Prenatal and pediactric

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  1. Genetic birth defect
    • Single gene
    • Multifactorial
  2. Chrosomal birth defect
    • Abnormal normal
    • Configuration
  3. Congential birth defect
    Unknown cause or abnormal developement
  4. What are the characteristics often seen in children with chromosomal abnormalities?
    • Obvious malformations
    • Odd facies
    • Abnormal ears
    • Heart and or kidney problems
    • Abnormal hands and or feet
    • Low birth weight
    • Unexplained mental retardation or changes in health
  5. List three diseases that are autosomal recessive!
    • Sickle cell
    • CF
    • Tay sachs
  6. What are the three symptoms of CHF?
    • Pulmonary edema
    • Increased WOB/ dyspnea
    • Coughing/ Wheezing
  7. What are the three signs of heart defects?
    • Congestive heart failure
    • Cyanosis
    • Murmur
  8. Peripheral cyanosis
    • Poor perfusion
    • Probably cardiac
    • tissue hypoxecimia
  9. Central cyanosis
    • Hypoxemia
    • Arterial hypoxecmia
  10. Central cyanotic breath sounds cause by pulmonary disease
    • Crackles- atelectasis or pneumonia
    • Wheezes- airway diseas
    • Rhonchi
  11. Central cyanotic CXR caused by pulmonary disease
    • lung expansion
    • Totally white lung color
  12. Central cyanotic ABG's caused by pulmonary disease
    • PaCO2 and PaO2 both abnormal
    • PaO2 changes with hyperventilation then pulmonary vasodilation
    • Low PaCO2 causes pulmonary vasodilation which would increase the PBF and the PaO2
  13. Central cyanotic breath sounds cause by cardiac disease
    • Normal breath sounds
    • Crackles- pulmonary edema
    • Wheeze- CHF
  14. Central cyanotic heart sounds cause by cardiac disease
    • Murmur
    • Pulse strength abnormalities increase the chances that it is cardiac
  15. Central cyanotic CXR cause by cardiac disease
    • Normal lungs
    • Bloow flow into the lungs- too much or too little
  16. Central cyanotic ABG's cause by cardiac disease
    • PaO2 different between upper and lower body
    • PaO2 gets worse with O2 therapy
  17. What is the normal RR for infants?
    40 to 60 breaths/minute
  18. What is the normal heart rate for infants?
    120 to 170 beats/minute
  19. What is the normal blood pressure for infants?
    • Adequate MBP = GA + 5
    • 30 weeks = MBP = 30
  20. What are the signs of respiratory distress in babies?
    • Tachypnea
    • Retractions
    • Grunting
    • Nasal flaring
    • Cyanosis
    • Apnea
  21. What are the differences between adults and babies?
    • Poor stability to the chest wall
    • Smaller and more reactive airways
    • Larger heart in proportion to cheast area
    • Easily distended abdomen
    • Fewer and smaller alveoli
    • Respiratory muscle fiber type
  22. What does the difference in adults and babies mean for a baby with a lung disease?
    • Only gonna see signs of respiratory distress in a sick baby
    • The soft ribs cave in when they have to create a extra large drop in pulmonary pressure.
    • The more negative they pull, the more the chest sucks in, the sicker the baby
    • The extra distended abdomen limits the effectiness of the abdomen
    • Babies retract because they have soft ribs and if they have lung disease they need to pull more negative in order to breath, which sucks in the chest
  23. Explain why babies must increase their RR and not their TV?
    • Weak diaphgram, 2 way its weak
    • retractions
  24. The more premature the baby,
    The more weaker the diaphgram, it tired more easily
  25. Choanal Atresia
    • No nasal opening in the back of the nasopharynx
    • Babies are obligate nasal breathers untill 6 weeks of age
    • If their nose is obstructed they cant breathe 
    • This problem may be uni or bi lateral
    • It is more common in boys
  26. Symptoms of unilateral choanal atresia!
    Secretions and sinus infection
  27. Symptoms of bilateral choanal atresia!
    • Retractions
    • Tachypnea
    • Flaring
    • Cyanosis (periods of dyspnea) interrupted by periods of crying
  28. Diagnosis of choanal atresia!
    • Symptoms and inability to pass a suction catheter through the nose
    • Obtain an ENT consult
  29. Treatment for bilateral choanal atresia!
    Orpharyngeal airway
  30. Most common tracheoesophageal fistula...
    • Is esophageal pouch and lower connection above the carina
    • Esophageal atresia with a distal tracheoesophageal fistula
  31. The complication for TE fistula!
    Is tonce you repair the fistula the patient will frequently have tracheal malacia or tracheal stenosis
  32. Symptoms of esophageal atresia with a distal tracheoesophageal fistula!
    • Can't swallow
    • Bubbly spit
    • Can't pass a feeding tube
    • Aspirates on feeding
    • Air in the stomach
    • History of polyhydramios
  33. H-type fistula
    Tracheosophageal fistula without esophageal atresia
  34. Symptoms of H-type fistula!
    • Can swallow
    • Aspirates very little
    • Presents with occasional wheeze and recurrent infections (long term micro aspirations)
  35. What are critical to the diagnosis of tracheoesophageal fistula!
    Cheast and abdominal radiographs
  36. The course and endpoint of the nasogastric tube confirms...
    Obstruction of the proximal esophagus by atresia and determines the relative position of the upper esophageal pouch
  37. Proximal atresia with evedience of air in the gastrointestinal tract indicates...
    A distal tracheoesophageal fistula, the most common form of the anomaly
  38. A proximal obstruction without evedience of gas distally most likely indicates...
    The presence of esophageal atresia with or without smaller fistulas
  39. Treatment of tracheoesophageal fistula!
    • surgical repair
    • Be careful with ETT placement and suctioning after surgery
  40. Diaphragmatic hernia!
    • This effect occurs early in pregnancy (8 - 10 weeks).
    • 85% of the defects are on the left
    • The amount of lung tissue is reduced on both sides, mostly on the affected side (intestine covered side)
  41. Survival of diaphragmatic hernia depends on...
    • Amount of lung tissue
    • The amount of pulmonary hypertension
  42. Why does pulmonary hypertension develope in diaphragmatic hernia!
    • Reduced number of pulmonary vessels
    • Increased pulmonary muscle mass
    • Hypoxic vasoconstriction
  43. Diagnosis of diaphragmatic hernia!
    • Physical exam
    • scaphoid (hollowed out) abdomen
    • Shifted away mediastium
  44. Treatment of diaphragmatic hernia!
    • Do not ventilate with a bag and mask it makes it worse
    • NG tube to suction
    • Intubate and ventilate with low pressure- maybe oscillator- Pneumothorax occurs easily
    • Give O2 and nitric oxide to reverse pulmonary hypertension caused by spasm
    • ECMO is an alternative when NO and ventilator fail. It only aloows the lungs to rest and repair while gas exchange happens in a machine outside the body 
  45. What is the problem with bag mask ventilation in patients with diaphragmatic hernia?
    It is avoided in order to keep the gut in the chest from becoming full of air and pushing against the lungs and causing tension pneumothorax physiology
  46. Why does pulmonary hypertension develope in CDH?
    • Hypoxic vasoconstriction
    • Which increases PVR
  47. Acyanotic cardiac defects
    • Left to right shunts
    • Obstructive lesions
    • Increased PBF
    • Decreased systemic flow
  48. Left to right shunts
    • Arterial blood is directed back to the lungs
    • increases pulmonary blood flow
    • Decreased systemic flow
    • Increased risk for pulmonary edema
  49. Obstructive lesions
    • Decreased systemic flow/pressure
    • Poor peripheral perfusion
    • Increased afterload
  50. What is the most common cardiac defect?
    Ventricular septal defect
  51. Anatomy of Ventricular septal defect
    • It is the most common defect accounting for approximately 20-30% of all defects
    • Hole in the ventricular septum
    • Blood flows from left ventricle to right ventricle
    • Treatment is pulmonary banding
  52. Ventricular septal defect
    • Shunt- Left to Right
    • PBF- Increased
    • Color- Acyanotic
    • Name- VSD
  53. Symptoms of Ventricular septal defect!
    • Are generally delayed untill 4 to 6 weeks of age when the left ventricular pressures exceed the right ventricular pressure
    • Systolic murmur
    • Pulmonary edema
    • CHF
  54. Hemodynamics of Ventricular septal defect!
    Depends on the size of the defect and the amount of PVR
  55. Pulmonary banding!
    Increases PVR which increases RV pressures and decreases the left to right shunt through the defect
  56. Anatomy of Coarctation of the aorta!
    • This is a norrowing of the aorta
    • It usually occurs high in the aorta usually near the insertion of the DA
    • Perepheral cyanosis
    • No shunt
  57. Coarctation of the aorta!
    • Shunt- No shunt
    • SBF- decreased
    • Color- Acyanotic
    • Name- Co Arc
  58. Symptoms of coarctation of the aorta!
    • Differential blood pressure is very diaganositc: High in the arms and low in the legs
    • Occasional hypertension
  59. What is prostin?
    • Minimizes ductal construction
    • Keep DA open for a patient who is ductal dependent
  60. What is Indocin?
    Closes the DA
  61. Cyanotic cardiac defects
    • Right to left shunts
    • Venous admixture shunts
    • Decreases in pulmonary blood flow
    • Blue baby
  62. Right to left shunt
    • Vena caval return is directed to the systemic side of circulation
    • Decreased PBF
    • Severity of the cyanosis depends on the degree of shunting
  63. Venous admixture shunts
    • Vena caval return and pulmonary venous return mix
    • The pulmonary and systemic circulations receive the same PaO2
    • PBF is varaible
  64. Ballock taussiq shunt!
    • Creates an artificial ductus arteriousus to increase PBF
    • Temporary to increase PBF usually works for 2 to 4 years then defenative repair
  65. Anatomy of Tetralogy of Fallot!
    • Right ventricle to left ventricle
    • Hypoxia induced SOB and Squatting to increase SVR
    • Treatment is Blalock- taussiq shunt
  66. Tetralogy of fallot!
    • Shunt- Right to left shunt
    • PBF- decreased
    • Color- Cyanotic (blue patient)
    • Name- Tet
  67. CXR of Tetralogy of fallot!
    Boot shaped heart
  68. What are the four defects in Tetralogy of fallot!
    • Pulmonary stenosis
    • Right ventricular hypertrophy
    • VSD
    • Abnormal (malpositioned) aorta
  69. Ballon septostomy!
    • This procedure includes advancing a balloon tipped catheter from the RA through the foramen ovale into the LA. This balloon is inflated and rapidly and forcefully withdrawn to create a large ASD
    • This ensures adequate mixing between the two atria
  70. Anatomy of Transpositions of the great arteries!
    • Venous admixture
    • shunts occur threw: ASD, VSD, PDA
    • Treatment is Ballon atrial switch
    • More common in males and LGA
  71. Transpositions of the great arteries!
    • Shunt- Bidirectional
    • PBF- Varies
    • Color- Acyanotic (blue)
    • Name-Transpo
  72. CXR of Transpositions of the great arteries!
    Egg on the side
  73. Anatomy of Hypoplastc left heart syndrome
    • Ductal dependent for systemic flow
    • Keep PaO2 low This Increases PVR, increases right to left shunt through DA, and keeps systemic flow going
    • Give prostin
    • Pulmonary to systemic
  74. Hypoplastc left heart syndrome
    • Shunt-Right to left
    • PBF- Varies
    • Color- Cyanotic (blue)
    • Path- Pulmonary to systemic
  75. Anatomical changes of Hypoplastc left heart syndrome
    • Small left ventricle
    • Abnormal aortic valve
    • Abnormal mitral valve
    • Abnormal aorta
  76. What cardiac defect can be made worse with O2?
    • Hypoplastic Left Heart Syndrome
    • Tetralogy of Fallot
  77. Laryngomalacia is the most common cause of...
    Stridor in children
  78. Vocal cord paralysis is the second most common...
    • Laryngeal abnormality in the newborn
    • Accounts for about 10% of all congential laryngeal abnormalies
  79. Tracheal Malacia!
    Obstructs when the airways
  80. Tracheal stenosis!
    Obstructs on inspiration and expiration
  81. Extra-thoracic (above the clavicals) on flow volume loop with Tracheal stenosis/malacia!
    • Narrows on inspiration because it is in the upper airway (Stridor)
    • Flow volume loop is limited on inspiration
    • No respond to vapo
  82. Intra-thoracis (below the clavical) on flow volume loop with Tracheal stenosis/malacia!
    • Narrows on inspiration because it is in the upper airway (wheeze)
    • Flow volume loop is limited on expiration
    • No response to B2 agonist
  83. Laryngeal Malacia!
    • Variable upper airway obstruction
    • Obstruction occurs on inspiration
    • Stridor does not respond to vaponephrine
    • Flow volume loop demonstrates limitation on inspiration with normal expiration
    • No treatment they will grow out of it
  84. Laryngeal stenosis!
    • Fixed obstruction
    • Onstructs on both inspiration and expiration
    • Usually occurs 3 to 4 weeks after intubation
    • May also occur as a congential malformation
    • Stridor does not respond to vapo, often biphasic
  85. Red flags in cardiac for neonatal patients!
    • Edema
    • Anuria (no urine)
  86. Red flags in gastrointestinal for neonatal patients!
    • Abdominal distension
    • Bloody stools
  87. Red flags in Metabolic for neonatal patients!
    • Vomiting
    • Diarrhea
  88. Red flags in general for neonatal patients!
    • Lethargy
    • Poor feeding
  89. The idea time to asses the gestational age of a newborn is...
    Within the first 12 hours
  90. Evaluating gestational age requires consideration of gestational duration based on
    • The last menstrual cycle
    • Prenatal ultrasound evaluation
    • Postnatal findings based on physical and neurological examinations
  91. Jaundice on the first day of life...
    is always an indication for immediate evaluation
  92. A delayed or weak femoral pulse in relation to the brachial pulse can indicate...
    coarctation of the aorta
  93. Placing pulse oximeters on preductal and postductal sites allows for assessing...
    right-to-left ductal level shunting through a patent ductus arteriosus, as seen with persistent pulmonary hypertension of the newborn
  94. A scaphoid, hollowed, or unusually flattened abdomen may be associated with...
    congenital diaphragmatic hernia
  95. The umbilical cord normally has...
    2 arteries and 1 vein
  96. The minimal platelate count for a newborn 24 hours old should be?
    150,000 mm
  97. If an 8 French (8F) catheter fails to pass through the nose into the oropharynx, what should be expected? 
    choanal atresia
  98. Chronic upper airway obstruction from anatomic malformations results in...
    • Chronic hypoxia
    • CO2 retention
    • Related sequelae such as cor pulmonale
    • Pulmonary hypertension
  99. Drooling is the first symptom in the majority of newborns with
    esophageal atresia
  100. A 3200g term infant male is born to a healthy mother. Apgar scores are 7 and 5 with the infant gasping and heart rates decreasing to 90. Physical exam reveals cyanosis, a scaphoid abdomen, and visible tracheal deviation to the right. Considering this information the only appropiate action would be to?
    Insert an oral suction catheter to vent the stomach
  101. Considering a likely diagnosis of congential diaphragmatic hernia, which would be appropriate decision concerning ventilator strategy?
    Rapid rate and low pressure
  102. Normal transition to extauterine life depends on the pulmonary vascular system...
    Changing from a high PVR to a low PVR
  103. What affects PVR?
    • Changes in PaO2
    • Changes in PaCO2
    • Changes in pH
  104. What is the therapeutic goal of subambient oxygen therapy?
    Increase PVR
  105. The purpose of managing PVR in the presence of cardiuac defects is to...
    Ensure the desired balance between systemic and pulmonary blood flow
  106. In complete transposition of the great arteries...
    The aorta and pulmonary artery circulation run in parallel.
  107. For which condition is a ventilator strategy utilizing larger tidal volumes, lower rates, and shorter I times typically used?
    Bidirectional shunts
  108. Increasing gradients between ETCO2 and PaCO2 in patients with congential cardiac defects are often the results of?
    Loss of calibration
Card Set:
Prenatal and pediactric
2013-03-06 01:23:49
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Test two
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