A nurse discovers an unresponsive 3-month-old infant in the nursery who is not breathing and has no pulse. Which action should the nurse take first when initiating CPR for this infant?

For an unresponsive infant without breathing or pulse, immediate chest compressions are prioritized first. Other options delay compressions: airway opening, rescue breaths, or pulse checks should follow after starting compressions.

Core Nursing Explanation Key Concept Analysis: This question tests the critical, life-saving sequence of Cardiopulmonary Resuscitation (CPR) for an infant. The core principle is the C-A-B (Compressions-Airway-Breathing) sequence for a patient who is unresponsive, not breathing, and pulseless. For infants and children, the sequence is the same as for adults when the arrest is witnessed or the cause is cardiac. However, the scenario implies a sudden discovery (unwitnessed), but the key is that the nurse has already assessed the infant as having no breathing and no pulse. Once that determination is made, the priority is to begin high-quality chest compressions immediately to circulate oxygenated blood to the brain and heart.

Answer Rationale: Key Point! The correct answer is to begin chest compressions first. The American Heart Association (AHA) guidelines emphasize that for any unresponsive victim without normal breathing and no definite pulse, rescuers should start CPR with chest compressions (C-A-B). Delaying compressions to open the airway, give breaths, or re-check the pulse reduces the chance of survival. For an infant, compressions are performed with two fingers on the lower half of the sternum, compressing at least one-third the anterior-posterior depth of the chest (about 1.5 inches or 4 cm).

Distractor Analysis:
• Watch out for confusion! Option ② describes opening the airway, which is part of the old A-B-C sequence. The current C-A-B sequence prioritizes compressions to minimize delay in circulating blood.
• Option ③ suggests giving breaths first. While ventilation is crucial, especially in pediatric arrests which are often respiratory in origin, once the patient is identified as pulseless, compressions must start first. The two initial breaths are no longer given before starting compressions in the C-A-B sequence.
• Option ④ involves checking the pulse for 10 seconds. The nurse has already determined there is "no pulse." Re-checking or spending additional time confirming would only delay the initiation of vital chest compressions.

Related Concepts: The C-A-B sequence applies to infants, children, and adults for cardiac arrest. The differences lie in compression technique (two fingers for infant single rescuer, two-thumb encircling for two rescuers), depth, and compression-to-ventilation ratio (30:2 for single rescuer, 15:2 for two-rescuer infant/child CPR). The initial assessment sequence is still to check for responsiveness, shout for help, check for breathing and pulse simultaneously (taking no more than 10 seconds), and then begin CPR if absent.

Nursing Clinical Practice Guide Clinical Scenario: You are working in the newborn nursery. During routine checks, you find a 3-month-old infant lying still, not crying, and not moving. You immediately shout for help, gently tap the infant's foot, and get no response. You look for chest rise and feel for a pulse at the brachial artery for no more than 10 seconds. You confirm no breathing and no pulse.

Nursing Intervention Strategy: 1. Activate Emergency Response: If alone, after confirming unresponsiveness, shout for help/activate the code blue system, then immediately begin CPR. If another person is present, send them to activate the emergency response and retrieve the crash cart and AED (with pediatric pads). 2. Initiate High-Quality CPR (C-A-B): • C (Compressions): Place the infant on a firm, flat surface. Using two fingers (index and middle) on the lower half of the sternum (just below the nipple line), compress at least 1/3 the depth of the chest (approx. 1.5 inches) at a rate of 100-120 compressions per minute. Allow full chest recoil. • A (Airway): After 30 compressions (if single rescuer), open the airway using a head-tilt chin-lift maneuver. For an infant, be careful not to over-extend the neck. • B (Breathing): Give 2 effective breaths using a bag-mask device, ensuring visible chest rise with each breath. If the first breath doesn't make the chest rise, reposition the airway before attempting the second breath. 3. Continue Cycles: Continue cycles of 30 compressions to 2 breaths if alone. If a second rescuer arrives, switch to a 15:2 ratio and consider using the two-thumb encircling hands technique for compressions. 4. Use AED: As soon as an AED arrives, apply pediatric pads and follow its prompts. Resume CPR immediately after shock delivery or if no shock is advised.

Patient Safety and Precautions: • Minimize interruptions in chest compressions. Limit pauses to less than 10 seconds for interventions like switching rescuers or AED analysis. • Ensure the surface under the infant is firm. Compressing on a soft mattress is ineffective. • Avoid compressing over the xiphoid process (tip of the sternum) to prevent internal organ injury. • For a suspected or confirmed airway obstruction as the cause, the sequence may involve giving 5 back blows and 5 chest thrusts before starting CPR, but this question specifies an unresponsive, pulseless infant, so standard CPR is initiated.

Nursing Procedure & Medication Flow Infant CPR Procedure (Single Rescuer): 1. Ensure scene safety. 2. Check responsiveness (tap & shout). 3. Shout for help/activate emergency response. 4. Check for no breathing or only gasping AND check pulse (brachial/femoral) simultaneously for ≤10 seconds. 5. If NO pulse: Begin CPR with 30 CHEST COMPRESSIONS. 6. Open airway (head-tilt chin-lift). 7. Give 2 breaths (1 second each, visible chest rise). 8. Continue cycles of 30:2 until help arrives, an AED is ready, the infant shows signs of life, or you are too exhausted to continue.

A Word from Your Senior Nurse "In a code, seconds feel like hours, and panic is the enemy. Muscle memory from practice is your best friend. Remember: for a pulseless patient, your hands on their chest are the only thing pumping blood to their brain. Don't delay for breaths, don't delay for another pulse check—push hard, push fast, and start immediately. On the NCLEX, they are testing your ability to prioritize the action that will most directly impact survival. In this scenario, that action is starting chest compressions without delay."