NRP and EINC

Question 1

newborns that are not problematic should be __

Answer 1

crying and/or moving all the extremities

Question 2

signs of a compromised newborn

Answer 2

poor muscle tone (should be flexed)
slow or no breathing
low hr
low bp
fast breathing
cyanosis

Question 3

t/f secondary apnea can be reversed with stimulation

Answer 3

false, needs assisted ventilation

Question 4

antepartum risk factors for resuscitation

Answer 4

gestational age less than 35 6/7 weeks or greater than 41 weeks
polyhydramnios
oligohydramnios

Question 5

intrapartum risk factors for resuscitation

Answer 5

emergency cs
forceps or vacuum assisted delivery
maternal general anes
placental abruption
chorioamnionitis

Question 6

if there are risk factors present ___ qualified people should be present

Answer 6

2

Question 7

what is done before the delivery

Answer 7

antenatal counseling, team briefing, equipment check, room temp check

Question 8

4 core steps of einc in normal delivery

Answer 8

immediate and thorough drying
early skin to skin contact
properly timed cord clamping
non-separation of the mother and baby

Question 9

4 steps of einc in cs delivery

Answer 9

immediate and thorough drying
cord clamping
skin to skin contact when possible

Question 10

how long to dry baby

Answer 10

at least 30 seconds
face and head, trunk and back, extremities
also assess baby at this time

Question 11

benefits of immediate drying

Answer 11

stimulates breathing

prevents hypothermia

Question 12

t/f it’s okay to slap, shake, or rub the baby

Answer 12

false

Question 13

t/f ventilation and suction is required during immediate drying

Answer 13

false, done only if indicated (floppy/limp or blocked mouth/nose)

Question 14

ideal room temp

Answer 14

25-28 c

Question 15

benefits of skin to skin contact

Answer 15

BLEST

breastfeeding success
lymphoid tissue system stimulation
exposure to maternal skin flora
sugar (protection from hypogly)
thermoregulation

Question 16

benefits of properly timed cord clamping

Answer 16

ATB

decrease in anemia in term (80%) and preterm babies (51%)
decreased need for blood transfusions in premature
decreased bleeding in the brain in premature (51%)

Question 17

how often to monitor baby and mother

Answer 17

never leave unattended, monitor every 15 mins for the first 1-2 hrs

Question 18

t/f skin to skin contact is still allowed for covid-19 positive/suspect mothers

Answer 18

true

Question 19

what to do if baby is apneic/gasping or limp in the first minute

Answer 19

call for help
change wet linen
clamp and cut the cord
transfer to warmer
position airway
clear secretions

Question 20

t/f suction nose before mouth

Answer 20

false, mouth before nose

Question 21

indications for pulse oximetry

Answer 21

when resuscitation is anticipated
to confirm suspicion of persistent central cyanosis
when supplemental o2 is administered
when ppv is required

Question 22

indications for ppv

Answer 22

apneic/gasping
hr <100 bpm
persistent central cyanosis and saturation remains below target values despite 100% o2

Question 23

t/f ventilation of the lungs is the single most important and most effective step in cardiopulmonary resuscitation of the infant

Answer 23

true

Question 24

target pre-ductal o2

Answer 24

1 min = 60-65%
5 min = 80-85%
10 min = 85-95%

Question 25

signs of effective ventilation

Answer 25

signs of adequate ventilation = bilateral breath sounds, chest movements signs of improvement in newborn = imporved hr, improved o2 sat, onset of spontaneous respiration

Question 26

ventilation corrective steps

Answer 26

MRSOPA ``` mask adjustment reposition airway suction open mouth pressure increase airway alternative ```

Question 27

what to do when baby is apneic/gasping or hr <100 bpm

Answer 27

ventilation corrective steps | intubate if needed

Question 28

what to do if baby has labored breathing or persistent cyanosis

Answer 28

position and clear airway spo2 monitoring consider cpap

Question 29

what to do if hr <60 bpm

Answer 29

intubate coordinated ppv and chest compressionis 100% o2 consider uvc insertion

Question 30

indications for ppv and chest compressions

Answer 30

ppv: <100 bpm | ppv + chest compressions: <60 bpm despite 30 s of ppv

Question 31

compression techniques

Answer 31

thumb technique and two finger technique

Question 32

compression-ventilation rhythm

Answer 32

90 compressions and 30 breaths per minute 120 events per minute 1-and-2-and-3-and-breathe

Question 33

complications of chest compressions

Answer 33

lacerations of major organs | broken ribs

Question 34

when to stop compressions and ppv

Answer 34

stop compressions when hr is >60 bpm | stop ppv when hr >100 bpm

Question 35

indications for intubation

Answer 35

- chest compressions, doing prolonged ppv - stabilization of newborn with suspected diaphragmatic hernia - surfactant administration - direct tracheal suctioning if airway is obstructed by thick secretions

Question 36

t/f always hold the laryngoscope with the right hand

Answer 36

false, left hand

Question 37

appropriate blades for laryngoscope

Answer 37

blade 1 term blade 0 preterm blade 00 extremely preterm

Question 38

guide for inserting the et tube

Answer 38

vocal cords (v-shaped structure)

Question 39

what is ntl method

Answer 39

length of nasal septum to ear tragus estimated insertion depth = ntl+1

Question 40

signs of correct tube position

Answer 40

BIN improved vital signs breath sounds over both lung fields but decreased/absent over stomach no gastric distention with ventilation

Question 41

problems to consider if baby worsens post intubation

Answer 41

DOPE Displaced endotracheal tube Obstructed endotracheal tube Pneumothorax Equipment failure

Question 42

what to do if hr is <60 bpm despite adequate ventilation and chest compressions

Answer 42

iv epi consider hypovolemia consider pneumothorax

Question 43

indication for medication administration

Answer 43

hr <60 despite 30 s of adequate ventilation and chest compressions

Question 44

how to administer epi

Answer 44

uv catheterization -> insert epi

Question 45

after delivery, if the hr of the newborn is 60, first action is

Answer 45

ppv

Question 46

indications for volume expansion

Answer 46

baby is not responding to resuscitation baby appears in shock hx of fetal blood loss

Question 47

how to administer volume expansion

Answer 47

normal saline (0.9% NaCl) IV or intraosseous over 5-10 mins, 10 ml/kg via umbilical vein

Question 48

expected response from volume expansion

Answer 48

increased hr stronger pulses less pallor increased bp

Question 49

t/f persistent cyanosis is usually caused by bradycardia

Answer 49

false, rarely caused by bradycardia, caused by inadequate ventilation

Question 50

t/f the persistent absence of detectable hr (apgar 0) at 10 mins is a strong predictor of mortality and serious morbidity

Answer 50

true