Neonatal Care

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Author:
readyreg29
ID:
273370
Filename:
Neonatal Care
Updated:
2014-05-07 13:42:26
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Neonatal Care
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Description:
MEDIC 2013
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  1. Refers to an infant within the first few hours after birth
    Newborn
  2. Refers to an infant within the first month after birth
    Neonate
  3. Antepartum (before birth) risk factors
    • Multiple gestation          No prenatal
    • Age <16 - >35             Drug usage
    • Post-term >42              Premature rupture 
    • Hypertension                Fetal anemia
    • Preeclampsia                
    • Diabetes
  4. Intrapartum (during birth) risk factors
    • Premature labor
    • Breech / abnormal presentation
    • Prolapsed cord
    • Meconium staining
    • Narcotics usage within 4 hours
    • Prolonged labor >24 hours
    • Significant bleeding
    • Placenta previa
  5. The process of transitioning from fetus to newborn includes:
    • 1st breath triggered by mild hypoxia
    • Hypercapnia (excessive C02)
    • Tactile stimulation (touching skin)
    • Cold stress
    • Lungs fill with air
  6. A newborn born at 38 to 42 weeks of gestation is described as:
    Term
  7. Causes of delayed transition in newborns
    • Hypoxia
    • Meconium or blood aspiration
    • Acidosis
    • Hypothermia
    • Pneumonia
    • Hypotension
    • Sepsis (bacteria infection)
    • Birth asphyxia
    • Pulmonary hypoplasia
    • Respiratory distress syndrome
  8. Measures to take to prepare for neonatal resuscitation
    • Patient history
    • Prepare environment & equipment
    • Warm dry blankets
    • Bulb syringe
    • 2 small clamps/ties
    • Clean scissors
  9. Complete list of resuscitation equipment
    • Suction
    • Bag-mask
    • Intubation
    • Medications (epi,ns,dextrose 10%)
    • Umbilical vessel catheterization
  10. The initial stabilization of a newborn includes what specific steps
    • Warming the newborn to prevent hypothermia
    • Positioning the newborn
    • Clearing the airway 
    • Drying & stimulating
  11. If the newborn does not appear vigorous with adequate respirations the safe tactile stimulation method include
    • Slapping/flicking soles of the feet
    • Rubbing the back or trunk gently
    • Supplemental O2
    • PPV
    • Intubation
    • Chest compressions
    • Medications
  12. Criteria to begin positive pressure ventilations:
    • Apeneic (20-sec. or longer respiratory pause)
    • Pulse rate <100 after 30 sec. of drying, stimulation, blow-by O2
  13. Conditions that may require an oral airway
    • Bilateral choanal atresia
    • Pierre Robin sequence
    • Macroglossia
    • Craniofacial defects affecting airway
  14. Macroglossia
    Large tongue size
  15. Bony or membranous obstruction of the back of the nose preventing air flow
    Bilateral choanal atresia
  16. A series of developmental anomalies including a small chin and posteriorly positioned tongue that frequently lead to airway obstruction
    • Pierre Robin sequnce
  17. Bag-mask ventilation is indicated when a newborn is:
    • Apneic
    • Inadequate respiratory effort
    • Pulse <100 bpm
  18. Signs of respiratory distress in a newborn
    • Periodic breathing
    • Intercostal retractions
    • Nasal flaring
    • Grunting on expirations
  19. The correct timing for ventilation rate of a newborn
    • 40 to 60 breaths/min
    • "breath-two-three, breath-two-three"
  20. The most common reasons for ineffective bag-mask ventilation are:
    • Inadequate seal of mask
    • Incorrect head position
    • Copious secrections
    • Pneumothorax
  21. Intubation is indicated in newborns when:
    • Meconium-stained fluid is present
    • Congenital diaphragmatic hernia
    • (suspected)
    • Does not respond to PPV, chest compressions,
  22. Bradycardia in a newborn is often a result of:
    Inadequate ventilation & usually responds to effective PPV
  23. When is epinephrine indicated in a newborn
    Pulse rate <60bpm after 30 sec. of effective ventilations & chest compressions
  24. Signs of hypovolemia in newborns
    • Pallor (color)
    • Persistently low pulse rate
    • Weak pulses
    • No improvements despite efforts
  25. A fluid bolus in a newborn consists of:
    • 10mL/kg
    • Normal saline
    • Lactated ringer's
    • O Rh-negative blood over 5 mins
  26. If suspected metabolic acidosis; interventions would be:
    10-mL/Kg normal saline bolus

    * aide in improving perfusion and clearance of acid
  27. If a newborns blood glucose level is less than ________, what is the intervention
    • 40 mg/dL
    • Administer 10% dextrose IV bolus (2mL/kg)
    • Recheck in 30 mins
  28. IV adminstration of dextrose often needs to be followed by a:
    10% dextrose infusion @ 60 to 100mL/kg/d
  29. Apnea is defined as
    A respiratory pause of greater than 20 seconds
  30. Causes of Apnea in a new born
    • Hypoxia
    • Hypothermia
    • Airway/respiratory muscle weakness
    • Prolonged/difficult labor
    • Seizures
  31. Assessment and management of bradycardia in newborns
    • Auscultate or palpate base of umbilical cord
    • PPV if <100bpm
    • Chest compressions if <60bpm
    • After 30 sec no change...
    • Epinephrine 0.1 to 0.3mg/kg
  32. If a newborn is delivered prematurely in the field what will optimize his/her survival and long term outcome
    Cardiorespiratory support and thermoneutral environment
  33. Types of seizures:
    • Subtle
    • Tonic
    • Focal clonic
    • Myoclonic
  34. The single most common cause of seizure in both term and preterm newborns
    • Hypoxic ischemic encephalopathy
    • (asphyxia-lack of O2 to tissues)
  35. Fever is defined as a rectal temperature of greater than
    38C (100.4F)
  36. Risk factors for hypothermia
    • 8 to 12 hours after birth
    • Home delivery
    • Prolonged resuscitation
    • Small for gestational age
    • CNS problems
    • Prematurity
    • Sepsis
    • Not keeping infant warm during transport
  37. Symptoms of hypoglycemia include:
    • Cyanosis
    • Apnea
    • Irritability
    • Poor sucking/feeding
    • Limpness
    • Irregular respirations
    • Eye rolling
    • Hypothermia
  38. What should you do if the baby is apneic or has a pulse rate less than 100 beats/min after 30 seconds of drying and stimulation and supplemental freeflow oxygen?
    Begin positive-pressure ventilation by bag-mask device
  39. The most common cause for low birth weight is:
    Prematurity

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