1.) A 6 day old who is vomiting all feeds and is found cyanotic with emesis in his mouth upon entering the room. What would you do?
As part of your care team you can use a charge nurse, CNA, resp. therapist, child life therapist, social worker, unit secretary, also available is one RN and LPN, NOT ALL IS USED.
It seems like such a simple question but im making it more out to be than what it is..
1. Assess the situation/infant (appears cyanotic)
2. Check for airway patency(Idk if you would take the time to listen to the lungs at this moment) ((find out that emesis is obstructing breathing))
3. (Heres were my order is bad) ... Call for assistance from LPN/RN, ask them to inform the charge nurse on the situation (call a code), (would they then call respiratory?)
4. Due to complete obstruction would you then administer infant CPR? try to "finger" out the emesis in the mouth then position the infant for back blows followed by chest thrusts? If baby was to be unconscious then go to two rescue breaths, if the chest doesn't rise then do 30 compressions. Re assess the baby for patency?
I'm not really sure to be honest this order although I should. Your going to want to get the obstruction out first of course. If you couldnt get the emesis out with fingers then due chest thrusts/back blows.. reassess airway and still if nothing maintain compressions/breaths??
If anyone has any advice I'd really appreciate it..
I'd like to compliment this student for explaining the assignment and going to good lengths to explain her thought processes and concerns, staying engaged in the conversation, and not just asking for the answer.
I'd like to compliment this student for explaining the assignment and going to good lengths to explain her thought processes and concerns, staying engaged in the conversation, and not just asking for the answer.
As an AHA instructor I can say that CAB is the acronym for both adult and pedi/infant. That being said not all scenarios are going to fit into the matrix that AHA uses. In this case I would be inclined to worry about ventilation and a patent airway.
However I am still a nursing student so just imparting my 2 cents
So if I may ask, say I did bulb suction first and respirations were produced. Would I then position the infant in a way to promote ventilation and perhaps give supplemental oxygen? Once that patent airway is established it's just a matter of monitoring right?
The question already gives your first assessment (infant cyanotic with vomit), so I would "save" the assessment answer for later.
1. Turn infant on side and suction.
2. Call for help.
3. Assess infant to see if it's breathing and if color is coming back with stimulation/suctioning, and check brachial pulse. If infant is breathing normally again and color is returning, apply blowbly and support infant until help arrives. Healthy infants usually regain color very quickly once they are able to start breathing again after an aspiration episode.
4. If not breathing and cyanotic, initiate CPR while waiting for help to arrive.
So if I may ask, say I did bulb suction first and respirations were produced. Would I then position the infant in a way to promote ventilation and perhaps give supplemental oxygen? Once that patent airway is established it's just a matter of monitoring right?
Yes, supplemental oxygen and monitoring. But even if ventilation is restored, I think if HR remains below 60 you continue with CPR.
Hello! I have the same homework assignment and I've found is challenging but so much fun! I found these steps on my book and this is what I got, I hope it's correct. My husband is a paramedic and he told me a suction bulb wouldn't be enough in this situation, so use the suction on the wall (next to the oxygen) available in the room with a catheter the appropriate size for the baby.
I will call charge nurse right away and start to perform a rapid cardiopulmonary assessment. Most pediatric arrests are related primarily to airway and breathing, and usually only secondarily to heart. Supported breathing may be all that is needed if the child has a strong, adequate pulse (Ricci, Kyle, Carman, 2013, p.1920). I have assessed brachial pulses and they are present. I have evaluated the airway, which is not patent. Since secretions are obstructing the airway, I will suction the oropharynx while asking the charge nurse to place the child on 100% oxygen and apply a pulse oximeter to monitor oxygen saturation levels. I will do the head tilt-chin maneuver to promote good airflow. And evaluate breathing by turning my head and place my ear over the child's mouth to look, listen, and feel†for spontaneous respirations. If the child is breathing, I will evaluate the quality of the respirations, respiratory rate, and child's color. If the child is not improving, I will begin assisted ventilation with a bag-valve-mask device (BVM) If the need for ongoing BVM ventilation continues, airway intubation may be required (Ricci, Kyle, Carman, 2013, p.1920). If this is the case, I will ask charge nurse to call code while I continue BVM ventilations.
PALS still says CAB for pediatric cardiac arrest, but I think the NRP guidelines are more applicable here, especially since you have a big hint (emesis around the mouth) that the problem is respiratory in origin. Plus, like I said before, I'm not sure how useful compressions are going to be if you already have cyanosis present. Maybe my NICU bias is showing, but I'd want to get that kid ventilated first.
Yes, with babies "codes" are usually respiratory and not cardiac in nature. In this case, I would start with suction to clear the airway and also to stimulate....see if the baby starts to breathe and respond with this. Then, CPR. Compressions for a HR below 60, BVM if not breathing.
However, as a general rule in both kids AND adults, if you cannot ventilate, that should never delay your compressions. You should still never be off the chest for more than ten seconds. Even if you aren't ventilating well, there is still residual oxygen in the blood and it is still worth while to circulate this oxygen! (Your RBCs dont dump all of the oxygen out with every trip through the body - even venous blood returning to the heart is partially oxygenated.)
nurseprnRN, BSN, RN
1 Article; 5,116 Posts
I'd like to compliment this student for explaining the assignment and going to good lengths to explain her thought processes and concerns, staying engaged in the conversation, and not just asking for the answer.