NB birth stress

Question 1

NB asphyxia-3

Answer 1

-hyperprofusion of lungs, large R to L shunt through ductus arteriosus bypassing lungs, change from aerobic to anaerobis metab (metabolic acidosis)

Question 2

NB asphyxia protective measures-4

Answer 2

immature brain, low resting metab rate, can use anaerobic metab for energy, cir sys can redistribute lactate and hydrogen ions (severe hypoxia will overcome)

Question 3

asphyxia risk factors-12

Answer 3

sustained bradycardia, mom not O2, blood flow to placenta, significant bleeding, long labor, meconium, premie, male, SGA, DM mom

• ominus if pH 7.2 lower
• start resuscitation before APGAR if needed

Question 4

asphyxia ass prebirth-4

Answer 4

1. gest age
2. meconium/infection in amnio
3. number of babies
4. other risk factors

Question 5

asphyxia ass post birth-4

Answer 5

1. full term
2. breathing/cry
3. muscle tone
   - if any “no”, resuscitate

Question 6

asphyxia treatment-5

Answer 6

1. stabilize (warm, clear airway, dry, stimulate)
2. O2 administration- pulse ox on rt hand/wrist (brain)
3. positive pressure vent
4. chest compressions
5. epi/volume expansion

Question 7

resuscitation mgt-4

Answer 7

• sniff position under radient heat
  1. position and clear airway, stimulate
  2. positive pressure vent- mask over mouth and nose w manometer, titrate 5-10 L/min
  3. observe chest move-40-60 breaths/min, never exceede pressure of 40
  4. intubate with compressions- HR absent or under 60 after 30 sec pos pressure O2

Question 8

chest compressions-4

Answer 8

1. proper position on firm surface- use thumbs w fingers wrapped around back, rate of 90 beats per min
2. use 3:1 ratio with ventilation- 90 compressions to 30 breaths
3. no response 30 sec- ept 0.1-0.3 mg/kg followed by NS
4. if shock occurs- NS or LR, blood products

Question 9

Respiratory distress syndrome-3

Answer 9

inadequate production of surfectant (starts at 24 wks)

• surfectant deficiency disease- failure to synthesize, atelectasis
• more energy needed to open lungs so each breath harder than last

Question 10

respiratory distress complications-3

Answer 10

hypoxia, respiratory acidosis, metabolic acidosis

Question 11

respiratory distress treatment-3

Answer 11

• resolution 7-10 days
• surfectant replacement
• increase UOP sign of resolution

Question 12

respiratory distress s/s-6

Answer 12

cyanosis, tachypnea (greater than 60), grunt, nasal flare, retractions, apnea

Question 13

transient tachypnea of NB-2

Answer 13

-term w fl in lungs, general overexpansion of lungs, higher with c/s

Question 14

transient tachypnea of NB s/s-4

Answer 14

grunt, flare, mild cyanosis, increase in anterior-posterior diameter of chest

Question 15

transient tachypnea of NB treat-2

Answer 15

usually resolves 48-72 hrs

-oral feed contraindicated

Question 16

meconium aspiration syndrome-5

Answer 16

• can indicate asphyxia unless breech

- mechanical obstructon of airways-> alveoli overdistended, chemical pneumonitis, inactivation of natural surfectant

Question 17

meconium aspiration syndrome s/s-4

Answer 17

barrel-shaped chest, prominent rales/rhonchi, possible displaced liver, yellow stained skin/nails/cord

Question 18

meconium aspiration syndrome treat-7

Answer 18

• if vigerous, nothing

- unstable- direct tracheal suck, O2, positive pressure vent, surfectant prophylactics, nitric oxide, abx

Question 19

pallor/mottling

Answer 19

poor peripheral circulation

Question 20

cyanosis

Answer 20

advanced hypoxia, exam mucous membrane and tongue

Question 21

jaundice skin color

Answer 21

metabolism alterations

Question 22

edema- resp distress

Answer 22

seen in hands and feet first 24 hrs then resolves by day 5

Question 23

tachypnea

Answer 23

RR 60+, early s/s resp distress

Question 24

retractions

Answer 24

seesaw resp when chest flat and abdo expands

Question 25

nasal flare

Answer 25

tries to lessen resistance of narrow nasal passage

Question 26

expiratory grunt-2

Answer 26

valsalva maneuver which NB exhales against partially closed glottis
*don’t intubate

Question 27

rales/rhonchi

Answer 27

interstitial/intrapleural air flow

Question 28

continuous systolic murmur

Answer 28

patent ductus arteriosus

Question 29

transcutaneous O2 monitor-4

Answer 29

• diffusion across skin surface
• clean, dry skin, avoid bony prominence,
• change skin site and recalibrate q 4hrs
• Os sats 88-92%