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