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RCP213 Peds Test 1
Peds Review for Test #1
| Question | Answer |
|---|---|
| What conditions delay surfactant production? | Acidosis, Hypoxia, shock, overinflation, mechanical ventilation, pulmonary edema, hypercapnia, maternal diabetes and small twin |
| What is considered a good L/S ratio? | Lecithin/Sphingomylin Ratio of 2:1 *another test Surfactant/Albumin |
| Name the factors affecting prenatal and post-natal lung growth | Pneumonectomy, altered metabolic rate, high O2 concentrations, maternal cigarette usage, chest wall compression, oligohydramnious, decrease respiratory effort |
| What does surfactant do? | Reduces surface tension in the alveoli |
| How does the radius of alveoli affect surface tension? | ↓Radius = ↑Surface tension Laplace's Law |
| What is Pulmonary Hypoplasia? | Failure of lung development in utero |
| What is Oligohydramnios? | insufficient amniotic fluid |
| What is the only component of the lung to multiply post-natally? | Alveoli |
| At what week is there a surge in surfactant production? | 32 weeks |
| At what week of development do "true alveoli" develop? | 32-34 weeks |
| What are the function of type I and type II cells? | Type I - create A/C membrane Type II - produce surfactant |
| What is the age of viability and what stage is it in? | 23 weeks Canalicular |
| Name the 5 fetal developmental stages (in order) | 1. Embryonal 2. Pseudoglandular 3. Canalicular *Viable 4. Saccular 5. Alveolar |
| What are conditions that accelerate surfactant productions? | Maternal diabetes, PROM-Premature Rupture of Membrane, Maternal Hypertension, Placental insufficiency, Maternal Admin of Betamethasone, Abruptio Placentae |
| At what gestational age is the heart fully developed? | 8 weeks |
| A fetal heart beat can be heard at what gestational age? | 4 weeks |
| What is a potential condition resulting from oligohydramnios? | Renal disorder and/or cord collapse |
| What is a potential condition resulting from polyhydramnios? | Downs Syndrome |
| What is polyhydramnios? | Excessive Amniotic Fluid |
| What is the Amnion? | The sac that surrounds the baby? |
| How much lung fluid is removed during a vaginal birth? | 1/3 |
| What is the composition & quantity of fetal lung fluid? | Term 20-30 ml/kg mainly electrolytes |
| Fetal lung fluid is a metabolically active organ. true or false? | True |
| What is an indication for chest compressions i a neonate? | HR<60 |
| What are indications for PPV in a neonate? | 1. shallow or slow respirations 2. Gasping or apnea 3. HR<100 *after stimulation |
| What are the causes for fetal asphyxia? | Maternal Hypoxia, Insufficient placental blood flow, Blockage of placental blood flow, Fetal disorders |
| What is the term for the umbilical cord being wrapped around the neck? | Nuchal Chord |
| What are possible causes for Rales/Crackles in a neonate? | Pulmonary Edema, RDS, Pneumonia |
| What are the possible causes for diminished or absent breath sounds in a neonate? | Pneumothorax, atelectasis, loss of lung volume |
| What are the signs of respiratory distress in a neonate? | 1. Tachypnea 2. Central Cyanosis 3. Nasal Flaring 4. Expiratory Grunting 5. Retractions (clavical the worst) |
| How do you calculate mean B/P in a neonate? | Gestational age (weeks) +5 |
| What is the normal HR for a neonate? | Norm 120-170 Bradycardia HR<100 Tachycardia HR>170 *apical pulse |
| What is a normal RR for a neonate? | 40-60 -Not always regular -Period breathing not apnea <10 seconds |
| A blue hue to the lips, head or trunk indicate what? | Central Cyanosis (possible hypoxemia) |
| A newborns' yellowish coloring indicates what? | Possible jaundice |
| What is Acrocyanosis? | Peripheral bluing (hands/feet) |
| What will the ears and feet look like on a preemie? | Ears-floppy, Feet-slick soles |
| What is lanugo? | Body hair that appears at 26 weeks and starts to disappear at 36 weeks and is gone at 40 weeks |
| What is Vernix and how does it help with estimating age? | Vernix cheese-like covering that appears at 20-24 weeks and begins to disappear at 36 weeks. |
| Name 4 important items of OB history | 1. Number of pregnancies 2. Number of premature deliveries 3. Number of abortion/miscarriages 4. Number of living children |
| Trace blood flow from the RA to the aorta | 1. RA 2. RV 3. Pulmonary Artery 4. Lungs (10%) 5. Pulmonary Vein 6. LA 7. LV 8. Aorta (body) |
| Where is the most oxygen-rich blood found int he fetal circulatory system? | Inferior vena cava |
| Trace blood flow from the superior vena cava to the descending aorta | 1. SVC 2. RA 3. RV 4. Pulmonary Artery 5. Ductus arteriosus 6. Descending aorta (lower body) |
| Trace fetal blood flow from the RA to the aorta | 1. RA 2. Foramen ovale 3. LA 4. LV 5. Aorta (body/brains) |
| What are the first four steps of fetal blood flow? | 1. Placenta 2. Umbilical vein 3. Ductus venosus 4. Inferior vena cava |
| The placenta contains as much as 50% of fetal blood volume true or false? | True |
| The ductus arteriosus shunt blood away from which fetal organ | The lungs |
| The ductus venosus shunts approximately 50% of blood around the fetal liver. true or false? | True |
| The ductus arteriosus is usually fully closed 2-4 weeks after birth. true or false? | True It becomes ligamentum arteriosum |
| What are reasons for decreased PVR in normal transitions? | 1. Fluid is removed from alveoli 2. As alveoli expand they pull pulmonary vessels 3. O2 increases reverse vasoconstriction |
| What establishes FRC? | Baby's first breath |
| What must occur for fetal shunts to close? | PVR must decrease below SVR |
| Name the 4 things that must occur for successful fetal-neonatal transition | 1. Activation of CNS and ANS 2. Replace lung fluid with air 3. Establish pulmonary circulation 4. Change blood flow in heart & great vessels |
| The umbilical cord has one artery and two veins. True or False? | False Two arteries carrying mixed blood back to the placenta and one vein carrying oxygenated blood to the fetus |
| What is the gelatinous covering on the umbilical cord? | Wharton's Jelly |
| Name the three fetal shunts | 1. Ductus venosus 2. Foramen ovale 3. Ductus Arteriosis |
| Why is fetal PVR higher than SVR? | Fluid in the alveolus (increased pressure) Vasculature is poor (increased resistance) |
| Pulmonary vascular resistance is lower in fetal circulation True or False? | False |
| What is the name of the shunt between the RA and LA in fetal circulation? | Foramen Ovale |
| What is Placenta Previa? | Placental implantation at the cervix preventing vaginal delivery |
| What is prolapse cord? | When the umbilical cord precedes delivery of the body |
| What is the name for a placenta that has prematurely separated? | Abruptio Placentae |
| How is IVH/PVL confirmed? | Cranial ultrasound |
| What is the key clinical presentation of IVH/PVL? | Abrupt drop in hemocrit with no response to transfusion |
| What is periventricular leukomalacia (PVL)? | Leaky vessels in the brain |
| What is intraventricular hemorrhage (IVH)? | Vessel rupture in the brain as a result of weak vessels or anoxic brain injury |
| What is retinopathy of prematurity (ROP) | Eye damage caused by retinal constriction in response to excessive O2 |
| What is pulmonary interstitial emphysema (PIE)? | Air dissects throughout the interstitial tissue of the lungs |
| What defines chronic lung disease (CLD) in infants? | 1. Requires O2 or mechanical ventilation and 2. Continues to require O2 at 36 weeks |
| What is the name of the CLD that exhibits over and under distention? | Broncho pulmonary dysplasia (BPD) |
| What is the lung disease that appears to resolve and returns 1-5 weeks later? | Wilson-Mikity Syndrome |
| Lung damage in infants younger than 30 weeks is preventable. True or False? | False |
| What defines Apnea of Prematurity? | 1. Absence of breathing >20 seconds or 2. shorter episodes with bradycardia or cyanosis |
| What is the gold standard for confirming PPHN? | Echo-cardiograms |
| What is another name for persistent pulmonary hypertension? | Persistent fetal circulation |
| All infants get w/MAS get suctioned completely. True or false? | False-vigorous infants are not suctioned below vocal chords |
| Cerebral palsy can be caused by hyperoxia at birth. True or false? | False-caused by hypoxemia |
| Meconium Aspiration Syndrome can lead to hyper inflated alveoli. True or False? | True-Ball Valve Effect |
| Name the five causes for transplacental pneumonia (TORCH)? | Toxoplasm Other- Rubella CMV-Cytomeglia Herpes |
| What ate the three categories of neonatal pneumonia? | Transplacental Perinatal Post Natal |
| What is the primary Tx for TTN? | 1. Oxygen Therapy 2. CPAP or Mechanical Ventilation |
| What is another name for "Wet Lung Syndrome"? | Transient Tachypnea of the newborn (TTN) |
| What is the cause of transient tachypnea of the newborn? | Delayed re-absorption of fetal lung fluid |
| What does the X-ray look like for RDS? | Clouded, opaque and ground glass |
| What are the respiratory clinical presentations of RDS? | Grunting, tachypnea, retractions, nasal flaring, cyanosis |
| The net effect of RDS is Hypoxia and Mixed Acidosis. True or false? | True |
| Severe RDS patients tend to die from other problems. True or False? | True |
| Term infants with RDS typically have what maternal influence? | Diabetes |
| RDS is a syndrome associated with prematurity or stressed high risk infants. True or false? | True |
| Surfactant surges when? | 34 weeks |
| What is another name for RDS? | Hyaline Membrane Disease |
| When does RDS peak? | 72 hours |
| What happen to the umbilical cord after 40 weeks? | It becomes stiff |
| What may be indicated by wheezes? | Any CLD |
Created by:
JimStry
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