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NPS Kettering Workbook > Pathology: Neonatal Diseases > Flashcards

Pathology: Neonatal Diseases Flashcards

1
Q

PPHN: presentation/dx

A

R-L shunt
Hypoxemia: PaO2 < 45 on 100%
Mild lung disease

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2
Q

PPHN: tx/mgmt
All therapies are meant to

A

Increase oxygenation
Decrease PVR
Increase pulmonary blood flow
Reverse R-L shunt

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3
Q

PPHN: tx/mgmt
Effect of hyperoxygenation on PVR? Shunt?

A

Decreases

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4
Q

PPHN: tx/mgmt
What is the effect of mild hyperventilation on PVR?

A

Decreases

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5
Q

PPHN: tx/mgmt
Examples of pulmonary vasodilators

A

INO (OI>25)
Mag sulfate
Sildenafil
Epoprostenol (Prost)

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6
Q

ECMO is indicated for OI> ____ with no response to _____

A

40, iNO

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7
Q

IRDS definition

A

Reduction in lung compliance and lung volume related to a lack of surfactant

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8
Q

IRDS: clinical presentation/dx
____ infant with ___ APGAR scores

A

Premature, low

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9
Q

IRDS: clinical presentation/dx
Higher incidence in

A

Maternal diabetics
Multiple births
C-section
Fetal asphyxia

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10
Q

IRDS: clinical presentation/dx
Clinical signs

A

Nasal flaring, grunting, retractions
Tachypnea
Cyanosis
Refractory hypoxemia

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11
Q

IRDS: clinical presentation/dx
CXR

A

Reticulogranular infiltrates, ground glass, honeycomb

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12
Q

IRDS: clinical presentation/dx
Appearance of volume/pressure curve

A

S-shaped with open loop

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13
Q

Complications of exogenous surfactant therapy in IRDS

A

Obstruction
Hypoxemia
Single lung delivery
Volutrauma

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14
Q

IRDS: treating hypoxemia with oxygen and CPAP

A

PaO2: 50-80
Initiate CPAP at 4-6 when SpO2 is <85% on 40-70% FiO2

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15
Q

When is MV and PEEP indicated for newborns with RDS

A

PH <7.2
PaCO2 >60
SpO2 <85% on CPAP w FiO2 40-70%

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16
Q

Transient Tachypnea of Newborn (TTN): may follow ______ pregnancy and delivery of _______________ infant

A

Uneventful, full-term

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17
Q

Transient Tachypnea of Newborn (TTN): more common in infants born by _______ without labor

A

C-section

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18
Q

Transient Tachypnea of Newborn (TTN): infant does well initially and then symptoms begin __ to __ hours and usually only lasts __ hours

A

12-24
24

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19
Q

Transient Tachypnea of Newborn (TTN): may be related to

A

Delayed absorption of fetal lung fluid

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20
Q

Transient Tachypnea of Newborn (TTN): apgar scores are ___ at birth

A

High

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21
Q

Transient Tachypnea of Newborn (TTN): signs of RD

A

Mild/moderate retractions
Tachypnea
Cyanosis
Grunting
Nasal flaring

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22
Q

Transient Tachypnea of Newborn (TTN): ABG

A

Mild/moderate hypoxemia
Hypercapnia
Respiratory acidosis

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23
Q

Transient Tachypnea of Newborn (TTN): CXR

A

Pulmonary congestion, increased vascular markings

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24
Q

Transient Tachypnea of Newborn (TTN): tx/mgmt

A

Self-limiting
Supplemental oxygen via oxyhood
CPAP
Delay oral feedings if rr >60

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25
Meconium Aspiration: the risk of aspiration is greatest in the presence of ___ or ____
Hypoxia or stress
26
Meconium Aspiration: clinical signs
Low apgar, gasping respirations Grunting, recreations, Tachypnea, cyanosis, nasal flaring PPHN
27
Meconium Aspiration: CXR
Bilateral patchy densities with widespread atelactasis, air trapping/hyperinflation
28
Meconium Aspiration: ABG
Hypoxemia, mixed acidosis
29
Meconium Aspiration: measures to prevent aspiration?
Suction all meconium before initiating PPV
30
Meconium Aspiration: how to treat a newborn if meconium is present and baby is vigorous?
Clear mouth first then nose
31
Meconium Aspiration: what to do if baby is not vigorous?
Move to radiant warmer PPV (HR <100, apnea) Routine intubation for suctioning not recommended
32
Meconium Aspiration: Provide oxygen to maintain SpO2 between ________ or PaO2 _______
92-97% 60-80
33
Meconium Aspiration: when should vent support be intitiated?
After airway is clear/indicated
34
Meconium Aspiration: other therapies
HFOV INO if PPHN develops ECMO Percussion/drainage
35
Congenital diaphragmatic hernia (CDH): anatomical changes
Absence/incomplete development of one of the hemidiaphragms, abdominal organs in thorax
36
Congenital diaphragmatic hernia (CDH): 85-90 % on the ____ side through the ___
Left Foramen of bochdalek
37
Congenital diaphragmatic hernia (CDH): mediastinal shift
Away from affected area
38
Congenital diaphragmatic hernia (CDH): abdomen
Scaphoid
39
Congenital diaphragmatic hernia (CDH): CXR
Loops of bowel in thoracic area
40
Congenital diaphragmatic hernia (CDH): feeding tube
Goes into the stomach then loops back up above the diaphragm
41
Congenital diaphragmatic hernia (CDH): why is OG inserted?
Decompress stomach
42
Congenital diaphragmatic hernia (CDH): why to avoid bag mask ventilation
Gastric dissension
43
Congenital diaphragmatic hernia (CDH): newborn should be intubated and ventilated using
Low airway pressures
44
Congenital diaphragmatic hernia (CDH): definitive treatment
Surgery
45
Congenital diaphragmatic hernia (CDH): post-op issues
Ventilatory failure PPHN ruptured hypoplastic L heart
46
Retinopathy of Prematurity: the effect of oxygen on the retinal vessels is dependent on the
Length of exposure Concentration (FiO20 PaO2 and SaO2
47
Retinopathy of Prematurity: PaO2 and SaO2 levels
50-80 88-95%
48
Retinopathy of Prematurity: vitamin _
E
49
Retinopathy of Prematurity: _______ surgery
Cryotherapy/laser
50
Retinopathy of Prematurity: use __________ to maintain acceptable oxygenation at lower FiO2
PEEP/CPAP
51
Bronchopulmonary dysplasia (BPD): definition
Baby copders, chronic, result of tx from IRDS, MV with high FiO2 for >28 days
52
Bronchopulmonary dysplasia (BPD): diagnosis
Oxygen dependent infants, abnormal CXR after 28 days
53
Bronchopulmonary dysplasia (BPD): clinical presentation/dx
Tachypnea, retractions, cyanosis Lengthy vent course
54
Bronchopulmonary dysplasia (BPD): CXR
Small areas of lucency alternating with areas of irregular densities
55
Bronchopulmonary dysplasia (BPD): how to prevent development
Lung protection strategies Low FiO2 Nutrition Corticosteroids
56
Bronchopulmonary dysplasia (BPD): treatment
Supplemental low flow oxygen Fluids Diuretics BP hygiene Bronchodilators
57
Neonatal pneumonia: how is it typically acquired?
Virus, bacteria, fungus
58
Neonatal pneumonia: what causes late-onset?
Staph Pseuodomonas
59
Neonatal pneumonia: what causes early-onset?
Group B strep E. coli ‘Klebsiella
60
Neonatal pneumonia: CXR
Resembles IRDS with fluffy infiltrates
61
Neonatal pneumonia: RD with periods of
Grunting Apnea Dyspnea Pallor Cyanosis
62
Neonatal pneumonia: problems with
Thermal instability
63
Neonatal pneumonia: ABG
Hypoxemia Metabolic acidosis
64
Neonatal pneumonia: treatment
Prevention strategies Oxygen/aerosol Airway clearance CPAP Antibiotics
65
Pierre-Robin syndrome: congenital abnormality characterized by
Glossoptosis Micrognathia Cleft palate
66
Pierre-Robin syndrome: what causes airway obstruction
Tongue large in comparison to jaw
67
Pierre-Robin syndrome: what causes problems with feeding?
Pulls tongue up into cleft palate, obstruction oropharynx
68
Pierre-Robin syndrome: clinical presentation/diagnosis
Symptoms vary with extent of anomoly Severe obstruction: retractions Choking/gagging during feeding,hyperextends neck Cyanosis
69
Pierre-Robin syndrome: treatment/mgmt
Nasal airway Prone Towel rolls under shoulders and forehead NG/OG Difficult airway Surgery Trach
70
Esophageal atresia with TE Fistula: anatomical changes with esophageal atresia
Fails to fully develop, leaves pouch at end of laryngopharynx
71
Esophageal atresia with TE Fistula: the TE fistula
Provides communication between esophagus and trachea
72
Esophageal atresia with TE Fistula: infants may have episodes of coughing and choking during
Feedings
73
Esophageal atresia with TE Fistula: diagnosis is often made when the nurse is unable to insert a
NG tube
74
Esophageal atresia with TE Fistula: CXR
Coiled tube in abdomen
75
Esophageal atresia with TE Fistula: place infant in ________ position to reduce risk of reflux and aspiration
Reverse trendelenburg
76
Esophageal atresia with TE Fistula: how to keep esophageal pouch empty?
Replogle tube
77
Esophageal atresia with TE Fistula: describe replogle tube
Double lumen, radio-opaque tube, gives continuous suction to pouch
78
Most common use of replogle tube
Esophageal atresia babies
79
Pulmonary interstitial emphysema (PIE): cause
Complication of MV, air found in connective tissue outside normal airways
80
Pulmonary interstitial emphysema (PIE): clinical presentation/dx
RD Hypoxia Increased PVR (can result in R-L shunt) Air trapping
81
Pulmonary interstitial emphysema (PIE): CXR
Irregular bubbles in hilar area, radiating outward, linear lucencies and streaks
82
Pulmonary interstitial emphysema (PIE): best treatment
Prevention
83
Pulmonary interstitial emphysema (PIE): keep PIP less than
30
84
Pulmonary interstitial emphysema (PIE): administer 100% oxygen for ___________ to facilitate ____________ __ ___
10-15 minute intervals, reabsorption of air
85
Pulmonary interstitial emphysema (PIE): in life-threatening situations
Lobectomy
86
Pulmonary interstitial emphysema (PIE): _________ ventilation
High frequency
87
Pneumothorax: blood pressure
Low
88
Pneumothorax: transillumination results
Increased light transmission on affected side
89
Pneumothorax: where should needle aspiration be performed?
Second or third intercostal space anteriorly Fourth or fifth intercostal midaxillary
90
Pneumothorax: 100% for _________ hours for infants with no underlying Lund disease/stable
6-12 hours
91
Necrotizing Enterocolitis (NEC): describe
Acute inflammatory bowel disorder, ischemic necrosis of GI mucosa leading to perforation or peritonitis
92
Necrotizing Enterocolitis (NEC): what activity potentially precipitates the condition?
Initiation of enteral feedings
93
Necrotizing Enterocolitis (NEC): CXR
Distended loops of bowel
94
Necrotizing Enterocolitis (NEC): treatment
Avoid oral feedings IV hydration NG to decompress Blood-replacement Broad-spectrum antibiotics Surgery

NPS Kettering Workbook (8 decks)

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