Module II Study Guide Flashcards
True or False:
In normal newborn circulation, clamping of the umbilical vessels result in a reduced PVR and an increased pulmonary blood flow
True
What are the factors responsible for 1st breath?
Transient Fetal Asphyxia: Fetal circulation is cut-off. Hypoxia and hypercapnia arise. Chemoreceptors stimulated
Thorax Compressed: On delivery, lung fluid removed, then re-expands for air entry
Environmental Stimulation: Sensory, Thermal & Mechanical Changes
-60 to –100 cmH20, but decreases on subsequent breaths
Normal neonatal transition components consists of all of the following except:
A. Clearance of lung fluid
B. Surfactant secretion and breathing
C. Transition of fetal to neonatal circulation D.Increase in pulmonary vascular resistance and decrease pulmonary blood flow
D. Should be DECREASE in pulmonary vascular resistance and INCREASED pulmonary blood flow
Fetal to neonatal circulation include all of the following except:
A. PVR declines due to a combination of ventilation of the lung and the circulatory reconfiguration and changes in blood gases
B. Pressure on the right side of the heart increases
C. Pressures in the left side decreases
D. Resulting in a decrease PVR
C. Should be INCREASED pressures on the left side
Caffeine is used to…
Stimulate breathing for premature infants (Apnea monitoring in home care is ALWAYS required)
What do you administer when a premature infant (1400 grams) has oxygenation problems ONLY?
Administer surfactant replacement therapy
Use the image to describe the cyanosis
Acrocyanosis- Hands and feet (peripheral vasoconstriction) often present in newborns and has no signs of respiratory distress (will improve)
How do you calculate the gestational age? (Ballard/Dubowitz)
Complete scoring including:
-Evaluation: Appearance, skin texture, motor function, reflexes
-Physical maturity: Performed the first 2 hours of birth
-Neuromuscular maturity: Completed within 24 hours after delivery
Circle picture add them all up
Silverman-Anderson Index- Critically ill and severely depressed children will have scores closer to…
10
Normal functioning children should have a cumulative score of 0
TCM works best with a temperature of…
41-44 celsius
Transcuatenous electrodes use oxygen _____ and CO2 _______
Clark (PTCO2)
Severinghaus (PTCCO2)
In regards to surfactant replacement therapy- Curosurf/Poractant alpha- What are the steps to support this administration?
1.Flat position with infant turned to the right and left (whole body)
2. Ventilator settings- RR 40-60, I-Time 0.5 seconds
3.Can readminister at 12 hour intervals up to a total of 3 doses (NO MANUAL BAGGING STAY ON VENT)
Once surfactant replacement therapy is administered- what should the RT adjust fast?
Decrease PIP or PC RR 40-60 and I-Time 0.5 sec
What is terbutaline used to treat?
Given first if low risk of premature birth
Understand moderate APGAR score treatment plan
APGAR Score 4-6
Tx Plan:
-SXN mouth and nose-patent airway
-Cont monitoring of HR
-Tactile stimulation- slapping feet and rubbing back
-HR <100 bag/mask, vent
-Stable oxyhood- 30-40% for 24 hours
Understand severe APGAR score treatment plan
APGAR Score 0-3
Emergency plan:
-SXN mouth and nose-Patent airway
-Continuous monitoring of HR
-Removal foreign matter from larynx and trachea by SXN (ETT ONLY if meconium is present)
-Bag mask vent- Consider intubation
-HR <60 start compression
-Successful resuscitation- Special 24 hours observation
High risk delivery of a confirmed case of meconium
- Isolette-> Warm baby
- Neo-puff-> PIP 20/PEEP 5/FIO2 .21 or .40
- Suction-> 60-80 mmHg- meconium aspirator
- Pulse ox-> Right hand, left foot-> Measuring right to left shunt
- ETT-> 4.0 mm-> Used as sxn catheter
- Miller-> Size 0-> Intubation
- UAC-> Accurate ABG or UVC-> Venous pH, paco2, fluid, med
Meconium stain noted-APGAR severe- what should the RT perform first?
Suction (ETT) and Intubate
CDH- APGAR severe- what should the RT perform first?
Dropping OG and Tube
True or False:
Results of decrease surfactant will result in decrease FRC with an increase in WOB leading to infant retractions
True
What will a decrease surfactant lead to?
-Increase surface tension, decreased lung compliance
-Decreased FRC (Lung Volumes), Increased WOB (Resulting in infant retractions
-Atelectasis (V/Q Mismatch-Hypoxia
-Hypercapnia (Respiratory Acidosis)
-Hypoxia (Anaerobic metabolism-metabolic acidosis)
-Acidosis- Increased PVR
Infant respiratory distress syndrome is also known as…
Neonatal Distress Syndrome (NRDS)
Hyaline Membrane Disease (HMD)
Respiratory Distress Syndrome of Newborn
Surfactant Deficiency Disorder (SDD)
What are the complications of surfactant administration?
-Bradycardia
-Oxygen desaturation
-Hypotension
-Increase chest expansion
What is the suction pressure for a neonate?
60-80 mmhg or 80-100 mmhg
