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rt 104
midterm 1
| Question | Answer |
|---|---|
| what phase of human lung develoment occurs from 17-26 week of gestation and is characterized by the formation of a capillary network around the airway passages? | canicular |
| regarding postnatal lung growth, by what age do most alveoli that will be present in the lung for life develop? | 1.5 years |
| what mechanism appear to explain why oligohydramnios is associated with lung hypoplasia | mechanical restriction of the chest wall, interference with fetal breathing, failure to produce fetal lung liquid. |
| what is the purpose of the material being secreted by the type II pneumocyte | to reduce surface tension |
| what vascular network is the major source of fetal lung liquid? | pulmonary circulation |
| what is the function of wharton's jelly inside the umbilical chord? | to prevent the vessels inside the cord from kinking |
| during the third gestational week, which organs is the first to form? | heart |
| what is the aproximate fetal heart rate by the sixth week of gestation? | 95 |
| what anatomic structures constitute fetal shunts? | foramen ovale, ductus venosus, ductus arteriosus |
| what event causes cessation of the right to left shunt through the foramen ovale? | increased systemic vascular resistance |
| what event or condition is the most important risk factor for preterm birth? | prior preterm delivery |
| whats generally accepted as a safe limit for alcohol consumption during pregnancy | no safe range of alcohol is deemed safe during pregnancy |
| what's the average birth weight difference between infants born of mothers who smoke and those of non smoking? | infants born to smokers tend to be 200g lighter than infants of non smokers. |
| what conditions are associated with preeclampsia | proteinuri, generalized edema, hypertension |
| what maternal or fetal conditions are associated with pregestational diabetes? | metabolic disturbances and fetal death |
| what drug is recommended to treat a group of B strep infection for a pt who is allergic to pcn | clindamycin |
| whats the main potential problem associated with the premature rupture of membranes? | fetal infection |
| how should the therapise interpret an amniotic fluid index of 25 cm? | polyhydramnios |
| a fetus is undergoing contraction stress test, uterine contractions stimulated by oxyticin, fetal PO2 drops below 12 and causes fetal heart to slow? what condition is likely to cause this? | unteroplcental insufficiency |
| how should a therapist interpret a fetal biophysical profile score of 6? | fetus appears to be normal |
| while trying to obtain a blood scalp gas sample, what can the therapist do to conduct an intrapartum assessment of the fetus? | fetal scalp stimulation |
| what medications are used as tocolytics? | magnesium sulfate, indomethacin |
| team has been called to delivery room for neonate resuc no perinatal history is available. what infor would be useful to know in order to prepair? | number of babies expected, gestational age, presence or absence of muconium |
| what measures can the therapist take to prevent heat loss and cold stress before preforming resuscitation on a preterm neonate> | dry infants skin, wrap the infant in prewarmed blankets, remove wet linens from around the infant |
| while stabilizing a preterm before resuscitation the therapist notices the infant display laryngeal spasm, bradycardia, and delayed onset of spontaneous breathing what could have caused this? | applying vacuum pressure in a range of 50-60mmhg |
| head of neonate presents at birth contaminated with muconium, heart rate montiro indicates 120 pulse and physician notes the infant has good muscle tone and a strong respiratory effort what measures should the physician take to provide airway care? | don't preform tracheal suction at this time |
| preterm neonate w a pulse of 55 is recieving ppv immediately after delivery, what should the therapist due at this time? | apply cardiac compressions and maintain ppv |
| term infant is born displaying acrocyanosis what should therapist due at this time? | do nothing as this condition is often transient. |
| what is acrocyanosis? | cyanosis in the extremities post birth |
| therapist completed a 1 minute apgar score w following findings, what number would they get? pale skins, pulse 90, respiratory rate and effort irregular, some muscle tone notes, no response to nasal suction | 3 |
| therapist observes newborn has adequate ventilatory efforts and pulse of 120 however infant also demonstrates cyanosis of lips and mucous membranes. what should be done? | direct 100% O2 flow at lpm about one half inch above the infants nose and mouth |
| RT sup is observing a staff member perform BVM on an infant being resuscitated. sup notices the therapist place his fingers on the anterior margin of infant's mandible and life the infants face into maks, what should the sup do at this time? | take no action because proper technique is being used |
| while performing ppv on a neonate thorax isn't displaying bilateral expansion, ausculatation diminished breath should bilaterally, pulse is at 85, central cyanosis noted. what happened? | pneumothorax, poorly placed or leaking mask, airway obstruction |
| what might be the resson for infrequent need to admin chest compression and cardio drugs to neonates in the delivery room? | delivery of adequate breath is the primary factor in effective resuscitation of neo |
| what ratio of chest chest to ppv breaths is administered to newborn during resuscitation | one to three |
| cardiopulmonary resuscitation has been performed for 90 secnonds, applying vent and 100% O2 as well as compressions, infant has maintained spont rate of 40rr what should be next? | administering epinephrine |
| which medications is used to reverse respiratory depression induced by opiod overdose? | naloxone |
| what actions are appropriate stimulation of a neonate? | flicking the bottoms of the feet and drying with a towel |
| what factors are taken into consideration when assessing the gestation age of a neonate? | prenatal ultrasound evals, postnatal findings based on physical and neurological exams, LMP |
| gestation age of a newborn is evaled at 34 wks, newborns weight is greater than 90th percentile, how is this infant classified? | LGA (large for gestational age) |
| newborn has a temp of 95.6 F axillary when arriving to the nursery, what might be responsible for this finding? | delivery room temperature was very low |
| physical exam is being performed, infants arms are moving asymmetrically. what could account for this? | an injury to infant's brachial plexus during birth |
| therapist notices an infant w irregular areas of dusky skin alternating w areas of pale skin. what conditions should therapist anticipate this pt having? | hypotension |
| what neonatal skin presentation at birth is associated w high hematocrit value or polycythemia and neonatal hyperviscocity syndrome? | reddish blue appearance |
| why are chest retractions more prominent among neonates than older children? | newborns have thin weak musculature and less rigid thorax |
| why is it difficult to localize auscultation of thorax of newborn? | neonates chest is small and sounds are difficult to differenciate |
| while examaning a newborn therapist notices pt of maximal cardiac impulse is to the left of the sternal border. what condition could be the cause? | right sided pneumothorax |
| what is a diagnostic procedure called transillumination? | direct light source towards the ipsilateral surface of the pt's thorax |
| neonate found to have bounding pulses, what condition may contribute to this? | patent ductus arteriosus and left to right shunt |
| what condition is responsible for a pulse ox indicating decreased perfusion while central blood pressure remains normal? | volume depletion with compensatory peripheral vasoconstriction |
| if assessing right to left shunt for pphtn what sires would render postductal blood? | left arm, left leg, right leg |
| what condition can cause abd distention? | enterocolitis and ascites |
| what conditions are associated with scaphoid abd? | gastoschisis and prube-belly syndrome |
| while examaning a neo's abd therapist can palpate infant's liver 1-2cm below the right costal margin. what condition can explain this? | normal liver position |
| Post umbilical chord cut of an LGA infant therapist notices its large and fat what maternal condition likely present? | Diabetes mellitus |
| newborn presents as pale, mottled, floppy, with little feeding interest and irritable most likely has? | sepsis |
| therapist placed a pulse o on finger of right hand of newborna dn on toe of left foot. pulse ox on the right hand reads 80% and left foot indicates 65% what condition is this? | persistent pulmonary hypertension |
| what white blood cell count constitutes condition leukopenia | less then or equall to 3500 mmcubed. |
| what information represents pt history for a new peds pt? | C/c, H and p, past medical history |
| 7 yo +productive cough, diaphoresis, fever while on vacation w parents what could it be? | respiratory distress (because pna is a diagnosis we can't diagnose) |
| what makes up the history of present illness? | frequency and duration of symptoms and onset |
| what makes up the past medical history? | birth weight, previous mechanical vents, previous ED visits |
| what parts of a pts medical history is intended to determine presence of symptoms not identified in the history of present illness and may relate to the underlying condition? | review of symptoms |
| child has head bobbing, nasal flairing, and grunting, is showing signs of? | respiratory distress |
| what diseases aren't chest wall deformities but are characterized by increased anteroposterior diameter? | severe asthma and cystic fibrosis |
| during exam of childs chest increased tactile fremitus noted over the right lower lobe. what may cause this? | pulmonary consolidation |
| therapist hears dull percussion note over child's right lung what can cause this? | atelectasis, pleural effusion and consolidation |
| therapist hears expiratory stridor in a child's trachea while auscultating what condition could do this? | tracheomalacia |
| therapist hears bilateral fine crackles what can produce these adventitious sounds? | pulmonary edema |
| exam of the ears, eyes, nose and throat may reveal findings associated with what condition? | allergies |
| whats the cause of hepasplenomegaly associated w advnaced CF? | right vent failure |
| what term is used to describe a low pitched wet sound similar to snoring suggesting nasopharyngeal, oropharyngeal, and hypopharyngeal airway obstruction? | stertor |
| what order should the therapist proceed in the assessment of a physical exam? | inspection, palpation, percussion, and auscultation |
| why must caution be excercised when using a face mask while PFT on neonates? | to prevent trigeminal nerve stimulation and to avert stimulation of vagal reflexes |
| gas flow measured over time is defined as | volume |
| what is the significance of hot wire anemometer containing two platinum wires? | to measure air flow during inspiration and expiration |
| which devices provide an approximate measurement of the pressure in the intrapleural space | esophageal balloon |
| whats the formula for the transpulmonary pressure gradient? | pleural pressure minus esophageal pressure |
| how is airway resisrance calculated? | dividing airway occlusion pressure by expiratory flow |
| pre and post bron partial expiratory pressure volume was performed on a 9 mth pre FRC was 67 post was FRC 94 how should this be interpreted? | pt has demonstrated a clinically significant improvement with bronchodilator administration |
| why must caution be excercised when using a face mask while PFT on neonates? | to prevent trigeminal nerve stimulation and to avert stimulation of vagal reflexes |
| gas flow measured over time is defined as | volume |
| what is the significance of hot wire anemometer containing two platinum wires? | to measure air flow during inspiration and expiration |
| which devices provide an approximate measurement of the pressure in the intrapleural space | esophageal balloon |
| whats the formula for the transpulmonary pressure gradient? | pleural pressure minus esophageal pressure |
| What PFT characterize obstructive lung disease? | FVC normal, FEV1 decreased, RV/TLC may be normal |
| if a PFT lab isn't equipped to accomodate exercise what technique can be substituted? | instructing the pt to breathe rapidly and deeply |
| the therapist is reviewing flow volume loop obtained from ped pt observes decreased volume and normal flows how should this be interpreted? | restrictive pattern |
| whats the clinical purpose of measuring MIP? | to evaluate the strength of respiratory muscles |
| FVC of 8 yo is below predicted norm, no change following administration of MDI (proterenol) this is consistent w what disorder? | cystic fibrosis |
| FEV1 for a 12 yo is below the predicted norm, marked improvement following alb results consistent w what disorder? | asthma |
| a supersyringe is used to calibrate? | spiromter |
| how is the percent of functional hemoglobin saturated w o2 determined via pulse ox? | ratio of the red and infrared light that reaches the photodiode signifies SpO2 |
| Bandage-type pulse ox prob too tightly on an infants finger what problems can be expected? | monitor will display a message indicating inadequate pulse |
| therapist applies polse oc finger prob to a neonate receiving supplemental O2 notices SpO2 reading is 100% what should therapise do in this situation? | therapist should obtain arterial blood sample from this pt |
| why do transcutaneous PO2 and PCO2 values differ from PaO2 and PaCO2 measurments? | because metabolism in tissue consumes O2 and produces CO2 at site of electrode |
| attending to NICU therapist notices that transcutaenous eletrode affixed to upper chest of neonate what should therapist do? | do nothing electrode placed properly |
| mechanically vent infant is observed w transcutaneous electrode temp set between 43-44 what action is needed? | temperature range is appropriate no action necessary |
| what factors are themain physiologic factor responsible for deriving accurate transcutaneous data? | peripheral perfusion |
| what characteristics apply to mainstream capnography? | employs infrared spectrometers and placed at the proximal end of et tube |
| what motor and linkage mechanisms are used in ventilator compressors? | electric motor/ rotating crank piston, electric motor/rack and pinion, direct-drive electric motor |
| wat valves function as output control valves? | electromagnetic poppet valves, electromagnetic proportional valves and pneumatic diaphragms |
| what is characterized as a ventilators control scheme as closed loop? | output variable measured and compared to reference and inpit cariable is modified as needed to more closely approximate desired output |
| what term is used to describe cariable responsible for intiating inspiration | trigger variable |
| what variable reaches a preset value before the end of inspiration? | limit variable |
| what variable is responsible for terminating inspiration? | cycle variable |
| what conditional variable can most easily become the baseline variable? | pressure |
| what describes the bear cub 750 vs? | a.c mode mandatory breats are time or flow triggered, if mandatory breaths are pc the resulting flow and volume waveforms are exponential, low gas supply alarm activates if wither air or O2 pressures fall below 24 +- 2 |
| the rate of increase in airway pressure from baseline at onset of inspiration is? | pressure rise breath |
| whith the drager medical evita 4 vent how will the inspiratory pressure waveform appear for a pc mandatory breath when pressure rise time is set at 0? | rectangle |
| what describes PB840 on a flow triggered breath? | backup triggereing occurs when flow differential equals value set as trigger sensitivity, backup pressure triggereing threshold of -2 cm H2o in effect when flow triggering selected, vent delivers base gas flow through pt circuit during exp phase of all |
| what settings require pt breath spontaneously? | pressure support vent w CPAP |
| on Maquet servoi whats the result of increasing inspiratory cycle off? | enables expiration to occur at earlier point in the peak flow requirements |
| whats the purpose of optional open lung tool on the servoi vent? | to assist in determining the inflatinf and deflating pressures of the lung |
| what sites can a therapist obtrain an Arterial blood sample from a neonate for acid-base and abg | dorsal pedis, temporal artery, posterior tibial artery |
| what arteries are considered optimal puncture site for ABG from neonetal and ped pts? | radial |
| what arteries are involved when modified allen's test is performed, using a foot as potential erterial puncture site? | posterior tibial artery and dorsalis pedis |
| NICU sup observing therapist w bevel of needle upward penetrating skin at 45 angle in direction against arterial flow. what should be done? | continue to observe procedure all is well |
| in addition to applying pressure to the puncture site post blood draw, what can therapist do t minimize risk of hematoma in pt who needs frequent abg's? | alternate arms used for arterial puncures as well as alternate sites |
| what factors ill adversely affect correlation between arterial measurements and capillary sample? | hypotension, hypovolemia, and hypthermia |
| 12 hour old in resp distress, heel stick is ordered what action therapist take? | inform the physician this procedure isn't indicated or appropriate at this time |
| with a UAC (umbilical artery catheter'0 in low position what blood vessels are avoided? | inferior mesenteric artery, renal artery, and aortic intersection |
| what is the average range of normal circulating blood volumein a neonate? | 85-90 ml/kg |
| Pt has a blood pressure of 100/75 whats the map? | 83 |
| what factors influence CVP? | right ventricular pressure, intravascular volume, and systemic venous return |
| how would the tricuspid stenosis be expected to influence a pt's CVP value? | elevate it above normal |
| what complications are associated w insertion of pulmonary artery catheter? | pneumothorac, bicuspid valve damage, cardiac dysthythmias,perforation of left atrium |
| what conditions can cause methemoglobinemia? | use of digocin and high fraction of inspired o2 |
| what vent settings are preset during time-cycled , pressure limited ventilation? | inspiratory time, respiratory rate, and inspiratory to expiratory ratio (I:e) |
| during volume controlled ventilation what factors influence the peak insporatory pressure? | pulmonary compliance |
| what modes of ventilation attempt tp maintain a minima target tidal volume w a constant pressure by manipulating inspiratory flow? | pressure regulated volume control |
| therapis is going to vent a neonate w vent that delivers volume guaranteed mode, what vent desstinf does therapist need to set? | tidal volume, inspiratory flow, and inspiratory time |
| therapist is initiating mech vent for 12 yo w status asthmaticus, what mode of vent is most appropriate for pt? | time or patient-triggered, pressure control ventilation |
| when airway pressure release ventilation us ised what physiologic process occurs as higher pressure is releasedand lower is achieved | exhalation of carbon dioxide |
| pt is about ot be switched from from conventional mode of vent to inverse ratio vent what should the therapist recommend? | pt be sedated and paralyzed |
| what factors influences gas volume compressed in the ventilator circuit? | water level in the humidifier |
| therapis is doing a vent check on a neonate notes peep5, pip 25, f 15 fio2 35 what should be recomended? | weaning from mech ventilation |
| a newboorn w meconium aspiration syndrome is breathing spont in an 89% O2 hood, ANG results are pH 7.18, PaCa2 56, PaO2 40, HACO3 21. what is recomended? | mechanical vent |
| ped pt w bacterial pna has ABG of pH 7.20, CO2 55, PaO2 61 haco3 22 what should be recomended? | mechanical vent |
| what whould be the most appropriate ventilator for pre term infant? | pressure limited time cycled ventilator |
| an adolescent receiving volume vent should receive a deliverd Vt witin what range? | 6-10ml/kg |
| what would be the most appropriate intial vent settings for a 5-day old infant with viral pna who requires mech vent | PIP 20 IT 0.6 flow of 10 l/min resp 20 |
| CPAP and pressure supposr are therapeutic modalitites most often utilized to | wean patients from mechanical vent |
| what would be best initial vent setting for a premature infant w respiratory distress | PIP 25 1T 0.5 flowrate 10 L/min and rr 30 |
| what is the ideal respiratory rate range for ventilation of a newborn infant? | 20-40 l/min |
| for time cycled ventilators inspiratory time is calculated by? | inspiratory time= TCT/(I+E) |
| preterm infant has received time cycled pressure limited ventilation for 12 days ehen he develops bronchopleural fistula. should recomend | high frequencey ventilation |
| adolescent pt suffering from an OD is being mechanically ventilated at these settings AC, 0.03 fio2, 16 f, flow 20, vt 600ml, pressure limit 40. pressure alarms ounds twice action is | increase the flow rate |
| to estimate Vt when using a time cycled vent noenoatla ped should use what formula? | Vt=flow rate x inspired volume |
| what condition should the neonat-oed specialist increase the madator minute vent settings? | fever, septicemia, increased metabolism |
| whaich of hte following confitions should the neonatal-peds specialist decrease the madatory minute vent settin? | weaning |
| what modes can be utilized w IMV to decrease the WOB? | pressure support ventilation |
| what controls determine the tidal volume delivered with a time cycled infant vent? | inspired flow |
| what are indications for pediatric ventilations? | chronic hypoxemia |
| high frequencies and lower PIP would be usedful in treating which of the folloing abnormalities? | infant respiratory distress syndrome |
| Infant is on a vent time cycled pressure limited vent at rate 20 ff I:E ratio 1:2 flow rate of 10:/min what's inspiratory time? | 1.0 |
| ped pt is on vol vent Vt 500mL, 18f, FiO2 40 flow rate 40 L/min whats inspiratory time? | 0.75 sec |
| Adolescent pt heroin OD set up on vent on Volume vent, 20F, Vt 500mL, I:E ratio 1:2 what would the flow be? | 30l/min |
| pressure alarm is sounding on vol vent increase in pt's static lung compliance, noenatal specialist recomends? | increasing the pressure limit |
| Ped pt developing resp distress is on Vt 500mL F12, PEEP 6 FiO2 100% in the assist control. Physician wants PaO2 increase without dumping BP | administer fluid challenge |
| MAP increases w increase of? | PIP, PEEP, F |
| MAP shouldnt exceed what? | 12cm H2o |
| sedation/paralysis would not be indicated for what? | guillain barre's syndrome |
| what paralyzing/sedative agent isn't reversable | succinylcholine |
| what drugs are reversed by administration of nalaxone | morphone sulfate |
| what are contraindications for CPAP | tracheoesophageal fistula and choanal artesia |
| What complication of CPAP can develope when infant experiences inadvertent PEEP from gas trapping resulting in tachypnea? | pneumothorax |
| what physiologic effects are associated w use of CPAPfor treatement of RDS? | stabilized chest wall, increased FRC |
| what outcomes are advantages of CPAP over mechanical ventilator in infants? | fewer respiratory related nosocimial infections, lower incidence of intraventricular hemorrhage, fewer cases of retinopathy of prematurity |
| where in CPAP delivery system should the pressure relief.pop off valve be situated? | as close to the pt airway as possible |
| what features are often components of CPAP systems incorporated w infant vents? | highly responsive demand flow systems, apnea backup breaths, leak compensation capabilities |
| how is the positive pressure level established in a bubble CPAP system? | therapise immerses the distal end of the expiratory limb a certain distance below the water surface |
| which form of CPAP is associated w a throacic wiggle? | BCPAP (bubble) |
| whats the set flow in an infant flow CPAP system based on? | flow of gas through the solenoid valve |
| which CPAP system delivers more consistent pressure, lowers WOB and is less sensitive to leas and is more effective at alveolar recruitment compared w other forms of CPAP? | IF-CPAP |
| which anatomical structures has been shown to break down because of useage of nasal masks associated w IF CPAP | philtrum |
| wWhat aBG values reflect vetn failure | PaCO2 greather than 60mm Hg and pH less than 7.25 |
| what FiO2 should a pt receive when CPAP is initiated | infant should receive the same FiO2 it was receiving before cPAP |
| after increasing level of CPAP delivered to infant therapist notices the Neonates PaCO2 rises and PaO2 falls what may cause this situation? | CPAP leve was too high |
| according to the US food and drug admin what mechanical ventilatory rate constitues a high frequency ventilation? | more than 150 breaths.minute |
| Enhanved diffuseion is a function of what factors? | tidal volume and respiratory frequency |
| what is the relationship between tidal volume and dead space volume in context of high frequency vent? | dead space volume is greater than tidal volume |
| what forms of mechanical ventilation is the most efficacious method for acquired bronchopleural fistulas? | high frequency jet ventilation |
| what describes the realtionshop between tidal volume and frequency during HFJV of pediatric and neontatl patients? | neonatal patients need higher frequencies and lower tidal volumes than pediatric patients |
| during HFOV what factors have a direct influence on a neonates delivered todal volume? | oscillatory amplitude and peak inspiratory pressure |
| during HFOV manipulation what components establishes continous distending pressure? | expiratory valve aperture and bias flow |
| what is the recommended inspiratory time percent setting for HFOV? | 33% |
| what factors need to be considered for HFV circuits? | time for gas egress during exhalation, circuit compliance, intrinsic timing mechanisms |
| what's the primary therapeutic goal when pt w lungs prone to ateectasis receives HFV? | optimize lung inflation |
| how's the high volume strategy achieved when the goal is to deliver high lung volume to a neo receiving HFV? | increasing the continuous distending pressure |
| what is a frequent requirement when low-volume strategy while ventilating a neonatal pt w pulmonary interstitial emphysema by HFV? | high inspired fraction of oxygen (FiO2) |
| how's the minute vent decreased when pt is being weaned from HFOV? | by reducint the oscillatory amplitude |
| how's the readiographic assessment of neonatal lung volue assessed? | counting the number of posterior ribs above the diaphragm |
| what are consequences of failing to quickly wean a neo pt from HFV? | pulmonary overdistention and imparied cardiac ouput |
| why did the original version of bunnell HFJV require a triple-lumen high low ETT? | for sampling pressure at distal ETT lumen and for connection to conventional ventilation through the proximal ett lumen |
| what steps are involved when assessing a pt suspected of reduction of airway diameter while receiving HFV? | observe chest wall for movement and reduce the oscillatory amplitude |
| whay may HFOV not be optimal vent for pt's w fresh particulate meconium aspiration or bronchopulmonary dysplasia | has trapping may develop |
| what issues continue to confront practice of surfactant replacement therapy? | tom,ing of surfactant replacement and method of delivery during HFV |
| high frequency ventilator has set frequency of 2.5 hertz this would be the equivalent of | 500/min |
| what are the components of high frequency jet ventilator system? | humidification system, oxygen blending system, and exhaled volume spirometer |
| the only control not present on a HFV is? | inspiratory time |
| an infant on HFOV has the aBG of pH 7.30, PaCO2 50, PaO2 60, HCO3 24 what should been done? | add peep |
| to improve oxygenation in a pt receiving HFV what can be increased? | FiO2, expiratory time, % inspiratory time |
| air trapping in pt's on HFV can be prevented by adjusting what? | frequency control |
| HFV is indicated for? | bronchopulmonary fistula |
| what is a common complication of HFV? | hypercarbia |
| what are the primary objectives of nppv? | to restore adequate carbon dioxide removal and to decrease a pt's wob |
| what's the primary goal of intermittent NPPV at night in children who have chronic disorders complicated bu alveolar hypoventilation? | to improve the quality of sleep |
| what effect should be expectred after initiating cPAP on neonate w restrictive lung disorder? | increased lung volume |
| what types of perdiatric pt has NPPV been used to stabilize airway fxn? | pt being weaned from mech vent after laryngotracheoplasty |
| what's been seen to effect NPPV on children w cystic fibrosis? | improves gas exchange |
| Pt receiving bilevel vent develops a leak at interface what action takes place at thist time | vent will automatically compensate for this leak |
| what mode of mech vent is generally absent on most portable volume controlled vent used in home? | pressure support |
| how should vc portable vent be adj to deliver appropriate Vt to ped pt during NPPV? | delivered Vt should be set at twice the child's physiologic Vt |
| when bilevel vent is used in spont/timed mode what point does the vent empley the timed feature? | during prolonged apnea |
| when NPPV used to vent ped pt what mode of vent is generally used? | spontaneous/timed |
| whats the primary rold of NPPV in treatment of children w acute resp failure? | to avoid ETT |
| whats the clinical significance of IPAP EPAP gradient in bilevel NPPV? | determines the pt's tidal volume |
| what bilevel adj would therapise need to make on vent to reduce a pt's PaCo2 | increase IPAP and EPAP |
| what bilevel vent setting influences upper airway stability? | EPAP |
| What NPPV interfaces place least amt of pressure in pt face? | nasal plugs an nasal pillows |
| what's most common complication associated w NPPV among pediatric pt's | skin irritation caused by interface |
| how can problem of conjuctival irritation associated w NPPV be overcome? | by using appropratel sized interface |
| ehat' only absolute contraindication to trial NPPV in ped pt w acute resp distress? | cardiovascular instability |
| what's a feared complication of ling-term intermittent NPPV applied by nasal mask to peds pt? | imparied maxillary bon growth |
| what type if monitoring should be used in out pt setting during NPPV for children w limited spont increase minute vent do to advanced neuro disorder | cardiorespiratory impedence monitor and pulse oximeter |
| what clinical signs receive the highest diagnostic yield in the neonatal population for flexible bronchoscopy | stridor |
| what condition is most commonly associated w stridor? | laryngomalacia |
| why is rigid bronchoschopy preferred over flixible for removal of foreign objects in the tracheobroncheal tree? | facilitates safer delivery of large foreign bodies through subglottic area and enables better vent while under anesthesia |
| a pt w cystic fibrosis has developed massive hemoptysis what's the utility of flexible bronchoscopy in this situation? | flexible bronch is usually inadequate in this situation |
| therapist selects a 3.0mm insertion tube to be used for flexible bronch on neonate who requires surfactant therapy what should therapist do w this insertion tube diameter? | substitute for a 2.0 |
| what features chracterize insetion tubes of broncoscopes described as spaghetti scopes? | lack cables necesarry to direct distal tip causing flex and distend, less then 2mm diameter, useis limited to visualization of an airway via insertion down an ett |
| what tpye of light used to iluminate airways via fiberoptic cables in bronchoscope? | halogen light and xenon light |
| what are advantages of video recording a flex bronch? | used to review findings post procedure, used to discuss treatment plans w pt/ fam, clarify lesions missed during procedure |
| what features are consistent w large flex bronch compared to smaller one? | has a suction channel and provides better visualization |
| what percent lidocain spray is used for neonatal flex bronch? | 1%-2% lidocaine |
| what drug combinations are used to induce conscious sedation in a neo undergoing a flex bronch? | benzodiazepine and narcotic |
| what medications are given in combo to achieve conscious sedation of pt receiveing flex bronch? | fentanyl and midazolam |
| during bronch on a ped pt's Spo2 is 90% what is indicated? | provide O2 till Spo2 is 95% |
| what medication is administered to pt's nasal mucosa for reducing risk of epistaxis during a bronch procedure? | phenylephrine |
| what are the most common complications of bronchoscopy? | transient cough, hypoxemia, resp depression, bronchospasm, |
| what procedure would be indicated to remove a large foreign body obstruction from child? | rigid bronchoscopy |
| a thoracentesis performed on a child reveals opaque fluid what is this associated with? | malignancy/tumors, CHF and infection |
| bronchial lavage is indicated for what disorders? | pneumonitis, cystic fibrosis, and laveolar proteinosis |
| who us honored w title of father of extracorporeal circulation? | Gibbon |
| who was the first person credited w performing cross circulation among humans? | lillehei |
| what factor is most responsible for the closures of the foramen ovale at birth? | PaO2 |
| what factors can cause pulmonary vascular resistance to reaim high at birth? | decreased PaO2 |
| what applies to meconium or meconium staining? | sterile because it originates in the fetal colon, staining is common in 10% deliveries, and hypoxemia may cause meconium to appear in amniotic fluid |
| what's the most commone microorganism responsible for neonatal sepsis? | group b Strep |
| neonat appearance 3 hours post birth:resp distress, scaphoid abd, diminished breath sounds on left side, ches xray reaveals GI structures in thorax | congenital diaphragmatic hernia |
| what action must be taken before ECLS is considered in pt w cardiac defects? | corrective vardiac surgeries first |
| what describes venoarterial ECLS? | blood removed from venous circulation through right jugular vein and cannula inserted into right common carotid artery for arterial return |
| during venovenous ECLS what effect does cardiac output have on O2 | changes in cardiac ouput either way will have little influence on the pt's O2 |
| what are major advantages for ECLS? | pulsatile flow maintained and potential emboli from circuit are trapped in pulmonary vasculature |
| deignation M number refers to the what components of an ECLS circuit? | cannula |
| what effect can a mediasinal shift have on the fxn of a venous cannula? | decreased venous return |
| what is the advantage of having centrifugal pump automtaically respond to resisitances against which its pumping? | maintains regulated flow throuh the system |
| what characteristics orefer to silicone rubber membrane in an ECLS circuit? | sweep gas flushed though air compartment optimizing gas exchange and contains separate air and blood compartments |
| in the gas membrane exchanger what limits the transfusion rate of Ocygen across the membrane? | the thickness of blood film between the membrane layers |
| in the gas membrane exchanger what limits the transfer rate of CO2 across the membrane? | gas flow |
| what can be done to lower a pt's PaCO2 when its elevated during ECLS? | increase flow of the sweep of gas |
| when a pt undergoes ECLS and experiences either oliguria or anuria what can be done to enhance fluid balance? | perform ultrfiltration |
| what factors contribute to increased rish of intraventricular hemorrhage associated with ECLS? | systemic heparinization and blood flow changes caused by ligation of both the right internal jugular vein and the right common carotid artery |
Created by:
janeth4035