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6337 > Test #1 > Flashcards

Test #1 Flashcards

1
Q

When is the greatest amt of weight gain in the fetal life?

A

26-36 weeks

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2
Q

How much protein does the placenta provide?

A

3.5 grms/k/day

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3
Q

What are the indications for TPN in a preterm and term infant?

A

Preterm: 1st day to decrease protein losses
Term: w/o adequate nutrition for 3days

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4
Q

What is the max dextrose concentration for PIVs?

A

12.5%

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5
Q

When should you consider a CL?

A

TPN >2 weeks and dextrose conc. >12.5%

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6
Q

What is the enteral caloric requirement of an infant?

A

85-130cal/kg/day

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7
Q

What are the parenteral requirements of an infant?

A

85-90cal/kg/day

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8
Q

What is the basal glucose utilization rate?

A

4-6mg/kg/min

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9
Q

What are three things that increase glucose utilization?

A

critically ill, hypothermia, and RDS

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10
Q

20-85% of hyperglycemia in ELBW is due to…(3)

A
  1. insulin resistance
  2. decrease insulin intake
  3. high glucose intake
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11
Q

When max oxidative capacity is reached, excess glucose is converted to?

A

Fat

12-13mg/kg/mn

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12
Q

Caloric content of parenteral D10W is

A

.34kcal/cc

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13
Q

What is the caloric value of protein? (trophamine) and how many grams is usually started on day 1

A

4kcal/gm

3grams

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14
Q

What type of amino acid does trophamine contain? its second to leucine which is found in EBM

A

taurine

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15
Q

What is the minimal amount of protein and glucose intake?

A

1.5g/kg/d and 30cal/kg/day

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16
Q

What two elements do not mix well in TPN, must watch!

A

Calcium and phosphorus -they turn to rocks

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17
Q

What is the desired Ca and P ratio to promote bone mineralization?

A

1.7 (or 2:1)

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18
Q

When checking labs, what should the product of Ca and P be to prevent bone demineralization?

A

C x P = >35

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19
Q

What is the usual dose of mag?

A

(0.5mEq/kg/day)

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20
Q

What is the goal of nutrition?

A

to supply energy calories in the form of CHO and fats while leaving protein free for growth

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21
Q

What is the non-protein calories to Nitrogen ratio?

A

150-200 : 1
1g N = 6.25g protein
Non-protein = fat and CHO calores

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22
Q

How many grams of fat are needed to prevent essential fatty acid (EFA) deficiency?

A

.5-1 gm/kg/day

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23
Q

These are clinical signs of what?

poor growth, failure to thrive, poor wound healing and hair growth, scaly skin, increase sus to bacterial growth

A

Essential fatty acid disease

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24
Q

How many calories are in one gram of fat?

20% IL = 2kcal/ml = 0.2gm/mL

A

9kcal/gram

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25
Q

What vitamin is not stable in TPN

A

vit A

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26
Q

What is the pH of TPN?

A

5.5-6.5

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27
Q

What is the caloric breakdown of TPN?

CHO, Protein, Fat

A

CHO - 35-55%
protein - 10%
fat - 45-50

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28
Q

When should labs be drawn?
Lytes:
CMP:

A

Lytes: daily
CMP: weekly

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29
Q

What is a known fungal infection with TPN and IL?

A

malassezia furfur

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30
Q

What complication can occur if on TPN for several week?

A

Cholestasis

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31
Q

Fatty acids compete with ____ for binding with prolonged TPN usage

A

bilirubin

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32
Q

When support is initiated, does it have to be continued?

A

No!

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33
Q

When discussing the morbidity with parents, the NNP should focus on…

A

The short term interventions - ventilator, survanta, antibx

34
Q

At what gestational age will all infants need ventilator support?

A

24 weeks

35
Q

What is the longest time to leave UVC and UACs in place?

A

UVC - 7-14days

UAC - 7-10days

36
Q

What are the fluid requirements for a
23 (500grm) -
24 (700grm) -
25-27 (1000grm) -

A

140-200
115-125
90-110

37
Q

if in 40% Humidified environment you should cut the fluids by

A

20%

38
Q

How much cc/kg/day of fluid should you add if infant is on phototherapy?

A

10-20cc/kg/day

39
Q

What is the minimal acceptable amount of Urine output within the first 24 hours?

A

12-24 hrs

40
Q

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

A

Non-oliguric hyperkalemia

41
Q

If you have an abnormal K+ level, you should ask?

A
  • collection technique
  • EKG changes
  • Look at BUN, Creatinine, and UO
42
Q

What are the major s/s of hyperkalemia?

A
  • peaked t waves
  • widening QRS
  • bradycardia
43
Q

What is the mgnt of Hyperkalemia?

A
  • stop all K
  • Give Ca++ gluconate (0.5-1 mEq/ kg)
  • glucose, insulin, and Bi Carb to drive K back into the cell
44
Q

what is the adequate GIR for infants?

A

4-6 mg/kg/min

45
Q

When should you treat Hypocalcemia?

A

When levels fall below 7.5mg/dl

46
Q

How many grams of protein should be started on day 1?

A

at least 3grams

47
Q

How many grams of Lipids should you start at?

A

0.5 - 1 gm/kg/day

48
Q

How much and what is the appropriate volume expanders?

A

10ml/kg

NS, LR, O-neg blood

49
Q

What is the 1st choice tx for hypotension (Pressors)? but should always use volume first!

A

dopamine - avoid wide swings

50
Q

What is when the alveolar rupture caused by overdistension.

A

Air leak

51
Q

When the air that has been leaked gets trapped in the connective tissue. Blebs are seen which increase the size of the lung tissue

A

PIE - pulmonary interstitial emphysemia

52
Q

Explain the patho of PIE

A

Free air compresses the alveoli and adds pressure on the blood vessels and heart. Causes poor CO and problems ventilating the infant

53
Q

What is a classic picture on an x-ray of PIE?

A

“salt and pepper”

54
Q

How do you treat PIE?

A

place affected side down and put on HFV

55
Q

When air accumulates at level of hilum. Free air dissects the vascularture and bronchi in the lung

A

pneumomediastinum

56
Q

What is a trademark sign of a pnwumomediastinum on a chest x-ray.

A

“sail sign” - when the thymus is being lifted up

57
Q

What is the mgnt of Pneumomediastinum, but no evidence to back it up. NO NEEDLES

A

nitrogen wash-out: 100% O2

58
Q

Grunting, retractions, cyanosis, tachypnea, abd distention, chest asymmetry, muffled heart tones, irritability are all signs of_____

A

Pneumothorax

59
Q

How do you treat Pneumothorax?

A

Needle aspiration, chest tube

60
Q

What is a medical ER, usually follows PIE and pneumomediastinum? Must needle to save life

A

Pneumopericardium

61
Q

What is the life threatening event caused by a penumopericardium?

A

Cardiac tamponade

62
Q

How do you needle the pericardium?

A

Insert needle at 30 degrees, just above and to the left of xiphoid process, aiming toward shoulder.

63
Q

When air ruptures from alveolus and enters into pulmonary capillaries- FATAL

A

Air embolus

64
Q

What is the presence of blood in trachea accompanied by respiratory depression?

A

Pulmonary Hemorrhage

65
Q

What are three main contributors to a pulmonary hemorrhage?

A

Prematurity, RDS, and Surfactant therapy

66
Q

When there is a drop in ____ all infants are at risk for Pulm hemorrhage

A

Pul vascular resistance

67
Q

How do you treat a pulm hemorrhage?

A

clear airway with gentle suctioning
Increase Fi02, PEEP, and rate to add pressure
HFOV

68
Q

What do you replace losses with when a pulm hemorrhage occurs?

A

10ml/kg —PRBC —>FFP —-> clotting factors

69
Q

What are two nebulized treatments for pulm hemorrhages?

A

epinephrine (0.1ml of 1:10,000)

cocaine 4%

70
Q

What is deactivated by blood and meconium?

A

surfactant

71
Q

Where does the fluid/air accumulate in pleural effusions?

A

between the visceral and parietal spaces

72
Q

When the rate of filtration in pleural space > rate of removal by lymphatic system?

A

Pleural effusions

73
Q

How do you treat pleural effusions?

A

thoracentesis

74
Q

You should place the chest tube____ with fluid and ____ with air

A

Fluid - posterior

air - anterior or lateral

75
Q

If a premie has MAS you should think?

A

Listeria infection

76
Q

What does a chest x-ray look like with MAS?

A

Streaky and over inflated lungs

77
Q

How much fluid shout you start a MAS infant?

A

80ml/kg/day - to prevent cerebral and pulm edema

78
Q

What are the morphine and fentanyl doses to give MAS infants to help decrease O2 demand?

A

Morphine: 0.1mg/kg
Fentanyl: 1-5mcg/kg

79
Q

In MAS you should decrease _____ on vent to prevent breath stacking

A

itime

80
Q

What is the best way to lower pulmonary vascular resistance in MAS?

A

iNO

81
Q

What are two classic signs of Chlamydia pneumonia?

A

Cough and runny nose

treat with erythromycin and azithromycin

82
Q

What is the tx for pneumonia?

A

TA with gram stain
start antibx
NPO, IVF, O2 (HFOV)

6337 (4 decks)

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