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Neo Resp Disease 2

MecAsp, PPH, AofP, Congenital Anomalies

QuestionAnswer
Etiology of Meconium Aspiration Hypoxia/Asphyxia, Gasping in Utero and Decreased rectal sphincter tone
What term babies can have meconium aspiration? Full term and post term
What is the composition of meconium? amniotic fluid and epithelial cells
In the Pathophysiology of Meconium Aspiration, the Ball-Valve obstruction results in what 4 things? air trapping, overinflation, alveolar collaps and pulmonary shunting
Chemical inflammation from Meconium aspiration causes what? Pneumonitis
When hypoxemia and acidosis from Meconium Aspiration are severe it leads to what? Persistent Pulmonary HTN
2 ways to prevent PPH from occuring d/t meconium aspiration are ob suctions nasopharynx during delivery, or intubate and suction infant at birth if not vigorous and crying per NRP guidelines
5 Clinical signs of Meconium Aspiration stained nails and cord, respiratory distress, Rhonchi, Metabolic Acidosis (ABG), Increased AP diameter and Hyperinflation on CXR (barrel chest)
Tx of Meconium Aspiration at birth includes CPT and Suctioning
Why do you want to keep PaO2 high after Meconium Aspiration? bc PaO2>100 helps prevent PPHN
Whay wouldn't you use CPAP on infant with Meconium aspiration? CPAP causes overinflation and air leaks
Ventilation used in cases of meconium aspiration? mechanical ventilation or high frequency- NO PEEP
In severe cases after Mecnium aspiration, waht Tx is used? ECMO
Prognoses after meconium aspiration depends on what? degree of asphyxia and aspiration
What dx process is this describing: Severely incerased PVR with rt-lt shunting occurs in term or post term babies and can be related to a clinical condition or idiopathic Persistent Pulmonary Htn
Persistent Pulmonary HTN was formerly known as what Persistent Fetal Circulation
Primary PPHN is usually caused by what? anatomic malformations
Secondary PPHN is usually associated with what? a disease
If the baby is asphyxiated, the hypoxia and acidosis cause what to occur resulting in PPHN the pulmonary vasculature to constrict
4 disease processes that can lead to PPHN severe RDS, Meconium Aspiration, CDH, Sepsis
Clinical presentation of PPHN signs of respiratory distress, hypoxia with increased O2 requirements, swings in PaO2, Acidosis
3 ways to diagnose PPHN echo or cariac cath, hyperoxia test, and simultaneous preductal/postductal ABG's
What is the hyperoxia test? place in 100% for 15 minutes and get ABG, if PaO2<50 infant has PPHN(or could be cardiac)
When simultaneously drawing ABGs from preductal/postductal sites, what result indicates PPHN present? shunting difference of 10-15
Tx for PPHN Keep PaO2 high(80-100+), wean O2 slowly, Hyperventilate , HFV, Nitric oxide, and ECMO
When hyperventilating a pt with PPHN, what do you want to keep you PaCO2 and pH between and why? PaCO2 20-30 and pH 7.45-7.55, mild pulmonary vasodilator
Why is HFV is used for Tx of PPHN? easy to creat alkalosis and decreases barotrauma
What does Nitric oxide cause? pulmonary vasodilation
Pharmacologic therapy for PPHN includes keep sedated, buffer the acidosis
What is Priscoline (Tolazoline hydrochloride), where must it be administered, and why? peripheral vasodilator given in the systemic side of the scalp so it can quickly reach the pulmonary system
What is Apnea of Prematurity and what is it associated with? no breathing for 20 seconds or greater, associated with bradycardia and desats
__% of all infants that present with Apnea of Prematurity are < __ grams 75%, 1250 grams
If a term infant presents with Apnea of Prematurity it is usually related to problems sucha as sepsis or respiratory distress
6 common causes of Apnea of Prematurity airway obstruction, CNS prematurity or disorder, Resp center depression, Temp instability, Sepsis, metabolic disorder
Tx of Apnea of Apnea of Prematurity involves what? treating the symptoms while looking for the cause
Ways to treat/find cause oo Apnea of Prematurity cardiac/apnea monitor, pulse ox, positioning, maintain temp, remove feeding tube, R/O sepsis, check ABG for acidosis or hypoxemia, bouncing bed, keep O2 los as possible, NCPAP, intubate/vent if necessary, Methylxanthines, and caffeine
Why is bouncing bed not a popular Tx for apnea of prematurity? danger of intraventricular hemorrhage
Name 3 congenital abnormalities of neonates Choanal Atresia, Treacheoesophageal Fistula, and Diaphragmatic Hernia (CDH)
What is Choanal Atresia? membrane or bony obstruction in nares, unilateral or bilateral, associated with other anomalies
3 Clinical signs for Choanal Atresia cyanosis, retractions, problems with feedings
Diagnosing Choanal atresia unable to pass a catheter down nare(s)
Tx for Choanal Atresia oral airway, hold feedings or use a special type of nipple, surgery for repair (a stent is placed during healing to hold open)
What is the definition of a T-E Fistula? a congenital interuption and or fistulous connection of the trachea and esophagus
4 Clinical signs of T-E Fistula excessive salive, drooling, choking, cyanotic episodes
Diagnosing T-E Fistula inability to pass NG tube into stomach, CXR(observe coiling of tube in esophagus), Esophageal pouch often filled with air
Tx for T-E Fistula place on abdomen and eleveate head 45 degrees, suction pouch, start IV or place Gtube, avoid agitation, trach if surgery to be delayed, surgical repair
What is a diaphragmatic hernia(CDH)? migration of abdominal viscera into the thoracic cavity
CDH occurs in how many births? 1in 3000
70% of Diaphragmatic hernias are on which side of the body? left side
Symptoms of CDH vary with what? degree of hernia and pulmonary hypoplasia
Clinical signs of CDH include scaphoid abdomen, respiratory distress, decreased BS on affected side, and mediastinal shift
A CXR of a pt with CDH would show what? air filled bowl in the thoracic cavity
What should you not do to Tx a pt with CDH do not bag/mask ventilate
Tx for CDH includes stabilize, place affected side down, keep vent pressures low to avoid barotrauma and pneumos, treat as PPHN (keep PO2>100, keep alkalotic, using HFV works well), ECMO, surgery to repair, outcome is improving
When is ECMO used to Tx CDH? used to stabilize and may also be needed after surgery
Created by: Dabi2