Exam 2 Flashcards
all pt go through all 3, go under anesthesia, and must obtain informed consent
Perioperative Phases
- Begins when pt and surgeon mutually decide
- Ends when pt is transferred to OR or operating bed
Preoperative
- Begins when pt is transferred and includes time spent in OR
- Ends in post-anesthesia care unit (PACU)
Intraoperative
- Begins: Admission to PACU
- Recovering pt
- Ends with recovery from surgery and follow-up with provider visit
Postoperative
- elective
- urgent
- emergency
- based on risk
- based on purpose
classification of surgical procedures
- non-urgent
- delay has no ill-effects
- can be schedules in advance based on pt’s choice
- ex) tonsillectomy, hernia repair, cataract, scare revision, facelift, mammoplasty
elective surgery
- performed within short-time frame (24-48 hours)
- ex) removal of gallbladder, coronary artery bypass, malignant tumor
urgent surgery
- must be done ASAP to preserve life, limb
- ex) gunshot wound, perforated ulcer, intestinal obstruction, control of hemorrhage, tracheostomy
emergency surgery
- major risk: may be elective, urgent, or emergency; ex) colostomy, hysterectomy, amputation, trauma repair
- minor risk: primarily elective; can return to activities sooner, less complications, almost always outpatient; ex) teeth extraction, skin biopsy, cataract
based on risk surgery
- diagnostic: to make or confirm diagnosis (breast biopsy, exploratory)
- ablative: remove a diseased body part (appendectomy, colon resection, amputation)
- palliative: relieve or reduce intensity of illness (colostomy, nerve root resection, arthroscopy)
- reconstructive: restore function to malfunctioning tissue or improve self-concept (scare revision, plastic surgery)
- transplantation: replace organs or structures that are diseased or malfunctioning (kidney, liver, heart, cornea)
- constructive: restore function in congenital anomalies (cleft palate)
based on purpose surgery
- general
- moderate sedation/analgesia
- regional
- topical and local
types of anesthesia
- Administered by inhalation or IV or combo
- Causes LOC, amnesia, analgesia, relaxed skeletal muscles, relaxed reflex
- Can be used for any age or any surgery
- Risk: circulatory and respiratory depression, post-op N/V leading to aspirations, bronchospasms can also occur
general anesthesia
- Short-term minimally invasive surgeries
- Maintains cardiorespiratory function
- Can respond to verbal commands
- Airway open and can respond to tactile areas
- Can be administered by specially trained nurses (endoscopy, radiology)
moderate sedation/analgesia
- injected near nerve or operative sight to lose feeling in that region
- nerve blocks
- spinal
- epidural
regional anesthesia
- Injected in nerve trunk
- Jaw, face, extremities
nerve block (regional)
- Injected in subarachnoid space through lumbar puncture and causes sensory, motor, and autonomic blockage
- Surgeries of lower abdomen, perineum, legs
- Side effects: hypotension, headache, urinary retention
spinal anesthesia (regional)
- Injection of anesthetic through intervertebral space usually in lumbar
- Chest, abdomen, and legs; most common - child birth
epidural anesthesia (regional)
- Mucus membranes, wounds, burns
- Intact skin
- Sprayed, spread, or applied with compress with drug-saturated gauze or cotton-tip
topical anesthesia
- Injected in specific area of body
- Minor, short-term, or diagnostic procedure
- Also can be injected in general anesthesia to manage pain
local anesthesia
- Nurse must witness signature on form
- Doctor should discuss the following in very plain language while taking into account educational level, language, and culturally sensitive:
○ Description of procedure including name, site, and side
○ Potential alternative therapies and option of non-treatment
○ Underlying disease process and natural course
○ Name and certification of physician performing procedure
○ Emphasize shared decision making
○ Explain risk - nature, magnitude
○ Benefits
○ Explain the pt has the right to refuse treatment and consent can be withdran
○ Explain the expected but not guaranteed outcome and recovery course
○ Signed, dated, and timed form is a legal document kept in chart
informed consent
- Legal document
- Protects patient, provider, facility
- Nurse witnesses signature
informed consent
- Legal document: specify instructions for healthcare if the pt is unable to communicate them
- Living will: explains instructions
- Durable power of attorney: appoints an agent the pt trusts to make choices for them in the event of incapacity
advanced directives
- cardiovascular
- respiratory
- central nervous system
- renal
- gastrointestinal
- integumentary
Age-related changes in perioperative patients
- decreased cardiac output, stroke volume, and cardiac reserve
- decreased peripheral circulation
- increased vascular rigidity
age-related cardiovascular changes (perioperative)
- obtain and record baseline vital signs
- assess peripheral pulses
- teach leg exercises, turning, and explain the purpose of early ambulation after surgery
- document baseline activity levels and tolerance of fatigue
- monitor fluid administration rate
- allow sufficient time for effects of medications to occur; administer the lowest dose possible of medications
nursing strategies for age-related cardiovascular changes (perioperative)
- reduced vital capacity
- diminished cough reflex
- decreased oxygenation of blood
- decreased chest expansion and strength of intercostal muscles and diaphragm
age-related respiratory changes (perioperative)
- obtain and record baseline respiratory depth and rate
- teach coughing and deep-breathing exercises
- teach use of incentive spirometer
- assess color of skin
- explain use of pulse oximeter for monitoring postoperative oxygenation
nursing strategies for respiratory age-related changes (perioperative)
- obtain and record baseline
- decreased reaction time and coordination
- reduced short-term memory
- sensory deficits
- decreased thermoregulation ability
CNS age-related changes (perioperative)
- orient to surroundings
- institute safety measures, such as keeping environment clear of clutter and using a night-light
- allow additional time for teaching, teach-back activities, and questions and answers
- use appropriate measures to conserve body heat
nursing strategies for CNS age-related changes (perioperative)
- decreased renal blood flow
- reduced bladder capacity
renal age-related changes (perioperative)
- monitor fluid and electrolytes status
- maintain and record intake and output
- provide ready access to toileting
nursing strategies for renal age-related changes (perioperative)
- increased gastric pH
- prolonged gastric-emptying time
- decreased hepatic blood flow and enzyme function
gastrointestinal age-related changes (perioperative)
- obtain baseline weight
- monitor nutritional status (weight, laboratory data)
- observe for prolonged effects of medication
nursing strategies for GI age-related changes (perioperative)
- decreased vascularity
- decreased skin moisture and elasticity
- decreased subcutaneous fat
integumentary age-related changes (perioperative)
- assess skin status
- monitor fluid status
- pad and protect bony prominences
- monitor skin for pressure areas
- use minimal amounts of tape on dressings and IV sites
- encourage active and passive range of motion, with repositioning as needed
nursing strategies for integumentary age-related changes (perioperative)
instruct the pt to:
- list medications and ask provider which ones should be taken or omitted the morning of surgery
- notify surgeon’s office if a cold or infection develops before surgery
- list all allergies, and be sure OR staff is aware
- follow al instructions from surgeon regarding bathing or showering with special soap
- remove nail polish, do not wear makeup, lotion, or deodorant on day of procedure
- leave all jewelry and valuables at home
- wear clothing that buttons in front, loose, easy to put on
- have someone available to transport you home
notify pt where and when to arrive for procedure and how long it will take
preoperative information for outpatient/same-day surgery
- reduces length of hospital stay
- cut costs
- reduce stress for pt
- preop is very important since they are not staying overnight for observation
out-patient/same-day surgery
- Risk factors in physical and psychosocial factors
- Developmental level
- Medical and surgical history (ALLERGIES)
- Medication history (Rx and OTC)
- Nutritional status
- Use of alcohol, illicit drugs, or nicotine
- Activities of daily living, and occupation
- Coping patterns and support systems
- Sociocultural needs
Preop Health History
- Anticoagulants: precipitate hemorrhage
- Diuretics: electrolyte imbalances, respiratory depression from anesthesia
- Tranquilizers: increase hypotensive effects of anesthetic agents
- Adrenal steroids: abrupt withdrawal may cause cardiovascular collapse
- Antibiotics in myocin group: respiratory paralysis when combined with certain muscle relaxants
surgical risk of Rx medications
- Aspirin and Gingko –> bleeding
- Echinacea and Kava –> liver damage
- Garlic supplements –> lower BP
- Ginseng –> raise BP, rapid HR
- Ephedra –> Raise BP, abnormal heart rhythms
- St. John’s Wort –> harder to recover from effects of anesthesia
- Valerian –> harder to wake after anesthesia, abnormal heart rhythm
surgical risks of OTC or Herbal Medications
- general survey: general state of health, body posture, vital signs
- integumentary: inspect color, characteristics, location/appearance of any lesions; assess skin over boney prominences; determine turgor
- respiratory: observe excursion and diameter/shape of thorax; auscultate breath sounds; palpate for tenderness/pain
- cardio: inspect JVD; auscultate apical rate, rhythm character; auscultate heart sounds; inspect for peripheral edema; palpate strength of peripheral pulses bilaterally
- GI: last intake of food/water; last BM; inspect abdominal contour; auscultate bowel sounds
- Neuro: orientation, level of consciousness, awareness, and speech; assess reflexes, motor, sensory ability, visual, and hearing ability
- Musculoskeletal: inspect joint range of motion; palpate muscle strength; assess ambulation
focused preop physical assessment
- risk surgeries do not require AEB
- readiness Dx do not require R/T statements
Dx impaired comfort
R/T
- insufficient environmental and situational control: impending surgery
- insufficient resources
AEB
- fear
- inability to relax
- irritability, restlessness, sighing
- uneasy in situation: verbalizations of distress, worry, being afraid
Dx risk for infection
R/T
- alteration in peristalsis
- alteration in skin integrity
- obesity
- smoking
- stasis of body fluid
preop nursing diagnosis
- Verbalize physical and emotional readiness for surgery
- Demonstrates and verbalizes understanding of coughing, turning, deep-breathing, use of incentive spirometry, leg exercises, and early
- Verbalizes expectations of postoperative pain management
- Maintains fluid intake and nutritional balance to meet healing needs
preop outcome identification and planning
- check informed consent
- gather needed equipment and supplies
- hand hygiene
- check vital signs and inform provider of pertinent changes
- verify adherence to food and fluid restriction
- instruct pt to remove clothing and change into gown
- give valuable to family members
- have pt empty bladder
- attend to special preop orders (IV)
- complete preop checklist
- administer preop medications as prescribed
- help move pt from bed to stretcher
- tell family where pt will be after surgery and show them the waiting room
- prepare room for post
preop implementation
We know it is effective if pt is physically and emotionally ready for surgery, verbalizes expected events and sensations of perioperative period, and demonstrates postoperative exercises and activities
preop evaluation
- Patient identification/verification process
○ Name, DOB, consents, preop checklist information (esp. factors that may increase surgical risk) - Final verification just prior to beginning the procedure, time-out
○ Team agree on ID of patient, correct surgical site (marked by surgeon), and the procedure to be performed - Patient –> anesthetized, positioned, prepped, and draped
- Nurse continually assesses patient during procedure and monitors supplies used to maintain safety
intraoperative assessment
- dx risk for imbalanced fluid volume R/T potential risk factors: hemorrhage, failure of regulatory mechanisms, administration of fluids in operating room
- dx risk for perioperative positioning injury R/T immobilization; can be impacted by associated conditions including: disorientation, edema, emacification, muscle weakness, obesity, and sensoriperceptual disturbance from anesthesia
intraoperative nursing diagnosis
- Remain free of neuromuscular injury
- Remain free from wrong-site, wrong-side, wrong-patient surgical procedure
- Maintain fluid and electrolyte balance
- Maintain skin integrity (other than for the incision)
- Have symmetric breathing patterns
- Be free of injury from burns, retained surgical items (inaccurate count of sharps, instruments, and soft goods such as surgical sponges used during the procedure), and medication errors
- Remain free from surgical site infection
Maintain normothermia
intraoperative outcome identification and planning
- Positioning
- Draping
- Documentation: Patient assessment, item counts, vital signs, urine output, blood loss, pulse oximetry, body temp, positioning, medications, dressings and drains, specimens, equipment used, and responses to care
- Transferring to the PACU: Handoff: patients care, procedure, tourniquet time, drains, medications used, presenting conditions, patient response
intraoperative implementation and evaluation
- Respiratory status
○ RR, rhythm, depth, breath sounds, SPO2, CO2 skin color, return of gag reflex, airway patency - Cardiovascular status
○ ECG/HR and rhythm, skin color, BP, peripheral pulses bilaterally, hypothermia, shivering - CNS status
○ Level of alertness (unconscious –> responds to touch/sounds –> drowsiness –> awake/not oriented –> awake/oriented), movement - Fluid status
○ Skin turgor, v/s/, urine output, wound drainage, IV fluid intake, blood products - Wound status
○ Dressing over incision: amount, consistency, color of drainage, any tube or drains and amount and type of drainage - Gastrointestinal status
○ Nausea/vomiting - Pain assessment
- General condition
immediate postoperative assessment (Q10-15 min)
- vital signs and oxygen saturation
- color and temperature of skin
- level of consciousness
- intravenous fluids
- surgical site
- other tubes
- comfort
- position and safety
ongoing postoperative assessment
dx acute pain R/T physical injury agent: surgical procedure AEB…
- change in physiologic parameters
- self-report or evidence of pain characteristics using standardized pain instrument
- self-focused
- positioning to ease pain
- guarding behavior
dx risk for delayed surgical recovery R/T
- malnutrition
- obesity
- pain
- postoperative emotional response
postoperative nursing diagnosis
- Carry out leg (including foot and ankle) exercises every 2-4 hours
- Deep breathe and cough effectively every 2 hours
- Engage in early ambulation
- Verbalize decreasing levels of pain
- Regain and maintain a balanced intake and output
- Regain normal bowel and bladder elimination
- Exhibit a healing surgical incision
- Remain free of infection
- Verbalize any concerns about appearance of wound
- Verbalize and demonstrate would self-care
postoperative outcome identification and planning
- Preventing cardiovascular complications
○ Hemorrhage, shock, thrombophlebitis/venous thromboembolism - Preventing respiratory complications
○ Pulmonary embolism, atelectasis, pneumonia - Preventing surgical site complications
- Promote a return to health
○ Elimination needs, fluids/nutrition needs, comfort/rest needs - Helping patient cope
- Providing outpatient surgery postoperative care
- Evaluation
postoperative implementation and evaluation
Leading causes of mortality in US
Heart disease
- Vital for exchange of gases
- Composed of the heart and the blood vessels
- The heart is a cone shaped, muscular pump, divided into four hollow chambers
- The upper chambers, the atria (singular, atrium), receive blood from the veins (the superior and inferior vena cava and the left and right pulmonary veins).
- The lower chambers, the ventricles, force blood out of the heart through the arteries (the left and right pulmonary arteries and the aorta).
Cardiovascular system
- Dysrhythmia or arrhythmia
- Myocardial ischemia
- Angina
- Myocardial infarction
- Heart failure
Alterations in the cardiovascular system
- Level of health
- Developmental considerations
- Medication considerations
- Lifestyle considerations
- Environmental considerations
- Psychological health considerations
Factors affecting cardiopulmonary functioning and oxygenation
- Hypoxia - not enough oxygenated blood
- Ischemia - inadequate supply of blood
○ Ex. Blood clot - Cyanosis - discoloration of skin, blue/gray, lack of deoxygenated blood
- Angina - pain from ischemia
- Cardiac output: amount of blood ejected from the left ventricle over 1 minute
- Tachycardia: fast heart rate (>100 bpm)
- Bradycardia: slow heart rate (<60 bpm)
- Myocardial infarction: death of heart muscle due to lack of blood flow
Perfusion Vocabulary
Cardiovascular
- Apical:
○ Rhythm: regular / irregular / regularly irregular
- monitor (telemetry): NSR / …etc
○ Quality: strong / distant / muffled
○ Murmurs/rubs/gallops: present? Extra heart sounds?
- Pain: discomfort / heaviness / pressure / crushing / radiation to where? arm / shoulder / jaw
- Vascular: Skin color: pink / pallor / ashen / dusky / cyanotic / flushed
○ Skin Temperature: warm / cool / cold to touch
○ Nail beds: capillary refill < 3 secs / 3 secs / > 3 secs
- Pulses (brachial, radial, femoral, popliteal, posterior tibial, pedal) quality: absent / thready / weak / diminished /equal / unequal / palpable / strong / bounding / present only with Doppler
- Edema: periorbital / anasarca / hands / peripheral pitting: 0 / 1+ / 2+ / 3+ / 4+
From “Nursing Assessment Phrasing”
- CLASS: RESPIRATORY FUNCTION
- Impaired gaseous exchange
- CLASS: CARDIOVASCULAR/PULMONARY
- Activity intolerance
- Risk for activity intolerance
- Ineffective breathing pattern
- Decreased cardiac output
- Risk for decreased cardiac output
- Risk for ineffective gastrointestinal perfusion
- Risk for ineffective renal perfusion
- Impaired spontaneous ventilation
- Risk for decreased cardiac tissue perfusion
- Risk for ineffective cerebral tissue perfusion
- Risk for ineffective peripheral tissue perfusion
- Ineffective peripheral tissue perfusion
- Dysfunctional ventilatory weaning response
- Risk for impaired cardiovascular function
“NANDA Nsg Dx” - Domain 4 – ACTIVITY/REST
- popliteal (behind knee)
- dorsalis pedis (on top of foot)
- posterior tibial artery (inside ankle)
- if you can’t find, use doppler
peripheral pulses
- Cardiac coronary catheterization
- Cardiac exercise stress testing
- Echocardiogram
- Endoscopic studies
- Holter monitor
- Lung scan
- Skin tests
- Radiography
Common diagnostic methods to assess cardiopulmonary function
- Amount of blood ejected from left ventricle x HR; Stroke rate x HR
- Measured by invasive hemodynamic monitoring or by echocardiogram
- Indirect measures of CO
- 2+ pulses
- Skin warm & dry
- Good capillary refill
- BP WNL
- Good UO
- Clear Sensorium
- HR WNL
- RR WNL
- Clear breath sounds
Cardiac Output
- Partial pressure of oxygen (PaO2)
- Partial pressure of carbon dioxide (PaCO2)
- pH
- Bicarbonate (HCO3)
- If you think your pt has an ABG the first thing you should do is pulse ox. ABG is more accurate and thorough
Collecting arterial blood gas (ABG) sample
- either side of sternum (V1-2)
- one next to left sternum (V3)
- midclavicular line (V4)
- anterior axillary line (V5)
- midaxillary line (V6)
- right arm
- right leg
- left arm
- left leg
Cardiac rhythm monitoring: 12-lead ECG
“clouds over sky; smoke over fire”
brown in middle
telemetry
- P wave: atrial depolarization
- QRS complex
- ventricular contraction
- T wave: ventricular depolarization
- ventricular filling phase: cardiac muscles are completely depolarized
electrical conduction represented on ECG
- R wave = ventricular rate
- P wave = atrial rate
- Is there a P wave for every R?
- Is rhythm regular?
6 seconds x 10 = 60 seconds
normal sinus rhythm
- HR over 140/min or less than 40/min
- RR over 28/min or less than 8/min
- Systolic BP > 180 mmHg or < 90 mmHg
- O2 Sat less than 90% despite O2 supplementation, deep breathing and coughing efforts, etc.
- Acute change in mental status
- Urine output < 30 cc in 1 hour
- Staff, family, or visitor has significant concern about the patient’s condition
rapid response
- Person has stopped breathing
- Person has no pulse
- Unable to determine if the person has a pulse or if they are breathing, and is unresponsive
call a code
1) assess patient’s description of chest discomfort and effect of coronary ischemia on perfusion to the heart (change in BP/rhythm), brain (change in LOC), kidneys (decrease urine output), skin (color/temp)
2) Dx risk for decreased cardiac tissue perfusion R/T reduced coronary blood flow
3) Planning: pt reports beginning relief of chest discomfort and symptoms; adequate cardiac output AEB stable/improving ECG
4) Implementation: administer oxygen, continuous ECG, administer medication therapy, ensure physical rest
5) Evaluation
ADPIE for myocardial infarction
- Atherosclerosis (plaque deposits on wall of arteries), can fully occlude or clot can break off and cause occlusion (CVA, MI)
- Thrombus can form in vein and if it enters circulation = embolism (DVT)
Clotting
Immobility, pregnancy or hormonal contraception, surgery or trauma, indwelling devices such as catheters, other co-morbidities such as cancer, older age…
venous thromboembolism (VTE)
1) decreased blood flow to skin and GI tract: cold, clammy hands; pale, ashen, cyanotic skin; decreased bowel sounds; diarrhea/constipation
2) decreased blood flow to kidneys, liver, lungs: increased RR, BUN, Cr, K, ALT/AST; decreased SpO2, urine output
3) Decreased blood flow to brain and heart: LOC, disorientation; slow pupils; CP, pressure; change in HR; ST elevation
clinical assessment of VTE
- Integrity of the airway system to transport air to and from lungs
- Properly functioning alveolar system in lungs
- Oxygenates venous blood
- Removes carbon dioxide from blood
- Properly functioning cardiovascular and hematologic systems
* Carry nutrients and wastes to and from body cells
Factors essential to normal functioning of the respiratory system
- Function: warm, filter, humidify inspired air
- Components
- Nose
- Pharynx
- Larynx
- Epiglottis
Upper Airway
- Functions: conduction of air, mucociliary clearance, production of pulmonary surfactant
- Components
- Trachea
- Right and left mainstem bronchi
- Segmental bronchi
- Terminal bronchioles
Lower Airway/Tracheobronchial Tree
- Inspiration: the active phase of ventilation
- Involves movement of muscles and the thorax to bring air into the lungs
- Expiration: the passive phase of ventilation
* Movement of air out of the lungs
Pulmonary Ventilation
Which respiratory organ is the site of gas exchange?
alveoli
- Level of health
- Developmental considerations
- Medication considerations
- Lifestyle considerations
- Environmental considerations
- Psychological health considerations
Factors affecting cardiopulmonary functioning and oxygenation
- Orthopnea: positional breathing problem; laying down; COPD pt
- CHF: fluid filling lungs
- Tachypnea: fast breathing >20
- Apnea: stopping breath; sleep apnea
- Crackles: popping sounds; fluid in alveoli
- Wheezing: whistling sound; expiration; narrowed airway; inflammation or edema of bronchi
- Kussmaui respirations - diabetes
- Dyspnea - pain or difficulty breathing
Respiratory vocabulary
- Mucous Membranes: pink / pale / cyanotic/ reddened / dry / moist
- Breath sounds: clear / diminished / absent / wheezing / stridor / crackles / rhonchi / friction rub / bilateral
- Pattern: unlabored / labored Rhythm: even / uneven / shallow / deep / nasal flaring /
- Chest expansion: symmetrical / asymmetrical Chest shape: normal / barrel-shaped / symmetrical
- Accessory muscles: retractions: mild, moderate, severe location?
- Cough: quality: dry / hacking / loose / moist / harsh / croupy / barking
- frequency: infrequent / occasional / frequent
- productive - sputum consistency: thin / thick / tenacious / mucous
- amount: small / moderate / copious color: clear / yellow / green / blood-tinged / hemoptysis
- Pulse oximetry: continuous / intermittent
- Supplemental oxygen: cannula/mask/ET-ventilator settings: O2%, O2 flow rate, humidification, vent settings…
Nursing Assessment Phrasing
CLASS: RESPIRATORY FUNCTION
* Impaired gaseous exchange
CLASS: CARDIOVASCULAR/PULMONARY
* Activity intolerance
* Risk for activity intolerance
* Ineffective breathing pattern
* Decreased cardiac output
* Risk for decreased cardiac output
* Risk for ineffective gastrointestinal perfusion
* Risk for ineffective renal perfusion
* Impaired spontaneous ventilation
* Risk for decreased cardiac tissue perfusion
* Risk for ineffective cerebral tissue perfusion
* Risk for ineffective peripheral tissue perfusion
* Ineffective peripheral tissue perfusion
* Dysfunctional ventilatory weaning response
* Risk for impaired cardiovascular function
From “NANDA Nsg Dx” - Domain 4 – ACTIVITY/RESP
- Determine why the patient needs nursing care.
- Determine what kind of care is needed to maintain a sufficient intake of air.
- Identify current or potential health deviations.
- Identify actions performed by the patient for meeting respiratory needs.
- Make use of aids to improve intake of air and effects on patient’s lifestyle and relationship with others.
Guidelines for obtaining a nursing history
- Why would patients with cardiac or renal problems have subsequent respiratory problems?
- What about chronic illness overall leading to muscle weakness…how could this affect respiratory function?
- What class of medication can cause respiratory depression?
- How big of a concern is cigarette smoking?
- Encourage cardiopulmonary fitness
- Don’t dismiss the importance of environmental factors
Risk factors
- Lungs are transformed from fluid-filled structures to air-filled organs.
- The infant’s chest is small, airways are short, and aspiration is a potential problem.
- Respiratory rate is rapid and respiratory activity is primarily abdominal.
- Synthetic surfactant can be given to the infant to reopen alveoli.
- Crackles heard at the end of deep respiration are normal.
Respiratory Activity in the Infant