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If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: what is the step toward acquiring the specialized knowledge needed to practice neonatal respiratory care?Answer: thorough understanding of how the resp system develops in the Question: what does the of the newborn infant begin with?Answer: the mother; condition/status of the Question: what all the health of the fetus?Answer: health, physiology, behaviors; pregnancy complications Question: what conditions can result in an outcome? Answer: interference w/ placental flow or transfer of O2 Question: what are maternal conditions that can affect neonatal ?Answer: previous complications, diabetes mellitus, age (<17,>35), smoking/drug/alcohol,placenta /previa, HTN Question: what is assessment performed with?Answer: ultrasonography, amniocentesis, fetal heart rate monitoring, fetal gas analysis Question: what does use?Answer: high-frequency sound waves to obtain a picture of in-utero Question: what does ultrasonography the physician to view?Answer: position of fetus/placenta, measure growth, identify anatomical anomalies, amniotic fluid Question: what does amniocentesis ? Answer: direct sampling/quantitative of amniotic fluid Question: what is amniotic fluid for?Answer: meconium or blood; genetic normality of sloughed fetal ; lung maturation Question: what is the -to-sphingomyelin ratio?Answer: measurement of 2 phospholipids, synthesized by the in utero Question: what does the L:S rise with?Answer: age Question: at 34-35 gestation, what does the ratio rise to?Answer: >2:1 Question: what does a ratio >2.1 ?Answer: surfactant production; mature lungs Question: _______________ is another lipid found in the amniotic fluid that is used to assess fetal lung maturity. when does this appear?Answer: phosphatidylglycerol (PG); 35-36 wks Question: if the PG is >1% of the total phospholipids, the is the risk of resp distress ?Answer: <1% Question: what is fetal monitoring?Answer: measurement of heart rate and uterine contractions during labor; monitor infant distress Question: what is a fetal heart rate? Answer: 120-160 /min Question: what is tachycardia a sign of?Answer: fetal hypoxemia, prematurity, fever Question: what are temporary drops in fetal heart rate called? and what are the 3 ?Answer: decelerations; mild (<15 beats/min), moderate (15-45 beats/min), severe (>45 /min) Question: how are classified?Answer: their occurance in the uterine contraction Question: when do early decelerations ?Answer: heart rate drops in beginning of contraction; benign, caused by vagal response Question: when does a late occur?Answer: rate drops 10-30 secs after the onset of contractions Question: what does a late deceleration pattern ?Answer: impaired maternal-placental blood flow or insufficiency Question: what with variable decelerations?Answer: no clear relationship between contractions and Question: what is the most common pattern of ? and what is it related to?Answer: variable decelerations; cord compression Question: a completely monotonous HR tracing may be indicative of ______ ________.Answer: asphyxia Question: what is fetal reactivity?Answer: ability of fetal HR to in response to movement or external stimuli Question: a healthy fetus will have ____ accelerations within a ___-minute period.Answer: two; Question: what is used to determine severity of ?Answer: blood pH Question: where is blood normally obtained from?Answer: capillary sample taken from body part, normally scalp Question: what is the fetal capillary pH range?Answer: 7.35-7.25 (lower occuring late in ) Question: what might a pH 7.20 indicate?Answer: fetus is asphyxia Question: when scalp pH only be used?Answer: in interpreting clinical signs of fetal distress Question: when does assessment of the begin?Answer: delivery Question: what is the initial steps at birth?Answer: warming, positioning of head, , suctioning Question: assessment of the ______ ______ is performed 1 and 5 minutes postdelivery and should not be used to direct resuscitative efforts.Answer: Apgar Question: what is the score? Answer: objective scoring system used to rapidly evaluate the Question: what are the 5 components of the Apgar ? what is each parameter scored?Answer: 1. HR 2. resp effort 3. muscle tone 4. reflex 5. skin color; 0, 1, or 2 Question: what is a Apgar score?Answer: 7 or at 1 minute Question: what a score of 7 indicate?Answer: supportive care (O2 or stimulation to ) Question: what might a of 6 or less require?Answer: more care Question: what are the 2 systems used to determine gestational age?Answer: 1. the dubowitz 2. ballard scales Question: what does the dubowitz score involve the of?Answer: 11 physical (skin texture/color, ) and 10 neurologic (posture, arm/leg recoil) signs Question: what does the ballard involve the assessment of?Answer: 6 physical, 6 Question: what are infants born between 38-42 wks ? before 38 wks? after 42 wks?Answer: term gestation; preterm; Question: newborns weighing less than _____ grams are considered low birth weight. newborns less than _____ grams are considered very low birth weight.Answer: 2500; Question: what percentile range is appropriate for gestational age?Answer: 10th-90th Question: preterm babies do not have fully developed _____; their _________ ______ cannot absorb fat as well; _______ ________ are not yet capable of warding off infections; the ___________ is less well developed, increasing hte likelihood of hemorrhage. Answer: lungs; digestive tracts; immune ; vasculature Question: preterm babies have a very ______ surface area-to-body weight ratio, what does this increase?Answer: large; heat loss and thermoregulation Question: what does physical assessment begin with measurement of?Answer: vital Question: what is a normal newborn respiratory rate? the ______ the gestational age, the higher the normal RR will be.Answer: 40-60 breaths/min; Question: what can occur because of?Answer: hypoxemia, acidosis, anxiety, Question: what are causes of ?Answer: meds, hypothermia, impairment Question: what is the normal infant HR? can heart rate be assessed?Answer: 100-160 beats/min; at apical pulse, brachial, femoral Question: what does weak pulse indicate? bounding ?Answer: , shock, vasoconstriction; major left-to-right shunt through pt ductus arteriosus (PDA) Question: what does a strong brachial pulse in the presence of a weak femoral suggest?Answer: PDA or of the aorta Question: what are the key signs that infants in resp distress typically exhibit?Answer: nasal flaring, cyanosis, expiratory grunt, tachypnea, retractions, breathing Question: what does nasal flaring coincide with? nasal flaring _________ the resistance to air flow.Answer: in WOB; decreases Question: _______ may be absent in infants with anemia, even when PaO2 levels are low.Answer: Question: what cyanosis?Answer: hyperbilirubinemia Question: when does occur?Answer: exhale against partially glottis Question: what does grunting help ?Answer: closure and alveolar collapse Question: when is grunting most ?Answer: distress syndrome Question: __________ represent the drawing in of chest wall skin between bony structures.Answer: Question: what is the difference in breathing in infants and adults?Answer: infants tends to draw in the wall during inspiration Question: retractions indicate...? breathing indicates...?Answer: increase WOB; increase ventilatory Question: what are the noninvasive of blood gas analysis?Answer: partial pressure of O2/CO2, pulse ox, capnography Question: gas is best for assessing infant's...?Answer: oxygenation/ventilation Question: what is capillary sampling provide regarding?Answer: and acid-base status Question: what is to produce maximum flow?Answer: forced exhalation Question: _______ __________ _____ ________ technique was developed because infants cannot perform forced expiratory maneuver.Answer: partial expiratory flow (PEFV) Question: how is the PEFV ?Answer: using compressive cuff placed around chest/abdomen of sedated ; cuff rapidly inflated Question: what does the external compressure do?Answer: forces air out of lungs, flow measured by pneumotach to mask Question: what is the goal of O2 ?Answer: provide adequate tissue oxygenation at the inspired FiO2 Question: what is the primary indication for O2 therapy in /children?Answer: documented Question: what indicates hypoxemia in a older than 28 days?Answer: PaO2 <60 mmHg or SpO2 <90% (same as ) Question: research suggests that the growing lung is mroe sensitive to _______ ______ than the adult lung.Answer: oxygen Question: _______ and its toxic effects may contribute to the development of bronchopulmonary dysplasia (infant COPD) and retinopathy in the premature infant.Answer: Question: ____________ __ __________ is caused by an abnormal vascularization of the retina which in the severest cases leads to retinal detachment.Answer: retinopathy of Question: what does promote?Answer: PDA closure, could be fatal w/ PDA-dependent defect Question: what does hyperoxia and decrease?Answer: increases aortic pressures/SVR; decreases CI and O2 transport in kids w/ congenital heart disease Question: what is a potential complication in newborn O2 ?Answer: flip-flop Question: what does flip-flop too?Answer: larger than expected drop in PaO2 when FiO2 is Question: what is this due too?Answer: reactive pulmonary vasoconstriction and increased -to-left shunting Question: what flip-flop?Answer: FiO2 in small increments of 1-2% Question: what are the safe of FiO2, SpO2, and PaO2?Answer: FiO2: <50%, SpO2: 88%-94%, PaO2: 60-80 Question: what does the of O2 devices depend on?Answer: performance of ; tolerance of pt for using device Question: what does selection of an O2 device need to be on?Answer: degree of hypoxemia; emotional/physical needs of child and Question: how can O2 be delivered to infants and ?Answer: mask, , incubator, oxyhood Question: what are the secretion techniques that can be to infants/children?Answer: CPT, PEP therapy, autogenic drainage, flutter therapy, in-exsufflation Question: what conditions is secretion common in?Answer: pneumonia, bronchopulmonary , CF, bronchiectasis Question: when is secretion considered?Answer: secretion accumulation impairs function, new infiltrates see on Question: ________ _______ _______ can also be valuable in the initial management of aspirated foreign bodies.Answer: bronchial therapy Question: what you be careful about during percussion?Answer: damage Question: ________ is used when secretions are mobilized with postural drainage and percussion.Answer: Question: what might help with pulmonary clearance in larger children with excessive ?Answer: combining coughing with postural drainage and percussion Question: what has been for CF pts?Answer: PEP, flutter, intermittent ventilation Question: what are the associated with bronchial hygiene therapy in infants/children? what can this be avoided by?Answer: regurgitation and possible aspiration; nasogastric Question: what are other complications of percussion and drainage?Answer: rib fractures, subperiosteal hemorrhages, increased risk of hemorrhage Question: what may precipitate intraventricular ?Answer: increased Question: what is contraindicated in these kinds of children?Answer: head-down Question: what is monitoring crucial with? what be monitored?Answer: instability; vital signs, colors, ICPs, breath (before, during, after tx) Question: ________ FiO2 during tx often required.Answer: Question: what are the key differences in humidity and aerosol in infants/children?Answer: assessent of pt response to therapy, age-related changes, equipment application Question: what decreases heat and water loss in premature infants, minimizing temperature stress and fluid imbalances?Answer: high humidity and temp levels provided by environmental O2 devices Question: because of newborn thermoregulation, adjustment and monitoring of _________ ____ are essential.Answer: gas Question: what will excessive gas temp in? inadequate gas temp?Answer: and tachycardia; hypothermia, apnea, acidosis, stress Question: what must be provided when the airway is bypassed by intubation?Answer: supplemental humidification w/ humidifier or nebulizer Question: what is avoided in infants/children?Answer: nebulization Question: what is humidification of inspired gases for infants and children receiving MV provided by?Answer: -controlled humidifier Question: what are common problems with systems?Answer: in tubing (prevented by heated wire circuits); inadequate humidification Question: what is an alternative to heated systems?Answer: hygroscopic humidifiers Question: what is a good alternative to systemic routes, especially for pulmonary ?Answer: administration Question: the ________ ______ is also safer and more comfortable than oral and parenteral approaches.Answer: route Question: what can be used to deliver aerosolized to infants/children?Answer: SVNs, MDIs, Question: what is used for pts unresponsive to intermittent SVN treatments and prior to ?Answer: continuous aerosol drug Question: how should equipment and be tailored to each child?Answer: according to size, weight, postpartum Question: what is used to estimate proper ET tube size and of insertion?Answer: 's age or weight Question: what if the tube is too small?Answer: a leak may , decreasing delivered VE Question: what do ETT have?Answer: high resistance, increasing spontaneous WOB Question: what happens when an inappropriately tube is used?Answer: cause mucosal and laryngeal damage, in UAO Question: most neonatal and pediatric ETT are ______ to eliminate cuff-related problems.Answer: uncuffed (aspiration more ) Question: what are in reducing complications?Answer: proper head positioning and avoidance of cumbersome apparatus Question: what laryngoscope blade is more appropriate for ?Answer: Miller (straight) blade (large /high epiglottis) Question: what can small changes in result in? Answer: bronchial/esophageal placement of Question: __________ are most useful to determine proper placement in trachea or esophagus.Answer: Question: what is the tube diameter equation?Answer: (age + 16)/4 Question: what does nasopharyngeal and suctioning help with?Answer: minimizing aspiration, prevents ETT , lowers RAW Question: what can oral and suctioning be done with?Answer: bulb Question: what can be used for nasopharyngeal and nasotracheal ?Answer: DeLee trap or a mechanical source w/ catheter Question: what is the suction pressure for neonates? what range is safe for large infants and children?Answer: -60 to -80 mmHg; -80 to -100 Question: what is done suctioning?Answer: 1-min preoxygenation; raise FiO2 by 10%-15% for 1-min suctioning Question: preoxygenation with ___% O2 be avoided in infants younger than 1 month.Answer: Question: what is the time on suctioning to minimize hypoxemia?Answer: 5 secs or Question: what does CPAP do?Answer: maintains I/E pressures ambient, improves FRC and static CL Question: when is CPAP ?Answer: when arterial oxygenation is inadequate despite a high Question: when is CPAP used?Answer: PaO2 <50 mmHg infant breathes FiO2 of 0.60 or greater, PaCO2 < or equal to 50 mmHg and pH is >7.25 Question: the application of CPAP is most commonly accomplished _____________.Answer: Question: what is used with CPAP on /term infants? children?Answer: nasal prongs or nasal pharyngeal ; nasal or full-face mask Question: what are CPAP levels and what increments are they adjusted by?Answer: 5-6 ; 1-2 cmH2O Question: when do you know that the CPAP level is achieved?Answer: RR to near-normal, resp distress lessened, SpO2 rises while O2 requirements reduced Question: when is and eventually discontinuing CPAP considered?Answer: FiO2 <0.30-0.40, reduction in WOB, CXR/clinical assessment indicate resolution Question: when is -term CPAP used? long-term?Answer: apnea in prematurity; airway problems, chronic lung disease, neuromuscular disorders Question: what is the most comfortable and simplest mean of supplemental O2 in infants/children?Answer: nasal Question: __-__ L/min for NC is as effective and is easier to than a nasal CPAP system.Answer: 2-8 Question: what is the one limiting for nasal cannula?Answer: utilize simple bubble humidifiers (doesn't provide sufficient of humidification to preserve mucosal integrity) Question: what might high-flow NC for pt?Answer: stabilizes acute resp failure caused by hypoxemia, reducing need for non/invasive Question: ___________ _________ __________ is the delivery of a bulk flow of humidified gas into and out of the lungs.Answer: mechanical ventilation Question: what is the removal of CO2 related to?Answer: ventilation Question: what is the of pressure required to move a particular amount of volume derived from?Answer: the CL of the system, resistance of airways Question: what are the goals of MV?Answer: improve O2 delivery to meet metabolic /eliminate CO2, while reducing WOB Question: what types do infants primarily use?Answer: -controlled Question: what are the most modes for infant/children?Answer: PCV-SIMV with Question: when is VCV-SIMV more used?Answer: when CL is essentially normal (neuromuscular ) Question: what mode is not used for infants?Answer: AC Question: during PCV, the ____ is preselected and is the ________ pressure that is reached and sustained throughout the inspiratory phase.Answer: PIP; Question: the difference between PIP and PEEP determines the delivered ______ ______.Answer: tidal Question: what of PIP increases the likelihood of barotrauma?Answer: >25 Question: what is the target VT for neonates? children?Answer: 5-7 ml/kg; 6-8 ml/kg Question: what is the step when applying VCV?Answer: selecting a Question: ______ rates have been used to try and mimic neonatal ventilation.Answer: Question: __________ __________ is a commonly used strategy that allows the use of less mechanical support with the aim minimizing barotrauma. hwat is the target PCO2?Answer: permissive ; 45-55 mmHg Question: I time is set as low as ___ for neonates and as long as ___ second for older children.Answer: 0.3; 1.0 Question: what determines the I:E ?Answer: I time and rate Question: ____ is kept low as possible to avoid O2 toxicity. what is the SpO2 range for preterm infant FiO2?Answer: FiO2; 88%-94% Question: _____ is used to increase FRC and treat refractory hypoxemia. what is the normal range?Answer: PEEP; 5-8 Question: _____ _______ ________ is the avg of all pressure applied to the pt airway throughout one full inspiratory and expiratory cycle, influenced by PIP, I and E time, and PEEP. Answer: mean pressure Question: what does the most PAW improve?Answer: oxygenation; minimizes side effects (barotrauma, CO) Question: what level of PAW is dangerous and what is needed if it gets to this point?Answer: >15 cmH2O; high-frequency Question: _____ may be used in the short term to manage acute resp failure that is likely to reverse such as pulmonary edema. Answer: NPPV Question: what does NPPV ?Answer: disorders and postextubation resp failure Question: what are the of a ventilator assessment?Answer: 1. evaluation of artifical airway 2. physical exam 3. pt-vent interaction 4. analysis of lab/radiographic data 5. assess humidification 6. alarms Question: what does the airway assessment include?Answer: airway is secure, at established landmark, in position by auscultation/CXR, if leak Question: what might the absence of a leak to extubation indicate?Answer: stridor from airway edema Question: what are airway graphics displayed?Answer: waveforms of flow, airway pressure, and volume Question: what are ideal humidification systems for ?Answer: low compressible-volume chambers, a closed continuous water feed, -wire circuits Question: what is the goal of MV the weaning phase?Answer: facilitate spontaneous breathing as the WOB is gradually returned to the pt Question: what is an essential of weaning?Answer: pt-vent Question: what does testing for extubation include?Answer: switching to PSV that overcomes resistance of ETT, PEEP to 5 cmH2O Question: ____-_________ __________ is a method of assisted ventilation that delivers small VTs (__-__ ml/kg) at rapid rates (>___/min).Answer: high-frequency ventilation; 1-3; Question: what are the 2 of HFV?Answer: 1. jet 2. Question: what does HFJV ?Answer: pulse of high-velocity gas, PEEP/sigh from vent, rates: 100-600, I time: 20-40 msecs, E passive Question: what are the for HFOV? what are I and E?Answer: 3-15 Hz (180-900 beats/min); active oscillating PAW Question: what is determined by?Answer: FiO2 and Question: what is the CO2 elimination by?Answer: amplitude and rate (lower rate results in CO2 elimination) Question: what are the benefits of HFV?Answer: improved gas exchange w/ less barotrauma Question: where is HFV used? and in what?Answer: newborn ICUs; severe hypoxic resp failure, severe resp distress, air leaks, severe Question: CO2 elimination during HFV is determined by delivered ________ ___________.Answer: ventilation Question: what should ventilator be set to achieve? what determines this?Answer: resonant frequency of the lung; underlying lung and age Question: what determines lung during HFV?Answer: delivered Question: what are the 2 HFV ?Answer: 1. high vol (recruitment) 2. low vol strategy (air leak) Question: when the FiO2 is equal to or <___, the Paw is weaned slowly. when the Paw is <___-___ cmH2O, the pt may be trialed off or to conventional ventilation.Answer: 0.6; 15-18 Question: _______ ______ ______ is a selective pulmonary vasodilator used to treat newborns who require MV for hypoxic resp failure.Answer: inhaled oxide Question: what does it improve and the need of?Answer: ; extracorporeal membrane oxygenation Question: what is the recommended INO dose? what once a response has been achieved and sustained?Answer: 20 parts per million; INO dose gradually reduced, 50% each step, dose is 1 ppm Question: why is so crucial?Answer: NO and O2 turn into NO2 which is potentially Question: a metabolite of INO is the formation _____________ as the NO molecule is bound to the RBC.Answer: Question: what is INO used for?Answer: congenital diseases; ARDS Question: ____________ _________ __________ is a modified form of cardiopulmonary bypass used to provide relatively long-term pulmonary or cardiopulmonary life support when maximum medical interventions have failed.Answer: extracorporeal membrane Question: what are the 2 types if ECMO ?Answer: 1. venoarterial (VA) (heart/lung supported) 2. venovenous (VV) (lungs supported) Question: what is in VA?Answer: blood taken from RA; CO2 removed, O2 ; heated returned right common carotid artery Question: what is in VV?Answer: same process but returned to heart Question: what has ECMO shown to improve in infants?Answer: pulmonary HTN, aspiration, sepsis, resp distress syndrome, congenital diaphragmatic hernia; ARDS Question: what is the most complication with ECMO?Answer: bleeding Question: where is treatment of a critically ill infant or child provided at?Answer: care facility |
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