NRSG 3302 Final Exam Questions With Complete Solutions
absent respiratory effort (APGAR)
0
slow, irregular respiratory effort (APGAR)
1
good cry respiratory effort (APGAR)
2
absent heart rate (APGAR)
0
slow, below 100 bpm heart rate (APGAR)
1
above 100 bpm heart rate (APGAR)
2
flaccid muscle tone (APGAR)
0
some flexion of extremities muscle tone (APGAR)
1
active motion muscle tone (APGAR)
2
no reflex activity (APGAR)
,0
grimace reflex activity (APGAR)
1
vigorous cry activity (APGAR)
2
pale, blue color (APGAR)
0
body pink, blue extremities color (APGAR)
1
completely pink color (APGAR)
2
factors needed for effective respiratory system
air replaces fluid
onset of breathing
increase in pulmonary flow
air replaces fluid
lungs are fluid-filled and are reabsorbed during L&D, air needs
to replace fluid in alveoli
vaginal pressure squeezes fluid out of lungs
surfactant is needed to stabilize alveoli and decrease surface
,tension; allows baby to have an easier time breathing (2:1 L/S
ratio; if diabetic 3:1)
if not enough surfactant - alveoli with continue to collapse and
need to be reopened with each new breath
onset of breathing
mechanical stimulation - first breath/gasp from initial lung
inflation
first breath is one of the hardest it will ever take
requires pressure that is 10-15x of later breaths because baby is
having to inflate all the alveoli at once
increase in pulmonary flow
in utero, pulmonary circulation has elevated pressure and low
flow states which leads to high pulmonary vascular resistance
chemical factors that initiate breathing
labor induces mild hypercapnia (increase in CO2), hypoxia
(decrease in O2), and decrease in pH (acidosis)
decrease in pH directly stimulates respiratory center
decrease in PO2 and increase in PCO2 stimulate respiratory
center via central/peripheral chemoreceptors
prostaglandins SUPPRESS respirations in utero - prostaglandin
, levels decrease with clamping of cord - leads to breathing
stimulation
respiration considerations
normal respiratory rate 30-60 breaths/min (shallow,
diaphragmatic, somewhat irregular)
normal: 5-15 second pauses
nose breathers
abnormal: true apnea - breathing is stopped >20 seconds
using intercostal muscles may indicate distress, grunting, nasal
flaring, retractions are definite signs of RD
systemic vascular resistance
when cord is clamped and placental circulation is lost, SVR
INCREASES and pulmonary artery pressure drops
foramen ovale
sends highly oxygenated blood between R and L atria (may take
3 months to close fully)
ductus arteriosus
connects the pulmonary artery with the descending aorta, allows
R ventricle to strengthen
ductus venosus
absent respiratory effort (APGAR)
0
slow, irregular respiratory effort (APGAR)
1
good cry respiratory effort (APGAR)
2
absent heart rate (APGAR)
0
slow, below 100 bpm heart rate (APGAR)
1
above 100 bpm heart rate (APGAR)
2
flaccid muscle tone (APGAR)
0
some flexion of extremities muscle tone (APGAR)
1
active motion muscle tone (APGAR)
2
no reflex activity (APGAR)
,0
grimace reflex activity (APGAR)
1
vigorous cry activity (APGAR)
2
pale, blue color (APGAR)
0
body pink, blue extremities color (APGAR)
1
completely pink color (APGAR)
2
factors needed for effective respiratory system
air replaces fluid
onset of breathing
increase in pulmonary flow
air replaces fluid
lungs are fluid-filled and are reabsorbed during L&D, air needs
to replace fluid in alveoli
vaginal pressure squeezes fluid out of lungs
surfactant is needed to stabilize alveoli and decrease surface
,tension; allows baby to have an easier time breathing (2:1 L/S
ratio; if diabetic 3:1)
if not enough surfactant - alveoli with continue to collapse and
need to be reopened with each new breath
onset of breathing
mechanical stimulation - first breath/gasp from initial lung
inflation
first breath is one of the hardest it will ever take
requires pressure that is 10-15x of later breaths because baby is
having to inflate all the alveoli at once
increase in pulmonary flow
in utero, pulmonary circulation has elevated pressure and low
flow states which leads to high pulmonary vascular resistance
chemical factors that initiate breathing
labor induces mild hypercapnia (increase in CO2), hypoxia
(decrease in O2), and decrease in pH (acidosis)
decrease in pH directly stimulates respiratory center
decrease in PO2 and increase in PCO2 stimulate respiratory
center via central/peripheral chemoreceptors
prostaglandins SUPPRESS respirations in utero - prostaglandin
, levels decrease with clamping of cord - leads to breathing
stimulation
respiration considerations
normal respiratory rate 30-60 breaths/min (shallow,
diaphragmatic, somewhat irregular)
normal: 5-15 second pauses
nose breathers
abnormal: true apnea - breathing is stopped >20 seconds
using intercostal muscles may indicate distress, grunting, nasal
flaring, retractions are definite signs of RD
systemic vascular resistance
when cord is clamped and placental circulation is lost, SVR
INCREASES and pulmonary artery pressure drops
foramen ovale
sends highly oxygenated blood between R and L atria (may take
3 months to close fully)
ductus arteriosus
connects the pulmonary artery with the descending aorta, allows
R ventricle to strengthen
ductus venosus
