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Neonatal PIV Insertion and NICU Review

Flashcards 69 questions Medicine & Health Sciences > Neonatal ICU by Sean Valentine
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Flashcards (69)

Card 1
Common sites for a neonatal IV insertion?
Answer
Hands, feet, scalp
Card 2
Is a PIV insertion a 1-person procedure?
Answer
No
Card 3
What type of bed should you perform a PIV insertion on?
Answer
Radiant warmer
Card 4
What are pain management strategies during a PIV insertion?
Answer
Sucrose, non-nutritive suck, swaddle
Card 5
Why should you NOT encircle the limb with tape?
Answer
Could obstruct blood flow
Card 6
Most important things when taping an IV for visualization and securement?
Answer
Make sure it's visible, secure, and not obstructing the hub of the catheter.
Card 7
What is the sterile towel used for?
Answer
Creating an easily accessible field
Card 8
How should the insertion site be prepped?
Answer
Alcohol x2
Card 9
How often should you assess/document the PIV insertion site when fluids are continuously infusing?
Answer
Hourly
Card 10
How often does the tubing get changed with a PIV when infusing D10W?
Answer
48 hours
Card 11
How often does the tubing get changed with a PIV when infusing D10W + Ca Glu + KCl?
Answer
24/48 hours
Card 12
How often does the tubing get changed with a PIV when infusing D12.5?
Answer
24 hours
Card 13
How often should you flush a Heparin Lock with what?
Answer
Every 4 hours with 0.5 mL
Card 14
How often should you document the site appearance of a Heparin Lock?
Answer
With cares, every 4 hours
Card 15
Term infants frequently present with which intracranial hemorrhages?
Answer
Subdural and Epidural
Card 16
Subdural hemorrhage definition
Answer
Bleeding between the dura and the cerebrum. Tears in cortical veins may need to be tapped.
Card 17
Epidural hemorrhage definition
Answer
Bleeding between the dura and the skull. Arterial bleeding which pushes the brain down and may have rapid deterioration.
Card 18
Symptoms of epidural hemorrhage
Answer
Pupils fixed and dilated on the side of the lesion, stem signs
Card 19
Subarachnoid hemorrhage definition
Answer
Bleeding into the subarachnoid space, between the pia matter and the arachnoid layer.
Card 20
Symptoms of subarachnoid hemorrhage
Answer
Fast onset, screaming cry, sepsis (7-10 days), reason newborn was born so quick, limp baby
Card 21
Intracerebellar hemorrhage is associated with what type of deliveries?
Answer
Breech deliveries, traumatic deliveries, hypoxic events, vitamin K deficiency, thrombocytopenia
Card 22
Probable neurologic deficits from intracerebellar hemorrhage
Answer
Amphetamine, Gent, Tragan
Card 23
Periventricular-Intraventricular hemorrhage primarily presents before how many weeks?
Answer
36 weeks
Card 24
Periventricular-Intraventricular hemorrhage grading system
Answer
1 (within the ventricles), 2, 3, 4 (extensive bleeding into the white matter)
Card 25
Periventricular-Intraventricular hemorrhage is associated with what conditions?
Answer
Low 5-minute apgar scores, general anesthesia, acidosis, asphyxia, pneumothorax
Card 26
Clinical presentation of Periventricular-Intraventricular hemorrhage
Answer
Sudden deterioration, desat, vomit, change in muscle tone, apnea, met acidosis
Card 27
Nursing considerations for Periventricular-Intraventricular hemorrhage
Answer
Blood dissipates, cysts where brain used to be
Card 28
Microcephaly definition
Answer
Head circumference less than two standard deviations below the mean
Card 29
Causes of microcephaly
Answer
Maternal infection, medications, metabolic conditions, genetic causes
Card 30
Craniosynostosis definition
Answer
Early closure of sutures leading to increased ICP and abnormal shape
Card 31
Nursing considerations for Craniosynostosis
Answer
1/2-1cm growth a week, always lower, can go back and open
Card 32
Seizures are a symptom of what?
Answer
Neurologic dysfunction
Card 33
Causes of seizures
Answer
Structural problems such as IVH & trauma, meningitis, metabolic encephalopathies, withdrawal from maternal drugs, genetic (usually day 2-3 of life)
Card 34
Clinical presentation of seizures in neonates
Answer
Subtle and varies; jitteriness must be ruled out for calcium depletion or hypoglycemia.
Card 35
Nursing considerations for seizures
Answer
Protect airway, monitor post-ictal (sleepy), more male than female, multifocal/clonic movement that migrates from one limb to another
Card 36
Spina bifida occulta involves what?
Answer
Vertebral bones and may not be noticeable at birth.
Card 37
Signs of Spina bifida occulta
Answer
Lower sacrum tuft of hair may be present, dimple, ultrasound
Card 38
Meningocele definition
Answer
Meningocele is protrusion of the meninges.
Card 39
Myelomeningocele definition
Answer
Myelo includes the inner cord and or nerve root. Often cannot tell apart before surgery.
Card 40
Nursing considerations for Myelomeningocele
Answer
Hydrocephalus, monitor at neuro, changes, still present if fixed in utero, latex issues, orthopedic issues, bowel training
Card 41
Encephalocele definition
Answer
Neural herniation which may or may not contain meninges or brain matter.
Card 42
Hypoxemia and anoxia can lead to what condition?
Answer
Metabolic acidosis and ischemia of brain tissue, continued hypoxia and ischemia lead to neurologic dysfunction, systemic asphyxia and multisystem organ failure.
Card 43
What is the cooling procedure for HIE?
Answer
Neuroprotective
Card 44
Mild HIE typically resolves in how many hours?
Answer
24 hours
Card 45
Symptoms of mild HIE
Answer
Wide awake, stool sucked, normal EEG
Card 46
Moderately severe HIE symptoms
Answer
Apnea, seizures in 1-2 weeks, drowsy, EEG not all normal, lethargic
Card 47
Severely severe HIE requires ventilator support, signs of increasing cerebral edema, comatose, seizures
Answer
True
Card 48
Head and body cooling are FDA approved for what?
Answer
Moderate to severe HIE
Card 49
Outcome of HIE is variable and based on what?
Answer
Placement and severity of insult
Card 50
Nursing considerations for HIE
Answer
Very tight fluid control, blood pressure = 35-40 + drops perfusion to brain, drops, watch sugars, SIS seizures
Card 51
Anencephaly definition
Answer
Cranial hemispheres are both missing
Card 52
Schizencephaly definition
Answer
Split brain, early onset in utero, seen but no signs
Card 53
Lissencephaly definition
Answer
Smooth brain, seizures in utero or due to genetic or environmental factors or both
Card 54
Failure of cells to migrate correctly leads to what condition?
Answer
Lissencephaly
Card 55
Baby can appear normal or be severely affected in what condition?
Answer
Lissencephaly
Card 56
Outcome is poor but some infants survive into early childhood in what condition?
Answer
Lissencephaly
Card 57
Neurologic assessment is based on what?
Answer
History, observation, physical examination including head size, muscle tone, reflex quality, cranial nerves function, lip smacking, subtle behaviors, tone alterations.
Card 58
Nursing care of patients on sedatives/paralytics
Answer
Look for movement, vital signs, pupillary response, growth and development
Card 59
Factors indicating difficult birth
Answer
LGA, CPD, prematurity, abnormal presentation, instrumented delivery
Card 60
Cephalohematoma definition
Answer
Subperiosteal bleed that does not cross sutures.
Card 61
Caput Succedaneum definition
Answer
Hemorrhagic edema that crosses suture lines.
Card 62
Subgaleal hemorrhage definition
Answer
Bleeding beneath the scalp into loose connective tissue which may cross suture lines in large enough quantities to cause exsanguination.
Card 63
Brachial nerve plexus injuries are due to what?
Answer
Stretching or tearing of the brachial plexus to cause nerve injury ranging from inflammation to full nerve root avulsion.
Card 64
Erb's Palsy involves what nerves?
Answer
C5-C6
Card 65
Erb-Duchenne-Klumpke involves what nerves?
Answer
C5 through T1
Card 66
If C4 is involved, you may have paralysis of what?
Answer
Diaphragm
Card 67
Skull fractures are usually what?
Answer
No cause, large, more damage
Card 68
Linear or depressed fractures can occur with what?
Answer
Vacuum, forceps
Card 69
Hypoxic-Ischemic Encephalopathy (HIE) definition
Answer
Asphyxia, acidosis, hypothermia, sucrose

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