Question Answer
Regarding postnatal lung growth,age by which most most alveoli will be present in the lungs 1.5 years
Reasons oligohydramnios is associated with lung hypoplasia Mechanical restriction of the chest wall, interference with fetal lung liquid, failure to produce fetal lung liquid
Purpose of material secreted by the type II pneumocyte To reduce surface tension
Function of Wharton’s jelly inside the umbilical cord Preventing vessels inside cord from kinking
First organ to form during first gestational week Heart
Approximate fetal heart rate by the sixth week of gestation 95 beats/minute
Anatomical fetal shunts Foramen ovale, ductius venosus, and ductus arteriosus
Event that causes cessation of right-to-left shunt through the foramen ovale Increased systemic vascular resistance
Most important risk factor for preterm birth Prior preterm delivery
Generally accepted safe limit for alcohol consuption during pregnancy to avoid development of fetal alcohol syndrome No safe range of alcohol consumption is deemed safe during pregnancy
Average birth weight difference between infants born of mothers who smoke and those born of nonsmoking mothers Infants born of mothers who smoke ten to be about 200g lighter than infants born of mothers who do not smoke
Conditions associated with preeclampsia Proteinuria, generalized edema, and hypertension
Maternal and/or fetal conditions associated with pregestational diabetes Ketoacidosis, preeclampsia, and fetal death
Drug recommended to treat a group B Streptococcus infection for a patient who is allergic to penicillin Clindamycin
Main potential problem associated with the premature rupture of membranes Fetal infection
Maternal or fetal condition(s) that can be determined or assessed via amniocentesis Maternal Rh isoimmunization and trisomy 21
Maternal complications associated with c-section Intraoperative bladder or bowel injuries and endomyometritis
Interpretation of an amniotic fluid index of 5 cm Oligohydramnios
Question Answer
Fetal shunts, purpose and location? The Ductus Venosus is at the liver and shunts 50% of blood from liver to inferior vena cava. The Foramen ovale is a shunt from R atrium to L atrium so only 10% of blood goes to lungs. The Ductus arteriosus goes from pulmonary artery to aorta bypass lungs
stages of fetal lung development Stage 1: embryonal phase, stage 2: pseudoglandular phase, stage 3: canalivular phase, stage 4: saccular phase, stage 5: Alveolar stage
Embryonal phase lung bud out of pharynx, bronchial buds, trachea starts to branch
Pseudoglandular Phase 3.5 – 16th week, lungs have glandlike appearance, subdividing of airways acinus may appear, development of airway catilage
Canalicular Phase 17-26 weeks, Growth of vascular bed, gas exchange happens!, extrauterine viability! 22-24 wks, surfactant production begins
saccular phase 26-35/36 weeks, development of mature alveoli
Alveolar Stage 36-18 months postnatal, not easily distinguishalbe from saccular phase
Postnatal lung development 80% of alveopli develop after birth, factors affecting lung development hypoxia or hyperoxia, nutrition or maternal smoking
Pulmonary Hypoplasia causes of decreased lung development, compression via diaphragmatic hernia, oligohydrmanios if baby has kidney issures, polyhydramnios if mom is diabetic, decreased ventilation, metablolic disorders ie diabetes
pulmonary surfactant development Type 1- gas exchange Type 2- pneumocytes, production, secretion, storage reuse surfactant, prevents alveolar collapse Early stimulation of surfactnat: beta agonists, prostaglandins, MV, steriods, heroin
Fetal Lung Liquid secretes 250-330 ml/day, swallowed or expelled into amniotic fluid, essential for normal lung development, stops at 14 weeks bc of skin hardening, removed after birth via blood and lymphatic vessels
maternal-fetal gas exchange umbilical cord, 2 small ateries and one large vein, chorion (chorionic villi) exchange stuff for mom’s side and babys side, keeps placenta attached to wall.
transition to extrauterine life increase pulmonary blood flow, pulmonary vasodilation decreaed co2 and increased pao2, stretching pulmonary units more surface area for more gas exvhange
Maternal History you would want to know any preterm delivery, cervical insufficiency, toxic habits of pregnancy, hypertension, diabetes mellitus, infectious disease, any previous miscarriages or following risk factors: placenta or umbilical abnormalities
placenta previa occurs when the placenta covers the cervical os. C-section usually required
Normal ABG PaO2 40-60, Co2 45-55, Bicarb 18 – 21/22, BE -5
Quick assessment for need of resuscitation gestational age (26 wks or less) clear amniotic fluid, respiratory effort, muscle tone
Basic resuscitation goals warmth and stimulation, oxygenation and ventilation, circulation, volume expanders, cardiotonic medications
What will Terbutaline and magnesium do to the baby? they are both smooth muscle dilators that are labor stopping but depress CNS with effects of bradycardia and some respiratory issues.
Normal respirations and heart rate? RR 40-60 minute, heart rate more than 100/beats min
Baby weight, tube size? Baby: <1,000g 2.5 Tube size 1,000-2,000g 3.0 tube size 2,000-3,000g 3.5 tube size >3g 4.0 tube size
gestational age and size estimation? GA is estimated before baby is 12 hours old, maternal menstrual cycle, prenatal ultrasound, postnatal assessment (physical and neurological examination..aka ballard score)
Vernix caseosa and Lanugo? Vernix caseosa is like thick white lotion on baby after birth, Lanugo are little hairs, usually when premie that will go away
Silverman score? Respiratory Distress Score, Grade 0-2 nares, chest and grunt
Signs of respiratory distress grunting, retractions, accessory muscle use, abdominal/chest wall synchrony
Circulating blood volume of neonate and peds? for a neonate 85-90 ml/kg, for a pediatric about 70-75ml/kg
Pain Control Anesthetic cream, lidocaine injection (must be 4months or older for either of those) or sucrose, good on binkies
CBG’s how different from ABG? Less invasive, correlates best with PH and PaCo2, babies need to be minimum 24 hours old, puncture sites are fingertips or heal, assessment of ventilation
Arterial catheters The umbilical arteries are considered “central” and peripheral arteries are radial, posterior tibial or dorsalis pedis
Transcutaneous monitoring pulse ox, transcutaneous Co2, heated to a temperature to increase perfusion to that area, moved every couple of hours to avoid burn
Normal SPo2 for children and neonate? Children: 80 mmhg Pao2 and up, spo2 95% or greater Neonate: premie 40-60 mmhg and Spo2 high 80’s% Term baby 60 mmhg and higher, Spo2 90% or higher
High-flow Nasal Cannula warmed and humidified, needed for AOP, 0.25 – 2.0 LPM if flow is too high (4lpm) can be like cpap on baby, ng tube almost always in baby. Hazards: excessive pressure, air in esophagus
L:S ratio, what is it and what it means? how mature the surfactant is, tested from the amniotic fluid, 2:1 ratio is what we want! a 1:1 ratio is likely to develop ARDS
TTN transient tachypnea of the newborn, up to 150 breaths per minute, grunting noise to increase FRC
MAS Meconium aspiration syndrome, ball-valve effect on air-trapping(auto-peep) hyperinflation leads to pneumonia, suctioning right away, do not stimulate baby to breathe!
PPHN Persistent pulmonary hypertension of the newborn – icreased PVR that isn’t going away preduct on right side, post duct anywhere else, more than 20 points you have a patent DA, baby looks cyanotic, tx HFV, nitric oxide, ECMO
diaphragmatic hernia PIP <25 cmh2o, hypoplastic lung, can move mediastinal and heart if severe.
CF Genetics CFTR screening, autosomal recessive, chloride test 60 ml or higher it’s present
PDA, managament? below 28 wks, 50-60% chance that baby will have a PDA, maintain hematocrit at the high end, administer indomethacin (best when given within the first 24 hrs of life)
Question Answer
Disease or condition suspected in an infant in respiratory distress and a physical exam has scaphoid abdomen Diaphragmatic hernia
Another name for Persistent Fetal Circulation Persistent Pulmonary hypertension
If delivered infant presents with acrocyanosis only and heart rate of 140 and respiratory rate of 60 Observe the infant, no intervention
Clincal signs of RDS Grunting, nasal flaring, and retractions, but not acrocyanosis
Respiratory disease resulting from the absence of both airflow and ventilatory effort Central Sleep Apnea
The main source of respiratory acidocis Hypoventilation
A disease that occurs primarily in infants how are delivered via c-section and often followed for rule out pneumonia and have high respiratory rates, AKA RDS type II Transient tachypnea of the newborn
A disease seen at times in infants who present with greenish tinted amniotic fluid on delivery Meconium Aspiration Syndrome
Reduce alveolar recruitment Decreased pulmonary compliance, increased pulmonary resistance, and decrease functional residual capacity
A typical RDS pattern on chest x-ray Ground glass appearance
Because of it, infants do better nowadays with recovering from RDS Surfactant
Not a complication of ARD Choanal atresia
Pierre Robin syndrome An infant with small jaw
The primary factor in the development of Retinopath of Prematurity Oxygen delivery
Infant appears with a distended abdomen that bowel loops can be felt and guaiac positive stools. As a clinician, the priamary consideration of differential diagnosis is Necrotizing enterocolitis
A defect that occurs most commonly as a direct protrusion from the umbilical cord Omphalocele
Purpose of Ballard and Dubowitz assessments Gestational age
Reason an infant would have less pulmonary reserve than an adult Large abdomen
The narrowest part of an infant’s airway Cricoid cartilage
Not true of an infant’s airway/breathing Tongue smaller
Greater that 90th percentile and Large for gestational age describe LGA
Adequate mean blood pressure can be calculated in a neonate with the formula Gestational age + 5
Not a “red flag” in the neonatal patient Respiratory rate greater than 40, but less than 60
Vernix describes a cheese-like appearance
Laguno describes Fine hair
Indicative of Polycythemia Ruddy appearance
Indicative of Meconium Green staining
Indicative of respiratory distress Head bobbing
Another name for huff coughing Forced exhalation technique
Technique whereby the patient is instructed to breathe at 3 different lung levels with huff coughing interspersed Autogenic drainage
Side of the diaphragm where the majority of diaphragmatic patients have the hernia Left
Causes of obstruction of mucus in the airway Infection, atelectasis, infalmmation, air trapping
The final step to chest physiotherapy Coughing
Infant is 35 weeks gestation and weighs 2500 CPT indicated
Chest tube located in left lower lobe, if CPT ordered to upper right lobe for pneumonia CPT incicated
Contrary to normal coughing, during forced expiratory technique Glottis remains open
Ideal range of pressure patient should generate 10 to 20 cmH20
Visible secretions in the ETT, patient with deterioration condition Signs of suctioning in intubated patient
accicdental extubation, atelectatsis mucosal damage, hypoxemia Hazards of suctioning
Proper position of oxygen analyzer to appropriately read FiO2 Close to infant’s face/head
With high flow nasal cannula unable to determine CPAP
Resuscitator bag that can deliver free flow oxygen through the mask port Flow inflating
Mask good to deliver both humidification and a precise FiO2 Venturi mask
Approximate PaO2 when oxygen saturation monitor reads 90% 60 torr
Term refering to abnormally low levels of oxygen in the tissue Hypoxia
Location of the fetal oxyhemoglobin curve reside in comparison with the normal adult oxyhemoglobin The fetal curve lies ot the left of the adult curve
Delivery device most suitable for the administration of heliox Nonrebreather mask
Excess condensate present in aerosol tubing will increase the FiO2
Question Answer
Prenatal ultrasound evaluations, Postnatal findings based on physical and neurologic examinations, and gestational duration based on last menstrual cycle Factors considedered when assessing the gestational age of a neonate
Large for gestational age Newborn with birth weight greater than the 90th percentile
The delivery room temperature was low Infant arrives in the newborn nursery with an axillary body temperature of 95.5F degree
An injury to the infant’s brachial plexus may have occurred during birth Infant’s arms do not move symmetrically
Hypotension condition anticipated in infant with irregular areas of dusky skin alternating with areas of pale skin
Reddish blue appearance skin presentation at birth associated with high hematocrit value or polycythemia and neonatal hyperviscosity syndrome
Newborns have relatively thin and weak musculature, and a less rigid thorax Reason chest retractions are more prominent among neonates than among loder children and adults
The neonate’s chest is small and sounds are difficult to differentiate Reason it is difficult to localize auscultation findings of the thorax of a newborn
Patent ductus arteriosus and left-to-right shunt Condition(s) that result(s) a neonate’s bounding pulse
Direct a light source toward the ipsilateral surface of the patient’s thorax Diagnostic procedure called transillumaination
Volume depletion with compensatory peripheral vasoconstriction Condition responsible for the therapist observing a pulse oximeter indication decreased perfusion while central blood pressure remains normal
Left arm, right leg, and left leg Sites that can render postductal blood when assessing right-to-left shunting, like PPHN
Enterocolitis and Ascites Conditions that can cause abdominal distention
Gastroschisis and Prune-belly syndrome Conditions associated with scaphoid abdomen
Sepsis Condition(s) characterized by a newborn presented with pale, mottled, floppy appearance and with little interces in feeding and slightly irritable
Persistent pulmonary hypertension of the newborn Possible condition in a neonate where a pulse oximeter a higher oxygen saturation in the right hand than in the left foot.
Less than or equal to 3500 count per cubic millimeters WBC count in neonate with leukopenia
Chief complaint, history of present illness, past medical history Components of patient history for a new pediatric patient
Respiratory distress Possible condition in a 7 year-old child in ER with a productive cough, diaphoresis, and fever while on vacation with parents
Frequency and duration of symptoms and onlset of symptoms Components of present illness section of a patient’s medical history
Components of past medical history section of patient’s medical history Birth weight, previous mechanical ventilation, and emergency department visits
Component of patient medical history intended to determine the presence of symptoms not identified in the history of present illness and that may be related or contritute to the child’s underlying condition Review of systems
Head bobbing, nasal flaring and grunting Signs of respiratory distress
Severe asthama and cystic fibrosis Pulmonary disease(s) that are not chest wall deformities, but are characterized by an increased anteroposterior diameter
Condition perceived with increased tactile fremitus over the patient’s right lower lobe Pulmonary consolidation
Condition(s) suspected with dull percussion note ausculted over a child’s lungs Atelectasis, pleural effusion, and consolidation
Condition suspected with expiratory stridor ausculted on small child trachea Tracheomalacia
Condition(s) which can produce bilateral fine crackles Pulmunary edema
Condition(s) that can be revealed with the examination of the ears, eyes, nose, and throat Allergies
Cause of hepatosplenomegaly associated with advanced cystic fibrosis Right ventricular failure
Term(s) used to describe a low-pitched, wet sound similar to snoring, which suggests nasopharyngeal, oropharyngeal, and/or hypopharyngeal airway obstruction Stertor
Order of physical assessment of the thorax Inspection, palpation, percussion, and auscultation
Question Answer
Incidence of respiratory distress syndrome (RDS) among infants born at less than 28 weeks of gestation 60%
Conditions responsible for the reduction in pulmonary blood flow during the course of RDS Hypoxemia, Acedemia, and Hypercarbia
Reason term or near-term infants commonly overlooked as a group of patients at risk for developing RDS These infants tend to be strong and have excellent pulmonary reserve
Significance of an infant with RDS demonstrating a grunt during each exhalation An effort to maintain its functional residual capacity (FRC)
Condition diffuse, fine, reticulogranular densities, thus ground-glass appearance the chest radiograph of a newborn, preterm infant would suggest Respiratory distress syndrome
Correct interpretation of a lecithin-to-sphingomyelin (L/S) ration of 2:1 The presence of lung maturity
Condition suggested by CXR showing pulmonary vascular congestion, prominent perihilar streaking, fluid in the interlobular fissures, hyperexpansion, flat diaphragm Transient tachypnea of the newborn
Therapeutic intervention(s) generally needed to treat transient tachypnea of the newborn (TTN) Oxygen administration
Reason meconium staining occur predominantly in infants greater than 36 weeks of gestational age These infants demonstrate strong peristalsis and have poweful anal sphincter tone
Typical radiograph features of an infant with MAS Patchy areas of atelectasis
Incidence of normal pulmonary vascular resistance that is achieved within 24 hours after birth 80%
Clinical presentations associated with apnea of prematurity Snoring, mouth breathing, choking
Recommended medication for an infant with apnea of prematurity experiencing prolonged episodes of apnea Methylxanthines aka caffeine
Proper intervention to perform when an infant is born with choanal atresia Insert an oropharyngeal airway
A way to confirn a diagnosis of choanal atresia Attempting to insert an 8 French suction catheter through each nasal cavity
Condition consistent with micrognathia, glossoptosis, and cleft palate in a newborn Pierre Robin syndrome
Most common form of tracheoesophageal fistula and essophageal atresia Blind-ending upper esophageal pouch of variable length associated with a fistula from the lower trachea or main stem bronchi leading into the distal esophagus
Clincal manifestations characterized by congenital diaphragmantic hernia The herniated contents cause coompression of the developing ipsilateral ung, Histologic studies demonstrate increased muculature in the media of the arteroles, and lung tissue is hypoplastic, including the pulmonary vasculature, even on the contralateral
Condition consistent with the presence of a scaphoid abdomen in a newborn with tachypnea Congenital diaphragmatic hernia
Interventions used to treat congenital diaphragmatic hernia Hig-frequency oscillatory ventilation, bag-mask ventilation immediately after birth, thoracostomy tube insertion if necessary
Most common patient complaint associated with pectus carinatum Cosmetic
Types of cells responsible for producing pulmonary surfactant Alveolar type II cells
A term or phrase that describes air leaving the lungs and entering the pulmonary interstitial spaces as a consequence of barotrauma Pulmonary interstitial emphysema
Condition that can be suspected if tachypnea, hypoxemia, or hypercarbia are present in a newborn Pneumothorax
An alternative to refractory surfactant replacement therapy and conventional mechanical ventilation Initiation of high-frequency ventilation
Condition consistent with finding a transcutaneous PO2 difference of 25 mm Hg between an infat’s right wrist and left leg Patent ductus arteriosus
Condition that should be suspected if a newborn has a respiratory rate greater than 60 bpm beyond an hour after birth Sepsis
Mechanism implicated in the development of retinopath of prematurity Fluctuating PaO2 values, or PaCO2 values, after vasoconstrictive injury
Measure that can help reduce the incidence of intraventricular hemorrhage in infants receiving mechanical ventilation Perform transfusions to keep the infant’s hematocrit greater than 40%
Question Answer
Acceptable PaO2 for neonatal blood gas? 60-80 torr….80-100 in adults…..premature neonates as low as 50mmHg
Acceptable pH..PaCO2…other blood gas values for neonates? Same as adult…only PaO2 is different
How is capillary blood gas taken in neonates? arterialization of site with hot rag (45C for 5-7 minutes)
Capillary PO2 will be lower than arterial PO2…Why?? Tissues have consumed some of the oxygen
Capillary blood gas from neonates is primarily used for… Finding CO2 and pH….NOT a good monitor for assessing oxygen
Advantages of a UAC (umbilical artery catheter)? Continuous monitor of BP…arterial samples for ABG and other labs….blood replacement (transfusions)
The PO2 from UAC can be used to regulate FIO2…True or false true
What is the congenital heart defect patent ductus arteriosis (PDA)? When the two major blood vessels leading from the heart do not close after baby is born…it usually does….can be diagnosed by comparing blood gas from radial artery and umbilical artery…difference>15 torr…PDA with r-l shunt…
Where should UAC be placed? L3-L5 on X-ray
Transcutaneous monitoring (TcPO2 or TcPCO2) can be used to monitor oxygen and carbon dioxide is infants…true or false true
Advantage and disadvantage of transcutaneous monitoring. advantage …noninvasive way to reduce frequency of arterial sampling and can be done continuously…disadvantage…cannot replace arterial sampling
How is transcutaneous monitoring done? Clark/Severinghaus Electrodes placed on skin..skin must be kept at 43-45C (improves capillary flow)…lower skin temps will cause TcPO2 readings to be lower than actual
In transcutaneous monitoring, what happens if the electrode comes off? The TcPO2 reading will suddenly read higher…but the TcPCO2 will read zero (hardly any CO2 found in ambient air)
The electrodes in transcutaneous monitoring can sometimes burn the skin….how can this be remedied? Move them every 4 hours…be sure electrodes are on a flat surface with good perfusion (chest)… if burns are noted, should change more often!!!
Trans. Monitoring can only be accurate if ________is happeneing. Perfusion…accuracy decreases if skin is thick, anemic conditions of poor perfusion (burns, shock, vascular disease, cardio defects) Correlate with blood gas values to be sure perfusion is happening
Most common mechanical problem with trans. monitoring is air leaks….causing an increasing TcPO2 to be higher than PaO2
Trans. Monitor can be calibrated with…. a zero solution and room air (PaCO2 = 0…..PaO2 = 150 torr) if can’t callibrate, check for torn membrane or poor connection
Why is an echocardiogram done on infants? To visualize cardiac related anatomy, esp. when suspecting congenital heart and anatomical abnormalities
When should APGAR be done? 1 minute and 5 minutes after birth
What does APGAR stand for? Appearance, pulse, grimace, activity, and respiratory effort
Two types of assessments for newborns. What are they? Birth and routine
Infant receives 7-10 on APGAR, what needs to be done? Routine care…suction mouth and nose, establish airway…keep warm
Infant receives 4-6 on APGAR, what needs to be done? Support infant….stimulation and oxygen…resuscitation MAY be necessary, suction nose, mouth…assure airway…supportive bag/mask ventilation if HR <100/min…30-45% oxygen by oxygen hood or nasal cannula
Infant receives 0-3 on APGAR, what needs to be done? CPR (heart or lungs or both) ..resuscitation IS required..suction mouth nose…establish airway – clear airway…supportive bag/mask ventilation…cardiac compressions if HR<60/min after 30 sec of resuscitation
Each APGAR area is scored how? 0,1,2 points
Under appearance in APGAR, a baby pink with blue extremities gets a score of 1
ET tube size for infants… fullterm – 3.0-3.5 preterm – 2.5-3.0
Miller laryngoscope blade size for infants is full term – 1…..pre term – 00
What ventilator is often used for infants? Time-cycled vent….inspiration continues for a specified # of seconds regardless of volume delivered, but usually incorporates a specified pressure with a press. pop off valve
Name 4 neonatal oxygen therapy devices. oxygen tent…oxygen hood….incubator …radiant warmer
Flow rate in an oxygen tent must be set in excess of ___lpm to continually flush out CO2 12 lpm
If an infant/child destroys an oxygen tent due to anxiety, what can you switch to? face mask
If a humidity/aerosal environment is desired which oxygen therapy device is most useful? oxygen tent
If analyed FIO2 near PT face in an oxygen tent is difficult to keep consistent, what can be done? ensure the plastic walls are tucked into the bed well
In an oxygen tent, maximum achievable FIO2 is about….% 40-50%
Due to high fluid filled environment in an oxygen tent, it may lead to ________ in the PT fluid retention…monitor input/output and weight often
In an oxygen tent, FIO2 may exist as a gradient, with the higher FIO2 where ……top or bottom? bottom….oxygen is heavier than the other gases
An oxyhood (oxygen hood) is a loosely enclosed environment placed over the infants head and is associated with using a (high or low) flow device?? High flow device (venturi) to ensure CO2 flushing
Minimum flow on an oxyhood is 7Lpm….higher is recommended to prevent build up of arterial CO2
Oxyhood can deliver ____% oxygen with an oxygen blender. 100%
FIO2 can be monitored in an oxyhood with a _____ oxygen analyzer probe near PT mouth…
Besides monitoring FIO2 with oxygen analzer probe near PT mouth in an oxyhood, what else needs monitoring inside the hood? temperature (probe)…must be monitored to prevent excess cooling from aerosol…too cool could cause an increase in oxygen consumption…too hot infant may become apneic(apnea)
Because of the loudness inside an oxyhood, what could happen? hearing damage and restlessness
How can the noise level be reduced in an oxyhood? By using a blender rather than a large volume nebulizer which can be very noisy , esp. on low FIO2 settings where much air is being entrained
What needs to be done when analyzed oxygen percentages in an oxyhood begin fluctuating? This is an indication of not enough flow….increase the flow
An incubator gives precise control over the environment including FIO2..humidity…temp… True or false true
It is a red flag warning sign when using an FIO2 of ____ in an incubator 1.0
Some hazards of using an incubator are skin burns, hearing damage, electrical shock
A radiant warmer for an infant is a good source of oxygen delivery…true or false false… must be combined with an oxyhood or some other oxygen delivery device
Which neonatal oxygen device is good for emergency cases? radiant warmer because is allows RT’s to have access to infant to give monitoring and care
Which neonatal oxygen delivery device is useful in controlling temperature and helps decrease insensible water loss dueto its neutral thermal environment? radiant warmer
Oropharyngeal suctioning on an infant can be done with ____ bulb syringe
Initial settings for mechanical ventilation for an infant ……respiratory rate…..FIO2…..PEEP????? respiratory rate – 20-30 bpm…….FIO2 – 40-60% room air (PT on oxygen, set on same as oxygen)….PEEP – 2-4 cmH2O (PT on CPAP, set on same level)
WHat pressure should be used when suctioning an infant? 60-80mmHg
Normal pulse for infants? 110-160 bpm…>170 = tachycardia…administer oxygen
Where should a pulse NOT be taken on an iinfant…brachially, femorally, radially or apically radially
Any pulmonary challenge will cause an increase in infants…heart contractility or heart rate heart rate
acceptable respiratory rate in infants is 30-60/min.
Apnea for 10 seconds is normal, apnea lasting 10-20 seconds is acceptable, but >20 , the infant needs…. apnea monitoring..also infants who have been treated with caffeine to stimulate ventilation should also be monitored as well as those at risk for SIDS
Factor indicating the need for apnea monitoring… One or more life threatening episodes(apnea cyanosis, choking, lifelessness requiring stimulation or CPR)…Sibling of SIDS baby…Preterm baby with significant apnea periods..snoring
WHat is used in an Impedance Apnea Monitor (Pneumogram) to monitor lungs expanding and contracting? Electrodes attached to chest senses changes in distance between electrodes as lungs expand and contract
Problems with pneumogram? false alarms…poor electrode contact (oily skin)…monitor may not sense obstructive apnea if PT has respiratory movement like hiccups…Must be used during napping, car or stroller riding…disconnect when eating..
Low heart rate alarm on a pneumogram should be set at 60-80 bpm
WHen can apnea monitoring be discontinued? two months free of events…no monitor alarms on apnea setting of > 20 seconds and HR <60 bpm…no symptons show after immunizations and experiences nasopharingitis…followup pneumogram is normal
Normal BP for infants? 60/40 mmHg…less if preterm (50/30mmHG)
Normal body temperature for infants? 36-37C…Servo-controlled radiant warmer should be used because babies lose body temp. quickly and easily. Servo-controlled radiant warmer has a probe to place on baby’s skin with low skin temp. alarm…may sound if comes off!!!!
What medical history is needed for infants? Maternal and family history
Normal term baby is ______weeks 38-42
A baby less than 38 weeks is considered preterm
Normal birth weight for an infant? 3000grams..low birth weight is related to increased risk of complications
What is minimum survivable age and weight of a baby? 1000 grams and 26-28 weeks…at risk for respiratory problems
What is acrocyanosis? a baby with blue extremities and a pink body…not cyanosis
a baby with retractions…grunting….nasal flaring… is showing signs of ventilatory distress
Silverman Score is used to evaluate…. respiratory distress in infants….uses 0-10 scale with 10 being the greater distress
If capillary refill is longer than 3 seconds there could be a problem with… cardiac output
What is a heart murmur an indication of in an infant? congenital heart defect…do echocardiogram
Why should arterial blood gases be done conservatively on infants? There blood is scarce
If PaO2 levels from right radial artery(pre-ductal) and umbilical artery (post ductal) is > _____, infant has PDA…send to surgery 15mmHg
If chest X-ray and transillumination shows a ground glass or reticulogranular pattern it indicates… IRDS or lung immaturity…treat with surfactant
How is transillumination done/ Shine bright light though one side of chest cavity while observing from the other side
If during a transillumination the lung field lights up completely, it indicates…. pneumothorax…follow up with a chest X-ray
During transillumination there is only the outline of the light (halo effect), that indicates… lungs are normal
Blood glucose levels for infants… >30 acceptable (>20mg/dL in preterm)…may be monitored in all infants
A reported conception date is the most reliable…true or false? False…it is the least reliable…substance abuse can cause fetus to mature quicker or slower than normal making a reported date unreliable
An ultrasound of the fetus can make an estimate of the gestational age by measuring…. lengths of a bone (femur) and size of the fetal skull
Best evaluation to tell gestational age of fetus for mothers with complications (diabetes, drug abuse…) is Dubowitz score…physical assessment AFTER birth to determine true gestational age…score of 40 correlates with 40 weeks…New Ballard Score is similar but more suitable for infants less than 30 weeks est. gestation age
Patent ductus arteriosus can be evaluated by using ….. transcutaneous monitoring or pulse oximetry….recommend echocardiogram to determine cause of shunt
If a womans’s last menstrual period is Feb 1…according to Nagele’s Rule (est. delivery date) when is the baby due? Add 7 months and 7 days to last menstrual date= Sept. 7
The lecithin/spinogomyelin (L/S ratio) is related to…. lung maturity in infants…Normal is 2:1….1:1 is bad,so administer surfactant
Hyaline membrane disease (HMD) now known as IRDS..can have L/S ratio as low as… 0
What does the PG level assess? (phosphatidyglycerol) Most reliable and accurate pulmonary maturity assessment (even in presence of diabetes) starting around 36 weeks of gestation
How is PG level assessment done? Using amniotic fluid…
What does a PC level assess? (phosphatydichloride) Alternate indicator of lung maturity…phosphatydichloride , found in surfactant, rises as lungs mature…phospholipids make up the majority of weight of surfactants
Question Answer
What is Pathophysiology of RDS? Insufficient amount of surfactant Immature cell & vascular development of the lungs
What is etiology of RDS? Prematurity- less 28 wks GA underdevelopment of alveoli Term/near term – Maternal diabetes or Hx late GA infants
ABG presentation hypoxemia hyPERcarbia mixed acidosis
What are CXR presentation for RDS? reticulogranular densities(GROUND GLASS) Heart-slighly enlarged
What are 4 stages of CXR for RDS? stage I- ground glass stage II- air brochograms stage III-air bronchograms beyond heart border Stage 1V- “white out”
What are the 3 treatments for RDS Prevention, Oxygen, Mechanical ventilation