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Peds Exam #7 Flashcards

1
Q

Brown adipose tissue

A

dark in color (enriched blood supply, dense cell content), easily metabolized to generate heat, richer blood supply aids in distribution of heat produced.

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2
Q

conditions necessary for BAT (brown adipose tissue) thermogenesis

A

norepinephrine, thyrozine, triglycerides, glucose, oxygen
All must be present to produce head
*usually missing

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3
Q

what complications can occur with BAT metabolism

A

metabolic acidosis, hypoglycemia, respiratory distress, hyperbilirubinemia

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4
Q

increased fatty acid release =

A

metabolic acidosis

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5
Q

increase in fatty acid =

A

hypoglycemia

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6
Q

decreased amount of surfactant

A

respiratory distress

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7
Q

free fatty acids use up bilirubin binding sites

A

hyperbilirubinemia

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8
Q

what can happen as a result of hyperbilirubinemia

A

brain damage

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9
Q

what are the A&P differences in temperature regulation in the NB

A

NB thin layer of subQ fat, blood vessels are closer to surface, has larger body surface area, vasomotor control is less developed, lose 4 times as much heat as an adult

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10
Q

NB produces heat primarily by

A

non shivering thermogenesis (fat metabolism)

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11
Q

how does the NB respond to the cold stress

A

crying, motor activity, increase RR

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12
Q

birth occurs after 20 weeks but before 37 weeks

A

preterm

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13
Q

weight of NB of less than 2500 gm (5lb 8oz)

A

LBW

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14
Q

weight less than 1500 gm

A

VLBW

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15
Q

below the 10th percentile for given gestational age

A

SGA

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16
Q

height for preterm babies

A

17-19 inches

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17
Q

head circumference for preterm babies

A

10-12 inches

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18
Q

when is subQ fat developed

A

4 weeks prior to term/delivery

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19
Q

is lanugo present in preterm

A

yes

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20
Q

will vernix be present in a preterm

A

yes, do not remove it

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21
Q

difference in preterm head

A

head bigger as compared to body, nose is short and small

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22
Q

difference in thorax of preterm

A

rib cage is weak, weak cough and gag, periodic breathing (always count for one minute)

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23
Q

what is different in the ear of the preterm

A

pinna is flat and slow or no recoil

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24
Q

reflexes of preterm

A

suck swallow gag is poor, moro, tonic neck, Babinski present,

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25
when does BAT appear
26-30 weeks
26
cold stress in a NB can cause what
hypoglycemia, hypoxia, academia, hyperbilirubinemia
27
S/sx of fluid volume excess
edema, crackles, increase body weight, bulging fontanels
28
s/sx of fluid volume deficit
sunken fontanels, decrease skin turgor, dry mucous membranes
29
preterm have insensible water loss because
respiratory (loss 30% if have resp issues), transepithelial (more water diffusion through skin bc of the thinness
30
when weighing diapers 1 gm of fluid = what
1 mL
31
what disturbances in nutrition can a preterm have
uncoordinated suck/swallow (develops at 33 wks), decrease of peristalsis, immature cardiac sphincter (decrease gastric emptying) deficient enzymes,
32
caloric needs for preterm
120-150 cal/kg/day
33
formula for a preterm needs to be what
24 calories/oz
34
why does a preterm have a high risk for infection
deficient placental transmission of and antenatal storage of minerals, vitamins, and immunoglobulins immature immune system, rate of IgM synthesis is slower than term baby
35
S/Sx of sepsis
cyanosis, grunting, apnea, lethargy, gitterness, seizure, rash, jaundice, pallor, tachycardia, unstable temperature****
36
when do you give a preterm Abx for possible sepsis
right after taking blood cultures
37
why are preterm at a high risk for hemorrhage/anemia
low prothrombin due to poor vit K synthesis, immature liver function, increase rate of hemolysis, walls of blood vessels are fragile, RBC survival time is less
38
babies breath mostly through
nose breathers
39
what is the tx for jaundice
phototherapy or exchange transfusion
40
jaundice etiology
rapid destruction of immature RBCs and immaturity of liver= prolonged course of higher bilirubin levels and jaundice
41
preterm respiratory system
weak respiratory musceles, alveoli are immature, decrease amount of surfactant, weak gag reflex
42
RR of NB
40-60
43
apnea in a NB
absence of breathing for 20 seconds or more
44
what can you do as Tx for apnea
tactile stimulation (usually grow out of it), can also be prescribed caffine
45
complications of preterm babies
ROP, BPD (chronic lung disease), speech defects, neurological defects, sensor neural hearing defects
46
what can cause a sensorineural hearing defects
ototoxic drug (Lasix)
47
results from a lack of surfactant
respiratory distress syndrome
48
RDS
onset about 2 hours after birth worsens at 48-72 hours, alveoli collapse each time the infant exhales bc surfactant isn't there to keep them open
49
S/sx of RDS
cyanosis on RA, nasal flaring, retractions of chest wall, expiratory grunt, apnea, tachypnea (above 60)
50
chest x ray of RDS
shattered glass
51
Tx for RDS
O2, surfactant administration
52
what is the drawback of using CPAP/PEEP for RDS
can cause vascular shunting in the pulmonary beds leading to persistent pulmonary HTN and worsening RDS
53
how is surfactant given
through a ET tube
54
what is done as a last resort for RSD
ECMO extracorporeal membrane oxygenation, use cardiopulmonary bypass to oxygenate the babies blood risk for bleeds
55
Broncho-pulmonary dysplasia (BPD
"chronic lung disease" e2 requirement @at 36 weeks post conceptional age, caused by ventilation which causes pulmonary trauma resulting in lung damage
56
S/Sx of BPD
fibrosis, cant get them off of oxygen, interstitial edema, epithelial swelling, atelectasis
57
BPD is Dx by
Xray
58
Tx for BPD
dexamethasone (decrease inflammatory response), PO diuretics (decrease lung fluid), bronchodilators
59
nutrition for BPD
increase of calories , add supplements
60
abnormal growth of blood vessels in the baby's eye, caused by increase of O2 which causes vasoconstriction when O2 drops causes vessels to grow rapidly and abnormally which causes scar tissue
Retinopathy of premature (ROP)
61
Tx of ROP
prevention, maintain PaO2 level of 60-80 give vit E, laser, cryotherapy
62
acute inflammatory disease of bowel
Necrotizing enterocolitis (NEC)
63
what are the three factors that play a role in the development of NEC
intestinal ischemia, colonization of bacteria, substrate (formula) in intestine
64
S/Sx of NEC
abdominal distention, gastric retention, bloody stools
65
Dx test for NEC
Xray: sausage shaped intestine, Labs: anemia, lukeopenia, electrolyte imbalance, metabolic acidosis
66
Tx for NEC
remove necrotic intestine, NG tube, Abx, IV nutrition
67
Intraventricular Hemorrhage (IVH)
high in premature infant bc of immature vessels esp. intracranial vessels
68
S.Sx of IVH
high pitched cry, irritability and convulsions (late sign), focal cerebral signs (eye can deviate), bulging of fontanel, anemia, apnea, decrease RR, Decrease HR, decrease in tone
69
Dx for IVH
U/S, CT scan, LP
70
Tx of IVH
prevention, relief of ICP by LP, shunt is rescue Tx

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