NPS Study

Question 1

Therapeutic hypothermia

Answer 1

Slows metabolism and decreases tissue oxygenation consumption when core body temperature is reduced below normal. Especially helpful in retarding inflammation processes and allowing the body to recuperate after an event such as cardiac arrest. The hypothermic condition
decreases demands on the heart.

Question 2

Capillary blood gases (CBG)

Answer 2

Typically done on heel or foot.
Used to assess CO2 and pH values mostly, CO2 and pH values are the same as arterial – therefore, the adequacy of ventilation can be assessed.
Do not utilize the oxygen value for patient care changes as the blood is mixed.

Question 3

NAS

Answer 3

Neonatal abstinence syndrome, caused by withdrawl from removal of drugs.

Question 4

2 Types of NAS

Answer 4

1) Prenatal NAS
Withdraw in the infant caused when a pregnant mother stops taking a drug prior to delivery.

2) Postnatal NAS
Withdraw from removing a drug that has been given directly to the infant.

Question 5

Hgb electrophoresis

Answer 5

a. Type of blood test that can detect different types of hemoglobin
b. Especially useful in detecting HbS, which is associated with sickle-cell anemia (sicklecell disease)

Question 6

Cardiac catheterization

Answer 6

Assesses the patency of cardiac blood vessels and look for blockages or impedance of blood flow to specific areas of the heart.

Question 7

Angiography

Answer 7

Occurs during cardiac cath If blockage is noted, a balloon on the end of the catheter can be inflated and vessels can be expanded.

Question 8

T-Piece Resuscitator

Answer 8

a. Device used to provide resuscitation without squeezing a bag.
b. Can be attached directly to a flowmeter
c. Has PIP (peak inspiratory pressure) and PEEP controls
d. Ideal for neonates 10kg or less

Question 9

Initial Settings for T-Piece Resuscitator

Answer 9

The flowmeter should be set from 5-15 L/min – 10 L/min is a good starting place.

2) PIP should be set to 20 cm H2O (initially)
3) PEEP can be controlled by a dial and should initially be set to 5 cm H2O.

Question 10

Cerebral Oximetry

Answer 10

a. Also called near-infrared spectroscopy (NIRS)
b. Used to assess oxygen saturation in localized areas
c. For cerebral assessment, sensors are placed on the cranium and cerebral oxygenation can be evaluated

Question 11

Bronchoscopy Biopsies

Answer 11

Biopsies: Scope is equipped with tools that can be advanced from the end of the scope and used for extraction of tissue, which can then be analyzed for a variety of purposes including an evaluation for malignancy of suspected cancerous cells, etc

Bronchs are considered both diagnostic and therapeutic.

Question 12

Bronchoscopy Brush

Answer 12

Brushes: The brush device can be extended from the end of the scope which is effective at mobilizing pathogenic organisms, allowing them to be suctioned into a trap for further culture, study, and evaluation

Question 13

NAVA (neurally adjusted ventilatory assist)

Answer 13

A type of ventilatory support that works by sensing electrical signals from the diaphragm via a catheter that resembles a nasogastric tube

Question 14

How do NAVA sensors work to provide ventilation?

Answer 14

Sensors signal the ventilator to modify frequency and pressure of delivered breaths. The sensor sits in the esophagus and receives the electrical signals from the diaphragm.

Question 15

Difficult intubation - Mallampatti Classification

Answer 15

Anatomical inspection of the upper airway patency. 4-point score classification of the tongue size relative to the size of the oral cavity. The large the tongue, the more obstructed

Question 16

Mallampatti Scores

Answer 16

MALLAMPATTI CLASSIFICATION SCORES
1 – full visibility of tonsils, uvula, and soft palate – OPEN
2 – can see the uvula, hard palate, soft palate, and upper portion of the tonsils only – SOMEWHAT OPEN
3 – only the hard palate, soft palate, and base of vallecula are visible
4 – only the hard palate is visible

Question 17

Ventilation

Answer 17

Rate: 10-20
Tidal Volume: 6-10mL/kg (USE IBW) and use CORRECTED Tidal Volume
FiO2: 30-60%
PEEP: 0-2 (Use any previous CPAP or BIPAP level (EPAP) if patient was on these modalities ie: 4 if Pt was on NPPV 10/4)

Question 18

CORRECTED tidal volume

Answer 18

~ corrected VT = Set Vt - tubing compressible volume
~ tubing compressible volume = Tubing compliance factor X (PIP-PEEP)
Corrected VT = Vt(set) - tubing compressible volume

Question 19

Adequacy of tidal volume may be assessed by evaluating

Answer 19

1) Chest rise and movement
2) Breath sounds (should hear in all fields)
3) End-tidal CO2 (PetCO2) by capnograph
4) Evaluating ventilator graphics (pressure volume loop should not have a big beak)

Question 20

FiO2 in mechanically ventilated patients

Answer 20

Use 0.30 if no pulmonary issues and the primary problem has been ventilation (not hypoxemia)

b. Use previous setting if the patient was on oxygen
c. Use 100% if the need for mechanical ventilation was caused by an emergency (post code, etc).
d. If not emergency and previous FIO2 is not known, setting oxygen anywhere between
0. 3 - 0.6 is suitable

Question 21

Isoflurane / Sevoflurane

Answer 21

Types of inhaled anesthetic agents that can be used on newborns- to put infant to sleep prior to surgery

Question 22

Brain death can be determined by:

Answer 22

a. EEG (electroencephalography)
b. Cerebral perfusion studies
c. Clinical evaluation
1) Unresponsiveness to verbal/painful stimuli
2) Complete apnea
3) Absence of reflexes
d. Reflex assessment
1) Pupillary - eyes to do not respond to light
2) Ocular reflexes - no eye movement is noted when
irritated.
3) Pharyngeal reflexes – no physical response when a blade is inserted into oropharynx
4.) Tracheal reflexes - no response