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68 Cards in this Set
- Front
- Back
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-surfactant can be administered as an adjunct to what 2 other things?
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oxygen and ventilation therapy
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-before ________wks of gestation, most infants do not produce enough surfactant to survive extrauterine life
as a result, what is decreased? |
34
- lung compliance is decreased and not enough gas exchange occurs as the lungs become atelectatic (incomplete expansion) and require greater pressures to expand |
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-with administration of artificial surfactant, what is improved?
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respiratory compliance is improved until the infant can generate enough surfactant on his/her own
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-potential SE of surfactant: (2)
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patent ductus arteriosus (PDA) and pulmonary hemorrhage
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-a method of providing nourishment to the infant who is compromised by respiratory distress, infant who is too immature to have a coordinated suck and swallow reflex, or the infant who is easily fatigued by sucking
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Gavage feeding
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-in gavage feeding, what is given to the infant through a nasogastric or orogastric tube
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breast milk or formula
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in gavage feeding, what does it spare the infant to do?
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(This spares the infant the work of sucking)
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-what may be used to stimulate or prime the GI tract to achieve better absorption of nutrients when bolus or regular intermittent gavage feedings can be given
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minimal enteral nutrition (MEN)
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-the volume of the continuous feedings is recorded _____,
the residual gastric aspirate is measured every ____hours. -residuals of less than ____ of a feeding can be refed to the infant to prevent what? |
hourly
4 hours a fourth / the loss of gastric electrolytes |
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-feeding is usually stopped if the residual is greater than a ______of the feedings and is not resumed until the infant can be assessed for a possible feeding intolerance
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quarter
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-the orogastric route (mouth) for gavage feeding is preferred, why?
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b/c most infants are nose breathers
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-documentation of a preterms infant’s sucking patterns also can be used to determine what?
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its readiness to nipple feed
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-feedings are advanced from passive to active. give example
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(parenteral and gavage) to (nipple and breast feeding)
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-feedings are advanced slowly and cautiously b/c if feedings are advanced too rapidly, tcan result in what?
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the infant may vomit (risk for aspiration), with diarrhea, abdominal distention, and apneic episodes
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-rapid advancement of feedings may also cause -2
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fluid retention with cardiac compromise
pronounced diuresis with hyponatremia |
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-soy and elemental formulas are used only for infants with very special dietary needs (2 ex)
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(allergies to cows milk or chronic malabsorption)
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-the infant receiving gavage feedings progresses to bottle feedings or breast milk feedings. To do this, the gavage feedings are decreased as the infants ability to suckle breast milk or formula improves
-often during this transition, the infant is fed by what? |
both nipple and gavage feeding to ensure the intake of both the prescribed volume of food and nutrients
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-when there is an indwelling tube, during nipple feedings, some infants experience what? .....nurses must watch for that
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an increased respiratory effect,
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-infants in NICUs are exposed to high levels of auditory input from various machine alarms which can cause adverse effects
-give ex |
-the infants hearing may be damaged if it is exposed to a constant decibel level of 90 db or frequent decibel swings higher than 110 db
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-what has been recognized as a SE of the NICU envt
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cochlear damage
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-respiratory equipment or a phototherapy mask may later affect the infant’s vision, making it difficult for the infant to do what
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interact with caregivers and family members
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-the infant may be unable to establish what because of the continuous exposure to overhead lighting
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diurnal and nocturnal rhythms
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-sedation or pain meds affect the way in which the infant perceives the
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envt
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-diuretics, antibiotics (gentamicin) and antimalarial agents can potentiate what
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noise-induced hearing loss
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-the retina of the immature infant has little protection from the nearly translucent eyelid, thus allowing light to almost continuously penetrate the retina unless it is artificially protected by dimming the lights or using isolette covers
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-the retina of the immature infant has little protection from the nearly translucent eyelid, thus allowing light to almost continuously penetrate the retina unless it is artificially protected by dimming the lights or using isolette covers
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-light and sound are known adverse stimuli that add to an already stressed preterm infant - how do we know that?
what is the result? -increased: -increased use of: -depression of: |
stress cues,
increased metabolic rates, increased oxygen and caloric use, depression of the immune system |
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Routine hearing screening should be performed in all infants before discharge, with universal screening completed by no later than
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the 3rd mo of life
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Kangaroo Care
-skin to skin holding how is the infant dressed? -what does it do to the infants temperature? |
-the infant is dressed only in a diaper
-the parents body temperature also functions as an external heart source that enhances the infant’s temperature regulation |
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Kangaroo Care
-the mothers report increased |
breast milk output and fewer feelings of helplessness related to their experiences in the NICU
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Kangaroo Care
-infants have been found to maintain what? (2) -they also experience fewer episodes of what? (3) -they have also been observed to be more: |
-the infants have been found to maintain their temperatures and oxygenation levels better
-experience fewer episodes of crying, apnea , and periodic respirations. -they also have been observed to be alert and quiet longer and have higher HRs |
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Parental Support
-mothers often state that their greatest source of stress is |
the appearance of their baby
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-the criteria showing an infant’s readiness for early discharge is what: (3)
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the infant’s physiologic condition is table,
the infant is receiving adequate nutrition the infant’s body temperature is stable |
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Meconium Aspiration Syndrome
--indicative of |
nonreassuring fetal status
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Meconium Aspiration Syndrome
-many infants with meconium staining exhibit no signs of depression at birth true or false |
true
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Meconium Aspiration Syndrome
-use of what has decreased some of the incidence |
amnioinfusion
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Meconium Aspiration Syndrome
because these infants are surfactant deficient, one method of prevention of MAS is to use |
surfactant lavages immediately after birth
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Meconium Aspiration Syndrome
-the presence of who is required at the birth of any infant with meconium-stained amniotic fluid |
a team skilled neonatal resuscitation
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Meconium Aspiration Syndrome
-if the infant is very depressed and the meconium is not removed from the airway at birth, it can migrate down to the terminal airways, causing mechanical obstruction leading to MAS -which can lead to? |
-such meconium aspiration can cause a chemical pneumonitis
-these infants may developed persistent pulmonary hypertension of the Newborn |
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Pain management
-evaluation must be based on what 2 things? |
physiologic changes and behavioral observations
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Pain management
-pain is the 5th vital sign true or false |
true
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Pain management
what is the most consistent and specific characteristics |
-facial expression
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Pain management
-preterms response to pain may be -2 |
blunted or absent
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Pain management
-when in doubt about the presence of pain in infants, base your decision for the need for intervention on the following rule: |
whatever is painful to an adult or child is painful to an infant unless proved otherwise.
Anticipate pain: do not wait for pain symptoms to appear before intervening |
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Pain management
-most infants respond with |
increased body movements, but the infant may be experiencing pain even when lying quietly with eyes closed
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Pain management
-nonpharm measures: to alleviate pain include |
repositioning,
swaddling, containment, cuddling, rocking, music, reducing envt stimulation, tactile comfort measures, nonnutritive sucking, use of oral sucrose |
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Pain management
-pharm measure: what is the most widely used opioid analgesic for neonatal pain, fentanyl is also used |
morphine
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Pain management
-parents have the right to withhold consent for invasive procedures true or false |
true
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-in preterm infants, additional stimulation such as stroking or envt light or noise may increase
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physiologic distress
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-kangaroo care is one method of parental intervention and comforts and calms the infant
-pain management is a standard of care, and it is considered unethical not to prevent and effectively treat pain true or false |
true
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ROP – retinopathy of prematurity
what does it affect? |
-affects the developing retinal vessels of preterm infants
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ROP – retinopathy of prematurity
-the normal retinal vessels begin to form in uterus at approximately 16 weeks in response to an unknown stimulus -the vessels reach maturity when |
at 42-43 weeks after conception
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ROP – retinopathy of prematurity
-the key to the management of ROP is prevention of -2 |
preterm birth and early detection
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ROP – retinopathy of prematurity
what is used in the prevention and treatment of ROP -3 |
-laser photocoagulation,
vitamin E therapy, decreasing the intensity of ambient light |
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ROP – retinopathy of prematurity
-another factor contributing to ROP is |
hyperglycemia
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-parents of preterm infants must accomplish numerous psychological tasks before effective relationships and parenting patterns can occur
1. -when does this process begin? -how long does it lost? when does being able to anticipate the loss give families and opportunity an opportunity to do? |
anticipatory grief over the potential loss of an infant
-(this process begins during labor -lasts until the infant dies or shows evidence of surviving) - to plan, feel more in control of their situations, and say good bye in a special way. |
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-parents of preterm infants must accomplish numerous psychological tasks before effective relationships and parenting patterns can occur
2. -what characterize this phase? -how long does it last? |
the mother’s acceptance of her failure to give birth to a healthy, full-term infant.
-Grief and depression typify this phase, -persists until the infant is out of danger and is expected to survive |
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-parents of preterm infants must accomplish numerous psychological tasks before effective relationships and parenting patterns can occur
3. -what forms in this stage? |
resuming the process of relating to the infant.
As the baby’s condition begins to improve and the baby gains weight, feeds by nipple, and is weaned from the incubator or radiant warmer, the parent can begin the process of developing an attachment to the infant that was interrupted by the infant’s critical condition at birth |
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-parents of preterm infants must accomplish numerous psychological tasks before effective relationships and parenting patterns can occur
4. |
learning about the ways in which this baby differs in terms of his or her special needs and growth patterns, care giving needs, and growth and development expectations
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-parents of preterm infants must accomplish numerous psychological tasks before effective relationships and parenting patterns can occur
5. |
adjusting the home envt to accommodate the needs of the new infant (limit the number of visitors to minimize exposure of the infant to pathogens)
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Corrected age
-the age of a preterm newborn is corrected by adding |
the gestational age and the postnatal age
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Corrected age
-for ex: an infant born at 32 weeks of gestation 4 weeks ago would now be considered ___ weeks of age. |
36
-the infants corrected age at 6 mo after the birth date is then 4 mo, and the infants responses are accordingly evaluated against the norm expected for a 4 mo old infant |
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Corrected age
-the preterm infant experiences catch up body growth when |
during the first 2 yrs of life
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Corrected age
-what is the first thing to experience catching up growth, followed by a gain in n -2 |
head
wt and height |
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-s/s when the preterm infant can go home
-4 |
-an ability to raise the head when prone and to hold the head parallel with the body when tested for the head lag response
-an ability to cry with vigor when hungry -an appropriate amount and pattern of weight gain according to a growth grid -neurologic responses appropriate for corrected age |
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Why are preterms more likely to be hypoglycemic?
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Using glucose fast to try and keep themselves warm,
SO WHAT SHOULD THEY DO??????????? eat small amounts frequently to keep sugars up |
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Respiratory distress syndrome (RDS) is caused by what:
Respiratory signs appear within how many hours what are some signs that appear? |
Caused by lack of surfactant
6 hours of birth Crackles, poor air exchange, pallor, retractions (when they breath, the muscle suck in at the chest), apnea (no energy to breath) |
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Complications associated with oxygen therapy
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Retinopathy of prematurity (ROP)
Affects developing retinal vessels in the eyes. They are not fully developed until 43 weeks of more. Retinas are very sensitive. The oxygen can cause injury to the eyes. |
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Meconium aspiration syndrome (MAS)/ causes _______________________–when the babies poop from stress or maturity, they breath it in and it gets in their lungs. When mec fluid comes out, extra staff needed b/c we don’t know what is going to happen
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chemical pneumonitis
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