Module II Study Guide

Question 1

True or False:
In normal newborn circulation, clamping of the umbilical vessels result in a reduced PVR and an increased pulmonary blood flow

Answer 1

True

Question 2

What are the factors responsible for 1st breath?

Answer 2

Transient Fetal Asphyxia: Fetal circulation is cut-off. Hypoxia and hypercapnia arise. Chemoreceptors stimulated

Thorax Compressed: On delivery, lung fluid removed, then re-expands for air entry

Environmental Stimulation: Sensory, Thermal & Mechanical Changes

-60 to –100 cmH20, but decreases on subsequent breaths

Question 3

Normal neonatal transition components consists of all of the following except:

A. Clearance of lung fluid
B. Surfactant secretion and breathing
C. Transition of fetal to neonatal circulation D.Increase in pulmonary vascular resistance and decrease pulmonary blood flow

Answer 3

D. Should be DECREASE in pulmonary vascular resistance and INCREASED pulmonary blood flow

Question 4

Fetal to neonatal circulation include all of the following except:

A. PVR declines due to a combination of ventilation of the lung and the circulatory reconfiguration and changes in blood gases
B. Pressure on the right side of the heart increases
C. Pressures in the left side decreases
D. Resulting in a decrease PVR

Answer 4

C. Should be INCREASED pressures on the left side

Question 5

Caffeine is used to…

Answer 5

Stimulate breathing for premature infants (Apnea monitoring in home care is ALWAYS required)

Question 6

What do you administer when a premature infant (1400 grams) has oxygenation problems ONLY?

Answer 6

Administer surfactant replacement therapy

Question 7

Use the image to describe the cyanosis

Answer 7

Acrocyanosis- Hands and feet (peripheral vasoconstriction) often present in newborns and has no signs of respiratory distress (will improve)

Question 8

How do you calculate the gestational age? (Ballard/Dubowitz)

Answer 8

Complete scoring including:

-Evaluation: Appearance, skin texture, motor function, reflexes

-Physical maturity: Performed the first 2 hours of birth

-Neuromuscular maturity: Completed within 24 hours after delivery

Circle picture add them all up

Question 9

Silverman-Anderson Index- Critically ill and severely depressed children will have scores closer to…

Answer 9

10

Normal functioning children should have a cumulative score of 0

Question 10

TCM works best with a temperature of…

Answer 10

41-44 celsius

Question 11

Transcuatenous electrodes use oxygen _____ and CO2 _______

Answer 11

Clark (PTCO2)

Severinghaus (PTCCO2)

Question 12

In regards to surfactant replacement therapy- Curosurf/Poractant alpha- What are the steps to support this administration?

Answer 12

1.Flat position with infant turned to the right and left (whole body)
2. Ventilator settings- RR 40-60, I-Time 0.5 seconds
3.Can readminister at 12 hour intervals up to a total of 3 doses (NO MANUAL BAGGING STAY ON VENT)

Question 13

Once surfactant replacement therapy is administered- what should the RT adjust fast?

Answer 13

Decrease PIP or PC RR 40-60 and I-Time 0.5 sec

Question 14

What is terbutaline used to treat?

Answer 14

Given first if low risk of premature birth

Question 15

Understand moderate APGAR score treatment plan

Answer 15

APGAR Score 4-6
Tx Plan:
-SXN mouth and nose-patent airway
-Cont monitoring of HR
-Tactile stimulation- slapping feet and rubbing back
-HR <100 bag/mask, vent
-Stable oxyhood- 30-40% for 24 hours

Question 16

Understand severe APGAR score treatment plan

Answer 16

APGAR Score 0-3
Emergency plan:
-SXN mouth and nose-Patent airway

-Continuous monitoring of HR

-Removal foreign matter from larynx and trachea by SXN (ETT ONLY if meconium is present)

-Bag mask vent- Consider intubation

-HR <60 start compression

-Successful resuscitation- Special 24 hours observation

Question 17

High risk delivery of a confirmed case of meconium

Answer 17

1. Isolette-> Warm baby
2. Neo-puff-> PIP 20/PEEP 5/FIO2 .21 or .40
3. Suction-> 60-80 mmHg- meconium aspirator
4. Pulse ox-> Right hand, left foot-> Measuring right to left shunt
5. ETT-> 4.0 mm-> Used as sxn catheter
6. Miller-> Size 0-> Intubation
7. UAC-> Accurate ABG or UVC-> Venous pH, paco2, fluid, med

Question 18

Meconium stain noted-APGAR severe- what should the RT perform first?

Answer 18

Suction (ETT) and Intubate

Question 19

CDH- APGAR severe- what should the RT perform first?

Answer 19

Dropping OG and Tube

Question 20

True or False:
Results of decrease surfactant will result in decrease FRC with an increase in WOB leading to infant retractions

Answer 20

True

Question 21

What will a decrease surfactant lead to?

Answer 21

-Increase surface tension, decreased lung compliance

-Decreased FRC (Lung Volumes), Increased WOB (Resulting in infant retractions

-Atelectasis (V/Q Mismatch-Hypoxia

-Hypercapnia (Respiratory Acidosis)

-Hypoxia (Anaerobic metabolism-metabolic acidosis)

-Acidosis- Increased PVR

Question 22

Infant respiratory distress syndrome is also known as…

Answer 22

Neonatal Distress Syndrome (NRDS)
Hyaline Membrane Disease (HMD)
Respiratory Distress Syndrome of Newborn
Surfactant Deficiency Disorder (SDD)

Question 23

What are the complications of surfactant administration?

Answer 23

-Bradycardia

-Oxygen desaturation

-Hypotension

-Increase chest expansion

Question 24

What is the suction pressure for a neonate?

Answer 24

60-80 mmhg or 80-100 mmhg

Question 25

Select the correct statements to support hyperoxia (hyperventilation test)

Answer 25

Oxygen challenge- hyperoxia test: used to identify right to left shunt used by congestive heart or PPHN

-Pao2 evaluated on RA .21 and after administration of 100% O2

If little or zero change in pao2 cong. heart defect

Question 26

How is survanta/beractant delivered?

Answer 26

-Administer 4 aliquots in trendlenburg position with head turned to the right and left

-Manually ventilated after each aliquot for one minute

-Can readminister at 6 hour intervals up to a total of 4 doses