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Principles II > Peds A+P Dan Miller Style!!! > Flashcards

Peds A+P Dan Miller Style!!! Flashcards

1
Q

Ages for Peds: New Born? Infant? Toddler? Preschooler? School age? Adolescent

A

Newborn -> 0-1 month Infant -> 1-12 months Toddler -> 1-3 yrs Preschool -> 4-6 yrs School -> 6-13 yrs Adolescent -> 13-18 yrs

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2
Q

Fetal Circulation

A
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3
Q

What should close in the fetus after delivery

A

Foramen Ovale

Ductus Arteriosus

Ductus Venosus

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4
Q

Why do these fetal heart changes take place

A

Pressure changes in the circulatory system

  1. Reduction of pulmonary vascular resistance
  2. Elevation of systemic vascular resistance
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5
Q

3 things stimulate the New born to take its first breath what are they??

A

Hypoxia, acidosis, sensory stimulation

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6
Q

Taking the first breath facilitates what in the Pulmonary vasculature?

A

Increases arterial and aveolar oxygen tension which helps reduce pulmonary vascular resistance

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7
Q

Why does the Foramen Ovale close

A

decreased right atrial pressure

increase SVR

removal of placental prostaglandins

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8
Q

Why dose the Ductus arteriosus close

A

PVR and SVR pressure changes

removal of placental prostaglandins

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9
Q

Why dose the Ductus Venosus close

A
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10
Q

Factors causing Persistant Pulmonary HTN

A

Hypoxemia

acidosis

hypothermia

preterm

meconium aspiration

congenital diaphramatic hernia

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11
Q

Persistant Pulmonary HTN

A
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12
Q

Treatement for Persistant Pulm. HTN

A

Nitric oxide inhalation

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13
Q

New borns brath through their nose or mouth

A

obligate nasal breathers

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14
Q

Gross anatomy differences from adults

A

large epiglotis

large tongue

large occiput

short neck

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15
Q

What is the narrowest point in the new born airway

A

cricoid cartilage

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16
Q

Cricoid is shaped like a ???

A

funnel

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17
Q

cuffed or uncuffed tubes

A

uncuffed and should hear a leak at 20-25 cm H2O

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18
Q

Newborns till age 5 have proportionally smaller distal airways, this causes

A

Increase work of breathing

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19
Q

Respiratory physiology for a Newborn

A

Increased O2 consumption

increased metabolic rate

increased aveolar ventilation

increased ventilatory rate

Decreased FRC

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20
Q

Infants have a increased closing capacity, this means??

A
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21
Q

Why are SNS and baroreceptors blunted in the infant

A

Immature and this causes a blunted response to EPI and ephedrine as well as endogenous catacholamines

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22
Q

Is the parasympathetic NS fully developed??

A

YES at birth and controlled HR in utero

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23
Q

Neonate/ Newborn cardiac out is mainly dependant upon

A
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24
Q

HR Neonate

A

160’s

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25
Q

HR and BP Newborn

A

120’s

60ish Systolic

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26
Q

Fetal Hemoglobin is special why?

A

higher affinity for O2

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27
Q

Fetal Hgb causes a R or L shift in the curve??

A
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28
Q

Fetal Hgb also causes and increase in ??

A

2,3-DPG

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29
Q

What causes the newborn to produce adult Hgb at about 2-3 months

A

The life cycle of the Fetal Hgb

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30
Q

The spinal cord ends where in pediatrics??

A

L3

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31
Q

the dominant Nervous system in newborns is PNS or SNS

A

PNS

32
Q

GFR normalizes at what age

A

1yr old

33
Q

Decreased GFR in children under one is because

A

Low SBP

increased renal vascular resistance

decreased glomerular capillary permeability

34
Q

Peds begin to concerntrate urine at age

A

2-3 yrs

35
Q

Ped liver function

A
36
Q

Hyperbilirubinemia

A

excessive breakdown of billirubin and impeded excreation

37
Q

Hyperbilirubinemia is most common in these infants

A

Preterm and breast fed

38
Q

what it kernicterus

A
39
Q

Gerd is seen in what % of newborns for the 1st week of life??

A

50 %

40
Q

GERD in the infant is due to

A

Decreased LES tone

41
Q

Meconium aspiration can cause

A

pneumonia

pneumothorax

PPHTN

42
Q

how do neonates increase their temp

A

nonshivering thermogenesis

Brown fat Metabolism

43
Q

4 reasons for neonates / newborns to regulate temp

A

Immature ANS

thin skin

reduced adipose tissue

increased BSA

44
Q

Heat loss can be by

A

radiation

conduction

convection

evaporation

45
Q

Where are the 4 areas of BROWN FAT, YA BROWN FAT??

A

between scapulas, axillae, mediastinum, surrounding kidneys

46
Q

Whats special about BROWN FAT

A

high concerntration of mitochondria

47
Q

Calculating rough weight

A

(2 x the age) +9 = kg

48
Q

why do neonates and newborns need more medication??

A

total body water content is 75% which causes a greater volume of distribution therefore less effect

49
Q

% things to keep in mind when dosing meds for a newborn

A

Decreased liver function

Decreased Plasma binding

Decreased GFR

Decreased enzymatic metabolism

immaturity of the BBB

50
Q

2 proteins that are decreased in the neonate

A

Albumin and

51
Q

Enzymatic metabolism is done 2 ways

A

Cytochrome P450

52
Q

Rectal routes of medication have 3 vascular pathways??

A
53
Q

Injection sites for meds

A

vastus lateralis (infants - small children)

Deltoid (older children)

54
Q

Volumes of injection

A
55
Q

Newborn IV sites

A
56
Q

Is MAC higher or lower in infants then adults

A

higher and trends down as they reach adults

57
Q

Peds dose of propofol

A

2-3 mg /kg

58
Q

Peds dose of ketamine

A

1-2 mg/kg

59
Q

Propofol infusion should NEVER be continued into ICU because of

A

Propofol infusion syndrome

60
Q

SX of propofol infusion syndrome??

A
61
Q

Percitipating factors for propofol infusion syndrome

A

> 48 hr infusion

> 5 mg/kg/hr

62
Q

why will you see an increased response to volital agnets in newborns

A

immature ANS

63
Q

Volital agent induction recmmendation is

A

Sevo- least cardiac depressive, nonpungent, fast induction, fast emergence

If maintaince is longer than an hour switch to ISO after induction.

64
Q

drugs of choice for pain control

A
65
Q

can you mix your reversal agents??

A
66
Q

which agent do you give first in reversals

A

anticholenergic

67
Q

Which drug do you give second in reversal

A
68
Q

why do you anticholenesterase ONLY AND I MEAN ONLY give the anticholinesterase after you have an increse in HR

A
69
Q

ONLY 2 reasons to give sucs in Peds??

A

laryngospasm and airway emergency

70
Q

Why do you not give sucs to Peds

A
71
Q

why should you be careful in fluid administration with peds

A
72
Q

Types of fluid administered for maintainance

A
73
Q

Hourly fluid for < 10 kg

A

4 ml/kg

OR

100ml/kg in 24 hours

74
Q

Fluid maintenance for 11-20 kg

A
75
Q

Fluid maintence for >20 kg

A
76
Q

Blood loss replacement

A

Principles II (25 decks)

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