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Peds & Neonates > Ch. 12 > Flashcards

Ch. 12 Flashcards

1
Q

What are some signs of ARDS?

A

• Increased RR
• Retractions
• Grunting
• Pulmonary edema
• Pink frothy secretions

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2
Q

What are some symptoms of ARDS?

A

• Anxiety
• SOB
• Inspiratory crackles

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3
Q

What is the first phase of ARDS?

A

Patient becomes dyspneic and tachypneic for latent pulmonary capillary leak into interstitial space surrounding a small number of the alveoli.

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4
Q

How will the CXR present in the first phase of ARDS?

A

Normal

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5
Q

How will the O2 sats and status present during the first phase of ARDS?

A

Normal

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6
Q

What is the second phase of ARDS?

A

Alveolar damage begins

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7
Q

How long does the second phase of ARDS occur?

A

With 12-24 hours characterized by interstitial edema

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8
Q

How will the CXR present during the 2nd phase of ARDS?

A

Diffuse infiltrates begin appearing

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9
Q

What happens during phase 3 of ARDS?

A

A larger portion of the alveolar/capillary membranes are overwhelmed with fluid, resulting in accumulation in the alveoli and distal airways.

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10
Q

What else happens during phase 3 of ARDS?

A

Respiratory failure develops with worsening hypoxemia, hypercarbia (CO2 > 60mmHg) and acidosis.

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11
Q

How will the CXR present in phase 3 of ARDS?

A

Diffuse infiltrates will appear along with development of air bronchograms.

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12
Q

What is the 4th phase of ARDS?

A

Describes as progressive respiratory failure, fibrosis of the lungs, and recurrent, resistant pneumonias.

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13
Q

How do you treat ARDS?

A

Support the injured lungs (using low stretch protocols) to maintain normal physiologic function, that is, giving them time to heal.

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14
Q

What are the 3 strategies for the tx of ARDS?

A
  1. Correction of physiologic derangements
  2. Suppression of alveolar inflammation
  3. The prevention of complications
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15
Q

The patient suffering from asthma will have a hx of what?

A

• Wheezing
• SOB mingled with periods of no symptoms at all

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16
Q

What are the signs of asthma?

A

Depends on the degree of the attack

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17
Q

What are the signs for a mild asthma attack?

A

• Dry hacking cough
• Little presence of wheezing

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18
Q

What are the signs for a moderate asthma attack?

A

• Productive cough
• Tachypnea
• Audible wheezing
• Tachycardia
• Possible cyanosis

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19
Q

What are the signs for a severe asthma attack?

A

• Diminished breath sounds
• Retractions
• Rapid shallow respirations
• Pt may be stuporous and lethargic from hypoxia and hypercapnia

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20
Q

What is the 1st phase of acute asthma?

A

Blood gases are within normal limits

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21
Q

What is the second stage of acute asthma?

A

CO2 begins to decrease and the pH becomes alkalotic.
There may or may not be signs of hypoxemia

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22
Q

What is stage three of acute asthma?

A

Shows a normal CO2 and pH in a fatigued hypoxemic patient
* These patients should be admitted to the ICU and observe closely*

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23
Q

The __________ may be increased in atopic asthma?

A

IgE levels

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24
Q

The use of _______ can be used to determine the extent of airway obstruction and responsiveness to BD therapy.

A

Peak expiratory flow (PEF)

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25
Q

What are some other causes of wheezing that are often misdiagnosed for asthma?

A

• left ventricular failure
• endobronchial lesions
• vocal cord dysfunction
• bronchitis obliterans organizing pneumonia (BOOP)

26
Q

What is the tx for asthma?

A

Avoiding the precipitating factors that trigger the attack

27
Q

What are the 2 phases of asthma?

A
  1. Acute phase
  2. Inflammatory phase
28
Q

What happens during the acute phase?

A

The presence of triggering stimuli on the airways causes rupture or degranulation of the mast cell

29
Q

What happens during the inflammatory phase?

A

Mediators are released by eosinophils, neutrophils, macrophages, and lymphocytes. These mediators initiate the inflammatory response by swelling and in bronchoconstriction of the airways.

30
Q

What are the two onset patterns of asthma?

A

• Sudden onset
• slow onset

31
Q

Younger CF patients are commonly affected with_________?

A

Staph aureus

32
Q

Older CF patients are commonly infected with ________?

A

Pseudomonas aeruginosa or serratia marcesans

33
Q

The survival rate of females with CF is ________that of males?

A

Less than
due to contracted mucoid P. aeruginosa 1.7 years earlier the males

34
Q

What is another bacteria that causes pneumonia in CF patients and is associated with poor outcomes?

A

Burkholderia cepacia

35
Q

What are some respiratory complications of CF?

A

• Chronic rhinosinusitis
• Nasal polyposis
• Pneumothorax
• Hemoptysis

36
Q

_________ is often present as a result of chronic hypoxia and result in increased pulmonary vascular resistance

A

Cor pulmonale

37
Q

When does werdnig Hoffman paralysis usually manifest?

A

At birth with the most apparent feature, being inactive (or non-vigorous) term neonate.

38
Q

T or F Werdnig Hoffman paralysis is the most common and most severe form of the spinal muscular atrophy diseases?

A

TRUE

39
Q

With werdnig Goodman paralysis the infant lies in what type of position that limits movement of the arms and legs?

A

Frog-like

40
Q

How is werdnig Hoffman paralysis diagnosed?

A

Electromyography

41
Q

What is electromyography?

A

A test which evaluates the electrical activity of skeletal muscles

42
Q

When does kugelberg-welander disease appear?

A

Later in childhood or adolescence

43
Q

Kugelberg-Welander disease has a __________?

A

Slow progression

44
Q

What are the first muscles affected by juvenile spinal muscular atrophy?

A

•Pelvic girdle
•arms
•legs

45
Q

What is the first stage of Reye’s syndrome?

A

Vomiting, lethargy, drowsiness, liver dysfunction, type, 1 EEG follow commands, brisk pupillary reaction

46
Q

What is the second stage of Reye’s syndrome?

A

Disorientation, combativeness delirium,
hyperventilation, hyperactive reflexes, appropriate responses to painful stimuli, evidence of liver dysfunction type one EEG, sluggish pupillary reaction

47
Q

What is stage 3 of Reye’s syndrome?

A

Obtunded coma, hyperventilation, decorticate rigidity, preservation of pupillary light reaction, vestibule-ocular reflex (all though sluggish).

48
Q

What is stage 4 of Reye’s syndrome?

A

Deepening coma, decerebrate rigidity (arms extending away from the body), loss of oculocephalic reflexes, large and fixed pupils, loss of doll’s eye reflex, loss of corneal reflexes; minimal liver dysfunction;

49
Q

What is stage 5 of Reye’s syndrome?

A

Seizures, loss of deep tendon reflexes, respiratory arrest, flaccidity; Type IV EEG, usually no evidence of liver dysfunction.

50
Q

What are the 3 factors that favor in utero infection?

A
  1. Prolonged rupture of the amniotic membranes usually more than 24 hours
  2. Prolonged labor even in the presence of intact membranes
  3. Excessive obstetrical manipulation
51
Q

What are the most causative organisms of perinatal infection?

A

Enteric organisms such as E. coli and group B streptococcus

52
Q

What are some causes of postnatal pneumonia?

A

• contamination of the neonates airway by infected humidifier reservoirs
• poor hand washing
• contaminated incubators and other equipment

53
Q

What are the most common organisms that cause postnatal pneumonia?

A

S. aureus & S. Epidermis

54
Q

What are some other organisms that can cause postnatal pneumonia?

A

• Klebsiella pneumonia
• Type b. H influenza
• P. Aeruginosa
• Candida albicans

55
Q

How will the infant appear with postnatal pneumonia?

A

• Flaccid
• Pale
• Cyanotic
• tachycardic
• showing signs of distress

56
Q

How will the amniotic fluid appear during postnatal pneumonia?

A

Foul smelling (which indicates presence of infection)

57
Q

What will the WBC count be for postnatal pneumonia?

A

< 5000 cells or > 15,000 cells

58
Q

How will the x-ray present with postnatal pneumonia?

A

Unilateral or bilateral streaky densities or consolidation in the perihilar region of the chest

59
Q

What is bronchiolitis?

A

An upper airway infection that typically starts with a runny nose, cough, and mild fever that last 2 to 3 days

60
Q

A patient less than three years with bronchiolitis will begin to show what?

A

Signs of small airway obstruction and congestion

61
Q

What is the antibiotic used to treat RSV?

A

Ribavirin

62
Q

What are some drugs that may be used to help reduce bronchospasm and improve ventilation until infection clears in bronchiolitis?

A

Theophylline and sympathomimetic drugs

Peds & Neonates (18 decks)

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