Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Patient Assessment 3 > Respiratory Assessment of Neonate > Flashcards

Respiratory Assessment of Neonate Flashcards

1
Q

Spontaneous Parameters of Neonate

A

RR: 40-60

Vt: 5-7

Vd/Vt: 0.3

FRC: 30

Resistance: 25-50

Compliance: 1-2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Neonate Respiratory Anatomy Compared to Adult

Anteroposterior transverse diameter ratio

A

Neonate: 1:1

Adult: 1:2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Neonate Respiratory Anatomy Compared to Adult

Angle of mainstream bronchi

A

Neonate: 10 degree to the right and 30 degrees to the left

Adult: 30 degrees to the right and 50 degrees to the left

Infant has a higher degree of curvature and are less prone to right lugnintubation also the trachea is shorter which is why they are so easy to extubate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Neonate Respiratory Anatomy Compared to Adult

Compliance of Trachea

A

Neonate: Compliant, fleixble

Adult: Noncompliant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neonate Respiratory Anatomy Compared to Adult

Level of Trachea Bifurcation

A

Neonate: T3-4

Adult: T5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Neonate Respiratory Anatomy Compared to Adult

Shape and Location of Epiglottis

A

Neonate: Long/C1

Adult: Flat C4

large and floppy epiglottis (in infants we are using the miller blade to help move the large floppy epiglottis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Neonate Respiratory Anatomy Compared to Adult

Narrowest Portion of Upper airway

A

Neonate: Cricoid Cartilage

Adult: Rima Glottidis

Cricoid cartilage is the narrowest part of the airway and is shaped in a funnel shape.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Neonate Respiratory Anatomy Compared to Adult

Laryngeal Shape

A

Neonate: Funnel Shape

Adult: Rectangular

Laryngeal soft tissue and lymph nodes which meakes them more susceptible to swelling and injury.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neonate Respiratory Anatomy Compared to Adult

Tongue Size

A

Neonate: Large

Adult: Porportional

Largetongue with small mouth which makes it easy to cause an obstruction and is more difficult to navigate around it with a laryngoscope.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Neonate Respiratory Anatomy Compared to Adult

Head/Body Ratio

A

Neonate: 1:4

Adult: 1:8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Neonate Respiratory Anatomy Compared to Adult

Body Surface Area/Body Size Ratio

A

Neonate: 9 x adult

Large heart and belly- increase impedance for tidal volume as the heart is taking up more room

Adult: Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Neonate Respiratory Anatomy Compared to Adult

Location of Heart

A

Neonate: Center of chest midline

Adult: Lower portion of chest left of midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Neonate Respiratory Anatomy Compared to Adult

Resting Poistion of Diaphragm

A

Neonate: Higher than adult

Adult: Normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Neonate Respiratory Anatomy Compared to Adult

Thoracic Shape

A

Neonate: Bullet shaped

Adult: Conical shaped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Respiratory Anatomy and Sniffing Position

A

Large occipital which makes it harder to get the baby in sniffing position (best way is to put a small blanket under their shoulders or even just use your hand),

Sniffing position is very important becase the airway is easy to coallpse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Neonates Aspiration Risk

A

Airway and trachea more anterior and superior which puts them on a greater risk for aspiration and difficult intubation

Smaller trachea making it easier for stuff to get stuck in there

Obligated nose breathers so when they get an infection with a stuffy nose their nose will occlude quicker and will have to be stimulated to breath

17
Q

Neonatal Compliance

A

Morecompliant chest wall because the cartilage under developed which will create high airway resistance in upper airway and more collapse in the lower airway (so when it comes out easier it will also collapse inwards easier

Accessory muscle are under developed so they are more susceptible to failure

18
Q

Infant Trachea and Carina

A

Infant trachea is 4 mm wide; adult trachea is 16 mm wide

Carina is higher (3rdvertebrae), T4/5 by age 10

Infant airway is more funnel shaped, narrowest point is cricoid

Infant epiglottis is OMEGA Ω shaped, less flexible, more horizontal

Infants have poor neck flexion = higher obstruction risk

Infants have large tongue with posterior placements and larger amounts of lymph tissue = higher obstruction risk

19
Q

Respiratory Failure

A
  • CO2 production is higher than adults and, so if baby/child is working harder to breathe than normal, they will tire out faster than an adult
    • Metabolic rate is twice as high as adults
  • O2 consumption is much higher than in adults, so hypoxemia effects will be more profound
    • Respiratory failure will occur much more quickly in an infant than in an adult
    • If infant goes hypoxemic it will be very profound and very quick
  • Infants tend to have smaller FRC’s than adults, so airway closure can occur more quickly creating shunting
20
Q

Respiratory distress in the neonate

A
  • Observed prior to birth via fetal monitoring strip, scalp pH, heart rate:
    • Distress = profound bradycardia, late decelerations, variable decelerations, loss of normal heart rate variability, scalp pH less than 7.15
  • Allows for preparation for resuscitation
  • Observedafter delivery via rapid assessment:
    • Assessment of the neonate commences as soon as baby presents…inspection!
21
Q

Questions at the Time of Delivery

A
  • Expected gestational age
  • Clear amniotic fluid
  • Singleton or…?
  • Other risk factors
22
Q

Rapid Assessment at Delivery

Inspection

A
  • Color
  • Tone / movement (active, flexed extremities vs flaccid, extended extremities)
  • WOB/ respiratory distress (gasping vs vigorous cry)
  • Presence of Meconium
  • RR [absent, too fast, too slow, depth]
23
Q

Rapid Assessment at Delivery

Routine

A

Infants who meet the following four criteria generally will not require resuscitation and can be quickly dried, placed on the mother’s abdomen, and covered with dry, warm linen to maintain temperature

–Infants born at full-term gestation

–Amniotic fluid clear with no evidence of infection

–Crying or normal breathing

–Good muscle tone

24
Q

APGAR Scores

A
  • Used to assess infants at
    • 1 and 5 minutes…
    • Will continue to be done q 5 minsuntil the baby is 7 or greater
  • Best use: reflective indication of fetal well being at time of delivery and the efficiency of interventions
    • Does not guide the resuscitation, rather it is a means of gauging the effectiveness of the resuscitation
25
Q

APGAR Scores Limintations

A

–Only gives snapshot of that particular instant

–Does not always reflect the clinical situation

–No substitute for clinical history – high risk etc.

–Will notdictate survival of the infant

26
Q

APGAR Scoring

A

Heart Rate

  • Absent (Score 0)
  • <100 bpm (Score 1)
  • >100 bpm (Score 2)

Respiratory Effort

  • Absent (Score 0)
  • Gasping, irregular (Score 1)
  • Good (Score 2)

Muscle Tone

  • Limp (Score 0)
  • Some Flexion (Score 1)
  • Active Motion (Score 2)

Reflex Irritability

  • No Response (Score 0)
  • Grimance (Score 1)
  • Cry (Score 2)

Color

  • body pale or blue, extremities blue (Score 0)
  • Body pink and extremities blue (Score 1)
  • Completely pink (Score 2)
27
Q

Determine Gestational Age

A
  • Neonatologists post stabilization in order to confirm gestational age if uncertain
  • 2 common scales used criteria measuring from 26 to 42 week:
    • Dubowitz: 11 score
    • Ballard: 6 neuromuscular & 6 physical maturity scores able 12 s (a revision of the Dubowitz)
  • Both use a system of neuromuscular assessments and physiological observations relating to gestational age
  • Most reliable in assessing babes earlier than 26 weeks gestation if done ASAP (before 12 hours of age)
28
Q

Signs & Symptoms of Respiratory Distress in the Neonate

A
  • Retractions
    • Intercostal, suprasternal, substernal (xiphoid)
  • Grunting
  • Nasal flaring
  • Increasing oxygen requirements
  • Cyanosis
  • Tachypnea
    • RR > 60 bpm
29
Q

Silverman Index

A

The Silverman Index is a good method of evaluating respiratory distress in the neonate.

30
Q

Rooting Reflex

A

Stroke the lip and corner of the cheek with a finger and the infant will turn in that direction and open his mouth

31
Q

Blink Reflex

A

Blink: Tap gently on the forehead and the eyes will blink

32
Q

Head Lag Reflex

A

Head Lag: Lift the babe by the arms and observe head position for head control

33
Q

Startle Reflex

A

Startle: Loud noise and observe response – babe should startle

34
Q

Grasping Reflex

A

Grasp: babe should grab a finger with full hand

35
Q

Cranial Nerve Reflex

A

Cranial Nerves:Reaction of the pupils and the ability of the infant to follow objects with its eyes

36
Q

Movement Reflex

A

Movement: Spontaneous movement of limbs, trunk, face, and neck should be observed. Tremors are normal but clonic movements are associated with seizures

37
Q

Moro Reflex

A

Moro: if babe “feels” it is falling

  • Spread arms (abduction)
  • Unspreadarms (adduction)
  • cry
38
Q

Neurological Expectations of a Newborn

•Gestational age 28 weeks:

A

–Can be awoken from sleep and can stay awake for a few minutes

–Flicker eye movement in response to light

–Active

39
Q

Neurological Expectations of a Newborn

•Gestational age 38 weeks:

A

–Can self-wake and can stay awake and alert for long periods

–Responds to stimulation like light and sound

–Can smile

–Active with good gross motor function

–Cries for food, mommy, snuggles, sleep, diaper issues, discomfort

–Can express pain

Patient Assessment 3 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions