Nrp Flashcards
When suctioning the baby’s nose and mouth, which should be suctioned first?
Mouth
What is a possible consequence of ventilation with high pressure and/or rate?
Pneumothorax
Which of the following CANNOT be used to effectively deliver free-flow oxygen?
Flow-inflating bag
T-piece resuscitator
All of the above can be used to deliver free-flow oxygen.
⭐Self-inflating bag
True or False: Care should be taken to prevent hyperextension or flexion of the neck, since either may restrict air entry.
True
If a newborn has copious secretions coming from the mouth, how should they be cleared?
Bulb syringe
Where should pressure be applied when performing compressions on the newborn?
Lower third of the sternum
Air that leaks from inside the lung and collects in the pleural space is called a
Pneumothorax
True or False: If a pneumothorax causes significant respiratory distress, it should be relieved by placing a percutaneous catheter or needle into the pleural space and evacuating the air.
True
If you place the endotracheal tube in too far, where is it most likely to end up?
Right mainstem bronchus
Pulmonary hypoplasia (lungs underdeveloped) is most commonly caused by which of the following conditions?
Severe oligohydramnios
What is the targeted pre-ductal SPO2 level 5 minutes after birth?
80% to 85%
The pulmonary blood vessels in babies who were hypoxemic and/or academic around the time of birth may remain constricted. What is this condition called?
Persistent pulmonary hypertension of the newborn
About ____ % of newborns will require some assistance to begin regular breathing?
10%
About _____% of newborns will require extensive resuscitation to survive.
1%
Chest compression and medication are (Rarely) (Frequently) needed when resuscitating newborns.
Rarely
Before birth, the alveoli in the baby’s lungs are ( collapsed) (expanded) and filled with (fluid) (air).
Expanded, fluid
The air that fills the baby’s lungs during normal transition contains _____ % O2.
21%
The air in the baby’s lungs causes the pulmonary arterioles to (relax) ( constrict) so that the O2 can be absorbed from the alveoli and distributed to all organs.
Relax
If a baby does not begin breathing in resp[onse to stimulation, you should assume she is in _____ apnea and you should provide _____.
Secondary, ppv
If a baby enters a stage of secondary apnea, her heart rate will (rise) (fall), and her blood pressure will (rise) (fall).
Fall/ fall
Resucitation (should) (should not) be delayed until the 1 minute Apgar score is available..
Should not
Premature babies may present unique challenges during resuscitation because of _____________.
Fragile brain cappilaries, Lungs deficient in surfactant, poor temperature control, higher liklihood of infection.
When there are twins expected, there should be _______ number of skilled clinicians in the room for resuscitative care.
atleast 4 ( 2 per kid)
What are 3 things needed for temperature regulation of a newborn?
Towels or warm blankets, plastic bag, thermoregulated incubator.
What is the epinephrin dose?
1:10,000
Who is most likely to be the first to stick a pneumo patient with a large bore needle? (Whether they need it or not)
Josh Sturgill
Who is most likely to erase the whiteboard in the patient’s room and draw them on the ventilator for everyone to see?
Holbrook
According to the NRP Algorithm, what are the indicators for positive pressure ventilation?
apnea, gasping, and HR less than 100 bpm
Before birth, pulmonary resistance is ___________ in the lungs.
High
Before birth, what can you assess to help identify which newborns are likely to require resuscitation?
Perinatal risk
Which block of the NRP algorithm helps you determine if the baby can stay with the mother or should be moved to the radiant warmer for further evaluation?
Rapid evaluation
What should the amount of oxygen ventilation be set to? (L)
10L/min
What are the three rapid evaluation questions?
- Does the baby appear to be term?
- Does the baby have good muscle tone?
- Is the baby breathing or crying?
At birth, the baby’s first breaths help move _________ out of the airways.
Fluid
During initial steps, if the baby is ___________ weeks gestation, do not dry the baby.
Less than 32
When the baby stays with the mother for initial steps after birth, what should be monitored to determine if additional interventions are required?
breathing, tone and activity, color, temperature
What is the purpose of the rapid evaluation of the newborn at birth?
determines if the baby can stay with the mother or should be moved to the radiant warmer
What should you do if an apneic newborn is moved to a radiant warmer after birth and is still not breathing after the initial steps?
begin PPV immediately
If a baby appears to be term, has good muscle tone but is nit breathing or crying, where should the baby receive initial steps?
At the radiant warmer
If a newborn is not breathing or the heart rate is less than 110 bpm, you should begin PPV within the first ______ seconds after birth.
60
If a baby is apneic, gasping or has a heart rate of less than 100 bpm after the initial steps of resuscitation _________ immediately.
Start PPV
How do you estimate a newborn’s heart rate?
Count the number of beats in 6 seconds and multiply by 10
If the baby is breathing after initial steps, you should assess and monitor the heart rate. It should be at least _______ bpm.
100
When providing positive pressure ventilation ti a term newborn, what peak inspiratory pressure should you start with?
20-25 cm h2o
It can be difficult to deliver PEEP with a self inflating bag. A T piece resuscitator delivers consistent inspiratory and PEEP.
What does PEEP help achieve?
- stable lung inflation
- prevents air spaces from collapsing during exhalation
- removes fluid
After the first 15 seconds of PPV, you do the first heart rate assessment. The heart rate is not increasing and the chest is not moving.
What should you do?
Begin MR, SOPA ventilation corrective steps immediately
What are the first two steps of the MR. SOPA ventilation corrective steps that often solve the problem?
Mask adjustment and reposition head
You are performing the MR. SOPA ventilation corrective steps on a term baby. You have adjusted the mask and repositioned the head. You have suctioned the mouth and nose and opened the mouth. There is no chest movement.
What is the next step?
Increase the pressure in 5 to 10 cm H2O increments, up to 40 cm H2O
For babies greater than 35 weeks gestation, start PPV with _________ oxygen.
21-30%
According to NRP 8th edition, for how long should umbilical cord clamping be delayed for eligible babies?
30-60 seconds
What physical parameter are you trying to achieve with the MR. SOPA ventilation corrective steps?
Chest movement with PPV
When placing an orogastric tube, measure the insertion depth with PPV or CPAP is in progress by measuring from the bridge of the nose to the earlobe and from the ear lobe to?
A point halfway between the xiphoid process (below sternum) and the umbilicus (bellybutton)
What are the indications for inserting a laryngeal mask?
What are the indications for inserting a laryngeal mask?
- newborn has a congenital anomalies involving the mouth, lip, tongue, palate, or neck
- newborn has a large tongue
- you cannot intubate
- newborn has a small mandible
- you cannot ventilate
If a newborn requires PPV with a face mask, laryngeal mask, or required CPAP for more than several minutes, consider placing a(n) _______________.
Orogastric tube
The endotracheal tube and the __________ are the alternative airways used for newborn resuscitation.
Laryngeal mask
When a baby is breathing well enough to sustain a heart rate over ________ bpm, discontinue PPV.
100
You are providing face mask PPV to a newborn who had bradycardia (HR >60) at birth. The heart rate has increased to more than 110 bpm and the baby is beginning to breathe spontaneously.
What is your next action?
Slow the rate of PPV and stimulate the baby
When performing PPV, you may not proceed to chest compressions or medication until the newborn has received at least ______ seconds of PPV that moves the chest, preferably through an endotracheal tube or laryngeal mask.
30
What is the most important indicator of successful PPV?
A rising heart rate
Where should the pulse oximeter be attached on the newborn?
Right hand or wrist
You are managing the care of a newborn whose heart rate is more than 100 bpm and breathing. The pulse oximeter has a reliable signal and displays an oxygen saturation below target range for the baby’s age in minutes.
What is the most appropriate action?
Administer free flow oxygen
What is the target oxygen saturation range for a baby that is 3 minutes old?
70-75%
What is a reasonable oxygen concentration with which to begin free flow oxygen?
30%
When can free flow oxygen be discontinued?
When the newborn can maintain saturation within the target range without supplemental oxygen
When providing PPV, what is the correct ventilation rate?
40-60 bpm
What’s Pulmonary hypoplasia?
An incomplete development of the lungs
What’s Oligohydramnios?
Deficiency of amniotic fluid in fetus
What’s Pneumothorax?
A collapsed lung.
This condition occurs when air leaks into the space between the lungs and chest wall.
Use of orogastric tube
a thin, flexible tube that is inserted through the mouth and into the stomach to deliver liquids or medications, or to remove stomach contents
Define hypoxia
An absence of enough oxygen in the tissues to sustain bodily functions.
Hypoxemia/ hypoxmic
A low level of oxygen in the blood.
Blood vessels around fetal lung alveoli are
Constricted
lungs bypassed by cardiac and systemic circulation is called (in fetus)
right to left shunt
Instead of sending blood through the lungs, the right side of the fetal heart send blood through….
Foramen ovale & ductus arteriosus to the left side of heart
What happens fetus to newborn with their oxygenation system transition?
Circulatory system switches from placenta-based oxygenation to lung based oxygenation
