Jarvis Quiz 4 Flashcards
During which week does the primitive lung bud emerge in utero?
Week 5
By which week in utero does the conducting airways of the respiratory system reach the same number as the adult
16 weeks
At what week does surfactant form in utero? What is the purpose of surfactant?
32 weeks gestation. Surfactant is the complex liquid substance needed for sustained inflation of the air sacs.
How many alveoli are there at birth? What significance does this have on the respiratory system?
70 million alveoli, ready to start the job of respiration.
When is the first breath taken? Why should a baby have a lusty cry when it is born?
At birth; the baby should have a lusty cry when it is born to reassure it is okay and that it’s respiratory system is working properly. Birth demands the instant performance of the respiratory system.
What happens when the umbilical cord is cut at birth?
The blood is cut off from the placenta and it gushes into the pulmonary circulation.
The respiratory system continues to develop throughout childhood. How so?
Airways increase in diameter and length. Number and size in alveoli increase. Adolescents have about 300million by adolescence.
What puts the baby at risk for respiratory distress? How does smoking harm the fetus and baby?
Having a smaller size and immature pulmonary system. The presence of smoking can cause chronic hypoxia, premature delivery, and low birth weight. It also sensitizes the fetal brain to nicotine. Prenatal and postnatal exposure to secondhand smoke can cause SIDS, lower respiratory illness, acute and chronic otitis media, breathlessness, asthma, and adverse lung function throughout childhood. Prenatal nicotine exposure can increase the risk for ADHD and depression in kids and teens.
What is the most common chronic disease in childhood? How many kids does it effect?
Asthma; it effects 9.5% of kids aged 0-17yo. African Americans and Hispanics have more indicators of poorly controlled asthma: more ER visits, more resuscitation equipment use, and lower use of inhalers.
What is the limit to the number of uncomplicated upper respiratory infections a young child can have before it becomes a concern
Limit of 4-6/year is expected
What are some possible allergies when discussing infant allergies
New foods or formula
What reduces the risk for respiratory tract infections and otitis media in babies?
Full breastfeeding for 6mos or more
Why would you assess if the child has a cough or seems congested, or has wheezing with noisy breathing?
May indicate chronic asthma or bronchitis
How would you position an infant while assessing their respiratory system?
Have the parent hold the infant, supported against their chest or shoulder. Ignore the usual sequence.
How should you assess a baby’s respiratory system when they are sleeping, vs. when they are crying?
Sleeping: inspect and then listens to lung sounds
Awake: enhances palpation of tactile Freitas and auscultation of breath sounds
How should you assess a child’s respiratory system?
Allow them to sit on the parent’s lap, if they want. Offer the stethoscope and let them handle it. Promote their participation. While listening to the lung sounds, have the child breath in deeply and blow out your penlight or have them “pant like a dog”.
What is the AP-to transverse ratio on an infant? When does it reach the adult ratio? What is the adult ratio?
The infant has a rounded thorax with an equal AP-transverse ratio. It reaches the adult ratio of 1:2 by age 6yo.
What should a newborn’s chest circumference be? What should it be in comparison to the head?
Chest circumference should be 30-36cm. It should be 2cm smaller than the head until 2yrs of age.
Describe the features of the infant’s chest
Ribs and xiphoid process are prominent. You should be able to see and feel the sharp tip of the xiphoid process. The thoracic cage is soft and flexible. The chest wall is thin with little musculature.
What would a barrel shape chest indicate if the child is already 6yrs old and still has one?
Cystic fibrosis or chronic asthma.
What does the APGAR scoring system measure? What times are they scored? What is a good score?
The successful transition to extrauterine life. They are scored at 1 and 5 minutes. APGAR total of 7-10 indicates good condition, needing only suctioning of the nose and mouth and otherwise routine care.
What causes respiratory depression in the immediate newborn period?
Maternal drugs, interruption of uterine blood supply, or obstruction of the tracheobronchial tree with mucus or fluid.
What does a 1minute APGAR score of 3-6 indicate in a newborn? What would a score of 0-2 indicate?
3-6 would be Moderately depressed. Needing more resuscitation and subsequent close observation. 0-2 would indicate severe respiratory depression indicating the need for full resuscitation, ventilatory assistance, and subsequent intensive care
What are the five categories on the APGAR scoring system? How can they be scored.
Heart rate, respiratory effort, muscle tone, reflex irritability, and color. Scored as 0,1, or 2 (0 being the worst).
How does the infant breathe during the first 3mos of life? What are normal findings of respirations?
Though the nose. Slight flaring of lower costal margins may occur with respirations, but normally no flaring of the nostrils and no sternal or intercostal retractions. Abdominal bulge with each inspiration is. Normal because intercostal muscles are not well developed. Count respirations while the infant is sleeping. Should be between 30-40. Brief periods of apnea less than 10-15 seconds are common, especially in premies.
What should you feel in palpating the infants respiratory system
Equal chest expansion, no lumps or masses or crepitus. You may feel costochondral junctions
What do marked retractions of the sternum and intercostal muscles indicate in a baby
Increased respiratory effort, atelectasis, pneumonia, and acute airway obstruction
What is accompanied with rapid respiratory rates in infants
Pneumonia, fever, asthma, and acute airway obstruction. An infant breathing 50-100bpm may be an early sign of heart failure.
What does asymmetric expansion indicate in a baby? What about crepitus? How about diminished breath sounds?
Asymmetric expansion: diaphragmatic hernia or pneumothorax
Crepitus: palpable around a fractured clavicle, may occur with forceps delivery
Diminished breath sounds: pneumonia, atelectasis, pleural effusion, or pneumothorax
What should auscultation sound like in a baby’s lungs?
Bronchovesicular breath sounds until 5-6yo. r/t their thin chest walls with underdeveloped musculature. This does not damp off the sound as do the thicker walls of adults. Breath sounds are louder and more harsh.
Describe crackles if heard in a newborn or infant
Fine crackles are commonly found in a fresh newborn. Bowel sounds may even be heard in the chest. Persistent fine crackles may occur with pneumonia, bronchiolitis, or atelectasis. Crackles in only the upper lung field occur with CF. Crackles in only the lower lung field occur with heart failure. Expiratory wheezing occurs with lower airway obstruction (asthma or bronchiolitis) and unilateral with foreign body aspiration.
What might persistent peristaltic sounds with diminished breath sound on the same side indicate?
Diaphragmatic hernia
What does stridor indicate in an infant?
Upper airway obstruction (croup, foreign body aspiration, or acute epiglottitis)
When does the fetal heart start to beat? How does the baby get oxygen in utero?
3 weeks. Compensates for nonfunctional lungs. Oxygen comes from the placenta and arterial blood is returned to the right side of the fetal heart.
There is no point in pumping all the freshly oxygenated blood through the lungs of the fetus in utero. Where is it rerouted to?
2/3rds of it is shunted through the foramen ovale (opening in atrial septum) into the left side of the heart where it is pumped through the aorta. The rest of the oxygenated blood is pumped by the right side of the heart out of the pulmonary artery, but it is detoured through the ductus arteriousus to the aorta.
When does the foramen ovale close? What about the ductus arteriosis?
Foramen ovale: closes within an hour after birth
Ductus arteriosis: closes usually within 10-15hrs of birth
Mass of the ventricles are no longer equal at 1yr of age. The left is heavier by a 2:1 ratio
Describe the fetal heart position compared to that of an adults
The fetal heart is more horizontal in the infant than the adult. The apex is higher, located in the 4th left intercostal space. It reaches the adult position when the child reaches age 7.
How do you assess for heart disease in an infant?
Fatigue during feeding, takes fewer ounces while feeding, becomes dyspneic with sucking, may be diaphoretic, falls asleep during feeding and awakens shortly, hungry again.
What does cyanosis in a kid indicate (other than hypoxia or respiratory depression)?
Tetralogy of Fallot or transposition of the great arteries
What might cause chest pain in a child?
Not common, usually musculoskeletal pain or respiratory causes such as asthma. May also be a psychogenic thing or a GI problem. Families usually freak out about it.
When do the fetal shunts of the heart close normally? When should you assess the baby’s CV system?
Within 10-15 hours, but may take 2 days. Assess during the first day and again in 2-3days
What does cyanosis just after birth indicate if it is not a respiratory issue?
Congenital heart disease and o2 desaturation
What are the most important signs of heart failure in a newborn?
Persistent tachycardia, tachypnea, liver enlargement, engorged veins, gallop rhythm, pulses alternans, respiration crackles (rales)
Where should you palpate the infant’s heart?
4th intercostal space just lateral to the midclavicular line
What would cause a displaced apex in a baby’s heart?
Cardiac enlargement=shifts to the left
Pneumothorax=shifts to opposite side of pneumo
Diaphragmatic hernia=most often shifts heart to the right
Dextrocardia is a rare anomaly which the heart is located on the right side of the chest
What is the normal HR for babies? Include ranges during rest with activity and just after birth
Just after birth= 100-180bpm
Stabilizes to 120-140bpm
70-90bpm with sleeping
170+ beats while crying
What is considered persistent tachycardia in newborns? What about in infants?
Newborns= more than 200bpm Infants= more than 150bpm
What is considered bradycardia in newborns? What about in infants?What is a result of bradycardia?
Newborns= less than 90bpm Infants= less than 60bpm
Causes a serious drop in cardiac output because the small muscle mass of their hearts cannot increase stroke volume significantly.
Why are infant’s heart sounds louder than an adults heart sounds?
The infant has a thinner chest wall, and S2 has a higher pitch than S1. Splitting of S2 with inspiration is common after a few hours of birth
Are murmurs normal in a newborn? What is associated with congenital heart defects?
YEs, they can be for the first 2-3 days r/t to the shunts being open. However, no murmurs doesn’t necessarily indicate the absence of a heart defect. Congenital defects are associated with harsh murmur quality, location, and timing.
What can indicate heart disease in a kid?
Poor weight gain, developmental delay, persistent tachycardia, tachypnea, DOE, cyanosis, and clubbing
What does a precordial bulge to the left of the sternum with a hyper dynamic precordium signal in a child?
Cardiac enlargement, because the cartilaginous rib cage is more compliant
Where should you auscultate the heart in kids, based on their age?
4th intercostal space, left of midclavicular until 4yo
4th intercostal space, midclavicular from 4-6yo
5th intercostal space, right of midclavicular at 7yo
What would a substernal heave indicate in kids? What about an apical heave?
Right ventricular enlargement with a substernal heave.
Ventricular hypertrophy with an apical heave.
What is a thrill?
Palpable vibration: not normal
Talk about the heart rate and auscultation sounds of a child’s heart
Heart rate slows as child grows. Sinus arrhythmia is often present. S3 is common and occurs in early diastole just after S2, best heard in apex.
What is a venous hum?
Caused by turbulence of blood flow in the jugular venous system. Common in healthy children. No pathological significance. Loudest in diastole, heart throughout the entire cycle. Not usually effected by respiration. May sound louder with standing. Obliterated by occluding jugular veins, this latter maneuver helps r/o venous hum from other cardiac murmurs such as PDA.
Talk about a carotid bruit
Benign murmur heard just above the clavicles. Slightly harsh, early or midsystolic, louder on the left and will disappear completely by carotid artery compression.
What are still’s murmur?
Innocent (functional) in origin . Soft, relatively short, early or midsystolic ejection murmur, medium pitch, vibratory, best heard at the left lower eternal or midsternal border, with no radiation.
Describe PDA.
Persistence of the channel joining left pulmonary artery to the aorta. There are usually no symptoms in early childhood, but BP is widened with bounding peripheral pulses. Thrill is often palpable at left upper sternal border. Heard in systole and diastole. “Machinery murmur”
Describe ASD
Arterial septal defect. Abnormal opening in the atrial septum, resulting usually in the left to right shunt and pausing a large increase in pulmonary blood flow. Symptoms are rare, but kids may have fatigue and DOE. A sternal shift is often present. S2 has a fixed split with P2 louder than A2. Murmur is systolic, medium pitch, best heard in left 2nd space.
Talk about VSD
Ventricular septal defect; abnormal opening in the septum between the ventricles, usually subaortic area. Small defects are asymptomatic by may have poor growth, slow weight gain, pale, thin, delicate, feeding problems, DOE, frequent respiratory infections, and heart failure (severe cases). Loud, harsh systolic murmur, best heard over the left lower sternal border, may have a thrill. Might have a diastolic murmur at apex with large defects.
Describe tetralogy of fallot
Four parts: right ventricular outflow stenosis, VSD, right ventricular hypertrophy, and overriding aorta.
A lot of venous blood is shunted directly into the aorta away from the pulmonary system. BLood never gets oxygenated. SEvere cyanosis present, squatting posture, DOE, slowed development. Palpable thrill at L lower sternal border. S1 is normal. S2 has A2 loud and P2 diminished or absent. Murmur is systolic, loud and crescendo-decrescendo.
Describe coarctation of the aorta.
Severe narrowing of the descending aorta, usually at the junction of the ductus arteriosis and the aortic arch. Distal of the left subclavian artery. increased workload of the left ventricle. Associated with aortic valve in most cases, PDA or VSD. Abnormal BP findings, Teens may c/o of lower extremity cramping, worse with exercise. Arm HTN 20mmHg higher than leg. Absent or greatly diminished femoral pulse. Systolic murmur best heard at L sternal border, radiating to the back.
Describe lymphoid tissue development in infants and children.
Developed at birth and quickly grows until ate 10/11yo. By 6yo, it reaches adult size and surpasses adult size by puberty. Then, it slowly atrophies.
Describe lymph nodes in children
Relatively large and often palpable in a healthy child. They should be small, firm (shotty), mobile and non tender. With infection, excessive swelling and hyperplasia occur. Enlarged tonsils are early signs of resp. Infection. They may also be the sequel of diaper rash or vaccinations.
What may be the cause of abdominal pain in kids r/t the lymphatic system?
The inflammation of the mesenteric lymph nodes and their rapid growth
What would you correlate weak pulses with in kids and babies? What about bounding pulses? Diminished/absent femoral pulses?
Weak pulse: vasoconstriction of diminished C.O.
Bounding pulse: PDA from the large L to R shunting
Diminished/absent femoral pulse: coarctation of aorta
