Nrp Continued Flashcards
At birth the blood vessels around the alveoli do what
Dilate and gas exchange across the lungs begins
At birth, the baby’s heart increases workload. Instead of shunting blood to the left heart, it now must move where?
Through the entire pulmonary vasculature and the formen ovale
After the circulatory system change of oxygenation in baby occurs the ductus arteriosus is___
Unoxygenated (the ductus arteriosus should close to create the vasculature the baby will have throughout life)
How long can it take after birth for the ductus arteriosus to fully close?
Hours to 2 days
When does complete dilation of the pulmonary blood vessels occur?
Several months after birth
Define Asphyxia
Lack of oxygen to the brain
When does Asphyxia (too much carbon dioxide , not enough oxygen) occur?
Before, during, or after birth
What happens if baby doesn’t take it’s first breath immediately after birth
prevents lung fluid from being absorbed
What causes Insufficient oxygen content in artieral blood?
When lung fluid is not absorbed (due to the baby not taking a breath immediately)
What is the impetus (momentum) for pulmonary vasodilation?
Increased oxygenation of arterial blood
How does lack of pulmonary vasodilation impair the neonate?
Impairs ability to oxygenate independently of the placenta
Define decompensation
the failure of an organ (especially the liver or heart)
What are signs of the need for resusitation (abnormal transition during birth)
-apnea
-tachypnea
-irregular breathing
-hypotension
-hypoxenia
-decreased muscle tone
Providers should ask what 3 questions at every delivery?
1) is neonate term? 37week+
2) neonate breathing/crying effectively?
3) neonate have adequate muscle tone? (Active with flexed extremities)
Is routine suctioning for neonates recommended?
No
What’s a clue to suction a neonate?
Meconium stained fluid or trouble clearing secretions
Tactile simulation should be limited to what 3 things?
Drying, rubbing back & soles of feet
What’s the proper position of airway support
Supine with neck slightly extended in the ‘sniffing’ position
What can help achieve proper degree of neck extension during airway support?
A small towel rolled under shoulders
What triggers vagal reflex?
Suctioning too deeply or vigorously
What causes bradycardia? And what is it?
A slowed heart rate under 60, (vagal reflex)
What kind of suctioning can cause the neonate to aspirate?
Suctioning nose before the mouth
Leaving a neonates skin wet can cause
Decrease body temp due to evaporation even under a radiant warmer.
What dual purpose does drying baby with towels do?
Simulate them to breathe, helps body temp from not being wet
Neonates less than 32 weeks should be warmed using special techniques
Drying can take place at same time as positioning/suctioning airway support
If baby is not breathing vigorously after suctioning, what’s your next step?
Gentle stimulation, tapping feet, rubbing back or chest
Harsh stimulation, deep rub or shaking are (never okay) (sometimes)
Never
What is the apgar score based on (5)
Color
Heart rate
Reflex irritability
Muscle tone
Respiration
When are apgar scores accessed?
1-5 min after birth
Are initial introventions determined by apgar score?
No
What is the apgar score useful for?
Index of response to resuscitation
If the apgar score is less than 7 at 5 minutes, then what?
The apgar assessment should be repeated every 5 minutes for up to 20 minutes
If neonate is gasping within first 60sec after birth then immediately provide
Ppv
While ppv is initiated, check ______
Heart rate
If neonate is breathing adequately, but HR is >100bpm the first intervention is
PPV (NOT chest compressions)
What’s the most importation intervention in neonatal resuscitation?
Ventilation
In addition to providing PPV, providers should also use what?
Oximeter & ECG (Electrocardiogram)
Where to put pulse oximeter on neonate?
Right wrist
Define auscultation
listening to the sounds of the body during a physical examination
Define palpation
using one’s hands to check the body
What could cause the pulse oximeter not to provide an accurate heart rate?
Poor tissue perfusion (passage of blood), peripheral circulation
Peripheral circulation
the part of the circulatory system that consists of the veins and arteries not in the chest or abdomen (i.e. in the arms, hands, legs and feet).
If the heart rate is at least 100 bpm and baby is not gasping or apneic, what should baby be examined for?
Cyanosis
During the transition period when is cyanosis normal?
When it’s only present in hands and feet
Define Acrocyanosis
Blueness in hands and feet
Define central cyanosis
Blueness in perioral area (lips, tounge, gums) or chest abdomen and back
Diagnosing cyanosis in some babies could be difficult under what conditions?
Dark skin tone
Ambient lighting
Radiant warmers
What is the underlying cause of cyanosis?
Poorly oxygenated blood
True or false: pulse oximetry does not give a more accurate assessment of poorly oxygenated blood
False
True or false: you can rely solely on skin coloration to diagnosis cyanosis
False, use pulse oximetry too
When is use of pulse oximetry indicated (advised)?
To diagnosis cyanosis
Resuscitation
PPV
With supplemental oxygen
Where is the preductal blood oxygenation measured at on infant?
Right arm
Why is the blood in the arteries on the left arm and legs less well oxygenated in a newborn?
Because some of the blood is shunted across the heart and ductus, bypassing the lungs. (Until the ductus arteriosus closes)
How long is the normal transition of blood oxygenation in neonate?
10-15 min
A normal pulse oximetry reading 2 mins after birth may range from ___ to ___
65% to 80%
What can be used as a guide to diagnosis hypoxemia?
The table of “normal” preductal percent blood oxygenation levels. (The percentage of oxygen in blood)
High concentrations of _____ are toxic to neonatal lung tissue
Oxygen
Oxygen concentrations that exceed concentration of oxygen in room air must be used with cation. What’s room air percentage of oxygen?
21%
Rule of thumb for free flow oxygen is
10L /min @ 30% oxygen concentration
What’s CPAP?
a therapy that helps newborns breathe by delivering a constant stream of air through a mask or prongs in the nose
CPAP can be administered to babies who are
Persistently cyanotic or who have labored breathing or both
“Normal” oxygen saturation 1 min after birth is
60-65%
Normal oxygen saturation 2 min after birth
65%-70%
Normal oxygen saturation 3 min after birth
70%-75%
Normal oxygen saturation 4 min after birth
75%-80%
Normal oxygen saturation 5 min after birth
80%-85%
Normal oxygen saturation 10 min after birth
85%-95%
Hypotension
Low blood pressure
Hypoxia
lack of oxygen in the body
Apnea
a pause in breathing that lasts 20 seconds or longer, or a shorter pause that’s accompanied by other signs
Tachypnea
Rapid and Shallow breathing
