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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
Q

Meconium Aspiration: the risk of aspiration is greatest in the presence of ___ or ____

A

Hypoxia or stress

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26
Q

Meconium Aspiration: clinical signs

A

Low apgar, gasping respirations
Grunting, recreations, Tachypnea, cyanosis, nasal flaring
PPHN

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27
Q

Meconium Aspiration: CXR

A

Bilateral patchy densities with widespread atelactasis, air trapping/hyperinflation

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28
Q

Meconium Aspiration: ABG

A

Hypoxemia, mixed acidosis

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29
Q

Meconium Aspiration: measures to prevent aspiration?

A

Suction all meconium before initiating PPV

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30
Q

Meconium Aspiration: how to treat a newborn if meconium is present and baby is vigorous?

A

Clear mouth first then nose

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31
Q

Meconium Aspiration: what to do if baby is not vigorous?

A

Move to radiant warmer
PPV (HR <100, apnea)
Routine intubation for suctioning not recommended

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32
Q

Meconium Aspiration: Provide oxygen to maintain SpO2 between ________ or PaO2 _______

A

92-97%
60-80

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33
Q

Meconium Aspiration: when should vent support be intitiated?

A

After airway is clear/indicated

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34
Q

Meconium Aspiration: other therapies

A

HFOV
INO if PPHN develops
ECMO
Percussion/drainage

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35
Q

Congenital diaphragmatic hernia (CDH): anatomical changes

A

Absence/incomplete development of one of the hemidiaphragms, abdominal organs in thorax

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36
Q

Congenital diaphragmatic hernia (CDH): 85-90 % on the ____ side through the ___

A

Left
Foramen of bochdalek

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37
Q

Congenital diaphragmatic hernia (CDH): mediastinal shift

A

Away from affected area

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38
Q

Congenital diaphragmatic hernia (CDH): abdomen

A

Scaphoid

39
Q

Congenital diaphragmatic hernia (CDH): CXR

A

Loops of bowel in thoracic area

40
Q

Congenital diaphragmatic hernia (CDH): feeding tube

A

Goes into the stomach then loops back up above the diaphragm

41
Q

Congenital diaphragmatic hernia (CDH): why is OG inserted?

A

Decompress stomach

42
Q

Congenital diaphragmatic hernia (CDH): why to avoid bag mask ventilation

A

Gastric dissension

43
Q

Congenital diaphragmatic hernia (CDH): newborn should be intubated and ventilated using

A

Low airway pressures

44
Q

Congenital diaphragmatic hernia (CDH): definitive treatment

A

Surgery

45
Q

Congenital diaphragmatic hernia (CDH): post-op issues

A

Ventilatory failure
PPHN ruptured hypoplastic L heart

46
Q

Retinopathy of Prematurity: the effect of oxygen on the retinal vessels is dependent on the

A

Length of exposure
Concentration (FiO20
PaO2 and SaO2

47
Q

Retinopathy of Prematurity: PaO2 and SaO2 levels

A

50-80
88-95%

48
Q

Retinopathy of Prematurity: vitamin _

A

E

49
Q

Retinopathy of Prematurity: _______ surgery

A

Cryotherapy/laser

50
Q

Retinopathy of Prematurity: use __________ to maintain acceptable oxygenation at lower FiO2

A

PEEP/CPAP

51
Q

Bronchopulmonary dysplasia (BPD): definition

A

Baby copders, chronic, result of tx from IRDS, MV with high FiO2 for >28 days

52
Q

Bronchopulmonary dysplasia (BPD): diagnosis

A

Oxygen dependent infants, abnormal CXR after 28 days

53
Q

Bronchopulmonary dysplasia (BPD): clinical presentation/dx

A

Tachypnea, retractions, cyanosis
Lengthy vent course

54
Q

Bronchopulmonary dysplasia (BPD): CXR

A

Small areas of lucency alternating with areas of irregular densities

55
Q

Bronchopulmonary dysplasia (BPD): how to prevent development

A

Lung protection strategies
Low FiO2
Nutrition
Corticosteroids

56
Q

Bronchopulmonary dysplasia (BPD): treatment

A

Supplemental low flow oxygen
Fluids
Diuretics
BP hygiene
Bronchodilators

57
Q

Neonatal pneumonia: how is it typically acquired?

A

Virus, bacteria, fungus

58
Q

Neonatal pneumonia: what causes late-onset?

A

Staph
Pseuodomonas

59
Q

Neonatal pneumonia: what causes early-onset?

A

Group B strep
E. coli
‘Klebsiella

60
Q

Neonatal pneumonia: CXR

A

Resembles IRDS with fluffy infiltrates

61
Q

Neonatal pneumonia: RD with periods of

A

Grunting
Apnea
Dyspnea
Pallor
Cyanosis

62
Q

Neonatal pneumonia: problems with

A

Thermal instability

63
Q

Neonatal pneumonia: ABG

A

Hypoxemia
Metabolic acidosis

64
Q

Neonatal pneumonia: treatment

A

Prevention strategies
Oxygen/aerosol
Airway clearance
CPAP
Antibiotics

65
Q

Pierre-Robin syndrome: congenital abnormality characterized by

A

Glossoptosis
Micrognathia
Cleft palate

66
Q

Pierre-Robin syndrome: what causes airway obstruction

A

Tongue large in comparison to jaw

67
Q

Pierre-Robin syndrome: what causes problems with feeding?

A

Pulls tongue up into cleft palate, obstruction oropharynx

68
Q

Pierre-Robin syndrome: clinical presentation/diagnosis

A

Symptoms vary with extent of anomoly
Severe obstruction: retractions
Choking/gagging during feeding,hyperextends neck
Cyanosis

69
Q

Pierre-Robin syndrome: treatment/mgmt

A

Nasal airway
Prone
Towel rolls under shoulders and forehead
NG/OG
Difficult airway
Surgery
Trach

70
Q

Esophageal atresia with TE Fistula: anatomical changes with esophageal atresia

A

Fails to fully develop, leaves pouch at end of laryngopharynx

71
Q

Esophageal atresia with TE Fistula: the TE fistula

A

Provides communication between esophagus and trachea

72
Q

Esophageal atresia with TE Fistula: infants may have episodes of coughing and choking during

A

Feedings

73
Q

Esophageal atresia with TE Fistula: diagnosis is often made when the nurse is unable to insert a

A

NG tube

74
Q

Esophageal atresia with TE Fistula: CXR

A

Coiled tube in abdomen

75
Q

Esophageal atresia with TE Fistula: place infant in ________ position to reduce risk of reflux and aspiration

A

Reverse trendelenburg

76
Q

Esophageal atresia with TE Fistula: how to keep esophageal pouch empty?

A

Replogle tube

77
Q

Esophageal atresia with TE Fistula: describe replogle tube

A

Double lumen, radio-opaque tube, gives continuous suction to pouch

78
Q

Most common use of replogle tube

A

Esophageal atresia babies

79
Q

Pulmonary interstitial emphysema (PIE): cause

A

Complication of MV, air found in connective tissue outside normal airways

80
Q

Pulmonary interstitial emphysema (PIE): clinical presentation/dx

A

RD
Hypoxia
Increased PVR (can result in R-L shunt)
Air trapping

81
Q

Pulmonary interstitial emphysema (PIE): CXR

A

Irregular bubbles in hilar area, radiating outward, linear lucencies and streaks

82
Q

Pulmonary interstitial emphysema (PIE): best treatment

A

Prevention

83
Q

Pulmonary interstitial emphysema (PIE): keep PIP less than

A

30

84
Q

Pulmonary interstitial emphysema (PIE): administer 100% oxygen for ___________ to facilitate ____________ __ ___

A

10-15 minute intervals, reabsorption of air

85
Q

Pulmonary interstitial emphysema (PIE): in life-threatening situations

A

Lobectomy

86
Q

Pulmonary interstitial emphysema (PIE): _________ ventilation

A

High frequency

87
Q

Pneumothorax: blood pressure

A

Low

88
Q

Pneumothorax: transillumination results

A

Increased light transmission on affected side

89
Q

Pneumothorax: where should needle aspiration be performed?

A

Second or third intercostal space anteriorly
Fourth or fifth intercostal midaxillary

90
Q

Pneumothorax: 100% for _________ hours for infants with no underlying Lund disease/stable

A

6-12 hours

91
Q

Necrotizing Enterocolitis (NEC): describe

A

Acute inflammatory bowel disorder, ischemic necrosis of GI mucosa leading to perforation or peritonitis

92
Q

Necrotizing Enterocolitis (NEC): what activity potentially precipitates the condition?

A

Initiation of enteral feedings

93
Q

Necrotizing Enterocolitis (NEC): CXR

A

Distended loops of bowel

94
Q

Necrotizing Enterocolitis (NEC): treatment

A

Avoid oral feedings
IV hydration
NG to decompress
Blood-replacement
Broad-spectrum antibiotics
Surgery

NPS Kettering Workbook (8 decks)

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