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CardioPulm 3 > CP Conditions in Peds > Flashcards

CP Conditions in Peds Flashcards

1
Q

When does the fetal heart begin to beat?

A

17 days gestation

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2
Q

T/F: If the fetal heart beat cannot be heard at 5-6 weeks of gestation, the parents should be concerned.

A

False, can’t be detected until 8-10 weeks.

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3
Q

T/F: The mother is responsible for oxygenation of fetal blood.

A

True

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4
Q

What cardiac features does the fetal heart have the does not exist in a fully developed heart?

A

Foramen ovale & Ductus arteriosus

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5
Q

Term: Foramen ovale

A

Opening in atrial septum allowing blood flow from RA to LA

Closes in 1st few hours of life

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6
Q

Term: Ductus Arteriosus

A

Opening b/w pulmonary artery and aorta allowing blood to exit the pulmonary artery and flow into aorta & systemic circulation.
Closes in 1st few weeks of life

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7
Q

At what point does the respiratory system develop?

A

22-26 days gestation

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8
Q

A child was born 4 weeks premature. From a respiratory standpoint, what might doctors be concerned about?

A

Surfactant. Adequate levels are generally reached at 2 wks before full term and is needed for adequate inflation.

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9
Q

When does surfactant production begin?

A

20 wks gestation

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10
Q

Structural Differences in Infants (3)

A

Higher larynx
Smaller airway diameter (increased resistance/work)
Increased rib cage compliance (decreased stability)

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11
Q

What are the primary stabilizers of the thorax in newborns?

A

Chest wall muscles

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12
Q

What aids in typical development of the ribcage & how do we work on this with infants?

A

Upright head, neck & trunk control.

Tummy Time for postural exercise

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13
Q

Peds Conditions that Impair Ventilation (4)

A

Asthma
Cystic Fibrosis
Infant Respiratory Distress Syndrome (RDS)
Bronchopulmonary Dysplasia (BPD)

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14
Q

Condition: Asthma

A

Characterized by episodic periods of reversible airway narrowing caused by inflammation, increased secretions and smooth muscle constriction.

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15
Q

Signs of Asthma (4)

A

Hyperventilation
Cough
Wheeze
Hypercapnia

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16
Q

Mgmt of Asthma

A

Meds: Inhalers/Rescue Inhalers, Oral steroids
PT: Secretion removal, Education on med usage, Postural exercises, Aerobic conditioning

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17
Q

Asthma & Aerobic Conditioning (4)

A

Pre-medication
Environment
Longer warm-up
Monitor closely

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18
Q

Condition: Exercise-Induced Bronchospasm (EIB)

A

SOB, wheezing, coughing, chest tightness induced by exercise
No chronic inflammation
Dx can occur w/o asthma dx

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19
Q

Condition: Cystic Fibrosis (CF)

A

Affects excretory glands causing thicker secretions and obstruction
Affects: Lungs, pancreas, GI, repro, sinuses, sweat glands
Obstruction of airways is most common cause of morbidity

20
Q

T/F: Cystic Fibrosis is a genetic disease.

A

True. Autosomal recessive, CFTR protein in both parents

21
Q

Mgmt of CF

A

Medical: Antibiotics, Steroids, Transplant
PT: Postural drainage, Secretion removal, Postural exercise, aerobic exercise, promote fxn

22
Q

Condition: Infant Respiratory Distress Syndrome (RDS)

A

Restrictive disease usually caused by inadequate surfactant due to lung immaturity

23
Q

Effects of Inadequate Surfactant (3)

A

Decreased lung compliance
Increased WOB
Hypoxia/Hypoxemia

24
Q

Condition: Bronchopulmonary Dysplasia (BPD)

A

Obstructive disease thought to occur due to RDS, infection, or exposure to high O2 concentration

25
Q

Clinical Definition of BPD (3)

A

Need for vent assist @ least 3 days & need for supplemental O2 at 28 days of life
Need for supplemental O2 at 36 wks gestation
Radiographic abnormalities and chronic ventilation required beyond initial period of RDS (past 1 month = RDS)

26
Q

Mgmt of RDS & BPD (5)

A 
Surfactant replacement therapy
Supplemental O2
Stress precautions (reduce stimulation)
Positioning
Secretion removal
27
Q

Musculoskeletal Impairments & Chest Mobility (5)

A 
Arthritis
Arthrogryposis
Osteogenesis
Scoliosis
Sternal abnormalities
28
Q

Term: Arthrogryposis

A

Multiple joint contractures

Typically adduction & internal rotation of shoulder, ROM, club foot, LEs

29
Q

Term: Osteogenica Imperfecta

A

A collagen defect leading to fragile bones, frequent fx

ie. Rib fx from normal breathing

30
Q

PT mgmt of Musculoskeletal Impairments (5)

A 
Thoracic mobility
Breathing exercises
Postural exercises
Positioning
Secretion removal
31
Q

Ventricular septal defect (VSD)

A

Opening in ventricular septum allowing blood flow from LV to RV (oxygenated blood skips systemic flow)

32
Q

Atrial septal defect (ASD)

A

Opening in atrial septum allowing blood flow from LA to RA

Less symptomatic than VSD

33
Q

Patent ductus arteriosus (PDA)

A

Ductus arteriosus does not close within weeks from birth

34
Q

Symptoms of Left to Right Shunting (7)

A 
Heart murmur
Crackles
Poor feeding
Fatige
Diaphoresis
Tachypnea
Decreased blood flow
35
Q

Mgmt of Left to Right Shunting (2)

A

Catheterization to close PDA, ASD or VSD

Surgery in extreme cases

36
Q

Values: Infant, Child & Adult HR

A

Infant: 100-140
Child: 80-120
Adult: 60-100

37
Q

Values: Infant, Child, Adult BP

A

Infant: 80/40
Child: 100/60
Adult: 120/80

38
Q

Values: Infant, Child Adult RR

A

Infant: 30-40
Child: 25-30
Adult: 12-18

39
Q

Secretion Removal Parameters (3)

A

Postural drainage, 5-20 min
Percussion, 2-5 for assisted cough
Huffing to tolerance

40
Q

Positive Pressure Ventilator

A

Invasive, pressurized gas delivered into the airways via endotrache or tracheostomy

41
Q

CPAP

A

Continuous delivery of distending pressure to open alveoli

42
Q

BiPap

A

Cycles b/w 2 CPAP levels for spontaneous breathing during ventilation
Often used for weaning

43
Q

Clinical Criteria for Mechanical Ventilation (7)

A 
Apnea
Weakened ventilatory effort
Decrease lung sounds
Systole
Brady/Tachycardia
Coma
Inability to cry/Limpness
44
Q

PaCO2 Lab Criteria for Mechanical Ventilation

A

Newborn: > 60-65 mmHg
Child: > 55-60 mmHg
Rapidly rising: > 5 mmHg

45
Q

PaO2 Lab Criteria for Mechanical Ventilation

A

Newborn:

46
Q

A child has been on mechanical ventilation and providers are assessing him for weaning. His parents are anxious to start the process. His chest radiographs are stable, lab values are within normal range and vitals have been stable for the last week. FiO2 is at .65 and vent support was increased slightly 2 days ago. Is the child a good candidate to begin weaning?

A

Based on proposed criteria, no. Ideally FiO2 would be less than 0.6 and vent support not increased in last 3 days.

CardioPulm 3 (6 decks)

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