respiratory therapy > final 142!! > Flashcards

final 142!! Flashcards

(68 cards)

Study These Flashcards
1
Q

what are early decelerations and what causes them

A

drop fetal heart rate during contractions, caused by fetal head compression

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

what are late decelerations and what cause them

A

the slowing of the fetal heart rate after a uterine contraction caused by uteroplacental insufficiency and typically associated with fetal distress.

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

what are variable decelerations and what causes them

A

slowing of FHR after a uterine contraction caused by cord compression (increases risk fo fetal hypoxia)

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

Correct ABG values for a term infant

A

PH: 7.3-7.4
PaCO2: 30-40
PaO2: 80-100
HCO3: 20-22

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

understand fetal circulation

A

1.Fetus doesn’t use lungs for gas exchange → uses placenta.
2.Three special shunts:
oForamen ovale: right atrium → left atrium (bypasses lungs).
oDuctus arteriosus: pulmonary artery → aorta (bypasses lungs).
oDuctus venosus: umbilical vein → IVC (bypasses liver).
Oxygenation pattern:
3.Oxygenated blood comes from the placenta (not the lungs).
4.Umbilical vein carries oxygenated blood to fetus.
5.Umbilical arteries carry deoxygenated blood back to placenta.
Pressures (important concept):
6.In the fetus: Pulmonary vascular resistance is high (lungs filled with fluid, not expanded).
7.Systemic resistance is low (because placenta is a big, low-resistance circuit).
8.After birth: this reverses (lungs expand → PVR drops, placenta removed → SVR rises).
Closure after birth:
9.First breath → ↓ pulmonary vascular resistance, ↑ left atrial pressure → closes foramen ovale.
10.Increased oxygen and ↓ prostaglandins → closes ductus arteriosus.
11.Clamping cord → closes ductus venosus.

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

medications typically used to help improve lung maturity before birth in preterm

A

Antenatal corticosteroids given to help surfactant production
Bethamethasone (IM)
Dexamethasone (IM)
Induces proteins that regulate the production of surfactant by type II cells in the fetal lungs. Decreases respiratory distress syndrome and neonatal morbidity by 50%.

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

site preferences for arterial puncture

A

1.NO femoral or brachial artery punctures
2.Radial artery
3.Dorsalis pedis- only if radial has bad circulation
4.Posterior tibial artery- only if radial has bad circulation
5.Temporal artery- helpful in premature babies because the temporal artery is typically larger than radial

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

complications of capillary blood gases

A
  1. Burns due to heel warming
  2. Infection
  3. Scarring
  4. Calcaneous osteomyelitis
  5. Nerve damage
  6. Arterial laceration
  7. Cellulitis
  8. Hematoma/Bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pulmonary diseases that may cause an increase in AP diameter but is not a chest wall deformity

A

BPD: air trapping
CF: chronic air trapping

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

appearance of CXR for RDS

A
  1. ground glass
  2. air bronchograms
  3. low lung volumes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

appearance of CXR for TTN

A
  1. pulmonary vascular congestion
  2. hyper expansion
  3. fluid in the fissures
  4. perihilar streaking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what structure looks like a sail on an AP chest radiograph of a neonate

A

the thymus looks like a “sail”

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

what is the cause of the steeple sign

A

on a lateral neck x-ray croup (laryngotracheobronchitis) will show subglottic narrowing below the vocal cords

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

definition of capnometry

A

capnometry= ETCO2 measured in exhaled gas, only expressed in mmHg or %

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

know what conditions cause the sound of a dull percussion note over the thorax of a child

A

dull percussion notes are found over infiltrates, effusions, or solid tissues.
pneumonia, atelectasis, pleural effusions)

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

definition of polyhydramnios

A

Polyhydramnios: The presence of excess fluid in the amniotic sac it is diagnosed if the deepest vertical pool is more than 8 cm or amniotic fluid index (AFI) is more than 95th percentile for the corresponding gestational age. With a deep pocket of 8 cm as criteria of polyhydramnios, the incidence is 1% to 3% of all pregnancies. About 20% are associated with fetal anomalies.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what meds are give for neonatal apnea

A

Xanthine’s- Theophylline, caffeine to stimulate diaphragmatic muscle contractions and increase sensitivity to CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

complications of oxygen therapy

A

1.Hypoventilation
2.Respiratory arrest
3.Absorption atelectasis
4.Pulmonary vasodilation (V/Q)
5.Pulmonary fibrosis
6.Retinopathy of prematurity (ischemia/retinal scarring)
7.IVH
8.Pneumothorax
9.PIE
10.pneumopericardium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

problems that occur because of absorption atelectasis

A

1.Absorption atelectasis → alveoli collapse as nitrogen is replaced by oxygen.
2.Pulmonary vasodilation → mismatched blood flow in the lungs.
3.Ventilation–perfusion (V/Q) mismatch → increased intrapulmonary shunting.
4.Worsened arterial oxygen delivery → despite high oxygen levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

be able to recall the conditions in which a high flow nasal cannula would be contraindicated

A

1.Pneumothorax
2.Severe upper airway obstruction
3.Absence of spontaneous ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

understand the signs and symptoms of epiglottitis as well as the clinical presentation

A

The 4 D’s of epiglottitis:
1. dysphonia
2. dysphagia
3. drooling
4. distress (toxic appearance)
life threatening infection commonly caused by haemophilus influenzae type B, “thumb sign on lateral neck XRAY)
signs and symptoms:
1. abrupt onset
2. high fever
3. severe sore throat
4. stridor
5. cyanosis
6. retractions
7. lethargy
8. nasal flaring
9. tripod position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

recall how RSV is transmitted

A

Highly contagious virus, transmitted by direct contact, respiratory droplets, or contaminated surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

be able to recall the characteristics of asthma

A

1.Inflammation
2.Acute bronchoconstriction
3.Airway edema
4.Mucous plugging
5.Airway hyperresponsiveness
6.Airway remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

recall the definition of esophageal atresia

A

A serious birth defect in which the esophagus, is segmented and closed off at any point. This condition usually occurs with TEF, in which the esophagus is connected to the trachea. Usually associated with prematurity and polyhydramnios. Causes a blockage of the passage for food or saliva.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
pathophysiology of congenital diaphragmatic hernias
Pathophysiology: -Failure of the diaphragm to form results in; herniation of the intestines into the thoracic cavity (8 weeks gestation) -Hypoplasia of the affected (ipsilateral lung) -Contralateral (unaffected) lung can be compressed and the heart shifts to right side -Muscular hypertrophy of the pulmonary vasculature (increased risk for PPHN)
26
know what causes pulmonary vascular resistance at birth to decrease
-in the fetus PVR is high( lungs filled with fluid, not expanded) -systemic resistance is low, because placenta is a big low resistance circuit -after birth: this reverses, lungs expand and PVR drops, placenta is removed causing SVR to rise.
27
Understand the L/S ratio that indicates an adequate lung maturity.
L:S Ratio: *Lecithin and sphingomyelin production can be determined from amniotic fluid analysis *The ratio of lecithin to sphingomyelin is calculated and used to estimate lung maturity *L:S Ratio >2:1= mature lungs *L:S Ratio <1:0= severe lung immaturity *L:S Ratio 1.5-2.0= lung disease may or may not develop *L:S Ratio is unreliable in pregnancies characterized by gestational diabetes or Rh incompatibility *Falsely high L:S is amniocentesis is contaminated with fetal/maternal blood or vaginal secretion
28
Be able to recall what values of CBG results correlate well with arterial values.
1.PH 2.PaCO2 3.HCO3 (PaO2 does not correlate well with arterial values)
29
Be able to recall the diaphragm level on x-ray that indicates adequate inspiratory effort.
*Being at posterior level of 8-9 ribs*
30
Recall the common complications of Transcutaneous monitoring
-Burns - Allergic skin reactions -Clinical judgments based on inaccurate values
31
Understand what causes meconium to be released in utero
A stressed baby has a drop in oxygen. When oxygen drops, the baby’s body reacts by relaxing the anal sphincter and increasing gut movement. That combination pushes meconium out into the amniotic fluid.
32
clinical presentation of transient tachypnea of newborns
Clinical presentation of TTN: -Tachypnea (60-150bpm) -Cyanosis -Grunting -Retractions -Nasal flaring -ABG’s: mild-moderate hypoxemia, hypercapnia and respiratory acidosis
33
characteristics of RDS
Premature lungs → ↓ surfactant → alveoli collapse at end-expiration Collapsed alveoli → ↓ compliance → stiff lungs → increased work of breathing V/Q mismatch → hypoxemia, CO₂ retention, and a decrease in pulmonary blood flow Results in: tachypnea, retractions, grunting, and eventually respiratory failure if untreated
34
complications of neonatal pneumonia
◦ IVH ◦ air leaks ◦ PPHN ◦ NEC ◦ Key to treatment is early intervention and aggressive therapy
35
Recall how Persistent Pulmonary Hypertension of the Newborn (PPHN) is diagnosed.
1. Presents in the first 12 hours of life with 2. Cyanosis 3. Tachypnea 4. Hypoxia (refractory oxygen therapy) 5. Signs of respiratory distress, retractions, grunting, and nasal flaring) 6. ABG’s: hypoxemia (may show resp alkalosis) 7. CXR: initially clear- hyper expansion with decreased vascularity 8. Echocardiogram that shows right to left shunting
36
Describe the signs of respiratory distress in an infant.
1.Nasal flaring- sign of air hunger occurs as an effort to draw in more air through the nose 2.Exp grunting- glottis partially closes during exhalation to attempt to maintain lung volumes by increasing end exp pressure 3.Tachypnea- RR>60 bpm 4.Retractions- usually indicates decreased lung compliance, can be associated with obstructive airway with normal compliance 5.Cyanosis 6.Apnea 7.Head bobbing- sternocleidomastoid accessory muscle contraction
37
Recall the anti-viral medication used to treat RSV.
Ribavirin: -Broad spectrum virustatic -Controversy associated with its use -SPAG (small particle aerosol generator) -Recommended for infants with increased risk of severe disease (BPD, congenital heart defects…) -No routine bronchodilators, PRN
38
Know the most predominant causative agent of neonatal pneumonia.
Bacterial pneumonia: -Group B Streptococcus -Escherichia coli -Klebsiella -Streptococci -Listeria monocytogenes -Pneumococci -Staphylococcus -Pseudomonas Viral (torch) pneumonia: -Toxoplasmosis -Rubella -Cytomegalovirus (most common?) -Herpes Most common viral PNA that causes babies to be born with it is cytomegalovirus and most common viral PNA after birth is caused by RSV most common source is hand contamination of health care personnel
39
Understand the definition of Hz in relation to a high frequency ventilator
Hz= 60bpm
40
Describe the variable that has the most significant effect on mean airway pressure.
MAP is the average pressure in the airway over the whole respiratory cycle, PEEP has the greatest effect on MAP because it is present 100% of the time (both inspiration and exhalation) while PIP only effects during inspiration.
41
contraindications of CPAP
Contraindications: -Infants with persistent apnea -When CPAP has failed CO2 >60 and/or PH <7.25 -Upper airway abnormalities like choanal atresia, cleft palate, and TEF -Untreated congenital diaphragmatic hernia -Neuromuscular disorders -CNS depressant medication -Central or frequent apnea
42
recalled devices to deliver CPAP by description and acronym
1.Mechanical ventilator CPAP aka V-CPAP Vent in CPAP mode with delivery through nasal prongs 2.Bubble nasal CPAP aka B-CPAP Inexpensive constant flow delivery system 3.Infant flow nasal CPAP aka IF-CPAP 4.infant flow synchronized intermittent positive airway pressure AKA IF-SIPAP (CPAP but with PS for spont breaths 5.HFNC
43
Understand the functions of pulmonary surfactant.
Surfactant: -reduces surface tension -alveolar stability, -increases lung compliance -decreases WOB
44
be able to recall the clinical manifestations that are consistent with an atrial septal defect (ASD)
Atrial septal defect: 1.An opening between the right and left atria (shunts L to R) 2.Increased pulmonary blood flow 3.Leads to right atrium enlargement and right ventricle volume overload 4.Over time this can lead too: Right ventricle hypertrophy CHF Pulmonary vascular disease
45
Be able to recall the clinical manifestations that are consistent with a large ventricular septal defect (VSD)
Ventricular septal defect: 1.Opening between the R and L ventricles (shunt L to R) 2.Large VSD leads to CHF Pulmonary hypertension 3.Cardiac silhouette will be enlarged, and the pulmonary vascular markings increased
46
be able to identify the cardiac anomaly of a CXR that has the cardiac "boot shaped"
Tetralogy of Fallot: boot shaped appearance of the heart
47
be able to identify the cardiac anomaly of a CXR that has the cardiac of "egg shaped heart"
Transposition of the great arteries: “egg shaped” heart, pulmonary vascular enlargement, and cardiomegaly appear after hour to days
48
Identify the clinical features that characterize aortic stenosis in the neonate
-Narrowing location: subvalvular, valvular (most common), or supravalvular -Left ventricle hypertrophy always present -Severe → low cardiac output, possible CHF -Can be ductal dependent → systemic blood flow relies on PDA -May have L → R shunt through foramen ovale if LA pressures rise -Can be diagnosed in utero Critically ill if severe → may need mechanical ventilation -Use O₂ cautiously to avoid PDA closure -Immediate surgery if severe
49
Recall the etiology of Air Leak syndrome
Air leak syndrome happens when alveoli rupture due to high pressure or volume, especially in fragile neonatal lungs or when ventilator pressures are excessive. The leaked air then moves into spaces like the pleura, mediastinum, or interstitium. Most common cause is positive pressure ventilation with high pressures: *high PIP *high MAP *overdistension *inadequate expiratory time causing air trapping Happens more easily in fragile neonatal lungs: *RDS *meconium aspiration *pneumonia *BPD *TTN (less common) Less common causes: *trauma from suctioning *CPAP with too much pressure or an improper seal *chest compressions
50
Recall the anomalies associated with Atrioventricular Septal Defect (AVSD).
Associated with trisomy 21 (Down syndrome), common in this heart disease, may exhibit anatomically smaller airways for their age, as well as macroglossia and hypotonia, which may complicate spontaneous breathing and extubation.
51
Be able to apply the "desired FIO2 equation" to make appropriate changes to a ventilator.
OI= FiO₂×MAP×100/ PaO₂ - OI ≥ 25 → Severe respiratory failure → ECMO may be considered -OI ≥ 40 → Strong indication for ECMO in neonates OI helps quantify how much ventilatory support is needed to maintain oxygenation and when to consider ECMO
52
Be able to LIST the four conditions that appear in tandem with Tetralogy of Fallot.
Consists of four conditions in tandem *Overriding aorta *Pulmonary artery stenosis *VSD *Right ventricular hypertrophy
53
Recall the system of ECMO that provides only pulmonary support.
The VenoVenous ECMO only provides pulmonary support, the blood is returned to the venous system, so the heart still must pump it to the body.
54
list indications for infant CPAP
1. Premature infants Apnea of prematurity CPAP in delivery room 2. Obstructive airway diseases BPD Bronchiolitis 3. Pneumonia 4. Meconium aspiration syndrome 5. Congestive heart failure 6. Pulmonary edema 7. TTN 8. Surfactant administration 9. Nitric oxide administration
55
Understand the NRP algorithm
Initial steps (first 30 seconds after birth): *Provide warmth Position airway *Clear secretions if needed *Dry and stimulate *Assess breathing and heart rate If the baby is breathing and HR ≥100: *Support as needed (maybe oxygen or CPAP if preterm) If the baby is not breathing or HR <100: *Start Positive Pressure Ventilation (PPV) Reassess after 30 seconds of PPV: *HR ≥100 → continue support as needed *HR <100 → perform corrective steps (MR SOPA) If HR <60 despite PPV for 30 seconds: *Begin chest compressions coordinated with PPV (3:1 ratio) *Consider epinephrine if HR remains <60 after 60 seconds of compressions and PPV
56
Recall the appropriate time frame in which intubation of the newborn should occur.
Intubation should take 30 seconds or less, intubate if PPV is ineffective
57
What practices may decrease a premature newborn’s risk of neurologic injury?
1 Handle baby gently 2 Gentle ventilation 3 Proper FiO2 according to gestational age 4 Avoid hyperoxia to reduce stress of brain 5 Don’t position baby legs higher than head 6 Avoid high pressure from CPAP or PPV 7 Don’t rapidly infuse IV fluids
58
Describe the unique challenges of a premature baby during resuscitation.
Premature infants have immature lungs and a weak respiratory drive, so they struggle to breathe and oxygenate. They lose heat very quickly, have very fragile airways, and their cardiovascular system is unstable, making resuscitation more delicate.
59
Name three things you can do to troubleshoot a bubble CPAP that is not bubbling
a. Check for flow, water level, expiratory limb submersion, kinks, open ports b. if open mouth-utilize a chin strap c. check mask/prongs are appropriate d. ensure hat or head strap fits correctly
60
Should an infant HFNC cannula occlude 100% of the nares T/F
False (only CPAP prongs should be fitted for 100% occlusion)
61
Where is a good place to start for initial settings for an infant on HFNC
1. 1-2L/kg/min 2. FiO2 to target SPO2
62
When using NPPV how can you tell if your positive inspiratory pressure breaths are adequate
when you can see the chest rise
63
Name two types of less invasive surfactant administration
- LISA (less invasive surfactant administration) -SALSA (Surfactant Administration via Laryngeal or Supraglottic Airway)
64
how would you size a pediatric OPA
from the corner of the mouth to the angle of the jaw
65
how would you size a pediatric NPA
measure from the nose septum (philtrum) to the tragus
66
list three indications that a patient needs to suctioned
1. breath sounds 2. visual secretions in the artificial airway, mouth, or nares 3. saw tooth pattern on the ventilator waveform 4. signs of respiratory distress like gasping, grunting, or decreased oxygen saturations 5. increased peak airway pressures
67
what equipment needs to be at bedside for a tracheostomy patients at ALL times
1. same size trach with obturator 2. next size smaller trach with obturator 3. suction 4. resuscitator (BVM, T-piece, flow inflating bag) 5. if cuffed syringe 6. lubricant
68
name three anatomical differences in pediatric populations and how do they affect airway management
1. larger occiput (back of head)- can kink the airway, worsen obstruction 2. Larger tongue- easily obstructs the airway, more difficult to visualize glottis during intubation 3. Smaller/softer airway structures- airway is more collapsible 4. Higher larynx- harder to intubate
respiratory therapy
flashcards
Decks in class (18)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions