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CPPT II > FINAL: Unit 4: Fetal Development+Congenital Heart Defects > Flashcards

FINAL: Unit 4: Fetal Development+Congenital Heart Defects Flashcards

1
Q

This system in terms of embryologic development

DEVELOPS EARLY

A

CARDIAC SYSTEM

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2
Q

Cardiac System

Embryologic Development

DAY 22 to 23

A

Fusion of the endocardial heart tubes

*THE HEART BEATS*

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3
Q

CARDIAC SYSTEM

Embryologic Dev

DAY 27

A

Heart starts circulating blood from the heart to the rest of the embryo

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4
Q

CARDIAC SYSTEM

Embryologic Dev

WEEK 8

A

4 Chambers of heart FULLY DEVELOPED

==> NORM heart function

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5
Q

CARDIAC SYSTEM

embryologic Dev.

WEEK 12***

A

Circulatory System is OPERATING

*NOTE: 12 weeks CARDIAC progress is 28-38wks progress for LUNGS

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6
Q

CARDIAC SYSTEM

Embryological Dev.

1st-2nd Trimester

A

HEART CAN FUNCTION

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7
Q

This system in terms of Embryologic Dev.

DEVELOPS LATE

A

PULMONARY SYSTEM

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8
Q

PULMONARY SYSTEM

Embryologic Dev.

WEEK 24*

A

Mucosal glands functional

Surfactant begins production (so the lungs can work—INC surf area)

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9
Q

PULMONARY SYSTEM

Embryologic Dev.

WEEK 28 TO TERM:

A

Surfactant production MATURES

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10
Q

PULMONARY SYSTEM

Embryologic Dev.

WEEK 36-40***

A

Alveoli appear, and surfactant reaches FULL MATURITY and is FUNCTIONAL

**REMEMBER—heart is fully working WAY BEFORE THIS (week 8 and by week 12 circulatory system is FULLY WORKING)

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11
Q

Fetal circulation is ________ from post-natal circulation

A

DIFFERENT

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12
Q

Fetal Circulation

Placenta

*Umbilical cord connects the placenta TO IVC and contains___________

A

Contains umbilical artery and umbilical vein

  • Umbilical artery brings De-O2’d blood OUT of body
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13
Q

Fetal Circulation

Blood from the IVC goes where?

A

IVC—-> Rt. Atrium

*O2 comes from placenta

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14
Q

Fetal Circulation

Foramen Ovale

A
  • permits MOST OF (90%) oxygenated blood ENTERING R. ATRIUM to pass INTO L. Atrium
    • ​**SKIPS R. VENTRICLE + LUNGS
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15
Q

Fetal Circulation

Ductus Arteriosus

A
  • Connects Aorta w/ the Pulm aa
  • SHUNTS most blood AWAY from lungs INTO aorta
    • ​SKIPS LUNGS + L. SIDE OF HEART
  • R. atrium–> R. vent–pulm aa–> aorta
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16
Q

Fetal Circulation

10% of blood goes where

A

10% goes to LUNGS only to nourish the developing lung tissue

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17
Q

BOTH Foramen Ovale and Ductus Arteriosus

Allow what?

A
  • Allow blood to skip or shunt R. ventricle

OR

  • Skip or shunt Lungs and L. side of heart
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18
Q

Fetal Circulation

More on blood vessels of Pulmonary circulation

*remember LUNGS for most part (only 10%) are SKIPPED

A
  • Vessels of pulm circulation are vasoconstricted in the fetus
    • blood traveling to and thru lungs is primarily used to nourish and develop lung tissue
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19
Q

Ductus Arteriosus

Blood b/w _______ and ________

A

Pulm aa & Aorta

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20
Q

Foramen Ovale

Blood b/w _________ and ________

A

R. and L. Atria

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21
Q

Umbilical Vein

O2’d blood into WHERE?

A

O2’d blood INTO IVC

**O2’d blood FROM PLACENTA

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22
Q

MORE PICS ON

O2’d blood from Placenta

Foramen Ovale–blood from Rt. atrium to L. atrium

Ductus Ateriosus–shunts blood AWAY from lungs

A

see pics

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23
Q

Fetal Circulation

Blood travels BACK TO PLACENTA via____________

A

Umbilical Arteries

*remember this is de-O2’d blood

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24
Q

Pediatric Development

Neonatal

Fetal fluid in lungs is squeezed out while passing thru birth canal.

Remaining fluid is Absorbed by capillaries and lymph

So that WHAT HAPPENS???

A

So infants lungs can expand w/ air w/ their first breath

  • Surfactant is necessary to maintain patent alveoli
    • ​PREVENTS COLLAPSE***
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25
Q

What closes the foramen ovale after birth?

A

Closes w/ INCd Pressure in L. atrium

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26
Q

Ductus arteriosus begins to close when?

A
  • w/in 24hrs of birth as lungs become filled w/ O2
    • ​BABY NOW BREATHING
      • ​causes PO2 lvls to rise
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27
Q

Once baby PO2 lvls rise…

what happens to ventricles?

A

Shift from working in parallel to working in series

*R. vent slightly EARLIER vs. L. vent

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28
Q

Alveoli grow until _________ yrs old

A

8 yrs old

*NO smoking in the house****

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29
Q

MSK Cardiopulm Development in Infants

0-3 months

SHAPE OF THORAX:

DIRECTION OF RIBS:

PRIMARY MM’S USED FOR INSPIRATION:

A

Triangular

Horizontal

Diaphragm

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30
Q

MSK Cardiopulm Development in Infants

3 to 6 months

SHAPE OF THORAX:

DIRECTION OF RIBS:

PRIMARY MM’S USED FOR INSPIRATION:

A

RECTANGULAR

HORIZONTAL

DIAPHRAGM + ACCESS. MM’S

*Happens as infant gains UE strength

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31
Q

MSK Cardiopulm Development in Infants

6 to 12 months

SHAPE OF THORAX:

DIRECTION OF RIBS:

PRIMARY MM’S USED FOR INSPIRATION:

A

Rectangular

Angled Downward

Diaphragm + Intercostals

*NOTE: @ around age 2, should demo little to NO activation of access mm’s during quiet breathing—–> JUST DIAPHRAGM

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32
Q

Shape of Ribs

Infant—Triangle (0-3mos)

Adult or 12mo’s–Angled Downward

A

see pics

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33
Q

MOST COMMON BIRTH DEFECT

A

Congenital Heart Defects

CHD

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34
Q

Dx of cardiac dysf may be made when ?

A

Prenatally

@ Birth

T/O life

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35
Q

CHDs most often occurr when ?

A

8-10th wk of gestation

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36
Q

CHD

Causes:

A
  • Genetics
  • FAS, Fetal drugs
  • Trisomy 21
  • SMA
  • Turners syndrome
  • VATER assoc.
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37
Q

10% of children w/ CHDs also have other phys malformations

A

*********

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38
Q

CHD Categorization

2 Cats:

A
  1. Acyanotic–> pts are PINK
  2. Cyanotic–> pts are BLUE
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39
Q

Acyanotic vs. Cyanotic

A

see pics

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40
Q

CHD Categories

Acyanotic

pts are PINK

A
  • Blood Shunts: L to R
  • Blood to body: FULLY O2’D to lungs and body
  • SV: LOW SV, heart works HARDER
  • SaO2: NORM SaO2
  • Pulm blood flow: INCd pulm blood flow
  • Color: PINK
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41
Q

CHD Categories

Cyanotic

pts are BLUE

A
  • Blood Shunts: R to L
  • Blood to Body: UNoxygenated blood returned to body
  • SV: GOOD quality SV
  • SaO2: 15-30% BELOW NORM
  • *RBCs: INCd RBC formation
  • *Viscosity: INCd blood viscosity—> risk of CVA
  • Color: BLUE
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42
Q

Acyanotic vs. Cyanotic

Common Lesions

A

see pics

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43
Q

Common Acyanotic Lesions :

A
  • Atrial Septal Defects- ASDs
  • Ventricular Septal Defects -VSDs
  • Atrioventricular Septal Defects-AVSDs
  • Patent Ductus Arteriosus- PDA
  • Coartication of the Aorta
  • Pulmonary Stenosis
  • Aortic Stenosis

*Alfred Ventured Ahead of Paula Cuz Paula Abdul

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44
Q

Common Cyanotic Lesions:

A
  • Tetralogy of Fallot
  • Transposition of the Great Arteries
  • Tricuspid Atresia
  • Pulmonary Atresia
  • Truncus Arteriosus
  • Total Anomalous Pulmonary Venous Return
  • Hypoplastic Left-Sided Heart Syndrome- HLHS

*Triple T, P, Double T, H

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45
Q

Acyanotic

Atrial Septal Defect

ASD

what is it

A
  • HOLE in septum b/w the atria
    • ​persistent (long term) foramen ovale
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46
Q

Acyanotic

Atrial Septal Defect

ASD

Allows _______ blood to flow from _______ to _______

A

Allows oxygenated blood to flow from L atria to R atria

  • Mixerespirated blood
  • Stresses heart===> CHF
  • >80% CLOSE in first yr w/out sx
47
Q

Acyanotic

Atrial Septal Defect

ASD

S/S

A
  • Murmur
  • racing heart beat
  • Enlarged pulm aa
48
Q

Acyanotic

Atrial Septal Defect

ASD

>80% close w/out sx BUT

What is the Sx intervention?

A

PATCH placed via open heart sx OR cath proc.

49
Q

Acyanotic Defects

Ventricular Septal Defect

VSDs

Explain generally

A
  • Opening in Septum b/w L and R ventricle
  • Blood flows b/w ventricles
  • HEART MUST WORK HARDER TO PUMP BLOOD TO BODY
50
Q

Acyanotic Defects

Ventricular Septal Defect

VSDs

LARGE DEFECTS…

A
  • LG. defects may lead to:
    • bacterial endocarditis
    • pulm vascular obstructive dis.
    • aortic regurgitation
    • INCd incidence of lower resp tract infections
    • CHF
51
Q

Acyanotic Defects

Ventricular Septal Defect

VSDs

S/S

A
  • Murmur
  • fatigue
  • INCd HR
  • poor growth/feeding
  • irritability
  • restlessness
  • rapid breathing
52
Q

Acyanotic Defects

Ventricular Septal Defect

VSDs

Tx:

A
  • Watch/Wait: may spontaneously close
  • Sx: close via patch w/ open heart sx
53
Q

Acyanotic Defects

Atrioventricular Septal Defect

AVSDs

*BOTH PLACES

Explain generally…

A
  • Persistent (long term) foramen ovale AND ventricle septal defect w/ incomplete valve formation
  • 15-40% children w/ Downs/Trisomy 21
54
Q

Acyanotic Defects

AtrioVentricular Septal Defect

AVSDs

S/S

A
  • Pulm HTN—-usually assoc’d w/ R.side HF
  • lung congestion
  • HF
55
Q

Acyanotic Defects

AtrioVentricular Septal Defect

AVSDs

Tx:

A
  • Sx usually required w/in first few months of life
56
Q

Acyanotic Defects

Patent Ductus Arteriosus

PDA

“Open Passageway”

*opening b/w Pulm aa & Aorta

Describe generally…

A
  • NORMALLY closes w/in 5-14 days after birth bc changes in prostaglandin lvls w/ INC O2 lvls
  • Often assoc’d w/:
    • ​prematurity/respiratory distress syndrome/hyaline membrane dis.
      • —> Hypoxia: O2 lvls NEVER HIGH ENOUGH to signal closure
57
Q

Acyanotic Defects

Patent Ductus Arteriosus

PDA

“Open Passageway”

*opening b/w Pulm aa & Aorta

S/S

A

*vary based on SIZE of opening

  • LARGE:
    • Compensatory tachycardia + INCd RR
    • poor wt. gain
  • SMALL:
    • ​asymptomatic
58
Q

Acyanotic Defects

Patent Ductus Arteriosus

PDA

“Open Passageway”

*opening b/w Pulm aa & Aorta

Tx:

A
  • Minimally invasive sx closure
  • Med mgmt w/ indomethacin
59
Q

Acyanotic Defects

Coartication (narrowing) of the Aorta

Explain Generally….

A

AKA 2* HTN

  • Narrowing of the Aorta after it branches off to the UPPER BODY
  • Obstructed of blood flow to LOWER BODY
  • INCd work on L. vent to pump
  • Can lead to CHF
60
Q

Acyanotic Defects

Coartication (narrowing) of the Aorta

S/S

A
  • INCd RR
  • INCd sweating
  • DECd growth
  • DECd endurance
  • murmur
61
Q

Acyanotic Defects

Coartication (narrowing) of the Aorta

Tx:

A
  • Cath to dilate
  • Stent to open
  • Sx:
    • ​REMOVE portion of aorta and sew back together or enlarge w/ patch
  • MAY RE-OCCUR
62
Q

Acyanotic Defects

PULMONARY STENOSIS

IN GENERAL….

A
  • Fused, thickened or missing leaflets of pulm valve causing OBSTRUCTION
  • INCs work on Rt. ventricle (bc this is where Pulm valve leaves) to pump blood to lungs
63
Q

Acyanotic Defects

PULMONARY STENOSIS

S/S

A
  • Fatigue
  • murmur
  • Rare cases have chest pain
64
Q

Acyanotic Defects

PULMONARY STENOSIS

Dx:

A
  • ECG
  • Chest X-ray
  • SpO2
  • Cath
  • MRI
65
Q

Acyanotic Defects

PULMONARY STENOSIS

Tx:

A
  • DEPENDS on anatomy and severity
    • ​Cath
    • Sx:
      • ​Valvotomy
      • homograft (self) valve
      • New valve
66
Q

Acyanotic Defects

AORTIC STENOSIS

In general…

A
  • Fused, Thickened, missing leaflets of Aortic valve (its IN the name of the defect as what it IS*)
  • Obstruction from LEFT vent to aorta (bc this is where Aortic valve leads)
  • INCd work on LEFT ventricle to pump blood to body (bc this is where Aortic valve is**)
67
Q

Acyanotic Defects

AORTIC STENOSIS

S/S

A

MOST ALL ACYANOTIC DEFECTS HAVE SAME S/S***

  • Fatigue
  • Murmur
  • Rarely chest pain
  • fainting
  • arrhythmias
68
Q

Acyanotic Defects

AORTIC STENOSIS

Dx:

A
  • Murmur
  • ECG
  • ECHO
  • chest x-ray
  • SpO2
  • Cath
  • MRI
69
Q

Acyanotic Defects

AORTIC STENOSIS

Tx:

A

Depends on severity

  • Balloon Valvuloplasty via cath
  • Sx:
    • ​artificial valve OR Ross proc.
70
Q

CYANOTIC DEFECTS

these pts are______

A

BLUE

“cyanotic”

71
Q

Cyanotic Defects

Tetrology or Fallot

Tetra==4***

COMBINATION of defects:

A
  • VSDs
  • Aortic Override
  • Pulm Stenosis
  • R. Ventricular Hypertrophy
72
Q

Cyanotic Defects

Tetrology or Fallot

Tetra==4***

What is it??

A
  • 50% of Cyanotic defects***
  • DECd blood flow to the lungs
  • POORLY oxygenated blood (bc SO much going on think about COMBO*) pumps out thru Aorta
  • *Degree of Cyanosis depends on pulm stenosis
73
Q

Cyanotic Defects

Tetrology or Fallot

Tetra==4***

S/S

A

Cyanosis

murmur

*clubbing

‘Tet spell”

74
Q

Cyanotic Defects

Tetrology or Fallot

Tetra==4***

Tx:

A
  • Sx:
    • ​repair VSD
    • dilate pulm valve (rt. vent–pulm aa)
75
Q

Cyanotic Defects

Transposition of the Great Arteries

“Transposition” meaning everything is all OUT OF POSITION***

EXPLAIN

A
  • Aorta comes out of R. Ventricle—-NOT GOOD
  • Pulm artery comes out of L. Ventricle—-NOT GOOD
  • NO COMMUNICATION B/W SYSTEMIC AND PULMONARY CIRCULATIONS***
76
Q

Cyanotic Defects

Transposition of the Great Arteries

S/S

A
  • Cyanosis
  • INCd RR
  • poor feeding/Wt. Gain/appetite
77
Q

Cyanotic Defects

Transposition of the Great Arteries

Dx:

A
  • Fetal ECHO
  • ECG
  • Cath
  • MRI
  • SpO2
  • Chest x-ray
78
Q

Cyanotic Defects

Transposition of the Great Arteries

Tx:

A
  • ALL will need open heart sx for arterial switch repair
  • *Arrhythmias or vent dysf’s may develop later in life
79
Q

Cyanotic Defects

Tricuspid Atresia

*IN NAME—–has to be something w/ Tricuspid Valve*****

General…

A
  • Tricuspid Valve (R. Atria–>R. Vent) fails to develop OR is patent
  • SMALLER than normal R. Vent
  • ALWAYS have ASD
  • SOMETIMES VSD
  • ***only 1 functioning ventricle
80
Q

Cyanotic Defects

Pulmonary Atresia

**IN NAME—–HAS to be something w/ Pulmonary valve (Rt. Vent—> Pulm aa)

General….

A
  • Abnorm. formed pulm valve
  • Block of blood from R. SIDE of heart TO lungs
  • **often assoc’d w/ VSD
81
Q

Cyanotic Defects

Pulmonary Atresia

S/S

A
  • cyanosis
  • poor feeding/wt. gain
  • SOB
82
Q

Cyanotic Defects

Pulmonary Atresia

Dx:

A
  • Fetal US
  • ECG
  • ECHO
  • SpO2
  • chest x-ray
  • MRI
83
Q

Cyanotic Defects

Pulmonary Atresia

Tx:

A
  • Balloon valvuloplasty via Cath.
  • Open heart sx
    • patch or Shunt
84
Q

Cyanotic Defects

Truncus Arteriosus

General….

A
  • Missing normal separation of the Aorta and Main Pulm aa during fetal development
  • RESULTS IN R. and L. vents empty into a single Lg. vessel
  • Single GREAT ARTERY arises from the Vents
    • ​carries BOTH pulmonary and systemic blood flow

*VSD ALWAYS present

*Heart functions as a SINGLE VENTRICLE

85
Q

Cyanotic Defects

Truncus Arteriosus

Tx

A

Sx repair is req’d for correction

86
Q

Cyanotic Defects

Total Anomalous Pulmonary Venous Return

General….

A
  • Pulm veins attach to the R. Atrium OR to other veins that drain into the R. Atrium
87
Q

Cyanotic Defects

Total Anomalous Pulmonary Venous Return

S/S

A
  • Pulm congestion
  • cyanosis
  • HF
88
Q

Cyanotic Defects

Total Anomalous Pulmonary Venous Return

*ASD may also be present…..what does this mean?

A

*ASD may also be present—-> Aids R. Atrium decompression

89
Q

Cyanotic Defects

Total Anomalous Pulmonary Venous Return

Sx:

A
  • Anastomosis (surgical joining) of the pulm veins TO L. atrium
    • ​PERFORMED EARLY AS POSS.
90
Q

CYANOTIC DEFECTS

HYPOPLASTIC LEFT-SIDED HEART SYNDROME

HLSHS

Includes 3 things:

A
  1. Hypoplastic (underdeveloped) L. Vent
  2. Aortic and Mitral Valve stenosis (narrowing) OR atresia (complete closure)
  3. Coartication of the Aorta
91
Q

Cyanotic Defects

Hypoplastic (underdeveloped) L. Sided Heart Syndrome

HLHS

S/S

A
  • may be MINIMAL while PDA (Patent Ductus Arteriosus) is open
  • cyanosis
  • poor feeding/wt. gain
  • INCd work of breathing
  • lethargy​
92
Q

Cyanotic Defects

Hypoplastic (underdeveloped) L. Sided Heart Syndrome

HLHS

Dx:

A
  • fetal echo
  • ECG
  • ECHO
  • chest x-ray
  • SaO2
  • cath
  • MRI
93
Q

Cyanotic Defects

Hypoplastic (underdeveloped) L. Sided Heart Syndrome

HLHS

Tx:

A
  • Prostaglandin E to maintain PDA (Patent Ductus Arteriosus)
  • Mech. Vent may be req’d until sx or heart transplant can occur
  • 3 staged sx procedure or transplant
94
Q

Pulmonary Patho of infancy or childhood

Abnorm Development

A
  • **Assess chest wall****
  • Looking for weakness and/or Tone imbalance:
    • ​Incomplete elongation of ribcage
    • Rib cage flaring—–ant or lat.
    • LOWER resting pos. of diaphragm
    • Kyphotic posture
    • Pectus excavatum
  • Abnorm dev of the chest can cause DEC in pulm function
95
Q

Soda Pop Model

*of Postural Support

A

“If you can’t breathe, you can’t function.”

Mary Massery

96
Q

Soda Pop Model

Ex. POOR POSTURE

EXTREME EXAMPLE

97
Q

COMMON Pediatric Pulmonary Dx’s

3 NEW

Rest you already know!!!!!

A
  • Meconium (baby’s poop in womb) Aspiration Syndrome
  • SIDS
  • Tracheoesophageal Fistula
  • Asthma
  • Resp. Distress Syndrome/Hyaline Memb Dis.
  • Pectus deformities
  • Bronchopulm Dysplasia (BPD)
  • Broncholitis Obliterans (BO)
  • Cystic Fibrosis (OLD)
  • Lung Transplants
98
Q

Meconium Aspiration Syndrome

MAS

What is Meconium?

A

contents of fetal/newborn bowel

99
Q

Meconium Aspiration Syndrome

MAS

WHEN occur?

A

W/ FIRST postnatal breaths

100
Q

Meconium Aspiration Syndrome

MAS

Reversible when?

A

Reversible IF airways are suctioned immediately @ birth

101
Q

Meconium Aspiration Syndrome

MAS

Can Cause:

A
  • Atelectasis
  • Tension pneumothorax—-WORSE KIND (one-way door)
  • Persistent (long term) Pulm HTN
  • Bronchiolitis
  • Pneumonitis
102
Q

Meconium Aspiration Syndrome

MAS
Tx:

A
  • Pulm hygiene
  • Supplemental Oxygen (PRN)
  • Assisted ventilation (PRN)
103
Q

Sudden Infant Death Syndrome

SIDS

what is it?

A

Sudden, unexpected death during sleep of an otherwise healthy infant

*MAY be linked be w/ respiration infection and brain stem dev.

104
Q

SIDS

Risk Factors:

A
  • Male infant
  • LOW birth wt
  • active resp. infection
  • sleeping on soft surfs
  • sharing bed w/ adults/siblings/pets
  • overheating
  • age (MOST RISK @ 2-3mos old
  • prematurity w/ immature neural development
  • 2nd hand smoke
  • maternal age <20
  • family hx
  • inad. prenatal care
105
Q

SIDS and “Back to Sleep”

A

Sleep in SUPINE

*incidence DECd by >50% since “Back to Sleep”

106
Q

SIDS

PT Role

A

Back to Sleep/Tummy to Play

107
Q

SIDS

Back to Sleep/Tummy to Play

Promoting compliance???

A

5 S’s****

1. Shush

2. Sound

3. Swaddle

4. Swing

5. Suck

108
Q

Tracheoesophageal Fistula

A
  • .02% of births
  • Abnorm connection b/w esophagus and trachea
    • ​—–> Causes fluids to pass thru esophagus INTO trachea and lungs
  • **Req’s Sx
109
Q

Tracheoesophageal Fistula

Commonly seen w/:

A

Trisomy 13, 18 and 21

VATER syndrome

heart defects

defects of kidney + urinary tract

110
Q

VATER syndrome

A

V: Vert abnormal

A: Anal Atresia

T: Trachea

E: Esophagus

R: Renal

111
Q

NORM Vital Signs for Various Ages

Ranges + Avgs

A

RPE Also

see pics

112
Q

Tx Ideas for CHDs and Pediatric Pulmonary Dx’s

A
  • Lateral costal breathing manual tech.
    • put your hand where YOU want them to breathe INTO
  • Diaphragmatic breathing QUICK STRETCH
    • RIGHT AFTER LOOOONG EXHALE JUST BEFORE INHALE!!!
  • Diaphragmatic breathing w/ visualization
  • IMTs
  • Flexibility
  • Strength
  • Posture
  • Pulm toileting
  • Functional Mobility
  • Endurance training—-OBSTACLE COURSES!!!

CPPT II (6 decks)

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