before birth, the alveoli in the fetal lungs are - ANSWER-expanded and filled with fluid
before birth, oxygen is supplied to the fetus - ANSWER-by the
... [Show More] placenta
after birth, air in the alveoli causes vessels in the baby's lungs to - ANSWER-relax
when resuscitating NB, chest compressions - ANSWER-are rarely needed
members of an effective resuscitation team - ANSWER-share information
the most important and effective action in NRP is to - ANSWER-ventilate the baby's lungs
some NB without any risk factors - ANSWER-will require resuscitation, including assisted ventilation
prolonged lack of adequate perfusion and oxygenation can - ANSWER-lead to organ damage
4 pre-birth questions to ask the care provider before every birth - ANSWER-i) what is the expected gestational age? ii) is the amniotic fluid clear? iii) how many babies are expected? iv) are there any additional risk factors?
every delivery should be attended by at least one skilled person - ANSWER-whose only responsibility is the management of the NB
if a high-risk birth is anticipated - ANSWER-a qualified team with full resuscitation skills should be present at the birth
during the pre-resuscitation team briefing - ANSWER-anticipate potential complications and discuss how responsibilities will be delegated
a qualified nurse or someone who has been trained in NRP and has strong leadership skills - ANSWER-can be the team leader
NRP key behavioural skills - ANSWER-- know the environment
- use available info
- anticipate and plan
- clearly identify a team leader
- communicate effectively
- delegate workload optimally
- allocate attention wisely
- use available resources
- call for additional help when needed
- maintain professional behaviour
Sp02 target 1 min - ANSWER-60-65%
Sp02 target 2 min - ANSWER-65-70%
Sp02 target 3 min - ANSWER-70-75%
Sp02 target 4 min - ANSWER-75-80%
Sp02 target 5 min - ANSWER-80-85%
Sp02 target 10 min - ANSWER-85-95%
rapid evaluation for every newborn - ANSWER-term? tone? breathing or crying?
initial steps of NB care - ANSWER-- provide warmth
- position the head and neck
- clear secretions if needed
- dry
- stimulate
every NB needs - ANSWER-an initial rapid evaluation - term, tone, breathing/crying
when using suction to clear secretions, first suction - ANSWER-the NB's mouth then nose
how do you assess the NB's response to the initial steps? - ANSWER-respirations & HR
apnea, gasping, HR below 100bpm? - ANSWER-start PPV, Sp02 monitor, consider ECG monitor
if the baby has not responded to the initial steps w/i the first minute of life - ANSWER-it is not appropriate to continue to provide only tactile stimulation
indications for pulse oximetry - ANSWER-- when resuscitation is anticipated
- to confirm your perception of central cyanosis
- when supplemental 02 is administered
- when PPV is required
free-flow 02 delivery devices - ANSWER-- 02 tubing
- 02 mask
- flow-inflating bag & mask
- T-piece resuscitator & mask
- open reservoir ("tail") on a self-inflating bag
for free-flow 02 delivery - ANSWER-adjust the flowmeter to 10L/min
start free-flow 02 supplementation with the blender set to - ANSWER-30% 02
what do you do if the baby has laboured breathing or persistently low 02 sat? - ANSWER-CPAP
CPAP should only be considered if - ANSWER-the baby is breathing and has an HR of at least 100bpm
CPAP cannot be given using - ANSWER-a self-inflating bag
CPAP can be given using - ANSWER-a flow-inflating bag or a T-piece resuscitator attached to a mask that is held tightly to the baby's face
meconium-stained fluid and a vigorous NB - ANSWER-stay with mother for initial steps and gently use a bulb syringe to suction the mouth then nose
meconium-stained fluid and a non-vigorous NB - ANSWER-bring the baby to the radiant warmer, gently use a bulb syringe to suction the mouth then nose, and proceed with initial steps
avoid vigorous and deep suctioning of - ANSWER-the posterior pharynx
a healthy NB breathing room air may take more than - ANSWER-10min to reach 02 sat greater than 90%
free-flow 02 supplementation is not effective if - ANSWER-the baby is not breathing
you count a NB HR for 6 sec and count 6 beats, you report the HR as - ANSWER-60 bpm
you have completed the initial steps and the baby is still limp and apneic 1 minute after birth, you next action is - ANSWER-PPV
peak inspiratory pressure (PIP) - ANSWER-highest pressure administered with each breath
positive end-expiratory pressure (PEEP) - ANSWER-the gas pressure maintained in the lungs b/w breaths when a baby is receiving assisted breaths
continuous positive airway pressure (CPAP) - ANSWER-the gas pressure maintained in the lungs b/w breaths when a baby is breathing spontaneously
rate - ANSWER-number of assisted breaths administered per minute
inspiratory time (IT) - ANSWER-the time duration (seconds) of the inspiratory phase of each positive-pressure breath
manometer - ANSWER-gauge used to measure gas pressure
what are the different types of resuscitation devices used to ventilate a NB? - ANSWER-self-inflating bag, flow-inflating bag, T-piece resuscitator
self-inflating bag - ANSWER-fills spontaneously with gas (air, 02 or a blend of both) after it is squeezed and released
flow-inflating bag (aka an anesthesia bag) - ANSWER-only fills when gas from a compressed source flows into it and the outlet is sealed
T-piece resuscitator - ANSWER-directs compressed gas toward the baby when an opening on the top of the T-shaped device is occluded
indications for PPV - ANSWER-- apnea (not breathing)
- gasping
- HR <100 bpm
- 02 sat below the target range despite free-flow 02 or CPAP
when indicated PPV should begin within - ANSWER-1 minute of birth
a trial of PPV may be considered if - ANSWER-the baby's breathing and HR is >/= 100 bpm, but the baby's 02 sat cannot be maintained w/i the target range despite free-flow 02 or CPAP
how do you prepare to begin PPV? - ANSWER-1. clear secretions from the airway
2. position yourself at the baby's head
3. position the baby's head & neck
how do you position the mask on the baby's face? - ANSWER-1. select the correct mask size
2. place the mask on the baby's face
- one-hand technique
- two-hand technique with jaw thrust
the single most important and most effective step in NRP is - ANSWER-ventilation of the lungs
PPV is indicated if the baby is - ANSWER-apneic or gasping, or the HR is <100 bpm after the initial steps
if PPV is given - ANSWER-at least 2 qualified providers will be needed
for PPV adjust the flowmeter to - ANSWER-10L/min
an anatomically shaped mask should be positioned with - ANSWER-the pointed end over the NB nose
administer PPV at a rate of - ANSWER-40-60 breaths per minute
begin PPV with an inspiratory pressure (PIP) of - ANSWER-20-25 cm h20
ventilation of the term NB begins with - ANSWER-21% 02
the 02 concentration used during resuscitation is guided by - ANSWER-the pulse oximeter that measures the baby's 02 sat
if you are using a device that administers PEEP, the recommended initial pressure is - ANSWER-5 cm h20
during ventilation, the head should be - ANSWER-neutral or slightly extended (sniffing position)
an airtight seal b/w the rim of the mask and the face is essential for providing PPV - ANSWER-with any resuscitation device
the initial 02 concentration for preterm NB <35 weeks is - ANSWER-21 - 30% 02
the most important indicator of successful PPV - ANSWER-is a rising HR
check the HR after - ANSWER-the first 15 sec of PPV
if the HR is not increasing w/i the first 15 sec of PPV and you do not observe the chest movement - ANSWER-start the ventilation corrective steps
the 6 ventilation corrective steps - ANSWER-MR SOPA
M - ANSWER-mask adjustment
R - ANSWER-reposition the head
S - ANSWER-suction mouth & nose
O - ANSWER-open the mouth
P - ANSWER-pressure increase (2-10 cm h20 increments) to a max of 40 cm h20
A - ANSWER-alternative airway
check the HR again after 30 sec of PPV - ANSWER-that inflates the lungs (moves the chest)
if the HR is at least 100 bpm, gradually reduce the rate and pressure of PPV while - ANSWER-observing for effective spontaneous respirations and stimulating the baby
PPV may be discontinued when - ANSWER-the hr is continuously >100 bpm and the baby has sustained spontaneous breathing
after PPV is discontinued - ANSWER-use free-flow 02 or CPAP as necessary to maintain 02 sat w/i the target range
if the HR is at least 60 bpm but <100 bpm and not improving despite 30 sec of PPV that inflates the lungs - ANSWER-reassess your ventilation technique, perform corrective steps, adjust 02 concentration, consider inserting an alternative airway if not already done, and call for additional help
if the HR is at least 60 bpm but <100 bpm and not improving despite 30 sec of PPV that inflates the lungs, reassess your ventilation technique, perform corrective steps, adjust 02 concentration, consider inserting an alternative airway if not already done, and call for additional help. if no improvement - ANSWER-increase 02 concentration to 100% and begin chest compressions
if you must continue CPAP or PPV with a mask for more than several min - ANSWER-an orogastric tube should be inserted to act as a vent for gas in the stomach during the remainder of resuscitation
to insert an orogastric tube - ANSWER-measure the distance from the bridge of the nose to the earlobe and from the earlobe to the point halfway between the xiphoid process and the umbilicus
self-inflating bags - ANSWER-- do not require a compressed gas source
- cannot be used to administer free-flow 02 through a mask
- cannot be used to administer CPAP to a spontaneous [Show Less]