NB birth stress Flashcards

1
Q

NB asphyxia-3

A

-hyperprofusion of lungs, large R to L shunt through ductus arteriosus bypassing lungs, change from aerobic to anaerobis metab (metabolic acidosis)

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2
Q

NB asphyxia protective measures-4

A

immature brain, low resting metab rate, can use anaerobic metab for energy, cir sys can redistribute lactate and hydrogen ions (severe hypoxia will overcome)

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3
Q

asphyxia risk factors-12

A

sustained bradycardia, mom not O2, blood flow to placenta, significant bleeding, long labor, meconium, premie, male, SGA, DM mom

  • ominus if pH 7.2 lower
  • start resuscitation before APGAR if needed
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4
Q

asphyxia ass prebirth-4

A
  1. gest age
  2. meconium/infection in amnio
  3. number of babies
  4. other risk factors
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5
Q

asphyxia ass post birth-4

A
  1. full term
  2. breathing/cry
  3. muscle tone
    - if any “no”, resuscitate
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6
Q

asphyxia treatment-5

A
  1. stabilize (warm, clear airway, dry, stimulate)
  2. O2 administration- pulse ox on rt hand/wrist (brain)
  3. positive pressure vent
  4. chest compressions
  5. epi/volume expansion
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7
Q

resuscitation mgt-4

A
  • sniff position under radient heat
    1. position and clear airway, stimulate
    2. positive pressure vent- mask over mouth and nose w manometer, titrate 5-10 L/min
    3. observe chest move-40-60 breaths/min, never exceede pressure of 40
    4. intubate with compressions- HR absent or under 60 after 30 sec pos pressure O2
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8
Q

chest compressions-4

A
  1. proper position on firm surface- use thumbs w fingers wrapped around back, rate of 90 beats per min
  2. use 3:1 ratio with ventilation- 90 compressions to 30 breaths
  3. no response 30 sec- ept 0.1-0.3 mg/kg followed by NS
  4. if shock occurs- NS or LR, blood products
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9
Q

Respiratory distress syndrome-3

A

inadequate production of surfectant (starts at 24 wks)

  • surfectant deficiency disease- failure to synthesize, atelectasis
  • more energy needed to open lungs so each breath harder than last
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10
Q

respiratory distress complications-3

A

hypoxia, respiratory acidosis, metabolic acidosis

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11
Q

respiratory distress treatment-3

A
  • resolution 7-10 days
  • surfectant replacement
  • increase UOP sign of resolution
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12
Q

respiratory distress s/s-6

A

cyanosis, tachypnea (greater than 60), grunt, nasal flare, retractions, apnea

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13
Q

transient tachypnea of NB-2

A

-term w fl in lungs, general overexpansion of lungs, higher with c/s

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14
Q

transient tachypnea of NB s/s-4

A

grunt, flare, mild cyanosis, increase in anterior-posterior diameter of chest

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15
Q

transient tachypnea of NB treat-2

A

usually resolves 48-72 hrs

-oral feed contraindicated

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16
Q

meconium aspiration syndrome-5

A
  • can indicate asphyxia unless breech

- mechanical obstructon of airways-> alveoli overdistended, chemical pneumonitis, inactivation of natural surfectant

17
Q

meconium aspiration syndrome s/s-4

A

barrel-shaped chest, prominent rales/rhonchi, possible displaced liver, yellow stained skin/nails/cord

18
Q

meconium aspiration syndrome treat-7

A
  • if vigerous, nothing

- unstable- direct tracheal suck, O2, positive pressure vent, surfectant prophylactics, nitric oxide, abx

19
Q

pallor/mottling

A

poor peripheral circulation

20
Q

cyanosis

A

advanced hypoxia, exam mucous membrane and tongue

21
Q

jaundice skin color

A

metabolism alterations

22
Q

edema- resp distress

A

seen in hands and feet first 24 hrs then resolves by day 5

23
Q

tachypnea

A

RR 60+, early s/s resp distress

24
Q

retractions

A

seesaw resp when chest flat and abdo expands

25
Q

nasal flare

A

tries to lessen resistance of narrow nasal passage

26
Q

expiratory grunt-2

A

valsalva maneuver which NB exhales against partially closed glottis
*don’t intubate

27
Q

rales/rhonchi

A

interstitial/intrapleural air flow

28
Q

continuous systolic murmur

A

patent ductus arteriosus

29
Q

transcutaneous O2 monitor-4

A
  • diffusion across skin surface
  • clean, dry skin, avoid bony prominence,
  • change skin site and recalibrate q 4hrs
  • Os sats 88-92%