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81 Cards in this Set
- Front
- Back
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What is extremely low-birth-weight infants?
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Infants whose birth weigh is 1000 grams or less
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What problems may affect the respiratory systems of preterm infants?
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1. Decreased number of functional alveoli
2. Deficient surfactant levels 3. Greater collapsibility or obstruction of respiratory passages 4. Insufficient calcification of the bony thorax 5. Weak or absent gag reflex 6. Immature and friable capillaries in the lungs 7. Greater distance between functional alveoli and the capillary bed |
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What is the normal respiratory rate of infants?
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30 to 60 breaths/min
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What are the early signs of respiratory distress?
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Flaring of the nares and expiratory grunting
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What indicates worsening respiratory distress?
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Seesaw breathing patterns, retractions, flaring of the nares, expiratory grunting, and/or apneic spells
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What is normal periodic breathing?
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5- to 10-second respiratory pauses followed by 10 to 15 seconds of compensatory rapid respirations
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What is apnea?
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15- to 20-second cessation of respirations
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What are symptoms of hypovolemia or shock?
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Hypotension, slow capillary refill (>3 seconds), and continued respiratory distress despite provision of oxygen and ventilation
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What factors place preterm infants at risk for temperature instability?
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1. Large body surface area in relation to weight
2. Minimal insulating subQ fat 3. Limited stores of brown fat 4. Fragile capillaries 5. Decreased or absent reflex control of skin capillaries (shiver response) 6. Inadequate muscle mass activity (rendering the preterm infant unable to produce its own heat) 7. Poor muscle tone resulting in more body surface area being exposed to the cooling effects of the environment 8. An immature temperature regulation center in the brain |
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What are the signs of cold stress?
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1. Skin temperature decreases before other signs
2. RR increases initially, then apneic spells occur 3. HR increases initially, then bradycardia occurs 4. Mottled skin color with acrocyanosis increasing to cyanosis 5. Increased physical activity in term infants without respiratory distress -or- Decreased physical activity in term infants with respiratory distress -or- Decreased physical activity in preterm infants 6. Unstable thermoregulatory control in premature infants |
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What problems cause the preterm infant's CNS to be susceptible to injury?
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1. Birth trauma that includes damage to immature structures
2. Bleeding from fragile capillaries 3. An impaired coagulation process, including prolonged prothrombin time 4. Recurrent anoxic episodes 5. Predisposition to hypoglycemia |
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What disadvantages do preterm infants have regarding intake?
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1. Weak or absent suck, swallow, gag reflexes
2. A small stomach capacity 3. Weak abdominal muscles 4. Compromised metabolic functions ==> limited store of nutrients, decreased ability to digest proteins or absorb nutrients, and immature enzyme systems |
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What is the preterm infant's immature renal system unable to do?
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1. Adequately excrete metabolites and drugs
2. Concentrate urine 3. Maintain acid-base, fluid, or electrolyte balance |
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What hematologic problems are preterm infants predisposed to?
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1. Increased capillary fragility
2. Increased tendency to bleed (prolonged PTT and partial thromboplastin time) 3. Slowed production of RBCs resulting from rapid decrease in erythropoiesis after birth 4. Loss of blood due to frequent blood sampling for lab tests 5. Decreased RBC survival r/t the relatively larger size of the RBC and its increased permeability to sodium and potassium |
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What are signs of anemia to look for in infants?
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1. Decreased hemoglobin and hematocrit levels
2. Pale skin 3. Increased apnea 4. Lethargy 5. Tachycardia 6. Poor weight gain |
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Why are preterm infants at increased risk for infection?
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1. They have a shortage of stored maternal immunoglobulins
2. They have an impaired ability to make antibodies 3. They have a compromised integumentary system |
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What is the single most important measure to prevent iatrogenic infections?
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Handwashing
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What is important to remember regarding growth and development of preterm infants?
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The growth and developmental milestones are corrected for gestational age until the child is approximately 2.5 years old
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What characteristics should the infant exhibit at discharge from the hospital?
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1. Ability to raise head when prone and hold the head parallel with the body when tested for head-lag response
2. An ability to cry with vigor when hungry 3. An appropriate amount and pattern of weight gain according to a growth grid 4. Neurologic responses appropriate for corrected age |
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What environmental support measures are provided for preterm infants in NICU or ICU?
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1. An incubator or radiant warmer placed over the infant to control body temperature
2. Oxygen administration, depending on the infant's cardiopulmonary and circulatory status 3. Electronic monitors as needed for the observation of respiratory and cardiac functions 4. Assistive devices for positioning the infant in neutral flexion and with boundaries 5. Clustering of care and minimization of stimulation according to infant cues |
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What are various metabolic measures provided in NICU and ICU?
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1. Parenteral fluids to help support nutrition and maintain normal arterial blood gas (ABG) levels and acid-base balance
2. IV access to facilitate the administration of antibiotic therapy if sepsis is a concern 3. Blood work to monitor ABG levels, pH, blood glucose levels, electrolytes, and the status of blood cultures |
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What are the clinical criteria for identifying the need for oxygen?
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1. Increased respiratory effort
2. Respiratory distress with apnea 3. Tachycardia 4. Bradycardia 5. Central cyanosis with or without hypotonia |
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What is the goal of weaning?
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The withdrawal of all oxygen support. However, some infants do not achieve this before discharge from hospital and may require home oxygen therapy for several months
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What is assessed during the weaning process?
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Signs and symptoms indicating poor tolerance of the process, such as increased pulse, respiratory distress, or cyanosis, or a combination of these
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What are the signs and symptoms indicating poor tolerance of the weaning process?
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Increased pulse, respiratory distress, or cyanosis, or a combination of these
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What are the benefits of nonnutritive sucking?
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1. Improve oxygenation
2. May lead to decreased energy expenditure with less restless 3. Positive weight gain 4. Promote faster attachment to nipple when oral feedings are initiated |
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How soon can the suck-and-swallow reflex be coordinated?
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As early as 32 weeks of gestation
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Why should harsh lights not be used with preterm infants?
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The retina of the immature infant has little protection from the nearly translucent eyelid
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What are some stress cues of infants?
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1. Increased metabolic rate
2. Increased oxygen and caloric use 3. Depression of the immune system |
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What body position is preferred for preterm infants in the nursery?
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Side-lying or prone (compared to supine)
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What encourages flexion of the extremities for the preterm infant?
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1. Prone position
2. A sling or hip roll |
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What are the infant's clues to overstimulation?
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1. Averting the gaze
2. Hiccuping 3. Gagging 4. Regurgitating food |
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What is indicative of a relaxed infant?
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1. Stabilization of vital signs
2. Closed eyes 3. Relaxed posture |
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What is kangaroo care?
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Skin-to-skin holding
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What are the reported benefits of kangaroo care?
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1. Increased breast milk output
2. Fewer feelings of helplessness r/t the experiences in the NICU 3. Infants maintain their temperatures and oxygenation levels better 4. Infants experience fewer episodes of crying, apnea, and periodic respirations |
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What is respiratory distress syndrome (RDS)?
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A lung disorder usually affecting preterm infants
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What causes RDS?
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1. Lack of pulmonary surfactant
2. Progressive atelectasis 3. Loss of functional residual capacity 4. A ventilation/perfusion imbalance with an uneven distribution of ventilation |
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What causes surfactant deficiency?
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1. Insufficient surfactant production
2. Abnormal composition and function 3. Disruption of surfactant production 4. Weak respiratory muscles and an overly compliant chest wall 5. Combination of the above factors |
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What causes further compromised lung capacity?
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The presence of proteinaceous material and epithelial debris in the airways. The resulting decreased oxygenation, cyanosis, and metabolic and respiratory acidosis can cause the pulmonary vascular resistance (PVR) to be increased. This increased PVR can lead to right-to-left shunting and a reopening of the ductus arteriosus and foramen ovale.
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What can an increased PVR lead to?
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A right-to-left shunting and a reopening of the ductus arteriosus and foramen ovale
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What are the clinical signs of RDS?
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1. Tachypnea
2. Grunting 3. Flaring 4. Retractions 5. Cyanosis 6. Increased work of breathing 7. Hypercapnia 8. Respiratory or mixed acidosis 9. Hypotension and shock |
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What is the treatment of RDS?
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Supportive - adequate ventilation and oxygenation must be established and maintained in an attempt to prevent ventilation/perfusion mismatch and atelectasis. Exogenous surfactant may be administered.
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What complications are associated with mechanical ventilation?
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1. Pulmonary interstitial emphysema
2. Pneumothorax 3. Pneumomediastinum 4. Pneumopericardium |
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How is acid-base evaluated in the preterm infant?
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By monitoring the ABG values
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What does frequent blood sampling require?
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Arterial access either by umbilical artery catheterization or by a peripheral arterial line
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How are trends in ventilation and oxygenation documented?
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With pulse oximetry and transcutaneous carbon dioxide and oxygen monitors
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What is evaluated to rule out neonatal pneumonia?
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1. Sepsis evaluation
2. CBC with differential 3. Lumbar puncture |
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What is administered while the results of cultures are pending when trying to rule out neonatal pneumonia?
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Broad-spectrum antibiotics
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What is the function of capillary blood gas values?
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Indicate the pH and P-CO2 status in infants who are in more stable condition
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What helps evaluate the infant's hydration status?
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Daily monitoring of the electrolyte values, urinary output, specific gravity, and weight
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What are the normal arterial blood gas values for neonates?
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1. pH = 7.32 - 7.49
2. Arterial O2 pressure = 60-70 mmHg 3. CO2 pressure = 26-41 mmHg 4. Bicarbonate (HCO3) = 16-24 mEq/L 5. O2 Sat = 40% - 90% |
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What assessment tools have been developed to assess pain in neonates?
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1. CRIES
2. Pain Assessment Tool (PAT) 3. Scale for Use in Newborns (SUN) 4. Behavioral Pain Score (BPS) etc. |
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Do neonates remember pain?
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Reports have indicated that infants remember painful events and that continual exposure to pain affects development, especially in response to human contact
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What are some manifestations of acute pain in the neonate?
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1. Increased HR
2. Increased BP 3. Rapid, shallow respirations 4. Decreased O2 sat 5. Crying, whimpering, groaning 6. Grimaces, brow furrowed, chin quivering, eyes tightly shut, mouth open and squarish 7.Limb withdrawal, thrashing, rigidity, flaccidity, fists clenched |
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What are some nonpharmacological measures to alleviate pain?
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1. Repositioning
2. Swaddling 3. Containment 4. Cuddling 5. Rocking 6. Music 7. Reducing environmental stimulation 8. Tactile comfort measures 9. Nonnutritive sucking 10. Use of oral sucrose |
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What is the most common pharmacological measure to alleviate pain?
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Morphine (with fentanyl as an effective alternative)
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What are near-term infants?
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Infants born between 34 and 37 weeks of gestation
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What complications arise with near-term infants?
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They experience temperature instability; hypoglycemia and poor feeding necessitating IV therapy; jaundice; evaluation for sepsis 3x more often than term infants, and need treatment with antibiotics
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What is a postmature infant?
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One that is born after 42 weeks of gestation
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What complications occur with postmaturity?
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Placental insufficiency, resulting in a fetus that has a wasted appearance (dysmaturity) at birth because of loss of subQ fat and muscle mass
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What is dysmaturity?
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Wrinkly, pruny appearance
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What are postmature infants at risk for?
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Meconium Aspiration Syndrome (MAS) because there is insufficient gas exchange in the postmature placenta, which can lead to hypoxia
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What methods can be used to prevent Meconium Aspiration Syndrome (MAS)?
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1. Amnioinfusion to thin out the meconium particles
2. Use of surfactant lavage immediately after birth 3. Suctioning of the hypopharynx after birth of the head and before birth of the shoulders |
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What is persistent pulmonary hypertension of the newborn (PPHN)?
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Combined findings of pulmonary hypertension, right-to-left shunting, and a structurally normal heart
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What is characteristic of PPHN?
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It usually proceeds into a downward spiral of exacerbating hypoxia and pulmonary vascoconstriction
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What do infants born with PPHN present with at birth?
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Tachycardia and cyanosis
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What are the physical characteristics of postmature infants?
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1. Normal skull, but the reduced dimensions of the rest of the body make the head look disproportionately large
2. Dry, cracked, parchment-like skin at birth 3. Hard nails extending beyond the fingers 4. Profuse scalp hair 5. Depleted subQ fat layers, leaving the skin loose ("old and wrinkly") 6. Long and thin body 7. Absent vernix 8. Often presence of meconium staining or perinatal infection 9. May have alert, wide-eyed appearance symptomatic of intrauterine hypoxia |
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What problems commonly affect SGA and IUGR infants?
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1. Perinatal asphyxia
2. Meconium aspiration 3. Hypoglycemia 4. Polycythemia 5. Heat loss |
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What are the symptoms of hypoglycemia?
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1. Poor feeding
2. Hypothermia 3. Diaphoresis 4. Tremors and jitterness 5. Weak cry 6. Lethargy 7. Floppy posture 8. Convulsions or coma |
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What is polycythemia?
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Hyperviscosity of the blood (thick blood)
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What causes polycythemia?
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Fetal hypoxia and intrauterine stress that forces the body to produce more RBCs in an attempt to provide oxygen to the developing fetus
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What increases the susceptibility of SGA infants to heat loss?
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1. Less muscle mass
2. Less brown fat 3. Less heat-preserving subQ fat 4. Little ability to control skin capillaries |
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What complications may be experienced by LGA infants?
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1. Transposition of the great vessel
2. Beckwith-Wiedemann syndrome 3. Birth trauma 4. Asphyxia or CNS injury, or both 5. Polycythemia??? |
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What is apnea?
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Cessation of respirations for MORE than 15 seconds associated with cyanosis
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What is bronchopulmonary dysplasia (BPD)?
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Pulmonary condition affecting preterm infants who have experienced respiratory failure and have been O2 dependent for more than 28 days
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What is dysmaturity?
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Fetal undergrowth of any cause
Also known as INTRAUTERINE GROWTH RESTRICTION (IUGR) |
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What is Transient Tachypnea of Newborn (TTN)?
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1. Rapid and labored breathing in newborns that usually goes away after a few days (with treatment)
2. If not treated, insufficient O2 to the lungs will cause insufficient production of surfactant and can lead to respiratory distress |
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What is the best formula choice, and why -- 13, 20, or 24 calorie based formula?
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20 because it is most similar in calories to breast milk
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Like the preterm infant, the newborn with postmaturity is at high risk for cold stress due to what?
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Decreased subcutaneous tissue
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What is an early sign of sepsis is in newborns?
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Tachycardia
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What is the MAJOR concern for newborns with a high concentration of indirect bilirubin?
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Neurotoxicity
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