PEDs/NICU midterm Flashcards

Question

APGAR

Answer 1

developed as an objective way to evaluate the condition of a neonate - First score is assessed at 1 minute - Second score at 5 minutes and every 5 minutes after that up to 20 minutes - 5 minute APGAR score is a predictive of future impairment with a low score of being associated with a high risk of long-term damage

Answer 2

- respiratory effort - heart rate - muscle tone - reflex irritability - color

Answer 3

- Increase in airway resistance - Hypoglycemia - Small diameter of nasal passage → can decrease caliber

Answer 4

Often caused by organisms found in the material intestinal and genital tracts - Can be caused by also poor aseptic technique in the nursery or with equipment

Answer 5

inflammatory response in amniotic fluid which leads to outpouring leukocytes into the fluid from inflamed amniotic tissues - mom and baby are malodorous

Answer 6

serious illness and even death in neonates - GBS is a normal flora of both intestinal and female genital tract (25% females are colonized) - Strep A, B, C and Listeria have strong evidence of abortion, premature birth, congenital disease, neonatal disease

Answer 7

= observe - Color - Languo - Activity - Overall look - Respirations/retractions → tachypnea respiratory rate above 160 bpm; bradycardia respiratory rate is below 100bpm - Chest movements should be symmetrical - Can see grunting and nasal flaring if baby is in distress

Answer 8

baby’s body is pink but feet and hands are still blue in the first 24 hours following birth

Answer 9

= start at the head and work down to the extremities - Inspect head for cuts and bruises - Inspect mouth to see any clefts or hindered breathing - Examine ears to determine gestational age assessment scale - Neck should be examined for presence of cyst or tumors - Normal heart rate is between 120-160bpm - Inability to maintain body temperature - Reduced vigor - Limp appearance

Answer 10

= dependent on the degree of intrauterine development toward maturation - Crying - Response to touch - movements - Muscular tone

Answer 11

- Large skin surface area is prone to heat loss - 80% of body weight is water - Makes overhydration and dehydration difficult to manage

Answer 12

1. Placing baby in the warmer 2. Placing baby on a warm blanket, warm mattress, warm towels 3. Minimizing cold objects to the baby’s body

Answer 13

= hypothermia; is any lowering of the thermoneutral temperature - Baby should be kept 97.9-99.5 (37 celsius) **A COLD NEONATE WILL NOT RESPOND TO RESUSCITATIVE EFFORTS

Answer 14

Peripheral vasoconstriction → shunt of blood away from the skin → anaerobic metabolism and metabolic acidosis Increased metabolism of brown fat → glucose levels begin to fall → hypoglycemia

Answer 15

Formerly called retrolental fibroplasia (RLF) means the formation of scar behind the lens, which is the culmination of the disease (retinal vessels constrict) → necrosis of the vessels - Affect infants born before 31 weeks gestation that weigh 1250 grams or less

Answer 16

- Supplemental oxygen - Retinovascular immaturity - Circulatory instability - Respiratory instability

Answer 17

Cryotherapy= introduces a probe that has been cooled to -20 celsius with nitrous oxide behind the eye and freezing the avascular portion of the retina, further abnormal vessel proliferation Laser therapy= argon or diode lasers are used to photocoagulation the avascular portion of the peripheral retina Vitrectomy and lensectomy are being investigated

Answer 18

= Idiopathic disorder characterized by ischemia and necrosis of the intestine in premature baby

Answer 19

prematurity, asphyxia, formula feeding

Answer 20

abdominal distention

Answer 21

perforation of the intestine leading to sepsis and then death

Answer 22

- Mucosal wall injury= ischemia/decreased blood flow to gut - Bacterial invasion into the damaged intestinal wall - Formula in the intestine= seen in 95% of infants with NEC

Answer 23

= avoidance of factors that lead to its presence - Good hand washing - Oral feeding stopped → nasogastric suctioning on empty stomach - Feeding through IV (hyperalimentation) - Fio2 increased to raise arterial PaO2 levels and aid in mucosal regeneration

Answer 24

= develops when the extra alveolar air ruptures to the external surface of the lung and into the pleural space

Answer 25

isolated pocket of free air in the pleural space that is not fed by a continuous inflow of gas from the point of the leak

Answer 26

addition of new air through the rupture with each breath, creating a larger air pocket that is under pressure

Answer 27

- Increase in respiratory distress with tachypnea - progressing to bradycardic and cyanotic - may have periods of apnea and hypotension

Answer 28

placement of high-intensity light source, usually fiber optic, on the thoracic surface to quickly diagnosis pneumothorax

Answer 29

- Depends on severity - Needle aspiration for life-threatening situations - Chest tube with a range from -15 cmH2O for small leaks and -25 cmH2O for large leaks

Answer 30

= yellowish-orange skin color that accompanies increased levels of bilirubin in the blood - Occurs in 25%-50% of all term neonates - Bilirubin levels excess 4-6 mg/dL - Serum unconjugated (indirect) bilirubin levels exceed 13 mg/dl in term neonates and 15 mg/dl in premature neonates. - Indirect levels rise more than 5mg/dl in a 24-hour period - Direct (conjugated) bilirubin levels exceed 1.5 mg/dl. - The jaundice persists beyond 7 days in term neonates and beyond 14 days in the preemie

Answer 31

comes from breakdown of old erythrocytes into its constituent parts and is a waste product that is normally eliminated from the body through the intestinal tract or kidneys

Answer 32

- Reabsorb large amounts of bilirubin - High percentage of erythrocytes - Blood disorders (Rh, ABO, G-6PD enzyme) - Hemorrhages in fetal body - Lack of enzyme glucuronyl - transferase - bacterial/viral infections - Crigler-Najjar/Lucey-Driscoll - Diabetic mothers - Prematurity - RDS - Galactosemia - Hypothyroidism - Oxytocin to induce labor

Answer 33

Treatment: - Phototherapy lights → blue spectrum most effective - Exchange transfusion for severe cases - Administration of phenobarbital/albumin Complications: - Kernicterus - Necrotizing enterocolitis (NEC)

Answer 34

= fetus passes meconium while still in the utero

Answer 35

Low Apgar scores, fetal hypoxia, acidosis, and abnormal fetal heart tracings

Answer 36

= Actual aspiration of meconium into the trachea occurs in about half of - the neonates born with meconium staining the amniotic fluid - placental insufficiency - maternal hypertension - maternal diabetes mellitus - Preeclampsia - Oligohydramnios - maternal smoking

Answer 37

- Infusion of warm, sterile saline into uterus to dilute• - Intubate and suction if not vigorous - Suction mouth and nose with bulb syringe if stable - Provide warmed, humidified oxygen

Answer 38

=ventricular fibrillation or unstable ventricular tachycardia 1. Administer shock at 2 Joules/kg 2. Administer high-quality CPR for 2 minutes 3. Check rhythm

Answer 39

= asystole or pulseless electrical activity(PEA) 1. Administer high-quality CPR for 2 minutes 2. Administer epinephrine 0.01 mg/kg IV or 0.1 mg/kg per ETT every 3-5 minutes 3. Check rhythm

Answer 40

= water lost by evaporation from the skin and respiratory tract - Due to abnormal losses of fluid and electrolytes → diarrhea, emesis, nasogastric tube drainage, thoracostomy tube losses, damaged skin

Answer 41

1. Early gestational age 2. Respiratory distress 3. Environmental temperature above the neutrothermal zone 4. Elevated body temperature 5. Skin breakdown and excoriations 6. Congenital skin defects (neural tube disorders) 7. Radiant warmer 8. Phototherapy 9. Increased motor activity and crying

Answer 42

IWL= Intake – Output – (change in weight)

Answer 43

= typical of respiratory distress with worsening or refractory PaO2 to oxygen therapy, increasing PaCO2, and combined acidosis - PaO2 should be maintained at a minimum between 50 and 80 mmHg, - PaCO2 maintained below 60 mmHg - pH should be greater than 7.25 - Administer glucocorticoids to mother before delivery

Answer 44

too much bicarbonate or too little acid in the blood. - A negative value, called a base deficit, or a negative base excess, occurs whenever there is too little base or too much acid

Answer 45

= used to identify those perinatal infections that are associated with severe fetal anomalies and even death T- toxoplasmosis O- other “other” infective agents are syphilis, HIV, coxsackie virus, varicella-zoster virus (chicken pox), and parvovirus B19 R- rubella C- cytomegalovirus H- herpes simplex type 2

Answer 46

= sudden infant death syndrome that remains unknown entity but has the highest number of death in infants of less than 1 year old - put them supine - 2-4 months more seen for male than females - Usually hits winter and at night

Answer 47

Infant‘s tongue is larger in area than adults - Large amount of lymphoid tissue in pharynx - Epiglottis is larger and less flexible - Larynx is higher - Diameter of trachea narrow - Ribs and sternum mostly cartilage

Answer 48

- Higher than adults - The caloric requirement for neonates is approximately 100 cal/kg and decreases to 40 to 50 cal/kg in the adult - Increases oxygen requirement - Results in challenges to pharmacotherapy

Answer 49

= intake of non-foods such as hair, dirt, animal droppings, and paint - At issue is not just a vitamin and mineral deficiency, but possible poisoning with heavy metals

Answer 50

= refusal to eat in a relentless pursuit to become thin

Answer 51

= binging on large quantities of high-caloric food, which then may be followed by self-induced vomiting or use of laxatives to “purge” the body

Answer 52

= have trouble paying attention and controlling their impulsive behaviors → overactive - One of the most common neurobehavioral disorders of childhood - between 3% and 7% of school-aged children have ADHD

Answer 53

1. predominantly inattentive type 2. predominantly hyperactive-impulsive type 3. combined type

Answer 54

= similar to autism, but function better than those with autism - generally have normal intelligence and near-normal language development, although they may develop problems communicating as they get older

Answer 55

=children who have significant problems with communication and play, and some difficulty interacting with others, but are too social to be considered autistic - sometimes referred to as a milder form of autism

Answer 56

1. First occurs between 18 and 24 months and is affectionately called the “terrible twos.” - During this time, the oppositional behavior is related 2. The second occurrence may be seen during the teenage years when there is another move toward an autonomous identity and a separation from the parents - These episodes typically last less than 6 months - children with ODD exhibit oppositional and defiant behavior chronically - Children with ODD show frequent temper tantrums, excessive arguing, and deliberate attempts to upset people, mean and hateful talking, and revenge seeking

Answer 57

= group of behavioral and/or emotional problems that lead to a disregard for rules and socially unacceptable behaviors - more prevalent in males where it often manifests as aggression - Of major concern with this disorder is the high rate of mortality, which may approach 50%

Answer 58

1. Canalicular stage → Weeks 17 through 26 = Alveoli begin to develop 2. Saccular stage → 26 to between 34 and 36 weeks =Continued development of the alveoli 3. Alveolar stage --> True alveoli are present between 32 to 34 weeks = Number of alveoli will increase until around 8 years old

Answer 59

An opening between the right and left atrium is present in the atrial septum; this opening is the second shunt - shunts blood from right to left atrium

Answer 60

= managing newborns with lung disease because of their ability to give views of the effect of various disease processes on the internal body structures It can usually be expected that a chest film of any newborn or intubated pediatric patient is an AP view

Answer 61

The umbilical vein is a single vessel of relatively large diameter that often appears filled with blood The umbilical arteries are a pair of vessels of smaller diameter that usually are more opaque and whitish in appearance and appear to contain little blood - After delivery, the umbilical arteries gradually spasm and close - The cord stump should first be checked to ensure that the umbilical arteries are still pulsatile

Answer 62

The average heart rate in early gestation is 140/min → dropping to an average of 120/min near term *The normal baseline heart rate will range between 120 and 160 beats per minute (bpm)* - A healthy, awake fetus has a constantly changing heart rate, usually between 5 and 10 bpm

Answer 63

normally between 30 and 60 bpm - Tachypnea, or a respiratory rate above 60 bpm → sign of respiratory distress

Answer 64

neonates, especially those born prematurely, may have periods of apnea usually lasting 5 to 10 seconds but without cyanosis or bradycardia

Answer 65

= A cross section of the umbilical cord reveals three vessels surrounded by a tough, gelatinous material, - insulates and protects the umbilical vessels - The presence of Wharton’s jelly prevents bending and pinching of the umbilical cord - Following delivery, abrupt temperature changes cause the Wharton’s jelly to collapse the umbilical vessels within about 5 minutes

Answer 66

= the sac that surrounds the growing fetus and contains the amniotic fluid - It arises from the trophoblast around the seventh gestational day - It begins as a small vesicle and develops into a sac, which covers the dorsal surface of the embryo

Answer 67

= the substance found on the alveolar wall that lowers surface tension - The first surfactant “immature surfactant” seen at approximately 24 weeks gestation - Can give 3 times in the span of first 72 hours from birth - Reduces muscular effort - Works in tandem with the change in size of the alveoli - Can be measured in amniotic fluid

Answer 68

=present around week 35 - Determined by lecithin-to-sphingomyelin ratio (L/S ratio) 2:1 generally around 35 weeks gestation - Shake or foam test - Amniotic fluid surfactant-albumin ratio (SAR) - TDx-FLM assay - Fluorescence polarization (FP) assay

Answer 69

= A baseline heart rate of less than 100 bpm or a maintained drop of 20 bpm from the previous baseline rate - seen during the second stage of labor (after the cervix is dilated to 10 cm through the delivery of the infant) is divided into end-stage and terminal bradycardia

Answer 70

Asphyxia --> Oxygen administration to the mother may help reduce the severity of asphyxia to the fetus

Answer 71

= Blood coming from the fetus follows the two umbilical arteries to the placenta, at which point they branch into smaller and smaller vessel - The umbilical arteries have relatively thick walls - Near the upper pelvic region, the aorta splits into the two common iliac arteries → The iliac arteries further divide into the external and internal iliac arteries → It is from the internal iliac arteries that the two umbilical arteries branch - Throughout fetal circulation, between 17% and 33% of blood flow passes through the umbilical arteries

Answer 72

= baseline is consistently above 180 bpm - The most common cause is maternal fever

Answer 73

= usually involves a failure of the tissue flap to cover the foramen, allowing the movement of blood between atria - Often symptomless - Openings in the atria can also occur in the upper and lower trial septum - Diagnosis A majority of ASDs are symptomless and go undetected - Severe ASDs may result in left-to-right shunting with resultant right ventricular overload

Answer 74

incompetent foramen ovale = defect is called an osteum secundum defect

Answer 75

= The term neonate has about 0.07 m2/kg = 28-week neonate has roughly 0.15 m2/kg.4 - This large surface area makes the neonate particularly prone to heat loss and often susceptible to cold stress

Answer 76

= Characterized by severe, persistent pulmonary vasoconstriction, which causes increased blood pressure in the lungs and decreased pulmonary blood flow (persistent fetal circulation)

Answer 77

- inhaled nitric oxide —> mechanical vent - The maintaining of temperature, fluids and electrolytes, blood sugar, oxygenation, blood pressure and perfusion - Minimize handling the patient - Mechanical ventilation

Answer 78

- The infant larynx lies higher in the neck in relation to the cervical spine - The narrowest segment of the larynx is at the level of the cricoid ring - The narrowest portion of the adult larynx is at the glottis - A child’s larynx is higher and more anterior anatomically than the adults → at about the level of the first or second vertebrae

Answer 79

= is a congenital heart defect that occurs when the ductus arteriosus, a temporary blood vessel in a fetus, doesn't close after birth - Right to left shunting - Hyperperfusion and engorgement of the pulmonary vessels with resulting pulmonary edema

Answer 80

= A defect in which one large vessel arises from both right and left ventricles over a large VSD - Diagnosed by electrocardiography and cardiac catheterization - Requires surgical treatment

Answer 81

= caused by decreased blood flow through the pulmonary artery and the resultant passage of venous blood into the aorta

Answer 82

1. peak inspiratory pressure (PIP) 2. positive end-expiratory pressure (PEEP) 3. continuous positive airway pressure (CPAP) 4. rate = when the neonate is apneic or gasping, or when spontaneous breathing cannot maintain the heart rate above 100 bpm

Answer 83

- flow-inflating bag - self-inflating bag - T-piece resuscitator

Answer 84

= Second attempt of fetus to ventilate - Respirations are weak, gasping, and ineffective - During secondary apnea, there will be no attempt to breathe again unless positive pressure ventilation (PPV) is initiated

Answer 85

Embryonal stage → First 7 weeks gestation = Lungs begin to develop at 24 days Pseudoglandular stage → 7 to 16 weeks gestation = Lungs continue to develop and begin to look like glands Canalicular stage → Weeks 17 through 26 = Lungs become vascularized Saccular stage → 26 to between 34 and 36 weeks = By 24 to 26 weeks, lungs are completely formed

Answer 86

= Safe Range (neonatal and pediatric) 7.35 to 7.45 = Acceptable Range (neonatal and pediatric) 7.30 to 7.50 = Fetal blood pH is considered to be normal above 7.25 - pH of 7.2 to 7.24 shows slight asphyxia - pH of less than 7.2 signifies severe asphyxia

Answer 87

1) when thick meconium is present in a nonvigorous infant 2) if bag and mask ventilation is difficult or ineffective 3) if prolonged PPV is required due to lung disease 4) if chest compressions have become necessary 5) in cases of extreme prematurity and need for surfactant administration

Answer 88

- term neonate will require a size 1 blade - size 0 blade is needed for premature neonates - Should be done in under 30 seconds to prevent hypoxia

Answer 89

First stage= Onset of regular contractions to full dilation and effacement of the cervix - 16–18 hr 7–12 hr Second stage= Full dilation and effacement of the cervix to delivery of the fetus - 1 hr (can last up to 2 hr) 20 min

Answer 90

= placenta covers cervix - the blastocyst attaches itself somewhere near the upper portion of the uterine cavity → implantation occurs in the lower portion of the uterus - All types of placenta previa are readily diagnosed by ultrasound

Answer 91

occupies the lower portion of the uterus but does not cover the cervical opening

Answer 92

covers a portion of the cervical opening but does not cover it completely

Answer 93

completely covers the opening of the cervix

Answer 94

25% of delivers in the US are done by C-section - Tachypnea of the newborn (TTN) - Prior cesarean delivery - Dystocia - Breech presentation - Fetal distress - Multiple gestations

Answer 95

It is estimated that 2% to 4% of all children are affected by obstructive sleep apnea Signs: - Choking - drop in the heart rate - rise in blood pressure - brain function arousal - Hypoxemia - disrupted sleep

Answer 96

- enlarged tonsils and adenoids - Obesity - lower jaw - tongue abnormalities - neuromuscular deficits

Answer 97

lead to social problems, behavioral and learning disorders, enuresis, growth shunting, obesity, and an increased risk of hypertension and other cardiopulmonary problems - Up to 25% of children diagnosed with ADHD may also have symptoms of obstructive sleep apnea

Answer 98

= Any swelling or inflammation of these structures greatly increases resistance and the patient’s work when breathing - Infants also have a large amount of lymphoid tissue in the area of the pharynx compared to the adult - The epiglottis of the infant is proportionally larger, less flexible, and omega shaped (Ω), which makes it very susceptible to trauma → the infant epiglottis also lies more horizontally than the adult - the narrowest segment of the larynx is at the level of the cricoid ring &the narrowest portion of the adult larynx is at the glottis