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Nrp > Lesson 6-7 > Flashcards

Lesson 6-7 Flashcards

1
Q

If it’s likely that the delivery will be complicated how many providers should be present at birth?

A

4+

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2
Q

Resuscitation team should prepare roles ahead of time. You should know who will be performing…(List 7)

A

Initial assessment
Stimulation, position, drying
PPV
Chest compressions
Umbilical catheter insertion
Medication administration
time and note keeping

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3
Q

What conditions can make resuscitation less effective or ineffective? (6)

A

Pneumothorax
Pleural effusion
Thick secretions
Robin sequence
Choanal atresia
Impaired respiratory drive

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4
Q

If efforts to ventilate the neonate are not causing the chest to rise despite good technique the provider should

A

look for and adapt to conditions

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5
Q

Define pneumothorax

A

Presence of air in plural space between chest wall and lung

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6
Q

If a neonate has Pneumothorax a small amount of air is not usually a problem, but large amounts of air can interfere with ____

A

PPV

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7
Q

(pneumothorax) the air can press on the heart and the contralateral (opposite) lung, this condition is called? _____

A

Tension Pneumothorax

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8
Q

Risk factors for Pneumothorax: (4) PMLP

A

PPV
Meconium aspiration
Lung deformities
Prematurity

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9
Q

If there is a sudden worsening in respiratory distress, providers should suspect ______

A

Pneumothorax

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10
Q

What study diagnosis pneumothorax?

A

Chest xray

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11
Q

Besides an X-ray how else can Pneumothorax be diagnosed?

A

Stethoscope and flashlight (decreased breath sounds, increased light penetration over affected area)

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12
Q

Decreased breath sounds, during PPV may not indicate pneumothorax because they are other causes for this, such as: (5)

A

Poor ventilation technique
Not properly placed ETT
Tracheal obstruction
CDH
Other

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13
Q

What can resolve small pneumothorax?

A

Supplemental oxygen therapy

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14
Q

A large pneumothorax may require a provider to

A

Place catheter into pleural space to draw off air

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15
Q

Where is the entry made to place catheter into plural space for pneumothorax?

A

Fourth intercostal space @ anterior axillary line or second intercostal space @ mid clavicular line

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16
Q

What size needle to use for putting catheter into plural space for pneumothorax?

A

18-20 gauge needle) catheter system just on the top of next rib

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17
Q

What way should the catheter be directed (pneumothorax)?

A

Directed upwards

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18
Q

If a catheter kit is not available what can be used in an emergency? (Pneumothorax)

A

Butterfly needle

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19
Q

When there is more definite treatment as far as pneumothorax goes and placing a catheter.. a ______ needs placed

A

Thoracostomy tube

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20
Q

Pleural effusion is

A

The presence of fluid in the pleural space

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21
Q

Presence of fluid in the pleural space can press on surrounding ______ and interfere with ______ & _______ efforts

A

Structures, breathing, ventilation

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22
Q

What a clue to identifying pleural effusion?

A

Generalized edema

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23
Q

Neonates with hydrops fetalis (severe abdominal swelling from edema, who are hard to ressusitate) are likely to have

A

Fluid in the pleural space

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24
Q

What tool/exam can be used to diagnose large pleural effusions before birth? After delivery, how will breaths sound and what can be used to definitely diagnose baby?

A

Ultrasound, breath sounds will be diminished over effusion, xray

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25
Q

Can small pleural effusions resolve on their own?

A

Yes

26
Q

Pleural effusions that’s causing baby to struggle to breathe can be treated how?

A

Inserting catheter into pleural space and draining off fluid

27
Q

Where is entry made for catheter to drain a pleural effusion?

A

Entry is made at the 5th or 6th intercostal place along the posterior axillary line

28
Q

What size needle for pleural effusion catheter?

A

18-20 gauge needle/catheter on top of next rib

29
Q

What direction is the catheter positioned for pleural effusion?

A

Directed posterior

30
Q

Should you save fluid from pleural effusion to send to lab?

A

Yes

31
Q

What is Robin sequence also known as?

A

Pierre Robin syndrome

32
Q

What does Robin Syndrome cause?

A

Lower jaw doesn’t develop properly in utero, a cleft palate

33
Q

In Robin sequence, the underdeveloped mandible and surrounding tissues block ____

A

Pharyngeal airway

34
Q

Robin sequence makes what type of masks difficult to insert during resuscitation?

A

ETT & LMA

35
Q

How to diagnose Robin sequence?

A

Visual inspection

36
Q

What way should a baby with Robin sequence be positioned for resuscitation? Why? If this doesn’t open airway then what?

A

Prone position, so gravity pulls jaw and tounge away from pharyngeal airway.

If it doesn’t open airway, a small (2.5 mm) ETT can be placed in the nose

37
Q

Terminus (placement) of the ETT is not the in trachea but in the

A

Pharynx

38
Q

Why is ETT placed with Robin sequence?

A

To open upper airway

39
Q

(Robinson sequence) in severe cases of respiratory distress, make every effort to place a ________. This is usually easiest with baby in the prone position.

A

Laryngeal mask airway

40
Q

Babies normal only breathe through their mouth when they are _____

A

Crying

41
Q

Choanal atresia

A

Nasal airway is blocked by tissue in nasal cavity/upper pharynx

42
Q

Babies with choanal atresia can only breathe effectively when _____

A

They’re crying

43
Q

Why can it be difficult to detect choanal atresia?

A

There are no external signs of disease

44
Q

What does a neonate with choanal atresia generally experience?

A

Cycles of oxygen destaturation, cyanosis (airway blocked)

(Crying opens the airway)

45
Q

What can test for choanal atresia ?

A

A suction catheter gently applied through the nares into the posterior pharynx

46
Q

Thin suction catheter cannot pass into the pharynx and or is not visible when looking into the mouth, you can make the presumptive diagnosis of ______

A

Choanal atresia

47
Q

Definite diagnosis and treatment of ______ ; requires a specialist

A

Choanal atresia

48
Q

What can you do to stabilize a baby with choanal atresia?

A

Insert an oral airway, ETT that terminates in the pharynx, or a feeding nipple that has been cut open and placed into neonates mouth to allow air flow. Both of these devices should be secured to the baby’s head to retain proper placement.

49
Q

A diaphragmatic hernia is usually diagnosed via sonogram @ how many weeks gestation?

A

18-22

50
Q

Symptoms of CDH at birth are:

A

Diminished lung sounds
Respiratory distress
Tachycardia
Bowel sounds in chest

51
Q

What type of ventilation should be avoided with babies who are born with CDH? And what should be done immediately?

A

Bag mask ventilation, they should be intubated

52
Q

(CDH) In order to prevent intestinal distension and compression of the available lung tissue,what must be inserted?

A

And orogastric tube (used to deliver meds or food or remove contents)

53
Q

Separate _______ and _______ should be placed while awaiting urgent pediatric surgery consultation and treatment.

A

Umbilical artery, vein catheters

54
Q

Neonates with CDH are at high risk for ______ and will likely require ____, _____ &______

A

persistent pulmonary hypertension, inhaled nitric oxide, vasopressor support (meds that help raise blood pressure), & extracorporeal membrane oxygenation (machine that temporarily performs functions of heart and lungs)

55
Q

Women who have taken opioids within 4 hours prior to delivery require ______

A

Special attention

56
Q

Opioids depress the drive to breathe, so neonates with opioids on board may have _____

A

Impaired respiratory drive

57
Q

How to treat baby with opioids on board?

A

Support with ventilation until baby metabolizes and clears the opioid. Once this happens baby should breathe spontaneously.

58
Q

Studies have shown that when mothers are on opioids or methadone treatment that ______ & _____ should not be used. What could happen if opioid receptor antigens are used in baby? (3)

A

Naloxone & other opioid receptor antigens. Could cause baby to have withdrawal seizures, pulmonary edema, & cardiac arrest

59
Q

Congenital heart malformations such as transposition of the great vessels and Tetralogy of Fallot (4 heart problems, usually are grey/blue skin due to low oxygen) can cause ____, these symptoms don’t usually appear in immediate postnatal period. But ____________

A

Cardiopulmonary impairment, But severe cardiac abnormalities can appear immediately.

60
Q

When should congenital heart malformations be suspected?

A

When neonate is cyanotic(blue purple skin) and tachypneic (rapid breaths)

Nrp (8 decks)

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