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neonates
| Question | Answer |
|---|---|
| Acceptable PaO2 for neonatal blood gas? | 60-80 torr....80-100 in adults.....premature neonates as low as 50mmHg |
| Acceptable pH..PaCO2...other blood gas values for neonates? | Same as adult...only PaO2 is different |
| How is capillary blood gas taken in neonates? | arterialization of site with hot rag (45C for 5-7 minutes) |
| Capillary PO2 will be lower than arterial PO2...Why?? | Tissues have consumed some of the oxygen |
| Capillary blood gas from neonates is primarily used for... | Finding CO2 and pH....NOT a good monitor for assessing oxygen |
| Advantages of a UAC (umbilical artery catheter)? | Continuous monitor of BP...arterial samples for ABG and other labs....blood replacement (transfusions) |
| The PO2 from UAC can be used to regulate FIO2...True or false | true |
| What is the congenital heart defect patent ductus arteriosis (PDA)? | When the two major blood vessels leading from the heart do not close after baby is born...it usually does....can be diagnosed by comparing blood gas from radial artery and umbilical artery...difference>15 torr...PDA with r-l shunt... |
| Where should UAC be placed? | L3-L5 on X-ray |
| Transcutaneous monitoring (TcPO2 or TcPCO2) can be used to monitor oxygen and carbon dioxide is infants...true or false | true |
| Advantage and disadvantage of transcutaneous monitoring. | advantage ...noninvasive way to reduce frequency of arterial sampling and can be done continuously...disadvantage...cannot replace arterial sampling |
| How is transcutaneous monitoring done? | Clark/Severinghaus Electrodes placed on skin..skin must be kept at 43-45C (improves capillary flow)...lower skin temps will cause TcPO2 readings to be lower than actual |
| In transcutaneous monitoring, what happens if the electrode comes off? | The TcPO2 reading will suddenly read higher...but the TcPCO2 will read zero (hardly any CO2 found in ambient air) |
| The electrodes in transcutaneous monitoring can sometimes burn the skin....how can this be remedied? | Move them every 4 hours...be sure electrodes are on a flat surface with good perfusion (chest)... if burns are noted, should change more often!!! |
| Trans. Monitoring can only be accurate if ________is happeneing. | Perfusion...accuracy decreases if skin is thick, anemic conditions of poor perfusion (burns, shock, vascular disease, cardio defects) Correlate with blood gas values to be sure perfusion is happening |
| Most common mechanical problem with trans. monitoring is | air leaks....causing an increasing TcPO2 to be higher than PaO2 |
| Trans. Monitor can be calibrated with.... | a zero solution and room air (PaCO2 = 0.....PaO2 = 150 torr) if can't callibrate, check for torn membrane or poor connection |
| Why is an echocardiogram done on infants? | To visualize cardiac related anatomy, esp. when suspecting congenital heart and anatomical abnormalities |
| When should APGAR be done? | 1 minute and 5 minutes after birth |
| What does APGAR stand for? | Appearance, pulse, grimace, activity, and respiratory effort |
| Two types of assessments for newborns. What are they? | Birth and routine |
| Infant receives 7-10 on APGAR, what needs to be done? | Routine care...suction mouth and nose, establish airway...keep warm |
| Infant receives 4-6 on APGAR, what needs to be done? | Support infant....stimulation and oxygen...resuscitation MAY be necessary, suction nose, mouth...assure airway...supportive bag/mask ventilation if HR <100/min...30-45% oxygen by oxygen hood or nasal cannula |
| Infant receives 0-3 on APGAR, what needs to be done? | CPR (heart or lungs or both) ..resuscitation IS required..suction mouth nose...establish airway - clear airway...supportive bag/mask ventilation...cardiac compressions if HR<60/min after 30 sec of resuscitation |
| Each APGAR area is scored how? | 0,1,2 points |
| Under appearance in APGAR, a baby pink with blue extremities gets a score of | 1 |
| ET tube size for infants... | fullterm - 3.0-3.5 preterm - 2.5-3.0 |
| Miller laryngoscope blade size for infants is | full term - 1.....pre term - 00 |
| What ventilator is often used for infants? | Time-cycled vent....inspiration continues for a specified # of seconds regardless of volume delivered, but usually incorporates a specified pressure with a press. pop off valve |
| Name 4 neonatal oxygen therapy devices. | oxygen tent...oxygen hood....incubator ...radiant warmer |
| Flow rate in an oxygen tent must be set in excess of ___lpm to continually flush out CO2 | 12 lpm |
| If an infant/child destroys an oxygen tent due to anxiety, what can you switch to? | face mask |
| If a humidity/aerosal environment is desired which oxygen therapy device is most useful? | oxygen tent |
| If analyed FIO2 near PT face in an oxygen tent is difficult to keep consistent, what can be done? | ensure the plastic walls are tucked into the bed well |
| In an oxygen tent, maximum achievable FIO2 is about....% | 40-50% |
| Due to high fluid filled environment in an oxygen tent, it may lead to ________ in the PT | fluid retention...monitor input/output and weight often |
| In an oxygen tent, FIO2 may exist as a gradient, with the higher FIO2 where ......top or bottom? | bottom....oxygen is heavier than the other gases |
| An oxyhood (oxygen hood) is a loosely enclosed environment placed over the infants head and is associated with using a (high or low) flow device?? | High flow device (venturi) to ensure CO2 flushing |
| Minimum flow on an oxyhood is | 7Lpm....higher is recommended to prevent build up of arterial CO2 |
| Oxyhood can deliver ____% oxygen with an oxygen blender. | 100% |
| FIO2 can be monitored in an oxyhood with a _____ | oxygen analyzer probe near PT mouth... |
| Besides monitoring FIO2 with oxygen analzer probe near PT mouth in an oxyhood, what else needs monitoring inside the hood? | temperature (probe)...must be monitored to prevent excess cooling from aerosol...too cool could cause an increase in oxygen consumption...too hot infant may become apneic(apnea) |
| Because of the loudness inside an oxyhood, what could happen? | hearing damage and restlessness |
| How can the noise level be reduced in an oxyhood? | By using a blender rather than a large volume nebulizer which can be very noisy , esp. on low FIO2 settings where much air is being entrained |
| What needs to be done when analyzed oxygen percentages in an oxyhood begin fluctuating? | This is an indication of not enough flow....increase the flow |
| An incubator gives precise control over the environment including FIO2..humidity...temp... True or false | true |
| It is a red flag warning sign when using an FIO2 of ____ in an incubator | 1.0 |
| Some hazards of using an incubator are | skin burns, hearing damage, electrical shock |
| A radiant warmer for an infant is a good source of oxygen delivery...true or false | false... must be combined with an oxyhood or some other oxygen delivery device |
| Which neonatal oxygen device is good for emergency cases? | radiant warmer because is allows RT's to have access to infant to give monitoring and care |
| Which neonatal oxygen delivery device is useful in controlling temperature and helps decrease insensible water loss dueto its neutral thermal environment? | radiant warmer |
| Oropharyngeal suctioning on an infant can be done with ____ | bulb syringe |
| Initial settings for mechanical ventilation for an infant ......respiratory rate.....FIO2.....PEEP????? | respiratory rate - 20-30 bpm.......FIO2 - 40-60% room air (PT on oxygen, set on same as oxygen)....PEEP - 2-4 cmH2O (PT on CPAP, set on same level) |
| WHat pressure should be used when suctioning an infant? | 60-80mmHg |
| Normal pulse for infants? | 110-160 bpm...>170 = tachycardia...administer oxygen |
| Where should a pulse NOT be taken on an iinfant...brachially, femorally, radially or apically | radially |
| Any pulmonary challenge will cause an increase in infants...heart contractility or heart rate | heart rate |
| acceptable respiratory rate in infants is | 30-60/min. |
| Apnea for 10 seconds is normal, apnea lasting 10-20 seconds is acceptable, but >20 , the infant needs.... | apnea monitoring..also infants who have been treated with caffeine to stimulate ventilation should also be monitored as well as those at risk for SIDS |
| Factor indicating the need for apnea monitoring... | One or more life threatening episodes(apnea cyanosis, choking, lifelessness requiring stimulation or CPR)...Sibling of SIDS baby...Preterm baby with significant apnea periods..snoring |
| WHat is used in an Impedance Apnea Monitor (Pneumogram) to monitor lungs expanding and contracting? | Electrodes attached to chest senses changes in distance between electrodes as lungs expand and contract |
| Problems with pneumogram? | false alarms...poor electrode contact (oily skin)...monitor may not sense obstructive apnea if PT has respiratory movement like hiccups...Must be used during napping, car or stroller riding...disconnect when eating.. |
| Low heart rate alarm on a pneumogram should be set at | 60-80 bpm |
| WHen can apnea monitoring be discontinued? | two months free of events...no monitor alarms on apnea setting of > 20 seconds and HR <60 bpm...no symptons show after immunizations and experiences nasopharingitis...followup pneumogram is normal |
| Normal BP for infants? | 60/40 mmHg...less if preterm (50/30mmHG) |
| Normal body temperature for infants? | 36-37C...Servo-controlled radiant warmer should be used because babies lose body temp. quickly and easily. Servo-controlled radiant warmer has a probe to place on baby's skin with low skin temp. alarm...may sound if comes off!!!! |
| What medical history is needed for infants? | Maternal and family history |
| Normal term baby is ______weeks | 38-42 |
| A baby less than 38 weeks is considered | preterm |
| Normal birth weight for an infant? | 3000grams..low birth weight is related to increased risk of complications |
| What is minimum survivable age and weight of a baby? | 1000 grams and 26-28 weeks...at risk for respiratory problems |
| What is acrocyanosis? | a baby with blue extremities and a pink body...not cyanosis |
| a baby with retractions...grunting....nasal flaring... is showing signs of | ventilatory distress |
| Silverman Score is used to evaluate.... | respiratory distress in infants....uses 0-10 scale with 10 being the greater distress |
| If capillary refill is longer than 3 seconds there could be a problem with... | cardiac output |
| What is a heart murmur an indication of in an infant? | congenital heart defect...do echocardiogram |
| Why should arterial blood gases be done conservatively on infants? | There blood is scarce |
| If PaO2 levels from right radial artery(pre-ductal) and umbilical artery (post ductal) is > _____, infant has PDA...send to surgery | 15mmHg |
| If chest X-ray and transillumination shows a ground glass or reticulogranular pattern it indicates... | IRDS or lung immaturity...treat with surfactant |
| How is transillumination done/ | Shine bright light though one side of chest cavity while observing from the other side |
| If during a transillumination the lung field lights up completely, it indicates.... | pneumothorax...follow up with a chest X-ray |
| During transillumination there is only the outline of the light (halo effect), that indicates... | lungs are normal |
| Blood glucose levels for infants... | >30 acceptable (>20mg/dL in preterm)...may be monitored in all infants |
| A reported conception date is the most reliable...true or false? | False...it is the least reliable...substance abuse can cause fetus to mature quicker or slower than normal making a reported date unreliable |
| An ultrasound of the fetus can make an estimate of the gestational age by measuring.... | lengths of a bone (femur) and size of the fetal skull |
| Best evaluation to tell gestational age of fetus for mothers with complications (diabetes, drug abuse...) is | Dubowitz score...physical assessment AFTER birth to determine true gestational age...score of 40 correlates with 40 weeks...New Ballard Score is similar but more suitable for infants less than 30 weeks est. gestation age |
| Patent ductus arteriosus can be evaluated by using ..... | transcutaneous monitoring or pulse oximetry....recommend echocardiogram to determine cause of shunt |
| If a womans's last menstrual period is Feb 1...according to Nagele's Rule (est. delivery date) when is the baby due? | Add 7 months and 7 days to last menstrual date= Sept. 7 |
| The lecithin/spinogomyelin (L/S ratio) is related to.... | lung maturity in infants...Normal is 2:1....1:1 is bad,so administer surfactant |
| Hyaline membrane disease (HMD) now known as IRDS..can have L/S ratio as low as... | 0 |
| What does the PG level assess? (phosphatidyglycerol) | Most reliable and accurate pulmonary maturity assessment (even in presence of diabetes) starting around 36 weeks of gestation |
| How is PG level assessment done? | Using amniotic fluid... |
| What does a PC level assess? (phosphatydichloride) | Alternate indicator of lung maturity...phosphatydichloride , found in surfactant, rises as lungs mature...phospholipids make up the majority of weight of surfactants |
Created by:
whiskers55
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