PNRC 06

Question 1

What are the two protocols for surfactant replacement?

Answer 1

prophylactic and therapeutic

Question 2

If a patient receives surfactant, what is the most important thing to monitor?

Answer 2

TV

Question 3

If surfactant administration is given to the patient and it was working well, what two things would have significant changes?

Answer 3

they should have a marked improvement in oxygenation and compliance

Question 4

values that indicate the need for CPAP

Answer 4

RR >30% of normal
s/s of cyanosis with FiO2>50%
Paradoxical chest movement
Recurrent apnea

Question 5

How do you know when the pt is failing on CPAP and when they need to move to mech ventilation

Answer 5

PaCO2 > 60
pH <7.25
High FiO2 and CPAP (10 or more)

Question 6

term infant

Answer 6

38-42 week

Question 7

PaO2 values for PPHN pre term and term

Answer 7

60-80 term
50-80 pre term
80-100 for PPHN

Question 8

6 indications for MV (mechanical vent)

Answer 8

improve oxygenation

stabilize chest wall

Question 9

Normal birth weight

Answer 9

2.7-3.9kg

Question 10

Weight to be determined premature or SGA

Answer 10

Anything less than 2500g

Question 11

What are the 7 things you can change to improve oxygenation in PCV

Answer 11

i time, I:E, PiP, PEEP, MAP, FiO2, and rate

Question 12

What are the FiO2, RR, PiP, Flow, and TV for pt with RDS

Answer 12

FiO2 of 40% for SpO2 90-92%
RR 30-60
PiP 15-25
Flow 4-8
TV 4-6

Question 13

Normal infant ABG

Answer 13

ph 7.3
CO2 40-50
PaO2 60-80 (term)

Question 14

How do you fix asynchrony in volume ventilation vs pressure ventilation?

Answer 14

Flow in volume ventilation and rise in pressure ventilation

Question 15

CO2 value and SpO2 value that would indicate successful CPAP treatment

Answer 15

SpO2 88-95%

PaCO2 < 60 with normal pH

Question 16

What is the most commonly used CPAP interface

Answer 16

CPAP prongs

Question 17

Sizing choice for RAM cannula

Answer 17

Should occlude 60-80% of the nares, if it is above 80% you would want to choose a size SMALLER and vice versa

Question 18

How to place the bevel in RAM cannula

Answer 18

place facing down

Question 19

Most common way children are mechanically ventilated

Answer 19

In volume ventilation or volume targeted

Question 20

What is the first step when weaning CPAP

Answer 20

You want to decrease the FiO2 to <30%

**Wean in very small increments to avoid the flip flop phenomenon

Question 21

After weaning down the FiO2 in CPAP, what do you want to decrease next?

Answer 21

You want to decrease the pressure next. In increments of 1-2 until goal of 3-5cmH2O is obtained

Question 22

When using bubble CPAP, what are reasons that you would no longer hear bubbling?

Answer 22

connections could be loose, prongs not fitting well, or crying
**Prevent: Offer pacifier to avoid crying and check all tubing conections

Question 23

NPPV interfaces for ages less than two compared tochildren?

Answer 23

RAM cannula for kids up to 2 years old. Masks are most common in older children
**Masks cause high risk for aspiration

Question 24

Purpose of NVVP in neuro patients

Answer 24

Helps improve quality of sleep

Question 25

Purpose of NPPV in CF pt

Answer 25

Won’t improve lung function but will help with gas exchange during an acute illness or waiting for a lung transplant.

Question 26

What is the most common type of NPPV used in peds pt

Answer 26

Bilevel Mode (Spontaneous/Timed)

Question 27

Initial IPAP EPAP settings

Answer 27

IPAP- 8-12

EPAP- 5-8

Question 28

If you have a pt with a high CO2 what would you change in IPAP EPAP settings?

Answer 28

Decrease the IPAP in order to decrease the PS which would decrease their ventilation rate

Question 29

PaCO2 value requiring mechanical ventilation

Answer 29

> 60

Question 30

PaO2 value requiring mechanical ventilation

Answer 30

1 <50 on FiO2 80

2 sats are 88% or less on FiO2 80%

Question 31

pH requiring mechanical ventilation

Answer 31

<7.20

Question 32

Most common type of mechanical ventilation in infants

Answer 32

TCPL

Question 33

Most common way children are mechanically ventilated

Answer 33

In volume ventilation or volume targeted

Question 34

Flow difference between TCPL vs PCV

Answer 34

Flow is constant throughout the cycle while in PCV the pressure is constant but the flow is variable

Question 35

In pressure control, what is very difficult to truly measure?

Answer 35

Cannot obtain a true static or dynamic compliance.

Not being able to set a preset TV causes this issue

Question 36

Flow sensors are placed where?

Answer 36

between the ETT and the “Y” of the circuit

Question 37

What purpose do flow sensors provide?

Answer 37

It is more responsive, allowing the pt to trigger breaths much easier and breathe more comfortably

Question 38

ventilatory rate for extubation criteria

Answer 38

5-10

Question 39

Most important alarm in PC

Answer 39

Low and high tidal volume alarms

Question 40

i time for initial setting

Answer 40

.4-.7 seconds

**LBW 0.25-0.4

Question 41

In PC when do you adjust the rise?

Answer 41

Too long or fast reaching the Pip