Neonatal Assessment Flashcard 2

B. Rationale: Pneumothorax is a common cause of respiratory distress in the newborn, caused by air leaking from the lungs into the thoracic cavity. As air accumulates in the pleural space, it will surround the lung, and if this causes significant restriction of lung motion, then it can cause respiratory distress. Pneumothorax can occur spontaneously, or it can be iatrogenic in nature after the administration of positive pressure ventilation (PPV).

A. Rationale: The pulse oximeter measures the pulsations and absorbed red light from the capillaries. Its output is the estimated oxygen saturation of hemoglobin in blood at a given time (in percent) and the heart rate.

B. Rationale: The three vital characteristics that must be monitored when giving positive pressure ventilation for a neonate in need of resuscitation are heart rate, respiration, and oxygen saturation via pulse oximetry.

A. Rationale: If after all the interventions have been administered correctly following the NRP algorithm and the newly born fails to achieve a heart rate of 60 bpm or higher, then pneumothorax and low blood volume must be considered.

D. Rationale: To respond to a neonatal resuscitation, the team must become aware of any perinatal risk factors by interviewing the attending obstetrician, pediatrician, and the patient or relatives. This interview guides them in planning for the potential needs of the newly born patient. Signficant antepartum risk factors include the following: gestational age < 36 weeks or > 41 weeks, pre-eclampsia, eclampsia, maternal hypertension, multiple gestation, fetal anemia, polyhydramnios, oligohydramnios, fetal hydrops, macrosomia, intrauterine growth restriction, fetal malformations, and no prenatal care.

B. Rationale: The DOPE mnemonic lists the common causes of sudden deterioration of a newly intubated newborn and includes the following: displaced endotracheal tube, obstructed endotracheal tube, pneumothorax, and equipment failure.

B. Rationale: Ultrasound is a cost-efficient method for detecting a fetal intrapartum pleural effusion. It is routinely obtained in every obstetric check-up and does not involve unnecessary radiation, such as when a chest X-ray or CT scan is used. Due to the logistical requirements of the MRI procedure, a sonogram is preferred.

C. Rationale: Intrapartum risk means that certain events during labor are more likely to lead to neonatal resuscitation. The following are intrapartum risks for neonatal resuscitation: emergency cesarean delivery, forceps or vacuum-assisted delivery, breech presentation, category II/III fetal heart pattern, maternal general anesthesia, placental abruption, intrapartum bleeding, chorioamnionitis, narcotics administered to mother within 4-hours of delivery, shoulder dystocia, meconium-stained amniotic fluid, and prolapsed umbilical cord.

C. Rationale: Maternal narcotics expose the newborn through the maternal-fetal circulation. Opioids can cause severe respiratory depression, a high-risk situation. The neonatal resuscitation team must be ready to immediately apply a facemask and administer positive pressure ventilation at delivery. It may also be necessary to provide endotracheal intubation if the newborn presents with prolonged apnea.

D. Rationale: A fundamental aspect of starting chest compressions during neonatal resuscitation is that the patient is not responding despite adequate ventilation. Healthcare providers must know how to assess if the patient is being administered adequate ventilation by observing a visible chest rise after each assisted breath.