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Peds Comp Final
Respiratory Comprehensive Final on Pediatrics
| Question | Answer |
|---|---|
| O2 Therapy Hazards | ROP, Fire hazards, O2 Toxicity, Cerebral vasoconstriction |
| Sxn Hazards | Bradycardia, Hypoxemia, Mucosal damage, Increased ICPs, Atelectasis, Accidental Extubation, Infection, Vagal stimulation |
| CPT Hazards | Increased ICP, Hypoxemia and SOB, Increased HR and RR (baby develops distress or decreased SpO2 while doing CPT (or sxn) stop tx, notify RN and MD |
| CPT Indications | Mobilized secretions, Treat Atelectasis, Increased secretions, Diseases indicating clearance: CF, BPD, pneumonia |
| Silverman Score | Grades severity of underlying lung disease |
| Head Injury Tx | Begin at accident site, Maintain airway: Intubate if Glasgow <7, Hyperventilate to keep PaCO2 25-30 mmHg(cerebral vasoconstriction & decreases blood flow to head), Hyperoxygenate, Treat high ICPs,: Phenobarbital & Lasix, Keep head of bed 30-45 degrees |
| Glasgow | Determines LOC |
| Lanugo | Fine hair on fetus skin |
| CF Late Complications | Cor pulmonale, Pulmonary hypertension, Bronchiectasis, Hemoptysis |
| BPD Factors | O2 toxicity, Barotrauma, Presence of PDA, Fluid overload |
| Croup Tx | Cool mist or cool air, Racemic epinephrine, Steroids, Hydration, Intubations only if VERY SEVERE and airway is compromised |
| Oxyhood | 7-10 LPM |
| Racimic Epinephrine | Used for upper airway edema, Vasoconstrictor |
| BPD Tx | Support bronchial hygiene |
| BPD Signs/Symptoms | Refactory hypoxemia, Cyanosis >50% FiO2, Expiratory grunting, Tachypnea, Marked (severe) retractions, Nasal flaring, Severe distress, Crackles and wheezes |
| RDS CXR | Ground glass appearance and hypoinflation; Reticulogranular densities and air bronchograms; Total white out in later stages of RDS |
| TTN CXR | Perihilar streaking w/ hyperinflation; Ground glass or reticulogranular w/ air bronchograms (like RDS CXR, but lungs HYPERINFLATED not HYPOINFLATED) |
| Anti-convulsants | Phenobarbital: Alters CNS by either depression or excitation, Dilantin: Inhibits spread of seizure in motor cortex of brain, Felbatol: peds mostly, Depakote- petit mal seizures, Tegretol- peds mostly |
| Sedatives | Chloral hydrate, Diazepam (valium), Lorazepam (ativan), Midazolam (versed), Morphine sulfate, Fentanyl citrate |
| Chloral hydrate | Used to calm agitation and aid in sleep |
| Diazepam (valium) | Sedative that also relieves anxiety, Also used for opiate withdrawal |
| Lorazepam (ativan) | Used for anxiety & sleep |
| Midazolam (versed) | Short-acting, rapid onset sedative, Hypnotic agent used for anesthesia (“twilight drug” pt not fully out, but doesn’t remember), Often used before procedure |
| Morphine sulfate | Muscle relaxant, Used for pain & sedation |
| Fentanyl citrate | 100 times more potent than morphine, Used for pain & sedation before procedure, Used to control chronic pain (fentanyl pops!) |
| Paralytics | Panuronium bromide (Pavulon), Vecuronium bromide (Norcuron), Rocuronium bromide (Zemuron) |
| Succinylcholine (Anectine) | Only depolarizing muscle relaxant, Used often due to short onset (<1 min) & short duration (<5 min) |
| Capillary Sticks | Useful for pH and CO2 (not O2), Primarily used once UAC removed, Best way to see acid-base on infants few weeks old |
| RDS Signs & Symptoms | May present healthy and deteriorate within 1st few hours, Refactory hypoxemia (not response to O2): Cyanosis >50% FiO2, Expiratory grunting, Tachypnea, Marked (severe) retractions, Nasal flaring, Severe distress, Major contributor Prematurity |
| NIF | Normal spontaneously breathing pt= > -60 cmH2O, Normal ventilator Pt= >-20 cmH2O, NIF < -20 cmH2O indicates muscle weakness (vented or non-vented) |
| T-wave | Ventricular Repolarization |
| ABG Needle Position | Hold like pencil (bevel side up), @ 35-45 degree angle, Advance until flash of blood then stop |
| P-wave | Atrial Depolarization |
| Sinus Rhythm Rates | SA= 60-100, AV= 40-60, Perkinje Fibers= 20-40 |
| DLCO | Diffusion capacity of the lung for Carbon Monoxide, Differentiates between asthma and emphysema, Decreased DLCO=Emphysema |
| Wrights respirometer | Sensitive to flows over 300 LPM, Sensitive to moisture, NEVER used for PEFR or FVC (too much flow) |
| Torsades De Pointes (TDP) | "Twisted Helix" Tx: Magnesium |
| Goals of Home Care | Support and maintain life, Promote quality of life, Improve patients well being, Improve self sufficiency, Ensure cost effective patient care |
| Home Care Conditions to be Met | Stable- no longer needs acute/sub-acute care, Can care for themselves safely, Can accurately administer prescribed therapy, If patient cannot, family/ caregivers must be able to perform therapy, Home environment must be adequate |
| Home Mechanical Ventilation Conditions | No dyspnea on vent, Acceptable ABGs, FiO2 <40%, Psychologically stable, No life threatening cardiovascular issues, PEEP <10 cmH2O, Less sxn needed, No re-admission to hospital for over a month |
| Discharge Planning | Incorporates 3 basic principles: Appropriateness of discharge, Optimal site of patient care, Financial resources |
| O2 Conserving Devices | Reservoir cannula (or pendant cannula), Transtracheal delivery system (catheter), Pulsed dose system |
| Pre-Pulmonary Rehabilitation | Before: Objective baseline, repeated halfway through: Objective measure of progress, to be done @ end: Objective measure of success- Includes:Complete pt hx, lab work, Diagnostic studies, Cardiopulmonary stress testing, Lvl of dyspnea, 6 min walk test |
| Good Candidates for Pulmonary Rehab | Moderate to severe COPD, Exercise limits due to severe dyspnea, Post lung resection, Motivated, willing participants |
| Poor Candidates for Pulmonary Rehab | Malignant neoplasms in lungs (cancer), Progressive neuromuscular abnormalities, Severe arthritis |
| 3 Domains of Learning | Cognitive: Understanding why, Affective: Understanding benefit, Psychomotor: Understanding how |
Created by:
geko546
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