Neonatal Intensive Care Unit NICU Exam 1|24 Questions with Verified Answers
NICU Levels - CORRECT ANSWER Because NICU's are so costly and such
... [Show More] specialized treatment facilities they are categorized by level of care and region
Level 1 NICU
Level II NICU
Level III NICU
Level 1V NICU
Level I NICU: - CORRECT ANSWER Able to identify at risk pregnancies and neonates; able to provide emergency care for complications; small community hospitals
Level II NICU: - CORRECT ANSWER Usually in urban areas; able to manage most maternal and neonatal complications; transitional care nursery; in-house anesthesia; ventilation; neonatal monitoring; 24-hour blood gas; radiography / ultrasonography, nutritional and respiratory therapy
Examples:
Central Maine Medical Center, Lewiston, Maine
Maine General, Augusta, Maine
Level III NICU: - CORRECT ANSWER Full range of maternal and neonatal care; able to care for the most complex neonatal conditions; neonatologist on staff; pediatric surgeon on staff; geneticist, radiologist, anesthesiologists, and epidemiologist on staff
Examples:
Maine Medical Center, Portland, Maine
Eastern Maine Medical Center, Bangor, Maine
Level IV NICU: - CORRECT ANSWER Similar to level III but can provide on-site surgical repair for serious birth defects; also provide training to lower level NICUs
Examples:
Mass General Hospital, Boston, MA
Gestational age: - CORRECT ANSWER Gestational age: the total number of weeks the infant spent in utero before birth
Chronological age: - CORRECT ANSWER Chronological age: the number of weeks / months / years since infant's birth
Corrected Age: - CORRECT ANSWER Corrected age: the age the infant would be had she been born at term
Example: 27 weeks GA; 40 - 27 = 13 weeks premature; this number is subtracted from the chronological age to get the corrected age. An infant turning 12 months old would have the corrected age of 9 months (12 months - 13 weeks)
Gestational vs. Corrected Age - CORRECT ANSWER Under-correction: normal; infants would present as delayed if their age was left uncorrected
Over-correction: abnormal infants would score in the normal range if the assessment was done prior to first birthday, particularly for infants born less than 33 weeks.
Correct vs. do not correct: the decision should be based on the purpose of the assessment & instrument used
When the purpose if to detect a developmental delay then use the uncorrected age. When the assessment is used to measure progress use corrected age and follow the procedures of the assessment
Birth Weight - CORRECT ANSWER Average size: 2500 grams 5 lbs., 5 oz.
Low Birth Weight (LBW): 1500-2500 grams / 5 lbs. 8 oz.
Very Low Birth Weight (VLBW): 1000-1500 grams / 3 lbs./ 5 oz.
Extremely Low Birth Weight (ELBW): less than 1000 grams / 2 lbs. 3 oz.
Ultralow Birth Weight (ULBW): less than 750 grams / 1 lb. 10 oz.
Appropriate for Gestational Age (AGA): between 10th -90th percentile
Small for Gestational Age (SGA): birth weight below 10th percentile
Large for Gestational Age (LGA): birth weight above 90th percentile
Common Medical Equipment - CORRECT ANSWER Radiant warmer
Incubator (isolette)
Open crib
Bag and mask ventilation
CPAP
Mechanical ventilation
ECMO
High-flow nasal cannula (HFNC)
Nasal cannula
Oxygen hood
The infant in the NICU - CORRECT ANSWER Immaturity from extreme prematurity or being under-grown (small for gestational age)
Medical illness, birth defects
Healthy infants born at 34 weeks are not as robust as infants born closer to term: they may demonstrate more autonomic sensitivity, a lower threshold to motor disorganization, difficulty self-calming, and have a more fragile ability to orient and attend to environmental and social stimuli
The caregiver in the NICU - CORRECT ANSWER Stress (financial; chronic life stress; poverty)
Fear/distrust of medical providers, state agencies...
History of their own adverse childhood events, trauma, addictions, illness (psychological or physical)...
Parent identified stressors in the NICU - CORRECT ANSWER Sights and sounds of the unit
Infant appearance
Parental role alteration
Altered relationship with their infant
The NICU's potential challenges to emerging co-regulation - CORRECT ANSWER The physical environment
The social/interactive environment
Principles of Developmental Care - CORRECT ANSWER Protect sleep
Pain and stress management and assessment
ADLs (positioning, feeding, skin care)
Family centered care: partnering with families
Healing environment
Optimizing nutrition
Positioning and handling
Developmental Care Approaches: Physical Environment - CORRECT ANSWER A physical environment that supports newborn-parent interaction...
Light: Soft, indirect vs bright or visually complex
Sound: Gentle, low, soothing sound levels
Activity level: Calm vs bustling/chaotic; regular predictable routines
Thermal conditions: Neutral warmth
Developmental Care Approaches: Social Environment - CORRECT ANSWER A social environment that supports newborn-parent interaction...
Concern for parent and infant emotional as well as physical comfort
Fosters an atmosphere of care, nurturance and respect for the infant and family.
Caregivers who can respond sensitively and appropriately to the infant and family
Unit policies and caregiving practices that are supportive of parent presence and participation
Supporting Neurodevelopment for the Infant - CORRECT ANSWER Initial Strategies:
Containment& body flexion
Positive oral stimulation, non-nutritive suck
Gentle touch, hand grasping, facial stimulation
Decrease painful and negative stimulation
Exposure to mother's scent
Minimize exposure to noxious odors
Noise abatement
Minimize ambient light exposure
Preserve normal sleep patterns (minimize sleep disruptions), including family support practices
Minimize exposure to narcotics or meds that may disrupt sleep patterns
Secondary Strategies:
Infant massage
Skin to skin care (Kangaroo care)
Exposure to audible maternal voice
Cycled lighting
Increase visual stimulation after 37 weeks (gestation)
OT Role - CORRECT ANSWER Help to minimize stress for the infant and parent
Address issues around skin protection
Assess self-regulation and develop strategies to help the infant regain homeostasis when he becomes disorganized
Assess reflex development, muscle tone, & posture
Provide therapeutic positioning for sleep, feeding, skin to skin care and bathing
Provide ROM if appropriate
Provide splinting if needed
Assess and address feeding needs
Parent education as needed
Intervention ~ Positioning - CORRECT ANSWER Positioning to improve oxygenation, promote state regulation, simulate flexed midline positions, maintain passive ROM
Facilitate the development of physiologic flexion despite ventilation and infusion equipment that exacerbate extensor tone / position
Prone and side-lying positions can help reduce extensor responses (chin tuck, trunk flexion, shoulder protraction, posterior pelvic tilt, symmetric flexion of the legs)
Promote hand to mouth activity to facilitate state regulation
Maintain proper body alignment to avoid postural asymmetries
Use position change to avoid the development of fixed postural position / contractures
Use positioning to maintain skin integrity
Engage the infant in developmentally appropriate occupations through positioning
Intervention ~ Sensorimotor Stimulation - CORRECT ANSWER Sensory stimulation should promote self regulation and behavioral organization
Sensory registration, processing and modulation will facilitate motor development
Input must be provided in a graded manner to avoid the infant becoming disorganized and losing state regulation
Swaddling and firm touch to the soles of the feet can help organize an infant, nonnutritive sucking can also be calming
Hypotonic, lethargic infants may require input to increase their arousal levels
The irritable and dysregulated infant may require calming and organizing input
Linear vestibular input is tolerated better than angular in put (rocking), light touch (stroking) and talking can be over stimulating for the infant
Vestibular, visual, and auditory stimulation should be introduced in a graded manner when the infant can tolerate it
Intervention ~ Oral Motor - CORRECT ANSWER Feeding issues often arise due to neurologic immaturity, low muscle tone, depressed oral motor reflexes, and ventilation tubes
The infant's tongue mobility, ability to form a seal on a nipple, and suck effectively will determine the method for feeding
Nonnutritive sucking is an important skill to develop - it will help with feeding an can be used to maintain state regulation
Intervention ~ Psychosocial - CORRECT ANSWER Model nurturing behaviors during periods of infant stress
Become aware of and respect parent's learning style, emotional availability, stress and priorities
Respect family values, beliefs, and culture
Validate parent's feeling even when they are negative
Provide hope and encouragement while being realistic about possible outcomes
Share decision making responsibilities for goal setting
Encourage active participation of parents in treatment program
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