RNC-NIC EXAM WITH COMPLETE SOLUTIONS
(A+ GRADED)
Treatment of gastroschisis or omphalocele - ANSWER Place in sterile owl bag
Cover defect with warm sterile moist dressings
Maintain NPO and gastric decompression
Maintain sidelying position
Bilious vomiting - ANSWER An obstruction distal to Ampulla of Vater
s/s of TEF/EA - ANSWER Copious oral secretions, drooling
Polyhydramnios
Small stomach on ultrasound
Coughing, choking, respiratory distress, or cyanosis
Recurrent pneumonia
Infants with EA or TEF should have an evaluation of which three systems? - ANSWER 1)
cardiac system
2) renal system
3) skeletal system
Treatment of TEF/EA (pre-op) - ANSWER Elevate HOB
Ventrol to drain
Minimize crying to decrease swallow air
No CPAP, intubate if need respiratory support
,Treatment of TEF/EA (post-op) - ANSWER Ventilate with low MAP
Avoid need to re-intubate & only by experienced practitioners
Suction length of ETT only
Pyloric stenosis - ANSWER Obstruction of pylorus caused by hypertrophy of pyloric
musculature
Associated with Apert's syndrome trisomy 18 and
trisomy 21
Pyloric stenosis incidence - ANSWER More common in white, full-term infants
Trisomy 21
Males 5:1
Pyloric stenosis treatment - ANSWER May resolve spontaneously before one year of life
Provide nutritional support
May need surgical repair
Duodenal stenosis atresia associated with - ANSWER Trisomy 21
CHD
Intestinal malrotation
TE abnormalities
Anorectal defects
Duodenal atresia stenosis s/s - ANSWER Polyhydramnios
Abdominal distention
No stools
Bilious vomiting within 24 hours
, "Double bubble" on xray - ANSWER Duodenal atresia
Malrotation - ANSWER Assortment of intestinal anomalies of rotation & retroperitoneal
fixation (occurs 6-10 weeks gestation)
Malrotation s/s - ANSWER Most have symptoms first week of life
Bileous vomiting
Abdominal distention
Abdominal pain
s/s shock /sepsis
Rectal bleeding
Meconion ileus - ANSWER Mechanical obstruction of distal ileum due to intraluminal
accumulation of thick meconium
Predominant cause cystic fibrosis
Meconium ileus s/s - ANSWER Abdominal distention of birth
Bilious vomiting
Failure to pass meconium in 12-24 hours
Abdominal x-ray shows "soap bubble" or ground glass appearance of distal intestine
Meconium ileus treatment - ANSWER Hypertonic contrast water soluble enema
(draws fluid into the intestine)
Works for 60% of patients
Surgical treatment
(A+ GRADED)
Treatment of gastroschisis or omphalocele - ANSWER Place in sterile owl bag
Cover defect with warm sterile moist dressings
Maintain NPO and gastric decompression
Maintain sidelying position
Bilious vomiting - ANSWER An obstruction distal to Ampulla of Vater
s/s of TEF/EA - ANSWER Copious oral secretions, drooling
Polyhydramnios
Small stomach on ultrasound
Coughing, choking, respiratory distress, or cyanosis
Recurrent pneumonia
Infants with EA or TEF should have an evaluation of which three systems? - ANSWER 1)
cardiac system
2) renal system
3) skeletal system
Treatment of TEF/EA (pre-op) - ANSWER Elevate HOB
Ventrol to drain
Minimize crying to decrease swallow air
No CPAP, intubate if need respiratory support
,Treatment of TEF/EA (post-op) - ANSWER Ventilate with low MAP
Avoid need to re-intubate & only by experienced practitioners
Suction length of ETT only
Pyloric stenosis - ANSWER Obstruction of pylorus caused by hypertrophy of pyloric
musculature
Associated with Apert's syndrome trisomy 18 and
trisomy 21
Pyloric stenosis incidence - ANSWER More common in white, full-term infants
Trisomy 21
Males 5:1
Pyloric stenosis treatment - ANSWER May resolve spontaneously before one year of life
Provide nutritional support
May need surgical repair
Duodenal stenosis atresia associated with - ANSWER Trisomy 21
CHD
Intestinal malrotation
TE abnormalities
Anorectal defects
Duodenal atresia stenosis s/s - ANSWER Polyhydramnios
Abdominal distention
No stools
Bilious vomiting within 24 hours
, "Double bubble" on xray - ANSWER Duodenal atresia
Malrotation - ANSWER Assortment of intestinal anomalies of rotation & retroperitoneal
fixation (occurs 6-10 weeks gestation)
Malrotation s/s - ANSWER Most have symptoms first week of life
Bileous vomiting
Abdominal distention
Abdominal pain
s/s shock /sepsis
Rectal bleeding
Meconion ileus - ANSWER Mechanical obstruction of distal ileum due to intraluminal
accumulation of thick meconium
Predominant cause cystic fibrosis
Meconium ileus s/s - ANSWER Abdominal distention of birth
Bilious vomiting
Failure to pass meconium in 12-24 hours
Abdominal x-ray shows "soap bubble" or ground glass appearance of distal intestine
Meconium ileus treatment - ANSWER Hypertonic contrast water soluble enema
(draws fluid into the intestine)
Works for 60% of patients
Surgical treatment
