TIME SPECIFIC CONTENT TEACHER- A.V.

AIDS EVALUATION
OBJECTIVES LEARNER
ACTIVITY
INTRODUCTION-
2 mins Introducing the Neonatal Resuscitation means to restore life to a baby Lecture cum Powerpoint
topic from the state of hypoxia. The aim of resuscitation is to discussion
give knowledge about the steps necessary to ventilate a
newborn baby that is not breathing and to protect the
life of the baby.
About a quarter of all neonatal deaths globally are
caused by birth asphyxia, and depending on how
quickly and successfully the infant is resuscitated,
hypoxic damage can occur to most of the infant’s
organs, but brain damage is of most concerned.
Most newborns are vigorous at birth. Approximately
10% will require some assistance at birth to begin
breathing. Less than 1% will require extensive
resuscitation.
INDICATIONS-
5 mins List the Indications of neonatal resuscitation include- Lecture cum Blackboard List down the
indications and  Birth asphyxia. discussion indications of
contraindication  Preterm with respiratory compromise. neonatal
s  Congenital anomalies with respiratory resuscitation
compromise- pulmonary hypoplasia.
 Meconium aspiration.
 Congenital cystic lung lesions.
CONTRAINDICATIONS-
3 mins  Diaphragmatic hernia. Lecture cum Blackboard List down the
discussion contraindications
 Untreated/un-prevented pneumothorax.
of neonatal
 Non- vigorous baby born through meconium
resuscitation
stained liquor.
Congenital anomaly incapable with survival- anen.
 RESUSCITATION EQUIPMENTS-
5 mins Elaborate the  Bag and mask equipment
resuscitation  Self- inflating bag- pediatric size-250- Lecture cum Powerpoint Elaborate the
500 ml discussion Demonstration equipments
equipments
 Face masks- (size 0 and 1) required for
 Suction Equipment neonatal
 Mucous extractor/ mechanical suction resuscitation
and tubing with clean tips
 Miscellaneous
 Radiant warmer
 Firm padded resuscitation surface
 Warm linen
 Clock with seconds hand
 Oxygen source with flow meter
 Gloves
 Shoulder roll
 Cord tie
 Sterile blade/scissors
TABC OF RESUSCITATION:
Explain the  T- Temperature: Provide warmth, dry the baby
2 mins and remove the wet linen. Lecture cum Powerpoint Explain the
TABC of discussion Flashcard TABC of
 A- Airway: Position the infant, clear the airway,
resuscitation resuscitation
if required.
 B- Breathing: Tactile stimulation to initiate
respiration, positive pressure breaths using
either bag and mask or bag and ET tube as
necessary.
 C- Circulation: Stimulate and maintain the
circulation of blood with chest compressions
and medications as indicated.
RESUSCITATION ALGORITHM :
Describe the
At the time of birth, if baby is not breathing or crying-
5 mins resuscitation Initial steps:
algorithm  Clamp the cord immediately. Lecture cum Powerpoint Describe the
 Shift the baby under the radiant warmer. discussion Chart algorithm of
 P- Position the head with neck slightly extended resuscitation
using shoulder roll.
 S- Clear airway by suctioning mouth than nose.
 S- Stimulate by gently rubbing the back 2-3
times.
 R- Reposition the head.
Assess the breathing-
 If breathing well, provide observational care
with mother.
 If not breathing well-
 Apply appropriate sized mask correctly.
 Inflate bag and mask correctly.
 Give 5 ventilatory breaths and look for
chest rise.
 If no chest rise after 5 breaths, take
corrective steps.
 If adequate chest rise, continue
ventilation for 30 seconds (breath-two-
three).
Assess the breathing-
 If breathing well, provide observational care
with mother.
 If not breathing well-
 Call for help
 Continue bag and mask ventilation
(golden 1 minute completed)
Continue bag and mask ventilation for 30 seconds (and
trained help assists with other tasks as below).
 Trained Help Assesses the heart rate-

 If heart rate ≥ 100/min-

 Assess breathing, if breathing well,
continue observational care with mother.

 If heart rate < 100/min and/or baby is not

breathing well-
 Continue bag and mask ventilation with
oxygen
 Provide chest compression, intubation
and medication.
Organize referral for care at SNCU and continue
1 min ventilation if not breathing well.
SUPPLEMENTAL OXYGEN-
Central cyanosis requires supplemental oxygen, which
Describe can be provided by an oxygen-mask or oxygen tube.
5 mins positive pressure POSITIVE PRESSURE VENTILATION-
ventilation PPV is given by using a self- inflating bag and face Lecture cum Powerpoint Describe
mask. The self- inflating bag is easy to use as it re- discussion Positive Pressure
inflates completely without any external compressed Ventilation
source of gas.
The bag is attached to sources of oxygen and air and a
blender which provides a desired concentration of
supplementary oxygen.
BMV is indicated, if-
1. The infant is apneic or gasping.
2. HR less than 100 beats per minute.
Procedure-
The infant’s neck should be slightly extended to ensure
an open airway. The care provider should be positioned
at head end or at the side of the baby. Select
 appropriate sized face mask that covers the mouth and
neck, but not eyes of the infant. The bed should be
compressed using fingers but not by hands.
PPV is the single most effective step in babies who fail
to breathe at birth.
If the baby is not responding to PPV by prompt
increase in HR, ventilation corrective steps are taken.
When normal rise of chest is observed, one should
begin ventilating. Ventilation should be carried out at a
rate of 40-60 breaths per minute, following a ‘breath,
two, three’ sequence.
Improvement in the infant’s condition is judged by
Explain the
increasing HR, spontaneous respiration and improving
5 mins chest color. If the infant fails to improve, check adequacy of
compression ventilation in form of visible chest rise. Lecture cum Powerpoint Explain the
CHEST COMPRESSION: discussion technique of
The heart circulates blood throughout the body Demonstration chest
delivering oxygen to vital organs. When an infant compression
becomes hypoxic, the HR slows and myocardial
contractility decreases.
As a result, there is diminished flow of blood and
oxygen to the vital organs.
Chest compressions consists of rhythmic compressions
of the sternum that compress the heart in against the
spine, increase intra- thoracic pressure and circulate
blood to the vital organs of the body.

Procedure-
Rescuers should ensure that assisted ventilation is
being delivered optimally before starting chest
compressions because ventilation is the most effective
 action and chest compressions are likely to compete
with effective ventilation.
The Chest Compressions are delivered by the thumb
technique. With the thumb technique, the two thumbs
are used to depress the sternum, with the hand
encircling torso and the fingers supporting the back.
The earlier used two finger technique for Chest
Compression is no more recommended. Compressions
should be delivered on the lower third of the sternum to
a depth of ≈ 1/3rd of the antero-posterior diameter of
the chest.
Compressions and ventilations should be coordinated
to avoid simultaneous delivery.

 The chest should be permitted to re- expand

fully during relaxation, but the rescuer’s thumbs
should not leave the chest.

 Compressions to ventilations ratio 3:1 (i.e., ≈

120 events/min to maximize ventilation at 90
compressions and 30 breaths.

 Thus each event will be allotted ≈ ½ sec, with

exhalation occurring during the first
compression after each ventilation.
Explaining Respirations, HR and oxygenation should be reassessed
5mins periodically, and coordinated chest compressions and Lecture cum Powerpoint Explain the
endotracheal
ventilations should continue until the spontaneous HR discussion procedure of
intubation ≥ 60/min. Demonstration endotracheal
intubation
ENDOTRACHEAL INTUBATION:
Endotracheal intubation is required only in a small
 proportion of asphyxiated neonates.

Indications-
1. When tracheal suction is required.
2. When prolonged BMV is required.
3. When BMV is ineffective.
Endotracheal Tube-
It should be of uniform diameter through the length of
the tube and have a vocal cord guide at the tip and
centimeter markings. Endotracheal Tube size depends
on the weight or gestation of the baby.
List the For intubation, a neonatal laryngoscope, with straight
5 mins blades of sizes ‘0’ and ‘1’ is required. Before Lecture cum Powerpoint List down the
medications discussion medications
intubating, the appropriate blade is attached to the
handle of laryngoscope and the light is turned on. used to stimulate
the heart
MEDICATIONS-
The majority of infants requiring resuscitation will
have a response to prompt and effective ventilation
with 100% oxygen.
Indications-
When HR is not increasing despite adequate ventilation
with 100% oxygen & chest compression, then use
drugs to stimulate heart-
 ADRENALINE (1:10,000) : 0.1-0.3 ml/kg, IV
repeated every 3-5 min.
 Volume expanders (N/S, R/L, 5% albumin):
10 ml/kg, IV 5-10 min
 Sodium bicarbonate: prolonged cardiac arrest
1-2 meq/kg IV
 Naloxone hydrochloride: 0.1 mg/kg IV,
maternal history of narcotics use within 4 hours
 of birth.
Routes of Administration-
Umbilical vein is the preferred route.
Epinephrine may be injected directly into the trachea-
bronchial tree through Endotracheal Intubation. The
drug is injected by a syringe or a feeding tube into the
2 mins Conclude the endotracheal tube, flushed with 0.5 ml normal saline
topic and dispersed into the lungs by PPV.

CONCLUSION
Neonatal training in facilities reduces term intra-partum
related deaths by 30%. Yet, coverage of this
intervention remains low in countries where most
neonatal deaths occur and is a missed opportunity to
save lives. Expert opinion supports smaller effects of
neonatal resuscitation on preterm mortality in facilities
and of basic resuscitation and newborn assessment and
stimulation at community level.

ASSIGNMENT
Give assignment on the TABC of resuscitation.

RECAPITULATION
In order to recall about the topic, the following
questions will be asked-
 What is neonatal resuscitation?
 What are the indications of neonatal resuscitation?
 What are the equipments required for performing
neonatal resuscitation?
 What are the TABC of resuscitation?
  What is the resuscitation algorithm?
 What is endotracheal intubation?

SUMMARY
Resuscitation is used to assist the newly-born infant in
making the transition from dependent fetal to
independent neonatal life. The aim of a resuscitation
protocol should be the immediate reversal of
hypoxemia, hypercapnia, and circulatory insufficiency
in order to prevent permanent central nervous system
damage or damage to other organs. If optimal outcome
is to be achieved, a resuscitation protocol should be
directed immediately toward (1) clearing the upper
airway of secretions, meconium, or other materials so
that alveolar expansion can occur; (2) providing
adequate oxygenation and elimination of excessive
carbon dioxide; (3) ensuring adequate cardiac output;
and (4) keeping oxygen consumption to a minimum.

CLASS GROUP: P.B. B.Sc Nursing 1st Year Students

NAME OF THE SUBJECT: Nursing Education

NAME OF THE TOPIC: Neonatal resusctitation

METHODS OF TEACHING: Lecture cum Discussion and Demonstration

PREVIOUS KNOWLEDGE OF STUDENTS: Knowledge about postnatal period.

DURATION: 45 mins

DATE & TIME:

A.V. AIDS USED: Powerpoint, Video, Chart, Pamphlets, Blackboard.

VENUE: Classroom(P.B. B.Sc N 1st Yr)

TIME:

PLACE: CPMS College of Nursing

NAME OF THE EVALUATOR: Ma’am Bidyalaxmi Hijam

NAME OF THE STUDENT TEACHER: Ms. Tholeh Lalramdini Jongte

GENERAL OBJECTIVES
At the end of the class students will acquire in depth knowledge, develop skill and positive attitude towards neonatal resuscitation, its
indications, contraindications, the equipments required, resuscitation algorithm.
SPECIFIC OBJECTIVES-
The students will be able to-
 introduce the topic
 list down the indications and contraindications
 elaborate the resuscitation equipments
 explain the TABC of resuscitation
 describe the resuscitation algorithm
 describe positive pressure ventilation
 explain the chest compression
 explain endotracheal intubation
 list the medications
 CPMS COLLEGE OF NURSING

LESSON PLAN

ON

NEONATAL RESUSCITATION

SUBMITTED TO: SUBMITTED BY:

MAAM BIDYALAXMI HIJAM THOLEH LALRAMDINI JONGTE

ASSISTANT PROFESSOR ROLL NO.- 10

OBSTETRICS & GYNAECOLOGY NURSING M. Sc (N) 1st YEAR

CPMS COLLEGE OF NURSING CPMS COLLEGE OF NURSING