Circulation, growth periods Flashcards
Embryonic Period
At how many weeks of preg term?
What is developed during this period?
> 0-7 Weeks
Appearance of Lung Buds
Division into Major Bronchi
Pseudoglandular Period
At how many weeks of preg term?
What is developed during this period?
> 7-17 Weeks
Rapid Branching
Airways lined by Columnar Epithelium
After 10 Weeks, appearance of Cartilage, Lymphatics, Mucous Glands, and Muscle Cells
At 17 weeks, Terminal Bronchioles present
Cannulicular Period
At how many weeks of preg term?
What is developed during this period?
> 17-27 Weeks
Development of Terminal Bronchioles, Respiratory Bronchioles, and Small Alveolar Sacs (Acinus)
Differntiation for type1 (Gas Excange) & type2 (Surfactant)
Beginning stage of gas exchange
Saccular Period
At how many weeks of preg term?
What is developed during this period?
> 27-36 Weeks
Enlargement of Peripheral Airways
Further differentiation of pnemocytes
Has better Gas Exchange
Alveolar Period
At how many weeks of preg term?
What is developed during this period?
> 36 weeks - 2 years post natal
Alveoli increase until 2-4 years and continue to increase in size until adolescence
Increase in Cartilage, Glands, and Muscles
300-400 million alveoli in Adults
What is the purpose of getting an L/S ratio?
Lecithin/Sphingomyelin Ratio
tests for surfactant production in fetus
What is the sample used in an L/S ratio?
amniotic fluid
What factors increase fetal surfactant production in fetus
fetal stress in utero
what factors can decrease in fetal surfactant production?
diabetic mother
what are the maternal risk factors?
17 risk factors
Parity—prima para, grandmulti para Multiple Births 40 years of age No prenatal Care Maternal Diabetes Smoking/Drugs/Alcohol Ethnicity Delivery History—dystocia, prom Position of fetus Hyperthyroidism Eclampsia/Pre-eclampsia Toxemia of Pregnancy Protenuria HELLP Isoimmunization rH factor Hydrops Fetalis/Hemolytic Anemia
what is the term for too much and too little amniotic fluid?
too much: polyhydraminos
too little: oligohydraminos
Describe a frank breech
fetal butt facing vaginal opening and both feet are pointing up.
Describe a complete breech
fetal butt facing vaginal opening. both legs and feet are crossed.
Describe an incomplete breech
fetal butt facing vaginal opening. one leg is facing up and one foot is facing down
what is grand multi para?
a woman who has already delivered 5 or more babies at 24 weeks or more.
What is primary apnea?
Responds to stimulation
deprivation of oxygen but is breathing is stimulated by giving oxygen.
what is secondary apnea?
unresponsive to stimulation/intervention
Deep irregular gasping
HR and BP decrease
If continues, HR & RR cease, O2 falls, death occurs
NEEDS positive pressure vent with appropriate FiO2
What are 2 compromising situations that can occur with the placenta?
Placental Abruption (partial or complete)
Placenta Previa
What is placental abruption?
What is the difference between complete and partial placental abruption?
Placental abruption is the separating of the placenta from the uterine wall and pool blood.
partial abruption, has no indication while complete abruption will show spotting and bleeding from the mother.
what is placenta previa? why is this a problem?
Placenta Previa is a situation where the placenta is blocking the vaginal opening preventing normal birth.
Placenta should not be delivered first as you dont wan to remove the fetus’ unit of respiration before it has a chance to come out. C-section needed
What are 3 causes of placental insufficiency due to blockage of umbilical blood?
cord prolapse - cord is delivered before baby (breech births)
Nuchal Cord - cord wraps around neck
Cord Knots
Fetal arteries carry deoxygenated or oxygenated blood?
DE-oxygenated blood
Fetal veins carry deoxygenated or oxygenated blood?
Oxygenated blood from the umbilical cord
what closes the ductus arteriosus?
increase in o2
decrease in C02
normalization of pH
Decrease in prostaglandins
This causes the ductus arterosus to contract
What closes the foramen ovale?
after birth, the cord is cut and clamped
This creates a back pressure to shut it.
What are the 3 shunts in fetal circulation?
Ductus Arteriosus
Ductus Venousus
Foramen ovale
How do you test to see if the baby has a patient ductus arteriosus?
you collect an ABG from the right radial and unbilicus.
If there is a difference of >15 torr you have a patient ductus arteriosus and still have a Right to Left shunt
What does the Ductus Arteriosus lead from and what does it connected to?
It leads blood that is coming from the pulmonary artery directly to the Aorta.
What allows the foramena Ovale to stay open and what closes it after birth?
Increased pressure from pulmonary arteries to right ventricles due to increased pulmonary vasculature.
After birth, decreased resistance into pulmonary vasculature decreases pressure in the right artrium and increases pressure in left atrium closing it.
What is the purpose of APGAR scoring?
What does the acronym APGAR comprise of?
It tests physical condition of the baby.
A = Appearance / Color P = Pulse G = Grimace / reflex A = Activity / muscle tone R = Respiration / respiratory effort
What and how do you score in the first “A” in A.p.g.a.r. Score?
Appearance / color
0 = Blue all over or Pale
1 = Acrocyanosis
2 = Pink all over
What and how do you score in the “P” in A.p.g.a.r. Score?
Pulse
0 = absent
1 = below 100
2= above 100
What and how do you score in the “G” in A.p.g.a.r. Score?
Grimace / reflex
0 = no response
1 = grimace or weak cry
2 = Good Cry
What and how do you score in the 2nd “a” in A.p.g.a.r. Score?
Activity / muscle tone
0 = Flacid
1 = some reflex of extremities
2 = Well flexed or active movements
What do you score in the “R” in A.p.g.a.r. Score?
Respiratory Effort
0 = absent
1 = weak irregular or gasping
2 = good / crying
What are the reference ranges for APGAR scoring and interventions?
7 - 10 normal and no interventions needed
4 - 7 = Needs resusitation
When and how often do you test APGAR?
at 1 min and 5 mins after birth.
You may have to test more if baby is
What is the Silverman Scoring system?
This evals degree of respi distress.
It subjective, it allows you to focus on respiratory effort
What does the Dubowitz Score test?
What are the parameters and values you use for evaluation?
It tests gestational age.
Premature 42 weeks
What are 2 ways for you to test for gestational age?
Date and Dubowitz/Ballard Scale are 2 ways to test it
What are the normal ranges for baby vital signs?
HR , RR , BP , MAP
HR = 120-170 brady = (=170) RR = 30 - 60 BP = 75/50 MAP = 60
What are causes of heat loss in babies?
4 causes
Why is this a concern?
Conduction (object to object directly)(Cold hands or Cold Stethoscope)
Convection (object to air)(Cold Air draws away heat)
Radiation (object to object indirectly)(Isolate walls coldness draw heat away from baby)
Evaporation (liquid to vapor) (liquid on baby from amniotic sac)
babies cant maintain heat, cant shiver, no brown fat to metabolize, increase surface area to weight.
What re the 4 “p’s” to indicate need for intubation?
Pulmonary funct / Respi failure
Provide Airway (upper airway obstruction issues)
Protect Airway (Loss of protective airway reflexes)
Pulmonary Hygene (unable to clear secretion)
What indicates respiratory failure for intubation?
pH
How do you choose et Tube size for infants?
Where do you start from and how do you calculate an increase in size?
> 1000g and 2.5 size
Increase by .5 for every increase in 1000g
What type of et tubes do you use for infants and peds?
you use cuffless et tubes until the age of 8
what laryngoscope do you use?
Miller straight blade
What is hylaline membrane disease?
Surfactant deficiency of the lung causing decreased lung compliance and atelectasis
Plasma leaks out of lung tissue and forms hyline membrane and prevent gas exchange
who are at risk of hyline membrane disease and RDS in infants?
8 risk factors
Premature infants
Where do you auscultate in in infants?
Only over the large airways
What is PPHN, persistant pulmonary hypertension causes?
Failure of shunts to close during transition from fetal circulation due to lack of O2
High PVR causing Right to Left shunt
Hypoxemia and acidemia causes further increase in PVR and perpetuates the cycle
how do you diagnose PPHN?
Compare pre and post ductal blood gas samples for R-L shunt
O2 hyperoxia test
hyperventillation test
Contrast echocardiography used to confirm shunting
