RCP170 Midterm
The following are stages associated with fetal lung development, Except?
Blastocystic
Which of the following antibiotics is commonly nebulized to treat infections caused by Pseudomonas aeruginosa in patients with CF?
Cayston (aztreonam)
The therapist is about to perform endotracheal intubation on a 900 gram infant. What size ET tube needs to be used?
2.5 mm
At what fetal development stage will cardiac defects develop?
3-8 weeks
What is the dead space ventilation? pH 7.30, PaCO2 60 mmHg, PaO2 65 mm Hg, HCO3 -28 with 35 PETCO2
42
Airway Clearance Therapy (ACTs) are required in only a limited number of conditions, all of which are characterized by which of the following?
Chronic excessive sputum production
After increasing the level of CPAP delivered to an infant, the therapist notices that the neonate's PaCO2 rises and the PaO2 falls. What may have caused this situation?
The CPAP level was raised too high and air-trapping occured
Which of the following anatomic differences in the larynx of the infant compared to that of an adult make intubation of the infant more difficult?
The larynx of an infant is more anterior or cephalad
When comparing the infant's anatomy to adult anatomy, all of the following are true, EXCEPT?
The neonate is an obligatory mouth breather
all the following are hazards or complications associated with the installation of surfactant, except?
decreased pulmonary compliance
During fetal circulation, the blood flow pathway after the right ventricle goes to which of the fetal shunts that causes the shunting of blood away from the lungs?
ductus arteriosus
What is the name of the process when the sternocleidomastoids contract an attempt to overcome decreased lung compliance and increased airway resistance, or both, during inspiration?
head bobbing
Your patient is a 24 wk neonate that is 10 days old with a corrected age 25 weeks 4 days. He is being mechanically ventilated with the following settings: PRVC, Vt 4, Rate 60, Peep 8, FiO2 80%, PIP 28-30. The patient suddenly begins to deteriorate. The MD orders a chest radiograph. What is/are the likely findings?
pulmonary interstitial emphysema & pneumothorax
The therapist is reviewing the chest radiograph of a preterm newborn and observes diffuse, fine, reticulogranular densities, revealing a ground-glass appearance. On the basis of these radiographic findings, which of the following conditions should the therapist suspect is present?
respiratory distress syndrome (RDS)
A compensatory mechanism for chronic hypoxemia is increased hemoglobin and hematocrit to carry more oxygen?
true
The goal of oxygen administration is to achieve adequate tissue oxygenation
true
Treatment for apnea in preterm includes administration of xanthines such as caffeine or aminophylline?
true
The therapist is conducting a bCPAP check for a neonate and makes the following notations on the ventilator flow sheet: POP off: 10 cm H2O Pressure: 3 cm H2O Flow Meter set at 8 L/min FiO2: 0.21
Wean from bCPAP
What is the primary reason the endotracheal tubes (ETTs) for neonates are available without cuffs?
For most neonates the ETT creates a good seal against the cricoid cartilage
Of the following microorganisms, which of them is most common and often affects pregnancy & neonatal outcomes?
Group B Streptococcus
What are the primary categories associated with the need for intubation:
- respiratory failure - upper airway disorders - hemodynamic instability - protect the airway against aspiration
HFNC is associated with hazards and concerns:
- selecting appropriate cannula size for the diameter of the nare - gastric distention - lung overexpansion due to the inability of measuring pressure - avoid with untreated pneumothorax
Which of the following physiologic effects are generally associated with the use of CPAP for the treatment of respiratory distress?
- stabilized chest wall - improved synchrony of breathing - increased functional residual capacity
Which of the following conditions are contraindications for Bubble CPAP?
- untreated diaphragmatic hernia - central or frequent apnea - upper airway abnormality, such as Choanal atresia
How should the therapist determine the depth of insertion of an endotracheal tube for a neonate during the intubation procedure?
- Adding 6 to the estimated weight in Kg - Measuring from the tragus to the middle of the nasal septum and adding 1 cm - Once you see the single dark black line on the Ett enter the vocal cords or glottis - Using the gestational age & size chart for the Ett placement in NRP lesson 5
Which of the following anatomic structures is (are) fetal shunt(s)?
- Foramen ovale - Ductus venosus - Ductus arteriosus
Heated High Flow Nasal Cannula (HFNC) has been shown to:
- Improve mucociliary clearance, lessen inflammation, reduce bronchoconstriction due to humidity and heat - Decrease anxiety as compared to nasal CPAP due to the comfort of nasal cannula - Improve patient access for holding, feeding, and performing patient assessment - Reduces iatrogenic injury as compared to invasive mechanical ventilation and positive pressure devices
What is the name of the mucolytic that is specifically indicated for CF?
- Pulmazyme - Dnase - Dornase alfa
In the presence of high FiO2 levels of oxygen, there are potential hazards related to the high partial pressure of O2. Of the following, choose all that apply:
- absorption atelectasis due to N2 wash out - pulmonary vasodilation causing worsening V/Q mismatching - Retinopathy of prematurity (ROP)
The best placement of a transcutaneous (TcO2) monitor's electrodes includes
- an area with adequate perfusion - on the chest just below the center of the clavicle
All of the following are clinical signs of hypoxia and respiratory distress:
- central cyanosis - nasal flaring and head bobbing - grunting and retractions
What are the contraindications for Airway Clearance Therapy (ACT)?
- frank hemoptysis - empyema - foreign body aspiration
All of the following are signs of respiratory distress in the newborn, infant, and child:
- grunting - head bobbing and paradoxical breathing - nasal flaring - suprasternal and intercostal retractions
Which of the following conditions could delay the closure of the ductus arteriosus?
- hypoxia - acidosis
To score a newborn using APGAR, which of the following components should be assessed?
- muscle tone - respiratory effort - heart rate - reflex/irritability - skin color/appearance
What are the indications for this device?
- premature respiratory distress - delivery room (intrauterine to extrauterine transition) - bridge to ventilator liberation - bacterial or viral pneumonia with hypoxemia
What is represented by fetal hypoxia, distress & possible mortality, and serious maternal vaginal hemmorhage?
A premature detachment of the placenta, also known as placental abruption
which of the following drugs should the therapist give before administering nebulized 7% saline to a patient with CF?
Albuterol
Surfactant is produced by:
Alveolar Type II cells
which of the following are therapeutic interventions would be appropriate for a neonate with a respiratory rate of 65 breaths/min while displaying paradoxical chest wall movement with suprasternal and substernal, grunting, nasal flarring, cyaonsis, along with a pH 7.30; arterial partial pressure carbon dioxide (PaCO2), 50 mm Hg, arterial partial pressure of oxygen (PaO2), 60 mm Hg?
Continuous positive airway pressure (CPAP)
The most common method of administering surfactant to a neonate is:
Direct instillation to the airway via ETT
Which of the following physiologic consequences would develop if the liquid-gas interface were lacking surfactant?
Each breath would require a considerable amount of pressure to expand the lung with each inspiration up to -80 cmH2O
You are the RRT on duty in the NICU today and have a 32 week gestational age baby requiring oxygen therapy. The physician has asked you to determine the best device for the baby that would deliver 35% oxygen. Which device would you choose?
Heated HFNC
A oxygen device that provides a fixed FiO2%, 99% optimal humidification at 37.0 C?
Heated high flow nasal cannula
Therapeutic objectives of CPAP or NIPPV include all of the following, EXCEPT?
Increased ICP's & gastric distention
End tidal CO2 PetCO2. What is the most likely cause?
a medically paralyzed patient, initiating a breath
The respiratory therapist should determine the depth of insertion of an endotracheal tube for a neonate during the intubation procedure, EXCEPT?
Measuring from the tragus to the middle of the nasal septum
Increased Pulmonary Vascular Resistance
PPHN
To support adequate gas exchange and pulmonary circulation what value(s) increase after the initial breaths of life?
PaO2 and FRC
Which of the following relationships is correct regarding the composition of amniotic fluid as it relates to determining fetal lung maturity?
Phosphatidylhylcerol (PG) and phosphatidylcholine (lecithine) decrease while sphingomyelin increases during gestation
Which of the following arteries is considered the optimal puncture site for obtaining arterial blood samples from neonatal and pediatric patients?
Radial
The limitations of the TCM that produce inaccurate results, EXCEPT
TCM temp range 41-44 and adequate perfusion
What is the first, most prominent clinical sign of respiratory distress in the newborn infant?
Tachypnea
Why is Oligodyramnios a concern for the RRT who is attending a delivery?
Too little amniotic fluid volume contributing to pulmonary hypoplasia
This type of monitor works when the heat transfer from the electrode increases capillary blood flow to measure oxygen and carbon dioxide
Transcutaneous Monitoring
Goals of bCPAP are: increasing FRC to increase pulmonary compliance, decrease airway resistance, decrease respiratory rate, & decrease work of breathing
True
The main goal of providing NIV is to improve gas exchange & minimize work of breathing?
True
All of the following are clinical signs of hypoxia and respiratory distress, EXCEPT:
acrocyanosis
What is the most important variable used to assess the efficacy of CPT?
amount of mucus obtained during and after treatment
What is the significance of an infant with RDS demonstrating during each exhalation?
an effort to maintain its functional residual capacity (FRC)
Which of the following is NOT considered clinical reason to initiate bCPAP for a neonate
central apnea
Which of the following conditions with the presence of scaphoid abdomen in a newborn with tachypnea?
congenital diaphragmatic hernia
A term infant presents with mild respiratory distress after a cesarean section and is now 35 hours old. The physician ordered the chest radiograph 20 hours ago. The SpO2 on room air is 95%, HR 148, RR 70-90. Capillary blood gas results as follows: 7.35, pCO2 48 mmHg, pO2 45 mmHg, HCO3 -21 mmHg.
continue to monitor
which of the following would NOT be useful in treating Apnea of Prematurity?
corticosteroids
ROP
damage to the ocular vessel that results in scarring and potential impairement
Impedance pneumography (home monitoring) is an important tool used for neonatal and pediatric patients who might:
experiencing periods of apnea
a neonate presents with respiratory distress due to lack of pulmonary surfactant, what is the primary cause of distress in the neonate?
high surface tension
A patient with an excessive amount of secretions and atelectasis has been receiving ACT. What is the most common complication of ACT?
hypoxemia
Of the following factors listed which are NOT part of what is occurring with the change from fetal to newborn circulation:
increased blood flow through the foramen ovale
When performing bCPAP checks on the neonate, aside from the settings, vitals, & correct placement, what is the name of the primary area of anatomy that should be checked each time?
philtrum (middle of the upper lip)
The end tidal CO2 monitor reveals?
pneumothorax
NEC necrotizing enterocolitis
portions of the bowel undergo tissue death
Fetal lung maturity testing involves the measurement of phospholipids in the amniotic fluid. Which of the statements listed below represents fetal lung maturity close to term gestation (meaning lung maturity is present)
presence of phosphatidylglycerol (PG)
Flaccid
weak muscle tone
When is the ideal time to assess the gestational age of a premature neonate using the Ballard Scale?
within the first 12 hours