neonate clinsims

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Author:
mlazar
ID:
28974
Filename:
neonate clinsims
Updated:
2010-08-04 18:12:30
Tags:
clinsims neonate
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Description:
neonate disorders
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  1. Initial care of the new born
    airway - clear the mouth then the nose with bulb syringe
  2. Apgar score
    • A - appearance
    • P - ulse
    • G - Grimance
    • A - activity
    • R - Respiratory
  3. A ppearance
    • 2 completely pink
    • 1 - pink body blue extremities
    • 0 Blue all over
  4. P ulse
    • 2 - 100bpm or greater
    • 1- 100bpm or less
    • 0 - no pulse
  5. G rimance
    • 2 cough or sneeze
    • 1 grimance
    • 0 no response
  6. A activity
    • 2 - active motion
    • 1 some flexion of extermities
    • 0 no movement limp
  7. R espiratory effort
    • 2 regular cry
    • 1 slow weak crt
    • 0 no cry
  8. Apagr score
    • 0 - 3 start cpr
    • 4-6 stimulate and warm
    • 7-10 routine care
  9. History
    • family
    • mother
    • pregnancy
    • weight
    • general appearance
    • breath sounds
  10. V/S
    • pulse 110 -160
    • RR 30 - 60
    • B/P 60/40
    • weight 3000g
  11. Infant Apnea / Sids assesment
    • History
    • any family history of sids
    • and periods of cyanotic apnea spells
    • gestational age - was the baby a premature
  12. Treatment of Sids / apnea
    • Oxygen - 30 -50%
    • teach parents cpr
    • use of home apnea monitor
  13. Meconium Aspiration
    more common in post term greater then 42 weaks

    Low apgar ascore
  14. General appearace of meconium aspiration
    • stained with meconium
    • granting
    • retractions
    • cyanosis
    • nasal flaring
    • asphyxia
  15. V/S of Meconium
    • tachycardia
    • respirations gasping with tachypnea
  16. Blood gas of meconium
    hypoxemia with mix acidosis
  17. chest x-ray of meconium
    patchy densities with wide spread atelectasis
  18. Treatment of meconium aspiration
    • suction mouth then nose
    • intubate and resuscitate
    • mechanical ventilation
    • agressisve cpt
  19. Congential heart defects History
    • my be premature
    • normal chest x-ray with respiratory disstress
    • cyanosis that is not corrected / improved with oxygen
    • Hypertension in upper extermities
    • hypotension lower extermities
  20. Tetralogy fallout
    • overriding aorta
    • pulmonary stenosis
    • ventricular septal defects
    • right ventricular hypertension
    • x-ray will of heart will look like boot
  21. Infant disstress syndrome (IDS)
    a reduction in lung volume due to lack of surfactant
  22. assesment of IDS
    • Gastational age less then 38 weeks
    • low apgar score
  23. onset of IDS symptoms
    at birth or a few hours after
  24. appearance of IDS
    • nasal flaring
    • granting
    • retarctions
    • cyanosis
    • increase rr
  25. x-ray of irds
    • reticulogranular infiltrates
    • honeycomb appearance
    • ground glass appearance
  26. ABG of IDS
    hypoxemia that does not improve with increase of fio2
  27. treatment of IDS
    • maintain PaO2 greater then 60 torr
    • use oxyhood then c-pap
    • surfactant therapy
  28. mechanical ventilation of IRDS
    • use of peep
    • simv
    • Reverse I:E
  29. adminstration of surfactant
    • use 2-5 mg ml/kg
    • divided into 2 - 4 dose.
    • manually ventilate after each does
    • rotate patient from side to side
  30. Bronchopulmonary dysphasia
    a chronic lung diease that developes as in newborns as a consequence of irds
  31. History of bronchopulmonary dysphasia
    premature that requires mechanical ventilation with high levels of fio2
  32. treatment of bronchopulmonary dysphasia
    • keep pao2 between 55 - 70 torr
    • paco2 45 - 60 torr
    • ph 7.25 7.40
    • use the lowest fio2
    • wean by decreasing rate
    • extubate when rr is between 5-15bpm
    • evoid ET - Cpap (this can increase raw)

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