1. C. Severe anemia 2. True 3. True 4. False Perinatal Continuing Education Program Pretest Answer Key Book IV: Specialized Newborn Care Unit 1: Direct Blood Pressure Measurement 5. True 6. A. Baby s heart 7. D. Measurement of acid-base balance Unit 2: Exchange, Reduction, and Direct Transfusions 1. True 2. True 3. False 4. False 5. C. Blood is not given. 6. A. 1 to 10 days. 7. True 8. True 9. False 10. False 11. D. Tachypnea 12. A. 30-week baby who is appropriate for gestational age 13. B. 18 ml Unit 3: Continuous Positive Airway Pressure 1. A. Intravenous fluids 2. D. Preterm baby with respiratory distress syndrome 3. False 4. False 5. C. Increase the baby s arterial oxygen concentration. 6. B. 4 to 8 cm H 2 O pressure 7. A. Decrease the Fio 2 to 40% to 50%, and decrease the nasal CPAP to 6 cm H 2 O pressure. Unit 4: Assisted Ventilation With Mechanical Ventilation 1. E. Expiratory resistance 2. B. Capillary Po 2 3. A. End-expiratory pressure should be higher. 4. B. A 1,500-g (3 lb 5 oz) baby with respiratory distress syndrome who is breathing 80% oxygen and has a Pao 2 of 45, Paco 2 of 65, and ph of 7.28 5. D. Rate should be faster. 6. C. High ph rom Sinkin, Robert Specialized A.;Chisholm, Newborn Christian Care, 3rd A. Edition (Book IV):, inkin, Downloaded Robert A.;Chisholm, on Jul 11, 2018, Christian 11:51 A. PM at 148.251.232.83 ownloaded Published on by Jul AAP, 11, 2017. 2018, All 11:51 rights PM reserved. at 148.251.232.83 ublished by AAP, 2017. All rights reserved. 155
Pretest answer key 1. A. Contains phospholipids and proteins 2. C. Will have a direct effect on alveolar stability 3. A. It is the cause of respiratory distress syndrome. 4. D. Mother is infected with HIV. 5. B. Lower 1. A. Urine ph 2. Yes No Unit 5: Surfactant Therapy 6. A. Bolus instillation into the trachea 7. False 8. True 9. True 10. False 11. True Unit 6: Continuing Care for At-Risk Babies Request consultation from social service department staff. Call the parents and chat with them about their baby. Begin making plans for the baby to be sent to a foster home. 3. B. 1,000-g (2 lb 3 oz), preterm baby requiring assisted ventilation 4. D. All preterm babies with a Pao 2 greater than 100 mm Hg will develop retinopathy of prematurity. 5. Yes No Measure baby s head circumference once a week. Start the baby on phenobarbital. Weigh the baby daily. Give iron dextran (Imferon) intramuscularly. Check the baby s hematocrit at least once a week. Attach the baby to a cardiac or respiratory monitor. 6. True 7. False 8. False 9. True 10. False 11. False 12. False 13. False 14. C. Bronchopulmonary dysplasia 15. B. Feed the baby as much as he or she will take by nipple while a feeding tube is in place, and then give the remainder of the feeding through the tube. 16. D. Adjusting the room temperature to neutral thermal environment during the weaning period 17. Yes No Blood electrolytes Volume of urine output Stool ph Hematocrit Weight gain Blood calcium Sinkin, Robert A.;Chisholm, 156 Christian A.
Index A Abnormally shaped waveforms, 9 Abnormally wide or narrow pulse pressure, 9 10 ABO incompatibility, 24 Absence of breathing. See Apnea Acidosis, 25 Air leaks mechanical ventilation and, 80 surfactant therapy and, 105 Albuterol, 140 Aldactone, 141 Alkalosis, 25 Alveoli collapsed, 98 normal, 98 Aminophylline, 140 Anemia monitoring for, 123 125 severe, 33, 35 Anticonvulsant drugs, 146 Apnea mechanical ventilation and, 74, 77 monitoring for, 121 123 Arterial blood gases chronic lung disease and, 144 mechanical ventilation and, 78, 80 surfactant therapy and, 102 Arterial catheter, 4 Aspiration syndrome, 99 surfactant therapy for, 104 Assessment of family, 128 129, 147 of growth, 118 121, 146 Assisted ventilation. See Mechanical ventilation B Blocked or displaced endotracheal tubes and mechanical ventilation, 80 Blood amount used for exchange transfusion, 25 preparation for exchange transfusion, 25 preservation, 24 25 types of donors, 24 urea nitrogen, 145 Blood pressure, 2 calibration of the monitor, 16 17 equipment needed, 4 5 measuring, 17 method of measurement, 4 monitoring types, 4 normal ranges, 6 7 posttest, 12 pretest, 3 self-tests, 5, 10 11 transducer monitoring, 5, 10 11, 13 17 waveforms interpretation, 8 10 Body weight, 120 Bradycardia, 123 BUN. See Blood, urea nitrogen C Caffeine, 141 Calibration, blood pressure monitor, 16 17 Cardiac complications of exchange transfusions, 29 Catheter, arterial, 4, 9 Catheter, peripheral arterial (PAC), 23, 32 Catheter, umbilical arterial (UAC), 23, 27, 32 Catheter, umbilical venous (UVC), 23, 26 28, 32 CHD. See Congenital heart disease (CHD) Chest movement and mechanical ventilation, 79 Chest radiographs, 142, 148 Chlorothiazide, 141 Cholestatic jaundice, 137 Chronic lung disease (CLD), 136, 140 144 Citrate phosphate dextrose adenine (CPDA-1), 24, 25 CLD. See Chronic lung disease (CLD) Clots within catheters, 9 complications of exchange transfusions, 29 exchange transfusion and, 27 Commercial stabilizers, 86 90 Complications, potential direct transfusion, 36 exchange transfusions, 28 29, 32 33 mechanical ventilation, 80 81 surfactant therapy, 104 105 Congenital heart disease (CHD), 138, 147 148 Continuing care, 112, 115 administering immunizations during, 125 assessment of family during, 128 129, 147 assessment of growth during, 118 121 assessment of head growth during, 147 cholestatic jaundice and, 137 chronic lung disease and, 136, 140 144 congenital heart disease and, 138, 147 148 developmental care and, 129 discharge and, 132 134 gastroesophageal reflux and, 136 hearing deficits and, 126 hydrocephalus and, 137, 146 late head ultrasound during, 128 monitoring and treatment guidelines for babies with special problems, 140 148 monitoring for anemia during, 123 125 monitoring for apnea during, 121 123 patent ductus arteriosus and, 138 posttest, 153 pretest, 113 114 recommended routines, 149 retinopathy of prematurity and, 126 127, 144 145 seizures and, 137, 146 self-tests, 130 131, 135, 139, 150 152 short bowel syndrome and, 137, 145 146 sleep position/environment and, 128 special problems that may be encountered in babies requiring, 136 138, 140 148 specific issues involved in, 115 131 temperature control during, 115 116 which babies require, 115 Continuous method of exchange transfusion, 26 27, 32, 49, 50 Book IV: index Sinkin, Robert A.;Chisholm, Christian A. 157
index Continuous positive airway pressure (CPAP), 56, 58, 73 adjusting, 67 68 conditions that benefit from, 58 delivery, 59 60, 63 68 given by high-flow nasal cannula, 61 maintaining, 68 mechanism, 58 posttest, 62 preparing babies for, 65 67 preparing equipment for nasal delivery, 64 65 pressure used in, 60 pretest, 57 surfactant therapy and, 103 104 weaning babies from, 60 when babies should receive, 59 CPAP. See Continuous positive airway pressure (CPAP) CPDA-1. See Citrate phosphate dextrose adenine (CPDA-1) D Damped waveform, 8 9 Delayed cord clamping, 31 Developmental care, 129 Diabetes mellitus, maternal, 99 Diastolic phase, 8 Dicrotic notch, 8 Direct blood pressure measurement, 4 5. See also Blood pressure Direct transfusions, 34 posttest, 40 potential complications of, 36 reasons for, 34 35 recommended routines, 37 self-tests, 36, 38 39 techniques, 35 36 Discharge of babies, 132 134 Diuretics, 147 Donor blood, 24 E Echocardiogram, 142, 148 ELBW. See Extremely low birth weight (ELBW) babies Electrocardiogram, 142, 148 Electrolytes, 141, 145, 148 Electronic monitors with waveform displays, 4 Emboli and direct transfusions, 36 Endotracheal tubes, 80, 81, 85 checking/changing the position of, 90 91 managing, 86 93 securing, 86 90 suctioning, 91 93 surfactant therapy and, 102, 105 Equipment blood pressure monitoring, 4 5 (CPAP), 64 65 Exchange transfusions, 20, 23, 41 blood amount used for, 25 caring for babies after, 52 54 in management of hyperbilirubinemia, 23 30 need for more than one, 28 partial, 30 34 performing, 47 52 posttest, 40 potential complications of, 28 29 preparing babies for, 42 46 preparing blood for, 25 preservation of blood for, 24 25 pretest, 21 22 reasons for, 23 recommended routines, 37 reduction, 31 33 self-tests, 26, 30, 34, 38 39 techniques, 26 28 types of donor blood used for, 24 Expiratory time (T E ), 75 Extremely low birth weight (ELBW) babies, 77 Eye examination, first, 127 F Family, assessment of, 128 129, 147 Fatigue and feeding, 117 Feedings continuing care and, 116 118 (CPAP) and, 60 Fetal lung development, 99 Flow rate (CPAP), 59 mechanical ventilation, 76 Furosemide, 141 G Gastroesophageal reflux (GER), 136, 145 Gestational age first eye examination and, 127 surfactant therapy and, 103 Growth assessment, 118 121 head growth, 146 H Head circumference, 120 121, 146 Hearing deficits, 126 Heart disease, congenital, 138 Heart rate and oximetry monitoring, 142 Heated humidifier with thermostat control in circuit, 74 Hematocrit, 25, 30, 35, 141, 147 HFNC. See High-flow nasal cannula (HFNC) High-flow nasal cannula (HFNC), 61 Home apnea monitoring, 123 Hydrocephalus, 121, 137 138, 146 Hyperbilirubinemia, 24 exchange transfusions in management of, 23 30 Hyperkalemia, 25 Hypocalcemia, 24, 51 Hypoglycemia, 24 Hypotension, 9 Hypovolemic, 35 Hypoxia, 123 I Immunizations, 125 Indirect blood pressure measurement, 4 Infant tubing circuit, 74 Infections complications of direct transfusion, 36 complications of exchange transfusions, 29 hydrocephalus and, 146 Initial settings, mechanical ventilation, 76 77 Inspiratory time (T I ), 75 Inspired oxygen concentration. See Oxygen concentration (Fio 2 ) Intravenous (IV) pump, 5 Intravenous (IV) solution, 5 In utero fetal-fetal transfusions, 31 In utero maternal-fetal transfusions, 31 Iron supplementation, 124 IV pump. See Intravenous (IV) pump J Jaundice, cholestatic, 137 K Kangaroo care, 116 Sinkin, Robert A.;Chisholm, 158 Christian A.
index L Lasix, 141 Late head ultrasound, 128 Lung development, fetal, 99 Lung disease, chronic. See Chronic lung disease (CLD) M MAP. See Mean airway pressure (MAP) Maternal diabetes mellitus, 99 Maternal steroid administration, 100 Mean airway pressure (MAP), 76 Mean pressure, 8 Mechanical ventilation, 70, 73 adjusting, 78 80 arterial blood gases and, 78, 80 commercial stabilizers, 86 90 how to set up, 75 76 initial settings, 76 77 managing endotracheal tubes for, 86 93 posttest, 84 potential complications, 80 81 pretest, 71 72 self-tests, 75, 82 83 suggested adjustments for various abnormal or clinical findings, 78, 79 80 surfactant therapy during, 102 types of, 74 what to do for babies receiving, 81 when to start, 73 74 which babies need, 73 Meconium aspiration, 77 Metabolic complications of exchange transfusions, 29 Minimum pressure, 8 Monitoring for anemia, 123 125 for apnea, 121 123 chronic lung disease, 140 144 gastroesophageal reflux, 145 head circumference, 146 hydrocephalus, 146 parent-baby attachment, 147 retinopathy of prematurity, 144 145 and treatment guidelines for babies with special problems, 140 148 N Nasal CPAP. See Continuous positive airway pressure (CPAP) Natural surfactants, 100 NeoBar endotracheal tube stabilizer, 89 90 Non-distensible tubing, 4 O Oximetry monitoring, 142 Oxygen concentration (Fio 2 ) chronic lung disease and, 143 (CPAP) and, 60 mechanical ventilation and, 74, 76 Oxygen desaturation, severe, 105 P PAC. See Peripheral arterial catheter (PAC) Palivizumab, 125, 133 Parent-baby interaction and attachment, 129, 147 Partial exchange transfusions, 30 34 Patent ductus arteriosus (PDA), 138 PDA. See Patent ductus arteriosus (PDA) Peak inspiratory pressure (PIP), 75 Peak pressure, 8 PEEP. See Positive end-expiratory pressure (PEEP) Peripheral arterial catheter (PAC), 23, 32 Peripheral intravenous (PIV) line, 23, 26 27, 35 PIP. See Peak inspiratory pressure (PIP) PIV. See Peripheral intravenous (PIV) line Pneumonia, 77, 99 surfactant therapy for, 104 Polycythemia, 30 33 Portex neonatal RSP endotracheal tube stabilizer, 88 89 Positive end-expiratory pressure (PEEP), 75, 77, 78 Postmenstrual age and continuing care, 116 117 Posttests blood pressure measurement, 12 continuing care, 153 (CPAP), 62 mechanical ventilation, 84 surfactant therapy, 108 transfusions, 40 Potassium levels and direct transfusion, 36 Prematurity mechanical ventilation and, 74 retinopathy of, 126 127, 144 145 surfactant therapy and, 99 Preparation of blood for exchange transfusion, 25 Preservation of blood, 24 25 Pressure regulation, continuous positive airway pressure (CPAP), 59, 60 Pretests continuing care for at-risk babies, 113 114 (CPAP), 57 direct blood pressure measurement, 3 exchange, reduction, and direct transfusions, 21 22 mechanical ventilation, 71 72 surfactant therapy, 97 Pull-push method of exchange transfusion, 26 27, 32, 48 Pulse pressure, 8 abnormally wide or narrow, 9 10 R Rate of breaths, 76 RDS. See Respiratory distress syndrome (RDS) Reduction exchange transfusions, 31 33 recommended routines, 37 Respiratory distress syndrome (RDS) continuous positive airway pressure (CPAP) and, 58 59 maternal steroid administration and, 100 mechanical ventilation for, 73. See also Mechanical ventilation surfactant therapy for, 99, 102, 103, 104, 105 Respiratory syncytial virus (RSV), 125 Retinopathy of prematurity (ROP), 126 127, 144 145 Rh incompatibility, 24 ROP. See Retinopathy of prematurity (ROP) RSV. See Respiratory syncytial virus (RSV) Sinkin, Robert A.;Chisholm, Christian A. 159
index S Safety pop-off valve, continuous positive airway pressure (CPAP), 59 Screening for hearing deficits, 126 for retinopathy of prematurity, 126 127 Seizures, 137, 146 Self-tests blood pressure measurement, 5, 10 11 continuing care, 130 131, 135, 139, 150 152 mechanical ventilation, 75, 82 83 surfactant therapy, 101, 106 107 transfusions, 26, 30, 34, 36, 38 39 Severe anemia, 33, 35 Severe oxygen desaturation, 105 Short bowel syndrome, 137, 145 146 Skin color and mechanical ventilation, 79 Sleep position and environment, 128 Solution, intravenous, 5 Spironolactone, 141 Stabilizers, commercial, 86 90 Steroid administration, maternal, 100 Stomach vent, continuous positive airway pressure (CPAP), 59 Suctioning endotracheal tubes, 91 93 Supplemental inspired oxygen concentration, 136. See also Oxygen concentration (Fio 2 ) Surfactant therapy, 74, 96 delivery, 102, 109 how often to give, 104 in intensive care facilities, 105 maternal steroid administration and, 100 during mechanical ventilation, 102 posttest, 108 potential complications, 104 105 preparations, 100 pretest, 97 self-test, 101, 106 107 surfactant components and, 98 surfactant deficiency and, 99 100 surfactant made during fetal development and, 98 which babies to treat with, 103 104 Synthetic surfactants, 100 Systolic phase, 8 T T E. See Expiratory time (T E ) Temperature control, 115 116, 117 T I. See Inspiratory time (T I ) Transducers, 4 air bubbles within, 9 blood pressure monitoring, 13 17 cable, 5 Transfusions. See Direct transfusions; Exchange transfusions Tubing, non-distensible, 4. See also Endotracheal tubes air bubbles within, 9 kinks in, 9 U UAC. See Umbilical arterial catheter (UAC) Ultrasound, late head, 128 Umbilical arterial catheter (UAC), 23, 27, 32 Umbilical venous catheter (UVC), 23, 26 28, 32 Ursodiol, 137 UVC. See Umbilical venous catheter (UVC) V Vascular complications of exchange transfusions, 28 Ventilation, mechanical. See Mechanical ventilation Ventilatory support and direct transfusion, 34 35 W Waveforms, blood pressure, 8 10 Weaning babies from continuous positive airway pressure (CPAP), 60 from incubators to cribs, 115 116 Weight, body, 120 -rays, chest. See Chest radiographs Sinkin, Robert A.;Chisholm, 160 Christian A.
EDITOR IN CHIEF, NEONATOLOGY Robert A. Sinkin, MD, MPH, FAAP EDITOR IN CHIEF, OBSTETRICS Christian A. Chisholm, MD, FACOG For more than 35 years, the Perinatal EARN Workbook Contents UP TO 54 CRED CME IT CONT S OR A HOUR CT S! Continuing Education Program () has enhanced the knowledge and skills of physicians, nurses, nurse midwives and practitioners, respiratory therapists, and other providers of care for pregnant women and newborns. The third edition workbooks have been brought up-to-date with leading-edge procedures and techniques. These information-rich volumes are filled with concise information, step-by-step instructions, and practice-focused exercises. They offer time-saving, low-cost solutions for self-paced learning or as adjuncts to instructor-led skills teaching. IS A PROVEN EDUCATIONAL TOOL FOR Improving perinatal care know-how, policies, practices, and procedures. Teaching both practical skills and cognitive knowledge. Saving time self-paced self-study approach streamlines the learning process. Saving money provide top-notch education at low per-participant costs. Encouraging cooperation and communication among diverse specialties and staffing levels. Simplifying education planning and budgeting. CONVENIENT, HASSLE-FREE CME OR CONTACT HOURS AMA PRA Category 1 Credit(s) or ANCC contact hours are available from the University of Virginia. Visit www.cmevillage.com for more information. The University of Virginia School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The University of Virginia School of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation. THE WORKBOOKS AND RELATED PRODUCTS CAN BE PURCHASED DIRECTLY FROM THE AMERICAN ACADEMY OF PEDIATRICS AT SHOP.AAP.ORG. MATERNAL AND FETAL EVALUATION AND IMMEDIATE NEWBORN CARE (BOOK I) Is the Mother Sick? Is the Fetus Sick? Fetal Age, Growth, and Maturity Fetal Well-being Is the Baby Sick? Resuscitating the Newborn Gestational Age and Size and Associated Risk Factors Thermal Environment Hypoglycemia MATERNAL AND FETAL CARE (BOOK II) Hypertensive Disorders of Pregnancy Obstetric Hemorrhage Perinatal Infections Other High-risk Conditions Abnormal Glucose Tolerance Premature Rupture or Infection of the Amniotic Membranes Preterm Labor Inducing and Augmenting Labor Abnormal Labor Progress and Difficult Deliveries Imminent Delivery and Preparation for Maternal/ Fetal Transport NEONATAL CARE (BOOK III) Oxygen Respiratory Distress Umbilical Catheters Low Blood Pressure Intravenous Therapy Feeding Hyperbilirubinemia Infections Review: Is the Baby Sick? Identifying and Caring for Sick and At-Risk Babies Preparation for Neonatal Transport Direct Blood Pressure Measurement Exchange, Reduction, and Direct Transfusions Continuous Positive Airway Pressure Assisted Ventilation With Mechanical Ventilators Surfactant Therapy Continuing Care for At-Risk Babies AAP Sinkin, Robert A.;Chisholm, Christian A. Perinatal Continuing Education Program IV 3RD EDITION Specialized Newborn Care Earn CME credits or contact hours! SPECIALIZED NEWBORN CARE (BOOK IV) BOOK Perinatal Continuing Education Program, 3rd Edition Perinatal Continuing Education Program, 3rd Edition, Book IV Time-efficient, cost-effective perinatal education and training