Neonatal Resuscitation Algorithm Flashcard 1
Rationale
A. Rationale: The newly born had to undergo the initial steps of neonatal resuscitation, indicating a problem with the transition from intrauterine to extrauterine life. Therefore, the neonate must be closely monitored in an environment such as the neonatal ICU, where a team of experienced and well-equipped healthcare providers can care for the patient. They will monitor breathing, thermoregulation, and other vital statistics until it is deemed safe to transfer the patient, a decision made by a neonatologist.
Question
A high-risk newly born undergoes the initial steps in neonatal resuscitation with positive pressure ventilation. After 1 minute, she has responded well. Her heart rate is 145 bpm, and preductal oxygen saturation is 72% at the second minute. What is the best course of action for this patient?
a. Monitor breathing
b. Initiate breastfeeding
c. Rooming-in
d. Monitor blood pressure
Answer
a. Monitor breathing
Rationale
C. Rationale: The initial steps are critical in this case. It is a priority to bring the newborn to a radiant warmer first. A strong predictor of morbidity and mortality in a newborn in need of resuscitation is the admission temperature, and hypothermic preterm patients are the most susceptible. Hypothermia is associated with interventricular hemorrhage, respiratory problems, hypoglycemia, and late-onset sepsis.
Question
A nurse has received a newly born boy born at 29 weeks gestation. The baby is apneic, bradycardic, and cyanotic. What is the first course of action for this patient?
a. Give rescue breaths
b. Start chest compressions
c. Bring the newborn to a warmer
d. Attach a defibrillator
Answer
c. Bring the newborn to a warmer
Rationale
A. Rationale: 1 out of 10 newborns requires life support measures by providing positive pressure ventilation to initiate breathing at birth.
Question
A high-risk newly born infant requires resuscitation. Which one of the following is most often used in these high-risk patients?
a. Positive pressure ventilation
b. High-quality CPR beginning with chest compressions
c. Intravenous pharmacologic therapy with epinephrine
d. Intravenous fluid therapy
Answer
a. Positive pressure ventilation
Rationale
A. Rationale: NRP guidelines allow 1 minute (the Golden Minute) to complete the initial steps in stabilization.
Question
A newborn girl is found to be apneic. The team leader decides to perform the initial steps to stabilize the patient. How long should it take to complete these initial steps?
a. 1 minute
b. 2 minutes
c. 5 minutes
d. 10 minutes
Answer
a. 1 minute
Rationale
C. Rationale: When a newly born is non vigorous at birth, with signs such as apnea and bradycardia, the initial steps in neonatal resuscitation are performed within 1 minute. If there is no improvement, then it is time to initiate positive pressure ventilation.
Question
A newborn girl is nonvigorous at birth. The obstetrician suggests that you give positive pressure ventilation. When is the best time to provide positive pressure ventilation?
a. At birth, when the risk for neonatal resuscitation is high
b. When the newborn has a heart rate of 50 beats per minute
c. After performing the initial steps and the newborn does not improve
d. When the newborn exhibits signs of apnea, and there is no pulse present
Answer
c. After performing the initial steps and the newborn does not improve
Rationale
C. Rationale: Positive pressure ventilation can also be used when a newborn with spontaneous breathing and an appropriate heart rate fails to achieve the predicted preductal oxygen saturation despite being given free-flow oxygen or continuous positive airway pressure.
Question
A newborn with free-flow oxygen supplementation is breathing normally with a heart rate of 140 bpm. Preductal oxygen saturation during the 15th minute is 70%. What is the best course of action at this point?
a. Monitor the patient for signs of deterioration
b. Give continuous positive airway pressure
c. Initiate positive pressure ventilation
d. Use a meconium aspirator to remove any obstruction
Answer
c. Initiate positive pressure ventilation
Rationale
D. Rationale: There is a visible chest rise with each ventilation, so you can assume that you are giving positive pressure ventilations adequately. In this situation, you must assess the newly born after 1 minute of chest compressions and good positive pressure ventilation before giving epinephrine. DO NOT give epinephrine if you have not established good PPV that inflates the lungs and high-quality chest compressions.
Question
A newly born boy is undergoing neonatal resuscitation. After giving 30 seconds of positive pressure ventilation with visible chest rise and 30 seconds of high-quality chest compressions, your next course of action is to:
a. Adjust the facemask and ensure that the bag-mask device is working properly.
b. Give epinephrine intravenously.
c. Defibrillate the patient.
d. Continue giving chest compressions for another 30 seconds more.
Answer
d. Continue giving chest compressions for another 30 seconds more.
Rationale
C. Rationale: It is essential to minimize interruptions in chest compressions during CPR. NRP guidelines recommend rechecking the heart rate 1 minute after giving epinephrine.
Question
A newly born fails to improve after 3 minutes of high-quality CPR. The team leader decides to give epinephrine to the patient. After giving epinephrine, when is the best time to reassess the heart rate?
a. 15 seconds
b. 30 seconds
c. 1 minute
d. 2 minutes
Answer
c. 1 minute
Rationale
A. Rationale: In this situation, after 30 seconds of positive pressure ventilation, the newly born does not improve and remains bradycardic. The next step in the algorithm is to perform chest compressions with positive pressure ventilation.
Question
A newly born girl is nonvigorous and apneic. After providing the initial steps and giving positive pressure ventilation, she does not improve. She has a heart rate of 40 bpm, and the team leader orders to intubate the patient. The ET tube is appropriately placed with a visible chest rise every given breath and bilateral breath sounds. After 30 seconds of positive pressure ventilation, the newly born has a heart rate of 40 bpm. What is your next course of action?
a. Perform chest compressions and positive pressure ventilation.
b. Place an umbilical line and give epinephrine 1 mg intravenously.
c. Continue positive pressure ventilation only.
d. Hook the newly born to a defibrillator and defibrillate the patient.
Answer
a. Perform chest compressions and positive pressure ventilation.
Rationale
C. Rationale: It is recommended to give crystalloid solutions as a volume expander for blood loss in the newly born. The recommended crystalloid solution is a 0.9% NaCl solution (normal saline). Another crystalloid is lactated Ringer solution, but this is not usually ordered. Hydroxyethyl starch and dextran are colloid solutions but are not recommended. Among the blood products, it is recommended to use packed red blood cells. Fresh frozen plasma contains only coagulation factors, usually used for patients with a risk of bleeding with poor coagulation.
Question
A newly born has lost a lot of blood volume during delivery from high-risk medical conditions. Which one of the following is the recommended volume expander?
a. Dextran
b. Hydroxyethyl starch
c. 0.9% normal saline solution
d. Fresh frozen plasma
Answer
c. 0.9% normal saline solution