Chapter 10 Special Considerations

Question 1

If the newborn is not improving despite resuscitation efforts, what might you suspect is the cause?

Answer 1

a pneumothorax
(p. 244)

Question 2

How is a pneumothorax diagnosed?

Answer 2

Transillumination

Question 3

If a baby has respiratory distress, edema, hydrops fetalis, what might you suspect the patient may have?

Answer 3

a pleural effusion

Question 4

What is an immediate intervention for Robin Sequence?

Two interventions

Answer 4

Small ETT inserted into the nose and place the baby prone
(p.245)

Question 5

How do your respiratory interventions change in the presence of a diaphragmatic hernia?

Answer 5

Avoid PPV via facemask and instead use ETT
(p. 245)

Question 6

In what position should spina bifida patients be placed?

Answer 6

on the side, avoid the back
(p. 246)

Question 7

What interventions (2) should be used on babies with gastrichisis or ompholcele?

Answer 7

placed in a clear plastic bag and positioned on the right side to optimize bowel perfusion
(p. 246)

Question 8

How to interpret transillumination?

Answer 8

The light on the side of the pneumo appears to spread further and glow brighter
(p. 248)

Question 9

What are the anatomical landmarks for needle aspiration of a pneumo? How is the needle inserted?

Answer 9

4th ICS at anterior axillary line
2nd ICS at MCL
insert needle OVER the top of the rib, not under the rib to avoid arteries that run along the under side of the rib.
(p. 250)

Question 10

What other abnormality may be seen with Robin sequence?

Answer 10

Cleft palate

Question 11

How does Robin sequence affect airway management?

Answer 11

ETT may be difficult, LMA nay be preferred
(p. 252)

Question 12

How might Choanal Atresia affect airway management ?

Answer 12

Should not impact PPV, as oral airway is patent
(p. 253)

Question 13

What is one airway management technique for Choanal atresia?

Name for specific device

Answer 13

McGill Nipple inserted into mouth
(p. 253)

Question 14

What conditions and issues can a congenital diaphragmatic hernia cause? How does this change respiratory interventions?
What visual assessment finding may be seen?
When is CHD usually diagnosed?

Answer 14

1. can prevent normal lung development
2. usually known prebirth via US
3. scaphoid abdomen
4. respiratory distress
5. PPV via facemask not recommended use ETT
6. Pulmonary HTN often associated with CDH
   (p.256)

Question 15

Can you use a UVC with omphocele?

Answer 15

No , use IO
(p.261)

Question 16

A NBs HR is 50 and ahs not improved with ventilation through a face mask or properly inserted ETT. The baby’s chest is NOT moving with PPV. You should (suction the trachea using a 5f to 8f suction catheter or tracheal aspirator/ proceed immediately to chest compressions)

Answer 16

You should suction the trachea with a 5f to 8f suction catheter

p. 263

Question 17

A NB has respiratory distress a birth. The baby has a small lower jaw and cleft palate. The baby’s respiratory distress may improve if you insert a small endotracheal tube into the nose and advance it into the pharynx, and position the baby (supine on the back/ prone on the stomach) ?

Answer 17

prone on the stomach p. 263

Question 18

You attend the birth of a baby that received PPV during the first minute of life. The baby improved and has been monitored in the nursery. A short time later the baby developed acute resp. distress. What might You should suspect caused this?

Answer 18

pneumothorax
p. 262

Question 19

A mother received an opiate medication for pain relief 1 hour before delivery. After birth, the baby does not have spontaneous respirations and does not improve with stimulation. What is your first priority?

Answer 19

PPV

Question 20

After birth place a newborn with gastroschisis in a sterile clear plastic bag and position the baby on ____?

Answer 20

Their right side p. 263