NRP 8th Edition Questions and Answers Already Passed

NRP 8th Edition Questions and Answers Already Passed At birth baby first breath help move fluid out of lungs What is the single most important and most effective and neonatal resuscitation? Ventilation What are the four pre-birth questions you should ask the obstetric provider to help assess perinatal risk likely requiring resuscitation? 1.What is the expected gestational age? 2.Is the amniotic fluid clear? 3.Are there any additional factors? 4.What is our umbilical cord management plan? assemble qualified team members, prepare supplies and equipment. Prior to BIRTH: 1.Assessed perinatal risk factor and assembled a qualified team 2.Checked equipment using standardized checklist 3.Conducted a Pre-briefing to clarify roles and responsibilities 4. Discussed the plan for delayed cord clamping with the ob provider 5. Spoke to parents At least 2 (two) qualified people should be present to solely manage the baby if factors are present. Depending on the setting, four (4) or more qualified providers. Meconium: 2 people intubation skills: identified and available When the assessment of risk factors indicate the likelihood of extensive resuscitation, who should be present at the time of birth? Advance resuscitation team What is included in the Neonatal Resuscitation program quick equipment checklist? Equipment to give free-flow oxygen Preheat warmer, towels and blankets ET tubes Bulb syringe According to the Neonatal Resuscitation program quick equipment checklist, how should the flowmeter be set to prepare for ventilation? 10L/min According to NRP 8th edition, for how long should umbilical cord clamping be delayed for eligible babies? At least 30-60 seconds In term and late Preterm newborns, improves hematologic measures (decrease chance of needing meds to support bp after birth-few blood transfusion) and neurodevelopmental outcomes What ae the potential benefits of delayed cord clamping for term and late preterm babies? Although uncertain, it may be beneficial for neurodevelopmental outcomes. Improved early hematologic measurements. What are the potential benefits of delayed cord clamping for preterm babies? -Possible improved survival -Requiring fewer blood transfusions during hospitalization -Decreasing the chance of needing medications to support blood pressure after birth What is the purpose of the rapid evaluation of the newborn at birth? Determines if the baby can stay with the mother or should be moved to the radiant warmer. What are the 3 rapid evaluation questions? 1. Breathing- Is the baby breathing or crying? 2.Tone- Does the baby have good muscle tone? 3.Term-Does the baby appear to be term? Before birth, pulmonary resistance is HIGH in the fetal lungs A qualified team with full resuscitation skills should be identified and immediately available for every resuscitation. What should their skills include? 1.Endotracheal intubation 2. PPV 3.Chest compressions 4.Emergency vascular access and medication administration After completing the rapid evaluation, the next step is completion of the initial steps of newborn care, which include "opening the airway" and "supporting spontaneous respiration" After completing initial steps the RN should apply a pulse oximetry What is included in the five (5) initial steps of newborn care? TTB *term? tone? breathing? 1. Provide warmth ( uncovered under warmer) 2. dry the baby (if>32wks gest) and remove wet linen. late by gently rubbing the baby's back and extremities (back, trunk, extremities). 4. position head and neck to open airway "sniffing position" (facilitates breathing). 5. Clear secretion from the airway, if needed (mouth and nose in anticipation of PPV If still not breathing after above steps-start PPV if Newborn resuscitation is usually the result of "Respiratory Failure". After a vaginal birth, the baby appears term, has good muscle tone and is crying. Where can the baby receive the initial steps? On the mother's chest or abdomen. How do you estimate a newborn's heart rate? Count the number of beats in 6 seconds and multiply by 10 Heart Rate Assessment: 1.Ascultate the left side of chest number of beats in 6 sec x10 (add a zero to the number of beats counted) 3. heat beat at least 100bpm; if less start PPV even if breathing. 4.PPV should begin 60 seconds after birth *Connect a Pulse oximeter(baby Right hand or Wrist) or a cardiac monitor if baby not vigorous. 1-2 minutes for pulse oximetry to display a reliable signal. *very low hr or poor perfusion-pulse oximeter may not be able to detect pulse or oxygen saturation. Perinatal risk factor increasing likelihood of resuscitation? Prolapse umbilical cord maternal hypertension Fetal anemia PPV: oxygen management *For babies > 35wks, start PPV with 21% oxygen(room air/blender based ). *For preterm babies <35wks, start PPV with 21%-30% oxygen. CPAP Continuous Positive Airway Pressure PEEP Positive End Expiratory Pressure VR: Ventilation Rate PIP Peak Inspiratory Pressure IT Inspiratory Time CPAP is a way of delivering PEEP but also maintains the set pressure throughout the respiratory cycle, during both inspiration and expiration PEEP gives a mixture of air and oxygen, to the lung between each breath to keep the lungs open and stop them collapsing PIP is the pressure delivered to the lungs each time the bag is squeezed T-Piece resuscitator: stable lung inflation; removes fluid; prevents air spaces from collapsing during exhalation First HR assessment: After 15 seconds of PPV -HR increasing:-Continue PPV and assess HR in 15 seconds. -HR NOT increasing, Chest is moving:-Continue PPV and assess in 15 seconds . HR NOT increasing, Chest NOT moving:- Begin MR. SOPA Rising HR is most important indicator of successful PPV What physical parameter are you trying to achieve with the MR. SOPA ventilation corrective steps? Chest movement with PPV M (mask adjustment) lift jaw forward,2hand hold. R (reposition airway), head neutral, slightly extended.-5 breaths and assess chest movement. If no chest move DO S (suction mouth and nose), bulb or suction catheter. O (open mouth), Give 5 breath and assess chest movement. If no chest movement, DO P (pressure increase) [Increase the pressure in 5 to 10cm H2o increments, up to 40cm h2o] A (alternate airway).Endotracheal tube/laryngeal mask The ENDOTRACHEAL TUBE and the LARYNGEAL MASK are the alternative airways used for newborn resuscitation. *size 1 laryngeal mask indicated for g. some require inflation, some tubes are straight/pre-curved; Inserted into mouth and advance into throat until it makes a seal over the entrance trachea(the glottis) is a better seal than facemask Positive-pressure ventilation: orogastric tube When placing an orogastric tube(leave it uncapped to act as a vent for the stomach, due to gas entering the esophagus and stomach), measure the insertion depth while PPV or CPAP is in progress by measuring from the bridge of the nose to the earlobe and from the earlobe to? A point halfway between the xiphoid process and the umbilicus To ensure immediate access to the laryngeal mask, where should it be located? At the warmer You are providing face mask PPV to a newborn who was bradycardic at birth. the HR has increased to more than 100 bpm and the baby is beginning to breathe spontaneously. What is your next action? Slow the rate of PPV and stimulate the baby Do not give free-flow oxygen through the MASK of a self inflating bag. START with 30% suppl o2; Guide pulse oximetry adjust FIO2 to maintain baby's oxygen sat within the TARGET Range for baby's age in minute. Goal to prevent LOW oxygen sat without exposing the newborn to unnecessary oxygen. 1. Adjust flowmeter to 10L/min 2. set o2 blender to 30% 3. Administer free-flow o2 4.Monitor oxygen sat 5.Adjust the oxygen concentration as needed to maintain o2 sat within target range. LARYNGEAL MASK: PLACEMENT AND REMOVAL Laryngeal mask should be immediately accessible at the warmer. -Size 1 laryngeal mask -CO2 detector -8F feeding tube and syringe for use as an orogastric tube. -5mL syringe(for mask inflation) Indication for use: Cannot ventilate /intubate; Congenital anomalies(mouth, lip, tongue, palate, neck);small mandible or large tongue; Limitation: size 1 mask fits > g; No studies use the mask to suction the airway; high ventilation pressure may cause leak in the seal and result in insufficient inflation pressure; few reports describe use during chest compressions.; insufficient evidence to recommend using a mask for intratracheal medication Consider using a cardiac monitor? 1.The heart rate is difficult to auscultate 2. baby no vigorous ox does not work alternate airway is required, a cardiac monitor is recommended. 5. PPV is required. - Free Flow Oxygen: 30% - Prevent HYPOXIA without using excess oxygen and exposing the newborn to the potential risk of unnecessary ox - Assisted ventilation should be given at a rate of 40-60 breaths per minute - Bag Mask ventilate at a rate of 1 breath every 3 to 5 seconds. Free flow oxygen devices: 1Oxygen mask and tubing; 2Mask of a flow inflating bag, 3Mask of a T-piece resuscitator, 4The open reservoir "tail" of a self inflating bag. When providing positive pressure ventilation to a term newborn, what peak inspiratory pressure should you start with? 20-25 cm H2O The goal is to prevent "hypoxia" without using excess oxygen and exposing the newborn to the potential risks of additional, unnecessary oxygen. It can be difficult to deliver PEEP (positive end expiratory pressure) with a self inflating bag. A T piece resuscitator delivers consistent inspiratory pressure and PEEP. What does PEEP help achieve? 1.Prevents air spaces from collapsing during exhalation 2. stable lung inflation 3.Removes fluid 3 . What are the primary methods of confirming endotracheal tube placement within the trachea? Continued central cyanosis and no mist in the tube Auscultation of bilateral breath sounds and no air entry heard over the abdomen Demonstration of exhaled carbon dioxide (CO2) and a rapidly increasing heart rate Absence of crying and no abdominal distension 4 . You are resuscitating a critically ill newborn whose heart rate is 20 bpm. The baby has been intubated and the endotracheal tube insertion depth is correct. You can see chest movement with PPV and hear bilateral breath sounds, but the colorimetric CO2 detector does not turn yellow. What is the likely reason for this? The endotracheal tube is not in the trachea. Excessive ventilation pressure. Epinephrine contamination. Low cardiac output