CV&P Neonate and Child

Question 1

Explain fetal heart pressure and how it differs from postnatal pressure

Answer 1

fetal heart pressure is opposite of postnatal
fetal right heart > left heart
R—> left shunt

Question 2

Where is there more resistance in fetal circulation

Answer 2

increased pulmonary vascular resistance vs systemic resistance

Question 3

what are the 3 anatomic shunts in fetal cirulation

Answer 3

1. foramen ovale- blood to flow from right to left bypassing lungs
2. ductus arteriosus- from pulmonary arter to aorta bypassing fetal lung
3. ductus venosus- connects umbillical vein and inferior vena cava bypassing portal cirulation

Question 4

oxygen rich blood is provided from the placenta to the fetus by what vein and enters where

Answer 4

by the umbilical vein and into the right atrium making a right to left shunt in fetal circulation

Question 5

Fetal circulation:
___ pulmonary vascular resistance
____ systemic vascular resistance

Answer 5

high pulmonary vascular resistance
low systemic vascular resistance due to placental circulation

Question 6

fetal circulation has a _____ to ____ shunt via ____ and ____

Answer 6

right to left shunt via patent foramen ovale and ductus arteriosis

Question 7

What happens during the transition from neonate to newborn?

Answer 7

aeration and expansion of the lungs
-inflating lungs initiates gas exchange
-opening of alveoli opens vascular units

Question 8

when the lungs inflate and alveoli open from the transition from neonate to newborn what happens to the Pulmonary vascular resistance and heart pressure

Answer 8

pulmonary vascular resistance decreases
Right heart pressure decreases

Question 9

what happens when the placental circulation is removed

Answer 9

systemic vascular resistance increases
increased pressure in the aorta and left heart pressure

Question 10

when does the foramen ovale close and what happens

Answer 10

anatomical closure ~2-3 months
left heart pressure> right heart pressure
systemic vascular resistance > than pulmonary vascular resistance

Question 11

when does the ductus arteriosus close?

Answer 11

functional closure- 15-72 hours
anatomical closure 2-3 weeks

Question 12

what happens if there is persistence of shunts or heart vascular defects?

Answer 12

can lead to altered circulation and altered blood gases

Question 13

what is a right to left shunt

Answer 13

fetal pressure is greater in the right V
foramen ovale open

Question 14

what is a left to right shunt

Answer 14

new born or adult
foramen ovale has closed
pressure greater in the left V

Question 15

what is an atrial septal defect?

Answer 15

patent foramen ovale- allows blood to flow between right and left atria

Fetal: normal right to left shunt through the FO
Birth/transitional circulation: FO should close due to increased left heart pressure

Question 16

what is a ventricular septal defect?

Answer 16

abnormal communication b/w right and left ventricular chambers of the heart

shunting depends on ventricular pressure usually left to right

Question 17

In ventricular spetal defect
CO is _____
may lead to ____ and ______

Answer 17

CO is increased
may lead to HF and persistent pulmonary HTN

Question 18

what is tetralogy of fallot? blue baby syndrome

Answer 18

cyanotic heart disease
four heart defects:
1. ventricular septal defect
2. pulmonary stenosis
3. right ventricular hypertrophy
4. overriding aorta

Question 19

what are common symptoms of congenital heart disease?

Answer 19

fast breathing, respiratory distress
poor feeding and poor weight gain
failure to thrive
decreased exercise tolerance

syncope
pulmonary and peripheral edema
palpitations

Question 20

can children with congenital heart diseases participate in cardiac rehab?

Answer 20

yes they can and should
but can be limited on exercise tolerance

Question 21

what accounts for >50 % of all illnesses in children?

Answer 21

respiratory illness

Question 22

what is surfactant and what does it do?

Answer 22

lipoprotein secreted by alveolar epithelium
reduces surface tension and decreases the effort needed to ventilate
prevents collapse of alveoli during expiration
it also has an immune effect to protect the lungs against invaders

Question 23

Surfactant ____ surface tension _____ compliance

Answer 23

decreases surface tension and increases compliance

Question 24

how are newborn/infant rib cages different than adults

Answer 24

ribs oriented parallel
limited ability to increase the thoracic volume during inspiration

increased chest wall compliance
decreased mechanical efficiency

Question 25

if a child has a hyper-compliant rib cage coupled with reduced lung compliance what happens?

Answer 25

asynchronous chest wall movements
loss of mechanical efficiency
increased work of breathing

Question 26

How does infant diaphragm continue to develop

Answer 26

increased muscle growth
increased cross sectional area
increased force production
increases strength

Question 27

what are some differences between preterm vs term infant

Answer 27

relative fatigability
decreased inspiratory reserve capacity
increased WOB: high metabolic rate; high RR
decreased lung compliance
increased chest wall compliance

Question 28

what is the difference between child and adult lungs
_____ lung surface area for gas exchange
______ rib alignment
______lung compliance
________ chest wall compliance
______RR
______ WOB

Answer 28

decreased lung surface area
horizontal rib alignment
decreased lung compliance
increased chest wall compliance
increased RR
increased work of breathing

Question 29

what respiratory syndrome is
-surfactant deficiency and lung inflammation
-decreased lung compliance
-atelectasis
-hypoxemia due to intrapulmonary shunt

Answer 29

hyaline membrane disease

Question 30

what is
-thickening of airway basement membranes
-hypertrophy of submucous glands
-edema and inflammation

Answer 30

asthma

Question 31

______ are integral part of pediatric lung disease

Answer 31

airway clearance techniques