chp 6-8 & 15
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| Core temp maintained at | show 🗑
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| Brown fat cells appear around | show 🗑
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| Where is brown fat stored? | show 🗑
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| Term for when brown fat is broken down to produce heat | show 🗑
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| What is ITG? What does it mean? | show 🗑
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| How does ITG heat travel thru body? | show 🗑
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| show | metabolic rate, fat present, surface area, distance from body core to skin
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| show | External Thermal Gradient = Temp difference between skin and environment
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| show | from skin to the cooler environment
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| What are the four factors effecting ETG? | show 🗑
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| show | Radiant, conduction, convection, & evaporation
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| show | loss of heat from neonate to cooler objects surrounding it, but not in direct contact of
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| Conduction | show 🗑
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| show | loss of heat from skin to air current passing over neonate
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| show | release of heat due to water changing from liquid to gas
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| show | from skin and respiratory tract
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| show | from sweating from skin
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| show | peripheral vasoconstriction shunting blood away from skin
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| Results of hypothermia | show 🗑
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| What does hypothermia trigger? | show 🗑
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| show | peripheral vasodilation to help release heat
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| show | increases metabolism and O2 consumption
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| show | Infection, dehydration. Also malfunctioning incubators, radiant warmers, humidifiers, and phototherapy (equipment malfunction)
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| show | Prevention of Evaporative heat loss, radiant heat loss, and convective & conductive heat loss
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| Prevention of Evaporative heat loss at delivery | show 🗑
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| Prevention of Radiant heat loss at delivery | show 🗑
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| show | Keep neonate covered, small preemies placed on warming mattress and prewarmed incubators
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| Thermoregulation in Nursery | show 🗑
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| show | Adv = controlled thermal environment; temp reg by servo-control, skin temp increases/decreases heat in incubator, skin probe secured to skin
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| Open Warmers | show 🗑
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| Behavioral based care | show 🗑
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| Sleep/Wake state | show 🗑
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| Risk Factors for Neonate for Upper Airway Occlusion | show 🗑
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| show | heart enlarged, no stability of ribs/sternum, large abdominal contents cause diaphragm not to flatten
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| Obstetrical history needed | show 🗑
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| PARA stands for | show 🗑
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| show | Length of stages, fetal pres, Vaginal vs. C-section, Fetal hr, anesthetic or tocolytic used, NST or ST, PROM b4 37 wks, maternal steroids, placenta problems
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| show | Naegele's Rule, Dubowitz, Ballard Score, Fetal ultrasound
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| Naegele's Rule | show 🗑
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| Dubowitz | show 🗑
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| Ballard score | show 🗑
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| show | Age determined by measurement of fetal head or femur diameter
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| show | AGA, SGA, LGA
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| show | Average for gestational age
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| SGA | show 🗑
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| show | Large for gestational age
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| show | Visual observances of color, skin, activity, inspect, and respirations
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| QE Color | show 🗑
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| QE Skin | show 🗑
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| show | Anxiety & irritable - suggests hypoxia / increased RR; ↓SpO2 during handling - suggests intolerance or cardiac anomaly
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| QE Inspect | show 🗑
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| show | look for 3 cardinal signs of Resp distress; nasal flaring, grunting, and retractions
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| Cardinal signs of Respiratory Distress | show 🗑
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| show | Pic chart used to grade severity of retractions & grunting
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| show | Substernal/subcostal (center)= lung disease, Intercostal (sides) = heart disease, Intrasternal/Marked substernal (center) = ETT obstruction
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| show | an attempt to get airway dilation to ↓ airway resistance and ↑ gas flow and volume
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| show | sound used at end expiration to ↑ lung volume
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| show | vital signs, chest, and abdomen
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| HOE Chest | show 🗑
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| HOE Abdomen | show 🗑
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| Distended abdomen | show 🗑
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| show | hollow concave abdomen (guts in chest) -- bowel sounds in chest which suggests diaphragmatic hernia
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| show | protruding intestines covered with membrane
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| show | protruding intestines not covered with membrane
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| Vital signs should include | show 🗑
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| show | 30 to 60 bpm
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| show | absence of breathing > 20 secs; due to aspiration, asphyxia, maternal drug use
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| Normal Pulse | show 🗑
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| Normal temp | show 🗑
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| show | 84-94%
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| BP | show 🗑
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| show | bradycardia; caused by hypoxia, heart disease, valsalva maneuver, drugs
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| show | tachycardia; caused by hyperthermia, heart disease, pain, crying, drugs
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| show | from R arm; if PaO2 more than 15 mm Hg> than Postductal = right to left shunt; suspect PDA or congenital heart defect
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| show | from UAC; If PaO2 on pre-ductal is more than 15 > than postductal = right to left shunt; suspect PDA or CGD
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| show | 130 - 150
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| Cl- for term | show 🗑
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| K+ for term | show 🗑
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| show | 20-24
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| show | 7,000 -14,000
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| Urine output | show 🗑
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| BUN | show 🗑
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| Creatinine | show 🗑
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| Glucose | show 🗑
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| Bilirubin | show 🗑
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| show | Ph=7.34-7.35, PCO2=26-40, PO2=50-70, HCO3=17-23, BE=+/- 2 to -10
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| show | Ph=7.34-7.46, PCO2=30-45, PO2=85-100. HCO3=20-28, BE=+/-2 to -4
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| show | Pneumothorax, atlectasis, Improper ETT, pneumonia, diaphragmatic hernia or paralysis, phrenic nerve palsy
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| transillumination of chest | show 🗑
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| show | asymmetrical chest w/resp distress, ↓ breath sounds, and/or absent heart sounds, with trachea or mediastinum shift away
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| Neonatal reflex tests | show 🗑
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| show | stroke corner of mouth, baby should turn that direction
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| Suck reflex | show 🗑
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| show | place index finger in palm, baby should grasp; place thumb over fingers and should be able to pull baby towards sitting position
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| show | slowly lie baby back down (after grasp) and just b4 head touches, remove fingers. Baby should extend arms up and out
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| show | Vernix=thick & all over, skin=thin, transparent, nails=short, sole=few creases, ears=flat, soft, little cartilage
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| show | Vernix=very little, skin=pale, few visible vessels, nails=normal, sole=creases over 2/3, ears=firm, recoil easy
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| Physical exam to determine post-term baby | show 🗑
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| show | Arms and legs are blue but core is pink
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| show | pink all over
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| cyanotic | show 🗑
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| show | ASD, VSD, AVCD, and PDA
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| show | Atrial Septal Defect = L to R shunt thru opening in atrial septum; causes extra blood R heart; ↑ pulm BF (CHF); give lasix for CHF & perform surgical repair
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| VSD | show 🗑
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| show | Atrioventricular Canal Defect = L to R shunt thru ASD, VSD; deformed mitral & tricuspid; causes CHF; give lasix & do surgery
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| PDA | show 🗑
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| 2 Acyanotic CHD's with NORMAL blood flow | show 🗑
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| show | Severe narrowing of aortic lumen; PDA present-keep open; give PGE to ↓ PVR due to extrapulm BF; Good pulse upper, weak pulse lower; perform surgery
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| show | Narrowing of aorta causes blood backup into lungs; no shunts; give lasix for CHF; give PGE to vasodilate; perform surgery
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| Common Cyanotic CHD's with ↑ pulmonary blood flow | show 🗑
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| show | Transposition of the Great Arteries = BF from R vent to aorta, & L vent to pulm arts; has PDA & ASD and/or VSD for mixing; Give PGE until surgery
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| Tricuspid Atresia | show 🗑
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| show | The two great vessels (pulm & aorta) are formed into one vessel. Blood shunts from L to R if VSD present
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| TAPVR | show 🗑
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| Common Cyanotic CHD's with ↓ pulm blood flow | show 🗑
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| Tetralogy of Fallot | show 🗑
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| Increased O2 | show 🗑
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| show | ↑ PVR = ↓ pulm BF
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| Increased CO2 | show 🗑
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| Decreased CO2 | show 🗑
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| show | vasodialates and ↓ PVR (doesn't systemically vasodilate due to short half life)
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| show | vasodilates and ↓ PVR
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| Viagra | show 🗑
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| Ribavarin | show 🗑
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| show | used for brady; dosage .01-.03 mg/kg IV over 1 min
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| epinephrine | show 🗑
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| digoxin | show 🗑
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| indocin | show 🗑
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| show | maintain PDA until surgery; dosage .1 mcg/kg/min UAC
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| dopamine | show 🗑
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| show | treats PPHN that is refractory O2 and vent; dosage 1-2 mg/kg/hr
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| lasix | show 🗑
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| aldactone | show 🗑
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| Corticosteroids | show 🗑
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| types of steroids given by MDI | show 🗑
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| Primary steroid given to Neonate for BPD & edema | show 🗑
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| Cromolyn Sodium (Intal) | show 🗑
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| Theophylline or Caffeine | show 🗑
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| Nitric Oxide (NO) | show 🗑
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| Artificial surfactant | show 🗑
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| types of surfactant | show 🗑
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| RDS | show 🗑
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| show | RR>60, grunting, retractions, nasal flaring, cyanosis, severe edema, flaccid muscles, hypoactivity
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| CXR RDS | show 🗑
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| Death RDS | show 🗑
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| Treatment RDS | show 🗑
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| Complications RDS | show 🗑
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| BPD | show 🗑
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| show | O2 toxicity, barotrauma, PDA, and fluid overload
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| show | ground glass & blood gas shows chronic lung disease
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| show | Prevention, ventilation, resp therapy, Fluid therapy, digoxin, nutrition, and vitamin E
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| Pulmonary Dysmaturity | show 🗑
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| PD CXR | show 🗑
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| show | hyperpnea, transient cyanosis, retractions, severe resp distress, poor feeding, and vomiting
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| show | mech vent for apnea & progressive hypercarbia, O2 for hypoxemia; once pt ventilated, treat as BPD
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| show | Retinopathy of Prematurity; formation of scar behind lens of eye caused by high PaO2
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| Contributing factors to ROP | show 🗑
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| show | cryotherapy or laser therapy, vitrectomy, lensectomy, prevention
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| show | Intracranial or intraventricular hemorrhage; bleeding in cranium
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| Subdural or subarachnoid bleeds | show 🗑
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| Cerebellar tissue bleeds | show 🗑
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| show | most common area neonates bleed
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| diagnosis of ICH/IVH | show 🗑
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| show | prevention, avoid wide fluxes in BP, O2, and pH
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| Complications ICH/IVH | show 🗑
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| 6 types of Pulmonary Air Leaks (PAL) | show 🗑
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| PAL Pnuemothorax | show 🗑
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| PAL Pneumomediastinum | show 🗑
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| show | Occurs when air enters the pericardial sac; it compresses the heart impeding CO; must have needle aspiration
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| PAL PIE | show 🗑
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| PAL Pulmonary air embolism | show 🗑
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| show | 2 degrees to other air leaks; occurs when air enters subcutaneous spaces; must fix primary air leak
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| show | Persistent Pulm Hypertension in Newborn; unknown cause; causes persistent pulm vasoconstriction ↑ ptressures & ↓ pulm BF causing persistence in fetal circulation
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| TTN | show 🗑
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| NEC | show 🗑
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| show | mucosal wall injury, bacterial invasion into damaged intestinal wall, and formula in the intestine
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| show | guaiac-positive stools, bile in emesis, poorly tolerated feedings, lethargy, ↑ FiO2 needs
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| Pulmonary Anomalies | show 🗑
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| Respiratory Care for Cardiac defect ↓ BF | show 🗑
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| Respiratory Care for Cardiac defect ↑ BF | show 🗑
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| show | Bacteria, Virus, Protazoa
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| show | Isolation, Identify antigen, aseptic technique, fetal immunity
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| Five classes of fetal immunity | show 🗑
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| IgA immunity | show 🗑
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| show | Found in serum tissue, unknown role, increases in presence of allergic reactions to milk, penicillin, insulin, & toxins
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| IgE immunity | show 🗑
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| IgG immunity | show 🗑
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| show | Produced by fetus @ 30 wks; used to test for infection; unreliable for early detection
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| Goals of mechanical ventilation | show 🗑
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| show | Normally time cycled/pressure limited
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| show | Normally Volume cycled
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| Initial PIP | show 🗑
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| Excessive PIP | show 🗑
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| show | ↑ PIP, ↑ PaO2 & ↓ PaCO2, by ↑ Ve, also ↑ MAP;
doesn't affect I:E or I-time
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| show | highest for neos 6-8 cm H2O; prevents alveoli collapse and ↑ FRC; Improves Oxygenation & compliance; ↑ PEEP ↓ Vt
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| show | RR directly affects Ve, PaCO2, MAP (Paw); ↑RR = ↑Ve; ↑RR = ↓PaCO2; ↑RR = ↑ Paw (MAP)
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| Inspiratory Time on mech vent | show 🗑
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| MAP or Paw on mech vent | show 🗑
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| Tidal Volume on mech vent | show 🗑
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| show | amt of speed to dlvr Vt; Directly affects MAP; ↑flows=↑vent & reverse atelectasis
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| Opening and driving pressures | show 🗑
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| show | Difference between PIP and PEEP
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| Indications for Neonatal ventilation | show 🗑
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| show | Putting baby on ventilation
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| Phase II ventilation | show 🗑
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| show | Weaning baby off vent
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| show | Neuromuscular, Pulmonary disease, Post-resuscitation, ventilatory failure = pH <7.30, PaCO2 >50, PaO2 <70 w/O2
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| show | Vt 6 to 8 ml/kg; RR 12-20; Ve primary factory controlling PaCO2; If PaCO2 ↓, can ↓ RR or Vt
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| Modes of vent | show 🗑
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| show | ABG, Transcutaneous monitor, Pulse Ox, Capnography
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| ABG Analysis -- when do you get it? | show 🗑
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| show | UAC, Arterial line, Arterial puncture, capillary puncture; UAC is preferred method
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| show | Most preferred; can be compared to R radial ABG to see if PDA; disadvantage=UAC's only in place 3-4 wks
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| R arterial sample Vs. UAC sample | show 🗑
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| Radial Arterial Line Sample | show 🗑
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| show | Difficult to obtain; these are done blindly; not suggested unless no UAC
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| show | Used prim after UAC gone; not reliable for PaO2; Must warm heel to puncture
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| show | Neo = 50-70 ; ped = 85-100
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| ABG Values PaCO2 | show 🗑
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| ABG Values pH | show 🗑
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| ABG Values BE | show 🗑
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| Alveolar Ventilation determined by | show 🗑
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| Acidosis may result because of | show 🗑
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| Alkalosis may result because of | show 🗑
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| show | noninvasively monitor O2, must changed frequently, PtcO2 can be lower than PaO2 by 2-3. ↓PtcO2 w/ N PaO2 = circulatory failure; ↓PtcO2 w/↓PaO2 = respiratory failure
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| Transcutaneous using Servinghaus | show 🗑
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| Pulse Ox | show 🗑
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| show | Noninvasive for CO2; determines end tidal PaCO2 (PetCO2); placed on ET tube or catheter in nose; trends are important with this, however inaccurate with severe resp distress
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