NRP
What is the IV epinephrine dose in ml/kg according to the 8th edition of NRP
0.2 ml/kg
All patients should have an updated emergency drug list at the bedside with the calculated dose for patient weight!
How many times should a mom pump each day to establish a milk supply?
8-12 times per day
What are the original 5 rights of patient medication administration?
right patient
right medication
right dose
right time
right route
Name 2 signs of a possible pneumothorax?
tachypnea
cyanosis
bradycardia or tachycardia
decreased femoral pulses
asymmetric appearing chest
decreased O2 saturation
When administering a blood product how frequent do you obtain vital signs for blood administration? (according to the SOP)
On initiation, at 15 minutes of transfusion and the end of transfusion.
Most transfusion reactions will happen during the first 15 minutes so staff must stay at the bedside during those first 15 minutes.
If a reaction occurs, stop the blood immediately and notify a provider.
What are the 5 steps in MR SOPA when trying to establish effective ventilation?
M: Mask Adjustment
R: Reposition airway
S: Suction mouth then nares
O: open mouth
P: Increase pressure to move chest
A: alternate airway (ETT or LMA)
What is the time frame to initiate total body cooling?
6 hours to reduce death and disability in babies with moderate to severe HIE
What are the 6 medications in the emergency drug tray in the NICU and name the indication of one medication.
epinephrine- reversed cardiac arrest or HR< 60 with active CPR
atropine- treats bradycardia
sodium bicarb- treats hyperkalemia during cardiac arrest
naloxone-treat respiratory depression after opioid exposure
calcium gluconate- treats hypocalcemia
What is the maximum depth for an Nasopharyngeal tube for a NICU patient?
5 cm
Always double check your tube depth during your rounding!
Where can you find a copy of the patients' rights and responsibilities?
It's available by using the QR code for your baby's journey binder in each room, also available on the point.
How long do you provide chest compressions for a heartrate <60?
1 minute, then pause and do a pulse check
Ensure your pulse check is via auscultation with a stethoscope or palpation. We've had multiple patients in PEA over the past several years!
According to our neuroprotective care SOP at what gestational age doe we begin day night light cycling.
33 to 33 6/7 weeks
Benefits of light cycling:
improved weight gain, oxygen saturations, decreased length of stay, more developed melatonin rhythm, reduced crying and fussiness, trend towards lower ROP, decreased sleep disturbances for patient and family
When obtaining a urine culture, which container do I place it in if the volume is under 3 ml?
YELLOW Tube-
The gray tube requires a minimum of 3 ml due to the additives for culture and sensitivity. Remember the omnis have pictures and reminders on them when grabbing supplies!
2-3 minutes
Epoprosinil is a potent vasodilator that allows for selective pulmonary vasodilation with minimal impact on the systemic BP. It is used to treat PPHN, neonatal hypoxemic respiratory failure and pulmonary hypertension secondary to BPD.
Name 2 of things we do to ensure medication is delivered safety in the NICU?
double check all medications
epic alaris integration (scanning all medications prior to administration)
labeling all medication that we draw up in the NICU
Epic alerts for high risk medications
After birth what are 2 ways to verify you have established effective positive pressure ventilation?
Chest rise and increasing HR
How many PO feedings can happen each day on Phase 3 Feeding?
6; no more than 3 PO feedings in a row
24-48 hours after birth. Testing for over 50 disorders, some of which are time critical and require immediate follow up. Testing is best at 24 hours. If transfusion of a blood product occurs prior to 24 hours, obtain screen and retest at 24 hours.
If parents refuse testing, they must sign a refusal form if they continue to refuse after education about the importance of testing.
interpret this blood gas the STABLE way:
ph. 7.19
pCo2: 63
HCO3: 22
___________ ____________ _____________ (3 words)
uncompensated respiratory acidosis
Where are the 2 locations I can review the contaminate instrument handling guidelines?
posted in the soiled utility room and on NEd on your phones or on the point.
What are the 4 pre-birth questions to help assess perinatal risk?
What is the expected gestational age?
is the fluid clear?
Are there any additional risk factors?
What is the umbilical cord management plan?
What is the acceptable temperature range for bath water?
36.5-38 degrees. Don't forget to document your temperature in EPIC!
Name 4 medications in the NICU that need monitoring of levels/troughs
vancomycin
gentamicin
theophylline
phenobarbital
enoxaparin
digoxin
What are 2 common risk factors in chronic lung disease (after delivery)
prematurity
mechanical ventilation
oxygen toxicity
inflammation
growth restriction/nutritional deficit
When is it appropriate to document assume pain present or assume pain controlled?
When a patient is sedated and has an N-PASS sedation score of -5 to -10 (the patient is too sedated to accurately assess for signs of pain) therefore you assume pain is controlled or assume pain is present depending on what is happening and deploy your interventions.
NEVER assume if you can assess for pain!