Term
Blood volume for a
preterm infant?
Full-Term?
Infant?
School aged child?
Adult male |
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Definition
100ml/kg
90ml/kg
80ml/kg
75ml/kg
70ml/kg |
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Term
urine concentrating ability is _______
in neonates urine osmolatlity is ____-_____mEq/L |
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Definition
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Term
| Decreased renal response to _____ |
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Definition
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Term
| Renal plasma flow and GFR are _____the adult values. Maturational differences make it difficult for the inflant to handle______ and ______loads |
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Definition
1/2
fluid fluctuations and solute loads |
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Term
| Hemostatic mechanisms are fully developed after ______ yr(s) old. |
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Definition
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Term
| Limited GFR make it difficult to excrete _______ |
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Definition
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Term
| Neonate losses ____-____% of its body wt. in the first few days d/t _____ |
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Definition
| 5-15% d/t isotonic salt and water |
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Term
| Day one fluid requirements are? |
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Definition
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Term
| First few days the fluid requirments increase. Premature neonates are mostly fluid and have increased fluid requirements...should be based on? |
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Definition
| wt, U/O, and serum sodium |
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Term
| Glucose levels in the first few hours of life should not be below? |
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Definition
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Term
| If need to replace glucose, replace with_____, bolus ___-____ml/kg OR continuous infludion at ____-____mg/kg/min |
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Definition
| D10W, 2-4ml/kg, OR 4-6 mg/kg/min infusion |
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Term
| d/t loss of fluids hyper______ is common? |
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Definition
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Term
| In a volumetric chamber the fluid in the chamber should be exceed____? |
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Definition
| The calculated hourly requirement for the child. Can use ______infusion set? |
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Term
| Glucose containing solutions are not used in the OR b/c D5W=______ |
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Definition
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Term
| hyperalimentation influsion volume should be ________ from isotonic fluids |
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Definition
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Term
| Know fluid deficit requirments and to replace NPO 1/2 the 1st hour and the remainder over the next 2 hours. |
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Definition
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Term
| Know age related norms for HR & BP |
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Definition
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Term
Signs of low intravascular volume?
Fluid Bolus ___-____ml/kg |
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Definition
| elevated HR, varied HR w/ surgical stimulation, BP reduction, narrow pulse pressure, cold extremities, slow cap refill. 10-20 ml/kg |
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Term
| Primary sources of fluid loss are? |
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Definition
| blood loss, capillary leak from surgical trauma, anesthetic vasodilation, direct evaporation |
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Term
| replace blood 1:1 with blood or colloid ____% albumin |
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Definition
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Term
| Replace blood loss with how much crystalloid 1:___? |
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Definition
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Term
| ____ml/kg/hr for mild tissue trauma? |
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Definition
| 3-4ml/kg/hr; 5-7 moderate; 10 for large abdominal procedures |
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Term
| A health child tolerates a Hct below____? shouldn't be transfused until hct is ____-____% |
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Definition
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Term
| If significant blood loss is expected what monitoring should be needed? |
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Definition
| urine catheter, central line, and art line |
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Term
| Maximum allowable blood loss calculation? |
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Definition
| starting HCT - Min HCT / starting HCT * estimate blood volume |
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Term
| most heat is lost by ______&________. The child should be considered ___________ |
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Definition
| poikilothermic; internal temp matches ambient temperature. |
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Term
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Definition
| radiation 40% and onvection 35%. |
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Term
| Increases the temperature of the OR air reduces ______ heat loss |
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Definition
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Term
| What is the most usefule device for warming children? |
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Definition
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Term
| Moisture exchanges are effective in preserving body heat but are ineffective to ______ the childs body temp. |
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Definition
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Term
| The IV set w/ a microdrip 60drops/ml is most practical in the _____kg child |
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Definition
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Term
| What is the name of the mask that is designed to minimize dead space? |
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Definition
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Term
| Most commonly used mask have a ____ ____ cuff |
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Definition
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Term
| What type of airways are not used in children? |
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Definition
| nasopharngeal. B/c the internal diameter is too small @increased risk of blockage by secretions. |
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Term
| After intubation check for a leak at _____-______ cm H20 |
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Definition
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Term
| In the mapleson circut what controls the amount of rebreathing? |
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Definition
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Term
| Name three disadvantages of Mapleson circuits. |
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Definition
| Pollution of the environment; need high fresh gas flow; loss of pt. heat and humidity |
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Term
| With Mapleson circuit rebreathing can occur with controlled ventilation when respiratory exceeds ______bpm. What is the reason for this phenomenon? |
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Definition
| 20 bpm; d/t inadequate washout of expired air before the next breath. |
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Term
| Babies respond to hypoxia by increasing ______? |
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Definition
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Term
| extremely low birth wt less than____grams. |
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Definition
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Term
| low birth wt. is less than _____grams |
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Definition
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Term
| Premature infants are predisposed to obstruction and difficulty w/ ventilation d/t? |
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Definition
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Term
| In the premie an ETT will increase _______ compared to a term infant |
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Definition
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Term
| Loss of muscle control caused by anesthesia can increase? |
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Definition
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Term
| More prone to what three airway anomalies? |
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Definition
| subglottic stenosis, tracheal stenosis, and tracheobroncomalacia |
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Term
| Preemies lung lung volumes and decreased heart compliance leads to increased________shunt and ______mismatch |
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Definition
| intrapulmonary shunt; and V/Q mismatch |
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Term
| What three lung issues are preemies at increased risk for? |
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Definition
| oxygen toxicity, barotrauma, development of bronchopulmonary dysplasia |
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Term
| preemies have a decrease ventilatory response to ______. and hypoxia further blunts this response. |
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Definition
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Term
| preemies are at increased risk for CV collapse d/t? |
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Definition
| more connective tissue and less contractile tissue. Heart is less compliant and less sensitive to catecholamines. |
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Term
| preemies cardiac output is dependent on? |
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Definition
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Term
| open patent ductus arteriosus predisposes the premie to? |
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Definition
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Term
| The area of the brain most commonly injured is the |
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Definition
| periventricular white matter |
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Term
| IVH occurs in _____ of mircropreemies. |
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Definition
| 1/3. diagnosed by ultrascound; grades I-IV |
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Term
| ROP occures in _____% of low birthwt. infants |
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Definition
| 50%. oxygen and bright light plays a role. Free radicals may be another cause. |
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Term
| premies require a higher level of ______to keep them normoglycemic |
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Definition
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Term
| preemies are suspeptible to hypothermia d/t less_______in the epidermis causes increased_________heat loss and insensible fluid loss. |
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Definition
| keratin; evaporative heat loss |
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Term
| preemies have little fate for insulation and a large________ _______ to mass ratio. |
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Definition
| surface area. Thermal regulation NOT developed...keep them warm! |
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Term
| Preemies have reduced kidney function have higher levels of plasma______and are at risk for ______. |
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Definition
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Term
| preemies have decrease _____and _____stores. at risk for____ and _____. |
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Definition
| glycogen and fat stores, hypo and hyperglycemia. They are insulin resistant....may need insulin to stay normoglycemic |
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Term
| preemie liver has reduced hepatic proteins putting them at risk for? |
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Definition
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Term
| preemie tissue oxygen deliver is maximized by maintaining a Hct between_____% |
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Definition
| 44-48%. Throbocytopenia is common, platelets should be available for major surgery. |
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Term
| MAC is ______ in the preemie. |
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Definition
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Term
| preemies which gas is not routinely used? |
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Definition
| nitrous d/t displacement of 02 and airfilled spaces. |
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Term
| D/T _________function, opiods are prolonged and benzos can last several hours. |
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Definition
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Term
| NEcrotizing enterocolitis is caused by _______ ________ ________. S&S are? |
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Definition
| intestinal mucosa ischemia; early signs of feeding intolerance; increase WOB; lethagy and temperature instability. Late signs: hypotentsion; abdominal distension; apnea; caogulopathy, multiorgan failure. A SURGICAL EMERGENCY |
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Term
| NEC preparation. What products need to be available during surgery. What drugs? |
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Definition
| Albumin, FFP, platelets, and RBC's....Epinephrine, dopamine, calcium gluconate (treat hypotension) |
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Term
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Definition
| Full stomach - RSI...or awake intubation. |
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Term
| NEC needs 2 large IV's plus what other lines? |
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Definition
| Art line, central line, foley, and NG tube. |
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Term
| NEC what is the anesthetic of choice? |
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Definition
| AWAKE OR RSI...most commonly use high dose opiod or ketamine. Small or no IA |
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Term
| NEC has large ______ losses during surgery. |
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Definition
| large; not uncommon for a preemie to receive 100ml/kg of fluid during the case. Replace blood loss with PRBC's keep platelets over 100,000. |
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Term
| Ligation of patent ductus arteriosus is common in preemies. causes ____to ____shunt. what makes it worse? |
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Definition
| left to right. pulmonary HTN...may cause cyanosis |
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Term
| PDA is ligated thru a left throacotomy. Put SP02 on upper and lower extemities...if loss signal on both? |
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Definition
| you ligated the Pulmonary artery. |
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Term
| PDA ligation give albumin _____ml/kg before induction to avoid? |
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Definition
| albumin 10ml/kg; hypotension; EXUBATE THE NEXT DAY!! |
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Term
| Inguinal hernia repair. GA or RA. May need ________mg/kg to avoid post-op apnea. FLuids @ 4ml/kg/hr. NO OPIOIDS d/t need to send home soon. |
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Definition
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Term
| Preterm infants with BPD may have compensated_________ and elevation_______. |
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Definition
| repsiratory acidosis and elevated ETCO2 |
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Term
| Inguinal hernia repair RA__________ block is commonly used. Bupivicaine _____% with epi 0.75ml/kg. excellent for preemie w/ BPD. |
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Definition
| .375%. Allows for 1-2 hours of anesthesia. |
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