Neonatal Advanced Assessment: Chest, Lungs, Abdomen, Cardiovascular Flashcards
What is bound in the chest cavity?
12 thoracic vertebrae
12 ribs
7 true ribs (vertebrocostal)
5 false (vertebrochondral)
Discuss the spinal vertebrae
7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal
How do neonatal ribs differ from adult ribs?
They are much more cartilaginous
In regards to rib composition, What accounts for increased chest wall compliance and retractions seen in infants with respiratory distress?
Infants have cartilaginous ribs
What is the lower boundary of the thorax formed by?
The diaphragm
What is the diaphragm?
A convex muscular sheath
Where does the diaphragm insert?
It inserts on the sternum, the first three lumbar vertebrae, and the lower six ribs.
Where is the suprasternal notch?
Found on the upper aspect of the sternum
Where is the xiphoid process found?
Protrudes below the sternum
How many lobes are on the right and left lung?
3 on the right; 2 on the left
What does the chest cavity consist of?
Mediatstimum
Right and left plueral cavities
What does the mediastinum contain?
Heart, esophogus, trachea, mainstem bronchi, thymus, major blood vessels
What are the lungs encased in?
Serous membranes, which make up the visceral and parietal pluera.
Discuss reference lines of the chest.
Midsternal Line
Nipple Line
Midclavicular Line
Anterior axillary Line
Midaxillary Line
Posterior Axillary Line
Describe each reference line:
Midsternal Line
Nipple Line
Midclavicular Line
Anterior axillary Line
Midaxillary Line
Posterior Axillary Line
Midsternal Line- Bisects the suprasternal notch
Nipple Line- Horizontal line drawn thru the nipples
Midclavicular Line- Vertical Line drawn thru the middle of the clavicle
Anterior axillary Line- Extends from the anterior axillary fold
Midaxillary Line
Posterior Axillary Line-
Prior to examining the baby, what should you review?
Maternal and newborn history
What should you check for on the maternal ultrasound?
Anomolies
Inspection of what in your assessment provides clues to oxygenation and respiratory status?
Overall assessment of the Infant’s color, tone, and activity
What is acrocyanosis?
Bluish discoloration of the hands and feet.
How long can Acrocyanosis persist during transition?
Up to 24 hours following delivery
What color deviations may occur?
Cyanosis- general or central
Acrocyanosis
Mottling
Ruddiness
Paleness
What is normal findings of tone and level of activity?
Flexed posture and active movement of all four limbs when awake
What are deviations seen in tone and activity?
May see decreased ability to attain and maintain flexion in prematurity.
Hypotonia and inactivity are deviations from normal.
How should you assess the infant’s respiratory rate?
Count for one full minute
What is the normal range for respirations?
30-60 bpm
What can cause the infant’s respiratory rate to vary?
If the room is very warm or cool
Temperature stress most often can cause tachypnea
Sometimes will cause bradypnea (less than 40bpm)
What can cause infant’s to have a higher likelihood of retained fetal lung fluid?
Infants born by c-section due to retained fetal lung fluid, will have a higher risk of TTN and RDS
Tachypnea that persists longer than 2 hours may indicate what?
Underlying lung pathology such as TTN, RDS, Mec Asp, puemonia
Hyperthermia
or
Pain
What are bradypnea and shallow respirations associated with?
Central Nervous System Depression secondary to factors such as maternal drug use, asphyxia, or birth injury.
What are normal findings in regards to the quality of respirations?
Relaxed, symmetric, diaphragmatic respirations are normal.
What does the infant use as the primary muscle of respiration?
The Diaphragm.
What normal findings of the diaphragm allow for it to work efficiently?
The rib cage must be stabilized by the IC muscles and the abdomen by the abdominal muscles.
Still developing in Term infants
Less developed in Pre term Infants
In Preterm infants, when state can respiratory instability be seen?
During Rapid Eye movement sleep
How does the diaphragm of a baby compare to an adult and how does this help ompensate for chest wall instability?
The infant’s diaphragm is situated higher in the chest and is more concave shaped that the adult diaphragm, allowing for more efficient contractions.
In normal respiratory efforts, what occurs with the thorax and abdomen during each breath?
The lower thorax pulls in, and the abdomen bulges with each respiration
What are deviations from normal that may be seen with work of breathing?
Asymmetric chest movement
Excessive thoracic expansion
Paradoxical /SeeSaw Respirations
What are Paradoxical/SeeSaw Respirations?
What do they suggest?
Chest wall collapes and the abdomen bulges on inspiration
Suggest:
Poor Lung compliance
Loss of Lung Volume
How do infants normally breathe in regards to nose and mouth.
When will infants breathe with their mouth?
Normally they will breathe thru nose.
Will breath thru mouth, If their nares are occluded.
What does nasal flaring represent?
Represents an attempt to decrease resistance to airflow by increasing size of nostrils.
Why can grunting or moaning be heard in the neonate right after birth?
What creates these noises?
The neonate may be attempting to clear fetal lung fluid from the lungs.
Created by exhalation against a partially closed glottis in an attempt to increase the FRC in the lungs and stabilize the alveoli
Presence of fetal lung fluid or lung pathology may decrease lung complaince and show what sign?
Visible retractions of the chest wall
Where can retractions be seen?
Above or below the sternum, under the rib cage, or between the ribs
Suprasternal, Substernal, Subcostal, Intercostal
Suprasternal retractions especially if accompanied by gasping or stridor may indicate what?
Upper airway obstruction
(Laryngeal webs, cysts, tumors, or vascular rings)
Beyond the immediate newborn period, flaring, grunting, and retractions suggest what?
Respiratory Problems such as TTN, RDS, Atelectasis, Puemonia
What can asymmetric chest movements result from?
Diaphragmatic hernia, cardiac lesions including failure, puemothorax, phrenic nerve damage.
Is sneezing a common and normal finding?
Yes, sneezing is common finding because it helps to lcear the nasal passages
Is coughing considered normal?
No, Coughing is considered abnormal
Normal newborns have what type of breathing pattern?
Irregular patterns of respiration are normal, and they vary with environmental temperature, sleep, and state following a feeding.
Maturity affects the degree of irregularity
Premature=more irregular
What is periodic breathing?
vigourous breaths followed by up to 20 second pause.
How long does it persist in term and preterm infants?
May persist for several days after birth in term infants
Persists in premature infants until they approach 40 weeks.
What indicates Apnea?
A period of of 20 seconds or more between respiratory cycles accompanied by braydcardia or color change.
Condition usually is gradually outgrown as infant approaches 40 weeks.
May persist in premature infants up to 43 weeks.
When is apnea abnormal?
It is abnormal in term or close to term infants and may indicate underlying illness
(sepsis, hypoglycemia, CNS injury or abnormality, siezures, or maternal ingestion of drugs)
What do normal secretions look like?
Clear to fothy white mucus
Is it normal to see nasal and oral secretions during transition?
Yes it is normal and reflects the lung’s attempts to clear fetal fluid.
Why can oral secretions vary in color and consistency after delivery?
Oral secretions can reflect the stomach contents swallowed during delivery.
May be yellow or green in the presence of meconium or blood tinged if maternal blood was swallowed.
What are deviations from normal in regards to secretions?
Excessive frothy oral secretions (may indicate EA)
Nasal stuffiness associated with drug use
Snuffles assocated with congenital syphillis
Thick yellow secretions may be assoc with respiratory infection
Copious white nasal secretions may be RSV
What is the nasal portion of the airway supported by?
Bony and carilaginous structures
How are the nasal passages in the newborn and why are they this way?
They are narrowed
resistance to airflow in the nose contributes significantly to total pulmonary resistance.
During normal respiratory efforts how does breathing occur?
The thorax pulls in, and the abdomen bulges with each respiration
