Perkins #2 Flashcards by Katie harris

Methods of providing oxygen via blow-by

Blow-by slide- set the O2 at 5 liters and if you hold the supply tubing ½ in from the face you get 80% 1inch – 60% 2-inch – 40%

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Initiation of positive pressure ventilation is done when…

Heart rate is less than 100, apnea or gasping

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Procedure for intubation

Position- sniffing, 0 miller blade- premature, uncuffed tube, insertion distance of the tube is 7,8,9 Rule- if its 1kg infant you would insert the tube until the mark says 7, repeat for 2 (8)-3(9) kg infant.
On handout (Neo. Review)
Attempts are limited to 30 seconds

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Size of catheters on neonates

2.5 tube -5 fr
3 tube- 6 fr
3.5 or 4- 8 fr

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Initiation of chest compressions happens when..& what method do we use?

HR less than 60
HR is less than 100 with apnea or gasping
Thumbs are preferred

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Indications for administration of Epinephrine and Narcan (naloxone)

If you have CPR going, and HR is still below 60 administer Epi- can give every 3-5 minutes
Narcan is given only if Respiratory Depression is because of narcotics

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Rate of compressions to breaths

3 compressions : 1 breath

If it’s a cardiac baby do 15:2

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Targeted Preductal SpO2 after 10 minutes

85-95%

over 95% can cause hyperoxia in preterm and can cause blindness (ROP)

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Recent changes in NRP

Resuscitation guidelines:
Use of the LMA
CO2 detector
Use 21% O2 with term newborn initially or slightly higher if premie.
Use a pressure manometer with all bags.
Intubation before compressions
If intubation doesn’t work use an LMA
Know all the answers on the NRP & ABG practice test

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Indication for phototherapy

If bilirubin is 5-9 mg per 100 grams

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Assessment of newborn’s cry

Normal is lusty

Abnormal is High pitched (CNS, chromosome abnormality)

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Signs of respiratory distress

Gunting, retracting, flaring, and RR greater than 60

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Conditions that cause shift of apical pulse

Pneumothorax

Atelectasis

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Condition that causes cyanosis

Hypoxemia

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Condition that causes yellowish hue to skin

Jaundice

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Abnormality usually associated with an abnormal number of vessels in the cord.

Urinary Tract Abnormality

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Classification of newborns by weight

SGA: Small gestational age 90% compared to all infants
AGA: Average/Appropriate 10-90%

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Causes of: Murmur, dark green staining, frothy secretions, Pallor, Restractions, Abnormal Facial Features, Scaphiod abdomen, Abdonminal distention

Murmur: Patent Ductus Ateriosis or Patent Foramen Ovale
Green/dark green staining: meconium
Frothy secretions: TEF: Tracheal Esophageal Fistula
Pallor: Shock
Retractions: Respiratory Distress
Abnormal facial features: Alcohol Syndrome
Scaphoid abdomen: Diaphragmatic Hernia

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Dubowitz scoring method

The Dubowitz scoring method determines gestational age when used within the first 5 days of birth
It is accurate within 2 weeks of the newborn’s gestational age.
The higher the score assigned, the greater the gestational age of the newborn

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Ballard Scoring

The Ballard score includes 6 neuromuscular/neurologic and six physical signs.
Neuromuscular signs - posture, square window, arm recoil, popliteal angle, scarf sign, and heal to ear.
Physical signs - skin, lanugo, plantar creases, breast, ears, and genitals.
It assesses the most useful items from the Dubowitz scoring system.
Gestational age is assessable from 26 to 44 weeks

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Purpose of the Dubowitz/Ballard

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Accurate Gestational Age

Normal abdominal skin temperature

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36-36.5

Clinical signs and treatment of of hypoglycemia, hypocalcemia, hypermagnesemia.

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Hypocalcemia: Jittery, seizures, apnea
Hypermagnesemia: Lethary, Hypotonia (low muscle tone), apnea
Hypoglycemia: tremors, apnea, jittery, convulsions

Nebulizers used for Continuous Neb Therapy

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Heart & Hope

Characteristics of periodic breathing

Intermittent respiratory pause for up to 10 seconds HR doesn’t change Apnea is 20s and there is a significant change in HR (brady) and color

Assessment of Fontanel

firm but soft

Neonatal tubes sizes

``` Less than 1000 grams = 2.5 1000 - 1500 grams = 3.0 1500 - 2500 grams = 3.5 Normal newborn = 3.5 - 4.0 6-12 months = 4.0 - 4.5 ```

Proper position of Umbilical Artery Catheter – high and low

oHigh: T8 oLow: L3-4

Use of non-rebreathing mask

Special gas therapy- blender 02 | Heliox therapy

Effectiveness of HMEs

Not as effective as uncuffed tubes

Use of DPIs in children

Used for kids 6 years and up

Good APGAR Score vs Good Silverman-Anderson Score.

APGAR: 10 SA: 0

Factors that decrease insensible water loss.

``` Decrease: oUse of heat shield oIncrease of environment humidification of dry gases oIncubation Increase: oAmbient Temp above NTE oRadiant warmer oPhototherapy ```

Trachypnea

>60

Identify the score used to assess the neonate at one and five minutes.

APGAR

FIO2 achieved with a simple mask.

Tight fitting: 60-80% | Loose: 40%

Artery used to assess pulse in the labor/delivery room

umbilical

Use of a bulb syringe

Clear mouth & nose

Indication for incubator

Warm & quiet environment | Maintain NTE

Select appropriate device for long term oxygen therapy

cannula

FIO2’s of nasal cannulas

.25L 24-27% .5L 26-32% 1L 30-35%

Use of an aerosol mist tent or croupette

Cool Aerosol and FiO2 < 50% FiO2 fuction of total gas flow Tent volume and tightness of seal Min flow of 10-15 L/min

Advantages /disadvantages of MDIs and DPIs (On O2 worksheet)

``` Spacer can be used (MDI) Limited choice of drugs Slow inspiratory Flow Breath Hold to optimize distribution Easy to Use (MDI) Portable/efficient ```

Administration of aerosol therapy

<5-6 year old If a child is babbling or laughing you get better aerosol deposition With a mask or blow-by Can cause infections

Administration of oxygen via hood – proper flowrates and temperature

Minimum flow 7L/min Max 15 L/min At or near body temp (min temp 32-34)

Airway clearance techniques – describe newer techniques

Fluttery valve (oscillatory PEP) Acapella (oscillatory PEP)Huff Cough- FET (forced exp. Technique) Autogenic Drainage (breathing at 3 diff levels) High frequency chest wall Oscillation (Vest) All of these are better than CPT because of fewer side effects and can do it themselves. She will describe theses tx to us on a matching question

Treatment for hyperbilirubinemia

Bili Light (blue lights/shades in incubator)

Source of non-shivering thermogenesis

Brown Fat

Four mechanisms for losing heat and an example of each.

On the thermoregulation handout Conduction: Loss of heat due to direct contact colder surface Radiation: Loss of heat due to colder surface NOT in direct contact Evaporation: Loss of heat due to evaporation from the skin Convection: Loss of heat due to cooler surrounding air

Review ABG test

answers

Importance of infection control

IGG only immunity factor that crosses over from the placenta. Protects against gram negative bacteria

Diagnosis and management of NEC

``` Diagnosis: o Abdominal Distention o Ultrasound Management: o Withhold oral feedings o Surgery ```

Perkins #2 Flashcards

(52 cards)