Bag mask ventilation is contraindicated to?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Explanation

In a congenital diaphragmatic hernia (CDH), abdominal organs are present in the chest cavity.
Bag-mask ventilation forces air into the stomach and intestines, which are located in the chest in CDH.
This inflation of the bowel compresses the underdeveloped lungs and shifts the heart, leading to severe cardiorespiratory compromise.
Therefore, BMV is absolutely contraindicated, and immediate intubation is required to secure the airway without inflating the gut.

Option A: Polycystic kidney disease is a renal disorder and does not pose a direct contraindication to the mechanics of bag-mask ventilation.
Option B: Cyanosis, or a blue discoloration of the skin, is a sign of hypoxia. It is a primary indication for initiating respiratory support, such as bag-mask ventilation, not a contraindication.
Option D: Birth asphyxia is a condition resulting from oxygen deprivation around the time of birth. It is one of the most common reasons to perform neonatal resuscitation, which frequently begins with bag-mask ventilation.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Bag-Mask Ventilation in Neonates as background academic context rather than a clinical decision trigger.
A key nursing assessment finding for CDH at birth is a scaphoid (sunken) abdomen, as the abdominal contents are in the chest. The nurse may also hear bowel sounds in the chest.
Recognizing these signs is critical to avoid the fatal error of using bag-mask ventilation.
What if? If a nurse starts BMV on an infant who then rapidly deteriorates, and a scaphoid abdomen is noted, they should immediately stop BMV, alert the team to the possibility of CDH, and prepare for emergency intubation and gastric decompression.

How to Approach the Question

First, identify the core of the question: it asks for a contraindication, meaning a reason not to perform the procedure.
The procedure is bag-mask ventilation (BMV), a form of positive pressure ventilation.
Consider the mechanism of BMV: it pushes air into the upper airway, which can enter both the lungs and the stomach.
Evaluate each option based on this mechanism:
Does polycystic kidney disease interfere with this process? No, it's a kidney issue.
Is cyanosis a reason to avoid giving oxygen/ventilation? No, it's a reason to provide it.

Concept Tested & Keywords

QLKEXUqa6439y06Uj4AvHm

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 1081-1083

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 158-160

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