Neonatal Resuscitation Program (NRP) 8th Edition: Guidelines for Newborn Resuscitation, Exams of Nursing

Download Neonatal Resuscitation Program (NRP) 8th Edition: Guidelines for Newborn Resuscitation and more Exams Nursing in PDF only on Docsity! NRP 8th edition 1. Rapid evaluation - Determines if the baby can stay with the mother for routine care or should be brought to the radiant warmer 2. Airway - The initial steps open the airway and support spontaneous respiration 3. Breathing - Assist breathing with positive pressure ventilation if the baby is apneic, gasping, or bradycardic. CPAP or oxygen may be appropriate for labored breathing or low oxygen sats 4. circulation - perform chest compressions coordinated with PPV if severe bradycardia persists despite effective assisted ventilation 5. Drug - Administer epinephrine if severe bradycardia persists despite PPV and coordinated chest compressions What type of shunting occurs before birth? - right to left What are the alveoli expanded and filled with before birth? - fluid What does the placenta supply before birth? - oxygen and carries out CO2 (removed by mother's lungs Where does the most highly oxygenated blood go in the fetus? - the brain and heart What are the pulmonary vessels that will carry blood to the alveoli like after birth? - tightly constricted Pulmonary resistance is (high/low) in the fetal lungs. - high What does the first breath of air (oxygen 21%) allow the lungs to do? - relax and dilate the pulmonary blood vessels As blood flows to the lungs and the baby's o2 level increases, what occurs in the heart? - 2 openings in the heart used for fetal circulation start to close and the blood can flow from the right side into the lungs (the right to left shunting gradually resolves) Where can the oxygenated blood from the baby's lungs flow once the right to left shunting resolves? - to the left side of the heart What does assessing perinatal right before birth help to identify? - which newborns are likely to require resuscitation What are the 4 pre-birth questions to determine if you have assembled the necessary personnel and equipment? - - expected gestational age - amniotic fluid color - additional risk factors - umbilical cord management plan What are the perinatal risk factors? - - gestational age less than 36 0/7 weeks - gestational age greater than or equal to 41 0/7 weeks - preeclampsia or eclampsia - maternal hypertension - multiple gestation - fetal anemia - polyhydramnios - fetal hydrops - fetal macrosomia - intrauterine growth restriction - significant fetal malformations or anomalies - no prenatal care - emergency C section delivery - forceps or vacuum-assisted delivery - breech or abnormal presentation - category II or III fetal heart rate pattern - maternal general anesthesia - maternal magnesium therapy - placental abruption - intrapartum bleeding - chorioamnionitis - opioids administered to mother within 4 hours of delivery - shoulder dystocia - meconium-stained amniotic fluid - prolapsed umbilical cord Who should attend every birth? - at least 1 qualified person skilled in the initial steps of newborn care and positive pressure ventilation whose only responsibility is management of the baby Who should attend the birth if risk factors are present? - at least 2 qualified people to solely manage the baby What will the number and qualifications of personnel vary depending on? - 1. place baby uncovered under warmer to heat 2. dry baby (if >32 weeks) remove wet linen 3. gently rub If still not breathing 4. position head and neck in "sniffing" position to facilitate breathing 5. suction mouth, then nose in anticipation of PPV What should be done if the newborn is not breathing after the initial steps? - PPV immediately What are the indicators for PPV according to the NRP algorithm? - - gasping - HR <100 bpm - Apnea What is the PPV oxygen management for babies at or greater than 35 weeks gestation? - 21% (room air) What is the PPV oxygen management for babies at or less than 35 weeks gestation? - 21% - 30% oxygen What is the ventilation rate when providing PPV? - 40-60 breaths per minute What is included in the NRP quick equipment checklist? - - preheated warmer, towels, blankets - equipment to. give free-flow oxygen - bulb syringe - endotracheal tubes What does PEEP help achieve? - - prevents air spaces from collapsing during exhalation - stable lung inflation - removes fluid What physical parameter are you trying to achieve with the MR. SOPA ventilation corrective steps? - chest movement with PPV What are the corrective steps in MR. SOPA? - - Mask adjustment - Reposition head and neck . - Give 5 breaths and assess chest movement. If no movement... : - Suction mouth and nose - Open mouth . - give 5 breaths and assess chest movement. If no movement... : - Pressure increase ( increase in 5-10 cm H2O increments to maximum recommended pressure. * max 40 cm H20 term, * Max 30 cm H2O preterm) - . Give 5 breaths and assess chest movement. If no movement... : - Alternative airway (laryngeal mask or endotracheal tube) What are all of the laryngeal mask supplies? - - size 1 laryngeal mask - CO2 detector - 8Fr feeding tube and syringe for orogastic tube, if needed - 5 mL syringe (if needed for mask inflation) What are the indications for inserting a laryngeal mask? - - cannot ventilate - small mandible - cannot intubate - congenital anomalies involving mouth, lip, tongue, palate, or neck - large tongue What is the most important indicator of successful PPV? - rising heart rate When should you consider using a cardiac monitor? - - PPV is required - baby is not vigorous - heart rate is difficult to auscultate - When pulse oximetry doesn't work - alternative airway Do not proceed to cardiac compression or medication until the newborn has received what? - 30 sec of PPV that moves the chest, preferably through an alternative airway When should PPV be discontinued? - when the heart rate is more than 100 bpm and the baby has sustained spontaneous respirations When resuscitation is anticipated, when should you apply pulse oximetry? - After completing the initial steps Is visual assessment of cyanosis a reliable indicator of a baby's oxygen saturation? - no What are the indications for pulse oximetry? - - to confirm perception of central cyanosis - guide oxygen concentration - when PPV is required - to assess the need for supplemental oxygen How do you know if the pulse oximeter is working properly? - if it displays a pulse that approximates the apical pulse, or heart rate on a cardiac monitor When is free-flow oxygen appropriate to be given? - in a breathing baby whose heart rate is at least 100 bpm What is a reasonable oxygen concentration to begin free-flow oxygen? - 30% Do not give free-flow oxygen through the ___ of a self-inflating bag. - mask What devices can be used to give free-flow oxygen? - - open reservoir (tail) of a self-inflating bag - mask of a flow-inflating bag - mask of a T-piece resuscitator - oxygen mask and tubing Where should the laryngeal mask be located? - at the warmer How many minutes may it take for pulse oximetry to display a reliable signal? - 1-2 min When may pulse oximetry not work? - if the baby has a very low heart rate or poor perfusion