Final Flashcards
1
Q
Normal heart rate of a newborn
A
120-160
2
Q
True or false, an L/S ratio of less than 2 indicates lung maturity
A
False
3
Q
What is the main purpose of the placenta?
A
To deliver nutrients and oxygen to the fetus and to carry CO2 and other wastes from the fetus
4
Q
Which way does fetal hemoglobin (HbF) shift the oxygen-hemoglobin dissociation curve?
A
Left
5
Q
Which type of fetal heart monitoring pattern is usually no cause for alarm and is not usually treated?
A
Early decelerations
6
Q
Dystocia
A
Prolongation of labor
7
Q
Fetal macrosomia
A
Weight more that 4000 g
8
Q
Microstomia
A
Small mouth
9
Q
Oligohydramnios
A
Too little amniotic fluid
10
Q
Pre-eclampsia
A
Hypertension, proteinuria, and generalized edema
11
Q
What may happen following Caesarean section and is a hazard of lung fluid retention?
A
Transient tachypnea of the newborn TTNB
12
Q
True or false, approximately 80% of the total alveoli present at adulthood were developed before birth
A
False
13
Q
What is defined as the volume at which surface tensions are so great that the structure alveolus collapses?
A
Critical volume
14
Q
What are treatments for late decelerations?
A
Maternal oxygen therapy, IV hydration for the mother, digital elevation of the fetal head out of the maternal pelvis.
15
Q
The significance of this stage of lung development is that the development of the remaining conducting airways occurs at this phase?
A
Pseudoglandular stage
16
Q
What is surface tension?
A
The tendency of a liquid surface to contract
17
Q
Immature surfactant appears during which stage of lung development?
A
Canalicular stage
18
Q
Normal breathing rate range for the newborn?
A
30-60
19
Q
The minute volume requirements for a newborn infant are greater than those of an adult. Yet their tidal volumes adjusted for body weight are about the same. How do infants meet this greater ventilatory demand?
A
Increasing the frequency of breathing.
20
Q
Infants weighing less than 1500 g are considered
A
Very low birth weight
21
Q
Generally, life is usually thought to be possible initially during which stage of lung development?
A
Canalicular stage
22
Q
Normal WBC count for infants
A
13,000-38,000 per mm
23
Q
Type 3 (variable) decelerations are most commonly caused by which of the following?
A
Umbilical cord compression
24
Q
The lung bud developed at 26 days gestation, during which stage of development does this occur?
A
Embryonic stage
25
Factors of maternal history that places the fetus at high risk?
```
Older than 35
Obesity
HIV/aids
Young age
Alcohol use
Drugs/Tobacco use
```
26
What is the best score that can be obtained using the Silverman index?
0
27
Fetal breathing movements begin in the fetus at about
12 weeks gestational age
28
The significance of this period of lung development is that the vascular and framework of the acinus is done. What fetal lung period is this?
Canalicular stage
29
What drug or groups of drugs would you suggest to increase the maturity of a baby’s lungs?
Glucocorticosteroids
30
True or false.
Pulmonary vascular resistance (PVR) increases allowing blood flow to increase through the lungs after cessation of umbilical blood flow.
False, it decreases and SVR increases
31
Breathing pattern that represents pauses during breathing for periods ranging for up to twenty seconds, then followed by several rapid shallow breaths. It is considered normal in infants less than one year and is called
Periodic breathing
32
```
Which of the following techniques would be best to recommend to assess the state of pulmonary maturity before birth?
A. Blood gas analysis
B. Amniocentesis
C. Ultra sound
D. Fetal scalp pH
E. Maternal history
```
B. Amniocentesis
33
The lecithin/sphingomyelin (L/S) ratio is predictive of which condition?
The likely maturity of the lungs
34
Immature surfactant appears in the fetus at about
24 weeks gestational age
35
The ductus venosus shunts blood from
The liver (umbilical vein) and the inferior vena cava
36
Most common cause of fetal tachycardia?
Maternal fever
37
Theories of why the newborn takes their first breath
1) The peripheral chemoreceptors stimulate the respiratory center of the brain which signals the muscles of ventilation to work.
2) the fetal thorax is compressed during vaginal delivery and the return of the chest to its original shape may trigger the breath.
3) the change of the baby’s environment from a warm, dark, quiet place to a bright, cold and noisy delivery room.
38
What are the reasons the ductus arteriosus closes at birth?
Higher PaO2 causes constriction of the ductus.
Removal of maternal prostaglandin sources
Pressures in left heart rises
39
What is the best indication of fetal lung maturity?
Phosphatidylglycerol (PG)
40
What are the Ballard and Dubowitz scores used fore
Estimation of gestational age
41
What are the three naturally occurring shunts in the fetus?
Ductus arteriosus
Ductus venosus
Foramen ovale
42
Hypoxemia hypoxia
Low oxygen content at altitude
43
Histotoxic hypoxemia
Poisoning of the tissue enzymes
44
Anemic hypoxia
Sickle cell anemia
45
Circulatory hypoxia
Hypovolemia
46
A bubble humidifier is best used with what type of oxygen administration device?
Nasal cannula
47
Following 1 minute of chest compressions on a 1000 g neonate, the heart rate remains below 60 BPM. The decision is made to administer epinephrine. The correct dosage for this patient is :
1:10,000 strength, .1 to .3 ml/kg
48
Following one minute of PPV using an FiO2 of 1.0, the heart rate is noted as being 18 beats in 10 seconds. What should be done in the resuscitation using this information?
Continue PPV and continue to monitor the heart rate .
49
Following delivery via c section, a newborn is brought to the assessment area of the delivery room. Following drying, positioning , and suctioning, the initial assessment determines the heart rate to be 85 BPM with no respiratory effort. What is the next step in resuscitation?
PPV with oxygen.
50
How would you treat the newborn with the apgar score of 2 after the 5 minute mark?
Chest compressions and PPV
51
Tachypnea in the newborn would be defined as a respiratory rate above what?
60
52
The cessation of respiratory effort in the newborn following gasping type respiration’s in which there is no further attempt by the newborn to breathe despite stimulation is called.
Secondary apnea
53
The earliest clinical manifestations of hypoxemia in the newborn are tachycardia and tachypnea. Worse hypoxemia results in:
Bradycardia, apnea, and decreased ventilation
54
Main indication for oxygen therapy in newborn
Hypoxemia
55
What is defined by hypoxia, hypercapnia, and acidosis?
Asphyxia
56
What size suction catheter would be used for a size 2.5 ETT?
5,6
57
Which drug IV technique would be given for newborns born under the influence of narcotics?
Naloxone
58
What are indications for intubation of the newborn?
1) bag and mask ventilation ineffective or prolonged
2) when chest compressions are performed
3) when tracheal suctioning for meconium is required
4) when endotracheal administration of medications is desired.
59
What are concerns of the neonatal airways and lungs and the road of causing respiratory distress?
The tracheo-bronchial tree is more compliant and prone to collapse
Prematurity reduces levels of mature surfactant and promotes instability of alveoli.
60
Which size endotracheal tube would be appropriate for a 30 week gestational age neonate?
3.0
61
What would cause decreased FRC and therefore be indications for CPAP?
Pneumonia, atelectasis, meconium aspiration, respiratory distress syndrome
62
What can cause metabolic acidosis?
Diarrhea, neonatal cold stress
63
What is the proper procedure to implement for an infant known to have experienced meconium aspiration before birth?
Intubate and suction only if the infant is not vigorous, otherwise follow the normal resuscitation procedures
64
Appropriate stimulation of a newborn includes
Flicking the bottoms of the feet
Drying with a warm towel
Gently rubbing back
65
If diaphragmatic hernia is suspected in the newborn, what steps should be taken?
Endotracheal intubation and nasogastric tube inserted to decompress bowel and allow ventilation.
66
Infants who do not require delivery room resuscitation will show what characteristics?
( gestational age, HR, apgar, amniotic fluid)
Born full term gestation
Crying or normal breathing
Amniotic fluid clear with no indication of infection
67
What is the best indicator of an infants overall cardiopulmonary status right after birth?
Apgar Score
68
The single most effective step in the resuscitation of a newborn is
Vigorously dry and stimulate immediately after birth
69
When used during neonatal resuscitation efforts, the self inflating bag
Requires the least experience and training for the individual using it
70
What are contraindications for capillary blood gas sampling?
Polycythemia
Hypotension
Accurate assessment of blood gases are needed
71
Factors that influence MAP
```
PIP
PEEP
I: TIME
FLOW
RATE
```
72
Minimum flow rate needed with oxygen head hood usage is
7 lpm
73
What initial inspiratory time range would you suggest for a term newborn infant being placed on time cycled, pressure limited ventilation?
0.30 to 0.50 seconds
74
What are hazards associated with oxygen therapy in newborns
Oxygen induced hypoventilation
Oxygen toxicity
Retinopathy of prematurity
75
CPAP is contraindicated in infants with
Cleft palate
Congenital diaphragmatic hernia
Tracheo-esophageal fistula
76
What are the goals of aerosol therapy in newborns and pediatrics
Delivery of medications
Humidify dry inspired gases
Aid in bronchial hygiene
77
What targeted Vt range should be used for mechanical ventilation in neonate
4 to 6 ml/kg
78
The goals of mechanical ventilation include
Provide adequate gas exchange
Improve oxygenation
Reduce work of breathing
79
Which of the following is not a factor that may reduce aerosol delivery in neonatal patients
Large tongue
Mouth breather
Small Vt
Rapid respiratory rate
Mouth breather
80
The maximum pressure exerted against a patients airway during the ventilator breath is the
PIP
81
When placing an FiO2 monitoring devices inside an oxygen head hood, you should consider the ______ and place it at the ______ of the head hood
Concentration layering
| Level of patients airway
82
What are some possible causes of transcutaneous monitoring and recent ABG not correlating well?
Improper calibration, trapped air bubbles , most recent ABG mixed with venous blood
83
What is the main indication for oxygen therapy in newborn
Treating hypoxemia
84
What aerosol devices would you recommend to administer bronchodilator to 15 day old baby breathing spontaneously
SVN
85
Minimum flow rate for croup tent
10-15 LPM
86
How do you wean newborn patient on cpap
Reduce FiO2 to below .60 then begin weaning CPAP pressures by 1 to 2 cmH20 monitoring patient with each step
87
What positive effects does the mean airway pressure have ? (MAP. PAW)
Recruitment of alveolar units
Surfactant preservation
Oxygenation directly proportional to MAP
Optimization of lung volumes
88
Bedside evaluation of the degree of hypoxemia may be best accomplished by
Pulse oximetry
89
In the mechanically ventilated neonates MAP greater than _____ may contribute to barotrauma
12 cmH20
90
What is the effective Vt for this patient ?
```
Vt set : 20
PIP : 15
Pstat: 10
PEEP : 5
Circuit factor : 1.5
```
12.5
91
The earliest clinical signs of hypoxemia in a newborn are
Tachypnea, tachycardia
92
What parameters influence MAP
PIP
PEEP
Ti
Flow
93
The greatest benefit from HFPPV is that ________ can be delivered at relatively _____ thus reducing risk of barotrauma
Small tidal volumes , low pressures
94
Hazards associated with all the different types of high frequency ventilation
Airway damage
Gas trapping
High levels of PEEP
95
In pressure control mode, the two ventilator parameters that most directly effect the Vt are ____ and _____
PEEP
| PIP
96
What are advantages of using oxygen blenders when caring for newborns
Uninterrupted therapy, easily managed
97
The most accurate way to detect changes in oxygenation in the blood is by obtaining
ABG
98
Signs of infant respiratory distress that indicated potential need for CPAP
Cyanosis
Radiograph indicating hyaline membrane disease or IRDS
Grunting
Severe retractions
99
What mean airway pressure is considered potentially deleterious when applying positive airway pressure to infants
13 cmH2O
100
How Is driving pressure calculated
Pplat-PEEP= driving pressure
101
What are indications for CPT
Atelectasis
IRDS
BPD
Ciliary dyskinesia
102
What ventilator parameters directly influence PaO2
PEEP
| FiO2
103
To determine the optimal CPAP pressure, the clinician should see an _______and_______with each cmH20 pressure increase
Increase in PaO2 , stable or decreasing PaCO2
104
What oxygen modalities would you recommend for a toddler needing a low fi02
Nasal cannula
105
After an abg what is the minimum amount of time you must keep pressure
5 minutes
106
What mask for specific FiO2
Air entrainment mask
107
In newborns older than 28 days, a PaO2 less than_____mmhg or an SpO2 of less than _____ indicates hypoxemia
60,90
108
The respiratory system arises from which of the following germ layers?
Endoderm
109
The heart develops from which germ layer
Mesoderm
110
Which of the following would indicate mature surfactant is present
L/S ratio of 2:1
111
In the placenta, the fetal vessels are contained in the
Chorionic villi
112
The ductus arteriosus shunts blood from
The pulmonary artery to the aorta
113
Which of the following statements are correct concerning fetal lung fluid?
1. The fetal lungs secrete about 250 ml to 300 ml of liquid per day
2. The presence of fetal lung fluid is essential for normal lung development
Both are correct
114
True or false, alveolar growth is completed by the time birth takes place and no new alveoli develop after birth
False
115
The acinar units are formed during what stage of lung development
Canalicular stage
116
The lung bud elongates and forms 2 bronchial buds and the trachea during what stage
Embryonic stage
117
Type 1 and type 2 epithelial cells can be differentiated during what stage of development
Canalicular stage
118
Carotid body chemoreceptors are mature enough to function during what stage
Terminal sac stage
119
Development of the conducting airways occurs in this stage
Pseudoglandular stage
120
Left and right pulmonary veins start to develop in this stage
Embryonic stage
121
Goblet cells appear in the bronchial epithelium in this stage
Pseudoglandular stage
122
True alveoli develops during this stage
Terminal sac stage
123
Cilia appear on the surface of the epithelium of the trachea and the main stem bronchi during this stage
Pseudoglandular stage
124
Submucosal glands arise as solid buds from basal layers of the surface epithelium during this stage
Pseudoglandular stage
125
What naturally occurring shunt goes between the right and left atrium
Foramen ovale
126
What naturally occurring shunt goes between the pulmonary artery and the aorta
Ductus arteriosus
127
What naturally occurring shunt goes between the umbilical vein and the inferior vena cava
Ductus venosus
128
What best describes surface tension
The tendency of a liquid surface to contract
129
What type (1 or 2) of cell is a flat epithelial cell that easily allows diffusion of gases
Type 1 cells
130
What type of cell (1 or 2) produces surfactant
Type 2 cells
131
What type of cell (1 or 2 or 3) has alveolar macrophages
Type 3 cells
132
During a resuscitation, PPV is indicated when
Breathing effort is absent
Spontaneously Breathing patients heart rate is below 100
133
Chest compressions are started when
The heart rate is below 60
134
What is the correct concentration and dosage of epinephrine during resuscitation
1:10,000 concentration given 0.1 to 0.3 ml/kg
135
Equipment used for resuscitation (i.e. defibrillator, oxygen tank, portable suction) should be checked at least
Every shift
136
Tetralogy of fallout is a combination of how many heart defects
4
137
Who do infants airways / respiratory system differ from adults
Infants airways are shorter and narrower than adults
Chest cage wall and musculature is highly compliant in neonates
138
A 36 week old gestational age patient is in a 40 % oxyhood following a breech delivery. The oximeter indicates an SpO2 of 97% the following cap. ABG is
```
PH 7.33
PcCO2 43 mmHg
PCO2 85 mmhg
HCO3 23 mEq/l
BE 0 mEq/L
```
What should be recommended
Decrease FiO2 to 35%
139
The earliest clinical manifestations of hypoxia in the infant are tachycardia and tachypnea. Worse hypoxia results in
Bradycardia
Decreased ventilation
Apnea
140
Cause for hypoxemic hypoxemia
Most common cause is v/q mismatch
141
Cause for anemic hypoxemia
Nitric oxide administration
142
Cause for circulatory hypoxemia
Caused by cardiac shock states
143
Cause for hypoxemic hypoxemia (2)
Hypoventilation
144
A physician orders a patient to be on 35 % FiO2 what device would be best to deliver specific FiO2
Venturi mask
145
True or false. The lower the gestational age, the more likely a patient is to develop ROP
True
146
Normal umbilical artery blood gas values
Ph 7.18-7.38
PO2 5.6-30.4 mmHg
PCO2 32.4-66 mmHg
146
Normal scalp ABG values
```
pH: >7.20
PCO2: <50
PO2 25-40
SpO2 >50
HCO3 >15
```
146
Abg <28 weeks values
Pao2 45-65
PaCO2 40-50
Ph >7.25
147
ABG 28-40 weeks values
Pao2 50-70
PaCO2 40-60
Ph >7.25
148
Normal umbilical vein blood gas value
pH 7.25-7.45
PO2 17.4-41.0 mmhg
PCO2 27-49.4 mmHg
