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RT134 > Circulation, growth periods > Flashcards

Circulation, growth periods Flashcards

1
Q

Embryonic Period
At how many weeks of preg term?
What is developed during this period?

A

> 0-7 Weeks
Appearance of Lung Buds
Division into Major Bronchi

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2
Q

Pseudoglandular Period
At how many weeks of preg term?
What is developed during this period?

A

> 7-17 Weeks
Rapid Branching
Airways lined by Columnar Epithelium
After 10 Weeks, appearance of Cartilage, Lymphatics, Mucous Glands, and Muscle Cells
At 17 weeks, Terminal Bronchioles present

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3
Q

Cannulicular Period
At how many weeks of preg term?
What is developed during this period?

A

> 17-27 Weeks
Development of Terminal Bronchioles, Respiratory Bronchioles, and Small Alveolar Sacs (Acinus)
Differntiation for type1 (Gas Excange) & type2 (Surfactant)
Beginning stage of gas exchange

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4
Q

Saccular Period
At how many weeks of preg term?
What is developed during this period?

A

> 27-36 Weeks
Enlargement of Peripheral Airways
Further differentiation of pnemocytes
Has better Gas Exchange

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5
Q

Alveolar Period
At how many weeks of preg term?
What is developed during this period?

A

> 36 weeks - 2 years post natal
Alveoli increase until 2-4 years and continue to increase in size until adolescence
Increase in Cartilage, Glands, and Muscles
300-400 million alveoli in Adults

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6
Q

What is the purpose of getting an L/S ratio?

Lecithin/Sphingomyelin Ratio

A

tests for surfactant production in fetus

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7
Q

What is the sample used in an L/S ratio?

A

amniotic fluid

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8
Q

What factors increase fetal surfactant production in fetus

A

fetal stress in utero

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9
Q

what factors can decrease in fetal surfactant production?

A

diabetic mother

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10
Q

what are the maternal risk factors?

17 risk factors

A 
Parity—prima para, grandmulti para
Multiple Births
 40 years of age
No prenatal Care
Maternal Diabetes
Smoking/Drugs/Alcohol
Ethnicity
Delivery History—dystocia, prom
Position of fetus
Hyperthyroidism
Eclampsia/Pre-eclampsia
Toxemia of Pregnancy 
Protenuria
HELLP
Isoimmunization
rH factor
Hydrops Fetalis/Hemolytic Anemia
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11
Q

what is the term for too much and too little amniotic fluid?

A

too much: polyhydraminos

too little: oligohydraminos

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12
Q

Describe a frank breech

A

fetal butt facing vaginal opening and both feet are pointing up.

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13
Q

Describe a complete breech

A

fetal butt facing vaginal opening. both legs and feet are crossed.

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14
Q

Describe an incomplete breech

A

fetal butt facing vaginal opening. one leg is facing up and one foot is facing down

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15
Q

what is grand multi para?

A

a woman who has already delivered 5 or more babies at 24 weeks or more.

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16
Q

What is primary apnea?

A

Responds to stimulation

deprivation of oxygen but is breathing is stimulated by giving oxygen.

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17
Q

what is secondary apnea?

A

unresponsive to stimulation/intervention
Deep irregular gasping
HR and BP decrease
If continues, HR & RR cease, O2 falls, death occurs
NEEDS positive pressure vent with appropriate FiO2

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18
Q

What are 2 compromising situations that can occur with the placenta?

A

Placental Abruption (partial or complete)

Placenta Previa

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19
Q

What is placental abruption?

What is the difference between complete and partial placental abruption?

A

Placental abruption is the separating of the placenta from the uterine wall and pool blood.

partial abruption, has no indication while complete abruption will show spotting and bleeding from the mother.

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20
Q

what is placenta previa? why is this a problem?

A

Placenta Previa is a situation where the placenta is blocking the vaginal opening preventing normal birth.
Placenta should not be delivered first as you dont wan to remove the fetus’ unit of respiration before it has a chance to come out. C-section needed

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21
Q

What are 3 causes of placental insufficiency due to blockage of umbilical blood?

A

cord prolapse - cord is delivered before baby (breech births)

Nuchal Cord - cord wraps around neck

Cord Knots

22
Q

Fetal arteries carry deoxygenated or oxygenated blood?

A

DE-oxygenated blood

23
Q

Fetal veins carry deoxygenated or oxygenated blood?

A

Oxygenated blood from the umbilical cord

24
Q

what closes the ductus arteriosus?

A

increase in o2
decrease in C02
normalization of pH
Decrease in prostaglandins

This causes the ductus arterosus to contract

25
Q

What closes the foramen ovale?

A

after birth, the cord is cut and clamped

This creates a back pressure to shut it.

26
Q

What are the 3 shunts in fetal circulation?

A

Ductus Arteriosus
Ductus Venousus
Foramen ovale

27
Q

How do you test to see if the baby has a patient ductus arteriosus?

A

you collect an ABG from the right radial and unbilicus.

If there is a difference of >15 torr you have a patient ductus arteriosus and still have a Right to Left shunt

28
Q

What does the Ductus Arteriosus lead from and what does it connected to?

A

It leads blood that is coming from the pulmonary artery directly to the Aorta.

29
Q

What allows the foramena Ovale to stay open and what closes it after birth?

A

Increased pressure from pulmonary arteries to right ventricles due to increased pulmonary vasculature.

After birth, decreased resistance into pulmonary vasculature decreases pressure in the right artrium and increases pressure in left atrium closing it.

30
Q

What is the purpose of APGAR scoring?

What does the acronym APGAR comprise of?

A

It tests physical condition of the baby.

A = Appearance / Color
P = Pulse
G = Grimace / reflex
A = Activity / muscle tone
R = Respiration / respiratory effort
31
Q

What and how do you score in the first “A” in A.p.g.a.r. Score?

A

Appearance / color
0 = Blue all over or Pale
1 = Acrocyanosis
2 = Pink all over

32
Q

What and how do you score in the “P” in A.p.g.a.r. Score?

A

Pulse
0 = absent
1 = below 100
2= above 100

33
Q

What and how do you score in the “G” in A.p.g.a.r. Score?

A

Grimace / reflex
0 = no response
1 = grimace or weak cry
2 = Good Cry

34
Q

What and how do you score in the 2nd “a” in A.p.g.a.r. Score?

A

Activity / muscle tone
0 = Flacid
1 = some reflex of extremities
2 = Well flexed or active movements

35
Q

What do you score in the “R” in A.p.g.a.r. Score?

A

Respiratory Effort
0 = absent
1 = weak irregular or gasping
2 = good / crying

36
Q

What are the reference ranges for APGAR scoring and interventions?

A

7 - 10 normal and no interventions needed

4 - 7 = Needs resusitation

37
Q

When and how often do you test APGAR?

A

at 1 min and 5 mins after birth.

You may have to test more if baby is

38
Q

What is the Silverman Scoring system?

A

This evals degree of respi distress.

It subjective, it allows you to focus on respiratory effort

39
Q

What does the Dubowitz Score test?

What are the parameters and values you use for evaluation?

A

It tests gestational age.

Premature 42 weeks

40
Q

What are 2 ways for you to test for gestational age?

A

Date and Dubowitz/Ballard Scale are 2 ways to test it

41
Q

What are the normal ranges for baby vital signs?

HR , RR , BP , MAP

A 
HR = 120-170 brady = (=170)
RR = 30 - 60
BP = 75/50
MAP = 60
42
Q

What are causes of heat loss in babies?
4 causes

Why is this a concern?

A

Conduction (object to object directly)(Cold hands or Cold Stethoscope)

Convection (object to air)(Cold Air draws away heat)

Radiation (object to object indirectly)(Isolate walls coldness draw heat away from baby)

Evaporation (liquid to vapor) (liquid on baby from amniotic sac)

babies cant maintain heat, cant shiver, no brown fat to metabolize, increase surface area to weight.

43
Q

What re the 4 “p’s” to indicate need for intubation?

A

Pulmonary funct / Respi failure

Provide Airway (upper airway obstruction issues)

Protect Airway (Loss of protective airway reflexes)

Pulmonary Hygene (unable to clear secretion)

44
Q

What indicates respiratory failure for intubation?

A

pH

45
Q

How do you choose et Tube size for infants?

Where do you start from and how do you calculate an increase in size?

A

> 1000g and 2.5 size

Increase by .5 for every increase in 1000g

46
Q

What type of et tubes do you use for infants and peds?

A

you use cuffless et tubes until the age of 8

47
Q

what laryngoscope do you use?

A

Miller straight blade

48
Q

What is hylaline membrane disease?

A

Surfactant deficiency of the lung causing decreased lung compliance and atelectasis

Plasma leaks out of lung tissue and forms hyline membrane and prevent gas exchange

49
Q

who are at risk of hyline membrane disease and RDS in infants?
8 risk factors

A

Premature infants

50
Q

Where do you auscultate in in infants?

A

Only over the large airways

51
Q

What is PPHN, persistant pulmonary hypertension causes?

A

Failure of shunts to close during transition from fetal circulation due to lack of O2

High PVR causing Right to Left shunt

Hypoxemia and acidemia causes further increase in ­PVR and perpetuates the cycle

52
Q

how do you diagnose PPHN?

A

Compare pre and post ductal blood gas samples for R-L shunt

O2 hyperoxia test

hyperventillation test

Contrast echocardiography used to confirm shunting

RT134 (11 decks)

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