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Patient Assessment 3 > Final > Flashcards

Final Flashcards

1
Q

Pre Term Baby

A

Born between 20-37 weeks

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2
Q

Parity

A

How many times they have carried past 20 weeks

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3
Q

Trimesters

A

1st Trimester: First 12 weeks

2nd Trimester: 13-28 weeks

3rd Trimester: 28 weeks onwards

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4
Q

Radiation

A

Heat loss to a cooler surface not in contact with the body

keep incubators heated or heat shielded and keep room temp high

Use heated incubator ans use bonnets

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5
Q

Conduction

A

Body heta loss to a cooler contact surface

Prevent placing the baby on a cool surface

Use a warm dry blanket, use preheated radient warmers

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6
Q

Evaporation

A

Removal of heat from a body that occurs as the liquid evaporates

Increase room humidity, dry the baby, wrap the baby, bag the preemie, humidify gases

Use warm blankets to dry and wrap the baby

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7
Q

Convetion

A

Heat loss to cooler surronding air

keep room temp high, avoid draft, and keep baby covered

use radient warmer or isolette

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8
Q

Radient Warmer

A

Overhead warmer

Body temp maintained with servo mode and skin prode attached to baby

Ex. Giraffe isolette for older babies

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9
Q

Closed Isolette

A

Will be closed isolette

Used for preemies with temp instability

Maintain temperature via skin probe, air temp control device or probe

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10
Q

Premature Infant Pain Profile (PIPP)

A

Minimium score of zero and max score of 21

the higher the score the greater the pain

Lower gestational age the higher the score

Done at admission to NICU and the score will determine how often it is done after

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11
Q

Non-Pharmacological Ways to Help With Pain

A

Giving Sucrose- Can not give to intubated patient

Rocking and Skin to Skin

Repoistioning-Prone Positioning

Diaper Change and Feeding

Decrease Enviromental Stimuli

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12
Q

Activity Level and Ability to Settle

A

Appropriate-Think of how term babies will have more tone and strength

Jittery-Try non pharmacological way to soothe

Lethargic

Unresponsive

Paralyzed-Rare

Intolerant of Handling

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13
Q

Fontanel

A

Soft and Flat

Depressed

Overriding Sutures- Normal and resolve quickly, but if an early or late can lead to distortion of the skull

Full/Bulging-Fluid overload

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14
Q

Tone

A

Check tone right away

Appropriate

Flaccid

Hypertonic-Bring in extremities, baby in pain or cold

Hypotonic

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15
Q

Head Circumference

A

Chest Circumference ~ Head Circumference

In a term infant

  • Occipitofrontal circumference above the ears is normally 32-37 cm at term
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16
Q

CT Scan

A

Looks for bleeds or fluid in subdural or subarachnoid space

Assess parenchyma and # of skull bones

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17
Q

Term Baby

A

38-42 weeks

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18
Q

Post Term Babies

A

>42 weeks

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19
Q

Primipartiety

A

First pregancy

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20
Q

VAP Prevention in Neonates

A

HOB 15 Degrees

Inline Suction and limit circuit breaks (only change when solid or indicated)

Single use nasal catheter

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21
Q

MRI

A

Myelination

Ischemic or hemorrhagic lesions

Agenesis of corpus callosum

AV malformations

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22
Q

CNS Pharmacology-Sedation

A

Lorazepam-Benzo and antianxiety medication

Phenobarbital-Stronger than a benzo and used for seizures

Try to avoid over sedation to avoid side effect (not as concerns with delirium as in adults)

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23
Q

CNS Pharmacology-Analgesia

A

Fentanyl-Less depressant effects than morphine

Morphine-Causes chest ridigity

Tylenol

As a last resort pain meds can be given intrathcal

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24
Q

Ultrasound

A

Looks for intracranial an intraventricular hemorrhage

Also used to assess hydrocephaly

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25
Q

Intracranial an Intraventricular Hemorrhage

A

Graded based on CT Scan

Grade 4 is the worse

After CT scan the baby will be taken to MRI for more information

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26
Q

Most common type of Hemorrhage Ultrasounds is looking for

A

Most common in premature infants is germinal matrix hemorrhage

Premature may be getting dialy ultrasounds in order to assess for this

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27
Q

Lumbar Punctures

A

Used to obtain cerebral spinal fluid to diagnose meningitis, encephalitis, and intracranial hemorrhage

Can be used to administer intrathecal medicine

Puncture will be done between 4th and 5th lumbar vertebra to avoid the spinal cord which ends at L2

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28
Q

CNS Pharmacology-Paralytics

A

Pancuronium

Vecronium

Not commonly used in neonates with the exception of use with therapeutic hypothermia

Side effect is third spacing

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29
Q

Therapeutic Hypothermia Used For

A

Treat hypoxic-ischemic encephalopathy (HIE) to minmize brain injury consequences

Cerebral palsy

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30
Q

Hypoxic-Ischemic Encephalopathy (HIE)

A

Can be caused at birth from perinatal asphxia which can occur when the baby is breech or has the vocal cord around the neck

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31
Q

Therpeutic Hypothermia Mechanism of Action

A

Will Reduce the Following

Swelling, bleeding and infection (neutrophil infiltration)

Excitatory neurotransmitters

Free radial production-Protect oxidative damage durign reperfusion

Cerebral tissue injury

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32
Q

Infants undergoing hypothermia may exhibit

A

Reduce HR

Elevate BP

Clotting Disorders- Lower platelet counts and long prothrombin time

Worsening Acidosis

Worsening oxygenation secondary to pulmonary hypertension

Abnormal EEG

Skin breakdown-Lack of perfusion and movement

Hypoatremia and Hypokalemia

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33
Q

Nullpara

A

Never carried past 20 weeks

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34
Q

High Risk Infants

A

Premature

Intrauterine Growth Retardation (IUGR)-Moms who do drugs or have a placenta deficiency

Asphyxia-Very low APGAR (0-3 for >10 min) which is associated with high mortality (>50%) and 25% mordity (Gomella)

TORCH Infections

Meningitis

Hypoglycemia and Polycythemia

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35
Q

TORCH Infection

A

Toxoplasmosis (Protozoan)-Cat feces

Other (syphilis)

Rubella

Cytomegalovirus

Herpes/Hepatitis/HIV

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36
Q

Perfusion

A

Cap refill can be done on stomach or foot

Newborns will have low systemic output and high vasoconstriction- This is completely normal for the 1st 24 hours

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37
Q

Changing in Perfusion

A

Enviromental temp

Circulating catecholamines which contribute to catecholamines

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38
Q

Nullgravida

A

Never been pregnant

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39
Q

Causes of Unstable Temp

A

Skin Temperature (36-36.5)

Premies

Shock-Will get more vasoconstriction or dilation

Decreased Perfusion

Cardiac Abnormalities

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40
Q

Why are Babies at a High Risk for Temperature Instability

A

Even term babies are at risk but preemies babies are more at risk

Preemies (<26 weeks) will have no brown fat and little sub q fat

There is a high body surface area to weight ration

Reduced glycogen stores

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41
Q

How do we treat a hypothermia (not therapeutic) baby

A

vasodilators and fluid

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42
Q

Rectal Core Temperature

A

36.5-37.5

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43
Q

Cold Stress

A

Cold Stress: Enviroment where baby is not warm enough

Mild Cold Stress: Normal newborn will pheriperally vasoconstrict. The amount of norepinephrine will increase and metabolize brown fat

Norepinephrine will break down brown fat to fatty acids which hydrolzye to glycerol and nonesterified fatty acids which are xoidized to produce heat to increase body temp

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44
Q

Non-Shivering Thermogenesis

A

Glycogen will be convered to glucose to generate energy

Will increase metabolic and O2 demands so if the baby is low on glycogen stores they are unable to warm themselves (sufficent nutrition important to maintain warmth)

When the baby is cold they may start to use anerobic glycolysis will lead to metabolic acidosis

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45
Q

Ruddy/ Plethora Color

A

Polycythemia (common in children as they transition to extrauterine life)

Hyperthermia

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46
Q

Dusky or Blue Color

A

Cyanosis

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47
Q

Hyperthermia

A

>37.5

Causes

  • Enviroment
  • Infection (most likley bacteria)
  • Dehydration
  • Maternal fever
  • Drug withdrawal
48
Q

Pale/Pallor Color

A

Wash Out

Anemia

Asphyxiation

Shock

Infection

Poro Perfusion

49
Q

Mottled

A

Cardiac problem such as hypovolemia

Marbling of the skin

50
Q

Cyanosis

A

Peripheral Cyanosis= Acroyanosis

Classically described as occurring if 5.0 g/dL of deoxyhemoglobin or greater is present.

51
Q

Anemic Babies and Cyanosis

A

These babies are pale and do not look as hypoxic as they are

52
Q

Cyanosis in Babies with High Hematocrit Levels

A

May look blue but are not cyanotic

53
Q

Caput Succadaneneum

A

Edema on the scalp secondary to delivery

Accompanied by bruising

Edema may also be on the eyes and face

54
Q

Generalized Edema

A

Indicative of fluid balance (renal) issue

55
Q

Heart Rate in Babies

A

In term Infants

  • HR: 120 to 170 beats/minute while awake
  • HR: 80 or 90 beats/minute while asleep

Neonates older than 35 weeks of gestation have greater variability in heart rate than an infant born at 27 to 35 weeks of gestation

56
Q

Transient Tachycardia

A

Transient tachycardia [>200 b/m] with stimulation or agitation

57
Q

Mean Artieral Blood Pressure

A

Ideal Mean Arterial Blood Pressure = Gestational Age (weeks) +5

Mean Arterial Blood Pressure= Diastolic Pressure + 1/3 Systolic Pressure

58
Q

RR in Neonates

A

Preemies = 30-60

Term= 40-60

59
Q

Slow HR Benign Reasons

A

Pooping

Feeding

Barfing

Suctioning

60
Q

Slow HR Pathological Reasons

A

Hypoxia

Seizures

Airway

Acidosis

Hypothermia

Drug

61
Q

Fast HR Benign Reasons

A

Stress

Pain

62
Q

Fast HR Pathological Reasons

A

Fever

Shock

Anemia

Sepsis

Cardiac Abnormalities

Drugs

63
Q

Bounding Pulse

A

PDA

L to R Shunt

64
Q

ECG Monitor

A

High incidence of arrhythmias in first few days

1-5% have some disturbance in HR or rhythm

Dropped beats (PAC); benign

65
Q

Umbilical Artery Catheter

A

High [T6-T8/9] below ductus arteriosus & above celiac artery

Low [L3-L4] above the inferior mesenteric and below the renal artery aorta intersection

66
Q

Pre/Post-Ductal SpO2

A

Pre: R arm will have a higher O2 saturation

Post: L arm & lower extremities will have a lower O2 saturation

67
Q

CO/ SVR Pharmacological Interventions

A

Dopamine [hypotension]

Dobutamine [hypotension]

68
Q

Rate & Rhythm Pharmacological Interventions

Bradycardia

A

Bradycardia -Atropine

69
Q

Rate & Rhythm Pharmacological Interventions

Narrow Complex

A

Narrow complex SVT - Adenosine

70
Q

Rate & Rhythm Pharmacological Interventions

Tachycardias

A

Na channel blockers

Beta blockers [propranolol]

K channel blockers [amiodarone]

Ca channel blockers [verapamil]

71
Q

Pulmonary vasodilators [PPHN] Pharmacology

A

iNO

Sildenafil (phosphodiesterase type inhibitor)

Prostacyclins/prostaglandins:

  • Iloprost
  • Treprostinil
  • Epoprostenol (flolan)•
72
Q

Anti-Thrombotics Pharmacology

A

Heparin

The use of anti thrombotics in newborns will remain weak

73
Q

Other Pharmacological Interventions

A

Iron: Needed for growth and development, used to help anemia

Folate:

Vit E:

74
Q

Functional Echocardiography

A

Ductal and Arterial Shunting

Pulmonary Artery Pressure

R and L ventricular output

SVC flow

Myocardial function

75
Q

PDA Closure

A

Indomethacin and Ibuprofen

Ligation

Intravacular Coils

76
Q

Blood Products

A

Blood products [N blood volume 80mL/kg]

PRBC: O Rh neg; to get hematocrit to 50% [maintenance of 02 carrying capacity]

FFP [fresh frozen plasma]

Albumin

EPO

77
Q

ETT Size for >3 000

A

Gestation Age >8

ETT 3.5-4

Suction 8 or 10

78
Q

ETT Size for 2 000- 3 000

A

Gestation Age 34-38

ETT 3.5

Suction 8

79
Q

ETT Size for 1 000-2 000

A

Gestation Age 28-32

ETT 3

Suction 6 or 8

80
Q

ETT Size for <1 000

A

Gestation Age <28

ETT 2.5

Suction 5/6

81
Q

Bronchopulmonary Hygiene

A
  • In the spontaneous breath pt
    • Flexible catheter with 80-100 mmHg (open)
  • Artifical Airway
    • Closed (100-120 mmHg)
  • Rarely on a schedule b/c it willsuck out surfactant
82
Q

Supplemental Oxygen

A

Free radicals will form from hyperoxygenation leading to cell death in the brain and poor long term development

Acceptable SaO2 87-95%

Increasing FiO2 can increase cerebral oxygenation above what is needed leading to whit ematter damage

83
Q

When Neonate Desaturates

A

Observe the infant to see if they self recover

Stimulation -Tactile Stimulation

Increase FiO2 in small intervals

BMV

84
Q

Chest X Ray

A

AP View: Heart appears larger

Inspiration: Want to see 8 ribs

Diaphram: Right side will be higher than left

Tracheal Narrowing during E

85
Q

Chest X Ray

ETT

A

Halfway between medial end of calvicles and carina

T2-T4

When the neck is flexed the ETT will move down and when extended it will move up

86
Q

Carina Position

A

Higher than in adults

Level of 3rd vertebrae in neonates

10 yrs level of 5th vertebrae

87
Q

Thymus Gland on a Chest XRay

A

Triangular shaped and called the sail sign

Largest at 2 yr of age

Can be mistaken for heart border or upper lobe atelectasis

88
Q

Hyperaeration

A

Hyperinflation

Increased radioluncency= Reduction in lung markings and depression

89
Q

Transient Tachypnea CXR

A

Infiltration of hilar region- Engorged veins and lympathic vessels

Hyperaertation - Incaresed Raw

90
Q

RDS Chest XRay

A

Reticulgrandular (ground glass) apperance

Lack of aeration (white out; increased opacification)

Lung may appear clear over a few days then apices and periphery first and then more centrally

91
Q

Meconium Aspiration CXR

A

In mild cases may seem normal

In severe cases will see bilateral infiltrates, air trapping, air leak syndrome, atelectasis, inflmattion, pleural effusion

92
Q

Pneumonia CXR

A

Diffused lung markings

pleural fluid may be present

Looks like RDS

93
Q

Pneumothorax CXR

A

lung displaced from chest by a dark band of air which will have no lung markings

Border of the lung will be seen as a sharp white line

94
Q

Tension Pneumothorax CXR

A

Depressed diaphram on affected side

Widening of intercostal space

Mediastinal shift to unaffected side

95
Q

Respiratory Pharmacology

A
  • Inhaled Medications
    • Bronchodilators
    • Steroids
  • Systemic Meds
    • Dexamethasone
    • Stimulants
      • Caffeine and theophyille
  • Specialty gases
    • Nitric oxide
96
Q

Translumination

A

a normal chest will have a small glowing halo around the light source

If the chest lights up the it is a pneumothorax

97
Q

Nectrotizing Enterocolitis

A

Occurs in 10% of babies <1500 g

More common in preemies but can occur in term babies

50% mortality

98
Q

Bowel Movement Frequency

A

99% of term infants will poop in first 24 hr

99% of preterm infants will poop in first 48 hr

Very premature infants are not fed because the colon is not developed

99
Q

Weight Trends

A

~10-15% of birth weight is lost during the first week

Weight gains will begin in second week of life. ~1-3% of body weight/day and preterms do not regain it as quickly

100
Q

Residuals/Aspirates

A

Gastric aspirates performed before feeding to determine feeding tolerance and rate of digestion

Will help to avoid over or under feeding

101
Q

Calorimetry

A

Resting Energy Expenditure (REE)

Direct Measure: Heat produced and lost by the body, requires specialized equitment and personal so it is expensive

Indirect Measure: Measure O2 consumption and CO2 production

102
Q

H2 Blockers

A

Decrease stomach acid production

Ranitidine (Zantac)

Cimetidine (Tagament)

103
Q

Proton Pump Inhibitors (PPIs)

A

Inactivates the pumps that produce stomach acid

Pantoprazole (Pantaloc)

104
Q

Colostrum

A

Colostrum is the first form of milk produced by the mammary glands of mammals

Thick, yellowish milk

Coats the GI tract with a protective barrier to decrease permeability & prevent pathogens from adhering

Laxative effect-helps with the passing of meconium

Decreasing the amount of bilirubin and aid in jaundice prevention

105
Q

Colostrum Composed Of

A

Immunoglobulins

Lipids

Proteins

Beta carotene

Leukocytes

106
Q

Urine Output

A

1-3 mL/kg/hr

Normal newborn kidney will not concentrate urine well

107
Q

Renal Failure Leads to

A

Volume overload

Hyperkalemia

Acidosis

Hyperphosphatemia

Hypocalcemia

108
Q

Renal Failure and Prerenal Causes

A

~25% of newborn will have renal failure and 75% will be due to pre renal causes

Causes include: Dehydration, asphyxia, Hypotension

109
Q

Urine Analysis

A

BUN >15-29 mg/dL suggests dehydration

Creatinine levels will drop to <0.6 mg/dL by 1 week and higher levels suggest renal disease

110
Q

Diuretics

A

Chlorothiazide with spironolactone-chronic management

Furosemide {lasix}-potent and good for rapid diuresis

Side effects: ototoxicity, electrolyte abnormalities, interference with bilirubin-albumin binding

111
Q

Foley (in/out)

A

Check to see if poor output secondary to obstruction

Collect adequate sample for labs, cultures

112
Q

Sepsis

A

Often diagnosed on clinical presentation and acted upon before lab results come back

Pale, mottled, floppy

Not feeding well

Irritable

Unresponsive (ominous)

113
Q

Leukopenia

A

<3500/mm3

114
Q

Leukopcytosis

A

>25 000/ mm3

Not unusual in the immediate period

115
Q

Immature Grnaulocytes/Total Granulocytes

A

>0.2:1 Implies infection

Patient Assessment 3 (12 decks)

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