nrp Flashcards
1
Q
nasal flaring
A
a sign of respiratory distress in infants
2
Q
echocardiogram
A
cardiac anomalies in infants
3
Q
Perinatal History, Mother’s History:
A
History of pregnancy, age, smoking, and substance abuse, nutrition, infection, previous pregnancies/outcome, hypertension/toxemia are all important to review.
4
Q
Mothers with diabetes are prone to have
A
premature and large-for-gestational age infants.
5
Q
Family history, delivery, and postnatal history will also provide
A
important information
6
Q
Gestational Age
A
time since the estimated date of conception
7
Q
Term Infant
A
born between 38 and 42 weeks of gestational age
8
Q
Preterm Infant (premature)
A
less than 38 weeks of gestational age
9
Q
Post term Infant weeks of gestational age
A
more than 42
10
Q
AGA
A
Appropriate for gestational age
11
Q
LGA
A
Large for gestational age. diabetes
12
Q
SGA
A
Small for gestational age. mom on drugs
13
Q
APGAR 1 minute score identifies
A
how well the infant tolerated delivery.
14
Q
APGAR 5 minute score identifies
A
how successful our efforts were
15
Q
APGAR Five factors are evaluated:
A
color, heart rate, reflex irritability, muscle tone and respiratory effort
16
Q
APPEARANCE PULSE under 100 = 1 point GRIMACE - cough/sneeze = 2 points ACTIVITY - some flexion is 1 point RESPIRATORY EFFORT - slow weak cry = 1 point
A
APPEARANCE PULSE under 100 = 1 point GRIMACE - cough/sneeze = 2 points ACTIVITY - some flexion is 1 point RESPIRATORY EFFORT - slow weak cry = 1 point
17
Q
0 to 3 points = resuscitate with 100% FiO2
4 to 6 points = stimulate
A
0 to 3 points = resuscitate with 100% FiO2
4 to 6 points = stimulate
18
Q
Transillumination
A
Recommend when a pneumothorax is suspected
19
Q
Transillumination
A
A bright fiberoptic light is placed against the infant’s chest in a darkened room
20
Q
Transillumination
A
Normally a lighted halo is seen around the point of contact
21
Q
Transillumination
A
A pneumothorax will cause the entire hemithorax to light up
22
Q
Transillumination L. Diaphragmatic hernia there is
A
no light
23
Q
Normal Temperature.
A
36.5 C.
24
Q
Servo-controlled isolettes and radiant warmers provide
A
automatic adjustment of temperature
25
If the temperature probe comes off the skin or malfunctions the unit may
overheat causing high air temperature and the low skin temperature alarms to sound
26
When an infant is kept warm, the oxygen consumption is
reduced
27
Normal heart rate for a term infant is
110 - 160 beats/min. (preterm infants have faster rates)
28
Tachycardia
170 beats/min. or greater.
29
Bradycardia
less than 100 beats/min.
30
Pulse/Heart Rate. is Measured using
brachial, femoral, or apical pulse.
31
An infant can only increase his/her cardiac output by
increasing the heart rate.
32
Normal respiratory rate is
30 to 60 breaths/min. (higher in preterm babies).
33
Respiratory pause
apnea for 5- 10 sec, normal.
34
Short apnea
apnea for 10-20 sec, may be normal.
35
Long apnea:
apnea for more than 20 sec, always abnormal.
36
Blood Pressure Term infant:
60/40 mm Hg.
37
Blood Pressure Preterm infant:
50/30 mm Hg.
38
Birth Weight Term infant:
over 3000 g or 3 Kg
39
Birth Weight 28 week gestational age
1000 g.
40
Low birth weight infants are at higher risk for
respiratory problems.
41
9,000 - 30,000 normal WBC until
3 weeks old
42
Acrocyanosis is
bluish extremities and is not true cyanosis.
43
Check mucous membranes of the
mouth, tongue, and nail beds.
44
increased WOB for infant
retractions, nasal flaring and grunting.
45
Retractions
Intercostal, subcostal, substernal or supraclavicular retractions are signs of respiratory distress
46
Nasal Flaring
Dilation of nasal openings also indicates respiratory distress for infants who must breathe through their nose.
47
Grunting
A sound heard at the end of exhalation that indicates respiratory distress (RDS) from decreased lung volume.
48
Capillary Refill
Blanching the infant's skin to see how long it takes for normal color to return.
49
Capillary Refill
Longer than 3 seconds may indicate a decreased cardiac output.
50
Silverman Score the higher the number is
the worse the baby is doing
51
Silverman Score is the Assessment of
respiratory distress.
52
Gestational Age
Dubowitz or Ballard Method
53
Dubowitz or Ballard Method Assessment of the gestational age is important to
differentiate between a premature infant and one that is just small for his/her gestational age.
54
Dubowitz or Ballard Method The higher the score
the higher the gestational age in weeks.
55
Dubowitz or Ballard Method
Normal score is 40 corresponding to 40 weeks.
56
Dubowitz or Ballard Method A score higher than 40 indicates
a post-term infant.
57
Dubowitz or Ballard Method
A score lower than 40 indicates a pre-term infant.
58
New Ballard Score (NBS) is a Modification of
Ballard Score.
59
New Ballard Score (NBS) Estimates
gestational age in very low birth weight infants.
60
PROM
premature rupture of the membrane. look for WBC going up and temperature would mean they have an infection
61
UA
umbilical artery = L. side
62
Pre- and Post-Ductal Blood Gas Studies, if right to left shunting occurs across the ductus arteriosus,
the PaO2 level obtained from a pre-ductal site (right arm) often exceeds the PaO2 level obtained from a post-ductal site (umbilical artery or a lower extremity vessel)
63
if the pre-ductal (right radial artery) PaO2 is 15 torr higher than the post-ductal (umbilical artery) PaO2 then
the patient has a patent ductus arteriosus with a right to left shunt
64
Pre- and Post-Ductal Blood Gas Studies
can also be evaluated by using transcutaneous monitoring or pulse oximetry.
65
Pre- and Post-Ductal Blood Gas Studies recommend an echocardiogram to
determine the cause of the shunt.
66
Blood Glucose term infants should have values
greater than 30 mg/dL. if lower then need to intervene
67
Blood Glucose Premature infants should have values
greater than 20 mg/dL. if lower then need to intervene
68
Lecithin/Sphingomyelin (L/S) ratio of 2:1 or higher is
good
69
Lecithin/Sphingomyelin (L/S) Ratio ratio less than 2:1 indicates
high risk of hyaline membrane disease (HMD) or infant Respiratory Distress Syndrome (IRDS)
70
As Lecithin/Sphingomyelin (L/S) Ratio drops below 2, incidence of HMD/IRDS ranges from 40-80%. Lower ratio indicating
higher risk.
As Lecithin/Sphingomyelin (L/S) Ratio drops below 2, incidence of HMD/IRDS ranges from 40-80%. Lower ratio indicating
higher risk.
71
As ratio drops below 2, Recommend
surfactant replacement therapy.
72
Phosphatidylglycerol (PG) is the Most reliable indicator of
Pulmonary maturity even with diabetes.
73
Phospholipid appearing at about 36 weeks gestation and rising until term.
Phospholipid appearing at about 36 weeks gestation and rising until term.
74
Phosphatidylglycerol (PG) is Only performed on amniotic fluid.
Phosphatidylglycerol (PG) is Only performed on amniotic fluid.
75
Phosphatidylcholine (PC) or Dipalmitoylphosphatidylcholine (DPPC) Indicator for lung maturity, and will rise as lungs mature.
Phosphatidylcholine (PC) or Dipalmitoylphosphatidylcholine (DPPC) Indicator for lung maturity, and will rise as lungs mature.
76
Phospholipid - lecithin makes up the majority of the weight of surfactant.
Phospholipid - lecithin makes up the majority of the weight of surfactant.
77
Transcutaneous PO2, and PC02, measurement Heating the skin around the electrode to 43- 45 °C
Transcutaneous PO2, and PC02, measurement Heating the skin around the electrode to 43- 45 °C
78
Clark
P02
79
Severinghaus
PCO2
80
Treating Severe Airway Obstruction in an Infant - If the infant is responsive
1. Infant is straddled over the rescuer arm face down (prone), the head lower than the trunk, and the head is supported by firmly holding the jaw.
2. Deliver 5 back blows with the heel of the hand between the infant's shoulder blades.
3. Turn the infant over and apply 5 chest thrusts (heimlich maneuver like on an adult)
4. Repeat the sequence until the obstruction is relieved or the infant becomes unresponsive.
81
Treating Severe Airway Obstruction in an Infant - If the infant becomes unresponsive.
1. Send someone to activate emergency response system.
2. Place infant on a hard surface, begin CPR (no pulse check).
3. Before attempting to ventilate, look for a foreign object in the mouth and remove it.
4. Continue CPR for 5 cycles or about 2 minutes.
- if alone, activate EMS system.
- Return and continue CPR.
82
Flow-inflating Resuscitation (Anesthesia) Bag is used for resuscitation and manual ventilation of neonates.
Flow-inflating Resuscitation (Anesthesia) Bag is used for resuscitation and manual ventilation of neonates.
83
Flow-inflating Resuscitation (Anesthesia) Bag Inflates only when gas source is turned on and opening of bag is sealed (mask placed tightly on neonate's face).
Flow-inflating Resuscitation (Anesthesia) Bag Inflates only when gas source is turned on and opening of bag is sealed (mask placed tightly on neonate's face).
84
Flow-inflating Resuscitation (Anesthesia) Bag Peak inspiratory pressure is controlled by:
- Flow to bag.
- Adjustment of flow control valve.
- How hard the bag is squeezed.
Flow-inflating Resuscitation (Anesthesia) Bag Peak inspiratory pressure is controlled by:
- Flow to bag.
- Adjustment of flow control valve.
- How hard the bag is squeezed.
85
Flow-inflating Resuscitation (Anesthesia) Bag Can also provide blow-by O, and PEEP/CPAP.
Flow-inflating Resuscitation (Anesthesia) Bag Can also provide blow-by O, and PEEP/CPAP.
86
Flow-inflating Resuscitation (Anesthesia) Bag Should always be used with a pressure manometer to monitor PIP and PEEP or the baby will die!!!
Flow-inflating Resuscitation (Anesthesia) Bag Should always be used with a pressure manometer to monitor PIP and PEEP or the baby will die!!!
87
Flow-inflating Resuscitation (Anesthesia) Bag - Neonate receives same FO, as the gas flowing to the bag.
Flow-inflating Resuscitation (Anesthesia) Bag - Neonate receives same FO, as the gas flowing to the bag.
88
Flow-inflating Resuscitation (Anesthesia) Bag should be kept approximately half-full between breaths
Flow-inflating Resuscitation (Anesthesia) Bag should be kept approximately half-full between breaths
89
Flow-inflating Resuscitation (Anesthesia) Bag Requires compressed gas source to operate
Flow-inflating Resuscitation (Anesthesia) Bag Requires compressed gas source to operate
90
Flow-inflating Resuscitation (Anesthesia) Bag will not inflate in the presence of
- Leaks.
- Low flow to bag.
- Opened flow control valve.
- Open pop-off valve.
Flow-inflating Resuscitation (Anesthesia) Bag will not inflate in the presence of
- Leaks.
- Low flow to bag.
- Opened flow control valve.
- Open pop-off valve.
91
Laryngoscope Straight Miller blade fits directly under the epiglottis
Laryngoscope Straight Miller blade fits directly under the epiglottis
92
Laryngoscope Straight Miller blade is Preferred for infant intubation
Laryngoscope Straight Miller blade is Preferred for infant intubation
93
pediatric Laryngoscope blade size
size 2
94
term infant Laryngoscope blade size
size 1
95
pre-term Laryngoscope blade size
size 0
96
ETT Pre-term 2.5 - 3
ETT Pre-term 2.5 - 3
97
ETT Full-term 3.0 - 3.5
ETT Full-term 3.0 - 3.5
98
oropharyngeal suctioning of infants can be done with a bulb syringe
oropharyngeal suctioning of infants can be done with a bulb syringe
99
vacuum pressure infant 80 - 100 mmHg
vacuum pressure infant 80 - 100 mmHg
100
modifying bronchial hygiene therapy considerations in infants;
- size of thorax
- fear
- positioning
modifying bronchial hygiene therapy considerations in infants;
- size of thorax
- fear
- positioning
101
Isolette (Incubator) has Filtered gas.
Isolette (Incubator) has Filtered gas.
102
Isolette (Incubator) Temperature control-will maintain a
| neutrothermal environment
Isolette (Incubator) Temperature control-will maintain a
| neutrothermal environment
103
Isolette (Incubator) you Administer oxygen to neonate by cannula, oxyhood, CPAP, etc.
Isolette (Incubator) you Administer oxygen to neonate by cannula, oxyhood, CPAP, etc.
104
Isolette (Incubator) Provides humidity
Isolette (Incubator) Provides humidity
105
Isolette (Incubator) is ldeal for stable newborns
Isolette (Incubator) is ldeal for stable newborns
106
```
Isolette (Incubator) hazards are;
Thermal burns.
Electrical shock.
Oxygen toxicity.
Fire.
Toxic inhalation.
Hearing damage.
```
```
Isolette (Incubator) hazards are;
Thermal burns.
Electrical shock.
Oxygen toxicity.
Fire.
Toxic inhalation.
Hearing damage.
```
107
Radiant warmer (Open Incubator) is Ideal for unstable newborns who require constant care.
Radiant warmer (Open Incubator) is Ideal for unstable newborns who require constant care.
108
Radiant warmer (Open Incubator) Provides a neutral thermal environment but will not decrease insensible water loss in premature infants because of evaporation.
Radiant warmer (Open Incubator) Provides a neutral thermal environment but will not decrease insensible water loss in premature infants because of evaporation.
109
Nasal CPAP Can lose CPAP if baby is crying. Readjust nasal prongs if losing CPAP.
Nasal CPAP Can lose CPAP if baby is crying. Readjust nasal prongs if losing CPAP.
110
CPAP loss of pressure indicates Leak or Insufficient flow.
CPAP loss of pressure indicates Leak or Insufficient flow.
111
CPAP Increased pressure indicates Obstruction
CPAP Increased pressure indicates Obstruction
112
CPAP With excessive flow, will cause a continuous venting of the pop-off valve will occur
CPAP With excessive flow, will cause a continuous venting of the pop-off valve will occur
113
Capillary samples or heel sticks can also be used to obtain blood gas samples in infants.
Capillary samples or heel sticks can also be used to obtain blood gas samples in infants.
114
the Capillary sample or heel stick site must be arterialized by wrapping it in a wet, warm cloth at 45° C for 5 - 7 minutes.
the Capillary sample or heel stick site must be arterialized by wrapping it in a wet, warm cloth at 45° C for 5 - 7 minutes.
115
during a Capillary sample or heel stick The heel is cleansed with alcohol and a lancet is used for the puncture and is done deep enough to allow for free-flowing blood.
during a Capillary sample or heel stick The heel is cleansed with alcohol and a lancet is used for the puncture and is done deep enough to allow for free-flowing blood.
116
in a Capillary sample or heel stick the Results will show a consistent correlation with arterial pH and PCO2
in a Capillary sample or heel stick the Results will show a consistent correlation with arterial pH and PCO2
117
with a Capillary sample or heel stick the PO2 values do not correlate well with actual arterial blood. This is especially true when the a PO2 is above 60 tor.
with a Capillary sample or heel stick the PO2 values do not correlate well with actual arterial blood. This is especially true when the a PO2 is above 60 tor.
118
Capillary gases should not be used to monitor oxygen therapy. Actual oxygen levels may de either higher or lower than what is measured in capillary sample.
Capillary gases should not be used to monitor oxygen therapy. Actual oxygen levels may de either higher or lower than what is measured in capillary sample.
119
Umbilical arterial lines are used for newborn babies
Umbilical arterial lines are used for newborn babies
120
Umbilical arterial lines at the PO2 of the left side of the heart
Umbilical arterial lines at the PO2 of the left side of the heart
121
in an Umbilical arterial line A catheter is inserted into the umbilical artery at the cut end of the umbilical cord
in an Umbilical arterial line A catheter is inserted into the umbilical artery at the cut end of the umbilical cord
122
in an Umbilical arterial line the safest place for the tip of the umbilical arterial catheter is at L-3 which is above the bifurcation of the aorta but below the renal arteries
in an Umbilical arterial line the safest place for the tip of the umbilical arterial catheter is at L-3 which is above the bifurcation of the aorta but below the renal arteries
123
Umbilical artery PO2 may be used to regulate FiO2
Umbilical artery PO2 may be used to regulate FiO2
124
Umbilical arterial line Catheter is in a post-ductal location and may be used to identify right-to-left shunting across the ductus arteriosus.
Umbilical arterial line Catheter is in a post-ductal location and may be used to identify right-to-left shunting across the ductus arteriosus.
125
umbilical artery catheter (UAC) Allows continuous monitoring of blood pressure.
umbilical artery catheter (UAC) Allows continuous monitoring of blood pressure.
126
umbilical artery catheter (UAC) gives Arterial samples for ABG and other lab analysis
umbilical artery catheter (UAC) gives Arterial samples for ABG and other lab analysis
127
umbilical artery catheter (UAC) is used for Blood replacement (transfusions).
umbilical artery catheter (UAC) is used for Blood replacement (transfusions).
128
Tidal Volume 4 - 6 mL/kg
Tidal Volume 4 - 6 mL/kg
129
infant PIP 20 - 30 cmH20
infant PIP 20 - 30 cmH20
130
infant respiratory rate 20 - 30
infant respiratory rate 20 - 30
131
infant peak flow 5 - 6 L/min
infant peak flow 5 - 6 L/min
132
infant Itime .5 - .6 seconds
infant Itime .5 - .6 seconds
133
APGAR 0 - 3 give them positive pressure
APGAR 0 - 3 give them positive pressure
134
PEEP without previous information set to 2 - 4
PEEP without previous information set to 2 - 4
135
PEEP max is 8
PEEP max is 8
136
is baby is on CPAP of 10 set PEEP to 10
is baby is on CPAP of 10 set PEEP to 10
137
pressures of 22/4 cm H2O then make the vent settings 22 peak/rate and the 4 is PEEP
pressures of 22/4 cm H2O then make the vent settings 22 peak/rate and the 4 is PEEP
138
```
chant
20 30 PIP
20 30 RR
5 6 PF
.5 .6 Itime
```
```
chant
20 30 PIP
20 30 RR
5 6 PF
.5 .6 Itime
```
139
infant Apnea Monitoring (Pneumogram) is Indicated for an infant who may be at risk for periods of significant apnea over 20 sec.
infant Apnea Monitoring (Pneumogram) is Indicated for an infant who may be at risk for periods of significant apnea over 20 sec.
140
infant Apnea Monitoring (Pneumogram) is indicated for One or more Apparent Life Threatening Episodes (ALTE). These occur when the infant has apnea, cyanosis, choking, or lifelessness that requires stimulation or CPR.
infant Apnea Monitoring (Pneumogram) is indicated for One or more Apparent Life Threatening Episodes (ALTE). These occur when the infant has apnea, cyanosis, choking, or lifelessness that requires stimulation or CPR.
141
infant Apnea Monitoring (Pneumogram) is indicated for a Sibling of a SIDS baby.
infant Apnea Monitoring (Pneumogram) is indicated for a Sibling of a SIDS baby.
142
infant Apnea Monitoring (Pneumogram) is indicated for Snoring in infants
infant Apnea Monitoring (Pneumogram) is indicated for Snoring in infants
143
Electrodes attached to the chest sense changes in impedance as the lungs expand and contract causing the distance between the electrodes to increase and decrease (impedance pneumogram).
Electrodes attached to the chest sense changes in impedance as the lungs expand and contract causing the distance between the electrodes to increase and decrease (impedance pneumogram).
144
Apnea Monitor/Pneumogram problems
- may have False alarms
- Poor electrode contact is patient has oily skin
Apnea Monitor/Pneumogram problems
- may have False alarms
- Poor electrode contact is patient has oily skin
145
Apnea Monitor/Pneumogram Monitor may not sense obstructive apnea if the patient has respiratory movements or has hiccups.
Apnea Monitor/Pneumogram Monitor may not sense obstructive apnea if the patient has respiratory movements or has hiccups.
146
Impedance Apnea Monitor/Pneumogram Set the low heart rate alarm between 60-80 beats/min.
Impedance Apnea Monitor/Pneumogram Set the low heart rate alarm between 60-80 beats/min.
147
Send baby home with apnea monitor after parents learn CPR
Send baby home with apnea monitor after parents learn CPR
148
Discontinue Apnea Monitor when 2 months free of events
Discontinue Apnea Monitor when 2 months free of events
149
discontinue apnea monitor After an asymptomatic period when infant receives DPT immunizations and experiences nasopharyngitis without reoccurrence of symptoms.
discontinue apnea monitor After an asymptomatic period when infant receives DPT immunizations and experiences nasopharyngitis without reoccurrence of symptoms.
150
Discontinuing Apnea Monitor when A follow-up pneumogram is normal.
Discontinuing Apnea Monitor when A follow-up pneumogram is normal.
151
Theophylline is a Methylxanthine (phosphodiesterase inhibitors) is a Side Door Bronchodilator that is given to increase diaphragmatic contractility and stimulate the CNS in infants with
apnea of prematurity. Serum levels are kept at 5-10 mcg/mL in neonates and children
Theophylline is a Methylxanthine (phosphodiesterase inhibitors) is a Side Door Bronchodilator that is given to increase diaphragmatic contractility and stimulate the CNS in infants with
apnea of prematurity. Serum levels are kept at 5-10 mcg/mL in neonates and children
152
caffeine is a Theophylline which is a Methylxanthine (phosphodiesterase inhibitors) or a Side Door Bronchodilator
caffeine is a Theophylline which is a Methylxanthine (phosphodiesterase inhibitors) or a Side Door Bronchodilator
153
Surfactant Replacement Therapy is used to prevent and treat IRDS/HMD
Surfactant Replacement Therapy is used to prevent and treat IRDS/HMD
154
Surfactant Replacement Therapy Prophylactic administration technique means it is administered to at-risk infants immediately after birth
Surfactant Replacement Therapy Prophylactic administration technique means it is administered to at-risk infants immediately after birth
155
Surfactant Replacement Therapy rescue administration technique means means that it is administered to infants after they demonstrate signs & symptoms of RDS
Surfactant Replacement Therapy rescue administration technique means means that it is administered to infants after they demonstrate signs & symptoms of RDS
156
Adverse effects of surfactant replacement therapy are pneumothorax, bradycardia, hypotension, hypoxemia, hemorrhage, apnea
Adverse effects of surfactant replacement therapy are pneumothorax, bradycardia, hypotension, hypoxemia, hemorrhage, apnea
157
Surfactant Replacement Therapy Calfactant is bovine
Surfactant Replacement Therapy Calfactant is bovine
158
Surfactant Replacement Therapy Beractant is bovine.
Surfactant Replacement Therapy Beractant is bovine.
159
Surfactant Replacement Therapy Poractant alfa is porcine.
Surfactant Replacement Therapy Poractant alfa is porcine.
160
Meconium Aspiration Syndrome (MAS) is a Condition in which a fetus aspirates a mix of fetal stool (meconium) and amniotic fluid during episodes of fetal hypoxemia.
Meconium Aspiration Syndrome (MAS) is a Condition in which a fetus aspirates a mix of fetal stool (meconium) and amniotic fluid during episodes of fetal hypoxemia.
161
Meconium Aspiration Syndrome (MAS) Occurs most commonly in full-term or post-term infants
Meconium Aspiration Syndrome (MAS) Occurs most commonly in full-term or post-term infants
162
Meconium Aspiration Syndrome (MAS) Results in chemical pneumonitis, upper airway obstruction, and hypoxia-induced pulmonary artery hypertension.
Meconium Aspiration Syndrome (MAS) Results in chemical pneumonitis, upper airway obstruction, and hypoxia-induced pulmonary artery hypertension.
163
Meconium Aspiration Syndrome (MAS) appears as Cyanosis, stained with meconium
Meconium Aspiration Syndrome (MAS) appears as Cyanosis, stained with meconium
164
Meconium Aspiration Syndrome (MAS) shows as Grunting, retractions, nasal flaring, gasping with tachypnea
Meconium Aspiration Syndrome (MAS) shows as Grunting, retractions, nasal flaring, gasping with tachypnea
165
Meconium Aspiration Syndrome (MAS) breath sounds are Wheezes, rhonchi, crackles, expiratory grunting.
Meconium Aspiration Syndrome (MAS) breath sounds are Wheezes, rhonchi, crackles, expiratory grunting.
166
Meconium Aspiration Syndrome (MAS) shows as Tachycardia, tachypnea, hypertension
Meconium Aspiration Syndrome (MAS) shows as Tachycardia, tachypnea, hypertension
167
Meconium Aspiration Syndrome (MAS) x-ray will have Irregular densities throughout the lungs with atelectasis and consolidation
Meconium Aspiration Syndrome (MAS) x-ray will have Irregular densities throughout the lungs with atelectasis and consolidation
168
Meconium Aspiration Syndrome (MAS) ABG will have Acute alveolar hyperventilation with hypoxemia.
Meconium Aspiration Syndrome (MAS) ABG will have Acute alveolar hyperventilation with hypoxemia.
169
Meconium Aspiration Syndrome (MAS) treatment is to Suction the nasopharynx and oropharynx thoroughly when amniotic fluid is stained.
Meconium Aspiration Syndrome (MAS) treatment is to Suction the nasopharynx and oropharynx thoroughly when amniotic fluid is stained.
170
Meconium Aspiration Syndrome (MAS) treatment if infant is vigorous, active and crying (Pulse more than 100, strong RR, good muscle tone;
- suction mouth and nose to clear pharynx.
- warm, dry and observe
- Blow-by oxygen as needed.
Meconium Aspiration Syndrome (MAS) treatment if infant is vigorous, active and crying (Pulse more than 100, strong RR, good muscle tone;
- suction mouth and nose to clear pharynx.
- warm, dry and observe
- Blow-by oxygen as needed.
171
Meconium Aspiration Syndrome (MAS) treatment if infant is not vigorous (Pulse less than 100, limp, depressed, poor tone, absent or gasping respirations):
- Initiate positive pressure ventilation if infant is not breathing or if heart rate is less than 100/min.
- Support ventilation and oxygenation, which may include intubation and suction if the airway is obstructed.
Meconium Aspiration Syndrome (MAS) treatment if infant is not vigorous (Pulse less than 100, limp, depressed, poor tone, absent or gasping respirations):
- Initiate positive pressure ventilation if infant is not breathing or if heart rate is less than 100/min.
- Support ventilation and oxygenation, which may include intubation and suction if the airway is obstructed.
172
Meconium Aspiration Syndrome (MAS) Stabilize infant (whether they were vigorous or not) and transfer to ICU.
1) Vigorous pulmonary hygiene (postural drainage, percussion, suctioning).
2) Oxygen therapy.
3) Mechanical ventilation for ventilatory failure.
4) Consider alternate ventilation/oxygenation strategies:
- High frequency ventilation / high frequency oscillatory ventilation.
- Inhaled nitric oxide (iNO).
- Extracorporeal membrane oxygenation (ECMO).
Meconium Aspiration Syndrome (MAS) Stabilize infant (whether they were vigorous or not) and transfer to ICU.
1) Vigorous pulmonary hygiene (postural drainage, percussion, suctioning).
2) Oxygen therapy.
3) Mechanical ventilation for ventilatory failure.
4) Consider alternate ventilation/oxygenation strategies:
- High frequency ventilation / high frequency oscillatory ventilation.
- Inhaled nitric oxide (iNO).
- Extracorporeal membrane oxygenation (ECMO).
173
Meconium Aspiration Syndrome (MAS) Antibiotics and Steroids
Meconium Aspiration Syndrome (MAS) Antibiotics and Steroids
174
Congenital Heart Defects are Structural abnormalities of the heart present at birth. The most serious defects create right-to-left shunting, resulting in severe hypoxemia
Congenital Heart Defects are Structural abnormalities of the heart present at birth. The most serious defects create right-to-left shunting, resulting in severe hypoxemia
175
Congenital Heart Defects are Tetralogy of Fallot and Transposition of the Great Vessels
Congenital Heart Defects are Tetralogy of Fallot and Transposition of the Great Vessels
176
Congenital Heart Defect Tetralogy of Fallot is overriding aorta, pulmonary stenosis, ventricular septal defect, and right
ventricular hypertrophy
Congenital Heart Defect Tetralogy of Fallot is overriding aorta, pulmonary stenosis, ventricular septal defect, and right
ventricular hypertrophy
177
Congenital Heart Defect Transposition of the Great Vessels is where the aorta is switched with pulmonary artery (aorta arises from right ventricle and the pulmonary artery arises from the left ventricle).
Congenital Heart Defect Transposition of the Great Vessels is where the aorta is switched with pulmonary artery (aorta arises from right ventricle and the pulmonary artery arises from the left ventricle).
178
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel the patient will have Cyanosis.
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel the patient will have Cyanosis.
179
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel the patient will have Tachypnea.
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel the patient will have Tachypnea.
180
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel the patient will have Normal breath sounds, and a loud heart murmur
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel the patient will have Normal breath sounds, and a loud heart murmur
181
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel the x-ray will possibly possibly an enlarged or abnormally shaped heart
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel the x-ray will possibly possibly an enlarged or abnormally shaped heart
182
Egg-shaped heart with Transposition of the Great Vessels
Egg-shaped heart with Transposition of the Great Vessels
183
Boot-shaped heart with Tetralogy of Fallot
Boot-shaped heart with Tetralogy of Fallot
184
Echocardiogram is the most important diagnostic test to identify cardiac defects
Echocardiogram is the most important diagnostic test to identify cardiac defects
185
Pre- and Post-ductal blood gas studies
Pre- and Post-ductal blood gas studies
186
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel if the pre-ductal (right radial artery) PO2 is 15 tor higher than the post-ductal (umbilical
artery) PO2 then the patient has a right-to-left shunt.
with the Congenital Heart Defects of Tetralogy of Fallot and Transposition of the Great Vessel if the pre-ductal (right radial artery) PO2 is 15 tor higher than the post-ductal (umbilical
artery) PO2 then the patient has a right-to-left shunt.
187
Pre- and Post-ductal blood gas studies for the Congenital Heart Defects Tetralogy of Fallot and Transposition of the Great Vessels Can also be evaluated using two transcutaneous monitors. One placed on the upper right thorax (pre-ductal) and the other on the lower left thigh or left abdominal region (post-ductal)
Pre- and Post-ductal blood gas studies for the Congenital Heart Defects Tetralogy of Fallot and Transposition of the Great Vessels Can also be evaluated using two transcutaneous monitors. One placed on the upper right thorax (pre-ductal) and the other on the lower left thigh or left abdominal region (post-ductal)
188
Congenital Heart Defects Tetralogy of Fallot and Transposition of the Great Vessels maintain PaO2 levels between 50 - 80 torr.
Congenital Heart Defects Tetralogy of Fallot and Transposition of the Great Vessels maintain PaO2 levels between 50 - 80 torr.
189
Prostaglandins to maintain patent ductus arteriosus
Prostaglandins to maintain patent ductus arteriosus
190
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) is Caused by insufficient amount of pulmonary surfactant or depressed surfactant activity that leads to massive atelectasis and hypoxemia.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) is Caused by insufficient amount of pulmonary surfactant or depressed surfactant activity that leads to massive atelectasis and hypoxemia.
191
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Primarily occurs in premature or high-risk infants.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Primarily occurs in premature or high-risk infants.
192
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Primarily occurs in Gestational age less than 38 weeks, low APGAR scores, signs of respiratory distress present at birth or within a few hours after delivery, L:S ratio less than 2:1.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Primarily occurs in Gestational age less than 38 weeks, low APGAR scores, signs of respiratory distress present at birth or within a few hours after delivery, L:S ratio less than 2:1.
193
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) shows cyanosis
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) shows cyanosis
194
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) shows Tachypnea and possible apnea, intercostal retractions, nasal flaring, grunting.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) shows Tachypnea and possible apnea, intercostal retractions, nasal flaring, grunting.
195
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) shows Bronchial or harsh, fine crackles/rales, expiratory grunting
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) shows Bronchial or harsh, fine crackles/rales, expiratory grunting
196
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) x-ray will show Increased opacity. ground glass appearance, and air bronchograms
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) x-ray will show Increased opacity. ground glass appearance, and air bronchograms
197
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) ABG will show Acute alveolar hyperventilation with hypoxemia
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) ABG will show Acute alveolar hyperventilation with hypoxemia
198
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Oxygen via oxyhood or nasal cannula.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Oxygen via oxyhood or nasal cannula.
199
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) CPAP (4-6 cm H20)
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) CPAP (4-6 cm H20)
200
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) CPAP (4-6 cm H20) maintain PaO2 between 50-80 torr and SpO2 between 89-90%
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) CPAP (4-6 cm H20) maintain PaO2 between 50-80 torr and SpO2 between 89-90%
201
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Maintain neutral thermal environment.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Maintain neutral thermal environment.
202
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Recommend surfactant replacement therapy
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) Recommend surfactant replacement therapy
203
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy should be administered immediately after birth (prophylactic) in neonates less than 35 weeks gestation age, or once IRDS has been diagnosed (rescue).
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy should be Administered immediately after birth (prophylactic) in neonates less than 35 weeks gestation age, or once IRDS has been diagnosed (rescue).
204
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy types;
- Calfactant from bovine
- Beractant from bovine.
- Poractant alfa from porcine.
- Lucinactant from synthetic.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy types;
- Calfactant from bovine
- Beractant from bovine.
- Poractant alfa from porcine.
- Lucinactant from synthetic.
205
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy is Instilled directly into the trachea through a 5 Fr catheter placed into the endotracheal tube.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy is Instilled directly into the trachea through a 5 Fr catheter placed into the endotracheal tube.
206
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy Catheter is removed after each administration.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy Catheter is removed after each administration.
207
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy Infant is manually ventilated for 30 seconds.
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy Infant is manually ventilated for 30 seconds.
208
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy Observe for adverse reactions (pneumothorax, apnea, bradycardia, etc.)
Infant Respiratory Distress Syndrome (IRDS)/Hyaline Membrane Disease (HMD) surfactant replacement therapy Observe for adverse reactions (pneumothorax, apnea, bradycardia, etc.)
209
Congenital Diaphragmatic Hernia Occurs when the diaphragm does not completely form. Causes the abdominal contents to be in direct contact with the thoracic cavity. The majority of cases occur on the left side through the foramen of Bochdalek.
Congenital Diaphragmatic Hernia Occurs when the diaphragm does not completely form. Causes the abdominal contents to be in direct contact with the thoracic cavity. The majority of cases occur on the left side through the foramen of Bochdalek.
210
Congenital Diaphragmatic Hernia appears as Scaphoid abdomen, barrel chest, cyanosis
Congenital Diaphragmatic Hernia appears as Scaphoid abdomen, barrel chest, cyanosis
211
Congenital Diaphragmatic Hernia appears as Respiratory distress at birth, tachypnea, intercostal and substernal
retractions, nasal flaring, expiratory grunting.
Congenital Diaphragmatic Hernia appears as Respiratory distress at birth, tachypnea, intercostal and substernal
retractions, nasal flaring, expiratory grunting.
212
Congenital Diaphragmatic Hernia breath sounds are Absent on affected side, bowel sounds on the affected side.
Congenital Diaphragmatic Hernia breath sounds are Absent on affected side, bowel sounds on the affected side.
213
Congenital Diaphragmatic Hernia heart sounds are Apical heart sounds heard over the unaffected side.
Congenital Diaphragmatic Hernia heart sounds are Apical heart sounds heard over the unaffected side.
214
Congenital Diaphragmatic Hernia Chest X-ray has Fluid and air-filled loops of bowel in the chest, shift of the heart and mediastinum toward unaffected side, atelectasis and complete lung collapse, hypoplastic left lung
Congenital Diaphragmatic Hernia Chest X-ray has Fluid and air-filled loops of bowel in the chest, shift of the heart and mediastinum toward unaffected side, atelectasis and complete lung collapse, hypoplastic left lung
215
Congenital Diaphragmatic Hernia ABG Acute alveolar hyperventilation with hypoxemia
Congenital Diaphragmatic Hernia ABG Acute alveolar hyperventilation with hypoxemia
216
Congenital Diaphragmatic Hernia Immediate oxygen therapy
Congenital Diaphragmatic Hernia Immediate oxygen therapy
217
Congenital Diaphragmatic Hernia Infant must not be manually ventilated with a bag and mask because of the danger of gastric
inflation.
Congenital Diaphragmatic Hernia Infant must not be manually ventilated with a bag and mask because of the danger of gastric
218
Congenital Diaphragmatic Hernia As soon as diagnosis is made, insert an orogastric tube to decrease gas in the bowel.
Congenital Diaphragmatic Hernia As soon as diagnosis is made, insert an orogastric tube to decrease gas in the bowel.
219
Congenital Diaphragmatic Hernia Prompt surgical repair is crucial.
Congenital Diaphragmatic Hernia Prompt surgical repair is crucial.
220
Congenital Diaphragmatic Hernia Use low PIP below 30 cm H20 and rapid respiratory rates.
Congenital Diaphragmatic Hernia Use low PIP below 30 cm H20 and rapid respiratory rates.
221
Congenital Diaphragmatic Hernia Use High frequency ventilation.
Congenital Diaphragmatic Hernia Use High frequency ventilation.
222
term infant
38 - 42 weeks
223
infant heart rate
110-160
224
infant RR
30 - 60
225
infant BP
60/40
226
term infant blood glucose
over 30
227
pediatric asthma early stages dyspnea, cough, increased production of secretions, accessory muscle use, increased respiratory rate, and expiratory wheezing
pediatric asthma early stages dyspnea, cough, increased production of secretions, accessory muscle use, increased respiratory rate, and expiratory wheezing
228
pediatric asthma Young children may complain of a stomach-ache.
pediatric asthma Young children may complain of a stomach-ache.
229
pediatric asthma During an acute episode, arterial blood gases may show hypoxemia with or without hypercarbia and the chest X-ray may show hyperinfilation, flattened diaphragms and infiltrates.
pediatric asthma During an acute episode, arterial blood gases may show hypoxemia with or without hypercarbia and the chest X-ray may show hyperinfilation, flattened diaphragms and infiltrates.
230
pediatric asthma Helpful diagnostic tests;
- Pulmonary function testing (spirometry).
- Exhaled nitric oxide testing (FENO) helpful in monitoring airway inflammation.
- Bronchoprovocation challenges with methacholine or exercise.
pediatric asthma Helpful diagnostic tests;
- Pulmonary function testing (spirometry).
- Exhaled nitric oxide testing (FENO) helpful in monitoring airway inflammation.
- Bronchoprovocation challenges with methacholine or exercise.
231
pediatric asthma control meds;
- LABAS
- Inhaled corticosteroids
- Leukotriene modifiers
- Immunomodulators
pediatric asthma control meds;
- LABAS
- Inhaled corticosteroids
- Leukotriene modifiers
- Immunomodulators
232
pediatric asthma control meds LABAS;
| salmeterol, formoterol., arformoterol.
pediatric asthma control meds LABAS;
| salmeterol, formoterol., arformoterol.
233
pediatric asthma control meds Inhaled corticosteroids: beclomethasone, budesonide, fluticasone.
pediatric asthma control meds Inhaled corticosteroids: beclomethasone, budesonide, fluticasone.
234
pediatric asthma control meds Leukotriene modifiers: montelukast, zileuton.
pediatric asthma control meds Leukotriene modifiers: montelukast, zileuton.
235
pediatric asthma control meds Immunomodulators:
| omalizumab, palivizumab.
pediatric asthma control meds Immunomodulators:
| omalizumab, palivizumab.
236
pediatric asthma Quick-relief (rescue) meds;
- SABA
- Anticholinergics
- Systemic corticosteroids
pediatric asthma Quick-relief (rescue) meds;
- SABA
- Anticholinergics
- Systemic corticosteroids
237
pediatric asthma Quick-relief (rescue) meds SABA; albuterol, levalbuterol.
pediatric asthma Quick-relief (rescue) meds SABA; albuterol, levalbuterol.
238
pediatric asthma Quick-relief (rescue) meds Anticholinergics: ipratropium.
pediatric asthma Quick-relief (rescue) meds Anticholinergics: ipratropium.
239
pediatric asthma Quick-relief (rescue) meds Systemic corticosteroids: prednisone, methylprednisolone.
pediatric asthma Quick-relief (rescue) meds Systemic corticosteroids: prednisone, methylprednisolone.
240
pediatric asthma Emergency room care;
1) Start with oxygen therapy.
2) Inhaled SABA agents: 3 treatments/hour or continuous.
3) Inhaled anticholinergics.
4) Systemic corticosteroids.
pediatric asthma Emergency room care;
1) Start with oxygen therapy.
2) Inhaled SABA agents: 3 treatments/hour or continuous.
3) Inhaled anticholinergics.
4) Systemic corticosteroids.
241
pediatric asthma status asthmaticus;
1) Continuous aerosol bronchodilator.
2) Subcutaneous epinephrine
3) Intravenous steroids.
4) Magnesium sulfate.
5) He/O therapy.
6) Inhaled anesthetics (isoflurane, sevoflurane, halothane).
pediatric asthma status asthmaticus;
1) Continuous aerosol bronchodilator.
2) Subcutaneous epinephrine
3) Intravenous steroids.
4) Magnesium sulfate.
5) He/O therapy.
6) Inhaled anesthetics (isoflurane, sevoflurane, halothane).
242
pediatric asthma status asthmaticus Use low respiratory rate with long expiratory time and Consider permissive hypercapnia.
pediatric asthma status asthmaticus Use low respiratory rate with long expiratory time and Consider permissive hypercapnia.
243
Viral Pneumonia most common type of pneumonia.
Viral Pneumonia most common type of pneumonia.
244
Viral Pneumonia runny nose (coryza), nasal congestion, cough, fever, malaise.
Viral Pneumonia runny nose (coryza), nasal congestion, cough, fever, malaise.
245
Respiratory Syncytial Virus (RSV) - most common cause of viral pneumonia.
Respiratory Syncytial Virus (RSV) - most common cause of viral pneumonia.
246
Respiratory Syncytial Virus (RSV) Occurs most commonly during the winter months (from mid- December through March).
Respiratory Syncytial Virus (RSV) Occurs most commonly during the winter months (from mid- December through March).
247
Respiratory Syncytial Virus (RSV) Chest X-ray reveals hyperinflated lungs with patchy infiltrate and/or atelectasis.
Respiratory Syncytial Virus (RSV) Chest X-ray reveals hyperinflated lungs with patchy infiltrate and/or atelectasis.
248
Respiratory Syncytial Virus (RSV) Diagnosis confirmed by rapid immunofiuorescent detection of RSV antigen in nasal washings.
Respiratory Syncytial Virus (RSV) Diagnosis confirmed by rapid immunofiuorescent detection of RSV antigen in nasal washings.
249
```
Respiratory Syncytial Virus (RSV) Previously treated with aerosolized ribavirin (Virazole®) administered by small particle
aerosol generator (SPAG)..
```
```
Respiratory Syncytial Virus (RSV) Previously treated with aerosolized ribavirin (Virazole®) administered by small particle
aerosol generator (SPAG)..
```
250
RSV is also responsible for the majority of cases of bronchiolitis in young children.
RSV is also responsible for the majority of cases of bronchiolitis in young children.
251
Viral Pneumonia is also caused by;
a) Parainfluenza Virus Types 1,2,3.
b) Influenza Virus.
c) Adenovirus.
d) Enterovirus,
e) Coronavirus.
Viral Pneumonia is also caused by;
a) Parainfluenza Virus Types 1,2,3.
b) Influenza Virus.
c) Adenovirus.
d) Enterovirus,
e) Coronavirus.
252
Bacterial pneumonia has a Higher mortality rate than viral pneumonia.
Bacterial pneumonia has a Higher mortality rate than viral pneumonia.
253
Bacterial pneumonia Risk factors include immunocompromise, aspiration from GERD, malnutrition, day care or school attendance.
Bacterial pneumonia Risk factors include immunocompromise, aspiration from GERD, malnutrition, day care or school attendance.
254
Bacterial pneumonia Signs & symptoms similar to viral pneumonia.
Bacterial pneumonia Signs & symptoms similar to viral pneumonia.
255
Bacterial pneumonia in Neonatal patients is caused by group B streptococcus, Escherichia coli.
Bacterial pneumonia in Neonatal patients is caused by group B streptococcus, Escherichia coli.
256
Bacterial pneumonia in Pediatric patients is caused by Staphylococcus pneumoniae, H infhuenza, S aureus
Bacterial pneumonia in Pediatric patients is caused by Staphylococcus pneumoniae, H infhuenza, S aureus
257
bacterial pneumonia Diagnosis is aided by blood cultures and elevated band count (> 1500 total bands).
bacterial pneumonia Diagnosis is aided by blood cultures and elevated band count (> 1500 total bands).
258
Croup (Laryngotracheobronchitis) is An inflammatory process that causes edema and swelling of the mucous membranes just
below the vocal cords (subglottic area) resulting in airway obstruction.
Croup (Laryngotracheobronchitis) is An inflammatory process that causes edema and swelling of the mucous membranes just
below the vocal cords (subglottic area) resulting in airway obstruction.
259
Croup (Laryngotracheobronchitis) is Primarily a viral infection, most often caused by Parainfluenza viruses or RSV transmitted by aerosol droplets
Croup (Laryngotracheobronchitis) is Primarily a viral infection, most often caused by Parainfluenza viruses or RSV transmitted by aerosol droplets
260
Croup (Laryngotracheobronchitis) is a Recent cold that developed gradually into a barking cough over 2-3 days,
more common in the fall and winter.
Croup (Laryngotracheobronchitis) is a Recent cold that developed gradually into a barking cough over 2-3 days,
more common in the fall and winter.
261
Croup (Laryngotracheobronchitis) shows as barking cough, stridor, hoarse voice.
Croup (Laryngotracheobronchitis) shows as barking cough, stridor, hoarse voice.
262
Croup (Laryngotracheobronchitis) shows as Cyanosis, alert with some accessory muscle use, nasal flaring, rhinorrhea.
Croup (Laryngotracheobronchitis) shows as Cyanosis, alert with some accessory muscle use, nasal flaring, rhinorrhea.
263
Croup (Laryngotracheobronchitis) shows as Tachypnea, substernal and intercostal retractions.
Croup (Laryngotracheobronchitis) shows as Tachypnea, substernal and intercostal retractions.
264
Croup (Laryngotracheobronchitis) breath sounds are Diminished with inspiratory stridor.
Croup (Laryngotracheobronchitis) breath sounds are Diminished with inspiratory stridor.
265
Croup (Laryngotracheobronchitis) shows as Increased HR, BP, low grade fever.
Croup (Laryngotracheobronchitis) shows as Increased HR, BP, low grade fever.
266
Croup (Laryngotracheobronchitis) Lateral Neck X-ray is Haziness in the subglottic area, steeple sign, pencil point, picket fence, hourglass narrowing of the upper airway.
Croup (Laryngotracheobronchitis) Lateral Neck X-ray is Haziness in the subglottic area, steeple sign, pencil point, picket fence, hourglass narrowing of the upper airway.
267
Croup (Laryngotracheobronchitis) ABG is Acute alveolar hyperventilation with hypoxemia.
Croup (Laryngotracheobronchitis) ABG is Acute alveolar hyperventilation with hypoxemia.
268
```
mild Croup (Laryngotracheobronchitis);
cool environment
humidification of inspired air
Oxygen therapy 30-40%
Cool aerosol mist (face mask)
Racemic Epinephrine
Corticosteroids For children who do not respond to cool aerosol and racemic epinephrine therapy.
```
```
mild Croup (Laryngotracheobronchitis);
cool environment
humidification of inspired air
Oxygen therapy 30-40%
Cool aerosol mist (face mask)
Racemic Epinephrine
Corticosteroids For children who do not respond to cool aerosol and racemic epinephrine therapy.
```
269
```
severe Croup (Laryngotracheobronchitis) looks like;
marked inspiratory stridor
Severe stridor at rest.
Diminished breath sounds.
Extreme accessory muscle usage.
```
```
severe Croup (Laryngotracheobronchitis) looks like;
marked inspiratory stridor
Severe stridor at rest.
Diminished breath sounds.
Extreme accessory muscle usage.
```
270
```
severe Croup (Laryngotracheobronchitis);
cool environment
humidification of inspired air
Transfer patient to ICU
Sedate to prevent inadvertent extubation
Place on T-piece or CPAP
extubate when air leak around tube
```
```
severe Croup (Laryngotracheobronchitis);
cool environment
humidification of inspired air
Transfer patient to ICU
Sedate to prevent inadvertent extubation
Place on T-piece or CPAP
extubate when air leak around tube
```
271
Epiglottitis is a Life threatening emergency caused by inflammation of the supraglottic region that includes the epiglottis, aryepiglottic folds, and false vocal cords that causes swelling just above the vocal cord
Epiglottitis is a Life threatening emergency caused by inflammation of the supraglottic region that includes the epiglottis, aryepiglottic folds, and false vocal cords that causes swelling just above the vocal cord
272
Epiglottitis is a Bacterial infection caused by Haemophilus inftuenza B (gram negative bacteria) transmitted by aerosol droplets.
Epiglottitis is a Bacterial infection caused by Haemophilus inftuenza B (gram negative bacteria) transmitted by aerosol droplets.
273
Epiglottitis will have a Sudden onset within 6-8 hours.
Epiglottitis will have a Sudden onset within 6-8 hours.
274
Epiglottitis Muffled cough
Epiglottitis Muffled cough
275
Epiglottitis looks like 2-6 years of age, pale or cyanotic, lifeless, drooling, hoarseness, difficulty swallowing (dysphagia), tongue thrusts forward during inspiration, voice and cry muffled, jaw jutted forward.
Epiglottitis looks like 2-6 years of age, pale or cyanotic, lifeless, drooling, hoarseness, difficulty swallowing (dysphagia), tongue thrusts forward during inspiration, voice and cry muffled, jaw jutted forward.
276
Epiglottitis will have Tachypnea, nasal flaring, substernal and intercostal retractions
Epiglottitis will have Tachypnea, nasal flaring, substernal and intercostal retractions
277
Epiglottitis breath sounds are Diminished with inspiratory stridor.
Epiglottitis breath sounds are Diminished with inspiratory stridor.
278
Epiglottitis will have Increased HR, BP, high grade fever.
Epiglottitis will have Increased HR, BP, high grade fever.
279
Epiglottitis you must Avoid any unnecessary stimulation of the child.
Epiglottitis you must Avoid any unnecessary stimulation of the child.
280
Epiglottitis Lateral Neck X-ray will have Haziness in the supraglottic area (epiglottis), supraglottic swelling (above the
glottis) or "Thumb Sign"
Epiglottitis Lateral Neck X-ray will have Haziness in the supraglottic area (epiglottis), supraglottic swelling (above the
glottis) or "Thumb Sign"
281
Epiglottitis ABG will be Acute alveolar hyperventilation with hypoxemia.
Epiglottitis ABG will be Acute alveolar hyperventilation with hypoxemia.
282
Epiglottitis CBC will have Elevated WBC.
Epiglottitis CBC will have Elevated WBC.
283
Epiglottitis will need Immediate placement of an artificial airway.
Epiglottitis will need Immediate placement of an artificial airway.
284
```
Epiglottitis;
intubate
transfer to ICU
sedate to prevent extubation
Place on T-piece or CPAP.
oxygen
Antibiotics.
extubate when swelling gone
```
```
Epiglottitis;
intubate
transfer to ICU
sedate to prevent extubation
Place on T-piece or CPAP.
oxygen
Antibiotics.
extubate when swelling gone
```
285
bronchiolitis/RSV is an Acute infection of the lower respiratory tract, usually caused by the respiratory syncytial virus (RSV).
bronchiolitis/RSV is an Acute infection of the lower respiratory tract, usually caused by the respiratory syncytial virus (RSV).
286
Bronchiolitis/RSV Results in inflammation and obstruction of the small bronchi & bronchioles and excessive airway secretions.
Bronchiolitis/RSV Results in inflammation and obstruction of the small bronchi & bronchioles and excessive airway secretions.
287
Bronchiolitis/RSV Patients at risk include children less than 1 year of age, children with weakened immune systems, and children with chronic respiratory or cardiac disease.
Bronchiolitis/RSV Patients at risk include children less than 1 year of age, children with weakened immune systems, and children with chronic respiratory or cardiac disease.
288
Bronchiolitis/RSV Upper respiratory infection in young children.
Bronchiolitis/RSV Upper respiratory infection in young children.
289
Bronchiolitis/RSV Nasal discharge, lethargic, nasal flaring, cyanosis
Bronchiolitis/RSV Nasal discharge, lethargic, nasal flaring, cyanosis
290
Bronchiolitis/RSV is an Acute infection of the lower respiratory tract, usually caused by the respiratory syncytial virus (RSV).
Bronchiolitis/RSV is an Acute infection of the lower respiratory tract, usually caused by the respiratory syncytial virus (RSV).
291
Bronchiolitis/RSV Results in inflammation and obstruction of the small bronchi & bronchioles and excessive airway secretions.
Bronchiolitis/RSV Results in inflammation and obstruction of the small bronchi & bronchioles and excessive airway secretions.
292
Bronchiolitis/RSV Patients at risk include children less than 1 year of age, children with weakened immune systems, and children with chronic respiratory or cardiac disease.
Bronchiolitis/RSV Patients at risk include children less than 1 year of age, children with weakened immune systems, and children with chronic respiratory or cardiac disease.
293
Bronchiolitis/RSV Upper respiratory infection in young children.
Bronchiolitis/RSV Upper respiratory infection in young children.
294
Bronchiolitis/RSV looks like Nasal discharge, lethargic, nasal flaring, cyanosis.
Bronchiolitis/RSV looks like Nasal discharge, lethargic, nasal flaring, cyanosis.
295
Bronchiolitis/RSV Tachypnea, apnea in severe cases, grunting, intercostal and substernal retractions, intermittent cough.
Bronchiolitis/RSV Tachypnea, apnea in severe cases, grunting, intercostal and substernal retractions, intermittent cough.
296
Bronchiolitis/RSV breath sounds Wheezes, crackles, upper airway noise from secretions.
Bronchiolitis/RSV breath sounds Wheezes, crackles, upper airway noise from secretions.
297
Bronchiolitis/RSV Hyperresonance in severe cases.
Bronchiolitis/RSV Hyperresonance in severe cases.
298
Bronchiolitis/RSV Chest X-ray will be Hyperinflation with areas of consolidation or atelectasis.
Bronchiolitis/RSV Chest X-ray will be Hyperinflation with areas of consolidation or atelectasis.
299
Bronchiolitis/RSV ABG Acute alveolar hyperventilation with hypoxemia.
Bronchiolitis/RSV ABG Acute alveolar hyperventilation with hypoxemia.
300
Bronchiolitis/RSV pulmonary function test decreased flowrates
Bronchiolitis/RSV pulmonary function test decreased flowrates
301
Bronchiolitis/RSV pulmonary function test decreased flowrates FEV1, FEF%, and FEF
Bronchiolitis/RSV pulmonary function test decreased flowrates FEV1, FEF%, and FEF
302
Bronchiolitis/RSV Detection of RSV antigen in washings from nasopharynx or oropharynx by RSV-enzyme immunoassay (EIA)
Bronchiolitis/RSV Detection of RSV antigen in washings from nasopharynx or oropharynx by RSV-enzyme immunoassay (EIA)
303
Bronchiolitis/RSV Detection of RSV antigen in washings from nasopharynx or oropharynx by Respiratory infectious disease panel (RIDP) by polymerase chain reaction (PCR).
Bronchiolitis/RSV Detection of RSV antigen in washings from nasopharynx or oropharynx by Respiratory infectious disease panel (RIDP) by polymerase chain reaction (PCR).
304
Prophylaxis with respiratory syncytial virus immune globin (RespiGam@) or palivizumab (Synagis®) recommended for children at risk of Bronchiolitis/RSV
Prophylaxis with respiratory syncytial virus immune globin (RespiGam@) or palivizumab (Synagis®) recommended for children at risk of Bronchiolitis/RSV
305
Bronchiolitis/RSV Many children can be treated at home with humidification and oral decongestants.
Bronchiolitis/RSV Many children can be treated at home with humidification and oral decongestants.
306
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Bronchopulmonary Dysplasia (BPD) is a chronic condition that results from treatment of RDS with mechanical ventilation and
high concentrations of oxygen over a prolonged period of time over 28 days
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Bronchopulmonary Dysplasia (BPD) is a chronic condition that results from treatment of RDS with mechanical ventilation and
high concentrations of oxygen over a prolonged period of time over 28 days
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307
Diagnosis of Bronchopulmonary Dysplasia (BPD) is made in newborns who are oxygen dependent and have an abnormal chest X-ray after 28 days of age.
Diagnosis of Bronchopulmonary Dysplasia (BPD) is made in newborns who are oxygen dependent and have an abnormal chest X-ray after 28 days of age.
308
Bronchopulmonary Dysplasia (BPD) shows as Tachypnea, retractions and persistent cyanosis.
Bronchopulmonary Dysplasia (BPD) shows as Tachypnea, retractions and persistent cyanosis.
309
Bronchopulmonary Dysplasia (BPD) Lengthy ventilatory course over 14 days is associated with poor response to therapy.
Bronchopulmonary Dysplasia (BPD) Lengthy ventilatory course over 14 days is associated with poor response to therapy.
310
Bronchopulmonary Dysplasia (BPD) X-ray shows small areas of lucency alternating with areas of irregular densities.
Bronchopulmonary Dysplasia (BPD) X-ray shows small areas of lucency alternating with areas of irregular densities.
311
Bronchopulmonary Dysplasia (BPD) Corticosteroids.
Bronchopulmonary Dysplasia (BPD) Corticosteroids.
312
Bronchopulmonary Dysplasia (BPD) Corticosteroids, Diuretics to reduce lung edema, and Bronchodilators.
Bronchopulmonary Dysplasia (BPD) Corticosteroids, Diuretics to reduce lung edema, and Bronchodilators.
313
DUBOWITZ score is a method of estimating the gestational age of a neonate based on 21 defined clinical signs
DUBOWITZ score is a method of estimating the gestational age of a neonate based on 21 defined clinical signs
314
A score dubowitz score of 40 indicates a gestational age of 40 weeks.
A score dubowitz score of 40 indicates a gestational age of 40 weeks.
315
SILVERMAN-ANDERSON SCORE Evaluates the degree of respiratory distress in neonates. The total score ranges from 0 to 10 with a high score indicating severe respiratory distress.
SILVERMAN-ANDERSON SCORE Evaluates the degree of respiratory distress in neonates. The total score ranges from 0 to 10 with a high score indicating severe respiratory distress.
316
THEOPHYLLINE LEVEL When used to treat neonates with apnea of prematurity, the level should be maintained at 5-10 mcg/mL.
THEOPHYLLINE LEVEL When used to treat neonates with apnea of prematurity, the level should be maintained at 5-10 mcg/mL.
317
Epiglottitis – 4 Ds (drooling, dysphagia, dyspnea, and dysphonia)
Epiglottitis – 4 Ds (drooling, dysphagia, dyspnea, and dysphonia)
318
IRDS diffuse bilateral radiopacity, reticulogranular and reticulonodular
IRDS diffuse bilateral radiopacity, reticulogranular and reticulonodular Pneumonia, air bronchogram, increased density from consolidation, antibiotics
319
Pneumonia, air bronchogram, increased density from consolidation, antibiotics
Pneumonia, air bronchogram, increased density from consolidation, antibiotics
320
4 month cough = bronchitis
4 month cough = bronchitis
321
Croup = fever and stridor
Croup = fever and stridor
322
Stridor – is it epiglottitis or croup?
1. Get a lateral neck x-ray
- Epiglottitis – low grade fever (they will give you a
specific number) – give racemic – if doesn’t work,
give steroids, if doesn’t work intubate
- Croup – racemic fixes
Stridor – is it epiglottitis or croup?
1. Get a lateral neck x-ray
- Epiglottitis – low grade fever (they will give you a
specific number) – give racemic – if doesn’t work,
give steroids, if doesn’t work intubate
- Croup – racemic fixes
323
2 year old RR = 20
2 year old RR = 20
324
Neonate – PDA or IRDS?
IRDS patient is not getting better with oxygen so give
surfactant
Neonate – PDA or IRDS?
IRDS patient is not getting better with oxygen so give
surfactant
325
Newborn PACO2 more than 50 = intubate
Newborn PACO2 more than 50 = intubate
326
First oxyhood THEN CPAP
First oxyhood THEN CPAP
327
Preemie – pre-ductal blood gas for preemie heart issues
Preemie – pre-ductal blood gas for preemie heart issues
328
Baby on vent for weeks = they will have a bronchopulmonary fistula
Baby on vent for weeks = they will have a bronchopulmonary fistula
329
Stridor – cool aerosol
Stridor – cool aerosol
330
Baby temp = choose CBC
Baby temp = choose CBC
331
Infant vent settings = PIP lower than 30
Infant vent settings = PIP lower than 30
332
Baby peripheral cyanosis – oxyhood
Baby peripheral cyanosis – oxyhood
333
Do not get a CBC on a neonate they don’t have much blood
Do not get a CBC on a neonate they don’t have much blood
334
Oxygen fixes TTN (transient tachypnea of the newborn)
Oxygen fixes TTN (transient tachypnea of the newborn)
335
Neonate PDA – confirm with echocardiogram
Neonate PDA – confirm with echocardiogram
336
Grab an x-ray for neonate – IRDS and just intubated
Grab an x-ray for neonate – IRDS and just intubated
337
Preemie = get new ballard scale
- IRDS – in oxyhood with low SPO2
- CBG – only look at PaCO2
Preemie = get new ballard scale
- IRDS – in oxyhood with low SPO2
- CBG – only look at PaCO2
338
2 year old = 20 RR
2 year old = 20 RR
339
Preemie : pre-ductal blood gas: for preemie heart issues
Preemie : pre-ductal blood gas: for preemie heart issues
340
Reticulogranular infiltrates = ARDS
Reticulogranular infiltrates = ARDS
341
Baby on vent for weeks = they will have a bronchopulmonary fistula
Baby on vent for weeks = they will have a bronchopulmonary fistula
342
Stridor = cool aerosol
Stridor = cool aerosol
343
Baby temp = choose CBC
Baby temp = choose CBC
344
A 2-year-old child recently diagnosed with laryngotracheobronchitis requires the administration of 40% oxygen. the most appropriate method for delivering the oxygen is Cool aerosol mask
A 2-year-old child recently diagnosed with laryngotracheobronchitis requires the administration of 40% oxygen. the most appropriate method for delivering the oxygen is Cool aerosol mask
345
A 2100 g neonate in the NICU is monitored with a TcPO2 monitor. The TcPO2 reads 53 torr with the temperature set at 40oC. The arterial PO2 is 73 torr. The TcPO2 temperature setting being too low explains the difference in TcPO2 levels.
A 2100 g neonate in the NICU is monitored with a TcPO2 monitor. The TcPO2 reads 53 torr with the temperature set at 40oC. The arterial PO2 is 73 torr. The TcPO2 temperature setting being too low explains the difference in TcPO2 levels.
346
Croup patient ready for extubation when Breath sounds are heard around the tube on auscultation.
Croup patient ready for extubation when Breath sounds are heard around the tube on auscultation.
347
Initial vent settings infant
- 20 30 PIP
- 20 30 RR
- 5 6 PF
- 5 6 ITime
Initial vent settings infant
- 20 30 PIP
- 20 30 RR
- 5 6 PF
- 5 6 ITime
348
APGAR 3,2,1,0 positive pressure
APGAR 3,2,1,0 positive pressure
349
Preemie : pre-ductal blood gas: for preemie heart issues
Preemie : pre-ductal blood gas: for preemie heart issues
350
Neonate – PDA or IRDS
| - IRDS patient is not getting better with oxygen so need to give surfactant
Neonate – PDA or IRDS
| - IRDS patient is not getting better with oxygen so need to give surfactant
351
First oxyhood, then CPAP
First oxyhood, then CPAP
352
Newborn PaCO2 more than 50 intubate
Newborn PaCO2 more than 50 intubate
353
NBRC stabilize patient and THEN transfer them
NBRC stabilize patient and THEN transfer them
354
Baby born 39 weeks with complications has TTN
Baby born 39 weeks with complications has TTN
355
Gravita = pregnancies
Gravita = pregnancies
356
Para = births (if have lost baby then this is a complicated birth)
Para = births (if have lost baby then this is a complicated birth)
357
Epiglottitis = fever, difficulty swallowing and mod. Stridor put them on a non-rebreather and or intubate, racemic will not help
Epiglottitis = fever, difficulty swallowing and mod. Stridor put them on a non-rebreather and or intubate, racemic will not help
358
Fever and stridor = croup
Fever and stridor = croup
359
APGAR scores for a baby born a few hours ago are what their scores were when they were born good ot see for IRDS etc
APGAR scores for a baby born a few hours ago are what their scores were when they were born good ot see for IRDS etc
360
Infant vent settings – PIP lower than 30
Infant vent settings – PIP lower than 30
361
Caffeine citrate is used to treat apneic conditions and indicates the need for homeapnea monitoring.
Caffeine citrate is used to treat apneic conditions and indicates the need for homeapnea monitoring.
362
Though there is evidence of auto-PEEP in the flow-time graphic, the patient's normal pH and stable hemodynamics indicate no intervention is currently needed.
Though there is evidence of auto-PEEP in the flow-time graphic, the patient's normal pH and stable hemodynamics indicate no intervention is currently needed.
363
A premature neonate with RDS receives the first dose of surfactant replacement therapy. Two hours later, the neonate's FIO2 requirement has increased from 0.35 to 0.70. Which of
the following should a respiratory therapist recommend FIRST? Get an x-ray
A premature neonate with RDS receives the first dose of surfactant replacement therapy. Two hours later, the neonate's FIO2 requirement has increased from 0.35 to 0.70. Which of
the following should a respiratory therapist recommend FIRST? Get an x-ray
364
The correct negative pressure to use when suctioning the airway of a child is -80 to-100 mm Hg.
The correct negative pressure to use when suctioning the airway of a child is -80 to-100 mm Hg.
365
A 3 year old is receiving VC ventilation. A respiratory therapist is preparing to administer aerosolized dornase alfa (Pulmozyme) in-line with the ventilator. Which of the following devices should the therapist select to administer the therapy? Vibrating mesh nebulizer
A 3 year old is receiving VC ventilation. A respiratory therapist is preparing to administer aerosolized dornase alfa (Pulmozyme) in-line with the ventilator. Which of the following devices should the therapist select to administer the therapy? Vibrating mesh nebulizer
366
Croup – severe suprasternal, subcostal, and substernal retractions are observed. Harsh barking cough, and stridor
Croup – severe suprasternal, subcostal, and substernal retractions are observed. Harsh barking cough, and stridor
367
Macroglossia is a disorder in which the tongue is larger than normal
Macroglossia is a disorder in which the tongue is larger than normal
