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school > Peds Exam #7 > Flashcards

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
Q

when does BAT appear

A

26-30 weeks

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26
Q

cold stress in a NB can cause what

A

hypoglycemia, hypoxia, academia, hyperbilirubinemia

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27
Q

S/sx of fluid volume excess

A

edema, crackles, increase body weight, bulging fontanels

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28
Q

s/sx of fluid volume deficit

A

sunken fontanels, decrease skin turgor, dry mucous membranes

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29
Q

preterm have insensible water loss because

A

respiratory (loss 30% if have resp issues), transepithelial (more water diffusion through skin bc of the thinness

30
Q

when weighing diapers 1 gm of fluid = what

A

1 mL

31
Q

what disturbances in nutrition can a preterm have

A

uncoordinated suck/swallow (develops at 33 wks), decrease of peristalsis, immature cardiac sphincter (decrease gastric emptying) deficient enzymes,

32
Q

caloric needs for preterm

A

120-150 cal/kg/day

33
Q

formula for a preterm needs to be what

A

24 calories/oz

34
Q

why does a preterm have a high risk for infection

A

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
Q

S/Sx of sepsis

A

cyanosis, grunting, apnea, lethargy, gitterness, seizure, rash, jaundice, pallor, tachycardia, unstable temperature**

36
Q

when do you give a preterm Abx for possible sepsis

A

right after taking blood cultures

37
Q

why are preterm at a high risk for hemorrhage/anemia

A

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
Q

babies breath mostly through

A

nose breathers

39
Q

what is the tx for jaundice

A

phototherapy or exchange transfusion

40
Q

jaundice etiology

A

rapid destruction of immature RBCs and immaturity of liver= prolonged course of higher bilirubin levels and jaundice

41
Q

preterm respiratory system

A

weak respiratory musceles, alveoli are immature, decrease amount of surfactant, weak gag reflex

42
Q

RR of NB

A

40-60

43
Q

apnea in a NB

A

absence of breathing for 20 seconds or more

44
Q

what can you do as Tx for apnea

A

tactile stimulation (usually grow out of it), can also be prescribed caffine

45
Q

complications of preterm babies

A

ROP, BPD (chronic lung disease), speech defects, neurological defects, sensor neural hearing defects

46
Q

what can cause a sensorineural hearing defects

A

ototoxic drug (Lasix)

47
Q

results from a lack of surfactant

A

respiratory distress syndrome

48
Q

RDS

A

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
Q

S/sx of RDS

A

cyanosis on RA, nasal flaring, retractions of chest wall, expiratory grunt, apnea, tachypnea (above 60)

50
Q

chest x ray of RDS

A

shattered glass

51
Q

Tx for RDS

A

O2, surfactant administration

52
Q

what is the drawback of using CPAP/PEEP for RDS

A

can cause vascular shunting in the pulmonary beds leading to persistent pulmonary HTN and worsening RDS

53
Q

how is surfactant given

A

through a ET tube

54
Q

what is done as a last resort for RSD

A

ECMO extracorporeal membrane oxygenation, use cardiopulmonary bypass to oxygenate the babies blood
risk for bleeds

55
Q

Broncho-pulmonary dysplasia (BPD

A

“chronic lung disease” e2 requirement @at 36 weeks post conceptional age, caused by ventilation which causes pulmonary trauma resulting in lung damage

56
Q

S/Sx of BPD

A

fibrosis, cant get them off of oxygen, interstitial edema, epithelial swelling, atelectasis

57
Q

BPD is Dx by

A

Xray

58
Q

Tx for BPD

A

dexamethasone (decrease inflammatory response), PO diuretics (decrease lung fluid), bronchodilators

59
Q

nutrition for BPD

A

increase of calories , add supplements

60
Q

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

A

Retinopathy of premature (ROP)

61
Q

Tx of ROP

A

prevention, maintain PaO2 level of 60-80 give vit E, laser, cryotherapy

62
Q

acute inflammatory disease of bowel

A

Necrotizing enterocolitis (NEC)

63
Q

what are the three factors that play a role in the development of NEC

A

intestinal ischemia, colonization of bacteria, substrate (formula) in intestine

64
Q

S/Sx of NEC

A

abdominal distention, gastric retention, bloody stools

65
Q

Dx test for NEC

A

Xray: sausage shaped intestine, Labs: anemia, lukeopenia, electrolyte imbalance, metabolic acidosis

66
Q

Tx for NEC

A

remove necrotic intestine, NG tube, Abx, IV nutrition

67
Q

Intraventricular Hemorrhage (IVH)

A

high in premature infant bc of immature vessels esp. intracranial vessels

68
Q

S.Sx of IVH

A

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
Q

Dx for IVH

A

U/S, CT scan, LP

70
Q

Tx of IVH

A

prevention, relief of ICP by LP, shunt is rescue Tx

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