NB birth stress Flashcards
NB asphyxia-3
-hyperprofusion of lungs, large R to L shunt through ductus arteriosus bypassing lungs, change from aerobic to anaerobis metab (metabolic acidosis)
NB asphyxia protective measures-4
immature brain, low resting metab rate, can use anaerobic metab for energy, cir sys can redistribute lactate and hydrogen ions (severe hypoxia will overcome)
asphyxia risk factors-12
sustained bradycardia, mom not O2, blood flow to placenta, significant bleeding, long labor, meconium, premie, male, SGA, DM mom
- ominus if pH 7.2 lower
- start resuscitation before APGAR if needed
asphyxia ass prebirth-4
- gest age
- meconium/infection in amnio
- number of babies
- other risk factors
asphyxia ass post birth-4
- full term
- breathing/cry
- muscle tone
- if any “no”, resuscitate
asphyxia treatment-5
- stabilize (warm, clear airway, dry, stimulate)
- O2 administration- pulse ox on rt hand/wrist (brain)
- positive pressure vent
- chest compressions
- epi/volume expansion
resuscitation mgt-4
- sniff position under radient heat
1. position and clear airway, stimulate
2. positive pressure vent- mask over mouth and nose w manometer, titrate 5-10 L/min
3. observe chest move-40-60 breaths/min, never exceede pressure of 40
4. intubate with compressions- HR absent or under 60 after 30 sec pos pressure O2
chest compressions-4
- proper position on firm surface- use thumbs w fingers wrapped around back, rate of 90 beats per min
- use 3:1 ratio with ventilation- 90 compressions to 30 breaths
- no response 30 sec- ept 0.1-0.3 mg/kg followed by NS
- if shock occurs- NS or LR, blood products
Respiratory distress syndrome-3
inadequate production of surfectant (starts at 24 wks)
- surfectant deficiency disease- failure to synthesize, atelectasis
- more energy needed to open lungs so each breath harder than last
respiratory distress complications-3
hypoxia, respiratory acidosis, metabolic acidosis
respiratory distress treatment-3
- resolution 7-10 days
- surfectant replacement
- increase UOP sign of resolution
respiratory distress s/s-6
cyanosis, tachypnea (greater than 60), grunt, nasal flare, retractions, apnea
transient tachypnea of NB-2
-term w fl in lungs, general overexpansion of lungs, higher with c/s
transient tachypnea of NB s/s-4
grunt, flare, mild cyanosis, increase in anterior-posterior diameter of chest
transient tachypnea of NB treat-2
usually resolves 48-72 hrs
-oral feed contraindicated
meconium aspiration syndrome-5
- can indicate asphyxia unless breech
- mechanical obstructon of airways-> alveoli overdistended, chemical pneumonitis, inactivation of natural surfectant
meconium aspiration syndrome s/s-4
barrel-shaped chest, prominent rales/rhonchi, possible displaced liver, yellow stained skin/nails/cord
meconium aspiration syndrome treat-7
- if vigerous, nothing
- unstable- direct tracheal suck, O2, positive pressure vent, surfectant prophylactics, nitric oxide, abx
pallor/mottling
poor peripheral circulation
cyanosis
advanced hypoxia, exam mucous membrane and tongue
jaundice skin color
metabolism alterations
edema- resp distress
seen in hands and feet first 24 hrs then resolves by day 5
tachypnea
RR 60+, early s/s resp distress
retractions
seesaw resp when chest flat and abdo expands
nasal flare
tries to lessen resistance of narrow nasal passage
expiratory grunt-2
valsalva maneuver which NB exhales against partially closed glottis
*don’t intubate
rales/rhonchi
interstitial/intrapleural air flow
continuous systolic murmur
patent ductus arteriosus
transcutaneous O2 monitor-4
- diffusion across skin surface
- clean, dry skin, avoid bony prominence,
- change skin site and recalibrate q 4hrs
- Os sats 88-92%
