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Neonatal and Pediatric Resp Care > Chap 1,2,3,4 > Flashcards

Chap 1,2,3,4 Flashcards

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1
Q

Normal Gestational Period

A

40 weeks, 9 months (3 trimesters of 3 mo.each)

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2
Q

Considered neonate

A

delivery to 1 month

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3
Q

Considered infant

A

1 month to 1 year

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4
Q

considered child

A

after 1 year

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5
Q

Stages of lung development

A

Embryonic 26-52 days
Pseudoglandular 52 days-16 weeks (structure)
Canalicular 17 - 26 weeks (I and II alveolar cells)!!
Saccular 26-36 weeks
Alveolar 36 weeks - term

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6
Q

I and II alveolar cells made when

A

17-26 weeks

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7
Q

Pulmonary hypoplasia

A

*hypoplastic lung
Underdeveloped lung tissue
Failure of the lungs to develop

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8
Q

Main cause of pulmonary hypoplasia

A

Diaphragmatic hernia: diaphragm is seperated and bowels are in thoracic cavity. Compresses lung tissue and it cannot develop adequately

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9
Q

Surface tension

A

mutual attraction of the like molecules for one another

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10
Q

Principle of La Place’s law as

A

the radius of a buble decreases the surface tension increases
soo.. a small alveoli has more surface tension and is more difficult to inflate than a large alveoli

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11
Q

Surfactant

A

a phospholipid found on the alveolar walls that lowers surface tension

  • it increases compliance
  • helps prevent alveolar collapse
  • is produced by type II alveolar cells
  • appears at approx 23-26 weeks gestation
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12
Q

Fetal lung fluid

A

20-30 ml/kg of body wt

-volume equivalent to FRC

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13
Q

Function of fetal lung fluid

A

maintain airway patency

-formation, size, and shape of air spaces

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14
Q

Evaluation of lung fluid

A

1/3 squeezed out during delivery

-the remaining fluid is absorbed by lymphatic system

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15
Q

lung fluid retention after C-section

A

transient Tachypnea of the newborn (passes fast)

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16
Q

What is the first major organ to develop

A

heart, pumps blood in 8 weeks

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17
Q

Which one is higher Venous or Arterial pressure

A

Venous pressure is higher than arterial, Right heart is stronger than left heart (opposite of us)

  1. High PVR
  2. Low placental resistance to blood flow - gets O2 from mother and rids of CO2
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18
Q

THREE FETAL SHUNTS

A
  1. ductus venosus- belly button
  2. Foramen Ovale- Hole between right and left atria
  3. Ductus arteriosus
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19
Q

Path of fetal blood flow

A

Placenta- umbilical vein- ductus venosus - inferior vena cava - right atrium_>
(a) Foramen ovale - left atrium - left ventricle - aorta- brain (the most oxygenated blood)
(b) Right ventricle- pulmonary artery - ductus arteriosus - aorta- body
(C) Right Ventricule - P.A. - lungs - left atrium (about 10% of the total blood supply)

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20
Q

Intrauterine structures

A

Placenta, Umbilical cord

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21
Q

Placental Structure

A

Chorionic villi exchanges the gases and nutrients from mom to fetus

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22
Q

Umbilical cord structure!!!

A

2 umbilical arteries, 1 umbilical vein, Whartons jelly

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23
Q

Stages of labor

A

Stage 1: onset of first true contraction to complete dilation and effacement
Stage 2: full dilation and effacement to delivery of the fetus
Stage 3: Expulsion of the placenta

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24
Q

Normal position during labor

A

Baby head down= vertex position

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25
Initiation of the first breath
1. Asphyxia= CO2 increases, PaO2 decreases 2. Recoil of the thorax 3. Environmental changes
26
First breath may require what pressure
-100cmH2O, less pressure needed as FRC is established
27
Change from fetal to adult circulation
1. Clamp umbilical cord removes placenta from arterial circulation increases arterial pressure 2. lung fluid replaced with air PaO2 increaes, PaCO2 decreases -> Pulmonary vasodilation (PVR decreaess) 3. Closure of shunts
28
Closure of shunts
D.V. - no blood flow F.O. - pressure changes (increase left atrial pressure) D.A. Increase PaO2 -> Decrease prostaglandins -> constricts smooth muscle around D.A.
29
Factors identifying a high-risk pregnancy
Preterm birth, less than 37 weeks gestation Alcohol Smoking Cocaine Hypertension (preclampsia) Diabetes Infection: herpes simplex, Hep B, HIB, Group B streptococcus
30
Placental abnormalitites
Placenta previa- may be partial or total (covered placenta)- might need C section Placental abruption- Premature separation of the placenta from the uterine wall
31
Umbilical Cord problems
Cord compression Prolapse (comes out first)- leading to cord compression Nuchal (around neck)
32
First sign of a baby with hypoxia
bradycardia- lack of blood flow
33
Amnion and Amniotic fluid
Polyhydramnios (from increased swallowing defect) | Oligohydramnios (from decrease renal/ urinary defect)
34
Amniotic Fluid functions
1. Protect fetus from trauma 2. Thermoregulation 3. Facilitate fetal movement 4. Dilation and effacement of the cervix
35
Preterm Birth Complications
``` Sepsis RDS IVH ROP-blind too much O2 BPD- on vent/ o2 NEC- dying of gut Corticosteroids given to mom to speed up fetal lung maturity ```
36
Tocolysis
Process of stopping premature labor - Beta-adrenergic drugs: Ritodrine (yutopar), Terbutaline (Brethine), Manesium Sulfate (reduces smooth muscle contractility- also used for asthma), Indomethacin (decrease prostoglandins) - Corticosteroids
37
Post Term Birth Complications
Meconium aspiration= toxic/ obstruction-> sev. pneumonitius | Placenta insufficiency
38
Antenatal Assessment (before birth assessment of fetus)
Ultrasonography, Amniocentesis, Fetal Biophysical Profile
39
Amniocentesis
A. L:S ratio (lung maturity! B. Rh isoimmunization (blood incompatibility) C. Bilirubin level (hemolytic disorders) (blood disease) D. Chromosomal disorders (downs) E. Enzyme Deficiencies F. Genetic mutation
40
Fetal Biophysical profile
Contraction stress test Nonstress test Fetal movement Biophysical profile (see how baby is doing)
41
Delivery positions
Normal, head down Breech, Any position but normal Assisted vaginal delivery, forceps
42
Cesarean Delivery: indications
1. Previous C sections: not absolute 2. Failure to progress 3. Malpresentation: breach 4. Placenta Previa: covered 5. Non reassuring fetal status: straps on belly, watch HR 6. Multiple gestations
43
Multiple gestations
Increased incidence of premature delivery Second twin is often more compromised female twins generally more healthy than male twins
44
Fetal Heart rate
BASELINE: 120-160 bpm | Variability- normal variability is 5-10 bpm
45
Fetal Bradycardia/ tachycardia
Brady: <100 or drop 20bpm below baseline- most dangerous cause of fetal bradycardia is asphyxia Tachy: Baseline consistently > 180, sign of infection
46
Fetal HR Acceleration/ decelerations
a. Accelerations FHR exceeds 160 for <2 min -Accelerates during contractions and are benign b. Decelerations FHR drops below 120 for less than 2 min -early decelerations closely follow contractions and are benign -Late decelerations occur 10-30 sec after the onset of contraction -indicate fetal asphyxia C SECTION ASAP -Variable decelerations occur independent of contractions usually indicate cord compression
47
Fetal Scalp pH
Used when fetal asphyxia is suspected (low O2 or high CO2 leads to acidosis) Normal pH > 7.25 slight asphyxia 7.20-7.25 severe < 7.20
48
Stabilization of the neonate
1. maintain warmth and dry (first thermoregulation! lose heat rapidly) 2. Provide and maintain an airway 3. stimulation (should breathe well or cry within 30 sec) 4. Apgar score (ranks babys activity/ muscle tone)
49
Apgar score
done at 1 min and 5 minutes, dont withhold care to wait for the 1 or 5 minutes -respiratory effort/ rate -heart rate -skin color -Reflex irritability : grimace -Muscle tone (Activity,pulse, grimace, appearance, respiration)
50
Gestational age assessment
- History of pregnancy and delivery - Ultrasound - postnatal physical exam (ballard, physical exam)
51
Physical exam (to assess gestational age): Ballard
``` Vernix (not on new ballard score): protects skin Skin maturity Lanugo: hair Ear/ eye Breast tissue Genitalia Plantar surface (sole creases) ```
52
Respiratory test
Silverman anderson
53
quiet exam
-General Assessment -Vitals: BP HR RR/ Rhythm Temp -Color/ Skin: Cyanosis central or acrocyanosis Capillary refill Mottling or pale Jaundice -Meconium: first bowel -Activity -Resp Status
54
RR
40-60 and apnea (apnea >20 sec) | -assess resp status during quiet breathing (silverman anderson index)
55
Signs of resp distress
- Nasal flaring - grunting - Retractions , upper and lower chest (see ribs)
56
Chest and cardiovascular
- Malformations (pectus excavatum and pectus carinatum - PMI: point of max impulse - Ausculate: BS- Squeeky - Transillumination of the chest to check for pneumothorax(will light up chest, norm will send halo)
57
Pectus excavatum/ carinatum
Excav-inward, Carinatum- outward(pigeon chest)
58
Diaphragmatic hernia
flat abdomen, gut in chest with resp distress
59
Fontanelles
soft spots
60
Nose, occlude each nostril for
choanal atresia- block back of throat =baby continuously crying
61
Reflex tests
Rooting reflex-turn towards Suck Reflex Moro Reflex-drop Stepping reflex
62
Neonatal Cardiopulmonary system (how it differs from adult): Upper Airway
-Larger tongue: nursing, oblig nose breathers -more lymphoid tissue -larger epiglottis (in proportion to larynx) -Narrowest portion at cricoid (adult is glottis) under laryn-croup -Trachea 4mm diameter at birth (adult 16mm) -Chest -ribs and sternum mostly cartilage) to increase VE must increase RR not able to increase VT (reasons they have retractions: lack of structure in chest)
63
Neonatal Cardiopulmonary system (how it differs from adult): Metabolism
``` Higher metabolic rate in neonate 100 cal/kg neonate 40-50 cal/kg adult proportionally higher O2 requirements=burn more cal unpredictable response to med dosage ```
64
Neonatal Cardiopulmonary system (how it differs from adult): other
larger body surface area - increase heat loss | 80% body weight is H2O- fluid balance precarious (I/O)
65
Examination and assessment of the peds: history
``` CC Hx of present illness past medical history review of symptoms family hx social and environmental histories: housing ```
66
Exam of the peds pulmonary system
Keep them calm if possible - vitals - Inspection - Palpation - percussion - Auscultation
67
Peds vitals exam
HR: count using 6 sec pulse RR Temp O2 sat: big toes-> best way to check o2 levels
68
Peds Inspection during exam
- Respiratory distress: tachypnea, breathlessness, head bobbing, grunting, nasal flaring, retractions - Chest wall: shape, muscle mass and stregnth, adipose tissue(hard to see chx movement)
69
Peds palpation during exam
- Neck: masses or adenopathy, trachea | - Chest: Fremitus(rumbling), motion with deep breathing
70
Peds percussion during exam
- Hyper-resonance: more air, pneumothorax - Dullness: fluid, hemothorax - Crepitus: crunchy sound, feel in chx
71
Auscultation during peds exam
-Audible: hear without steth.. grunting, stridor, stertor(on exp, low pitched, wet), wheezes -Breath sounds: Symmetry, intensity, location: lobes/segs, Phases: insp/exp/both Adventitious sounds: Crackles, wheezes, monophonic or polyphonic
72
monophonic and polychonic
mono- localized, poly- asthma
73
low crackles
rhonchi
74
peds muscle weakness or atrophy
waste away of muscles
75
peds abdominal distension
babies= crying - swallowing air
76
dermatitis (allergy)
irritation of skin, more prone to asthma
77
edema
hear failure- fluid overload
78
Peds lab tests
``` CXR PFT inc bronchial challange SpO2 with exercise Sweat chloride-CF CBC ABG, you gotta really want them ```

Neonatal and Pediatric Resp Care (4 decks)

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