Patient Assessment Flashcards

A 28-week gestational age neonate presents with grunting, nasal flaring, and intercostal retractions. What is the most likely diagnosis?

Answer: Respiratory distress syndrome (RDS)

Respiratory distress syndrome (RDS) is highly common in premature neonates, especially those born at 28 weeks gestation, due to insufficient surfactant production in their immature lungs. The presented symptoms of grunting, nasal flaring, and intercostal retractions are classic signs of increased work of breathing characteristic of RDS. Other options are less likely given the specific gestational age and clinical presentation.

What is the primary purpose of performing a Silverman-Anderson score on a neonate?

Answer: To evaluate the severity of respiratory distress

The Silverman-Anderson score is a clinical assessment tool specifically designed to quantify the severity of respiratory distress in neonates. It evaluates five parameters related to respiratory effort, such as nasal flaring and retractions. A higher score indicates more severe respiratory distress, which helps guide appropriate medical interventions and monitoring.

Which of the following is a common clinical finding in a neonate with patent ductus arteriosus (PDA)?

Answer: Bounding peripheral pulses

Patent ductus arteriosus (PDA) involves the failure of a fetal blood vessel to close after birth, leading to shunting of blood from the aorta to the pulmonary artery. This results in increased systemic blood flow during diastole, causing a wide pulse pressure and characteristically bounding peripheral pulses. This clinical finding is a key indicator of PDA.

A term neonate has a capillary blood gas drawn from the heel. The results are as follows: pH 7.28, PCO2 52 mm Hg, HCO3 24 mEq/L. How should these results be interpreted?

Answer: Respiratory acidosis

The blood gas results show a pH of 7.28 (acidic) and an elevated PCO2 of 52 mm Hg, while the HCO3 is within the normal range. An elevated PCO2 indicates that the lungs are not effectively eliminating carbon dioxide, leading to a buildup of carbonic acid in the blood. Therefore, the primary problem is respiratory acidosis.

Which of the following is a sign of increased work of breathing in a pediatric patient?

Answer: Subcostal retractions

Subcostal retractions are a clear sign of increased work of breathing in a pediatric patient. This occurs when the child uses accessory muscles, pulling the skin inward below the rib cage, to overcome airway resistance or decreased lung compliance. It indicates that the respiratory system is working harder than normal to achieve adequate ventilation.