FINAL!!! Flashcards
1
Q
What is the first stage referred to?
A
(ovum 12 to 14 days)
2
Q
Rapid cell division happens in the first stage
(16-50 cells blastocyst)
A
**
3
Q
What is the second stage called?
A
embryo
4
Q
Period from end of ovum measures rougly 3 cm (54 to 56 days)
A
**
5
Q
Second stage includes 3 germ layers, what are they?
A
- Ectoderm
- Endoderm
- Mesiderm
6
Q
Ectoderm is the _______________ and____________ layer
A
outer and thicker
7
Q
Endoderm is the _____________ layer
A
innermost
8
Q
Mesiderm is the layer in….
A
between… It forms between the other two layers
9
Q
Third stage is called
A
fetus
10
Q
Third stage is the period of development (210 to 214)
A
**
11
Q
After delivery developmental stages are identified as (3)
A
- Neonate: birth to first month
- Infant: 1 month to 1 year
- Child: Above 1 year
12
Q
What is the placenta?
A
The organ of respiration for the fetus
13
Q
What is the umblicord?
A
The lifeline between mother and fetus
14
Q
The umblical cord consist of 3 vessels….
A
2 small arteries
1 large vein
15
Q
What is the white gelatous substances protecing the 3 vessels and helps prevent kinking or compression of the cord
A
Warton’s Jelly
16
Q
What are the 5 development lung stages?
A
- Embroynal
- Pseudoglandular
- Canalicar
- Saccular
- Alveolar
17
Q
Embryonal stage
A
First 7 to 8 weeks (Development of the anatomical structure)
18
Q
Pseudoglandular stage
A
8 through 16 weeks (epiglottis appears and the opening to the lower airways)
19
Q
Canalicur stage
A
17 through 26 weeks (Alveoli begins to develop)
20
Q
Saccular stage
A
27 through 36 weeks ( Terminal airways do not contain true alveoli and surfactant begins to develop)
21
Q
Alveolar stage
A
32 weeks (mature surfactant is present )
22
Q
When does the production of surfactant begin
A
24 weeks
23
Q
What is the L/S ratio
A
lecithin to sphingomyelin is 2:1
24
Q
L/S ratio less than 2:1 is not enough. Must give steriods 2 doses within 36 hrs prior to birth
A
KNOW
25
What is oligohydraminos?
To little amniotic fluid.
**When this occurs babies have an 85% chance of survival**
26
What is polyhydraminos
To much amniotic fluid
27
What is the first major organ to develop?
Heart
28
**In fetal circulation pressures are reversed of those in adult. Pressures in the RIGHT is higher than pressures in the LEFT**
KNOW
29
How long should it take the Ductus arterissus
96 hours
30
Doppler assessment measures
blood flow through the umbillical cord, placental, and fetal vessels
31
What is the Gold Standard for determining fetal development
Amniocentesis
32
The average HR in early gestation is
140/ min
33
FHR can be monitored in three ways
- external abdmoinal transducer
- electrodes on abdominal
- Fetal scalp electrode
34
Which FHR montoioring is the **most accurate**
Fetal scalp electrode
35
Uterine contractions can be monitored by one or two devices, the most common device used is a _______________________. The second device is called the
tocodynamometer;
intrauterine pressure cathter
36
What is the normal baseline FHR range?
120 to 160
37
When the FHR **exceeds** 160 bpm for **less than** 2 mins, it is called
accelerations
38
When the FHR **DROPS** below 120 for **less than** 2 mins, it is called
decelerations
39
Average HR for term babies is
160 bpm
40
Average HR for pre-term is
140 bpm
41
Bradycardia is less than 100 bpm. Most common cause is
asphyxia
42
Tacycardia is HR **consistently** above 180 bpm. Most common cause is....
maternal fever or infection
43
_______________ ______ is the most common method of determining estimating date of confinement (EDC)
Nägele's Rule
44
To determine EDC, 3 months is subtracted from the first day of the last period. 7 days is then added to the result to determine EDC
KNOW
45
If the first day of the last period was March 25, subtracting 3 months would arrive at Decemeber 25. Adding 7 days gives us an EDC of January 1
KNOW
46
Gravida means the
number of pregnacies
47
Parity or Para means the
number of previous live births
48
Gravida always includes pregnancy while Para **only indicates previous viable births**
KNOW
49
TPAL stands for
- Term
- Preterm
- Abortion/ Miscarriage
- Live births
In that order
50
Gravida 4 Para 2102 (G4P2102) means
- 4th pregnancy, 2 term, 1 preterm, 0 abortions/miscarriage, 2 living
51
The process of giving birth is called
Parturition
52
What are the events that make up the birth process (5)
1: Rupture of the membrane
2: Dilation of the cervix
3: Contraction of the uterus
4: Separation of the placenta
5: Shrinking of the uterus
53
How many stages of Labor are there?
3
54
The 1st stage of labor begins with the
onset of the first true contraction to full dilation and effacement of the cervix
55
The strecthing or effacement and widening is called
dialation
56
The 2nd stage of labor,
full (100%) dilation and effacement of the cervix to delvery of the fetus
57
The 3rd stage is the
delivery of the fetus and placenta
58
The process of stopping labor is called
tocolysis
59
Any fetal presentation other than vertex is considered abnormal
KNOW
60
The ________ presentation is the most common of all abnormal presentation, compromising about ____% of all births
breech;
3.5
61
What are the 3 breech presentations called
- Complete
- Frank
- Footling
62
95 % of all births occur with the fetus in the head down or _________ position
vertex
62
_________________ position cannot delivered vaginal EVER
Transverse
63
When implantation occurs in the lower portion of the uterus it is called
placenta previa
64
Any time normally attached placenta seperate prematurely from the uterine wall is called
abruptio placentae
65
Intiation of the first breath: biochemical
Asphyxia. Increased PaCO2, decreased PaO2, and pH stimulate the chemoreceptors which then stimulate gasping
66
Intiation of the first breath: Physical
The fetal thorax is compressed as it descends through the birth canal
67
Intiation of the first breath: Environmental changes
As the fetus passes from an environment of darkness and warmth into a bright, loud, cold environment, which intiates a cry reflex
68
Intiation of the first breath: Production of surfactant
- Reduces surface tension
- Reduces muscle fatigue
69
___________, which is a combination of hypoxia, hypercapnia and acidosis, may lead to irreversible damage to the brain and other vital organs
Asphyxia
70
If the hypoxia is not corrected, the vent effort ceases and the fetus enters a period of apnea called
primary apnea
71
During __________ ______ there will be no attempt to breathe again unless PPV is initiated
secondary apnea
72
Prepartion for Resuscitation (3)
1. Anticipation of a high risk delivery
2. Equipment
3. Trainned personnel
73
According to NRP guidelines there are 3 questions that should be asked upon delivery of the neonate, what are they?
1. Is the neonate term?
2. Is the neonate crying or breathing?
3. Is there good muscle tone?
74
What is the first step in resuscitaing the neonate?
Thermoregulation
75
___________ heat loss is the transfer of heat from one object to another **without** coming in contact
Radiant
76
___________ heat loss is the loss of heat through **direct contact** of one object with a cooler surface
Conductive
77
_______________ heat loss is the loss of heat through evaporation of liquids from a surface
Evaporative
78
_________________ heat loss is the loss of heat due to the movement of air past the skin and carring away heat
Convective
79
The next step in the resuscitation is to open the airway by placing baby in sniffing position
KNOW
80
A **vigorous** neonate is defined as one with
strong respiratory effort, good muscle tone, and HR that is greater than 100 bpm
81
If the neonate presents with any gasping, apnea, or a HR less than 100 bpm, what should be initiated?
Positive pressure ventilation (PPV)
Neopuff /T-piece
82
Asses the HR by grasping the base of the umbillical stump between the middle finger and thumb. The HR is measured for 6 seconds and multipled by 10 (HR should be greater than 100 bpm)
KNOW
83
Define acrocyanosis
the blueness of the hands and feet
84
It may take up to 10 mins for a neonate to obtain oxyegnation sat of >85%
KNOW
85
PPV is indicated when the neonate is
apneic, gasping, or when spontaneous breathing cannot maintain the HR above 100 bpm
86
When should chest compressions should be intiated
A persistent HR of less than 60 bpm, despite tactile stimulation and 30 seconds adequate PPV
87
What are 2 ways chest compressions can be administered
Thumb technique and two-finger technique
88
The **thumb technique** is the perferred method
KNOW
89
Tube size: <28 weeks
2.5
90
Tube size 28-34 weeks
3.0
91
Tube size: 34 - 38 weeks
3.5
92
Tube size: >38 weeks
3.5 - 4.0
93
The umbilical vein is the most easily accessible route for direct adminstration of meds and fluids during acute resuscitation
KNOW
94
Indications for Epi during a resuscitation are: (2)
1. the HR remains below 60 bpm despite 30 seconds of effective PPV and 30 seconds of chest compression
2. the HR is zero
95
The use of _____________ ___________ is indicated in those infants showing signs of hypovolemic shock due to acute blood loss
volume expanders
96
Volume expanders used in neonatal resuscitation include: (3)
- normal saline
- ringers lacate
- O Rh-negative packed RBC (fetal anemia)
97
What are the APGAR scores, 5 areas examined?
1. Appearance
2. Pulse
3. Grimace
4. Activity
5. Respirations
98
The first APGAR score is asses at 1 minute after delivery with a 2nd evaluation performed at 5 mins, then every 5 mins as needed up to 20 mins
KNOW
99
Normal glucose for term is
> 35
100
Normal glucose for preterm is
>25
101
Neonatal hypoglycemia is defined as a plasma glucose of
< 25
102
What is the most common complication for a UAC
Thrombus formation
Air embolism
103
Additional complication for a UAC Includes hypertension and NEC
KNOW
104
What does the S.T.A.B.L.E mnemonic stand for
- Sugar
- Temperature
- Airway
- BP
- Labs
- Emotional support
105
Neonates have a large amount of skin surface area to their body weight protional to size and weight
KNOW
106
___% of the neonate's total body weight is water and the water is mainly found in the _____________ spaces
80% ;
extracellular
107
What is the purpose of the physical assessment?
To determine how well the extra-uterine transition is taking place
108
Dubowitz Gestational Age Assessment exams....
11 physical or "external" criteria and 10 neurological signs
109
Ballard Gestational Age Assessment exam
6 physical and 6 neurological and is the **MOST ACCURATE**
110
Ballard system is the most reliable if the examation is done before 42 hours of life. Takes less time to perform
KNOW
111
What is Lanugo?
fine, downy hair on the arms and back
112
Examination of the ______, or the external portion of the ear, is helpful in determining gestational age
pinna
113
The sole creases appear as faint red lines at roughly
26 weeks
114
At ____ weeks, the creases have covered the anterior portion of the foot
30 weeks
115
By _____ weeks 2/3 of the sole is covered with creases
34
116
This is the temp difference between the warm body core and the cooler skin
Internal Thermal Gradient (ITG)
117
The temp difference between the skin and the environment is called the
External Thermal Gradient (ETG)
118
There are four factors that determine heat loss through the ETG, what are they?
- Radiant
- Conductive
- Convective
- Evaporative
119
What is the initial response to **hypothermia**?
peripheral vasoconstriction
120
The intial response to **hyperthermia** is a
vasodilation of the peripheral vessels to help dissipate heat
121
The perfusion of the skin decreased with larger fluid deficits, and decreased skin ________ may be present
turgor
122
Insensible water loss (IWL) is water loss by
evaporation from the skin and respiratory tract
123
What are factors that increase insensible water loss
- Early gestational age
- Respiratory distress
- Environmental temp above the neutrothermal zone
- Elevated body temp
- Skin breakdown and excoriations
- Congenital skin defects (neural tube disorders)
- Radiant warmer
- Phototherapy
- Increased motor activity and crying
124
What is NEC?
an idiopathic disorder characterized by ischemia and necrosis of the intestine
125
What is the cause of NEC?
It is unknown but 3 main factors are seen as key etiological factors:
1. mucosal wall injury
2. bacterial invasion into the damage intestinal wall
3. formula in the intestine
126
Once NEC is detected oral feeds are stopped immediately and nasogastric suctioning is started to empty the stomach of bile residuals
KNOW
127
What is the primary cause of respiratory disorders in the neonate
Respiratory distress syndrome (RDS) also called hyaline membrane disease (HMD)
128
RDS is estimated to be the cause of ___% of neonatal deaths; As many as ____% of preterm deaths are also attributed to RDS
30%
70%
129
What is the tx for RDS? (2)
- adminstration of glucocorticoids to the mother 2 days prior to delivery;
- surfactant replacement
130
Most incidences of Bronchopulmonary Dysplasia (BPD) occur following the Tx of
RDS
131
The pathophysiology of BPD appears to be linked to four factors:
1. oxygen toxicity
2. barotrauma
3. presence of a PDA
4. Fluid overload
132
Pulmonary Dysmaturity ( Wilson-Mikity Syndrome)
Looks similar to BPD w/ exception, the infant has not been ventilated
133
Retinopathy of Prematurity is caused by
- Oxygen toxicity
- immaturity
- hyperoxia
- hypoxia
- blood transfusions
- apnea
- PDA
- hypercarbia
- intraventricular hemorrhage
- Vitamin E deficiency
- lactic acidosis
- genetic factors
134
A pnemothorax develops when the
extraalveolar air ruptures to the external surface of the lung and into the pleural space
135
Pneumomediastinum occurs when extra-alveolar air dissects through the lung interstitium and ruptures into the mediastinum
KNOW
136
Air that dissects through the perivascular sheaths to the great vessels may rupture into the pericardial sac causing pneumopericardium
KNOW
137
What causes Pulmonary Interstitial Emphysema (PIE)
chronic use of High PEEP, high PIP and prolonged I-times
138
Persistent Pulmonary Hypertension of the Neonate (PPHN)
139
Transient Tachypnea of the Newborn (TTN) / RDS Type II is formed by
retention of fetal lung fluid following birth
140
Patent Ductus Arteriosus (PDA) requires closure either surgically or by the administration of
indomethacin (Indocin)
141
Complete Transposition of the Great vessels requires surgically or the administration of
prostaglandin E
142
Croup is also called
Laryngotracheobronchitis (LTB)
143
Epiglottis age range
2 to 6 years old
144
Epiglottis is a _______ onset
rapid
145
What causes Epiglottitis
H. influnzae type B
146
What are clinical presentations of Epiglottitis?
- High fever
- anxious
- drooling
- low pitched stridor
- muffled voice
- no cough
147
Xray examination of Epiglottitis
thumb sign seen on a lateral neck film
148
Croup age range
6 months- 3 years
149
Croup has a ________ onset
slow (2- 3 days)
150
Croup is caused by
Parainflunzae virus
151
What are clinical presentations of Croup
- May be afebrile or febrile
- hoarse
- barky cough
- tight upper airway stridor
152
Xray for Croup
A-P neck film hourglass
Narrowing of the subglottic airway
153
Children have a proportionately larger body surface area (BSA)
KNOW
154
With CF each offspring has a ___% of having CF, a ___% of being clear of the gene, and a ___% chance of being a carrier
25
25
50
155
What is the most relaible indicator for CF ?
Sweat chloride
156
What are 2 primary sources of arteial blood sampling in the neonate?
- the umbilical
- radial artery
- Capillary blood can also be assessed `
157
What are the hazards with UAC?
- thromboembolism
- hypertension
- infection
- hemorrhage
- vessel perforation
- NEC
158
What are the hazards for radial artery catheter?
- infection
- air embolism
- arteial occlusion
- infiltration of fluids
- nerve damage
159
What are the complications of capillary sampling
- osteomyelitis
- bone spurs
- infection
- burn
- hematoma
- nerve damage
- bruising
- scarring
- tibial artery laceration
- bleeding
160
What is the safe range for Pao2 in neonate and peds
Neo: 50-70 mmHg
Peds:80-100 mmHg
161
What is the safe range PaCO2 peds/ neonate
35 to 45 mmHg
162
Safe range for pH neonate/peds
Acceptable range pH
7.35 to 7.45
7.30 to 7.50
163
Densities found on Xray: Air
black
164
Densities found on Xray:fluid
gray
165
Densities found on Xray: Tissue
grayer
166
Densities found on Xray: Bone
white
167
RDS or Hyaline Memebrane Disease XRay
ground glass/ frosted glass appearance /complete white out
168
What causes Bronchopulmonary Dysplasia (Neonatal Chronic Lung Disease)
- Tx from MV
- Oxygen toxicity
- High PEEP
- PIP
- Prolonged I-times
Usually follows Tx from RDS
169
Most common neonatal ventilation used is
pressure-limiting modes to prevent baraotrauma
170
The pressure that must be applied to the irways to overcome the combined tension is the critical
opening pressure
171
What is the most powerful influence on oxygenation ?
Mean Airway Pressure (MAP)
172
High levels of MAPleads to what?
Decreased CO, pulmonary hypoperfusion, increased risk of barotrauma
173
MAP is affected by PIP, PEEP, I-times, and rate
KNOW
174
What is the driving pressure?
The difference between the baseline pressure or PEEP and the PIP
175
What is the spontaneous Raw in neonates (594
20 to 30 cm H2O/L/min
176
What is the normal compliance in newborn ?
2.5 to 5 mL/cm H2O
177
The immediate indication for MV is
respiratory failure
178
What are some partial vent support modes?
- CPAP
- IMV
- SIMV
- PSV
179
Full vent support modes include
- SIMV
- CMV
180
Once it is determined that the pt is in respiratory failure, what is often the first setting made on the vent?
Mode
181
Initial Ventilatory Parameters: PIP
15 to 20 cm H2O
182
Initial Ventilatory Parameters: PEEP
3 to 5 cm H2O
183
Initial Ventilatory Parameters: FIO2
Set to keep pt pink; 90-92%
184
Initial Ventilatory Parameters: Rate
30 -40 breaths/min
185
Initial Ventilatory Parameters: Flow
6-8 L/min
186
Initial Ventilatory Parameters: I-times
1.0- 1.5 sec
187
Initial Ventilatory Parameters: I:E ratio
1:1.5 to 1:2
188
Initial Ventilatory Parameters: Vt
Term:8 mL/kg
Low-birth weight: 6 mL/kg
Very low birth-weight: 4- 6 mL/kg
189
Prophylactic administration of surfactant is indicated for those infants who are at a
high risk of developing RDS
190
Therapeutic administation (also called rescue) is not given until the pt
develops signs of RDS
191
Nitric oxide (NO) is a
colorless gas that is produced in endothelial cells of the body
192
Incdications fo NO
- PPHN
- RDS
- sepsis
