Test 3 Flashcards
what is the last thing that develops in the fetus?
lungs
lungs develop postnatally until what age?
8-12 yo
what is a zygote?
fertilized ovum
what is an embryo
once zygote implants approx day 14
what is a fetus
week 7 to week 40
what age is the baby incapable of life outside the mother?
less than 20 weeks
what is the age of viability?
24 weeks, 50% survival rate
what is a neonate?
birth to 28 days (first month of life)
what are the phases of lung development
embryonic, pseudoglandular, canalicular, sacular, alveolar
embryonic period characteristics
week 3-6, proximal conducting airways formed, tracheal cartliage, and segmental lung buds, diaphragm develops and main organs
Pseudoglandular period characteristics
week 7-16, all conducting airways present in mini form. fetal breathing movements begin
Canalicular period characteristics
week 17-26, terminal bronchioles, lymphatics, and pulmonary circulation, respiratory bronchioles appear, and type 2 cells appear which produce surfactant
sacular period characteristics
alveoli increase in size and number, type 2 cells mature, capillaries move closer to alveoli to inc gas exchange
alveolar period characteristics
week 36-birth, gradual inc in size and number of alveoli, alveolar shape changes from shallow to cup like
Composition of lung fluid and surfactant
95% phospholipids and neutral lipids, 5-10% proteins
L/S ratio test
2:1 ratio at 35 weeks considered to have mature lungs, if 1:1 90% have resp. distress
Fetal lung maturity test
not needed for fetus >39 weeks or <32 weeks
Antenatal steroids are used for what
to accelerate lung maturity and surfactant production, given 24-34 weeks, repeated doses not recommended
what are some things that can cause accelerated lung maturity
chronic HN, preeclampsia, HELLP syndrome, placental insufficiency IUGR, prolonged rupture of membranes PROM
What can cause a delayed maturity of the lungs
maternal diabetes mellitus, Rh isoimmunization, male babies, second born twin
What are tocolytics
drugs used to inhibit uterine contractions, may prolong pregnancy for 2-7 days
What can help determine high risk neonates
previous pregnancies, previous live births, previous premature deliveries, previous miscarriage
GPA abbreviations
G=gravida (number of pregnancies), P=para (number of live births), A=abortio (number of non viable fetuses)
what is the most common medical problem encountered during pregnancy
hypertension
What are the 4 categories of hypertensive disorders during pregnancy?
chronic HN, preeclampsia/eclampsia, preeclampsia superimposed on chronic HN, gestational HN
What is preeclampsia?
HN and proteinuria (spilling protein/glucose into urine), with or without pathologic edema
What are the risks to the fetus during preeclampsia?
ischemia encephalopathy, growth retardation, premie
What is the only way to treat preeclampsia?
delivery
gestational diabetes mellitus accounts for what percentage of pregnancys?
90%
Where do you want the baby to implant?
top 1/3 of uterus
what is placenta previa?
placenta comes before fetus
what are some prenatal screening tests?
alpha fetoprotein, triple test, quad test (all blood tests)
what does the urinary estriol test show?
predicts integrity of placenta, dec values = fetus is possibly dead, chronically low= placenta isnt working right
chorionic villus sampling
takes sample of chorion, guided by US
amniocentesis is what
aspiration of amniotic fluid/fetal cells, done around week 12-14 or 16-18, tested for DNA, surfactant levels, bilirubin, AFP
What measurements are taken for gestational age during an US?
femur, head, abdomen, and measure head to butt
what is a non stress test?
one measures heart rate and the other measures contractions, performed after 28 weeks,
how long do typical contractions last?
90 seconds to 2 minutes
Fetal biophysical profile is what?
US to monitor babies movements, five parameters are monitored and scored 2, 1, 0
What are the 5 things monitored of the fetal bio profile?
body movements, fetal tone, fetal breathing, reactive FHR, AFV
What is a sinusoidal heart rate mean?
undulating regular and smooth oscillations of FHR, severe acidosis and hypoxemia
What are some cardio maternal changes during pregnancy?
SBP dec, DBP dec, mean BP dec, heart rate increase 12-18 bpm, stroke volume increase, and CO increase
what are some respiratory maternal changes during pregnancy?
RR stays same, tidal volume inc by 100-200 mL, ERV decreases by 15%, residual vol dec, VC stays same, Insp capacity increase, min vol increases by 40%
uterine size pregestational
70g, size of first, pear shaped
uterine size term
1000g , 2 L volume, more rounded
What is the normal weight gain during pregnancy?
20-35 pounds
the onset of labor is due to what?
hormonal changes (more estrogen and oxytocin), weight of fetus
Stage 1 of labor
1-24 hours, onset of regular contractions to 10 cm cervical dilation
stage 2 of labor
2 hours or less, delivery of fetus, crown of head 1st (vertex position), face down, head rotates 90 degrees then shoulders
Stage 3 of labor
delivery of placenta, <30 minutes blood loss to mom is 1 pint of blood
what is dystocia?
long or difficult labor, stage 1 >24 hours and stage 2>2 hours
what is a breech?
butt first
what are the 4 risks of fetal death
hypoxemia, brain/spinal injuries, long delivery, intercrainal hemorrhage
fetal breathing movements begin when?
13-16 weeks
Stimulation for the neonates first breath
experience a resp and metabolic acidosis at birth, hypoxemia, temp changes, stimulation, chest wall recoil
For the babies first breath what pressures are required
-40 to -80 cmH2O
what is the babies first tidal volume
40 mL
normal FRC of baby
20-30 ml/kg
prior to delivery little blood flows to lungs via pulmonary arterties because of what?
low PO2 causes vasoconstriction, high PVR due to kinked, twisted BV, fluid filled lung structures also offer resistance
After delivery PVR decreases because of what
removal of placenta, aeration of lungs causes a dec in PVR, and oxygenation reverses hypoxemia
how long does it take the foramen ovale to close?
24 hours
the fetus thrives in a low PO2 because why?
fetal hemoglobin carries more O2, higher percantage of hemogloblin, pH changes encourages moms blood to give up O2 and baby take it up
the apgar score is done when?
1 min and 5 minutes after birth
0-3 apgar score means what?
severe distress/needs resuscitation
4-7 apgar score means what?
mild/moderate
8-10 apgar score means what?
good/normal
What does the apgar score look at?
heart rate, Resp effort, color, reflex, muscle tone
where does the pulse ox go on a baby?
right hand or wrist
target SPO2 at 1 minute
60-65%
target SPO2 at 2 minutes
65-70%
target SPO2 at 3 minutes
70-75%
target SPO2 at 4 minutes
75-80%
target SPO2 at 5 minutes
80-85%
target SPO2 at 10 minutes
85-95%
How can you give oxygen to a baby
mask, ambu, t piece, oxygen tubing
what are the 3 set pressures on Neo puff
pop off 30-40 (high pressure), PIP (15-20), PEEP
how to you quickly check a newborns heart rate
count for 6 seconds and add 0 to end
what equipment is needed for intubation
laryngoscope, blades, ETT, stylet, CO2 monitor, suction setup, waterproof tape, scissors, oral airway, stethoscope, PPV, pulse ox, mask
1000g (1kg) is what gestational age and what ETT is needed?
below 28 weeks, 2.5 tube size
2000g (2kg) is what gestational age and what ETT is needed?
28-34 weeks and size 3 tube
3000g (3kg) is what gestational age and what ETT is needed?
34-38 weeks and size 3.5 tube
how long do you have to inset ETT?
30 seconds
what are the 3 ways to determine if the tube is in the right spot?
chest rise, BS/stomach, CO2 cap, xray
how do you figure out how deep to insert tube based on babies weight?
add 6 to babies weight
when is the ballard test the most reliable
12 hours and infant needs to be kept warm
what are some possible reasons for a SGA baby
economic status, malnutrition, teenage preg, drugs/alchol, HM, toxemia, multiple gestation, placental insufficiency, congenital abnormalities
how to prevent evaporation heat loss
dry baby after being born and throw away wet towels
how to prevent convection heat loss
keep babies away from cold air currents
how do you prevent condution
(when your body touches something colder than yourself), keep on radiant warmer, moms chest, isolette
How do you prevent radiation heat loss
(when you stand next to something cold and you can feel the cold air without touching it), dont put crib near external wall
normal newborn temp axillary
97.6 or 36.4
what is the normal response to cold stress in a term infant
vasoconstriction in arms and legs, inc movement, and brown fat metabolism
what is brown fat metabolism
accumulates in last trimester, acts like a big vest. It is brown because of inc blood flow.
what do babies need to burn brown fat
oxygen and norepi which is released during stress
what is the neutral thermal enviornment
enviro where they can maintain normal body temp w/o using alot of their metabolic rate
where do you place skin probes
want in core area away from brown fat, live and spleen
advantages of skin probes
continuous, can be hooked up to equipment to help respond to changes
disadvantages of skin probes
if misplaced or might not be attached to baby which can be very bad, baby can get burned
what piece of equipment can truly stop all forms of heat loss
isolette
radiant warmers protect from what types of heat loss
evaporation or convection
wraps prevent what types of heat loss
conductive, convection, and evaporation
how do you get approx mean BP in baby
use gestational age and add 5 to it
Where can you monitor pulse on a baby
umbilical cord for first 4 days of life, brachial, femoral, or auscultation
what causes the high amount of bilirubin in babies
comes from breakdown of excess Hgb, immature liver, late cord clamping, competition of processing in the liver
treatment for elevation of bilirubin
based on how high and age
what is used to treat high bilirubin
phototherapy
kernicterus is what
bilirubin encephalopathy, brain damage, levels above 20 mg/dL
target glucose level in infants
50-110 mg/dl
signs and symptoms of hypoglycemia
jittery, irritable, lethargy, high pitched or weak cry, hypothermia, poor suck, tachypnea, cyanosis, apnea, seizures
what is the umbilical artery catheter is used for what?
fluids, BP, and ABG
high line of UAC
tip located b/w t6 and t9
low line of UAC
tip located b/w L3 and L4
what is a heelstick used for?
used to monitor trends in pH, PCO2, glucose, CBC, HCT, not good for monitoring PO2
procedure of a heelstick
arteriolize, firmly hold heel, pierce with lancet, aspirate into capillary tube
when is a heelstick not accurate
for first 48 hours of life
