NRP Flashcards
what are the 5 tests for high risk baby determination?
- US
- Non-stress test
- contraction stress test
- Biophysical profile
- amniocentesis
what is a non-stress test?
fetal US that evaluates the baby’s breathing, body movements, muscle tone and amniotic fluid.
what is a contraction stress test?
How the baby’s HR reacts when the mom’s uterurs contracts
what is a biophysical profile?
Non stress test + contraction stress test
what is amniocentesis?
Takes a sample of the amniotic fluid to screen for developmental abnormalities.
what are the three phases of labour
Latent, Active, Deceleration
LAD
What are two ways to monitor the fetus during L&D?
Fetal heart rate monitoring (FHR) and Fetal scalp blood sampling
What is fetal heart rate monitoring?
Measures the fetus HR and provides trends estimating a fetus’s tolerance to the labour process.
What are accelerations in FHR associated with?
Fetal movement which is a sign of well being
What do early decelerations in FHR mean?
These are benign and represent head compression or changes in baby tone after a brief hypoxic episode.
What do variable decelerations in FHR mean?
These are the most common, and they mean umbilical cord compression
What do late decelerations in FHR mean?
These mean uteroplacento insufficiency (UPI) and if recurrent, this can mean fetal compromise
What is fetal scalp blood sampling
Used during labour when FHR monitoring is non reassuring to determine fetal acid-base status.
Fetal scalp pH >7.25 is reassuring.
Acidotic (pH <7.25) is suggestive to intolerance to labor
Whats a newborns FRC?
25-30 ml/kg
Why do infants/children have a lower FRC than adults?
- Larger heart in comparison to thoracic diameter, imposing the lungs, decreasing lung capacity
- elastic recoil of a child’s lung is less than adult (children have very compliant lungs).
- Increased extra thoracic pressure from proportionally large abdominal contents
How many weeks old is a baby that requires plastic wrapping?
<32 weeks.
4 pre-birth questions
- what is the expected gestational age
- is the amniotic fluid clear
- how many baby
- are there additional risk factors?
What is the benefit of delayed cord clamping for preterm newborns?
Decreased mortality, higher blood pressure and volume.
Decrease need for blood transfusion.
Lower incidence /risk of brain hemorrhage.
Lower risk of necrotizing enterocolitis
What is the benefit of delayed cord clamping in term newborns?
Decreases changes of developing iron-deficiency anemia.
May improve neurodevelopment clamping
what are the three questions for rapid assessment of newborns?
- does the baby appear to be term? - If preterm, bring to warmer
- does the baby have good muscle tone? - is the baby active with flexed extremities vs flaccid, extended extremities.
- is the baby breathing or crying? - crying is an indicator of strong respiratory effort. Gasping is not
CHAT
Answered yes to all Q’s - baby can go to mom
Baby is not vigorous and is preterm, what are your next steps?
Provide warmth Position head and neck. Clear secretions (mouth b4 nose) Dry - wet skin increases evaporation heat loss. Stimulate .
What suction pressure do you use for nares/mouth?
80-100 mmHg
Baby is apneic, gasping and HR <100 bpm, what do you do?
Start PPV (1 and 2 and 3 and breathe), put SpO2 monitor on and ECG hooked up.
Baby is having laboured breathing (grunting), what do you do?
Position a/w.
SpO2 monitor on.
CPAP!
Baby has persistent cyanosis, what do you do?
Position a/w.
SpO2 monitor on.
Supplemental O2
What is central cyanosis?
Lips, tongue, torso have blue hue.
What is acrocyanosis?
Hands and feet are blue but trunk is pink.
Why the right hand or wrist for pulse oximetry placement?
This will provide the pre ductal oximetry reading (b4 the ductus arterioles) and a more reliable reading of the blood sats that reach the brain and heart!
Postductal (i.e. left arm or legs) receives blood from the aorta after if mixes with venous blood from the ductus arteriosus.
What does APGAR stand for?
Appearance Pulse Grimace Activity Respirations
When are APGAR scores assigned?
a 1 minute, 5 minutes and repeated every 5 minutes until an APGAR of 7 is achieved.
What is primary apnea?
Stimulation results in resumption of breathing
What is secondary apnea
no amount of stimulation will restart breathing.
PPV is needed
What are the advantages of self-inflating bags?
- does not need compressed gas source
- fills spontaneously with fresh gas after being squeezed
- pop-off valve present
what’s the function of the pop off valve on the self inflating bag and at what pressure does it release?
Limits the peak inspiratory pressures and prevents barotrauma and overinflation. 30-40 cmH2O
What are the disadvantages of self-inflating bags?
- challenging to determine good seal
- reservoir attachment required if need to deliver 100% O2.
- requires PEEP valve
what are the advantages of flow inflating bags?
- easier to assess seal of mask
- ability to “feel” the patient’s compliance
- ability to provide free flow O2.
- ability to provide reliable FIO2 (because it’s coming from a direct gas source)
What are the disadvantages of flow-inflating bags?
- requires access to compressed gas source
- requires a tight seal
- does not have a pop off valve (but has the max insp pressure control valve)
- requires flow between 5-10 lpm to aide with inflating the bag in-between breaths delivered.