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Hi, I’m just stuck on Daisy’s social and psychology assessments/rationals.... does anyone have any examples or ideas? Just struggling to think of five!

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Jayne Harris
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what is meant by physiology of shock? confusing me, like is this to do with the symptoms or signs and physiology of that if that makes sense? - Hi there, in essence it's about what is shock? (Reduced oxygenation to tissue). What's the physiological causes of the signs and symptoms of shock, such as tachycardia, prolonged CRT etc. So you can talk about the baroreceptor response, the impact of a reduced blood volume, chemoreceptors etc. Always think back to the cardiac output equation - CO = HR and SV, as well BP = CO and SVR :)

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Would you be marked down or failed if for your physical assessment: it weren’t in an ABCD order? Hi there, no you wouldn't get marked down for this if this was in the incorrect order, especially if you thought of other ideas after you have done the social and psychological. Just ensure you highlight that it's a physical assessment if you do :)

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Hi there, really struggling to understand signs and symptoms of AKI and physiology. Please can someone explain further. - Hi there, basically think about how a patient might present if they had an acute kidney injury. So think about things like urine output, a patient's mental state, their hydration etc. Then try to think about in physiological terms, why do these signs and symptoms occur. Remember in the exam the signs and symptoms must be specific to the kidney and not too general :)

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Under prevention of AKI it says to consider measuring lactate - is this because lactate levels would be high in the blood due to reduced kidney function therefore reduced bicarb production to buffer the lactate? Hi there, in a nut shell yes. If there is no bicarb to buffer the hydrogen ions then the blood will continue to be more acidic, and lactic acid will be produced more because of anaerobic respiration :)

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what would be Appropriate discharge communication for jayden? - Hi there, it is any information that you feel you need to give to the parents that will ensure full understanding on how to care for Jaydn. So for example you might give Leanne and Joshua advice on how to look after Jaydn, contact details if they require any further help or other health professional input. It's also about ensuring that you answer any questions that the parents have, ensuring full details of medication are given to them and many more :)

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^ Jadyn would be at risk of hypovolaemic shock I believe, due to the gastroschisis (increased risk of dehydration through evaporation of fluid from the eviscerated gut, losing albumin in a silo back etc - can lead to hypovolaemic shock) Also because he's a neonate he's at increased risk of transdermal losses. Hope that helps :) - Well done!! This is absolutely spot on what you have said here. In regards to Evan, because of his liver failure, Evan is likely to be more at risk of Distributive shock, mainly because he is at risk of sepsis or even toxic shock.

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Hi, just looking at shock for all 3 case studies. Daisy is at risk of hypovolemic shock due to fluid loss, cariogenic shock due to damage to myocardium. Just wondering what type of shock Jaydn and Evan are at risk off? Thank you

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what is meant by physiology of shock? confusing me, like is this to do with the symptoms or signs and physiology of that if that makes sense?

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I'M BACK EVERYONE!! Thank you all so much for helping each other out whilst I was gone. I have now caught up with everything I will start replying to your latest questions when I can. So please keep posting questions, I will be continuing to monitor this daily :)

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Would you be marked down or failed if for your physical assessment: it weren’t in an ABCD order?

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Hi there, really struggling to understand signs and symptoms of AKI and physiology. Please can someone explain further.

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Under prevention of AKI it says to consider measuring lactate - is this because lactate levels would be high in the blood due to reduced kidney function therefore reduced bicarb production to buffer the lactate?

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what would be Appropriate discharge communication for jayden?

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^ Jadyn would be at risk of hypovolaemic shock I believe, due to the gastroschisis (increased risk of dehydration through evaporation of fluid from the eviscerated gut, losing albumin in a silo back etc - can lead to hypovolaemic shock) Also because he's a neonate he's at increased risk of transdermal losses. Hope that helps :)

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Hi, just looking at shock for all 3 case studies. Daisy is at risk of hypovolemic shock due to fluid loss, cariogenic shock due to damage to myocardium. Just wondering what type of shock Jaydn and Evan are at risk off? Thank you

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Thank you Kelvin for all your help on this padlet! It has been very useful and your explanations have been very clear! Take care :)

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I am going on annual leave now everyone. I will have limited access to my laptop or emails during this time. If you have any other questions please keep posting and I will do my best to reply to them all next monday. But in the mean time, try to help each other out by answering other people's question. I can then clarify when I get back. Keep up the great work everyone, and I will speak to you all soon. Bye :)

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Explain the symptoms of liver failure and underlying physiology and relate to nursing practise? examples please, e.g. would jaundice be one? because unconjugated bilirubin remains in the bloodstream due to liver not being able to be processed because liver failing - Hi there, yes jaundice is a great example and the physiology is spot on, ensure you add on about bile as bile is what helps the transport of bilirubin to the large intestines to be excreted via faeces. Think about each symptom and try to use physiology to define what you would be looking out for. For example, why would you look out for bruising? Why would you look out for abdominal distension? and many more :)

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what is meant by Nursing care priorities: regarding fluid balance? is this ensuring strict fluid balance is documented and consideration of fluid balance making sure not over hydrated or dehydated Hi there, yes in affect it's any nursing practice methods you would do in order to ensure that your patient is not either dehydrated or overhydrated. So a strict fluid balance is one, as is things like checking the urine output, your vital observations, looking at insensible losses, recommending fluid boluses etc. Remember, you have to back each nursing care priority with solid rationale, so always think - why am I doing this? Why will this benefit the patient? :)

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Physiological reasons for a fluid restriction in acute liver failure? Hi there, let's first of all have a look at the livers role in protein synthesis of carrier proteins such as Albumin. Albumin is a protein that is designed to help transport other proteins or even toxins to where ever they need to go. But albumin is also needed to encourage oncotic pressure in intravascular spaces. Now with oncotic pressure, this pressure is needed to prevent any excess fluid accumulating in the interstitual spaces, which could reduce the intravascular volume. So proteins like albumin can either prevent fluid from getting into the interstitual spaces, or by drawing fluid back into the intravascular spaces. Imagine albumin is like a "fluid magnet." So, if a patient was in acute liver failure, then the protein synthesis processes will be disrupted, therefore not produced Albumin or other carrier proteins. This will reduce oncotic pressure which will increase the likely hood of fluid entering the interstitual spaces, as fluid in the interstitual spaces are at a lower pressure in comparison to intravascular fluid which is at a higher pressure. One particular place where fluid can build up is in the peritoneum in the abdomen, where there is a large amount of capillary networks. Fluid can "leak" out into the peritoneum and into the intersitual spaces, causing that classic sign of abdominal distension you see in patients in liver failure. The fluid in the peritoneum is called Ascites, and it cause a lot of problems with breathing, circulation etc. So by fluid restricting a patient in acute liver failure, you are trying to prevent further ascites forming that could compromise things such as your breathing. Imagine the amount of pressure your diaphragm would be under if your abdomen was distended, it could prevent the diaphragm from flattening fully. Hope that helps :)

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What is the impact of down syndrome on the individual? is that regarding the intellectual features etc? - Hi there, yes you are on the right lines, think about physical, emotional, social, psychological and educational impacts on an individual with down syndrome :)

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Physiology explanation how hypovolemia can lead to AKI? And renal failure category?  Hi there, the physiology has already been answered in a conversation previously if you would like to have a look. In terms of renal failure category, it would be pre-renal :)

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Role of Hypovoleamis in AKI?
Hi there, this has already been answered previously, please read from previous conversations :)

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Describe how the psychological needs of the neonate and family can be met on a NNU. - Hi there, so think about things like:
1. The neonate - the neonate has come out of the womb where they were protected, so how do you ensure that a neonate feels protect and reassured. A lot is to with things like lighting, noise, touch etc. Think about the consequences if these were not addressed sufficiently.
2. The family - their baby is in an incubator, think about the impact this would have on the family. All they will be wanting to do is to care for their little baby but they might feel restricted due to the incubator, lines etc. So how will you support the family and what can you encourage the family to do to protect the family's psychological needs.

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How can a NNU environment impact a neonate?
is this to do with the impact of light and noise within nnu setting - Hi there, yes that is correct :)

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what is meant by appropriate discharge communication? Hi there, it's information you would give in order to ensure that a patient and family has the correct information to look after themselves at home. So think about ways you would ensure a family understands the instructions you are giving and that the family will know what to do in an emergency etc :)

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Hi, just looking at the acid base balance session and really struggling to understand the concept of buffers and the respiratory and renal regulation. Just wondering if someone can explain this further. Thank you - Hi there, let me try and help you with this :) Have a read of the box above to give you an idea what makes a solution more acidic, in this case it's hydrogen ions. Now, base can "mop up" or "buffer" hydrogen ions in order to either neutralise or make a solution more alkaline. When it comes to something like respiratory acidosis, carbon dioxide would have reacted with water to make carbonic acid, a highly acidic substance that would make blood more acidic during respiratory distress. So one solution would be to hyperventilate and blow off carbon dioxide, preventing further carbonic acid being produced in the blood. Then the kidneys will release bicarbonate ions, buffering agents that are designed to mop up any hydrogen ions that has caused the blood to go acidic, making the blood more neutral and better for tissue to extract oxygen and nutrients without being damaged by the acid. Does that help your question? :)

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1)   Why is hydrogen an acid gas? - Hi there, just like the above answer, it's all to do with what happens when hydrogen gets into water. Normally, water molecules contains two hydrogen binded to an oxygen molecule, thus making H2O as we all know and love. Water is a neutral substance, and neutral is what the body likes in order to maintain good function. Now basically without getting too much into chemistry, some water molecules can "split apart" and form two different molecules, hydroxide and hydrogen ions. Hydroxide ions are base, as they can "mop up" hydrogen ions, and hydrogen ions are what makes a solution acidic. So if more and more hydrogen ions get into water, this will make the solution more acidic, as there will be more hydrogen ions than water molecules and other base molecules present. It's why on blood gases you might see either hydrogen ions, or pH which measures how acidic a solution is. So if the hydrogen ions are higher in a solution, then this will decrease the pH as it's a more acidic solution. The lower the hydrogen ions are, the higher the pH as it's a more alkaline solution. Hope that helps :)

2)

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Why is CO2 an acid gas? - Hi there, it's not so much that the gas is acidic, it's what happens when carbon dioxide reacts with water which is what makes it acidic. When carbon dioxide goes into water, it creates an acid called carbonic acid. This is what lowers the blood pH during respiratory acidosis :)

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Physiology explanation how hypovolemia can lead to AKI? Hi there, this has already been answered on a previous question in this padlet, it's not too far up, hopefully that helps you :)

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For Jadyn's blood results, when providing physiological reasons for raised urea & creatinine, could this link in with the nephrons still developing despite the kidneys being fully developed? Therefore waste products are not being excreted effectively? Also due to neonates being at risk of dehydration due to transdermal losses, could this be linked in with reduced kidney function, the nephrons not being fluished out properly, build up of waste products, etc? Hi there, you are on the right lines yes, especially with Jaydn being at risk of dehydration and the kidneys don't fully develop until the age of 2. As you said if there is dehydration, the nephrons won't be flushed out, encouraging toxins to damage the nephrons and impair their function. Luckily if the damage isn't too severe they can repair overtime :)

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in what stage of shock does the BP begin to drop? Hi there, you see this in the progressive (decompensatory) stage of shock. Two things cause this, firstly there is vasodilation of the vessels in order to encourage blood flow to the tissues, but consequently it will also reduce your blood pressure. And secondly, at this stage the kidneys will be shut off from the systemic circulation, so the RAAS will stop too :)

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sorry this question may already been asked but how would daisy be at risk of prerenal aki? is this because of the increase risk of hypovolaemic or cardiogenic shock? Hi there, that's absolutely right. Hypovolaemic shock can cause pre renal AKI because of the reduced blood flow getting to the kidneys, therefore reducing perfusion to the kidney. And in cardiogenic shock, because there is something wrong with the structure of the heart, the heart might no be able to pump the blood sufficiently around the body, and therefore will mean again that the kidneys won't get vital oxygen and nutrients to maintain function :)

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Explain the symptoms of liver failure and underlying physiology and relate to nursing practise? examples please, e.g. would jaundice be one? because unconjugated bilirubin remains in the bloodstream due to liver not being able to be processed because liver failing

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what is meant by Nursing care priorities: regarding fluid balance? is this ensuring strict fluid balance is documented and consideration of fluid balance making sure not over hydrated or dehydated

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Physiological reasons for a fluid restriction in acute liver failure?

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What is the impact of down syndrome on the individual? is that regarding the intellectual features etc?

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Physiology explanation how hypovolemia can lead to AKI? And renal failure category?

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Describe how the psychological needs of the neonate and family can be met on a NNU.

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How can a NNU environment impact a neonate?
is this to do with the impact of light and noise within nnu setting

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what is meant by appropriate discharge communication?

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Hi, just looking at the acid base balance session and really struggling to understand the concept of buffers and the respiratory and renal regulation. Just wondering if someone can explain this further. Thank you

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1)   Why is hydrogen an acid gas?

2)

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Why is CO2 an acid gas?

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Physiology explanation how hypovolemia can lead to AKI?

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For Jadyn's blood results, when providing physiological reasons for raised urea & creatinine, could this link in with the nephrons still developing despite the kidneys being fully developed? Therefore waste products are not being excreted effectively? Also due to neonates being at risk of dehydration due to transdermal losses, could this be linked in with reduced kidney function, the nephrons not being fluished out properly, build up of waste products, etc?

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in what stage of shock does the BP begin to drop?

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sorry this question may already been asked but how would daisy be at risk of prerenal aki? is this because of the increase risk of hypovolaemic or cardiogenic shock?

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thank you for your help!! referring back to 'what is the physiology behind a response rate or increase in response rate, or change in heart rate or crt' behind the respiratory is the chemoreceptors, behind the heart rate there's baroreceptors however what is the physiology behind a change in CRT? The physiology behind the CRT is all about perfusion, which is influenced by oxygenation and blood volume together. So ensure you understand that if the CRT increases, it means that perfusion has been reduced, because there is either reduced oxygen, reduced blood volume or a combination of both. Plus, the body will try to protect the vital organs as it is compensating for a reduced blood volume, this is done by an increase in sympathetic nervous activity :)

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on mock exam answers it say 'avoid just bullet pointing questions!' does this mean actually asking questions for the assessment or actually using bullet points in the question? if that makes sense? - Hi there, in essence it means try not to just bullet point questions like "Who are the health professionals involved in his care?" "Who else lives with Jaydn/Daisy/Evans?" "Does Evans have any friends?" Think about how you are going to assess these, such as for the first example "I would have a conversation with Leanne to establish if there are any other health professionals involved in Jaydn's care" The added detail here is that you are having a conversation with Leanne, so that's how you are assessing if Jaydn has other health professionals involved. You say "I would have a conservation with Leanne about..........." a few times and that's fine, because a lot of the social and psychological assessments involve conversation and communication. Hope that makes sense :)

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Hi, Is there going to be a quiz put on Moodle for Daisy? I have seen the ones for fluid calculations and APLS however a quiz like the one for Evan would be very beneficial. Thank you :) Hi there, are you referring to the KAhoot quizzes? There is a kahoot quiz for each case study, but I have noticed that one of the quizzes has disappeared. So here are the links for you: Case Study 1 - https://play.kahoot.it/#/?quizId=96436118-9535-4a6c-81bf-0c72c2c2c005, Case Study 2 - https://play.kahoot.it/#/?quizId=974470f5-963a-4372-99f0-b7068a49e15f, Case Study 3 - https://play.kahoot.it/#/?quizId=f8cf6a16-155f-4830-858b-206fd94b181b. There will be another quiz being released soon that will combine all case studies together :)

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Looking at the signs or symptoms of AKI and explaining the underlying physiology, I focused on blood and protein being passed through the urine and that this would be found in the urine test. I said that healthy kidneys do not allow significant amount of protein to pass through the filters unless they are damaged. In AKI proteins such a Albumin leak into the urine. A common risk factor is high blood pressure and ACE inhibitors can also increase the development of pre-renal AKI. How can I add more of the underlying physiology into my answer? Many thanks - Hi there, the only thing I can think of adding is the effect of high blood pressure on the glomerulus? What happens to the glomerulus if it's exposed to high blood pressure. Remember as well blood in the urine is often a sign of an infection, and doesn't necessarily mean they are in AKI unless they had sepsis :)

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Im confused about how hypovolaemia can lead to AKI, could you explain this please? Hi there, don't worry I'm happy to help you with this :) Hypovolaemia can lead to AKI in different ways. Two things to consider here is perfusion and toxicity exposure. But first lets consider where the kidneys are in comparison to the heart. The kidneys are very far away, in fact they are some of the last organs where systemic circulation goes to. If a change occurs in the blood volume, such as if there was a bleed, then the kidneys are often the first organ to be hit by a lack of perfusion. Now for effective perfusion to occur you need oxygen and blood volume, so without that blood volume needed to go to the kidneys, then perfusion of the kidneys will be affected as there won't be enough blood to carry that vital oxygen and nutrients the kidneys needs to function. So as a result the kidney function will slow down which will result in a reduced urine output, that will eventually progress to full kidney failure. Another consideration is the damage that toxins can do to the kidneys. The nephrons in the kidney always needs a good supply of water to "wash out" the nephrons, and stop any toxic substances like urea and creatinine from sitting in the nephrons. Initially when the blood goes to the nephron it has to pass through the glomerulus, a bundle of capillaries that prevents large proteins and blood getting into the nephron. The blood flow is controlled by the afferent arterioles, which can constrict to control the pressure of the blood flowing through the glomerulus - the glomerular filtration rate (GFR). Now if hypovolaemia occurs, the body will work to prioritise central organs via sympathetic nervous stimuli. When the peripherals have blood flow has been restricted, then the kidneys blood supply gets shut off too. This is done by constricting that afferent arteriole, which will initially not affect the GFR, but once the RAAS kicks in, the renin and angiotensin 2 will further constrict that arteriole and shut off the blood supply to the glomerulus. Plus the nephrons will reabsorb water to increase the blood volume. The result of that is, because the nephrons are no longer getting "flushed" through with fluid, any toxin that hasn't been washed out will start damaging the nephrons, causing AKI. Sorry if that's a lot of information, but to summarise, if blood volume reduces, it can affect the perfusion as the lack of blood volume will make it difficult for the kidneys to get oxygen and nutrients. Plus if the nephrons aren't being constantly flushed through, and the afferent arteriole constricts,  this could cause toxins to build and damage the fragile nephrons. Hope that helps :)

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thank you for your help!! referring back to 'what is the physiology behind a response rate or increase in response rate, or change in heart rate or crt' behind the respiratory is the chemoreceptors, behind the heart rate there's baroreceptors however what is the physiology behind a change in CRT?

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on mock exam answers it say 'avoid just bullet pointing questions!' does this mean actually asking questions for the assessment or actually using bullet points in the question? if that makes sense?

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Hi, Is there going to be a quiz put on Moodle for Daisy? I have seen the ones for fluid calculations and APLS however a quiz like the one for Evan would be very beneficial. Thank you :)

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Looking at the signs or symptoms of AKI and explaining the underlying physiology, I focused on blood and protein being passed through the urine and that this would be found in the urine test. I said that healthy kidneys do not allow significant amount of protein to pass through the filters unless they are damaged. In AKI proteins such a Albumin leak into the urine. A common risk factor is high blood pressure and ACE inhibitors can also increase the development of pre-renal AKI. How can I add more of the underlying physiology into my answer? Many thanks

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Im confused about how hypovolaemia can lead to AKI, could you explain this please?

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why is evan on lactulose? Hi there, Evan is on Lactulose because Lactulose can help reduce ammonia levels down if the liver is struggling to detoxify the blood :)

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also what is meant by physiological processes which relate to pre renal failure? - Hi there, this is anything physiologically that can affect pre renal failure. So shock is a good example, particular if there is hypovolaemic shock. But it could also be part of cardiogenic shock as the heart will struggle to get blood to the kidneys as they are so far away from the heart. All of these things have an impact on the GFR (Glomerular Filtration Rate), which is how efficiently the glomerulus can filter the blood initially. If there is pre-renal failure, blood flow reduces down, causing the afferent arterioles to constrict in order to maintain a good pressure for GFR to occur. But if the arterioles constrict too much, it will eventually restrict blood flow too much and filtration won't occur :)

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what are examples of 'physiology of related observations and assessments and impact of illnesses' of cardiovascular and respiratory system? (from revision check list) - Hi there, these are examples like "what is the physiology behind a respiratory rate, or what happens when the respiratory rate increases." Or "what is the physiology behind a change in heart rate or CRT etc". Think about things like that :)

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what is the impact of light and noise on neonates? because the ppt is not available on moodle, only has the gapped handout - Hi there, it can affect neonates in the short and long term. Short term affects of noise for example could be interference of sleep and rest, changes to blood flow to the brain, they find it hard to relax or "tune out" and they can be affect sociably too. This can have a knock on affect to their development such as speech, hearing and their ability to meet milestones. Light is the same as well, adding on the impact to their eyes. The thing to consider here is why is it preferred for a baby to fully develop in the womb? It's because the womb offers all of these protective measures, dark environment, reduced sound, comfort and warmth. So in terms of your care for a neonate, you have to mimic how the neonate would like to be in the womb :)

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what are associated problems with gastroschisis? is this such as ability to lose heat/fluid via evaporation due to eviscerated bowel? - Hi there, yes heat loss and fluid loss are big factors here. But also think about things such as increased risk of infection, inability to feed, positioning troubles etc :)

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why is evan on lactulose?

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also what is meant by physiological processes which relate to pre renal failure?

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what are examples of 'physiology of related observations and assessments and impact of illnesses' of cardiovascular and respiratory system? (from revision check list)

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what is the impact of light and noise on neonates? because the ppt is not available on moodle, only has the gapped handout

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what are associated problems with gastroschisis? is this such as ability to lose heat/fluid via evaporation due to eviscerated bowel?

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thank you kelvin!! you legend

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I'm struggling to think of what dependency level of care Evan may fall in within parts of the cast study? would he be under the high dependency care of 0.5:1 or 1.1 due to he's mental health? if that makes any sense? - Hi there, yes this makes perfect sense :) This is a tricky one as the guidelines don't state mental health as a factor for levels of care. But usually the CAMHS team would advise us as nurses on the level of care required, whether it is 1:1 or at a high dependency level. In my experience over the years, I have never looked after patients with mental health concerns at a 1:4 level, they have been either looked after at 1:1 by the CAMHS team, or 1:2 with guidance from the CAMHS team if their mental health is more stable. Patients with mental health should always be looked after at a higher level due to their vulnerability :)

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would daisy be level 3 1.5:1 regarding dependency of care? because she is ventilated? when in PICU post surgery - Hi there, if Daisy is reliant on a ventilator and has just come back post surgery, but was cardiovascularly stable, then she would technically be Level 2 - 1:1. But if Daisy was on any vasoactive inotropes like Adrenaline or needed regular fluid say due to cardiovascular instability, then she would be classed as Level 3 1.5:1 :)

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what would be examples of psychosocial care for jaydn, daisy and evan? e.g for Evan- talk about any medical procedures that would occur to help any anxiety? - Hi there, for the benefit of the exam you only need to concentrate on the psychosocial issues around Evan and adolescents. Because psychosocial care measures how a person's psychological function is affected by the social environment, it is difficult to assess this with Jaydn and Daisy, as they are so reliant on their parents and have limited social understanding. So for Evan, think about how the environment might affect adolescent's psychological wellbeing like Evan. Such as, think about the effects of peer pressure, hormonal change and maybe wanting to be an adult :)

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Hi, just want to confirm that the diagrams in the exam are the same ones that are available on Moodle? Thanks.-  Hi there, yes I can confirm they will be the same :)

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I'm struggling to think of what dependency level of care Evan may fall in within parts of the cast study? would he be under the high dependency care of 0.5:1 or 1.1 due to he's mental health? if that makes any sense?

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would daisy be level 3 1.5:1 regarding dependency of care? because she is ventilated? when in PICU post surgery

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what would be examples of psychosocial care for jaydn, daisy and evan? e.g for Evan- talk about any medical procedures that would occur to help any anxiety?

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Hi, just want to confirm that the diagrams in the exam are the same ones that are available on Moodle? Thanks.

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I am glad I can help, I will ensure that this padlet is observed until your exams so please continue to ask any questions :)

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Thank you so much! That was really helpful as I was trying to understand how the neonatal triangle interlinks for  the 3H’s and got slightly stuck on that part! Once again thank you so much :)

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In terms of if it's the same for peripheral vasoconstriction, hypoxia is relevant but peripheral vasoconstriction is also heavily influenced by a reducing blood flow/pressure as well

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This hypoxia will then start to affect your pulmonary vessels such as your pulmonary artery. This is a necessary reflex that the body goes through in order to prioritise blood flow to areas of the lungs that has good oxygenation capability. But the problem with a reduced surfactant level is that all of the alveoli can be affected, so the vasoconstriction can be huge and cause pulmonary hypertension. Babies who have a reduced surfactant often have a condition called Infant Respiratory Distress Syndrome (IRDS) and they require mechanical ventilation and surfactant administration to stabilise them.

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How surfactant benefits the alveoli is by reducing surface tension caused by water vapour in the alveoli. Water vapour will always try to collapse the alveoli and reduce it's surface area, but surfactant stops this from happening. So without surfactant, you will have a lower surface area for the alveoli, and therefore gas exchange reduces and causes hypoxia.

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Hi, is it possible to explain how a Hypoglycaemic baby can end up in hypoxia due to ‘decreased surfactant production and pulmonary vasoconstriction?’
Also can you explain what pulmonary vasoconstriction is as I am trying to link it to the neonatal energy triangle. Is pulmonary vasoconstriction the same as peripheral vasoconstriction? Thank you! - Hi there, of course I am happy to help with this :) A lot of this answer comes down to how cellular respiration occurs. In order to create ATP (Energy) and Heat, cells need Glucose and Oxygen. Now surfactant is produced by particular alveoli cells in order to increase the surface area of the alveoli, and these cells will need energy to perform to their optimum capacity. For a neonate who is very vulnerable and dependant on feeding to grow, a reduced glucose can have a massive impact on how well these cells function. So if these alveoli cells can't line the alveoli with surfactant due to a lack of glucose, then the alveoli start to get affected.

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Hi, is it possible to explain how a Hypoglycaemic baby can end up in hypoxia due to ‘decreased surfactant production and pulmonary vasoconstriction?’
Also can you explain what pulmonary vasoconstriction is as I am trying to link it to the neonatal energy triangle. Is pulmonary vasoconstriction the same as peripheral vasoconstriction? Thank you!

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Hi. My response for Q5. Neonates have a higher circulating blood volume of 90ml/kg. The increase in the amount of blood being expelled out the heart increases HR as it has to beat faster to excrete the carbon dioxide. Increase in HR increases CO and therefore increases BP. This leads to hypertension. Therefore higher circulating blood volume affects the observations we make as this leads to hypertension. Children have generally higher BP than adults. Is this right? With regards to smaller airway I am struggling to explain how this would affect observations? Thanks in advance. - This is a really good answer and you are on the right lines. Think about the heart's size and structure as well in terms of how the heart will compensate for a higher circulating blood volume. The smaller airway is more about airway control and positioning, so it could affect observations in terms of oxygenation and respiratory effort :)

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The link is working now everyone :)

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Anyone been able to access answers?

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CANCEL

upload

link

search_web

camera

more_horiz
POST

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still not able to access them :(

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Tray and access them again and let me know if you have any problems

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Try an

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thanks :)

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I'll double check in 5 :-) Still here!

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Hi I was just wondering when the answers to todays mock exam will be open? Thanks

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why is central cap refill more accurate?

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Hi. My response for Q5. Neonates have a higher circulating blood volume of 90ml/kg. The increase in the amount of blood being expelled out the heart increases HR as it has to beat faster to excrete the carbon dioxide. Increase in HR increases CO and therefore increases BP. This leads to hypertension. Therefore higher circulating blood volume affects the observations we make as this leads to hypertension. Children have generally higher BP than adults. Is this right? With regards to smaller airway I am struggling to explain how this would affect observations? Thanks in advance.