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RT240 > Neonates & Pediatrics > Flashcards

Neonates & Pediatrics Flashcards

1
Q

What is considered a neonate?

A

delivery to the first month of life(may or may not be premature.)

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2
Q

What is considered an infant?

A

one month to one year.

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3
Q

What is considered a child?

A

over one year of age.

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4
Q

What does GA stand for and mean?

A

Gestational age. This is the time since conception.

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5
Q

How many weeks is a term infant?

A

38-42 weeks GA.

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6
Q

How many weeks is a pre-term infant?

A

< 38 weeks GA.

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7
Q

How many weeks is a post-term infant?

A

More than 42 weeks GA.

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8
Q

What does SGA and LGA stand for?

A

Small for gestational age(SGA) and large for gestational age(LGA).

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9
Q

List the five key differences between the adult and pediatric airway.

A
  1. proportionally larger head and tongue.
  2. More anterior and cephalad larynx.
  3. Long, sometimes floppy epiglottis.
  4. Short trachea and neck.
  5. The narrowest point in the pediatric airway is the cricoid cartilage.
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10
Q

Most neonates are obligate nose breathers until about __ to __ months of age.

A

4-5 months.

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11
Q

Why does an infant extends its neck when it is in respiratory distress?

A

Because the larynx in their necks are positioned higher and in more of a straight line.

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12
Q

The larynx is more _______ than the older child, so the narrowest passage is through the ________ cartilage.

A

funnel-shaped, cricoid

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13
Q

ETT size is based on diameter of the cricoid cartilage, usually with an A-P diameter of ___ to ___ mm.

A

4-6.

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14
Q

T or F?
The large conducting airways of the newborn are longer and narrower.
hint: Do babies have shorter or longer necks than that of an adult?

A

FALSE. Their airways are SHORTER and narrower.

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15
Q

T or F?
Neonates, especially preterm infants, have frequent short periods of apnea and periodic breathing.

A

True

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16
Q

The ___ ________ _____ of a newborn is nearly twice that of an adult due to more O2 consumption and CO2 production.

A

basal metabolic rate

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17
Q

Why does newborns tend to have a reduced FRC?

A

Because their chest wall tends to be very compliant.

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18
Q

What is the main cause of death from 26 weeks GA to 4 weeks after birth?

A

Failure of the respiratory system to function.

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19
Q

What are the 3 stages of fetal development and growth?

A

Ovum stage, embryonic stage, and fetal stage.

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20
Q

What is the ovum stage? When does it occur?

A

The ovum stage is conception to ovum implantation(attaches to uterus for nourishment).
12-14 days

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21
Q

What is the embryonic stage? When does it occur?

A

14th day till embryo measures 3cm long (54-56 days).

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22
Q

What occurs during the embryonic stage?

A

Major organ systems develop. The embryo is very susceptible to drugs, infections, and radiation leads to severe congenital malformations.

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23
Q

What is the fetal stage and when does it occur?

A

The fetal stage is the end of the embryonic stage till the end of pregnancy.

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24
Q

What happens during the fetal stage?

A

Major organ systems grow. Here, the fetus is less susceptible to drugs, infections, and radiation.

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25
Q

List the five stages of respiratory development in utero.

A

Embryonic period, pseudo-glandular stage, canicular stage, saccular stage, and the alveolar stage.

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26
Q

What time and period does the diaphragm start to develop?

A

24-28 days GA, embryonic period(first 5 wks GA)

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27
Q

What time and period does the diaphragm complete?

A

Week 7 in the pseudoglandular stage

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28
Q

What developmental abnormalities can occur in the pseudo-glandular stage?

A

Congenital diaphragmatic hernia and transesophageal fistula

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29
Q

What is a congenital diaphragmatic hernia?

A

An opening in the diaphragm that allows abdominal content displacement into lung space and pulmonary hypoplasia.

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30
Q

What is a Transesophageal Fistula? What can this lead to?

A

failure of the closure of the link between the trachea and esophagus. This can lead to aspiration of stomach contents and severe respiratory complication.

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31
Q

In what stage does immature type 2 cells form and begin to produce immature surfactant?

A

Cannicular stage

32
Q

In what stage does surfactant become mature?

A

Saccular stage

33
Q

Average number is __ to ___ million alveoli, resulting in 15-50% of the total number.

A

50-150 million

34
Q

List some factors affecting lung growth.

A

High FiO2, fetal hypoxia, pre/post-natal nutrition deprivation, cigarette smoke,etc.

35
Q

What is the purpose of surfactant?

A

To prevent alveoli collapse by reducing surface tension.

36
Q

FIRST surfactant produced lacks _________(hint:PG) and is termed ________ surfactant.

A

Phosphatidylglycerol, immature

37
Q

During the early stage of surfactant development, what can prevent its production? hint: HAI SHOPS

A

Hypoxia, acidemia, infants of diabetic moms, shock, hypoxemia, overinflation, pulmonary edema, and smaller sibling of twin.

38
Q

_________ surfactant is present at week __ (PG APPEARS).

A

mature, 35

39
Q

How long is surfactant’s half life?

A

14h

40
Q

T or F?
Lung maturity is primarily based off growth of surfactant.

A

True

41
Q

What is the L:S Ratio, and how is it determined?

A

This is a ratio that compares levels of lecithin to sphingomyelin to determine lung maturity.
It uses samples of amniotic fluid.

42
Q

What must the L:S ratio be to be considered mature?

A

2:1, 2x more lecithin

43
Q

T or F?
The presence of blood in samples or a diabetic mom will not alter the results of an L:S ratio.

A

False, it will be inaccurate if bloody samples or diabetes are present.

44
Q

What is the lung profile test?

A

It is a combination testing for L:S and PG presence.

45
Q

T or F?
The L:S ratio is the #1 indicator for lung maturation.

A

False, lung profile testing is the most reliable indicator of lung maturity, even with diabetes and blood contamination.

46
Q

What is the shake/foam test? How is it done?

A

This is a test that detects the presence of lecithin. Mix amniotic fluid with ethanol, shake for 15s, check 15mins later.

47
Q

With the shake/foam test, if a ring of bubbles is still present, what does that mean? What do you do if foam is NOT present?

A

If a ring of bubbles is still present that means enough lecithin is present.

If foam is NOT present, do L:S test.

48
Q

T or F?
With the shake/foam test, just like the lung profile test, results are accurate regardless of blood and meconium contamination.

A

False, it will be inaccurate

49
Q

What is the organ of respiration for the fetus? hint: it represents the lungs, kidneys, liver, and digestive organ of the fetus.

A

The placenta

50
Q

T or F?
The placenta has two umbilical arteries and one umbilical vein.

A

FALSE. There are two umbilical veins whom which are oxygenated and one umbilical artery that is deoxygenated.

51
Q

Maternal PaO2 is __ to __mmHG, while fetal PaO2 is __ mmHg.

A

80 to 100, 16

52
Q

Why does the fetus have an increased O2 carrying capacity?

A

Because fetal blood has a high amount of Hgb.

53
Q

Fetal Hgb has a ______ affinity for O2, causing a ____ shift of the oxyhemoglobin dissociation curve.

A

higher, left

54
Q

Fetal blood in the umbilical artery has a CO2 of __ to __, so the vein is alkalotic by comparison. This shifts the ODC to the ______.

A

40-45, left

55
Q

Around what time is fetal Hgb replaced by adult Hgb.

A

4-6 mo/ old

56
Q

Pressure in fetal circulation are ______ that of an adult.

A

reverse
why? b/c lungs provide high resistance to airflow

57
Q

T or F?
Pressures in right, or venous side, are higher than pressures on the left, or arterial side.

A

True

58
Q

List some maternal risk factors.

A

Mom’s age and parity, mom’s medical history prior or exiting maternal disease, problems with previous pregnancy, insufficient prenatal care, and maternal drug & alcohol abuse.

59
Q

What are the three phases of fetal assessment. Describe them.

A

Assessment BEFORE infant is born, quick assessment in delivery room at birth, and complete physical exam after infant warmed and stabilized.

60
Q

List some methods of fetal assessment.

A

Ultrasonography, amniocentesis, fetal HR monitoring, and fetal blood gas analysis.

61
Q

A normal fetal heart rate ranges between __ and ___ bpm.

A

120-160

62
Q

Fetal blood gases are analyzed mainly for the pH. Normal fetal capillary pH ranges from what?

A

7.25-7.35

63
Q

What does a pH below 7.20 indicate?

A

A combined respiratory and metabolic acidosis.

64
Q

What is the normal RR for an infant? When is it determined? What value is considered tachypnea?

A

30-60 bpm; determined when the baby isn’t crying; >60 bpm

65
Q

Apnea is often seen in premature newborns weighing less than ____, with a respiratory rate less than ___ breathes per minute.

A

1500 grams, 30

66
Q

What is a way you can stimulate an infant to end the episode of apnea.

A

Gently shake or rub the newborn. It usually returns spontaneously.

67
Q

What is grunting? What creates the sound?

A

Grunting is the sound heard on expiration created by the newborn exhaling through a partially closed glottis.

68
Q

Why is grunting created?

A

Grunting is created to maintain positive pressure in the lung to maintain alveolar stability.(increases FRC too!)

69
Q

What is acrocyanosis and when is it present?

A

Acrocyanosis is present initially following birth. This type of cyanosis is of the hands and feet only.

70
Q

General cyanosis or _______ cyanosis is found in the ___ and _____ _____ of the mouth. It is a indication of respiratory distress with hypoxemia.

A

central, lips and mucosal lining

71
Q

What is normal fetal heart rate?

A

120-160 bpm.

72
Q

The ____ _____ is the most sensitive indicator of hypoxia.

A

heart rate

73
Q

List the three R to L shunts.

A

Tetralogy of fallot, coarctation of aorta, and complete transposition of great vessels.

74
Q

List the three L to R shunts.

A

Atrial septal defect, ventricular septal defect, and patent ductus arteriosus.

75
Q

What is Transillumination and why is it done? If a halo is present, what does this indicate? What about if the entire hemithorax lights up?

A

Transillumination is the usage of shining a light through the chest. This eliminates or confirms any issues.

A small halo around light source signifies a normal lung. If the entire chest lights up that indicates that there may be a presence of a pneumothorax or a pneumomediastinum.

RT240 (5 decks)

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