Cardiopulmonary considerations in infant and child Flashcards
Normal physiologic values of newborn:
RR=40-60
HR=120-200
BP=60-9-/30-60
Stress response in newborns
breathe faster because they cannot realistically breathe deeper
-horizontal rib cage, narrow intercostal space, no anterior chest wall, movement against gravity
Normal physiologic response of 2 yr old
RR=20-30
HR=100-180
BP=75-130/45-90 mmHg
Development of pulmonary system: 6-12 mos
MSK?
- antigravity movement of all trunk planes of motion is possible
- infant able to use accessory mm for breathing
- rib cage moves downward and intercostal spaces widen
Development of pulmonary system: 6-12 dos
Respiratory?
- diaphragms mechanical advantage has improved w/ increased mm length, allowing 3-d movement
- respiratory reserves have inc.
- ling size inc. 4x since birth
- RR continually dec.
functional implications of new respiratory capacity by 12 mos
- infant can breathe and move
- can support the 02 demands of large mm involved in gross motor skills
- rotation throughout the spine possible
Size and shape of infant chest?
- occupies 1/3 of trunk cavity
- triangular frontal plane, circular A-P plane
Toddler and child examination of cardiopulmonary system
- CNS coordinates dual role of postural control and breathing for all mm of trunk
- when stressed, the respiratory mm will dec. postural support in order to focus immediate needs of respiration
- BREATHING ALWAYS WINS!
- as a PT and an expert in movement dysfunction, should always consider impact of camrdiopulm system.
Multisystem Management:
Neuromuscular test and measures
- functional assessment
- phonation
- myafascial screening,
- connective tissue assessment
- joint play assessment
- neuromuscular coordination
Multisystem Management:
Internal organs - test and measures
- episods of reflux
- color of unrine
- # of wet diapers a day
Multisystem Management:
MSK - test and measures
- posture
- biomechanics
- functional strenght
Examination of cardiopulmonary system:
- Hx
- allegies
- airway
- vitals
- surgeries/hospitalizations
- what positions make it better?
Examination of functional impact of cardio pulmonary problems?
- # of acute problems
- (pneumonia, atelectasis, asthma
# of missed days from school
-# of trips to ER
Functional impact of cardiopulmonary problems:
- behavior changes - keep track of changes
- inc/dec. in:
- fussiness
- eye contact
- talking
- interest in eating
signs of airway obstruction?
child will demonstrate inspiratory restrictions such as stridor or inability to take a breath while crying
where to examine chest wall excursion?
- level of 3rd rib
- xiphoid process
- half the distance between xiphoid and umbilicus
Is breathing pattern efficient and effective to support ADL’s?
Possible interventions?
- positioning
- neuromuscular retraining
- MSK intervention
- “bath chair”
Newborn stress response :
- breathe faster because they cannot realistically breathe deeper
- horizontal rib cage
- narrow intercostal spacing
- no anterior chest wall movement against gravity
pyramid of synactive theroy
physiologic stability –> motor organization –> behavioral state organization –> attention/interaction –> self regulation
signs of overstimulation/ stress
- labored breathing, grunting, nostril flaring
- skin color changes
- startles
- irritability/drowsiness
- sneezing, gaze aversion
- bowel movement, hiccups
- finger splay, arm salute, trunk arching
fetal circulation
- lungs not functional
- blood deoxygenated by placenta
- blood circulated by 3 shunts
- R ventricle strengthens
5 fetal adaptations before birth.
- umbilical vein
- ductus venous
- foramen ovale
- ductus arteriosus
- umbilical artery
neonatal circulation
- lungs become functional
- three fetal shuts close
- aeration of lungs
what occurs in aeration of lungs?
- dec. in pulmonary vascular resistance
- inc. in pulmonary blood flow
- thinning of walls of pulmonary arteries
What are the 3 fetal shunts?
- ductus venosus
- foramen ovale
- ductus arteriosus
What are 3 cases of Acyanotic (L to R shunting) causing extra blood flow to lungs?
- Patent ductus arteriosus PDA
- atrial septal defect (ASD)
- ventricular septal defect (VSD)
what occurs in patent ductus arteriosus -PDA?
- ductus arteriosus remains open
- pressure gradient between aorta and pulmonary arteries forces blood from aorta through PDA
- oxygenated blood mixes with deoxygenated blood
- varies in size and severity
- prolonged closure of PDA increases risk of poor developmental outcomes
What occurs in atrial septal defect? ASD
- failure of foramen ovale to close
- abnormal communication between L & R atria
- usually repaired by suture or patch around 4-6 yrs
What occurs in ventricular septal defect? VSD
- most common 20-30% of all defects
- abnormal communication between L & R ventricles
- if severe shunting, can switch to R to L shunting, causing severe respiratory distress
- may close spontaneously
Developmentally supportive care
-continuous observation and documentation during and after routines
- behavioral state
- autonomic signals
- motor signals
- attention signals
- vital signs
- SaO2
Developmentally supportive care
-Benefits
- shorter hospital stays
- decreased days on ventilator support
- increased weight gain
- earlier transition from gavage feeding
- cost saving of 1100/day
- decreased incidence of IVH
Developmentally supportive care
Changing the NICU environment
- low lights
- honor babies unique sleep/wake/feeding cycle
- low noise level
- positioning
- thoughtful handling and support infant during daily procedures
