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