Exam (elaborations)
RNC NIC Exam Questions and answers | With complete solution 2024/25
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RNC NIC Exam Questions and answers | With complete solution 2024/25
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RNC NIC Exam Questions and answers |With complete solution 2024/25
GIR - 6-8mcg/kg/min caloric intake
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ii D10 Bolus - 2mL/kg ii ii ii ii ii
ii Fluid Volume Bolus - 10mL/kg ii ii ii ii ii ii
Term Parenteral Fluid Requirement - 80mL/kg/day
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Enteral 100-150 mlk/kg/day ii ii
Preterm Parenteral Fluid Requirement - 120
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Enteral 150-200ml/kig/day ii
ii GIR Calculation - (%dextrose x IV rate) / (6 x wt in kg)
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ii I/T ratio - %Metas + Bands / %Metas + Bands + Segs
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I/T ratio greater than >0.2 to >.25 suggestive of infection
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>0.8 associated with shock ii ii ii
Absolute Neutrophil COUNT - WBC x (%) Segmented neutrophils + band neutrophils +
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metamyelocytes
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Example. 15,000 x 35 segs + 15 bands + 3 metas (turns into percent) ii ii ii ii ii ii ii ii ii ii ii ii ii
15,000 x .53 = 7950 ii ii ii ii
ANC <1800 suggestive of infection
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Normal Range ii
ii Mature WBCs - Poly, Segs, Neutrophils ii ii ii ii ii ii ii
ii Immature WBCs - Meta, Bands, Stabs ii ii ii ii ii ii ii
Platelet Range - 150-400k
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Thrombocytopenia (< 100,000/mm 3 ): possible association with bacterial sepsis or viral ii ii ii ii ii ii ii ii ii ii ii
infection, but usual onset does not occur until 1 to 3 days after infection onset (late
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indicator). May also occur with maternal HELLP syndrome ( h emolysis, e levated l iver
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function test results, and l ow p latelet count), pregnancy-induced hypertension, and
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intrauterine growth restriction, as well as some syndromes such as trisomies 13, 18, and
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21, Turner's syndrome, and hemolytic disease.
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ii CRP level - CRP level usually <1.6 for the first two days of life
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,Elevated cord blood CRP levels are associated with chorioamnionitis with prolonged
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rupture of membranes.
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Most common pathogens - Currently, GBS
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E. coliii
Candidas - -Diaper dermatitis presents with intense erythema and satellite lesions.
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ii
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-Congenital candidiasis presents with widespread erythematous maculopapular rash, and ii ii ii ii ii ii ii ii
preterm infants may present with pneumonia.
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Congenital CMV infection - congenital infection include: intrauterine growth restriction,
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hepatosplenomegaly, jaundice, purpura, pneumonitis, microcephaly, hydrocephalus,
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intracerebral calcifications, hearing loss, chorioretinitis, and optic atrophy.
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ii Endotracheal Measurement - 6 + wt in kg ii ii ii ii ii ii ii ii ii ii
Proper placement on an endotracheal tube is midway between the thoracic inlet and the
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carina.
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Polyethelane Wrap for Infant < 29 weeks - Dry infants head only
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Place infant in bag, from neck down
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Remove bag once infant is in an NTE and humidified environment
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UAC Placement - High Placement T6-T9
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Low Placement L3-L4
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UVC Placement - 1 to 2cm above the diaghragm
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Low Lying 2-4cm in the cord
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Chest Tube Placement - Mid Clavicular line with distal chest tube hole inside the thoracic
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space
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lecithin/sphingomyelin (L/S) ratio - An L/S ratio greater than 2:1 is considered to indicate
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fetal lung maturity.
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Anatomic events Five stages of lung development - 1. Embryonic development (weeks 1
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to 5). The endoderm-derived embryonic foregut provides a single lung bud that begins to
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divide ventrocaudally through the mesenchyme surrounding the foregut. The pulmonary
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vein develops and extends to join the lung bud. The trachea develops at the end of the
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embryonic period. There are three divisions on the right side and two on the left side that
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will eventually become the lobes of the lungs.
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ii
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2. Pseudoglandular period (weeks 6 to 16). All conducting airways are formed. Cartilage
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appears; main bronchi are formed; demarcation of major lobes occurs; formation of new
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bronchi is complete; capillary bed is formed with connecting bronchial blood supply; no
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connection made with terminal air sacs. The lung at this time undergoes 14 more
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,generations of branching and the formation of the terminal bronchioles. The lung
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resembles an exocrine organ because of surrounding loose mesenchymal tissues, hence
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the name pseudoglandular .
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3. Canalicular period (weeks 16 to 26). Formation of gas-exchanging acinar units (i.e.,
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respiratory units). The appearance of glycogen-rich cuboidal cells and inclusions for
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surface-active material storage are seen; capillaries invade terminal airway walls; type II
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alveolar epithelial cells appear. Airway changes from glandular to tubular and increases in
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length and diameter. Vascular system proliferates and the capillaries are now closer to the
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epithelium-conducting airways. Respiratory bronchioles that will participate in gas
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exchange can be differentiated.
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4. Terminal sac period (weeks 26 to birth). Around week 26 alveolar sacs are formed; air-
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blood surface area is limited for gas exchange; and type II cells are unable to release
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surfactant in sufficient quantity to maintain air breathing. Capillary loops increase; type II
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cells cluster at alveolar ducts, beco
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IUGR asymmetrical - Weight low for Gestation Age
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Head Sparing (less restriction on brain growth)
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Old man appearance
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Appear wasted, thin ii ii
Results from: Poor Placental function ii ii ii ii
Maternal Hypertension* ii
Smoking
IUGR Symmetric - Lower weight, height, length, and head circumference for gestational
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age
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Results from intrauterine viral infection, chromosomal genetic abnormalities, long standing
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disease
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ii Prostaglandin E1 (alprostadil) - Prevent premature closure of the PDA ii ii ii ii ii ii ii ii ii ii ii
Side Effects: Apnea, hypotension, hyperthermia, bradycardia
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Indomethicin (NSAID - 1. Hypoglycemia
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2. Platelet dysfunction
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3. Gastrointestinal perforation w/ steroids
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4. Renal effects, decreases urine output!
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Used if PDA fails to close to prevent pulmonary over circulation and PPHN
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Diuretics effects - 1. Metabolic Alkalosis
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2. Ototoxicity
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3. Decreased calcium absorption in bones
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ii Theophylline - Bronchodilator. Opens airways. ii ii ii ii ii ii ii
, Short half life, caffeine preferred treatment due to longer half life and more tolerable side
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effect profile.
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Digoxin - Enhances contractility
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Inhibits Na + K+ ATP ii ii ii ii
Reduces HR, CI'd if HR <60 ii ii ii ii ii
Hypokalemia increases drug concentration ii ii ii
Most frequent disorder associated with downsyndrome - Deudonal Atresia
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Double Bubble ii
May see VSD, AV Canal, Tetralogy of Fallot
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ii Upper GI Gold Standard for - Malrotation
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Position for gastroschesis - Lateral (side lying) to prevent occlusion of the mesenteric
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arteries that supply blood to the bowel. Tie bag to the axilla.
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ii VACTERAL, associated with what two disorders? - TEF/EA ii ii ii ii ii ii ii ii ii
vertebral defects ii
anal atresia
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cardiac anomalies ii
trachoesophageal fistula ii
radial defects ii ii
renal and limb anomalies
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Hirschbrung Disease - Starts in distal rectum
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Clinical sign : failure to pass meconium within first 24-48 hours
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May be associated with bilious emesis and a distended abdomen
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Associated with CF ii ii
Types of test to determine diagnosis: Barium enema, biopsy of rectum
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Congenital Diaphragmatic Hernia - Space occupying lesion, intestinal contents fill the
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lung cavity
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Presents with a scaphoid abdomen, barrel chest ii ii ii ii ii ii ii
Can result in pulmonary hypoplasia, pulmonary hypertension
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Requires intubation, HFOV, ECMO ii ii ii
Insert OG or NG tube ii ii ii ii ii
CPAP is Contraindicated! ii ii
Clinical Signs of Pyloric Stenosis - Dehydration
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Non bilious projectile vomiting
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Peristaltic waves in the epigastrium ii ii ii ii ii
Electrolyte disturbances ii
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