Neonatal Resuscitation Program: Guidelines for Newborn Resuscitation, Exams of Nursing

Download Neonatal Resuscitation Program: Guidelines for Newborn Resuscitation and more Exams Nursing in PDF only on Docsity! NEONATAL RESUSCITATION PROGRAM NEONATAL RESUSCITATION PROGRAM- NRP 5 INITIAL STEPS OF 2024 GRADED A NEWBORN CARE 1. Provide warmth 2. Position head and neck to open airway 3. Clear secretions if necessary 4. Dry baby 5. Stimulate **Establishing Effective Ventilation of the baby’s lungs is the MOST IMPORTANT and effective action during resuscitation 4 QUESTIONS TO ASK BEFORE EVERY BIRTH 1. What is expected gestational age 2. Is the amniotic fluid clear 3. How many babies are expected 4. Are there any additional risk factors RAPID EVALUATION FOR ALL NEWBORNS IS REQUIRED—ASK IF THE BABY IS: 1. Term? 2. Tone? (Healthy babies should be active and flex extremities) NEONATAL RESUSCITATION PROGRAM 3. Breathing/Crying? (Gasping is a sign of severely impaired gas exchange) NEONATAL RESUSCITATION PROGRAM Chorioamnionitis- inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection- Bacteria ascends from the vagina into the uterus usually caused by prolonged labor Newborns usually require resuscitation because of a problem with respiration leading to inadequate gas exchange -Fetal respiration is performed by the placenta -When placental respirations fail, the fetus receives an insufficient supply of O2 to support cellular function and CO2 cannot be removed Babies temp should be maintained between 36.5- 37.5C (97.7-99.5F) during resuscitation Place baby supine with head and neck in the sniffing position (do not hyperextend or flex-chin to chest) Clear secretions if baby is not breathing, gasping or has poor tone or meconium stained fluid NEONATAL RESUSCITATION PROGRAM Suction mouth THEN nose *Remember M before N -can use bulb syringe -if using suction, catheter, set to 80-100 mmHg Dry baby if wet-discard wet towels If baby is less than 32 weeks, wrap in polyethylene plastic NEONATAL RESUSCITATION PROGRAM Can gently stimulate baby by rubbing back, trunk or extremities—Don't’ over stimulate—Can cause injury If newborn remains apneic, begin PPV (positive pressure ventilation)- 21% Oxygen **NRP recommends that resuscitation of the baby 32 weeks and greater is initiated with 21% oxygen. If baby doesn’t have spontaneous respirations and a heart rate of 100bpm or higher within 1 minute of birth, begin PPV HR should be at least 100bpm—auscultation along the left side of the chest is the most accurate to determine HR -Palpation at the umbilical cord base may be felt but is less accurate and may underestimate the true HR -Using a stethoscope, estimate the HR by counting the number of beats in 6 seconds and multiply by 10 ie. 6 seconds x 12 beats= 120bpm NEONATAL RESUSCITATION PROGRAM Normal Pulse Ox is 60% INTRA-UTERINE so normal transition may take several minutes to increase their blood oxygen saturation to more than 90% Oxygen saturation levels are slightly lower in cesarean births than vaginal births HR on pulse oximeter should be the same as the HR on the cardiac monitor (ECG) Central Cyanosis-low oxygen saturation causing the baby’s lip, tongue, and torso to appear blue *Healthy babies may have central cyanosis for several minutes after birth Place the pulse oximeter on the RIGHT HAND OR WRIST **This is because the left arm and both legs may have lower oxygen saturation because they may receive 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 TARGET SPO2 AFTER BIRTH • 1 minute- 60-65% • 2 minute- 65-70% • 3 minute- 70-75% NEONATAL RESUSCITATION PROGRAM • 4 minute-75-80% • 5 minute-80-85% • 10 minute-85-95% NEONATAL RESUSCITATION PROGRAM **A healthy newborn breathing room air may take more than 10 minutes to achieve oxygen saturation greater than 90% Supplemental O2 is indicated when the oximeter remains below the target range for baby’s age FREE FLOWING oxygen is when the oxygen is held close to the baby’s mouth and nose-CANNOT GIVE IF BABY IS NOT BREATHING!! *For free flowing oxygen delivery, adjust the flow meter to 10L/min *Start free flow oxygen supplementation with the blender to set to 30% oxygen. Using the blender, adjust the oxygen concentration as needed to achieve oxygen saturation target. **Goal is to prevent hypoxia without using excess oxygen to cause hyperoxia To prevent heat loss, oxygen given to newborns for a prolonged period should be heated and humidified NEONATAL RESUSCITATION PROGRAM IT- inspiratory time- time duration (seconds) of the inspiratory phase of each positive pressure breath NEONATAL RESUSCITATION PROGRAM DIFFERENT TYPES OF RESUSCITATION DEVICES USED TO VENTILATE NEWBORNS Self-Inflating bag (Ambu bag)- self-inflating bag refills itself when you stop squeezing it. Squeezing the bag inflates the lungs. Releasing the pressure allows the bag to refill with air as well as with oxygen if an oxygen source is attached. The use of a self-inflating bag without supplemental oxygen will deliver an oxygen concentration of 21%. When the bag is attached to oxygen at a rate of 10-12 liters per minute, you will deliver O2 levels of 40- 60%. Adding a reservoir bag and running O2 at 12-15 liters per minute raises the concentration to 100%, but only if the reservoir is allowed to fill. In contrast, a flow inflation bag is filled with 100% oxygen all of the time. When using a self-inflating bag it’s important to squeeze the bag in a manner designed to maximize oxygen concentration. When you abruptly allow the bag to refill after squeezing, it will tend to refill with room NEONATAL RESUSCITATION PROGRAM air rather than with oxygen, whose inflow time is limited. It is better to allow the bag to refill over 3–4 seconds by releasing the pressure of your hand gradually over that time period. NEONATAL RESUSCITATION PROGRAM bag that may lure you into a false sense of security because it’s always full, even if the lungs are not filling well. On the negative side, unlike self-filling bags, there must be a good seal of the mask against the face to allow a flow inflation bag to provide positive pressure. A poor seal causes the flow inflation bag to deflate like a big balloon. A novice ventilator may have difficulty maintaining the seal needed. Because flow inflation bags are dependent on an oxygen source and require more training, emergency ventilation is usually provided by self-inflating bags. T-piece resuscitator- NEONATAL RESUSCITATION PROGRAM Epinephrine Epinephrine is indicated if the baby’s HR remains below 60 bpm after: • At least 30 seconds of PPV that inflates the lungs and… • Another 60 seconds of chest compressions coordinated with PPV using 100% oxygen Epinephrine is NOT indicated before you have established ventilation that effectively inflates the lungs Concentration Epinephrine is available in 2 concentrations ONLY the 1:10,000 preparation (0.1mg/ml) should be used for neonatal resuscitation NEONATAL RESUSCITATION PROGRAM Administration should be given into either the umbilical vein or intraosseous. Trying to administer into a peripheral vein is not recommended for emergency medication administration in the setting of cardiovascular collapse. Extravasation into the tissue is likely to happen and will delay lifesaving therapy. NEONATAL RESUSCITATION PROGRAM 2. You are at the resuscitation of a newborn that is gasping and has a heart rate of 60 beats per minute. What is the most important action you can take? Provide positive pressure ventilation NEONATAL RESUSCITATION PROGRAM 3. 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 800 g)? 2.5mm 4. Your team attends an emergency cesarean delivery of a term baby because of chorioamnionitis, meconiumstained amniotic fluid, and fetal heart rate decelerations. At delivery, the newborn is term as expected, with very poor tone and he is not breathing (apneic). You quickly perform initial steps, but the newborn is still not breathing. What is the most appropriate next step of resuscitation? Start positive pressure ventilation and check HR response after 15 sec. 5. During the resuscitation of a newborn, you auscultate the apical pulse and count 10 beats over a 6 second period. What heart rate do you report to your team? 100 bpm 6. You are part of a team preparing for the birth of a baby who has meconiumstained fluid and a category III fetal heart rate tracing. A person skilled in endotracheal intubation should be Present at birth 7. You are at a delivery of a baby born through meconium stained amniotic fluid, and the baby is not vigorous. What steps should be taken immediately after birth? The baby should be brought to the radiant warmer for initial steps of newborn care NEONATAL RESUSCITATION PROGRAM 8. What is the most effective maneuver to establish spontaneous breathing in a baby that is apneic after initial NEONATAL RESUSCITATION PROGRAM 14. A fullterm baby is born by emergency cesarean delivery because of fetal bradycardia (Category III fetal heart rate tracing). The baby is limp and not breathing after initial steps. What is the next step in the resuscitation process? Initiate positive pressure ventilation and check for increasing HR 15. What is the appropriate technique to stimulate a baby to breathe? Gently rub the babies back or extremities 16. You are called to attend to a newborn at birth. At the time the baby is delivered, which 3 questions should you ask to evaluate whether the baby can stay with his mother or be moved to the radiant warmer for further assessment? Is the baby term? Does the baby have good muscle tone? Is the baby breathing or crying? 17. What is the recommended way to determine if a baby requires supplemental oxygen in the delivery room? Place an oximeter sensor on the baby's right hand or wrist and assess oxygen saturation. 18. You have determined a baby needs resuscitation at birth. What are the initial steps of newborn care? Provide warmth, position head and neck to open the airway, clear secretions from the airway if needed, dry, stimulate NEONATAL RESUSCITATION PROGRAM 19. The steps of intubation should ideally be completed within which duration? 30 seconds NEONATAL RESUSCITATION PROGRAM 20. Effective team functioning is critical in ensuring the best performance. Which of these characteristics is critical in team leaders? They should be able to maintain situational awareness 21. You have been called to attend a birth and are the only healthcare provider responsible for the management of the newborn in the room. When should you first call for additional help? Before birth, when you have identified the presence of a perinatal risk factor that increases the likelihood of requiring neonatal resuscitation. 22. After the initial steps of newborn care, a baby is apneic. What is the most important and effective action to take in the resuscitation of this baby? Provide positive pressure ventilation 23. Which statement describes recommended practice when using a pulse oximeter in the delivery room? Place the pulse oximeter sensor on the right hand and use the minute specific oxygen saturation target to guide oxygen supplementation. 24. Which of the following is an indication for endotracheal intubation? The need for positive pressure ventilation lasting more than a few minutes NEONATAL RESUSCITATION PROGRAM 30. A laboring woman received a narcotic medication for pain relief 1 hour before delivery. The baby does not have spontaneous respirations and does not improve with stimulation. Your first priority is to Start positive pressure ventilation 31. During resuscitation, a baby is responding to positive pressure ventilation with a rapidly increasing heart rate. Her heart rate and oxygen saturation suddenly worsen. She has decreased breath sounds on the left side and trans illumination, also reveals a bright glow on the left side. What is the most likely cause of this distress? Left side pneumothorax 32. Which of the following is true about the preparation and resources needed for a very preterm birth? Prepare the preheated radiant warmer with a thermal mattress, plastic wrap or bag, and a hat. 33. Which of the following may be associated with delayed cord clamping in vigorous preterm newborns? Decreased need for blood transfusions 34. For a newborn weighing 1 kg, what dose of 1:10,000 (0.1 mg/mL) concentration of intravenous epinephrine is indicated? 0.1ml NEONATAL RESUSCITATION PROGRAM 35. A baby required ventilation and chest compressions. After 60 seconds of chest compressions, the electronic cardiac monitor indicates a heart rate of 70 beats per minute. NEONATAL RESUSCITATION PROGRAM What is your next action? Stop chest compressioncontinue positive pressure ventilation 36. How soon after administration of intravenous epinephrine should you pause compressions and reassess the baby's heart rate? 1 minute 37. What is the preferred method for assessing heart rate during chest compressions? ECG monitoring 38. A baby's heart rate does not increase after intubation and the breath sounds are louder on the right side than the left side of the chest. Which of the following is a common cause of asymmetric breath sounds in an intubated baby? ET tube is in too deep 39. If a preterm birth is anticipated, at what temperature should the room be set? 23ºC to 25ºC (74° F 77° F) 40. After chest compressions with coordinated ventilations are started, the heart rate should be assessed: after 60 seconds 41. In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn? The newborns parents NEONATAL RESUSCITATION PROGRAM supplementation in the delivery room. He continues to require supplemental oxygen after birth. Which of the following statements is true? His blood glucose level should NEONATAL RESUSCITATION PROGRAM be checked soon after resuscitation and then at regular intervals until stable and normal. 48. What is the appropriate dose of 1:10,000 (0.1 mg/mL) concentration of epinephrine for endotracheal administration to a baby weighing 3 kg? 1.5 ml 49. When coordinating positivepressure ventilation with chest compressions, how many events are performed each minute? 30 breaths, 90 compressions 50. A newborn requires complex resuscitation. You have intubated and are administering positivepressure ventilation and chest compressions. Which 3 signs are used to evaluate the effectiveness of your actions, and the need to continue one or both of these measures? Respiration, heart rate, oxygen saturation 51. Which of the following statements is true about resuscitating and stabilizing extremely premature newborns? They have more difficulty achieving effective spontaneous ventilation than term newborns 52. Which of the following is the best indication for volume expansion after resuscitative efforts that included intubation, chest compressions, and IV epinephrine? The baby's heart rate remains 50 beats per minute after resuscitative efforts and pulses are weak. NEONATAL RESUSCITATION PROGRAM 53. A mother had an emergency cesarean birth at 39 weeks' gestational because of sudden fetal bradycardia and a