Neonatal Assessment Flashcard 1

A. Rationale: Generalized edema and electrolyte imbalances such as hyperkalemia indicate possible renal organ system involvement. The kidneys primarily excrete potassium, and its excess suggests renal impairment. Generalized edema can also be caused by water retention and leakage of albumin, both of which also suggest renal impairment. This can also lead to pulmonary congestion as intravascular fluids can leak into the lungs causing cardiopulmonary distress.

B. Rationale: A collection of fluid in the pleural cavity is known as a pleural effusion and is caused by the extravasation of fluid into the thoracic cavity or leakage from the lymphatic system. In newborn patients, this can be caused by fetal hydrops, generalized edema, twin-to-twin transfusion, cardiac arrhythmia, congenital heart disease, infections, or a genetic syndrome.

D. Rationale: The primary cause for needing resuscitation in the newborn is inadequate gas exchange or poor ventilatory function.

D. Rationale: Maternal narcotic use will decrease the newly born’s respiratory drive, causing a high-risk birth. The neonate must be managed with respiratory support via facemask PPV. Prolonged apnea warrants the use of a laryngeal mask or endotracheal intubation. There is insufficient evidence to use the antidote, naloxone, in a newborn exposed to opioids because it may cause seizures, edema, and cardiac arrest, as seen in animal studies.

B. Rationale: The four prebirth questions cover both antepartum and intrapartum risk factors. It has been simplified to four questions that can be remembered easily. These include: “What is the expected gestational age?” “Is the amniotic fluid clear?” “Additional risk factors?” and finally, “What is the umbilical cord management plan?

D. Rationale: The most accurate way to monitor the heart rate of a newly born preterm patient is a 3-lead ECG. A downside of ECG monitoring is that electrical impulses may be measured even if there is no adequate systolic function (such as cardiac arrest due to pulseless electrical activity). As the patient is prone to hypothermia, weak pulse, and small appendages, the pulse oximeter is not an efficient device for monitoring heart rate. Auscultation can be difficult, especially during intense situations such as neonatal resuscitation, and it is prone to errors. Weak pulses in the preterm patient make it difficult to feel the pulse. NRP guidelines now recommend cardiac monitoring as soon as an alternative airway is deemed necessary.

C. Rationale: The DOPE mnemonic is a troubleshooting guide used to aid the clinician review the possible causes of sudden deterioration of a newly born after successful implementation of an ET tube. D = displaced ET tube; O = obstructed ET tube; P = pneumothorax; E = equipment failure.

B. Rationale: It only takes one red flag from the four prebirth questions to alert the neonatal resuscitation team to anticipate a high-risk neonatal patient in need of resuscitation. A “Yes” answer to any one of these four pre-birth questions is a red flag.

D. Rationale: The following are indications that the endotracheal tube is in place: color change within the CO2 detector, increasing heart rate, equal breath sounds, symmetrical chest movement, no air leak from the mouth after each given breath, and no signs of air entry into the stomach during auscultation of the gastric area. The team should verify placement in multiple ways.

D. Rationale: The algorithm for neonatal resuscitation assists providers in their decisions on next interventions and whether to continue the resuscitation or determine that the newborn can no longer benefit from resuscitative efforts. The two clinical signs of importance are respiration and heart rate.