NPS Pathology Flashcards
Four defects involved in Tetralogy of Fallot
Ventricular Septal Defect
Overriding Aorta
Right ventricular hypertrophy
Pulmonary Stenosis
Treatment for Tetralogy of Fallot
100% O2
Give prostaglandins to keep ductus open
Surgical correction
Boot-shaped heart indicates ___.
Egg-shaped heart indicates ___.
Tetralogy of Fallot.
Transposition of Great Vessels.
What are the symptoms of a preductal coarctation?
Right to left shunt
Cyanosis will be present.
What are the symptoms of a postductal coarctation?
Left to right shunt.
No cyanosis
Pulmonary HTN
Pulmonary edema
(Left to right/right to left) shunts result in hypoxemia.
Right to left. (More dangerous than left to right)
(Left to right/right to left) shunts result in pulmonary congestion..
Left to right.
If blood pressure in the arms is a lot higher than in the legs, suspect this pathology:
Coarctation of aorta.
What is the pathology of a truncus arteriosus? What is the treatment (besides surgery)?
Single common vessel for both the aorta and pulmonary artery. Also a septal defect.
Give O2 but not too much because you have to keep PVR high.
What is the pathology of hypoplastic left heart syndrome (x3)?
Severely underdeveloped left ventricle.
Stenosis (narrowing) of mitral valve
Small left atrium
What is the treatment for hypoplastic left heart syndrome?
Target SpO2 sat 75-85%
Give prostaglandins to keep ductus open.
Surgery.
(If you give too much O2 things will close that you need to stay open)
What is the pathology of Total Anomalous Pulmonary Venous Return?
Pulmonary veins don’t return to left atria.
“Snowman” heart shape on CXR.
What is the pathology of an atrial-septal defect?
Foramen ovale doesn’t close. L to R shunt.
May require supportive O2.
Not usually critical. Can be fixed at 5-6 years old.
What is the pathology of a ventricular septal defect? How do you treat it small defects? Large defects?
An opening between ventricles.
Small defects: O2, digoxin, diuretics.
Large defects: Surgery
How do you treat PDA?
High FiO2
Indomethacin.
Give Lasix.
Fluid restrictions.
How can you use PO2 to diagnose PDA or PPHN?
Preductal PO2 increased, post-ductal PO2 decreased. Difference must be 15 torr.
What is the pathology of Atrial-ventricular canal?
It is common with what syndrome?
ASD, VSD, Tricuspid valve defect, and mitral valve defect.
Common in Down syndrome.
What is the pathology of PPHN? What’s it caused by?
Severe hypoxemia and cyanosis right after birth.
Caused by increased pulmonary vascular resistance.
Similar to PDA.
How do you treat PPHN?
Hyperoxygenate. (This dilates pulmonary arteries)
Give Tolazoline (Priscoline) (Vasodilator)
Nitric oxide
HFOV
ECMO
How do you treat Transient Tachypnea of the Newborn (TTNB)?
40-60% FiO2 via hood. May require CPAP.
Usually self limiting.
How do you treat MAC?
Intubate and suction thoroughly via ET tube.
Percussion and drainage with suctioning x 8 hours
Nitric oxide if PPHN develops.
If the patient has CDH, do not ___ until you get a ___.
Do not ventilate until you get an NG tube.
If an infant shows signs of shock and mother is sick, you should suspect ___.
Strep B infection.
What is the pathology of Pierre-Robin Syndrome? To treat it, place a ___. Position patient in ___ position. Feed with a ___. And if it’s severe, perform a ___.
Tongue is too big and jaw is too small. Place a nasal airway. Place pt in prone position. Feed by NG tube. If severe, tracheostomy may be necessary.
What is the pathology of Tracheoesophagea fistula?
Esophagus is a dead end. A hole goes into the trachea.
Place pt. in reverse trendelenberg.
Put replogle tube to keep esophageal pouch empty.
Clear secretions with a bulb syringe.
Requires surgery.
What is the pathology of PIE? CXR will show __ or __. May also show ___ in the hilar area.
Air leaking from lungs into interstitial space.
CXR will show pneumothorax or pneumomediastinum.
Bubbles.
How do you treat PIE?
Keep PIP down.
Give 100% O2 for 10-15 min intervals.
Single-lobe intubation.
HFOV
What is the pathology of Necrotizing Entercolitis?
Ischemic necrosis to part of the GI tract.
CXR shows distended loops of bowel.
How do you treat Necrtoizing Entercolitis?
No oral feeding. Abdominal decompression via NG tube. Blood replacement Antibiotics Surgical resection of bowel.
What are two vaccines for RSV?
What do you use to treat RSV (3 answers)
Respigam or Synagis
Treat with Ribavirin with SPAG and scavenger system.
A normal sweat chloride test reading is around ___.
CF reading is ___.
If reading is positive, what should you do?
28
60
Repeat a second time to confirm.
What is the most common infection for a CF patient?
What two drugs treat it?
Pseudomonas.
Tobramyacin or aztreonam
How do you treat asthma?
If asthma is poorly controlled, give ___ or ___.
Always start with O2 (40-60%)
Bronchodilators
Inhaled steroids & mast cell inhibitors if poorly controlled
A moderate asthma patient who is 5-11 year old has an FEV1 of ___. Their FEV1/FVC is ___. They use their SABA ___ times a week. And ___ times a week, they wake up in the night.
60-80%
75-80%
7 (every day)
Not more than 2 nights per week
Yellow zone of asthma action plan:
Peak flow will be ___.
Take ___.
Begin or increase regimen of ___.
50-80% Take albuterol or SABA. Begin or increase oral steroids. Call doctor. Return to Green when symptoms improve.
To remove a foreign body that has been aspirated, use a (flexible or rigid) bronchoscopy.
Rigid
What is the treatment for croup?
Mist tent, 30-40%.
Racemic epinephrine.
Rest
Throat and blood cultures.
If croup is severe, treat in the ICU. Severe croup presents with ___ and ___. (Treatment is the same)
Inspiratory and expiratory stridor and Retractions
What is the treatment for epiglottitis?
Maintain child's position. Take lateral X ray, look for thumb sign. Intubate (or tracheostomy in OR only) Antibiotics Humidified O2 by T tube or CPAP.
