CV&P Neonate and Child Flashcards
Explain fetal heart pressure and how it differs from postnatal pressure
fetal heart pressure is opposite of postnatal
fetal right heart > left heart
R—> left shunt
Where is there more resistance in fetal circulation
increased pulmonary vascular resistance vs systemic resistance
what are the 3 anatomic shunts in fetal cirulation
- foramen ovale- blood to flow from right to left bypassing lungs
- ductus arteriosus- from pulmonary arter to aorta bypassing fetal lung
- ductus venosus- connects umbillical vein and inferior vena cava bypassing portal cirulation
oxygen rich blood is provided from the placenta to the fetus by what vein and enters where
by the umbilical vein and into the right atrium making a right to left shunt in fetal circulation
Fetal circulation:
___ pulmonary vascular resistance
____ systemic vascular resistance
high pulmonary vascular resistance
low systemic vascular resistance due to placental circulation
fetal circulation has a _____ to ____ shunt via ____ and ____
right to left shunt via patent foramen ovale and ductus arteriosis
What happens during the transition from neonate to newborn?
aeration and expansion of the lungs
-inflating lungs initiates gas exchange
-opening of alveoli opens vascular units
when the lungs inflate and alveoli open from the transition from neonate to newborn what happens to the Pulmonary vascular resistance and heart pressure
pulmonary vascular resistance decreases
Right heart pressure decreases
what happens when the placental circulation is removed
systemic vascular resistance increases
increased pressure in the aorta and left heart pressure
when does the foramen ovale close and what happens
anatomical closure ~2-3 months
left heart pressure> right heart pressure
systemic vascular resistance > than pulmonary vascular resistance
when does the ductus arteriosus close?
functional closure- 15-72 hours
anatomical closure 2-3 weeks
what happens if there is persistence of shunts or heart vascular defects?
can lead to altered circulation and altered blood gases
what is a right to left shunt
fetal pressure is greater in the right V
foramen ovale open
what is a left to right shunt
new born or adult
foramen ovale has closed
pressure greater in the left V
what is an atrial septal defect?
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
what is a ventricular septal defect?
abnormal communication b/w right and left ventricular chambers of the heart
shunting depends on ventricular pressure usually left to right
In ventricular spetal defect
CO is _____
may lead to ____ and ______
CO is increased
may lead to HF and persistent pulmonary HTN
what is tetralogy of fallot? blue baby syndrome
cyanotic heart disease
four heart defects:
1. ventricular septal defect
2. pulmonary stenosis
3. right ventricular hypertrophy
4. overriding aorta
what are common symptoms of congenital heart disease?
fast breathing, respiratory distress
poor feeding and poor weight gain
failure to thrive
decreased exercise tolerance
syncope
pulmonary and peripheral edema
palpitations
can children with congenital heart diseases participate in cardiac rehab?
yes they can and should
but can be limited on exercise tolerance
what accounts for >50 % of all illnesses in children?
respiratory illness
what is surfactant and what does it do?
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
Surfactant ____ surface tension _____ compliance
decreases surface tension and increases compliance
how are newborn/infant rib cages different than adults
ribs oriented parallel
limited ability to increase the thoracic volume during inspiration
increased chest wall compliance
decreased mechanical efficiency
if a child has a hyper-compliant rib cage coupled with reduced lung compliance what happens?
asynchronous chest wall movements
loss of mechanical efficiency
increased work of breathing
How does infant diaphragm continue to develop
increased muscle growth
increased cross sectional area
increased force production
increases strength
what are some differences between preterm vs term infant
relative fatigability
decreased inspiratory reserve capacity
increased WOB: high metabolic rate; high RR
decreased lung compliance
increased chest wall compliance
what is the difference between child and adult lungs
_____ lung surface area for gas exchange
______ rib alignment
______lung compliance
________ chest wall compliance
______RR
______ WOB
decreased lung surface area
horizontal rib alignment
decreased lung compliance
increased chest wall compliance
increased RR
increased work of breathing
what respiratory syndrome is
-surfactant deficiency and lung inflammation
-decreased lung compliance
-atelectasis
-hypoxemia due to intrapulmonary shunt
hyaline membrane disease
what is
-thickening of airway basement membranes
-hypertrophy of submucous glands
-edema and inflammation
asthma
______ are integral part of pediatric lung disease
airway clearance techniques
