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Neonatal Physiology > Test 3 - F&E, Hematology > Flashcards

Test 3 - F&E, Hematology Flashcards

1
Q

What part of the body water is 2/3 of the compartment. Its in all cells including RBC

A

Intracellular Fluid

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2
Q

The compartment that holds the plasma (intravascular) and the space between the cells (interstital)

A

Extracellular Fluid

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3
Q

Where is the most water lost in the first few days of life? And what affects this?

A

The ECF, Na and H2O

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4
Q

What is the normal value of serum osmolaity? and it is determined by?

A

270-300osm/kg/water

determined by the solute

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5
Q

How is the balance of the compartments maintained?

A

Osmosis - moves from high to low

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6
Q

What regulates water and sodium in the ECF to maintain a balance and not have edema?

A

The kidneys

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7
Q

What is the primary cation and anion in the ECF?

A

Na +

Cl-

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8
Q

Water balance is regulated by _____ in the ECF?

A

Colloid osmotic pressure

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9
Q

What molecules are in the ICF?

A

K+
Mg+
PO4-

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10
Q

Water balance is regulated by _____ in the ICF?

A

K+ and Na-K-ATPase pump

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11
Q

What factors contribute to an increase in % of water and TEWL?

A

lower gestational age

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12
Q

What are two major factors that affecct fluid calculations?

A

gest age and kidney function

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13
Q

at 12 weeks gest, how much is the total body water in a neonate?

A

94% (water balloon)

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14
Q

What problems can be associated with excess fluid intake?

A

PDA, NEC, BPD

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15
Q

What is the “Physiologic” weight loss in the neonate?

what is considered pathologic?

A

5-10% BW in term

> 20%

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16
Q

What % of total fluid requirements should be accounted for TEWL?

A

30%

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17
Q

What % of IWL is from the lungs and can be increased with tachypnea
Skin IWL?

A

20-30%

70%

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18
Q

What are three major causes of water loss D/T the renal system?

A

diuretics, osmotic diuresis(glucosuria), Congential adrenal hyperplasia

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19
Q

What causes a decrease in renal water loss

A

renal faliure, SIADH, CHF

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20
Q

There is an increase in glomerlus until weeks_____

A

34-35 weeks

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21
Q

What hormone is secreted by the pituitary in resonse to a decrease in IF volume. it conserves water to help increase BV

A

Antidiuretic hormone (vasopressin)

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22
Q

What is secreted by the adrenal cortex, and helps balance K+ which then reabsorbs water and Na+ to increase fluid retention

A

Aldosterone

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23
Q

What hormone system is released by the kidneys, vasoconstrictor, and releases aldosterone?

A

RAAS

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24
Q

What is triggered when there is a vol overload and the atria is distended? it is triggered when there is too much Na and H2O retention

A

Atrial natriuretic peptide (ANP)

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25
Q

What % of loss should be evaluated for possible excessive fluid administration? and what infant a less of a loss of BW?

A

<2% and SGA infants

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26
Q

What is a good and early sign of water loss?

and an early sign of metabolic acidosis?

A

weak pulses, with cap refill >3sec

tachypnea

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27
Q

A Na+ of <280 suggests?

A

SIADH because serum is too dilute

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28
Q

A pH < 7.28 and a base deficit >5 suggests

A

dehydration

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29
Q

What is the normal range for the Anion Gap? What causes an increase in the Gap?

A

5-15 (Na+K)-(Cl +HCO3)

dehydration, poor perfusion, lactic acidemia

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30
Q

How much fluid should be given if Acute Tubular Necrosis (ATN) is seen with asphyxia. Need to be very tight because renal system can’t handle too much fluid

A

40-60ml/kg/day

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31
Q

How much does a 1500-2000gm infant need in TF replacement in the 1st 48Hours of birth?

A

80-110ml/kg/day

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32
Q

How much does a 1500-2000gm infant need in TF replacement in the 1st 7 dys of life?

A

110-150 ml/kg/day

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33
Q

When an infant presents with edema, hyponatremia, low SP, low serum osmolality with Increased HR, RR, and urine output, you know this is a sign of

A

Excessive fluid intake = puffy baby

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34
Q

When an infant presents with metabolic accidosis, sunken fontanel, decrease UO, Increase in HR, RR, Na, BUN, Creatinine, you know this is

A

signs of fluid deficcits

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35
Q

What signs are usually seen first in dehydrated infants?

A

the physical signs

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36
Q

What is the major ECF cation? and is needed for tissue growth?

A

Na+

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37
Q

What is the maintenance level for
Na+
K+

A

> 30wks = 2-3mEq/kg/d

2-3mEq/kg/d

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38
Q

What are the two causes of hyopnatremia?

A

> 130mEq/L

  • Dilutional (vol. overload)
  • inadequate intake/losses
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39
Q

What prob with Hyponatremia is caused by CNS probs? and how do you treat?

A

SIADH

Tx with fluid restriction 50-60ml/kg/day

40
Q

what drugs cause hyponatremia and why?

A

Indomethacin - water retention (dilutional)

  • diuretics - Na Losses
  • barbs, opiates - SIADH
41
Q

What is the difference between dilutional vs. body deficit?

A

dilutional usually see increase in weight - edema

42
Q

What level of hyponatermia usually causes seizures/coma?

A

<115!!! = give Na suppliments or cut fluids!

43
Q

What is the most common cause of Hypernatermia and what is the level?

A

Iatrogenic - >145

Dehydration or Excessive Na intake

44
Q

What are the S/S of Hypernatermia caused by:

  1. Na overload
  2. dehydration?
A
  1. CHF - can cause IVH, seizures

2. lethargy, poor skin tugor, high pitched cry!!

45
Q

How do you treat Hypernatremia?

A

restrict Na - includes flushes

increase free water and help prevent IWL

46
Q

What ion is needed to help regulate cell membrane? major ICF ion. (90%)
Range?

A

Potassium K+

3.5-5mEq/L

47
Q

Why are infants <1000g or 28wks ata higher risk for hyperkalemia?

A

Fluid shifts from ICF (cell) to ECF (bld vessel)

48
Q

K is inversely porportional to gest age

A

As gest increases K decreases

49
Q

The basis for K should never be from…

A

heelstick

50
Q

make sure of _____ before K is supplimented

A

Urine output / renal fx

51
Q

What are some major causes of hypokalemia? >3.5

A

low intake,
losses - GI (diarhea, sx, vomiting)
Mvmt back into the cell - albuterol, turbulaline

52
Q

What ion is the major regulator for heart chnages?

A

Potassium!
hypo - depressed t waves or u waves, ST depression
hyper - peaked T waves - widen QRS

53
Q

What are a feew major causes of Hyperkalemia?

A

tissue necrosis, adrenal insufficiency, Acute acidosis (pushes K out of the cell)

54
Q

What are some treatments for Hyperkalemia?

A

give Ca++ to help with heart issues

Glucose and BiCarb to make him more Alkoltic - push K back into cell

55
Q

What is the major ECF anion? level?
the action potential of Muscle fibers, tissue growth
found in CSF, gastric,

A

Chloride 97-110

56
Q

What two serum concentrations are inversely related? that leads to Meabolic alkalosis?

A

decreasing Cl- with increasing bicarbonate

57
Q

What causes hypochloremia? <90mEq/L

A

soy formulas, gi losses, chronic diuretics: BPD

poor growth and chronic metabolic acidosis

58
Q

What day do fetal cardiac cells form in the yolk sac?

A

14-16 days

59
Q

Name the three hematopoetic organs that make and store the stem cells for the fetus

A

yolk sac, liver/spleen, bone marrow

60
Q

When does circulation begin in the fetus?

A

day 22

61
Q

what organ is the primary RBC maker? by what weeks gest? but then regresses as the bone marrow takes over?

A

Liver - 8–9 weeks

62
Q

There are very few long bones in the fetus. what are the other four sites of hematopoiesis?

A

spleen, lymph nodes, thymus, kidneys

63
Q 
How is the stimuli of erythopoietin normally stimulated?
What organs (prenatally and postnatally?
A

hypoxia

liver (pre) and kidneys (post)

64
Q

what is the average life span of preterm RBC?

A

60-80 days

65
Q

what are reticulocytes and what is the avg level?

A

Immature RBCs (making RBC too fast or destroying Mature RBCs) 3-7% term, 8-10% preterm

66
Q

What is the normal level of plts?

A

150,000-400,000 similar to that of an adult

67
Q

What are three common disorders that are caused when maternal antibodies attack fetal cells? when an Rh neg mother is carrying an Rh pos baby

A

fetal anemia, neutropenia, and thrombocytopenia

68
Q

What is the range of blood vol in the placenta and cord at term?
and bld vol in infant when…
Early clamping, late clamping, and preterm

A

75-125mls
72mls/kg
93ml/kg
89-105ml/kg

69
Q

When are coagulation proteins present in utero and when can fetal blood clot?

A

5-10weks

11-12wks

70
Q

What helps the fetus clot and prevents fetus from significant blood loss?

A

the Placenta

71
Q

Fibrinogen in liver begins @ ____ weeks and reach adult levels at 30 weeks. but the fx is still not there bc placenta is still doing the work

A

fibrinogen - 5weeks

72
Q

What is the physiologic process in a term and preterm infant at birth?

A

anemia

blood loss from birth, decrease life of RBC, and alsoRBC production

73
Q

There is a major drop in _____ post birth which is in response to the increase in tissue oxygenation.

A

erthropoietin

74
Q

What is the expected life span of RBC in the NB and the _____ _____ must work harder to keep up

A

60-90 days

Bone marrow

75
Q

What is a major concerning factor with anemia? and hemodilution occurs when ___

A

when infant stops growing

rapid growth/weight gain

76
Q

Anemia is caused by low _____ &/or_____ which leads to a decrease oxygen carrying capacity of blood

A

hemoglobin/RBCs

77
Q

How does the body try to compensate for anemia? but this leads to poor feeding/growth, A&Bs, lactic acid build up

A

tachycardia and tachypnea

78
Q

What are the three pathologic causes of anemia?

A

Increase loss and destruction or RBC and decrease production of RBC

79
Q

What is the highest vol of blood loss in a IVH?

A

subgaleal

80
Q

What is caused when the Rh- mother’s antibodies attack the fetal RBC (Rh+)

A

Hemolytic anemia

81
Q 
A person with type A blood has
\_\_\_\_antibodies &
\_\_\_\_antigens
A person with type O blood has
\_\_\_\_antibodies &
\_\_\_\_antigens
A

Type A: A antigens & B Antibodies

Type 0: No antigens & A&B antigens

82
Q

What is the most common type of ABO hemolytic anemia?

A

An O mother with an A or B fetus

83
Q

What is the normal MCV value?

Mean corpuscular value (the size of the RBC)

A

119

84
Q

What does a positive coombs test indicate?

A

the presence of maternal IgG antibodies on the fetal RBCs - high risk for hyperbilirubinemia

85
Q

What diagnostic test identifies if the fetal hgb is in the maternal blood - might be the cause for fetal anemia (fetal transfusion)

A

Kleihauer-Betke test

86
Q

If you have a hydrops pt that is severely anemic you should… and why is he anemic

A

he’s anemic bc of dilutional anemia (too much extra fluid but the approp. amt of hgb/hct)
A partial exchange to take out the extremely dilute vol and replace with the concentrated RBCs

87
Q

How should you treat emergent Blood loss?

A

O neg PRBC, FFP, albumin, or saline is blood is not available

88
Q

What are some unique signs of severe ABO incompatibility?

A

the rapid and increase hemolysis of RBC causing a rapid increase in bilirubin which usually ends up in a double exchange transfusion ( taking out the baby’s blood vol twice)

89
Q

What are the hgb and hct levels in polycythemia?

A

hgb >22 and hct >65%

90
Q

What is the major cause of fetal polycythemia?

A

hypoxia which then increases epo production ->increases the mass of RBC causing viscosity

91
Q

What can the increase in viscosity cause to the infant?

A

compromised BF to vital organ, jittery, RDS, plethora, acidosis, hyperbili, hypoglycemia d/t sugar being eat up

92
Q

Vit K is needed in the NB d/t decrease in the clotting factors __, ___, ___, ___

A

II, VII, IX, X

93
Q

Preterm infant might need ____ and another dose of ____ to help stop bleeding (IVH) d/t immature livers for more clotting factors

A

FFP, vit K

94
Q

What values defines thrombocytopenia?

and caused by (3)

A

plt < 100,000
increase consumption
decreased production
pooling in spleen

95
Q

Plts are made by _____.

What is formed when they are trapped and consumed?

A

Megokaryocytes

Hemangiomas

Neonatal Physiology (3 decks)

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