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137 Cards in this Set
- Front
- Back
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AGA
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appropriate for gestational age
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Neonate considered premature if born before_______________
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37 weeks
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What is the most sensitive indicator for well being?
a) weight b) length c) gestational age at birth |
weight
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SGA
a) small for gestational age b) <10th percentile c) <75th percentile d) both a & b |
small for gestational age
<10th percentile |
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Reasons a baby may be small for gestational age
a) malnutrition b) toxic factors c) placental insufficiency d) all of the above |
malnutrition
toxic factors placental insufficiency |
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LGA
a) large for gestational age b) > 90th percentile c) r/t maternal diabetes d) all of the above |
large for gestational age
> 90th percentile r/t maternal diabetes |
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The fetus whose mother has diabetes
a) has increased insulin production b) does not have increased insulin production (because glucose doesn't cross placenta) c) increased risk of polycythemia d) increased risk of hypoglycemia e) increased risk of hyaline membrane disease |
has increased insulin production
increased risk of polycythemia increased risk of hypoglycemia increased risk of hyaline membrane disease |
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The most accurate measurement of gestational age
a) weight b) crown-rump length c) femur length d) head circumference |
crown-rump length
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Length is the best measurement of ______________________
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skeletal growth
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IUGR
a) intrauterine growth retardation b) r/t infection c) r/t sick mom d) dec. uteroplacental blood flow e) drug/ETOH abuse |
Intrauterine growth retardation
r/t infection r/t sick mom dec. uteroplacental blood flow drug/ETOH abuse |
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ANS stability is achieved
a) @ 40wks b) @ 60 wks c) @ 2 years of age d) @ 24 wks |
@ 60 wks
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Why would you not use restraints on an intubated preemie/neonate?
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interferes with L & R brain development
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Atropine should be given after/before/mixed with neostigmine
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Before!!! to prevent bradycardia assoc with neostigmine
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In regards to psychological development "Trust-mistrust"
a) Erik Erikson stage of development b) up to 1 year old c) requires an infant be protected from pain |
Erik Erikson stage of development
up to 1 year old requires an infant be protected from pain |
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T/F Nervous system elements required for the transmission of painful stimuli are functional by 24 weeks gestation
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TRUE
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T/F pain is especially harmful to preemie because the resources infant needs for growth and healing are used to cope with pain
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TRUE
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The most effective and specific indicator of pain in a preemie
a) crying b) elevated HR c) facial expression d) withdrawal |
facial expression
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Non-pharmacological interventions for pain include
a) swaddling b) pacifier c) decreased enviro stimuli d) sucrose as an analgesic |
swaddling
pacifier decreased enviro stimuli sucrose as an analgesic |
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Social aversion
a) a result of painful stimulus b) associates pain with human face c) results in feeding difficulties |
a result of painful stimulus
associates pain with human face |
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Oral aversion
a) a result of painful stimulus b) from continued suctioning c) results in feeding difficulties d) results in failure to thrive |
a result of painful stimulus
from continued suctioning results in feeding difficulties results in failure to thrive |
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CNS immaturity results in _________ to a specific stimuli and reflex control
a) a specific response b) a global response |
a global response
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ANS immaturity leads to __________________________
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BRADYCARDIA & APNEA
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Myelination of brain & nerve endings progresses from ________to _______
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head to toe
cephalocaudal development |
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A human is neurologically intact
a) shortly after birth b) within 6 mths of birth c) at 2 years of age |
at 2 years of age
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The moro reflex
a) startle reflex b) sucking reflex c) evident at 27 weeks inutero d) evident after birth |
startle reflex
evident at 27 weeks inutero |
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Grasp reflex
a) last only a few months b) continues until gross motor skills are achieved c) stronger in preemie than term infant d) stronger in term infant than preemie |
last only a few months
stronger in preemie than term infant |
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Laryngeal reflex
a) "diving reflex" b) stimulated with oral/airway stimulation c) can lead to laryngospasm |
"diving reflex"
stimulated with oral/airway stimulation can lead to laryngospasm |
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PSNS/SNS more developed in neonate
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PSNS
meaning carotid/aortic baroreceptors not fully functional! |
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T/F General anesthesia decreases the threshold at which the body will respond to hypothermia
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True
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Why does the neonate's body favor heat loss?
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r/t body/head ratio
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The reason neonates don't sweat effectively is
a) immature epocrine glands c) immature apocrine glands |
immature apocrine glands
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The neutral temperature in the preemie baby is > than or < that of the term baby
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>, meaning that the body temperature of a preemie must be kept higher so that it will not expend any energy
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Neutral temperature r/t thermoregulation of body temp
a) the temp at which no energy is expended to maintain body temp b) the temp at which the body can't maintain normal body heat |
the temp at which no energy is expended to maintain body temp
neutral temp (preemie) 34 degrees C neutral temp (term) 28 degrees C |
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T/F the critical temp for a preemie is equal to the neutral temp for a term baby
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TRUE the critical temp for a preemie is 28 degrees C while the neutral temp for a term baby is 28 degrees C
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Critical temp r/t thermoregulation of body temp
a) the temp at which no energy is expended to maintain body temp b) the temp at which the body can't maintain normal body heat |
the temp at which the body can't maintain normal body heat
Critical temp (preemie) 28 degrees C Critical temp (term) 23 degrees C |
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Hypothermic stress
a) activates SNS b) increases BMR c) decreases surfactant production d) increases O2 consumption |
activates SNS (release of Epi/NE)
increases BMR decreases surfactant production increases O2 consumption |
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T/F the initial response to hypothermic stress is Tachycardia & HTN
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True, then Bradycardia & Apnea
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What happens when the brown fat needed for non-shivering thermogenesis runs out?
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BRADYCARDIA & APNEA
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Where is the brown fat needed for non-shivering thermogenesis located?
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over upper portion of chest and back as well over the kidneys
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IVH (Intraventricular Hemorrhage) results from
a) Hypoxia b) Hypercarbia c) Acidosis d) hypothermia e) hyperosmolar fluids |
Hypoxia
b) Hypercarbia c) Acidosis d) hypothermia e) hyperosmolar fluids EVERYONE OF THESE LEADS TO HTN WHICH CAN CAUSE IVH! |
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IVH can result in
a) developmental delay b) mental retardation c) CP d) hyprocephalus e) need for VP shunts |
developmental delay
mental retardation CP hyprocephalus need for VP shunts |
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T/F glucose & bicarb are hyperosmolar fluids
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True they must be cut in 1/2 with H2O to prevent risk of IVH
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Ultimately IVH can lead to
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BRADYCARDIA & APNEA
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Place in order the development of fetal CNS
pons, forebrain, medulla, midbrain |
Medulla
Pons Midbrain Forebrain |
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T/F at 27 weeks the fetus will startle to noise
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True
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What drug might possibly prevent neural tube closure defects?
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Folic acid
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Being the good CRNA before you start an IV on the neonate you want to prevent pain, somebody else says "hey put some EMLA cream on" you say.........
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NO! the skin is too thin and it would be TOXIC to the neonate! GOOD FOR YOU!
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The larynx in the preemie
a) C3 b) C4 c) C5 |
C3
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Why did God put the larynx in the preemie/neonate/infant higher than the adult?
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To prevent aspiration when taking bottle
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Epiglottis
a) narrow/angled b) wide |
narrow/angled
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Why (although controversial) is it that a cuffed ETT is not an absolute need in the newborn?
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Because Trachea is funnel shaped
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Newborn is an obligate
a) nose breather b) mouth breather |
nose breather
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Fetus is capable of gas exchange
a) 20 weeks b) 24 weeks c) 30 weeks |
24 weeks
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When does surfactant start being produced?
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Between 24-37 weeks
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Newborn is an obligate
a) nose breather b) mouth breather |
nose breather
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Surfactant
a) increases surface tension allowing alveoli to stay open b) decreases surface tension making it easier for alveoli to expand |
increases surface tension allowing alveoli to stay open
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When does surfactant start being produced?
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Between 24-37 weeks
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Surfactant
a) increases surface tension allowing alveoli to stay open b) decreases surface tension making it easier for alveoli to expand |
increases surface tension allowing alveoli to stay open
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A newborns lungs________than adult
a) more compliant b) less compliant |
less compliant
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A newborns chest wall _________than adult
a) more compliant b) less compliant |
more compliant (that's why you see retractions with respirations)
Ribs are parallel instead of curved like Adults |
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The diaphram of a neonate
a) domed b) flat c) pulls down more than adult d) pulls down less than adult |
flat
pulls down less than adult Can't get neg. intrathoracic pressure so see retractions |
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Urine output
a) expect 1cc/kg/hr b) minimum acceptable 0.5cc/kg/hr c) both of the above |
expect 1cc/kg/hr
minimum acceptable 0.5cc/kg/hr |
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Diaphramatic muscle fibers
a) slow twitch b) high oxidative c) fatigue resistant d) amt have is < than adult |
slow twitch
high oxidative fatigue resistant amt have is < than adult |
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When a neonate is in respiratory distress what will he do to keep his airways open?
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Laryngeal braking
grunting/auto-peep |
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A decrease in FRC does what to O2 consumption and CO2 production?
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DOUBLES BOTH OF THEM!
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Neonate response to Hypoxemia
a) initial increased RR b) initial increased VT c) later decreased RR d) later decreased VT |
initial increased RR
later decreased RR THERE IS NO CHANGE IN VT!!!! |
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How is the Newborn response to hypercarbia without hypoxemia different from the response to hypercarbia with hypoxemia?
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With Hypoxemia there may be a suppressed response to Hypercarbia (so won't increase rate to breath it off)
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T/F There is small airway closure with normal tidal ventilation in the neonate
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True
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What medication can be given to the mom of a fetus who wants to "come into the world" early?
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Betamethasone, this stress dose will increase surfactant production
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Fetal Hbg
a) right shift on oxyhgb curve b) left shift on oxyhgb curve c) holds on to O2 d) releases O2 readily |
left shift on oxyhgb curve
holds on to O2 |
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O2 consumption of neonate
a) 6cc/kg b) 3cc/kg c) 15cc/kg |
6cc/kg
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Hering Breur Reflex
a) "stretch" reflex b) normal c) in response to stress d) causes periodic breathing |
Stretch reflex, in response to stretching of lungs on inspiration, will cause periodic apnea, irregular breathing pattern
APNEA brought on by Bradycardia in response to stress is DIFFERENT!! |
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What is the narrowest part of the neonate airway?
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subglottic area/cricoid cartilage
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Typical sizes of ETT
a) 2.5 cm b) 3.0 cm c) 4.0 cm |
2.5 cm
3.0 cm |
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How is the ETT depth determined?
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Usually 3x the size
ie: 2.5 cm 7-8 cm depth 3 cm 9 cm depth |
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How do you determine whether the ETT is the right size?
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By doing a leak test
If when adjusting pop off valve you hear (with precordial) air leaking around tube at 15cm the ETT is too small If hear air leaking around tube at a pressure > 25 cm the ETT is too big (IDEAL PRESSURE 15-25 cm) |
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Typical vent settings
a) low FiO2 b) VT 7-10cc;kg c) Rate 30-60/min d) pressure mode |
low FiO2
VT 7-10cc;kg Rate 30-60/min (look at ETCO2) pressure mode (watch for easy rise in chest) |
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Why would you not want to use bronchodilators in a neonate?
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Because lung tissue is friable
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What is the danger associated with running high FiO2's?
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Retinopathy of Prematurity
Hyperoxia causes dilation of retinal artery leading to detached retina |
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In a neonate with Right to Left shunting what would be the perfect SaO2?
a) 90% b) 95% c) 80% d) 100% |
80%
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Because the PSNS is more active in the neonate what would the normal response to stress be?
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BRADYCARDIA
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T/F Cardiac Output in a neonate
is Heart rate dependent |
True
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Neonate heart ventricles
a) compliant b) non compliant |
non compliant STIFF right ventricle must adapt to being a volume chamber vs. a pump when transition to extrauterine life
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Preemie PA pressure
a) 1/2 it's systemic BP b) 1/3 it's systemic BP c) The same as the systemic BP |
1/2 it's systemic BP
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Neonate PA pressure
a) 1/2 it's systemic BP b) 1/3 it's systemic BP c) The same as the systemic BP |
1/3 it's systemic BP
The infants PA pressure is this as well |
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Cardiopulm transition to extrauterine life
a) decreases Pulm Vasc Resist b) increases Pulm Vasc Resist c) increased O2/decreased CO2 d) both a & c |
decreases Pulm Vasc Resist
increased O2/decreased CO2 |
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If using Sux or Pavulon as muscle relaxant what med would you want to pretreat with?
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Atropine d/t bradydysrhythmias caused by those drugs
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T/F Respiratory distress in the newly born infant recreates in-utero state
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True which opens Duct Art. and result in shunting of blood to vital organs, CHF, widened pulse pressure, may result in NEC related to the shunting of blood away from the gut
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What medication can be used to close the PDA?
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Indomethacin but need to be cautious as it also decreases RBF which will increase creatinine
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What is formula for K calculation in the symptomatic infant?
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Desired K - Actual K = total dose
then Total dose / 3 = hourly dose |
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Estimated Blood Volume
Preemie Neonate Toddler Preschooler School Age |
Preemie 100cc
Neonate 90cc Toddler 80cc Preschooler 75cc School Age 70cc |
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Neonate's renal function
a) immature until 6-12 mths b) unable to concentrate urine if dehydrated c) unable to dilute urine if overloaded d) decreased GFR until 1 yr old |
immature until 6-12 mths
unable to concentrate urine if dehydrated unable to dilute urine if overloaded decreased GFR until 1 yr old |
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Albumin binds
a) with acids b) with bases |
with acids
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Alpha acid glycoprotein binds
a) with acids b) with bases |
with bases
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Examples of acid drugs
a) phenytoin b) narcs c) LA's d) NMBD's |
phenytoin
NMBD's as well as ASA, PCN |
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Examples of Basic drugs
a) Valium b) LA's c) Phenytoin d) Narcs |
Valium
LA's Narcs as well as atropine |
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Decreased protein & albumin binding
a) decreases amount of free drug b) increases amount of free drug |
increases amount of free drug
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Bilirubin competitively binds with protein, what would knock the bilirubin off the protein and lead to kernicterus?
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Hypoxia, Acidosis
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T/F Fetal protein has a decreased binding affinity?
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True
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Which of the following would require you to give a higher dose of drug because of it
a) delayed metabolism b) high volume of distribution c) protein binding |
high volume of distribution
protein binding (drugs such as muscle relaxants will bind to protein, making some of it "unavailable" for immediate use) But will require infrequent dosing as drug separates from protein and becomes available |
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Neonate "naivety" to drugs
a) requires a higher dose b) requires lower dosing |
requires lower dosing
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Increased cardiac output
a) slows uptake of inhalation agents b) increases uptake of inhalation agents c) has no effect on inhalation agents as they are inhaled |
slows uptake of inhalation agents
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Neonates have a larger vessel rich group proportionally what does this do to uptake of inhalation agents?
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Rapid equilibration
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T/F The MAC required is usually more than the neonate heart can tolerate
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True
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Preemie MAC requirement less than/greater than term infant
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less than
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T/F MAC increases with age and then decreases by about 6 mths
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True
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Barbiturates
a) high amount of free drug b) low amount of free drug |
high amount of free drug
THIS IS RELATED TO THE LOW PROTEIN STORES |
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High dose Ketamine
a) increases SNS stimulation b) increases PSNS stimulation c) can lead to paradoxical apnea d) may be used for tamponade |
increases SNS stimulation
can lead to paradoxical apnea may be used for tamponade |
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T/F Narcotics can lead to Bradycardia/Apnea which decreases cardiac output
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True BECAUSE CARDIAC OUTPUT IS HEART RATE DEPENDENT
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Myleomenigocele
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failure of neural tube to close, ( before 28 days gestation) Thoracic/Lumbar sacral most common
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Repair of a Myleomenigocele should be done
a) emergently b) once stablized |
emergently
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What s/s might make you suspect a Tracheoesophageal Fistula?
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inability to pass a NG tube, increased oral secretions, GI distention regurgitation, cyanosis
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Repair of a Tracheoesophageal Fistula should be done
a) emergently b) once stablized |
once stablized
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What other anomalies are associated with Tracheoesophageal Fistula?
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VATER
Vertebral/Vascular Anal malformation TracehoEsophageal Renal/Radial deformities |
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What other anomalies are associated with Tracheoesophageal Fistula?
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VACTERL
Vertebral/Vascular Anal malformation Cardiac anomolies TracehoEsophageal Renal/Radial Limb deformities |
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What position would you place a neonate with Tracheoesophageal Fistula in for surgery?
a) prone b) supine c) right lateral d) left lateral |
left lateral
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Where would you place the pre-cordial on a neonate undergoing Tracheoesophageal Fistula repair
a) right side b) left side c) makes no difference |
left side
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What needs to be done before the repair of Tracheoesophageal Fistula?
a) correct metabolic abnormalties b) hydrate c) both of the above |
correct metabolic abnormalties
hydrate |
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How could you place the ETT in a patient undergoing Tracheoesophageal Fistula repair so that you would have the best ventilation?
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above carina, with anterior rotation so that ventilation of fistula is avoided
AVOID + PRESSURE VENTILATION PRIOR TO INDUCTION |
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Tracheoesophageal Fistula more common in
a) males b) females |
males
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Congenital Diaphragmatic Hernia
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Invades chest cavity on LEFT SIDE (most common) thru Foramen of Bochdalek (8-10 weeks gestation)
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Why after repair of Congenital Diaphragmatic Hernia would you not want to reinflate the lung?
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Because lung is HYPOPLASTIC (the small lung is NOT r/t atelectisis)
PEAK AIRWAY PRESSURE no greater than 25-30 mmHg |
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What side is the pre-cordial placed on a neonate undergoing repair of Congenital Diaphragmatic Hernia
a) left b) right c) makes no difference |
Right
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What other anomalies are associated with Congenital Diaphragmatic Hernia?
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Myelomenigocele
Hydrocephalus PDA Esophageal atresia |
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With Congenital Diaphragmatic Hernia
a) increased PVR b) decreased PVR c) R to L shunt d) L to R shunt e) decreased O2 |
increased PVR
R to L shunt decreased O2 |
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Where would you want to place peripheral IV's in a neonate undergoing
repair of Congenital Diaphragmatic Hernia? a) upper extremities b) 1 in the upper extremity & 1 in the lower extremity c) makes no difference |
upper extremities because once hernia is repaired there will be increased intra-abdominal pressure compressing on IVC)
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Gastroschisis
a) right lateral abd defect b) has a sac over it c) no covering d) associated with other anomalies |
right lateral abd defect
no covering |
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Where would you want to place peripheral IV's in a neonate undergoing Gastroschisis repair
a) upper extremities b) 1 in the upper extremity & 1 in the lower extremity c) makes no difference |
upper extremities, with surgical repair there will be increased intra-abd pressure (in fact this surgery may be done in stages to prevent the high pressures)
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Omphalocele
a) herniation of bowel into umbilicus b) has a sac over it c) no covering d) associated with other anomalies |
herniation of bowel into umbilicus
has a sac over it associated with other anomalies (Cardiac, Downs, Preemie) |
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Necrotizing Enterocolitis
a) develops with stress in preemies < 36 weeks b) associated with PDA many times c) can be prevented with breast feeding d) surgical repair results in high blood loss |
a) develops with stress in preemies < 36 weeks
b) associated with PDA many times c) can be prevented with breast feeding d) surgical repair results in high blood loss |
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PDA ligation
a) required for incomplete closure of Ductus Arteriosis b) placed in Right lateral position c) will require re-inflation of lung after ligation d) all of the above |
a) required for incomplete closure of Ductus Arteriosis
b) placed in Right lateral position c) will require re-inflation of lung after ligation |
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If during the ligation of a PDA your neonate suddenly drops his BP and then loses his postductal then preductal SaO2 you would suspect
a) ligation aorta b) ligation PA c) ligation of PDA |
ligation aorta
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If during the ligation of a PDA your neonate suddenly drops his SaO2 and then loses his BP or it drops very low and progresses to Bradycardia you would suspect
a) ligation aorta b) ligation PA c) ligation of PDA |
ligation PA
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If during the ligation of a PDA your neonate has a decrease in pulse pressure, and a narrowing of pre/post ductal SaO2's you would suspect
a) ligation aorta b) ligation PA c) ligation of PDA |
ligation of PDA THIS IS WHAT YOU SHOULD SEE!
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Where should SaO2 monitors be placed on a neonate undergoing ligation of PDA?
a) R hand (preductal) b) L hand (preductal) c) L or R foot (postductal) d) L or R foot (preductal) |
R hand (preductal)
L or R foot (postductal A BP cuff should also be placed on the lower leg |
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Stress associated with PDA is associated with?
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NEC Necrotizing enterocolitis
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What position is a neonate undergoing PDA ligation placed in?
a) left lateral b) supine c) right lateral |
right lateral
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