[Verified Answer]: Web resources: AARC Clinical Practice…

Web resources: AARC Clinical Practice Guideline: Application of Continuous Positive Airway Pressure to Neonates via Nasal Prongs, Nasopharyngeal Tube, or Nasal Mask—2004 Revision & Update; aarc.org AARC Clinical Practice Guideline: Surfactant Replacement Therapy: 2013; aarc.org Unit Specific Objectives Upon completion of this unit the student will be able to: 1. Recommend an appropriate initial ventilator mode or mode modification for the perinatal/pediatric patient. a. Continuous Positive Airway Pressure (CPAP) b. Noninvasive Positive Pressure Ventilation (NPPV or NIV) c. Pressure Support Ventilation (PSV) d. Intermittent Mandatory Ventilation (IMV) e. Synchronized Intermittent Mandatory Ventilation (SIMV) f. Assist Control (A/C) g. Pressure Control Ventilation (PCV)/ Time-cycled, Pressure-limited Ventilation (TCPL) h. Pressure Regulated Volume Control (PRVC) 2. Recommend appropriate perinatal/pediatric settings for the following set ventilator parameters when given specific patient information. a. Peak inspiratory pressure (PIP)/Tidal volume (VT) b. Positive end expiratory pressure (PEEP) c. Set rate or frequency d. Flow rate (Inspiratory flow and bias flow) e. Inspiratory time (IT or I-time), Expiratory time (ET or E-time), I:E Ratio f. FIO2 g. Rise time h. Sensitivity (flow, pressure, motion, neurally adjusted ventilator assist-NAVA) 3. Determine acceptable perinatal/pediatric ranges for the following monitored parameters and describe how they may change utilizing the set parameters in Objectives 1 and 2. a. Mean airway pressure (Paw) b. Inspiratory /expiratory tidal volume (VT) c. Respiratory rate/total rate d. Deadspace/alveolar ventilation e. Compliance f. SpO2 g. Blood gas results 4. Explain how changes in mean airway pressure affect oxygenation. 5. Identify indications for mechanical ventilation in the perinatal/pediatric patient. 6. State the advantages and disadvantages of utilizing volume-cycled ventilation and pressure-limited ventilation. 12. State the indications for weaning the neonatal and pediatric patient and choose an appropriate method. 13. Recommend extubation and appropriate, specific post-extubation settings for oxygen delivery or CPAP for the neonatal and pediatric patient based on ventilator settings and/or patient assessment. 14. Describe proper monitoring of a neonate on nasal CPAP and NPPV. 15. State the objectives and indications for nasal CPAP and NPPV. 16. Discuss the physiologic effects of CPAP and NPPV. 17. Discuss appropriate patient interface devices used to deliver infant and pediatric CPAP and NPPV. 18. Recommend CPAP/NPPV initial mode/settings, modifications, weaning techniques, and discontinuance when given necessary patient data. 19. Identify hazards and contraindications of CPAP/NPPV. 20. Recommend the use of nasal CPAP and NPPV by identifying appropriate signs of respiratory distress and assessing blood gas results. 21. State the indications for prophylactic and therapeutic surfactant replacement therapy. 22. Describe surfactant administration techniques and the associated procedural adverse effects. 23. State the physiological adverse effects of surfactant replacement therapy. 24. Describe potential changes in oxygenation and lung compliance following surfactant administration and subsequent ventilator modifications that are necessary as a result. 25. Recommend a corrective action to a patient problem when given a surfactant administration scenario. 26. Explain the potential hazards of administering aerosol medication via standard small volume nebulizer to the mechanically ventilated neonatal patient and how vibrating mesh nebulizers can reduce them.