RNC-NIC Exam with Complete Solution

Correct ETT placement - ANSWER T1-T2 level of clavicles Correct UVC placement - ANSWER T 8-9 0.5-1 cm above diaphragm Tip in inf. vena cava Correct UAC placement - ANSWER Low-L3-4 Below renal arteries High- ...

Correct ETT placement - ANSWER T1-T2 level of clavicles Correct UVC placement - ANSWER T 8-9 0.5-1 cm above diaphragm Tip in inf. vena cava Correct UAC placement - ANSWER Low-L3-4 Below renal arteries High-T6-10 Correct PICC placement - ANSWER T3-5 Lower 1/3 of s. Vena cava Normal weight loss of preterm infant - ANSWER 10-15% Healthy term infant requires how many kcal/kg/day for normal growth? - ANSWER 100-120 kcal/kg/day Formula to calculate GIR - ANSWER ml/kg/day x %dextrose ➗1.44 Normal GIR - ANSWER 4-6 ml/kg/min initially May go as high as 12 Anomalies associated with esophageal atresia - ANSWER SGA VATER synd. -vertebral -imperf anus -renal dysplasia Increased risk of mec plug? - ANSWER -premature -IDM -small left colon -cystic fibrosis Signs of pyloric stenosis - ANSWER Distended stomach on x-ray with little or no gas below duodenum Can palpate "olive" Present at 2 to 3 weeks of life with Bile stained vomiting Normal temp range axillary - ANSWER 36.5 to 37.4°C TTN vs RDS - ANSWER Usually requires less than 40% FI O2 Improves quicker Larger lung volumes Natural diuresis occurs at_____________ hours of age as condition improves - ANSWER 48-72 hours Prolonged rupture of membranes - ANSWER Greater than 18 hours Difference in PaO2 of________ or greater documents ductal shunting - ANSWER 15% With PPHN goal is to keep PaO2 ________or > - ANSWER 50 Signs and symptoms of MAS - ANSWER Chest hyperinflated on x-ray Low PaO2 with O2 given Air leaks Prone to PPHN Treatment of micrognathia - ANSWER Prone positioning Oral airway placement Trach in rare cases Generally mandibular growth "catches up" by 6 to 12 months Surgery if significant compromise Micrognathia associated with - ANSWER Pierre Robin syndrome Trisomy 18 Trisomy 21 Cri-du-chat syndrome Causes of pulmonary hemorrhage - ANSWER Prematurity Erythroblastosis Intracranial hemorrhage Asphyxia Aspiration Heart diagnosis, PDA Sepsis Hypothermia Surfactant replacement Treatment of pulmonary hemorrhage - ANSWER Vent and use PEEP to decrease bleeding Transfused PRBC's as needed Treat clotting problems Assess and treat PDA Treat underlying disease processes Apneic event - ANSWER Cessation of respiration for 20 seconds, or less if accompanied by cyanosis, pallor, decreased tone, bradycardia Causes pulmonary hypoplasia - ANSWER 1) conditions that limit lung growth (CCAM, DH) 2) oligohydramnios (thoracic compression) 3) associated congenital malformations (Potters, phrenic nerve absence) Normal blood gas results - ANSWER ph 7.35-7.45 PaCO2 35-45 PaO2 50-80 HCO3 22-26 BE -2 to +2 Vent Setting VT (tidal volume) - ANSWER -Primary factor affecting oxygenation and ventilation -should be 4-5 ml/kg Vent Settings -To increase ventilation - ANSWER Increase rate Vent settings -to increase oxygenation - ANSWER Increase FiO2, PEEP, or VT Inclusion criteria for ECMO - ANSWER 1) GA > 34 weeks 2) BE > 2000 grams 3) reversible lung disease 4) no lethal anomalies or brain injuries 5) IVH Gr 2 or < 6) no significant bleeding issues Vent Setting Rate - ANSWER Set rate at 30-40/minute for respiratory failure Set rate at 20-30/minute for no respiratory failure Adjust to maintain PCO2 40-50 Rate >40/minute can lead to air trapping Vent setting PIP - ANSWER Determines VT and affects PaO2 Determined by weight, GA, lung compliance, & airway resistance 20 is appropriate for most preterm infants Look at chest wall movement Vent Setting PEEP - ANSWER Physiologic PEEP is about 2cm Usually set at 4-7cm >7 can cause air leaks Aids maintaining FRC Stabilizes and recruits atelectatic areas Increase compliance and V/Q mismatch Vent setting MAP - ANSWER Average distending pressure throughout complete respiratory cycle Major determinant of oxygenation Increased MAP causes barotrauma HFOV parameters - ANSWER 1) MAP 2) Amplitude-volume delivered 3) Frequency-3-15 Hz (1 Hz=60 breaths) Lasix dose - ANSWER 1-2mg/kg IV or po Digoxin works by - ANSWER Increasing intracellular calcium leading to a +inotropic effect which increases contractility Beta-lactam antibiotics include and work by - ANSWER PCN & cephalosporins Lysing bacterial cell walls Dexamethasone adverse effects - ANSWER -increased glucose levels -increase blood pressure -Poor weight gain -Increased risk of sepsis iNO effects - ANSWER Smooth muscle relaxant. Promotes relaxation of the pulmonary smooth muscles to facilitate perfusion of the lung in gas exchange iNO side effects - ANSWER May cause methemoglobinemia & decreased platelet aggregation Suggested vent settings for extubation - ANSWER IMV- 10-20/" PIP- 14-18 Vt - 3.5-5ml/kg FIO2- 21-30% Boot shaped heart on x-ray is diagnostic of - ANSWER Tetrology of Fallot CHD's with increased pulmonary bloodflow - ANSWER 1) PDA 2) VSD 3) ASD 4) endocardial cushion defect Most common CHD - ANSWER VSD (nearly 50%) Treatment of VSD - ANSWER 50-75% of small VSDs close on their own Large VSDs may get smaller Treat mild CHF with Digoxin and diuretics Surgery at 6 to 12 months of age if needed ASD s/s - ANSWER Failure to thrive Recurrent respiratory infections Most common CHD with Trisomy 21 - ANSWER Endocardial cushion defect Obstructive CHD's with pulmonary venous congestion - ANSWER 1) coarctation of aorta 2) aortic stenosis Most common CHD associated with Turner's syndrome - ANSWER Coarctation of aorta Treatment of coarctation of aorta -