Neonatal Care: Conditions in NICU and Developmental Approaches, Exams of Nursing

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Pad-Neonatal Therapy Examination Questions with Answers 100% Verified Nursery Classifications - Correct answer Level I Level II Level III Level IV Level I - Correct answer healthy newborns & stable late-preterm infants Level II - Correct answer able to take care of infants born less than 23 wks. w/ birth weight 1500 g/ more Level III - Correct answer extremely high risk infants (critical care) Level IV - Correct answer same as Level III but able to do surgery on site & other criteria NICU Environment - Correct answer accommodations respiratory support "lines" miscellaneous equipment NICU Team Members - Correct answer MD (neonatologists, surgeons, anesthesiology, ophthalmology, orthopedics, epidemiology, etc.) Neonatal fellows residents interns medical students nurse practitioners transport RN RN's respiratory therapy OT d/c/ planning RN's interpreters front desk clerks PCT's housekeeping Prematurity Causes - Correct answer pre-term labor preterm premature rupture of membranes (PPROM) infections pre-eclampsia high blood pressure abruption placenta prevail multiple gestation (twins, triplets, etc.) drug use poor prenatal care Primary Diagnosis in NICU - Correct answer premature infants late preterm infants w/ feeding difficulties cleft lip/ palate infants w/ heart defects (ASD, VSD, PDA, tetralogy of fallout, etc.) infants requiring ECMO down syndrome meconium aspiration arthrogryposis gastroschisis brachial plexus injuries twin gestation / other multiples neonatal abstinence HIE - hypoxic ischemic encephalopathy IVH - intraventricular hemorrhage esophageal atresia genetic anomalies/ syndromes Secondary Diagnosis in NICU - Correct answer RDS - respiratory distress syndrome BPD - bronchopulmonary dysplasia PPHN - persistent pulmonary hypertension of the newborn infants w/ heart defects (ASD, VSD, PDA, tetralogy of fallot, etc.) clinical sepsis SGA/ IUGR hyperbilirubinemia apnea anemia feeding intolerance ROP - retinopathy of prematurity NEC - necrotizing enterocolitis ileus IVH - intraventricular hemorrhage PVL - periventricular leukomalacia pneumothorax hypoglycemia hyperparathyroidism -limpness -hypertonic -arching -fisting stability -muscle tone consistent in trunk & extremities -smooth controlled posture -smooth movements State System - Correct answer stress -whimpers -crying -staring -gaze aversion -irritable -eye floating -dull look -hyper alert -abrupt state changes -panicked look stability -clear defined sleep states -consolable -alert & focused -smooth transition b/w states Foundation of Developmental care - Correct answer being able to read an infant's cues Thermoregulation - Correct answer convection conduction radiation evaporation Convection - Correct answer heat loss to air Conduction - Correct answer heat loss from body contact Radiation - Correct answer heat loss of objects Evaporation - Correct answer converted to vapor High risk for heat loss due to - Correct answer thin skin lack of brown fat brain inability to thermo regulate positioning procedures Prevention of Heat Loss - Correct answer kangaroo care isolate warmer positioning Z-flow swaddling hats &/ clothing Touch - Correct answer predominately invasive (ex: IV sticks, NGT placement, etc.) nurturing touch: -Kangaroo care - deep touch -being held by parent/ staff -massage? Light in the NICU - Correct answer eyes remain fused into 24-26 wks. GA minimal spontaneous eye opening until after 29 wks. unable to close their eyelids tightly until after 30 wks thin eyelids do not adequately filter light iris does not significantly constrict until 30--34 wks. average lighting in NICU's is 30-150 fc w/ peaks up to 1500 fc (typical office is 40 to 50 fc) continuous light exposure has been linked to chromosomal damage, disruption of biological rhythms, changes in endocrine glands & gonadal function & alteration of vitamin D synthesis Hearing - Correct answer structures formed & functioning by 25 wks. exposed to low & high frequency noises w/o the buffer of mom's body high risk for hearing loss high risk for auditory processing problems Sound in the NICU - Correct answer hearing threshold is 40 dB for infant 28-34wks, 30 dB at 35-38 wks. and <20 dB at term typical NICU noise level is 50-90dB (street traffic & light machinery) NICU noise levels peak to 120 dB (heavy machinery) OSHA noise limit is 90 dB for 8 hrs. for adult workers our pts. react to this by crying/ getting agitated which in turn decreased O2 levels, increases ICP & changes HR & RR disrupts sleep patterns Term Infant Positioning - Correct answer limited intrauterine space provides infant w/ posture of flexion, containment & midline enhances early motor control last trimester promotes development of neural connections & pathways connections & pathways become dominant & lead to normal motor & sensory development Preterm Infant Positioning - Correct answer no longer receives input from the intrauterine space to promote a posture of flexion, containment & midline posture is flat w/ limbs abd., ER & ext. decreased motor control potential neural pathways/ connections weaken/ disappear due to lack of repetitive input form the intrauterine space at risk for atypical motor & sensory development Developmental Impact of Positioning - Correct answer ALL positoning (correct/ incorrect) affects the developmental outcomes of NICU pts Incorrect positioning can lead to - Correct answer positional deformities atypical movement patterns developmental delays head flattening increased stress level of the infant decreased physiologic stability (ex: O2 sats, HR, RR, glucose levels, etc) decreased tolerance to caregiving restlessness & poor sleep patterns decreased growth/ weight gain Correct positioning promotes - Correct answer correct body alignment appropriate motor patterns developmentally appropriate skills attractive head shaping decreased stress level of the infant physiologic stability (O2 sats, RR, HR, glucose levels, etc.) tolerance to caregiving restful sleep patterns appropriate growth/ weight gain Containment =/ restring - Correct answer baby must be able to move for the baby MSK system to develop - awake baby uses 7x more calories than sleeping -active baby uses 15x more calories than sleeping -crying baby uses 30x more calories than sleeping Restless/ agitated baby - Correct answer glucose stores are used/ depleted & O2 consumption is increased parent satisfaction improves when their baby is positioned comfortably 4 keywords for positionnig - Correct answer flexed contained knowledge of NICU culture specific skills related to OT in assessing & adapting environment knowledge of structures that support OT practice in NICU Necessary Characteristics - Correct answer ability to synthesize info & apply it to NICU ability to observe infant & environment & identify subtle nuances of behavior & physiology interest in & ability to bring about changes for infant understanding one's own interpersonal communication & how to modify if it response to family, staff, needs etc commitment to seek ongoing knowledge, education & peer consultation in this field ability to provide formal & informal educational programs insight into one's professional knowledge & skills ability to value, communicate & collaborate w/ other NICU team members & resources understanding of ability to articulate one's values & attitudes understanding of the AOTA code of ethics as it applies to NICU General Responsibilities in NICU - Correct answer evil & treatment of infants w/ a variety of diagnoses which may affect neurodevelopment, neuromuscular, neurobehavioral, MSK, oral motor &/ feeding/ swallowing therapeutic interventions to optimize overall development, oral skills & prevent squeal splinting as indicated (rarely indicated) education of parents & staff regarding OT services in the NICU, premature development, positioning, stress/ stability cues, bottle & breast feeding, developmental milestones etc. OT Evils - Correct answer may be observational/ hands-on (not a traditional rehab model for evils/ interventions) assess -tolerance to caregiving & environmental stimuli -resting posture -muscle tone -movement patterns -quality of sleep & arousal -orientation to auditory & visual stimuli -response to nurturing touch -self-calming abilities -bottle/ breast feeding readiness & performance Types of evils - Correct answer NIDCAP evaluation - baseline, positioning, stress signals, stability signals, feeding Hammersmith evil Gesell - full term (45 wks.) OT Treatment Plans - Correct answer based on each baby's specific strengths, needs & vulnerabilities continually adapted as baby matures/ medical status changes pts are seen 2-5x/week until infant is d/c from hospital/ goals met Goals Focus on - Correct answer improving neuromuscular status, neurobehavioral status, oral-motor performance, tolerance to handling, developmental milestones & parent education Precautions/ Contraindications for OT - Correct answer infant's condition is assessed constantly for tolerance to handling, stability &/ for any concerns that may arise during intervention medical stability dictates intervention sedation status stress level from previous procedure(s) line stability infant's state (don't wake a sleeping baby!) did infant just feed? OT Interventions - Correct answer developmentally supportive consist of: -environmental & care giving modifications to reduce stress & promote sleep -supportive the infant during medical procedures -therapeutic positioning -nurturing touch -promotion of skin-to-skin contact (Kangaroo Care) -non-nutritive sucking -bottle feedings -assistance w/ breast feeding -family education/ collaborative/ support -older stable infants receive traditional developmental stimulation to achieve milestones D/C & Beyond - Correct answer parents are educated on tummy time, developmental milestones, infant cues & feeding skills (prior to/ at d/c) parents must demonstrate competency in caring for infant & ability to feed infant prior to d/c infant requires ongoing developmental assistance; OT will make a referral to ECI program in county of residence. referrals only made w/ parent approval infants that meet criteria will return to our preemie/ special services clinic in order for OT, PT & SLP to monitor progress & screen for potential problems Actual Age v. Corrected Age - Correct answer developmental skills for ___ I was born on ___ at ___ wks. gestational age corrected age means the age your baby would be if they were born on the due date OT Credentials & Certifications in UTMB NICU - Correct answer OTR COTA NIDCAP (neonatal individualized developmental care assessment plan) certified NOMAS (neonatal oral motor assessment scale) certified State certified Breastfeeding educators CITMI (certified infant touch & massage instructors)