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Nur 943 OB > Exam 2- NN Assessment 1+2 > Flashcards

Exam 2- NN Assessment 1+2 Flashcards

1
Q

The newborn is the first ____ hours after birth

A

24

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2
Q

The neonatal period consists of:

A

1st month of neonatal life (28 days)

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3
Q

Trace fetal blood flow starting blood leaving the placenta via the umbilical vein through the fetal circulation and back to the placenta.

A

Placenta, umbilical vein, ductus venosus, IVC, RA, foramen ovale, LA, LV, Upper body/brain, SVC, RA, RV, ductus arteriosus, distal aorta, lower body, umbilical artery, placenta.

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4
Q

What happens to fetal circulation after birth?

A

Placental blood flow stops, aortic pressure increases, clamping of the umbilical vein increases SVR, lung expansion decreases PVR, increased PaO2 leads to pulmonary vasodilation.

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5
Q

Discuss the intracardiac pressures during the transition phase. What causes the foramen ovale to close?

A

Decreased RA pressure + Increased LA pressure leads to closure of the foramen ovale.

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6
Q

When does complete closure of the foramen ovale occur?

A

2-3months

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7
Q

What causes the closure of the ductus arteriosus?

A

Increased SVR and Increased PaO2 and decreased PVR leads to constriction of the ductus arteriosus.

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8
Q

When does the ductus arteriosus closure occur?

A

Functional closure occurs 1-8 days, anatomic closure requires 1-4 months.

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9
Q

When does the ductus venosus close?

A

Constricts 1-3 hours postnatally. Blood flow into the liver and increase in portal venous pressure.

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10
Q

Fetal breathing begins at ___ weeks

A

11 weeks, however, this movement decreases throughout pregnancy.

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11
Q

Fetal lung liquid is an ultrafiltrate of plasma with of volume of _____ml/kg

A

30ml/kg. Partial reabsorption occurs during L/D and 2/3 is expelled during birth.

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12
Q

Retained liquid in the fetal lung can lead to…

A

Transient Tachypnea of the Newborn (TTN).

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13
Q

Babies 1st breath occurs…

A

9 seconds after delivery

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14
Q

Lung inflation releases what?

A

surfactant

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15
Q

Name the 5 parameters of the APGAR

A 
Heart Rate
Respiratory Effort
Muscle Tone
Reflex Irritability
Color
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16
Q

How do you score HR on Apgar?

A

> 100=2
<100=1
Absent=0

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17
Q

How do you score Respiratory effort on Apgar

A

Robust Crying=2
Irregular, slow, shallow, or gasping resp=1
Absent=0

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18
Q

How do you score reflex irritability on Apgar?

A

Active coughing and sneezing=2
Grimace=1
No response=0

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19
Q

How do you score Muscle Tone on Apgar?

A

Active movement=2
Some flexion of extremities=1
Absent/limp=0

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20
Q

How would you score Color on Apgar?

A

Pink=2
Acrocyanotic (trunk pink, extremities blue)=1
Cyanotic=0

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21
Q

When is Apgar scored?

A

at 1 min and 5 min after birth

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22
Q

What is a normal Apgar score?

A

8-10

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23
Q

What Apgar score would signify moderate impairment?

A

4-7

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24
Q

What Apgar score would require immediate resuscitation?

A

0-3

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25
Q

Persistent pulmonary HTN the newborn (PPHTNN) may also be called…

A

Persistent fetal circulation

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26
Q

What are the 3 characteristics of persistent fetal circulation of PPHTNN?

A

Sustained elevated PVR
Decreased lung perfusion
Continued R-L shunting (PFO and ductus arteriosus)

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27
Q

What is associated with PPHTNN or persistent fetal circulation? (ie factors leading to…)

A 
Severe birth asphyxia
Meconium aspiration
Sepsis
Congenital diaphragmatic hernia
Maternal use of NSAIDS
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28
Q

Primary precipitating factors of PPHTNN?

A

Hypoxemia
Acidosis
Pneumonia
Hypothermia

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29
Q

Other risk factors for PPHTNN?

A

Maternal diabetes
Maternal asthma
C-Sec delivery

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30
Q

Physiology of PPHTNN?

A

Elevated PVR->ductus arteriosus and PFO stay open->R-L shunt->hypoxia and normal/elevated PaCo2

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31
Q

Treatment for PPHTNN?

A 
Correcting predisposing disease
Mechanical ventilation
Exogenous surfactant
Inhaled nitric oxide
Alkalization
ECMO
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32
Q

Respiratory value goals for PPHTNN?

A

PaO2=50-70mmHg, PaCO2=50-55mmHg

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33
Q

Define Meconium Aspiration Syndrome

A

Respiratory distress in neonate whose airway was exposed to meconium and CXR shows findings associated with aspiration (consolidation and atelectasis).

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34
Q

Neonatal CO is dependent on what?

A

Heart Rate

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35
Q

What it the preferred treatment for fetal bradycardia and decreased CO?

A

Epinephrine

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36
Q

The neonatal ANS is predominantly controlled by SNS or PNS

A

PNS

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37
Q

What is the blood volume for a neonate?

A

80-90ml/kg

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38
Q

Give the normal HR for Neonate, 12 mos, 3 year, and 12 year.

A

Neonate-120bpm
3 mos- 120bpm
3 years- 100bpm
12 years- 80 bpm

39
Q

Give the normal SBP for Neo, 1 year, 3 year and 12 year

A

Neo-70-75
1 year- 95
3 year 100
12 year- 110

40
Q

Give normal DBP for Neo, 1, 3, 12 year

A

Neo-40
1-65
3-70
12-60

41
Q

Give EBV for Preemie, Newborn, 3mos-3years, children > 6 and Adults

A 
Preemie- 90-100
Newborn-80-90
3m-3y- 75-80
>6y-65-70
Adults-65-70
42
Q

The epiglottis lies at ____ in the neonate.

A

C1

43
Q

The glottis is ____ at full term, ____for pre-term

A

C4 full term, C3 neonate

44
Q

What shape is the neonatal epiglottis?

A

Omega

45
Q

The babies 1st breast establishes what

A

FRC

46
Q

The vocal cords are ____ slanted

A

anterior

47
Q

The larynx lies at

A

C2-C4

48
Q

The majority of neonates are preferential ____ breathers

A

nose

49
Q

The tongue is (large/small) compared to mouth opening.

A

large

50
Q

Term fetus Po2, PCo2 and pH before labor?

A

Po2-25
PCo2-40
pH 7.37

51
Q

Term fetus Po2, PCo2, and pH at end of labor?

A

Po2-10-20
PCo2-55
pH- 7.25

52
Q

MV:FRC is ______ x higher in newborn

A

2-3x higher than that of an adult

53
Q

Describe the types of fibers in the newborn and which is predominate

A

Type 1 Slow twitch

Type 2 Fast twitch- more predominate in newborn, so more likely to fatigue easily.

54
Q

Stimulation of the carina or SLN will lead to….

A

Respiratory depression/apnea, following upper AW obstruction or lung hyperinflation (Hering - Breuer reflex).

55
Q

RR rate of Infant compared to Adult

A

Infant RR is 30-50

Adult RR is 12-16

56
Q

TV of Infant compared to Adult

A

Tidal Volumes
Infant 7ml/kg
Adult 7ml/kg
SAME SAME

57
Q

FRC of Infant compared to Adult

A

Infant FRC-27-30/kg
Adult-30ml/kg
Infant is slightly less

58
Q

O2 consumption of infant compared to Adult

A

Infant 7-9 ml/kg/min (more)

Adult 3 ml/kg/min (less)

59
Q

Nervous system is complete by age…

A

3 years old

60
Q

Peripheral Nervous system begins in

A

motor roots

61
Q

Cerebral nerves system begins in

A

sensory system

62
Q

The diaphragm is more responsive to which type of NMBs?

A

NDMRs

63
Q

Signs of pain in newborn

A 
Tachycardia
Elevated BP
Crying
Restlessness
Grimacing
64
Q

The Conus Medullaris terminates between ____ in neonates

A

L2-L3

65
Q

Primary source of fuel in the neonate?

A

Glucose- has decreased stores- hypoglycemia is a maj source of morbidity

66
Q

Which is more responsive in the newborn, SNS or PNS

A

PNS- so stress/hypoxemia causes bradycardia

67
Q

Liver is not fully functional at birth, my see ______ develop in the 1st few days of life.

A

Hyperbilirubinemia (6-8mg/ml)

Clotting factors also may be low

68
Q

Neonate has ____ GFR.

A

Low (1-2ml/kg/min)

69
Q

GFR _____ by 2 weeks of age

A

doubles

70
Q

4 reasons newborns have low GFR

A

Low systemic arterial pressure
High renal vascular resistance
Low permeability of the glomerular capillaries
Small size and number of glomeruli

71
Q

The kidneys are 60-70% mature by

A

1 month

72
Q

GFR reaches normal levels by

A

12-24 months

73
Q

What ml/kg/hr of urine would indicate hypovolemia or decreased renal function in a newborn

A

<1ml/kg/hr = Hypovolemia or decreased renal function

74
Q

Half life of meds that are excreted by GFR are (reduced or prolonged)

A

prolonged

75
Q

How do newborn tolerate fluid overload?

A

poorly

76
Q

Newborns are Obligate _____ excreters

A

obligate SODIUM excreters

77
Q

TBW is about ____% for Term infant

A

75%

78
Q

Preterm TBW is ____%

A

80-85%

79
Q

Factors for increased heat loss in neonate?

A

Cold environment
High ratio of surface area to body weight
Reduced SubQ fat
Poor shiver response to cold

80
Q

Newborn response to cold

A

Increasing metabolic rate and releasing norepinephrine- non-shivering thermogenesis. “Brown fat Thermogenesis”

81
Q

Conus medullaris is located at _____ in neonates and infants

A

L3

82
Q

Conus medullaris reaches ____ at 1 year of age (and stays throughout adulthood)

A

L1

83
Q

LP for SAB?

A

L4-L5,L5-S1

84
Q

Skin to SAS in neonate? cm

A

1.4cm

85
Q

Respiratory causes of neonatal bradycardia and cardiac arrest

A 
AW obstruction
Bronchospasm
Pulmonary Aspiration
Inadequate O2 delivery
Pneumothorax
86
Q

Pharmacologic causes of neonatal bradycardia and arrest

A

Inhalation agents
Succinylcholine
Anticholinesterases

87
Q

Neurogenic causes of neonatal bradycardia and arrest

A

Celiac reflex
Oculocardiac Reflex
Superior/Recurrent nerve stimulation

88
Q

Metabolic causes of neonatal bradycardia and arrest

A

Hypoglycemia
Anemia
Hypothermia
Acidosis

89
Q

Spinal Anesthesia doses for newborn

A

1% Tetracaine in 5% Dextrose 0.6-1mg/kg

  1. 5% Bupivi 0.5-1mg/kg
  2. 75% Bupivi in 8.25% dextrose 0.5-1mg/kg
90
Q

Steps for performing a Caudal Block

A

Lateral position, upper knee flexed
Landmarks: tip of coccyx, sacral cornua
22g needle, bevel up at 45 deg angle to skin
Feel LOR, reduce needle angle and advance CEPHALAD
Volume determines height of block (think epidural)
1.2-1.5ml/kg provide anesthesia/analgesia to T4-T6
DONT USE MORE THAN 2.5 mg/kg

91
Q

Which blade is preferable for infants?

A

Straight blade

92
Q

ETT sizes for Preterm, Full Term, 3-12 months

A

Pre term- 2-3
Full term- 3-3.5
3-12 months- 4.0
Shortcut- look at pinky finger

93
Q

Allow for air leak at

A

20-30cm H2O

94
Q

Length of insertion of ETT

A

<10cm, between 8-10cm

Nur 943 OB (11 decks)

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