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Nrp Continued Flashcards

1
Q

At birth the blood vessels around the alveoli do what

A

Dilate and gas exchange across the lungs begins

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2
Q

At birth, the baby’s heart increases workload. Instead of shunting blood to the left heart, it now must move where?

A

Through the entire pulmonary vasculature and the formen ovale

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3
Q

After the circulatory system change of oxygenation in baby occurs the ductus arteriosus is___

A

Unoxygenated (the ductus arteriosus should close to create the vasculature the baby will have throughout life)

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4
Q

How long can it take after birth for the ductus arteriosus to fully close?

A

Hours to 2 days

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5
Q

When does complete dilation of the pulmonary blood vessels occur?

A

Several months after birth

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6
Q

Define Asphyxia

A

Lack of oxygen to the brain

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7
Q

When does Asphyxia (too much carbon dioxide , not enough oxygen) occur?

A

Before, during, or after birth

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8
Q

What happens if baby doesn’t take it’s first breath immediately after birth

A

prevents lung fluid from being absorbed

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9
Q

What causes Insufficient oxygen content in artieral blood?

A

When lung fluid is not absorbed (due to the baby not taking a breath immediately)

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10
Q

What is the impetus (momentum) for pulmonary vasodilation?

A

Increased oxygenation of arterial blood

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11
Q

How does lack of pulmonary vasodilation impair the neonate?

A

Impairs ability to oxygenate independently of the placenta

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12
Q

Define decompensation

A

the failure of an organ (especially the liver or heart)

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13
Q

What are signs of the need for resusitation (abnormal transition during birth)

A

-apnea
-tachypnea
-irregular breathing
-hypotension
-hypoxenia
-decreased muscle tone

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14
Q

Providers should ask what 3 questions at every delivery?

A

1) is neonate term? 37week+
2) neonate breathing/crying effectively?
3) neonate have adequate muscle tone? (Active with flexed extremities)

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15
Q

Is routine suctioning for neonates recommended?

A

No

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16
Q

What’s a clue to suction a neonate?

A

Meconium stained fluid or trouble clearing secretions

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17
Q

Tactile simulation should be limited to what 3 things?

A

Drying, rubbing back & soles of feet

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18
Q

What’s the proper position of airway support

A

Supine with neck slightly extended in the ‘sniffing’ position

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19
Q

What can help achieve proper degree of neck extension during airway support?

A

A small towel rolled under shoulders

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20
Q

What triggers vagal reflex?

A

Suctioning too deeply or vigorously

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21
Q

What causes bradycardia? And what is it?

A

A slowed heart rate under 60, (vagal reflex)

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22
Q

What kind of suctioning can cause the neonate to aspirate?

A

Suctioning nose before the mouth

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23
Q

Leaving a neonates skin wet can cause

A

Decrease body temp due to evaporation even under a radiant warmer.

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24
Q

What dual purpose does drying baby with towels do?

A

Simulate them to breathe, helps body temp from not being wet

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25
Neonates less than 32 weeks should be warmed using special techniques
Drying can take place at same time as positioning/suctioning airway support
26
If baby is not breathing vigorously after suctioning, what's your next step?
Gentle stimulation, tapping feet, rubbing back or chest
27
Harsh stimulation, deep rub or shaking are (never okay) (sometimes)
Never
28
What is the apgar score based on (5)
Color Heart rate Reflex irritability Muscle tone Respiration
29
When are apgar scores accessed?
1-5 min after birth
30
Are initial introventions determined by apgar score?
No
31
What is the apgar score useful for?
Index of response to resuscitation
32
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
33
If neonate is gasping within first 60sec after birth then immediately provide
Ppv
34
While ppv is initiated, check ______
Heart rate
35
If neonate is breathing adequately, but HR is >100bpm the first intervention is
PPV (NOT chest compressions)
36
What's the most importation intervention in neonatal resuscitation?
Ventilation
37
In addition to providing PPV, providers should also use what?
Oximeter & ECG (Electrocardiogram)
38
Where to put pulse oximeter on neonate?
Right wrist
39
Define auscultation
listening to the sounds of the body during a physical examination
40
Define palpation
using one's hands to check the body
41
What could cause the pulse oximeter not to provide an accurate heart rate?
Poor tissue perfusion (passage of blood), peripheral circulation
42
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).
43
If the heart rate is at least 100 bpm and baby is not gasping or apneic, what should baby be examined for?
Cyanosis
44
During the transition period when is cyanosis normal?
When it's only present in hands and feet
45
Define Acrocyanosis
Blueness in hands and feet
46
Define central cyanosis
Blueness in perioral area (lips, tounge, gums) or chest abdomen and back
47
Diagnosing cyanosis in some babies could be difficult under what conditions?
Dark skin tone Ambient lighting Radiant warmers
48
What is the underlying cause of cyanosis?
Poorly oxygenated blood
49
True or false: pulse oximetry does not give a more accurate assessment of poorly oxygenated blood
False
50
True or false: you can rely solely on skin coloration to diagnosis cyanosis
False, use pulse oximetry too
51
When is use of pulse oximetry indicated (advised)?
To diagnosis cyanosis Resuscitation PPV With supplemental oxygen
52
Where is the preductal blood oxygenation measured at on infant?
Right arm
53
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)
54
How long is the normal transition of blood oxygenation in neonate?
10-15 min
55
A normal pulse oximetry reading 2 mins after birth may range from ___ to ___
65% to 80%
56
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)
57
High concentrations of _____ are toxic to neonatal lung tissue
Oxygen
58
Oxygen concentrations that exceed concentration of oxygen in room air must be used with cation. What's room air percentage of oxygen?
21%
59
Rule of thumb for free flow oxygen is
10L /min @ 30% oxygen concentration
60
What's CPAP?
a therapy that helps newborns breathe by delivering a constant stream of air through a mask or prongs in the nose
61
CPAP can be administered to babies who are
Persistently cyanotic or who have labored breathing or both
62
"Normal" oxygen saturation 1 min after birth is
60-65%
63
Normal oxygen saturation 2 min after birth
65%-70%
64
Normal oxygen saturation 3 min after birth
70%-75%
65
Normal oxygen saturation 4 min after birth
75%-80%
66
Normal oxygen saturation 5 min after birth
80%-85%
67
Normal oxygen saturation 10 min after birth
85%-95%
68
Hypotension
Low blood pressure
69
Hypoxia
lack of oxygen in the body
70
Apnea
a pause in breathing that lasts 20 seconds or longer, or a shorter pause that's accompanied by other signs
71
Tachypnea
Rapid and Shallow breathing

Nrp (8 decks)

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