Respiratory
How long should you count respirations for in the NICU?
60 secs
What is the difference between an Omphalocele and gastroschisis?
Omphalocele: Herniation of intestine/other viscera into the umbilicus
Gastroschisis: Evisceration of intestinal loops with no sac covering
What is the Normal Heart Rate Range for Infants?
90-180
What are the 4 modes of heat loss?
Conduction, convection, radiation, and evaporation.
What is the name of the pain scale we use and what is it looking to score?
N-PASS
Crying, behavior, facial expressions, tone, vital signs
• A day old full term infant admitted for R/O sepsis develops respiratory distress. An ABG drawn via the right radial artery reveals the following result:
•pH = 7.15, pCO2 = 36, PO2 = 60, HCO3 = 12
This blood gas is:
a. Normal
b. Compensated
c. Uncompensated
d. Partial Compensated
The blood gas reveals:
a. Respiratory Acidosis
b. Respiratory Alkalosis
c. Metabolic Acidosis
d. Metabolic Alkalosis
What intervention should be anticipated by the bedside RN?
Partially Compensated metabolic acidosis
Anticipate holding feeds, possibly administering fluids... Na Acetate
What is a nursing consideration for an infant with Esophageal Atresia with a TE Fistula?
Avoid bag and mask ventilation and nasal CPAP to prevent over-distension of the stomach, place a replogle with suction as ordered, and consider/anticipate the need for intubation.
What is the only heart rhythm NICU RN's need to recognize?
Normal Sinus
Where should you place the skin temperature probe on an infant in and isolette? on a radiant warmer?
Under the axilla, over the liver
If you are admitting a baby who has potential HIE with an arterial blood gas suggesting the need for whole body cooling, what would you do first?
set the radiant warmer to 35 degrees C
What is the correct order to set up a needle aspiration?
tubing, stopcock, 30cc syringe (minimum)
What is the primary risk factor for NEC?
Prematurity
How should you administer adenosine and for what rhythm can it be used for?
fast push followed by a fast flush
SVT that has not responded to vagal maneuvers.
Why is it important to recognize temperature instability in an infant and how can the RN recognize temperature instability?
Can be an early sign of sepsis
Monitoring axillary temperatures, ISC- skin and air temperatures
What other body system should be a focus when considering the neurological system of an infant
Integumentary system/skin
What type of ventilation is commonly used for Meconium aspiration syndrome, persistent pulmonary hypertension, or Pulmonary Interstitial Emphysema
High Frequency Jet Ventilation
How often should you flush a replogle, where should you flush and with what?
PRN or once a shift, flush using a tree and the main port of the replogle, and with NS or sterile water.
Name a congenital cyanotic heart defect and at least 3 nursing considerations.
Coarctation of the aorta, Aortic stenosis, Hypoplastic left heart, Tetralogy of Fallot, Transposition of the great vessels.
monitor vitals (EKG, BPs, Pulse ox., etc.)
monitor Is & Os (weigh diapers)
Listen to heart sounds and lung sounds
monitor for cyanosis
administer medications as ordered with careful consideration to their effects.
What is the appropriate NTE for a 5 day old 2000 g infant?
31.0-33.2 with a starting temperature of 32.1
Name three common signs of an infant with NAS.
Tremors, Restlessness, Hyperactive reflexes, Regurgitation, Increased muscle tone, High pitched cry, Sneezing, Frantic sucking of fists, Inability to sleep, Stretching, Nasal stuffiness, Respiratory distress, Vomiting, Frequent yawning, Sweating, Excoriation of knees, toes and nose, Mottling, Diarrhea, Fever, Pallor, Lacrimation and Generalized convulsion
•Complete & accurate respiratory assessment is essential
•Bubbling in water seal chamber is normal when air is escaping – monitor the level in the chamber to monitor the severity of the leak
•Order to water seal - turn off WALL Suction
Observe the following:
•Chest tube dressing with Vaseline gauze – needs to be an occlusive dressing -
•Ensure tubing is patent without
–tubing kinks
–dependent loops
–Clots
•Tubing is securely pinned to the bed – prevent tension on the tube.
•Chest drainage system, which should be upright and below level of tube insertion
•Hang chest drain system on the RW or incubator
How should you place an NG/OG tube and how do you check for placement?
Prep site of NG/OG, measure from orifice to tragus to zyphoid and add, insert tube and secure with 3M tape without tension on the skin. Check placement with Rightspot: attach rightspot to 5-10cc enteral syringe, connect to NG/OG, insert .5 to 1 cc of air and then pull back until gastric contents touch's paper, watch for color change (good placement = pH of 5 or less), disconnect the rightspot and discard in the biohazard, then document.
What happens in the initial period to infant circulation once the infant takes its first breath and the umbilical cord is cut?
Pressure decreases in the pulmonary arteries allowing blood to circulate to the lungs which leads to the eventual closure of the ductus arteriosus and the foreman ovale.
What are the detrimental effects of cold stress on an infant?
hypoxemia, hypoxia, hypoglycemia, acidosis
What is a myelocele and what are the nursing considerations?
Myelocele - Most severe form of myelomeningocele – flattened, plate-like mass of nervous tissue with no overlying membrane.
RNs should consider keeping the infant prone and covering the defect with sterile moist gauze until brought to OR for revision