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Pediatrics Exam 2

Respiratory Exam on Pediatrics

Incubators (aka isolettes) Temp lvls= 36.5C, FiO2 about 25-40%, Hazard: More difficult accessing baby
Internal Thermal Gradient (ITG) Difference between core temp and skin temp, Preemies have less ability to maintain ITG due to: Large skin surface area, Thin skin, Less brown fat, Can’t take in enough calories to produce heat, Response to cold impaired by hypoxia
SXN indications Lack of effective cough (weakness, paralysis), Cilia not fully developed, Diseases indicating clearance (RDS, BPD, MAS), Excessive secretions, Prophylactic (to avoid reintubation), Sputum sample
Umbilical Cord ABGs Artery: pH= 7.20-7.30, CO2= 43-53, O2= 12-24 Vein: pH= 7.25-7.35, CO2= 33-43, O2= 22-34
O2 Devices NC, Mask, Tent, oxyhood, incubator
SXN Hazards Bradycardia, Hypoxemia, Mucosal damage, Increased ICPs, Atelectasis, Accidental Extubation, Infection, Vagal stimulation
Neonatal Arterial Blood Gases Method and area of collection depends on age of child, Scalp pH, Cord gas, Umbilical artery catheter • Radial artery catheter • Arterial puncture • Capillary sticks
O2 Hazards Retinopathy of prematurity (Blindness caused by retinal vasoconstriction, Prevent by keeping PaO2 60-80 and SpO2 87-92%), O2 toxicity-Leads to BPD, Cerebral vasoconstriction-Less blood flow to brain, Fire hazard-No hot wheels or metal toys
Oxyhood Hood only goes over baby’s head to shoulders, connects to aerosol system via o2 blender, Provides Pt access, Liter flow= 7-10 LPM to avoid CO2 build up, FiO2 analyzed close to baby’s head for accuracy, FiO2 range= 21-100%
Nasal Cannula 0.25-6 LPM (NL range), Blended O2 used in nursery, May not be tolerated by toddler
Acceptable PaO2 in neonates= 40-70
Hypoxemia Heart rate changes (Tachycardia in kids/adults, Bradycardia in newborns), Nasal flaring, Tachypnea, Decreased level of activity, Grunting, Low saturations
Bilirubin Levels <5 no Tx, 3-9 Phototherapy (sunlight) diaper only, 10-14 phototherapy Exchange transfusion if bilirubin rises quickly, 15-19 Exchange transfusion if levels elevated in <48 hrs Phototherapy if >48 hrs, >20 Exchange transfusion
Hypothermia 1st response to hypothermia is peripheral vasoconstriction, Shunts blood away from skin to maintain ITG, Shunts blood away from extremities to preserve core organs
Sodium Hypernatremia (high sodium)= Caused by: Insensible water loss, too much sodium intake, Hyponatremia (low sodium)= Caused by: inadequate sodium intake, renal insufficiency, diuretics
Potassium Hyperkalemia (high potassium), Caused by: acute renal failure, Baby may need dialysis to remove K+, Hypokalemia (low potassium)= Caused by: Diuretics, gastric losses
Calcium Hypercalcemia (high calcium)= Caused by: giving too much calcium, Hypocalcemia (low calcium)= Baby may be jittery, have seizures, apnea, irritability, Treat w/ Ca+, Caused by: Mom diabetic, Phototherapy, Renal disease, IV lipid infusion
Magnesium Hypermagnesia (high magnesium)= Secondary to mom being given magnesium during labor, Magnesium stops labor… passes on to baby via placenta (baby may be apnic and require ventilation)Hypomagnesia (low magnesium)= Associated w/ hypoglycemia
4 ways to loose heat (ETG) Radiant: Loss of heat to things cooler around baby (but not in contact with), Conductive: Loss of heat to cooler things in contact w/ baby, Convective: Loss of heat through air passing around baby, Evaporative: Water leaving surface of skin
HR Neonate= 110-160, Infant= 100-120, Child= 80-100
RR Neo= 30-60, Inf= 25-50, Child= 15-30
BP Neo= 60/40 (60-80/40-50) (>60 systolic), Inf= 70-95, Child= 80-110
APGAR Assesses need for resuscitation
Ballard Assesses gestational age by maturational examination
Hemoglobin 14.5-18 g/dl
Hematocrit 45-56 g% (3x Hgb)
Thermoregulation Balance between heat production and heat loss, Around 26-30 weeks, fetus develops brown fat,Used for heat production since baby can’t shiver
Created by: geko546