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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
S/S of TTN
Tachypnea grunting retractions nasal flaring resp acidosis Perihilar haziness hyperinflation & streakiness
26
Treatment of TTN
adequate fluid intake maintain ABGS supplemental oxygen and or CPAP antibiotics always if theres prenatal hx indicating
27
Meconium definition
consists of cells and bile salts that are found in the intestinal tract of the fetus
28
MAS
Meconium aspirated by the fetus d/t stress or repeated episodes of asphyxia in utero
29
Ball Valve phenomena
partial obstruction that allows gas in but not out = uneven ventilation d/t lung collapse / air trapping which then leads to hyperventilation
30
S/S of MAS
``` 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 ```
31
Treatment MAS
``` NRP in delivery room frequent ABGs assisted ventilation (HFV) iNo if PPHN Surfactant therapy ```
32
MAS complications
``` air leaks (pneumomediastinum) pphn chemical pneumonitis acidosis hypoglycemia neuro effects d/t possible asphyxia ```
33
PPHN
Persistant higher pulmonary vascular resistance than the systemic resistance diagnosed after transition from interuterine to extrauterine life (within first 72 hrs of life)
34
3 types of causes of PPHN
underdevelopement maladaption maldevelopment
35
Causes of PPHN underdevelopment type
- pulmonary hypoplasia - lesions or masses in the lung (Diaphragmetic hernia - lungs didnt have the space to grow) - congenital heart dx
36
Maladaption PPHN causes
- 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
37
Maldevelopment PPHN causes
- intrauterine asphyxia (blood to fetus lung) - fetal ductal closure - congenital heart dx - can be unknown
38
S/S PPHN (10)
``` tachypnea retractions cyanosis low PaCo2 Low BP murmur hypoglycemia hypocalcemia meta acidosis decreased urine output ```
39
Dx PPHN
``` CXR - may be normal unless other dx process ongoing pre/post ductal Pao2 hyperoxia test Echo abg = acidosis/hypoxemia CBC and BMP ```
40
Tx of PPHN
``` 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 ```
41
2 types of Pneumonia
congenital and neonatal
42
Congenital pneumonia causes
infection from mom passed in utero/delivery
43
Neonatal pneumonia definition and causes
occurs after birth | d/t to hospital stay
44
S/S penumonia
``` tachypnea apnea temp instability increased WOB CXR increase in interstitial lung markings (but can look like RDS) ```
45
Tx of pneumonia
``` CXR ABGs Blood cultures and CBC tracheal aspirate culture antibiotics NTE Fluid management ventilation hemodynamic monitoring correcting acidosis ```
46
BPD definition
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
Pneumomediastinum findings and tx
``` "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
Pneumopericardium findings and tx
``` Very rare air in pericardial sac usually preceded by other air leaks muffled heart sounds life threatening tx - pericardial taps ```
49
Pulmonary Interstital Emphysema (PIE)
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
Pneumothorax S/S (4) | and how to Dx
``` sudden deterioration if large decreased breath sounds on affected side hypotension shift of mediastinum transillumination (affected side illuminates) or CXR ```
51
Tx Pneumothorax
if small, self resolving | if large - thoracentesis, chest tube, and supplemental oxygen
52
Thoracentesis placement
2nd intercostal space midclavicular line
53
Pulmonary Hemorrhage
Bleeding into the lungs Bright red blood No suctioning!
54
Hemorrhagic pulmonary edema
Blood that escaped the pulmonary vasculature Pink tinged blood Limit suctioning
55
S/S of Hemorrhagic pulmonary edema or Pulmonary Hemorrhage (7)
``` sudden deterioration bloody secretions from airway fighting vent hypotensive increased WOB hypercapnic red or frothy pink secretions from trachea ```
56
Tx of Hemorrhagic pulmonary edema or Pulmonary Hemorrhage
``` Ox and ventilation increasing PEEP transfusion correct acidosis treating any underling dx that contributes (PDA, sepsis) ```
57
Pulmonary Hypoplasia
Inhibited lung growth (congenital) | can be unilateral or bilateral
58
Tx Pulmonary Hypoplasia
Mech Vent/CPAP treat PPHN iNO ECMO
59
Apnea
cessation of respirations lasting more than 20 seconds
60
Causes of Apnea (5)
``` immature CNS decreased neurotransmitters immature central respiratory center sleep state decreased response to hypercapnia ```
61
Primary apnea
responds to stim
62
secondary apnea
requires PPV
63
Central Apnea definition
Complete absence of air flow/respiratory effort and drive Can respond to medication but if it doesnt treatment is a tracheostomy
64
Obstructive
airway obstruction at the level of the larynx or pharynx
65
Management of apnea
``` treat underlying cause temp regulation medical/surgical intervention positioning of the infant decrease environmental stim CPAP medication (caffeine) ventilation ```
66
Congenital Diaphragmatic Hernia (CDH)
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
Most common side CDH appears on
Left (85%)
68
S/S CDH
``` diminished lung sounds and bowel sounds on affected side barrel chest scaphoid abdomen metabolic and respiratory acidosis heart tones shifted ```
69
Tx of CDH
``` iNO HFV ECMO Surgery Genetic eval correct acid/base imbalance NPO Gastric decompression* NO PPV* Intubate in delivery room immediately ```
70
Tracheoesophageal fistula (TEF) 4 types
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
Infants that are dx with TEF should have which other consults/evals
cardiac, renal, and skeletal
72
VATER components
``` Vertebrae Anus Trachea Esophagus Renal ```
73
VACTERL components
``` Vertebral defects Anal atresia Cardiac defects Tracheo-esophageal fistula Renal anomalies Limb abnormalities ```
74
S/S of TEF
``` accumulation of secretions coughing resp distress inability to pass a gastric tube recurrent penumonia ```
75
Management and Tx TEF
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
Choanal Atresia
obstruction of nares Can be membranous (10%) or bony obstruction (90%) may be uni or bilateral
77
S/S of Choanal Atresia
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
Tx Choanal atresia
oral airway | surgical repair
79
Cystic Hygroma
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
Tx cystic hygroma
surgical excision to remove timing of the surgery is dependent on whether the airway is compromised
81
Micrognathia
undergrowth of the mandible
82
Tx Micrognathia (Pierre Robin)
Prone positioning oral airway or intubation trach mandibular distraction surgery
83
CHARGE association components
``` 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
Disorders that cause Resp Acidosis
``` Lung disease Pneuothorax Airway obstruction mech vent poor resp effort neuro injury apnea ```
85
Disorders that cause Resp Alkalosis
Hypoxemia Pain Hyperventilation causing decrease in Co2
86
Disorders that cause Metabolic Acidosis
``` Shock Hypothermia Hypoglycemia CHD Sepsis Inborn errors or metabolism ```
87
Causes of Metabolic Alkalosis
Loss of acid (gastric suctioning, vomitting, diuretics, diarrhea) Admin of bicarb
88
Vent Mangement: | Increasing the PIP
Increases the O2 | decreases the CO2
89
Vent Mangement: | Increasing the PEEP
Increases the O2 | Increases the Co2
90
Vent Mangement: | Increasing the rate (IMV)
Minimally increased the PaO2 | Decreased the PaCo2
91
Vent Mangement: | Increasing the FiO2
increased the PaO2 | Doesnt change the PaCo2
92
Vent Mangement: | Increasing the I:E ratio
increased the PaO2 | doesnt change the Co2
93
Vent Mangement: | Increasing the Flow
minimally increased the O2 | minimally decreased the Co2
94
Vent Mangement: | Increasing the power (HFOV)
doesnt change the PaO2 | Decreased the PaCo2
95
Vent Mangement: | Increasing the PAW
increased the PaO2 | minimally decreased the PaCo2
96
Pulmonary Interstital Emphysema (PIE) Tx
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
Syndromes that often contain micrognathia
Pierre Robin, trisomy 18, trisomy 21, and cri-du-chat syndrome
98
Usually micrognathia "catches up" in growth by
6-12 months
99
Larngotracheomalacia results from
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
Cystic Adenomatoid malformation (CAM)
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
Bronchogenic Cyst
Mucus producing cyst in the trachea, bronchi, or esophagus causing obstruction surgical excision
102
Congenital lobar emphysema
overdistention of one or more lobes of the lung causing the inability to deflate properly usually upper lobes surgical resection
103
Chondrodystrophies
group of disorders relating to bone growth | possible resp distress due to small thoracic cavity

CCRN-NIC (3 decks)

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