Cardiopulm Conditions in Children Flashcards
What are stages of cardiac system maturation?
One of first functioning organ within growing fetus.
Contractions of heart begin at 17 days gestation
Effective blood flow at end of first month
Fetal heart sounds can be detected by 8-10 weeks gestation
Fetal blood oxygenated by placenta and maternal circulation
12% of blood follows pathway of adult circulation
Fetal circulation has alternative pathway due to fluid filled lungs
What is the foramen ovale and ductus arteriosus?
Ovale: one way door in atrial septum, blood flows from RA>LA>LV>aorta and systemic, closes within first few hours of life
Arteriosus: vascular link outside the heart between PA and aorta allowing blood to exit PA and directly into the aorta for systemic circulation, closes within first few weeks of life
What is maturation of pulmonary system?
Respiratory system begins to develop at 22-26 days gestation
Production of surfactant at about 20 weeks gestation
Surfactant amount increases as gestational age progresses- adequate levels reached about 2 weeks before birth to ensure adequate lung inflation
Respiratory complications occur in infants born prematurely due to immaturity of pulmonary system
Ventilation occurs after birth- first few breaths to inflate lungs and force fluid into lymphatic system
What is surfactant?
Lipid like substance that allows for adequate alveolar expansion by limiting surface tension across the alveolar membrane
What are structural and anatomical differences of cardiopulm system in infants?
Infants have higher larynx
Smaller airway diameter
Newborns chest wall is primarily cartilaginous- increased compliance of rib cage
Chest wall muscles in newborn primary stabilizers of thorax
Horizontal alignment of ribcage vs elliptical shape in older kids
Increased resistance to airflow
Increased work of breathing
Increased ribcage compliance results in decreased thoracic stability
T/F: upright anti gravity head, neck, trunk control helps with typical development of ribcage structure and function
True
What are characteristics, etiology, incidence of asthma?
Obstructive pulmonary disease: episodic periods of reversible airway narrowing, caused by airway inflammation increased secretions and smooth muscle bronchoconstriction
Etiology: unknown- genetics, environment, infection
Incidence: most common chronic childhood disease, from 1979 to 1995 incidence increased 160% in kids ages 0-4 and 74% in kids 5-14
What is medical and PT management for asthma?
Medical: maintenance meds (inhaled anti inflammatory drugs, oral steroids), rescue meds (inhaled bronchodilator)
PT: secretion removal, proper timing/use of inhaled medication, posture exercises, aerobic conditioning (premeds, exercise environment, longer warm up, monitor closely for symptoms)
What is exercise induced bronchospasm? Treatment?
Shortness of breath, wheezing, cough, chest tightness, induced by exercise
No chronic inflammation
May have EIB without diagnosis of asthma
Stabilizing meds used vs maintenance
Exercise triggers bronchospasm in many kids with asthma
What is CF? What does it effect?
Affects excretory glands of body
Secretions are thicker/more viscous and can obstruct systems of body
Affects lungs, pancreas, GI, reproductive organs, sinuses, sweat glands
Dysfunction of pulmonary system most common cause of morbidity and mortality: thick secretions may narrow or obstruct airways
What is epidemiology, etiology, incidence, life expectancy, dx of CF?
Autosomal, recessive, genetically inherited disease
Etiology: abnormal gene product CFTR; CFTR is expressed abundantly in respiratory GI reproductive sweat glands; allows chloride to pass through luminal membrane of cell, membrane permeable to sodium, leads to increased levels of NaCl which stimulates fluid secretion
Incidence: higher in white population
Life expectancy: 37.4 yrs
Diagnosis: analyze NaCl in sweat, genetic testing
What is medical and PT interventions for CF?
Medical: antibiotics, steroids, lung or heart-lung transplants
PT: pulmonary, secretion removal, posture exercises, aerobic exercise, promote function
What is infant respiratory distress syndrome?
Restrictive pulmonary disease
Etiology: inadequate levels of pulmonary surfactant and lung immaturity
Normal surfactant: initially produced at 20 weeks, adequate levels reached 2 weeks before birth
Incidence: 75% is born 26-28 weeks, 5% if born >36 weeks
What does inadequate surfactant lead too?
Decreased lung compliance, increased WOB, may result in hypoxemia (low blood oxygen) and hypoxia (decreased oxygen supply to tissue)
What is BPD?
Bronchopulmonary dysplasia
Obstructive pulmonary disease: thought to occur as result of RDS, if symptoms of RDS continue for more than one month after birth
Damage to lungs caused by mech vent and long term use of O2 exposure to high concentrations of O2
Etiology: exposure of immature infant to high concentrations of oxygen, inadequate surfactant production, infection
What is clinical definition of BPD?
Need for vent support at least 3 days and the need for supplemental O2 at 28 days of life
Need for supplemental O2 at 36 weeks gestational age
Radiographic abnormalities and chronic ventilation beyond initial period of RDS
What is management of respiratory distress syndrome and bronchopulmonary dysplasia?
Surfactant replacement therapy
Supplemental oxygen
Stress precautions: reduce environmental stimulation
Positioning to optimize cardiopulmonary function
Secretion removal
Provision of development stimulation activities
T/F: Musculoskeletal impairments in cardiopulm impact chest wall mobility, lung compliance, muscle strength, ROM or skeletal formation can impact muscle alignment and restrict ribcage movement
True
What are types of musculoskeletal system impairments in peds?
Arthritis: costovertebral joints, sternocostal joints, sternoclavicular joints, shoulders
Arthrogryposis – congenital disorder, multiple joint contractures, adduction and IR of shoulder joints, jaw and tongue ROM limitations, other contractures in UE and LE, club foot common
Osteogenesis Imperfecta- bone fragility, genetic disorder, collagen defect, bone fragility and frequent fracture
Scoliosis - lateral curvature of the thoracic spine
Sternal abnormalities - Pectus excavatum (lower sternal depression) and Pectus carinatum (protrusion, ‘pigeon chest’)
What is PT management of muscle impairments?
Thoracic mobility, breathing exercises, posture exercises, positioning, secretion removal
What are the 3 different cardiovascular structural defects?
Ventricular septal defect
Atrial septal defect
Patent ductus arteriosus
What happens in VSD?
Opening in ventricular septum which allows blood to flow from LV to RV (left to right shunt)
Already oxygenated blood flows back from LV to RV to pulmonary arteries and back into the lungs, bypassing systemic circulation
What happens in ASD?
Opening in the atrial septum
Oxygenated blood flows from LA to RA, pulmonary artery and back to the lungs (left to right shunts)
Less symptomatic than VSD
What happens in PDA?
Ductus arteriosus does not close (alternative route in the fetus)
Blood flows from aorta to pulmonary artery, or from left to right causing oxygenated blood to return to the lungs
What are symptoms and management of left to right shunts?
Symptoms: murmur on cardiac auscultation, crackles on lung auscultation, poor feeders, fatigue, diaphoresis, tachypnea, decreased systemic blood flow
Repair: heart cath to close PDA or seal ASD/VSD, surgery in complicated cases
What are test and measures used in peds?
Vitals: HR, RR, BP, SaO2, height, weight Auscultation ROM: UE and chest wall excursion Posture Muscle strength Milestones Mobility
What should vitals look like in kids?
HR infant: 100-140 HR child: 80-120 HR adult: 60-100 BP infant: 80/40 BP child: 100/60 RR infant: 30-40 RR child: 25-30 RR adult: 12-18
What is impact of cardiopulm conditions on activities?
Limited endurance and activity intolerance
Limited environmental exploration/play
Slowed physical growth and development
Impact of cardiopulm dysfunction on function and participation?
Infants: feeding, growth and wakefulness, limiting environmental exploration
Child: mobility and socialization with peers, sports, play, and school
Adolescents: socialization, employment, sports, concern about transition into independent adulthood
What is intervention for kids with cardiopulm issues?
Acute management Prevention of secondary impairment Motor performance Activity and performance Impact on overall motor development Be mindful of any precautions Secretion removal: postural drainage 5-20 min per position, percussion 2-5 min, huffing Positive expiratory pressure Breathing exercises: diaphragmatic, segmental ROM/positioning Aerobic exercise
what are types of mech vents in kids?
Positive pressure vent: invasive, pressurized gas delivered into airways via ET or trach tube
CPAP: continuous positive airway pressure
BiPAP: bi level positive airway pressure
Negative pressure vent: non invasive, creates negative pressure gradient around patients body during inspiration; providing using chest shell, poncho/wrap, or tank
What is selection criteria for mech vent?
Clinical: apnea, weakening vent effort, decreased breath sounds, asystole, severe brady or tachycardia, coma, nonresponsive, limpness, no ability to cry
Lab: PaCO2 >60-65 (newborn), >55-60 (child), rapidly rising >5; PaO2
What are normal PaO2 and PaCO2 in infants, child?
CO2
Infant 2: 35-45
O2
infant: 60-90
older infant/child: 80-100
What is proposed criteria for vent weaning?
No escalation in vent support within 2 days prior
Stable chest radiograph
Blood PaCO2 not more than 10% above baseline
Blood pH within normal range
Supplemental fraction of inspired oxygen of 0.6 or lower
Stable BP over 5-7 days prior
HR no greater than 95% of normal for age
Adequate nutrition
No active infection, acute pain, other med problems
Understanding by family/guardian
