Cardiopulmonary/NICU

Question 1

Differences between adult and infant chests

Answer 1

LOOK AT SLIDES 3 AND 4 (nice table summarizes everything)

Question 2

List 2 components of normal chest development.

Answer 2

1. 6-12 months 2° to abdominal pull, ribs move from horiz. orientation to downward rotation
2. Provides optimal pull for diaphragm and intercostals

Question 3

List 3 components of abnormal chest development secondary to weak abdominals.

Answer 3

1. Lower borders wing or flare (SB or SCI)
2. Lateral flare of rib cage
3. Intercostal retractions

Question 4

Cystic fibrosis is a chromosome ___ autosomal recessive disease which causes _______ dysfunction due to a decrease in ________.

Answer 4

Chromosome 7

EXOCRINE gland dysfunction

CF transmembrane regulator

Question 5

List 4 endocrine glands affected by CF.

Answer 5

1. Respiratory
2. Reproductive organs
3. Pancreas
4. Sweat glands

Question 6

What occurs as a result of decreased CF transmembrane regulator?

Answer 6

Increase NaCl loss = hyper-viscous secretions

Question 7

List 5 impairments associated with CF.

Answer 7

1. Progressive airway obstruction
2. Secondary infection, bronchiectasis, irreversible airway damage
3. Impaired muscle dysfunction
4. Hypoxemia
5. Decreased vital capacity and tidal volume

Question 8

Increase PACO2 levels lead to ________ which causes 95% of deaths in CF. What may this condition also cause?

Answer 8

Hypercapnic respiratory failure

May cause OSTEOARTHROPATHY (clubbing in fingers/toes)

Question 9

_______ is a sign of decreased release of enzymes in the digestive system of children with CF. What does this condition lead to? (2)

Answer 9

Steatorrhea

1. Malabsorption of fats and proteins
2. Diabetes mellitus (7%)

Question 10

Malnutrition leads to ______ and _______.

Answer 10

Muscle wasting

Failure to thrive

Question 11

List 4 direct breathing techniques used to treat respiratory dysfunction in children with CF.

Answer 11

1. Huffing
2. Forced expiration
3. Autogenic drainage
4. Positive expiratory pressure

Question 12

What are 2 problems with performing postural drainage and vibration in children?

Answer 12

1. Postural drainage = GE reflux (no head down positions)

2. Vibration = difficult due to rapid breathing rates in infants

Question 13

Describe the forced expiratory technique. (4)

Answer 13

1. 1-2 huffs (forced expiration) from mid to low lung volume
2. Upper chest relaxed
3. Relaxed diaphragmatic breathing
4. Repeated until secretions mobilize

Question 14

Describe autogenic drainage.

Answer 14

1. Sitting upright, relaxed position
2. Several breaths at normal or relatively slow rhythm
3. Secretion move upward due to breathing at different lung volumes
4. Expel using gentle cough or forced expiration (huff) at end of sequence

Question 15

Phase I of autogenic drainage is the ______ phase, which incorporates normal breathing and a ________ volume. The secretions are brought up to the _______.

Answer 15

Phase I = UNSTICK PHASE
SMALL tidal volume
Bronchial tree

Question 16

Phase II of autogenic drainage is the ______ phase, which incorporates ________ lung volume. The secretions are brought up to the _______.

Answer 16

Phase II = COLLECT Phase
Low to mid volume
Central airways

Question 17

Phase III of autogenic drainage is the ______ phase, which incorporates ________ volume.

Answer 17

Phase III = EVACUATE

Normal to high volume

Question 18

Active cycle breathing involves ______ expansion, _____ times with pausing after each expansion.

Answer 18

Thoracic expansion

3-4 times

Question 19

_______ can be done during chest expansion.

Answer 19

Percussion

Question 20

Describe the active cycle breathing technique (ACBT). (3)

Answer 20

1. Breath control + 2-3 thoracic expansions + inspiratory hold
2. Breath control + 1-2 huffs + breath control
3. Repeat as needed (until dry huff or nonproductive cough)

Question 21

List 2 precautions to exercise in patients with CF.

Answer 21

1. Bronchial hyperactivity (asthma)

2. Sweating (loss of electrolytes)

Question 22

Asthma is caused by a defect in chromosome ____.

Answer 22

11

Question 23

What is asthma? (2)

Answer 23

1. Intermittent reversible episodes of dyspnea, wheezing, coughing
2. Airways hypersensitive to stimuli or triggers

Question 24

Those with acute asthma are all sensitive to developing a _______, and 60% are sensitive to ______.

Answer 24

Upper respiratory infection

Exercise (60%)

Question 25

List 5 signs of acute asthma.

Answer 25

1. Expiratory grunting 2. Retractions 3. Nasal flaring 4. Alterations in inspiratory expiratory ratio 5. Coughing

Question 26

What is the exercise challenge test? What result indicated a diagnosis of exercise induced asthma?

Answer 26

1. 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

Question 27

List 4 impairments that arise from using accessory muscles for respiration.

Answer 27

1. Decreased thoracic mobility/thoracic kyphosis 2. Hypoextensibility of pecs, hip and knee flexors 3. Elevated adducted shoulders/winging scap. 4. Hypertrophied neck muscles/forward head

Question 28

What are 2 main differences between acyanotic and cyanotic heart defects?

Answer 28

Acyanotic 1. Blood shunted from left to right side of heart 2. Oxygenated blood goes to lungs 3. Decreased weight Cyanotic 1. Blood is shunted from right to left side 2. Unoxygenated blood returns to the body 3. Decreased weight and height

Question 29

Children with cardiac defects will have a poor ______ experience, and never properly _____ due to energy requirements.

Answer 29

Poor FEEDING | Never CRAWL due to energy requirements

Question 30

Describe the HR, respiratory effort, muscle tone, reflex irritability, and color of a baby with an Apgar score of 0.

Answer 30

``` HR = absent Respiratory effort = absent Muscle tone = extreme hypotonicity/limp Reflex irritability = none Color = blue/pale throughout ```

Question 31

Describe the HR, respiratory effort, muscle tone, reflex irritability, and color of a baby with an Apgar score of 1.

Answer 31

``` HR = <100bpm Respiratory effort = irregular or slow Muscle tone = some flexion Reflex irritability = grimace Color = extremities blue/pale ```

Question 32

Describe the HR, respiratory effort, muscle tone, reflex irritability, and color of a baby with an Apgar score of 2.

Answer 32

``` HR = >100bpm Respiratory effort = good strong cry Muscle tone = normal physiological flexion Reflex irritability = cry or sneeze Color = pink color throughout ```

Question 33

List 3 progressions a premature baby will undergo.

Answer 33

1. Generalized hypotonia to flexor tone (caudocephalic) 2. Random total movements to purposeful controlled movements 3. Inconsistent (absent) primitive reflexes to consistent presences (cephalocaudal)

Question 34

Premature babies in the NICU typically have _____ syndrome, which can progress to _______ if on O@ for greater than 28 days.

Answer 34

Respiratory distress syndrome | Bronchopulmonary dysplasia

Question 35

_______ and _______ are 2 conditions that can result from an ischemic lesion.

Answer 35

Periventricular leukomalacia | Periventricular/intraventricular hemorrhage

Question 36

List 3 risk profiles for premature infants.

Answer 36

1. Irritable/Hypotonic (poor midline with disorganized movement) 2. Lethargic hypotonic (poor feeding) 3. Disorganized (fluctuating tone and irritable when stimulated)

Question 37

List 3 impairments associated with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE).

Answer 37

1. Growth deficiency 2. Cardiac defects 3. CNS dysfunction (development delays, poor judgement/comprehension)

Question 38

________ is an impairment associated with FAS but not present with FAE.

Answer 38

Dysmorphology (facial anomalies)

Question 39

List 5 direct effects of cocaine on infants.

Answer 39

1. Vasoconstriction 2. Growth retardation 3. Anomalies 4. Abnormal neurotransmitter levels 5. Decreased auditory and visual responsiveness

Question 40

List 2 indirect effects of cocaine on infants.

Answer 40

1. Placental insufficiency | 2. Fetal hypoxia

Question 41

List 5 signs of cocaine withdrawal in new borns.

Answer 41

1. Irritability 2. Tremors 3. Apnea 4. Seizure 5. Sleep disturbances

Question 42

List 3 impairments caused by cocaine exposure in the 1st year of life.

Answer 42

1. Increased muscle tone 2. Poorly developed primitive reflexes 3. Delayed automatic reactions and volitional movements