Patient Assessment Flashcards
What are the 4 Life Functions?
Ventilation, Oxygenation, Circulation, Perfusion
What is Gravida (G)?
Any pregnancy regardless of duration. Measuring how many times mom was pregnant
What is Para (P)?
Birth after 20 weeks regardless of whether infant is viable
What is LGA/SGA/NGA?
Large for Gestational Age
Small for Gestational Age
Normal for Gestational Age
What are some Tx used in maternal Hypertension?
Bed rest
Diet
antihypertensive meds
Magnesium sulfate is used for what purpose?
Lower blood pressure and delay preterm delivery
How can we estimate gestational age of a baby in the womb?
Fetal Ultrasound Biophysical Profile (BPP)
What is amniocentesis? And why do we do it?
A procedure where a needle is used to extract amniotic fluid.
Gives us L/S ratio and help us determine lung development
What is Amniotic Fluid Index (AFI)?
Used to quantify amniotic fluid volume, obtained by ultrasound as they measure the largest pocket of fluid in uterine quadrants
What is a Normal AFI?
Normal = 8-18
An AFI of <5-6 is considered what? And what can this lead to?
Oligohydramnios or a reduced amount of amniotic fluid (usually resulting in IUGR, poor lung development, prematurity
Can lead to, Potters syndrome
An AFI of >20-24 is considered what? and what can it lead to?
Polyhydramnios or excessive amount of amniotic fluid
Can lead to T-E fistulas and esophageal atresia
What is a Normal L/S ratio? What should be considered if it is Low?
2:1 is normal but 3:1/4:1 is also okay
If Low, consider surfactant
How can you test lung maturity of a baby more accurately in a diabetic mother?
Phosphatidylglycerol (PG) Test
What are some other ways to test for lung development and presents of surfactant?
Surfactant/Albumin (S/A) Ration = needs 1ml sample, Less expensive than L/S ratio, Normal is 55mg/g
Shake Test = Mix amniotic fluid and 95% ethanol and shake if solution foams/bubbles surfactant is present
What is a Coombs Test?
Evaluates blood type incompatibility
Most commonly used medications to inhibit uterine contractions by relaxing smooth muscle?
Terbutaline and Magnesium Sulfate
What is the range for a normal fetal heart rate (FHR)?
Normal = 110-160/min
What is early deceleration or Type I when talking about a FHR?
During a uterine contraction, FHR slows down to near or below 110. This is a normal response due to head compression
What is Late deceleration or Type II?
FHR begins to slow down after the start of a contraction and persist after it has ended
Tx = Administer Oxygen to Mother
What is Variable deceleration or Type III?
FHR decelerates independently from uterine contractions, This is a high-risk delivery
Corticosteroids may be administered to mom before baby is born for what reason?
To stimulate surfactant production
What are 2 postnatal methods to estimate gestational age?
Dubowitz method = for infants greater than 28 weeks
New Ballard score = for infants less than 28 weeks
What does APGAR stand for? and what is a good APGAR score?
A = Appearance (color) P = Pulse G = Grimice (Reflex) A = Activity (Muscle tone) R = Respiratory Effort
A score of 7 or higher is considered good.
What is the Silverman Anderson Scoring?
Like the APGAR score it is used to evalute neonates in Respiratory distress but only looking at how baby is breathing, however the higher the score the worse the baby is doing.
Why do we use Pre and Post ductal blood gases?
To identify the presence of a Right-to-Left cardiac shunt. If the Pre-ductal PaO2 is 15 torr higher than Post-Ductal PaO2 you have a Right-to-Left shunt.
{ You can also used two pluse oximeters and if there is a difference of 10% + then you have Right-to-Left shunting }
What causes a Right-to-Left shunt?
Congenital Heart Defect
Patent ductus arteriosus (PDA)
Persistent Pulmonary hypertension of the newborn (PPHN)
What test can help in determining if the Right-to-Left shunt is caused by the Lungs or the Heart?
Oxygen challeng Test
PaO2 is evaluated on room air and after adminstration of 100% O2 for 10 mins
Minimal or no increase in PaO2 indicates right-to-left shunting caused from the heart and not the lungs.
What is a normal body temp for babies?
36-37 degrees celcius
What can happen to a baby if it becomes hypothermic?
Increased Oxygen consumption
Apnea
Bradycardia
What is a Normal Na+ (Sodium)?
133-149 mmol/L
What is a normal Cl- (Chloride)?
87-114 mmol/L
What is a normal K+ (Potassium)?
5.3-6.4 mmol/L
What is a normal HCO3- (Bicarbonate)?
19-24 mmol/L
What is a normal BUN?
4-17 mg/dl
What is a normal Creatinine?
0.11-0.68 g/24hr
What is a normal urine output of a baby?
1ml/kg/hr
What is a normal range for RBC?
4.1-5.7 mm
What is a normal rage for Hemoglobin?
12.7-18.6 g/dl
What is a normal Hematocrit?
43-63%
What are 2 types of abnormal hemoglobins?
Hemoglobin S = present in Sickle cell disease
Hemoglobin C = does not carry oxygen well
What is a normal range for a WBC?
10,000 - 30,000 mm
Normal range of Blood Glucose in a baby
50-100 mg/dl
What is a normal Albumin/Globulin Ratio? And what should you be worried about if it is reduced or elevated?
Normal = 0.8 - 2.0
If Elevated or Reduced, this can lead to Renal failure and Liver disease
What do these colors of sputum indicate? Clear Mucoid Yellow Green
Clear = Normal Mucoid = white/gray (normal) Yellow = Presence of WBC, infection, Gram + Green = Infection, Gram -
What do these colors of sputum indicate?
Brown/Dark
Bright Red
Pink frothy
Brown/Dark = Old blood
Bright red = hemoptysis, active bleeding
Pink frothy = pulmonary edema
Why would an infant have the appearance of Mottling?
This may result from chilling or prolonged apnea
What is a Normal Respiratory rate of an infant?
30-60 breath/min
Respiratory distress that decreases during crying may indicate what?
Choanal atresia
What is Transillumination and when is it used?
Placing a bright light against the babies chest. Usually used to rule out pneumothorax.
If you place the light on the chest and that hemithorax lights up, this indicates a pneumothorax.
If you have a decreased or no light passing through. this indicatess diaphragmatic hernia, or consolidation
What is Omphalocele?
intestines are protruding from the stomach but contained in a sac.
Needs surgical intervention
What is Gastroschisis?
Intestines are protruding from the stomach that are not contained in a sac.
What is Myelodysplasia?
A condition where the cerebrospinal fluid is protruding from the spine. Also called spina bifida
Keep baby on there stomach
What is DiGeorge’s Syndrome?
Condenital defect on chromosome 22
characterized by: low set ears, small mouth, wide set and downward slanting eyes
What is Potter Syndrome?
An atypical physical appearance of a neonate caused by lack of amniotic fluid which disrupted babies development.
What is a normal pulse for a baby?
120-170/min
What should you suspect if you hear a bounding pulse in an infant?
PDA
A-V Fistula
Tetralogy of Fallot
What is Pulsus Alternans?
When the pulse is alternating between a weak and strong beat
This may indicate myocardial failure
What is it called when a pulse is weaker on inspiration and stronger on exhalation?
Pulsus paradoxus or paradoxical pluse
This indicates and emergency like cardiac tamponade, pericardial effusion, severe RDS, Tension pneumothorax
What causes tracheal deviation toward the affected side?
Pulmonary atelectasis
What causes tracial deviation away from the affected side?
Tension pneumothorax
Large mediastinal mass
When percussing the chest, you hear a hyper resonance sound. What does that mean?
This means air trapping or pneumothorax. There is more air then there should be
When percussing the chest, you hear a dull or Flat sound. What does that mean?
This mean consolidation or having more fluid or tissue in a area then should be there
When Auscultating the chest you hear crackles, what does this mean?
lungs are filled with secreations/fluid
Fine crackles = indicate fluid in the alveoli, (plumonary edema)
When Auscultating the chest you hear Wheezing, what does this mean?
Airway diameter is narrowed i.e. Bronchospasm, airway edema, foreign body, asthma, BPD
Tx = bronchodilators
Unilateral wheezing may indicate what?
Foreign body aspiration
What is normal blood pressure for a baby?
they base it of the weight of the baby
2000 g = 50/30
Good rule => Mean arterial pressure should be greater than gestational age
What is a Glasgow Coma Scale (GCS)?
This scale measures the responsiveness of the pt. in a coma
The higher the number the better the score
Difficulty breathing except in the upright position is called what?
Orthopnea (this usually associated with cardiac problems)
What is general malaise and what is it associated with?
This is a general run down feeling, nausea, weakness. And it is associated with an electrolyte imbalance
What is the sweat test?
This test is used to dx cystic fibrosis.
If you have a value of >60mmol/L this mean you are confirmed to have CF
A redness of the skin is called
Erythema
Cheyne-Stokes breathing pattern is usually associated with
Increased ICP
drug overdose
Biot’s breathing pattern is associated with what
CNS problems
Kussmaul’s breathing pattern is usually associated with what
metabolic acidosis
renal failure
diabetic ketoacidosis
What is tactile fremitus and what does an increased or decreased finding mean?
Tactile fremitus = vibrations felt by touch on the chest
Increased = consolidation/Pneumonia
Decreased = Pleural effusion
When would you get a lateral decubitus film?
When you are trying to rule out a pleural effusion
When would you get a Lateral Neck film?
When trying to dx croup or epiglottitis
