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
2
Q
The compartment that holds the plasma (intravascular) and the space between the cells (interstital)
A
Extracellular Fluid
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
4
Q
What is the normal value of serum osmolaity? and it is determined by?
A
270-300osm/kg/water
determined by the solute
5
Q
How is the balance of the compartments maintained?
A
Osmosis - moves from high to low
6
Q
What regulates water and sodium in the ECF to maintain a balance and not have edema?
A
The kidneys
7
Q
What is the primary cation and anion in the ECF?
A
Na +
Cl-
8
Q
Water balance is regulated by _____ in the ECF?
A
Colloid osmotic pressure
9
Q
What molecules are in the ICF?
A
K+
Mg+
PO4-
10
Q
Water balance is regulated by _____ in the ICF?
A
K+ and Na-K-ATPase pump
11
Q
What factors contribute to an increase in % of water and TEWL?
A
lower gestational age
12
Q
What are two major factors that affecct fluid calculations?
A
gest age and kidney function
13
Q
at 12 weeks gest, how much is the total body water in a neonate?
A
94% (water balloon)
14
Q
What problems can be associated with excess fluid intake?
A
PDA, NEC, BPD
15
Q
What is the “Physiologic” weight loss in the neonate?
what is considered pathologic?
A
5-10% BW in term
> 20%
16
Q
What % of total fluid requirements should be accounted for TEWL?
A
30%
17
Q
What % of IWL is from the lungs and can be increased with tachypnea
Skin IWL?
A
20-30%
70%
18
Q
What are three major causes of water loss D/T the renal system?
A
diuretics, osmotic diuresis(glucosuria), Congential adrenal hyperplasia
19
Q
What causes a decrease in renal water loss
A
renal faliure, SIADH, CHF
20
Q
There is an increase in glomerlus until weeks_____
A
34-35 weeks
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)
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
23
Q
What hormone system is released by the kidneys, vasoconstrictor, and releases aldosterone?
A
RAAS
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)
25
What % of loss should be evaluated for possible excessive fluid administration? and what infant a less of a loss of BW?
<2% and SGA infants
26
What is a good and early sign of water loss?
| and an early sign of metabolic acidosis?
weak pulses, with cap refill >3sec
| tachypnea
27
A Na+ of <280 suggests?
SIADH because serum is too dilute
28
A pH < 7.28 and a base deficit >5 suggests
dehydration
29
What is the normal range for the Anion Gap? What causes an increase in the Gap?
5-15 (Na+K)-(Cl +HCO3)
| dehydration, poor perfusion, lactic acidemia
30
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
40-60ml/kg/day
31
How much does a 1500-2000gm infant need in TF replacement in the 1st 48Hours of birth?
80-110ml/kg/day
32
How much does a 1500-2000gm infant need in TF replacement in the 1st 7 dys of life?
110-150 ml/kg/day
33
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
Excessive fluid intake = puffy baby
34
When an infant presents with metabolic accidosis, sunken fontanel, decrease UO, Increase in HR, RR, Na, BUN, Creatinine, you know this is
signs of fluid deficcits
35
What signs are usually seen first in dehydrated infants?
the physical signs
36
What is the major ECF cation? and is needed for tissue growth?
Na+
37
What is the maintenance level for
Na+
K+
>30wks = 2-3mEq/kg/d
| 2-3mEq/kg/d
38
What are the two causes of hyopnatremia?
>130mEq/L
- Dilutional (vol. overload)
- inadequate intake/losses
39
What prob with Hyponatremia is caused by CNS probs? and how do you treat?
SIADH
| Tx with fluid restriction 50-60ml/kg/day
40
what drugs cause hyponatremia and why?
Indomethacin - water retention (dilutional)
- diuretics - Na Losses
- barbs, opiates - SIADH
41
What is the difference between dilutional vs. body deficit?
dilutional usually see increase in weight - edema
42
What level of hyponatermia usually causes seizures/coma?
<115!!! = give Na suppliments or cut fluids!
43
What is the most common cause of Hypernatermia and what is the level?
Iatrogenic - >145
| Dehydration or Excessive Na intake
44
What are the S/S of Hypernatermia caused by:
1. Na overload
2. dehydration?
1. CHF - can cause IVH, seizures
| 2. lethargy, poor skin tugor, high pitched cry!!
45
How do you treat Hypernatremia?
restrict Na - includes flushes
| increase free water and help prevent IWL
46
What ion is needed to help regulate cell membrane? major ICF ion. (90%)
Range?
Potassium K+
| 3.5-5mEq/L
47
Why are infants <1000g or 28wks ata higher risk for hyperkalemia?
Fluid shifts from ICF (cell) to ECF (bld vessel)
48
K is inversely porportional to gest age
As gest increases K decreases
49
The basis for K should never be from...
heelstick
50
make sure of _____ before K is supplimented
Urine output / renal fx
51
What are some major causes of hypokalemia? >3.5
low intake,
losses - GI (diarhea, sx, vomiting)
Mvmt back into the cell - albuterol, turbulaline
52
What ion is the major regulator for heart chnages?
Potassium!
hypo - depressed t waves or u waves, ST depression
hyper - peaked T waves - widen QRS
53
What are a feew major causes of Hyperkalemia?
tissue necrosis, adrenal insufficiency, Acute acidosis (pushes K out of the cell)
54
What are some treatments for Hyperkalemia?
give Ca++ to help with heart issues
| Glucose and BiCarb to make him more Alkoltic - push K back into cell
55
What is the major ECF anion? level?
the action potential of Muscle fibers, tissue growth
found in CSF, gastric,
Chloride 97-110
56
What two serum concentrations are inversely related? that leads to Meabolic alkalosis?
decreasing Cl- with increasing bicarbonate
57
What causes hypochloremia? <90mEq/L
soy formulas, gi losses, chronic diuretics: BPD
| poor growth and chronic metabolic acidosis
58
What day do fetal cardiac cells form in the yolk sac?
14-16 days
59
Name the three hematopoetic organs that make and store the stem cells for the fetus
yolk sac, liver/spleen, bone marrow
60
When does circulation begin in the fetus?
day 22
61
what organ is the primary RBC maker? by what weeks gest? but then regresses as the bone marrow takes over?
Liver - 8--9 weeks
62
There are very few long bones in the fetus. what are the other four sites of hematopoiesis?
spleen, lymph nodes, thymus, kidneys
63
```
How is the stimuli of erythopoietin normally stimulated?
What organs (prenatally and postnatally?
```
hypoxia
| liver (pre) and kidneys (post)
64
what is the average life span of preterm RBC?
60-80 days
65
what are reticulocytes and what is the avg level?
Immature RBCs (making RBC too fast or destroying Mature RBCs) 3-7% term, 8-10% preterm
66
What is the normal level of plts?
150,000-400,000 similar to that of an adult
67
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
fetal anemia, neutropenia, and thrombocytopenia
68
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
75-125mls
72mls/kg
93ml/kg
89-105ml/kg
69
When are coagulation proteins present in utero and when can fetal blood clot?
5-10weks
| 11-12wks
70
What helps the fetus clot and prevents fetus from significant blood loss?
the Placenta
71
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
fibrinogen - 5weeks
72
What is the physiologic process in a term and preterm infant at birth?
anemia
| blood loss from birth, decrease life of RBC, and alsoRBC production
73
There is a major drop in _____ post birth which is in response to the increase in tissue oxygenation.
erthropoietin
74
What is the expected life span of RBC in the NB and the _____ _____ must work harder to keep up
60-90 days
| Bone marrow
75
What is a major concerning factor with anemia? and hemodilution occurs when ___
when infant stops growing
| rapid growth/weight gain
76
Anemia is caused by low _____ &/or_____ which leads to a decrease oxygen carrying capacity of blood
hemoglobin/RBCs
77
How does the body try to compensate for anemia? but this leads to poor feeding/growth, A&Bs, lactic acid build up
tachycardia and tachypnea
78
What are the three pathologic causes of anemia?
Increase loss and destruction or RBC and decrease production of RBC
79
What is the highest vol of blood loss in a IVH?
subgaleal
80
What is caused when the Rh- mother's antibodies attack the fetal RBC (Rh+)
Hemolytic anemia
81
```
A person with type A blood has
____antibodies &
____antigens
A person with type O blood has
____antibodies &
____antigens
```
Type A: A antigens & B Antibodies
Type 0: No antigens & A&B antigens
82
What is the most common type of ABO hemolytic anemia?
An O mother with an A or B fetus
83
What is the normal MCV value?
| Mean corpuscular value (the size of the RBC)
119
84
What does a positive coombs test indicate?
the presence of maternal IgG antibodies on the fetal RBCs - high risk for hyperbilirubinemia
85
What diagnostic test identifies if the fetal hgb is in the maternal blood - might be the cause for fetal anemia (fetal transfusion)
Kleihauer-Betke test
86
If you have a hydrops pt that is severely anemic you should... and why is he anemic
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
How should you treat emergent Blood loss?
O neg PRBC, FFP, albumin, or saline is blood is not available
88
What are some unique signs of severe ABO incompatibility?
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
What are the hgb and hct levels in polycythemia?
hgb >22 and hct >65%
90
What is the major cause of fetal polycythemia?
hypoxia which then increases epo production ->increases the mass of RBC causing viscosity
91
What can the increase in viscosity cause to the infant?
compromised BF to vital organ, jittery, RDS, plethora, acidosis, hyperbili, hypoglycemia d/t sugar being eat up
92
Vit K is needed in the NB d/t decrease in the clotting factors __, ___, ___, ___
II, VII, IX, X
93
Preterm infant might need ____ and another dose of ____ to help stop bleeding (IVH) d/t immature livers for more clotting factors
FFP, vit K
94
What values defines thrombocytopenia?
| and caused by (3)
plt < 100,000
increase consumption
decreased production
pooling in spleen
95
Plts are made by _____.
| What is formed when they are trapped and consumed?
Megokaryocytes
Hemangiomas
