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NPS Kettering Workbook > Patient Assessment > Flashcards

Patient Assessment Flashcards

1
Q

What are the four critical life functions? (Order of importance)

A

1) ventilation
2) oxygenation
3) circulation
4) perfusion

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2
Q

What life function is the first priority?

A

Ventilation

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3
Q

What assessments would measure how well a pt is ventilating?

A

RR, Vt, chest movement, BS, PET CO2, PA CO2

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4
Q

How would you know if a pt is having problems with oxygenation?

A

1) heart rate
Color, sensorium, SpO2, PaO2

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5
Q

What is the most common problem in neonates and children?

A

Oxygenation

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6
Q

What factors in maternal history would indicate a high risk pregnancy

A

Maternal age (<16 or >40)
Alcohol use
Smoking
Drug abuse
Caffeine

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7
Q

Para

A

Amount of births after 20 wks

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8
Q

Gravida

A

Any pregnancy, regardless of outcome, includes current pregnancy

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9
Q

Pre-eclampsia

A

Maternal hypertension with proteinuria and edema

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10
Q

Eclampsia

A

Maternal hypertension with seizures/coma

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11
Q

Pre-eclampsia/eclampsia treatment

A

Treat symptoms: balanced diet, bed rest, antihypertensive, anticonvulsant, mag sulfate

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12
Q

What does mag sulfate do

A

Decrease BP and delay preterm delivery

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13
Q

Methods of determining GA

A

Nagele’s rule: first day of last period - 3 mos + 7 days
Fetal US: measure diameter of fetal head or length of femur

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14
Q

Biophysical profile 8-10

A

Normal; CNS functional, fetus not hypoxic

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15
Q

Biophysical profile 6

A

Equivocal; repeat within 24 hrs

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16
Q

Biophysical profile <4

A

Abnormal; repeat test same day if <32 wks
Then delivery if <6
Labor induction if GA >32 wks

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17
Q

Amniotic fluid index (AFI) 8-18

A

Normal

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18
Q

AFI <5-6

A

Oligohydramnios (suspect potters syndrome)

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19
Q

AFI >20-24

A

Polyhydramnios (suspect esophageal atresia, TE fistula, hydrops fetalis)

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20
Q

What procedure is required to obtain fluid for L/S ratio

A

Amniocentesis

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21
Q

What is the significance of L/S ratio of 1:1

A

High risk for RDS

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22
Q

What information is obtained from evaluation of phosphatidylglycerol (PG) and what popoplation is this test better for vs L/S?

A

Pulmonary maturity, shows up at 35 wks, better for maternal diabetics

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23
Q

Describe one advantage of the S/A ration to determine lung maturity

A

Less expensive, quicker (>55 = lung maturity)

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24
Q

What is the significance of an LBC of >35,000

A

Fetal lung maturity

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25
Q

What is the significance of the presence of bubbles in the shake test fluid?

A

Presence of surfactant

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26
Q

What is the Coombs test?

A

Blood type compatibility between mother and fetus (RH- baby and RH+ mom is bad)

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27
Q

What developmental abnormalities may be detected by AFP testing? + NV

A

Omphalocele
Gastroschisis
Neural tube defects (spina bufuda)
NV: <10

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28
Q

Why are c-sections done? Why are infants at greater risk with this type of delivery?

A

Previous c-sections, complications
Risk for RDS, transient Tachypnea of newborn, and depression from anesthesia

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29
Q

What is the action of tocolytic agents? List 2 commonly used

A

Inhibit contractions
Mag sulfate and beta-Adrenergic agents (-ine)

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30
Q

Four types of breech

A

Frank: butt first
Complete: butt and lower extremities first
Footling/incomplete: lower extremities first
Transfers: shoulder/arm/trunk first

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31
Q

Which type of presentation has the highest risk of mortality and why?

A

Breech; increased risk of trauma and asphyxia

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32
Q

3 types of decelerations that can occur during fetal heart rate monitoring

A

Early deceleration (type 1): slowing to near/below 100 during contraction
Late deceleration (type 2): slowing after contraction begins or persists after, or no hr change
Variable (type 3): slowing independent of contractions, random

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33
Q

How to treat type 2 and 3 decels

A

Give mom oxygen

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34
Q

Normal FSpO2

A

40-70%

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35
Q

What is the significance of FSpO2 of <25%?

A

Hypoxia, emergency delivery

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36
Q

Maternal bleeding and effect on fetus

A

Any bleeding after first trimester, asphyxia

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37
Q

Premature/prolonged rupture of membrane and effect on fetus

A

Rupture of amniotic sac before 37 wks, RDS, sepsis

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38
Q

Why would corticosteroids be administered to the mother before birth?

A

Stimulate surfactant production

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39
Q

Dubowitz method

A

Determine GA, score of 40 indicates mature infant

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40
Q

New Ballard score

A

Modified dubowitz for infants <28 weeks

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41
Q

Vernix

A

Preterm: completely covered
Term: little
Postterm: no vernix

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42
Q

Skin

A

Preterm: thin, transparent
Term: pale
Postterm: thick, soft, may crack

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43
Q

Lanugo

A

Preterm: prominent
Term: normal length
Post: absent

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44
Q

Nails

A

Pre: short
Term: normal
Post: long

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45
Q

Sole (plantar) creases

A

Pre: 1-2 anterior creases
Term: creases over 2/3rd of sole
Post: entire sole covered in creases

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46
Q

Ears

A

Pre: flat, soft, little cartilage
Term: firm recoil easily

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47
Q

Five factors evaluate in apgar

A

Appearance
Pulse
Grimace
Activity
Respiratory effort

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48
Q

Treatment for neonate with apgar of 1

A

Suction mouth nose, patent aw, ventilate, NRP

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49
Q

Significance of high Silverman anderson score

A

Severe respiratory distress

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50
Q

Wher is the pre-ductal sample obtained

A

Right arm/radial artery

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51
Q

Where is the post ductal sample obtained

A

Umbilical artery or lower extremity

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52
Q

What conclusion could be drawn from the following data:
PaO2 from right radial artery: 95 torr
PaO2 from umbilical artery: 65 torr

A

Right to left shunt (PDA or PPHN)

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53
Q

What is the purpose of the oxygen challenge test?

A

Determine heart or lung problem, if no change with 100%, heart problem

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54
Q

What is the purpose of the hyperoxia-hyperventilation test

A

Differentiate PPHN v CHD

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55
Q

Four mechanisms by which and infant can lose heat to the environment

A

Conduction
Convection
Evaporation
Radiation

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56
Q

What causes hyperthermia in a neonate?

A

Infection, warm environment, dehydration, CNS issues, medications

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57
Q

What happens to oxygen consumption as the infant loses heat?

A

Increases

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58
Q

Na+ normal value

A

133-149 (140)

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59
Q

Cl- Normal value

A

87-114 (100)

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60
Q

K+ normal value

A

5.3-6.4 (5)

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61
Q

HCO3- (total CO2 content) normal value

A

19-24 (21)

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62
Q

BUN and Creatinine normal values and what it relates to

A

BUN: 4-17
Creatinine: 0.11-0.68
Renal function

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63
Q

Urine output normal value and what critical life function it relates to

A

1 ml/kg/hr
Circulation/perfusion

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64
Q

RBC function, NV, significance in low value, significance in high value

A

Carries hemoglobin
4.1-5.7
Anemia
Polycythemia

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65
Q

Hb function, NV, significance in low value, significance in high value

A

Carries oxygen
12.7-18.6
Anemia
Polycythemia

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66
Q

Hct function, NV, significance in low value, significance in high value

A

43-63 %
Anemia
Polycythemia

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67
Q

WBC function, NV, significance in low value, significance in high value

A

Infection
10,000-30,000

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68
Q

What lab procedure is recommended to check for different types of hemoglobin

A

Hemoglobin electrophoresis

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69
Q

Hemoglobin S

A

Sickle cell anemia

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70
Q

Hemoglobin C

A

Does not carry oxygen well

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71
Q

What is the source of bilirubin

A

Byproduct of breakdown of RBC in liver

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72
Q

Normal value for bilirubin in a full-term infant at birth?

A

1.4-1.9

73
Q

How is hyperbilirubinemia treated?

A

Phototherapy

74
Q

Normal blood glucose level for a term infant

A

50-100

75
Q

Most common cause of hyperglycemia

A

Septicemia

76
Q

3 causes of hypoglycemia

A

Infection
Hyperinsulinism
Cold stress and resuscitation

77
Q

Normal value for serum protein

A

6-8

78
Q

Normal value for albumin

A

3.5-5.5

79
Q

Normal value for globulin

A

2.0-3.5

80
Q

Normal value for albumin/globulin ratio

A

0.8-2.0

81
Q

What causes a decrease in the albumin/globulin ratio?

A

Autoimmune disease, renal failure, liver disease

82
Q

What causes an increase in albumin/globulin ratio?

A

Renal failure, liver disease, low thyroid activity

83
Q

How should hypotension or decreased urine output be treated in the neonate?

A

Infusion of normal saline

84
Q

Central cyanosis

A

Whole body

85
Q

Acrocyanosis

A

Blue extremities (hands/feet)

86
Q

Mottling

A

Lacy pattern of dilated blood vessels under skin

87
Q

Harlequin sign

A

Deep red on one side of face, pale on other

88
Q

Potential cause of mottling

A

Chilling/prolonged apnea

89
Q

Normal respiratory rate for term infant

A

30-60

90
Q

What term would describe a respiratory rate of <15

A

Bradypnea

91
Q

Causes of bradypnea

A

Narcotics
Hypothermia
CNS diseases

92
Q

Causes of Tachypnea

A

Hypoxemia
Hyperthermia
Metabolic/respiratory acidosis
CHD

93
Q

Pathology that would result in unequal (asymmetrical) chest movement

A

Pneumo
Atlectasis
Improperly placed ETT
Diaphragmatic hernia

94
Q

What is the significance of marked substernal and intrasternal retractions accompanied by Tachypnea?

A

Obstructed ETT, significant anatomical obstruction

95
Q

Grunting

A

Expiration before rapid inspiration

96
Q

When should the specialist recommend trans illumination?

A

Suspected pneumo

97
Q

What findings would indicate a pneumothorax

A

Entire hemithorax lights up

98
Q

What does a decrease in trans illumination indicate?

A

Diaophragmatic hernia, consolidation, absent hemidiaphragm

99
Q

What pathology is indicated by a scaphoid abdomen?

A

Diaphragmatic hernia

100
Q

Gastroschisis v omphalocele

A

Gastroschisis: protruding intestines not in membrane/sac
Omphalocele: protruding intestines contained in translucent membrane

101
Q

What is myelodysplasia and how is it diagnosed prenatally?

A

AFP

102
Q

What blood vessel should be used to evaluate the pulses in:
Infants <1yr
Infants >1yr
Following delivery of newborn

A

Brachial
Carotid
Umbilical

103
Q

Normal HR for term infant

A

120-170

104
Q

Bradycardia causes

A

Hypoxia
Apnea
Heart disease
Drugs
Hypothermia

105
Q

Poor femoral pulse could be an indication of

A

Coarctation of the aorta

106
Q

Bounding pulses could be indicative of

A

PDA, AV fistula, anemia, CHD, Tetralogy of falot

107
Q

Tachycardia causes

A

Hyperthermia
Heart disease
Pain
Crying

108
Q

Pulsus Alterans

A

Alternating weak/strong pulses (myocardial failure)

109
Q

Pulsus paradoxis

A

Weaker on inspiration, stronger on exhalation, emergency! Cardiac tamponade, pleural effusion, RDS

110
Q

What pathologies would cause the trachea to shift toward the affected side

A

Atelectasis
Diaphragmatic paralysis

111
Q

What pathologies would cause the trachea to shift away from the affected side?

A

Tension pneumo, tumors, d hernia

112
Q

Resonance

A

Normal

113
Q

Flat/dull percussion

A

Losing air, atelectasis, consolidation, pleural effusion

114
Q

Tympanic/hyper resonance

A

Extra air, pneumo, airtrapping

115
Q

Type of BS heard in consolidation

A

Increased

116
Q

BS heard in IRDS

A

Decreased

117
Q

BS heard in IRDS

A

Decreased

118
Q

BS heard in occluded ETT

A

Absent

119
Q

BS heard in pneumothorax

A

Unequal

120
Q

Coarse crackles pathologies

A

Secretions

121
Q

Medium crackles pathology

A

Middle aw secretions

122
Q

Fine crackles pathology

A

IRDS, pulm edema, pneuomonia

123
Q

Wheezes patho

A

IRDS, BPD, asthma

124
Q

Stridor patho

A

Upper aw obstruction

125
Q

Stridor patho

A

Upper aw obstruction

126
Q

Stertor patho

A

Partial obstruction of upper aw above larynx

127
Q

What is the significance of the presence of the 3rd and 4th heart sounds

A

Need echo

128
Q

Normal range blood pressure for term infant

A

1000g: 48/25
2000g: 50/30
3000g: 50/35

129
Q

What pathology should be suspected if the specialist notes the presence of bowel sounds in the left hemithorax

A

Diaphragmatic hernia

130
Q

6 levels of consciousness in order from most responsive to least responsive

A

Alert and responsive
Lethargic
Stupurous/confused
Obtunded
Semi-comatose
Comatose

131
Q

Gradual onset of illness

A

Croup, rsv, upper respiratory infection

132
Q

Sudden onset of illness

A

Epiglottitis, cardiac abnormalities, FBO

133
Q

Chronic/recurrent onset of illness

A

CF, asthma

134
Q

Glasgow coma scale

A

Moderate: 9-12
Lower=more severe

135
Q

Marasmus

A

6-18 mos, inadequate energy intake, “matchstick” arms

136
Q

Kwashiorkor

A

Lack of protein with normal intake, protruding belly, edamatous face and limbs

137
Q

RBC peds

A

4-5

138
Q

Hb peds

A

10-14

139
Q

Hct peds

A

32-40%

140
Q

WBC peds

A

5,000-10,000

141
Q

What pathology is identified with the sweat chloride test? And value

A

CF, >60

142
Q

What pathologies can result in peripheral edema?

A

Fluid overload, CHF

143
Q

What causes digital clubbing?

A

Chronic hypoxemia

144
Q

Kyphoscoliosis and pulmonary function values

A

Convex and lateral curvature of spine, restrictive

145
Q

Respiratory rate for peds ages

A

Infant: 30-60
Toddler: 24-40
Pre-schooler: 22-34
School age: 18-30
Adolescent: 12-20

146
Q

HR normal values peds

A

1-2 year: 80-130 (110)
2-6 year: 70-120 (100)
6-10 year: 70-100 (90)
10-16 year: 60-100 (85)

147
Q

What pathologies could cause inspiratory Stridor

A

Supraglottic swelling (Epiglottitis)
Subglottic swelling (croup, post extubation)
FBO

148
Q

Normal blood pressures 1,2,7,15 years old

A

1: 68-105/22-66
2: 70-105/26-66
7: 79-112/38-71
15: 93-128/66-85

149
Q

Where should the tip of the ETT be positioned for an infant with an uncuffed ETT

A

Mid trachea, T2-T4

150
Q

Where should the tip of the cuffed ETT be positioned for a child with a cuffed ETT?

A

1-2 cm above carina

151
Q

How should the NPS evaluate tube placement prior to the CXR

A

observation. Auscultation, EtCO2

152
Q

Where should the tip of the NG or OG be positioned when views on X-ray? What does it mean if it’s higher?

A

T9-T10
D hernia, esophageal atresia, TE fistula

153
Q

What pathology is is dictated when a feeding tube is seen coiled in the mediastinum on an X-ray?

A

Esophageal atresia

154
Q

Describe normal position of the hemiadiaphragms on an X-ray

A

Both rounded and dome-shaped
Right slightly higher then left

155
Q

IRDS CXR

A

reticulogranular densities, reticulonodular, ground glass, honeycomb, air bronchograms

156
Q

BPD CXR

A

Diffuse haziness, opacification, Airtrapping, spongelike

157
Q

Atelectasis CXR

A

Patchy infiltrates, scattered densities, plate-like, elevated hemidiaphragm, crowding

158
Q

Congenital diaphragmatic hernia CXR

A

Hypoplastic lung on affected side, mediastinal shift away, NG tube enters abdomen and passes back above diaphragm

159
Q

Pneumonia CXR

A

Air bronchograms, consolidation, discoid-shaped infiltrate

160
Q

Pneumothorax CXR

A

Hyperlucensy, absent vascular markings, flattened diaphragm on effected side, mediastinal shift away

161
Q

Pulmonary interstitial edema (PIE) CXR

A

Modular, air bubbles radiating outward from hilum, linear licensees and streaks

162
Q

Pneumopericardium CXR

A

Hyperlucensy in a ring around the heart or under the inferior heart border

163
Q

Pleural effusion CXR

A

Basilar infiltrates with meniscus, blunting of costrophrenic

164
Q

Pulmonary edema CXR

A

Bilateral, diffuse, fluffy, infiltrates originating from hilum, butterfly or batwing

165
Q

RLL pneumonia CXR

A

Silhouette sign

166
Q

Elevated thymus (pneumediastinum) CXR

A

Sail sign

167
Q

Tetralogy of fallot CXR

A

Boot-shaped heart

168
Q

Transposition of great vessels CXR

A

Egg-shaped heart

169
Q

Total anomalous pulmonary venous return CXR

A

Snowman-shaped heart

170
Q

Indication for inspiratory and expiratory film

A

FBO

171
Q

Indication for end-expiratory film

A

Small pneumo

172
Q

Indication for lateral decubitus film

A

Pleural effusion

173
Q

Indication for lateral neck film

A

Croup or epiglottitis

174
Q

Significance of steeple sign on lateral neck X-ray

A

Croup

175
Q

Significance of thumb sign on lateral neck X-ray

A

Epiglottitis

176
Q

What imaging procedure will be helpful to determine the precise position of a thoracic tumor?

A

MRI

177
Q

Which imaging procedure would be helpful to establish a dx of Bronchiectasis?

A

CT

178
Q

Which imaging procedure would be helpful to establish the dx of diaphragmatic paralysis?

A

Fluroscopy

179
Q

Four indications for cardiac catheterizations

A

Confirm suspected heart pathology
Quantify severity
Intracardiac/intravascular pressures
Tissue samples

NPS Kettering Workbook (8 decks)

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