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Advance Assessment > Neonatal Advanced Assessment: Chest, Lungs, Abdomen, Cardiovascular > Flashcards

Neonatal Advanced Assessment: Chest, Lungs, Abdomen, Cardiovascular Flashcards

1
Q

What is bound in the chest cavity?

A

12 thoracic vertebrae

12 ribs

7 true ribs (vertebrocostal)

5 false (vertebrochondral)

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2
Q

Discuss the spinal vertebrae

A

7 cervical

12 thoracic

5 lumbar

5 sacral

4 coccygeal

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3
Q

How do neonatal ribs differ from adult ribs?

A

They are much more cartilaginous

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4
Q

In regards to rib composition, What accounts for increased chest wall compliance and retractions seen in infants with respiratory distress?

A

Infants have cartilaginous ribs

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5
Q

What is the lower boundary of the thorax formed by?

A

The diaphragm

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6
Q

What is the diaphragm?

A

A convex muscular sheath

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7
Q

Where does the diaphragm insert?

A

It inserts on the sternum, the first three lumbar vertebrae, and the lower six ribs.

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8
Q

Where is the suprasternal notch?

A

Found on the upper aspect of the sternum

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9
Q

Where is the xiphoid process found?

A

Protrudes below the sternum

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10
Q

How many lobes are on the right and left lung?

A

3 on the right; 2 on the left

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11
Q

What does the chest cavity consist of?

A

Mediatstimum

Right and left plueral cavities

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12
Q

What does the mediastinum contain?

A

Heart, esophogus, trachea, mainstem bronchi, thymus, major blood vessels

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13
Q

What are the lungs encased in?

A

Serous membranes, which make up the visceral and parietal pluera.

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14
Q

Discuss reference lines of the chest.

A

Midsternal Line

Nipple Line

Midclavicular Line

Anterior axillary Line

Midaxillary Line

Posterior Axillary Line

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15
Q

Describe each reference line:

Midsternal Line

Nipple Line

Midclavicular Line

Anterior axillary Line

Midaxillary Line

Posterior Axillary Line

A

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-

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16
Q

Prior to examining the baby, what should you review?

A

Maternal and newborn history

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17
Q

What should you check for on the maternal ultrasound?

A

Anomolies

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18
Q

Inspection of what in your assessment provides clues to oxygenation and respiratory status?

A

Overall assessment of the Infant’s color, tone, and activity

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19
Q

What is acrocyanosis?

A

Bluish discoloration of the hands and feet.

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20
Q

How long can Acrocyanosis persist during transition?

A

Up to 24 hours following delivery

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21
Q

What color deviations may occur?

A

Cyanosis- general or central

Acrocyanosis

Mottling

Ruddiness

Paleness

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22
Q

What is normal findings of tone and level of activity?

A

Flexed posture and active movement of all four limbs when awake

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23
Q

What are deviations seen in tone and activity?

A

May see decreased ability to attain and maintain flexion in prematurity.

Hypotonia and inactivity are deviations from normal.

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24
Q

How should you assess the infant’s respiratory rate?

A

Count for one full minute

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25
Q

What is the normal range for respirations?

A

30-60 bpm

26
Q

What can cause the infant’s respiratory rate to vary?

A

If the room is very warm or cool

Temperature stress most often can cause tachypnea

Sometimes will cause bradypnea (less than 40bpm)

27
Q

What can cause infant’s to have a higher likelihood of retained fetal lung fluid?

A

Infants born by c-section due to retained fetal lung fluid, will have a higher risk of TTN and RDS

28
Q

Tachypnea that persists longer than 2 hours may indicate what?

A

Underlying lung pathology such as TTN, RDS, Mec Asp, puemonia

Hyperthermia

or

Pain

29
Q

What are bradypnea and shallow respirations associated with?

A

Central Nervous System Depression secondary to factors such as maternal drug use, asphyxia, or birth injury.

30
Q

What are normal findings in regards to the quality of respirations?

A

Relaxed, symmetric, diaphragmatic respirations are normal.

31
Q

What does the infant use as the primary muscle of respiration?

A

The Diaphragm.

32
Q

What normal findings of the diaphragm allow for it to work efficiently?

A

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

33
Q

In Preterm infants, when state can respiratory instability be seen?

A

During Rapid Eye movement sleep

34
Q

How does the diaphragm of a baby compare to an adult and how does this help ompensate for chest wall instability?

A

The infant’s diaphragm is situated higher in the chest and is more concave shaped that the adult diaphragm, allowing for more efficient contractions.

35
Q

In normal respiratory efforts, what occurs with the thorax and abdomen during each breath?

A

The lower thorax pulls in, and the abdomen bulges with each respiration

36
Q

What are deviations from normal that may be seen with work of breathing?

A

Asymmetric chest movement

Excessive thoracic expansion

Paradoxical /SeeSaw Respirations

37
Q

What are Paradoxical/SeeSaw Respirations?

What do they suggest?

A

Chest wall collapes and the abdomen bulges on inspiration

Suggest:

Poor Lung compliance

Loss of Lung Volume

38
Q

How do infants normally breathe in regards to nose and mouth.

When will infants breathe with their mouth?

A

Normally they will breathe thru nose.

Will breath thru mouth, If their nares are occluded.

39
Q

What does nasal flaring represent?

A

Represents an attempt to decrease resistance to airflow by increasing size of nostrils.

40
Q

Why can grunting or moaning be heard in the neonate right after birth?

What creates these noises?

A

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

41
Q

Presence of fetal lung fluid or lung pathology may decrease lung complaince and show what sign?

A

Visible retractions of the chest wall

42
Q

Where can retractions be seen?

A

Above or below the sternum, under the rib cage, or between the ribs

Suprasternal, Substernal, Subcostal, Intercostal

43
Q

Suprasternal retractions especially if accompanied by gasping or stridor may indicate what?

A

Upper airway obstruction

(Laryngeal webs, cysts, tumors, or vascular rings)

44
Q

Beyond the immediate newborn period, flaring, grunting, and retractions suggest what?

A

Respiratory Problems such as TTN, RDS, Atelectasis, Puemonia

45
Q

What can asymmetric chest movements result from?

A

Diaphragmatic hernia, cardiac lesions including failure, puemothorax, phrenic nerve damage.

46
Q

Is sneezing a common and normal finding?

A

Yes, sneezing is common finding because it helps to lcear the nasal passages

47
Q

Is coughing considered normal?

A

No, Coughing is considered abnormal

48
Q

Normal newborns have what type of breathing pattern?

A

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

49
Q

What is periodic breathing?

A

vigourous breaths followed by up to 20 second pause.

50
Q

How long does it persist in term and preterm infants?

A

May persist for several days after birth in term infants

Persists in premature infants until they approach 40 weeks.

51
Q

What indicates Apnea?

A

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.

52
Q

When is apnea abnormal?

A

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)

53
Q

What do normal secretions look like?

A

Clear to fothy white mucus

54
Q

Is it normal to see nasal and oral secretions during transition?

A

Yes it is normal and reflects the lung’s attempts to clear fetal fluid.

55
Q

Why can oral secretions vary in color and consistency after delivery?

A

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.

56
Q

What are deviations from normal in regards to secretions?

A

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

57
Q

What is the nasal portion of the airway supported by?

A

Bony and carilaginous structures

58
Q

How are the nasal passages in the newborn and why are they this way?

A

They are narrowed

resistance to airflow in the nose contributes significantly to total pulmonary resistance.

59
Q

During normal respiratory efforts how does breathing occur?

A

The thorax pulls in, and the abdomen bulges with each respiration

60
Q
A

Advance Assessment (2 decks)

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