Patient Assessment Flashcards
1
Q
What are the four critical life functions? (Order of importance)
A
1) ventilation
2) oxygenation
3) circulation
4) perfusion
2
Q
What life function is the first priority?
A
Ventilation
3
Q
What assessments would measure how well a pt is ventilating?
A
RR, Vt, chest movement, BS, PET CO2, PA CO2
4
Q
How would you know if a pt is having problems with oxygenation?
A
1) heart rate
Color, sensorium, SpO2, PaO2
5
Q
What is the most common problem in neonates and children?
A
Oxygenation
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
7
Q
Para
A
Amount of births after 20 wks
8
Q
Gravida
A
Any pregnancy, regardless of outcome, includes current pregnancy
9
Q
Pre-eclampsia
A
Maternal hypertension with proteinuria and edema
10
Q
Eclampsia
A
Maternal hypertension with seizures/coma
11
Q
Pre-eclampsia/eclampsia treatment
A
Treat symptoms: balanced diet, bed rest, antihypertensive, anticonvulsant, mag sulfate
12
Q
What does mag sulfate do
A
Decrease BP and delay preterm delivery
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
14
Q
Biophysical profile 8-10
A
Normal; CNS functional, fetus not hypoxic
15
Q
Biophysical profile 6
A
Equivocal; repeat within 24 hrs
16
Q
Biophysical profile <4
A
Abnormal; repeat test same day if <32 wks
Then delivery if <6
Labor induction if GA >32 wks
17
Q
Amniotic fluid index (AFI) 8-18
A
Normal
18
Q
AFI <5-6
A
Oligohydramnios (suspect potters syndrome)
19
Q
AFI >20-24
A
Polyhydramnios (suspect esophageal atresia, TE fistula, hydrops fetalis)
20
Q
What procedure is required to obtain fluid for L/S ratio
A
Amniocentesis
21
Q
What is the significance of L/S ratio of 1:1
A
High risk for RDS
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
23
Q
Describe one advantage of the S/A ration to determine lung maturity
A
Less expensive, quicker (>55 = lung maturity)
24
Q
What is the significance of an LBC of >35,000
A
Fetal lung maturity
25
What is the significance of the presence of bubbles in the shake test fluid?
Presence of surfactant
26
What is the Coombs test?
Blood type compatibility between mother and fetus (RH- baby and RH+ mom is bad)
27
What developmental abnormalities may be detected by AFP testing? + NV
Omphalocele
Gastroschisis
Neural tube defects (spina bufuda)
NV: <10
28
Why are c-sections done? Why are infants at greater risk with this type of delivery?
Previous c-sections, complications
Risk for RDS, transient Tachypnea of newborn, and depression from anesthesia
29
What is the action of tocolytic agents? List 2 commonly used
Inhibit contractions
Mag sulfate and beta-Adrenergic agents (-ine)
30
Four types of breech
Frank: butt first
Complete: butt and lower extremities first
Footling/incomplete: lower extremities first
Transfers: shoulder/arm/trunk first
31
Which type of presentation has the highest risk of mortality and why?
Breech; increased risk of trauma and asphyxia
32
3 types of decelerations that can occur during fetal heart rate monitoring
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
33
How to treat type 2 and 3 decels
Give mom oxygen
34
Normal FSpO2
40-70%
35
What is the significance of FSpO2 of <25%?
Hypoxia, emergency delivery
36
Maternal bleeding and effect on fetus
Any bleeding after first trimester, asphyxia
37
Premature/prolonged rupture of membrane and effect on fetus
Rupture of amniotic sac before 37 wks, RDS, sepsis
38
Why would corticosteroids be administered to the mother before birth?
Stimulate surfactant production
39
Dubowitz method
Determine GA, score of 40 indicates mature infant
40
New Ballard score
Modified dubowitz for infants <28 weeks
41
Vernix
Preterm: completely covered
Term: little
Postterm: no vernix
42
Skin
Preterm: thin, transparent
Term: pale
Postterm: thick, soft, may crack
43
Lanugo
Preterm: prominent
Term: normal length
Post: absent
44
Nails
Pre: short
Term: normal
Post: long
45
Sole (plantar) creases
Pre: 1-2 anterior creases
Term: creases over 2/3rd of sole
Post: entire sole covered in creases
46
Ears
Pre: flat, soft, little cartilage
Term: firm recoil easily
47
Five factors evaluate in apgar
Appearance
Pulse
Grimace
Activity
Respiratory effort
48
Treatment for neonate with apgar of 1
Suction mouth nose, patent aw, ventilate, NRP
49
Significance of high Silverman anderson score
Severe respiratory distress
50
Wher is the pre-ductal sample obtained
Right arm/radial artery
51
Where is the post ductal sample obtained
Umbilical artery or lower extremity
52
What conclusion could be drawn from the following data:
PaO2 from right radial artery: 95 torr
PaO2 from umbilical artery: 65 torr
Right to left shunt (PDA or PPHN)
53
What is the purpose of the oxygen challenge test?
Determine heart or lung problem, if no change with 100%, heart problem
54
What is the purpose of the hyperoxia-hyperventilation test
Differentiate PPHN v CHD
55
Four mechanisms by which and infant can lose heat to the environment
Conduction
Convection
Evaporation
Radiation
56
What causes hyperthermia in a neonate?
Infection, warm environment, dehydration, CNS issues, medications
57
What happens to oxygen consumption as the infant loses heat?
Increases
58
Na+ normal value
133-149 (140)
59
Cl- Normal value
87-114 (100)
60
K+ normal value
5.3-6.4 (5)
61
HCO3- (total CO2 content) normal value
19-24 (21)
62
BUN and Creatinine normal values and what it relates to
BUN: 4-17
Creatinine: 0.11-0.68
Renal function
63
Urine output normal value and what critical life function it relates to
1 ml/kg/hr
Circulation/perfusion
64
RBC function, NV, significance in low value, significance in high value
Carries hemoglobin
4.1-5.7
Anemia
Polycythemia
65
Hb function, NV, significance in low value, significance in high value
Carries oxygen
12.7-18.6
Anemia
Polycythemia
66
Hct function, NV, significance in low value, significance in high value
43-63 %
Anemia
Polycythemia
67
WBC function, NV, significance in low value, significance in high value
Infection
10,000-30,000
68
What lab procedure is recommended to check for different types of hemoglobin
Hemoglobin electrophoresis
69
Hemoglobin S
Sickle cell anemia
70
Hemoglobin C
Does not carry oxygen well
71
What is the source of bilirubin
Byproduct of breakdown of RBC in liver
72
Normal value for bilirubin in a full-term infant at birth?
1.4-1.9
73
How is hyperbilirubinemia treated?
Phototherapy
74
Normal blood glucose level for a term infant
50-100
75
Most common cause of hyperglycemia
Septicemia
76
3 causes of hypoglycemia
Infection
Hyperinsulinism
Cold stress and resuscitation
77
Normal value for serum protein
6-8
78
Normal value for albumin
3.5-5.5
79
Normal value for globulin
2.0-3.5
80
Normal value for albumin/globulin ratio
0.8-2.0
81
What causes a decrease in the albumin/globulin ratio?
Autoimmune disease, renal failure, liver disease
82
What causes an increase in albumin/globulin ratio?
Renal failure, liver disease, low thyroid activity
83
How should hypotension or decreased urine output be treated in the neonate?
Infusion of normal saline
84
Central cyanosis
Whole body
85
Acrocyanosis
Blue extremities (hands/feet)
86
Mottling
Lacy pattern of dilated blood vessels under skin
87
Harlequin sign
Deep red on one side of face, pale on other
88
Potential cause of mottling
Chilling/prolonged apnea
89
Normal respiratory rate for term infant
30-60
90
What term would describe a respiratory rate of <15
Bradypnea
91
Causes of bradypnea
Narcotics
Hypothermia
CNS diseases
92
Causes of Tachypnea
Hypoxemia
Hyperthermia
Metabolic/respiratory acidosis
CHD
93
Pathology that would result in unequal (asymmetrical) chest movement
Pneumo
Atlectasis
Improperly placed ETT
Diaphragmatic hernia
94
What is the significance of marked substernal and intrasternal retractions accompanied by Tachypnea?
Obstructed ETT, significant anatomical obstruction
95
Grunting
Expiration before rapid inspiration
96
When should the specialist recommend trans illumination?
Suspected pneumo
97
What findings would indicate a pneumothorax
Entire hemithorax lights up
98
What does a decrease in trans illumination indicate?
Diaophragmatic hernia, consolidation, absent hemidiaphragm
99
What pathology is indicated by a scaphoid abdomen?
Diaphragmatic hernia
100
Gastroschisis v omphalocele
Gastroschisis: protruding intestines not in membrane/sac
Omphalocele: protruding intestines contained in translucent membrane
101
What is myelodysplasia and how is it diagnosed prenatally?
AFP
102
What blood vessel should be used to evaluate the pulses in:
Infants <1yr
Infants >1yr
Following delivery of newborn
Brachial
Carotid
Umbilical
103
Normal HR for term infant
120-170
104
Bradycardia causes
Hypoxia
Apnea
Heart disease
Drugs
Hypothermia
105
Poor femoral pulse could be an indication of
Coarctation of the aorta
106
Bounding pulses could be indicative of
PDA, AV fistula, anemia, CHD, Tetralogy of falot
107
Tachycardia causes
Hyperthermia
Heart disease
Pain
Crying
108
Pulsus Alterans
Alternating weak/strong pulses (myocardial failure)
109
Pulsus paradoxis
Weaker on inspiration, stronger on exhalation, emergency! Cardiac tamponade, pleural effusion, RDS
110
What pathologies would cause the trachea to shift toward the affected side
Atelectasis
Diaphragmatic paralysis
111
What pathologies would cause the trachea to shift away from the affected side?
Tension pneumo, tumors, d hernia
112
Resonance
Normal
113
Flat/dull percussion
Losing air, atelectasis, consolidation, pleural effusion
114
Tympanic/hyper resonance
Extra air, pneumo, airtrapping
115
Type of BS heard in consolidation
Increased
116
BS heard in IRDS
Decreased
117
BS heard in IRDS
Decreased
118
BS heard in occluded ETT
Absent
119
BS heard in pneumothorax
Unequal
120
Coarse crackles pathologies
Secretions
121
Medium crackles pathology
Middle aw secretions
122
Fine crackles pathology
IRDS, pulm edema, pneuomonia
123
Wheezes patho
IRDS, BPD, asthma
124
Stridor patho
Upper aw obstruction
125
Stridor patho
Upper aw obstruction
126
Stertor patho
Partial obstruction of upper aw above larynx
127
What is the significance of the presence of the 3rd and 4th heart sounds
Need echo
128
Normal range blood pressure for term infant
1000g: 48/25
2000g: 50/30
3000g: 50/35
129
What pathology should be suspected if the specialist notes the presence of bowel sounds in the left hemithorax
Diaphragmatic hernia
130
6 levels of consciousness in order from most responsive to least responsive
Alert and responsive
Lethargic
Stupurous/confused
Obtunded
Semi-comatose
Comatose
131
Gradual onset of illness
Croup, rsv, upper respiratory infection
132
Sudden onset of illness
Epiglottitis, cardiac abnormalities, FBO
133
Chronic/recurrent onset of illness
CF, asthma
134
Glasgow coma scale
Moderate: 9-12
Lower=more severe
135
Marasmus
6-18 mos, inadequate energy intake, “matchstick” arms
136
Kwashiorkor
Lack of protein with normal intake, protruding belly, edamatous face and limbs
137
RBC peds
4-5
138
Hb peds
10-14
139
Hct peds
32-40%
140
WBC peds
5,000-10,000
141
What pathology is identified with the sweat chloride test? And value
CF, >60
142
What pathologies can result in peripheral edema?
Fluid overload, CHF
143
What causes digital clubbing?
Chronic hypoxemia
144
Kyphoscoliosis and pulmonary function values
Convex and lateral curvature of spine, restrictive
145
Respiratory rate for peds ages
Infant: 30-60
Toddler: 24-40
Pre-schooler: 22-34
School age: 18-30
Adolescent: 12-20
146
HR normal values peds
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
What pathologies could cause inspiratory Stridor
Supraglottic swelling (Epiglottitis)
Subglottic swelling (croup, post extubation)
FBO
148
Normal blood pressures 1,2,7,15 years old
1: 68-105/22-66
2: 70-105/26-66
7: 79-112/38-71
15: 93-128/66-85
149
Where should the tip of the ETT be positioned for an infant with an uncuffed ETT
Mid trachea, T2-T4
150
Where should the tip of the cuffed ETT be positioned for a child with a cuffed ETT?
1-2 cm above carina
151
How should the NPS evaluate tube placement prior to the CXR
observation. Auscultation, EtCO2
152
Where should the tip of the NG or OG be positioned when views on X-ray? What does it mean if it’s higher?
T9-T10
D hernia, esophageal atresia, TE fistula
153
What pathology is is dictated when a feeding tube is seen coiled in the mediastinum on an X-ray?
Esophageal atresia
154
Describe normal position of the hemiadiaphragms on an X-ray
Both rounded and dome-shaped
Right slightly higher then left
155
IRDS CXR
reticulogranular densities, reticulonodular, ground glass, honeycomb, air bronchograms
156
BPD CXR
Diffuse haziness, opacification, Airtrapping, spongelike
157
Atelectasis CXR
Patchy infiltrates, scattered densities, plate-like, elevated hemidiaphragm, crowding
158
Congenital diaphragmatic hernia CXR
Hypoplastic lung on affected side, mediastinal shift away, NG tube enters abdomen and passes back above diaphragm
159
Pneumonia CXR
Air bronchograms, consolidation, discoid-shaped infiltrate
160
Pneumothorax CXR
Hyperlucensy, absent vascular markings, flattened diaphragm on effected side, mediastinal shift away
161
Pulmonary interstitial edema (PIE) CXR
Modular, air bubbles radiating outward from hilum, linear licensees and streaks
162
Pneumopericardium CXR
Hyperlucensy in a ring around the heart or under the inferior heart border
163
Pleural effusion CXR
Basilar infiltrates with meniscus, blunting of costrophrenic
164
Pulmonary edema CXR
Bilateral, diffuse, fluffy, infiltrates originating from hilum, butterfly or batwing
165
RLL pneumonia CXR
Silhouette sign
166
Elevated thymus (pneumediastinum) CXR
Sail sign
167
Tetralogy of fallot CXR
Boot-shaped heart
168
Transposition of great vessels CXR
Egg-shaped heart
169
Total anomalous pulmonary venous return CXR
Snowman-shaped heart
170
Indication for inspiratory and expiratory film
FBO
171
Indication for end-expiratory film
Small pneumo
172
Indication for lateral decubitus film
Pleural effusion
173
Indication for lateral neck film
Croup or epiglottitis
174
Significance of steeple sign on lateral neck X-ray
Croup
175
Significance of thumb sign on lateral neck X-ray
Epiglottitis
176
What imaging procedure will be helpful to determine the precise position of a thoracic tumor?
MRI
177
Which imaging procedure would be helpful to establish a dx of Bronchiectasis?
CT
178
Which imaging procedure would be helpful to establish the dx of diaphragmatic paralysis?
Fluroscopy
179
Four indications for cardiac catheterizations
Confirm suspected heart pathology
Quantify severity
Intracardiac/intravascular pressures
Tissue samples
