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Peds #4
NIMonitor/O2 therapy/Meds/Cpt/Sx/Intubation
| Question | Answer |
|---|---|
| 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 |
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Dabi2
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