Neonatal Developmental Care and Specialists, Exams of Nursing

Download Neonatal Developmental Care and Specialists and more Exams Nursing in PDF only on Docsity! Pads- NICU and Neonatal Care Exam questions with answers Nursery classification: - Correct answer Level I Level II Level III Level IV Level 1: - Correct answer Hospital setting with the ability to provide neonatal resuscitation and postnatal Care of healthy newborn infants and stable late‐preterm infants born at 35‐37 weeks' Gestation Ability to stabilize ill newborns or infants born at less than 35 weeks' gestation prior to transfer to a higher level facility Level 2: - Correct answer Hospital setting with special care for infants born at or less than 32 weeks' gestation with Birth weight of 1500 g or less who are physiologically immature but are expected to Resolve rapidly with continued maturation (body temp, oral feedings, etc.) Level 2 NICUs may serve infants who are recovering From a higher level of care. Level 2 NICUs can provide continuous positive airway pressure and may provide mechanical ventilation for brief periods. Level 3: - Correct answer Hospital setting able to provide continuous life support and comprehensive care for extremely high‐risk Neonates and those experiencing critical illnesses; services for infants born extremely premature Level 3 NICUs have access to a range of pediatric medical Subspecialists and are equipped to provide critical medical and surgical care with ongoing assisted ventilation, Advanced imaging services, ophthalmologic services, Surgical specialists and anesthesiologists on site or close by Level 4: - Correct answer Abilities of level 3 NICU and are housed in institutions that can provide on‐site surgical repair of serious congenital or Acquired malformations; can offer outreach education to other area NICUs Initially infant survival rate was the indicator of __________ - Correct answer NICU success As survival rates have increased, focus on environmental and caregiver influences have emerged: - Correct answer Infant development Family issues Primary medical concerns To meet these emerging considerations for NICU care a ______________________________________________ role has to be established: - Correct answer Neonatal development specialist The following can be Neonatal developmental specialist: - Correct answer OT PT SLP Nurse Child life specialists Current NICU services are ______________________ From birth to promote physiologic stability and Optimal neurodevelopment instead of waiting For the baby to become medically stable: - Correct answer neuroprotective Two NICU neuroprotective services: - Correct answer Protect from sleep disruption Protect from excessive sensory input As the neonate progresses and becomes more Physiologically stable, traditional therapy Methods may be introduced to address issues In: - Correct answer ROM Muscle tone Extreme irritability Poor feeding Developmental delay Gestational age (GA) - Correct answer total time between the First day of the last normal menstrual period and the day of birth in completed weeks; Remains the same after birth Full term: - Correct answer 38-42 weeks Preterm: - Correct answer prior to 38 weeks Late-preterm: - Correct answer 34-37 weeks Post-term: - Correct answer after 42 weeks Positioning and handling Safeguarding sleep Minimizing stress and pain Protecting skin Optimizing nutrition NICU sensory components: - Correct answer lighting Sound Environmental modifications Development of fetal sensory systems: - Correct answer Chronological, but overlapping order Limbic system (emotions), tactile (somatosensory), movement (kinesthetic, proprioceptive, vestibular), smell (olfactory), and hearing (auditory) are complete structurally, but are immature functionally at the earliest age of viability These systems respond to external stimuli typically by 25‐28 weeks' gestation and exhibit in utero learning Developmentally supportive care will address the developmental needs of each of the sensory systems. The visual system structures and functions are Not viable because their earliest use is typically at gestational term Occurs when one developing sensory system is stimulated out of turn or overwhelmed with inappropriate stimuli: - Correct answer Sensory interference Auditory is developed in the ____________ without completing sensory development: - Correct answer Last trimester Vision: Premature birth with early exposure to light may facilitate earlier _______________; however, premature infants exposed to light in the NICU during the ________ trimester have an increased rate of auditory processing difficulties by school age: - Correct answer Visual system function Last Developmental interventions in the NICU: - Correct answer Preservation of sleep, calm and organized states NICU light and sound modifications Therapeutic positioning Nurturing touch Non‐nutritive sucking Alteration of caregiver timing and handling Techniques Increased family involvement A primary goal of neonatal care is to arrange a neutral thermal environment in which the infant is not gaining or losing heat at the expense of energy expenditure: - Correct answer Thermoregulation Infants in the NICU must be protected from _____ ____________ during each and every contact: - Correct answer Heat destabilization ________ _________ and _______________ can cause serious complications for infants in the NICU: - Correct answer Cold stress Overheating Pre-term infants are at risk for excessive heat loss and are at risk for cold stress due to: - Correct answer Extended postures Thin skin Immature thermoregulation Reduced insulating subcutaneous fat Pulmonary dysfunction CNS immaturity Frequent caregiving interventions Kangaroo care: - Correct answer Skin‐to‐skin holding of the infant on the bare chest of the mother or father Optimal environment for newborns, particularly preterm infants Provides infants with tactile and proprioceptive input necessary for his/her developing brain When parents are unavailable, Thermoregulation efforts are then focused on the infant's individual bed space VLBW or premature infants need to be cared for in incubators or radiant warmers Skin‐to‐skin contact, The temperature of a mother's chest will increase by 2 degrees Celsius to warm a cool infant and decrease by 1 degree Celsius to cool an overheated infant: - Correct answer Thermo synchrony Positioning: - Correct answer Midline, flexed, contained position (minimize movement and energy expenditure) Therapeutic positioning aids Swaddling Touch and proprioception: - Correct answer A high percentage of touch experiences for infants in the NICU is medically based and Often painful Non‐medical touch may be perceived as painful when it follows other painful sensations Balance medical and nurturing touch input through: - Correct answer Physical support during caregiving handling and Procedures Kangaroo care Holding by a parent Infant massage Research indicates that __________ is associated with numerous physiologic, neurologic, Behavioral and neuromuscular benefits for Infants: - Correct answer Massage With infant massage parents report: - Correct answer Decreased stress, increased Attachment, improved self‐esteem, and a more active role in caregiving Massage can be stressful to preterm infants younger than __________ weeks' PMA as well as those who are medically unstable: - Correct answer 32 weeks' Infants' physiologic and neurobehavioral responses must be carefully monitored with modifications provided as needed: - Correct answer Overstimulation Cold stress Massage can be stressful to preterm infants younger than 32 weeks' PMA as well as those who are medically unstable Static hand swaddle/facilitative tuck works is preferred Sound and noise: 1. Structures (ears: outer, middle, inner and cortical auditory center) are formed and functioning by _________ weeks’ gestation 2. Neurosensory development occurs from ________ weeks' gestation to ~_____________ months post-term - Correct answer 25 weeks gestation 25 weeks' ~5‐6 months Signs of organization - Correct answer Autonomic Motor State Attention/Interaction The premature infant must adapt and respond To many changes _______________ to survive And thrive outside the womb after birth: - Correct answer simultaneously Highly active development of the neurologic System is during the third trimester: - Correct answer Synaptogenesis Stress management in NICU: - Correct answer Pharmacologic Non-pharmacologic Non-nutritive sucking Infants prior to _______ weeks’ gestation have very fragile skin with higher risk of epidermal stripping and edema: - Correct answer 30 Bath time recommendations: - Correct answer well supported body with extremities contained Immersion in warm water preferred over sponge Bathing Swaddled bathing with immersion to the shoulders Families in the NICU: - Correct answer Issue of family Inclusion Skin-to-skin holding Discharge planning Evaluation in the NICU: 1. Do no _______ 2. ________ takes priority over continence 3. _________ evaluation tool thoroughly before interacting with an infant 4. Consider the _________ position in protecting the infant and use clinical observation of the infant and environment before _________ 5. Do not schedule a NICU evaluation based upon _________ 6. Accurately analyzing evaluation results can be __________ 7. Consider the value of ________ evaluation procedures vs. the potential stress on the infant - Correct answer 1. Harm 2. Safety 3. Review 4. Nurse's; touching 5. Convenience 6. Difficult 7. Hands-on Evaluation methods for NICU infants may include: - Correct answer Clinical Observation Consultation with parents and team Neonatal Individualized Developmental Care and Assessment Program (NIDCAP) - specialized Training required Hammersmith Neonatal Neurological Examination Infant progression in NICU In-turning: - Correct answer Immature and/or critically ill neonate Minimal handling with maximal environmental and caregiving protection Infant progression in NICU Coming-out: - Correct answer Fragile and vulnerable neonate, but there are short periods of availability to attend to their environment Graded unmoral stimulation can be provided for brief periods based on monitoring of infant state and tolerance Infant progression in NICU Reciprocity: - Correct answer Mature and stable neonate Attends and interacts when in a quiet alert state Caregiver must continue to respect approach and avoidance signals Infant’s degree of Consciousness with improvements expected With age and maturity: - Correct answer Arousal state 6 Categories of arousal state: - Correct answer State 1 = deep sleep State 2 = light sleep State 3 = transitional state of dozing or drowsiness State 4 = quiet and alert State 5 = active alert State 6 = crying Infant neurobehavioral development: - Correct answer Information on neural organization and control Can be interpreted as the infant transitions Between states. Smooth transition requires appropriate Regulation and response to a variety of sensory Stimulation. Intrinsic and extrinsic factors can affect the ability To modulate arousal state, i.e. pain, stress, Immaturity, illness, light, noise, caregiving Techniques, etc. Neuromata development - Correct answer Hypotonic to flexion Random to purposeful Reflexes become consistent Flexor tone (caudal cephalic) Posture and movement patterns Therapeutic positioning Range of motion __________ testing is extremely stressful for infants in the NICU: - Correct answer Reflex Self-regulating reflexes including ________ and _________ can demonstrate _______ reflex development: - Correct answer Suck and grasp Primitive Plasticity to adapt through life span Extremely preterm infants and LBW infants are at high risk for: - Correct answer behavioral problems ADHD ASD Anxiety Other emotional disorders Preterm survivors often have: - Correct answer neurodevelopmental impairments Neurodevelopmental impairments - Correct answer cognitive Language Behavioral issues without major neurosensory deficits Protecting sleep: - Correct answer Synaptogenesis occurs during sleep, in the absence of external stimulation Produces brain complexity and plasticity Only occurs during REM sleep after 28 weeks' gestation Minimizing pain - Correct answer preterm infants are particularly susceptible to pain Stress of typical caregiving routines and invasive procedures required by medical environment Stress has a negative effect on brain development Stress cause - Correct answer physiologic instability, medical complications, sleep disturbances, feeding issues, poor self-regulation Increased energy expenditure, decreased healing and growth, impaired physiologic stability, altered brain development Raised cortisol levels which decreases neuroplasticity reorganization and as a result learning and memory of motor skills Recommendations for caregiving in the NICU - Correct answer coordinating care among disciplines Consider the infant's cues, sleep state, and ongoing medical status to determine the timing and sequencing of caregiving Provide procedures and interventions on an individualized basis, considering the necessity rather than nursery routines Avoid unnecessary or rough handling and movement Movement should be slow and interactive with an unmoral sensory input The sensory interface of the brain is: - Correct answer the skin Recommendations for skin protection - Correct answer handling and positioning that minimizes pressure, friction, and shear is crucial for skin integrity Therapeutic positioning, interface surfaces and comfort assume high significance in NICU caregiving Bath time is often _____ and _____ for infants in the NICU - Correct answer stressful Exhausting Sanative Theory of Development - Correct answer individualized developmentally supportive and family-centered care Subsystems of emerging capabilities of preterm infants to organized and control their behavior - Correct answer Physiological or autonomic responses Motor responses State control Attention and interaction behaviors Self-regulation Infant is communicating ____ and _____ _____ through sanative theory sublevels: - Correct answer stress Stability levels Infants demonstrate _____ and ______ _____ via 5 STD subsystems - Correct answer maturity Health status Infant stress behaviors vs. stability behaviors - Correct answer the attempts of an infant to maintain or return to a calm, organized state Arousal states affect - Correct answer muscle tone Feeding performance Reaction to stimuli Arousal state may be reflective of: - Correct answer infant’s temperament Resting posture is flat and extended with ______, _______, and ______ ______ - Correct answer asymmetry Abduction External rotation Contributing negative influences include: - Correct answer gravity Hypotonic Primitive reflexes Immature neuromata control Illness Energy depletion Weight and position of medical equipment Postural alignment goals of OT in NICU - Correct answer midline Symmetrical Flexion Body awareness When is splinting necessary in the NICU? - Correct answer protecting skin integrity Facilitate active and spontaneous movement Consider proper joint alignment Monitor, adapt as needed - educate staff and caregiver(s)