Test Your Neonatal Critical Care Knowledge - page 3

by SteveNNP 16,063 Views | 52 Comments

So, by popular demand..... here is a thread dedicated to questions posed to help increase one's knowledge base in regards to the acute care NICU population. If anyone desperately wants a separate thread dedicated solely to the... Read More


  1. 0
    Quote from Humbled_Nurse
    Usually the proximal obstructions present with bilious vomiting, but the distal obstructions such as hirschsprungs, meconium ileus, and meconium plug syndrome do not present with bilious vomiting. Am I on the right track?
    I was also thinking hirschsprungs...
  2. 0
    I thought Hirschsprungs did present with vomiting. Maybe Intussecption(sp?)?I need to research more..
  3. 0
    Well, I was thinking pyloric stenosis. Because often these kids aren't vomiting until a couple to several weeks of life, when they start with the projectile vomiting. (not usually bilious?) So...it doesn't present with vomiting early in the newborn period, but I suppose technically it is still considered neonatal in the first 30 days. I'm just a little hung up on the exact meaning of the wording of your question.
  4. 0
    Steve? You still hear? I'm waiting on the edge of my seat.
  5. 0
    I'm still here! Sorry... been working a lot lately...haha


    The answer is pyloric stenosis. Every other intestinal obstruction whether proximal or distal results in some sort of bilious emesis/aspirates.

    Pyloric stenosis usually develops between 2-4 weeks of age.


    So let's talk about Hirschprung's disease...

    1. How does it present?
    2. What neonatal condition is Hirschprung's often associated?
    3. What diagnostic tests would you run if you suspected Hirschprung's?
    4. Describe briefly the pre and postop nursing care of an infant with Hirschprung's?
  6. 0
    Hirschprung's disease usually presents with failure to pass meconium within 24-48 hours of delivery. Imperforate anus may be associated with Hirschprung's disease. Diagnostically, I would expect a barium enema followed by a rectal biopsy. Preoperatively, I would expect the baby to be NPO and on IV fluids. Also, I would expect enemas to facilitate bowel movements. Postoperatively, I would provide pain management and the baby will be NPO and receiving parenteral nutrition.
  7. 0
    Here are the answers:

    1. How does it present?
    -failure to pass meconium in the first 48 hours
    -history of constipation
    -bilious vomiting and abdominal distention
    -enterocolitis (rarer)


    2. What neonatal condition is Hirschprung's often associated?
    -it can be associated with Trisomy 21

    3. What diagnostic tests would you run if you suspected Hirschprung's?
    -Abdominal xray, usually nonspecific
    -Barium enema - shows areas of dilatation and narrowing with a transitional zone
    -Rectal biopsy - definitive diagnosis... shows absence of innervation.

    4. Describe briefly the pre and postop nursing care of an infant with Hirschprung's?
    - Replogle to low suction, NPO, IVF, broad spectrum antibiotics due to increased peritonitis risk, and colonic irrigation.
    -Hirschprungs is treated surgically using a colostomy with later pull-through procedure, or a complete pull-through.
    -Postop, expect pain management, slow feeds after period of gastric decompression with replogle, ostomy care, also expect bowel dysmotility, stricture formation risk.
  8. 0
    Question:

    Why do infants receiving TPN require less total calories and fluids than infants on enteral feeds?
  9. 0
    Quote from SteveNNP
    Question:

    Why do infants receiving TPN require less total calories and fluids than infants on enteral feeds?
    hmm, because the nutrients/calories are placed directly into the blood stream and sent where needed compared to needing to use energy to digest through the stomach/digestive tract into the bloodstream and to the rest of the body???
  10. 0
    Exactly.

    You are attending the delivery of a 29 week c/s secondary to placental abruption. Mom received induction of general anesthesia with a narcotic. The baby arrives to your warmer floppy with no respiratory effort. You provide routine resuscitative measures, but the baby still has minimal resp effort. Your colleague starts to draw up an endotracheal dose of naloxone (Narcan) and prepares to give it to the baby. You tell her to wait....

    1) What info is important to know before giving Narcan, especially in a baby of mother who has abrupted?

    2) If your colleague had given Narcan, what adverse effects could have potentially occurred to the baby?


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