STABLE Flashcards
Normal Neurological Status
no signs of distress
active
alert
good tone
strong cry
normal feeding pattern
abnormal neurological status
Early signs:
-poor feeding, weak suck, disinterest
change in LOC
-increased sleepiness, difficulting awakening
Signs of Shock
-irritability
-weak cry
-lethargy, poor tone
-unresponsiveness, comatose
abnormal skin color
-central cyanosis
central cyanosis:
-bluish tongue, mucus membranes caused by desaturations of arterial blood.
abnormal skin color
-acrocyanosis
-cyanosis
-why is it important to interpret saturation values and cyanosis in context of infants hemoglobin
peripheral cyanosis - bluish hands/feet
NO mucus membrane involvement
-R/O hypothermia
Cyanosis: the color of reduced hemoglobin (Hb) or Hb that is not bound to O2 is purple. It takes 3-5g per dL of reduced Hb for cyanosis to be apparent.
-Hb of 15gm/dL - cyanosis will be visible when O2 sats are 67-80%
-Hb of 10gm/dL, cyanosis will be visible when the O2 saturation is 50-70%.
-If a patient is anemic, they won’t appear “dusky” until their saturations are lower and significantly hypoxemic.
this becomes a problem when your anemic pt. is desaturating and hypoxemic but they “look fine.”
Physical Assessment for CHD
vitals:
-RR
-HR and Rhythm
-BP
color
pulses
skin perfusion
liver size and location
neuro status
physical appearance
precordial activity
heart sounds
murmurs
Normal RR for newborn
30-60
easy breathing effort
comfortably tachypneic
> 60 breaths per minute
may be first sign of congenital heart disease
sign of exhaustion
<30 breaths per minute
labored breathing
gasping
ominous sign of impending cardiopulmonary arrest
-intubation
Respiratory signs of severe CHF
labored breathing
sternal and intercostal retractions
grunting
nasal flaring
Normal HR
120-160BPM
range (80-200)
lower at rest
higher with activity or crying
normal sinus rhythm
bradycardia in newborn
<70 bpm
usually pathologic
evaluate for shock
pathologic causes of bradycardia
hypoxia - apnea
hypertension, hyperkalemia, hypercalcemia
hypothermia, hypothyroidism
increased ICP
differential dx for bradycardia
sinus bradycardia
complete heart block
ECG of sinus bradycardia
PR interval is regular and p wave precedes each QRS complex
Complete heart block (third degree AV block)
sinus atrial impulses are not conducted to teh ventricles
ventricular rate (QRS) ranges between 45-80bpm
ECG of complete heart block
P waves are unrelated to QRS complex –> atrial impulses not conducted into ventricles –> blocked at AV node
causes of complete heart block
-congenital
-autoimmune
-acquired
-congenital: structural heart disease
-autoimmune: Sjogren syndrome, lupus
-acquired: complication of heart surgery
tachycardia in newborn
HR sustained >80bpm at rest
may indicate poor cardiac output, shock, or CHF
what should you evaluate for in a newborn with tachycardia
Shock/CHF –> Respiratory status, labs, perfusion
others
-anemia
-fever
-pain
-meds - catecholamines, methylxanthines
-arrythmias
Supraventricular Tachycardia (SVT)
sustained HR >220
-may be present with HR >180bpm
well tolerated unless hydrops or structural CHD
What to assess for when your pt. in SVT
assess for signs of shock
perfusion, pulses, BP, O2 saturations, NIRS if available, Respiratory status/effort, LOC,
development of met acid and lactate
What happens to a BP measurement if your cuff size is too small or too large?
undersized cuff –> overestimates BP
oversized cuff –> underestimates BP
Late sign of shock
hypotension
- always look at HX, patient baseline, labs, dx
