Respiratory Disfunction of the Newborn Flashcards
what are the 3 critical factors in the development of respiratory distress syndrome
preterm unable to produce enough surfactant
muscle coat of pulmonary blood vessels are incompletely developed
ductus arterioles may remain open due to hypoxia
what helps close the PDA
hyperoxemia
what could happen if the PDA does not close
pulmonary congestion and overload
why are preterm newborns at an increased danger of respiratory obstruction
- the bronchi and trachea are very narrow and mucus obstructs airway
- positioning
- weak or absent gag reflex could result in aspiration
if O2 sats are dropping low what should you do
position them in a prone position for chest expansion
what are signs of respiratory distress
nasal flaring retractions crackles asthma (wheezing) grunting cyanosis tachypnea
what are the two positions you can place the baby in for maintenance of resp function
supine with head slightly elevated without hyper flexion and prone position
why do you not want to do a lot of suctioning
this could put further stress on the baby
what should be assessed before oral feedings are started
infants gag and suck reflex as well as if they are breathing fast or not
why will a baby not go higher than 100% O2 sats on oxygen?
because we want to ween the baby off of the oxygen because too much can cause problems to the baby (ROP)
what delivers 400 breaths a minute to the infant and you will see a constant wiggle of their chest
high frequency oscillation
what is it when the baby poops in utero and they breath it into their lungs
meconium aspiration syndrome
what stops producing due to the meconium build up
surfactant
what is the biggest issue with MAS
mechanical obstruction because it plugs up the airway, making it sticky
MAS happens to….
full term or post term
what are clinical signs of MAS
severe respiratory distress shortly after birth and audible rales or rhonchi on auscultation
- barrel chest
- not a good apgar
- PO2 is low
- Acidosis
what is the management of MAS
ventilation and monitoring
surfactant admin
results when the normal vasodilation and relaxation of the pulmonary vascular bed do not occur
persistent pulmonary hypertension of the newborn (PPHN)
PPHN happens to…
term or near term infants (wimpy white boys don’t do well, african american females do the best)
what are 6 risk factors of PPHN
hypoxia RDS pneumonia bacterial sepsis hypo or hyperthermia
for PPHN babies where do we check blood pressure
right arm
why do PPHN babies desat
their lung pressure is higher than systemic pressure and this makes blood bypass the lungs (going through PDA)
what are assessment finding in a PPHN baby
- term or near term infant
- low apgar score
- symp within 12 hrs
- hypoxia at birth
- tachypnea
- retraction/grunting
- cyanosis
- hypotension
- heart murmur
- met acidosis
preductal is the
right arm
post ductal is the
left arm
what helps increase systemic pressure so blood will go to lungs for the PPHN babies
vasopressors
why are sedatives and analgesics given to PPHN babies
they are very sensitive and if we touch them they will drop their sats so care is done every hrs
delayed clearance of fetal lung fluid and usually resolves by 48-72 hours
transient tachypnea of newborn (TTN) aka wet lungs
what is a main cause of TTN
the babies don’t get a good squeeze of lungs as they make their way through vaginal canal or a c section is performed so there is no squeezing at all
what are clinical manifestations of TTN
respiratory distress and or cyanosis
cessation of breathing for 20 sec or longer or for less than 20 sec when associated with cyanosis, pallor, and bradycardia.
apnea
what are two types of apnea
central and obstructive apnea
caused by preterm infants irregular breathing pattern
central apnea
preterm infant when there is a cessation of airflow associated with blockage of the upper airway
obstructive apnea
apnea is a dx of _______
exclusion
what is often used to treat apnea of prematurity
methylxanthine (caffeine citrate
when would you hold the mthylxanthine (caffeine citrate)
when HR is high (>170)
surfactant deficiency is the main issue of this and underdeveloped alveoli
respiratory distress syndrome
RDS happens to…
usually preterm babies
what is a good indicator that RDS babies are getting better
baby is starting to pee more
what are risk factors for RDS
low gestational age
male predominance
maternal diabetes
perinatal depression
why would maternal diabetes be a risk for RDS
increase sugar and insulin deactivates the surfactant
how can you lessen the severity of RDS
giving mom steroids because it helps lung development but it should be given 30-1hr before birth
what will the RDS baby look like
gray dusky color
nasal flaring
grunting
how can we manage RDS
artificial surfactant given via ET tube resp support and monitoring oxygen supplementation fluid and metabolic management (withhold feeding and give tpn)
bone or mucus is blocking the nasal cavity
choanal atresia
s/s of choanal atresia
cyanosis and retractions at rest
noisy respirations
difficulty breathing during feeding
how do you assess potency of nares
listen for breath sounds while holding mouth closed and alternately compressing each nostril
how should you position choanal atresia pt
head elevated
what is a sign the baby probably has choanal atresia
put a pacifier in babies mouth and sats drop
why is sx for choanal atresia put off
it is too close to the brain so they don’t want to do sx on it too soon (track is usually done first)
too much oxygen can cause this to happen to the eye
retinopathy of prematurity (ROP)
what is the main risk factor for ROP
hyperoxemia
how can we prevent ROP
judicial use of supplemental oxygen therapy (for sats usually <93%)
