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high risk infant Flashcards

(76 cards)

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1
Q

what is included on the ballard score?

A

-posture
-square window
-arm recoil
-popliteal angle
-scarf sign
-heel to ear

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2
Q

supplies checklist for preterm delivery

A

-radiant warmer preheated
-room temp at 80
-suction
-cracked heat pad
-plastic wrap/bag
-hats/blankets
-intubation kit
-ventilator/CPAP/nasal O2/ambu bag
-pulse ox, stethoscope
-emergency meds: epi and saline
-supplies for umbilical lines
-warmed transport isolette

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3
Q

methods of O2 therapy

A

-hood therapy
-nasal cannula
-CPAP
-manual ventilation
-nitric oxide therapy (“INO”)
-extracorporeal membrane oxygenation (ECMO)

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4
Q

what is adverse effect of too much oxygen in preterm infants

A

blindness
*oxygen L/min and O2%
(above 36 weeks it doesn’t matter as much)

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5
Q

-clear plastic hood over infants head
-nurse controls O2 conc

A

hood therapy

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6
Q

-delivers set pressure in spontaneously breathing infants
-keeps alveoli open
-measured by centimeters 5-10

A

CPAP (continuous positive airway pressure)

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7
Q

what number CPAP can result in a pneumothorax

A

8 cm

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8
Q

-delivers some breaths in spontaneously breathing infants on CPAP
-no ET tube

A

NIPPV
(non-invasive positive pressure ventilation)

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9
Q

-oxygen delivery needed for hypoxemia, hypercapnia, or persistent apnea
-set to provide a predetermined amount oxygen during spontaneous respirations and in absence of spontaneous respirations

A

mechanical ventilation

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10
Q

3 functional modes ventilation
-pressure ventilation
-volume ventilation
-high frequency ventilation

A

-pressure ventilation: constant flow
-volume ventilation: predetermined volume of inspiratory pressure
-high frequency ventilation: smaller volumes of O2 at more rapid rate (>300/min, jet/oscillator)

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11
Q

-oxygen delivery device
-vasodilator, decreases pulmonary vascular resistance
-used for persistent pulmonary HTN, meconium aspiration, congenital heart disease

A

nitric oxide therapy
“INO”

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12
Q

risk with nitric oxide therapy

A

nitric oxide binds to Hgb resulting in production of methemoglobin which can’t bind to O2 (methemoglobinemia)

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13
Q

what is emergency drug given for methemoglobinemia (from nitric oxide therapy)

A

methylene blue

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14
Q

PPHN

A

pulmonary HTN of the newborn

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15
Q

-treatment for pts with life threatening heart/lung problems
-long term breathing and support support
-adds O2 to blood and remove CO2 and return it to infant

A

ECMO
extracorporeal membrane oxygenation

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16
Q

can preterm infants receive ECMO

A

no
increases risk brain bleeds

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17
Q

S+S pain in newborn

A

-increased HR
-increased BP
-rapid and shallow respirations
-decreased O2
-pallor and sweating
-increased muscle tone, dilated pupils, increased ICP, metabolic and endocrine changes
-crying, grimacing

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18
Q

N-PASS

A

neonatal pain, agitation and sedation scale

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19
Q

what is included in NPASS

A

-cry/irritability
-behavioral state
-facial expression
-extremities tone
-VS
-premature pain assessment

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20
Q

highest score on NPASS

A

10
(+1 if <30 wks EGA)

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21
Q

pain management meds used in NICU

A

-morphine
-fentanyl
-methadone
-precedex
-midazolam (versed)
-lorazepam (ativan)

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22
Q

when should babies be back to their birthweight after birth

A

2 weeks

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23
Q

equivalent between grams and mL

A

1 g = 1 mL
mostly weigh diapers for babies on IV fluids

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24
Q

when does suck-swallow-breath develop

A

32-34 wks

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25
limit time for PO feeding babies
30 mins
26
how much milk should babies get per day (formula)
150-160mL/kg/day
27
risk with long term (1 yr+) TPN
liver failure
28
IDM issues
RDS hypoglycemia hyperbilirubinemia
29
potential problems in LGA infants
-hypoglycemia -birth trauma -pulmonary HTN -poor feeding
30
can preterm babies be cooled
no. have to be full term
31
potential problems in IUGR infants (<10% for gestational age)
-hypoglycemia -hypothermia -polycythemia -infection (increased risk NEC)
32
potential problems in postterm infants
-meconium aspiration -asphyxia -shoulder dystocia
33
syndrome caused by lack of pulmonary surfactant which prevents the alveoli from collapsing
respiratory distress syndrome RDS
34
S+S RDS
-crackles -poor air exchange -color changes: pallor/cyanosis/mottling -increased work breathing: tachypnea, nasal flaring, grunting, retractions -apnea
35
when might babies not need surfactant administered
moms who received steroids before birth
36
Tx RDS
give surfactant O2 therapy
37
-very low lung volumes -stiff and difficult to ventilate
hypoplastic lung
38
what are babies with hypoplastic lungs at high risk for
pneumothorax
39
what babies might have hypoplastic lungs
-moms water broke early (around 20 wks) -congenital diaphragmatic hernia
40
-chronic lung disease -develops when premature infants with RDS need mechanical ventilation for long time, causing inflammation and scarring in lungs making it difficult to extubate
bronchopulmonary dysplasia (BPD)
41
S+S BPD
-increased work breathing -tachypnea -retractions -nasal flaring -tachycardia -intolerance to stimuli and feeds
42
Tx BPD
-O2 therapy -nutrition -fluid restriction -meds (diuretics, steroids, bronchodilators) -time for lungs to heal
43
classic signs congenital diaphragmatic hernia
-resp distress -scaphoid abdomen -bowel sounds in chest
44
Tx congenital diaphragmatic hernia
-ET intubation -OG tube placement -often ECMO -minimize bag mask ventilation -surgery to correct
45
intestines are outside stomach through hole in abdomen
gastroschisis
46
intestines, liver and other organs remain outside stomach in sac
omphalocele
47
-open defect of spinal cord -failure of closure of neural tube
mylomeningocele
48
how should babies with mylomeningoceles be positioned
on the stomach (decubitus positioning) sterile plastic covering over it
49
risk factors for retinopathy of prematurity (ROP)
preterm birth when vessels aren't fully developed and require supplementary oxygen
50
Tx ROP
-sometimes self resolve -avastin injection -laser therapy
51
S+S PDA
-murmur -active precordium -bounding pulses -tachycardia -tachypnea -crackles -hepatomegaly -wide pulse pressures -high O2 requirement -unable to wean off resp support
52
what do you give to keep PDA open
prostaglandins
53
Tx PDA
-vent support -fluid restriction and diuretics (decrease CV volume overload) -indomethacin, ibuprofen or tylenol causes PDA to constrict -surgical ligation
54
side effect use of indomethacin to treat PDA
NEC
55
tissue in small or large intestines is injured or dying causing it to become inflamed or even perforate
necrotizing enterocolitis (NEC)
56
risk factors NEC
-premature birth -decreased blood flow to intestines -infection -umbilical lines -congenital heart disease
57
S+S NEC
-distended and discolored abdomen -bilious residuals -feeding intolerance -no stool and/or dark/bloody stools -lethargic -increased apnea and bradycardia
58
Tx NEC
-NPO -give fluids -NG suction decompression (repogle) -surgery
59
maternal risks for NN sepsis
-untreated GBS -STDs -chorio -prolonged ROM
60
risk factors intraventricular hemorrhage (IVH)
premature hypoxia ischemia unstable BP
61
S+S IVH
apnea bradycardia frequent transfusions boggy head/full fontanels lethargy
62
consequences of IVH
midline shift hydrocephalus requiring shunt cerebral palsy developmental delays
63
4 criteria for whole body cooling
-infant >36 wks and <6 hrs old -need for resuscitation at birth or Dx of encephalopathy -moderate to severe encephalopathy -1 of 3: (pH <7 or base deficit >16, acute event and assisted ventilation at birth >10 mins, acute perinatal event and 10 min apgars at 5 or below)
64
what is temp lowered to during body cooling
33.5 C (95 F)
65
how long is baby cooled for
72 hrs
66
S+S neonatal abstinence syndrome
-tremors -seizures possible -overactive reflexes and hypertonia -excessive crying -poor feeding -tachypnea -fever and sweating -diarrhea -inability to sleep for prolonged periods
67
neck muscles contract causing head to be turned to one side
torticollis
68
criteria for cooling therapy in newborn
-infant >36 wks EGA and <6 hrs old -need for resuscitation at birth secondary to poor resp effort or Dx of encephalopathy -moderate to severe encephalopathy -one of following 3: (pH <7 or base deficit >16; acute event and assisted ventilation at birth for 10+ mins; acute perinatal event and 10 min apgar score <5)
69
why would nitrous oxide be given to newborn
vasodilator: relaxes pulmonary smooth muscle and decreases pulmonary resistance
70
Tissue in the small or large intestines is injured or dying causing it to become inflamed or even perforate
NEC
71
S+S NEC
-distended and discolored abdomen -visible bowel loops -bilious residuals and feeding intolerance -no stool and/or dark or bloody stools -lethargic -increase in apnea and bradycardia
72
Tx NEC
-NPO -give fluids -repogle for gastric decompression -Abx -x-rays -surgery
73
S+S PDA
-murmur -active precordium -bounding peripheral pulses -tachycardia -tachypnea -crackles -hepatomegaly -wide pulse pressures -high oxygen requirement -unable to wean off respiratory support
74
Tx PDA
-ventilatory support -fluid restriction and diuretics to decrease cardiovascular volume overload - Indomethacin, ibuprofen, acetaminophen which causes the PDA to constrict -surgical ligation
75
S+S RDS
-crackles -poor air exchange -color changes (pallor/cyanosis/mottling) -increased work breathing (tachypnea, nasal flaring, grunting, retractions) -apnea
76
Tx RDS
-adequate ventilation -admin surfactant -oxygen therapy

high risk OB (14 decks)

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