developmental issues occur on a continuum, with the usual course interrupted by preterm birth or illness -Neurmotor maturation follows predictable sequence as premature infant progresses to 40 weeks -Actual timing is individual What are potential complications of neurodevelopmental issues? - correct answer✔✔ -Developmental delays -Learning disabilities -ADHD -Autism -Cerebral palsy -Failure to thrive Why is developmental support in the NICU important? - correct answer✔✔ -Integrate the developmental needs of infants wit intensive medical care to optimize outcomes -Provide care in the lease disruptive way -Adapt intervention goals to medical limitations in NICU -Recognize and respond to infant's behavioral cues -Foster parent-infant interaction -Enhance parents' understanding of infant as individual What are developmental interventions in the NICU? - correct answer✔✔ -Therapeutic handling -Positioning -Non-nutritive sucking (promotes soothing and gastrin release to promote digestion) -Negative visual/auditory stimulus (cyclic lighting and low noise) -Kangaroo care -Assess feeding ability -PT and OT -Infant massage What are the benefits of kangaroo care? - correct answer✔✔ -Reduced severe illness, infection, length of hospital stay, mortality -Improved temperature stability, cardiorespiratory stability, milk production and breastfeeding, neurodevelopmental outcomes, -Enhanced parental attachment What should the nurse understand about music therapy? - correct answer✔✔ -Preferred choice of music is lullaby, softly sung or played by instrument -Benefits: Improved sleep, feeding, heart rate, development What should the nurse understand about NAS? - correct answer✔✔ -Sx appear within 72 hours in majority of infants -Need to be monitored at least 5 days -Opiate specific disorder What are the sx of NAS? - correct answer✔✔ Hypertonia, tremors, irritability, high pitched cry, sleep disturbances, seizures, yawning, nasal stuffiness, sweating, sneezing, low grade fever, diarrhea, vomiting, poor feeding, emesis, poor weight gain, tachypnea, skin excoriation How is NAS managed? - correct answer✔✔ -Finnegan scoring -Morphine/methadone/subutex -Reduction of negative stimuli -Couplet care (mom is part of care too)