Test #1 Flashcards
When is the greatest amt of weight gain in the fetal life?
26-36 weeks
How much protein does the placenta provide?
3.5 grms/k/day
What are the indications for TPN in a preterm and term infant?
Preterm: 1st day to decrease protein losses
Term: w/o adequate nutrition for 3days
What is the max dextrose concentration for PIVs?
12.5%
When should you consider a CL?
TPN >2 weeks and dextrose conc. >12.5%
What is the enteral caloric requirement of an infant?
85-130cal/kg/day
What are the parenteral requirements of an infant?
85-90cal/kg/day
What is the basal glucose utilization rate?
4-6mg/kg/min
What are three things that increase glucose utilization?
critically ill, hypothermia, and RDS
20-85% of hyperglycemia in ELBW is due to…(3)
- insulin resistance
- decrease insulin intake
- high glucose intake
When max oxidative capacity is reached, excess glucose is converted to?
Fat
12-13mg/kg/mn
Caloric content of parenteral D10W is
.34kcal/cc
What is the caloric value of protein? (trophamine) and how many grams is usually started on day 1
4kcal/gm
3grams
What type of amino acid does trophamine contain? its second to leucine which is found in EBM
taurine
What is the minimal amount of protein and glucose intake?
1.5g/kg/d and 30cal/kg/day
What two elements do not mix well in TPN, must watch!
Calcium and phosphorus -they turn to rocks
What is the desired Ca and P ratio to promote bone mineralization?
1.7 (or 2:1)
When checking labs, what should the product of Ca and P be to prevent bone demineralization?
C x P = >35
What is the usual dose of mag?
(0.5mEq/kg/day)
What is the goal of nutrition?
to supply energy calories in the form of CHO and fats while leaving protein free for growth
What is the non-protein calories to Nitrogen ratio?
150-200 : 1
1g N = 6.25g protein
Non-protein = fat and CHO calores
How many grams of fat are needed to prevent essential fatty acid (EFA) deficiency?
.5-1 gm/kg/day
These are clinical signs of what?
poor growth, failure to thrive, poor wound healing and hair growth, scaly skin, increase sus to bacterial growth
Essential fatty acid disease
How many calories are in one gram of fat?
20% IL = 2kcal/ml = 0.2gm/mL
9kcal/gram
What vitamin is not stable in TPN
vit A
What is the pH of TPN?
5.5-6.5
What is the caloric breakdown of TPN?
CHO, Protein, Fat
CHO - 35-55%
protein - 10%
fat - 45-50
When should labs be drawn?
Lytes:
CMP:
Lytes: daily
CMP: weekly
What is a known fungal infection with TPN and IL?
malassezia furfur
What complication can occur if on TPN for several week?
Cholestasis
Fatty acids compete with ____ for binding with prolonged TPN usage
bilirubin
When support is initiated, does it have to be continued?
No!
When discussing the morbidity with parents, the NNP should focus on…
The short term interventions - ventilator, survanta, antibx
At what gestational age will all infants need ventilator support?
24 weeks
What is the longest time to leave UVC and UACs in place?
UVC - 7-14days
UAC - 7-10days
What are the fluid requirements for a
23 (500grm) -
24 (700grm) -
25-27 (1000grm) -
140-200
115-125
90-110
if in 40% Humidified environment you should cut the fluids by
20%
How much cc/kg/day of fluid should you add if infant is on phototherapy?
10-20cc/kg/day
What is the minimal acceptable amount of Urine output within the first 24 hours?
12-24 hrs
What is seen in ELBW when the serum K+ rises with the shift of K from ICF (in cell) to ECF (plasma). Assoc with hyperflycemia, they NEED tx
Non-oliguric hyperkalemia
If you have an abnormal K+ level, you should ask?
- collection technique
- EKG changes
- Look at BUN, Creatinine, and UO
What are the major s/s of hyperkalemia?
- peaked t waves
- widening QRS
- bradycardia
What is the mgnt of Hyperkalemia?
- stop all K
- Give Ca++ gluconate (0.5-1 mEq/ kg)
- glucose, insulin, and Bi Carb to drive K back into the cell
what is the adequate GIR for infants?
4-6 mg/kg/min
When should you treat Hypocalcemia?
When levels fall below 7.5mg/dl
How many grams of protein should be started on day 1?
at least 3grams
How many grams of Lipids should you start at?
0.5 - 1 gm/kg/day
How much and what is the appropriate volume expanders?
10ml/kg
NS, LR, O-neg blood
What is the 1st choice tx for hypotension (Pressors)? but should always use volume first!
dopamine - avoid wide swings
What is when the alveolar rupture caused by overdistension.
Air leak
When the air that has been leaked gets trapped in the connective tissue. Blebs are seen which increase the size of the lung tissue
PIE - pulmonary interstitial emphysemia
Explain the patho of PIE
Free air compresses the alveoli and adds pressure on the blood vessels and heart. Causes poor CO and problems ventilating the infant
What is a classic picture on an x-ray of PIE?
“salt and pepper”
How do you treat PIE?
place affected side down and put on HFV
When air accumulates at level of hilum. Free air dissects the vascularture and bronchi in the lung
pneumomediastinum
What is a trademark sign of a pnwumomediastinum on a chest x-ray.
“sail sign” - when the thymus is being lifted up
What is the mgnt of Pneumomediastinum, but no evidence to back it up. NO NEEDLES
nitrogen wash-out: 100% O2
Grunting, retractions, cyanosis, tachypnea, abd distention, chest asymmetry, muffled heart tones, irritability are all signs of_____
Pneumothorax
How do you treat Pneumothorax?
Needle aspiration, chest tube
What is a medical ER, usually follows PIE and pneumomediastinum? Must needle to save life
Pneumopericardium
What is the life threatening event caused by a penumopericardium?
Cardiac tamponade
How do you needle the pericardium?
Insert needle at 30 degrees, just above and to the left of xiphoid process, aiming toward shoulder.
When air ruptures from alveolus and enters into pulmonary capillaries- FATAL
Air embolus
What is the presence of blood in trachea accompanied by respiratory depression?
Pulmonary Hemorrhage
What are three main contributors to a pulmonary hemorrhage?
Prematurity, RDS, and Surfactant therapy
When there is a drop in ____ all infants are at risk for Pulm hemorrhage
Pul vascular resistance
How do you treat a pulm hemorrhage?
clear airway with gentle suctioning
Increase Fi02, PEEP, and rate to add pressure
HFOV
What do you replace losses with when a pulm hemorrhage occurs?
10ml/kg —PRBC —>FFP —-> clotting factors
What are two nebulized treatments for pulm hemorrhages?
epinephrine (0.1ml of 1:10,000)
cocaine 4%
What is deactivated by blood and meconium?
surfactant
Where does the fluid/air accumulate in pleural effusions?
between the visceral and parietal spaces
When the rate of filtration in pleural space > rate of removal by lymphatic system?
Pleural effusions
How do you treat pleural effusions?
thoracentesis
You should place the chest tube____ with fluid and ____ with air
Fluid - posterior
air - anterior or lateral
If a premie has MAS you should think?
Listeria infection
What does a chest x-ray look like with MAS?
Streaky and over inflated lungs
How much fluid shout you start a MAS infant?
80ml/kg/day - to prevent cerebral and pulm edema
What are the morphine and fentanyl doses to give MAS infants to help decrease O2 demand?
Morphine: 0.1mg/kg
Fentanyl: 1-5mcg/kg
In MAS you should decrease _____ on vent to prevent breath stacking
itime
What is the best way to lower pulmonary vascular resistance in MAS?
iNO
What are two classic signs of Chlamydia pneumonia?
Cough and runny nose
treat with erythromycin and azithromycin
What is the tx for pneumonia?
TA with gram stain
start antibx
NPO, IVF, O2 (HFOV)
