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Person Peds > Albert #2 > Flashcards

Albert #2 Flashcards

1
Q

When is the liver functional?

A

1-2 Weeks Postnatal

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2
Q

When is the liver mature

A

6-12 months postnatal

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3
Q

Liver enzyme function is a _______ function

A

Postnatal

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4
Q

What are phase 1 liver functions.

A
  • Oxidation
  • Reduction
  • Hydrolysis
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5
Q

What is the phase 2 liver function?

A

Conjugation

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6
Q

What 2 liver functions are functional at birth?

A
  • Hydrolysis

- Sulfonation

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7
Q

Because liver function is still developing, _______ is increased for many drugs.

A

Half Life

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8
Q

Why is it OK to give acetaminophen to PEDS?

A

-Half life remains normal due to sulfonation.

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9
Q

Why is renal function limited at birth?

A
  • ↑ vascular resistance
  • ↓ blood flow
  • ↓ GFR
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10
Q

When does renal function improve after birth?

A

Day 5

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11
Q

How long does obligatory Na loss last?

A

1st month

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12
Q

By the end of month 1 the kidney is ______ mature.

A

70%

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13
Q

biggest difference in PEDS fluid compartments?

A

ECF is 40% total body water

adults 20%

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14
Q

Where does the excess ECF in PEDS come from?

A

Interstitial fluid

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15
Q

Why do PEDS have more total body water 80 vs 60%?

A

Less muscle mass

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16
Q

Why do PEDS have increased metabolic rate?

A

increased fluid metabolism (greater % of TBW is exchanged perday)

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17
Q

Increased fluid metabolism leads to an increased risk of what?

A

Dehydration

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18
Q

What is the most marked electrolyte difference between PEDS and adults?

A

K

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19
Q

What is normal K in peds

A

5-6.5

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20
Q

A PEDS K of 3-3.5 represents a significant need for what?

A

Rehydration and electrolyte replacement

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21
Q

What leads to an increased risk if metabolic acidosis in PEDS?

A

Increased Cl

Decreased Bicarb

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22
Q

How can a slight acidosis be beneficial?

A

increased O2 delivery to tissues

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23
Q

Uptake and distribution in the GI tract is ________ in neonates.

A

Decreased

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24
Q

Why are inhalation agents faster in PEDS than adults?

A
  • ↑ CO
  • ↓ FRC
  • ↑ Tidal volumes
  • ↑ Tissue perfusion
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25
Q

Peds has _______ Plasma binding due to decreased ________.

A

Decreased

Plasma proteins

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26
Q

Increased membrane permeability is due to what?

A
  • Incomplete mylenation

- Incomplete BBB

27
Q

What slows onset of several drugs in peds?

A

ECF/TBW ratio

28
Q

Renal clearance takes up to 2 years to reach adult levels, but most by when?

A

3 Months

29
Q

When do enzyme levels mature?

A

1st 3 months of life

30
Q

Describe basic maintenance fluid calculation for PEDS.

A

1st 0-10kg = 4ml/kg/hr
11-20kg = 2ml/kg/hr
21+ = 1ml/kg/hr

31
Q

What are the blood volumes for Premie, 0-2, and 2-16 year olds

A

100 ml/kg
80 ml/kg
70 ml/kg

32
Q

What procedures are 3rd space loss generally replaced?

A

Thoracic and intra abdominal

33
Q

How much fluid should be given back for 3rd space?

A

2-10ml/kg over 2nd and 3rd hours

34
Q

Instead of crytaloids, you should consider replacing the last _____ with ______.

A

25%

Blood

35
Q

Other types of fluid loss.

A
  • Respiratory loss
  • GI loss
  • Urine
36
Q

Urine output should be?

A

1-2ml/kg/hr

37
Q

What 2 things should be minimized?

A
  • Tachycardia

- Hypotension

38
Q

Best monitors for proper fluid intake?

A
  • Urine production

- Proper BP

39
Q

3 types of hydration

A
  • Isotonic
  • Hypotonic
  • Hypertonic
40
Q

What 4 things cause Isotonic (most common) dehydration?

A
  • Pyloric obstruction
  • bowel loss
  • peritonitis
  • starvation
41
Q

What 3 things cause hypotonic dehydration?

A
  • Fever
  • Diarrhea
  • Starvation
42
Q

What 3 things cause hypertonic dehydration?

A
  • Burns
  • Sweating
  • Diarrhea
43
Q

What are the 3 degrees of dehydration in infants and children?

A

Mild 5 and 3%
Moderate 10 and 6%
Severe 15 and 9%

44
Q

What type of fluid causes carries the greatest risk in rehydration and why?

A

Hypertonic fluid due to fluid shifts.

45
Q

If hypertonic fluid is replaced too fast what can happen?

A

ceberal edema

Seizures

46
Q

What type of acidosis is common in PEDS?

A

Metabolic

47
Q

What are some common causes of metabolic acidosis in PEDS?

A
  • Cold
  • Hypoxia
  • Dehydration
  • hypotension
  • poor perfusion
48
Q

What is is about bicarb that warrants caution?

A

High osmolality

49
Q

Bicarb administration can cause what problems?

A

Ceberal edema and hemorrhage

50
Q

What is the classic example of metabolic alkalosis?

A

Pyloric stenosis

51
Q

When is pyloric stenosis considered an emergency?

A

Never

52
Q

What must be done prior to PEDS surgery?

A
  • Fluid balance
  • K correction
  • Metabolic abnormalities fixed
53
Q

Development of alkalosis is from loss of what?

A

H+

54
Q

Metabolic alkalosis is a result of what, fluid loss from what?

A

Vomiting

55
Q

Vomiting leads to a loss of what?

A
  • H
  • Cl
  • H2O
56
Q

Vomiting is an example of what kind of dehydration?

A

Isotonic

57
Q

In metabolic acidosis, pH may increase to _______ and K to ______

A
  • 7.5-7.6

- 3.0-3.5

58
Q

Metabloic alkalosis does what to K?

A

Decrease

59
Q

What 6 things should be asked about birth history?

A
  • Post conceptions weeks at birth
  • Length of stay
  • Respiratory support
  • Cardiac Problems
  • Nervous system problems
  • Muscular problems
60
Q

What is the ongoing rule for when it is safe to do surgery as outpatient?

A

60 weeks post conception

61
Q

Unique concerns with children in the preop eval

A
  • Birth History
  • Congenital problems
  • Developmental milestones
  • Respiratory infections
  • NPO status
62
Q

What should you ask about respiratory infections?

A
  • How long
  • Temperature
  • Appetite
  • Activity
  • Parent assessment
63
Q

What is the 2/4/6/8 NPO rule?

A
  • 2 hours clears
  • 4 hours Breast milk
  • 6 hours formula
  • 8 hours solids
64
Q

How does injury/pain effect NPO status?

A

Delays gastric emptying

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