L6/7 Cardiopulmonary & Pain Flashcards
Asthma
- obstructive pulmonary disease, episodic periods of reversible narrowing by way of airway inflammation
- most common chronic childhood disease
- 20% of those with asthma at 7 will have asthma at 42
- presents as prolonged exhalation time
Etiology of Asthma
genetics
infection
environment (air quality, air pollution, allergens, cold/dry air)
Exacerbations of Asthma
irritant
virus
cigarette smoke
Asthmatic Airway vs normal airway
wall is inflammed and thickened
during an asthma attack, the smooth muscles become tight, and air becomes trapped in the alveoli
PT’s role with asthma
- encourage aerobic conditioning
- monitor impact of inhaled corticosteroids
- help with medication use and timing
- longer warm up period
Outcome measure for asthma
pediatric asthma QOL questionnaire
Exercise induced bronchospasm
- defined by s/s within 5-10 min of exercise with intensity of 70-85%
- may include airway narrowing that occurs anytime during or immediately after exercise
- resolves spontaneosusly within 20-30 min
S/S of EIB
- SOB
- wheezing
- cough
- tightness of chest
Refractory EIB
repeated bouts of exercise within 2 hours of of the initial episode (EIB) will not exacerbate EIB
Cystic Fibrosis
- autosomal recessive, genetically inherited disease
- thick, viscous secretions by excretory glands
- decreased enzymatic production in GI tract
- commonly impacts pulmonary system with obstruction of airways, resulting in hyperinflation, infection, tissue destruction
- child may have concurrent failure to thrive due to GI issues
Airways with cystic fibrosis
- thick sticky mucus blocks airway
- dilated airway
- blood in mucus
- bacterial infection
PT role with CF
- secretion removal techniques
- education
- aerobic exercise program
- bladder control techniques
- medication, environmental controls, navigating health care system
Common thing parent says with CF
“my baby tastes salty”
Congenital cardiac defects
- structural anomalies that allow for an alternative route of blood through CVP systems or obstruct usual rote of blood flow
- usually require surgical intervention if they are symptomatic
PT role with congenital cardiac defects
- preoperative and post operative care
- positioning
- modifications for exercise activity
Neurodevelopmental effects of congential cardiac defects
decreased brain volume
mild motor deficits
language deficits
impacted participation
Can you use the borg scale with kids?
YES
WeeFIM 2
used for kids with congenital or acquired diseases to measure function
Pediatric Pain
Acute (traumatic, burns)
Chronic (disease)
Combo
Pain presentation in kids
- verbal
- crying, screaming, grunting
- grabbing body part, limping
- change in pace, energy level, agitation level, movement, facial expression
- change in want for touch/support from others (either increased or decreased)
Components of pain to address
behavioral
emotional
functional
physical
Faces pain scale
used as a way to determine pain level of a child if they aren’t able to verbally share
Pain mgmt action items
- look at communication and alertness
- recognize disparities between children of color
- engage with multiple disciplines, use peds pain programs, use PT/exercise
- pain attention to child’s baseline
- believe the patient
Face, Legs, Activity, Cry, Consolability Behavioral Pain Scale
reliable and valid for children with cognitive impairments
Pain self-assessment for kids
Wong-Baker FACES
for ages 3+
Pressure Injuries Prevention
Manage prevent and avoid:
immobility
shear
friction
mositure
Transfers for kids
- execute safe transfers every time
- education for families, caregivers, other providers
- includes beds, toilets, stretchers, w/c
Stages of pressure injury
- 1: intact skin
- 2: partial thickness loss
- 3: full thickness loss with visible fat
- 4: full thickness loss with visible bone, muscle
- Unstageable: full thickness with slough
- DTPI: intact or nonintact, deep red or maroon
Burns
- 25% of burn injuries in US occur in kids under 15 yrs
- can be caused by scalding, fires, electric, matches
PT role with burns
- acute care includes assessment, functional mobility, positioning, wound care
- rehab includes management of chronic wounds, functional mobility maintenance
- outpatient/long term, helping with long term funciton
Burn classification
Categorization utilizing thickness, zones, identified locations
anatomical proportions change throughout lifespan development, so age matters
child’s function will be dependent on size and location
Abuse and disability
children with a disability have increased likelihood of being abused or neglected AND may have challenges communicating or physically getting away
Abuse recognition
- observation of skin
- sensitive areas of body
- unexplained bruises, burns, scars, other signs of trauma
