NeoPeds Final

92 questions

What are the 5 stages in embryonic lung growth?

• Embryonic Period

• Pseudoglandular Period

• Cannalicular Period

• Saccular Period

• Alveolar Period

What is happening in the Embryonic Period? (Day 26-52) ?

• Development of the trachea

• Lungs are small buds arising from the esophagus

What is happening in the Pseudoglandular Period? (Day 52- W16)

• Subdiving (bronchial branching) of the conducting airways begin

• Cilia appear

What is a baby called when born in Pseudoglandular Period?

Fetal dimis (baby born dead)

What is happening in the Canalicular Period? (Week 17-29)

• Lung lobes are now recognizable

• Alveolar ducts are formed

• Type 1 (form alveolar capillary membrane) and Type 2 (begins producing surfactant) primitive alveoli develop

What is happening in Saccular Period? (Week 26-36)

• Alveoli are beginning to develop

  • Good development of Surfactant

What is happening in the Alveolar Period? (Week 36- term)

• Alveoli are still groing and everything is just increasing in number

What is surfactant?

• Phospholipids (PC)

• Phosphatidylglycerol (PG)

• Neutral lipids

• Protiens

What is the purpose of surfactant and what does it do?

It helps reduce surface tension allowing lung expansion and make it easier to breathe

When does immature surfactant appear?

Anything before 35 weeks

When does mature surfactant appear?

At 35 weeks (PG)

What are ways to detect surfactant is present in a baby?

• Look at amniotic fluid

• Level of PC L/S (Lecithin/Sphingomyelin) 2:1

How do we know when lung maturity is determined?

When L/S ratio is at 2:1

What is the pressure difference between right and left heart pressure wise for baby circulation?

Baby in utero right side is stronger when born left is stronger ???

How does the blood flow from the placenta to the baby?

Deoxygenated blood goes through arteries (Fetus to mother)

Oxygenated blood goes through veins (Mother to fetus)

Shunt that is encountered??? Confused

How does the flow of blood look in a baby compared to an adult?

SVC/IVC- RA- Tricuspid valve- RV- Pulmonary valve- PA- Lungs- PV - LA- Mitrial Valve- LV- Aortic valve- Aortia

What does the baby have in the heart as a afetus compared to what adults have?

• PDA

• Ductus Arteriosis

Describe maternal history risk factors?

• Previous C-section

• Hx of Placenta previa or abruption

• Hx of birth trauma

• Congenital anomalies

• Recurrent spontaneous abortions

• Premature delivery

What is Preeclampsia and what problems can be associated with it?

• Blood pressure higher than 160/110

• Proteinuria

• Pulmonary edema

• Thrombocytopenia

• Headache

• Grand mal seizure

Describe the two amniotic fluid disorders?

• Polyhydramnios

• Oligohydramnios

What is Polyhydramnios?

Too much fluid, indicates problem with fetus swallowing (neuro disfunction)

What is Oligohydramnios?

Too little fluid indicates problem with urinary system (kidney function)

What are some signs of preterm labor?

• Back pain

• Menstrual like pains

• Pelvic heaviness

• Vaginal discharge

• Vaginal bleeding

What are some complications to preterm labor?

• Sepsis

• RDS

• Retinopathy

• Bronchopulmonary dysplasia

• Cerebral palsy

• Hemorrhage

• Necrotizing entercolitis (esophagus death )

What are some interventions to stop pre-term labor?

• Intravenous hydration

• Magnesium sulfate

• Indomethacin

• Positiong (put mom on side)

• B-mimetic (rarely used)

When there is fetal asphyxia what can happen to the babies lungs?

Neonate unable to generate negative force to open alveoli and push out fluid

How can fetal asphyxia occur with a fetus?

• Cord getting wrapped around neck ??? Nuchal Cord

What is primary apena with a baby?

infant will respond to stimulation by re-initiation of bx.

What is secondary apnea with a baby?

Asphyxia continues, the infant begins irregular gasping respiratory efforts which then slowly decrease in frequency

What is intrauterine asphyxia?

What happens to the cardiovascular system when there is periods of intrauterine asphyxia?

Know how to give an appropriate Apgar Score when provided with pt data?

• Appearance (Color)

• Pulse (HR)

• Grimace (Response to Stimulation)

• Activity (Muscle Tone)

• Respirations

Know what is included in the gestational age assessment ? (Ballard Score)

• Ear recoil

• Sole creases

• Skin appearance

• Lanugo (hair)

What is vernix?

Helps protect baby skin and helps it stay not dry

At what age does Vernix appear in which gestational age?

20-24 wks by 36 weeks begins to disappear

Be able to tell the gestational age of a pt with the information from the slides

Put the gestational age chart and example of foing the chart

Know what gestational age gelatinous and transparanent skin forms?

25-26 wks- gelatinous by 35 weeks starts to flake

Pectin products for skin

Know what gestational age you find Lanugo?

Usually all over body at 26 weeks

Usually gone by 32 weeks

Know what gestational age you will find sole creases?

• 26 wks small creases appear

• 30 wks creases cover top portion of sole

• 34 wks creases cover 2/3 of sole

When does Ear recoil appear?

• 34 wks cartilage forms

When does Breast Tisue appear?

By 27 wks small bud of tissue develops

Know the purpose for the physical exam of the neonate?

Not everyone knows how far along they actually are

The nature of respirations includes what values?

Know what causes Jaundice?

Low bilirubin levels turns skin yellowish color

Know the importance of encironmental control?

• Cluster care ???

Know some skin care recommendations for premature neonates?

Pectin bases tape

Why is the skin of the preemie sensitive?

there skin hasnt fully developed its protective layer

What do we do or give if an infants bilirubin levels are too low?

phototherapy

Know what is included withing the pulmonary examination?

• Auscultation

• Palpation

• Percusion

• Inspection

Know what lab tests are performed on respiratory disease pt?

Know why PFT’s in neonatal and pediatric pt are hard to measure and the special considerations involved?

• Pt Cooperation

• Environment

Know the CXR positoins and which one you would use for an intubated pt?

What will you see on a baby xray with asthma?

• Hyperinflation

• Hyperlucent (Airtrapping) DARK

What will you see on a baby xray with meconium?

• Bilateral infiltrates (chunky)

• Air trapping

what will you see on a baby xray with CF?

• Over airfilled

• Mucus plugging

• Hyper-aeration

what will you see on a baby xray with ARDS?

• Fluffy infiltrates

• Light lung appearance

what will you see on a baby xray with TTN?

• Stringy infiltrates

• Hyper-aerated

• Fluid filled streaks

What is a diaphragmetic hernia?

• Opening in diaphragm that allows abdominal organs to migrate into chest cavity

• No bagging but intubate asap

What will you see with a diaphragmatic Hernia?

• Sunken abdominal canity

• Barrel chest

• Vital deterioration

• Decrease BS

• Bowel sounds in chest

How do we fix diaphragmatic hernia?

Surgery

What is PIE have on a CXRAY actually? (Pulmonary interstital emphysema)

• Atelectasis

• Small dark streaks and cysts

• Black paint flicked onto with background

Know the normal structures important to an RT on an X-ray ?

• Heart

• Ribs (bones)

• Diapghram

• Airways

• Lungs

• Organs in upper abdomen

What are indications to do an ABG on a neonatal or pediatric baby?

• Signs of RD

• Change in clinical course without reason

• Post ventilator change

• Ensure proper ventilator settings

• Assess oxygenation and ventilation

Know the difference sources of blood collection for neo/peds pts?

• Umbilical Artery

• Brachial

• Radial

• Temoral artery

• Femoral

• Capillary stick

Know about pulse oximetry?

• Contains 2 LEDs

• Light passes through blood and tissue

• measures SpO2 level

transcutaneous monitoring ?

• Measures oxygenation at the tissue

• Can cause burn

• Dont use as often

What are the indications/contraindications for CPAP?

• Cardiac instability (contraindications)

• Decrease WOB (indications)

• Improve oxygenation (indications)

Understand the physiologic effects of CPAP?

Physically holds alveoli open during exhalation

Needs spontaneous breaths

When would CPAP be considered a failure in when use on pediatric and infant pts?

Identify commonly used to delivery systems and interfaces?

Identify advantages to using CPAP over mechanical ventialtion?

Describe how to manage pts recieving CPAP?

Identidy common complications and how they can be avoided?

Know how to wean a pt off of CPAP?

How can adjustments in inspiratory and expiratory Positie airway pressures affect respiratory function?

Describe the effects of noninvasive positive pressure ventilation on respiratory function?

Describe NPPV on respiraoty function for babies

Identify respiratory disorders in infants and children most amenable to trial of noninvasive ventialtion?

What disorders are most common to need NIV before Invasice

Identify common complications/Contraindications to NPPV?

Determine inital vent settings for various pt sizes?

Explain when mechanical ventilation is indicated in neonatal and pediatric pts?

I

Identify potential complications associated with mechanical ventialation and how to minimize these complications?

Foe example talk about how high VT can cause baratrauma and significantly hurt the baby

What does pressure control do?

• Bx are delivered with a preset pressure during the set time and frequency

• Volumes vary

What does volume control do?

• Delivers a set volume during a preset time and frequency

• Pressures will vary

What does dual control breath PRVC do?

• Takes a set Vt while regulating pressure

• Pressure varies

What control do we normally put babies on?

Pressure control

How would we wean a baby from MV?

When would be a good time to try to wean a baby?

What is HFOV?

Describe the relative role frequency and tidal volume play during high-frequency ventilation?

Settings, Indications and Complications associated with HFV?

Review etiology, assessment and major alterations of the lungs and management of IRDS?

Review etiology, assessment and major alterations of the lungs and management of PPHN?

Review etiology, assessment and major alterations of the lungs and management of TTN?

Review etiology, assessment and major alterations of the lungs and management of MAS?

When do we know when to give surfactant?

What kind of surfactant is there to give to babies?

Know the difference cardiac instabilities?

K

Know the Hemodynamics of a baby?

Know how to figure out a R to L and a L to R shunt?