RN 55 Exam 1

RDS

Lung immaturity and surfactant deficiency

Which group is more commonly associated with bronchopulmonary dysplasia

Males

Temperature instability, tachycardia, poor feeding, lethargy, irritability, and nasal flaring

Neonatal sepsis

How many mL can be injected IM into a neonate

No more than 1 mL in the vastus lateralis

How many mL can be injected into a child

No more than 3 mL

Retinopathy of prematurity cause:

Often when high doses of oxygen are given during RDS

organs outside of body with protective sac around the organs (peritoneum)

Omphalocele

RSV (upper and lower): Impaired Gas exchange that causes respiratory ____________________

acidosis

Is IVH innate or acquired

acquired

A child has an inflamed conjunctiva with itchy eyes and watery discharge. Which type of conjunctivitis

allergic conjuncitivits

watery, stringy, red, itchy eyes, and swollen eyelids → Antihistamine or mast cell stabilizer drops

allergic conjunctivitis

Birth weight should ____________ by 6 months

double

What can the nurse do to promote parental participation

encourage them to be involved int he care of their child and make decisions about treatment

List 4 nursing interventions for a child with CF

pancreatic enzymes on every meal high protein diet. high calorie diet humidify air aerosolized antibiotics

Fixed and dilated pupils indicate

brain stem herniation and brain death

Night actions with infants should be

brief

cough, fever, appearing ill, labored breathing, retractions, tachypnea/nasal flaring, wheezes or crackles

pneumonia

Which age group is likely to engage in imaginative play

preschoolers

babies with hypothermia will show signs of

respiratory distress and apnea

Grunting, nasal flaring and inspiratory crackles are typical findings for

respiratory distress syndrome

apgar score less than 7 at 1 and 5 minutes

resuscitation measures must be taken

Piaget's theory birth - 2 years

sensorimotor

learns through senses actions become purposeful gains control of reflexes

sensorimotor

Retinal hemorrhages when pupils are filleted can indicate:

shaken baby syndrome

Pupils look white Don't follow objects Don't recognize faces

sx of ROP

List 3 things that will help mother with sore nipples form breastfeeding

teach proper latching allow breast milk to dry on nipples air dry nipples between feedings

Crying and grunting when passing stool (infant) is normal unless

the stool is hard and dry

What happens if the baby soft spot closes too early

they will usually have craniosynostosis

Polycythemia

thick blood caused by an excess of RBCs

Why are savage feedings done with transient tachypnea

to reduce oxygen demands

Weight should ____________ by 1 year

triple

watery mucoids and enlarged lymph nodes. Swollen eyelids are common. → symptoms relief

viral conjunctivitis

pathologic hyperbilirubinemia

within 24 hr of life total serum level greater than 5 mg/dL

Post term neonates may have skin that is

wrinkly or peels

If a patient is declared seas, what are you required to do as a nurse

you contact the donor network but DO NOT have that conversation with the patients family, the donor network will talk with them

RR for school aged child

14-22

Which would be concerning to be absent in an 8 mo old

Babinski

If a 6 mo old baby weighs 14 lB during her well baby visit, but her birth weight was 8, what does this indicate?

Baby is behind in their growth. By 6 mo baby should be double their birth weight.

Intraventricular hemmorhage

Bleeding into the brain

3 causes of NEC

Bowel ischemia Bacterial flora Effects of feeding

T/F: A six month old who weighs 14 lbs attends a wellness check their birth weight was 8 lbs. There is no concern with the bby

False

T/F: 3 month olds when pulled to sit lead with their head before their body

False, at 4 months

What are two ways we can monitor intraventricular hemorrage

Frequent head ultrasounds / head circumference to monitor

Pleasure comes from oral activities such as sucking, feeding, and biting

Freud's oral stage

organs outside of body + no sac

Gastroschisis

Acute Epiglottis prevention

HIB vaccine

Why do babies have fontanels

To help baby move through birth canal, and allows for brain growth

T/F: As NEC worsens, infants develop s.sx of septic shock

True

T/F: At six months, infants should be able to tripod sit

True

T/F: Infants are capable of increased topical absorption compared to adults

True

T/F: TPN is good for 24 hours once opened AND requires blood sugar checks Q6hr

True

Erickson theroy

Trust vs. Mistrust

IVH is caused by

immature vasculature and changed blood flow

How to decrease polycythemia vera

increase fluids

What can place the baby at risk for cognitive defects and cerebral palsy

intraventricular hemorrhage

why can't babies under 12 months have honey

it can cause infant botulism

length should be increased by ________% by 12 months

50

When can a sippy cup be introduced?

6 months

tripod sits

6 months

HR for school age child

60-100

sits alone with some hand support

7 months

Normal HR for toddler

70-120

Object permanence by ____________ months

8

sits unsupported

8 months

Normal HR for infant

80-150

crawls

9 months

Retinopathy of Prematurity (ROP) SpO2 needs to be between

90-95%

Dysphagia, drooling, agitation (hypoxemia), and no cough Respiratory obstruction → emergency trach (to maintain airway)

Acute Epiglottis

Caregivers respond to an infants needs which creates trust, infants realize they are separate form caregivers

Erickson's trust vs. mistrust

pulls to stand

10 months

Transition to table meat should not take place until

10-12 months

Newborns sleep ___________ hours per day

10-19

Nonrebreather is ____% oxygen

100

walks independently

12 months

rolls to supine to prone and back

5 months

lift/turn head to side

1 month

5 complications of RDS

1. Air leak syndrome 2. Broncho-pulmonary dysplasia 3. PDA (patent ductus arterosis), CHF, IVH 4. Retinopathy 5. NEC

4 NEC indications:

1. Bloody stools 2. Distended abd 3. Bilious vomiting 4. Lethargy

Manifestations of sepsis in a child include?

1. Hypothermia 2. Oliguria 3. Anuria 4. Lack of interest in feeding 5. Lethargy

List 3 tricks to help prevent spitting up during/after feedings?

1. Keep the baby upright for 30 mins after 2. Burp the baby at least 2-3 times during feedings 3. Feed smaller amounts on a more frequent basis

3 causes of dilated pupils

1. amphetamines 2. caffeine 3. atropine

Necrotizing enterocolitis 3 pathological mechanisms

1. bowel ischemia 2. bacterial flora 3. effect of feeding surgical emergency

2 causes of sluggish pupil response

1. opioids 2. bentos

Head circumference pains _______ cm within the first year

10

weight loss no more than ___________% after birth

10

When does the anterior fontanel close?

18 months

improved head control

2 month

When does the step reflex disappear?

2 months

When does the posterior fontanelle usually close

2-3 months

Normal RR for toddler

20-30

Room air is ____% oxygen.

21

NC 1-5 L is _____% oxygen

25-30

rise head 45 degrees

3 months

how much on avg does a neonate gain/day

30 g

Normal RR for infant

30-60 breaths/min

Simple mask 5-10 L is____% oxygen

35-50

IV bolus for 6.5 kg kid over 30 mins

390 mL

Physiologic hyperbilirubinemia

3rd/4th day of life total serum level greater than 5 mg/dL

head leads body when ruled to sit, lifts head looks around

4 months

Weight should double by ___________- months

4-5

When do babies typically begin to make certain vowel sounds, laughing and vocalizing in response to voices

4-5 months

Retinopathy of prematurity

Abnormal blood vessel growth in the retina - happens in preemies who weigh less than 3 lb at birth - usually goes away on its own - follow up screening Q2-3 weeks, depending on severity

DO NOT attempt to visualize throat ( say "ahh") if the patient has

Acute Epiglottis

what ethnic groups tend to be lactose intolerant

African Americans, Native Americans, Asians

If a baby's severe meconium aprkation syndrome with no improvement, what may be needed?

ECMO

Tx for RSV

Elevate HOB Frequent suctioning Hydration Bronchodilators Vaccination (preventative)

The nurse and mother discuss infant safety, which response indicates need for further teaching

I can let the baby sleep in the crib with a stuffed animal

when should a nurse stop resuscitation efforts on a baby

If there is no heartbeat or respiratory effort after 10 mins

A child has a tonsillectomy, what are two appropriate interventions

Institute a soft diet Assess for bleeding

Baby born at 3.8 kg, 5 days later baby is 3.5 kg (-8%) decrease, what do you inform mom about this change

It is normal for infants to lose 5-10% of their weight the first week

infection of the MIDDLE ear that causes inflammation and fluid build-up behind the ear drum

Otitis Media

"swimmer ear" infection of the skin in the external auditory canal

Otitis externa

no infection present but fluid is within the ear Appears like "bubbles"

Otitis media with effusion

s/sx Lactose intolerance

Pain, distension, bulky, frothy, watery stool

Ground glass pattern on chest XR indicates

Respiratory distress syndrome

List 5 signs of respiratory distress

Retractions Nasal flaring Grunting Head bobbing Cyanosis

what is the typical first solid food introduced to an infant

Rice cereal mixed with breast or formula milk until it is a thin consistency

Upper airway obstruction causes which type of retractions

Suprasternal contractions/ supraclavicular contractions

Post term infants are at a greater risk of

Swallowing or aspirating meconium in utero or after birth

The nurse is planning care for child with severe croup sx who is suspected of having epiglottis. What should the nurse NOT do

Use a tongue blade

Lower airway obstruction causes which type of retractions

Wheezing, subcostal/ substernal/ intercostal retractions

Excess pressure on the __________ causes the ___________ to remain open

alveoli, ductus arteriosus

What to assess for IVH

anterior fontanel, HCT, color, perfusion, LOC, feeding/sucking and high pitched cries

Who is at risk for IVH

babies less than 1500 g weight or less than 35 weeks gestation

What action should be taken if omphalocele occurs

baby should be placed in a sterile drawstring bowel bag

purulent/mucoid discharge

bacterial conjunctivitis

When does trust vs. mistrust occur?

birth to 1 year

LGA (large for gestational age) babes are at risk for what during birth

clavicle injuries

Examples of developmental care in the NICU

closer care and acitivies

Tetralogy of Fallot

congenital malformation involving four (tetra-) distinct heart defects that results in decreased pulmonary blood flow

ICH prevention

corticosteroids given at 24-34 weeks Vaccination CAV-1 & CAV-2

Genetic disorder causes exocrine gland dysfunction

cystic fibrosis

List symptoms and labs r/t neonatal sepsis

decreased or elevated temp lumbar puncture, blood and urine culture

Infant growth is fastest during the

first 6 mo

Omphalocele

herniation of the intestines through a weakness in the abdominal wall around the navel occurring in infants at birth

Can cause high ICP and bulging fontanels --> increased CSF fluid

hydrocephalus

Lifelong restriction of ____________ is needed for people with galactosemia

lactose

nearsightedness

myopia

Freud theory birth - 1 year

oral stage