Ch. 31 (Egan's) - Neonatal and Pediatric Respiratory Disorders
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| show | 60,000-70,000
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| what is another name for RDS and what is RDS? | show 🗑
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| what are the 4 major factors in the pathophysiology of RDS? | show 🗑
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| what does the severe hypoxemia and acidosis increase in RDS? | show 🗑
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| because of the low surfactant production, what happens to the alveolar? from this, what happens? | show 🗑
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| the increased PVR leads to what? which overall leads too? | show 🗑
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| show | tachypnea (occurs soon after birth); retractions, paradoxical breathing, grunting, nasal flaring
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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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| what mimics the aspect of RDS? | show 🗑
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| what is definitive diagnosis of RDS made with? and what is typically found? | show 🗑
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| show | CPAP and PEEP; surfactant replacement therapy and high-freq ventilation
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| if the condition is not severe, what is indicated? | show 🗑
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| when should MV with PEEP be initiated? | show 🗑
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| what is the goal of MV for RDS? | show 🗑
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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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| show | lowest PaCO2, highest PaO2; must increase f or PIP; less than 30 cmH2O, lower for more immature infants
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| show | 1. beractant (survanta) 2. calfactant (infasurf) 3. poractant alfa (curosurf)
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| show | liquid suspensions that are instilled directly into trachea; all given through ETT
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| show | 100; 4; 1/4 dose quickly in each of 4 positions; Q6 or more often
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| what is the dosing, ml/kg, administration, and dosing interval for calfactant (infasurf)? | show 🗑
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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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| what is the most common respiratory disorder of the newborn? | show 🗑
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| what is the likely cause of TTN? | show 🗑
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| show | 2/3; lyphatics' absorption (immature lymphatics impairs absorption)
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| what are the first clinical manifestations of TTN? | show 🗑
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| show | looks like pneumonia; hyperinflation, pleural effusions, perihilar streaking (lymphatic engorgement)
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| what is the most common treatment that infants respond to in TTN? | show 🗑
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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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| show | mucopolysaccharides, cholesterol, bile acids and salts, intestinal enzymes, others
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| show | 12%; 37; 95
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| what is the real causative agent in MAS? | show 🗑
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| what are the 3 primary problems of MAS? | show 🗑
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| the lung tissue injury caused by MAS is _________ __________. | show 🗑
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| what is evidence that the fetus is at high risk of MAS? | show 🗑
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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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| show | immediate intubation and suctioning; after ETT is inserted, it is removed to see meconium, if there is new ETT is inserted
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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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| what has become a major adjunt in the management of persistent pulmonary hypertension? | show 🗑
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| show | infants with severe respiratory failure in the first few weeks of life
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| show | immaturity, genetics, malnutrition, O2 toxicity, MV
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| show | atelectrauma and volutrauma
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| show | hyperoxia/hypoxia, mechanical forces, vascular maldevelopment, inflammation, nutrition, genetics
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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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| what does atelectrauma and volutrauma cause a need for? | show 🗑
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| show | decreased alveolarization rather than prominent airway damage of the "old" BPD
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| show | progressive respiratory distress (needs O2 and MV)
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| show | atelectasis, emphysema, fibrosis diffusely intermixed
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| what does the ABG look like? | show 🗑
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| what is the best management of BPD? | show 🗑
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| show | surfactant
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| show | minimize additional lung damage and prevent pulmonary HTN and cor pulmonale
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| show | diuretics; antibiotics; chest physiotherapy; bronchodilator
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| show | steroid therapy with dexamethasone
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| what are the periods of apnea of prematurity in infants? | show 🗑
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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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| premature infants have an immature ____________ of ___________ ______. | show 🗑
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| show | underlying cause if identified; tactile stimulation
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| ______ is used to reduce mixed and obstructive apnea by splinting the upper airway. | show 🗑
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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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| show | further R-L shunting, severe hypoxemia, and metabolic and resp acidosis
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| show | foramen ovale and the ductus arteriosus
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| show | low
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| show | if the PVR does not decrease to allow the PVR/SVR ratio to become less than 1
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| show | 1. vascular spasm 2. increased muscle wall thickness 3. decreased cross-sectional area of pulmonary vessels
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| what is vascular spasm? | show 🗑
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| show | chronic condition develops in utero in response to several different factors (chronic fetal hypoxia, incr pulm blood flow, pulm venous obstruction)
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| what is decreased cross-sectional area of vasculature related to? | show 🗑
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| show | when rapidly changing SpO2 hypoxemia is worse than indicated on chest radiograph
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| show | performing preductal and postductal SpO2 (pred should be >5% post)
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| show | removal of underlying cause, hypoxemia w/ O2 and surfactant for RDS
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| show | needs intubation and MV; sedation, paralysis; HFV; inhaled nitric oxide; ECMO (if all fails)
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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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| show | inspiratory stridor, gas trapping, expiratory wheezing, accessory resp muscle activity
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| show | hemangiomas, neck or thoracic masses, vascular rings
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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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| show | esophageal atresia w/ a distal fistula (85%-90%); H fistula
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| what do all these malformations manifest as? | show 🗑
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| show | surgical ligation of the fistula and reconnection of the interrupted esophagus
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| show | congenital cystic adenomatoid malformation of the lung (C-CAM)
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| what is the usual treatment of C-CAM? | show 🗑
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| what are less common lung malformations? | show 🗑
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| show | severe disease that usually manifests in newborns as severe respiratory distress
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| what is the pathophysiologic mechanism of CDH? | show 🗑
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| show | 1. Bochdalek hernia (lateral/posterior, left) 2. Morgagni hernia (medial/anterior, either side)
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| what might physical examination include in CDH? | show 🗑
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| what is the initial treatment? | show 🗑
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| show | surgical repair for PVR to fall
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| what can large defects in the abdominal wall cause? | show 🗑
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| what is omphalocele? | show 🗑
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| show | gastroschesis (abdominal wall defect that is completely separate from the insertion of UC)
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| show | spinal muscular atrophy, congenital myasthenia gravis, myotonic dystrophy, and others
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| what are the 2 large categories of congenital heart diseases? | show 🗑
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| what are cyanotic heart diseases? | show 🗑
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| what are acyanotic heart diseases? | show 🗑
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| what are the 2 most common cyanotic heart diseases? | show 🗑
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| what does tetralogy of Fallot include? | show 🗑
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| show | heart murmur, intermittent severe cyanotic spells, infant squatting/entering knee chest position
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| show | heart murmur and severe continuous cyanosis
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| show | the heart disease that most frequently causes severe cyanosis
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| what does it manifest as? | show 🗑
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| show | emergency atrial septostomy (cutting a hole in the wall b/t two atria)
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| what is the goal? | show 🗑
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| show | ventricular septal defect
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| show | hypoplastic left heart syndrome
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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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| what is patent ductus arteriosus treated with? | show 🗑
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| show | comfort care (allows infant to die), palliative surgical procedure, transplantation
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| show | SIDS
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| what infant normally dies to SIDS? | show 🗑
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| what age is most suseptible and when does it normally occur? | show 🗑
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| the _______ sleeping position has been strongly associated with increased risk of SIDS. | show 🗑
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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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| show | reactive airway disease, aspiration pneumonia, laryngospasm, stridor, chronic cough, choke, apnea
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| show | bronchiolitis
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| show | inflammation/obstruction of small bronchi/bronchioles
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| show | after a viral upper respiratory infection (fever, cough, dyspnea, tachypnea, wheezes)
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| what does the chest radiograph show? | show 🗑
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| what is the treatment of bronchiolitis? | show 🗑
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| _________ is given to decrease the length of MV in severe cases. | show 🗑
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| show | croup (laryngotracheobronchitis)
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| what is viral infection resulting in subglottic swelling? | show 🗑
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| show | after 2-3 days of nasal congestion, fever, coughing; stridor, barking cough, dyspnea, cyanosis, exhaustion
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| what does the chest radiograph show? | show 🗑
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| what is the treatment of croup? | show 🗑
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| __________ is an acute and often life-threatening infection of the upper airway that causes severe obstruction secondary to supraglottic swelling. what is the most common cause? | show 🗑
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| what are the clinical manifestations of epiglottitis? | show 🗑
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| what does the LATERAL NECK radiograph show? | show 🗑
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| what is the treatment of epiglottitis? | show 🗑
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| what is the most common lethal genetic disease among caucasian americans? what does it involve? | show 🗑
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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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