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Pediatric/Neonatal Respiratory Care > FINAL!!! > Flashcards

FINAL!!! Flashcards

1
Q

What is the first stage referred to?

A

(ovum 12 to 14 days)

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2
Q

Rapid cell division happens in the first stage
(16-50 cells blastocyst)

A

**

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3
Q

What is the second stage called?

A

embryo

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4
Q

Period from end of ovum measures rougly 3 cm (54 to 56 days)

A

**

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5
Q

Second stage includes 3 germ layers, what are they?

A
  • Ectoderm
  • Endoderm
  • Mesiderm
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6
Q

Ectoderm is the _______________ and____________ layer

A

outer and thicker

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7
Q

Endoderm is the _____________ layer

A

innermost

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8
Q

Mesiderm is the layer in….

A

between… It forms between the other two layers

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9
Q

Third stage is called

A

fetus

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10
Q

Third stage is the period of development (210 to 214)

A

**

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11
Q

After delivery developmental stages are identified as (3)

A
  • Neonate: birth to first month
  • Infant: 1 month to 1 year
  • Child: Above 1 year
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12
Q

What is the placenta?

A

The organ of respiration for the fetus

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13
Q

What is the umblicord?

A

The lifeline between mother and fetus

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14
Q

The umblical cord consist of 3 vessels….

A

2 small arteries
1 large vein

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15
Q

What is the white gelatous substances protecing the 3 vessels and helps prevent kinking or compression of the cord

A

Warton’s Jelly

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16
Q

What are the 5 development lung stages?

A
  • Embroynal
  • Pseudoglandular
  • Canalicar
  • Saccular
  • Alveolar
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17
Q

Embryonal stage

A

First 7 to 8 weeks (Development of the anatomical structure)

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18
Q

Pseudoglandular stage

A

8 through 16 weeks (epiglottis appears and the opening to the lower airways)

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19
Q

Canalicur stage

A

17 through 26 weeks (Alveoli begins to develop)

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20
Q

Saccular stage

A

27 through 36 weeks ( Terminal airways do not contain true alveoli and surfactant begins to develop)

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21
Q

Alveolar stage

A

32 weeks (mature surfactant is present )

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22
Q

When does the production of surfactant begin

A

24 weeks

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23
Q

What is the L/S ratio

A

lecithin to sphingomyelin is 2:1

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24
Q

L/S ratio less than 2:1 is not enough. Must give steriods 2 doses within 36 hrs prior to birth

A

KNOW

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25
Q

What is oligohydraminos?

A

To little amniotic fluid.
When this occurs babies have an 85% chance of survival

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26
Q

What is polyhydraminos

A

To much amniotic fluid

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27
Q

What is the first major organ to develop?

A

Heart

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28
Q

In fetal circulation pressures are reversed of those in adult. Pressures in the RIGHT is higher than pressures in the LEFT

A

KNOW

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29
Q

How long should it take the Ductus arterissus

A

96 hours

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30
Q

Doppler assessment measures

A

blood flow through the umbillical cord, placental, and fetal vessels

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31
Q

What is the Gold Standard for determining fetal development

A

Amniocentesis

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32
Q

The average HR in early gestation is

A

140/ min

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33
Q

FHR can be monitored in three ways

A
  • external abdmoinal transducer
  • electrodes on abdominal
  • Fetal scalp electrode
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34
Q

Which FHR montoioring is the most accurate

A

Fetal scalp electrode

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35
Q

Uterine contractions can be monitored by one or two devices, the most common device used is a _______________________. The second device is called the

A

tocodynamometer;
intrauterine pressure cathter

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36
Q

What is the normal baseline FHR range?

A

120 to 160

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37
Q

When the FHR exceeds 160 bpm for less than 2 mins, it is called

A

accelerations

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38
Q

When the FHR DROPS below 120 for less than 2 mins, it is called

A

decelerations

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39
Q

Average HR for term babies is

A

160 bpm

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40
Q

Average HR for pre-term is

A

140 bpm

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41
Q

Bradycardia is less than 100 bpm. Most common cause is

A

asphyxia

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42
Q

Tacycardia is HR consistently above 180 bpm. Most common cause is….

A

maternal fever or infection

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43
Q

_______________ ______ is the most common method of determining estimating date of confinement (EDC)

A

Nägele’s Rule

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44
Q

To determine EDC, 3 months is subtracted from the first day of the last period. 7 days is then added to the result to determine EDC

A

KNOW

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45
Q

If the first day of the last period was March 25, subtracting 3 months would arrive at Decemeber 25. Adding 7 days gives us an EDC of January 1

A

KNOW

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46
Q

Gravida means the

A

number of pregnacies

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47
Q

Parity or Para means the

A

number of previous live births

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48
Q

Gravida always includes pregnancy while Para only indicates previous viable births

A

KNOW

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49
Q

TPAL stands for

A
  • Term
  • Preterm
  • Abortion/ Miscarriage
  • Live births
    In that order
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50
Q

Gravida 4 Para 2102 (G4P2102) means

A
  • 4th pregnancy, 2 term, 1 preterm, 0 abortions/miscarriage, 2 living
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51
Q

The process of giving birth is called

A

Parturition

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52
Q

What are the events that make up the birth process (5)

A

1: Rupture of the membrane
2: Dilation of the cervix
3: Contraction of the uterus
4: Separation of the placenta
5: Shrinking of the uterus

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53
Q

How many stages of Labor are there?

A

3

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54
Q

The 1st stage of labor begins with the

A

onset of the first true contraction to full dilation and effacement of the cervix

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55
Q

The strecthing or effacement and widening is called

A

dialation

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56
Q

The 2nd stage of labor,

A

full (100%) dilation and effacement of the cervix to delvery of the fetus

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57
Q

The 3rd stage is the

A

delivery of the fetus and placenta

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58
Q

The process of stopping labor is called

A

tocolysis

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59
Q

Any fetal presentation other than vertex is considered abnormal

A

KNOW

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60
Q

The ________ presentation is the most common of all abnormal presentation, compromising about ____% of all births

A

breech;
3.5

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61
Q

What are the 3 breech presentations called

A
  • Complete
  • Frank
  • Footling
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62
Q

95 % of all births occur with the fetus in the head down or _________ position

A

vertex

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62
Q

_________________ position cannot delivered vaginal EVER

A

Transverse

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63
Q

When implantation occurs in the lower portion of the uterus it is called

A

placenta previa

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64
Q

Any time normally attached placenta seperate prematurely from the uterine wall is called

A

abruptio placentae

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65
Q

Intiation of the first breath: biochemical

A

Asphyxia. Increased PaCO2, decreased PaO2, and pH stimulate the chemoreceptors which then stimulate gasping

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66
Q

Intiation of the first breath: Physical

A

The fetal thorax is compressed as it descends through the birth canal

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67
Q

Intiation of the first breath: Environmental changes

A

As the fetus passes from an environment of darkness and warmth into a bright, loud, cold environment, which intiates a cry reflex

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68
Q

Intiation of the first breath: Production of surfactant

A
  • Reduces surface tension
  • Reduces muscle fatigue
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69
Q

___________, which is a combination of hypoxia, hypercapnia and acidosis, may lead to irreversible damage to the brain and other vital organs

A

Asphyxia

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70
Q

If the hypoxia is not corrected, the vent effort ceases and the fetus enters a period of apnea called

A

primary apnea

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71
Q

During __________ ______ there will be no attempt to breathe again unless PPV is initiated

A

secondary apnea

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72
Q

Prepartion for Resuscitation (3)

A
  1. Anticipation of a high risk delivery
  2. Equipment
  3. Trainned personnel
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73
Q

According to NRP guidelines there are 3 questions that should be asked upon delivery of the neonate, what are they?

A
  1. Is the neonate term?
  2. Is the neonate crying or breathing?
  3. Is there good muscle tone?
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74
Q

What is the first step in resuscitaing the neonate?

A

Thermoregulation

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75
Q

___________ heat loss is the transfer of heat from one object to another without coming in contact

A

Radiant

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76
Q

___________ heat loss is the loss of heat through direct contact of one object with a cooler surface

A

Conductive

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77
Q

_______________ heat loss is the loss of heat through evaporation of liquids from a surface

A

Evaporative

78
Q

_________________ heat loss is the loss of heat due to the movement of air past the skin and carring away heat

A

Convective

79
Q

The next step in the resuscitation is to open the airway by placing baby in sniffing position

A

KNOW

80
Q

A vigorous neonate is defined as one with

A

strong respiratory effort, good muscle tone, and HR that is greater than 100 bpm

81
Q

If the neonate presents with any gasping, apnea, or a HR less than 100 bpm, what should be initiated?

A

Positive pressure ventilation (PPV)
Neopuff /T-piece

82
Q

Asses the HR by grasping the base of the umbillical stump between the middle finger and thumb. The HR is measured for 6 seconds and multipled by 10 (HR should be greater than 100 bpm)

A

KNOW

83
Q

Define acrocyanosis

A

the blueness of the hands and feet

84
Q

It may take up to 10 mins for a neonate to obtain oxyegnation sat of >85%

A

KNOW

85
Q

PPV is indicated when the neonate is

A

apneic, gasping, or when spontaneous breathing cannot maintain the HR above 100 bpm

86
Q

When should chest compressions should be intiated

A

A persistent HR of less than 60 bpm, despite tactile stimulation and 30 seconds adequate PPV

87
Q

What are 2 ways chest compressions can be administered

A

Thumb technique and two-finger technique

88
Q

The thumb technique is the perferred method

A

KNOW

89
Q

Tube size: <28 weeks

A

2.5

90
Q

Tube size 28-34 weeks

A

3.0

91
Q

Tube size: 34 - 38 weeks

A

3.5

92
Q

Tube size: >38 weeks

A

3.5 - 4.0

93
Q

The umbilical vein is the most easily accessible route for direct adminstration of meds and fluids during acute resuscitation

A

KNOW

94
Q

Indications for Epi during a resuscitation are: (2)

A
  1. the HR remains below 60 bpm despite 30 seconds of effective PPV and 30 seconds of chest compression
  2. the HR is zero
95
Q

The use of _____________ ___________ is indicated in those infants showing signs of hypovolemic shock due to acute blood loss

A

volume expanders

96
Q

Volume expanders used in neonatal resuscitation include: (3)

A
  • normal saline
  • ringers lacate
  • O Rh-negative packed RBC (fetal anemia)
97
Q

What are the APGAR scores, 5 areas examined?

A
  1. Appearance
  2. Pulse
  3. Grimace
  4. Activity
  5. Respirations
98
Q

The first APGAR score is asses at 1 minute after delivery with a 2nd evaluation performed at 5 mins, then every 5 mins as needed up to 20 mins

A

KNOW

99
Q

Normal glucose for term is

A

> 35

100
Q

Normal glucose for preterm is

A

> 25

101
Q

Neonatal hypoglycemia is defined as a plasma glucose of

A

< 25

102
Q

What is the most common complication for a UAC

A

Thrombus formation
Air embolism

103
Q

Additional complication for a UAC Includes hypertension and NEC

A

KNOW

104
Q

What does the S.T.A.B.L.E mnemonic stand for

A
  • Sugar
  • Temperature
  • Airway
  • BP
  • Labs
  • Emotional support
105
Q

Neonates have a large amount of skin surface area to their body weight protional to size and weight

A

KNOW

106
Q

___% of the neonate’s total body weight is water and the water is mainly found in the _____________ spaces

A

80% ;
extracellular

107
Q

What is the purpose of the physical assessment?

A

To determine how well the extra-uterine transition is taking place

108
Q

Dubowitz Gestational Age Assessment exams….

A

11 physical or “external” criteria and 10 neurological signs

109
Q

Ballard Gestational Age Assessment exam

A

6 physical and 6 neurological and is the MOST ACCURATE

110
Q

Ballard system is the most reliable if the examation is done before 42 hours of life. Takes less time to perform

A

KNOW

111
Q

What is Lanugo?

A

fine, downy hair on the arms and back

112
Q

Examination of the ______, or the external portion of the ear, is helpful in determining gestational age

A

pinna

113
Q

The sole creases appear as faint red lines at roughly

A

26 weeks

114
Q

At ____ weeks, the creases have covered the anterior portion of the foot

A

30 weeks

115
Q

By _____ weeks 2/3 of the sole is covered with creases

A

34

116
Q

This is the temp difference between the warm body core and the cooler skin

A

Internal Thermal Gradient (ITG)

117
Q

The temp difference between the skin and the environment is called the

A

External Thermal Gradient (ETG)

118
Q

There are four factors that determine heat loss through the ETG, what are they?

A
  • Radiant
  • Conductive
  • Convective
  • Evaporative
119
Q

What is the initial response to hypothermia?

A

peripheral vasoconstriction

120
Q

The intial response to hyperthermia is a

A

vasodilation of the peripheral vessels to help dissipate heat

121
Q

The perfusion of the skin decreased with larger fluid deficits, and decreased skin ________ may be present

A

turgor

122
Q

Insensible water loss (IWL) is water loss by

A

evaporation from the skin and respiratory tract

123
Q

What are factors that increase insensible water loss

A
  • Early gestational age
  • Respiratory distress
  • Environmental temp above the neutrothermal zone
  • Elevated body temp
  • Skin breakdown and excoriations
  • Congenital skin defects (neural tube disorders)
  • Radiant warmer
  • Phototherapy
  • Increased motor activity and crying
124
Q

What is NEC?

A

an idiopathic disorder characterized by ischemia and necrosis of the intestine

125
Q

What is the cause of NEC?

A

It is unknown but 3 main factors are seen as key etiological factors:
1. mucosal wall injury
2. bacterial invasion into the damage intestinal wall
3. formula in the intestine

126
Q

Once NEC is detected oral feeds are stopped immediately and nasogastric suctioning is started to empty the stomach of bile residuals

A

KNOW

127
Q

What is the primary cause of respiratory disorders in the neonate

A

Respiratory distress syndrome (RDS) also called hyaline membrane disease (HMD)

128
Q

RDS is estimated to be the cause of ___% of neonatal deaths; As many as ____% of preterm deaths are also attributed to RDS

A

30%
70%

129
Q

What is the tx for RDS? (2)

A
  • adminstration of glucocorticoids to the mother 2 days prior to delivery;
  • surfactant replacement
130
Q

Most incidences of Bronchopulmonary Dysplasia (BPD) occur following the Tx of

A

RDS

131
Q

The pathophysiology of BPD appears to be linked to four factors:

A
  1. oxygen toxicity
  2. barotrauma
  3. presence of a PDA
  4. Fluid overload
132
Q

Pulmonary Dysmaturity ( Wilson-Mikity Syndrome)

A

Looks similar to BPD w/ exception, the infant has not been ventilated

133
Q

Retinopathy of Prematurity is caused by

A
  • Oxygen toxicity
  • immaturity
  • hyperoxia
  • hypoxia
  • blood transfusions
  • apnea
  • PDA
  • hypercarbia
  • intraventricular hemorrhage
  • Vitamin E deficiency
  • lactic acidosis
  • genetic factors
134
Q

A pnemothorax develops when the

A

extraalveolar air ruptures to the external surface of the lung and into the pleural space

135
Q

Pneumomediastinum occurs when extra-alveolar air dissects through the lung interstitium and ruptures into the mediastinum

A

KNOW

136
Q

Air that dissects through the perivascular sheaths to the great vessels may rupture into the pericardial sac causing pneumopericardium

A

KNOW

137
Q

What causes Pulmonary Interstitial Emphysema (PIE)

A

chronic use of High PEEP, high PIP and prolonged I-times

138
Q

Persistent Pulmonary Hypertension of the Neonate (PPHN)

A
139
Q

Transient Tachypnea of the Newborn (TTN) / RDS Type II is formed by

A

retention of fetal lung fluid following birth

140
Q

Patent Ductus Arteriosus (PDA) requires closure either surgically or by the administration of

A

indomethacin (Indocin)

141
Q

Complete Transposition of the Great vessels requires surgically or the administration of

A

prostaglandin E

142
Q

Croup is also called

A

Laryngotracheobronchitis (LTB)

143
Q

Epiglottis age range

A

2 to 6 years old

144
Q

Epiglottis is a _______ onset

A

rapid

145
Q

What causes Epiglottitis

A

H. influnzae type B

146
Q

What are clinical presentations of Epiglottitis?

A
  • High fever
  • anxious
  • drooling
  • low pitched stridor
  • muffled voice
  • no cough
147
Q

Xray examination of Epiglottitis

A

thumb sign seen on a lateral neck film

148
Q

Croup age range

A

6 months- 3 years

149
Q

Croup has a ________ onset

A

slow (2- 3 days)

150
Q

Croup is caused by

A

Parainflunzae virus

151
Q

What are clinical presentations of Croup

A
  • May be afebrile or febrile
  • hoarse
  • barky cough
  • tight upper airway stridor
152
Q

Xray for Croup

A

A-P neck film hourglass
Narrowing of the subglottic airway

153
Q

Children have a proportionately larger body surface area (BSA)

A

KNOW

154
Q

With CF each offspring has a ___% of having CF, a ___% of being clear of the gene, and a ___% chance of being a carrier

A

25
25
50

155
Q

What is the most relaible indicator for CF ?

A

Sweat chloride

156
Q

What are 2 primary sources of arteial blood sampling in the neonate?

A
  • the umbilical
  • radial artery
  • Capillary blood can also be assessed `
157
Q

What are the hazards with UAC?

A
  • thromboembolism
  • hypertension
  • infection
  • hemorrhage
  • vessel perforation
  • NEC
158
Q

What are the hazards for radial artery catheter?

A
  • infection
  • air embolism
  • arteial occlusion
  • infiltration of fluids
  • nerve damage
159
Q

What are the complications of capillary sampling

A
  • osteomyelitis
  • bone spurs
  • infection
  • burn
  • hematoma
  • nerve damage
  • bruising
  • scarring
  • tibial artery laceration
  • bleeding
160
Q

What is the safe range for Pao2 in neonate and peds

A

Neo: 50-70 mmHg
Peds:80-100 mmHg

161
Q

What is the safe range PaCO2 peds/ neonate

A

35 to 45 mmHg

162
Q

Safe range for pH neonate/peds
Acceptable range pH

A

7.35 to 7.45
7.30 to 7.50

163
Q

Densities found on Xray: Air

A

black

164
Q

Densities found on Xray:fluid

A

gray

165
Q

Densities found on Xray: Tissue

A

grayer

166
Q

Densities found on Xray: Bone

A

white

167
Q

RDS or Hyaline Memebrane Disease XRay

A

ground glass/ frosted glass appearance /complete white out

168
Q

What causes Bronchopulmonary Dysplasia (Neonatal Chronic Lung Disease)

A
  • Tx from MV
  • Oxygen toxicity
  • High PEEP
  • PIP
  • Prolonged I-times
    Usually follows Tx from RDS
169
Q

Most common neonatal ventilation used is

A

pressure-limiting modes to prevent baraotrauma

170
Q

The pressure that must be applied to the irways to overcome the combined tension is the critical

A

opening pressure

171
Q

What is the most powerful influence on oxygenation ?

A

Mean Airway Pressure (MAP)

172
Q

High levels of MAPleads to what?

A

Decreased CO, pulmonary hypoperfusion, increased risk of barotrauma

173
Q

MAP is affected by PIP, PEEP, I-times, and rate

A

KNOW

174
Q

What is the driving pressure?

A

The difference between the baseline pressure or PEEP and the PIP

175
Q

What is the spontaneous Raw in neonates (594

A

20 to 30 cm H2O/L/min

176
Q

What is the normal compliance in newborn ?

A

2.5 to 5 mL/cm H2O

177
Q

The immediate indication for MV is

A

respiratory failure

178
Q

What are some partial vent support modes?

A
  • CPAP
  • IMV
  • SIMV
  • PSV
179
Q

Full vent support modes include

A
  • SIMV
  • CMV
180
Q

Once it is determined that the pt is in respiratory failure, what is often the first setting made on the vent?

A

Mode

181
Q

Initial Ventilatory Parameters: PIP

A

15 to 20 cm H2O

182
Q

Initial Ventilatory Parameters: PEEP

A

3 to 5 cm H2O

183
Q

Initial Ventilatory Parameters: FIO2

A

Set to keep pt pink; 90-92%

184
Q

Initial Ventilatory Parameters: Rate

A

30 -40 breaths/min

185
Q

Initial Ventilatory Parameters: Flow

A

6-8 L/min

186
Q

Initial Ventilatory Parameters: I-times

A

1.0- 1.5 sec

187
Q

Initial Ventilatory Parameters: I:E ratio

A

1:1.5 to 1:2

188
Q

Initial Ventilatory Parameters: Vt

A

Term:8 mL/kg
Low-birth weight: 6 mL/kg
Very low birth-weight: 4- 6 mL/kg

189
Q

Prophylactic administration of surfactant is indicated for those infants who are at a

A

high risk of developing RDS

190
Q

Therapeutic administation (also called rescue) is not given until the pt

A

develops signs of RDS

191
Q

Nitric oxide (NO) is a

A

colorless gas that is produced in endothelial cells of the body

192
Q

Incdications fo NO

A
  • PPHN
  • RDS
  • sepsis

Pediatric/Neonatal Respiratory Care (9 decks)

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