1] CP Topics In Peds Flashcards
What weeks does the respiratory system begin to develop?
Weeks 4 - 7
Bronchial buds continue to evolve until all segments are formed; what weeks?
Week 7 - 16
Around what week does the diameter expand?
Week 13
By what week are all major lung structures developed
Week 16
Blood vessels and alveolar ducts have developed by what weeks?
Weeks 16 - 24
Type I and Type II pneumocytes have began to differentiate at week
Week 19
Fetal breathing at week?
Week 20
Sufficient alveolar precursors have
matured so that a baby born prematurely at thistime can usually breathe on its own
At week ?
Week 28
Alveoli develop and mature until the age of ?
8 years old
Less what type fibers in the diaphragm of an infant?
Less type 1 fibers
Age 0 - 3 months chest wall is ?
Triangular in anterior plane and circular from lateral view
The ribs are what age 0 - 3 months
Horizontal
Independent sitting happens around what months?
6 - 12 months
Chest becomes elliptical in what view at 6 - 12 months
Lateral view
Mutation of a gene on chromosome 7 that produces a protein called CFTR
Cystic fibrosis
Problems with CF
Chronic inflammation and infection in airways, digestive enzymes cant reach stomach, at risk for DIOS
Antibiotic therapies, steroids, bronchodilators, hypertonic saline and pulmozyme and new meds help manage?
CF
Autosomal recessive disease that effects the growth and function of hair-like structures called cilia
PCD
Primary ciliary dyskinesia
Life expectancy for PCD is?
Normal
What 4 parts of the body does PCD affect?
Sinus
Lungs
Ears
Reproductive system
Sinus rinses, bronchodilators, hypertonic saline, Pulmozyme.
Steroids and antibiotics similar to those used with CF
Airway Clearance
Exercise
All help to manage?
PCD
Saccharine tests for CF
Less than 60 minutes
Saccharine test for PCD
More than 60 minutes
Sweat test for CF vs PCD
Normal to elevated for CF
Normal for PCD
Lung disease for CF vs PCD
Progressive for CF
Stable for PCD
Life expectancy for CF vs PCD
Limited for CF
Normal for PCD
A serious lung condition that affects infants, primarily the premature infants
BPD
Bronchopulmonary dysplasia
commonly associated with low birth weight, prematurity, low amount of surfactant, supplemental O2 support
BPD
What is RDS
Respiratory distress syndrome; its when the infant lungs are not fully formed and it affects their ability to make surfactant
What is surfactant?
A liquid that coats the lungs that keep the lungs open to allow for spontaneous breathing when born
Outcome of BPD
Most babies show improvement over time with proper management
Medical management: Bronchodilators, steroids, and diuretics
Supplemental O2 via nasal cannula, CPAP, or mechanical ventilation
Surfactant replacement therapy
Emphasis on nutrition and caloric intake
Management of BPD
WHat does BPD stand for?
Broncopulmonary dysplasia
Survivors of BPD are at increased risk for ?
Respiratory disease and infection, asthma like disease, arterial hypertension
A birth defect formed in uterus where there is 1 or more abnormal connections b/w the esophagus and trachea
TEF
What does TEF stand for
Tracheoesophageal fistula
What happens in TEF? Patho wise
Fluids improperly pass through to trachea and lungs during swallowing
TEF is commonly seen with
Trisomy 13,18,21
Heart issues
VACTERL syndrome
Kidney and urinary issues
How do you fix TEF
Surgery
PEP therapy for tracheomalacia
What’s tracheomalacia
Cartilage that keeps trachea open is so soft that it kind of collapses especially during increased airflow
Most common (90%) congenital deformity of the chest wall with worsening at time of the adolescent growth spurt
Pectus excavatum
Pectus excavatum is higher prevalence with ?
Caucasian and Marfan syndrome
Acquired pectus excavatum is seen with ?
Severe chronic upper or lower airway obstruction
Abnormal growth of the costochondral cartilage
Pectus excavatum
Pectus excavatum appears?
Caved in
Signs and Sx of severe cases of pectus excavatum is when the sternum compresses the <3
Recurrent respiratory infections,
Chest pain, Heart murmur
Development of scoliosis or
displacement of vertebral bodies
Clinical presentation of pectus excavatum
Thoracic kyphosis Rounded shoulders Rotated pelvis Sinked in chest Rib flare and potbelly
2 treatments for pectus excavatum
NUss and Ravitch procedure
Precautions of pectus excavatum
No sidelying No bending No lifting No twisting No pushing/pulling >8-10lbs
A rare disease that affects arteries
in the lungs and the right side of theheart
Pulmonary hypertension
5 group classification of pulmonary hypertension
Pulmonary arterial HTN Left sided HF Lung disease Chronic blood clots Other
What is PHT
Pulmonary hypertension
Progression of PHT
Part 1
Pulmonary arterioles and
capillaries become narrowed,
blocked or destroyed.
Progression of PHT part 2
Harder for blood to flow through lungs and increases pressure in the lungs arteries
Progression of PHT part 3
As the pressure builds, the heart’s lower right chamber (right
ventricle) works harder which
eventually causing your heart
muscle to weaken and fail
Signs and Sx of PHT
Poor posture SOB with min activity Dizzy Chest pain Fatigue
Continuous IV or subcutaneous medication
May eventually require lung or heart-lung transplantation
Managing PHT
What is BO or BOOP
Bronchiolotis obliterans
What is BO
An inflammatory obstruction of the bronchioles
A cause by chemical particles or respiratory infections, particularly
after organ transplants, leading to extensive scarring that blocks theairways
BO
Signs and Sx of BO
Dry cough/wheezing
SOB
Fatigue
Tx to stabilize or slow down BOOP
Antibiotics, corticosteroids, and immunosuppressive drugs
Airway clearance and exercise
Lung transplant
7 pediatric Dx associated with pulmonary problems
SCI SMA TBI CP Muscular dystrophy Downs yndrome Prune belly
4 steps of airway clearance
1- get air behind mucus
2- loosen/mobilize secretions from small airways
3- move secretions into large airways
4- evacuate secretions from centra airways
HRmax for aerobic exercise
70-80%
Frequency of aerobic exercise
3x/week, 30-60 min
Maintain Sp02 of more than what for aerobic exercise?
More than 90%
Frequency for strength training
2-3x/week
Reps and sets for strength
1-3 sets of 6-15 reps
What’s the 1RM for strength
50-80%
Frequency for stretching
2-3x/week
Reps and hold for stretching
15-30 second hold
3-5 reps
Which points of the pelvic floor are the weakest?
Think of soda can, top and bottom are weakest b/c when you open either end, pressure will release
occurs when the
pelvic floor does not contract or does notcontract effectively when the individual
sneezes, coughs, laughs, jumps, etc.
Urinary incontinence
Exercise for pelvic floor
Kegel exercises
Thoracic extension =
Inhalation
Thoracic flexion =
Exhalation
Should flex/aBD/ER =
Upper accessory muscles
Should ext/ADD/IR =
Diaphragm and lower chest muscles
Inhalation is what type of contraction
Concentric
Exhalation concentric is
Diaphragm produces FORCEFUL exhalation
Eccentric exhalation is
Diaphragm CONTROLS exhalation during speech
What is HFCWO
Vest therapy
Prevents airway wall collapse to improve efficiency of airway clearance
PEP
What’s better according to research and why: PEP vs HFCWO
PEP b/c lower # of exacerbation requiring antibiotics
Typical program for OPEP (oscillating)
Typical program: (10 reps inhaling and exhaling through device +coughing techniques) x repeat = 10-15 minute duration
Switches quickly between higher and lower resistance creating
pressure as well as provides
oscillations
Aerobika
Provides rapid bursts of air and saline mist into thelung through a mouthpiece or mask
IPV = intrapulmonary percussive ventilation
Tidal volume is ?
Total vital capacity is ?
Tidal volume = regular breathing
Total vital capacity = deep breathing
