NRP
What is the IV epinephrine dose per kg according to the 8th edition of NRP?
0.2 mg/kg
All patients should have an emergency drug list at the bedside with the calculated dose for patient weight.
What 5 medications are in the emergency drug trays in the NICU?
A: epinephrine, atropine, sodium bicarb, naloxone and calcium gluconate
EPI- used to reverse cardiac arrest for HR<60 with active CPR.
Atropine- used to treat bradycardia
Sodium Bicarb-used to treat hyperkalemia during cardiac arrest
Naloxone-used to treat respiratory failure due to opioid exposure
Calcium Gluconate-used to treat hypocalcemia
*all of these medications are weight calculated on your emergency drug sheet for your patient!
What is the max number of attempts by an expert to obtain PIV access?
2 attempts then contact senior resident or ARNP and follow difficult venous pathway
Find the pathway in the Pediatric Venipuncture SOP
When administering blood products how frequent do you obtain VS for blood administration?
Besides your normal VS protocol, on initiation, 15 minutes after transfusion has started and at the end of transfusion
Most transfusion reactions will happen during the first 15 minutes of administration so staff must stay at the bedside during that time to observe for s/s
What is the maximum depth of a NPCPAP tube?
5 cm
appropriate size tube and depth are critical to reduce trauma to oral mucosa and effectively deliver CPAP
What are 2 ways to verify you have established effective PPV?
chest rise with ventilation and increasing HR
After a D10 bolus for a glucose of 36, when do you obtain a repeat glucose?
15-30 minutes
Impact of hypoglycemia- can lead to brain injury. Presenting signs and symptoms:
Poor feeding
jitteriness
tachypnea
pallor
sweating
hypothermia
lethargy
seizures
coma
even death if untreated!
How many times should a mom pump each day to establish a milk supply?
8-12 times (roughly every 2-3 hours)
15-20 minutes per session. Important to establish milk supply, help milk transition from colostrum to mature milk and makes a big difference in long term milk supply.
Where are 2 locations I can review the Contaminated Instrument Handling guidelines?
Posted in the Soiled Utility room and available on NED
You all know this question was guaranteed for our TJC review :)
Your patient is on Ram of 6 and begins desaturating about 5 minutes after you complete cares. You go in to assess the patient who is breathing intermittently but has some retracting and flaring and HR is 86 and saturations are 71. What is your next step?
Remove ram cannula and provide PPV due to HR < 100 and saturations below limit.
What are the 5 Steps in MR SOPA when trying to establish effective ventilation?
MR: mask adjustment and reposition airway
SO- suction and open mouth
PA- pressure increase, alternate airway
When obtaining urine culture which container do I place it in if the volume is under 3 ml?
Yellow Tubes!
Gray tubes require minimum 3 ml volume due to additives for culture and sensitivity.
The omnicells have pictures and reminders on them for reference.
What is the max temperature setting you should program on a radiant warmer or isolette on skin temp control.
37.0 degrees to maintain a core temperature between 36.5-37.5 degrees
Increasing the set temp above this risk's hyperthermia, typically will heat skin and not raise core temperature putting patient at risk.
When is it appropriate to document assume pain present or assume pain controlled?
When a patient has an N-Pass sedation score -4 to -10
When the N-PASS sedation score is -4 to -10 the patient is too sedated to accurately assess for signs of pain therefore you document assume pain present or assume pain controlled and deploy appropriate interventions.
Interpret this blood gas the STABLE way:
Ph 7.19
PCO2 63
HCO3 22
uncompensated respiratory acidosis
Uncompensated due to ph being too low. Primary problem is respiratory due to high PCO2
How long do you provide chest compressions for HR< 60?
60 seconds then pause for a pulse check
Ensure the pulse check is either via auscultation with stethoscope or palpation. Not on the monitor due to risk for PEA
Pulseless electrical activity (PEA), also known as electromechanical dissociation, is a clinical condition characterized by unresponsiveness and impalpable pulse in the presence of sufficient electrical discharge. (National Library of Medicine)
What is the recommended time to obtain a newborn screen and why?
24-48 hours after birth. Testing for over 50 disorders some of which are time critical and require immediate follow up.
Test early in the event of blood product administration. Discharge before 24 hours, transfer to other facility
According to our neuroprotective care SOP at what gestational age group do we begin day night light cycling?
33-36 6/7 weeks
Where can I find a copy of the patients’ rights and responsibilities?
Available on the QR code that links your baby’s journey binder info or on the point
What are 2 common risk factors in chronic lung disease?
Prematurity, mechanical ventilation, oxygen toxicity, inflammation, growth restriction/nutritional deficit.
What are the 4 pre-birth questions to help assess perinatal risk?
1. What is the expected gestational age?
2. Is the fluid clear?
3. Are there any additional risk factors?
4. What is the umbilical cord management plan?
What is the daily dose recommendation for Vitamin D for preterm and term infants?
400 units/day
Where would you double check this if they initiate this medication for the first time on your shift?
`formulary
`NICU Reference Card
`NICU dieticians
Which blood products provides the most direct supply of fibrinogen in a patient in DIC?
Cryoprecipitate
Where can I find the patient problem list? (More specific than EPIC)
On the plan of care story under the summary tab
What is the half-life of epoprostinil?
2-3 minutes
Epo is a potent vasodilator that allows for selective pulmonary vasodilation with m minimal impact on the systemic BP. Used to treat PPHN, neonatal hypoxemic respiratory failure and pulmonary hypertension secondary to BPD.