Resp 230 Causes of Persistent Perinatal Illness

Respiratory care of the patient with cardiac defects Increases pulmonary blood flow

1. VSD 2. Coarctation of the aorta 3. Subaortic stenosis 4. PDA 5. Anomalous venous return 6. Decreases compliance 7. Use high ventilatory pressures and PEEP

Viral Infections HIV

1. acquired from infected mother

Fungal diagnosis and treatment of infection

1. by analysis of specimen 2. blood test

Respiratory care of the patient with cardiac defects reduce blood flow to the lungs

1. Tricuspid atresia 2. tetralogy of Fallot 3. compliance increases 4. oxygen is used cautiously

Tracheoesophageal Clinical symptoms

1. Accumulation of secretions in the mouth Sporadic or continuous respiratory distress, especially during feedings 2. Repeated regurgitation of feelings

Protozoal and Fungal Infections Pneumocystis Carinii

1. An inhaled yeast-like fungus 2. Treatment consists primarily of trimethoprim-sulfamethoxazole for 21 days.

Congenital Anomalies Cardiac System- Complete transposition of the great vessels

1. Aorta arises from the right ventricle and the pulmonary artery arises from the left ventricle 2. Diagnosed by ultrasound and cardiac catheterization 3. Requires surgical correction

congenital anomalies Tracheoesophageal

1. Atresia of the upper esophagus, with an accompanying fistula between the lower esophageal tube and the trachea 2. Atresia of the esophagus, without any fistula attachment to the trachea

HIV postpartum Care

1. CBC and differential 2. Administration of zidovudine as soon as possible after delivery 3. Initiation of ARV therapy

Congenital Anomalies Cardiac System- Ventricular septal defect

1. Classified based upon location 2. Diagnosis by ultrasound 3. Treatment generally withheld but if prolonged will require surgical intervention

Congenital Anomalies Cardiac System- Tetralogy of Fallot

1. Combination of 4 defects: 1) VSD, 2) an overriding aorta, 3) hypertrophy of the right ventricle, and 4) obstruction to flow through the pulmonary artery 2. Diagnosed by ultrasound and echocardiogram

Congenital Anomalies Cardiac System- Coarctation of the aorta

1. Constriction of the aorta that severely restricts blood flow 2. Decreased cardiac output

Congenital Anomalies Cardiac System - Patent ductus arteriosus

1. Failure of closure upon delivery 2. Hyperperfusion and engorgement of the pulmonary vessels with resulting pulmonary edema 3. Diagnosed by physical assessment and lab data 4. Treated by restricting fluids and pharmacological intervention

Congenital Anomalies Cardiac System- Atrial septal defect

1. Failure of the tissue flap to cover the foramen, allowing the movement of blood between atria 2. Often symptomless

HIV treatments- is complex and ever changing

1. Fusion inhibitors 2. Integrase inhibitors 3. NNRTI 4. NRTI 5. Protease inhibitor

congenital anomalies Pierre-robin sequence

1. Hypoplasia of the mandible, which forces the tongue to be positioned posteriorly in the pharynx, creating an obstruction to breathing 2. Maintain the patient's airway patency until the mandible grows to its appropriate size.

Tracheoesophageal Treatment

1. Insertion of NG tube 2. Position in a 30° upright position 3. Surgical repair

Congenital Anomalies Cardiac System hypoplastic left heart syndrome

1. Involves several anomalies including coarctation of the aorta, hypoplastic left ventricle, and aortic and mitral valve stenosis or atresia 2. Restricts blood flow and may lead to shock

Bacterial Infections found in

1. Maternal intestinal and genital tracts 2. or by poor aseptic technique 3. ruptured amniotic sac 4. NICU

Congenital Anomalies Cardiac System- Anomalous venous return

1. Return of pulmonary venous blood to the right atrium instead of the left atrium 2. Requires cardiac catheterization and surgical repair

Congenital Anomalies Cardiac System- Subaortic stenosis

1. Stenosis either at the aortic valve, above it, or below it, causing an obstruction to the outflow from the left ventricle 2. Reduces cardiac output 3. Diagnosis by cardiac catheterization 4. Treatment is by surgical intervention

Rubella Symptoms

1. early gestation infection include cataracts, 2. cardiac defects, 3. hearing loss, 4. intrauterine growth retardation, 5. chronic encephalitis, 6. direct hyperbilirubinemia, 7. microcephaly

Bacterial infections may enter

1. fetal mouth and infect the lungs 2. intestinal tract and my even enter the bloodstream from one of these sites

Cytomegalovirus symptoms

1. include intrauterine growth retardation, 2. direct hyperbilirubinemia secondary to liver damage, 3. hepatosplenomegaly, microcephaly, 4. brain damage, 5. progressive sensorineural hearing loss

Bacterial infections Group B strep

1. serious concern 2 25% of women are colonized with GBS and can pass it on during birth 2. GBS infection can result in serious illness or death of the infant

Choanal atresia causes

1. severe respiratory distress 2. Use of an oral airway or intubation may be required

Infections may be acquired

1. through placenta 2. traveling through birth canal 3. direct contact with infected maternal tissue 4. as a hospital-acquired infection

Congenital Anomalies Pulmonary sytems

1. tracheoesophageal 2. choanal atresia 3. Pierre-robin sequence

Protozoal and Fungal Infections Toxoplasmosis

1.vTransmitted from the mother to the fetus through the placenta 2. Symptoms include neurological abnormalities such as microcephaly, coma, convulsions, and hydrocephalus. Other symptoms are hepatosplenomegaly, jaundice with both direct and indirect hyperbilirubinemia, small skin hemorrhages (petechiae ), and pallor secondary to anemia.

Congenital Anomalies Cardiac System- Tricuspid atresia

A complete agenesis of the tricuspid valve between the right atrium and ventricle

Congenital Anomalies Cardiac System- Truncus arteriosus

A defect in which one large vessel arises from both right and left ventricles over a large VSD

Herpes treatment

Antiviral drugs

Herpes Simplex Types I

Causes recurrent lesions on the lips and on other parts of the skin, usually above the waist

Herpes Simplex Types II

Infected by the ascent of the virus up the birth canal, from infected genitalia, or from the direct contact with infected tissues during delivery

HIV Diagnosis

Lab test

congenital anomalies Choanal atresia

The membrane that separates the nasal cavity from the nasopharynx during embryologic development fails to disintegrate and blocks the passage of a

TORCH list

Toxoplasmosis Other Rubella Cytomegalovirus Herpes simplex type 2

Cardiac System- Truncus arteriosus diagnosis

electrocardiography and cardiac catheterization

Viral infections Cytomegalovirus

member of the herpes virus family

Cardiac System hypoplastic left heart syndrome treatment

no medical treatment

Cytomegalovirus treatment

nutritional support and general supportive care

Cardiac System hypoplastic left heart syndrome diagnosis

physical assessment and lab data

Bacterial Infections Choroamnionitis

presence of bacteria in the amniotic fluid

Viral disease can be avoided by

prevention and immunization

Cardiac System- Truncus arteriosus treatment

surgical

Cardiac System- Tricuspid atresia treatment

surgical correction

Cardiac System- Coarctation of the aorta Treatment

surgical repair

TORCH complex is used for what

to identify those perinatal infections that are associated with severe fatal anomalies and even death

Bacterial infections are

treated with broad spectrum antibiotics

Cardiac System- Coarctation of the aorta Diagnosis

ultrasound and cardiac catheterization

Cardiac System- Tricuspid atresia diagnosis

ultrasound and cardiac catheterization

Fetal Immunities

•Some protection through maternal factors •Develops own immunity •Immunity provided through antibodies •IgA, IgD, IgE, IgG, IgM