Review NRP: part I Lone Star: Kingwood college

1. Review NRP: part ILone Star: Kingwood college By Elizabeth Kelley Buzbee AAS, RRT-NPS, RCP

2. List the equipment that you need to assemble in the delivery room to take care of a newborn question

3. You need to assemble: • Clean dry warmed towels or blankets • Self-inflating bag and mask in various neonatal sizes • 02 Flow meter • Laryngoscope , blades & ET tubes to fit newborns • Suction catheters, and meconium aspirator answer

4. List the four questions you should always ask when presented with a new born question

5. You ask if: • The baby is term • The amniotic fluid is clear • The baby is breathing or crying • The baby has good muscle tone answer

6. If your baby is term gestation, is breathing well and has clear amniotic fluid and good muscle tone, what do you do with him? question

7. If the baby seems ok, we need to first dry him off by wiping him down with dry warmed towels. • Replace the towels as he get them wet • Position him so his airway is patent and clear as necessary • Assess his color • If there is no change in his appearance give him to mother answer

8. If your baby is premature what do you do with him? question

9. The premature infant is at risk for respiratory distress • Check his respirations and pulse • He is at increased risk for cold stress so warm and dry him and watch his response to stimulation • is his muscle tone good? answer

10. If your baby has a respiratory rate that is irregular with a HR that is 120 BPM what do you do? question

11. Establish airway by placing baby in sniffing position with shoulder roll under her • You would start her on supplementary 02 by blow by with cupped hands for reservoir • Make sure she is warm and dry, and gently stimulate her for 30 seconds • Reassess breathing? Is it shallow, gasping. Is the baby pinking up? • If not, start mask bagging with 02 answer

12. How do we deal with the cyanotic infant. • Lips are blue; fingers are blue; toes are blue question

13. Establish the airway with sniffing position • Administer blow by 02 and observe for 30 seconds • Gentle stimulation if breathing is irregular • Continue to monitor RR and HR • Once the baby pinks up on supplementary 02 he can be sent for observational care under 02 • If he still has central cyanosis, continue 02 until he pinks up • Get ABG and pulse oximeter on him answer

14. How do you assess HR on the new born? question

15. Measure the pulse at the base of the umbilical cord as it goes into the baby. • Tap finger on the bed so others can count the HR • Count for 6 seconds and multiply by 10 for HR answer

16. If your baby has cloudy or stained amniotic fluid what do you do with him? question

17. If the baby is meconium-stained and is vigorous-- we would clear mouth and then nose with bulb syringe • Observe the baby for color and for HR and RR • If the baby is floppy, HR less than 100 BPM or depressed respirations, with observation by laryngoscope, suction oral and pharyngeal intubate without mask bagging, suction below the cords and remove the ET tube. • Reassess baby. Repeat till airway clear • Or baby needs more resuscitation answer

18. Can you administer free flowing 02 via a self-inflating manual resuscitator bag? question

19. No, there is not enough flow going through this type of bag • Use non-self inflating bag and mask • Or 02 with hands cupped over face for reservoir • Or hand-held simple 02 mask answer

20. At what point do we mask bag the baby? question

21. If the baby goes apnic • or the respirations are irregular • and there is central cyanosis that failed to respond to supplementary 02 • If the HR drops below 100 BPM answer

22. List the three ways that the RCP could bag the baby. question

23. The self-inflating bag with 02 • The flow inflating bag • The T-piece resuscitator answer

24. Discuss the advantages & disadvantages of the self-inflating bag question

25. ADVANTAGES • The self inflating bag can be used without supplementary 02 • Pressure release can protect the baby from excessive PIP • DISADVANTAGES • Will inflate even if there is a poor seal • Requires a reservoir • for high Fi02 • Cannot deliver free flow 02 • Cannot deliver CPAP answer

26. List advantages & disadvantages of the flow inflated bags in neonatal resuscitation question

27. ADVANTAGES of flow inflated bags • Can deliver free-flow 02 • Can deliver CPAP • Can have fine control over Fi02 based on blender settings • Easy to see if the face seal is good • DISADVANTAGES • Must have tight seal • Must have gas source • Usually doesn’t have safety pop off answer

28. While you are mask bagging your patient how do you know you are effective? question

29. You observe the HR • You look at chest rise • You look at patient’s skin color and muscle tone • You hear bilateral breath sounds [on axillary line on both sides] answer

30. How do you find the proper sized mask? question

31. The proper sized mask Covers the chin, mouth and nose without covering the eyes answer

32. What volume should the bag have for the newborn? question

33. The right sized bag should have a volume of 200-450 ml so that the baby can get a VT of 15-25 ml answer