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Apex Review > Neonatal A&P 2 > Flashcards

Neonatal A&P 2 Flashcards

1
Q

During an inhalation induction, a neonate begins to desaturate shortly after the removal of the facemask. Which statement BEST explains why the neonate desaturated so quickly?
a. decreased tidal volume to dead space ratio
b. oxygen consumption is 3 mL/kg/min
c. increased alveolar ventilation to FRC ratio
d. the patient is experiencing malignant hyperthermia

A

c. increased alveolar ventilation to FRC ratio

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2
Q

What is the oxygen consumption of neonates compared to adults?

A

higher to support metabolic demand (6 mL/kg/min)

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3
Q

What is the FRC of the neonate?

A

slightly decreased than the adult which reflects a reduced oxygen reserve

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4
Q

Compared to adults, neonates have an _________________ to increase oxygen supply

A

increased alveolar ventilation

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5
Q

During hypoventilation or apnea, the neonate’s relatively higher oxygen consumption will

A

quickly exhaust the oxygen reserve contained in the FRC leading to rapid desaturation

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6
Q

Describe the speed of inhalation inductions for neonates.

A

faster b/c faster turnover of the FRC allows for speedier development of anesthetic partial pressure inside the alveoli

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7
Q

It is metabolically more efficient for the neonate to increase ___________ rather than ___________

A

respiratory rate; tidal volume

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8
Q

Alveolar ventilation of the neonate is

A

130 mL/kg/min

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9
Q

Tidal volume of the neonate is

A

6 mL/kg

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10
Q

When compared to the adult, select the true statements regarding the pulmonary system in the newborn. (select 2)
a. the diaphragm has more type 1 than type 2 muscle fibers
b. the diaphragm has more type 2 than type 1 muscle fibers
c. the newborn has a higher tidal volume on a per weight basis
d. neonates have the same amount of dead space on a per weight basis

A

b. the diaphragm has more type 2 than type 1 muscle fibers
d. neonates have the same amount of dead space on a per weight basis

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11
Q

__________ is the primary muscle of inspiration

A

The diaphragm

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12
Q

Neonates have a lower amount of _____________ muscle fibers which increases the neonate’s risk for

A

type 1 slow-twitch endurance; respiratory fatigue and developing respiratory failure

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13
Q

Neonates are at risk of _______ following surgery and anesthesia

A

apnea

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14
Q

______________________ should be admitted for 24 hour observation with an apnea monitor

A

Patients less than 60 weeks post-conceptual age

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15
Q

The risk of apnea is inversely related to

A

gestational and post-conceptual age

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16
Q

_______________ may reduce the risk of postoperative apnea after general anesthesia but it does NOT take the place of postoperative admission with apnea monitoring

A

Prophylactic caffeine (10 mg/kg IV)

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17
Q

______________ is an alternative to caffeine but it carries a higher risk of toxicity

A

theophylline

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18
Q

________________ have a greater risk of postoperative apnea than infants >44 weeks PCA

A

Former pre-term infants < 44 weeks PCA

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19
Q

In the neonate, what percentage of respiratory muscles are type-1 fibers?

A

25% (compared to 55% in adults)

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20
Q

When compared to the adult, which statement presents the MSOT accurate understanding of neonatal pulmonary mechanics? (select 2)
a. airflow resistance during tidal breathing is decreased
b. residual volume is decreased
c. closing capacity is increased
d. chest wall compliance is increased

A

c. closing capacity is increased
d. chest wall compliance is increased

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21
Q

Compared to the adult, the newborn has _______ lung compliance and __________ chest wall compliance

A

lower lung compliance and higher chest wall compliance

22
Q

The lower lung compliance and higher chest wall compliance of the newborn favors

A

chest wall collapse during inspiration (paradoxical breathing) and reduced lung volumes at expiration

23
Q

What is the neonates residual volume compared to adults?

A

higher

24
Q

What is the neonates closing capacity compared to adults?

A

higher

25
Q

What is the FRC of the neonate compared to adults

A

lower

26
Q

What is the vital capacity and total lung capacity of the neonate compared to adults?

A

lower

27
Q

When the neonate inspires, it must overcome the

A

resistance to airflow as well as the elastic properties of the chest wall and lungs

28
Q

Minor reductions in airway diameter of the newborn can

A

significantly increase the work of breathing

29
Q

The newborn is predisposed to hypoxemia because

A

the closing capacity overlaps with tidal volume during normal breathing leading to V/Q mismatch and increased A-a gradient

30
Q

How does the newborn dynamically increase FRC?

A

sustained tonic activity of inspiratory muscles
narrowing of glottis during expiration
shorter expiratory time with a faster RR creates end-expiratory pressure

31
Q

Select the data set that MOST accurately depicts a normal umbilical artery blood gas.
a. pH= 7.20 PaO2= 50 PaCO2= 50
b. pH= 7.30 PaO2= 20 PaCO2=50
c. pH= 7.35 PaO2= 30 PaCO2= 40
d. pH= 7.40 PaO2= 90 PaCO2=30

A

b. pH= 7.30
PaO2= 20
PaCO2= 50

32
Q

Describe the fetal circulation (umbilical vein & artery)

A

umbilical vein supplies oxygen to the fetus
umbilical arteries (2) return Co2-rich blood to the placenta

33
Q

Clamping the umbilical cord stimulates the newborn to

A

breathe rhythmically

34
Q

________________ promotes continuous breathing——– _______ causes apnea

A

an acute rise in PaO2; hypoxemia

35
Q

The arterial pH of the newborn stabilizes at

A

1 hour after delivery

36
Q

Respiratory control doesn’t mature until

A

42-44 weeks post-conceptual age

37
Q

What is the blood gas of the umbilical vein?

A

pH: 7.35
PaO2: 30
PaCO2: 40

38
Q

What is the blood gas of the umbilical arteries?

A

pH: 7.30
PaO2: 20
PaCO2: 50

39
Q

What is the blood gas of the newborn 10 minutes after delivery?

A

7.20
PaO2: 50
PaCO2: 50

40
Q

What is the blood gas of the newborn 1 hour after delivery?

A

pH 7.35
PaO2: 60
PaCO2: 30

41
Q

The newborn comes into the world

A

hypoxic
acidotic
retaining CO2

42
Q

After maturation of respiratory control, hypoxemia

A

stimulates ventilation

43
Q

Which statement regarding fetal hemoglobin is TRUE?
a. it has a higher P50 than the adult
b. it is replaced by hemoglobin A at 9 months of age
c. it has an increased affinity for 2,3 DPG
d. erythrocytes containing hemoglobin F have a shorter lifespan

A

d. erythrocytes containing hemoglobin F have a shorter lifespan

44
Q

Fetal hemoglobin shifts the curve to the

A

left

45
Q

The P50 of fetal hemoglobin is

A

19.5 mmHg

46
Q

Why is a leftward hemoglobin shift beneficial for the fetus?

A

it creates an oxygen partial pressure gradient across the uteroplacental membrane that facilitates the pass of O2 from the mother to the fetus

47
Q

Hemoglobin A begins to replace hemoglobin F at _________ and this is complete by ___________

A

2 months of life; 6 months of life

48
Q

The adult P50 is

A

26.5 mmHg

49
Q

What is the makeup of fetal hemoglobin versus adult hemoglobin?

A

fetal hemoglobin- two alpha & two gamma chains
adult hemoglobin- two alpha and two beta chains

50
Q

The binding site for 2,3 DPG is only on

A

the beta chain so fetal hemoglobin cannot bind to 2,3 DPG

51
Q

What happens to the infants hemoglobin at 2-3 months of age?

A

physiologic anemia Hgb declines to 10 g/dL as Hgb A starts replacing Hgb F

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