NBRC NPS EXAM WITH COMPLETE
SOLUTIONS
nitric oxide (NO) - ANS-: SUGGEST ON PATIENTS WITH PPHN (PERSISTENT
PULMONARY
HYPERTENSION OF THE NEWBORN WHEN OXYGENATION INDEX IS >25
MOA: REDUCES PULMONARY ARTERY PRESSURE, VASODILATION,
INCREASES Fi02 AND REDUCES PULMONARY SHUTING
What to monitor with nitric oxide admin - ANS-MONITOR NO2 (NITROGEN DIXOIDE)
LEVELS-OCCURS WHEN NO MEETS O2. LEADS TO PULMONARY EDEMA,
REBOUND HYPERTENSION
MONITOR METHEMOGLOBIN LEVELS
NITRIC OXIDE MUST BE WEANED AND NEVER ABRUPTLY DISCONTINUED DUE
TO REBOUND EFFECTS
Oxygen Index Formula - ANS-MAP (in cmH 2 O) × FiO 2 × 100 ÷ PaO2
ETT depth - ANS-= TUBE SIZE * 3
ETT DEPTH FOR PREEMIE (UNDER 3KG) = ADD 6 TO WEIGHT IN KG -ALWAYS
HAVE ONE HALF SIZE SMALLER AVAILABLE
CRICOID PRESSURE (SELLICK MANUEVER) : - ANS-USED TO PREVENT
REGURGUTATION, AIDS WITH VISUALIZATION OF THE GLOTTIS DURING
INTUBATIO
Gram positive organisms - ANS-USUALLY THE COCCI GROUP -DISEASES
ASSOCIATED : H. FLU, PNEUMONIA, PHARYNGITIS,
ENDOCARDITIS.
SPUTUM CULTURE: RULE OUT
ACID FAST STAIN -RULE OUT TB
Laryngotracheomalacia - ANS-- "Floppy airway", may present with stridor, expiratory
wheezing, worsens with agitation
Tracheoesophageal fistula (TEF)- - ANS-pathway between esophagus and trachea.
Requires surgical intervention
Choanal atresia- - ANS-Newborns are obligate nose breathers, respiratory distress will
present at birth in bilateral choanal atresia.
, the practitioner will be unable to pass suction catheters through nares. Requires
surgical intervention
Pierre Robin Syndrome - ANS-- Cleft palate, micrognathia (small jaw) and posterior
tongue. Prone positioning may alleviate symptoms until surgery can be performed.
Croup - ANS-Caused by mild viral illness
Barking cough
Subglottic narrowing
"Steeple Sign" on x-ray
Stridor at rest requires treatment such as racemic epi, corticosteroids, inhaled steroids,
oxygen
Epiglottis - ANS-Supraglottic swelling of the epiglottis
usually bacterial
high fever, sore throat, muffled voice, drooling
"thumb sign" on lateral neck x-ray
DO NOT directly visualize airway. DO NOT lay patient flat without a secure airway.
DO NOT SUCTION WITHOUT SECURE AIRWAY
intubate, start antibiotics and Corticosteroids
Central sleep apnea - ANS-Absence of respiratory effort during sleep
May be due to an immature respiratory drive (APNEA OF PREMATURITY)
May be associated with underlying conditions such as Ondine's Curse, Prader-Willi,
drugs, sepsis
Can occur with obstructive sleep apnea (mixed sleep apnea)
obstructive sleep apnea - ANS-Most commonly caused by large adenoids and tonsils,
also occurs with other predisposing factors I.E. obesity, Down Syndrome,
neuromuscular diseases, etc
Treatment includes fixing physical anomalies (I.E. having tonsils and adenoids
removed) or CPAP
Asthma - ANS-Disease of inflammation
Recurrent bronchospasm causing wheezing, sob and cough
Mucous plugging may lead to atelectasis
Confirmation requires PFT
May present with hypoxemia, acidosis
Use peak flow meter to assess obstruction. Green, Yellow, Red are the zones, Red
being the worst severity of obstruction
Treating Asthma - ANS-Inhaled corticosteroids- Ex: Budesonide (Pulmicort),
Beclomethasone
(Qvar), Fluticasone (Flovent). "controller" meds. Bronchodilators: Albuterol (B2 agonist)
for quick relief. Ipratropium
(Atrovent) - anticholinergic
, Systemic corticosteroids- prednisone or methylprednisone for acute asthma
exacerbation. Very important.
Mechanically ventilate 6-8ml/kg with low to moderate PEEP, monitor for auto-PEEP.
May need longer expiratory time.
Heliox and/or Magnesium Sulfate for severe exacerbations. (See Heliox slide.)
Bronchiolitis - ANS-Lower respiratory infection most common in infancy
Usually caused by Respiratory Syncytial Virus (RSV). Secondary pneumonia can occur
Thick mucus and inflammation blocks nasal passages and airways
Presents with nasal flaring, tachypnea, hypoxemia, retractions, accessory muscle use
Treatment-oxygen, suctioning, fluid maintenance
Severe respiratory distress and apnea may occur, requiring intubation
Synagis (palivizumab) - ANS-protects infants with chronic lung or heart disease from
RSV, very expensive, not always effective
CF - ANS-Autosomal recessive trait caused by a genetic mutation of the CFTR protein
Affects endocrine function- sweat glands, pancreas and lung
Complications of lung disease are the leading cause of death in CF patients.
Reoccurring infections common
Treat with chest physiotherapy, Pulmozyme, hypertonic saline, bronchodilators,
antibiotics
May see a question about pseudomonas on the test. A CF patient will have foul or
sweet smelling, green sputum. - ANS-Treat with antibiotics (ex: Tobi)
CF diagnosis - ANS-Diagnose is made with sweat chloride level greater than 60mEq/L.
PFTs show obstructive component
Spinal Muscular Atrophy - ANS-Hereditary disorder that is seen as progressive muscle
weakness due to gradual destruction of the spinal cord.
Onset may begin in infancy or later in life and may vary in severity.
Pts have weak cough,respiratory muscles. Subject to resp failure and pulmonary
infections.
Muscular dystrophy - ANS-Genetic disorder
Gradual progression of skeletal, respiratory
and cardiac muscle weakness.
Pts have weak cough,respiratory muscles. Subject to resp failure and pulmonary
infections.
Septic shock - ANS-- Hypotension due to severe infection. Treat with fluids, antibiotics,
pressors. May need ECMO for severe cardiac insufficiency Patient could enter
Multisystem Organ Failure (MSOF)
SOLUTIONS
nitric oxide (NO) - ANS-: SUGGEST ON PATIENTS WITH PPHN (PERSISTENT
PULMONARY
HYPERTENSION OF THE NEWBORN WHEN OXYGENATION INDEX IS >25
MOA: REDUCES PULMONARY ARTERY PRESSURE, VASODILATION,
INCREASES Fi02 AND REDUCES PULMONARY SHUTING
What to monitor with nitric oxide admin - ANS-MONITOR NO2 (NITROGEN DIXOIDE)
LEVELS-OCCURS WHEN NO MEETS O2. LEADS TO PULMONARY EDEMA,
REBOUND HYPERTENSION
MONITOR METHEMOGLOBIN LEVELS
NITRIC OXIDE MUST BE WEANED AND NEVER ABRUPTLY DISCONTINUED DUE
TO REBOUND EFFECTS
Oxygen Index Formula - ANS-MAP (in cmH 2 O) × FiO 2 × 100 ÷ PaO2
ETT depth - ANS-= TUBE SIZE * 3
ETT DEPTH FOR PREEMIE (UNDER 3KG) = ADD 6 TO WEIGHT IN KG -ALWAYS
HAVE ONE HALF SIZE SMALLER AVAILABLE
CRICOID PRESSURE (SELLICK MANUEVER) : - ANS-USED TO PREVENT
REGURGUTATION, AIDS WITH VISUALIZATION OF THE GLOTTIS DURING
INTUBATIO
Gram positive organisms - ANS-USUALLY THE COCCI GROUP -DISEASES
ASSOCIATED : H. FLU, PNEUMONIA, PHARYNGITIS,
ENDOCARDITIS.
SPUTUM CULTURE: RULE OUT
ACID FAST STAIN -RULE OUT TB
Laryngotracheomalacia - ANS-- "Floppy airway", may present with stridor, expiratory
wheezing, worsens with agitation
Tracheoesophageal fistula (TEF)- - ANS-pathway between esophagus and trachea.
Requires surgical intervention
Choanal atresia- - ANS-Newborns are obligate nose breathers, respiratory distress will
present at birth in bilateral choanal atresia.
, the practitioner will be unable to pass suction catheters through nares. Requires
surgical intervention
Pierre Robin Syndrome - ANS-- Cleft palate, micrognathia (small jaw) and posterior
tongue. Prone positioning may alleviate symptoms until surgery can be performed.
Croup - ANS-Caused by mild viral illness
Barking cough
Subglottic narrowing
"Steeple Sign" on x-ray
Stridor at rest requires treatment such as racemic epi, corticosteroids, inhaled steroids,
oxygen
Epiglottis - ANS-Supraglottic swelling of the epiglottis
usually bacterial
high fever, sore throat, muffled voice, drooling
"thumb sign" on lateral neck x-ray
DO NOT directly visualize airway. DO NOT lay patient flat without a secure airway.
DO NOT SUCTION WITHOUT SECURE AIRWAY
intubate, start antibiotics and Corticosteroids
Central sleep apnea - ANS-Absence of respiratory effort during sleep
May be due to an immature respiratory drive (APNEA OF PREMATURITY)
May be associated with underlying conditions such as Ondine's Curse, Prader-Willi,
drugs, sepsis
Can occur with obstructive sleep apnea (mixed sleep apnea)
obstructive sleep apnea - ANS-Most commonly caused by large adenoids and tonsils,
also occurs with other predisposing factors I.E. obesity, Down Syndrome,
neuromuscular diseases, etc
Treatment includes fixing physical anomalies (I.E. having tonsils and adenoids
removed) or CPAP
Asthma - ANS-Disease of inflammation
Recurrent bronchospasm causing wheezing, sob and cough
Mucous plugging may lead to atelectasis
Confirmation requires PFT
May present with hypoxemia, acidosis
Use peak flow meter to assess obstruction. Green, Yellow, Red are the zones, Red
being the worst severity of obstruction
Treating Asthma - ANS-Inhaled corticosteroids- Ex: Budesonide (Pulmicort),
Beclomethasone
(Qvar), Fluticasone (Flovent). "controller" meds. Bronchodilators: Albuterol (B2 agonist)
for quick relief. Ipratropium
(Atrovent) - anticholinergic
, Systemic corticosteroids- prednisone or methylprednisone for acute asthma
exacerbation. Very important.
Mechanically ventilate 6-8ml/kg with low to moderate PEEP, monitor for auto-PEEP.
May need longer expiratory time.
Heliox and/or Magnesium Sulfate for severe exacerbations. (See Heliox slide.)
Bronchiolitis - ANS-Lower respiratory infection most common in infancy
Usually caused by Respiratory Syncytial Virus (RSV). Secondary pneumonia can occur
Thick mucus and inflammation blocks nasal passages and airways
Presents with nasal flaring, tachypnea, hypoxemia, retractions, accessory muscle use
Treatment-oxygen, suctioning, fluid maintenance
Severe respiratory distress and apnea may occur, requiring intubation
Synagis (palivizumab) - ANS-protects infants with chronic lung or heart disease from
RSV, very expensive, not always effective
CF - ANS-Autosomal recessive trait caused by a genetic mutation of the CFTR protein
Affects endocrine function- sweat glands, pancreas and lung
Complications of lung disease are the leading cause of death in CF patients.
Reoccurring infections common
Treat with chest physiotherapy, Pulmozyme, hypertonic saline, bronchodilators,
antibiotics
May see a question about pseudomonas on the test. A CF patient will have foul or
sweet smelling, green sputum. - ANS-Treat with antibiotics (ex: Tobi)
CF diagnosis - ANS-Diagnose is made with sweat chloride level greater than 60mEq/L.
PFTs show obstructive component
Spinal Muscular Atrophy - ANS-Hereditary disorder that is seen as progressive muscle
weakness due to gradual destruction of the spinal cord.
Onset may begin in infancy or later in life and may vary in severity.
Pts have weak cough,respiratory muscles. Subject to resp failure and pulmonary
infections.
Muscular dystrophy - ANS-Genetic disorder
Gradual progression of skeletal, respiratory
and cardiac muscle weakness.
Pts have weak cough,respiratory muscles. Subject to resp failure and pulmonary
infections.
Septic shock - ANS-- Hypotension due to severe infection. Treat with fluids, antibiotics,
pressors. May need ECMO for severe cardiac insufficiency Patient could enter
Multisystem Organ Failure (MSOF)
