S.T.A.B.L.E Program 6th Edition Quiz

Questions and Answers

Which of the following infants are at increased risk for hypoglycemia due to hyperinsulinism?

An infant whose birthweight is at the 8th percentile for weight. (correct)

An infant born at 27 weeks who is also growth restricted. (correct)

An infant whose birthweight is at the 95th percentile for weight.

What is the most concerning cause of the infant's symptoms in this scenario?

Respiratory distress syndrome

Cyanotic congenital heart disease

Bacterial sepsis (correct)

Infants of diabetic mothers are at increased risk for becoming hypoglycemic because they have:

Increased utilization of glucose

Increased levels of insulin (correct)

Decreased glycogen stores

Should the infant with abnormal vital signs be bathed at this time?

No, the vital signs are not in a normal range and the bath should wait. Signup and view all the answers

Late preterm infants, born between 34 and 36 weeks gestation, are at increased risk for which of the following complications?

All are correct Signup and view all the answers

What is the explanation for the infant's hypoglycemia in this scenario?

Chronic intrauterine stress from maternal hypertension limited the fetus's ability to make and store glycogen for use after birth. Signup and view all the answers

Which statement(s) about hypothermia are true?

All are correct Signup and view all the answers

Which one of the following infants is at most risk for hypoglycemia due to increased glucose utilization and depletion of glycogen stores?

40 weeks gestation, septic shock, 50th percentile, pH 7.15, PCO2 38, PO2 20, HCO3 13 Signup and view all the answers

The correct interpretation of this blood gas result: pH 7.03, PCO2 55, HCO3 (bicarbonate) 14 is:

Uncompensated mixed metabolic and respiratory acidosis Signup and view all the answers

Which one of the following actions increases the risk for patient harm and should be questioned?

Infuse Dopamine 10 mcg/kg/minute via the UAC Signup and view all the answers

Which organ may be most adversely affected by severe hypoglycemia?

Brain Signup and view all the answers

Dopamine is a drug prescribed to treat hypotension and may be administered via:

A peripheral vein or umbilical venous catheter. Signup and view all the answers

This information indicates the infant is most likely experiencing:

Moderate respiratory distress Signup and view all the answers

What does S.T.A.B.L.E. stand for?

Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support Signup and view all the answers

A neonate with a pneumothorax may exhibit which of the following signs? (Select all that apply)

All are correct Signup and view all the answers

You discuss the patient and CBC results with the infant's medical staff provider. What is your assessment of this response?

You are concerned because the infant's clinical presentation is not being adequately considered. Signup and view all the answers

Which one of the following should be performed emergently for an infant who vomited lime green emesis?

An upper gastrointestinal (UGI) exam to evaluate for malrotation Signup and view all the answers

What is the most appropriate therapy for a term infant weighing 1400 grams with a bedside glucose test at 30 minutes of life at 10 mg/dL?

Insert an IV then give a 2.8 mL bolus of D10W Signup and view all the answers

The function of brown fat is to:

Generate heat when it is metabolized Signup and view all the answers

Which of the following respiratory illnesses is most likely causing the signs observed in the infant post-delivery?

Tracheoesophageal fistula Signup and view all the answers

Which of the following physician orders would be appropriate for a hypotonic infant?

CBC with differential, c-reactive protein and blood culture Signup and view all the answers

Which therapy do you anticipate the physician may order for the infant delivered via emergency cesarean section?

O-negative packed red blood cells, 10 mL/kg IV Signup and view all the answers

The correct interpretation of this arterial blood gas result (pH 7.35, PCO2 23, HCO3 12) is:

Compensated metabolic acidosis Signup and view all the answers

Which one of the following interventions should be done immediately for the infant with severe retractions and an enlarged tongue?

Place the infant prone and assess Signup and view all the answers

What does a trend of decreasing absolute neutrophil count indicate?

Increased risk of neutrophil depletion Signup and view all the answers

The immature-to-total ratio on CBCs suggests which outcome?

Increasing percentage of immature neutrophils Signup and view all the answers

Which of the following may cause hypovolemic shock?

All are correct Signup and view all the answers

Positive pressure ventilation should be performed without delay if the infant:

Is gasping Signup and view all the answers

Which diagnosis correlates with the infant's clinical presentation and blood gas results?

Ductal-dependent congenital heart disease Signup and view all the answers

What condition should be suspected in the infant with scalp bruising and hypotonicity following vacuum-assisted delivery?

Subgaleal hemorrhage Signup and view all the answers

Which statement about elevated hemoglobin A1c levels during pregnancy is TRUE?

Indicates the mother had poor glucose control during pregnancy. Signup and view all the answers

What does the drop in temperature from 36.3ºC to 35.3ºC indicate?

Increased metabolic rate and oxygen consumption due to hypothermia. Signup and view all the answers

Which of the following methods for rewarming a hypothermic preterm infant is appropriate?

Place the infant on a chemical thermal mattress and cover with plastic Signup and view all the answers

Which statement is true regarding post-resuscitation stabilization for a newborn?

Stabilization should include IV access and starting a D10W infusion. Signup and view all the answers

What does a narrow pulse pressure indicate?

May indicate poor cardiac output. Signup and view all the answers

Which signs are commonly observed in a 34-week gestation infant with a temperature of 31ºC?

Hypotension, bradycardia, bradypnea Signup and view all the answers

Given an infant's respiratory distress profile, which diagnoses are most likely?

Bacterial sepsis, congenital heart disease Signup and view all the answers

Where should the endotracheal tube tip be positioned for a 3-kilogram infant needing intubation?

Too low. Signup and view all the answers

Which stabilization option should be performed first for the limp, cyanotic infant?

Evaluate the endotracheal tube position. Signup and view all the answers

The correct interpretation of this arterial blood gas result (pH 7.18, PCO2 63, HCO3 23) is:

Uncompensated respiratory acidosis Signup and view all the answers

Which statement is FALSE regarding the treatment for a term infant on a ventilator?

Sodium bicarbonate should be given immediately. Signup and view all the answers

Where will the two oximeter probes be placed for post-ductal saturation monitoring?

Right hand and left foot Signup and view all the answers

The pattern of saturation change in an infant is typical for which condition?

Choanal atresia Signup and view all the answers

The correct interpretation of this arterial blood gas result (pH 7.25, PCO2 36, HCO3 15) is:

Uncompensated metabolic acidosis Signup and view all the answers

What is the term for an infant whose birthweight is at the 95th percentile for weight?

Large for gestational age Signup and view all the answers

Study Notes

Pneumothorax Symptoms in Neonates

Signs of pneumothorax in neonates include increased work of breathing, bradycardia, asymmetric chest appearance, cyanosis, and decreased femoral pulses.
Correct answer: All listed signs are indicative of pneumothorax.

Clinical Assessment in Infants

Tachypnea, tachycardia, hypotonia, and elevated temperature in a newborn warrant concern for possible infection, despite a normal CBC.
Medical staff's reassurance based on normal CBC results may overlook the infant's concerning clinical signs.

Gastrointestinal Concerns in Infants

Green-colored emesis in a breastfeeding infant suggests possible malrotation.
An upper gastrointestinal (UGI) exam is necessary for evaluation in emergent cases.

Hypoglycemia Treatment

For a term infant weighing 1400 grams and with a blood glucose level of 10 mg/dL, an IV bolus of D10W followed by continuous infusion is recommended.
Feeding by gavage or sending for confirmation without immediate treatment are less appropriate in this urgent situation.

Function of Brown Fat

Brown fat's primary function is to generate heat when metabolized, essential for thermoregulation in neonates.

Respiratory Distress Indicators

In an infant with immediate post-birth respiratory distress and observable physical signs like barrel chest and sunken abdomen, tracheoesophageal fistula is a potential diagnosis.

Signs of Possible Infection

An infant presenting with hypotonia and tachycardia 24 hours after birth requires a CBC, C-reactive protein test, and blood culture to evaluate for potential infection.

Emergency Blood Product Administration

An infant with pallor and weak pulses, due to placental abruption, may necessitate O-negative packed red blood cells IV for stabilization.

Arterial Blood Gas Interpretation

A pH of 7.35 with low HCO3 levels suggests compensated metabolic acidosis.

Immediate Intervention for Respiratory Distress

An infant with severe retractions and a possible airway obstruction should be placed prone to assess the need for additional airway support.

Neutrophil Count Trends

A declining absolute neutrophil count in an infant undergoing treatment for sepsis indicates an increased risk of neutrophil depletion.

Immature Neutrophils Ratio

A rising immature-to-total neutrophil ratio indicates an increasing percentage of immature neutrophils, important for infection assessment.

Causes of Hypovolemic Shock

Conditions such as placental abruption, pneumothorax, and twin-to-twin transfusion syndrome can lead to hypovolemic shock.

Positive Pressure Ventilation Indicators

Gasping indicates a critical need for immediate positive pressure ventilation or intubation.

Ductal-Dependent Congenital Heart Disease

Presentation of weak cry, absent femoral pulses, and acidosis suggests a diagnosis of ductal-dependent congenital heart disease.

Subgaleal Hemorrhage Signs

An infant with a concerning increase in head circumference and hypotonia after vacuum-assisted delivery may be experiencing subgaleal hemorrhage.

Maternal Diabetes and Infant Outcomes

Elevated HbA1c levels in a diabetic mother correlate with poor glucose control during pregnancy and an increased risk of macrosomia in the newborn.

Hypothermia Effects Post-Bath

An infant may exhibit increased metabolic rate and oxygen consumption due to hypothermia following a bath, necessitating immediate warming measures.

Rewarming Techniques for Hypothermic Infants

Use chemical thermal mattresses and plastic coverings to safely rewarm hypothermic preterm infants.

Post-Resuscitation Care

Stabilization after resuscitation should include careful attention to heat loss, IV access establishment, and initiation of D10W infusion.

Pulse Pressure Indications

A narrow pulse pressure can indicate poor cardiac output, assisting in cardiac function assessment.

Signs Associated with Hypothermia

Hypotension, bradycardia, and bradypnea are common signs in an infant with a significantly low body temperature.

Likely Diagnoses for Respiratory Distress

Respiratory distress in an infant after a long labor may indicate bacterial sepsis or congenital heart disease due to rapid onset of severe symptoms.

Endotracheal Tube Placement Assessment

Proper positioning of the endotracheal tube is crucial; too low placement could lead to ineffective ventilation.

Stabilization of Newly Delivered Infants

Immediate evaluation of an intubated infant's endotracheal tube placement is critical for ensuring effective ventilation.

Arterial Blood Gas Analysis for Acidosis

Blood gas interpretation revealing acidosis can guide urgent treatment measures to prevent organ damage.

Monitoring Pre- and Post-Ductal Saturation

Proper placement of oximeter probes (right hand for pre-ductal and left foot for post-ductal saturation) is essential in evaluating pulmonary conditions.

Choanal Atresia Presentation

Variable O2 saturation readings in a newborn that improve with crying may point to choanal atresia as a diagnostic consideration.

Blood Gas Analysis for Metabolic Acidosis

The interpretation of blood gas results indicates uncompensated metabolic acidosis when pH is lowered with normal PCO2.

Risk Factors for Infant Hypoglycemia

Infants with higher birth weights (95th percentile) are at increased risk for hypoglycemia due to hyperinsulinism.

Early Indicators of Bacterial Sepsis

Term infants with prolonged membrane rupture, displaying unresponsiveness, may be suffering from bacterial sepsis, requiring immediate medical attention.

Insulin Levels in Infants of Diabetic Mothers

Increased insulin levels contribute to a greater risk of hypoglycemia in newborns from diabetic mothers.

Timing for Infant Bathing

If an infant's vital signs are abnormal, bathing should be deferred until stabilization is achieved.

Complications in Late Preterm Infants

Late preterm infants (34-36 weeks) are at increased risk for various complications, which require careful monitoring and management.### Neonatal Conditions and Challenges
Temperature Instability: Common issue in neonates, often requiring close monitoring and interventions to maintain normothermia.
Hypoglycemia: Newborn may experience low blood sugar, especially due to inadequate glycogen stores from maternal conditions such as chronic hypertension.
Respiratory Distress: Symptoms may include tachypnea, cyanosis, and grunting; often indicates the need for oxygen supplementation.
Apnea: Intermittent cessation of breath, frequent in preterm infants, necessitating monitoring and potential intervention.
Hyperbilirubinemia: Increased bilirubin levels which can require phototherapy; often linked to prematurity or hemolytic disease.
Feeding Difficulties: Commonly arise in neonates due to respiratory or metabolic issues, often leading to challenges in maintaining adequate nutrition.

Maternal Impact on Neonatal Health

Severe maternal hypertension can result in chronic intrauterine stress, limiting fetal glycogen production and storage, increasing hypoglycemia risk after birth.
Poor prenatal care can significantly affect birth outcomes, contributing to low birth weight and associated complications.

Hypothermia and Its Effects

Mild Hypothermia: Stimulates norepinephrine release, elevating metabolic rate and enhancing brown fat metabolism for thermoregulation.
Severe Hypothermia: Leads to decreased heart rate and cardiac output, causing tissue hypoxia and reliance on anaerobic metabolism, potentially worsening overall condition.

Blood Gas Analysis

Arterial blood gas results can indicate critical conditions; for instance, mixed metabolic and respiratory acidosis is suggested by low pH while both bicarbonate and carbon dioxide levels are abnormal.

Risk Factors for Hypoglycemia in Infants

Infants in septic shock (e.g., a 40-week gestation infant with critical lab results) are particularly at risk for hypoglycemia due to significant metabolic demands and depletion of glycogen stores.

Clinical Interventions for Hypotension

Dopamine can be administered via umbilical venous catheter or peripheral veins to treat hypotension. Precautions are necessary when administering via umbilical artery catheter due to increased risk of harm.

Organ Vulnerability

Brain: Most sensitive to severe hypoglycemia; protracted episodes can cause permanent damage or neurological deficits.

Guidelines for Care

The S.T.A.B.L.E. program provides a framework for assessment and intervention in neonates, focusing on key areas: Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support.

Observation of Vital Signs

Regular monitoring is crucial; abnormal vital signs like elevated heart rate and abnormal blood gas values signal potential respiratory distress or metabolic issues, necessitating prompt evaluation and intervention.

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Description

Test your knowledge on the signs exhibited by neonates with pneumothorax according to the S.T.A.B.L.E. Program 6th edition. This quiz will challenge your understanding of critical neonatal care concepts and symptoms to look out for. Prepare to assess various clinical signs and their implications for patient care.