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Nicu > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

1 hertz=

A

60 breaths

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2
Q

Less than 1 kg infant tube size is?

A

2.5 mm

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3
Q

1-2 kg sized infant is fitted with an ?

A

3.0 mm sized tube

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4
Q

2-4 kg infant is sized with an ?

A

3.5 mm endotube

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5
Q

5 settings for newborns for HFOV

A

Paw Power Frequency I:E Bias flow

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6
Q

5 tips for suctioning

A

•Use a closed-system suctioning •hyperoxygenate prior to suctioning **not with preemies** •pass the catheter frequently •keep attempts short •pass the catheter a predetermined distance

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7
Q

A 1 year old child is selected for a ___ sized endotube ?

A

4.0 mm

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8
Q

A preemie by age is selected for an ___ sized endotube?

A

2.5 mm

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9
Q

A term baby by age is selected for a ___ sized endotube ?

A

3.0 mm

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10
Q

Anatomical considerations in the neonate

A

•cricoid ring is narrower than the glottis •larynx is more anterior •larynx is more cephalic •tongue is large and bulky •epiglottis is long and stiff

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11
Q

Cannula and masks for peds

A

Lower flows than adult values are appropriate due to lower inspiratory flow rates and smaller tidal volumes

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12
Q

Concerns with HFNC?

A

•increased time needed for RT support •increase delay to start oral feeding •increase length of stay in hospital •increase incidence of ROP and BPD

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13
Q

Define HFJV

A

High frequency jet ventilation •needs a special adaptor or ETT and Two vents

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14
Q

Depth of insertion by age for a 1 year old?

A

12 cm

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15
Q

Depth of insertion by age for a 2 year old?

A

14 cm

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16
Q

Depth of insertion by age for a 6 month ?

A

10 cm

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17
Q

Depth of insertion by age for a newborn?

A

9 cm

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18
Q

Depth of insertion by age for a preemie?

A

8 cm

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19
Q

Depth of insertion by age for any tube for a nasal tube?

A

Add 3 cm to the age depth

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20
Q

Depth of insertion by weight for a 2kg?

A

8 cm

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21
Q

Depth of insertion by weight for a 1kg ?

A

7 cm

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22
Q

Depth of insertion by weight for a 3 kg?

A

9 cm

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23
Q

Depth of insertion by weight for a 4 kg?

A

10 cm

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24
Q

Drug dosage self -limiting

A

It is appropriate to use “adult drug doses for children

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25
Q

During Pressure control; what determines Flow?

A

By machine

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26
Q

During Pressure control; what determines Te?

A

Ti and F

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27
Q

During Pressure control; what determines Ve?

A

F and Vt

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28
Q

During Pressure control; what determines Vt?

A

PiP-peep and cst

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29
Q

Five phases of ROP

A

•Bilateral vasoconstriction and obliteration of the retinal capillaries •neovascularization •vessel fibrosis •retinal hemorrhage •retinal detachment

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30
Q

Flow-inflating bags

A

Mapleson system

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31
Q

Frequency-important note (HFOV)

A

Decrease the frequency will increase volume and decrease PaCO2

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32
Q

Goals of tent therapy

A

•oxygen delivery •humidity control •environmental temperature control •isolated environment •drug therapy

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33
Q

Greater than 4 kg infant is sized with ?

A

4.0 mm endotube

34
Q

Hazards of MV

A

•Infection •ETT and mechanical problems •Pulmonary oxygen toxicity •cardiac problems •increase ICP • auto peep, over inflation, pneumothorax •ventilator induced lung injury

35
Q

Hazards of oxygen therapy

A

Hearing loss,n2 washout *FIO2*, Pulmonary oxygen toxicity *PAO2*, and Retinopathy of prematurity *PaO2*

36
Q

How to initiate cpap?

A

•determine need •place on 5-6 cm h2O and appropriate fio2 •flow rate at 6-8 L/min • re-evaluate •cpap may be increased to 8 cm h2O •if minimal improvement, consider MV

37
Q

How to place an endotube for an infant ?

A

•Solid black line on ETT is vocal cord marker •tip of the ETT should be at 1 cm above the carina •use of miller blade for 0-1 (for new borns)

38
Q

How to prevent ROP ?

A

Delay birth, keep pao2 50-80, (sats 95%) ; use a short course of O2 therapy

39
Q

How would you define a HFV ventilator?

A

Delivers more than 150 breaths per minute Oxygenation is controlled by MAP and Fi02

40
Q

In HFJV what determines VT and CO2?

A

PIP

41
Q

In HFOV what is directly influencing PaCO2?

A

Frequency is directly influencing PaCO2

42
Q

Indications for HFJV?

A

•Pulmonary Interstitial Emphysema •severe pulmonary air leak •diaphragmatic hernia •meconium aspiration •surfactant replacement •support of pts. With bronchopulmonary dysplasia •large and persistent bronchopleural fistula

43
Q

MDI with mask

A

Ages less than 5 years of age

44
Q

Neonatal considerations

A

•Low-flow flow meters •use of a blender •non- heated humidifiers may be used to humidity the gas

45
Q

Notes for CPT

A

•May result in hypoxemia in some infants •t-burg may cause intracranial bleed in preemies •may use rubber adapters, masks, electric toothbrush and vibrators to preform therapy

46
Q

Oxygen hood therapy (oxyhood)

A

•Maintains controlled environment of temperature, humidity and oxygen. •warmed, humidity oxygen should be delivered at a flow >7 L/min •constantly monitor temperature and fio2 •may use with or without an isolette

47
Q

Reasons for Retinopathy of prematurity

A

•unknown factors •increase PaO2, don’t increase for suction..keep 83%-93% •duration of exposure to increase PaO2 •maturity at 36 weeks gestation

48
Q

Ribavirin (virazole)

A

•An antiviral agent •used to treat RSV infections •administered as an aerosol using SPAG •is teratogenic

49
Q

Weight formula for insertion depth

A

(Weight in kg + 6)

50
Q

What are the complications of HFJV?

A

Atelectasis Hypotension Over-inflation Air trapping Apnea

51
Q

What are the complications of suctioning ?

A

•muscosal trauma •atelectasis •hypoxemia •arrhythmia/ hypotension •contamination/infection •bronchospasm • increased icp

52
Q

What are the downsides of incubator therapy?

A

•difficult to regulate oxygen concentration •must monitor temperature •nursing care is hindered

53
Q

What are the flows are used in a high flow nasal cannula ?

A

Flows from 2-6 L/m are used

54
Q

What are the goals of CPAP?

A

•improve PaO2 while decreasing FIO2 •stabilize alveoli •alveolar recruitment •increase FRC, surface area •improve V/Q matching •decrease shunt and WOB •stimulate surfactant production

55
Q

What are the indications for artificial airways

A

•Bypass upper airway obstruction •provide mechanical ventilation •provide auction •prevent aspiration

56
Q

What are the ranges for sight?

A

Poor eyesight to total blindness

57
Q

What are the straight tubes?

A

Mcgill and Murphy

58
Q

What can a HFNC replace?

A

HFNC can be used to tug heated humidity instead of cpap or as a next step in weaning from oxygen

59
Q

What causes respiratory failure?

A

•CNS •Cardiac •metabolic •pulmonary •misc

60
Q

What do self inflating bags have?

A

•40 cm H2O with an override •40 +/- 10 cm h2O for child pressures •40 +/- 5 cm h2O for infant pressures

61
Q

What does HFJV offer over conventional outcomes?

A

HFJV does not offer additional benefits over conventional in reducing mortality rate or incidence of BPD

62
Q

What does HFOV mean?

A

High frequency oscillation ventilation

63
Q

What does MMAD stand for?

A

Mass median aerodynamic diameter

64
Q

What does NTE stand for?

A

Neutral thermal environment

65
Q

What is HFOV?

A

High frequency oscillation ventilation

66
Q

What is HFV?

A

High Frequency Ventilation Use of high rates and very small VTs

67
Q

What is TCPLV?

A

Time cycled pressure limited ventilation •pressure targeted •pc-ac

68
Q

What is TCVLV?

A

Time cycled volume limited ventilation •volume targeted •VC-AC

69
Q

What is the common rate for HFOV?

A

600-900 b/min (10-15 hertz)

70
Q

What is the formula for tube by age?

A

(Age + 16)/4 for 1-16 years

71
Q

What is the suctioning pressure of a Adult?

A

100-150 mm hg

72
Q

What is the suctioning pressure of a child?

A

100-120 mm hg

73
Q

What is the suctioning pressuring of a neonate?

A

60-100 mm hg

74
Q

What setting most influential to PaCO2?

A

F VT (if in VC-AC) Change in pressure;pip-peep (in PC-AC)

75
Q

What setting most influential to PaO2 during MV?

A

FiO2 and peep Also v/q matching adjusts in the lung

76
Q

What should we do to confirm insertion depth?

A

Verify with chest x ray!

77
Q

When auto flow is off what determines PiP?

A

Peep,vt, flow, raw and cst

78
Q

When auto flow is off what determines Te?

A

Ti and F

79
Q

When auto flow is off what determines Ti?

A

VT and flow

80
Q

When auto flow is off what determines VE?

A

F and Vt

81
Q

When do use cpap?

A

-spontaneous breathing patients -paO2 <50 mm hg on high fio2

Nicu (2 decks)

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