RT 231 - Maternal and Neonatal Respiratory Care

Credits: 2

1. Demonstrate an understanding of transcutaneous monitoring.
   1. Describe the different methods of monitoring the neonate.
   2. Describe and explain the function of the TcO2 and TcCO2 electrodes.
   3. Explain how TcO2 measurements are interpreted.
   4. Explain how the function of the TcO2 electrode is related to perfusion at the monitoring site.
   5. Explain how the perfusion is monitored.
   6. Explain the use of heat at the monitoring site.
   7. Describe how the TcO2 and TcCO2 monitors are calibrated.
   8. Explain where and how the electrodes are applied.
   9. Explain the advantages and disadvantages of TcO2 monitoring.
   10. Explain the function and use of oximetry.
   11. Explain the advantages and disadvantages of oximetry.
   12. Explain the advantages and disadvantages of invasive blood gas sampling techniques.
   13. Explain the complications of invasive blood gas sampling techniques.
2. Demonstrate an understanding of hypoxia and oxygen therapy involving infants.
   1. Describe the major indication for oxygen therapy.
   2. Explain the different types of hypoxia.
   3. Explain the clinical signs of hypoxia.
   4. Explain the significance of cyanosis as a sign of hypoxia.
   5. Give an appropriate rationale for maintaining an infant's PaO2 within the "acceptable" range.
   6. Explain the use of oxygen as a diagnostic tool.
   7. Describe the different methods of oxygen administration.
   8. Explain the advantages and dis-advantages of the various methods of oxygen administration.
   9. Explain the hazards of oxygen therapy.
   10. Describe methods to prevent RLF and BPD.
   11. Explain the use of vitamin E therapy in the prevention of RLF and BPD.
3. Demonstrate an understanding of how to evaluate the newborn.
   1. Identify and explain factors that would indicate a “high-risk” birth.
   2. Describe the basic equipment needed for a newborn resuscitation.
   3. Describe the evaluation of the newborn in distress.
   4. Describe the management of the newborn in distress.
4. Demonstrate an understanding of suctioning with infants.
   1. Describe the complications of suctioning the infant and methods to avoid these complications.
   2. List the pressure ranges used when suctioning the infant.
   3. Describe the procedure for pharyngeal and nasopharyngeal suctioning of the infant.
   4. Explain the risks of nasotracheal and orotracheal suctioning of the infant.
   5. Describe the method for selecting an appropriate size suction catheter for endotracheal suctioning.
   6. Describe the procedure for endo-tracheal suctioning.
5. Demonstrate an understanding of CPAP and mechanical ventilation use with infants.
   1. Describe the goals of CPAP therapy.
   2. Explain the pulmonary effects of CPAP.
   3. Explain the cardiovascular effects of CPAP.
   4. Describe the ideal CPAP system.
   5. Explain the advantages and disadvantages of various types of CPAP systems.
   6. List the indications of CPAP.
   7. Describe how CPAP is applied.
   8. Explain how CPAP systems are monitored.
   9. Describe how infants are weaned from CPAP.
   10. Explain the goals of mechanical ventilation.
   11. List the indications for mechanical ventilation of the neonate.
   12. Describe the “special problems” associated with mechanical ventilation of the neonate.
   13. Explain the use of PEEP in treating the neonate.
   14. Describe how infants are weaned from mechanical ventilation.
6. Demonstrate an understanding of neonatal transport.
   1. Describe the “ideal” transport incubator.
   2. State the percentage of all births requiring transport.
   3. Explain the importance of early transport.
   4. State factors, which influence the decision to transport an infant.
   5. Explain how the request for transport is handled.
   6. Describe the stabilization of the neonate before and after the transport team arrives.
   7. Describe the care of the “second patient” involved.
   8. Describe problems encountered from nursery incubator to transport incubator and methods to deal with these problems.
   9. Describe problems encountered from nursery to ambulance and methods to deal with these problems.
   10. Describe problems encountered in the ambulance in transit and methods to deal with these problems.
7. Demonstrate an understanding of fertilization and fetal development.
   1. Define:
      1. Zygote
      2. Blastomere
      3. Morula
      4. Blastula
      5. Gastrula
      6. Neurula
   2. Explain the early stages of development of the fetus from stage 1 to the neurulation stage.
   3. List the organs that develop from the:
      1. Endoderm
      2. Mesoderm
      3. Ectoderm
   4. Describe the development of the upper respiratory tract.
   5. Describe the development of the lower respiratory tract, including the:
      1. Trachea
      2. Bronchi
      3. Glands
      4. Alveoli
      5. Surfactant
   6. Characterize the three general phases of lung development.
   7. Explain the significance of the L/S ratio.
   8. Explain the storage and use of glycogen in the fetal lung.
8. Demonstrate an understanding of the placenta.
   1. Describe the development of the placenta.
   2. Identify and explain the function of the
      1. Fetal artery
      2. Fetal vein
      3. Chorionic villi
      4. Intervillous space
      5. Endometrial arteries
      6. Endometrial veins
   3. Explain the main functions of the placenta.
   4. Explain the function of the:
      1. Ductus venosus
      2. Foramen ovale
      3. Ductus arteriosus
   5. Describe the flow of blood through the fetal circulation.
   6. State the relative O2 saturations through the fetal circulation.

9. Demonstrate an understanding of apnea.

   1. Describe the factors that stimulate the infant to initiate breathing.
   2. Describe the events that assist with the transition from fluid filled to air filled lungs.
   3. Describe the factors that oppose this transition.
   4. Explain changes, following birth, in:
      1. FRC
      2. Lung compliance
      3. Airway resistance
   5. Define and explain the treatment of:
      1. Primary apnea
      2. Secondary apnea
      3. Periodic breathing
   6. Describe the events that cause the transition from fetal to neonatal circulation.
   7. Explain the role of bradykinin in this transition.
   8. Explain the factors that affect the infant’s ability to bind and release oxygen.

10. Demonstrate an understanding of abnormalities common to infants at birth.

    1. Define:
       1. Esophageal atresia
       2. Tracheoesophageal fistula
       3. Congenital diaphragmatic hernia
       4. Pierre-Robin Syndrome
       5. Choanal atresia
       6. Congenital lobar emphysema
    2. For each of the above, describe the:
       1. Pathophysiology
       2. Clinical presentation
       3. Treatment

11. Demonstrate an understanding of respiratory complications of infants.

    1. Define:
       1. Infant Respiratory Distress Syndrome
       2. Meconium Aspiration Syndrome
       3. Bronchopulmonary Dysplasia
       4. Pulmonary Barotrauma
       5. Pulmonary Dysmaturity
       6. Transient Tachypnea of the Newborn
    2. For each of the above, describe the:
       1. Etiology
       2. Pathophysiology
       3. Clinical presentation
       4. Radiologic presentation
       5. Treatment

12. Demonstrate an understanding of congenital heart defects affecting infants.

    1. Define:
       1. Persistent Pulmonary Hypertension of the Newborn (PPHN)
       2. Congenital Heart Disease
          1. Patient Ductus Arteriosus
          2. Ventricular Septal Defect
          3. Atrial Septal Defect
          4. Tetralogy of Fallot
          5. Transposition of the Great Vessels
          6. Coarctation of the Aorta
    2. For each of the above, describe the:
       1. Pathophysiology
       2. Clinical presentation
       3. Treatment