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MAP II Final > Cardiopulmonary considerations in infant and child > Flashcards

Cardiopulmonary considerations in infant and child Flashcards

1
Q

Normal physiologic values of newborn:

A

RR=40-60
HR=120-200
BP=60-9-/30-60

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2
Q

Stress response in newborns

A

breathe faster because they cannot realistically breathe deeper
-horizontal rib cage, narrow intercostal space, no anterior chest wall, movement against gravity

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3
Q

Normal physiologic response of 2 yr old

A

RR=20-30
HR=100-180
BP=75-130/45-90 mmHg

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4
Q

Development of pulmonary system: 6-12 mos

MSK?

A
  • 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
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5
Q

Development of pulmonary system: 6-12 dos

Respiratory?

A
  • 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.
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6
Q

functional implications of new respiratory capacity by 12 mos

A
  • infant can breathe and move
  • can support the 02 demands of large mm involved in gross motor skills
  • rotation throughout the spine possible
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7
Q

Size and shape of infant chest?

A
  • occupies 1/3 of trunk cavity

- triangular frontal plane, circular A-P plane

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8
Q

Toddler and child examination of cardiopulmonary system

A
  • 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.
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9
Q

Multisystem Management:

Neuromuscular test and measures

A
  • functional assessment
  • phonation
  • myafascial screening,
  • connective tissue assessment
  • joint play assessment
  • neuromuscular coordination
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10
Q

Multisystem Management:

Internal organs - test and measures

A
  • episods of reflux
  • color of unrine
  • # of wet diapers a day
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11
Q

Multisystem Management:

MSK - test and measures

A
  • posture
  • biomechanics
  • functional strenght
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12
Q

Examination of cardiopulmonary system:

A
  • Hx
  • allegies
  • airway
  • vitals
  • surgeries/hospitalizations
  • what positions make it better?
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13
Q

Examination of functional impact of cardio pulmonary problems?

A
  • # of acute problems
  • (pneumonia, atelectasis, asthma
    # of missed days from school
    -# of trips to ER
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14
Q

Functional impact of cardiopulmonary problems:

A
  • behavior changes - keep track of changes
  • inc/dec. in:
  • fussiness
  • eye contact
  • talking
  • interest in eating
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15
Q

signs of airway obstruction?

A

child will demonstrate inspiratory restrictions such as stridor or inability to take a breath while crying

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16
Q

where to examine chest wall excursion?

A
  • level of 3rd rib
  • xiphoid process
  • half the distance between xiphoid and umbilicus
17
Q

Is breathing pattern efficient and effective to support ADL’s?
Possible interventions?

A
  • positioning
  • neuromuscular retraining
  • MSK intervention
  • “bath chair”
18
Q

Newborn stress response :

A
  • breathe faster because they cannot realistically breathe deeper
  • horizontal rib cage
  • narrow intercostal spacing
  • no anterior chest wall movement against gravity
19
Q

pyramid of synactive theroy

A

physiologic stability –> motor organization –> behavioral state organization –> attention/interaction –> self regulation

20
Q

signs of overstimulation/ stress

A
  • labored breathing, grunting, nostril flaring
  • skin color changes
  • startles
  • irritability/drowsiness
  • sneezing, gaze aversion
  • bowel movement, hiccups
  • finger splay, arm salute, trunk arching
21
Q

fetal circulation

A
  1. lungs not functional
  2. blood deoxygenated by placenta
  3. blood circulated by 3 shunts
  4. R ventricle strengthens
22
Q

5 fetal adaptations before birth.

A
  1. umbilical vein
  2. ductus venous
  3. foramen ovale
  4. ductus arteriosus
  5. umbilical artery
23
Q

neonatal circulation

A
  1. lungs become functional
  2. three fetal shuts close
  3. aeration of lungs
24
Q

what occurs in aeration of lungs?

A
  • dec. in pulmonary vascular resistance
  • inc. in pulmonary blood flow
  • thinning of walls of pulmonary arteries
25
Q

What are the 3 fetal shunts?

A
  • ductus venosus
  • foramen ovale
  • ductus arteriosus
26
Q

What are 3 cases of Acyanotic (L to R shunting) causing extra blood flow to lungs?

A
  1. Patent ductus arteriosus PDA
  2. atrial septal defect (ASD)
  3. ventricular septal defect (VSD)
27
Q

what occurs in patent ductus arteriosus -PDA?

A
  • 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
28
Q

What occurs in atrial septal defect? ASD

A
  • failure of foramen ovale to close
  • abnormal communication between L & R atria
  • usually repaired by suture or patch around 4-6 yrs
29
Q

What occurs in ventricular septal defect? VSD

A
  • 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
30
Q

Developmentally supportive care

-continuous observation and documentation during and after routines

A
  • behavioral state
  • autonomic signals
  • motor signals
  • attention signals
  • vital signs
  • SaO2
31
Q

Developmentally supportive care

-Benefits

A
  • 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
32
Q

Developmentally supportive care

Changing the NICU environment

A
  • low lights
  • honor babies unique sleep/wake/feeding cycle
  • low noise level
  • positioning
  • thoughtful handling and support infant during daily procedures

MAP II Final (9 decks)

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