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RCP213 Peds Test 1

Peds Review for Test #1

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