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Test #1 Flashcards

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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
What vitamin is not stable in TPN
vit A
26
What is the pH of TPN?
5.5-6.5
27
What is the caloric breakdown of TPN? | CHO, Protein, Fat
CHO - 35-55% protein - 10% fat - 45-50
28
When should labs be drawn? Lytes: CMP:
Lytes: daily CMP: weekly
29
What is a known fungal infection with TPN and IL?
malassezia furfur
30
What complication can occur if on TPN for several week?
Cholestasis
31
Fatty acids compete with ____ for binding with prolonged TPN usage
bilirubin
32
When support is initiated, does it have to be continued?
No!
33
When discussing the morbidity with parents, the NNP should focus on...
The short term interventions - ventilator, survanta, antibx
34
At what gestational age will all infants need ventilator support?
24 weeks
35
What is the longest time to leave UVC and UACs in place?
UVC - 7-14days | UAC - 7-10days
36
What are the fluid requirements for a 23 (500grm) - 24 (700grm) - 25-27 (1000grm) -
140-200 115-125 90-110
37
if in 40% Humidified environment you should cut the fluids by
20%
38
How much cc/kg/day of fluid should you add if infant is on phototherapy?
10-20cc/kg/day
39
What is the minimal acceptable amount of Urine output within the first 24 hours?
12-24 hrs
40
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
41
If you have an abnormal K+ level, you should ask?
- collection technique - EKG changes - Look at BUN, Creatinine, and UO
42
What are the major s/s of hyperkalemia?
- peaked t waves - widening QRS - bradycardia
43
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
44
what is the adequate GIR for infants?
4-6 mg/kg/min
45
When should you treat Hypocalcemia?
When levels fall below 7.5mg/dl
46
How many grams of protein should be started on day 1?
at least 3grams
47
How many grams of Lipids should you start at?
0.5 - 1 gm/kg/day
48
How much and what is the appropriate volume expanders?
10ml/kg | NS, LR, O-neg blood
49
What is the 1st choice tx for hypotension (Pressors)? but should always use volume first!
dopamine - avoid wide swings
50
What is when the alveolar rupture caused by overdistension.
Air leak
51
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
52
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
53
What is a classic picture on an x-ray of PIE?
"salt and pepper"
54
How do you treat PIE?
place affected side down and put on HFV
55
When air accumulates at level of hilum. Free air dissects the vascularture and bronchi in the lung
pneumomediastinum
56
What is a trademark sign of a pnwumomediastinum on a chest x-ray.
"sail sign" - when the thymus is being lifted up
57
What is the mgnt of Pneumomediastinum, but no evidence to back it up. NO NEEDLES
nitrogen wash-out: 100% O2
58
Grunting, retractions, cyanosis, tachypnea, abd distention, chest asymmetry, muffled heart tones, irritability are all signs of_____
Pneumothorax
59
How do you treat Pneumothorax?
Needle aspiration, chest tube
60
What is a medical ER, usually follows PIE and pneumomediastinum? Must needle to save life
Pneumopericardium
61
What is the life threatening event caused by a penumopericardium?
Cardiac tamponade
62
How do you needle the pericardium?
Insert needle at 30 degrees, just above and to the left of xiphoid process, aiming toward shoulder.
63
When air ruptures from alveolus and enters into pulmonary capillaries- FATAL
Air embolus
64
What is the presence of blood in trachea accompanied by respiratory depression?
Pulmonary Hemorrhage
65
What are three main contributors to a pulmonary hemorrhage?
Prematurity, RDS, and Surfactant therapy
66
When there is a drop in ____ all infants are at risk for Pulm hemorrhage
Pul vascular resistance
67
How do you treat a pulm hemorrhage?
clear airway with gentle suctioning Increase Fi02, PEEP, and rate to add pressure HFOV
68
What do you replace losses with when a pulm hemorrhage occurs?
10ml/kg ---PRBC --->FFP ----> clotting factors
69
What are two nebulized treatments for pulm hemorrhages?
epinephrine (0.1ml of 1:10,000) | cocaine 4%
70
What is deactivated by blood and meconium?
surfactant
71
Where does the fluid/air accumulate in pleural effusions?
between the visceral and parietal spaces
72
When the rate of filtration in pleural space > rate of removal by lymphatic system?
Pleural effusions
73
How do you treat pleural effusions?
thoracentesis
74
You should place the chest tube____ with fluid and ____ with air
Fluid - posterior | air - anterior or lateral
75
If a premie has MAS you should think?
Listeria infection
76
What does a chest x-ray look like with MAS?
Streaky and over inflated lungs
77
How much fluid shout you start a MAS infant?
80ml/kg/day - to prevent cerebral and pulm edema
78
What are the morphine and fentanyl doses to give MAS infants to help decrease O2 demand?
Morphine: 0.1mg/kg Fentanyl: 1-5mcg/kg
79
In MAS you should decrease _____ on vent to prevent breath stacking
itime
80
What is the best way to lower pulmonary vascular resistance in MAS?
iNO
81
What are two classic signs of Chlamydia pneumonia?
Cough and runny nose | treat with erythromycin and azithromycin
82
What is the tx for pneumonia?
TA with gram stain start antibx NPO, IVF, O2 (HFOV)

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