Rspt 1340 Beachey Ch 16 Fetal & Newborn Cardiopulmonary Physiology

Front 1

What are some congenital anomalies during the embryonic period?

Back 1

Tracheosophageal fistula, Choanal atresia, and Pulmonary hypoplasia

Front 2

A female infant with an estimated gestational age of 30 weeks was delivered with apgar scores of 5 and 7 at 1 and 5 minutes, respectively. Over the next hour the infant's respiratory status began to deteriorate with the infant exhibiting nasal flaring, expiratory grunting, and intercostal retractions. Based on an FIO2 of 0.60 via oxygen hood ABG results were as follows: PH = 7.26 PaCO2 = 50MMHG and Pa02 = 40MMHG. A chest X-ray revealed findings consistent with respiratory distress syndrome (RDS), bi lateral ground glass appearance, and decreased lung volumes. The infant was intubated and placed on mechanical ventilation and exogenous surfactant was delivered. ABG results after surfactant administration are as follows: PH = 7.36 PaCO2 = 37MMHG and Pa02 = 78MMHG on an FIO2 of 0.80. What should be done at this time?

Back 2

Decrease ventilator parameters and FIO2.

Front 3

What are some important functions of the amniotic fluid?

Back 3

-It protects the fetus from trauma.

-It allows the fetus to move.

-It helps control the temperature of the fetus.

Front 4

What is consistent with PPHN?

Back 4

-It presents within 12 hours after birth.

-It causes respiratory distress, often unresponsive to oxygen therapy.

-Some infants may require extracorporeal life support (ECLS).

-Nitric oxide therapy is an alternative treatment.

Front 5

Atrial Septal Defect

Back 5

Blood flows from the higher pressure left atrium into the lower pressure right atrium through the defect in the atrial septum.

Front 6

Ventricular Septal Defect

Back 6

Blood flows from the higher pressure left ventricle into the lower pressure right ventricle through an abnormal opening between the ventricles.

Front 7

Patient Ductus Arterious (PDA)

Back 7

Blood flows from the higher pressure aorta through the patent ductus arteriosus into the pulmonary artery.

Front 8

Atrioventricular Septal Defect

Back 8

Blood flows freely between all heart chambers, owing to incomplete development of atrial and ventricular septa and malformation of tricuspid in mitral valves.

Front 9

Tetralogy Fallot

Back 9

The 4 defects associated with this defect are:

1. Pulmonary stenosis

2. Ventricular septal defect

3. Overriding aorta

4. Right ventricular hypertrophy

Front 10

Transposition of the Greater Arteries

Back 10

The major arteries of the heart are reversed. The aorta comes off the right ventricle and the pulmonary artery arises from the left ventricle.

Front 11

Anomalous Venous Return

Back 11

Oxygenated blood is carried abnormally to the right atrium instead of the left atrium

Front 12

Tricuspid Atresia

Back 12

Blood cannot flow from the right atrium into the left ventricle, requiring an atrial septal defect, ventricular septal defect, or patent ductus arteriosus for survival.

Front 13

Truncus Arteriosus

Back 13

An overriding aorta receives blood from both ventricles through a ventricular septal defect.

Front 14

Coarctation of the aorta

Back 14

Vessel supplying the head and upper extremities occur before the area of narrowing (Coarction). This accounts for the upper and lower extremity blood pressure differences.

Front 15

Aortic Stenosis

Back 15

Blood flow into the aorta is obstructed by a narrow lumen.

Front 16

Hypoplastic Left Heart Syndrome

Back 16

A patent ductus arteriosus is necessary to supply the systemic circulation.

Front 17

Back 17

-Superior Vena Cava

-Lung

-Right Atrium

-Right Ventricle

-Inferior Vena Cava

-Left Hepatic Vein

-Ductus Venosus

Front 18

Back 18

-Arch of Aorta

-Ductus Arteriosus

-Pulmonary trunk

-Pulmonary Veins

-Left Atrium

-Valve of Foramen Ovale

-Descending Aorta

Front 19

Back 19

-Sphincter

-Gut

-Kidney

-Urinary Bladder

-Lower Limb

-Internal Iliac Artery

Front 20

Back 20

-Portal Vein-Umbilical Vein-Umbilicus-Umbilical Arteries -Placenta

Front 21

Fetal Lung Growth Order

Back 21

1. Mainstem bronchi formed.

2. Diaphragm development is complete.

3. Type 1 and type 2 cells and immature surfactants are present.

4. Mature surfactant is present.

5. Efficient gas exchange occurs across alveolar capillary membrane.

Front 22

What problems would you expect in an infant born with Choanal atresia?

Back 22

-Blockage will result in respiratory distress

-Cyanotic

-Inability to pass suction cath through site

Front 23

How would incomplete development of the diaphragm in gestational week 7 cause breathing difficulties in an infant after birth?

Back 23

Because hypoplasia will cause respiratory distress.

Front 24

What factors lead to increased heat loss in the newborn infant? Why are Premature infants more prone to heat loss then term in infants?

Back 24

-Loss of Brown fat

-Larger head to body size

-Faster metabolism

Front 25

Explain how a fetus can survive when the maximum PO2 reached during fetal life is only 30MMHG.

Back 25

Because of Fetal Hemoglobins (HBF) high affinity for oxygen.

Front 26

Why are upper airway infection such as croup or epiglottitis more problematic in the infant then they are in the adult?

Back 26

Because an infant structures are smaller and narrower than in adult

Front 27

Why is the heart the 1st organ system to develop and function in the fetus?

Back 27

Because it requires an efficient method to transport 02 nutrients and waste products between maternal and fetal circulations

Front 28

What percentage of babies are born with some congenital heart defect?

Back 28

1%

Front 29

What is the most common type of congenital heart defect?

Back 29

Atrial septal defect

Front 30

What are defects associated with Tetralogy of Fallot?

Back 30

Pulmonary Stenosis, VSD, Right Ventricular Hypertrophy, Overriding or dextroposition of the aorta

Front 31

What is the most common cyanotic congenital heart defect?

Back 31

Tetralogy of fallot

Front 32

What are therapeutic strategies to close a PDA?

Back 32

Administering indomethacin or ibuprofen and surgical intervention

Front 33

What conditions can delay the closure of the ductus arteriosus?

Back 33

Hypoxic and acidosis

Front 34

When does the ductus arteriosus anatomically close?

Back 34

24 weeks

Front 35

Infants born by to cesarean section makes experience retention of fetal lung fluid. What is the name of the condition that can result in short term respiratory distress?

Back 35

Transient Tackypnea of the newborn

Front 36

What is the name of the structure that allows passage of blood from the pulmonary artery into the descending aorta?

Back 36

Ductus arteriosus

Front 37

What percentage of the blood in the pulmonary artery enters the pulmonary circulation to perfuse the lungs in utero?

Back 37

13 to 25%

Front 38

What conditions decrease an infant's ability to generate heat?

Back 38

Hypoxia Acidosis and Hypoglycemia

Front 39

What is the most important means of heat production in the new born infant?

Back 39

Brown fat embolism

Front 40

What are common signs of respiratory distress in the infant?

Back 40

Nasal flaring, expiratory grunting, inspiratory retractions, and paradoxial breathing

Front 41

What statements are true of croup?

Back 41

Viral infections

Front 42

What appears to be the function of fetal lung fluid?

Back 42

Maintains lung expansion

Front 43

Premature detachment of the placenta from the uterine wall is known as what?

Back 43

Abrubtio placentae

Front 44

What is the number of vessels in the umbilical cord?

Back 44

Three

Front 45

What are characteristics of epiglottitis?

Back 45

Life threatening bacteria infection

Front 46

What is the incidence of meconium stained amniotic fluid?

Back 46

12%

Front 47

As a results of the HBF in the fetus a PO2 of 30MMHG corresponds to what level of SA02?

Back 47

75-80%

Front 48

What values represent the maximum PO2 of the Fetus?

Back 48

30MMHG

Front 49

Fetal hemoglobin is the predominant form of hemoglobin in the fetus. It is about 90% of the total hemoglobin at 24 weeks of gestation. When is HBF replaced by HBA?

Back 49

6 to 12 months of life

Front 50

Why are children younger than 10 years of age more likely to develop airway obstruction and atelectasis than older children?

Back 50

Canals of Lambert and Pores of Kohn are poorly developed.

Front 51

By which ages alveolar development usually complete?

Back 51

8 years old

Front 52

Mature surfactant contains the phospholipid phosphatidylglycerol (PG) which is required for normal surfactant function. When does PG appear?

Back 52

35 weeks gestation

Front 53

When is a small amount of surfactant present in infants born prematurely?

Back 53

Approximately 20 weeks gestation

Front 54

Type 2 cells began to synthesize surfactant during which period of lung development?

Back 54

Saccular period

Front 55

A premature baby is potentially capable breathing and may survive with intensive medical care at how many weeks of gestation?

Back 55

24 weeks

Front 56

What organs began to develop during the 4th week of gestation?

Back 56

Lungs, mainstream bronchi, and organs in the lower respiratory track