Download NRP 2024 – 8th Edition Neonatal Resuscitation Study Guide with Updated Questions and Answe and more Exams Nursing in PDF only on Docsity!
NRP 2024 – 8th Edition Neonatal
Resuscitation Study Guide with Updated
Questions and Answers
Which block of the NRP algorithm helps you determine if the baby can stay with the mother or should be moved to the radiant warmer for evaluation? Airway Circulation Rapid Evaluation Breathing - ✔ Rapid Evaluation This evaluation determines if the baby can stay with the mother for routine care or should be moved to RW 5 Blocks of NRP Algorithm: - ✔ 1. Rapid evaluation -This evaluation determines if the baby can stay with the mother for routine care or should be moved to the RW
- Airway The initial steps open the airway and support spontaneous respiration
- Breathing Assist breathing with PPV if infant is apneic, gasping or bradycardic. CPAP or oxygen may be appropriate for labored breathing or low oxygen saturation
- Circulation
perform chest compressions coordinated with PPV if severe bradycardia persists despite effective assisted ventilation
- Drugs Administer epinephrine if severe bradycardia persists despite PPV and coordinated chest compressions What occurs during the 1st block of the NRP algorithm: Rapid evaluation? - ✔ This evaluation determines if the baby can stay with the mother for routine care or should be moved to RW What occurs during the 2nd block of the NRP algorithm: Airway? - ✔ Initial steps open the airway and support spontaneous respiration What occurs during the 3rd block of the NRP algorithm: Breathing? - ✔ Assist breathing with PPV if the baby is apneic, gasping or bradycardic. CPAP or oxygen may be appropriate for labored breathing or low oxygen saturation What occurs during the 4th block of the NRP algorithm: Circulation? - ✔ Perform chest compressions coordinated with PPV if severe bradycardia persists despite effective assisted ventilation What occurs during the 5th block of the NRP algorithm: Drug? - ✔ Administer epinephrine if severe bradycardia persists despite PPV and coordinated chest compressions After completing the rapid evaluation, the next step is completion of the initial steps of newborn care, which include: Blank & Blank - ✔ Answer: Open the airway & Supporting spontaneous respiration
✔ Perinatal risk What are the four pre-birth questions you should ask the obstetric provider to help you assess perinatal risk (SATA)? What Is the maternal Group B Strep Status Are there any additional factors? What is the expected GA? What is our umbilical cord management plan? Is the amniotic fluid clear? - ✔ Answer: B.Are there any additional factors? C.What is the expected GA? D. What is our umbilical cord management plan? E. Is the amniotic fluid clear? Which of these are perinatal risk factors that increase the likelihood of resuscitation (SATA)?: Term gestation Fetal anemia Prolapsed umbilical cord Maternal hypertension - ✔ Answer: B.Fetal anemia C.Prolapsed umbilical cord D. Maternal hypertension Who Attends The Birth? - ✔ At every birth... At least one qualified individual skilled in the initial steps of newborn care & PPV, whose only responsibility is to manage the baby
If risk factors are present... At least 2 qualified people just to manage the baby A qualified team with full resuscitation skills endotracheal intubation, chest compressions, emergency vascular access, medication administration How many providers could be on a resuscitation team - ✔ about be 4 or more qualified members Where is the resuscitation team located? - ✔ they most be onsite at the hospital not oncall or at home when resuscitation is needed, it must be done without delay What type of team do you need if meconium stained fluid is the only risk factor? - ✔ need only 2 qualified individuals at the birth if this is the only risk factor as there is an increased need for resuscitation. There does need to be an individual with intubation skills immediately available What type of team do you need if there is meconium stained fluid and additional risk factors? - ✔ Need a team with full resuscitation skills A qualified team with full resuscitation should be identified & immediately available for every resuscitation. What should their skills include? Chest compression PPV Lumbar puncture Emergency Vascular access and medication administration Vacuum extraction Endotracheal intubation -
Bulb syringe Endotracheal tubes Equipment to give free-flow oxygen Preheated warmer, towels, and blankets Blood pressure cuff - ✔ Answer: B.Bulb syringe C. Endotracheal tubes D. Equipment to give free-flow oxygen E. Preheated warmer, towels, and blankets According to the Neonatal Resuscitation Program quick equipment checklist, how should the flowmeter be set to prepare for ventilation? 10 L/min 5 L/min 18 mL/min 15 L/min - ✔ Answer: 10 L/min According the NRP 8th edition, for how long should umbilical cord clamping be delayedfor eligible babies? - ✔ At least 30-60 seconds What are the potential benefits of delayed cord clamping for preterm babies? Requiring fewer blood transfusions during hospitalization Although uncertain, it may be beneficial for neurodevelopmental outcomes Improved early hematologic measurements
Decreased mortality Higher BP and blood volume - ✔ Answer: A.Requiring fewer blood transfusions during hospitalization B. Although uncertain, it may be beneficial for neurodevelopmental outcomes What are the potential benefits of delayed cord clamping for preterm babies? Improved thermoregulation Decreasing the change of needing medication Decreased change of needing phototherapy Possibly improved survival Requiring fewer blood transfusions during hospitalization - ✔ Answer: B. Decreasing the change of needing medication D.Possibly improved survival E.Requiring fewer blood transfusions during hospitalization Benefits for delay cord clamping in preterm babies include - ✔ Decreasing the chance of needing medications to support blood pressure after birth Requiring fewer blood transfusions during hospitalizations Possible improved survival. Benefits for delay cord clamping in term babies include - ✔ improve early Hematologic measurements uncertain there might be benefits for the neurodevelopmental outcomes.
✔ 1. Provide warmth place baby uncovered under radiant warmer
- Dry the baby (> 32 weeks) and remove wet linen
- Stimulate by gently rubbing the baby's back and extremities if the baby is still not breathing (dry the baby is often enough stimulation to elicit respirations)
- Position head and neck to open the airway ("sniffing" position)
- Clear secretions from the airway, if needed (suction mouth, then the nose, in anticipation of PPV If the baby stays with the mother for initial steps, when should you clear secretions with a bulb syringe? - ✔ If secretions are obstructing the baby's breathing When the baby stays with the mother for initial steps after birth, what should be monitored to determine if additional interventions are required? - ✔ Temp color breathing tone & activity What should you do if an apneic newborn is moved to a radiant warmer after birth and is still not breathing after the initial steps? - ✔ Begin PPV Immediately If a baby if apneic, gasping or has a HR less than 100 bpm after the initial steps of resuscitation, what do you do immediately? - ✔ Begin PPV Immediately If the newborn is not breathing after these initial steps, PPV begins immediately within how long after birth? - ✔ within 60 seconds!
How do you estimate a newborns heart rate: - ✔ Count the number of breast in 6 seconds & multiply by 10 At least how many qualified people should be present to solely manage the baby if risk factors are present? - ✔ Answer: Two If a newborn is not breathing or the HR is less than 100 bpm, you should being PPV within how soon after birth? - ✔ 60 seconds If the baby is not vigorous and the HR is difficult to auscultate, what should you do? - ✔ Connect a pulse oximeter or cardiac monitor For babies >35 weeks gestation, start PPV with fiO2 at what? - ✔ 21% oxygen For preterm babies < 35 weeks gestation, start PPV with fiO2 of what? - ✔ 21-30% oxygen Oxygen saturation goals: - ✔ -Oxygen saturation goals are listed on the target oxygen saturation table -It may take 1-2 minutes for pulse ox to display a reliable signal -If the baby has a very low HR or poor perfusion, pulse ox may not work or have a reliable signal -Increasing the oxygen concentration used for PPV may not help if the lungs are not being inflated
-Stable lung inflation -prevents air spaces from collapsing during exhalation If the baby is breathing after initial steps, you should assess and monitor the HR. It should be at least what bpm? - ✔ 100 bpm After the first 15 seconds of PPV, you do the first HR assessment. The HR is not increasing and the chest is not moving. What should you do? - ✔ Being MR. SOPA ventilation corrective steps immediately After starting PPV, when do you do your first HR assessment? - ✔ 15 seconds What is the rate and rhythm for ventilated breaths? - ✔ 40-60 bpm using the waltzing rhythm breathe 2, 3 breath 2, 3 What is the ideal PIP rate to ventilate baby with PPV? - ✔ Start with a PIP of 20-25 cm H Full term infants may require 30-40 cm H20 for their first few breaths to infalte the lungs, then need less pressure to maintain chest movement How do you know if you are giving adequate breaths during PPV? - ✔ Should see a gentle rise and fall of chest What do you do if you cannot get a good seal on the mask? -
✔ Try a 2 hand technique -hold mask against face with thumb & first finger -place other 3 fingers of each hand under boney angle of jaw and lift the jaw forward -Hold head in sniffing position -2nd person gives breaths -3rd person monitors HR and chest movement CO2 detector - ✔ -placed between mask and inflator bag -detects if lungs are inflating -Should change yellow by 8-10 breaths indicating ventilation that inflate lungs How does PEEP help maintain stable lung inflation? - ✔ -removes fluid -prevents air spaces fron collasping during exhalation Where do you place pulse ox? - ✔ Rt hand or wrist During PPV, HR is increasing what do you do? - ✔ Continue PPV for another 15 seconds Assess HR
--give 5 breaths and asses chest movement, if none, do next steps P: pressure increase -increase in 5 to 10 cm H20 increments to recommended max pressure -max for term: 40 cm h -make preterm: 30 cm h --give 5 breaths and asses chest movement, if none, do next steps A: alternate airway -Insert a laryngeal mask or endotracheal tube Try PPV and assess for chest movement and breath sounds Once you obtain chest movement after doing through the MRSOPA steps, what do you do next? - ✔ Give 30 seconds of PPV with chest movement What physical parameter are you trying to achieve with the MR. SOPA ventilation corrective steps? - ✔ Chest movement with PPV What are the first 2 steps of MR. SOPA ventilation corrective steps that often solve the problem? - ✔ Mask adjustment & reposition head You are performing the MR. SOPA ventilation corrective steps on a term baby. You have adjusted the mask and repositioned the head. You have suctioned the mouth and nose and opened the mouth. There is still no chest movement. What is the next step? - ✔ Increase the pressure in 5 to 10 cm H20 increments, up to 40 cm H If a newborn requires PPV with a face mask, laryngeal mask or required CPAP for more than several minutes, consider placing a what? - ✔ Orogastric tube
When placing an OG tube, measure the insertion depth while PPV or CPAP is in progress by measuring from the nose to the earlobe and from the ear lobe to? - ✔ A point halfway between the xiphoid process and the umbilicus If a baby appears to be term, has good muscle tone but is not breathing or crying, where should the baby receive the initial step? - ✔ At the radiate warmer The endotracheal tube and what are the alternative airways used for a newborn resuscitation? - ✔ Laryngeal mask What are the indications for inserting a laryngeal mask? A. Newborn has a small mandible B. You cannot ventilate C. You cannot intubate D. Newborn has a large tongue E. A self-inflating bag is not available F. Newborn has congenital anomalies involving mouth, lip, tongue, palate, or neck - ✔ A. Newborn has a small mandible B. You cannot ventilate C. You cannot intubate D. Newborn has a large tongue F. Newborn has congenital anomalies involving mouth, lip, tongue, palate, or neck When to discontinue PPV - ✔ -As the heart rate increases to over 100 and the baby begins to breathe, slow the rate of PPV and gently stimulate the baby. -When the baby is breathing well enough to sustain a heart rate of 100 discontinued PPV.
-When the pulse oximetry does not work NOT: when the baby first arrives at the RW for initial steps of resuscitation Indications for using a pulse oximetry - ✔ -When resuscitation is anticipated (applied after initial steps of NRP) -to confirm preception of central cyanosis that persists for several min after birth and need for supplemental oxygen -To guide oxygen concentration when supplemental O2 is administered -when PPV is required When do you apply a pulse ox - ✔ after the initial steps of NRP What is the single most effective step in neonatal resuscitation> - ✔ Ventilation of the lungs What is the most important indicator of successful PPV? - ✔ Rising HR How many seconds of PPV need to occur before proceeding with cardiac compressions or medications? - ✔ do not proceed with compressions or meds until the newborn has received 30 seconds of PPV that moves the chest, preferably through an alternative airway When performing PPV, you may not proceed to chest compressions or medication until the newborn has received at least ___ seconds of PPV that moves the chest, preferably through an endotracheal tube or laryngeal mask -
✔ 30 seconds To ensure immediate access to the laryngeal mask, where should it be located? - ✔ At the warmer Five initial steps of newborn care - ✔ 1.) Provide warmth 2.) Dry the baby (> 32 weeks) and remove wet linen 3.) Stimulate by gently rubbing the baby's back and extremities (dry the baby is often enough stimulation to elicit respirations) 4.) Position head and neck to open the airway ("sniffing" position) 5). Clear secretions from the airway, if needed What GA is it okay to dry the infant during the initial 5 steps of NRP - ✔ >32 weeks Healthy babies may have central cyanosis for several minutes after birth. What can be used as a reliable method for assessing a baby's oxygen saturation with central cyanosis? - ✔ Pulse oximetry Why do you place pulse ox on right hand or wrist? - ✔ -the heart & brain usually receive blood from an artery that attaches to the artery before the ductus arteriosus (preductal) -left arm & both legs may show lower O2 as it has received blood from the aorta after it has mixed with poorly oxygenated venous blood shunted from the right side of the heart through the ductus arteriosus
