Question 1

Which of the following medications should the therapist recommend for an infant with apnea of prematurity experiencing episodes of apnea?

Accepted Answer

Caffeine's proposed mechanisms include stimulation of skeletal and diaphragmatic muscle contraction,increase in the respiratory center's sensitivity to carbon dioxide,and stimulation of the central respiratory drive.Caffeine appears to be a safer drug,can be given less frequently than aminophylline or theophylline,and is more effective in treating apnea.

Question 2

Which of the following blood gas parameters should the therapist target when managing patients with PPHN?
I.SaO₂ > 95%
II.PaCO₂ 35-45 mm Hg
III.pH 7.35-7.45
IV.PaO₂ > 95 mm Hg

Accepted Answer

Adjust ventilators to maintain adequate oxygenation and mild hyperventilation,until stability is achieved for 12 to 24 hours after initially attempting to keep the oxygen saturation above 95%,arterial carbon dioxide tension (PaCO₂)at 35 to 45 mm Hg,and pH at 7.35 to 7.45.

Question 3

A neonate diagnosed with a pneumothorax was treated with a chest tube.After 36 hours,the therapist noticed that bubbling is present in the chest tube system.What should the therapist do at this time?

Accepted Answer

Suction should be maintained until fluctuation of air in the tube and active bubbling have ceased.At this time the tube should be clamped and removed within 24 hours if there has been no reaccumulation of air in the pleural cavity.

Question 4

The therapist is assessing a newborn on the mechanical ventilator.The neonate shows clear signs of respiratory distress,and lung auscultation reveals shifting of the PMI towards the left and breath sounds decreased on the right.What should the therapist suspect this newborn developed?

Accepted Answer

Neonates with spontaneous pneumothorax are usually asymptomatic or have mild signs of tachypnea with an oxygen requirement.Occasionally,severe respiratory distress (grunting,nasal flaring,and intercostal retractions)may occur.In the ventilated neonate,pneumothorax may lead to a rapid clinical deterioration,resulting in cyanosis,hypotension,hypoxemia,hypercapnia,and respiratory acidosis.In unilateral pneumothorax,the cardiac apex can be shifted away from the affected side and breath sounds decreased over that side.

Question 5

While reviewing the chest X-ray of a newborn,the therapist observes the following features: continuous diaphragm sign and linear bands of air paralleling the left side of the heart and the descending aorta with extension superiorly along the great vessels into the neck.Which of the following conditions does this patient likely have?

Accepted Answer

Typical radiological signs of pneumomediastinum include the continuous diaphragm sign (interposition of air between the pericardium and the diaphragm,which becomes visible in the central mediastinal part)and linear bands of mediastinal air paralleling the left side of the heart and the descending aorta (pleura appears as a fine opaque line)with extension superiorly along the great vessels into the neck.

Question 6

A newborn suspected of having a pneumothorax is rapidly deteriorating.What should the therapist suggest at this time?

Accepted Answer

Needle aspiration: In a rapidly deteriorating clinical situation,thoracentesis or pericardiocentesis may confirm the diagnosis and be therapeutic in pneumothorax and pneumopericardium,respectively.

Quiz 22: Neonatal Complications and Pulmonary Disorders

Which of the following medications should the therapist recommend for an infant with apnea of prematurity experiencing episodes of apnea?

Which of the following blood gas parameters should the therapist target when managing patients with PPHN? I.SaO₂ > 95% II.PaCO₂ 35-45 mm Hg III.pH 7.35-7.45 IV.PaO₂ > 95 mm Hg

A neonate diagnosed with a pneumothorax was treated with a chest tube.After 36 hours,the therapist noticed that bubbling is present in the chest tube system.What should the therapist do at this time?

The therapist is assessing a newborn on the mechanical ventilator.The neonate shows clear signs of respiratory distress,and lung auscultation reveals shifting of the PMI towards the left and breath sounds decreased on the right.What should the therapist suspect this newborn developed?

A newborn suspected of having a pneumothorax is rapidly deteriorating.What should the therapist suggest at this time?