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Peds test 3 > Test 3 > Flashcards

Test 3 Flashcards

1
Q

what is the last thing that develops in the fetus?

A

lungs

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2
Q

lungs develop postnatally until what age?

A

8-12 yo

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3
Q

what is a zygote?

A

fertilized ovum

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4
Q

what is an embryo

A

once zygote implants approx day 14

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5
Q

what is a fetus

A

week 7 to week 40

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6
Q

what age is the baby incapable of life outside the mother?

A

less than 20 weeks

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7
Q

what is the age of viability?

A

24 weeks, 50% survival rate

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8
Q

what is a neonate?

A

birth to 28 days (first month of life)

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9
Q

what are the phases of lung development

A

embryonic, pseudoglandular, canalicular, sacular, alveolar

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10
Q

embryonic period characteristics

A

week 3-6, proximal conducting airways formed, tracheal cartliage, and segmental lung buds, diaphragm develops and main organs

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11
Q

Pseudoglandular period characteristics

A

week 7-16, all conducting airways present in mini form. fetal breathing movements begin

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12
Q

Canalicular period characteristics

A

week 17-26, terminal bronchioles, lymphatics, and pulmonary circulation, respiratory bronchioles appear, and type 2 cells appear which produce surfactant

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13
Q

sacular period characteristics

A

alveoli increase in size and number, type 2 cells mature, capillaries move closer to alveoli to inc gas exchange

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14
Q

alveolar period characteristics

A

week 36-birth, gradual inc in size and number of alveoli, alveolar shape changes from shallow to cup like

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15
Q

Composition of lung fluid and surfactant

A

95% phospholipids and neutral lipids, 5-10% proteins

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16
Q

L/S ratio test

A

2:1 ratio at 35 weeks considered to have mature lungs, if 1:1 90% have resp. distress

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17
Q

Fetal lung maturity test

A

not needed for fetus >39 weeks or <32 weeks

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18
Q

Antenatal steroids are used for what

A

to accelerate lung maturity and surfactant production, given 24-34 weeks, repeated doses not recommended

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19
Q

what are some things that can cause accelerated lung maturity

A

chronic HN, preeclampsia, HELLP syndrome, placental insufficiency IUGR, prolonged rupture of membranes PROM

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20
Q

What can cause a delayed maturity of the lungs

A

maternal diabetes mellitus, Rh isoimmunization, male babies, second born twin

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21
Q

What are tocolytics

A

drugs used to inhibit uterine contractions, may prolong pregnancy for 2-7 days

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22
Q

What can help determine high risk neonates

A

previous pregnancies, previous live births, previous premature deliveries, previous miscarriage

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23
Q

GPA abbreviations

A

G=gravida (number of pregnancies), P=para (number of live births), A=abortio (number of non viable fetuses)

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24
Q

what is the most common medical problem encountered during pregnancy

A

hypertension

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25
Q

What are the 4 categories of hypertensive disorders during pregnancy?

A

chronic HN, preeclampsia/eclampsia, preeclampsia superimposed on chronic HN, gestational HN

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26
Q

What is preeclampsia?

A

HN and proteinuria (spilling protein/glucose into urine), with or without pathologic edema

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27
Q

What are the risks to the fetus during preeclampsia?

A

ischemia encephalopathy, growth retardation, premie

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28
Q

What is the only way to treat preeclampsia?

A

delivery

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29
Q

gestational diabetes mellitus accounts for what percentage of pregnancys?

A

90%

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30
Q

Where do you want the baby to implant?

A

top 1/3 of uterus

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31
Q

what is placenta previa?

A

placenta comes before fetus

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32
Q

what are some prenatal screening tests?

A

alpha fetoprotein, triple test, quad test (all blood tests)

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33
Q

what does the urinary estriol test show?

A

predicts integrity of placenta, dec values = fetus is possibly dead, chronically low= placenta isnt working right

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34
Q

chorionic villus sampling

A

takes sample of chorion, guided by US

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35
Q

amniocentesis is what

A

aspiration of amniotic fluid/fetal cells, done around week 12-14 or 16-18, tested for DNA, surfactant levels, bilirubin, AFP

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36
Q

What measurements are taken for gestational age during an US?

A

femur, head, abdomen, and measure head to butt

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37
Q

what is a non stress test?

A

one measures heart rate and the other measures contractions, performed after 28 weeks,

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38
Q

how long do typical contractions last?

A

90 seconds to 2 minutes

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39
Q

Fetal biophysical profile is what?

A

US to monitor babies movements, five parameters are monitored and scored 2, 1, 0

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40
Q

What are the 5 things monitored of the fetal bio profile?

A

body movements, fetal tone, fetal breathing, reactive FHR, AFV

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41
Q

What is a sinusoidal heart rate mean?

A

undulating regular and smooth oscillations of FHR, severe acidosis and hypoxemia

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42
Q

What are some cardio maternal changes during pregnancy?

A

SBP dec, DBP dec, mean BP dec, heart rate increase 12-18 bpm, stroke volume increase, and CO increase

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43
Q

what are some respiratory maternal changes during pregnancy?

A

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%

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44
Q

uterine size pregestational

A

70g, size of first, pear shaped

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45
Q

uterine size term

A

1000g , 2 L volume, more rounded

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46
Q

What is the normal weight gain during pregnancy?

A

20-35 pounds

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47
Q

the onset of labor is due to what?

A

hormonal changes (more estrogen and oxytocin), weight of fetus

48
Q

Stage 1 of labor

A

1-24 hours, onset of regular contractions to 10 cm cervical dilation

49
Q

stage 2 of labor

A

2 hours or less, delivery of fetus, crown of head 1st (vertex position), face down, head rotates 90 degrees then shoulders

50
Q

Stage 3 of labor

A

delivery of placenta, <30 minutes blood loss to mom is 1 pint of blood

51
Q

what is dystocia?

A

long or difficult labor, stage 1 >24 hours and stage 2>2 hours

52
Q

what is a breech?

A

butt first

53
Q

what are the 4 risks of fetal death

A

hypoxemia, brain/spinal injuries, long delivery, intercrainal hemorrhage

54
Q

fetal breathing movements begin when?

A

13-16 weeks

55
Q

Stimulation for the neonates first breath

A

experience a resp and metabolic acidosis at birth, hypoxemia, temp changes, stimulation, chest wall recoil

56
Q

For the babies first breath what pressures are required

A

-40 to -80 cmH2O

57
Q

what is the babies first tidal volume

A

40 mL

58
Q

normal FRC of baby

A

20-30 ml/kg

59
Q

prior to delivery little blood flows to lungs via pulmonary arterties because of what?

A

low PO2 causes vasoconstriction, high PVR due to kinked, twisted BV, fluid filled lung structures also offer resistance

60
Q

After delivery PVR decreases because of what

A

removal of placenta, aeration of lungs causes a dec in PVR, and oxygenation reverses hypoxemia

61
Q

how long does it take the foramen ovale to close?

A

24 hours

62
Q

the fetus thrives in a low PO2 because why?

A

fetal hemoglobin carries more O2, higher percantage of hemogloblin, pH changes encourages moms blood to give up O2 and baby take it up

63
Q

the apgar score is done when?

A

1 min and 5 minutes after birth

64
Q

0-3 apgar score means what?

A

severe distress/needs resuscitation

65
Q

4-7 apgar score means what?

A

mild/moderate

66
Q

8-10 apgar score means what?

A

good/normal

67
Q

What does the apgar score look at?

A

heart rate, Resp effort, color, reflex, muscle tone

68
Q

where does the pulse ox go on a baby?

A

right hand or wrist

69
Q

target SPO2 at 1 minute

A

60-65%

70
Q

target SPO2 at 2 minutes

A

65-70%

71
Q

target SPO2 at 3 minutes

A

70-75%

72
Q

target SPO2 at 4 minutes

A

75-80%

73
Q

target SPO2 at 5 minutes

A

80-85%

74
Q

target SPO2 at 10 minutes

A

85-95%

75
Q

How can you give oxygen to a baby

A

mask, ambu, t piece, oxygen tubing

76
Q

what are the 3 set pressures on Neo puff

A

pop off 30-40 (high pressure), PIP (15-20), PEEP

77
Q

how to you quickly check a newborns heart rate

A

count for 6 seconds and add 0 to end

78
Q

what equipment is needed for intubation

A

laryngoscope, blades, ETT, stylet, CO2 monitor, suction setup, waterproof tape, scissors, oral airway, stethoscope, PPV, pulse ox, mask

79
Q

1000g (1kg) is what gestational age and what ETT is needed?

A

below 28 weeks, 2.5 tube size

80
Q

2000g (2kg) is what gestational age and what ETT is needed?

A

28-34 weeks and size 3 tube

81
Q

3000g (3kg) is what gestational age and what ETT is needed?

A

34-38 weeks and size 3.5 tube

82
Q

how long do you have to inset ETT?

A

30 seconds

83
Q

what are the 3 ways to determine if the tube is in the right spot?

A

chest rise, BS/stomach, CO2 cap, xray

84
Q

how do you figure out how deep to insert tube based on babies weight?

A

add 6 to babies weight

85
Q

when is the ballard test the most reliable

A

12 hours and infant needs to be kept warm

86
Q

what are some possible reasons for a SGA baby

A

economic status, malnutrition, teenage preg, drugs/alchol, HM, toxemia, multiple gestation, placental insufficiency, congenital abnormalities

87
Q

how to prevent evaporation heat loss

A

dry baby after being born and throw away wet towels

88
Q

how to prevent convection heat loss

A

keep babies away from cold air currents

89
Q

how do you prevent condution

A

(when your body touches something colder than yourself), keep on radiant warmer, moms chest, isolette

90
Q

How do you prevent radiation heat loss

A

(when you stand next to something cold and you can feel the cold air without touching it), dont put crib near external wall

91
Q

normal newborn temp axillary

A

97.6 or 36.4

92
Q

what is the normal response to cold stress in a term infant

A

vasoconstriction in arms and legs, inc movement, and brown fat metabolism

93
Q

what is brown fat metabolism

A

accumulates in last trimester, acts like a big vest. It is brown because of inc blood flow.

94
Q

what do babies need to burn brown fat

A

oxygen and norepi which is released during stress

95
Q

what is the neutral thermal enviornment

A

enviro where they can maintain normal body temp w/o using alot of their metabolic rate

96
Q

where do you place skin probes

A

want in core area away from brown fat, live and spleen

97
Q

advantages of skin probes

A

continuous, can be hooked up to equipment to help respond to changes

98
Q

disadvantages of skin probes

A

if misplaced or might not be attached to baby which can be very bad, baby can get burned

99
Q

what piece of equipment can truly stop all forms of heat loss

A

isolette

100
Q

radiant warmers protect from what types of heat loss

A

evaporation or convection

101
Q

wraps prevent what types of heat loss

A

conductive, convection, and evaporation

102
Q

how do you get approx mean BP in baby

A

use gestational age and add 5 to it

103
Q

Where can you monitor pulse on a baby

A

umbilical cord for first 4 days of life, brachial, femoral, or auscultation

104
Q

what causes the high amount of bilirubin in babies

A

comes from breakdown of excess Hgb, immature liver, late cord clamping, competition of processing in the liver

105
Q

treatment for elevation of bilirubin

A

based on how high and age

106
Q

what is used to treat high bilirubin

A

phototherapy

107
Q

kernicterus is what

A

bilirubin encephalopathy, brain damage, levels above 20 mg/dL

108
Q

target glucose level in infants

A

50-110 mg/dl

109
Q

signs and symptoms of hypoglycemia

A

jittery, irritable, lethargy, high pitched or weak cry, hypothermia, poor suck, tachypnea, cyanosis, apnea, seizures

110
Q

what is the umbilical artery catheter is used for what?

A

fluids, BP, and ABG

111
Q

high line of UAC

A

tip located b/w t6 and t9

112
Q

low line of UAC

A

tip located b/w L3 and L4

113
Q

what is a heelstick used for?

A

used to monitor trends in pH, PCO2, glucose, CBC, HCT, not good for monitoring PO2

114
Q

procedure of a heelstick

A

arteriolize, firmly hold heel, pierce with lancet, aspirate into capillary tube

115
Q

when is a heelstick not accurate

A

for first 48 hours of life

Peds test 3 (1 decks)

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