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Clinical Simulation > Neonatal Diseases > Flashcards

Neonatal Diseases Flashcards

1
Q

Assessment and stabilization of the neonate immediately following delivery

A

Delivery Room Care

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2
Q

Primary assessment for Delivery Room Care

A

Clear airway first with bulb syringe

Dry infant and keep warm

APGAR score- Performed at 1 min and then again at 5 mins

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3
Q

Secondary assessment for Delivery Room Care

As neonate’s condition allows, evaluate

A
  • History: family, mother, pregnant, delivery
  • Gestational age
  • Weight
  • General appearance: color, chest configuration
  • Breath Sounds
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4
Q

APGAR score of 0 to 3

A
  • Resuscitate

- CPR

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5
Q

APGAR score of 4 to 6

A
  • Stimulate
  • Warm
  • Administer oxygen
  • Assist ventilation
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6
Q

APGAR score of 7 to 10

A
  • Monitor

- Routine care

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7
Q

Apnea caused by immature neurologic control of ventilation resulting in death

A

Apnea of Prematurity

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8
Q

Etiology of Apnea of Prematurity

A

Immature central nervous system

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9
Q

Past medical history: premature, episodes fo central apnea

  • Respiratory pattern: periodic apnea, irregular breathing
  • Color: periodic cyanotic spells
  • Vital Signs: periods of bradycardia, variations of thermal regulation
A

Primary assessment for Apnea of Prematurity-

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10
Q

Secondary assessment - Apnea of Prematurity

A
  • Basic Lab Tests: help rule out other causes

- Special tests

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11
Q

Special tests for Apnea of Prematurity

A

Polysomnogram

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12
Q

Treatment and management for Apnea of Prematurity

A
  • Oxygen therapy 30 to 50 % as indicated by oximetry
  • Methylxanthines (caffeine)
  • MV if necessary
  • Teach parents/family CPR
  • Send infant home with an apnea monitor
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13
Q

Condition in which a fetus aspirates a mix of fetal stool (meconium) and amniotic fluid during episodes of fetal hypoxemia

A

Meconium Aspiration Syndrome

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14
Q
  • Past medical history: most common in post term infants (more than 42 wks)
  • Respiratory pattern: grunting, substernal retractions/abdominal distention (seesaw movement), nasal flaring, asphyxia, gasping with tachypnea
  • Color: cyanosis
  • Physical appearance: Low Apgar score, stained with meconium
  • Heart Rate: tachycardia, elevated BP
A

Primary assessment for Meconium Aspiration Syndrome

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15
Q

Secondary assessment for Meconium Aspiration Syndrome

A

CXR

ABG

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16
Q

Irregular densities throughout the lungs with atelectasis and consolidation

A

CXR findings in Meconium Aspiration Syndrome

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17
Q

Treatment and management for Meconium Aspiration Syndrome

A

-Suction the nasopharynx and oropharynx throughly when amniotic fluid stained
-Follow NRP guideline
Stabilize infanta and transfer to ICU

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18
Q

Meconium Aspiration Syndrome

  • Infant is not vigorous,
  • Pulse < 100
  • Limp
  • Depressed RR
  • Poor tone
  • Absent or gasping respirations
A
  • No positive pressure ventilation
  • Visualize vocal cords with laryngoscope
  • Intubated with a meconium aspirator and suction the trachea
  • Repeat until airway is clear- even if pulse is low
  • Intubate and provide airway
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19
Q

Meconium Aspiration Syndrome

  • Vigorous, active and crying,
  • Pulse > 100
  • Strong RR
  • Good muscle tone
A
  • Suction mouth and nose to clear pharynx
  • Warm, dry, and observe
  • Blow by oxygen as needed
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20
Q

Once patient is in ICU - Meconium Aspiration Syndrome

A
  • Vigorous pulmonar hygiene
  • Oxygen therapy
  • Mechanical ventilation for ventilatory failure
  • Drug therapy
  • -Antibiotics
  • -Steroids
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21
Q

Structural abnormality of the heart present at birth

A

Congenital Heart Defects

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22
Q

Etiology of Cyanotic - Congenital Heart Defects

A

Right to left shunt (Hypoxemia)

  • Tetralogy of Fallot
  • Transposition of the Great Vessels
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23
Q

Etiology of Acyanotic Congenital Heart Defects

A

Left to Right shunt (pulmonary congestion)

  • Atrial septal defect
  • Ventricular septal defect
  • Patent ductus arteriosus
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24
Q

Primary assessment for Congenital Heart Defects

A
  • Color: cyanosis
  • Breath Sounds: normal breath sounds, heart murmur
  • Physical appearance: respiratory distress
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25
Q

Secondary assessment for Congenital Heart Defects

A

CXR: Possibly and enlarged or abnormal shaped heart

26
Q

Congenital Heart Defects - Egg shaped heart

A

With transposition of the Great vessels

27
Q

Congenital Heart Defects - Boot shaped heart

A

With tetralogy of Fallot

28
Q

Most important test to ID cardiac defects

A

Echocardiogram

29
Q

Overriding aorta, pulmonary stenosis, ventricular septal defect, and right ventricular hypertrophy

A

Tetralogy of Fallot

30
Q

Aorta is switched with pulmonary artery (aorta arises from the right ventricular and the pulmonary artery arises from the left ventricle)

A

Transposition of the Great Vessels

31
Q

Failure of the ductus arterioles to close.

Most often results in a left to right shunt (increased pulmonary blood flow)

However, if the pressure in the right ventricle is greater than the pressure in the left ventricle, blood will flow from right to left across the ductus (shunt effect)

A

Patent Ductus Arteriosus

32
Q

A constriction in the aorta.

Demonstrates as hypertension in the upper extremities and hypotension in lower extremities

A

Coarctation of the Aorta

33
Q

Opening in the atrial septum

A

Atrial Septal Defect (ASD)

34
Q

Opening in the ventricular septum

A

Ventricular Septal Defect (VSD)

35
Q

Combined pulmonary artery and aorta

A

Truncus Arteriosus

36
Q

Pre and Post ductal blood gas studies

A

-If the pre ductal (right radial artery) PO2 is >15 torr higher than the post ductal (umbilical artery) PO2, then the patient has a right to left shunt

37
Q

Treatment and management for Congenital Heart Defects

A
  • Oxygen therapy: maintain PaO2 levels between 60 to 80 torr
  • Mechanical ventilation for ventilatory failure
  • Supportive care prior to surgery to correct defect
  • Prostaglandin E, may be helpful to maintain a PDA
38
Q

Primarily associated with prematurity or high risk infants

-Caused by insufficient amount of pulmonary surfactant or depressed surfactant activity that leads to massive atelectasis and hypoxemia

A

Infant Respiratory Distress Syndrome (IRDS)

39
Q
  • Past medical history: gestational age < 38 wks, low APGAR score, onset present at brith or within a few hours after delivery, L:S ratio < 2:1
  • Appearance of the chest: intercostal retractions
  • Respiratory pattern: tachypnea and possible apnea
  • Color: cyanosis
  • Breath sounds: bronchial or harsh, fine crackles/rales, expiratory grunting
  • Physical appearance: nasal flaring, grunting, retractions
  • Vital signs: increased HR, BP, QT
A

Primary assessment for Infant Respiratory Distress Syndrome

40
Q

Secondary assessment for Infant Respiratory Distress Syndrome

A

CXR

ABG

41
Q
  • Increased opacity
  • Ground glass appearance
  • Air bronchograms
A

CXR findings for Infant Respiratory Distress Syndrome

42
Q

Treatment and management for Infant Respiratory Distress Syndrome

A
  • Correct hypoxemia
  • Maintain neutral thermal environment
  • Surfactant replacement therapy
  • Mechanical ventilation for ventilatory failure (time cycled ventilation) with PEEP
43
Q

How to correct hypoxemia for Infant Respiratory Distress Syndrome

A
  • Oxygen via oxyhood or nasal cannula
  • CPAP 4 to 6 cmH2o
  • Maintain PaO2 between 60 to 80 torr
44
Q

How to give surfactant therapy for Infant Respiratory Distress Syndrome

A
  • Administer immediately after birth (prophylactic) in neonates <35 weeks or once IRDS has bee diagnosed
  • Instill directly into the trachea though 5 fr catheter placed into the ETT
  • Solution is administered in 4 portions, one at a time
  • Catheter is removed after each administration
  • Infanta is manually ventilated for 30 seconds
  • Change patient position to increase distribution
  • Observe for adverse reactions
45
Q

Surfactant Replacement Drugs for IRDS

A

Survanta (beractant)
Infasurf (calfactant)
Curosurf (poractant alfa)
Surfaxin (lucinactant)

46
Q

Chronic lung disorder characterized by bronchiolar metaplasia and interstitial fibrosis.

A chronic lung disease that developed in newborns as a consequence of treatment of IRDS with oxygen and positive pressure ventilation for primary lung disorder

A

Bronchopulmonary Dysplasia

47
Q

Common factors of Bronchopulmonary Dysplasia

A
  • Low gestational age and low birth weight
  • Mechanical ventilation with high airway pressures
  • High oxygen concentrations
  • History of IRDS
48
Q
  • Past medical history: prematurity
  • Appearance of the chest: intercostal retractions
  • Respiratory pattern: > 60/min
  • Color: cyanosis
  • Breath sounds: wheezes, rhonchi, crackles, expiratory grunting
  • Physical appearance: nasal flaring, substernal retractions/abdominal distention (seesaw movement)
  • Vital signs: increased HR, BP, QT
A

Primary assessment of Bronchopulmonary Dysplasia

49
Q

Secondary assessment of Bronchopulmonary Dysplasia

A

CXR

ABG

50
Q

-Initially resembles IRDS, then progresses to atelectasis, followed by cyst like areas of hyperlucency which increase in later stages

A

CXR findings in Bronchopulmonary Dysplasia

51
Q

Treatment and management for Bronchopulmonary Dysplasia

A
  • Oxygen therapy
  • Pulmonary hygiene
  • Mechanical ventilation
  • Ventilation and oxygenation should be maintained at the lowest possible level
  • Drug therapy: bronchodilators
  • Monitor fluid balance
  • Surgical ligation of PDA for infants that are difficult to wean
  • Supportive care to relieve symptoms
  • Minimize mean airway pressure
  • Extubation can be done at ventilator rates between 5 and 15
  • Avoid endotracheal CPAP
  • Maintain ABG values PaO2= 55-70, PaCO2 45-60, pH 7.25 -7.40
52
Q

Respiratory distress that begins 4-6 hrs after brith and produces symptoms similar to the early stages of IRDS

A

Transient Tachypnea of the Newborn/Type II RDS

53
Q

Primary assessment of Transient Tachypnea of the Newborn/Type II RDS

A
  • Past medical history: good APGAR score at brith then develops respiratory distress in next 12 hrs
  • Cough: depressed effort, excessive secretions and mucus
  • Appearance of the chest: intercostal retractions, nasal flaring
  • Respiratory pattern: increased rate > 60/min
  • Color: cyanosis
  • Breath sounds: wheezes, rhonchi, crackles, expiratory grunting
  • Vital signs: increased HR, BP, QT
54
Q

Secondary assessment of Transient Tachypnea of the Newborn/Type II RDS

A

CXR

ABG

55
Q
  • Initially appears normal, sign of pulmonary congestion developed 12 hours after birth
  • Patchy infiltrates
  • Cardiomegaly and pleural effusion may be present
A

CXR findings in Transient Tachypnea of the Newborn/Type II RDS

56
Q

Treatment and management for Transient Tachypnea of the Newborn/Type II RDS

A
  • Support care to relieve symptoms
  • Oxygen therapy
  • CPAP to offset pulmonary congestion and interstitial edema
  • Pulmonary hygiene
  • -Increased bronchial hydration
  • -Postural drainage and percussion
  • -Suctioning
  • Mechanical ventilation
57
Q

Occurs when the diaphragm does not completely form.

Causes the abdominal contents to be in direct contact with the thoracic cavity

A

Congenital Diaphragmatic Hernia

58
Q

Primary assessment of Congenital Diaphragmatic Hernia

A

Past medical history: respiratory distress at birth, may be detected on prenatal ultrasound
Appearance of the chest: intercostal and substernal retractions, nasal flaring, expiratory grunting
Respiratory pattern: increased > 60/min
Color: cyanosis
Breath sounds: Absent on affected side, bowel sounds on the affected side
Physical appearance: Scaphoid abdomen, barrel chest
Vital signs: increased HR, BP, QT

59
Q
  • Fluid and air filled loops of intestine in the chest
  • Shift of the heart and mediastinum toward unaffected side
  • Atelectasis and complete lung collapse
  • Hypoplastic left lung
A

CXR findings in Congenital Diaphragmatic Hernia

60
Q

Treatment and management of Congenital Diaphragmatic Hernia

A
  • Always an emergency
  • Prompt surgical repair is crucial
  • Insert an oral gastric tube to decrease gas in the bowel
  • Immediate oxygen therapy
  • Place infant on affected side
  • Do not ventilate with a mask
  • May require intubation and mechanical ventilation
  • -use low PIP <30 cmH2O and higher RR
  • -High frequency ventilation

-ECMO for severe cases

Clinical Simulation (7 decks)

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