Neonates Chap 5

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Neonates Chap 5
2012-03-06 23:45:50
Chapter peds

Chapter 5: Assessment of the Neonatal and Pediatric Patient
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  1. Which of the following are true regarding the anatomic and physiologic differences between adults and infants?
    1. Infants have a proportionally larger tongue.
    2. Infants have a proportionally larger epiglottis.
    3. Infants have a proportionally larger body surface area.
    4. The Infant trachea is only a third the diameter of teh adult's
    5. Infants have a higher oxygen consumption.
    1, 3, and 5
  2. While reviewing a patient's chart before her delivery, you note the previous history shows PARA 3-1-0-1? What does this mean?
    The patient has had 1 miscariage.
  3. Identify which of the following are included in the Ballard gestational age assessment?
    1. Ear recoil
    2. Presence of edema
    3. Sole Creases
    4. Skin appearance
    5. Presence of lanugo
    1, 3, 4, and 5
  4. Upon examination of a newborn, you find thick vernix covering the infant, gelatinous transluccent skin, thick lanugo over the body, faint red lines on teh soles of the feet, flat areola with no bud, slow ear recoil, a male genitalia that shows no scrotal rugae or testicular descent. The proximate gestational age of the infant is???
    26-28 Weeks
  5. Which of teh follwing are done during the quiet examination?
    • 1. Assess skin color
    • 2. Assess patient movement
    • 3. Overall visual inspection
  6. Increased intracranial pressure is indicated when:
    the fontanelles are bulging or tense.
  7. A pediatric patient presents with a history of a dry, nonproductive cough. You would suspect which of the following?
    Foreign body aspiration
  8. When assessing a pediatric, you discover that the patient has a rapid bounding pulse, confusion, and muscular twitching. What is suspected?
  9. Which of the following is NOT an indication to performing PFTs on a neonate or pediatric patient?
    Assess the extent of a pneumothorax
  10. Of the following, which may result in inaccurate pleural pressure readings when an esophageal ballon is used?
    1. Increased airway resistance
    2. Cardiac artifact
    3. Paradoxical chast movement
    4. REM sleep
    5. Presence of infection
    2, 3, and 4
  11. Body plethysmography uses which of the following gas laws to measure thoracic gas volume?
    P x V = P1 x V1
  12. An accurate pulmonary function study done on a pediatric patient is mainly dependent on:
    Cooperation and maturity of the patient
  13. State 10 anatomic and physiologic differences between the infant and adult.
    • 1.The infants tongue is proportionally larger 2. Infants have a large amount of lymphoid tissue in the area of the pharynx
    • 3. The epiglottis of the infant is proportionally larger, less flexible, and omega-shaped, which makes it susceptible to trauma.
    • 4. The diameter of the trachea above the carina is roughly 4mm at birth compared to 16mm in the adult.
    • 5. The infant epiglottis also lies more horizontally.
    • 6. Infants are considered to be obligatory nose breathers
    • 7. The infant larynx lies higher in the neck in relation to the cervical spine.
    • 8. The length of the trachea increases from 57 mm at birth to 120 mm in the adult.
    • 9. The infant chest is mostly cartilage.
    • 10. The metabolic rate of neonates and infants is higher than in adults.
  14. What does PARA stands for.
    • History, use the mnemonic, texes power and light.
    • Term pregnancies
    • Premature deliveries
    • Abortions/Miscarriages
    • Living children
  15. Identify the physical and neurologic signs examined in the Dubowitz gestantional age assessment.
    • Neurological Sign:
    • Posture, Square Window, Ankle Dordiflexion, Arm Recoil, Leg Recoil, Popliteal Angle, Heel to Ear, Scarf Sign, Head lag, Ventral Suspension.
    • External Sign:
    • Edema Skin texture, Skin color, skin capacity (trunk), lanugo (over back), Plantar creases, nipple formation, breast size, ear form, ear firmness, genitalia male/female (with hips half-abducted)
  16. Identify the physical and neurologic signs examined in the ballard gestational age assessments.
    • Neuromuscular Maturity:
    • Posture, Square, Window (wrist), Arm Recoil, Popliteal, angle, Scarf Sign, Heel to ear.
    • Physical Maturity:
    • Skin, Lanugo, Plantar Surface, Breast, Eye/Ear, Genitals male, Genitals Female
  17. Compare and contrast the Dubowitz and Ballard gestational age assessments.
    • Dubowitz uses more categories and 1-10 scoring system.
    • Ballard has similar categories and 1-5 scoring system.
  18. Describe seven physical signs that are used to determine gestational age.
    • 1. Vernix
    • 2. Skin Maturity
    • 3. Lanugo
    • 4. Ear Recoil
    • 5. Breast Tissue
    • 6. Genitalia
    • 7. Sole Creases
  19. List five purposes of the neonatal physical examination.
    • 1. physical defects
    • 2. successful transition to extrauterine life
    • 3. Thoroughly assess gestational age.
    • 4. Check for signs of infection or metabolic disease.
    • 5.establishes baseline for future comparisons.
  20. Describe quiet examination.
    • Observe:
    • Color
    • Meconium
    • Lanugo
    • Amount of activity
    • Overall look of patient
    • Respiration
  21. Describe hands-on examination.
    • With warm hands and stethoscope, inspect:
    • Head for cuts or bruises
    • Mouth for clefts
    • Auscultate heart (norm BPM 120-160)
    • Evaluate lungs
    • Compare brachial and femoral pulses
    • Measure blood pressure
    • Listen for bowel sound
    • Check temp (norm=36.2 to 37.3C Axillary)
  22. Describe Neurologic Examination:
    • movements
    • crying
    • response to touch
    • and body tone are all checked.