PRNC 02 Flashcards
What solution do you use in order to remove adhesives on infants?
citrus oil
What is the best indicator to assess if the infant is improving with bag mask ventilation?
Rising HR
What is the most narrow area of the infants trachea?
the cricoid cartilage
Whats different about the pharynx in an infant?
The pharynx is more anterior
Trachea size for a term
5-6cm long and 4mm wide
Trachea size for a preterm
2cm long and 2-3mm wide
Apgar score of 7-10 indicates what?
Monitor them, routine care
APGAR of 4-6 indicates what?
Support them, stimulate/warm/give O2
APGAR score of 0-3 indicates what?
Resuscitation efforts are necessary
When do you perform the the APGAR assessment?
At minute 1 and minute 5
**Can be repeated q 5 min but usually ceases at minute 20
The lower score correlated with APGAR at minute 5 indicates what?
It is directly correlated with neonatal mortality. Lower the score at minute 5 means higher mortality rate
Score for baby who is blue or pale
0
Score for being acrocyanotic
1
How to assign a score for reflex irritability
0 no response
1 Grimace/withdraws slightly
2 Crying/active withdraw
HR of 5 receives which APGAR score?
1
**A 0 is only assigned if HR is absent
What tool is used to assess the DEGREE of respiratory distress?
Silverman-Anderson Index
What does a higher silverman score tell you?
That the baby is in severe respiratory distress
**lower score is better
What are the four signs of respiratory distress?
Nasal Flaring–Needs oxygen
Grunting–Needs CPAP or BiPAP b/c trying to create own peep
Retractions– Decreased lung compliance
Tachypnea– >60 and indicates the baby is trying to increase their minute ventilation
What are the four signs of respiratory distress?
Nasal Flaring–Needs oxygen
Grunting–Needs CPAP or BiPAP b/c trying to create own peep
Retractions– Decreased lung compliance
Tachypnea– >60 and indicates the baby is trying to increase their minute ventilation
What tools help estimate the age of the baby?
Ballard and Dubowitz
What is the difference between the Ballard and the Dubowitz assessment tools
Ballard is more RAPID and examines only 6 physical signs and 6 neuro signs compared to 11 and 10
Gestational Age +5 will give you what value?
determines what the mean arterial pressure should be
what is pallor? and what causes it?
Pale or white skin usually due to blood loss or hypovolemia
When is jaundice okay in a baby?
This is normal AFTER the first day but not immediately after birth
At what level of PaO2 does cyanosis begin to show?
Shows up once PaO2 falls below 30
What is the most important thing to regulate during the physical exam?
Thermoregulation
***If a problem is suspected…check the temperature first
What are the normal values for axillary temp vs skin temp?
axillary is 36-37 while skin temp is 36-36.5
What does mottling indicate?
Mottling is usually caused by hypotension/shock/anemia
periodic breathing vs apnea
periodic breathing is normal and can last 5-10 seconds long but WITHOUT cyanosis or bradycardia.
True apnea lasts longer than 15-20 seconds and WITH cyanosis or bradycardia
Acrocyanosis
Typically seen in the first 24 hours but abnormal past 24 hours. Blue hands and feet
What is the normal resting position for a baby?
Feet and Arms flexed towards the body
What are some physical finding of chromosomal abnormalities?
only having a single palmar crease, wider set eyes, flatter face
How is jaundice treated?
The use of Billi lights/tanning lights
What do you need to do if a baby has True Apnea?
Stimulate baby by flicking foot or rubbing their back
**Don’t be an idiot and shake them
What does a bounding pulse indicate?
R to L shunt through ductus arteriosis
What does it mean if the lower extremities show a slower pulse than the brachial?
That there is PDA or coarction of the aorta
Where do you place the BP cuff?
place cuff around the thigh
How does BP change with age?
As they get older, they will have higher blood pressures
When using a suction catheter, what pressure do you set it at?
set to 80-100
What are the tools to assess pain level?
N-PASS scales and pediatric faces pain scale
What can you use for infants to help control pain levels pre-procedure?
Dip their pacifier in sweet ease solution. Oral use ONLY
What are the three indicators for PPV?
HR less than 100
Apnea
SpO2 less than desired target (**despite using free flow FiO2)
How can you administer free flowing O2?
Only through flow inflating bag and T-piece resuscitator
What is the only way to administer O2 without having a compressed gas source?
Self-inflating
What are the three things that can cause free flowing bag mask not to work well?
Hole in the bag, mask not fully sealed, or not enough gas flow
How to properly measure while placing an OG tube
From bridge of nose to ear lobe, then from ear lobe to between the xyphoid process and umbilicus
Why do you place the pulse ox on the right wrist?
Because it is preductal
Decision making during resuscitation is based off what assessments?
RR and HR
Persistent fetal circulation is caused by what?
aphyxia causes pulmonary HTN which then causes PFC.
**PFC is secondary to pulmonary HTN
Indications of cardiac problems?
Murmur, bounding pulses, weaker femoral pulses, and preductal/post ductal measurements are greater than 5% apart
APGAR assesses what 5 things?
Appearance, Pulse, grimace, activity, and respiration effort
HR for a newborn/premature
120-170
*Premature baby will be closer to the 170 (higher)
What defines a term baby
37-42 weeks
Anything over 4 kilos means what?
automatically the baby is LGA
What does grunting sound like?
high pitched sound made by partially closing of the epiglottis over the trachea
What is the only way to assess a PDA that is not invasive?
Pre and Post ductal pulse oximetry
**Done by placing one on the right hand and one on the left foot
Why do infants require more oxygen?
higher metabolic rate
How does a newborn appear (color) during first 24 hours
Blue hands and feet, pink membranes and trunk.
**This is acrocyanosis
