Understanding Respiratory Failure & Effective Ventilation in Newborns, Exams of Javascript programming

Download Understanding Respiratory Failure & Effective Ventilation in Newborns and more Exams Javascript programming in PDF only on Docsity! Neonatal R esuscitation Program (NRP) 184 Questions with Verified Solutions. Neonates needing resuscitation usually have normal __________ - ANS heart The need for resuscitation caused by ____________, either before or after birth. - ANS respiratory failure After birth, respiratory failure occurs if baby does not initiate or cannot maintain effective ______________ - ANS breathing effort The focus of neonatal resuscitation is _______________of the baby's lungs - ANS effective ventilation If the baby is in early respiratory failure, ____________ may be enough. - ANS tactile stimulation Fetal lungs do not participate in ____________ - ANS gas exchange Potential alveoli filled with _________ instead of _________ - ANS fluid, air __________ Vessels that will carry blood to alveoli are tightly constricted to prevent blood flow. - ANS pulmonary The __________ vein supplies O2 which diffuses into fetal blood vessels. - ANS umbilical Most blood is shunted right-to-left via patent ___________ and __________ - ANS foramen oval, ducts arteriosus What is the result after the baby breathes and the umbilical cord is clamped? - ANS Newborn uses lungs (instead of placenta) for gas exchange What is the result after the fluid in the alveoli is absorbed? - ANS Air replaces fluid in alveoli, O2 moves from alveoli into pulmonary blood vessels and CO2 moves into alveoli to be exhaled What is the result of air in the alveoli cause blood vessels in lungs to dilate? - ANS Pulmonary blood flow increases and ducts arteriosus gradually constricts. It may take up to __________ get a newborn's SpO2 greater than 90%. - ANS 10 Initially in fetal transition, the blood flow is redistributed away from organs to ____________ and __________ - ANS heart, brain If inadequate gas exchange continues, the fetal heart begins to ____________ and blood to all organs ___________ - ANS fail, decreases Clinical findings in the interruption of fetal transition includes apnea, tachypnea, bradycardia, tachycardia, decreased ___________, low ___________, and low __________ - ANS muscle tone, SpO2, BP A prolonged lack of perfusion and oxygenation can lead to ___________. - ANS organ damage What are the three questions to ask during a newborn initial assessment? - ANS - Is the baby term? - Is the newborn breathing or crying? - Does the newborn have good muscle tone? What are the 5 blocks for the steps in newborn evaluation and resuscitation? - ANS - Initial Assessment - Airway - Breathing - Circulation - Drug What is the question to ask for initial assessment? - ANS Can the baby stay with mom or be moved to radiant warmer for further evaluation? When on the airway block, it is important to establish open __________ and support ___________ respirations. - ANS airway, spontaneous When on the breathing block, it is important to use _________ to assist in breathing if apneic or bradycardia (CPAP or O2 is also acceptable). - ANS PPV When on the circulation block, it is important to due __________ for circulation if PPV is not working. - ANS chest compressions When on the drug block, it is important to administer ___________ for severe bradycardia as PPV and check compressions continue. - ANS Epinephrine It is important in neonatal resuscitation to have a pre-resuscitation team ___________ and establish a team __________ - ANS briefing, leader A team leader orders 1 mg of epinephrine, and a team member verbally acknowledges when the medication is administered. What element of effective resuscitation team dynamics does this represent? - ANS closed-loop communication It is important to position the ____________ and ___________ to open the airway - ANS head, neck In order to open the airway, is important to extend the head and neck into the _____________ - ANS sniffing position If suction is needed you need to suction __________, then __________, and finally suction gently with ___________ syringe - ANS mouth, nose, and bulb Suction catheter pressure should be set at ____________ - ANS 80 to 100 mmHg It is important to prevent __________ heat loss and use brief tactile _________ (i.e., rub back/trunk/extremities). - ANS evaporative, stimulation It is important to give __________ for central cyanosis. - ANS O2 Polyethylene plastic should be used for babies who are _________ gestation. - ANS less than 32 wks. Newborns should have __________ respirations and a HR __________ within 1 minute after birth. - ANS spontaneous, greater than 100 Reassessment for PPV should happen less than or equal to ____________ - ANS 30 sacs PPV should begin in a newborn if they have _________, __________, and ___________ - ANS - Apnea/gasping - Persistent central cyanosis despite 100% supplemental O2 - HR (auscultate) less than 100 BPM Palpating the __________ is not accurate for obtaining pt.’s HR. - ANS umbilici _____________ is a common finding in newborns - ANS Acrocyanosis ____________ may be present in healthy babies for several minutes after birth. - ANS Central cyanosis Persistent cyanosis requires ______________ reading to evaluate oxygenation - ANS pulse dosimeter It is important to not use cyanosis to guide ______________ - ANS supplemental O2 The normal intrauterine state is ________ and normal state of air-breathing healthy newborns is _________ - ANS 60%, 90% This is blood to the heart and brain from an artery that attaches to the aorta before the ducts arteriosus - ANS Pre-ductal blood The predictable blood measures SpO2 of blood perusing the __________ and __________ - ANS heart, brain What hand does the pulse dosimeter go on for SpO2 of predictable blood? - ANS right hand Supplemental O2 is given via _____________ for spontaneously breathing neonates with low SpO2 for their age. - ANS free flow O2 Some things that can be done to maintain target SpO2 range includes adjusting __________ and using a ____________ - ANS FIO2, blender What flow should be used in free flow O2 delivery? - ANS 10 LPM It is important when administering supplemental O2 to start with _________ and titrate, and if a newborn requires a prolonged use of O2 it needs to be hooked up to ____________ and ___________ - ANS 30%, heat, and humidification If the newborn has labored breathing or low SpO2, then the pt. needs to be placed on ___________ or ___________ - ANS CPAP or PPV This type of ventilation is used to maintain FRC - ANS CPAP CPAP is only used in delivery room if the baby is __________ and has a HR of __________ - ANS breathing, less than 100 BPM CPAP can be done using ______________ and ___________ resuscitator. - ANS flow- inflating bag, T-piece CPAP and free-flow O2 cannot be given via ____________ - ANS self-inflating bag With vigorous newborn, use ___________ while baby is with mom to gently clear mouth and nose of secretions. - ANS bulb syringe A non-vigorous newborn has ___________ respirations or __________ tone. - ANS depressed, poor muscle Non-vigorous newborns need to be placed under a ___________ and perform initial steps, use __________ to clear mouth and nose, and begin PPV for HR ___________ or ___________ - ANS radiant warmer, bulb syringe, less than 100, apnea ___________ suctioning no longer recommended immediately after birth. - ANS tracheal ____________ is the single most important and effective step of neonatal resuscitation. - ANS Ventilation A ____________ fills with spontaneously with gas - ANS self-inflating bag A ____________ only fills with gas from a compressed source - ANS flow-inflating bag (anesthesia bag) A ___________ directs compressed gas toward the baby when an opening on top is occluded. - ANS T-piece resuscitator Some indications of PPV in a newborn includes __________, _____________, HR less than __________, or SpO2 less than targeted range despite free-flow O2 or CPAP - ANS apnea, gasping, 100 When using a T-piece resuscitator, the RT can set a specific ___________ and ________ - ANS PEEP, PIP If the hole on a T-piece resuscitator is not being covered, it is just giving the pt. __________ - ANS CPAP What FIO2 should be used on newborns that are greater than or equal to 35 wks. gestation? - ANS 21% What FIO2 should be used on newborns that are less than 35 wks? gestation? - ANS 21% to 30% All bag-mask ventilation devices should be set at __________ - ANS 10 L/min What should the RR be set at for PPV of a newborn? - ANS 40 to 60 BPM What should the initial PIP be set at in PPV of a newborn? - ANS 20 to 25 cmH20 Full term babies may need a PIP of _________, and then gradually decrease. - ANS 30 to 40 cmH2O Why do you want to set PIP at lower pressures for preterm neonates? - ANS If you have a baby less than 25 wks. You want to start with lower pressures and work your way up to prevent a pneumothorax from occurring. What should the PEEP be set at in PPV of a newborn? - ANS 5 cmH20 ________ is the most important indicator of PPV - ANS HR Laryngeal mask airways do not require _________ against face, bypasses _________, and does not require visualization of _________ for placement. - ANS tight seal, tongue, vocal cords Some limitations when it comes to the use of LMA includes _____________ secretions, high ventilation pressures, __________, intratracheal measurements, and use in neonates less than ___________ - ANS suctioning, chest compressions, 1500 g Newborns with congenital anomalies involving mouth, lip, tongue, palate, or neck, cannot get a good _________ - ANS seal An indication of chest compressions in a neonate includes a HR less than __________ after greater than ________ of PPV - ANS 60, 30 Chest compressions should be performed on the lower ______ of the sternum with the thumbs. - ANS 1/3rd Compressions should depress the sternum about _______ AP diameter. - ANS 1/3 How many compressions should be done per minute? - ANS 90 _____ Compressions: _____ ventilation - ANS 3, 1 How much FIO2 should be used during chest compressions? - ANS 100% Assess fetal HR after initial ________ seconds of chest compressions, chest compressions should be stopped for HR greater than ________ BPM - ANS 60, 60 How many events should be done per minute during neonatal chest compressions? - ANS 120 With a HR less than 60 BPM after 60 seconds of compression, you should continue compressions, see is the chest is moving, listen for _____________, use of __________ O2, ensure compression depth and rate, and administer _________ - ANS bilateral BS, 100%, epinephrine Epinephrine is a _________ and __________ stimulant - ANS cardiac, vascular Epinephrine causes blood vessels to ___________ and will increase blood flow to restore cardiac function. - ANS constriction Epinephrine increases rate and strength of __________ contractions - ANS cardiac When is the use of epinephrine indicated in the resuscitation of the newborn? - ANS If the patient has a HR of less than 60 BPM after greater than 30 sacks of PPV with chest movement and 60 seconds of coordinated compressions and ventilation A need for meds occurs when blood flow into __________ is severely decreased, resulting in such a low O2 delivery to newborn's heart that it can't contract effectively - ANS coronary arteries Epinephrine improves coronary artery _________ and _______ delivery. - ANS perfusion, O2 What is the concentration of Epinephrine? - ANS 0.1 mg/mL What are the two ways to administer epinephrine? - ANS IV (or intraosseous) or Endotracheal What is the dosing for epinephrine when used through an IV or intraosseous? - ANS 0.1 to 0.3 mL/kg (0.01 to 0.03 mg/kg) What is the dosing for epinephrine when used through an endotracheal? - ANS 0.5 to 1 mL/kg (0.05 to 0.1 mg/kg) Epinephrine needs to be administered _________ and ___________ route is the most preferred route of epinephrine - ANS rapidly, IV It is important to follow ETT route of epinephrine with several ___________ breaths. - ANS PPV After the administration of epinephrine, it is important to continue coordinated ___________ and PPV with _______ O2 and assess HR 1 minute after administration. - ANS compressions, 100% If the HR is still less than 60 seconds after the administration of epinephrine, it is important to repeat the dose every _____________ - ANS 3 to 5 minutes If the HR is still less than 60 seconds after the administration of epinephrine, it is important to consider ____________ subsequent doses, other problems (i.e. hypovolemia and tension pneumothorax), check ____________, ETT, ___________, and minimize interruption in compressions. - ANS increase, ventilations, chest compression depth Some causes of hypovolemic shock includes acute fetal-maternal ____________, bleeding vasa prevail, extensive ___________, placental laceration, petal trauma, umbilical cord ________, and blood loss from umbilical cord. - ANS hemorrhage, vaginal bleeding, prolapse Some symptoms of hypovolemic shock includes ___________, __________ capillary refill, and _________ pulses. - ANS pale, delayed, weak Some indications for volume expansion includes no response to resuscitation and signs of __________ or history of acute _____________ - ANS shock, blood loss What are two types of expanders used? - ANS - Crystalloid fluid - RBCs What is the dose for volume expanders? - ANS 10 mL/kg Volume expanders are administered via ____________ or ___________ needles. - ANS Umbilical vein catheter, IO Volume expanders are infused over _________ to __________ minutes. - ANS 5 to 10 minutes If the fetal blood has not been cross matched, it is important to use non-cross matched, type ______, Rh __________ RBCs. - ANS O, negative In preterm babies, rapid volume administration may increase risk of __________ - ANS Intraventricular hemorrhage If HR remains absent after ____________ of resuscitation, considerations to stop resuscitative efforts need to be addressed. - ANS 10 minutes In postnatal care, normal physiologic transition continues for several ____________ - ANS hours Vigorous term babies need to remain with mom to promote _____________ - ANS bonding Post-resuscitation requires closer _________ and ongoing ____________ support. - ANS assessment, respiratory In post-resuscitation, is it important to consider __________, persistent pulmonary hypertension of the newborn, _____________, hypoglycemia, feeding problems, __________ failure, metabolic acidosis, seizures/apnea, and hypothermia/hyperthermia? - ANS pneumonia, hypotension, renal Therapeutic ___________ reduces risk of death and improves neurologic outcomes after resuscitation with moderate to severe Hypoxic Ischemic Encephalopathy. - ANS hypothermia ____________ Births are more likely to require resuscitation. - ANS premature Some risks due to premature birth includes, thin skin, insufficient _________, poor __________, weak chest muscles for efficient spontaneous breathing, immature lungs