Exam (elaborations)
RNC-NIC QUESTIONS AND ANSWERS FULLY SOLVED
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Exam of 16 pages for the course RNC-NIC at RNC-NIC (RNC-NIC)
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RNC-NICCorrect ETT placement - answerT1-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 - answerLow-L3-4
Below renal arteries
High-T6-10
Correct PICC placement - answerT3-5
Lower 1/3 of s. Vena cava
Normal weight loss of preterm infant - answer10-15%
Healthy term infant requires how many kcal/kg/day for normal growth? - answer100-120
kcal/kg/day
Formula to calculate GIR - answerml/kg/day x %dextrose ➗1.44
Normal GIR - answer4-6 ml/kg/min initially May go as high as 12
Anomalies associated with esophageal atresia - answerSGA
VATER synd.
-vertebral
-imperf anus
-renal dysplasia
Increased risk of mec plug? - answer-premature
-IDM
-small left colon
-cystic fibrosis
Signs of pyloric stenosis - answerDistended 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 - answer36.5 to 37.4°C
TTN vs RDS - answerUsually requires less than 40% FI O2
Improves quicker
Larger lung volumes
Natural diuresis occurs at_____________ hours of age as condition improves -
answer48-72 hours
Prolonged rupture of membranes - answerGreater than 18 hours
Difference in PaO2 of________ or greater documents ductal shunting - answer15%
With PPHN goal is to keep PaO2 ________or > - answer50
Signs and symptoms of MAS - answerChest hyperinflated on x-ray
Low PaO2 with O2 given
Air leaks
Prone to PPHN
Treatment of micrognathia - answerProne 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 - answerPierre Robin syndrome
Trisomy 18
Trisomy 21
Cri-du-chat syndrome
Causes of pulmonary hemorrhage - answerPrematurity
Erythroblastosis
Intracranial hemorrhage
Asphyxia
Aspiration
Heart diagnosis, PDA
Sepsis
Hypothermia
Surfactant replacement
Treatment of pulmonary hemorrhage - answerVent and use PEEP to decrease bleeding
Transfused PRBC's as needed
Treat clotting problems
Assess and treat PDA
Treat underlying disease processes
, Apneic event - answerCessation of respiration for 20 seconds, or less if accompanied
by cyanosis, pallor, decreased tone, bradycardia
Causes pulmonary hypoplasia - answer1) conditions that limit lung growth (CCAM, DH)
2) oligohydramnios (thoracic compression)
3) associated congenital malformations (Potters, phrenic nerve absence)
Normal blood gas results - answerph 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 - answerIncrease rate
Vent settings
-to increase oxygenation - answerIncrease FiO2, PEEP, or VT
Inclusion criteria for ECMO - answer1) 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 - answerSet 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 - answerDetermines 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 - answerPhysiologic PEEP is about 2cm
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