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Intubation has been identified as a painful procedure and associated with physiologic side-effects including bradycardia, desaturation, increased blood pressure and increased intracranial pressure which may be associated with intraventricular haemorrhage. Premedication administered to newborns for elective intubation has also demonstrated a decrease in the time and number of attempts needed to complete the intubation procedure and minimises the potential for intubation-related trauma.
Patent IV access is required. An evidenced-based, optimal protocol for premedication prior to elective intubation in neonates is to administer a vagolytic, an analgesic and a muscle-relaxant medication.
In emergency situations, it may be appropriate to intubate without premedication. For full medication monographs with dosing information, refer to Lexicomp Online resource Pediatric and Neonatal Lexi-Drugs. Morphine or Fentanyl Opioid analgesics, which provide sedation throughout procedure, prevent systemic hypertension and reduce endocrine and endorphin responses to painful procedures.
Morphine Assisting in endotracheal intubation nursing essay a longer onset of action than Fentanyl: If morphine is utilised as a premedication prior to intubation, staff must wait for the onset of action to be optimal prior to administering other premedications and proceeding with elective intubation.
Side effects include apnoea, hypotension and CNS depression. The risk of chest wall rigidity can be reduced by administering Fentanyl IV over 1 minute and can be treated with muscle relaxants.
Atropine Increases the heart rate, blocks the vagal response that placement of a laryngoscope and ETT may induce and minimises oral secretions improving visibility of the vocal cords. Expected within 2 minutes. Caution should be used if re-administering atropine within several hours of a previous dose.
In patients prone to SVT, atropine may precipitate arrhythmia and can block the effect of vagal manoeuvres. Ensure IV that medication is to be administered through is patent, not extravasated.
Administration of this medication precedes administration of muscle-relaxant. Flush with saline following Atropine dose to ensure dose enters circulation. Ensure medication actions are available prior to administering muscle-relaxant.
Muscle relaxants Prevent the increase in intracranial pressure reported during endotracheal intubation, and reduce duration of and number of intubation attempts and hence reduces hypoxia.
Muscle relaxants used for intubation are are either Suxamethonium or Pancuronium. Suxamethonium Onset of action: Effects can be reversed with Neostigmine administration. Mild histamine release, hypertension, tachycardia, bronchospasm, excessive salivation Nursing responsibilities Position the neonate for optimal intubation: Ensure thermoregulation is maintained e.
Ensure monitoring is continuous and audible for heart rate and SpO2 so that staff are alerted to a change in heart rate. Checking and drawing up the medications, ensuring patent IV access is available. Administration of premedication agents should take into account their onset and duration of action.
Thus the opioid is administered first, with sufficient time elapsing to ensure action is optimal, prior to administering Atropine, then the muscle-relaxant of choice.
Assist Medical staff or Neonatal Nurse Practitioner with intubation procedure. If intubation procedure fails, maintain face mask ventilation with Neopuff in appropriate oxygen concentration and ensure adequate chest excursion and vital signs until staff are ready to repeat procedure.
To confirm ETT position in the trachea, the following is confirmed by medical staff or Neonatal Nurse Practitioner, at the time of intubation: No colour change indicates that the ETT is not in the trachea, or may not colour change in the clinical setting where cardiac output is low or the lungs are under ventilated.
Ensure a naso-gastric or oro-gastric tube is re-inserted and connected to free drainage post-procedure to ensure the stomach is drained of any air inadvertently instilled. Documentation Within EMR, ensure:Choose the correct statement pertaining to a major difference between endotracheal intubation and the use of other advanced airways such as the Combitube, LMA, or King airway.
a. Endotracheal intubation does not permit suctioning of the lower airways. Emphasis will be on pharmacy and pharmacology, radiology, surgical nursing and anesthesia basics, and laboratory and clinical pathology procedures including during endotracheal intubation.
Proper use of positioning devices (with the false statement corrected to be true), fill in the blank, matching and short essay. As these will be.
Midwifery Studies August August 10th. Frequency of endotracheal suctioning for the prevention of respiratory morbidity in ventilated newborns: Link. March 3rd.
Iron supplementation in pregnancy or infancy and motorised development. Midwifery and nursing .
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Endotracheal intubation is MOST accurately defined as: passing an ET tube through the glottic opening and sealing off the trachea. Other than overall patient appearance, the patient's __________ is/are the MOST objective data for determining his or her status.