Test Your Neonatal Critical Care Knowledge - page 3

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... Read More

  1. by   SteveNNP
    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.
  2. by   SteveNNP

    Why do infants receiving TPN require less total calories and fluids than infants on enteral feeds?
  3. by   ittybabyRN
    Quote from SteveNNP

    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???
  4. by   SteveNNP

    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?
  5. by   littleneoRN
    Well, you want to know if there is any history or suspected history of narcotic abuse. The Narcan would be an antagonist not only to the narcotic from the general anesthesia but also drugs of abuse in the baby's system, sending him into immediate and abrupt withdrawal.
  6. by   darynash
    Giving narcan to a baby that has illegal drugs in their system can cause seizures and in a 29-weeker, then a head bleed. When I did L&D, they always told us never to give narcan to a mom with no prenatal care (may be an illegal drug user). Am I close?
  7. by   Humbled_Nurse
    Abruption can possibly be a result of drug abuse in the mother so Narcan would not be indicated.
  8. by   SteveNNP
    Very good! You guys know your stuff!

    Here's another one.

    Why do we start babies on vanilla TPN or clear IV fluid without electrolytes for the first few days of life?....and what do we look for when getting ready to add electrolytes to TPN?
  9. by   gudiarani
    Kidney function, right? And also the existing electrolyte balance before giving electrolytes. The first set of lab values is mostly mom's. We wait for more accurate labs within the first 24 hours to have a better look at the BABY's electrolyte balance.
  10. by   gudiarani
    Never heard it called "vanilla TPN"!! haha
  11. by   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.
  12. by   babyNP.
    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 <1500 gram infants within the first two days of life; something about better brain development.
  13. by   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?