3490 test 2

What maternal condition would cause the nurse to expect signs of respiratory distress syndrome (RDS) in a neonate? 1 Has type 1 diabetes 2 Has been hypertensive during pregnancy 3 Was preeclamptic during the labor and birth 4. Prior use of heroin or opioids

1Infants of mothers with diabetes are at risk for respiratory distress syndrome as a result of delayed synthesis of surfactant caused by a high serum level of insulin. The infant of a mother with hypertension may be small for gestational age but not necessarily preterm and at risk for RDS. Preeclampsia does not predispose the full-term newborn to the development of RDS. The mother's use of heroin or other opioids does not necessarily predispose the newborn to RDS.

Respiratory distress syndrome (RDS) develops 6 hours after birth in a neonate born at 33 weeks' gestation. What would the nurse's assessment of the newborn at this time reveal? 1 High-pitched cry 2 Intercostal retractions 3 Heart rate of 140 beats/min 4 Respirations of 30 breaths/min

2

What is an appropriate nursing intervention for a neonate with respiratory distress syndrome (RDS)? 1 Avoid handling the infant to conserve energy 2 Position the infant to promote respiratory efforts 3 Assess the infant for congenital birth defects to enable early treatment 4 Set the incubator thermostat 10° F (12° C) below body temperature to prevent shivering

2

Hemolytic uremic syndrome can lead to the need for: (Select all that apply.) 2. Hemodialysis. 3. Blood transfusions. 4. Antiepileptic medications. 5. Antihypertensive medications.2

2, 3, 4, 5, Hemodialysis will be needed to filter out waste products for the patient. 3. A blood transfusion may be needed because the patient is at risk for anemia. 4. The patient is at risk for seizures, so preventative measures may be needed. 5. Close monitoring of blood pressure is required because of the vascular changes which occur with the disease.

A preterm infant with respiratory distress syndrome (RDS) has blood drawn for an arterial blood gas analysis. Which test result should the nurse anticipate for this infant? 1 Increased Po2 2 Lowered HCO3 3 Decreased Pco2 4 Decreased blood pH

4

Supplemental oxygen is ordered for a preterm neonate with respiratory distress syndrome (RDS). What action does the nurse take to reduce the possibility of retinopathy of prematurity? 1 Humidifying oxygen flow to prevent dehydration 2 Uncovering the entire body to increase exposure to the oxygen 3 Applying eye patches to both eyes to protect them from the oxygen 4 Verifying oxygen saturation frequently to adjust flow on the basis of need

4

The nurse is planning care for a school-age child with bacterial meningitis. Which nursing intervention should be included? A. Keep environmental stimuli to a minimum. B. Avoid giving pain medications that could dull the sensorium. C. Measure the head circumference to assess developing complications. D. Have the child move the head side to side at least every 2 hours.

A Children with meningitis are sensitive to noise, bright lights, and other external stimuli because of the irritation on the meningeal nerves. The nurse should keep the room as quiet as possible with a minimum of external stimuli, including lighting.After consultation with the practitioner, pain medications can be used on an as-needed basis. A school-age child will have closed sutures; therefore, the head circumference cannot change. The head circumference is not relevant to a child of this age.The child is placed in a side-lying position, with the head of the bed slightly elevated. The nurse should avoid measures such as lifting the child's head that increase discomfort and put tension on the neck.

A nurse is discussing the changes in the breast that occur after birth to a group of pregnant women. One woman says, "My friend who was breastfeeding told me that at first, her breast milk was dark yellow." Which response by the nurse would be appropriate? A. "That is called colostrum. It is rich in antibodies and proteins." B. "That was just fluid that normally collects to make your breasts get bigger." C. "Your friend probably had a mild infection in her milk ducts." D. "The fluid is yellow because of the anesthesia your friend recea i b v ire b.d co."

Answer: A Rationale: Prolactin stimulates the production of milk within a feaw b i r bd . a c oy m s / ta e sf t ter childbirth, but in the interim, dark yellow fluid called colostrum is secreted. Colostrum contains more minerals and protein but less sugar and fat than mature breast milk. Colostrum secretion may continue for approximately 1 week after child birth, with gradual conversion taob i rmb . cao tmu/ rtee smt ilk. Colostrum is rich in maternal antibodies, especially immunoglobulin A (IgA), which offers protection for the newborn against enteric pathogens. Colostrum is not fluid that has collected during pregnancy that causes breasts to enlarge, not a sign of infecton, or the result of anesthesia given. Question format: Multiple Choice Chapter 3: Anatomy and Physiology of the Reproductive System Cognitive Level: Understand Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Reference: p. 100

After teaching a group of pregnant women about breastfeedinagbi, rbt.hcoemn/tuesrt se determines that the teaching was successful when the group identifies which hormone as being inhibited during pregnancy but is important for the production of breast milk after birth? A. placental estrogen B. progesterone C. gonadotropin-releasing hormone D. prolactin

Answer: D Rationale: Following birth and the expulsion of the placenta, levels of placental hormones (progesterone and lactogen) fall rapidly, and the action of prolacta i b n irb( .m coi m lk/te - s p t roducing hormone) is no longer inhibited. Prolactin stimulates the production of milk within a few days after birth. Placental estrogen and progesterone stimulate the development of the mammary glands during pregnancy. Gonadotropin-releasing hormone induces the release of stimulating hormone and luteinizing hormone to assist with ovulation. Question format: Multiple Choice Chapter 3: Anatomy and Physiology of the Reproductive System Cognitive Level: Analyze Client Needs: Health Promotion and Maintenance Reference: p. 100

The nurse is admitting a young child to the hospital because bacterial meningitis is suspected. What is the major priority of nursing care? A. Initiate isolation precautions as soon as the diagnosis is confirmed. B. Initiate isolation precautions as soon as the causative agent is identified. C. Administer antibiotic therapy as soon as it is ordered. D. Administer sedatives and analgesics on a preventive schedule to manage pain.

C Initiation of antibiotic therapy is the priority action. Antibiotics are begun as soon as possible to prevent death and to avoid resultant disabilities.Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued.Isolation should be instituted as soon as a diagnosis is anticipated and should remain in effect until bacterial or viral origin is determined. If bacterial meningitis is ruled out, then isolation precautions can be discontinued.Initiation of antibiotics is the priority nursing intervention. Pain should be managed on an as-needed basis.

The nurse is caring for a neonate with suspected meningitis. Which clinical manifestations should the nurse prepare to assess if meningitis is confirmed? (Select all that apply.) a. Headache b. Photophobia c. Bulging anterior fontanel d. Weak cry e. Poor muscle tone

C,D,E Assessment findings in a neonate with meningitis include bulging anterior fontanel, weak cry, and poormuscle tone. Headache and photophobia are signs seen in an older child.DIF: Cognitive Level: Understand REF: p. 890TOP: Integrated Process: Nursing Process: AssessmentMSC: Area of Client Needs: Physiologic Integrity: Physiologic Adaptation

A neonate born at 30 weeks' gestation is in the neonatal intensive care nursery for observation. What will the nurse do next in response to the assessment findings (above)? a. Provide positive-pressure ventilation. b. Initiate chest compressions. c. Increase stimulation. d. Administer caffeine.

Correct: A Rationale: The neonate is experiencing a prolonged apnea that is resulting in bradycardia and desaturation. The nurse should administer positive-pressure ventilation to ventilate the lungs and provide respiratory support. Gentle stimulation has already been provided without result; the preterm neonate cannot tolerate vigorous stimulation. Positive-pressure ventilation should be initiated first, prior to chest compressions. Caffeine may be used to prevent apneic episodes, but it is not a treatment for an acute episode.

A preterm newborn receives oxygen therapy to treat respiratory distress syndrome (RDS). Which complication should the nurse consider a result of oxygen administration at a high concentration? a. retinopathy of prematurity b. diminished erythropoiesis c. bronchopulmonary dysplasia (chronic lung disease) d. necrotizing enterocolitis

Correct: A Rationale: Retinopathy of prematurity can occur as a complication associated with the use of high concentrations of oxygen. High concentrations of oxygen can damage the fragile retinal blood vessels of the preterm infants and cause retinopathy. Bronchopulmonary dysplasia (chronic lung disease), diminished erythropoiesis, and necrotizing enterocolitis are not complications associated with a high concentration of oxygen. Bronchopulmonary dysplasia (chronic lung disease) results from the effect of long-term mechanical ventilation. Diminished erythropoiesis in the preterm newborn is due to immaturity of the hemopoietic system. Necrotizing enterocolitis is associated with ischemia of the bowel, leading to necrosis and perforation.

a child is newly diagnosed with neonatal bronchopulmonary dysplasia. which intervention should the nurse perform first to help the parents a. teach cardiopulmonary resuscitation b. refer them to support groups c. help parents id necessary lifestyle changes d. evaluate and assess parents' stress and anxiety levels

D

the nurse is preparing a care plan for the parents of a child with neonatal bronchopulmonary dysplasia. which outcome would the nurse anticipate for this childs parents a.report the same level of stress b. make safe decisions with professional assistance c. participate in routine caretaking activities d. verbalize the causes, risks, therapy options and nursing care

D

the nurse is educating the parent of a 2yo with neonatal bronchopulmonary dysplasia who is placed on furosemide. which statement by the parents best indicates an understanding of this medication a. i need to make sure my child uses the bathroom at least every 6 hours b. i need to make sure m child gets his blood pressure checked twice a year c. i need to make sure my child wears short sleeves when outside d. i need to make sure my child eats foods rich in potassium

D (should eat foods rich in potassium to replace what is lost through diuresis while taking furosemide)

A child has been diagnosed with febrile seizures. Which of the following information should the nurse include in the parent teaching session? A. "Whenever your child develops a fever, place him in a warm bath and pour the water over his arms and legs." B. "Make sure to give your child high dosages of acetaminophen whenever his temperature goes above 104 degrees." C. "It is very important that your child have no more seizures to prevent him from experiencing permanent injury to his brain." D. "It should be comforting to know that most children outgrow the febrile seizures by the time they reach 5 years of age."

D. "It should be comforting to know that most children outgrow the febrile seizures by the time they reach 5 years of age."

A nurse is reviewing the medical record of a newborn who has necrotizing enterocolitis (NEC). Which of the following findings is a risk factor for NEC? A. Macrosomia B. Transient tachypnea of the newborn (TTN) C. Maternal gestational hypertension D. Gestational age 36 weeks

D. CORRECT: A gestational age of 36 weeks, or a preterm birth, places a newborn at risk for NEC.

Fortification of breastmilk associated with

HUMAN MILK FORTIFIERS are most often derived from cows milk short term increases in weight, length and head growth BUT by 12 months of age no differences are found risks: minor slower gastric emptying times and possible feed intolerance; increased osmolarity of the feed increased morbidity and mortality from gastrointestinal disease

what is hemolytic uremic syndrome

HUS is a rare but serious disease that affects the kidneys and blood clotting functions of infected people. Infection with HUS causes destruction of red blood cells, which can then cause kidney failure. HUS occurs as a complication of a diarrheal infection (usually E.coli O157:H7 infection). The disease occurs more commonly in children under 5 years of age than in other age groups.

Opisthotonic positioning

Head and neck arched backwards to relieve inflammation of spinal cord

Comparison of colostrum in term: preterm

Higher concentrations of: 1. IgA 2. lysozyme 3. lactoferrin 4. macrophages 5. lymphocytes 6. neutrophils growth factors (including epidermal growth fact and transforming growth factor-alpha)

parent education for child with febrile seizure

If your child has a febrile seizure, stay calm and: Gently place your child on the floor or the ground. Remove any nearby objects. Place your child on their side to prevent choking. Loosen any clothing around their head and neck. Watch for signs of breathing problems, including a bluish color in the face. Try to keep track of how long the seizure lasts. If the seizure lasts more than 5 minutes, or your child turns blue, it may be a more serious type of seizure — call 911 right away. Febrile seizures are triggered by fever. Typically, in children 6 months - 5 years, Most often there is a loss of consciousness and bilateral extremities shake (convulse) uncontrollably. In some cases there will be eye rolling, rigid limbs, or unilateral twitching of an extremity. They are brief and occur with a fever over 101°F (38.3°C). They do not cause any long-term health problems.

A pre-term newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and increased head circumference. These signs indicate the newborn most likely has which of the following complications? a) Intraventricular hemorrhage (IVH) b) Retinopathy of prematurity (ROP) c) Cold stress d) Respiratory distress syndrome

Intraventricular hemorrhage (IVH) Explanation: Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full (or bulging) fontanelle, cyanosis, and increased head circumference.

NEC treatment

MAINTENANCE OF FLUID AND NUTRITION STATUS immediately report abdomen appearing red and shiny Prevent possible transmission to other infants- KNOW NEC is an INFECTIOUS DIEASE!- KNOW Strict hand washing- Confirmed multiple cases are isolated- Persons with symptoms of GI disorder should not care for these or any other infants •Bowel rest and antibiotic therapy; IV fluids •Ongoing assessment and close monitoring •Girth measurements, shiny bowel •Surgery with proximal enterostomy Discontinuation of all oral feedings NPO- Time to reinstitute is usually at least 7-10 days after diagnosis and treatment- Feeding usually reestablished using human milk Breast milk preferred for oral feeds- Confers some passive immunity (IgA), macrophages and lysozymes-Has been shown to decrease the risk of NEC No diaper (due to abdominal distention)- Could also place it very low on the child - not on abdomen! NGT placement for decompression Supine/side-lying position (not prone, because that would hurt (abdominal distention))- Also easier to continuously observe the abdomen Monitor vital signs for changes that might indicate bowel perforation, septicemia, or cardiovascular shock KNOW Especially important to avoid rectal temperatures because of the increased danger of perforation Measure abdominal girth Q 8 hours Measure NGT output Q 4 hours Listen for bowel sounds Colostomy care

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include: a. Hypertonia, tachycardia, and metabolic alkalosis. b. Abdominal distention, temperature instability, and grossly bloody stools. c. Hypertension, absence of apnea, and ruddy skin color. d. Scaphoid abdomen, no residual with feedings, and increased urinary output.

b. Abdominal distention, temperature instability, and grossly bloody stools.(Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis.)

Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is supportive; however, known interventions may decrease the risk of NEC. To develop an optimal plan of care for this infant, the nurse must understand which intervention has the greatest effect on lowering the risk of NEC: a. Early enteral feedings b. Breastfeeding c. Exchange transfusion d. Prophylactic probiotics

b. Breastfeeding(A decrease in the incidence of NEC is directly correlated with exclusive breastfeeding. Breast milk enhances maturation of the gastrointestinal tract and contains immune factors that contribute to a lower incidence or severity of NEC, Crohn's disease, and celiac illness. The neonatal intensive care unit nurse can be very supportive of the mother in terms of providing her with equipment to pump breast milk, ensuring privacy, and encouraging skin-to-skin contact with the infant. Early enteral feedings of formula or hyperosmolar feedings are a risk factor known to contribute to the development of NEC. The mother should be encouraged to pump or feed breast milk exclusively. Exchange transfusion may be necessary; however, it is a known risk factor for the development of NEC. Although still early, a study in 2005 found that the introduction of prophylactic probiotics appeared to enhance the normal flora of the bowel and therefore decrease the severity of NEC when it did occur. This treatment modality is not as widespread as encouraging breastfeeding; however, it is another strategy that the care providers of these extremely fragile infants may have at their disposal.)

benefits of breastmilk for preterm infant

babies who don't get human milk are more likely to get NEC. Human milk is easier to digest. It also contains substances that help fight infection and help intestinal cells mature. Breast milk preferred for oral feeds- Confers some passive immunity (IgA), macrophages and lysozymes-Has been shown to decrease the risk of NEC Psychological benefits: increased self-confidence and bonding with infant Physical benefits: delay in monthly ovulation resulting in longer intervals between pregnancies optimal food for infants; protection from iron deficiency; better gains in cognitive ability; fewer acute respiratory and gastrointestinal illnesses; and lower risk of allergies and asthma optimal nutrition; balanced nutrients; isosmatic human milk; meets protein needs without overloading kidneys; contains soft, easily digestible curd; provides generous amount of the right lipids; long chain polyunsaturated fatty acids needed from CNI development are present; enhanced availability of minerals rate of growth modeled on expected intrauterine growth pattern. protein and energy needs takes into consideration the infants need to gain lean body mass while limiting fat deposition protein content decrease fat, lactose and energy increase WHY: slow closing of the tight junctions between the lactocytes

prematurity

baby is born before 37 weeks gestation. higher rate of death & disability => -infants (espec those born before 32 weeks) brain, lungs, and liver are all immature -those that survive may have issues (breathing, feeding, vision, hearing, neuromuscular and cognitive, developmental) -These infants also take an emotional toll on a family and place many families in financial hardship.

which neonate is at highest risk for developing neonatal bronchopulmonary dysplasia a. a neonate born at 38 weeks receiving 1-4L of O2 during feedings b. a premature neonate born at 34 weeks receiving supplemental oxygen c. a premature neonate born at 28 weeks on a high pressure ventilator d. a neonate born at 42 weeks who requires treatments for respiratory syncytial

c (neonate less than 30 weeks)

which nursing intervention is the priority for an infant with neonatal bronchopulmonary dysplasia a. weight the infant on the same scale, at the same time each day b. give the infant higher calorie formula as ordered c. monitor oxygen status via pulse ox d. monitor strict I & O

c (priority)

Transitory tachypnea of the newborn (TTN) is thought to occur as a result of a. a lack of surfactant b. hypoinflation of the lungs c. delayed absorption of fetal lung fluid d. a slow vaginal delivery associated with meconium-stained fluid c. delayed absorption

c. delayed absorption of fetal lung fluid

preterm colostrum

greater potential for preventing infection Store colostrum until baby can have enteral feeds then begin feeds using first colostrum preterm milk continues to be a better source of antibacterial and anti inflammatory factors Higher concentrations of IGA, lactoferrin g, lysozyme and adiponectin growth factors Cellular content similar operates through the secretory immune system Bronchomammary and enteromammary pathways Increase skin to skin time so mums milk is induced to make specific antibodies antibodies in preterm breastmilk: E coli pseudomonas aeruginos salmonella minnesota

Necrotizing enterocolitis (NEC)

•Bowel inflammation, ischemia or necrosis -happens when tissue in the large intestine (colon) gets inflamed. This inflammation damages and kills tissue in the colon. d/t •Underdeveloped immune system, compromised mucosal barrier, slow moving gut •Cold stress (poor perfusion) Any newborn can get NEC but it's most common in very sick or premature babies. •10% of LBW < 1500 gm High mortality rate The exact cause is unknown but is thought to be related to low oxygen levels in the intestinal tissues weakening the intestinal wall and leading to perforation. Perforation is considered a medical emergency as the infant is a great risk for sepsis. Other complications from NEC include strictures, short bowel syndrome and death. All preterm infants are at risk for NEC but babies who don't get human milk are more likely to get NEC. Human milk is easier to digest. It also contains substances that help fight infection and help intestinal cells mature. Signs and symptoms: 1. abdominal distention and tenderness 2. bloody stools 3. feeding intolerance (bilious vomiting) 4. sepsis 5. lethargy 6. apnea 7. shock 8. KUB: air in bowel wall; dilated bowel loops

risk reduction for intraventricular hemorrhage of the premature neonate

•Nursing Implications - PREVENTION •Pay attention to ICP •Sx, PPV, oxygen, acid base balance, thermoregulation, BP, HR •Fluid replacement rates and amounts •Min Stim Environment - Cluster Care •Midline positioning •Head Circumference •Anemia •Indomethacin before 6 hours of life •Lab work which indicates unexplained blood loss - CBC H/H •Supportive Care delayed cord clamping, minimal handling for the first few hours, avoiding head down position, antenatal corticosteroids, and establishing standard diagnostic.

family education on NEC of the newborn includes

•What may come to be •Ostomy •Failure to Thrive •Short Gut

hemolytic uremic syndrome signs and symptoms**

●watery diarrhea with cramping/ vomiting ●After days, diarrhea becomes bloody then improves ●Pallor, toxic appearance, edema, oliguria (decreased urine output), or anuria (absent urine output) ●Elevated blood pressure & abdominal tenderness ●Neurologic involvement ○irritability, altered LOC, seizures, posturing, or coma As infection progresses, persons may experience fatigue, weakness, fainting, bruising, and paleness. Complications may occur leading to high blood pressure, seizures, blood-clotting problems, kidney disease, stroke, or coma.

others treatments for apnea of prematurity:

-Nasal CPAP (splints open the upper airway to prevent pharyngeal collapse, decreases the risk of OSA). Also aids in dec duration of O2 desaturation -blood transfusions (can increase respiratory drive) -treatment of GERD

Physical Examination: of infant with bacterial meningitis

-Opisthotonic position -Nuchal rigidity -Bulging fontanel -Positive Kernig -Brudzinski Rash

What are risk factors of IVH?

-Premature birth: Less than 34 weeks gestation, respiratory failure, requiring intubation/mechanical ventilation-Low apgars-Asphyxia-Low birth weight-Hypotension/hypertention-Low hematocrit-Rapid infusions of hyperosmolar solutions-Rapid fluid boluses-Rapid bicarb infusions-Many More -IVH precautions, very limited movement, baby remains supine and midlin for 3 days, minimize noxious sitmuli, clustering cares-HUS at 7 days of age minimum, sooner if concerns of occurance of bleed-Correct acidosis, maximize ventilation, avoid hyperosmolar solutions, avoid swings in blood pressure and saturations-Avoid excessive suctioining in vented patients-Serial HUS on babies with bleeds and follow up HUS on all ar risk babies at 36 weeks CGA

apnea:

-cessation of breathing for 20 sec or longer OR -shorter pause accompanied by bradycardia (<80), cyanosis (spo2 <80-85%), or pallor

what is not recommended in the treatment for apnea of prematurity?

-routine home monitoring (most apnea/bradycardia events resolve by 40 weeks CGA).

Because preterm infants are at risk for respiratory distress syndrome, immediate nursing intervention is required when a preterm infant exhibits what sign? 1 Supraclavicular retractions 2 Tachycardia of 160 beats/min 3 Respirations of 50 to 60 breaths/min 4 Neonatal Infant Pain Scale (NIPS) score of three

1

Which component of nursing care is most important for a newborn with respiratory distress syndrome (RDS)? 1 Keeping the infant in a warm environment 2 Turning the infant frequently to prevent apnea 3 Tapping the infant's toes to stimulate deep breathing 4 Maintaining the infant's oxygen administration level at the same rate

1 Keeping the infant in a warm environment

complications of respiratory distress syndrome

1. Air leak syndrome, BPD (CLD) 2. PDA 3. CHF 4. intraventricular hemorrhage 5. ROP 6. NEC 7. complications resulting from intravenous catheter use (infection, thrombus formation) 8. developmental delay or disability

potential complications of prematurity

1. Respiratory Distress Syndrome- RDS 2. Apnea of Prematurity AOP 3. Retinopathy of prematurity - ROP 4. Intraventricular or Periventricular Hemorrhage -IVH 5. Necrotizing enterocolitis -NEC 6. Transient Tachypnea of the Newborn - TTN 7. Chronic Lung Disease (CLD) AKA Bronchopulmonary Dysplasia =BPD

Continuous positive-pressure ventilation therapy by way of an endotracheal tube is started in a newborn with respiratory distress syndrome (RDS). The nurse determines that the infant's breath sounds on the right side are diminished and that the point of maximum impulse (PMI) of the heartbeat is in the left axillary line. How should the nurse interpret these data? 1 These findings are expected because infants with this disorder often have some degree of atelectasis. 2 The inspiratory pressure on the ventilator is probably too low and needs to be increased for adequate ventilation. 3 These findings indicate that the infant may have a pneumothorax and that the health care provider should be contacted immediately. 4 The endotracheal tube needs to be pulled back to ventilate both lungs because it has probably slipped into the left main stem bronchus.

3

A newborn with respiratory distress syndrome (RDS) is receiving continuous positive airway pressure (CPAP) therapy by way of an endotracheal tube. The nurse determines that the infant's breath sounds on the right side are diminished and that the point of maximum impulse (PMI) of the heartbeat is in the left axillary line. What is the interpretation of these assessment data and the appropriate nursing action? 1 Inspiratory pressure on the ventilator is probably too low and should be increased for adequate ventilation. 2 Infants with RDS often have some degree of atelectasis, and there should be no change in treatment. 3 The endotracheal tube has slipped into the left main stem bronchus and should be pulled back to ventilate both lungs. 4 The infant may have a pneumothorax, and the health care provider should be called so that corrective therapy can be started immediately.

4

What is the focus of nursing care for a newborn with respiratory distress syndrome (RDS)? 1 Tapping the toes to stimulate respirations 2 Turning the infant frequently to prevent apnea 3 Maintaining oxygen concentration at 40% to support respiration 4 Keeping the infant warm to maintain body temperature at 98° F (37° C)

4

which nursing action would be most appropriate to facilitate gas exchange for an infant with bronchopulmonary dysplasia a. provide or arrange for chest physiotherapy b. provide adequate rest periods c. monitor oxygen saturation d. promote bonding between parent and child

A (actively facilitates gas exchange by mobilizing secretions)

A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? Select all that apply. A. Perform hemoccult test on stools. B. Monitor for an increase in abdominal girth. C. Measure gastric contents before each feed. D. Assess bowel sounds before each feed. E. Assess for anal fissures daily.

A. Perform hemoccult test on stools. B. Monitor for an increase in abdominal girth. C. Measure gastric contents before each feed. D. Assess bowel sounds before each feed

Which intervention is the most important to prevent necrotizing enterocolitis? A: Exclusive human milk feeding B: Surfactant C: Oxygen D: Ventilator support

A: Exclusive human milk feeding

A 2-hour-old newborn delivered by cesarean section at 38 weeks with clear amniotic fluid has a respiratory rate of 80 with grunting and nasal flaring. The mother experienced preeclampsia while pregnant. What is the most likely cause of this infant's condition? 1. Prematurity of the neonate 2. Respiratory distress syndrome 3. Meconium aspiration syndrome 4. Transient tachypnea of the newborn

Answer: 4 4. The infant is term and born by cesarean section. The baby is most likely experiencing transient tachypnea of the newborn. Explanation: 1. The infant is not premature. Prematurity alone does not cause respiratory distress; the lack of surfactant causes respiratory distress syndrome.2. The infant is not premature and therefore is not likely to be experiencing respiratory distress syndrome.3. There was no meconium in the amniotic fluid, which rules out meconium aspiration syndrome.

Who gets hemolytic uremic syndrome?

Anyone infected with E. coli O57:H7 or another Shiga toxin-producing E. coli(STEC) strain can get HUS. Children who are less than 5 years old, people with weakened immune systems (such as those with cancer, HIV/AIDS, or a transplant), or persons with a family history of HUS are more at risk to develop the disease. Only a small fraction of people diagnosed with E.coli O57:H7 (or STEC) infection develop HUS.

Apnea of Prematurity (AOP)

Apnea of prematurity is one of the most common complication of prematurity % of AOP by prematurity *100% born <28 weeks *85% born ~30 weeks *20% born~34 weeks

A 6-month-old infant is admitted to the hospital with suspected bacterial meningitis. She is crying, irritable, and lying in the opisthotonic position. The priority nursing intervention would be: A Educate the family on ways to prevent bacterial meningitis. B Initiate appropriate isolation precautions and begin intravenous antibiotics. C Assess the infant's fontanels. D Encourage the mother to hold the infant and feed her.

B

the nurse is planning care for a child admitted to the pediatric unit with neonatal bronchopulmonary dysplasia. which intervention should the nurse perform first a. keep fluids at a minimum b. provide humidified oxygen c. give palivizumab vaccine d. keep ambient air temperature cooler than normal

B (liquify secretions)

What clinical manifestations would the nurse expect to find in a newborn who has developed necrotizing enterocolitis (NEC)? A. Hyperthermia B. Gastric residual and melena C. The passage of ribbon-like stools D. Projectile vomiting

B. Gastric residual and melena

infants with neonatal bronchopulmonary dysplasia require frequent, prolonged rest periods. which sign indicates over-stimulation a. increased alertness b. good eye contact c. cyanosis d. increased appetite

C

A pediatric nurse has floated to the NICU to work her shift. The physician has ordered a dose of intravenous caffeine for a newborn baby who was born 4 weeks' prematurely. Which of the following describes the rationale for giving this infant caffeine? 1). Caffeine reduces instances of infant apnea 2). Caffeine works to increase the infant's blood pressure to normal levels 3). Caffeine helps the infant to stay awake to eat 4). Caffeine helps the infant to gain weight by accumulating brown fat

Caffeine reduces instances of infant apnea (Caffeine is a type of stimulant mostly found in foods and drinks consumed by adults; however, it may also be given orally or intravenously to preterm infants to reduce episodes of apnea. A preterm infant is at higher risk of periods of central apnea when the brain does not always stimulate the body to breathe. The baby can suffer a loss of oxygen with frequent periods of apnea. Caffeine is given as a stimulant to reduce apneic episodes.)

common symptoms of bacterial meningitis

Common symptoms: -Fever -irritable -poor feeding -high pitched cry -bulging fontanel (infant) -nuchal rigidity -back arching -sleepiness change in personality -photophobia -seizures

What is a consequence of hypothermia in a newborn? a. respirations of 46 b. heart rate of 126 c. skin pink and warm d. holds breath 25 seconds

Correct response: D Rationale: Apnea is the cessation of breathing for a specific amount of time, and in newborns it usually occurs when the breath is held for 15 seconds. Apnea, cyanosis, respiratory distress, and increased oxygen demand are all consequences of hypothermia.

A newborn is being monitored for retinopathy of prematurity. Which condition predisposes an infant to this condition? a. hydrocephalus b. respiratory distress syndrome c. esophageal atresia d. Down syndrome

Correct: B Rationale: Retinopathy of prematurity (ROP) is a complication that can occur when high concentrations of oxygen are given during the course of treatment for respiratory distress syndrome (RDS). ROP is caused by separation and fibrosis of the retinal blood vessels and can often result in blindness.

The nurse is caring for a preterm neonate on an apnea monitor. When the monitor alarms, what action does the nurse take? Select all that apply. a. Begins bag and mask ventilation b. Administers a dose of caffeine c. Counts the respiratory rate for a full minute d. Performs a focused assessment of the neonate e. Silences the alarm

Correct: C, D, E Rationale: The nurse needs to perform a focused assessment to determine if the neonate is apneic and if position or other factors contributed to the episode. The respiratory rate is counted for a full minute as part of the assessment. The alarm is silenced to decrease environmental noise and stress. Bag and mask ventilation is used for respiratory arrest, not an episode of apnea. Many neonates with apnea are on caffeine, but the dose is scheduled and not given in response to an apneic episode.

It's also important to know what you should not do during a febrile seizure:

Do not try to hold or restrain your child. Do not put anything in your child's mouth. Do not try to give your child fever-reducing medicine. Do not try to put your child into cool or lukewarm water to cool off.

Bacterial Meningitis

Infection of the meninges ○Leads to brain/nerve damage, deafness, stroke, and even death Requires rapid assessment and treatment!

A 28-weeks'-gestation newborn experienced birth asphyxia at the time of delivery. What is a long-term complication of birth asphyxia? a. Intraventricular hemorrhage. b. Anemia of prematurity. c. Retinopathy of prematurity. d. Necrotizing enterocolitis

Intraventricular hemorrhage

Diagnosis of meningitis

Looking for source of infection and R/O sepsis >Lumbar puncture >blood tests >CT scan Cultures -Blood, urine, and nasopharyngeal culture -Blood culture positive = septicemia lumbar puncture (LP)—CSF BACTERIAL ○Increased (WBCs) ○Increased protein ○Low glucose (the bacteria present feed on glucose).

Intraventricular Hemorrhage (IVH)

MOST SERIOUS NEUROLOGICAL INJURY bleeding inside or around the ventricles. •Usually originates in subependymal germinal matrix region and extends to ventricles D/T -Fluctuations in blood flow -Immature cerebral vasculature -Thin fragile capillaries Up to 50% BW < 1,500 gm/35 wks (3 pounds, 5 ounces) > 50% if VLBW in first 6-8 hours of life Grades I - IV This bleeding occurs due to the fragile blood vessels in a premature baby's brain. Nearly all IVH occurs within the first few days of life. This bleeding can cause severe damage and may lead to brain injury and in some cases hydrocephalus. Nursing management to prevent IVH is key

oxygen (as related to ROP)

Oxygen is a drug and you need orders. Nursing can titrate oxygen up and down to maintain oxygen saturations in the range ordered by the healthcare provider. For example in a NICU you will see sat range goals. Maintain oxygen saturations above 95%. In some cases in babies with heart or lung disease the sat orders may be to maintain oxygen saturations above 88%. Always check orders and monitor saturations. Especially with a preterm infant at risk for ROP to prevent vision loss.

How does Shigatoxin-producing E.coli (STEC) spread?

People become infected with E.coli O157:H7 when they ingest any product contaminated with the bacteria, including raw (or undercooked) meat, lettuce, alfalfa sprouts, salami, or raw (unpasteurized) milk, juice, or cider. Infection spreading from person to person can occur if those infected do not wash their hands after using the toilet.

prevention of apnea of prematurity

Preventative: 1. positioning: avoid extreme flexion or extension of neck (maintain patency of airway) -> prone positioning 2. provide stable thermal environment 3. limit nasal suctioning and use heated humidifed air to maintain nasal patency 4. maintain spo2 between 88-94% (hypoxia can stimulate apneic episodes) 5. bradycardic episodes that spontaneously resolve and are feeding related should not be counted in the countdown period.

retinopathy of prematurity

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder Happens when abnormal blood vessels grow in the retina primarily affects premature infants born about 2¾ lbs (1250 grams) or before 31 weeks gestation. The smaller or more preterm the infant the greater the risk. It is one of the most common causes of visual loss in childhood can lead to lifelong vision impairment and blindness. Some babies with ROP have mild cases and get better without treatment Some babies need treatment to protect their vision and prevent blindness. Associated with the use of Oxygen with Premature infants

treatment for bacterial meningitis

Treatment Depends of cause: Bacterial meningitis must be treated immediately with IV antibiotics. To reduce the risk of complications, such as brain swelling and seizures. Bacterial - IV antibiotics, possible steroids plus supportive care to relieve symptom Viral - Supportive care - relieve symptoms Support care = Rest, fluids, antipyretics, analgesics, oxygen, ventilator Avoid stimulating pts. CNS (Keep the environment quiet and dim lights bc stimulation of CNS can cause ICP) Assess for HA (could indicate swelling in the brain or inflammation of the meninges) Assess for fever patient most likely already has a fever due to an infection, but keep the fever under control and prevent it from going up. If prescribed administer Tylenol. Monitor s/s of ICP such as changes in pupillary reaction to light, LOC, HA, drowsiness, ↓ alertness, vomit, bulging fontanelle (infants). Monitor for seizures from swelling and pressure in the brain and toxins in the fluid surrounding the brain. Have precautions such as side rails up and padded, suction and o2 near, loose clothes HOB elevated 30

when should you call 911 for febrile seizure?

When Should I Call 911? Get emergency medical care if your child: has a febrile seizure that lasts longer than 5 minutes has a seizure that involves only some parts of the body instead of the whole body has trouble breathing or turns blue isn't responding normally has another seizure within 24 hours had to take an anti-seizure medicine to make the seizure stop A child who has missed getting some vaccines and has a febrile seizure could have a higher risk for meningitis. Febrile seizures can be scary to see. But they're fairly common and not usually a symptom of serious illness

Protein in breast milk

Whey easily digested renal solute load is low

Risk factors associated with necrotizing enterocolitis (NEC) include (Select all that apply): a. Polycythemia. b. Anemia. c. Congenital heart disease. d. Bronchopulmonary dysphasia e. Retinopathy.

a. Polycythemia. b. Anemia. c. Congenital heart disease. (Risk factors for NEC include asphyxia, respiratory distress syndrome, umbilical artery catheterization, exchange transfusion, early enteral feedings, patent ductus arteriosus, congenital heart disease, polycythemia, anemia, shock, and gastrointestinal infection.)

A nurse is assessing a 37-weeks'-gestation newborn born by cesarean section, and now at 4 hours of age on room air. The newborn had no breathing problems at birth. The nurse notes the following signs: expiratory grunting, flaring of the nares, mild cyanosis, and respirations of 90 bpm. The newborn most likely is experiencing: a. Transient tachypnea of the newborn. b. Apnea of prematurity. c. Congenital diaphragmatic hernia. d. RDS (respiratory distress syndrome).

a. Transient tachypnea of the newborn. Rationale: This is a clear picture of how transient tachypnea of the newborn presents. In transient tachypnea of the newborn, tachypnea is usually present by 6 hours of age, with respiratory rates consistently higher than 60 bpm. It is more prevalent in cesarean-birth newborns who have not had the thoracic squeeze that occurs during vaginal birth and removes some of the lung fluid.

Immunology of preterm milk

antimicrobial agents and immunological factors are higher in bm of mums birthing preterm

supportive care of NEC nursing management focuses on

anxiety

The nurse is admitting a 9-year-old child with hemolytic uremic syndrome. What clinical manifestations should the nurse expect to observe? (Select all that apply.) a. substantial proteinuria b. Anorexia c. Hypertension d. Purpura

b, c, d Clinical manifestations of hemolytic uremic syndrome include anorexia; hypertension; and purpura, which persists for several days to 2 weeks. Gross hematuria is seen in acute glomerulonephritis. Substantial proteinuria and periorbital edema are common manifestations in nephrotic syndrome.

In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level? a. Necrotizing enterocolitis (NEC) b. Retinopathy of prematurity (ROP) c. Bronchopulmonary dysplasia (BPD) d. Intraventricular hemorrhage (IVH)

b. Retinopathy of prematurity (ROP)(ROP is thought to occur as a result of high levels of oxygen in the blood. NEC is caused by the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site. BPD is caused by the use of positive pressure ventilation against the immature lung tissue. IVH results from rupture of the fragile blood vessels in the ventricles of the brain. It is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow.)

When the seizure is over. . .

call your doctor for an appointment to find the cause of the fever. The doctor will examine your child and ask you to describe the seizure. In most cases, no other treatment is needed. The doctor might order tests if your child is under 1 year old and had other symptoms, like vomiting or diarrhea. The doctor may recommend the standard treatment for fevers, which is acetaminophen or ibuprofen. Giving these medicines around the clock is not recommended and won't prevent febrile seizures. The doctor might prescribe an anti-seizure medicine to give at home if your child has more than one or two febrile seizures that last more than 5 minutes.

extra care to prevent IVH

can be reduced by gentle handling and good monitoring Pay attention to ICP •Sx, PPV, oxygen, acid base balance, thermoregulation, BP, HR •Fluid replacement rates and amounts •Min Stim Environment - Cluster Care •Midline positioning •Head Circumference •Anemia •Indomethacin before 6 hours of life •Lab work which indicates unexplained blood loss - CBC H/H •Supportive Care changes in blood pressure may occur as a result of handling for example: -movement -crying -feeding -intubation -suctioning -stimulation avoid: 1. Lifting the lower extremities above the midline with diaper changes 2. Giving rapid fluid boluses 3. High O2 and ventilation

why are apneas important

can cause ventilatory and perfusion disturbances for example: 1. retinopathy of prematurity 2. altered growth discordant 3. cardiovascular regulation 4. neurodevelopmental disabilities.

Respiratory Distress Syndrome (RDS)

common in preterm babies (occurs in full term babies as well) characterized as >Lung immaturity & >lack of alveolar surfactant due to a lack of surfactant, a slippery substance that helps keep the alveoli open. surfactant begins actively developing around 34 weeks* The more preterm, the less surfactant. risk factors •Preterm, C section, male, cold stress, GDM, Infant with respiratory distress will present with: 1. increased work of breathing 2. retractions 3. nasal flaring 4. oxygen desaturations 5. cyanosis 6. distinctive 'grunting' sound. diagnosis: Chest x-ray: >hypoaeration, >underexpansion, and >ground glass pattern

distinctive grunting

commonly seen in respiratory distress syndrome The grunting is made when the newborn tries to create an 'end' pressure in the lung to prevent the alveoli from collapsing. This increased work of breathing is difficult and exhausting

The following neonates are admitted to the nursery. The nurse should withhold the scheduled initial feeding on which newborn? a. A neonate with a sustained heart rate of 118 beats/min b. A neonate with an axillary temperature of 36.4°C (97.5°F) c. A neonate who is small for gestational age (SGA) d. A neonate with a sustained respiratory rate of 68 breaths/min

d. A neonate with a sustained respiratory rate of 68 breaths/min

The nurse is caring for a preterm infant who is at risk for an intraventricular hemorrhage (IVH). Which daily assessment is most critical for this infant? a. Moro reflex b. Intake and output c. Blood pressure d. Occipital frontal circumference (OFC)

d. Occipital frontal circumference (OFC)Explanation:Changes in blood pressure might occur, but the changes might not be as noticeable, and can be caused by many other problems. Increasing occipital frontal circumference (OFC) is an indication of increasing intracranial pressure, which could result from an intraventricular hemorrhage (IVH). It should be assessed in infants at risk for an IVH every 8-12 hours. Intake and output are routine measurements that are not directly helpful in this situation. Changes in Moro reflex are not an indication of an IVH.

The nurse is preparing to initiate bottle feeding in a preterm infant. In which situation would the nurse withhold the feeding and notify the health care provider? a. Yellow tint to skin and sclera b. Apical heart rate 120 c. Axillary temperature 97.2°F d. Respiratory rate 72

d. Respiratory rate 72 Explanation: An apical heart rate of 120 is a normal finding. Although an infant temperature of 97.2°F is considered hypothermia, it would not be a contraindication to oral feedings. Jaundice can be considered abnormal, but it alone would not be an indication to withhold an oral feeding. Any sustained respiratory rate higher than 60 breaths/minute increases the risk of aspiration in the infant. Oral feedings should be withheld on infants experiencing tachypnea to decrease the risk of aspiration.

discharge instructions for infant who has apnea of prematurity

discharge: 1. infants free of significant or apneic bradycardic events prior to discharge 2. initiate countdown period few days after discontinuation of caffeine therapy.

etiology of apnea of prematurity

etiology: 1. central (cessation of breathing effort) 2. obstructive (airflow) 3. mixed -Diagnosis is not associated w/ inc. risk of SIDS (but regardless, preterm infants generally have higher risk of SIDS).

Positive Brudzinski's sign

is flexion of the hips and knees when the neck is flexed in a client with meningitis

treatment for Apnea of Prematurity

methylxanthines (caffeine) Caffeine citrate: 1. blocks adenosine receptors 2. inc minute ventilation 3. improved CO2 sensitivity 4. dec periodic breathing 5. dec hypoxic depression 6. improved diaphragmatic contractility 7. shorter duration of mechanical ventilation than earlier treatments initiated. 8. recommended for all infants born <28 weeks as well as 29-32 weeks (depending on clinical course) 9. loading dose 20 mg/kg caffeine citrate 9. maintenance dose 10mg/kg/day 10. trial of caffeine after apnea-free period of 5-7 days OR 32-34 CGA whichever comes first 11. side effects of caffeine -tachycardia -cardiac dysrhythmias -seizures -feeding intolerance -increase metabolic demand

Positive Kernig's sign:

resistance to leg extension after flexing the thigh on the body; sign of meningitis

Energy expenditure of breastmilk

significantly greater when preterm infants are fed preterm artificial milk rather than breast milk

Bronchopulmonary Dysplasia (BPD)

sometimes referred to as Chronic Lung Disease form of chronic lung disease that affects newborns, mostly those who are born prematurely or with respiratory distress at birth. In BPD the bronchi are damaged, causing tissue destruction (dysplasia) in the alveoli. results in arrested lung development and can be fatal This is an acquired disorder often caused by mechanical ventilation and oxygen toxicity The severity varies from infant to infant. The more premature the newborn, the greater the risk of developing BPD. most common morbidity of extremely preterm infants These infants are at risk for pulmonary hypertension and in severe cases heart failure can occur. Many also have feeding difficulty and delayed development. incidence of BPD highly variable treatments 1. Bronchodilators (albuterol, caffeine citrate, ipratropium bromide) 2. Corticosteroids (hydrocortisone, dexamethasone) 3. Diuretics (Lasix) 4. Inhaled nitric oxide 5. caffeine 6. vitamin A 7. Surfactant-replacement therapy

transient tachypnea of the newborn (TTN)

very common occurrence in preterm and some newborn infants. d/t -inadequate clearance of fetal alveolar fluid. -extra squeezing's during the C-section inc risk d/t: -c-section self-limiting/usually resolves within 48-72 hours w/ respiratory support. Nursing assessment: 1. Maternal sedation or birth by cesarean 2. breathing: -tachypnea -expiratory grunting -retractions -labored breathing -nasal flaring -mild cyanosis -RR 100-140 -barrel-shaped chest -slightly low breath sounds 3. Chest x-ray: -mild symmetric lung over aeration -prominent perihilar interstitial marks and streaks treatment: •Nursing management •Oxygenation •Supportive care >>>>>IV fluids or gavage feedings** Priority nursing interventions •Supplemental oxygen •Neutral thermal environment Note- Infants with respiratory distress will not be fed by mouth (bottle). They may be fed via tube feeding or the may require TPN for nutrition

long term complications of IVH

•Long term neurological impact •Learning, vision, hearing, motor function

treatment for respiratory distress syndrome

•Supportive care; close monitoring 1. administration of surfactant directly into their lungs 2. respiratory support - CPAP or intubation. •PREVENT unplanned extubations 3. Antibiotics for positive cultures 4. Fluids and gavage feedings 5. Blood glucose level monitoring 6. Clustering of care 7. Decubitus prevention 8. Turn and position, tube stabilization, IV assessments 9. Developmental positioning 10. Parental support and education