Neonate 2

Front 1

Indications for O2 therapy are

Back 1

To relieve arterial hypoxemia, thus relieving tissue hypoxia

Front 2

O2 administration in the premature infant.

Back 2

PaO2 <50mmHg

Front 3

O2 administration in the premature term infant

Back 3

Pao2<60mmHg or Sao2 < 85%

Front 4

O2 administration in the premature child.

Back 4

PaO2 < 60mmHg or SaO2 < 85%

Front 5

Nasal Cannula:
Advantages

Back 5

Allows better accessibility for patient care and assessment

Front 6

Nasal Cannula:
Disadvantages

Back 6

1. Provides low concentration of 02
2. FIO2 varies with size
3. RR pattern and age
4. Must have proper size and fit

Front 7

Oxygen Mask:
Advantages

Back 7

1. May be tolerated better, short term administration.

Front 8

Oxygen Mask:
Disadvantages

Back 8

1. Inadequate flows may cause build up of CO2
so, the flow must be set at > 5lpm
2. Proper placement, not indicated for comatose
infants/children
3. High flows applied to face can cause apnea (cold gas for neonates)
4. Difficult to keep on younger children and active
infants.

Front 9

Venturi type Mask: (rarely used on kids).
Advantages

Back 9

1. Helps provide an accurate FiO2
2. Useful for long periods of time.

Front 10

Venturi type Mask: (rarely used on kids).
Disdvantages

Back 10

1. FIO2 predictable as long as no back
pressure is created must exceed PIP flow
2. Same disadvantages as using a mask on an
infant or child.

Front 11

Oxygen tent:
Advantages

Back 11

1. Usually a cool environment (6-8’ below ambient air)
2. High levels of humidity
3. FIO2 up to .50 depending on tight fitting canopy
4. Flow fitting canopy
5. Flow rates
6. Size of canopy

Front 12

Oxygen tent:
Disadvantges

Back 12

1. Must keep all potential spark emitting equipment out of tent ( i.e. toys, games and all lights)
2. Minimum flows of 10-15 lpm to flush out CO2, can be run off air with oxygen bled in
3. FIO2 must be analyzed, hazards associated with aerosol therapy.

Front 13

Oxygen hoods:
Advantage

Back 13

1. Various sizes
2. Allows for variable FIO2 and heated humidification
3. Easy acess to patient
4. Maintains stable FIO2 around infant’s head (used with isolettes to maintain NTE)

Front 14

Oxygen hoods:
Disadvantages

Back 14

1. Overheating can cause apnea & dehydration
2. Under heating will cause increased O2 consumption 3. Increased noise level in hood flows
4. CO2 buildup (flow should be +7 lpm)

Front 15

Incubators/isolettes:
Advantages

Back 15

1. Used for neonates to control temperature (servo-controlled)
2. Humidity (75-90%) filtered gas O2
concentration

Front 16

Incubators/isolettes:
Disadvantages

Back 16

1. FIO2 fluctuates due to opening of ports for access to patients,
2. Increased risk of bacterial growth due to warm & moist temp
3. Variable O2
4. Infant warmed by convection

Front 17

Recognize hazards associated with O2 therapy:
Hypoxemia (<50 mm Hg)

Back 17

1. Bradycardia (infants) 2. Systemic vasodilatation 3. Pulmonary vasoconstriction 4. Metabolic acidosis
5.Atelectasis
6. Decreased respiratory effort in preemies (hypoventilation, apnea)
7. Tissue damaged (especially brain & kidneys)
8. Death

Front 18

Recognize hazards associated with O2 therapy:
Hyperoxemia (>100mmHg)

Back 18

1. Cerebral vasoconstriction (brain damage)
2. Retinopaty of Prematurity
3. Decreased RBC formation (increasing anemia)

Front 19

Recognize hazards associated with O2 therapy:
High FIO2 (>/= 55) for several days

Back 19

1. Chest pain
2. Parenthesis
3. Lung toxicity (BPD, CLD)
4. absorption atelectasis
5. Decreased surfactant production
6. Increased utilization of surfactant
7. Decreased mucous flow
8. Pulmonary congestion
9. Edema fibrosis
10.Death

Front 20

Describe how a R-L shunt through the ductus arteriosus can be detected using:
TCM Monitors

Back 20

Two monitors are used, one in a preductal location (right upper chest) and one in the post ductal location (left inner thigh). Congenital defects with shunting are indicated when the pre-ductal monitor reads higher than the post- ductal monitor

Front 21

Describe how a R-L shunt through the ductus arteriosus can be detected using:
Pulse Oximeter

Back 21

This has become the standard for noninvasive monitoring of oxygenation, especially in those with congenital cardiac anomalies. This is accomplished by placing one pulse oximeter probe on a right upper extremity(preductal) and simultaneously placing a probe on any other extremity(postductal) can assess shunting. A difference between the preductal and postductal O2 saturation, with saturation in the legs 5-10% lower than the right arm, shunting should be suspected.

Front 22

Describe how a R-L shunt through the ductus arteriosus can be detected using:
Blood gas PaO2

Back 22

The most accurate method of measuring PaO2 and SaO2 involves placement of an indwelling catheter in either the aorta via an umbilical artery or in a peripheral artery; however, use of such catheters must be restricted to critically ill neonates because of frequent and serious thrombotic and infectious complications. A problem associated with peripheral arterial catheters is hemodilution. Sampling methods should minimize blood loss and assure an undiluted arterial blood sample. Intermittent sampling of a peripheral artery often changes PaO2 significantly when the infant responds to pain by crying and can therefore underestimate or overestimate baseline PaO2 . The site of arterial access must be considered if the ductus arteriosus, which connects the aorta and pulmonary artery, is still patent because a right-to-left shunt at this level will result in lower oxygen values in the descending aorta than in the blood perfusing the brain and eyes.

Front 23

Briefly describe the mechanical aspects of a TCM, how the sensors work.

Back 23

The heating element in the sensors elevates the temperature in the underlying tissue. Increasing the capillary blood flow to the tissues as well as the partial pressure of oxygen and carbon dioxide. This makes the skin permeable to gas diffusion

Front 24

Describe how a TCM can be useful even if not reading arterial values

Back 24

Provides accurate information regarding pediatric patient’s oxygen status, provides immediate, continuous information on the body’s ability to deliver O2 to the tissues and to remove CO2 by way of the cardiopulmonary system. Electrodes are measuring the gas tension of the underlying tissue, NOT the arterial gas tension

Front 25

List the factors that can interfere with an accurate reading of a:
TCM

Back 25

Poor perfusion (hypovolemia, severe hypoxia) Bruising Vasodilators Anatomical anomalies

Front 26

List the factors that can interfere with an accurate reading of a:
Pulse Oximeter

Back 26

Nail polish Bright ambient light Inability to sense pulse

Front 27

Describe how a pulse oximeter determines arterial oxygen saturation

Back 27

To measure arterial blood, the sensor detects pulsatile blood as it enters the tissue. SaO2 is measured in both pulsatile and nonpulsatile states, and the ratio is corrected to determine functional saturation

Front 28

Advantages and disadvantages of pulse oximeters

Back 28

Advantages
1. Non invasive technique for continuous monitoring O2 saturation and pulse

Disadvantages
1. Does not provide good info regarding hyperoxia in the neonatal patient
2. Artifacts created by patient movements
3. Electrical
4. Noise and rapidly changing ambient light can produce inaccurate readings

Front 29

Advantages and disadvantages of TCMs

Back 29

Advantages
1. Non-invasive continuous monitoring
2. Decrease ABGs

Disadvantages
1. Labor intensive

Front 30

List explain the limitations of Capnography

Back 30

The values given may be misleading when fast respiratory rates or low tidal volumes are used. End tidal PCO2 is accurate only in healthy individuals. This measurement is affected by V/Q mismatch, low cardiac output, and minute ventilation. Watch trends instead of snapshots!

Front 31

Formation of bilirubin:

Back 31

Formed from catabolism of hemoglobin 75% of bilirubin is derived from normal destruction of RBC, free bilirubin molecule is formed is formed in the spleen and liver and is fat soluble and can’t be excreted in bile or urine.

Front 32

Hyperbilrubinemia & Tx

Back 32

Can lead to kernicterus, encephalopathy.

Tx: Phototherapy transfusion , exchange transfusion. Phototherapy- blue light decomposes bilirubin, forming nontoxic byproducts. Exchange transfusion- involves actual removal of infant’s blood and replacing it with blood transfusions.

Front 33

List the appropriate equipment and procedure used to suction and infant’s airway( catheter size, Sx pressures, FIO2, type of resuscitation bag, bagging RR, PIP, PEEP etc)

Back 33

Catheter size – no greater than half the inner diameter of the ETT

Sx pressure – 60-80mmHg

FIO2 – increased by 10% of set
Resuscitation bag – anesthesia “CPAP” bag

PIP – same as set on the ventilator

PEEP- same as set on the ventilator

Bagging RR-

Front 34

Major complications of suctioning

Back 34

Hypoxemia Bradycardia
Resultant hypotension

Bronchospasms

Laryngospasms
Airway trauma

Hemorrhage

Infection

Aspiration.

Front 35

Procedures that can prevent complications of suctioning

Back 35

Can be reduced by frequent bagging between suctioning

Limiting suction time

Increasing FIO2