Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Physical Assessment > APGAR Scoring and Transition > Flashcards

APGAR Scoring and Transition Flashcards

1
Q

Define resistance to flow.

A

a force that must be overcome to push blood through the circulatory system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does vasodilation affect vascular resistance?

A

dilation causes an increase in blood vessel diameter and subsequent decrease in vascular resistance; very little resistance = easy work for the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does vasoconstriction affect vascular resistance?

A

decrease in blood vessel diameter increases vascular resistance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define SVR.

A

the resistance offered by the vasculature of the peripheral circulation (that the LV has to pump against); increases post birth r/t cord clamping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define PVR.

A

the resistance offered by the vasculature of the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is reverse end diastolic flow?

A

the placenta is the low resistance organ in utero; in diastole there should be no trouble for blood to travel through the descending aorta to return to the placenta; with PIH, the placenta is high resistance, not permitting blood to return for exchange easily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the function of the placenta in fetal circulation?

A

exchange organ for O2, CO2, nutrients and waste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the function of the ductus venosus in fetal circulation?

A

blood from the placenta by-passes the liver to enter the IVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the function of the foramen ovale in fetal circulation?

A

blood from the IVC by-passes the lungs to the LA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the function of the ductus arteriosus in fetal circulation?

A

blood from the pulmonary artery by-passes fetal lungs to the aorta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where is the highest O2 content in fetal circulation?

A

umbilical vein; 35 mmHg or 70% SpO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where is the lowest O2 content in fetal circulation?

A

right atrium from SVC; 16mmHg of 40% SpO2; blood is then to go through the PA and be shunted away from the lungs by the DA and return to the placenta for exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When does transition occur?

A

begins at stabilization and lasts about 6-12h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does the catecholamine surge prior to labor facilitate elimination of fetal lung fluid?

A

the surge just before or during labor changes Na channel transport in the lung from secretions to absorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What percentage of fetal lung fluid is absorbed prior to a normal term birth?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What effect does the fist breath have on carotid chemo receptors and aortic baro receptors?

A

hypercarbia stimulates chemo receptors to have spontaneous breathing effort; stimulating baroreceptors will help to maintain independent homeostasis of BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does the first breath affect the pulmonary tissue?

A

replaces fluid with air; first breath = Tv 12-67mL; pressures needed 20-60 cm/H2O

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does lung expansion affect the pulmonary system?

A

release of surfactant, decreases alveolar tension, creates a stable FRC (~30mL/kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When is near normal FRC established?

A

within the first 15 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the affect of increased blood flow to the lungs?

A

1) increase pH, decrease CO2, increase O2
2) decrease PVR
3) simultaneous decrease R side heart pressures and increase L side
4) increase blood return to the L side of the heart
5) when L>R; functional closure of FO
6) increase pulmonary metabolism of PGE
7) increasing O2 stimulates closure of DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the biggest supplier of PGE in utero?

A

the placenta; also metabolized in the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the effect of the DA when exposed to oxygen?

A

remains open in utero r/t high levels of PGE from the placenta and relative pulmonary hypoxia; response post birth with increasing O2 is to constrict

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the effect of a clamped cord (no blood flow FROM the placenta) on SVR post birth?

A

decrease in R atrium pressures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What mechanisms facilitate a decrease in RV pressure post birth?

A

Increasing pH, decreasing CO2 & increasing O2 causes a decrease in PVR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the effect of a clamped cord (no blood flow TO the placenta) on SVR post birth?

A

1) increase SVR
2) increase aortic pressure
3) increase pressure in the L atrium, then L ventricle
4) pressure in L>R; functional closure of FO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the effect of the loss of the placenta have on SVR post birth?

A

1) means loss of a large source of prostaglandins

2) closure of DA (fx closure at 15-24h; structural @ 3-4wks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the effect of blood no longer flowing through the DV?

A

closure; structurally closed @ 1-2wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the results if transitional changes do not occur?

A

hypoxia (low pH, high CO2, low O2)

  • causes high PVR
  • persistent PDA and PFO
  • R>L shunting
  • PPHN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

When does the transfer of blood occur post birth from the placenta to the infant?

A

during the first 3 minutes after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How does the volume of blood transfer from the placenta vary with timing?

A

30-60sec after delivery (15-20%), 60-90 sec (25%), 3 min (50-60%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the effect of a 2 min cord clamping delay in a term infant as it pertains to volume and Fe?

A

delivers an additional 40mL/kg of blood and an additional 75mg of Fe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Where should the preterm infant be positioned for a delayed cord clamping?

A

needs to stay in lap or at maternal thigh level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What infant health outcomes have been improved by the practice of delayed cord clamping in preterm newborns?

A

a delay of 30-120 secs improved cerebral oxygenation, BP, less anemia requiring blood transfusion and less IVH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What infant health outcomes have been improved by the practice of delayed cord clamping in term newborns?

A

improved blood volume and hct, decreased anemia in first 6mo of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What infant health outcomes have been improved by the practice of milking the cord x3 over <30 secs in preterm newborns?

A

improved BO, high hct, less transfusion; no difference in IVH, NEC or death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What comprises the APGAR score?

A

A (appearance, color) P (pulse, HR) G (grimace, reflex irritability) A (activity, muscle tone) R (respirations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Why was the Apgar score created?

A

to facilitate clinical assessment of the newborn and guide resuscitation efforts

38
Q

What is the Apgar score?

A

a cursory assessment of the cardiopulmonary and neurological status of the newborn

39
Q

What action should be taken if the score is < 7 at 5min?

A

repeat the scoring every 5 min until 20 min has passed or the infant earns 2 consecutive scores > 7

40
Q

What do the scores at 1 and 5 min indicate?

A

1: how they tolerated labor; 5: how they tolerated resuscitation

41
Q

What are the factors that influence the Apgar score?

A
  • GA
  • maternal meds: narcotics, general anesthesia
  • infection: chorio, GBS, TORCH
  • congenital disorders: CDH, CHD
  • cardiopulmonary conditions: PPHN
  • neurologic conditions
42
Q

What are the new NRP questions to guide resuscitation?

A

term gestation? breathing or crying? good tone?

if yes, baby stays with MOB, warm & dry, sx ONLY if evidence of obstruction

43
Q

Why should deep sx be avoided?

A

vagal stimulation to decrease HR

44
Q

What should be the focus of resuscitation?

A

respirations> HR > oxygenation

45
Q

What are the target Sat ranges for a term infant post delivery?

A

1 min: 60%; 5 min: 90%; term CSX without labor 90% at 7 min

46
Q

The majority of evidence suggests that it takes what length of time for healthy late preterm infants to ‘pink up’?

A

5-10 min; sats >90%

47
Q

When is pulse oximetry monitoring indicated post birth?

A

1) supplemental O2 is used
2) PPV is required for more than a few breaths
3) central cyanosis is persistent or need to confirm perception of central cyanosis
4) resuscitation is anticipated

48
Q

What is the danger of giving babies unnecessary supplemental oxygen?

A

newborns are relatively deficient in anti-oxidants and too much oxygen may damage tissues

49
Q

What is the significance of touch during a resuscitation?

A

how you touch a baby during resuscitation can alter adaptations to extrauterine life

50
Q

What is the type of touch an infant is subjected to during a resuscitation?

A

human touch- used to evaluate the baby; mechanical touch- PPV & sx; protective touch- gentle, soothing, caring

51
Q

What are the implications of a low Apgar score?

A

not necessarily markers of later neurologic dysfunction, somewhat prognostic

52
Q

What are the implications of a low Apgar score at 1 min?

A

not predictive of survival and long-term neurologic status

53
Q

What are the implications of a low Apgar score at 5 min?

A

more predictive of survival and neuro status

54
Q

What are the implications of a persistently low Apgar score?

A

at 10 min may provide useful prognostic data; risk for CP increases with severely depressed Apgar scores

55
Q

What percentage of infants who later develop CP have normal Apgar scores at birth?

A

75%

56
Q

What is asphyxia?

A

a severe deprivation of oxygen derived from a failure to establish normal respirations; duration is critical to outcome

57
Q

When can asphyxia occur in the newborn?

A

prior to birth (r/t maternal/fetal conditions), during L&D, due to conditions that occur after birth

58
Q

What are maternal causes of asphyxia?

A

infection and asthma

59
Q

What are placental causes of asphyxia?

A

severe PIH, abruption

60
Q

What are fetal causes of asphyxia?

A

anemia, cord compression

61
Q

What is placenta accreta?

A

chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis

62
Q

What is placenta increta?

A

chorionic villi invade into the myometrium

63
Q

What is placenta percreta?

A

chorionic villi invade through the myometrium and potentially into surrounding organs

64
Q

How does asphyxia present in the newborn?

A

1) combination of hypoxemia, hypercapnea and metabolic acidosis
2) PVR remains high
3) DA remains open R>L shunt
4) FO remains open R>L shunt

65
Q

What is characteristic of asphyxia just prior to birth?

A

should respond to ventilation & resusc; if poor response, probably d/t prolonged, severe acidemia

66
Q

What will happen if the process of asphyxia is not quickly reversed?

A

it is self perpetuating and may result in severe hypoxemia, ischemia, acidosis and irreversible organ damage

67
Q

What should be suspected if an infant is vigorous at birth, then develops apnea, cyanosis and bradycardia?

A

1) wrong steps in resusc

2) baby has an airway/lung disorder/anomaly

68
Q

What are possible causes of airway obstruction after delivery?

A

1) mec aspiration or severe pneumonia
2) intrathoracic malformations that interfere with ventilation- CDH, CAM
3) congenital anomalies of airway- laryngeal web, vascular ring
4) pneumo

69
Q

How frequently does mec appear in the amniotic fluid of normal term deliveries?

A

10-15%; mec in term infant as an isolated finding is not considered significant for CP

70
Q

When will an umbilical cord appear yellow or green?

A

if mec has been passed 6-12h prior to delivery

71
Q

What are characteristic markers of birth asphyxia?

A

1) mec in amniotic fluid
2) fetal HR
3) Apgar scores
4) pH and other acid/base measures

72
Q

What are the current recommendations of the AAP for the use of Apgar scores and the determination of perinatal asphyxia?

A

should not be used alone to establish a diagnosis of asphyxia

73
Q

What is the best marker to identify asphyxia during L & D?

A

low pH; recent research is not conclusive that pH correlates to neuro outcomes

74
Q

What is the only clinical predictor of later neurologic outcome?

A

neonatal encephalopathy with early seizures

75
Q

What is HIE?

A

H: hypoxemia- decreased oxygen to the brain
I: ischemic- decreased blood perfusing the brain
E: encephalopathy- any dysfunction of the brain

76
Q

What are the 4 factors necessary for diagnosis of HIE?

A

1) low Apgar scores (0-3 for >5min)
2) cord gas pH < 7
3) Evidence of neurologic manifestations in 1st 24h of life such as hypotonia, coma or sz
4) evidence of other organ damage (brain will be protected as long as it can)

77
Q

In the pathophysiology of HIE, following termination of the insult, what can occur?

A

a cascade of deleterious events resulting in cell death (necrosis and cell death)

78
Q

What are the 2 main areas of the brain affected by HIE?

A

basal ganglia and thalamus, resulting in: hearing loss, learning disability, mild motor dysfunction, CP, severe motor dysfx and death

79
Q

What is the effect of mild thermal stress?

A

can help to establish respirations, thyroid and catecholamine surge

80
Q

What is the effect of severe thermal stress?

A

acidosis, hypoxia, hypoglycemia, DIC, IVH, shock, death

81
Q

What is the effect after birth of temp stability?

A

temp falls 2-3 degrees C, triggers metabolic processes and increases heat production

82
Q

What is the effect of a decreasing core temperature on the newborn’s metabolism?

A

increases 100% by 15-30 min; 170% by 1 week of age (term infants)

83
Q

What is the thermic response mounted by the newborn?

A

non-shivering thermogenesis of brown fate

84
Q

When does brown fat develop in the fetus?

A

~ 26 weeks through 3-5 weeks post birth; accounts for 1/10th adipose tissue in the full-term infant

85
Q

Describe the appearance of brown fat.

A

smaller vacuoles, high in glucose, mitochondria, sympathetic nerves and blood supply

86
Q

Where is brown fat located?

A
  • mid scapula
  • back of the neck
  • under clavicles
  • abdominal aorta
  • kidneys
  • mediastinum
  • trachea
  • heart
  • liver
  • esophagus
  • adrenal glands
87
Q

What is the mechanism of convective heat loss?

A

skin > air; depends on air temp, air flow, relative humidity, clothes and hat; head is 21% surface area and brain produces 44% of body heat

88
Q

What is the mechanism of radiant heat loss?

A

skin > environment; heat lost to walls, windows, objects NOT in direct contact

89
Q

What is the mechanism of conductive heat loss?

A

skin > surface; direct contact of baby with blankets, scale, diapers, etc

90
Q

What is the mechanism of evaporative heat loss?

A
  • biggest source of heat loss* 58 calories are lost for every gram of H2O evaporated; depends on air flow and humidity
91
Q

How quickly should an infant be rewarmed?

A

term: no faster than 1 degreeC/hr; if t rewarm faster than 0.5 degreeC/hr

Physical Assessment (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions