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Neonatal Final > Final > Flashcards

Final Flashcards

1
Q

Normal heart rate of a newborn

A

120-160

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2
Q

True or false, an L/S ratio of less than 2 indicates lung maturity

A

False

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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

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4
Q

Which way does fetal hemoglobin (HbF) shift the oxygen-hemoglobin dissociation curve?

A

Left

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5
Q

Which type of fetal heart monitoring pattern is usually no cause for alarm and is not usually treated?

A

Early decelerations

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6
Q

Dystocia

A

Prolongation of labor

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7
Q

Fetal macrosomia

A

Weight more that 4000 g

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8
Q

Microstomia

A

Small mouth

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9
Q

Oligohydramnios

A

Too little amniotic fluid

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10
Q

Pre-eclampsia

A

Hypertension, proteinuria, and generalized edema

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11
Q

What may happen following Caesarean section and is a hazard of lung fluid retention?

A

Transient tachypnea of the newborn TTNB

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12
Q

True or false, approximately 80% of the total alveoli present at adulthood were developed before birth

A

False

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13
Q

What is defined as the volume at which surface tensions are so great that the structure alveolus collapses?

A

Critical volume

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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.

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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

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16
Q

What is surface tension?

A

The tendency of a liquid surface to contract

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17
Q

Immature surfactant appears during which stage of lung development?

A

Canalicular stage

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18
Q

Normal breathing rate range for the newborn?

A

30-60

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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.

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20
Q

Infants weighing less than 1500 g are considered

A

Very low birth weight

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21
Q

Generally, life is usually thought to be possible initially during which stage of lung development?

A

Canalicular stage

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22
Q

Normal WBC count for infants

A

13,000-38,000 per mm

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23
Q

Type 3 (variable) decelerations are most commonly caused by which of the following?

A

Umbilical cord compression

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24
Q

The lung bud developed at 26 days gestation, during which stage of development does this occur?

A

Embryonic stage

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25
Q

Factors of maternal history that places the fetus at high risk?

A 
Older than 35
Obesity 
HIV/aids 
Young age 
Alcohol use 
Drugs/Tobacco use
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26
Q

What is the best score that can be obtained using the Silverman index?

A

0

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27
Q

Fetal breathing movements begin in the fetus at about

A

12 weeks gestational age

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28
Q

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?

A

Canalicular stage

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29
Q

What drug or groups of drugs would you suggest to increase the maturity of a baby’s lungs?

A

Glucocorticosteroids

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30
Q

True or false.
Pulmonary vascular resistance (PVR) increases allowing blood flow to increase through the lungs after cessation of umbilical blood flow.

A

False, it decreases and SVR increases

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31
Q

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

A

Periodic breathing

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32
Q 
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
A

B. Amniocentesis

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33
Q

The lecithin/sphingomyelin (L/S) ratio is predictive of which condition?

A

The likely maturity of the lungs

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34
Q

Immature surfactant appears in the fetus at about

A

24 weeks gestational age

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35
Q

The ductus venosus shunts blood from

A

The liver (umbilical vein) and the inferior vena cava

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36
Q

Most common cause of fetal tachycardia?

A

Maternal fever

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37
Q

Theories of why the newborn takes their first breath

A

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.

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38
Q

What are the reasons the ductus arteriosus closes at birth?

A

Higher PaO2 causes constriction of the ductus.

Removal of maternal prostaglandin sources

Pressures in left heart rises

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39
Q

What is the best indication of fetal lung maturity?

A

Phosphatidylglycerol (PG)

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40
Q

What are the Ballard and Dubowitz scores used fore

A

Estimation of gestational age

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41
Q

What are the three naturally occurring shunts in the fetus?

A

Ductus arteriosus
Ductus venosus
Foramen ovale

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42
Q

Hypoxemia hypoxia

A

Low oxygen content at altitude

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43
Q

Histotoxic hypoxemia

A

Poisoning of the tissue enzymes

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44
Q

Anemic hypoxia

A

Sickle cell anemia

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45
Q

Circulatory hypoxia

A

Hypovolemia

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46
Q

A bubble humidifier is best used with what type of oxygen administration device?

A

Nasal cannula

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47
Q

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 :

A

1:10,000 strength, .1 to .3 ml/kg

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48
Q

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?

A

Continue PPV and continue to monitor the heart rate .

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49
Q

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?

A

PPV with oxygen.

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50
Q

How would you treat the newborn with the apgar score of 2 after the 5 minute mark?

A

Chest compressions and PPV

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51
Q

Tachypnea in the newborn would be defined as a respiratory rate above what?

A

60

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52
Q

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.

A

Secondary apnea

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53
Q

The earliest clinical manifestations of hypoxemia in the newborn are tachycardia and tachypnea. Worse hypoxemia results in:

A

Bradycardia, apnea, and decreased ventilation

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54
Q

Main indication for oxygen therapy in newborn

A

Hypoxemia

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55
Q

What is defined by hypoxia, hypercapnia, and acidosis?

A

Asphyxia

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56
Q

What size suction catheter would be used for a size 2.5 ETT?

A

5,6

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57
Q

Which drug IV technique would be given for newborns born under the influence of narcotics?

A

Naloxone

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58
Q

What are indications for intubation of the newborn?

A

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.

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59
Q

What are concerns of the neonatal airways and lungs and the road of causing respiratory distress?

A

The tracheo-bronchial tree is more compliant and prone to collapse

Prematurity reduces levels of mature surfactant and promotes instability of alveoli.

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60
Q

Which size endotracheal tube would be appropriate for a 30 week gestational age neonate?

A

3.0

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61
Q

What would cause decreased FRC and therefore be indications for CPAP?

A

Pneumonia, atelectasis, meconium aspiration, respiratory distress syndrome

62
Q

What can cause metabolic acidosis?

A

Diarrhea, neonatal cold stress

63
Q

What is the proper procedure to implement for an infant known to have experienced meconium aspiration before birth?

A

Intubate and suction only if the infant is not vigorous, otherwise follow the normal resuscitation procedures

64
Q

Appropriate stimulation of a newborn includes

A

Flicking the bottoms of the feet

Drying with a warm towel

Gently rubbing back

65
Q

If diaphragmatic hernia is suspected in the newborn, what steps should be taken?

A

Endotracheal intubation and nasogastric tube inserted to decompress bowel and allow ventilation.

66
Q

Infants who do not require delivery room resuscitation will show what characteristics?
( gestational age, HR, apgar, amniotic fluid)

A

Born full term gestation

Crying or normal breathing

Amniotic fluid clear with no indication of infection

67
Q

What is the best indicator of an infants overall cardiopulmonary status right after birth?

A

Apgar Score

68
Q

The single most effective step in the resuscitation of a newborn is

A

Vigorously dry and stimulate immediately after birth

69
Q

When used during neonatal resuscitation efforts, the self inflating bag

A

Requires the least experience and training for the individual using it

70
Q

What are contraindications for capillary blood gas sampling?

A

Polycythemia
Hypotension
Accurate assessment of blood gases are needed

71
Q

Factors that influence MAP

A 
PIP
PEEP
I: TIME 
FLOW 
RATE
72
Q

Minimum flow rate needed with oxygen head hood usage is

A

7 lpm

73
Q

What initial inspiratory time range would you suggest for a term newborn infant being placed on time cycled, pressure limited ventilation?

A

0.30 to 0.50 seconds

74
Q

What are hazards associated with oxygen therapy in newborns

A

Oxygen induced hypoventilation
Oxygen toxicity
Retinopathy of prematurity

75
Q

CPAP is contraindicated in infants with

A

Cleft palate
Congenital diaphragmatic hernia
Tracheo-esophageal fistula

76
Q

What are the goals of aerosol therapy in newborns and pediatrics

A

Delivery of medications
Humidify dry inspired gases
Aid in bronchial hygiene

77
Q

What targeted Vt range should be used for mechanical ventilation in neonate

A

4 to 6 ml/kg

78
Q

The goals of mechanical ventilation include

A

Provide adequate gas exchange
Improve oxygenation
Reduce work of breathing

79
Q

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

A

Mouth breather

80
Q

The maximum pressure exerted against a patients airway during the ventilator breath is the

A

PIP

81
Q

When placing an FiO2 monitoring devices inside an oxygen head hood, you should consider the ______ and place it at the ______ of the head hood

A

Concentration layering

Level of patients airway

82
Q

What are some possible causes of transcutaneous monitoring and recent ABG not correlating well?

A

Improper calibration, trapped air bubbles , most recent ABG mixed with venous blood

83
Q

What is the main indication for oxygen therapy in newborn

A

Treating hypoxemia

84
Q

What aerosol devices would you recommend to administer bronchodilator to 15 day old baby breathing spontaneously

A

SVN

85
Q

Minimum flow rate for croup tent

A

10-15 LPM

86
Q

How do you wean newborn patient on cpap

A

Reduce FiO2 to below .60 then begin weaning CPAP pressures by 1 to 2 cmH20 monitoring patient with each step

87
Q

What positive effects does the mean airway pressure have ? (MAP. PAW)

A

Recruitment of alveolar units
Surfactant preservation
Oxygenation directly proportional to MAP
Optimization of lung volumes

88
Q

Bedside evaluation of the degree of hypoxemia may be best accomplished by

A

Pulse oximetry

89
Q

In the mechanically ventilated neonates MAP greater than _____ may contribute to barotrauma

A

12 cmH20

90
Q

What is the effective Vt for this patient ?

Vt set : 20
PIP : 15 
Pstat: 10 
PEEP : 5 
Circuit factor : 1.5
A

12.5

91
Q

The earliest clinical signs of hypoxemia in a newborn are

A

Tachypnea, tachycardia

92
Q

What parameters influence MAP

A

PIP
PEEP
Ti
Flow

93
Q

The greatest benefit from HFPPV is that ________ can be delivered at relatively _____ thus reducing risk of barotrauma

A

Small tidal volumes , low pressures

94
Q

Hazards associated with all the different types of high frequency ventilation

A

Airway damage
Gas trapping
High levels of PEEP

95
Q

In pressure control mode, the two ventilator parameters that most directly effect the Vt are ____ and _____

A

PEEP

PIP

96
Q

What are advantages of using oxygen blenders when caring for newborns

A

Uninterrupted therapy, easily managed

97
Q

The most accurate way to detect changes in oxygenation in the blood is by obtaining

A

ABG

98
Q

Signs of infant respiratory distress that indicated potential need for CPAP

A

Cyanosis
Radiograph indicating hyaline membrane disease or IRDS
Grunting
Severe retractions

99
Q

What mean airway pressure is considered potentially deleterious when applying positive airway pressure to infants

A

13 cmH2O

100
Q

How Is driving pressure calculated

A

Pplat-PEEP= driving pressure

101
Q

What are indications for CPT

A

Atelectasis
IRDS
BPD
Ciliary dyskinesia

102
Q

What ventilator parameters directly influence PaO2

A

PEEP

FiO2

103
Q

To determine the optimal CPAP pressure, the clinician should see an _______and_______with each cmH20 pressure increase

A

Increase in PaO2 , stable or decreasing PaCO2

104
Q

What oxygen modalities would you recommend for a toddler needing a low fi02

A

Nasal cannula

105
Q

After an abg what is the minimum amount of time you must keep pressure

A

5 minutes

106
Q

What mask for specific FiO2

A

Air entrainment mask

107
Q

In newborns older than 28 days, a PaO2 less than_____mmhg or an SpO2 of less than _____ indicates hypoxemia

A

60,90

108
Q

The respiratory system arises from which of the following germ layers?

A

Endoderm

109
Q

The heart develops from which germ layer

A

Mesoderm

110
Q

Which of the following would indicate mature surfactant is present

A

L/S ratio of 2:1

111
Q

In the placenta, the fetal vessels are contained in the

A

Chorionic villi

112
Q

The ductus arteriosus shunts blood from

A

The pulmonary artery to the aorta

113
Q

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
A

Both are correct

114
Q

True or false, alveolar growth is completed by the time birth takes place and no new alveoli develop after birth

A

False

115
Q

The acinar units are formed during what stage of lung development

A

Canalicular stage

116
Q

The lung bud elongates and forms 2 bronchial buds and the trachea during what stage

A

Embryonic stage

117
Q

Type 1 and type 2 epithelial cells can be differentiated during what stage of development

A

Canalicular stage

118
Q

Carotid body chemoreceptors are mature enough to function during what stage

A

Terminal sac stage

119
Q

Development of the conducting airways occurs in this stage

A

Pseudoglandular stage

120
Q

Left and right pulmonary veins start to develop in this stage

A

Embryonic stage

121
Q

Goblet cells appear in the bronchial epithelium in this stage

A

Pseudoglandular stage

122
Q

True alveoli develops during this stage

A

Terminal sac stage

123
Q

Cilia appear on the surface of the epithelium of the trachea and the main stem bronchi during this stage

A

Pseudoglandular stage

124
Q

Submucosal glands arise as solid buds from basal layers of the surface epithelium during this stage

A

Pseudoglandular stage

125
Q

What naturally occurring shunt goes between the right and left atrium

A

Foramen ovale

126
Q

What naturally occurring shunt goes between the pulmonary artery and the aorta

A

Ductus arteriosus

127
Q

What naturally occurring shunt goes between the umbilical vein and the inferior vena cava

A

Ductus venosus

128
Q

What best describes surface tension

A

The tendency of a liquid surface to contract

129
Q

What type (1 or 2) of cell is a flat epithelial cell that easily allows diffusion of gases

A

Type 1 cells

130
Q

What type of cell (1 or 2) produces surfactant

A

Type 2 cells

131
Q

What type of cell (1 or 2 or 3) has alveolar macrophages

A

Type 3 cells

132
Q

During a resuscitation, PPV is indicated when

A

Breathing effort is absent

Spontaneously Breathing patients heart rate is below 100

133
Q

Chest compressions are started when

A

The heart rate is below 60

134
Q

What is the correct concentration and dosage of epinephrine during resuscitation

A

1:10,000 concentration given 0.1 to 0.3 ml/kg

135
Q

Equipment used for resuscitation (i.e. defibrillator, oxygen tank, portable suction) should be checked at least

A

Every shift

136
Q

Tetralogy of fallout is a combination of how many heart defects

A

4

137
Q

Who do infants airways / respiratory system differ from adults

A

Infants airways are shorter and narrower than adults

Chest cage wall and musculature is highly compliant in neonates

138
Q

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

A

Decrease FiO2 to 35%

139
Q

The earliest clinical manifestations of hypoxia in the infant are tachycardia and tachypnea. Worse hypoxia results in

A

Bradycardia

Decreased ventilation

Apnea

140
Q

Cause for hypoxemic hypoxemia

A

Most common cause is v/q mismatch

141
Q

Cause for anemic hypoxemia

A

Nitric oxide administration

142
Q

Cause for circulatory hypoxemia

A

Caused by cardiac shock states

143
Q

Cause for hypoxemic hypoxemia (2)

A

Hypoventilation

144
Q

A physician orders a patient to be on 35 % FiO2 what device would be best to deliver specific FiO2

A

Venturi mask

145
Q

True or false. The lower the gestational age, the more likely a patient is to develop ROP

A

True

146
Q

Normal umbilical artery blood gas values

A

Ph 7.18-7.38
PO2 5.6-30.4 mmHg
PCO2 32.4-66 mmHg

146
Q

Normal scalp ABG values

A 
pH: >7.20
PCO2: <50
PO2 25-40
SpO2 >50
HCO3 >15
146
Q

Abg <28 weeks values

A

Pao2 45-65
PaCO2 40-50
Ph >7.25

147
Q

ABG 28-40 weeks values

A

Pao2 50-70
PaCO2 40-60
Ph >7.25

148
Q

Normal umbilical vein blood gas value

A

pH 7.25-7.45
PO2 17.4-41.0 mmhg
PCO2 27-49.4 mmHg

Neonatal Final (1 decks)

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