Infants and shii test 2

Acrocyanosis is what?

Persistent blue discoloration of the hands and feet

Gravid is known as what?

The state of pregnancy

Gravida is known as what in terms of women?

The number of pregnancies a woman has had

Parity is known as what?

The number of live births a woman has had( aka para)

Macrosomia is known as what?

An unusually large newborn (>4kg): infant is said to be macrocosmic

Nicu Levels include what levels? 

Level 1- Level 2- Level 3- A,B,C 

Level 1 ( basic) NICU includes what?

Stabilizes infants born <35 weeks or ill until transfer to a higher facility. Provides most basic support, and neonatal resuscitation 

Level 2 NICU is what type of NICU?

A Specialty site for infants less than >32 weeks and weighing > 1500g

Is a APGAR test used to determine if resuscitation is required?

No 

1 minute APGAR score tells what?

How well an infant tolerated delivery

In CBG puncture sites you should avoid what?

The curvature of the heel

5 minute Apgar score indicates what?

How well a infant is tolerating the transition period

Signs of impeding respiratory Failure

Head bobbing, chin up, and during inspiration and down during exhalation, See-saw respirations with chest retractions while abdomen expands. ( Paradoxical Breathing)

New Born Heart rate is?

100-160 bpm

Fetal Heart rate is ?

120-160 bpm

Physical assessment of Gestational Age includes

Skin texture, Skin Color, Genitalia

Neurological characteristics of Gestational Age includes

Posture, Arm recoil, Leg recoil

Important of identifying Gestational Age is to see if the infant is?

Too large or too small for GA or if infant is premature with a higher risk of ( immature lungs, Increased heatless, poor digestion, Underdeveloped vasculature = hemorrhage)

What is a term baby in weeks?

38-42 wks

What is a preterm baby in weeks?

Less than 38 weeks

What is a gestational age of a Post term baby in weeks?

More than 42 weeks

What is the Classification of a baby with a LBW?

less than 2500 g

What is the classification of a baby with a VLBW?

less than 1500 g

what is the classification of a baby with ELBW?

Less than 1000g

What weight percentile is considered appropriate for AGA?

10th and 90th 

What weight percentile is considered appropriate for LGA?

Weight above the 90th percentile

What weight percentile is considered appropriate for SGA?

Weight below the 10th percentile

What is normal Respiratory Rate for Infants?

40 -60 bpm

The lower the GA indicates what to the Normal Rate?

The higher the normal rate

Tachypnea is considered what in infants? and is caused by what? 

Greater than 60bpm and is caused by Hypoxemia, Acidosis, Anxiety, Pain 

Where is Heart Rate taken at in infants?

Taken by auscultation at apical pulse located at the 5th intercostal space , midclavicular line; Can also be taken at brachial and femoral sites

What does a weak pulse mean in an infant?

Think shock, hypotension, vasoconstriction

what does a bounding pulse in an infant mean?

L-R shunt through PDA

Strong Brachial w/weak femoral pulse is caused by what? 

think PDA or Coarctation of the aorta

What is the treatment for RDS?

CPAP, Surfactant

What are noninvasive techniques to meausure blood gas and pulse ox in infants?

Transcutaneous PO2, Transcutaneous CO2, End tidal CO2, Pulse OX

What are the sites for an ABG from an infant?

RadiAL Artery, Umbilical Artery, Dorsal Pedia Artery, Posterior tibial Artery, Temporal Artery

How to perform a modified Allen’s test if puncturing the wrist or foot? 

Elevate hand or foot and occlude both arteries dorsal pedis / posterior tibial for foot and radial/ ulna for hand. and release the artery that is not being punctured for skin coloration 

What do Capillary samples (CBG) correlate best with arterial values?

When the site is warmed

What Values are not reliable on a CBG?

PO2 is not reliable

What values are questionable on a CBG from an Infant?

Hypotension, Hypothermia, Hypovolemia, Poor Perfusion

What are the CBG puncture sites? 

Posterolateral foot ( avoiding the curve), In children and older infants - the fleshy part of fingers and toes. With the earlobes being a secondary site in children. 

CBG Considerations include?

Warming the site properly, Wipe away first drop of blood with dry, sterile gauze, Apply moderate pressure to heel without massaging or squeezing( sometimes referred to as Milking)

What is the normal ABG Values in a preterm infant (1-5) hrs ?

pH 7.33, CO2 47, O2 60, HCO3 25, BE -4

What is the normal ABG Values in a normal term ( 5 hrs)

Ph 7.34, 35 CO2, 74 O2, 19 HCO3, -5 BE

What is the ABG values in a Normal Preterm (5 days)?

PH- 7.38 , CO2 - 36, O2 - 76, HCO3 - 21, BE- -3 

What is the ABG values of a child?

Ph - 7.40, CO2 - 40, O2 - 95, HCO3 - 24, BE- 0

What is the common probe placement of a pulse ox on an infant?

Wrist or Medial Surface of palm or foot

What is essential for accuracy of a Pulse Ox?

Good cardiac output or perfusion

What should correlate with the cardiac monitor rate before drawing conclusions about an infants oxygenation? 

Pulse Ox Heart Rate 

If Pulmonary hypertension is suspected what should you do for the infant?

pre ductal/ post ductal saturation assessment with a greater than 5% difference to be abnormal

Normal Breathing is what in infants?

Quiet Inspiration and Passive expiration

Respiratory Rate depend son what as a child gets older?

Age because the rate decreases as you get older

Assessment of pediatric patients begin with what? 

Signs of Respiratory distress, Chest /abdominal movement (movement without BS= total obstruction), Check for stridor ( upper airway obstruction) including Croup, Foreign body aspirations, Congenital abnormalities, Allergic reaction, Edema

Lower airway obstruction is shown in pediatric patients with?

Bronchiolotis, Asthma, Wheezing for bronchodilation and possibly helix

What are you assessing in a pediatric patient’s alertness?

If they are fully awake, Agitated, Minimally responsive, Unresponsive

The ability of a child to protect their airway os questionable if the child is?

Minimally responsive, or unresponsive.

Level 3 NICU is considered what?

The highest level of Neonatal care unit

What heart rate does a infant need Bagging with a mask?

Less than 100bpm

What heart rate does a infant need chest compressions?

Less than 60 bpm

Level 2A NICU hospitals are not capable to do what?

Not capable of providing MV for brief durations or CPAP

Level 2B NICU hospitals are capable of doing what?

Providing MV and CPAP for brief durations

Level 3A NICU hospitals take care of what infants?

Infants >1000g and > 28 weeks. Continous life support limited to conventional mechanical ventilation.

Level 3B NICU Hospitals take care of what infants? 

ELBW infants <1000g and 28 wks or less with advanced respiratory care of HFV, INO

Level 3C NICU hospitals has everything Level 2B NICU hospitals have plus what?

ECMO

Maternal Risk Factors include

PIH, Age less than 17 or Age greater than 35, Placenta prevue, Abruptio placenta, Smoking, Drug Use,

Type 1 diabetes

Failure to produce insulin, aka is Juvenile diabetes

Type 2 diabetes is 

Insulin resistance aka adult onset diabetes 

Pregnant women without diabetes that develop hyperglycemia during pregnancy is called what?

Gestational Diabetes

Mothers with pre-existing DM effect fetal or neonatal outcomes by?

Increasing chance of Macrosomia, Congenital Malformations, RDS, Hypoglycemia

Pregnancy Induced Hypertension (PIH) is aka

PreClampsia

PIH is characterized by what 

High blood pressure, Swelling due to fluid retention, Proteinuria 

PIH occurs more commonly for women with?

First Pregnancies, Pregnant teens, Women over 40

Placenta not getting enough blood from PIH results in what?

Prematurity, LBW/SGA, Seizures in mother, Placental Abruption

CBG should not be performed on an infant who is?

Less than 24 hours old

Decelerations are categorized by what?

Mild, Moderate, Severe

Fetal Lung Maturity is tested by?

Lecithin to sphingomyelin ratio and Phosphatidylglycerol

What ratio does the L:S ratio have to be greater than in order to confirm mature Lungs?

2:1

What must Phosphatidylglycerol be to confirm lungs are mature?

> 1%

What happens if Phosphatidylglycerol is less than 1% in fetal lung testing?

The risk of RDS increases