Author Question: A preterm infant has just been admitted to the neonatal intensive care unit. The infant's parents ... (Read 81 times)

luvbio · **on:** Jun 28, 2018

A preterm infant has just been admitted to the neonatal intensive care unit. The infant's parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. What should the nurse's explanation be?

a. Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli.
b. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief.
c. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences.
d. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

Question 2

The nurse is reviewing an electronic fetal monitor tracing from a patient in active labor and notes the fetal heart rate gradually drops to 20 beats per minute (bpm) below the baseline and returns to the baseline well after the completion of the patient's

contractions. How will the nurse document these findings?

a. Late decelerations
b. Early decelerations
c. Variable decelerations
d. Proximal decelerations

frre432 · **Reply #1 on:** Jun 28, 2018

Answer to Question 1

ANS: D
Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response. The pathways are sufficiently myelinated to transmit the painful stimuli and produce the pain response. Local and systemic pharmacologic agents are available to permit anesthesia and analgesia for neonates.

Answer to Question 2

ANS: A
Late decelerations are similar to early decelerations in the degree of FHR slowing and lowest rate (30 to 40 bpm) but are shifted to the right in relation to the contraction. They often begin after the peak of the contraction. The FHR returns to baseline after the contraction ends. The early decelerations mirror the contraction, beginning near its onset and returning to the baseline by the end of the contraction, with the low point (nadir) of the deceleration occurring near the contraction's peak. The rate at the lowest point of the deceleration is usually no lower than 30 to 40 bpm from the baseline. Conditions that reduce flow through the umbilical cord may result in variable decelerations. These decelerations do not have the uniform appearance of early and late decelerations. Their shape, duration, and degree of fall below baseline rate vary. They fall and rise abruptly (within 30 seconds) with the onset and relief of cord compression, unlike the gradual fall and rise of early and late decelerations. Proximal decelerations is not a recognized term.