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Pediatrics > Anatomy & Physiology > Flashcards

Anatomy & Physiology Flashcards

1
Q

Premature Infant

A

Less then 37 weeks gestational age

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2
Q

Neonate

A

Less then 30 days old

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3
Q

Infant

A

1 month to 1 year old

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4
Q

Children

A

1 to 12 years old

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5
Q

Adolescent

A

13 to 18 years old

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6
Q

Gestational Age

A

Preterm = < 37 weeks
Term = 38 weeks
Post term = 42 weeks

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7
Q

Brain Development:

A

25% neuronal cells present at birth
@ 1 yo cortex and brain stem nearly mature
brain weight doubles @ 6mo, triple @ 1 yo
Myelination not complete until 3 yo
BBB immature until 1 yo

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8
Q

Spinal Cord Development:

A

nerve cell maturation until 6-7 yo
SC ends @ L3 at birth, L1 at 1 yo
Dural sac ends @ S3-4 at birth, S1-2 at 1 yo

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9
Q

Autonomic Nervous System

A

Innervation to heart and blood vessels has vagal predomincance
SNS is immature, SNS innervation more developed and functional by 4-6 months

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10
Q

Reasons for neonatal bradycardia

A

1 is hypoxia / drugs (succs, sevo, neostigmine), med error / acidosis, hypercarbia, hypoglycemia, hypothermia, hypovolemia, apneic periods, intubation, OCR, celiac

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11
Q

Pain Response

A

Pain pathways present at birth
Response are behavioral and neuro-endocrine
Become tachycardic and HTN –> poss IVH/ICH
May have re-wiring of neuronal pain pathways with excessive/rept noxious stimuli

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12
Q

Cranium Characteristics

A

Circum incr by 10cm by 1 yo
Supple and expansive w/ suture lines and fontanelles, allow assessment of hydration and ICP
Anterior - closes at 9-18 months
Posterior - closes at 4 months

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13
Q

Upper Airway Characteristics

A

Tongue - large relative to oral cavity
Epiglottis - short, stiff, 45* posterior aim
Larynx - cephalad and anterior, at acute angle from tongue base to glottis - Prem @ C3, Infant @ C4, Adult @ C5-6
VC - concave shape/u-shaped (omega-shaped), vs adult rigid v shape

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14
Q

Cricoid and Trachea Characteristics

A

Cricoid - narrowest part of pediatric airway, conical shape, creates risk of subglottic edema post extubation
Reaches adult shape/size at 12 yo
Trachea - shorter in pediatric pt (<1 yo 5-9cm), softer and easily compressed, R/L mainstem with similar angles

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15
Q

Respiratory Muscles

A

Type 1 = slow twitch, resist fatigue, for sustained activity
Type 2 = fast twitch, fatigue easy
Diaphragm = Prem - 10% type 1, NB = 25% type 1, adult = 55% type 1
Intercostals - primarily type 2 fibers until 2 months
NB are diaphragmatic breathers

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16
Q

Pulmonary Mechanics

A

Large abdo hinders diaphragm mvmt
All major airway tubes liable to be compressed d/t incr compliance (trachea, larynx, cricoid)
Neonates lung compliance less than adults, incr with age

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17
Q

Thoracic Cage

A

Ribs extend horizontally, decr thorax expansion with respiration, soft and cartilaginous
Neonates chest wall 20-40x more compliant, decr with age
Retraction and small airway collapse d/t less mechanical support from rib cage,

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18
Q

Lung Volumes

A

Neonates - decr TLC
Vt and Vd = to adults
Peds FRC < adults
Closing volume/CC - small caliber and decr elasticity contributes to early airway closure, CC occurs in Vt breathing, CC incr with Peds vs adults

19
Q

Induction Issues with Ventilation

A 
Decr FRC (most in neos) + Incr CC + Incr BMR = mandatory supportive ventilation throughout induction, shortened apnea time
Decr compliance = care Vt/PC ventilation parameters, keep PAP low
Decr sensitivity of chemoreceptors, easily atelectatic, high O2 needs, reduced resp effort/compensation ability
Easily apneic once anesthetized with remaining paradoxical abdo/diaphragm breathing = incr Vd = V/Q mismatch
20
Q

Resp Control

A

Incr BMR = Incr MVe
Decr chemoreceptor responsiveness, poorly sustained compensation, depressed by hypoxemia/hyperoxemia
Hypoglycemia, hypothermia, anemia = resp depressants

21
Q

Surfactant

A

Two phospholipids = lecithin, sphingomyelin
Produced by type 2 pneumocytes, begins at 22 weeks, sharp incr @ 35-36 weeks
Decreased alveoli surface tension - P=2T/R (Laplace)
Role - incr compliance, stents alveoli/prevents collapse, promote gas exchange interface, decr WOB, keep alveoli dry

22
Q

Causes of Apnea

A

Anemia, hypothermia, hypoglycemia, acidosis, sepsis, physio stress, congenital anomolies

23
Q

Fetal Circulation Pathway

A

(+oxy blood) Placenta –> One Umb v. –> Liver/Ductus Venosis 50/50 –> IVC –> RA –> FO –> LA –> LV –> AscAo –> Upper body/brain
(-oxy blood) Upper body/brain –> SVC –> RA –> RV –> PA –> DA/Pulm –> DescAo –> lower body –> Two Umb a. –> placenta

24
Q

Unique Fetal Circ shunts/etc

A

Placenta - o2/co2 exchange, nutrients, wastes
Ductus Venosus - allows oxy blood to bypass liver to IVC
FO - intra atrial, allows oxy blood to bypass pulmo circ to AscAo
DA - allow blood to bypass fetal lungs to DescAo and placenta

25
Q

HD changes in transitional circulation

A

Inflated lungs –> decr PVR, decr RH pressures, assists in FO closure, incro PO2, increases LAP
Placental loss –> incr SVR and Ao pressure, incr LH pressures, assists in FO closure
DA with reversed flow with incr Ao pressure, Decr RH pressure, incr PO2 all assist with closure

26
Q

Shunt Closures

A

DA - fxnl @ 15h - 4days, anatomical 1 month
FO - fxnl @ few hours, anatomical 1 year
Delayed by patho factors that maintain fetal circ

27
Q

Persistent Fetal Circulation causes

A

hypoxia, acidosis, prematurity, congenital heart disease, prolonged physio stress, hypothermia, sepsis, mecon aspiration
Pulmo vaso constriction from patho maintains incr RH to LH pressures, flows cont thru FO and DA, contributing to venous shunting and persistent hypoxia

28
Q

Neonatal cardiac output

A

7ml/kg/min vs adult of 3.9 ml/kg/min, maintained by HR, is vagally mediated system so incr HR is desirable
Compliance is poor, undesirable location on F-S curve, poor contractile structure/organization, cells immature in Ca handling

29
Q

HR ranges, Hypotension Defined

A 
Neos/NB = 85-205, BP < 60
1m-1yr = 100-190, BP <90
30
Q

Blood Volumes

A 
Neo - dependent on cord blood given, BP = circ volume
PreNB = 90-100 ml/kg
FTNB = 80-90 ml/kg
3m-3yr = 75-80 ml/kg
3-6yr = 70-75 ml/kg
6yr + = 65-70 ml/kg
31
Q

ECF:ICF proportions

A

Neo/Inf has increased amounts of ECF compared to ICF, which doesnt vary with age, ECF as %BW decr with age, TBW decr accordingly with EBV decr per age

32
Q

Hematopoetic Issues

A

Physio Infant anemia - d/t decr epo levels p/ birth with loss of hypoxic environment, h/h lowest 3-4m, h/h = 9-11/30-40

33
Q

Hemoglobin and oxy Curve

A

HbF - less responsive to 2-3DPG, shifted oxy curve to L, 2 alpha/gamm vs HbA 2 alpha/beta and incr resp to 2-3DPG
NeoNatal Hb is 60-90% F, 3-4mo HbF/A is 50/50
P50 - NB = 20, 3mo = 30, adult = 27

34
Q

Glucose Levels, Tx of hypoglycemia

A

Prem = 20-65, Neo = 40-100, Inf/Child = 60-115

Tx: 1-2 cc/kg D50 diluted to D10 (too hypertonic –> IVH)

35
Q

Neos At risk for hypoglycemia / signs and symptoms

A

Overall Neo with immature liver and limited glycogen stores.
At risk: born from DM mothers, hyperalimentation, SGA, prolonged fasting, premature
resp distress, apnea, tachy-bradycardia, lethargy, cyanosis, tremors, diaphoresis, hypotension

36
Q

Hepatic Drug Metabolism

A

Decr d/t decr liver blood flow and decr CP450 enzyme conc and function. Enzymes fully active at 2-3mo, mature/adult at 2-3yr

37
Q

Hyperbilirubinemia

A

Occurs during first week, primarily d/t excess bili from RBC bkdown (physio jaundice), limited hepatic uptake of bili, and decr hepatic conjugation. Pathological hemolysis of NB with Rh incompatibility.

38
Q

Renal Issues

A

Neonate has decr renal function d/t low renal blood flow and decr GFR. At risk for fluid overload with rapid admin, unable to excrete excess lytes/fluid, drugs. Tend to loose sodium and water. Limited responses to aldosterone and ADH. Overall low GFR, decr Na retention and drug excretion.

39
Q

GI Issues

A

High risk for aspiration with decr LES tone, increase incidence of GERD <1yr. Poor breathing/swallowing coordination.

40
Q

Thermoregulation: Factors that increase heat loss

A

Large BSA to weight, decr subQ tissue, thin skin.

41
Q

NonShivering Thermogenesis

A

Increases core temp by metabolism of brown adipose tissue in mediastinum, kidneys, adrenals, neck and scapula. Hypothermia –> catecholamines –> triglycerides metab to FA and glycerol –> rls heat. Byproducts contribute to acidosis, pulm/peri vasoconstriction, hypoxia and r->l shunting.

42
Q

Mechanisms for Heat Loss

A 
#1 - Radiation, heat loss from body to environment, gradient = patient --> environment
#2 - Convection, heat loss from body by ambient cool current air = patient --> air, rises, replaced by cool air
#3 - Evaporation, heat loss from vapor press difference between body surface and environment = sensible and insensible loss, prep solutions (skin and lungs, 20% of heat loss)
#4 - Conduction, heat loss from exposed body to cooler surface = patient --> table/blanket/fluids
43
Q

Methods to Prevent Hypothermia

A

Incr room temp / heating blankets / sterile drapes / radiant heat / heated fluids/irrigation / covering head (loose 60% of heat) /HME / low gas flows
Most Eff way to maintain normothermia = warm OR
Most Eff way to rewarm hypothermia = forced air warmer

44
Q

Core Temp Monitoring Sites

A

Esophageal, tympanic likely to produce most accurate, simplest core temps. Also consider nasopharyngeal if correctly placed

Pediatrics (5 decks)

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