Cystic Fibrosis, Obesity, and Child Abuse Flashcards
What is cystic fibrosis?
is an inherited, recessive, genetic disorder that affects the exocrine glands (those glands that secrete mucus) due to a genetic defect.
How does CF present?
CF usually presents with primary problems in the lungs, sinus cavities, and digestive system
What are the early symptoms of CF?
Early symptoms include a dry cough, and an increased respiratory breathing rate
What are the later symptoms of CF?
Later symptoms include frequent cough and frequent respiratory infections.
What is the incidence of CF?
1/2500 births
___% are diagnosed with CF in the first year of life, ____% by age two and ____% by 10 years of age.
60% are diagnosed in the first year of life
75% by age two
90% by 10 years of age.
Approximately _____ people in the US are diagnosed with CF
30,000
Adults with CF now account for _____%
of CF population
38.7
The key to Cystic Fibrosis is …
Clogging of ducts
With CF, the affected areas of the body are …
the airways, liver, pancreas, intestine, and
reproductive tract.
With CF, Usually, death occurs early; often before age ___-___ (median life expectancy ____ yrs)
30-40
37.5
How are airways affected by CF?
Clogging and infection of bronchial passages impede breathing
Infections destroy the lungs
Lung disease accounts for the most deaths from CF
How is the liver affected by CF?
Plugging of small bile ducts impedes digestion and disrupts liver function in 5% of pts
How is the pancreas affected by CF?
Occlusion of ducts prevents the pancreas from delivering critical digestive enzymes to the bowel in 65% of patients
Diabetes can result as well
How is the small intestine impacted by CF?
Obstruction of the gut by thick stool necessitates surgery in about 10% of newborns
How is the reproductive tract impacted by CF?
Absence of fine ducts, such as the vas deferans, renders 95% of males infertile. Occasionally, women are made infertile by a dense plug of mucus that blocks sperm from entering the uterus.
How is the skin impacted by CF?
malfunctioning of sweat glands causes perspiration to contain excessive salt. Measurement of chloride in sweat is a mainstay of diagnosis.
What are the chances of a baby getting CF?
If both parents are carriers; ● A 25% chance that the child will be born with cystic fibrosis; ● A 50% chance that the child will not have CF, but will be a carrier; ● A 25% chance that the child will not have CF, and will not be a carrier.
Gene responsible for CF identified in1989:
CF Transmembrane Regulator Protein (CFTR).
In normal cells, CFTR allows …
the release of Clˉ from the cell.
When the Clˉ leaves the cell, an imbalance is created which …
draws water out of the cell through osmosis.
Pathophysiology of CF
● Abnormally thick, viscous mucus secretions principally affecting:
◦ BRONCHIAL TUBES
–◦ obstruction, damage to cilia, immobility of mucus blanket
◦ PANCREATIC DUCTS
–◦ digestive enzymes cannot leave the pancreas- malnutrition
◦ SWEAT GLANDS
–◦ salty sweat loss
◦ CARDIOPULMONARY SYSTEM
–◦ nailbed clubbing, airway collapse, etc.
◦ REPRODUCTIVE SYSTEM
–◦ sterility in males, difficulty with conception in females
Which lower airway infection is a death sentence for patients with CF?
p. cepacia
What red flag occurs when a newborn doesn’t poop?
meconium ileus
What are the treatments for CF?
1) Postural drainage⇒ bronchial dilator⇒ gravity drainage, percussive therapy
2) Intermittent positive pressure breathing (IPPB)
3. Self- administered airway clearance techniques (ACTs), Autogenic drainage, active cycle of breathing, ThAIRapy Vest and PEP devices such as the Acapella and the Flutter
How does CF impact exercise response?
● Related to severity of lung disease
● Can be affected by nutritional status
● Can be affected by pathophysiology of skeletal muscle tissue
True or false: An
inactive lifestyle may partially explain the poorer survival of female patients with CF.
True
What are the exercise recommendations for patients with CF?
● Exercise is “self-limiting”
● HR-based: not recommended since pulmonary function may be limiting factor
● Target HR: < desaturation level during exercise (keep above 90%)
● Swimming is highly recommended
● Facilitation of mucus expectoration
Long-term survival better in people with CF without
___________ insufficiency
pancreatic
In CF, poorer outcomes with colonization of…
pseudomonas, persistent respiratory problems
and airway hyperactivity
The prevalence of obesity was higher among __________ and ________ than among _________.
Hispanics (21.9%) and non-Hispanic blacks (19.5%) than among non-Hispanic whites (14.7%).
The prevalence of obesity was lower in ________ than in youth who were ________, ___________ or __________.
non-Hispanic Asian youth (8.6%) than in youth who were non-Hispanic white, non-Hispanic black, or Hispanic.
What are three things that increases a child’s risk of developing type II diabetes ?
⚫ Overweight and obesity is the most significant risk factor in the development of type 2 diabetes (T2DM) in children.
⚫ Prenatal exposure to maternal type I or II diabetes
⚫ Family history/culture
Ages ___-___ are the most important developmental stages for establishing healthy exercise and eating pattern
0-6
Parents should make sure that 3-4 year olds should get ______ of “active” play each day
at least one hour
How can overweight and obesity be prevented and treatedin children?
● Reaching and maintaining an appropriate body weight
● Focus on small but permanent changes in eating rather than a series of short-term changes that can’t be sustained.
● Reducing dietary fat is the easiest change.
● Highly restrictive diets that forbid favorite foods are likely to fail and should be limited to patients with severe complications who must
lose weight quickly.
What is prevention of increased weight gain velocity?
In treating mostoverweight children,
the main emphasis should be to prevent weight gain above what’s
appropriate for expected increases in
height.
What are the factors that predict success of maintaining a healthy life style?
◦ frequent intervention visits
◦ including parents in the dietary treatment program
◦ strong social support of dietary intervention from others involved in preparing food
◦ regular exercise prescription including social support
A BMI over the ____th percentile has arbitrarily been used to define obesity, even though variations in body size (as well as increases in body fat) increase the BMI.
95th
Children and adolescents exhibit a _______
frequency and _______ tidal volume than adults at
all intensities of exercise
higher frequency and lower tidal volume
Children process _____ air (liters per minute) than adults
Less
children process ______ liters/min/kg body weight than adults at submaximal exercise
More
At max exercise, children use _______ air (liters/min/kg) as adults
A similar amount
True or false: children sweat more than adults
False
True or false: children have a higher muscle blood flow than adults
True
True or false: Max HR is higher in adults than children and adolescents
Max HR is higher in children and
adolescents than adults
_____-_____ beats per min is not extraordinary for
children
and HR >_____ is not a cause for alarm unless there are other signs of distress or pathology
195-205 beats per min is not extraordinary
HR >200 is not a cause for alarm
True or false: healthy children can exercise at over 200 for a few minutes without any cause for alarm
True
True or false: HR will recover to resting levels over a longer period in children and adolescents
False
Relative to body weight, VO2max:
Remains unchanged in boys from ___ to ___ yo and then
decreases steadily
In girls remains unchanged until ___ to ___ yo and then decreases
steadily
Boys: 8-16
Girls: 10-12
Because puberty
True or false: High temperatures take less of a toll on children than adults
False
◦ Lower SV will necessitate an increased HR
◦ Lower blood pressure will result and blood to the vital organs will be decreased
More activity leads to _______ bone volume and mass (mineralization)
Increased
True or false: Having high bone density early in life
helps later in life
True
True or false: Even before puberty, boys have physical advantages that make them stronger than girls
False: There is little difference in strength between girls and boys before puberty
Boys increase muscle mass due to…
Testosterone
Girls increase __________ due to estrogen
fat mass
What are the precautions for children and adolescents performing resistance training, as per ACSM?
Children and adolescents can participate in resistance training, but there are specific precautions:
◦ Requires close, adult supervision ◦ Adequate warm-up ◦ High reps per set (no less than 6-8) ◦ No more than 2-3x/wk ◦ Emphasis on form ◦ Flexibility exercises ◦ Competitive lifting/body building should never be done ◦ Do not perform isolated eccentric workouts ◦ Maximal lifts are contraindicated
Mandated reporters are required to report suspected child abuse or maltreatment when they are presented
with …
a reasonable cause to suspect child abuse or maltreatment in a situation where a child, parent, or
other person legally responsible for the child is before the mandated reporter when the mandated reporter is acting in his or her official or professional capacity.
True or false: Abuse
also includes situations where a parent or other
person legally responsible knowingly allows someone else to inflict such harm on a child
True
What is maltreatment?
A child’s physical, mental or emotional
condition has been impaired, or placed in imminent danger of impairment, by the failure of the child’s parent or other person legally responsible to exercise a minimum degree of care
What are some things that fall under the umbrella of maltreatment?
✶ failing to provide sufficient food, clothing,
shelter, education; or
✶ failing to provide proper supervision,
guardianship, or medical care (refers to all medical issues, including dental,
optometric, or surgical care); or
✶ inflicting excessive corporal punishment, abandoning the child, or misusing alcohol or other drugs to the extent that the child was placed in imminent danger.
What are some indicators of maltreatment?
✶ Obvious malnourishment, listlessness, or fatigue;
✶ Stealing or begging for food;
✶ Lack of personal care—poor personal hygiene, torn and/or dirty clothes;
✶ Untreated need for glasses, dental care, or other medical attention;
✶ Frequent absence from or tardiness to school;
✶ Child inappropriately left unattended or without supervision.
What are some indicators of physical abuse?
✶ Injuries to the eyes or both sides of the head or body (accidental injuries typically only affect one side of the
body);
✶ Destructive, aggressive, or disruptive behavior;
✶ Passive, withdrawn, or emotionless
behavior;
✶ Fear of going home or fear of parent(s).
✶ Frequent injuries of any kind (bruises, cuts, and/or burns), especially if the child is unable to provide an adequate explanation of the cause. These mayappear in distinctive patterns such as grab marks, human bite marks, cigarette burns, or impressions of other instruments;
What are some indicators of sexual abuse?
✶ Symptoms of sexually transmitted diseases;
✶ Injury to genital area;
✶ Difficulty and/or pain when sitting or
walking;
✶ Sexually suggestive, inappropriate, or promiscuous behavior or verbalization;
✶ Expressing age-inappropriate knowledge of sexual relations;
✶ Sexual victimization of other children
True or false: Anyone who is mandated to report
suspected child abuse or maltreatment—and fails to do so could be charged with a CLASS A MISDEMEANOR and subject to
CRIMINAL PENALTIES.
Further, mandated reporters can be SUED in a civil court for monetary damages for any harm caused by the mandated reporter‘s failure to make a report to the SCR.
TRUE
