Exam 3

Question 1

Nasogastric tubes are used for feeding and for gastric suction

Answer 1

Baby may have an NG tube or OG (orogastric) tube

Question 2

Baby may have an umbilical artery catheter, umbilical vein catheter, or both

Answer 2

○ An umbilical artery catheter is placed into the umbilical cord stump then threaded into one of the two umbilical arteries and into the aorta. It is used to monitor arterial blood glasses.
It is rarely left in place more than 1 week.
○ An umbilical vein catheter is placed into the umbilical stump and progressed through the
ductus venosus and into the inferior vena cava. It remains in place about a week and is used for fluid and medication administration and can be used for blood pressure monitoring.
○ Inserted right after delivery or else the stump will dry out

Question 3

Nasal canula are available in different sizes and allows for visualization of the baby’s face

Answer 3

Usually for older babies

Question 4

Continuous positive airway pressure (CPAP) is useful for infants unable to obtain adequate oxygenation by nasal canula alone.

Answer 4

CPAP helps keep alveoli open so gas exchange is efficient

Question 5

An endotracheal tube (ET) is placed by intubation through the infant’s mouth. The ET tube is then
attached to a ventilator.

Answer 5

Far less common, they try not to do ET anymore if possible

Question 6

An oxygen hood is appropriate for infants who do not need supplemental oxygen pressure.

Answer 6

If the infant is removed from the hood (for example, during a feeding) oxygen should be
supplied by nasal canula.

Question 7

Approximately 11.6% of babies are born before 37 weeks every year in the United States

Answer 7

34-37 weeks do pretty well & may not need NICU

Of those babies, 3.4% are born before 34 weeks

Question 8

Preterm babies face many challenges including

Answer 8

○ Respiratory distress syndrome (RDS)
○ Bronchopulmonary Dysplasia (BPD)
○ Intraventricular hemorrhage (IVH)

○ Necrotizing Enterocolitis (NEC)

Question 9

Risks for prematurity are many and include:

Answer 9

○ Infection (ex. mom has GI or GU infection)
○ Fetal anomalies
○ Preeclampsia/eclampsia

Question 10

Risks for prematurity are many and include:

Answer 10

○ Infection (ex. mom has GI or GU infection)
○ Fetal anomalies
○ Preeclampsia/eclampsia (Delivery is the only way to treat this)

Question 11

Respiratory distress

Answer 11

■ Baby has very small & immature resp system w/ narrow passageways
■ The alveoli are underdeveloped; little to no surfactant so gas exchange cannot
occur well

Question 12

Retinopathy of prematurity

Answer 12

Immature / weak vessels

Question 13

Potential complications for infant include

Answer 13

○ Hyperbilirubinemia
○ Patent ductus arteriosus
○ Bronchopulmonary dysplasia
○ Sepsis
○ Necrotizing enterocolitis
○ Severe intraventricular hemorrhage
○ Periventricular leukomalacia

Question 14

Hypoglycemia

Answer 14

■ Preterm are at risk bc they didn’t have the reserves they need when born, were not being profused well, liver is immature so they cannot make glucose, & metabolic rate is up from stress

Question 15

Increased hospitalizations in childhood

Answer 15

At risk for infection

Question 16

Impairments of learning and memory

Answer 16

Brain not developed/mature enough

Question 17

Cerebral palsy

Answer 17

Often occurs if they had lack of O2 for any period of time

Question 18

Potential long-term complications include:

Answer 18

○ Behavioral problems such as attention deficit hyperactivity disorder
○ Sensory difficulties (such as vision and hearing)
○ Chronic kidney disease
○ Respiratory disease, including asthma
○ Impaired insulin regulation as adults
○ Hypertension as adults

Question 19

Reduced reproductive capacity

Answer 19

May have infertility issues

Question 20

Factors that contribute to respiratory issues for preterm infants include:

Answer 20

○ Surfactant (responsible for alveoli expansion and facilitating gas exchange) production is
decreased.
○ Airway lumens are small.

Question 21

Premature infants lack a gag reflex

Answer 21

At risk for aspiration

Question 22

Apnea

Answer 22

is common in preterm infants and significant if breathing stops for more than 20 seconds or is associated with either a heart rate less than 70 to 80 bpm or oxygen saturation below 80% to 85%

Question 23

Respiratory distress syndrome (RDS) is caused by

Answer 23

insufficient surfactant and immature lungs

Question 24

Signs and symptoms of RDS include

Answer 24

○ Low oxygen saturation
○ Decreased lung sounds
○ Nasal flaring
○ Use of expiratory grunting
○ Use of accessory muscles of breathing

Question 25

RDS Treatment

Answer 25

respiratory support with either CPAP or positive end expiratory pressure (PEEP) to keep alveoli open

Question 26

Supportive Care measures / outcomes

Answer 26

can lead to better outcomes
Supportive care measures include maintaining thermoregulation and providing adequate nutrition.
○ Keep baby warm- when they get cold, they are at risk for resp depression & distress
○ Adequate nutrition- metabolic rate is very high & at risk for hypoglycemia

Question 27

RDS additional info

Answer 27

● Really only a disorder of preterm infants, you don’t see this in term babies
● Normal breaths/min is 30-60
● Cyanosis is always a later sign
● Very difficult to feel peripheral pulse on these babies

Question 28

Nursing Interventions: Infant Respiratory Distress Syndrome

Answer 28

● Ensure orders (chest x-ray, lab work, etc.) are obtained.
● Monitor for further decompensation.
● Notify provider of changes in condition.
● Ensure infant is stressed as little as possible by:
○ Regulating temperature to decrease risk of cold stress.
○ Ensuring good nutrition.
● Often give surfactant replacement
● Want to detect early.
● Good assessments are key- is baby pink? Are they flexed? What is going on?