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NU 404 Unit 8 Test With Complete Solution
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NU 404 Unit 8 Test WithComplete Solution
Preterm infants - ANSWER vast majority of high risk infants are those born
less than 37 weeks gestation
High risk - ANSWER _ __ infants are most often classified according to birth
weight, gestational age, and predominant pathophysiologic problems
Preterm - ANSWER -birth before completion of 37th week
-_ infant is likely to have difficulty adjusting to extrauterine life
-s/s of resp distress (GFR) or apnea and be ready to intervene by providing
adequate oxygenation
Apnea - ANSWER breathing pauses greater than 20 seconds
Term - ANSWER birth occurring b/t 38 & 42 weeks
Post-term - ANSWER birth after 42nd week
Cyanosis - ANSWER -acro_: normal finding in the neonate
-central _: indicates an underlying problem that requires immediate
evaluation
40-60 - ANSWER normal respirations in the newborn per min
Periodic breathing - ANSWER -common
-5-10 second resp pauses followed by 10-15 secs of compensatory rapid resp
,Respiratory problems - ANSWER -cyanosis
-pallor
-hypotonia
-bradycardia
Cardio function - ANSWER -nurse must be prepared to intervene if symptoms
of hypovolemia, shock, or both are found
-s/s: hypotension, slow cap refill (>3 secs), and continued resp distress
despite being oxygenated and ventilated
Maintain body temp - ANSWER -goal: want to _ a neutral thermal
environment
-preterm infants susceptible to ___ instability r/t large body surface in
relation to their weight and risk for heat loss
-hypothermia vs hyperthermia
Hypothermia - ANSWER apnea, bradycardia, central cyanosis, coagulation
defects, hypoglycemia, hypotonia, hypoxia, feeding intolerance, inc
metabolic rate, irritability, lethargy, metabolic acidosis, peripheral
vasoconstriction, poor weight gain, shivering, weak cry or suck
Hyperthermia - ANSWER apnea, CNS depression, dehydration, flushed/red
skin, hypernatremia, irritability, lethargy, poor feeding, seizures, sweating,
tachycardia, tachypnea, warm to touch, weak or absent cry
Cold stress - ANSWER -maintain body temp
-preterm infants have few reserves r/t less calories and fat stores which puts
them at risk for this
,Hypothermia care - ANSWER rewarm immediately, but not rapidly bc it can
cause apnea and acidosis
BMR - ANSWER the LBW infant may be unable to inc their _ due to:
-impaired gas exchange
-caloric restriction
-poor thermoregulation
-infant demonstrating signs of cold stress should also be assessed for
infection bc of similar symptoms
Temp maintenance - ANSWER -radiant warmer
-kangaroo care
-axillary is preferred route
-in cold stressed baby this route may cause false high reading
-in severely premature infant this route is ok and rectal route is
contraindicated
Kangaroo care - ANSWER -helps premature infants directly interact with their
parents
-maintains thermal stability, oxygen saturation, and helps reduce dec stress
in preterm infants
-also dec pain perception during painful heel sticks
Supportive measures - ANSWER -total parenteral nutrition for infant who
, can't tolerate gavage feedings
-position infant so as to facilitate respiration and suction PRN
-neutral thermal environment must be maintained
-group activities to preserve oxygen stores
-gavage feedings if resp distress is severe
Criteria for O2 use - ANSWER -inc respiratory effort
-resp distress with apnea
-tachycardia
-bradycardia
-central cyanosis with or without hypotonia
Oxygen - ANSWER -if PaO2 is <50 mmHg with 60% O2 or the O2 sat is <90%,
_ is needed
-compromised infants often require sats of >95% to maintain resp stability
-_ should be warmed and humidified
Oxygen delivery - ANSWER -methods: oxyhood and nasal cannula
-mechanical ventilation: surfactant administration, CPAP, ECMO, positive
pressure mask, endotracheal tube
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