Ch.13 Neonatal and Peds Flashcards
An APGAR score of 5 is determined 1 minute after delivery of a term infant. Which of the following should be done NEXT?
A. Stimulate and deliver low-to-moderate O2 concentrations.
B. Intubate and initiate mechanical ventilation.
C. Intubate and initiate CPAP and 80% O2.
D. Initiate nasal CPAP and 100% O2.
Stimulate and deliver low-to-moderate O2 concentrations.
The Apgar score assesses the neonate in five areas: heart rate, respiratory effort, color, reflex irritability, and muscle tone. Each area is scored 0, 1, or 2 points, and the higher the score, the better. A score of 7 to 10 is normal, and as the infant is observed, the upper airway is suctioned with a bulb syringe, and the infant is placed in a warmer. A score of 4 to 6, as seen in this question, indicates moderate asphyxia, which requires stimulation and O2 administration. A score of 0 to 3 indicates severe asphyxia, which requires immediate resuscitation with ventilator assistance.
The foramen ovale and ductus arteriosus remain patent in infants with persistent fetal circulation as a direct result of which of the following?
A. Hypocarbia
B. Pulmonary hypertension
C. Hyperoxia
D. Arterial hypotension
Pulmonary hypertension
High pulmonary artery pressures (pulmonary hypertension) are normal in utero. After birth, the infant breathes in air containing O2, which is a pulmonary vasodilator, which dilates the pulmonary vessels and results in a drop in pulmonary artery pressures. As the pressure drops, the foramen ovale and ductus arteriosus gradually close. If pulmonary pressures remain ele- vated, such as in persistent fetal circulation (PFC) or persistent hypertension of the neonate (PPHN), the high pressure keeps the foramen ovale and ductus arteriosus open, which results in blood shunting through these openings from the right side of the heart to the left, bypassing the lungs and resulting in hypoxemia.
Which of the following is not an indication for nasal CPAP in an infant?
A. To increase static lung compliance
B. To decrease functional residual capacity
C. To decrease pulmonary vascular resistance
D. To decrease intrapulmonary shunting
To decrease functional residual capacity
CPAP increases FRC by keeping alveoli from collapsing and maintaining more air in the lungs after exhala- tion occurs. CPAP is used to improve oxygenation. If atelectasis and intrapulmonary shunting are reduced and lung compliance is increased, PaO2 increases. Pulmonary vascular resistance begins to decrease as the PaO2 level increases by dilation of the pulmonary vasculature.
Which of the following are potential complications of an umbilical artery catheter (UAC)?
- Pneumothorax
- Thromboembolism
- Infection
A. 1only
B. 2 only
C. 1 and 3 only
D. 2 and 3 only
- Thromboembolism
- Infection
Potential complications of an umbilical artery catheter (UAC) include infection, thromboembolism, air embolism, and hemorrhage. UACs should be left in place no longer than 7 to 10 days so that these complications are avoided.
Which of the following may occur as a result of cold stress to an infant?
- Hypoxemia
- Metabolic acidosis
- Hypoglycemia
- Decreased O2 consumption
A. 1 and 3 only
B. 2 and 4 only
C. 1, 2, and 3 only
D. 1, 2, and 4 only
- Hypoxemia
- Metabolic acidosis
- Hypoglycemia
An infant that is cold stressed generates heat by breaking down brown fat. As brown fat is metabolized, O2 consumption increases, which often results in hypoxemia. This leads to lactic acidosis (metabolic acidosis). Cold stress may also result in hypoglycemia (decreased glucose) and apnea.
An elevation in the levels of chloride in sweat is diagnostic for which of the following lung conditions?
A. Bronchiolitis
B. Cystic fibrosis
C. Hyaline membrane disease
D. Epiglottitis
Cystic fibrosis
A diagnostic tool for cystic fibrosis is an elevated sweat chloride level. Ninety-eight percent of patients with CF have increased levels of chloride in their sweat (.60 mEq/L). The ability of the sweat glands to reabsorb sodium and chloride ions is defective, therefore increasing the levels in sweat.
A 28-week gestational age neonate is suspected of having a pneumothorax. Which of the following should the respiratory therapist recommend to help diagnose if this condition is present?
- Transillumination of the chest
- Transcutaneous PO2 monitoring
- Chest radiograph
- Arterial blood gases
A. 1 and 3 only
B. 1, 2, and 3 only
C. 2, 3, and 4 only
D. 1, 2, 3, and 4
- Transillumination of the chest
3.Chest radiograph
Chest radiographs are always observed to help diagnose a pneumothorax in all patients, but a transilluminator is used on neonates as well. The transilluminator utilizes a light source that is placed on the neonate’s chest wall. If air is present under the skin, an area of orange appears below the transilluminator as the air shines through the skin. This is an indication of an air leak or pneumothorax.
To prevent the development of retinopathy of prematurity in a neonate, the partial pressure of oxygen in arterial blood (PaO2) should not exceed what level?
A. 40 mm Hg
B. 60 mm Hg
C. 80 mm Hg
D. 100mmHg
80 mm Hg
Studies indicate that if PaO2 levels are maintained below 80 mm Hg, the risk for ROP is reduced.
A pre- and postductal study is done on a neonate using two transcutaneous O2 monitors. The transcutaneous oxygen pressure (TcPO2) reads 60 mm Hg on the
right upper chest and 40 mm Hg on the thigh. This is indicative of which of the following?
A. Bronchopulmonary dysplasia (BPD)
B. Persistent pulmonary hypertension of the newborn (PPHN)
C. Tension pneumothorax
D. Retinopathy of prematurity (ROP)
Persistent pulmonary hypertension of the newborn (PPHN)
If persistent pulmonary hypertension of the neonate (PPHN) occurs, venous blood returning to the heart is shunted from the pulmonary artery through the ductus arteriosus to the descending aorta, delivering deoxygenated blood to the lower body. This can be diagnosed by placing a TcPO2 electrode on the right upper chest and one on the lower body. If the PaO2 reading on the right upper chest is more than 15 mm Hg higher than in the lower body, PPHN is likely. Ultrasonography should be done to verify this right-to-left shunt through the ductus arteriosus.
Which of the following is appropriate treatment for PPHN?
A. Permissive hypercapnia
B. Maintaining PaO2 levels at 40 to 50 mm Hg
C. Vasopressor administration
D. Inhaled nitric oxide
Inhaled nitric oxide
Therapy aimed at vasodilation is essential to dilate the pulmonary vascular beds, which helps close the ductus arteriosus. Nitric oxide is a vasodilator used for this purpose. Permissive hypocapnia and maintaining the PaO2 around 100 mm Hg for the first few days may also close the ductus by causing pulmonary vasodilation.
The APGAR assessment is done at 1 minute after delivery to determine whether immediate intervention is required and again at 5 minutes after birth.
know
APGAR score of ___________is normal; requires routine observation, suctioning the upper airway with bulb syringe, drying the infant, and placing under a warmer.
7 to 10
APGAR score of 4 to 6 indicates
moderate asphyxia; requires stimulation and O2 administration
indicates severe asphyxia; requires immediate resuscitation with ventilatory assistance.
0 to 3
APGAR stands for
A- appearance (color)
P- pulse ( heart rate)
G- grimace (reflex irritabilty)
A- activity (muscle tone)
R- respiration (respiratory effort)
Acrocyansosis or cyanosis in the hands and feet is
normal after birth
Cyanosis observed in the mucous membranes or lips indicates…
O2 must be given immdeiately
To assess gestational age which scoring system is the most accurate
Ballard
Indications for nasal CPAP
(1) To improve oxygenation
(2) To increase static lung compliance
(3) To increase functional residual capacity (FRC)
(4) To decrease the work of breathing
(5) To decrease intrapulmonary shunting
(6) To decrease pulmonary vascular resistance
(PVR)
What device is used to diagnosee pneumothorax in neonates?
Transilluminator
Respiratory Distress Syndrome affects
premature infants that is caused by inadequate amounts of pulmonary surfactant, which leads to massive atelectasis and hypoxemia. (Also known as hyaline membrane disease [HMD].)
Immature lungs with surfactant deficiency indicated by a lecithin-sphingomyelin (L:S) ratio of less than
2:1
