Test Your Neonatal Critical Care Knowledge

[SteveNNP]

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 Well Newborn, we'll have to talk to Elvish about that one

So here's the plan. I'll pose a question drawn from an experience I've had, a clinical scenario I've formulated, or concepts I come across in the literature and board exam review. I will try to keep it in the vein of the NICU nurse, which will be interesting, since I've been saturated in NNP classes for a few years now.

Let's also keep in mind (and we all know this) that practice varies WIDELY from unit to unit. Feel free to answer based on your personal practice, but let's all keep in mind that the "book" answer may be different.

A little about me:

I have been practicing in NICU for almost 5 years, two in a level IIIb, and nearly 3 in a level IIIc quaternary NICU. I have had the privilege of caring for ECMO, pre/postop open hearts, single-lung ventilation, etc, as well as the gamut of preemie and surgical diagnoses. I finished up my NNP grad degree last December, and I'm now in the process of studying for my national certification/boards, as well as looking for a NNP position.

So here goes...

[theatredork]

We start them on vanilla TPN because the kidneys don't have the ability to concentrate urine initially. We look for increased diuresis during the 48-72 hour window before adding electrolytes into the mix.

[babyNP., APRN]

Hmm...when we get admits of brand new infants, we give them D10 with calcium...there's also this new thing we're trying out giving them special types of protein for the

[wannabesedated]

Since it's been a year I thought it was time to bring this thread back! I'll start..

Your patient is a one-week old boy presenting with six episodes of non-bilious vomiting within the last 2 days and reduced urine output for the last 12 hours. He is also lethargic and is feeding poorly. There is no history of fever or diarrhea. His antenatal history is uncomplicated, with a birth weight of 3.2 kg. He was breastfed from birth.

1. What do you think could be going on?

2. How should this be treated?

[NotReady4PrimeTime, RN]

Sounds like pyloric stenosis. Stabilization with IV fluids is first. Treatment is surgical - pyloromyotomy.

[wannabesedated]

That's a good guess Jan and it definitely does fit in with the clinical picture. Pyloric stenosis typically presents in the first few weeks of life with episodes of nonbilious emesis that gradually become more frequent and projectile. I chose a tough one here so I'll give you a clue. Serum electrolytes were drawn:

Na: 129

K: 6.9

Cl: 105

[NeoPediRN]

Salt wasting disorder of some kind, guessing hypoaldosteronism secondary to something like CAH? In which aggressive rehydration and steroids are necessary.

[NotReady4PrimeTime, RN]

I think we have a winner. It's hard to suss out a diagnosis when the only clues one has are non-specific. Having the labs made all the difference.

[wannabesedated]

You're right NeoPedi. As Jan says, the labs made all the difference in the diagnosis. In a vomiting patient, we would expect to see low Cl and K. The hyponatremia & hyperkalemia are suggestive of a salt wasting disorder and in this case it is CAH (congenital adrenal hyperplasia).

CAH is a term used for a group of autosomal recessive disorders, involving a deficiency in cortisol, aldosterone, or both. The most common form of CAH is due to a deficiency of 21-hydroxylase (which is required for the production of cortisol). The deficiency of cortisol can lead to overstimulation of the adrenal cortex, resulting in overproduction of androgens. Infants may present with ambiguous genitalia or salt wasting. Symptoms of the salt wasting form can be non-specific and involve vomiting, weight loss, lethargy and dehydration. The clue to diagnosis is in the labs which show hyponatremia, hyperkalemia, metabolic acidosis and hypoglycemia.

Treatment includes rehydration with saline & dextrose, as well as steroids (to replace the deficiency in cortisol, which is the primary reason for salt wasting).

[khvegas]

so with keeping this thread going lets go into the environment and handling of the neonate and things to support development. here is a few questions to answer (which should be interesting to see the different responses based on the experience of nurses here)!

1. what type of handling aids in myelinization by increasing hypothalamic activity? with the increase of hypothalamic activity which hormone is also produced by this type of handling?

while at the same time in preterm infants this type of handling suggests that it also increases increased levels of insulin.

**hint this should not be used in acutely ill preterm infants and should be confined to preterm growers.

2. in the nicu environment we all know noise is a big issue. can someone list at 3-5 cardiorespiratory changes that occur with loud noise, how the baby will react to the loud noise, an interesting thing i found was that an increase in cerebral blood flow from loud noise causes an increased risk for ________________ ______________ (two words).

*we know it disturbs sleep wake cycle so we can leave that out*

hopefully these are some good interesting questions (and not too easy).

about me: i am currently in my preceptorship during my nursing program and placed in the nicu (which i love and want to be here my whole nursing career)!

[mrs.-nancy]

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 Well Newborn, we'll have to talk to Elvish about that one :DSo here's the plan. I'll pose a question drawn from an experience I've had, a clinical scenario I've formulated, or concepts I come across in the literature and board exam review. I will try to keep it in the vein of the NICU nurse, which will be interesting, since I've been saturated in NNP classes for a few years now. Let's also keep in mind (and we all know this) that practice varies WIDELY from unit to unit. Feel free to answer based on your personal practice, but let's all keep in mind that the "book" answer may be different. A little about me:I have been practicing in NICU for almost 5 years, two in a level IIIb, and nearly 3 in a level IIIc quaternary NICU. I have had the privilege of caring for ECMO, pre/postop open hearts, single-lung ventilation, etc, as well as the gamut of preemie and surgical diagnoses. I finished up my NNP grad degree last December, and I'm now in the process of studying for my national certification/boards, as well as looking for a NNP position.So here go Hello, I 'm RN and I worked for 9 years in a NICU in Argentina. I read all your experience and is wonderful to read it, that keep me updated, but I would like knowing some acronym that I don't understand, can you clear them for me please. Thanks you so much.

[mrs.-nancy]

Hello, I 'm RN and I worked for 9 years in a NICU in Argentina. I read all your experience and is wonderful to read it, that keep me updated, but I would like knowing some acronym that I don't understand, can you clear them for me please. Thanks you so much.

[prmenrs, RN]

@Mrs.-nancy---

What acronym don't you understand?