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Ch. 31 (Egan's) - Neonatal and Pediatric Respiratory Disorders

Quiz yourself by thinking what should be in each of the black spaces below before clicking on it to display the answer.
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Question
Answer
show 60,000-70,000  
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show hyaline membrane disease; a disease of prematurity  
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what are the 4 major factors in the pathophysiology of RDS?   show
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show PVR  
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show instability and collapse, leads to increased WOB; incr. surface tension, fluid in alveoli  
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the increased PVR leads to what? which overall leads too?   show
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what is the first sign in RDS? what occurs next?   show
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show fine inspiratory crackles  
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if central cyanosis is present, what is likely that the infant has?   show
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show systemic hypotension, hypothermia, poor perfusion  
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show chest radiography; diffuse, hazy, reticulogranular densities w/ air bronchograms w/ low lung vols  
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show CPAP and PEEP; surfactant replacement therapy and high-freq ventilation  
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show a trial of nasal CPAP, 4-6 cmH2O (nasal prongs preferred)  
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show if oxygenation doesn't improve w/ CPAP or if the pt is apneic or acidotic  
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show prevent lung collapse and maintain alveolar inflation  
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what type of tubes are used for ETT? and what type of ventilation is used for infants?   show
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what does optimal PEEP provide for RDS? what is done if high PaCO2 persists? what should the PIP be to minimize potential for volutrauma?   show
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show 1. beractant (survanta) 2. calfactant (infasurf) 3. poractant alfa (curosurf)  
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how is the surfactant given to infant?   show
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what is the dosing, ml/kg, administration, and dosing interval for beractant (survanta)?   show
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show 100; 3; 1/2 dose slowly supine then rotated; Q12 or more often  
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show 100-200; 1.25-2.5; whole or 1/2 dose supine; Q12 or more often  
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show transient tachypnea of the newborn (type II RDS)  
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show delayed clearance of fetal lung liquid  
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how much does the birth canal squeeze normally accounts for clearance? what accounts for the final third?   show
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show tachypnea; normal VA, pH, and PaCO2  
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what does the chest radiograph reveal?   show
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show low FiO2 by infant oxygen hood or nasal cannula; need higher FiO2, use CPAP  
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what is given once a culture is obtained?   show
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show 24-48 hours  
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show term and near-term infants; aspiration of meconium in central airways of the lung; perinatal depression and asphyxia  
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what does meconium consist of?   show
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amniotic fluid stained with meconium is found in approximately ___ of all births. it is rare if the infant is less than ___ weeks' gestation age. ___ of infants w/ inhaled meconium clear lungs spontaneously.   show
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show fetal asphyxia that precedes after aspiration  
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what are the 3 primary problems of MAS?   show
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show chemical pneumonia  
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show thick meconium, fetal tachycardia, absent fetal cardiac accelerations during labor  
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show gasping respirations, tachypnea, grunting, retractions  
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show irregular pulmonary densities (areas of atelectasis), hyperlucent areas (hyperinflation from air-trapping)  
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show hypoxemia with mixed resp and metabolic acidosis; R-to-L shunting and persistent PHTN  
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what should be done first for treatment?   show
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show CPAP; MV  
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what is shown to decrease the risk of air leak in MAS?   show
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show nitric oxide (DO NOT use high mean airway pressures)  
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show infants with severe respiratory failure in the first few weeks of life  
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what have been implicated in the origin of BPD?   show
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show atelectrauma and volutrauma  
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what conditions lead to BPD?   show
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__________ is the term coined to describe loss of alveolar volume that is both a consequence and a cause of lung injury. ____________ is the term used to describe local overinflation (and thus stretch) of airways and alveoli.   show
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show increased supplemental O2 concentrations  
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show decreased alveolarization rather than prominent airway damage of the "old" BPD  
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what occurs approximately 2-3 weeks of life?   show
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what does the chest radiograph for severe disease show?   show
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show hypoxemia and hypercapnia secondary to airway obstruction, air-trapping, pulm fibrosis, atelectasis  
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show prevention  
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show surfactant  
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what is involved in the treatment steps of BPD?   show
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show diuretics; antibiotics; chest physiotherapy; bronchodilator  
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what is given to produce substantial short-term improvement in lung function, often allowing rapid weaning from ventilatory support?   show
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show 5-10 seconds followed by 10-15 seconds of rapid respiration  
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show 1. they last longer than 15 secs 2. they are associated with cyanosis, pallor, hypotonia, or bradycardia  
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show if no effort to breathe occurs during a spell  
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show if breathing efforts occur but obstruction prevents air flow  
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show combination, that starts as obstructive and develops into central  
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show chemo-control; respiratory drive  
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what should be managed in infants with apnea? and what can terminate apnea periods in infants?   show
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show CPAP  
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show theophylline and caffiene; doxapram  
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show transfusion; mechanical ventilation  
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when does periods of apnea begin to disappear?   show
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show return to fetal circulatory pathways, usually because of high PVR  
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what does this condition result in?   show
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what 2 anatomic shunts does the fetus have?   show
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the intrauterine total pulmonary blood flow is ____.   show
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when is it definite that the infant has PPHN?   show
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what are the 3 fundamental types of PPHN?   show
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what is vascular spasm?   show
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what is increased wall thickness?   show
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show hypoplasia of the lungs and occurs with congenital diaphragmatic hernia, absent kidneys, and decreased amniotic fluid  
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when should PPHN be suspected?   show
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show performing preductal and postductal SpO2 (pred should be >5% post)  
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what is the initial therapy for PPHN?   show
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what if correction does not correct hypoxemia?   show
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show internal obstruction, external obstruction, disruption  
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show laryngomalacia, tracheomalacia, laryngeal webs, tracheal stenosis, hemangiomas  
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what do these conditions manifest as?   show
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what is caused by external obstruction?   show
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show tracheoesophageal fistula (usually associated with esophageal atresia)  
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what are the 5 types of TEF?   show
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what is the most common of these? least common?   show
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show difficulty swallowing, bubbling/frothing at mouth, choking  
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what is TEF managed with?   show
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what is the most common severe lung malformation?   show
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show surgical removal of the affected lobe  
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show pulmonary sequestration and lobar emphysema  
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what is congenital diaphragmatic hernia?   show
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show lung hypoplasia and abnormal development  
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show 1. Bochdalek hernia (lateral/posterior, left) 2. Morgagni hernia (medial/anterior, either side)  
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show scaphoid abdomen, decreased breath sounds, displaced heart sounds, severe cyanosis  
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show intubation, paralysis, MV, continuous gastric suction  
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show surgical repair for PVR to fall  
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show severe respiratory compromise, most commonly omphalocele  
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show abdominal wall defect involving insertion of umbilical cord  
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show gastroschesis (abdominal wall defect that is completely separate from the insertion of UC)  
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what diseases are included in poor neuromuscular control?   show
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show cyanotic and acyanotic  
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show blood shunts from R to L, bypassing the lungs, thus deoxygenated  
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show blood shunts from L to R, thus causes CHF  
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show 1. tetralogy of Fallot 2. transposition of the great arteries  
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what does tetralogy of Fallot include?   show
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what does a mild case manifest as?   show
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show heart murmur and severe continuous cyanosis  
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what is transposition of the great arteries?   show
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what does it manifest as?   show
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what treatment is frequently needed?   show
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show allow PVR to decrease and then perform arterial switch operation in the 2nd or 3rd wk of life  
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show ventricular septal defect  
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what is among the most severe of congenital heart diseases?   show
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show left-to-right shunt and CHF; 6-8 wks as PVR falls  
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what is the most common type of atrial septal defect?   show
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show indomethacin (pharmacologic) or ligation (surgical)  
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what are the 3 accepted treatments of hypoplastic left heart syndrome?   show
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what is the leading cause of death among infants younger than 1 year in the US?   show
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show preterm african-american boy born to a poor mother <20 w/ inadequate prenatal care  
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what age is most suseptible and when does it normally occur?   show
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show prone  
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_________ is the treatment of SIDS and what does this include?   show
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show regurgitation of stomach contents into the esophagus  
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what are the respiratory problems associated with GERD?   show
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show bronchiolitis  
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what is the clinical manifestations of bronchiolitis?   show
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when does it occur?   show
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show hyperinflation with areas of consolidation  
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show relief of airway obstruction and hypoxemia; systemic hydration, croup tent, O2 hood, NC  
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show ribavirin  
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show croup (laryngotracheobronchitis)  
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show the most common cause of obstruction in 6 month-6 year olds  
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when do the symptoms become evident?   show
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show subglottic narrowing of trachea, "steeple sign"  
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what is the treatment of croup?   show
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show epiglottitis; H. influenzae type B infection  
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show high fever, sore throat, stridor, labored breathing, muffled voice  
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show epiglottis thickened and flattened ("thumb sign"), aryepiglottic folds swollen, vallecula may not be visualized  
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show elective intubation under general anesthesia, place on CPAP w/ low PSV (3 cmH2O)  
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show CF; gene mutation affecting chloride movement, particularly in exocrine glands  
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show sweat glands, pancreas, lungs; skin is salty  
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what does pancreatic insufficiency lead to?   show
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show complications of lung disease  
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what do the patients produce?   show
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what is the treatment of CF?   show
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what is the most commonly used form of lung transplantation in the treatment of CF?   show
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what is the median survival age of patients with CF?   show
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Created by: christa_2008
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