CVP ISSUES- NEONATE AND CHILD Flashcards

Question

What are the different cell types in the lungs & why are they important in the developing lung? Why is surfactant so important for viability?

Answer 1

TYPE I PNEUMOCYTES: -majority of alveolar epithelium TYPE II PNEUMOCYTES: -produces surfactant --> this cell develops around 20 weeks gestation SURFACTANT: -lipoprotein -alveoli is air: liquid interface -antimicrobial; immune defense; protect lung against invaders (surfactant proteins) -prevents alveolar collapse and helps with lung inflation -decreases surface tension to make the lungs more compliant; decrease muscular effort needed to ventilate lungs -when lung deflates, surfactant lines up next to each other and prevents the alveoli from fully deflating

Answer 2

LIMIT OF VIABILITY: is the gestational age at which a prematurely born fetus/infant has a 50% chance of long-term survival -FUNCTION OF : -->baby's gestational age and birth weight: increases 3-4% per day between 23 and 24 weeks of gestation and about 2-3% per day between 24 and 26 weeks of gestation -->medical and tech capacity differs throughout the world: prenatal care, exogenous surfactant; mechanical ventilation, incubators, neonatology

Answer 3

NEWBORN -Ribs oriented in parallel -limited ability to increase thoracic volume during inspiration -greater oblique orientation with standing and walking -increased chest wall compliance --> increased risk of thoraco-abdominal coupling -decreased mechanical efficiency

Answer 4

Normally the contracting chest wall muscles stabilize the infant rib cage --> minimizes inward rib cage displacement and allows effective volume change --> promotes mechanical efficiency ABNORMAL: -hypercompliant rib cage coupled with reduced lung compliance --> asynchronous chest wall movements --> loss of mechanical efficiency (increased WOB) -increased acidosis and hypoxemia -limited pulmonary reserve * may need to use breathing apparatus

Answer 5

prematurity

Answer 6

INFANT -infant diaphragm continues to develop postnatally -increased muscle growth and increased CSA -increased force production and fatigue resistance PRETERM VERSUS TERM INFANT -preterm: relative fatiguability; decreased inspiratory reserve capacity -increased WOB: high metabolic rate; high RR; decreased lung compliance; increased compliance of chest wall; thoraco-abdominal un-coupling

Answer 7

-intercostal collapse -blue baby

Answer 8

* Decreased lung surface area for gas exchange * Horizontal rib alignment (infant) * Decrease lung compliance; Increased chest wall compliance * Increased RR with an irregular respiratory pattern * Diaphragm continues to develop * Limited airway clearance abilities * Increased WOB * predisposition of children to respiratory problems

Answer 9

Hyaline Membrane Disease CHARACTERISTICS: -surfactant deficiency and lung inflammation --> decreased compliance --> atelectasis --> hypoxemia low V/Q and R to L shunt physiology (bypass lungs) AT RISK: -babies <32 weeks gestation and weighing <1200 g -often worsens over days 2-4--> progressive respiratory failure -could lead to BPD --> oxygen toxicity --> thickened alveoli walls, lungs are edematous --> mechanical ventilation OTHER COMPLICATIONS: -IVH -developmental delay -mitral regurgitation -retinopathy of prematurity

Answer 10

-high pressure of air going into lungs--> can damage delicate infant lungs

Answer 11

-seen following IRDS -Fibrotic changes resulting in reduced compliance & diffusion impairment -usually hypercapnic and hypoxemic respiratory failure -incidence is inversely related to birth weight (lower birth weight) -TREATMENT: -- prevention: limit exposure to mech ventilation and o2 therapy --> nutrition --> airway clearance, positioning, mobilization --> motor milestones

Answer 12

Meconium: -early stool of infant; can be expelled prior to birth in amniotic fluid --> aspiration --> stickiness and tar consistency can block airways --> pneumonitis and/or pneumonia Treatment: -supportive med management -mech vent. if resp. insufficiency (consider duration due to risk of BPD) -airway clearance (postural drainage) Common Complications -tension pneumothorax: large air collection in the pleural space compromises respiration and cardiac function (DANGEROUS) -pulmonary HTN

Answer 13

-developmental defect -80% of hernias on L -baby is: cyanotic, dyspneic, and tachycardic -requires surgery; can be in utero -outcome depends on lung development --> could result in pulm. hypoplasia -usually diagnosed at time of birth ** intestine herniates through the diaphragm

Answer 14

Pulmonary hypoplasia is a relatively uncommon medical condition characterized by incomplete development of the lungs that can affect the overall development of the child. It can be either primary (idiopathic) or secondary to other congenital anomalies and usually leads to severe respiratory insufficiency in the fetus.

Answer 15

-defective CF gene--> deficient CFTR protein--> decreased chloride secretion/altered ionic transport --> increased water absorption and abnormal mucus composition--> bronchial obstruction--> bacterial infections--> inflammation--> bronchiectasis and lung insufficiency -chromosome 7 alteration -90% of CF deaths are pulmonary related

Answer 16

PANCREAS -DM, poor fat digestion -pancreas can't release enzymes into duodenum DIGESTIVE TRACT -malnutrition; blockage/obstruction MSK -arthropathy

Answer 17

In cystic fibrosis (CF), airway surface liquid (ASL) is dehydrated and acidic, and produces viscous secretions that are difficult to clear. This is due to defective anion transport, sodium and water compartmental shifts, and upregulated epithelial sodium channel (ENaC) activity

Answer 18

airway clearance techniques

Answer 19

P aeruginosa MOST FATAL: B cepacia : 10-15 years of life

Answer 20

CORRECTION OF UNDERLYING DEFICIT -meds -gene therapy REDUCTION IN THE MUCUS BURDEN -airway clearance and -exercise training -DNA ase -mucolytics -hyperosmolar agents CONTROL OF INFECTION -Nebulised anti-pseudomonal antibiotics (AB) I-V anti-pseudomonal ABs -Oral antibiotics -Vaccinations -Long-term oral anti-staph antibiotics CONTROL OF INFLAMMATION -Oral corticosteroids -Inhaled corticosterods -NSAIDs -Macrolides (antibiotic) OTHER MANAGEMENT -Bronchodilators -Vaccinations -Long term O2 therapy -Non invasive ventilation (NIV) -Lung transplantation

Answer 21

ETIOLOGY: In asthma there is goblet cell hyperplasia/hypertrophy, subepithelial fibrosis, increased vascularity, and smooth muscle hypertrophy and hyperplasia -thickening of the airway basement membranes -hypertrophy of submucous bronchial galnds and bronchial wall muscle -edema and inflammation -thick, firm mucous in airways -lungs may be overinflated

Answer 22

-can and should participate in PA -can fully participate in physical activity when they are symptom-free. - Activity may need to be modified when a student’s asthma is not well-controlled - so preventing asthma episodes and responding effectively to them are paramount. - Pre-medication, if prescribed, and physical warm-ups are essential and can help prevent asthma episodes. -Asthma Action Plans should include modified exercise recommendations from personal physician--> must be provided to school staff and individual asthma emergency protocol -monitor environment for potential triggers - Permit student to monitor breathing status using a Peak Flow Meter (see below) (gives you idea of flow rate)

Answer 23

50% or less of peak flow with peak flow meter -call doctor -go to hospital or call ambulance

Answer 24

GREEN 80-100% peak flow YELLOW 50-79% peak flow -have student take meds -consider activities that involve stopping and starting or a warm up in moist setting -provide appropriate activity modifications, including rest periods RED 0-49% peak flow -STOP activity -follow emergency plan -inhaled meds -call 911 if no improvement

Answer 25

- Observation for signs/symptoms of respiratory distress – Symptoms/DOE: Borg RPE 4-6 – SpO2 (O2 saturation): as needed – Be aware of the Asthma Action Plan

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CVP ISSUES- NEONATE AND CHILD Flashcards

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