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Peds #4

NIMonitor/O2 therapy/Meds/Cpt/Sx/Intubation

What does a Pulse ox measure? saturation of functional Hgb
What must someone have in order for Pulse ox to work? a pulsating capillary bed
Advantages of Pulse Ox monitoring? rapid, continuous, responds to changes within seconds, no heating or calibrating
Disadvantages of Pulse Ox? no indication of alveolar ventilation, light interference, motion artifact, emitter and detector must stay aligned
Sites you can put a Pulse ox Infants-hands excluding thumbs,feet, wrist; Older children- hands, feet, toes, fingers
How does Transcutaneous monitoring work? Uses probes and electrodes to continuously read O2 or CO2
Advantages of Tc Monitoring? immediate and continuous, monitors during procedures, can detect deterioration, used for weaning
Disadvantages of Tc monitoring? must have good perfusion, burns skin, needs to be calibrated, and less correlation of values at extreme CO2
What type of babies must you not use Tc monitoring on? micro-preemies
Clinical situations that would cause capnograph reading of CO2 to decrease? partial obstruction or leak
Clinical situation that would cause capnograph reading of CO2 to increase? complete obstruction or circuit disconnect
A decrease in Hgn concentration will lead to a decrease in what? oxygen carrying capacity
2 early signs of Hypoxia tachypnea and tachycardia
3 late signs of hypoxemia apnea, cyanosis, and bradycardia
How does hypoxemia cause irritability? depletes energy stores and eventually leads to lethargy
In the infant what prevents rapid desats and how? fetal Hgb bc it has increased affinity for O2
Problems associated with Hypoxia local vasodilation, Pulmonary vasoconstriction, metabolic acidosis, tissue damage, impaired surfact production and neuro impairment
Causes of hypoxemia lung immaturity/disease (V/Q mismatch), Sepsis(55% have apnea and cyanosis, Krebs cycle utilizes oxygen), and stress (stress mediators increase O2 demand)
4 hazards of Oxygen therapy O2 induced hypoventilation, Absorption atelectasis, Retinopathy of prematurity, and Chronic lung Toxicity (BPD)
Describe Oxygen induced hypoventilation Occurs in pts with baseling PaCO2>50, increasing PaO2>60 removes hypoxic drive and stimulates peripherl chemoreceptors thus decreasing ventilation
What is Nitrogen? an inert gas that maintains a residual volume in the alveoli
Describe Absorption atelectasis as oxygen increases partial pressure of Nitrogen decreases(volume decreases) and pulmonary vasculature dilates resulting in atelectasis and V/Q mismatch
Descibe retinopathy of Prematurity Increase PaO2 >100 causes retinal vasoconstriction damaging endothelial cells leading to fibrotic changes in eye tissue resulting in scarring and permanent visual impairment
Describe Chronic Lung Toxicity(BPD) Biochemical products from oxygen cause varying degrees of structural and metabolic changes within tissue cells resulting in epithelia cell cell damage, alteration and damaged Type II cells
Examples of oxygen free radicals include superoxide ions, hydrogen peroxide and hydroxyl radicals
7 Factors increasing risk and severity of O2 Toxicity O2, Duration of exposure, Level of FiO2, Lack of antioxidant defense, Nutrition Deficiency, Hormonal influence, and Prematurity
What are Variable performance O2 delivery systems? Low flow systems bc the oxygens concentrations vary with RR, depth, and flow rate.
3 examples of variable performance o2 delivery systems? NC, Simple mask, and Reservoir mask
What are Fixed performance deliver systems? High flow bc they can meet or exceed the pt inspiratory demand while providing an accurate O2 concentration
3 examples of Fixed performance delivery systems? Air entrainments masks, air-entrainment nebs, and O2 blender systems
What are Enclosure O2 delivery systems? provide some means of controlling temp, humidity and O2 concentration
Examples of Enclosure delivery systems oxyhoods, tents, and isolettes
Monitoring O2 analysis should be done when continuous for hoods and vents, Q 2-4 hours and with changes on blended gas systems
O2 analyzers must be _____ and alarms set at what? calibrated; +/- 2
For infants you must regulate oxygen to maintain what PaO2? 50-70mmHg
Why is capillary blood glas not always reliable for PaO2 bc when PaO2 <60, CBG~10 less
What can lower PaO2 results? Pain/crying
Transcutaneous monitors are used for what and should be validated with ____ trending; ABG
Pulse oximeters are not reliable when SaO2<__% 70%
How much aerosolized medications reach the lungs for deposition? 8-12%
Factors reducing rate and deposition of aerosol medication in pediatric patients lg tongue, nose breathing, narrow airway, fast RR, small Vt, inability to hold breath, High ins flow rate during crying
There are no recognized doses for pediatric patients so __% of drugs have disclaimers for ped pt 90%
Aerodynamic diameter is > _ micrometers--airways 5
What size particles deposit in the lung parenchyma 0.8-2um
What are Beta 2 adrenergic agonists used for and give examples acute asthma and bronchospasm, Ex: albuterol and Terbutaline
What are Parasympatholytics used for and give examples of grugs chronic bronchitis and decreasing secretions, Ex: atropine and Atrovent (no effect on ciliary function)
What are corticosteroids and give an example anti-inflammatory used for asthma and BPD, Ex: Pulmicort
What is Pulmozyme? mucolytic agent that reduce viscosity of sputum by hydrolizing extracellular DNA, normally given to Cf pt
What do methylxanthines do and give an example of a drug used as bronchodilators for asthma, BPD pt, used to stimulate CNS in apneic pt, used to stimulate cardiac muscle and promote diuresis, Ex: Thephylline
What is the therapeutic serum theophylline range 10-20 ug/ml
Adverse effects of methylxanthines nausea, vomiting, abd. pain, insomnia, seizures,headache, nervousness, tachycardia, tachypnea
3 Purposes for CPT? remove excess secretions, reverse/prevent atelectasis, and strengthen respiratory muscles
7 examples of conditions that usually require CPT? CF, Asthma, Bronchiolitis, Pneumonia, Atelectasis, Post-op, and NM
Contraindications for CPT? Pulmonary hemorrhage, pneumothorax, hemoptysis, unstable cardiovascular disease, elevated ICP, or internal organ trauma
3 Contraindications for Postural drainage head injry, Aspiration, IVH
Suctioning vaccuum pressure for neonates 60-80 mmHg
Suctioning vaccuum pressure for pediatrics 80-100 mmHg
How deep should you advance the suction cath? just to distal tip of ET tube, never touch carina
What size suction cath should you use? 1/2 internal diameter of ETT/Trach, never occlude
Describe technique to suction and pediatric/neonatal pt Preoxygenate 10-20%, ventilate with same PIP, 10 seconds only, Oxygenate and ventilate between passes
Wetting agent for lavage NSS
Detergent for lavage NaBicarb or mucolytics
3 reasons closed systems are better for suctioning maintain PEEP, prevent alveolar collapse, and prevent infection
Clinical signs to observe for during Sx cardiac arrhythmias from vagal stim, hypoxia, bronchospasm, trauma, pulm air leak, accidental extubation, and atelectasis
What are the ETT tubes made out of? nontoxic plastic or polyvinyl chloride
Describe the ETT tubes radiopaque line, vocal cord guide near tip, murphy eye, and cm markings as reference when securing
Who are uncuffed tubes used for and why? up to 8 yrs old, prevents damage to delicate tissue
Common uncuffed sizes are 2.0-4.0
Common cuffed sizes are 4.5-8.0
Tube size for infant < 1000g 2.5
Tube size for infant 1000g to 2000g 3.0
Tube size for infant 2000g to 3000g 3.5
Tube size for infant >3000g= 4.0
How do you determine tube size for children (age in yr + 16)/4 or (age/4) +4
Where should the ETT be seen on CXR in infants between 2nd and 3rd rib
Where should ETT be in CXR of child tip half way bw the carina and clavicles or 2cm above the carina
What type of pt do you wean slow? any shunting like in PPHN
How would you wean preemies? as quickly as possible
Created by: Dabi2