Download NRP 8th Edition Neonatal Resuscitation Program Study Guide with Key Concepts and Answers and more Exams Nursing in PDF only on Docsity!
NRP 8th Edition Neonatal Resuscitation
Program Study Guide with Key Concepts and
Answers
Your team has provided face-mask PPV with chest movement for 30 seconds. When is placement of an endotracheal tube strongly recommended? - ✅ The baby's heart rate remains less than 100 bpm and is not increasing. During a delivery, when and where should a person with intubation skills be available? - ✅ In the hospital and immediately available What are the primary methods of confirming endotracheal tube placement within the trachea? - ✅ Demonstration of exhaled carbon dioxide (CO2) and a rapidly increasing heart rate 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? - ✅ Low cardiac output According to the Textbook of Neonatal Resuscitation, 8th edition algorithm, at what point during resuscitation is a cardiac monitor recommended to assess the baby's heart rate? - ✅ When an alternative airway is inserted What size laryngoscope blade is recommended to intubate a preterm newborn with an estimated gestational age of 32 weeks (estimated birth weight of 1.4 kg)? - ✅ 0 What size laryngoscope blade is recommended to intubate a preterm newborn with an estimated gestational age of 28 weeks? - ✅ 00
Even brief interruptions of chest compressions may significantly reduce their effectiveness, but it is also important to assess the need to continue chest compressions. What is the preferred way to assess the heart rate during chest compressions? - ✅ Briefly interrupt chest compressions every 60 seconds to assess the heart rate using the cardiac monitor. Your team is resuscitating a newborn at birth. The heart rate is low and the baby has poor perfusion. Which is the preferred method to assess the heart rate? - ✅ Cardiac monitor When are chest compressions indicated? - ✅ When the heart rate remains less than 60 bpm after at least 30 seconds of PPV that moves the chest, preferably through an alternative airway After 60 seconds of PPV coordinated with chest compressions, the cardiac monitor indicates a heart rate of 70 beats per minute. What is your next action? - ✅ Stop chest compressions and continue PPV. What is the recommended depth of chest compressions? - ✅ One-third of the anterior-posterior diameter of the chest During chest compressions, which of the following is correct? - ✅ To coordinate compressions and ventilations, the compressor calls out one-and-two-and-three- and-breathe-and.... During chest compression with of the following is correct? - ✅ Your team is resuscitating a newborn whose heart rate remains less than 60 bpm despite effective PPV and 60 seconds of chest compressions. You have administered epinephrine intravenously. According to the Textbook of Neonatal Resuscitation, 8th edition, what volume of normal saline flush should you administer? - ✅ 3 mL
is consistent with hypoxic-ischemic encephalopathy (HIE). Which of the following is the most appropriate intervention for this newborn? - ✅ Admit the newborn to a center with capability to perform therapeutic hypothermia. A term baby was vigorous at birth but receives CPAP for 3 minutes after birth for grunting respirations. The baby is now 15 minutes old, breathing comfortably in room air, and bonding with their mother. The team plans for the baby to room-in with their mother. What immediate decision needs to be made regarding post-resuscitation care? - ✅ Identify who will continue to monitor the baby in the mother's room. A baby's heart rate does not increase after intubation and the breath sounds are louder on the right side than on the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? - ✅ Endotracheal tube inserted into the right mainstem bronchus uring resuscitation, a baby initially responds to PPV with a rapidly increasing heart rate. Subsequently, the baby's heart rate and oxygen saturation suddenly worsen. The baby has decreased breath sounds on the left side and transillumination reveals a bright glow. What is the most likely cause of this distress? - ✅ Left-sided pneumothorax You attend the birth of a baby with prenatally diagnosed severe congenital diaphragmatic hernia. What are the most appropriate steps as you begin your resuscitation? - ✅ Intubate the trachea and insert an orogastric tube into the stomach. A woman in labor received opioid medication for pain relief 1 hour before delivery. The baby does not breathe spontaneously and remains apneic after stimulation. What is your next intervention? - ✅ Start PPV In most cases, who are the usual and appropriate surrogate decision makers for a newborn? - ✅ The newborn's parents When a newborn has a high risk of mortality and there is a significant burden of morbidity among survivors, what should be included in the discussion with the parents concerning options for resuscitation? -
✅ The option of providing comfort care can be considered. You are in the delivery room caring for a preterm newborn at 27 weeks gestation. The baby is 5 minutes old and breathing spontaneously. The baby's heart rate is 120 bpm and the oxygen saturation is 90% without respiratory support. The baby's respirations are labored. Which of the following is an appropriate action? - ✅ Administer CPAP at 5 cm H2O pressure with 21% oxygen. Ideally, how quickly should the intubation procedure be completed? - ✅ 30 seconds Which of the following is an indication for placement of an alternate airway? - ✅ The need for PPV is prolonged What size (internal diameter) endotracheal tube should be used to intubate a newborn with an estimated gestational age of 26 weeks (estimated birth weight of 0.8 kg)? - ✅ 2.5 mm When coordinating PPV with chest compressions how long does it take to complete a cycle of 3 compressions and 1 breath? - ✅ 2 seconds When chest compressions are in progress, how often should the heart rate be assessed? - ✅ Every 60 seconds A baby is delivered at 29 weeks gestation. At 5 minutes after birth, the baby is breathing spontaneously while receiving CPAP (at a pressure of 5 cm H2O) and 30% oxygen. A pulse oximeter sensor on the baby's right hand is reading 95% and oxygen saturation is increasing. What is the most appropriate next step? - ✅ Decrease the oxygen concentration What are the indicators for performing PPV on a neonate? - ✅ apnea, gasping, and heart rate < 100
What 3 questions will you ask to help determine if the baby will need resuscitation? - ✅ what is the expected gestational age, is the amniotic fluid clear, what is the umbilical cord management plan risk factors for resuscitation? - ✅ § Gestational age < 36 0/7 weeks § Gestational age > or = to 41 0/7 weeks § Preeclampsia or eclampsia § Maternal hypertension § Multiple gestation § Fetal anemia § Polyhydramnios § Oligohydramnios § Fetal hydrops § Fetal macrosomia § IUGR § Significant fetal malformation or anomalies § No prenatal care § Emergency cesarean delivery § Forceps or vacuum-assisted delivery § Breech or other abnormal presentation § Category 2 or 3 fetal heart rate pattern § Maternal general anesthesia § Maternal Magnesium therapy § Placental abruption § Intrapartum bleeding § Chorioamnionitis § Opioids administered to mother w/in 4 hours of delivery § Shoulder dystocia § Meconium-stained amniotic fluid
§ Prolapsed umbilical cord Who should attend a normal birth? - ✅ At every birth, at least ONE qualified provider skilled in initial steps of newborn care and PPV Who attend birth if RISK FACTORS are present? - ✅ If risk factors are present, at least TWO qualified providers to solely manage baby Who should be present for every neonate resuscitation? - ✅ Qualified team with full resuscitation skills be immediately available for every resuscitation (FOUR or more providers) Who should be present for birth when meconium-stained fluid is the only risk factor? - ✅ When meconium-stained fluid is the only risk factor, at least TWO qualified providers must be present from time of birth to manage baby. Provider with intubation skills be immediately available. What should you use when checking supplies and equipment before every birth? - ✅ standardized equipment checklist identify items on the standardized checklist for essential supplies - ✅ Warm: preheated warmer, warm towels or blankets, temperature sensor and sensor cover for prolonged resuscitation, hat, plastic bag or warm and thermal mattress for < 32 weeks' gestation Clear airway: bulb syringe, 10F or 12F suction catheter with wall suction set to 80-100 mm Hg, tracheal aspirator Auscultate: stethoscope Ventilate: flowmeter set to 10L, oxygen blender set to 21% (21-30% if < 35 weeks'), PPV device, term- and preterm-sized masks, 8F orogastric tube and mL syringe, laryngeal mask (size 1) and 5-mL syringe, 5F or 6F orogastric tube if insertion port present on laryngeal mask, access to cardiac monitor and leads
o Although uncertain, it may be beneficial for neurodevelopmental outcomes · What are the potential benefits of delayed cord clamping for preterm babies? - ✅ o Requiring fewer blood transfusions during hospitalization o Decreasing the chance of needing medications to support blood pressure after birth o Possibly improved survival · What are the 3 rapid evaluation questions? - ✅ o Is the baby breathing or crying? o Does the baby have good muscle tone? o Does the baby appear to be term? If any answer is no, move baby to radiant warmer · After vaginal birth, the baby appears term, has good muscle tone, and is crying. Where can the baby receive the initial steps? - ✅ on mom's chest or abdomen · What is included in the five initial steps of newborn care? - ✅ o Stimulate by gently rubbing the baby's back and extremities o Provide warmth o Dry the baby and remove wet linen (if > 32 weeks gestation) o Clear secretions from the airway, in needed o Position head and neck to open the airway (sniffing position) · If the baby stays with the mother for initial steps, when should you clear secretions with a bulb syringe? - ✅ o 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? - ✅ o Breathing, temp, color, tone, and activity
· If the baby is not term, move to radiant warmer immediately - ✅ o Mouth is suctioned in anticipation of PPV o PPV is initiated within 60 seconds of birth · 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 How would you assess the heart rate of a newborn? - ✅ o Count the number of beats in 6 seconds and multiply by 10 (add zero to the number of beats counted) · If the baby is breathing after initial steps, you should assess and monitor the heart rate. What should it be? - ✅ at least 100 bpm · If the baby is not vigorous and the heart rate is difficult to auscultate, what should you do? - ✅ Connect a pulse oximeter or a cardiac monitor · PPV: oxygen management - ✅ o For babies > = 35 weeks, start with 21% oxygen (room air) o For preterm babies < 35 weeks, start with 21-30% oxygen o *** increasing oxygen concentration used for PPV may not help if the lungs are not being inflated (ensure good seal with mask *** What are typical CPAP settings for the term newborn? - ✅ 25/ When providing ventilation, what is the correct ventilation rate? - ✅ 40-
· When placing an orogastric tube, measure the insertion depth. While positive pressure ventilation CPAP is in progress by measuring from the bridge of the nose to the earlobe and from the earlobe to? - ✅ o A point halfway between the xiphoid process and the umbilicus · Laryngeal mask: an alternative airway - ✅ o A in MR. SOPA denotes alternative airway o ETT and laryngeal mask are the two alternative airways used o Size 1 LMA for newborns 1500-2000 grams · To ensure immediate access to the laryngeal mask, where should it be located? - ✅ At the warmer · What are the indications for inserting a laryngeal mask airway? - ✅ o You cannot ventilate o You cannot intubate o Newborn has a large tongue o Newborn has a small mandible o Newborn has congenital anomalies involving the mouth, lip, tongue, palate, or neck · You are providing face Mask PPV to a newborn who was bradycardic at birth. The heart rate has increased to more than 100 BPM and the baby is beginning to breathe spontaneously. What is your next action? - ✅ o Slow the rate of PPV and stimulate the baby · When a baby is breathing well enough to sustain a heart rate over 100 bpm, do you continue giving PPV? - ✅ NO. discontinue PPV · If you are alone when a baby needs PPV, what is the first thing you should do? - ✅ o Start PPV and mobilize additional help
· When an alternative airway is required, what type of monitoring is recommended for the most accurate assessment of the baby's heart rate? - ✅ cardiac monitor At what point will you proceed to chest compressions in the newborn? - ✅ · DO NOT proceed to cardiac compressions or medication until the newborn has received 30 seconds of PPV that moves the chest, preferable through an alternative airway · If a baby appears to be term, has good muscle tone, but is not breathing or crying, where should the baby receive initial steps? - ✅ At the radiant warmer · When should you consider using a cardiac monitor? - ✅ o The baby is not vigorous o When an alternative airway is required, a cardiac monitor is recommended o The heart rate is difficult to auscultate o Pulse oximetry does not work o PPV is required · Healthy babies may have central cyanosis for several minutes after birth. What is the first montior you will use on ALL newborns? - ✅ Pulse oximetry can be a reliable method for assessing a baby's oxygen saturation. When resuscitation is anticipated, when should you apply pulse oximetry? - ✅ after completing the inital steps How long may it take a newborn to achieve a oxygen saturation of 100% - ✅ up to 10 minutes preductal sat at 3-5 minutes is ~75%
· if the baby is not vigorous at birth but placental circulation is intact what may be the reasonable course of action. - ✅ o The provider may clear the airway with the bulb syringe and gently stimulate the baby to breathe. What is the epinephrine dose for IV/IO? - ✅ 0.02 mg/kg flush with 3 mL NS repeat every 3-5 minutes if the HR is less than 60 bpm What is the ETT dose for epinephrine - ✅ 0.1 mg/kg ETT rapid push Provide PPV to distribute into lungs. may administer while vascular access is established. once vascular access is established, no need to wait, can give the IV/IO immediately. What is a reasonable initial oxygen concentration for PPV in a < 35 weeks' GA newborn? - ✅ 21%-30% oxygen After you have given IV epinephrine and the HR remain < 60, what two things should you consider as a differential? - ✅ hypovolemia and pneumothorax hypovolemia: give 0.9% NS dosed at 10 mL/kg given over 5-10 minutes When a MR. SOPA step results in chest movement, what do you do next? - ✅ ventilate for at least 30 seconds at a rate of 40-60 breaths per minute and reassess heart rate
