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203 Cards in this Set

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TTN
Transient Tachypnea of the Newborn
TTN occurs in _____ or _____-______ infants
term or near term
What are 2 other names for TTN?
wet lung disease
RDS type II
What causes TTN?
delayed absorption of normal lung fluid
in TTN where does the fluid accumulate?
in the lymphatics and brochovascual spaces
What maternal hormone excreted during labor helps to stop the chloride mechanism and expell lung fluid in the neonate?
epinephrine
When should TTN go away?
in three days after delivery
FLuid in the interlobar fissures, perihilar streaking, hyperaeration of the lungs, mild cardiomegaly, and alveolar edema will be seen in the CXR of a neonate with....
TTN
The CBG/ABG results of an infant with TTN will show...
respiratory acidosis, mild to moderate hypoxemia
What drug is NOT helpful for TTN?
lasix
With TTN when is oxygen need the highest?
just after birth
WHat form of oxygen delivery may help move fluid out of the lungs in TTN treatment?
C-pap
Oxygenated blood from the placenta enters the fetus through the Umbilical _______
vein
PPHN
Persistent Pulmonary Hypertension
Cardiopulmonary disorder characterized by systemic arterial pulmonary vascular resistance with resultant shunting of pulmonary blood flow to the systemic circulation
PPHN
What causes the systemic decrease in PO2 with PPHN?
right to left shunt
What causes PPHN?
peripheral vascular resistance is greater than systemic vascular resistance
In fetal circulartion PVR ____ SVR
>
With the first breath SVR becomes _____ PVR
>
What causes the Foramen Ovale to close?
The Left atrial pressure is greater than right atrial pressure
In PPHN what remains elevated?
PVR
Clinical cyanosis and difficulty in oxygenation are symptoms of....
PPHN
In fetal circulation pulmonary vascular resistance (PVR) is _______
high
In fetal circulation systemic vascular resistance (SVR) is _______
low
When the systemic vascular resistence increases at birth, pressure is increased in which ventricle?
left
an increase in pressure of the left ventricle at birth closes....
foramen ovale
In PPHN __________ vascular resistance fails to decrease after birth
pulmonary
In PPHN blood continues to flow through the ___ ________ and _______ ________ after birth
foramen ovale and ductus arteriosus
What sided heart failure may result from PPHN?
Right sided
PPHN is usually in ___ or ______-_____ infants
term or post-term
Hyperventilation test is used to diagnose:
PPHN
Preductal vs. postductal Pa)2 gradient is used to diagnose:
PPHN
What acid base imbalance may be used to treat PPHN?
alkalosis
Nitric oxide may be used to treat....
PPHN
ECHMO may be used to treat...
PPHN
What drugs may be used to treat pPHN?
Vasodilators
What side of the infants body is "pre-ductal"?
right
CMV, RSV, Enterovirus, and Herpes may all cause...
Pneumonia
Chlamydia and aspiration my lead to .....
pneumonia
Group B, E.Coli, Staph Aureus, H. Flu, and Listeria may all cause....
pneumonia
Congenital PNA
born with it
Chorioamnionitis may cause....
PNA
Neonatal pneumonia
hospital/environment acquired PNA
Fetal tachycardia and loss of heart rate pattern variability may indicate....
PNA
A labor lasting > 24 hours may indicate>.....
PNA
Tachypnea, grunting, retractions, cyanosis, hypoxemia, hypercapnia, recurrent apnea may all be signs of?
PNA
What breath sounds will be heard with PNA?
diminished and rales
Why might an LP be done for a patient with PNA?
meningitis rule out
What antibiotics do you start with for PNA?
ampicillan and gentomycin
What antibiotic will be used to treat PNA with a gram - bacteria?
vancomycin
neutrothermal
normal temperature
IVIG
Intravenous immunoglobulins
GCSF
granulocyte stimulating factor
Glucose levels will be _____ wlith infection such as PNA
increased
What are the 3 focus' of the VAP bundle?
1- ET tube care
2- Oral care
3- respiratory equipement care
what method is used for ETT stabilization?
neobars
Is saline lavage used for ETT suctioning?
NO
Are bulb syringes used with vents?
no
how often is oral care given with the VAP bundle?
q 3-4 hours
how often are resuscitation bags replaced?
once/week
asphyxia is defined biochemically as _________, ________, and mixed _______
hypoxia, hypercapnia, mixed acidoses
What is the #1 concern for asphyxia?
brain damage
FIve mechanisms for perinatal asphyxia:
1. Interruption of ________ blood flow
umbilical
FIve mechanisms for perinatal asphyxia:
2. Failure of gas exchange across the _______
placenta
FIve mechanisms for perinatal asphyxia:
3. inadequate perfusion of the __________
placenta
FIve mechanisms for perinatal asphyxia:
4. compromised fetus who cannot tolerate ______
labor
FIve mechanisms for perinatal asphyxia:
5. failure to _________ lungs after birth
inflate
In early asphyxia how will respirations be?
gasping
Diving relfex
redistribution of blood flow
diving relfex occurs in _________ asphyxia
early
neutrothermal
normal temperature
IVIG
Intravenous immunoglobulins
GCSF
granulocyte stimulating factor
Glucose levels will be _____ wlith infection such as PNA
increased
What are the 3 focus' of the VAP bundle?
1- ET tube care
2- Oral care
3- respiratory equipement care
what method is used for ETT stabilization?
neobars
Is saline lavage used for ETT suctioning?
NO
Are bulb syringes used with vents?
no
how often is oral care given with the VAP bundle?
q 3-4 hours
how often are resuscitation bags replaced?
once/week
What endocrine changes are seen in early asphyxia?
relsease of catecholamines, renin, vasopressin, and glucocorticoids
What happens to respiratory center if asphyxia progresses?
depression
What happens to cardiac system if asphyxia progresses?
decreased myocardial fucntion with eventual failure
APGAR scores
Umbilical ABG
time to sustain spont. resp.
neurological status
multiple end organ eval

Are all used to diagnose:
perinatal asphyxia
Movement of H2O across cell membranes from less concentrated to more concentrated
osmosis
Osmosis
movement of water across cell membranes from low concentration to high concentration
Active Transport
Substance moves across cell membranes from less conctenrated solution to more concentrated solution- requires a carrier
When a substance moves across cell membranes from less concentrated cell to more concetrated solution and requires an active carrier
active transport
List 7 major electrolytes
sodium
potassium
chloride
phosphate
magensium
calcium
bicarbonate
Main Cation of ECF?
sodium (Na+)
Dyspnea
Disorientation
coma
dysrythmias
pH < 7.35
PaCo2 > 45
hypokalemia
hyporemia

are all signs of....
respiratory acidosis
With respiratory acidosis you will have ______kalemia
hypo
what IV drug can b e given to treat respiratory acidosis?
IV sodium bicarb
Tachycardia
SOB
CP
Syncope
Coma
Seizures
Numbness/tingling
blurred vision

are all signs of.....
respiratory alkalosis
What do you do for a patient who is hyperventilating to treat respiratory alkalosis?
breath into a bag and breath more slowly
What may done to treat respiratory alkalosis?
sedation
Kussmaul's respirations are a sing of....
metabolic acidosis
kussmal's respirations
lethargy
HA
Weakness
N/V

are all signs of.....
metabolic acidosis
Hyperventilation
dysrhythmias
dizziness
hypertonic muscle tetany
hypokalemia
hypocalcemia

are all signs of....
metabolic alkalosis
What electrolyte is given to treat metabolic alkalosis?
K+ (potassium)
Normal value for pH
7.35-7.45
Normal value for PaCO2?
35-45
Normal Value for PaO2?
80-100
Normal value for HCO3?
22-26
WHat are the 2 buffers?
H2CO3 (carbonic acid)
NaHCO3 (base bicarbonate)
Apnea
cessation of respiration for at least 20 seconds, or less if complicated by cyanosis, pallor, hypotonia, or bradycardia
What type of Apnea:
Initial cessation of respiratory movement after priod of rapid respiration as a result of asphyxia in the delivery process
primary
Primary Apnea
Initial cessation of respiratory movement after priod of rapid respiration as a result of asphyxia in the delivery process
How do you treat primary apnea
exposure to stimulation
What type of Apnea:
apnea occurring after a period of deep, gasping respirations with fall in BP and HR, brought on by prolonged asphyxia
Secondary
What type of Apnea:
responds to stimulation
primary
What type of Apnea:
does not respond to stimulation, need vigorous resussication
secondary
is it possible to distinguish between primary and secondary apnea at birht?
no
Advantages of c-pap
increases end expiratory lung volumes

splints upper airway and weak chest wall
disadvantages of c-pap
complicates feedings (esp gavage)

may increase risk of aspiration

increased risk of air leak
WHy is caffeine given to apnea patients?
stimulates central respiratory chemoreceptors
methylxantine is the fancy name for...
caffeine
Tidal volume
the amount of gas moved in one breath
what is the standard tidal volume?
6cc/kg
frequency
the rate of ventilator breaths delivered in one minute
Normal value for pH
7.35-7.45
Normal value for PaCO2?
35-45
Normal Value for PaO2?
80-100
Normal value for HCO3?
22-26
WHat are the 2 buffers?
H2CO3 (carbonic acid)
NaHCO3 (base bicarbonate)
Apnea
cessation of respiration for at least 20 seconds, or less if complicated by cyanosis, pallor, hypotonia, or bradycardia
What type of Apnea:
Initial cessation of respiratory movement after priod of rapid respiration as a result of asphyxia in the delivery process
primary
Primary Apnea
Initial cessation of respiratory movement after priod of rapid respiration as a result of asphyxia in the delivery process
How do you treat primary apnea
exposure to stimulation
What type of Apnea:
apnea occurring after a period of deep, gasping respirations with fall in BP and HR, brought on by prolonged asphyxia
Secondary
tidal volume
the amount of gas moved in one breath
what is the standard tidal volume?
6cc/kg
frequency
the rate of ventilator breaths delivered in one minute
minute ventilation
amount of gas moved in one minute
how do you calculate minute ventilation?
tidal volume x frequency
Peak Inspiratory Pressure (PIP)
the highest pressure generated
Positive end-Expiratory pressure (PEEP)
pressure that remains in the chest after a ventilator breath
Delta P
Change in pressure
Inspiratory Time
the amount of time the pressure is held in the lung
Mean Airway pressure
Combination of:
PEEP
inspiratory time
Delta P
Pressure support
patient initiaties the breath and then the vent delivers a set pressure to boost the patients breath
SIM V
Set pressure and number of breaths delivered by vent, spontaneous breaths of patient also supported with pressure
What patients might benefit from iNO?
PPHN
Premature
CHD
Acute peds lung injury
when does gut motility develop?
around 30 weeks
when does the lower esophageal sphincter fully develop?
12 months of life
when does lacatse reach mature levels?
36-40 weeks
What should be started on DOB if you can't start TPN?
amino acids
how gradually should dextrose be increased?
bt 1-2 mg/kg/min as needed
what are the caloric needs for growth?
90-110 kcal/kg
what should BG be?
90-125
Normal BUN
12-20
how should you "prime" the gut?
10-20 ml-kg-day of MBM or 20ckal/oz premie formula
If there is severe perinatal asphyxia what must be done to decrease risk of NEC?
withhold feeds
When can lipids be DC"d?
`when feeds are 60 ml/kg/day
when can TPN be dc'd?
when feeds are at 100ml/kg/day
when does suck/swallow/breath develop?
32-34 weeks
what are qualifications to nipple feed?
>32 wks
RR < 60-70
when must fortified milk be used?
within 24 hours
WHat is adequate weight gain for an infant < 2 kg?
10-15g/kg/d
WHat is adequate weight gain for an infant > 2 kg?
20-50 g/d
where does SIP usually occur?
terminal ileum
Most infants with SIP have never been ______
fed
When does SIP usually present?
first 2 weeks of life
SIP
Spontaneous intestinal perforation
WHat color is the abdomen in SIP?
bluish discoloration
what, if seen on x-ray, should raise suspision of SIP?
disappearing bowel gase
"blow out" lesions are seen in>>>>>
SIP
Both SIP and NEC are primarily found in....
premature infants
when does NEC usually onset?
3-10 days after birth
A patient who develops NEC is often close to ____ _____
feeds
Sudeen feeding intolerance
abdominal distention
tenderness
pneumatosis intestinalis
occult or frank blood in stool
intestinal necrosis
bowel perforation
sepsis
shock

all may be clinical presentations of...
NEC
NEC
necrotizing intercolitis
What stage of NEC:
temp instability
lethargy
apnea
bradycardia
decreased appetite
gastric residuals
emesis
abdominal distention
bloody stool
Stage 1
What stage of NEC:
severe abdominal distention and tenderness

grossly bloody stools
stage 2
WHat is the most common surgical emergency of the newborn?
NEC
pustule
vesicle filled with purulent fluid
vesicle
fluid filled lesion , 0.5 cm
bullae
fluid filled lesion >0.5 cm
papule
solid elevated lesion with distinct borders <0.5 cm
plaque
solid, elevated lesion iwth dstinct borders > 0.5 cm
petechia
subepidermal pinpoint hemmorhages
wheal
hives
nodule
< 0.5 cm
tumor
> 0.5 cm
cyst
fluid filled nodule
telanglectasis
dilated dermal blood vessel
scar
fibrosis of the dermis
fissure
linear erosion of the epidermis
crust
scales covered with serum
scale
flakes of skin
ulceration
erosion into the dermis
erosion
superficial rupture of the epidermis
atrophy
depressed lesion
mongolion spots
hyperpigmented macules or patches on the buttocks, flanks, or shoulder
linea nigra
line of increased pigmentation from umbilicus to genitalia
cutis marmorata
marbling or lace effect to the skin
harlequen sign
sharply demarcated separation in which one side of the body becomes and the other becomes pale
cafe au lait spots
irrecularly shaped tan colored patches
erythema toxicum nenatorum
small white or yellow pustules with erythematous margin located on the face, trunk, or limbs
less collagen in the preterm infant >>
skin integrity challenges/risks
with a younger age the fibrils connecting dermis to epidermis _________
decrease
how often should a healthy neonate > 34 weeks old be bathed?
1-3 times/wk
what is the primary cause of skin breakdown in the NICU?
adhesive use