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203 Cards in this Set
- Front
- Back
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TTN
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Transient Tachypnea of the Newborn
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TTN occurs in _____ or _____-______ infants
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term or near term
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What are 2 other names for TTN?
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wet lung disease
RDS type II |
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What causes TTN?
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delayed absorption of normal lung fluid
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in TTN where does the fluid accumulate?
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in the lymphatics and brochovascual spaces
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What maternal hormone excreted during labor helps to stop the chloride mechanism and expell lung fluid in the neonate?
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epinephrine
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When should TTN go away?
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in three days after delivery
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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....
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TTN
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The CBG/ABG results of an infant with TTN will show...
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respiratory acidosis, mild to moderate hypoxemia
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What drug is NOT helpful for TTN?
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lasix
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With TTN when is oxygen need the highest?
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just after birth
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WHat form of oxygen delivery may help move fluid out of the lungs in TTN treatment?
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C-pap
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Oxygenated blood from the placenta enters the fetus through the Umbilical _______
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vein
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PPHN
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Persistent Pulmonary Hypertension
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Cardiopulmonary disorder characterized by systemic arterial pulmonary vascular resistance with resultant shunting of pulmonary blood flow to the systemic circulation
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PPHN
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What causes the systemic decrease in PO2 with PPHN?
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right to left shunt
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What causes PPHN?
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peripheral vascular resistance is greater than systemic vascular resistance
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In fetal circulartion PVR ____ SVR
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>
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With the first breath SVR becomes _____ PVR
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>
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What causes the Foramen Ovale to close?
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The Left atrial pressure is greater than right atrial pressure
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In PPHN what remains elevated?
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PVR
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Clinical cyanosis and difficulty in oxygenation are symptoms of....
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PPHN
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In fetal circulation pulmonary vascular resistance (PVR) is _______
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high
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In fetal circulation systemic vascular resistance (SVR) is _______
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low
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When the systemic vascular resistence increases at birth, pressure is increased in which ventricle?
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left
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an increase in pressure of the left ventricle at birth closes....
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foramen ovale
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In PPHN __________ vascular resistance fails to decrease after birth
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pulmonary
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In PPHN blood continues to flow through the ___ ________ and _______ ________ after birth
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foramen ovale and ductus arteriosus
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What sided heart failure may result from PPHN?
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Right sided
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PPHN is usually in ___ or ______-_____ infants
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term or post-term
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Hyperventilation test is used to diagnose:
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PPHN
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Preductal vs. postductal Pa)2 gradient is used to diagnose:
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PPHN
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What acid base imbalance may be used to treat PPHN?
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alkalosis
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Nitric oxide may be used to treat....
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PPHN
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ECHMO may be used to treat...
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PPHN
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What drugs may be used to treat pPHN?
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Vasodilators
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What side of the infants body is "pre-ductal"?
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right
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CMV, RSV, Enterovirus, and Herpes may all cause...
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Pneumonia
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Chlamydia and aspiration my lead to .....
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pneumonia
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Group B, E.Coli, Staph Aureus, H. Flu, and Listeria may all cause....
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pneumonia
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Congenital PNA
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born with it
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Chorioamnionitis may cause....
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PNA
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Neonatal pneumonia
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hospital/environment acquired PNA
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Fetal tachycardia and loss of heart rate pattern variability may indicate....
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PNA
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A labor lasting > 24 hours may indicate>.....
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PNA
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Tachypnea, grunting, retractions, cyanosis, hypoxemia, hypercapnia, recurrent apnea may all be signs of?
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PNA
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What breath sounds will be heard with PNA?
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diminished and rales
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Why might an LP be done for a patient with PNA?
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meningitis rule out
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What antibiotics do you start with for PNA?
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ampicillan and gentomycin
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What antibiotic will be used to treat PNA with a gram - bacteria?
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vancomycin
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neutrothermal
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normal temperature
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IVIG
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Intravenous immunoglobulins
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GCSF
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granulocyte stimulating factor
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Glucose levels will be _____ wlith infection such as PNA
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increased
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What are the 3 focus' of the VAP bundle?
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1- ET tube care
2- Oral care 3- respiratory equipement care |
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what method is used for ETT stabilization?
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neobars
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Is saline lavage used for ETT suctioning?
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NO
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Are bulb syringes used with vents?
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no
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how often is oral care given with the VAP bundle?
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q 3-4 hours
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how often are resuscitation bags replaced?
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once/week
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asphyxia is defined biochemically as _________, ________, and mixed _______
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hypoxia, hypercapnia, mixed acidoses
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What is the #1 concern for asphyxia?
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brain damage
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FIve mechanisms for perinatal asphyxia:
1. Interruption of ________ blood flow |
umbilical
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FIve mechanisms for perinatal asphyxia:
2. Failure of gas exchange across the _______ |
placenta
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FIve mechanisms for perinatal asphyxia:
3. inadequate perfusion of the __________ |
placenta
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FIve mechanisms for perinatal asphyxia:
4. compromised fetus who cannot tolerate ______ |
labor
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FIve mechanisms for perinatal asphyxia:
5. failure to _________ lungs after birth |
inflate
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In early asphyxia how will respirations be?
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gasping
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Diving relfex
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redistribution of blood flow
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diving relfex occurs in _________ asphyxia
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early
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neutrothermal
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normal temperature
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IVIG
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Intravenous immunoglobulins
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GCSF
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granulocyte stimulating factor
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Glucose levels will be _____ wlith infection such as PNA
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increased
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What are the 3 focus' of the VAP bundle?
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1- ET tube care
2- Oral care 3- respiratory equipement care |
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what method is used for ETT stabilization?
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neobars
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Is saline lavage used for ETT suctioning?
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NO
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Are bulb syringes used with vents?
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no
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how often is oral care given with the VAP bundle?
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q 3-4 hours
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how often are resuscitation bags replaced?
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once/week
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What endocrine changes are seen in early asphyxia?
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relsease of catecholamines, renin, vasopressin, and glucocorticoids
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What happens to respiratory center if asphyxia progresses?
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depression
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What happens to cardiac system if asphyxia progresses?
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decreased myocardial fucntion with eventual failure
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APGAR scores
Umbilical ABG time to sustain spont. resp. neurological status multiple end organ eval Are all used to diagnose: |
perinatal asphyxia
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Movement of H2O across cell membranes from less concentrated to more concentrated
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osmosis
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Osmosis
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movement of water across cell membranes from low concentration to high concentration
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Active Transport
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Substance moves across cell membranes from less conctenrated solution to more concentrated solution- requires a carrier
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When a substance moves across cell membranes from less concentrated cell to more concetrated solution and requires an active carrier
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active transport
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List 7 major electrolytes
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sodium
potassium chloride phosphate magensium calcium bicarbonate |
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Main Cation of ECF?
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sodium (Na+)
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Dyspnea
Disorientation coma dysrythmias pH < 7.35 PaCo2 > 45 hypokalemia hyporemia are all signs of.... |
respiratory acidosis
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With respiratory acidosis you will have ______kalemia
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hypo
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what IV drug can b e given to treat respiratory acidosis?
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IV sodium bicarb
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Tachycardia
SOB CP Syncope Coma Seizures Numbness/tingling blurred vision are all signs of..... |
respiratory alkalosis
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What do you do for a patient who is hyperventilating to treat respiratory alkalosis?
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breath into a bag and breath more slowly
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What may done to treat respiratory alkalosis?
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sedation
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Kussmaul's respirations are a sing of....
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metabolic acidosis
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kussmal's respirations
lethargy HA Weakness N/V are all signs of..... |
metabolic acidosis
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Hyperventilation
dysrhythmias dizziness hypertonic muscle tetany hypokalemia hypocalcemia are all signs of.... |
metabolic alkalosis
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What electrolyte is given to treat metabolic alkalosis?
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K+ (potassium)
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Normal value for pH
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7.35-7.45
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Normal value for PaCO2?
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35-45
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Normal Value for PaO2?
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80-100
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Normal value for HCO3?
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22-26
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WHat are the 2 buffers?
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H2CO3 (carbonic acid)
NaHCO3 (base bicarbonate) |
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Apnea
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cessation of respiration for at least 20 seconds, or less if complicated by cyanosis, pallor, hypotonia, or bradycardia
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What type of Apnea:
Initial cessation of respiratory movement after priod of rapid respiration as a result of asphyxia in the delivery process |
primary
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Primary Apnea
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Initial cessation of respiratory movement after priod of rapid respiration as a result of asphyxia in the delivery process
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How do you treat primary apnea
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exposure to stimulation
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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
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What type of Apnea:
responds to stimulation |
primary
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What type of Apnea:
does not respond to stimulation, need vigorous resussication |
secondary
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is it possible to distinguish between primary and secondary apnea at birht?
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no
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Advantages of c-pap
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increases end expiratory lung volumes
splints upper airway and weak chest wall |
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disadvantages of c-pap
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complicates feedings (esp gavage)
may increase risk of aspiration increased risk of air leak |
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WHy is caffeine given to apnea patients?
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stimulates central respiratory chemoreceptors
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methylxantine is the fancy name for...
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caffeine
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Tidal volume
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the amount of gas moved in one breath
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what is the standard tidal volume?
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6cc/kg
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frequency
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the rate of ventilator breaths delivered in one minute
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Normal value for pH
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7.35-7.45
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Normal value for PaCO2?
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35-45
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Normal Value for PaO2?
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80-100
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Normal value for HCO3?
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22-26
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WHat are the 2 buffers?
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H2CO3 (carbonic acid)
NaHCO3 (base bicarbonate) |
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Apnea
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cessation of respiration for at least 20 seconds, or less if complicated by cyanosis, pallor, hypotonia, or bradycardia
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What type of Apnea:
Initial cessation of respiratory movement after priod of rapid respiration as a result of asphyxia in the delivery process |
primary
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Primary Apnea
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Initial cessation of respiratory movement after priod of rapid respiration as a result of asphyxia in the delivery process
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How do you treat primary apnea
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exposure to stimulation
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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
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tidal volume
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the amount of gas moved in one breath
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what is the standard tidal volume?
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6cc/kg
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frequency
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the rate of ventilator breaths delivered in one minute
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minute ventilation
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amount of gas moved in one minute
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how do you calculate minute ventilation?
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tidal volume x frequency
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Peak Inspiratory Pressure (PIP)
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the highest pressure generated
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Positive end-Expiratory pressure (PEEP)
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pressure that remains in the chest after a ventilator breath
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Delta P
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Change in pressure
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Inspiratory Time
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the amount of time the pressure is held in the lung
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Mean Airway pressure
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Combination of:
PEEP inspiratory time Delta P |
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Pressure support
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patient initiaties the breath and then the vent delivers a set pressure to boost the patients breath
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SIM V
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Set pressure and number of breaths delivered by vent, spontaneous breaths of patient also supported with pressure
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What patients might benefit from iNO?
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PPHN
Premature CHD Acute peds lung injury |
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when does gut motility develop?
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around 30 weeks
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when does the lower esophageal sphincter fully develop?
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12 months of life
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when does lacatse reach mature levels?
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36-40 weeks
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What should be started on DOB if you can't start TPN?
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amino acids
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how gradually should dextrose be increased?
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bt 1-2 mg/kg/min as needed
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what are the caloric needs for growth?
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90-110 kcal/kg
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what should BG be?
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90-125
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Normal BUN
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12-20
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how should you "prime" the gut?
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10-20 ml-kg-day of MBM or 20ckal/oz premie formula
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If there is severe perinatal asphyxia what must be done to decrease risk of NEC?
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withhold feeds
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When can lipids be DC"d?
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`when feeds are 60 ml/kg/day
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when can TPN be dc'd?
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when feeds are at 100ml/kg/day
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when does suck/swallow/breath develop?
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32-34 weeks
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what are qualifications to nipple feed?
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>32 wks
RR < 60-70 |
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when must fortified milk be used?
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within 24 hours
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WHat is adequate weight gain for an infant < 2 kg?
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10-15g/kg/d
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WHat is adequate weight gain for an infant > 2 kg?
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20-50 g/d
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where does SIP usually occur?
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terminal ileum
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Most infants with SIP have never been ______
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fed
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When does SIP usually present?
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first 2 weeks of life
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SIP
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Spontaneous intestinal perforation
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WHat color is the abdomen in SIP?
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bluish discoloration
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what, if seen on x-ray, should raise suspision of SIP?
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disappearing bowel gase
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"blow out" lesions are seen in>>>>>
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SIP
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Both SIP and NEC are primarily found in....
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premature infants
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when does NEC usually onset?
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3-10 days after birth
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A patient who develops NEC is often close to ____ _____
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feeds
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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
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NEC
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necrotizing intercolitis
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What stage of NEC:
temp instability lethargy apnea bradycardia decreased appetite gastric residuals emesis abdominal distention bloody stool |
Stage 1
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What stage of NEC:
severe abdominal distention and tenderness grossly bloody stools |
stage 2
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WHat is the most common surgical emergency of the newborn?
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NEC
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pustule
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vesicle filled with purulent fluid
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vesicle
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fluid filled lesion , 0.5 cm
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bullae
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fluid filled lesion >0.5 cm
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papule
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solid elevated lesion with distinct borders <0.5 cm
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plaque
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solid, elevated lesion iwth dstinct borders > 0.5 cm
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petechia
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subepidermal pinpoint hemmorhages
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wheal
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hives
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nodule
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< 0.5 cm
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tumor
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> 0.5 cm
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cyst
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fluid filled nodule
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telanglectasis
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dilated dermal blood vessel
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scar
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fibrosis of the dermis
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fissure
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linear erosion of the epidermis
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crust
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scales covered with serum
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scale
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flakes of skin
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ulceration
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erosion into the dermis
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erosion
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superficial rupture of the epidermis
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atrophy
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depressed lesion
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mongolion spots
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hyperpigmented macules or patches on the buttocks, flanks, or shoulder
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linea nigra
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line of increased pigmentation from umbilicus to genitalia
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cutis marmorata
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marbling or lace effect to the skin
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harlequen sign
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sharply demarcated separation in which one side of the body becomes and the other becomes pale
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cafe au lait spots
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irrecularly shaped tan colored patches
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erythema toxicum nenatorum
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small white or yellow pustules with erythematous margin located on the face, trunk, or limbs
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less collagen in the preterm infant >>
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skin integrity challenges/risks
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with a younger age the fibrils connecting dermis to epidermis _________
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decrease
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how often should a healthy neonate > 34 weeks old be bathed?
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1-3 times/wk
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what is the primary cause of skin breakdown in the NICU?
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adhesive use
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