Prenatal and pediactric

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darrell2662
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209091
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Prenatal and pediactric
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2013-04-06 23:52:55
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Test three
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Test three
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  1. Why does cyanosis occur in babies?
    Hypoxemia
  2. Why does nasal flaring occure in babies?
    Decrease aiway resistance
  3. Why do retractions occur in babies?
    • Soft ribs
    • Large change in intraplueral pressures
  4. Why does grunting occure in babies?
    PEEEP manuver
  5. The biggest problem in RDS!
    Lack of surfactant
  6. Decribe the snowball pattern of RDS!
    • Decreased surfactant production
    • Decreased alveolar size
    • Atelectasis
    • Decreased surface area
    • Decreased gas exchange
    • Decreased O2 and increased CO2
    • Damages alveoil
  7. Explain how RDS causes increased WOB and altered ABG's!
    • Decreased alveolar Size
    • Decreased compliance
    • Increased WOB
    • Decreased tidal volume
  8. What does early CPAP do for the RDS patient and how might this be better than SRT in more mature infants?
    Minimal surfactant with CPAP will increase alveolar size and will maintain better oxygenation and better oxygenation continues surfactant production
  9. What are the primarily and secondary pathophysiologic changes?
    • Primarily is compliance
    • Secondary is diffusion
  10. What can be done to prevent RDS!
    • Premature deliery should be delayed
    • Glucocorticoids given for at least 2 days before delivery.
  11. Which types of patients are more likely to develop tachypnea of the newborn?
    Boys and infants with perinatal asphyxia
  12. What are the treatments for tachypnea of the newborn?
    • O2 therapy
    • CPAP
    • MV
  13. What symptoms are unique to GBS?
    • Poor peripheral perfusion
    • Decreased blood pressure
    • Metabolic acidosis
    • Tachycardia
  14. How is GBS similar to RDS?
    • Because the endotoxin produced by the organism breaks down surfactant
    • Same snowball effects as RDS
  15. What are the treatments?
    • Antiobiotics
    • O2
    • CPAP
    • MV with respiratory acidosis
    • Surfactant replacement
  16. What type of acidosis is seen with pneumonia?
    • Metabolic and respiratory
    • Mixed
  17. How is RDS treated?
    • O2- Hypoxic
    • CPAP
    • Mechanical vent- Resp acidosis
    • Surfactant
  18. Why are antibiotics given to RDS babies?
    Because it is similar to pneumonia
  19. What are the complications associated with RDS?
    • Chronic lung disease
    • Retinopathy of prematurity
    • Intraventricular hemorrhage
    • Necrotizing Entrocolitis
    • Air leaks
  20. What changes are seen in CBC with GBS pneumonia?
    Abnormal low white blood cell count
  21. Intraventricular hemorrhage
    ?
  22. Necrotizing Entrocolitis
    ?
  23. What is meconium?
    • The first stool of a baby
    • Green tinged
  24. What causes it to be passed in utero?
    Something stresses the baby
  25. What is the delivery room management of meconium aspiration?
    • Do not want them to aspirate
    • Intubate
  26. What are the two major consequenses of MAS?
    • Surfactant
    • Airway problem chemical nuemonitits
  27. Explain airway obstruction associated with MAS?
    • Can be peripheral or central (proximal)
    • Peripheral comes in 2 forms, total airway obstruction or partial airway obstruction
  28. What is the result of total airway obstruction associated with MAS?
    Atelectasis
  29. What is the result of partial airway obstruction associated with MAS?
    • Hyperinflation
    • ball valve
  30. What is the ball valve effect with MAS?
    • On inspiration they get air in and on expiration they don't
    • Air tarpping
    • Pneumonthorax
  31. What is the treatment of MAS?
    • Ventilate (HFOV) only if necessary
    • SRT
    • Keep well oxygenated
  32. What are the complication of MAS?
    • Pneumothorax
    • PPHN
  33. What complications occur during SRT adminatration?
    • Plugging of endotracheal tube (ETT) by
    • surfactant
    • Hemoglobin desaturation and increased need for supplemental O2
    • Bradycardia due to hypoxia
    • Tachycardia due to agitation, with reflux of
    • surfactant into the ETT
    • Pharyngeal deposition of surfactant
    • Administration of surfactant to only one lung
    • Administration of suboptimal dose
  34. What diseases can SRT be used for?
    RDS and MAS
  35. How are ven setting altered if the SRT is effective?
    • Reduction in FIO2
    • Reduction in ventilatory support
  36. What are the positive effect of SRT?
    • Reduction in WOB
    • Improvement of aeration
    • Improvement in lung compliance
    • Improvement in ratio of arterial to alveolar PO2 and oxygen index
  37. When do you give SRT?
    • Delivery room- prevent
    • NICU- treat
  38. What are the three categories associated with the changes in pulmonary vascular resistance? Major causes of PPHN
    • Maladaptation
    • Muscularization
    • Hypoplasic development
  39. Maladaptation associated with PPHN!
    • Asphyxia
    • Hypoxia/acidosis
    • Vasoconstriction
    • MAS and GBS babies
  40. Muscularization associated with PPHN!
    • Increased muscle mass
    • Inappropriate muscle location
  41. Hypoplasic development associated with PPHN!
    • Diaphragmatic hernia
    • Pulmonary hypoplasia
  42. Explain the PPHN snowball!
    • Decreases pulmonanary perfusion
    • Hypoxemia
    • Increase PVR
    • Increased R to L shunt threw DA
  43. Hyperoxia test!
    Hyperoxygenate the patient and if he not respond then there is a right to left shunt
  44. Pre and Post-ductal PaO2!
    • If there is a difference then the patient has a right to left shunt threw the ductus arteriosus
    • If the difference is 20 then ductal shunting
  45. Hyperventilation-hyperoxia test!
    • Respiratory alkalosis causes pulmonary vasodilation (CO2 of 30)
    • which decreases PVR, Increases PBF and decreases PAP
    • PaO2 should rise because change in PBF
    • Increase in PaO2 is secondary to increase in PBF that came from the decrease in PVR
    • (O2<25) + (>100) = PPHN
  46. Critical PaCO2!
    • Causes pulmonary vasodilation
    • Which increases PBF
    • And increases PaO2
  47. What is the treatment for PPHN?
    • Mechanical vent to increase pulmonary vasodilation, increase PBF, and increase O2
    • O2
    • HFOV
    • iNO
    • ECMO
  48. What is the treatment for maladaption associated with PPHN?
    • Surfactant
    • HFOV
    • iNO
  49. What is the treatment for muscularization associated with PPHN?
    • O2/Vent
    • iNO
  50. What is the treatment for hypoplasic developement associated with PPHN?
    • HFOV
    • iNO
  51. What are the complications of PPHN?
    • Neurologic problems
    • Seizures
    • Cerebral infraction
    • IVH
  52. What medications can be used for PPHN?
    • Nitric oxide
    • Surfactant
  53. Why does iNO work best for excessive muscularization and least for CDH?
    • Because the pulmonary blood vessels that CDH have are normal, there already open
    • The problem is they dont have enough of them
  54. How is nitric oxide administered?
    • NO is bled into the brething circuit before the humidifier
    • Usually start out at 20 ppm
  55. How does it maximize V/Q matching?
    Increasing perfusion where ventilation is good
  56. When can you discontinue nitric oxide?
    • Decrease the iNO by 5 ppm untill you are down to just 5 ppm
    • Stay at 5 ppm for a couple of days
    • If FiO2 is less that 40-60% you can D/C or wean by 1 ppm
  57. What are the complications of nitric oxide?
    • Nitrogen dioxide
    • Methemoglobin
  58. Nitric oxide is an...
    • Unstable
    • Highly reactive
    • Lipophilic
    • Diatomic free radical
  59. What chemical is most associated with smooth muscle contractility?
    Calcium
  60. Inhaled nitric oxide reduces shunt by...
    Vasodilating only pulmonary capillaries adjacent to functional lung units
  61. How does ECMO work?
    • The technique of supporting the function of the heart or lungs, or both, with external artificial organs.
    • Enables the pracitiner to minimize the ventilator's support, thereby avoiding iatrogenic damage to the lungs and the problems associated with high mean airway pressure while allowing the disease process to run its natural course
    • Allows us to rest the lung and let it heal from whatever is going on and allows for gas exchange outside the body
  62. What patients and diseases can be treated with ECMO?
    • PPHN
    • MAS
    • Sepsis
    • CDH
    • CHD
    • Aspiration syndromes
    • Infection
    • Cardiomypathy
  63. What are the risks and complications of ECMO?
    • Hemorrhage- Cardiac dysrhythmia
    • CNS damage- Renal Failure
    • Seizures- Hyperbilirubinemia
    • Fluid retention and severe edema- Sepsis
  64. What is the oxygen index to indicate ECMO?
    >40 on 2 or more arterial blood gas measurements
  65. How do you calculate oxygen index?
    (MAP x FIO2 x 100)/ PaO2
  66. Explain the many causes of chronic lung disease!
    • Mechanical vent
    • O2 toxicity
    • Infection (VAP, sepsis)
    • PDA
    • Surfactant deficiency
    • Barotrauma
    • Nutrition
    • Decrease alveoli
    • Decrease pulmonary vessels
  67. How is chronic lung disease like COPD in terms of alveoli and airway changes?
    • Fewer and larger alveoli
    • Damaged airway and bronchoconstriction problems
    • Abnormal blood vessels changes leading to cor pulmonal
    • Blood gas
  68. How can chronic lung disease be prevented?
    • Minimize ventilation
    • Keep sats low
    • Minimize barotrauma
    • Early treatment
  69. What is the treatment for chronic lung disease!
    • Settle for less than normal blood gas
    • Steriods
    • Antibiotics
    • RSV immunization
    • O2
    • Nutrution
    • GERD
    • Caffine
  70. What are the complications of chronic lung disease?
    • Cor pulmonale
    • Increased risk of respiratory infections
    • Asthma like symptons
    • Altered respiratory function for years
  71. Are the complications of GBS the same for premies and for term babies?
    No they are not
  72. Complications for premies with GBS!
    • CLD
    • ROP
    • IVH
    • PDA
  73. Complications for term babies with BPD!
    • PPHN
    • IVH only if on ECMO
  74. The five sign of respiratory in neonates occurs to...
    Try to normalize the blood gas
  75. What happens last in the five signs of respiratory distress in neonates?
    • Cyanosis
    • Slow desaturation
  76. Why does PDA occur just as the patient is geting better from RDS?
    • Small lungs
    • Increased PVR
    • Give surfactant open lungs decrease PVR
    • Normal SVR
    • Low PVR
    • PDA
    • Left to right shunt 
  77. Why does SRT not cure RDS in all paitents?
    • More probles than just surfacant deficiency
    • Thickened alveolar capillary membrane
    • Poor surface area for gas exchange
    • Weakened diaphram
    • Inmature respiratory drive
  78. What are the complications of TTN?
    • Aspiration
    • Not many
  79. A 25 week gestation newborn appears cyanotic and with ABG analysis indicating hypoxia and hypercarbia. The infant has severe chest wall retractions with inspiratory effort. The amniotic fluid appeared normal at birth. What is most likely the cause of respiratory distress?
    Surfactant distress
  80. A full term infant is delivered via cesarean section and demonstrates mild symptoms of RDS including cyanosis, tachypnea, and nasal flaring. APGAR scores are good and chest radiograph shows hyperexpansion and perihilar streaking. What situation most likely fits this case?
    The infant has TTN and will likely recover completely by 72 hours
  81. A newborn infant begins to develope symptoms of respiratory distress at 5 days of life. A cerebrospinal fluid culture tests positive for B strep infection. Which modes of transmission is most likely the cause of the infection?
    Perinatal or postnatal
  82. Which condition would be most critical in leading the caregiver to anticipate MAS?
    Yellowish green colored amniotic fluid
  83. fetuses may be assessed as “at risk” for MAS, including those with
    • Oligohydramnios
    • Abnormal fetal heart rate tracings
  84. PPHN can be associated with which underlying pulmonary disorder?
    • MAS
    • RDS
  85. A full term newborn diagnosed with PPHN is refractory to oxygen therapy and mechanical ventilation. Which would be the next logical therapy to try?
    iNO therapy
  86. A newborn at 34 weeks gestation is experiencing breif periods of apnea, which results in bradycardia and cyanosis. Blood and cerebrospinal fluid cultures test negative for infection. Which interventions can help reduce the incidence of apneic episodes?
    • Upright positioning
    • Temperature stability
    • Low FiO2 of 0.23 to 0.25
  87. What are the complications of surfactant production?
    • Cyanosis
    • Airway obstruction
    • Pulmonary hemorrhage
  88. What surfactant associated protein deficiency is fetal in infancy without lung transplantation?
    SP-B deficiency
  89. The high placement of the umbilical artery catheter should be visually confirmed at which anatomic landmark, using an X-Ray?
    T6-T8
  90. How is CLD defined in an infant?
    Requring oxygen or mechanical ventilation, and continuing to requrie oxygen at 36 weeks GA
  91. What is an important component to preventing oxidative stress in the treatment of CLD in the newborn?
    • Resuscitating with a minimum FiO2 at birth
    • Administration of vitamin E
  92. What is the most important cause of intraventricular hemorrhage?
    Lack of autoregulation and resulting fluctuations in cerebral blood flow
  93. What percedure is performed to diagnose intraventricular hemorrhage?
    A head ultrasound

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