Ch. 9 The High-Risk Newborn and Family

How can human immunodeficiency virus (HIV) be transmitted from the mother to the infant?

1. Transplacental 2. vaginal delivery 3. in breast milk

A primary objective in the care of high-risk infants is to maintain respiration. Describe how the nurse should complete the respiratory assessment.

1. describe the shape of the chest (barrel, concave), symmetry, presence of incisions, chest tubes, or other deviation 2. describe use of accessory muscles; nasal flaring or substernal, intercostal, or subclavicular retraction 3. describe respiratory rate and regularity 4. auscultate and describe breath sounds - stridor, crackles, wheezing, diminished air entry, equality of breath sounds 5. determine whether suctioning is needed 6. describe ambient oxygen and method of delivery - if intubated, describe size of tube, type of ventilatory and settings, and method of securing tube 7. determine oxygen saturation by pulse oximetry

Identify the two most critical objectives in caring for the high-risk infant.

1. establish and maintain respiration - infant will exhibit adequate oxygenation 2. external warmth - infant will maintain stable body temperature

A thorough systematic physical assessment is a must in the care of the high-risk neonate. An underlying problem is often indicated by subtle changes in: 1. 2. 3. 4. 5. 6.

1. feeding 2. behavior 3. activity 4. color 5. oxygen saturation 6. vital signs

_____________ _____________, a common preservative in bacteriostatic water and saline, has been shown to be toxic to newborns and is not used to flush IV catheters or reconstitute medications.

Benzyl alcohol

Discuss the important of surfactant to the preterm infant's lungs.

Deficient surfactant production causes unequal inflation of alveoli on inspiration and the collapse of alveoli on end expiration; infants are unable to keep their lungs inflated and therefore exert a great deal of effort to re-expand the alveoli with each breath

T or F: Methadone withdrawal in the fetus is less severe than heroin withdrawal.

F

T or F: infants exposed to cocaine in utero demonstrate immediate untoward effects at birth

F

T or F: marijuana use during pregnancy can result in infants with larger head circumference and developmental delays

F

T or F: the mother using methadone is not allowed to breastfeed her infant

F

T or F: Nurses should turn off alarm systems for electronic monitoring devices when their sounds disturb the infant's parents.

False

T or F: Research has shown that infants receiving trophic feelings versus no feedings have an overall higher number of days to full feedings and a longer hospital stay.

False

T or F: Sophisticated monitoring and life-support systems can replace the observations of the infant by nursing personnel.

False

T or F: Studies have shown that infants receiving a heel puncture for blood collection demonstrated less pain response than those receiving a venipuncture.

False

T or F: When hydrogel electrodes are used on the neonate's skin, they are easily removed by lifting the edge and wiping with alcohol.

False

The major source of increased production of heat during cold stress in the high-risk neonate is _____________________________.

Non-shivering thermogenesis

_________________ ________________ decreases hospital stay, enhances transition from tube to bottle-feeding, and results in better bottle-feeding performance in preterm infants.

Nonnutritive sucking

T or F: Fetal abnormalities are not related to the amount of the mother's alcohol intake but to the amount of alcohol consumed in excess of the liver's ability to detoxify it.

T

T or F: Fetal alcohol spectrum disorder is the leading cause of preventable cognitive impairment

T

T or F: a higher incidence of preterm delivery and placental abruption are associated with methamphetamine use during pregnancy

T

T or F: cocaine can affect fetal cardiac function and suppress fetal immune system

T

T or F: infants exposed to methamphetamine in utero have significantly smaller head circumferences and birth weights than those not exposed

T

T or F: it is recommended that women wanting to become pregnant should stop drinking alcohol 3 months before planning to conceive.

T

T or F: marijuana is the most common elicit drug used by women by childbearing age in the U.S.

T

T or F: the methadone-exposed fetus shows no increased incidence of congenital anomalies

T

TORCHS complex is a group of microbial agents that cause similar manifestations in the neonate. Identify what each letter stands for.

T - toxoplasmosis O - other agents such as hepatitis B, parvovirus, HIV R - rubella C - cytomegalovirus infection H - herpes simplex S - syphilis

Baby Mark was born at 36 weeks of gestation and weighed 2300g (5lb) at birth. At 1 minute of age, his Apgar score was 5, Mark was suctioned, and oxygen administration was started. He responded with spontaneous respirations. You are the nurse who has been assigned to care for Mark in the special care nursery. His admission vital signs are heart rate 150 beats/min, respirations 56 breaths/min, and axillary temperature of 35.8 degrees celsius. Mark is placed in a radiant warmer, and oxygen administration is continued by oxygen hood. Mark has had an apnea episode. What should the nurse include in the documentation of this episode?

The number of apneic spells the appearance of the infant whether the infant self recovers or tactile stimulation is needed to restore breathing

As a nurse in the NICU, you are assigned to care for an 1,815 g (4 lb) preterm infant named Maria. In report you learn that Maria is still on garage feedings and that tomorrow she is scheduled to begin bottle feeding. If Maria tolerates her bottle-feedings well, she is scheduled to go home in a few days. You observe Maria closely for behaviors that indicate readiness for bottle-feedings. Describe how you as the nurse in the special care nursery should position Maria, the preterm infant.

The nurse should use therapeutic positioning to reduce the potential for acquired positional deformities and to accommodate necessary medical equipment and medical needs.

T or F: Although infants demonstrate some sucking and swallowing activities before birth, coordination of these mechanisms does not occur until approximately 32-34 weeks of gestation, and they are not fully synchronized until 36-37 weeks

True

T or F: An accurate output measurement can be obtained in the neonate by using a urine collecting bag or by weighing the infant's diaper (40-g weight of urine would be recorded as 40 mL of urine)

True

T or F: Infants who are mechanically ventilated can have lower blood pressures.

True

T or F: Neonates under intensive observation are placed in a controlled environment and monitored for HR, respiratory activity, and temperature.

True

T or F: each infant is different; therefore supportive developmental care requires ongoing data collection by the needs of the nurse.

True

Low-birth-weight infants are at a disadvantage for heat production when compared with full-term infants because they have: I. small muscle mass ii. fewer deposits of brown fat iii. less insulating subcutaneous fat iv. poor reflex control of skin capillaries a. I, ii, iii, iv b. Ii, iii, and iv c. I, ii, iii d. I, iii, iv

a. I, ii, iii, iv

Infants diagnosed with bronchopulmonary dysplasia have special care needs. These needs include: a. adequate rest b. avoiding diuretics c. decreasing caloric intake d. rapid weaning from ventilator

a. adequate rest

At birth the newborn is immediately assessed to determine any apparent problems and to identify those that demand immediate attention. The assessment NOT usually conducted at birth or immediately after birth is: a. assignment of a gestational age score b. assignment of an APGAR score c. evaluation for obvious congenital anomalies d. evaluation for neonatal distress

a. assignment of a gestational age score

A late and serious sign of respiratory distress in the neonate is: a. central cyanosis b. respiratory rate of 90 breaths/min c. substernal retractions b. nasal flaring

a. central cyanosis

Retinopathy of prematurity nursing care management includes: a. decreasing or avoiding events known to cause fluctuations in systemic blood pressure and oxygenation b. using cool compresses to decrease the edema of the eyelids after the infant undergoes laser surgery c. delaying all eye medication administration until the eye edema has subsided and the infant can open his or her eyes d. delay breastfeeding or bottle-feeding for 24 hours after laser eye surgery

a. decreasing or avoiding events known to cause fluctuations in systemic blood pressure and oxygenation

the amount to be fed to the infant by nipple is: a. determined by the infant's tolerance to previous feedings b. increased when the infant requires 25 minutes or more for feeding completion c. increased when the infant reaches the postnatal age of 34 weeks d. increased when prodding techniques are used to increase sucking and decrease aspiration

a. determined by the infant's tolerance to previous feedings

why does the nurse carefully monitor and record amounts of all blood drawn for tests in the preterm infant: a. early prevention of anemia b. prevention of infection c. prevention of polycythemia d. detection of factors that contribute to hypothermia

a. early prevention of anemia

suctioning of the infant with respiratory distress syndrome: a. is performed by inserting the catheter to a predetermined depth b. is performed routinely every 30 minutes to keep the airway open c. is performed by gently inserting the catheter until resistance is felt d. is performed by advancing the catheter until resistance is met and then withdrawing

a. is performed by inserting the catheter to a predetermined depth

Which one of the following statements about neonatal stroke is true? a. it is the second leading cause of seizures in term neonates b. it is more common in females, where there is a tendency toward left-side involvement c. known risk factors include maternal and/or fetal factor V Leiden, antiphospholipid, and prothrombin factors d. diagnosis is most accurate with head ultrasonography

a. it is the second leading cause of seizures in term neonates

The best way to prevent infection in the high-risk neonate begins with: a. meticulous and frequent hand washing of all persons coming in contact with the infant b. observing continually for signs of infection c. requiring everyone working in the neonatal intensive care unit (NICU) to put on fresh scrub clothes before entering the unit d. performing epidemiological studies at least once a month

a. meticulous and frequent hand washing of all persons coming in contact with the infant

Baby Mark was born at 36 weeks of gestation and weighed 2300g (5lb) at birth. At 1 minute of age, his Apgar score was 5, Mark was suctioned, and oxygen administration was started. He responded with spontaneous respirations. You are the nurse who has been assigned to care for Mark in the special care nursery. His admission vital signs are heart rate 150 beats/min, respirations 56 breaths/min, and axillary temperature of 35.8 degrees celsius. Mark is placed in a radiant warmer, and oxygen administration is continued by oxygen hood. The nurse will develop a care plan for Mark that recognizes which of the following as the best expected outcome? a. oxygen is administered correctly, and arterial blood gases are within normal limits b. monitor for changes in thermal environment c. record oxygen delivery rates every 2 hours d. assess respiratory status every hour

a. oxygen is administered correctly, and arterial blood gases are within normal limits

Which of the following is the best way for the nurse to promote a healthy parent-infant relationship for the family with a high-risk neonate? a. reinforce parents during their caregiving activities and interactions with their infant b. help parents understand that the preterm infant offers no behavioral rewards c. reassure parents that the infant is doing well d. encourage the mother to stay by the infant's bedside to promote bonding

a. reinforce parents during their caregiving activities and interactions with their infant

Discharge instructions for the parents of the preterm infant should not include: a. warning parents that their infant may still be in danger and will need constant attention b. providing information to the parents on how to contact personnel for later questions c. instructions about car safety seats, including how these seats can be adapted for smaller infants with the placement of blanket rolls on each side of the infant to support the head and trunk d. providing adequate information about immunization needs

a. warning parents that their infant may still be in danger and will need constant attention

The term _______________ ___________ is used when parents show hesitancy to embark on a relationship with their infant, unconsciously preparing themselves for the infant's death.

anticipatory grief

Baby Mark was born at 36 weeks of gestation and weighed 2300g (5lb) at birth. At 1 minute of age, his Apgar score was 5, Mark was suctioned, and oxygen administration was started. He responded with spontaneous respirations. You are the nurse who has been assigned to care for Mark in the special care nursery. His admission vital signs are heart rate 150 beats/min, respirations 56 breaths/min, and axillary temperature of 35.8 degrees celsius. Mark is placed in a radiant warmer, and oxygen administration is continued by oxygen hood. You identify Mark as being at risk for developing respiratory distress syndrome based on his: I. gestational age ii. the Apgar score iii. hypothermia iv. respiratory rate of 56 breaths/min a. I, ii, iii, and iv b. I, ii, iii c. ii, iii, and iv d. ii and iii

b. I, ii, iiii

A complication that develops with the use of the umbilical catheter is thrombi. This complication is best recognized by the appearance of: a. blanching of the buttocks and genitalia b. bluish discoloration seen in the toes, called "Cath toes" c. bounding pedal pulses d. hemorrhage from the umbilical catheter area

b. bluish discoloration seen in the toes, called "Cath toes"

The preterm infant is having respirations with absence of diaphragmatic muscle function. This is causing a lack of respiratory effort because the CNS is not transmitting signals to the respiratory muscles. What is this type of apnea called? a. obstructive apnea b. central apnea c. periodic apnea d. mixed apnea

b. central apnea

Baby Mark was born at 36 weeks of gestation and weighed 2300g (5lb) at birth. At 1 minute of age, his Apgar score was 5, Mark was suctioned, and oxygen administration was started. He responded with spontaneous respirations. You are the nurse who has been assigned to care for Mark in the special care nursery. His admission vital signs are heart rate 150 beats/min, respirations 56 breaths/min, and axillary temperature of 35.8 degrees celsius. Mark is placed in a radiant warmer, and oxygen administration is continued by oxygen hood. The nurse's plan for oxygen administration includes: a. frequent suctioning b. frequent assessment to include unobstructed nares c. nipple feeding with respiratory rates of 70 breaths/min and below d. turning off monitor alarms to allow the neonate to rest

b. frequent assessment to include unobstructed nares

John is a newborn just delivered of a diabetic mother. The nurse will watch John for signs that he is rapidly developing: a. hyperglycemia b. hypoglycemia c. failure of the pancreas d. dehydration

b. hypoglycemia

therapy for preterm infants who develop PDA often includes the administration of: a. theophylline b. indomethacin c. digoxin d. heparin

b. indomethacin

which of the following interventions is least likely to be effective for high-risks neonates? a. keeping the infant on servo control in an incubator or radiant warmer b. placing the heat-sending probe on the infant's abdomen when the infant is in the prone position c. ensuring that the oxygen supplied to the infant via a hood around thread is warmed and humidified d. warming all items that come in direct contact with the infant, including the hands of caregivers

b. placing the heat-sending probe on the infant's abdomen when the infant is in the prone position

a physical characteristic usually observed in the preterm infant and not observed in the full term infant is: a. proportionately equal head in relation to the body b. skin that is translucent, smooth, and shiny with small blood vessels clearly visible underneath the epidermis c. distinct creases extending across the entire palms of the hands and down the soles of the feet d. absence of lanugo and little vernix caseosa

b. skin that is translucent, smooth, and shiny with small blood vessels clearly visible underneath the epidermis

Susie, a neonate born 20 minutes ago, was observed at birth to have meconium staining. If Susie has meconium in the lungs, this most likely will: a. prevent air from entering the lungs b. trap inspired air in the lungs c. cause no problems with breathing d. lead to respiratory alkalosis

b. trap inspired air in the lungs

Feeding facilitation techniques for preterm infants include: a. using a pliable nipple with faster flow b. using a slightly firm nipple with slow flow c. manipulating the nipple frequently by twisting and turning when the infant stops sucking d. positioning the infant on the back with the head supported

b. using a slightly firm nipple with slow flow

Why are diagnosis and treatment of sepsis sometimes delayed in the neonate?

b/c of infant's poor response to pathogenic agents, there is often no local inflammatory response at the portal of entry to indicate an infection

Bryan, a 2 day old preterm infant being cared for in the NICU, had some periods of apnea yesterday. Today when you arrive to work, you learn in a report that the infant has had no further apneic episodes since yesterday. However, shortly after you begin your shift, Bryan's apnea monitor alarm sounds. What should you do first? a. use tactile stimulation, rubbing on the infant's back to stop the apneic spell b. suction his nose and oropharynx c. assess the infant for color and for presence of respiration d. place the infant on his abdomen

c. assess the infant for color and for presence of respiration

when a high-risk neonate needs transportation to a facility that can provide intensive care, the nurse recognizes that equipment for this neonate must include: a. transfer of both the mother and infant b. immediate transport, often before stabilization of the neonate c. complete life support system available during transport d. prevention of transport delay by carrying the infant in the nurse's arms to the waiting transport vehicle

c. complete life support system available during transport

Infants born to drug-dependent mothers may exhibit all of the following clinical manifestations except: a. tremors and restlessness b. frequent sneezing c. coordinated suck and swallow reflex d. high-pitched shrill cry

c. coordinated suck and swallow reflex

Introduction of minimal enteral feedings in the preterm infant: a. increases incidence of necrotizing enterocolitis b. increases mucosal atrophy incidence c. decreases incidence of necrotizing enterocolitis d. maintain serum glucose homeostasis

c. decreases incidence of necrotizing enterocolitis

Baby Mark was born at 36 weeks of gestation and weighed 2300g (5lb) at birth. At 1 minute of age, his Apgar score was 5, Mark was suctioned, and oxygen administration was started. He responded with spontaneous respirations. You are the nurse who has been assigned to care for Mark in the special care nursery. His admission vital signs are heart rate 150 beats/min, respirations 56 breaths/min, and axillary temperature of 35.8 degrees celsius. Mark is placed in a radiant warmer, and oxygen administration is continued by oxygen hood. Baby Mark's parents are visiting him for the first time. How can the nurse assist the parents in feeling more comfortable in the NICU atmosphere? a. discourage questions of a technical nature b. tell the parents that Mark is going to be fine c. Explain what is happening with Mark and why he is receiving this type of care d. leave the parents alone with the infant

c. explain what is happening with Mark and why he is receiving this type of care

To help parents deal with neonatal death, the nurse should: a. discourage the parents from staying with the infant before death to prevent overattachment b. explain to the parents that the infant would have had many developmental problems and it is better that the infant did not suffer c. give the parents the opportunity to hold and talk with the infant before and after death d. force the parents to see the infant after death because closure is necessary

c. give the parents the opportunity to hold and talk with the infant before and after death

Baby Mark was born at 36 weeks of gestation and weighed 2300g (5lb) at birth. At 1 minute of age, his Apgar score was 5, Mark was suctioned, and oxygen administration was started. He responded with spontaneous respirations. You are the nurse who has been assigned to care for Mark in the special care nursery. His admission vital signs are heart rate 150 beats/min, respirations 56 breaths/min, and axillary temperature of 35.8 degrees celsius. Mark is placed in a radiant warmer, and oxygen administration is continued by oxygen hood. You would classify Baby Mark as a: I. full-term infant ii. preterm infant iii. low-birth-weight infant iv. small-for-gestational-age infant a. I and iv b. ii and iv c. ii and iii d. I and iii

c. ii and iii

the nurse must be able to distinguish between seizures and jitteriness in the neonate. Which of the following is true about seizures? a. seizures are not accompanied by ocular movement b. seizures have their dominant movement as tremor c. in seizures the dominant movement cannot be stopped by flexion of the affected limb d. seizures are highly sensitive to light manual stimulation

c. in seizures the dominant movement cannot be stopped by flexion of the affected limb

The administration of exogenous surfactant to preterm neonates with respiratory distress syndrome: a. shows no difference in improvement when synthetic surfactant is used versus natural surfactant b. is done by intravenous infusion c. requires adjustment of ventilator settings d. requires suctioning the infant during administration

c. requires adjustment of ventilator settings

_______________, the most common type of intracranial hemorrhage, occurs in both term and preterm infants. Small hemorrhages of venous origin with underlying contusion may occur. a. subdural hemorrhage b. intracerebellar hemorrhage c. subarachnoid hemorrhage d. hematoma

c. subarachnoid hemorrhage

clinical manifestations of patent ductus arteriosus (PDA) include which of the following? a. decreased PaCO2, increased PaO2, and decreased FiO2 b. narrow pulse pressure with increased diastolic blood pressure c. systolic or continuous murmur heard as a "machinery-type" sound d. Bradycardia

c. systolic or continuous murmur heard as a "machinery-type" sound

reduce loss of heat by warming items with which infant has direct contact

conductive heat loss

Method that provides constant distending pressure by means of nasal prongs, a face mask, or an endotracheal tube

continuous positive airway pressure (CPAP)

occurs when infants are exposed to drafts or when surrounding air is cool

convective heat loss

Apnea in the preterm infant is defined as a lapse of spontaneous breathing lasting for how many seconds? a. 5 b. 10 c. 15 d. 20

d. 20 seconds

clinical signs seen in necrotizing enterocolitis are: I. increased abdominal girth ii. increased gastric residual iii. positive stool hematest iv. hypertension a. I, ii, iv b. I, iii c. ii, iii, iv d. I, ii, iii

d. I, ii, iii

which of the following is a correct statement about persistent pulmonary hypertension of the newborn (PPHN)? a. PPHN is primarily a condition of preterm infants b. PPHN is rarely associated with meconium aspiration c. a loud pulmonary component of the second heart sound and a systolic ejection murmur may be present with PPHN d. ECMO is often used to decrease CO

d. a loud pulmonary component of the second heart sound and a systolic ejection murmur may be present with PPHN

An important nursing function is close observation of neonates at risk for developing air leaks. These infants include: a. those with respiratory distress syndrome b. those with meconium-stained amniotic fluid c. those receiving continuous positive airway pressure (CPAP) to positive-pressure ventilation d. all of the above

d. all of the above

an infant who weighs 1400 g appears to be ready for enteral feedings. which of the following should the nurse include in the implementation of garage feedings? a. insert the tube into the unobstructed nares b. perform the procedure with the infant in a supine position with the head elevated 45 degrees c. aspirate the contents of the stomach, measure these contents, and replace the residual as part of the feeding d. allow the feeding to flow by gravity; then push a small amount of the feeding into the stomach; then allow the remainder of the feeding to flow by gravity

d. aspirate the contents of the stomach, measure these contents, and replace the residual as part of the feeding

which of the following is NOT used as a category in the classification of high-risk newborns? a. birth size b. gestational age c. mortality d. birth age

d. birth age

what is the best measurement of feeding success in the infant? a. soft abdomen b. no aspirated gastric residual c. ability to suck on pacifier d. coordinated sucking and swallowing ability

d. coordinated sucking and swallowing ability

The laboratory evaluation for the diagnosis of sepsis at least likely to include: a. blood cultures b. spinal fluid culture c. urine culture d. gastric secretions culture

d. gastric secretions culture

The nurse can expect the infant with fetal alcohol syndrome to exhibit which of the following on assessment? a. normal prenatal growth patterns b. hypertonia c. thicker upper lip and longer palpebral fissures d. irritability

d. irritability

Which of the following is a neonatal intensive care facility that provides care for extremely love-birth-weight infants plus sustained life support and surgical repair of serious congenital cardiac malformations? a. level I facility b. level IIB facility c. level IIIB facility d. level IV facility

d. level IV facility

a cause of fetal and neonatal mortality in postterm infants as compared with term infants is: a. absence of lanugo b. skin cracking, parchmentlike, and peeling c. depletion of subcutaneous fat d. macrosomia and meconium aspiration syndrome

d. macrosomia and meconium aspiration syndrome

The nurse recognizes which fo the following as true about the infant diagnosed with neonatal abstinence syndrome (NAS)? a. methadone treatment by the mother will prevent withdrawal reaction in neonates b. meconium sampling for fetal drug exposure is less accurate than neonatal urine sampling because it does not take into accurate recent drug use by the mother c. mothers of NAS infants usually do not want the pregnancy or the infant d. the most severe symptoms are observed in the infants of mothers who have taken large amounts of drugs over a long period

d. the most severe symptoms are observed in the infants of mothers who have taken large amounts of drugs over a long period

When mothers smoke: a. their infants will have normal birth weights as long as the number of cigarettes smoked does not exceed one pack per day b. their level of nicotine is higher than that of their newborn c. their breast milk will not be affected d. their rate of preterm births is increased

d. their rate of preterm births is increased

Which of the following interventions is contraindicated in the preterm infant with increased ICP? a. avoiding interventions that produce crying b. avoiding rapid volume expansion following hypotension c. administering analgesics to reduce discomfort d. turning the head to the right without body alignment

d. turning the head to the right without body alignment

which of the following is a correct nursing intervention to prevent skin damage in the neonate? a. instruct parents before discharge on regular use of sunscreen for all infants under 6 months of age b. apply adhesive tape to protect arms, elbow, and knees from friction rubs c. use powders on diaper dermatitis areas as a moisture barrier d. use gel mattresses to decrease skin breakdown

d. use gel mattresses to decrease skin breakdown

In caring for a preterm infant's skin, the nurse knows to: a. use scissors to remove dressing or tape from the infant's extremities b. use solvents to remove tape from the neonate's skin c. use alkaline-based soaps in removal of stool d. use zinc oxide-based tape to secure monitoring equipment or intravenous

d. use zinc oxide-based tape to secure monitoring equipment or intravenous infusions

can be decreased by providing a high-humidity atmosphere

evaporative heat loss

An infant whose birthweight is less than 1000g (2.2 lbs)

extremely low-birth-weight infant

T or F: Preterm infants receiving continuous feedings show better weight gain than those receiving intermittent bolus feedings.

false

T or F: containment or facilitated tucking positioning of the infant during procedures has been shown to increase physiologic and behavioral stressors

false

T or F: developmental maturation for the young preterm infant is seen by a decrease in quiet sleep

false

T or F: milk produced by mothers whose infants are born at term contains higher concentrations of protein, sodium chloride, and immunoglobulin A (IgA).

false

T or F: pasteurization of donor human milk serves little purpose, since all donors are carefully screened.

false

T or F: preterm infants have the same capacity to digest and absorb protein, carbohydrates, and fats as full-term infants

false

T or F: prolonged "clustering" of care for the ill infant promotes physiologic stability

false

T or F: using earmuffs in the NICU is an important intervention to prevent later speech and language difficulties

false

death of a fetus after 20 weeks of gestation

fetal death

an infant born between the 38th week and completion of the 42nd week of gestation

full term infant

Define polycythemia and identify the infants who are most at risk for this condition.

hematocrit of 65% or greater; the small-for-gestational age infant

method that delivers gas at very rapid rates to provide adequate minute volumes using lower proximal airway pressures

high-frequency ventilation (HFV) modalities

Oral or parenteral medications should be sufficiently diluted if they are ____________________ solutions to prevent necrotizing enterocolitis.

hyperosmolar

Identify three major consequences produced by cold stress that create additional hazards for the neonate.

hypoxia, metabolic acidosis, and hypoglycemia

Brenda is a 1 year old newborn who suffered asphyxia before birth, resulting in hypoxic-ischemic brain injury. What signs can the nurse expect to see indicating encephalopathy?

infant may be stuporous or comatose seizures may begin after 6-12 hours and become more frequent and severe between 24-72 hours, deterioration in the LOC may occur after 72 hours, stupor and disturbances of sucking and swallowing are seen Muscular weakness of the hips and shoulder in the full-term infant and lower limb weakness in the preterm infant occur apneic episodes may occur

Method that allows infant to breathe spontaneously at his or her own rate but provides mechanical cycled respirations and pressure at regular preset intervals by means of an endotracheal tube and ventilator

intermittent mandatory ventilation (IMV)

an infant whose birth weight falls above the 90th percentile on intrauterine growth curves

large-for-gestational-age infant

an infant born between 34 0/7 and 36 6/7 weeks of gestation, regardless of birth weight

late preterm infant

Prenatal diagnostic test for lung maturity

lecithin/sphingomyelin ratio

An infant whose birthweight is less than 2500 g (5.5 lb), regardless of gestational age

low-birth-weight infant

lung distensibility

lung compliance

signals respiratory distress/increased work of breathing

nasal flaring

death that occurs in the first 27 days of life

neonatal death

allows one to maintain normal core temperature with minimal oxygen consumption and caloric usee

neutral thermal environment

describes the total number of fetal and early neonatal deaths per 1000 live births

perinatal mortality

method that provides increased end-expiratory pressure during expiration and between mandatory breaths, preventing alveolar collapse

positive end-expiratory pressure (PEEP)

an infant born after 42 weeks of gestation

postterm (postmature) infant

an infant born before completion of 37 weeks of gestation

preterm infant

condition that develops in the preterm infant with respiratory distress syndrome and immature lungs as a result of over distention of distal airways

pulmonary interstitial emphysema

occurs by transfer of heat to a cooler object not in direct contact

radiant heat loss

What are the signs of infiltration?'

redness, edema, or color change at site; blanching at site

An infant whose birthweight falls below the 10th percentile on intrauterine growth curves

small-for-gestational-age infant

the ____________ sleeping position is recommended by the American Academy of Pediatrics for healthy infants in the first year of life as a preventative measure for sudden infant death syndrome.

supine

infant-triggered ventilator with signal detector and assist/control mode

synchronized intermittent mandatory ventilation (SIMV)

Capacity to balance heat production, heat conservation, and heat dissipation

thermal stability

T or F: Therapeutic positioning for preterm and high-risk infants should provide support to maintain flexed and midline postures

true

T or F: developmentally, supportive care uses both physiologic and behavioral information to evaluate the needs of the infant in a NICU setting

true

T or F: fortified human milk is mixed as close to feeding time as possible and stored in the refrigerator

true

T or F: low-birth-weight infants (<1500 g) who are fed only human milk demonstrate decreased growth rates and nutritional deficiencies

true

T or F: milk produced by mothers by preterm infants changes in content over the first 30 days postnatally, until its content is similar to that of full-term human milk.

true

T or F: nursing care for the neonate should include modification of care to provide longer episodes of undisturbed sleep

true

T or F: preterm infants are less responsive to visual stimulation and have less acuity and accommodation than full term infants

true

T or F: preterm infants who are fed fortified human milk have shorter hospital stays and less infection than infants given preterm formulas.

true

T or F: stroking a preterm infant who is not physiologically stable can result in distress, including oxygen desaturation.

true

T or F: strong visual stimulation such as high-contrast black-and-white patterns can evoke an obligatory staring response by the immature infant, who is unable to break away from it.

true

T or F: studies have shown that preterm infants who received human milk during their hospitalization demonstrated better intellectual performance scores at 7.5 to 8 years of age compared with children who received formula.

true

T or F: the best time for care of an infant is when the infant is awake

true

T or F: the number of calories required for optimal growth in sick and very low-birth-weight infants is higher than for healthy infants

true

T or F: therapeutic positioning for preterm and high-risk infants should provide support to maintain flexed and term infants

true

The term _____________ ___________ _____________ is applied to physically healthy children who are perceived by parents to be at high risk for medical or developmental problems.

vulnerable child syndrome