CCRN

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daschielover08
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CCRN
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2011-05-31 20:10:12
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MAS
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  1. MAS
    • -Bil atelectasis/patchy infiltrates due to air trapping- interferes with surfactant
    • -Flattened hemidiaphragms /barrel shapped
    • -pneumoitis 2 to bile slats in mec
    • -use a lower PEEP and inc rate to induce alkalosis to prev PPHN
  2. BPD
    • -multifactorial
    • -O2 toxicity
    • -excessive fluid intake
    • -gestational age
    • -nutritional deficits
    • -Blebs in CXR

    • -use steroids
    • -at inc risk for RSV
  3. Inc PIP- dec PaCO2
    Inc PEEP- Inc PAO2

    Inc MAP- Inc oxygentation, inc PaO2 (PIP, rate, it, PEEP)

    dec MV improves resp alkalosis by inc CO2

    inc TV- Inc MV- dec CO2- hyperventilation
  4. Pneumomediastinum
    • - sail sign
    • - pul. air leak
    • - anticipate with MAA
    • - usually not tx
  5. PIE
    • -CPAP, BM vent, MEC vent
    • -over distension of alveoli & rupture
    • -microcystic- hyperinflated lungs & flattened diaphragm (accum. of air in lungs)
    • -hypoxia and hypercapnia
    • -TX- intubation of mainstem bronchus on the unaffected side
    • -BPD
  6. Types of Pulmonary leak syndrome
    • -PIE
    • -Pneumothorax
    • -Pneumomediastinum
    • -Pneuompericardium
    • -Pneumoperitoneum
    • -Sub Q Emphysema
  7. Pulmonary Hypoplasia
    - def. or inhibited growth of the lungs

    • -Patho:
    • -conditions that compress the lungs- CDH, CAM
    • -conditions that result in oligo- renal D/O
    • -congenital malforamtions- Potter syn
  8. Choanal Atresia
    • - bone or memebrane protrudes into nasal passages casuing blockage or narrowing
    • - obligate nose breathers
    • -ass. with CHARGE
    • -place prone
    • -cyanosis when quiet, pink when crying
  9. -Acidosis causes inc. of iCa
    -Acidosis inhibits Ca binding ability with albumin therefore inc. serum Ca
  10. -Metabolic acidosis causes serum K to be low-
    • -If pH is high, K is driven into the cell causing serum K levels to be low
    • -Insulin forces K back into the cell by stimulating the Na/K pump
  11. Congenital Diaphragmatic Hernia
    • -herniation of abd. organs into the thoracic cavity through a defect in the diaphragm
    • -H/O polyhydram.

    • -resp distress & cyanosis- worsens with BMV as intestines distend with air
    • -diminished BS
    • -heart tones shifted
    • -Barrel chest
    • -scaphoid abd
    • -ECMO
    • -Intubate- Avoid BMV
  12. -Parathyroid hormone
    -Calcitonin
    -Antidiuretic hormone
    • - inc serum Ca
    • - dec serum Ca
    • - controls H2O excretion and retention in the kidneys
  13. Kayexalate ( Na polystyrene sulfonate)
    -For every mEq of K absorbed, kayexalate release 1 mEq of Na
  14. ROME
    • -Resp Acidosis- dec pH, inc PaCO2
    • -Resp alkalosis- inc Ph, dec PaCO2

    • -Meta Acidosis- dec pH, dec HCO3
    • -Meta Alkalosis- inc pH, inc HCO3
  15. Cellular humoral immunity
    B lymphocytes
  16. Erythropoietin levels increase with-
    • -Down's
    • -IUGR
    • -hypoxia
    • -PIH
    • -diabetes
  17. Kernicterus
    - damage to the brain ctrs caused by inc levels of unconjug bilirubin

    -yellow kern- kern=commonly affected area of the brain (nuclear region, cerebellum, hypothal.)

    • -neurotoxicity secondary to unconjug bilirubin
    • -bilirubin not attached to albumin is free to cross the bld brain barrier
    • -most commonly found with Rh & ABO incomp.

    -ass. with CP
  18. Conjugation of bilirubin
    - conversion of yellow lipid- soluble pigment into H2O soluble pigment
  19. Unconjugated (indirect) bilirubin
    • -brkdn from HgB that is released from destroyed RBCs
    • - not an excretable form and a potential toxin
    • - found in cord blood
  20. Conjugated (direct)
    -excretable form
  21. BF jaundice
    • - occurs in the 1st fews days of life
    • - ass. with poor feeding and not with milk
    • - encourage freq. feeding
  22. BM jaundice
    • - related to BM that contains inc fatty acids that compete with bilirubin for binding sites on albumin
    • - temp cessation of BF when bilirubin reaches 20 mg/dL
  23. Physiologic jaundice
    • - occurs AFTER 24 hours of life
    • - acc. destruction of fetal RBC's, impaired conjug of bilirubin & inc bilirubin reabsorption
    • -Normal biologic response of the newborn

    - yellow color results from inc levels of unconjug bilirubin

    - peak bilirubin levels- 3-5 days term; 5-7 days preterm

    • - maintain neutral environment
    • - monitor stools
    • - encourage early fdg
    • - phototherapy
  24. Pathologic jaundice (hyperbilirubinemia)
    • - hemolytic dis. of the newborn
    • - secondary to Rh incompat.
    • - Rh- or O blood type
  25. -Asphyxia
    -Acidosis
    -hypothermia
    -hypoglycemia
    -indomethacin
    -prematurity
    -dec the # of albumin binding site inc bilirubin
  26. Erythroblastosis fetalis (isoimmune hemolytic dis)
    • - breakdown of RBCs
    • - ABO or RH incompatibility

    • -Anemia
    • -hyperbilirubinemia 24 hrs after birth
    • -jaundice
    • -hepatosplenomegaly
    • -erythropoiesis

    -Erythropoietin- stimulate RBC formation, initiation of early fdg, phototx, exchange transfusion

    -Rhogam within 72 hrs of delivery

    -RH- mother, RH+ baby- maternal antibodies enter fetal circulation & attach/destroy the fetal RBCs, fetal sys reponds by inc RBC prod

    -erythroblasts- immature RBCs
  27. Hydrops fetalis
    - most sever form of erythroblastosis fetalis caused by multiple organ failure

    -ABO incomp.
  28. Erythroblastosis
    • - petechiae
    • - hypoglycemia- inc RBC destruction stimulates insulin secretion
    • - + direct Coombs test
  29. + direct Coombs
    - presence of Maternal IgG on Infants RBC
  30. + indirect Coombs
    - antibodies against Infants RBC present in Maternal serum
  31. Kleihauer- Betke
    - id's fetal Hgb in maternal bld
  32. Serum bilirubin level
    Total serum bilirubin level
  33. Thalassemia
    - form of anemia
  34. Hemorrhagic dis. of the newborn
    • - vit K def.
    • - vit K important in formation of Ca binding sites
    • - intestinal flora req. for vit K synthesis- BF infants may prod. less vit K than that of formula fed infants
  35. DIC
    • - acquired hemorrhagic d/o
    • - fibrinogen converts to fibrin

    • - causes:
    • -eclampsia
    • -placental abnormalities
    • -fetal distress
    • -dead twin fetus
    • -tramatic delivery
    • -infection
    • -thrombocytopenia
    • -RH incomp.
  36. Thrombocytopenia
    • - plt. destruction
    • - IgG crosses the placenta & destroy fetal plts
  37. Apnea of prematurity
    • - cessation of breathing for 20s or laonger or for < than 20s when ass. with cyanosis, pallor, & bradycardia
    • - presents 2-7 days of life
    • -neuronal immaturity (central apnea)
  38. Primary Apnea
    -initial cessation of resp movts as a result of asphyxia during delivery
  39. Secondary Apnea
    - occurs after a period of resp as a result of prolonged asphyxia during delivery
  40. Central apnea
    - absence of airflow and resp effort
  41. Obstructive apnea
    - ass. with blockage
  42. R aterial pressure = central venous pressure
  43. Erythropoietin
    • - prod postnatally in the kidneys
    • - fetal life- liver, submandibular glands
    • - levels inc. with anemia & low O2
    • - levels dec. with hypertransfusion
  44. RBC life span
    • - term 60-70 days
    • - preterm 35-50 days
  45. Thymus derived (T) lymphocytes
    - graft vs host dis & delayed hypersensitivity rxns.
  46. Bone marrow derived (B) lymphocytes
    - prod & secretion of immunoglobulins & antibodies
  47. Blood volume
    • - term- 80-100 ml/kg
    • - preterm- 90-105 ml/kg
  48. Metabolic acidosis
    • HCO3 <22, Base deficit >-2 & <7.35
    • - failure to retain HCO3 or an inc. in blood acid
  49. Metabolic Alkalosis
    • - HCO3 >26, BE >+2, pH>7.45
    • - failure to excrete HCO3 which is controlled by kidney fxn
  50. Resp Alkalosis
    • - PaCO2 <35, pH>7.45
    • - hyperventilation
    • - dec of CO2
  51. Resp acidosis
    • - PaCO2>45, pH<7.35
    • - hypoventilation
    • - accumulation of CO2 the resp Acid
  52. ABG's
    • pH- 7.35-7.45
    • PaCO2- 35-45
    • PO2- 50-80
    • HCO3- 22-26
    • BE- -2- +2
  53. MAP
    - depend on rate, PIP, PEEP, iT- improves oxygentation ( inc. PAO2, dec PaCO2 )
  54. O2 transport
    - amt of O2 delivered to the tissues in dep on CO
  55. Hypoxia
    - delivery of O2 to tissues is inadequate
  56. Hypoxemia
    - O2 content of arterial blood is low
  57. Thermoregulation:
    - conduction
    - convection
    - radiation
    - evaporation
    • - heat transfer via direct contact; ie scale, warm blankets
    • - via air currents; ie incubators
    • - w/o direct contact through absorption & infrared rays
    • - conversion of liquid into vapor
  58. RDS
    • - effects mostly preemies
    • - surfactant deficiency; c/s, DM, 2nd twin, asphyxia
    • - alveolar atelectasis
    • - exp. grunt- forcing air past closed glottis or PEEP
    • - reticulogranular pattern- Ground glass
    • - r/o pneumonia
    • - metabolic acidosis- hypoxemia & acidemia
    • - inc WOB- hypoglycemia
    • - NaHCO3 for acidosis
    • - CP
  59. RDS (hyaline membrane disease)
    • - immature lung tissue
    • - prematurity, DM, stressful delivery
    • - lack of surfactant, atelectasis, resp acidosis, inc RR, retractions, exp grunt, meta acidosis
    • - ground glass
    • - thermoreg, admin surfactant, O2
  60. Broncholitis
    • - inflammation of the bronchioles secondary to a viral infection
    • - most commonly caused by RSV
  61. Transient tachypnea of the newborn- TTN
    • - wet lung disease- delayed clearance of fetal lung fluid
    • - fetal lung fluid has a inc Cl concentration
    • - bil perihilar
    • - air trapping
    • - tachypnea- 60-120 bpm
    • - birth near or at term, maternal asthma, c/s, maternal sedation
  62. Inotropic
    • - improve CO by inc the HR
    • -ie-
    • - Digoxin- dec conduction through the SA & AV nodes to slow vent rate in tachyarrhythmias
    • - Epi, Dopa, Dobutamine, isoproterenol
    • - Epi inc BP by stimulating a1 & b1
    • - Dobuta- inc CO by stimul. b1
  63. Hypoplastic L heart
    • - most common cause of cardiac death in the 1st week of life
    • - hypoplastic L vent, aortic arch, ascending aorta, mitral & aortic valves
    • - obstruction of blood flow through L side of heart leads to pul congestion and edema
    • - blood supply is dep on PDA
    • - asymptomatic at birth
    • -CHF

    • - PDA closes-
    • - severe mottling
    • - gray pallor of skin
    • - diminished pulses

    - PGE, iNO
  64. Preductal and postductal
    • - right hand (preductal) & right foot
    • - right hand (preductal) & left hand
  65. CHF
    • - a set of s/s that reflect the heart's inability to deliver adeq O2 to meet metabolic req of the body
    • - CO is unable to meet body's metab. req

    • -CHF-
    • - cardiac defects
    • - sepsis
    • - asphyxia
    • - anemia
    • - vol overload- twin to twin transfusin

    - tachypnea, tachycardia, arrythymias, *hepatomegaly

    • - maintain neutral thermal environ
    • - dec vol intake, polycose or MCT oil
    • - Digoxin- improves CO, HR <100 don't give
    • - lasix, diuril, aldactone
    • - inotropics- dopa, dobu, isoproterenol
  66. PPHN
    • - R to L shunting
    • - secondary to inc of PVR & PAP
    • - hypoxia/asphyxia, polycythemia, CDH
    • - dec PaO2, preductal/postductal
    • - iNO- pul. vasodilator
    • - vasopressors- inc systemic pressure grater than pul to dec R to L shunting
    • - Dopa- catecholamine
    • - Dobu- B1 effects
    • - Nitroprusside- inc CO by dec preload & afterload
    • - Epi- inc sys BP, inc HR & improve cardiac contractility
  67. PPHN
    • - the arteries to the lungs remain constricted, after delivery limiting the amt of blood flow to the lungs & amt of O2 to the bloodstream
    • - iNO helps to dilate the arteries
    • - in utero the bld vessels to the lungs are constricted, When the cord is cut the alveoli are filled with air instead of fluid & the pul arteries dilate so bld flows through the lungs. If the don't dilate bld pressure in the pul arteries is too high (pul htn) & bld flow to the lungs is insuff & not enough O2 reaches the blood
  68. PPHN
    • - a cardioresp d/o charac by systemic arterial hypoxemia secondary to elev pul vas resis. with shunting of blood flow to the sys circulation
    • - the result of elev PVR so much that bld is diverted through fetal channels into the sys circ & bypassing the lungs resulting in sys areterial hypoxemia
  69. PPHN (persistant fetal circulation)
    - while in the womb there is high bld pressure in the lungs. when baby takes its 1st breath the pressure falls & the PDA closes. With PPHN the pressure stays high & the PDA remains open
  70. Tetralogy of Fallot
    • - Most common cyanotic heart lesion
    • - 4 defects:
    • - pul. stenosis
    • - VSD
    • - Aorta overriding VSD
    • - R ventricular hypertrophy

    • - R to L shunting
    • - Boot shaped heart
    • - tet spells (paroxysmal dyspnea & severe cyanosis)

    • - Mngmt:
    • - propranolol, PGE, surgery
  71. Transposition of the great vessels
    • - most common cardiac cause of cyanosis in neonates
    • - L to R shunt
    • - Pul artery arises form the L ventricle & Aorta from the R ventricle
    • - mixing of oxygenated & unoxygenated blood is req. for survival
    • - oxygenated blood returns from the lungs to L atrium & ventricle then back to lungs via pul artery
    • - unoxygen blood returns to R atrium & ventricle & then to the body via the Aorta

    • - Egg on a string
    • - cyanosis present within 1st 24 hrs
    • - cardiac emergency
    • -correct metabolic acidosis- due to tissue hypoxia and dec CO
    • -PGE
  72. Truncus Arteriosus
    • - single artery arises from both ventricles, overriding a VSD
    • - both ventricles pump blood into the common trunk supplying the sys/pulm circulation
    • - As PVR dec shunting to pulm circul occurs inc blood flow to the lugs & workload of L vent
    • - CHF with bounding pulses & widened pulse pressure
    • - Diuretics, digoxin, ACE inhibitors
  73. Total Anomalous Pul venous return
    • - pul veins drain into the R atrium
    • - CHF
    • - Snowman on xray
    • - R to L shunt
  74. CO= SV X HR
    • - CO- vol of blood ejected by the heart in 1 min
    • - correcting hypovol inc blood vol, preload, SV & CO
    • - as HR fluctuates so will CO
    • - persis bradycardia dec CO
    • - tachycardia can improve CO
  75. Stroke vol
    - depends on preload, contractility, & afterload
  76. Preload
    • - vol of blood in the ventricles before contraction (ventricular filling)
    • - dec in preload will dec SV & CO
    • - measurement of pressure rather than vol
    • - inc vol in the ventricles improves SV
    • - infant can inc SV if there is no inc in systemic vascular resis or rapid rise in aortic pressure
  77. Contractility
    • - speed of ventricular contraction
    • - systole- ventricular contraction
    • - diastole- ventricular relaxatio
    • - contractility dec by:
    • - acidosis ( inc K which inturn dec contractility)
    • - Hypoxia
    • - e- disturbances
    • - hypoglycemia
  78. Afterload
    • - the resistance to blood leaving the ventricle; if art pressure inc, afterload inc
    • - dependent on sys vascular resis & pul vasc resistance; if SVR or PVR inc, afterload inc
    • - afterload can be reduced by vasodilators- ie nitro, Amrinone, Nitroprusside
    • - Dobutamine can be used to dec PVR
  79. CHD greater in women with:
    • - DM*
    • - lupus
    • - rubella
    • - CMV
    • - obesity
    • - ETOH
    • - sz, coagul d/o
  80. S1
    S2
    S3
    • - mitral & tricuspid valves closing
    • - Aortic & pulmonic valves closing
    • - blood flow
  81. weak pulses indicate low CO
    bounding pulses indicate aortic runoff
  82. BP normal
    • - SBP 56-77
    • - DBP 33-50
    • - MAP 42-60
  83. SBP of upper extr 20 mmHg above lower ext indicates:
    • - Coarct
    • - Aortic Arch abnormality
  84. PDA
    • -failure of the ductus to close within 72 hrs
    • - noncyanotic
    • - L to R shunt- causes inc pul artery pressure & inc L ventricular pressure & vol leading to CHF
    • - bounding peripheral pulses
    • - widening pulse pressure
    • - dec DBP
    • - metabolic acidosis

    • - mngmt-
    • - fluid restriction
    • - diuretics
    • - PEEP- reduces L to R shunt
  85. VSD
    • - L to R shunt = pul edema
    • - noncyanotic
    • - no surgery unless symptomatic
    • - excellent prognosis
  86. ASD
    • - opening between atria
    • - L to R shunt
    • - noncyanotic
    • - defect may be ostium primum
    • ostimum secundum ( most common)
    • endocardial cushion defect
    • - CHF
  87. Endocardial Cushion Defect- Atrioventricular Canal
    • - Most common defect found with Down's
    • - probs with Atrial septum, vent septum, mitral & tricuspid valves
    • - L to R shunting
    • - CHF (digoxin, diuretics)
    • - think Oliver
  88. Coarctation of the Aorta
    • - seen with Turner syndrome
    • - constriction of Aorta
    • - CHF
    • - dec or absent pulses in L ext
    • - ventricular hypertrophy
    • - inc BP in upper ext.
    • - PGE
    • - ballon angioplasty
  89. Indomethacin
    • - oliguria
    • - dec renal blood flow
    • - GI bleeds
  90. Caput Succ
    r u
    o t
    s u
    s r
    e e
    s line
  91. CMV-
    - IUGR
    - purpura
    - hepatosplenomegaly
    - szs
    - hearing loss
  92. Coagulase + org
    - staph aureus
  93. Coagulase - org
    - staph epi
  94. Upper airway infection often acc. by viral conjuct secondary to chlamydia
  95. Autosomal dominant
    - 50 % chance the offspring of each preg. will have the d/o
  96. X linked rec d/o
    - male offspring affected & carrier females transmitting the d/o
  97. Trisomy 21
    • - epicanthal folds
    • - flat face
    • - protr. tongue
    • - herniated umb
  98. DiGeorge Syndrome
    • - chromosome d/o/ deletion syn
    • - heart defects
    • - cleft palate
    • - hypothyroidism
    • - abnormal facies
    • - short stature
    • - craniofacial
    • - cardiac defects
    • - hypocalcemia
    • - learning disabilities
    • - cardiac- most common cause of death
  99. - Vit K effects PT
    - Vein of Galen=CHF
    - multicystic dysplastic kidney dis= HTN
    - Incarcerated inguinal hernia= vomiting
    - perinatal asphyxia=ARF= dec NA, dec osmol & inc CRT
  100. -Vent rate affects carbon dioxide (CO2) levels by dec the rate (dec min ventilation) the CO2 levels inc improving resp alkalosis
    -resp alkalosis= dec CO2
    -inc vent rate will dec PaCO2 worsening alkalosis
    -inc PIP & dec PEEP would inc TV leading to dec in CO2 level exacerbating resp alkalosis
  101. TV
    - amt of air that moves in/out of the lungs with each single breath @ rest
  102. VC
    - vol of air maximally inspired/expired
  103. Fxn residual capacity (FRC)
    - vol of gas that remains in the lungs after normal expiration
  104. TLC
    - amt of air contained in the lungs after maximal inspiration
  105. Omphalocele
    - herniation of abd. viscera into the umbilical cord
  106. Gastroschesis
    - herniation of abd contents through an abd wall defect lateral to the umbilical ring
  107. Pyloric stenosis- abnormal narrowing
    • - obstruction of pylorus caused by hypertrophy of the pyloric musculature
    • - nonbilious projectile vomiting
    • - visible peristaltic waves in epigas
    • - palpable pyloric "olive" in RUQ
  108. Jejunal atresia
    • - congenital obstruction of the jejunum; ileum or both
    • - H/O polyhyd.
    • - BE shows microcolon
    • - Bilious vomiting 24-28 hrs
    • - Abd dis
    • - no stools
    • - jaundice
  109. Duodenal Atresia
    • - absence or closure of a normal opening (atresia)
    • - double bubble
    • - congenital obstruction of the duodenum (1st part of the sm. bowel. its not open & can't allow passage of stomach contents)
    • - H/O polyhyd
    • - Abd dis
    • - no stools
    • - Bilious vomiting within 1st 24 hrs
  110. Pul. stenosis
    • - cyanosis
    • - hepatomegaly
  111. Beckwith- Wiedman- overgrowth d/o
    • - prom occiput
    • - omphalocele
    • - macroglossia
    • - polycyth.
    • - hypogly
  112. Hydrops fetalis
    • - Rh isoimmunization
    • - fluid builds up in 2 or more fetal compartments- ascites, plueral eff, pericardial effusion, CHF (severe resp distress), & hypoxia from anemia
  113. Erythroblastosis fetalis (hemolytic disease of the newborn)
    • - hemolytic disease when the mother & baby have different blood types. ie ABO, Rh
    • - marked by anemia, jaundice, liver enlargement, spleen enlarg, & edema (hydrops)
    • - erythroblasts in the blood
  114. Inborn Errors of Metabolism
    • - group of hereditary d/o transmitted by mutant genes, which causes an enzyme defect
    • - biochemical d/o if left untreated can cause brain damage and death
    • - maternally & paternally inherited- usually autosomal or X linked recessive
    • - can be storage diseases or metabolism of small molecules- glucose, lactate, AA, organic acids, ammonia
    • - ie- PKU- amino acid d/o; MSUD, homocystinuria, galactosemia, congenital hypothyroidism
  115. PKU (phenylketonuria)- error of protein metabolism
    • - most common inborn error of AA metabolism that may result in mental retardation
    • - autosomal recessive trait
    • - def. of the liver enzyme phenylalanine hydrolase to convert phenylalanine to tyrosine. lack of this enzyme is resp. for brain disease
    • - low protein diet & use of special AA containing formula that doesn't contain phenylalanine
  116. Galactosemia- error of carbohydrate metabolism
    • - GALT def is the most common of these d/o
    • - GALT blocks conversion of lactose so infants are unable to metabolize lactose
    • - autosomal recessive
    • - jaundice
    • -E coli sepsis occurs as a complication
    • - absence of the enzyme nec for breakdown & metabolism of galactose
    • - lactose free diet
    • - mental retardation rates remain high, speech problems
  117. Maple Sugar Urine Disease- error of AA metabolism
    • - rare
    • - Autosomal recessive trait
    • - usually well at birth but become lethargic, poor fdg, high pitched cry, obtunded and coma after 2-3 days of fdgs
    • - odor of maple syrup on breath
  118. DIC
    • - def in vit K & folate
    • - extrinsic & intrinsic pathway is activated
    • - gram - infections
    • - plts dec
    • - PT/PTT normal in early DIC
    • - fibrinogen dec

    • -mngmt-
    • - FFP
    • - PLT
    • - cryo
  119. UAC
    UVC
    • - Low L3-L4
    • - High T6-T10

    - just above the diaphragm
  120. Neurologic System
    • - Gluc metabolism
    • - neonatal brain is gluc dep
    • - gluc levels <30- significant inc in cerebral blood flow
  121. Cerebral blood flow
    • - affected by pH, K, hypoxemia
    • - as pH dec cerebral blood flow inc
    • - as K inc cerebral blood flow inc
    • - hypoxemia cerebral blood flow inc
    • - cerebral blood flow inc when gluc falls <30
  122. Meningitis (congenital viral infection)
    • - blueberry muffin rash-viral
    • - ass with rubella, CMV, toxoplasmosis, syphilis, herpes
  123. Cholestasis
    • - impairment in blie flow
    • - jaundice
  124. Sex chromosome abnormalities-
    Turner syndrome
    • - loss of all or part of one copy of X chromosome in females
    • - horseshoe kidney
    • - webbed neck
    • - low set ears
    • - coarct
    • - broad nasal bridge



  125. Sex chromosome abnormalities
    - Klinefelter syndrome
    • - affects males
    • - most common cause of hypogonadism
    • - infertiltiy
  126. Normal variations in newborn skin-
    cutis marmorata
    Harlequin
    Erythema toxicum
    milia
    Epstein pearls
    • - bluish mottling or marbling disappers when rewarmed
    • - diff in amt of blood flow in R & L sides of body
    • - sm white or yel pustules
    • - yel or pearly white papules 1mm in size- brow, cheeks, nose
    • - palate
  127. Scalded skin syndrome
    • - inflam skin d/o caused by group II staph
    • - may follow upper resp infection or otitis media
    • - methicillin, bacitracin
  128. GBS & E coli
    - are resp for the majority of early onset sepsis
  129. IgG
    • - serum & interstitial fluid prov immunity against viral & bacterial pathogens
    • - dec levels in preterm, post term & SGA
    • - placental transfer is either active or passive
    • - inc gradually until 40 weeks; majority is passed in 3rd trimester
  130. IgM
    • - doesn't cross placental barrier
    • - levels inc with intrauterine infection
    • - levels inc after birth
    • - body fluids & 1st antibody in intial exp to antigen
  131. IgA
    • - most common in GI/resp tracts, colostrum/human milk
    • - found in milk, saliva, tears, resp & GI mucin- prev bacteria/viruses from invading the body through the mucosa of the GI, pul & GU tracts
    • - does not cross the placental barrier
    • - does not become detectable in the infant until 2-3 weeks of postnatal life
  132. IgE
    • - resp & intestinal tracts- Allergic rxns
    • - major role in allergic rxns
  133. HTN
    • - BP consis > than 95th %
    • - most common caused by intrinsic RF
    • - coarct
    • - BPD
    • - cocaine/heroin
    • - wilm's tumor
    • - szs, ICP
    • - closure of abd wall defect
    • - ECMO

    - hydralazine, captopril, enalapril, Na nitroprusside

    • BP >90/60- term
    • > 80/50- preterm
  134. Potter syndrome (oligohydramnios)
    • - renal agensis, dec amniotic fluid
    • - male predominance
    • - epicanthal folds
    • - low set ears
    • - death within hrs-days secondary to RDS by pul hypoplasia
  135. ARF tx
    • - nutrition- 100 cal/kg with fat & carbs
    • - 1-2 g/kg/day protein
  136. Clinical presentation ARF
    • - oliguric ARF- UOP < 1ml/kg/hr
    • - nonoliguric- UOP is above this level
    • - azotemia with a BUN > 20 mg/dl or inc more than 1mg/dl/day
    • - inc CRT > 1.5 mg/dl or inc more than 0.2 mg/dl/day
  137. Renal resp. to Acidosis
    • - reabsorbs HCO3
    • - inc secretion of H
    • - production of Ammonia
  138. Renal resp to Alkalosis
    • - excretes HCO3
    • - dec prod of Ammonia
    • - dec secretion of H
  139. Ability to dilute urine is fully dev. in term & pretem but concen ability is limited

    - concen & dilution- loop of henle & collecting duct

    - specific gravity- 1.002-1.010
    - urine osmolarity- 100-300
  140. GFR
    • - dec GFR caused by:
    • - dec BP
    • - dec HCT
    • - renal vasoconstriction
    • - dehydration
    • - hypoproteinemia
  141. Renin- angiotensin- aldosterone
    - resp for regulation of systemic BP, NA & K
  142. Renal blood flow depends on cardiac output
  143. Indomethacin
    • - causes dec UOP, inc CRT & hyponatremia
    • - inhibits prostaglandin prod
    • - prostaglandin synthe. in the kidneys
  144. Prerenal
    • - hypoperfusion of normal kidneys
    • - most common cause of ARF
    • - responses of structurally intact kidneys to external processess
    • - Hemmorrhage
    • - sepsis
    • - CHF
    • - dehydration
    • - NEC
    • - RDS
    • - Hypoxia
    • - ACE inhibitors, indomethacin, Amph B

    • - dispropor rise in BUN/CRT
    • - tx specific causes of hypoperf.
  145. Intrinsic
    • - renal cellular damage; structural changes within the kidneys
    • - prev flow of urine from the kidney into the bladder causing a back up of urine
    • - most common cause perinatal asphyxia, sepsis
    • - agensis
    • - renal dysplasia
    • - polycystic kidney dis
    • - renal vein/renal artery thrombosis
    • - DIC
    • - pyelonephritis
    • - cardiac surgery
    • - nephrotoxic drug admin

    • - presence of casts, proteinuria
    • - proportionate rise in BUN/CRT

    - supportive care until fxn returns
  146. Post renal
    • - obstruction to urinary flow distal to kidney
    • - due to structural abnormalities in the ureters, bladder, urethra
    • - post uretheral valves
    • - bilateral ureteropelvic jxn obstruction
    • - obstructive nephrolithoasis

    - surgery/nephrology
  147. Fluid Challange
    • - given to r/o prerenal
    • - 10/20 ml/kg NS/1 hr
    • - rapid & sustained diuresis within 1-2 hrs indicates prerenal
    • - UOP < 2ml/kg/hr with lasix suggests intrinsic or postrenal
  148. ARF- inc K, dec NA, inc Phos, dec CA
    - renal fxn dep. on prostaglandin prod
  149. - elev HCT dec GFR decreasing UOP
  150. Renal masses are the most common Abd masses in the newborn
  151. ARF
    • - loss of ability to maintain H2O & e- homeostasis
    • - ass with abrupt & sever dec in GFR, UOP, & a progressive inc in BUN & CRT

    - oligohydraminos

    - inc K, dec NA, dec Ca, inc Phos
  152. Hydronephrosis
    • - dilation of kidneys secondary to obstruction of blood flow
    • - abd mass felt; most common cause of an abd. mass
    • - reflux- cystography every 12-18 months
  153. Patent Urachus
    - comm. bet. the bladder & umbilicus causing a leakage of urine from the umbilicus
  154. Thrombocytopenia
    - acquired disease where plt count is dec (<150,000)
  155. PT
    • - used to assess extrinsic
    • - initiated by tissue injury
  156. PTT
    • -used to assess intrinsic
    • - vascular endothelial injury
  157. D Dimer
    - marker for thrombin/plasmin prod
  158. Inc PTT= hemophilia, factor VIII or IX def, liver dis, DIC
  159. HCT
    - % of RBC in a unit vol of blood
  160. Erythropoiesis
    - prod of erythrocytes (RBCs)
  161. HgB
    • - major Fe- component of RBC
    • - carries O2 from the lungs to the tissues

    - RBCs contain 70-90% HbF ( fetal HgB) @ birth

    • - HgB- 14-18
    • - HCT- 45-58
  162. Cryoprecipitate
    - carries factor VII, XII, & Fibrinogen
  163. Truncus arteriosus
    - forms the Aorta & pul artery
  164. Arnold- Chiari malformation
    - almost always acc. myelom
  165. Insensible H2O loss
    • - 2/3 through the skin
    • - 1/3 via resp tract
  166. Hyperkalemia- peaked T waves, widened QRS
    Hypokalemia- can be caused by NG sx
  167. Na
    Na- major extracellular cation
  168. Hyponatremia
    - fluid shifts into the cell causing cellular edema & intravascular dehydration
  169. Hypernatremia
    - fluid shifts into the extracellular space causing cellular dehydration & intravascular overload
  170. HIE
    - Hypoxemia, anoxia, & ischemia leading to diminished blood supply perfusing the brain, & metabolic acidosis
  171. Oxyhemoglobin Dissociation Curve
    • - describes the relationship between available oxygen and amount of oxygen carried by hemoglobin
    • - A left shift will increase oxygen's affinity for hemoglobin- In a left shift condition (alkalosis, hypothermia, etc.) oxygen will have a higher affinity for hemoglobin.SaO2 will increase at a given PaO2, but more of it will stay on the hemoglobin and ride back through the lungs without being used. This can result in tissue hypoxia even when there is sufficient oxygen in the blood.
    • - A right shift decreases oxygen's affinity for hemoglobin- In a right shift (acidosis, fever, etc.) oxygen has a lower affinity for hemoglobin. Blood will release oxygen more readily.This means more O2 will be released to the cells, but it also means less oxygen will be carried from the lungs in the first place

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