Prematurity Flashcards
Transition to extrauterine life reuqres many __ for infant
tend to have difficulty w \_\_ vulnerable to \_\_ more l\_\_ and \_\_ more i\_\_\_ and h\_\_\_ potential for \_\_ related injuries high risk for developing \_\_
avoid __ during ressu
reduce __ if resus not req
preterm infants may require __ and __ after birth
physio changes
transition cold stress lung immaturity/RDS intracranial hemorrhage, hypoGly O2 related injuries NEC
rough handling
heat loss
endotracheal intubation/surfactant admin
Administer __ slowly
follow __ carefully
__ may be dec, infant may experience __ secondary to perinatal compromise
maintain normal __ after resus
Major physio problems of prematurity R, B, A, C P, H, R \_\_ that inc risk of infection prevent \_\_\_
meds
glucose
glycogen, hypoGly
O2 range
RDS, BPD, Apnea of prematurity, chronic lung dz
PDA, hypoTN, ROP
immune system immaturity
IVH
Addtl problems skin \_\_/\_\_ T and G issues F/E imbalances due to immature \_\_ fxn \_\_ disorders \_\_ manage developmental issues of \_\_
RDS risk factors low _ M born to \_\_ born after \_\_ before birth born after \_\_-\_\_ hemorrhage Multiple \_\_
immaturity/fragility thermoregulation/GI fluid/electrolyte, renal acid-base pain CNS
gestational age male diabetic mother asphyxial insult maternal-fetal hemorrhage gestation
RDS characterized by diffuse __ of the lungs
primarily due to def of __
leads to higher __ at surface of alveoli, interfering w exchange of __/__
Sx
Difficulty in establishing __, esp if pt has __ for RDS
__ while infant is not crying
__/__ retractions due to inc __ and dec ___
Nasal __
C and T
alveolar atalectasis, surfactant
surface tension, O2/CO2
normal resp, RF expiratory grunting intercostal/sternal, rib cage comp, lung compliance Nasal flaring Cynosis/tachypnea
RDS
give __ to all preg women at __ wks at risk for __ w/in 7 days
can use __ or ___
repeat course of __ should not routinely be given to __
Tx- Thermo__
__ balance and __
__/___/__ care
__ assessment
focus to __/__ atalectasis
minimize effects of __ and ___/__
treat underlying __/__/__ probs
maintain blanaced __ enviro
antenatal steroids, 24-34 wks, perterm delivery
betamethasone, dexamethasone
CS
thermoregulation
fluid, nutrition
skin/develop/family
pain
prevent/minimize
O2, barotrauma/volutramua
CV, infect, phsio
phsio
Surfact therapy surfactant coats inside of \_\_ prevents \_\_\_ and keeps alveoli open at end of _ given via \_\_ \_\_ appears more beneficial than \_\_ \_\_ leads to improved clinical outcomes
Adjunct tx for RDS CPAP- assists \_\_ w continuous \_\_\_ valuable when \_\_ is adequate and \_\_ is not excesive inc \_\_ and improves \_\_/\_\_ reduces \_\_/\_\_
alveoli atalectasis, expiration endotracheal tube prophylactic, resuce multiple doses
lung expansion, distending pressure
spontaneous breathing, pulm dz
TP pressure, oxygen/ventilation
tachypnea/grunting
Adjunct tx for RDS
HFV- allows use of small ___ and high ___
limits __ and wide __ swings assc w __/__ caused by trad mech vent
O
tidal volumes, freq
large tidal volumes, ventilator
pressure, volu/barotrauma
oscillation
BPD- uncommon after __
secondary disease that develops in neonates tx w ___ and __ for primary lung problems (aka RDS)
Sx \_\_ w prolonged O2 req H/T w inc work of \_\_ Episodic \_\_ w wheezing C/C abnormal postures of \_\_/_
Therapy is __/__
preventative measures begin __ and prevent __ using single course of __
Early/careful mx of __ w low __ and careful use of __/__
32wks
PPV and O2
hypoxemia hypercapnia/tachypnea, breathing bronchospasm CHF, cor pulmonale neck/upper trunk
preventive/supportive
prenatally, prematurity, antenatal steroids
RDS, vent pressures, O2/exo surfactant tx
post natal steroids- systemic admin of __ to mech ventilated premature infants dec inc of __ and __
does not dec ___
__ tx for VLBW infants assc w impaired __/__ delay
__ does not have benefits
__ use of dex is not supported
outside of trials, use of ___ should be limited to infant on max __
dexomethasone, CLD/extubation failure
overall mortality
dexamethasone, growth/neurodevelopmental
inhaled CS
routine
postnatal CS, ventilatory support
BPD care
prevent ___
wean __ and ___ slowly
stressful situtations can __ hypoxemia inducing events
use __ w notnutritive __ before painful procedures to reduce __
__ (inc FiO2 before suction) may prevent __ w suction
__ is helpful to parent
use __ or premature __ for WG
__ promotes bonding
further lung damage
ventilator, o2 support
minimize
sucrose, pain
preoxygenation, hypoxemia
consistent caregiver
fortified breastmlk, specialty formula
kangaroo care
__ improves gas exchange and __ in premies
NO __ on physio stability
improved __ in mothers wishing to ___
positive impact on ___
kangaroo care, temp
AE
lactation, breastfeed
parenting process
MC cardiac comp in premies is __
more likely w ___
sx
__, inc need for __, inability to __ from ventilator
widened __, active __, Bounding __ and ___ w/wout gallop
__ is most useful to eval
initial approach w __ and __/__
__ is effective in closing PDA
PDA
severe prematurity
CHF, O2, wean
pulse presure, precordium, peripheral pulses, tachycardia
echo
med management, fluid restriction/diuretics
indomethacin
PDA care
contine to assess __ for pulse/pressure/perfusion and ausculation for __
assess infant after indomethacin for __, dec __, __
ROP- significant cause of __ initiated by delay in ___ growth
more __ the infant, more likely __ is
RF
low __
prolonged __ and __ admin
H/H/S/A/S
high risk infants, murmur
ductal closure, urine output, thrombocytopenia
blindness, retinal vasc
premature, ROP
birth weught
mech vent, O2
hyperoxia/hypoxia/sepsis/acidosis/shock
ROP patho
normal retinal blood vessel development needs __
if baby gets lots of __, __ dec
when stop giving O2, _ inc and new __ develop
nrormal retinal vasc occurs from _ to __
nasally by ___
temporally by ___
Normal- choroid vascularises at __
retinal vascularization starts at __ at 16w. proceeds toward __
__ is almost complete by term
__- primitive plexus formed from ___ (VEGF __)
angiogenesis- new vessels from __, (VEGF __)
central 1/3 formed by __
VEGF
O2, VEGF
VEGF, vessels
optic disc to periphery
36wks
40wks
6wks
optic nerve head, periphery
vascularisation
vasculogenesis, precursor cells, independent
pre existing vasc, dependent
vasculogensis
Premature delivery interrupts normal ___
Phase 1: delayed __ (birth- 32 wks)
developing retina exposed to __ enviro
reduces __ factors delaying ___
Phase 2: N__
neuroretina continues to delveop causing __ w overprod of __ esp VEGF
causes uncontrolled __ growth
vasc growth
retinal vascularization
hyperoxic
angiogenic, retinal vasc
neurovascularization
hypoxia, angiogenic factors
retinal BV
