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CCRN-NIC > Respiratory > Flashcards

Respiratory Flashcards

1
Q

Large bud development, trachea and bronchi differation

A

Embryonic Stage of lung development (week 1-5)

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2
Q

formation of conducting airways, terminal bronchioles, immature neural network, appearane of type-II pneumocytes

A

pseudoglandular stage of lung development (week 6-16)

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3
Q

lung periphery formation, increased vacularization, appearance of type-I pneymocytes, formation of air-blood interface

A

canalicular stage of lung dev week 17-27

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4
Q

alveolar saccules formation, surfactant detectable in amino fluid, ECM formation

A

Saccular stage of lung dev week 27-36

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5
Q

mature alveolar formation, proliferation and expansion of capillaries, nerve and gas exchange areas

A

alveolar stage of lung dev week 36 weeks - 7-10 years of life

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6
Q

Surfactant is produced by which cells and when

A

Type-II pneymocytes; 25-30 weeks and continue to term

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7
Q

Phosphatidylglycerol (PG) has a correlation with which disease process

A

RDS
when PG is present there is less than 1% chance of baby developing RDS
it is either absent or present in amniotic fluid

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8
Q

Lectithin/sphingomyelin (L/S) ratio is used to access what

A

fetal lung maturity

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9
Q

L/S ratio greater than ____ is considered to indicate fetal lung maturity

A

2:1

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10
Q

An infant born to a _____ mother may still develop RDS even with a mature L/S ratio

A

Diabetic mother

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11
Q

Chronic fetal stress (i.e maternal hypertension, maternal drug use, smoking, bleeding, etc) will tend to do what to a fetus’ lungs ?

A

mature quicker - accelerates surfactant production resulting in a mature L/S ratio in premies

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12
Q

Betamethasone and dexamethasone are given to whom and for what

A

to mothers who are expected to deliver between 24-34 weeks of gestation soon

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13
Q

Definition - Increasing resp difficulty in the first 3-6 hours post birth, leading to hypoxia and hypoventilation
with possible progressive atelectasis

A

Definition of RDS

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14
Q

Pathophysio and etiology - surfactant deficiency leading to diffuse alveolar atelectasis, pulm edema, and cell injury leading to the leaking of serum proteins that inhibit surfactant function into the alveoli

A

RDS

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15
Q

Clinical presentation of _____ (early)

tachypnea, audible expiratory grunting, retractions, nasal flaring, cyanosis, increased O2 requirements

A

RDS

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16
Q

Diagnostic studies/labwork for RDS

A

Xray, blood gas, blood cultures/CBC/GBS testing is risk factors for infection present, and glucose

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17
Q

Management of RDS

A

supportive until disease resolves (is self-limiting/transient) and to prevent further lung injury
give surfactant

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18
Q

Prophylaxis treatment of surfactant therapy includes

A

1 dose given within the first 15 mins of life for infants less than 27-30 weeks especially if mother did not have prenatal steroids

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19
Q

Early rescue treatment of surfactant therapy includes

A

1-2 hours of life with signs of RDS
multi doses can be given
the goal of therapy being to avoid progressive alveolar atelectasis leading to resp failure requiring PPV

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20
Q

Late rescue treatment of surfactant therapy includes

A

4-6 hours of life for infants requiring mechanical ventilation and more than 40% O2

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21
Q

INSURE means

A

intubation and surf administration with immediate extubation to nasal CPAP

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22
Q

TTN

A

delay in the removal of lung fluid

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23
Q

What initiates the removal of lung fluid

A

labor initiates the sodium chloride channels within the lungs to absorb the fluid

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24
Q

Duration of TTN

A

1-5 days

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25
Q

S/S of TTN

A

Tachypnea grunting retractions nasal flaring resp acidosis
Perihilar haziness
hyperinflation & streakiness

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26
Q

Treatment of TTN

A

adequate fluid intake
maintain ABGS
supplemental oxygen and or CPAP
antibiotics always if theres prenatal hx indicating

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27
Q

Meconium definition

A

consists of cells and bile salts that are found in the intestinal tract of the fetus

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28
Q

MAS

A

Meconium aspirated by the fetus d/t stress or repeated episodes of asphyxia in utero

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29
Q

Ball Valve phenomena

A

partial obstruction that allows gas in but not out
= uneven ventilation d/t lung collapse / air trapping
which then leads to hyperventilation

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30
Q

S/S of MAS

A 
Tachypnea grunting retractions 
stained green nail beds 
barrel shaped chest 
coarse crackles
resp/meta acidosis
low PaO2
CXR - diffuse coarse increase in lung markings and hyperinflation
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31
Q

Treatment MAS

A 
NRP in delivery room 
frequent ABGs
assisted ventilation (HFV) 
iNo if PPHN
Surfactant therapy
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32
Q

MAS complications

A 
air leaks (pneumomediastinum) 
pphn 
chemical pneumonitis 
acidosis 
hypoglycemia
neuro effects d/t possible asphyxia
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33
Q

PPHN

A

Persistant higher pulmonary vascular resistance than the systemic resistance
diagnosed after transition from interuterine to extrauterine life
(within first 72 hrs of life)

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34
Q

3 types of causes of PPHN

A

underdevelopement
maladaption
maldevelopment

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35
Q

Causes of PPHN underdevelopment type

A
  • pulmonary hypoplasia
  • lesions or masses in the lung (Diaphragmetic hernia - lungs didnt have the space to grow)
  • congenital heart dx
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36
Q

Maladaption PPHN causes

A
  • hypoxia/asphyxia/perinatal stress (most common)
  • pulm dx (RDS, MAS, pneumonia)
  • hemorrhage
  • bacterial sepsis
  • prenatal pulm hypertension
  • complications at delivery (CNS, resus, hypothermia)
  • acidosis
  • polycthemia
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37
Q

Maldevelopment PPHN causes

A
  • intrauterine asphyxia (blood to fetus lung)
  • fetal ductal closure
  • congenital heart dx
  • can be unknown
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38
Q

S/S PPHN (10)

A 
tachypnea 
retractions 
cyanosis
low PaCo2
Low BP
murmur
hypoglycemia
hypocalcemia
meta acidosis
decreased urine output
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39
Q

Dx PPHN

A 
CXR - may be normal unless other dx process ongoing 
pre/post ductal Pao2 
hyperoxia test
Echo
abg = acidosis/hypoxemia
CBC and BMP
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40
Q

Tx of PPHN

A 
correct ABG 
minimal handling to reduce stress 
umbilical artery/venous catheter 
pre/post ductal sats monitoring
vasopressors 
pulmonary vasodilators (sildenafil)
ventilation/oxygen 
iNO
surfactant 
ECMO
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41
Q

2 types of Pneumonia

A

congenital and neonatal

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42
Q

Congenital pneumonia causes

A

infection from mom passed in utero/delivery

43
Q

Neonatal pneumonia definition and causes

A

occurs after birth

d/t to hospital stay

44
Q

S/S penumonia

A 
tachypnea 
apnea
temp instability
increased WOB
CXR increase in interstitial lung markings (but can look like RDS)
45
Q

Tx of pneumonia

A 
CXR
ABGs
Blood cultures and CBC
tracheal aspirate culture
antibiotics
NTE
Fluid management
ventilation
hemodynamic monitoring 
correcting acidosis
46
Q

BPD definition

A

persistant oxygen dependence up to 28 days of life
can be mild moderate or severe
mild - weaned from supplemental oxygen
moderate - continues to need up to 30% Os
severe - needs more than 30% and/or CPAP/ventilation needed

47
Q

Pneumomediastinum findings and tx

A 
"Sail sign"
looks like a sailboat on CXR 
d/t elevated thymus 
will usually resolve by itself 
close observation needed to make sure it doesnt turn into a pneumothorax
Should be anticipated with MAS
48
Q

Pneumopericardium findings and tx

A 
Very rare
air in pericardial sac
usually preceded by other air leaks 
muffled heart sounds 
life threatening
tx - pericardial taps
49
Q

Pulmonary Interstital Emphysema (PIE)

A

air trapped in between alveoli and capillaries
affects gas exchange
NOT free air like a pneumothorax
but can turn into one
Difficult to differentiate between other diagnoses
CXR shows microcystic areas
may progress to a pneumomediastinum or pneuothorax

50
Q

Pneumothorax S/S (4)

and how to Dx

A 
sudden deterioration if large
decreased breath sounds on affected side
hypotension
shift of mediastinum
transillumination (affected side illuminates)
or CXR
51
Q

Tx Pneumothorax

A

if small, self resolving

if large - thoracentesis, chest tube, and supplemental oxygen

52
Q

Thoracentesis placement

A

2nd intercostal space midclavicular line

53
Q

Pulmonary Hemorrhage

A

Bleeding into the lungs
Bright red blood
No suctioning!

54
Q

Hemorrhagic pulmonary edema

A

Blood that escaped the pulmonary vasculature
Pink tinged blood
Limit suctioning

55
Q

S/S of Hemorrhagic pulmonary edema or Pulmonary Hemorrhage (7)

A 
sudden deterioration
bloody secretions from airway
fighting vent
hypotensive
increased WOB
hypercapnic 
red or frothy pink secretions from trachea
56
Q

Tx of Hemorrhagic pulmonary edema or Pulmonary Hemorrhage

A 
Ox and ventilation
increasing PEEP
transfusion
correct acidosis
treating any underling dx that contributes (PDA, sepsis)
57
Q

Pulmonary Hypoplasia

A

Inhibited lung growth (congenital)

can be unilateral or bilateral

58
Q

Tx Pulmonary Hypoplasia

A

Mech Vent/CPAP
treat PPHN
iNO
ECMO

59
Q

Apnea

A

cessation of respirations lasting more than 20 seconds

60
Q

Causes of Apnea (5)

A 
immature CNS
decreased neurotransmitters
immature central respiratory center
sleep state
decreased response to hypercapnia
61
Q

Primary apnea

A

responds to stim

62
Q

secondary apnea

A

requires PPV

63
Q

Central Apnea definition

A

Complete absence of air flow/respiratory effort and drive
Can respond to medication
but if it doesnt treatment is a tracheostomy

64
Q

Obstructive

A

airway obstruction at the level of the larynx or pharynx

65
Q

Management of apnea

A 
treat underlying cause 
temp regulation
medical/surgical intervention
positioning of the infant
decrease environmental stim
CPAP
medication (caffeine)
ventilation
66
Q

Congenital Diaphragmatic Hernia (CDH)

A

Herniation of abdominal organs into thoracic cavity
Can range from just a slit in the diaphragm to complete absence
May be isolated or apart of a syndrome prognosis depends on size of defect and lung hypoplasia

67
Q

Most common side CDH appears on

A

Left (85%)

68
Q

S/S CDH

A 
diminished lung sounds and bowel sounds on affected side
barrel chest
scaphoid abdomen
metabolic and respiratory acidosis
heart tones shifted
69
Q

Tx of CDH

A 
iNO
HFV
ECMO
Surgery
Genetic eval
correct acid/base imbalance 
NPO
Gastric decompression*
NO PPV*
Intubate in delivery room immediately
70
Q

Tracheoesophageal fistula (TEF) 4 types

A
  1. Esophageal atresia (EA) with Tracheoesophageal fistula
  2. isolated esophageal atresia
  3. H-Type
  4. EA with proximal or proximal and distal communication with the trachea
71
Q

Infants that are dx with TEF should have which other consults/evals

A

cardiac, renal, and skeletal

72
Q

VATER components

A 
Vertebrae
Anus
Trachea
Esophagus
Renal
73
Q

VACTERL components

A 
Vertebral defects
Anal atresia
Cardiac defects
Tracheo-esophageal fistula
Renal anomalies
Limb abnormalities
74
Q

S/S of TEF

A 
accumulation of secretions 
coughing
resp distress
inability to pass a gastric tube
recurrent penumonia
75
Q

Management and Tx TEF

A

manage airway
prevent aspiration (Replogle to LIS)
comfort measures until surgical repair
EA repair would include anastomosis and TEF would include ligation
elongation preior to repair may be necessary

76
Q

Choanal Atresia

A

obstruction of nares
Can be membranous (10%) or bony obstruction (90%)
may be uni or bilateral

77
Q

S/S of Choanal Atresia

A

unable to pass suction catheter/NGT
resp distress
cyanosis when quiet or at rest and pink when crying (babies are nose breathers and would pink up with crying through their mouth)

78
Q

Tx Choanal atresia

A

oral airway

surgical repair

79
Q

Cystic Hygroma

A

Cystic lymphangiomas with lymphatic fluid
most commonly found in the neck
Benign
May compromise the airway
Surgical excision is preformed between 4-12 months and may be staged out to prevent damage to the nerves/vessels attached

80
Q

Tx cystic hygroma

A

surgical excision to remove

timing of the surgery is dependent on whether the airway is compromised

81
Q

Micrognathia

A

undergrowth of the mandible

82
Q

Tx Micrognathia (Pierre Robin)

A

Prone positioning
oral airway or intubation
trach
mandibular distraction surgery

83
Q

CHARGE association components

A 
Coloboma of the eye
Heart Defects
Atresia of the choanae 
Retardation of the growth and or development 
Genital and/or urinary abnormalities
Ear abnormalities and deafness

Typically an autosomal dominant disorder
Defects occur all together but differ from pt to pt

84
Q

Disorders that cause Resp Acidosis

A 
Lung disease
Pneuothorax
Airway obstruction
mech vent
poor resp effort
neuro injury 
apnea
85
Q

Disorders that cause Resp Alkalosis

A

Hypoxemia
Pain
Hyperventilation causing decrease in Co2

86
Q

Disorders that cause Metabolic Acidosis

A 
Shock
Hypothermia
Hypoglycemia
CHD
Sepsis
Inborn errors or metabolism
87
Q

Causes of Metabolic Alkalosis

A

Loss of acid (gastric suctioning, vomitting, diuretics, diarrhea)
Admin of bicarb

88
Q

Vent Mangement:

Increasing the PIP

A

Increases the O2

decreases the CO2

89
Q

Vent Mangement:

Increasing the PEEP

A

Increases the O2

Increases the Co2

90
Q

Vent Mangement:

Increasing the rate (IMV)

A

Minimally increased the PaO2

Decreased the PaCo2

91
Q

Vent Mangement:

Increasing the FiO2

A

increased the PaO2

Doesnt change the PaCo2

92
Q

Vent Mangement:

Increasing the I:E ratio

A

increased the PaO2

doesnt change the Co2

93
Q

Vent Mangement:

Increasing the Flow

A

minimally increased the O2

minimally decreased the Co2

94
Q

Vent Mangement:

Increasing the power (HFOV)

A

doesnt change the PaO2

Decreased the PaCo2

95
Q

Vent Mangement:

Increasing the PAW

A

increased the PaO2

minimally decreased the PaCo2

96
Q

Pulmonary Interstital Emphysema (PIE) Tx

A

if unilateral - intubation of main stem bronchus to the unaffected side of the lung
if bilateral - regular intubation/support (HFV)
Place affected side in dependent position if unilateral
minimize PEEP and iT

97
Q

Syndromes that often contain micrognathia

A

Pierre Robin, trisomy 18, trisomy 21, and cri-du-chat syndrome

98
Q

Usually micrognathia “catches up” in growth by

A

6-12 months

99
Q

Larngotracheomalacia results from

A

the collapse of the larynx and cervical trachea which produces stridor
self limiting resoles by 6 to 12 months when tracheal diameter increases and the cartilage matures

100
Q

Cystic Adenomatoid malformation (CAM)

A

varying types of CAM
basically single or a few cysts that form in the lungs from the lungs not forming correctly in utero
mostly benign and mostly block the bronchi
Tx - surgical excision of the involved lobe if severe

101
Q

Bronchogenic Cyst

A

Mucus producing cyst in the trachea, bronchi, or esophagus causing obstruction
surgical excision

102
Q

Congenital lobar emphysema

A

overdistention of one or more lobes of the lung causing the inability to deflate properly
usually upper lobes
surgical resection

103
Q

Chondrodystrophies

A

group of disorders relating to bone growth

possible resp distress due to small thoracic cavity

CCRN-NIC (3 decks)

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