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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
HR and BP Newborn
120's 60ish Systolic
26
Fetal Hemoglobin is special why?
higher affinity for O2
27
Fetal Hgb causes a R or L shift in the curve??
28
Fetal Hgb also causes and increase in ??
2,3-DPG
29
What causes the newborn to produce adult Hgb at about 2-3 months
The life cycle of the Fetal Hgb
30
The spinal cord ends where in pediatrics??
L3
31
the dominant Nervous system in newborns is PNS or SNS
PNS
32
GFR normalizes at what age
1yr old
33
Decreased GFR in children under one is because
Low SBP increased renal vascular resistance decreased glomerular capillary permeability
34
Peds begin to concerntrate urine at age
2-3 yrs
35
Ped liver function
36
Hyperbilirubinemia
excessive breakdown of billirubin and impeded excreation
37
Hyperbilirubinemia is most common in these infants
Preterm and breast fed
38
what it kernicterus
39
Gerd is seen in what % of newborns for the 1st week of life??
50 %
40
GERD in the infant is due to
Decreased LES tone
41
Meconium aspiration can cause
pneumonia pneumothorax PPHTN
42
how do neonates increase their temp
nonshivering thermogenesis Brown fat Metabolism
43
4 reasons for neonates / newborns to regulate temp
Immature ANS thin skin reduced adipose tissue increased BSA
44
Heat loss can be by
radiation conduction convection evaporation
45
Where are the 4 areas of BROWN FAT, YA BROWN FAT??
between scapulas, axillae, mediastinum, surrounding kidneys
46
Whats special about BROWN FAT
high concerntration of mitochondria
47
Calculating rough weight
(2 x the age) +9 = kg
48
why do neonates and newborns need more medication??
total body water content is 75% which causes a greater volume of distribution therefore less effect
49
% things to keep in mind when dosing meds for a newborn
Decreased liver function Decreased Plasma binding Decreased GFR Decreased enzymatic metabolism immaturity of the BBB
50
2 proteins that are decreased in the neonate
Albumin and
51
Enzymatic metabolism is done 2 ways
Cytochrome P450
52
Rectal routes of medication have 3 vascular pathways??
53
Injection sites for meds
vastus lateralis (infants - small children) Deltoid (older children)
54
Volumes of injection
55
Newborn IV sites
56
Is MAC higher or lower in infants then adults
higher and trends down as they reach adults
57
Peds dose of propofol
2-3 mg /kg
58
Peds dose of ketamine
1-2 mg/kg
59
Propofol infusion should NEVER be continued into ICU because of
Propofol infusion syndrome
60
SX of propofol infusion syndrome??
61
Percitipating factors for propofol infusion syndrome
\> 48 hr infusion \> 5 mg/kg/hr
62
why will you see an increased response to volital agnets in newborns
immature ANS
63
Volital agent induction recmmendation is
Sevo- least cardiac depressive, nonpungent, fast induction, fast emergence If maintaince is longer than an hour switch to ISO after induction.
64
drugs of choice for pain control
65
can you mix your reversal agents??
66
which agent do you give first in reversals
anticholenergic
67
Which drug do you give second in reversal
68
why do you anticholenesterase ONLY AND I MEAN ONLY give the anticholinesterase after you have an increse in HR
69
ONLY 2 reasons to give sucs in Peds??
laryngospasm and airway emergency
70
Why do you not give sucs to Peds
71
why should you be careful in fluid administration with peds
72
Types of fluid administered for maintainance
73
Hourly fluid for \< 10 kg
4 ml/kg OR 100ml/kg in 24 hours
74
Fluid maintenance for 11-20 kg
75
Fluid maintence for \>20 kg
76
Blood loss replacement

Principles II (25 decks)

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