Pediatric Assessment & Intervention Flashcards
What are three cardiovascular structures that must close at birth?
The foramen ovale, ductus arteriosus and ductus venosus
The ductus arteriosus must close to allow blood flow to which structure?
lungs
The ductus venosus must close to allow blood flow to which structure?
liver
What does the foramen ovale connect?
It’s the hole between the right and left atria
What is the most common condition found in premature newborns?
Patent ductus arteriosus
What can patent ductus arteriosus lead to?
heart failure and inadequate oxygenation of the brain
What is atrial septal deficits characterized by?
an opening in the septum between the right and left atrial chambers
What does atrial septal deficits result in?
“wet lungs,” may lead to respiratory infection, heart failure due to the right ventricle working too hard and poor exercise tolerance and being small for chronological age
What does “wet lungs” mean?
too much blood sent to the lungs
Which heart defect may result in poor exercise tolerance and being small for chronological age?
atrial septal deficits
Which heart defect is characterized by one or more opening in the muscular or membranous portions of the ventricular septum?
ventricular septal deficits
T or F: More than 50% of ventricular septal deficits self-correct by age 5
True, otherwise surgery is warranted
Ventricular septal deficits may result in which complex and obstruction?
Eisenmenger’s complex or pulmonary vascular obstruction owing to prolonged exposure to increased blood flow and high pressure
What are some symptoms of ventricular septal deficits?
feeding difficulties, shortness of breath, increased perspiration, increased respiratory infections, fatigue with increased activity and delayed growth.
What are deficits that decrease pulmonary blood flow?
tetralogy of Fallot
What is tetralogy of Fallot characterized by?
pulmonary valve or artery stenosis, a ventricular septal deficit, right ventrical hypertrophy, and override of the ventricular septum.
What are symptoms of tetralogy of Fallot?
central cyanosis, coagulation defects, clubbing of fingers and toes, feeding difficulties, failure to thrive and dyspnea.
What is dyspnea?
difficult or labored breathing, SOB
What is central cyanosis?
a bluish discoloration of the skin due to increased levels of deoxygenated hemoglobin in an area around the core, lips and tongue (mucous membranes)
What is a deficit with mixed pulmonary blood flow?
transposition of great arteries
What is transposition of great arteries characterized by?
no communication between the systemic and pulmonary circulations and is a result of coexisting congenital transposition of the ventricles
What are some symptoms of transposition of great arteries?
cyanosis (bluish discoloration due to increased levels of deoxygenated hemoglobin), congestive heart failure (heart is unable to pump blood effectively) and respiratory distress (fluid build up in the lung’s air sacs, depriving organs of oxygen)
It is important for OTs to educate clients and family of children with congenital heart defects in what?
general health maintenance (e.g. diet, exercises, avoidance of smoke inhalation)
Children whose cardiopulmonary conditions have not resolved or been treated surgically are likely to have…
compromised endurance
Activities for children with congenital heart defects should be..
appropriately paced (due to low endurance) and selected with care
What condition is characterized by an abnormally slow heart rate (<60 beats/min)?
bradydysrhythmia
How many beats/min is considered abnormally slow?
<60 beats/min
What condition is characterized by an abnormally fast heart rate (<200-300 beats/min)?
Tachydysrhythmia
How many beats/min is considered abnormally fast?
<200-300 beats/min
What may medical intervention include for bradydysrhythmia?
pacemaker
What is the most common type of bradydysrhythmia?
atrioventricular block
Which dysrhythmia is most common in children?
Tachydysrhythmia
Which dysrhythmia can lead to congestive heart failure?
Tachydysrhythmia
What is the typical presentation of someone with Tachydysrhythmia?
irritability, poor eating habits and pallor
T or F: Conduction disturbances are most common after surgery and may be temporary.
True
Which acute respiratory condition is common in preterm infants?
respiratory distress syndrome
What is respiratory distress syndrome caused by?
a deficiency of surfactant, which is not produced until the 34th-36th week of gestation
Respiratory distress syndrome results in..
compromised oxygen absorption and carbon dioxide elimination
T or F: Many infants recover after a few days of medical intervention for respiratory distress syndrome, however some develop chronic lung conditions.
True
What is bronchopulmonary dysplasia a result of?
Prolonged use of mechanical ventilation and other traumatic interventions to treat acute respiratory problems
Bronchopulmonary dysplasia results in..
the airway thickening, the formation of excess mucus and restricted alveolar growth
Children with bronchopulmonary dysplasia are at a greater risk for..
respiratory infections and problems
What is asthma characterized by and what does it cause?
bronchial smooth muscle hyperreactivity that causes airway constriction in the lower respiratory tract, difficulty breathing and wheezing
The first symptoms of asthma typically appear before what age?
age 5
What triggers asthma attacks?
allergens, smoke, cold air, exercise, and the inhalation of irritants.
An OT would educate a client with asthma regarding..
breathing exercises, stretching and controlled breathing to manage attacks
T or F: An OT would teach a client with asthma self-management strategies (pacing and stress management) and encourage structured peer-group activities to reduce the likelihood of social isolation.
True
What is cystic fibrosis characterized by?
the muscle-producing glands malfunctioning and producing secretions that are thick, viscous and lacking in water; these secretions block the pancreatic duct, the bronchial tree and digestive tract
What is an early symptom of CF in infants?
blockage of the small intestine, resulting in abdominal distension
T or F: Salty-tasting skin is a symptom of CF
True, it’s a result of the excessive sodium levels.
T or F: Greasy, foul-smelling stools is a symptom of CF
cue pancreatic insufficiency and problems with vitamin malabsorption.
What is the most serious complication of CF?
Chronic pulmonary disease
What is chronic pulmonary disease characterized by?
chronic cough, wheezing and lower respiratory infections
T or F: CF may result in an enlarged left side of the heart.
False, it may result in an enlarged RIGHT side of the heart, which could lead to heart failure
What are some treatment implications for OTs working with clients with CF?
educate the client about disease’s progression, instruct on energy conservation, teach techniques to promote efficient breathing.
What is a hematologic disorder characterized by too many red blood cells and elevated white blood cells, also referred to as transient leukemia?
Erythrocytosis
Transient leukemia is common in one in every 150 children with what syndrome?
downs syndrome
Which hematologic disorder is characterized by the absence or reduction of one of the clotting blood proteins?
hemophilia
Which hematologic disorder results in longer bleeding time or bleeding episodes?
hemophilia
Which type of hemophilia occurs after minor injuries?
moderate hemophilia
Which type of hemophilia occurs after injuries or without an apparent cause?
severe hemophilia
Which type of hemophilia may affect joints and muscles?
severe hemophilia
Which type of hemophilia is usually seen after a traumatic event or injury?
mild hemophilia
What are some signs of hemophilia?
excessive bleeding, excessive bruising, spontaneous bleeding or bleeding without a known cause and nosebleeds
What is anemia caused by?
iron deficiency in the blood
How is anemia treated?
through diet (i.e. iron-rich diet)
What is sickle cell anemia caused by?
abnormally shaped red blood cells
Children with sickle cell anemia demonstrate what?
decreased energy for daily tasks
Children with sickle cell anemia are at risk for what?
organ damage resulting from blocked blood flow caused by the sickle cells
Children with sickle cell anemia may experience what?
pain and require intervention for pain management
Children with osteogensis imperfecta (OI) suffer from?
decreased bone disposition caused by an inability to form Type I collagen
T or F: Multiple fractures or repeated fracture of the same bone may cause a limn to become misshapen and eventually muscularly underdeveloped.
True
T or F: Minor trauma may cause a fracture in individuals with OI.
True
What is the most severe form of OI?
Fetal
Which form of OI causes fractures in utero and during birth with a high mortality?
fetal
Which form of OI causes many fractures in early childhood with severe limb deformities and growth disturbances?
infantile (moderately severe)
Which form of OI causes fractures in late childhood with bones often beginning to harden with fewer fractures occurring during puberty?
juvenile (least severe)
Monitored activity that promotes _____ ______ should be encouraged for individuals with OI
weight bearing
Maternal education in _______ and ________ is essential to prevent fractures
handling and positioning
What is arachondactyly?
Marfan’s syndrome, characterized by excessive growth at the ephiphyseal plates
Children with marfan’s syndrome present with _____
long and slender fingers, skull asymmetries and tall stature, may have differences in their joints, eyes and heart
Marfan’s syndrome is associate with
lax and hypermobile joints and poorly developed striated muscles
What are some common comorbidities with Marfan’s syndrome?
dislocation of the lenses, scoliosis, coxa vara, depressed sternum, stooped shoulders, and fragility of the blood vessels
Which developmental milestone may be delayed for children with Marfan’s syndrome?
walking, all other milestones should be met
What is achondroplasia/chrondrodystrophia?
dwarfism, stunting of the ephiphyseal plate growth and cartilage formation, spontaneous mutations also occur.
People with achondroplasia’s limbs are typical in _____ but shorter in _____
width, length
What are common comorbidities of achondroplasia?
lumbar lordosis, coxa vera and cubitus varas
What is coxa vera?
Coxa vara is a deformity of the hip, whereby the angle between the head and the shaft of the femur is reduced to less than 120 degrees. This results in the leg being shortened, and the development of a limp.
What is cubitus varas?
A deformity of the elbow resulting in a decreased carrying angle (so that, with the arm extended at the side and the palm facing forward, the forearm and hand are held at less than 5 degrees). There is deviation of the forearm toward the midline of the body.
Pain in which two areas of the body are common in people with achondroplasia?
back and leg pain; becomes more pronounced in adulthood
