Cardiopulmonary/NICU Flashcards
Differences between adult and infant chests
LOOK AT SLIDES 3 AND 4 (nice table summarizes everything)
List 2 components of normal chest development.
- 6-12 months 2° to abdominal pull, ribs move from horiz. orientation to downward rotation
- Provides optimal pull for diaphragm and intercostals
List 3 components of abnormal chest development secondary to weak abdominals.
- Lower borders wing or flare (SB or SCI)
- Lateral flare of rib cage
- Intercostal retractions
Cystic fibrosis is a chromosome ___ autosomal recessive disease which causes _______ dysfunction due to a decrease in ________.
Chromosome 7
EXOCRINE gland dysfunction
CF transmembrane regulator
List 4 endocrine glands affected by CF.
- Respiratory
- Reproductive organs
- Pancreas
- Sweat glands
What occurs as a result of decreased CF transmembrane regulator?
Increase NaCl loss = hyper-viscous secretions
List 5 impairments associated with CF.
- Progressive airway obstruction
- Secondary infection, bronchiectasis, irreversible airway damage
- Impaired muscle dysfunction
- Hypoxemia
- Decreased vital capacity and tidal volume
Increase PACO2 levels lead to ________ which causes 95% of deaths in CF. What may this condition also cause?
Hypercapnic respiratory failure
May cause OSTEOARTHROPATHY (clubbing in fingers/toes)
_______ is a sign of decreased release of enzymes in the digestive system of children with CF. What does this condition lead to? (2)
Steatorrhea
- Malabsorption of fats and proteins
- Diabetes mellitus (7%)
Malnutrition leads to ______ and _______.
Muscle wasting
Failure to thrive
List 4 direct breathing techniques used to treat respiratory dysfunction in children with CF.
- Huffing
- Forced expiration
- Autogenic drainage
- Positive expiratory pressure
What are 2 problems with performing postural drainage and vibration in children?
- Postural drainage = GE reflux (no head down positions)
2. Vibration = difficult due to rapid breathing rates in infants
Describe the forced expiratory technique. (4)
- 1-2 huffs (forced expiration) from mid to low lung volume
- Upper chest relaxed
- Relaxed diaphragmatic breathing
- Repeated until secretions mobilize
Describe autogenic drainage.
- Sitting upright, relaxed position
- Several breaths at normal or relatively slow rhythm
- Secretion move upward due to breathing at different lung volumes
- Expel using gentle cough or forced expiration (huff) at end of sequence
Phase I of autogenic drainage is the ______ phase, which incorporates normal breathing and a ________ volume. The secretions are brought up to the _______.
Phase I = UNSTICK PHASE
SMALL tidal volume
Bronchial tree
Phase II of autogenic drainage is the ______ phase, which incorporates ________ lung volume. The secretions are brought up to the _______.
Phase II = COLLECT Phase
Low to mid volume
Central airways
Phase III of autogenic drainage is the ______ phase, which incorporates ________ volume.
Phase III = EVACUATE
Normal to high volume
Active cycle breathing involves ______ expansion, _____ times with pausing after each expansion.
Thoracic expansion
3-4 times
_______ can be done during chest expansion.
Percussion
Describe the active cycle breathing technique (ACBT). (3)
- Breath control + 2-3 thoracic expansions + inspiratory hold
- Breath control + 1-2 huffs + breath control
- Repeat as needed (until dry huff or nonproductive cough)
List 2 precautions to exercise in patients with CF.
- Bronchial hyperactivity (asthma)
2. Sweating (loss of electrolytes)
Asthma is caused by a defect in chromosome ____.
11
What is asthma? (2)
- Intermittent reversible episodes of dyspnea, wheezing, coughing
- Airways hypersensitive to stimuli or triggers
Those with acute asthma are all sensitive to developing a _______, and 60% are sensitive to ______.
Upper respiratory infection
Exercise (60%)
List 5 signs of acute asthma.
- Expiratory grunting
- Retractions
- Nasal flaring
- Alterations in inspiratory expiratory ratio
- Coughing
What is the exercise challenge test? What result indicated a diagnosis of exercise induced asthma?
- PFT at 5 min intervals, 20-30 min after treadmill run
2. Drop of 15% from prelevels OR development of a cough/wheeze = exercise induced asthma
List 4 impairments that arise from using accessory muscles for respiration.
- Decreased thoracic mobility/thoracic kyphosis
- Hypoextensibility of pecs, hip and knee flexors
- Elevated adducted shoulders/winging scap.
- Hypertrophied neck muscles/forward head
What are 2 main differences between acyanotic and cyanotic heart defects?
Acyanotic
- Blood shunted from left to right side of heart
- Oxygenated blood goes to lungs
- Decreased weight
Cyanotic
- Blood is shunted from right to left side
- Unoxygenated blood returns to the body
- Decreased weight and height
Children with cardiac defects will have a poor ______ experience, and never properly _____ due to energy requirements.
Poor FEEDING
Never CRAWL due to energy requirements
Describe the HR, respiratory effort, muscle tone, reflex irritability, and color of a baby with an Apgar score of 0.
HR = absent Respiratory effort = absent Muscle tone = extreme hypotonicity/limp Reflex irritability = none Color = blue/pale throughout
Describe the HR, respiratory effort, muscle tone, reflex irritability, and color of a baby with an Apgar score of 1.
HR = <100bpm Respiratory effort = irregular or slow Muscle tone = some flexion Reflex irritability = grimace Color = extremities blue/pale
Describe the HR, respiratory effort, muscle tone, reflex irritability, and color of a baby with an Apgar score of 2.
HR = >100bpm Respiratory effort = good strong cry Muscle tone = normal physiological flexion Reflex irritability = cry or sneeze Color = pink color throughout
List 3 progressions a premature baby will undergo.
- Generalized hypotonia to flexor tone (caudocephalic)
- Random total movements to purposeful controlled movements
- Inconsistent (absent) primitive reflexes to consistent presences (cephalocaudal)
Premature babies in the NICU typically have _____ syndrome, which can progress to _______ if on O@ for greater than 28 days.
Respiratory distress syndrome
Bronchopulmonary dysplasia
_______ and _______ are 2 conditions that can result from an ischemic lesion.
Periventricular leukomalacia
Periventricular/intraventricular hemorrhage
List 3 risk profiles for premature infants.
- Irritable/Hypotonic (poor midline with disorganized movement)
- Lethargic hypotonic (poor feeding)
- Disorganized (fluctuating tone and irritable when stimulated)
List 3 impairments associated with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE).
- Growth deficiency
- Cardiac defects
- CNS dysfunction (development delays, poor judgement/comprehension)
________ is an impairment associated with FAS but not present with FAE.
Dysmorphology (facial anomalies)
List 5 direct effects of cocaine on infants.
- Vasoconstriction
- Growth retardation
- Anomalies
- Abnormal neurotransmitter levels
- Decreased auditory and visual responsiveness
List 2 indirect effects of cocaine on infants.
- Placental insufficiency
2. Fetal hypoxia
List 5 signs of cocaine withdrawal in new borns.
- Irritability
- Tremors
- Apnea
- Seizure
- Sleep disturbances
List 3 impairments caused by cocaine exposure in the 1st year of life.
- Increased muscle tone
- Poorly developed primitive reflexes
- Delayed automatic reactions and volitional movements
