Test 2 - Skin, Renal, Lungs, Heart Flashcards
(119 cards)
1
Q
When is the first structure of the skin developed?
A
60 days of fetal life
2
Q
By what trimester is the skin similar to that of an adult?
A
3rd
3
Q
What is the earliest organ system to develop?
A
the skin
4
Q
At what part of the skin is where tape can disrupt the junction? it is critical for skin integrity
A
The epidermis and the dermis
5
Q
What layer developes at 5-8 wks from ectoderm. It consists of the stratum corneum and basal layer (brick and mortar.)
A
Epidermis
6
Q
What layer is not mature until the first week of life or 21-33 days in the preterm infant. And not fully functional until 2-3 years
A
Dermis
7
Q
What is under the dermis and is where the BAT develops?
A
Hypodermis
8
Q
When are fingernails and toenails formed?
A
10wks gest.
9
Q
What are two major functions of the skin?
A
- Balances F&E between the fetus and the A.F.
2. Contributes to the vernix which provides insulation and minimizes friction at delivery**
10
Q
The amount of vernix is associated with…
A
gest age and birth weight - more of vernix leads to more hydrated skin
11
Q
What are some events that can harm the skin in utero/birthing? Some external skin issues may indicate something inside
A
- scalp monitoring
- vacuum extraction
- forceps
12
Q
When is the epidermal layer (stratum corneum) present?
A
> 24 weeks. Before then, no real barrier protection
13
Q
What is the pH of the skin?
A
< 5 - bacteriostatic - bacteria can’t grow well
14
Q
What can reduce TEWL?
higher humidity = lower H2O losses
A
thermal blankets, plastic covers with humidity, aquaphor
15
Q
Why is the dermosepidermal cohesion not anchored well in preterm infants?
A
The collagen fibers are widely spaced. As the collagen gets closer the binding increases
16
Q
What is responsible for the stretch of the skin?
A
elastin
17
Q
When there is a loss in collagen, what are some connective issues in the preterm infant?
A
- trauma
- edema
- fluid loss
- no insulation (temp instability)
18
Q
What are the two major mechanism that protects the infant against pathogens?
A
- acid mantle
- skin colonization
19
Q
What two systems develop together? And have the highest %of anomalies?
A
GU and genital systems
20
Q
What two systems develop together? they have the highest % of anomalies
A
GU and gental systems with GU having the highest %
21
Q
When is urine production established in the fetus?
A
9-10wks
22
Q
What are the three phases of the kidney’s maturation? and what are the weeks that they occur?
A
Pronephrons - 3-4 wks
Mesonephrons - 5-12 weeks
metanephrons - 5-34 weeks - THE KIDNEY
23
Q
When do the nephrons stop increasing in number and start their function?
A
34-36 wks
24
Q
When does the vasculature to the kidneys mature?
A
14-15 wks
25
Why is the BF to the kidneys decreased in fetal life and what is the major way the fetus gets rid of waste?
1. increase in vasculature resistance
2. low systemic BF
The placenta*
26
what system is in charge of keeping a balance with Blood pressure, Na, K, and blood flow
Renin-angiotensin-aldosterone system
27
When is the bladder formed?
6wks
28
GFR doubles in the 1 week of life d/t
increased MAP, renal BF, and permeability of glomerular surface area = increase U/O
29
decrease in Na++ excretion and vascular resistance and
| increase in concentration of urine and BF are all
postnatal changes
30
explain the route of how urine is created
1. blood passes through capillaries
2. plasma is filtered thru glomerular
3. filtrate is collected in Bowman's space and enters tubules
4. excreted as urine
31
What is the main controller of GFR. If low _____ then there is none or very low GFR?
Hydrostatic pressure
32
What are two major impacts on neonates with a low GFR
1. Hard to excrete water = edema, overhydration
| 2. Longer to excrete drugs = toxicity
33
At what age is the tubular function mature which helps increase U/O and is more easy to balance the neonates F&E?
34Weeks
34
What can a preterm and term infant do better?
1. dilute
2. concentrate
and why?
they can dilute better bc the renal medulla is still immature (loop of henle and Collecting duct) is where the kidneys concentrate urine.
35
What does specific gravity measure? normal values? and it is highly dependent on the nephron integrity and antidiuretic hormone (vasopressin)
it measures the concentrating ability; 1.001-1.020 term; less than that for preterm.
36
The preterm infant is also at risk for hyperglycemia. we like to start the VLBW infant on what?
Starter D5 so they get less sugar and more water because IWL
37
When does the the AF vol. peak? and how much vol?
34 wks----500-1500ml
38
What defines oligohydramnios?
Polyhydramnios
< 50% at any gest. age
>2000ml
39
What is a normal u/o?
oliguria?
1-3cc/kg/hr
<0.5cc/kg/hr
40
What is the pH of urine?
>6 in NB; 4.5-8 in preterm
41
Creatinine level? and what is the level used to measure?
0.4 in term; GFR - when GFR is high, creatinine is low = good u/o
42
```
What is the normal value for:
Na++
K+
BUN
Creatine
```
130-145
3.5-5.5
10-26
0.4
43
What is is always normal at birth d/t the placental function. Even with infants born w/out kidneys?
BUN
44
What is BUN affected by? and the value decreases when?
- Protein and postnatal age
| - the infant can concentrate urine better
45
When WBC or bacteria is seen in urine?
UTI
46
What drugs are almost cleared exclusively by GF?
Aminoglycosides (amikacin and gentamycin)
47
When is GFR significantly reduced after this tx?
NSAIDS - watch U/O!!
| indomethacin and ibuprofen - reduces clearance of vanco by 50%
48
What drug is processed through the GF and tubules? and with high levels it may lead to tubular necrosis.
Gentamicin
49
At what age is the lung bud beginning to form?
then the main bronchus
then the 3 branches on (R) and 2 on (L)
4 wks
5 wks
6wks
50
What phase of lung development is from 3-6wks gest. The lung buds arise from foregut - this is where the Trachea and esophagus forms from one primary structure into 2
Embyronic phase
51
What phase of lung development is from 6-16wks. 20 divisions develop and by the end all major elements including vasculature is developed.
This is where CDH can be seen bc of the diaphragm also developing
Pseudograndular
52
What phase of lung development is from 16-26wks? the bronchioles are larger (Canals forming) and at 24wks gas exchange is occurring. (BF is getting closer)
Canalicular Phase
53
What phase of lung development is from 26wks to birth? The caps are very close to alveoli, type 2 pnemocytes (surfactant) develop, and steadily increase closer to term.
Terminal - walking to the terminal, waiting to be delivered)
54
What phase of the lung development is from 32 wks to 8 years old? 95% develop postnatally.
from 50 million at birth to 300 million at 8years
Alveolar
55
Airway # does not increase at ____wks postnatally but growth in length and size thru childhood. focus on nutrition!!
16 postnatal
56
At what age is the lung bud beginning to form?
then the main bronchus
then the 3 branches on (R) and 2 on (L)
4 wks
5 wks
6wks
57
What phase of lung development is from 3-6wks gest. The lung buds arise from foregut - this is where the Trachea and esophagus forms from one primary structure into 2
Embyronic phase
58
What phase of lung development is from 6-16wks. 20 divisions develop and by the end all major elements including vasculature is developed.
This is where CDH can be seen bc of the diaphragm also developing
Pseudograndular
59
What phase of lung development is from 16-26wks? the bronchioles are larger (Canals forming) and at 24wks gas exchange is occurring. (BF is getting closer)
Canalicular Phase
60
What phase of lung development is from 26wks to birth? The caps are very close to alveoli, type 2 pnemocytes (surfactant) develop, and steadily increase closer to term.
Terminal - walking to the terminal, waiting to be delivered)
61
What phase of the lung development is from 32 wks to 8 years old? 95% develop postnatally.
from 50 million at birth to 300 million at 8years
Alveolar
62
Airway # does not increase at ____wks postnatally but growth in length and size thru childhood. focus on nutrition!!
16 postnatal
63
At what age does a TE fistula or esophageal atresia happen? the foregut doesn't partition correctly
4-5 wks gest
64
What is produced by the lung tissue as early as 20 weeks. traces found in A.F.
Surfactant
65
What is the main mechanism of surfactant?
helps decrease surface tension to keep terminal sacs open.
| it also prevents atelectasis and maintains FRC
66
When are fetal breathing mvmts seen?
| it helps with chest wall and diaphragm development
10wks gest
67
What are three things that help accelerate lung maturity?
glucocorticoids, thyroid hormones, and catecholamines (stress hormones)
68
What is given to reduce: IVH, NEC, mortality, and RDS. but at risk for delivery within 7days
antenatal steroids - betamethasone and dexamethosone
69
What is the major marker for surfactant? - shows little risk for RDS
PG
70
What ratio measure is the lungs are mature.
| if its 2:1 = mature lungs, 1:1 = immature
L/S ratio (lecithin to sphingomyelin)
71
When is fluid present?
how much does a term infant produce?
and it is mostly secreted by what type of cells?
6wks gest
10-30ml/kg/day
type 1 and 2
72
What is the mechanism of fetal lung fluid removal?
a surge of epi, active Na absorption, a rise in O2, and increased pul BF all help to remove fluid in a NB's lungs
73
What is the natural tendency for stretched objects to return to their resting state?
Elastic recoil
74
What detects the needs (CO2/O2 levels) and alters ventilation to help regulate breathing
Chemoreceptors
75
What reflex is when the lung is inflated and the breath is terminated which prolongs the expiratory time?
Hering-Breuer reflex
76
What is the measure of how elastic the lung tissue is?
Lung compliance
| -if the curve is lying down (lots of pressure but to change in lung volume) = RDS (low lung vol)
77
If the Lung compliance curve is very high (lots of volume and high pressure) =
Obstructive lungs
MAS (ball-valve effect)
Barotrauma (BPD)
Hyperventilation
78
What time constants are 1/2 as long as _____ time constants? 1:2 (I:E ratio)
inspiration; expiration - so you have time to empty the entire lung before the next breath
79
Resistance is inversely related to_____.
lung volume
80
What is the natural tendency for stretched objects to return to their resting state?
Elastic recoil
81
What is the point at which opposing forces balance at the end of expiration? and what is the level?
FRC - Functional residual capacity
| 20-30ml/kg
82
What is the earliest sign of respiratory distress? and if it persists = increase O2 demand, caloric demand, work or breathing
tachypnea - >60 Breaths/min
83
Approx. 50% of airway resistance is due to ______.
Nasal resistance
84
What causes the Oxyhemoglobin curve to be shifted to the right? think ADULTS, hgb releases O2 to tissues easily
***up right, except pH***
Acidemia, hypercarbia, and hyperthermia
85
What causes the Oxyhemoglobin curve to be shifted to the left? think FETUS, hgb holds onto O2
Alkalemia, hypocarbia, and hypothermia
86
A mismatch between ventilation and perfusion causes ______.
Hypoxemia - inadequate amt of O2 in blood
87
What is when there is perfusion but no ventilation/oxygenation?
Atelectasis
88
What is when there is ventilation but no perfusion?
Pulmonary emboli - the O2 is not getting to the vaculature
89
When the sprouting of 2 new blood vessels from existing ones.
Angiogenesis
90
What is the first major system to Fx in the embryo?
The fetal heart
91
When does the heart begin to beat?
22-23 days
92
When does the partitioning of the heart begin?
4th-5th week
93
When is the most critical period for heart development?
20-50 days (3-7 wks) post fertilization
94
When does the SA node develop
5th week
95
When endothelial cells are recruited and differentiated into mature endothelial cells to form new BV
Vasculogenesis
96
When the sprouting of 2 new blood vessels from existing ones.
Angiogenesis
97
What veins are the main drainage system in the embryo. From the head and feet back to the heart
Cardinal veins
98
What % of Congenital heart disease is caused by chromosomal abnormalities?
8%
- trisomy 21, 18, 13
- Turner's
- Down's
99
Only 2% of CHD is caused by environments factors which include...
- maternal diseases: diabetes, lupus, rubella
- drugs
- toxins
100
The EFFICIENCY of the ventricular contraction - how well the vent can empty vol
Contractility
101
When the vents contract, 70mmHg, AO and OA valves open, blood is ejected, valves close =
systole
102
When mitral/tricuspid valves open, 70% of blood flows in vents (some into aorta & coronary arteries), atrias contract, valves close =
Diastole
103
SV X HR; vol. of blood ejected by the LV in 1 minute
Cardiac Output
104
What mechanism helps to increase CO?
increase in HR and not SV like in adults
105
What law is defined by the hearts pumps what it receives. Balanced out/in; no pooling
Frank-Starling Law
increase in EDP will = increase in SV!
106
What is the vol of blood in vents immediately before a contraction?
Preload - End Diastolic pressure
107
The EFFICIENCY of the ventricular contraction - how well the vent can empty vol
Contractility
108
What is the pressure/resistance the heart must pump against to empty its contents?
Afterload
109
What is the difference between PVR and SVR?
PVR - RV afterload
| SVR - LV afterload
110
When a baby has very high pressures and can't get blood to lungs - PVR is very high
PPHN
111
What is when the CO is decreased and can't meet metabolic demands = myocardial dysfunction
Congestive heart failure
112
When does PVR start to fall in the postnatal life?
2-8weeks
113
Explain the patho of CHF
- Peripheral vasoconstriction - decreased BF to renal system
- Hyperaldosteronism
- Na + H2O retension=edema
114
What is the first sign of pulmonary edema?
| What rhythm is heard d/t abnormal filling bc of dilated vent
Tachypnea
Gallop
115
What is the earliest signs of CHF in children? also seen is
Hepatomegaly
periorbital edema
Diaphoresis
116
What is the difference in Heart block and bradycardia?
The p wave is not related to QRS. In bradycardia, a QRS follows every P wave
117
If the BPs are >15mmHg in the upper compared to the lower, this usually =
Coarctation
118
If the infant continues to have acrocyanosis >24hrs old think...
The Heart
119
What is when desaturated blood is leaving the heart, tongue and mucousa are bluish?
Central cyanosis
