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
