Pediatric cardiopulm Flashcards
Acyanotic Lesions
increase pulmonary blood flow and fully oxygenated blood is shunted back into the lungs as well as to the body, left to right shunting
Symptoms of acyanotic lesions:
sweating, increased RR, HF
Most common problem in acyanotic lesions:
low partial pressure of oxygen (Po2) to periphery, low systemic SV and increased work on the heart
Atrial Septal Defects
most commonly caused by a patent (open) foramen ovale, hole in atrial wall that usually closes after birth
Patent Ductus Arteriosus
o often associated with prematurity or Down syndrome, too much blood may enter the lungs
Symptoms of Patent Ductus Arteriosus
♣ tachycardia, increased respiratory distress, poor weight gain
Ventricular Septal Defect
one or more small openings in the wall separating the ventricles, may lead to bacterial endocarditis, pulmonary vascular obstructive disease, aortic regurgitation, increased incidence of lower respiratory tract infections, or CHF
Symptoms of ventricular septal defect:
♣ feeding problems, poor weight gain, restlessness, rapid breathing, irritability
Atrioventricular Septal Defects
may involve failure of formation of any or all endocardial cushions
Symptoms of Atrioventricular Septal Defects
pulmonary HTN, lung congestion, HF
Coarctation of Aorta
o obstruction of L ventricular outflow because of a narrowing of the aorta
Cyanotic Lesions involve right to left shunting
o involves right to left shunting
most of the blood bypasses the lungs
o decreased arterial oxygen saturation occurs as unoxygenated blood is returned to the body
o the body signals increased RBC formation because of the decreased arterial oxygen saturation levels and polycythemia results
o the body is at risk for cerebrovascular insult
Tetralogy of Fallot
o pulmonary stenosis, VSD, overriding aorta, R ventricular hypertrophy
Hypoplastic Left-Heart Syndrome
underdeveloped L ventricle, aortic and mitral valve stenosis or atresia (complete closure), coarctation of the aorta
Transposition of the Great Arteries
pulmonary artery leaving the L ventricle and the aorta exiting the R ventricle with no communication between the systemic and pulmonary crculations
Tricuspid Atresia
tricuspid valve is either not open or absent, obstruction of blood flow into the right enticle and the right ventricle is frequently underdeveloped
Pulmonary Atresia
pulmonary valve fails to develop, obstruction of blood from the R side of the heart to the lungs
Truncus Arteriosus
normal separation of the aorta and main pulmonary artery do not occur during fetal development
Total Anomalous Pulmonary Venous Return
pulmonary veins attach to the R atrium or to other veins that drain into the R atrium
Apnea of prematurity
cessation of breathing for 20 seconds or longer
• Bronchopulmonary Dysplasia (BPD)
o Chronic respiratory disorder characterized by scarring of lung tissue, thickened pulmonary arterial walls, mismatched between lung ventilation and perfusion
o Persistence of respiratory symptoms after 1 month, abnormal radiographic findings, dependence on supplemental O2
o Mechanical ventilation is etiological factor
0-3 months shape of thorax and direction of ribs
triangular
horizontal
3-6 months months shape of thorax and direction of ribs
rectangular
horizontal
6-12 months months shape of thorax and direction of ribs
rectangular
angled downward
0-3 months primary muscles used for inspiration
diaphragm
3-6 months primary muscles used for inspiration
diaphragm and acces. muscles
6-12 months primary muscles used for inspiration
diaphragm and intercostals
When is there no activation of accessory muscles during quiet breathing?
around 2 years
High-frequency chest wall oscillation
o Patient dons a vest that contains an air bladder; generator that attaches to vest; uses air to inflate the vest, then provide high-frequency bursts of air
Absolute contraindication to high frequency chest wall oscillation:
unstable head, neck, rib cage, back injury, active hemorrhage
Relative contraindications to high frequency chest wall oscillation:
subcutaneous emphysema, recent epidural spinal infusion, recent skin grafts, burns, open wounds, transvenous pacemaker, suspected pulmonary TB, lung contusion, bronchospasm, complaint of chest wall pain
When to stop exercise in children:
chest pain or discomfort RPE greater than 17 dyspnea of 4 dizziness visual changes pale or ashen new onset joint pain HR greater than 80% man O2 below 90%
