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Neonatal and Pediatric Resp Care > Chap 1,2,3,4 > Flashcards

Chap 1,2,3,4 Flashcards

1
Q

Normal Gestational Period

A

40 weeks, 9 months (3 trimesters of 3 mo.each)

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2
Q

Considered neonate

A

delivery to 1 month

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3
Q

Considered infant

A

1 month to 1 year

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4
Q

considered child

A

after 1 year

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5
Q

Stages of lung development

A

Embryonic 26-52 days
Pseudoglandular 52 days-16 weeks (structure)
Canalicular 17 - 26 weeks (I and II alveolar cells)!!
Saccular 26-36 weeks
Alveolar 36 weeks - term

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6
Q

I and II alveolar cells made when

A

17-26 weeks

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7
Q

Pulmonary hypoplasia

A

*hypoplastic lung
Underdeveloped lung tissue
Failure of the lungs to develop

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8
Q

Main cause of pulmonary hypoplasia

A

Diaphragmatic hernia: diaphragm is seperated and bowels are in thoracic cavity. Compresses lung tissue and it cannot develop adequately

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9
Q

Surface tension

A

mutual attraction of the like molecules for one another

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10
Q

Principle of La Place’s law as

A

the radius of a buble decreases the surface tension increases
soo.. a small alveoli has more surface tension and is more difficult to inflate than a large alveoli

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11
Q

Surfactant

A

a phospholipid found on the alveolar walls that lowers surface tension

  • it increases compliance
  • helps prevent alveolar collapse
  • is produced by type II alveolar cells
  • appears at approx 23-26 weeks gestation
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12
Q

Fetal lung fluid

A

20-30 ml/kg of body wt

-volume equivalent to FRC

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13
Q

Function of fetal lung fluid

A

maintain airway patency

-formation, size, and shape of air spaces

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14
Q

Evaluation of lung fluid

A

1/3 squeezed out during delivery

-the remaining fluid is absorbed by lymphatic system

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15
Q

lung fluid retention after C-section

A

transient Tachypnea of the newborn (passes fast)

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16
Q

What is the first major organ to develop

A

heart, pumps blood in 8 weeks

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17
Q

Which one is higher Venous or Arterial pressure

A

Venous pressure is higher than arterial, Right heart is stronger than left heart (opposite of us)

  1. High PVR
  2. Low placental resistance to blood flow - gets O2 from mother and rids of CO2
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18
Q

THREE FETAL SHUNTS

A
  1. ductus venosus- belly button
  2. Foramen Ovale- Hole between right and left atria
  3. Ductus arteriosus
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19
Q

Path of fetal blood flow

A

Placenta- umbilical vein- ductus venosus - inferior vena cava - right atrium_>
(a) Foramen ovale - left atrium - left ventricle - aorta- brain (the most oxygenated blood)
(b) Right ventricle- pulmonary artery - ductus arteriosus - aorta- body
(C) Right Ventricule - P.A. - lungs - left atrium (about 10% of the total blood supply)

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20
Q

Intrauterine structures

A

Placenta, Umbilical cord

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21
Q

Placental Structure

A

Chorionic villi exchanges the gases and nutrients from mom to fetus

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22
Q

Umbilical cord structure!!!

A

2 umbilical arteries, 1 umbilical vein, Whartons jelly

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23
Q

Stages of labor

A

Stage 1: onset of first true contraction to complete dilation and effacement
Stage 2: full dilation and effacement to delivery of the fetus
Stage 3: Expulsion of the placenta

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24
Q

Normal position during labor

A

Baby head down= vertex position

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25
Q

Initiation of the first breath

A
  1. Asphyxia= CO2 increases, PaO2 decreases
  2. Recoil of the thorax
  3. Environmental changes
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26
Q

First breath may require what pressure

A

-100cmH2O, less pressure needed as FRC is established

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27
Q

Change from fetal to adult circulation

A
  1. Clamp umbilical cord removes placenta from arterial circulation increases arterial pressure
  2. lung fluid replaced with air
    PaO2 increaes, PaCO2 decreases -> Pulmonary vasodilation (PVR decreaess)
  3. Closure of shunts
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28
Q

Closure of shunts

A

D.V. - no blood flow
F.O. - pressure changes (increase left atrial pressure)
D.A. Increase PaO2 -> Decrease prostaglandins -> constricts smooth muscle around D.A.

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29
Q

Factors identifying a high-risk pregnancy

A

Preterm birth, less than 37 weeks gestation
Alcohol
Smoking
Cocaine
Hypertension (preclampsia)
Diabetes
Infection: herpes simplex, Hep B, HIB, Group B streptococcus

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30
Q

Placental abnormalitites

A

Placenta previa- may be partial or total (covered placenta)- might need C section
Placental abruption- Premature separation of the placenta from the uterine wall

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31
Q

Umbilical Cord problems

A

Cord compression
Prolapse (comes out first)- leading to cord compression
Nuchal (around neck)

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32
Q

First sign of a baby with hypoxia

A

bradycardia- lack of blood flow

33
Q

Amnion and Amniotic fluid

A

Polyhydramnios (from increased swallowing defect)

Oligohydramnios (from decrease renal/ urinary defect)

34
Q

Amniotic Fluid functions

A
  1. Protect fetus from trauma
  2. Thermoregulation
  3. Facilitate fetal movement
  4. Dilation and effacement of the cervix
35
Q

Preterm Birth Complications

A 
Sepsis 
RDS
IVH
ROP-blind too much O2
BPD- on vent/ o2
NEC- dying of gut
Corticosteroids given to mom to speed up fetal lung maturity
36
Q

Tocolysis

A

Process of stopping premature labor

  • Beta-adrenergic drugs: Ritodrine (yutopar), Terbutaline (Brethine), Manesium Sulfate (reduces smooth muscle contractility- also used for asthma), Indomethacin (decrease prostoglandins)
  • Corticosteroids
37
Q

Post Term Birth Complications

A

Meconium aspiration= toxic/ obstruction-> sev. pneumonitius

Placenta insufficiency

38
Q

Antenatal Assessment (before birth assessment of fetus)

A

Ultrasonography, Amniocentesis, Fetal Biophysical Profile

39
Q

Amniocentesis

A

A. L:S ratio (lung maturity!
B. Rh isoimmunization (blood incompatibility)
C. Bilirubin level (hemolytic disorders) (blood disease)
D. Chromosomal disorders (downs)
E. Enzyme Deficiencies
F. Genetic mutation

40
Q

Fetal Biophysical profile

A

Contraction stress test
Nonstress test
Fetal movement
Biophysical profile (see how baby is doing)

41
Q

Delivery positions

A

Normal, head down
Breech, Any position but normal
Assisted vaginal delivery, forceps

42
Q

Cesarean Delivery: indications

A
  1. Previous C sections: not absolute
  2. Failure to progress
  3. Malpresentation: breach
  4. Placenta Previa: covered
  5. Non reassuring fetal status: straps on belly, watch HR
  6. Multiple gestations
43
Q

Multiple gestations

A

Increased incidence of premature delivery
Second twin is often more compromised
female twins generally more healthy than male twins

44
Q

Fetal Heart rate

A

BASELINE: 120-160 bpm

Variability- normal variability is 5-10 bpm

45
Q

Fetal Bradycardia/ tachycardia

A

Brady: <100 or drop 20bpm below baseline- most dangerous cause of fetal bradycardia is asphyxia
Tachy: Baseline consistently > 180, sign of infection

46
Q

Fetal HR Acceleration/ decelerations

A

a. Accelerations
FHR exceeds 160 for <2 min
-Accelerates during contractions and are benign
b. Decelerations
FHR drops below 120 for less than 2 min
-early decelerations closely follow contractions and are benign
-Late decelerations occur 10-30 sec after the onset of contraction -indicate fetal asphyxia C SECTION ASAP
-Variable decelerations occur independent of contractions usually indicate cord compression

47
Q

Fetal Scalp pH

A

Used when fetal asphyxia is suspected (low O2 or high CO2 leads to acidosis)
Normal pH > 7.25
slight asphyxia 7.20-7.25
severe < 7.20

48
Q

Stabilization of the neonate

A
  1. maintain warmth and dry (first thermoregulation! lose heat rapidly)
  2. Provide and maintain an airway
  3. stimulation (should breathe well or cry within 30 sec)
  4. Apgar score (ranks babys activity/ muscle tone)
49
Q

Apgar score

A

done at 1 min and 5 minutes, dont withhold care to wait for the 1 or 5 minutes
-respiratory effort/ rate
-heart rate
-skin color
-Reflex irritability : grimace
-Muscle tone
(Activity,pulse, grimace, appearance, respiration)

50
Q

Gestational age assessment

A
  • History of pregnancy and delivery
  • Ultrasound
  • postnatal physical exam (ballard, physical exam)
51
Q

Physical exam (to assess gestational age): Ballard

A 
Vernix (not on new ballard score): protects skin
Skin maturity
Lanugo: hair
Ear/ eye
Breast tissue
Genitalia
Plantar surface (sole creases)
52
Q

Respiratory test

A

Silverman anderson

53
Q

quiet exam

A

-General Assessment
-Vitals: BP HR RR/ Rhythm Temp
-Color/ Skin: Cyanosis central or acrocyanosis
Capillary refill
Mottling or pale
Jaundice
-Meconium: first bowel
-Activity
-Resp Status

54
Q

RR

A

40-60 and apnea (apnea >20 sec)

-assess resp status during quiet breathing (silverman anderson index)

55
Q

Signs of resp distress

A
  • Nasal flaring
  • grunting
  • Retractions , upper and lower chest (see ribs)
56
Q

Chest and cardiovascular

A
  • Malformations (pectus excavatum and pectus carinatum
  • PMI: point of max impulse
  • Ausculate: BS- Squeeky
  • Transillumination of the chest to check for pneumothorax(will light up chest, norm will send halo)
57
Q

Pectus excavatum/ carinatum

A

Excav-inward, Carinatum- outward(pigeon chest)

58
Q

Diaphragmatic hernia

A

flat abdomen, gut in chest with resp distress

59
Q

Fontanelles

A

soft spots

60
Q

Nose, occlude each nostril for

A

choanal atresia- block back of throat =baby continuously crying

61
Q

Reflex tests

A

Rooting reflex-turn towards
Suck Reflex
Moro Reflex-drop
Stepping reflex

62
Q

Neonatal Cardiopulmonary system (how it differs from adult): Upper Airway

A

-Larger tongue: nursing, oblig nose breathers
-more lymphoid tissue
-larger epiglottis (in proportion to larynx)
-Narrowest portion at cricoid (adult is glottis) under laryn-croup
-Trachea 4mm diameter at birth (adult 16mm)
-Chest -ribs and sternum mostly cartilage)
to increase VE must increase RR not able to increase VT (reasons they have retractions: lack of structure in chest)

63
Q

Neonatal Cardiopulmonary system (how it differs from adult): Metabolism

A 
Higher metabolic rate in neonate
100 cal/kg neonate
40-50 cal/kg adult
proportionally higher O2 requirements=burn more cal
unpredictable response to med dosage
64
Q

Neonatal Cardiopulmonary system (how it differs from adult): other

A

larger body surface area - increase heat loss

80% body weight is H2O- fluid balance precarious (I/O)

65
Q

Examination and assessment of the peds: history

A 
CC
Hx of present illness
past medical history
review of symptoms
family hx
social and environmental histories: housing
66
Q

Exam of the peds pulmonary system

A

Keep them calm if possible

  • vitals
  • Inspection
  • Palpation
  • percussion
  • Auscultation
67
Q

Peds vitals exam

A

HR: count using 6 sec pulse
RR
Temp
O2 sat: big toes-> best way to check o2 levels

68
Q

Peds Inspection during exam

A
  • Respiratory distress: tachypnea, breathlessness, head bobbing, grunting, nasal flaring, retractions
  • Chest wall: shape, muscle mass and stregnth, adipose tissue(hard to see chx movement)
69
Q

Peds palpation during exam

A
  • Neck: masses or adenopathy, trachea

- Chest: Fremitus(rumbling), motion with deep breathing

70
Q

Peds percussion during exam

A
  • Hyper-resonance: more air, pneumothorax
  • Dullness: fluid, hemothorax
  • Crepitus: crunchy sound, feel in chx
71
Q

Auscultation during peds exam

A

-Audible: hear without steth.. grunting, stridor, stertor(on exp, low pitched, wet), wheezes
-Breath sounds: Symmetry, intensity, location: lobes/segs, Phases: insp/exp/both
Adventitious sounds: Crackles, wheezes, monophonic or polyphonic

72
Q

monophonic and polychonic

A

mono- localized, poly- asthma

73
Q

low crackles

A

rhonchi

74
Q

peds muscle weakness or atrophy

A

waste away of muscles

75
Q

peds abdominal distension

A

babies= crying - swallowing air

76
Q

dermatitis (allergy)

A

irritation of skin, more prone to asthma

77
Q

edema

A

hear failure- fluid overload

78
Q

Peds lab tests

A 
CXR
PFT inc bronchial challange
SpO2 with exercise
Sweat chloride-CF
CBC
ABG, you gotta really want them

Neonatal and Pediatric Resp Care (4 decks)

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