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Health & Wellness > Pediatric Cardiopulm conditions > Flashcards

Pediatric Cardiopulm conditions Flashcards

1
Q

What postural/ trunk control consequences does weak abdominal obliques have?

A
  1. Passive Lumbar Lordosis
  2. Protruding Tummy
  3. Lower Rib Flaring
  4. Decreased Trunk Rotation
  5. Unable to Weight Shift
  6. Dependence on Rectus Abdominals
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2
Q

What postural/ trunk control consequences does tight pec minors have?

A
  1. Forward Shoulders
  2. Scapular pulled laterally and anteriorly, away from thoracic wall
  3. Upper Thoracic Flexion
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3
Q

What postural/ trunk control consequences does weak serrates anterior have?

A

Weak upper fibers– medial edge of scapula leaves thoracic wall

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4
Q

What postural/ trunk control consequences does decreased active upper thoracic extension have?

A
  1. Kyphotic upper trunk

2. Passive overlengthening of scapular retractors (ineffective length-tension relationship as a result)

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5
Q

What postural/ trunk control consequences does decreased rib stability have?

A

Serratus anterior will elevate the ribs rather than stabilize the scapular against the thoracic wall

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6
Q

What respiratory consequences does weak abdominal obliques have?

A
  1. Ineffective cough
  2. High Chest
  3. Retained horizontal rib alignment
  4. Tight rectus leading to pectus excavatum
  5. Child may use diaphragm for trunk control, limiting its function as a primary mm of respiration
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7
Q

What respiratory consequences does tight pec minor have?

A

Anterior upper chest cannot adequately expand

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8
Q

What respiratory consequences does weak serratus anterior have?

A
  1. Decreased structural reinforcement of the posterior chest wall
  2. Interdigitation of the lower fibers of serratus anterior with the external abdominal oblique will interact to affect the dynamic stability of the ri
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9
Q

What respiratory consequences does decreased active upper thoracic extension have?

A

Approximation of the upper ribs decreased upper chest mobility decreased oxygenation of the upper lobe abdominal breathing

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10
Q

What respiratory consequences does decreased ribcage stability have?

A

Decreased structural support for the respiratory muscles to work from

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11
Q

What does the soda can model of respiratory and postural control mean?

A
  • Structurally weak, yet functionally strong
  • Unopened, very strong because pressure is exerted
  • Opened becomes weak; Structural integrity of thorax not inherently strong; Spine and rib cage not able to maintain alignment
  • Muscular support is required to help “close the can”
  • Thoracic and abdominal chambers separated by diaphragm
  • m support allows increases in internal pressure to withstand external forces
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12
Q

What muscles, when contracted, can increase thoracic and abdominal pressures?

A
  1. intercostals
  2. diaphragm
  3. back extensors
  4. abdominals (transverse abdominus)
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13
Q

What happens when the diaphragm contracts and inspires?

A
  • Diaphragm contracts and central tendon descends; Create negative pressure in the thoracic cavity; Intercostals contract to prevent inward pull of negative pressure
  • As diaphragm continues to contract; Abdominal pressure rises; There is equal negative pressure in the thoracic to the positive pressure in the abdominal pressure (absolute value)
  • diaphragm plays less recognized role in trunk stability but creates pressure differences in cavities
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14
Q

What forms the superior pressure valve?

A

the glottis

  • important for talking and coughing
  • If compromised, there is not way to control positive pressure created upon inspiration.
  • Impairments in the glottis may result in speech or eccentric motor impairment
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15
Q

What forms the inferior support of the “soda can”?

A

pelvic floor muscles

  • If muscles are injured or ineffective, they will allow pressure to be released via the pelvic opening - Urinary stress incontinence; Less productive cough or sneeze
  • Muscles are often affected after childbirth - Crossing legs is a compensatory support mechanism; LBP often decreases pelvic floor functioning
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16
Q

What internal organs use changes in pressure to augment their function?

A
  1. Lungs and esophagus
  2. Heart
  3. Lumbar stabilization
  4. Gastrointestinal mobility; SCI and CP – why they have troubles with some bowel and bladder – abnormal gradients = inefficiency etc missed some
  5. Lymphatic flow
  6. Hemodynamic flow
    - Dysfunction of this mechanism - Hypotension, inefficient breathing, bowel and bladder emptying
17
Q

What is the reasons someone can develop pectus excavatum?

A
  1. NM disease
  2. Pulm dysfunction
  3. Trauma
18
Q

What are S and S of pectus excavatum?

A
  1. Cough, wheeze, decreased stamina, dyspnea, chest pain, throat pain and tightness
  2. Parasthesias, heartburn, dizziness/syncope, frequent infections(due to not fully being able to inhale), stridor, muscle cramps
  3. Paradoxical breathing – one b reathing pattern that should resolve in a normal child, but if it doesn’;t, may lead to this
  4. lower inferior rib flare
  5. Significant indentation at xiphoid process
19
Q

What are interventions for pectus excavatum?

A
  1. Surgical - not going to talk about specifics – but would probably follow surgeon’s post-surgical protocol for these; Nuss procedure, Modified Ravitch
  2. Conservative/Physical Therapy- Pull sunken anterior chest wall outward and forward (move xiphoid position); Stretch anterior and middle scalenes, sternocleidomastoid, serratus anterior and pec minor; Lower sternum and sunken ribs = Core stabilization
20
Q

CHD in which blood is adequately saturated with oxygen but may be poorly distributed to the body; Blood is shunted from the left side(well O2) to the right side of the heart, rather than going out to the body

A

Acyanotic

21
Q

CHD in which there is poor oxygen saturation; Includes shunting unoxygenated blood to the body; Blood is shunted from the right side of the heart to the left side, thus blood is unable to be oxygenated by the lungs before being ejected to the body

A

cyanotic

22
Q

What conditions result in acyanotic heart defects?

A
  1. Atrial Septal Defects
  2. Ventricular Septal Defect
  3. Patent Ductus Arteriosis
  4. coarction of the aorta
  5. pulmonary stenosis
  6. aortic stenosis
23
Q

What heart defects can cause CHF?

A
  1. Ventricle septal defect (VSD)-opening between the right and left ventricles (Most common)
  2. Patent ductus arteriosis (PDA)
  3. Atrial septal defect (ASD)
24
Q

Acyanotic CHD resulting in persistent fetal circulation; In many cases of CHD, this may be done intentionally with pharmaceutical intervention to prevent further cardiac damage; Patency is located between the pulmonary artery and the aortic arch, allowing oxygenated blood to flow with unoxygenated blood in the pulmonary artery and go back to the lung

A

PDA

- Ductus areteriosus remains open (between the pulmonary artery and the aorta)

25
Q

What are symptoms of acyanotic CHD?

A
  1. Pulmonary hypertension
  2. Respiratory distress
  3. Diaphoresis
  4. Fatigue
  5. Tachycardia
  6. Weakness
  7. Restlessness
  8. Low BP
  9. Cool extremities
  10. Blue lips and nail beds
  11. Poor feeding (Failure to thrive)
26
Q

What conditions result in cyanotic CHD

A
  1. Tetralogy of Fallot
  2. Transposition of the great arteries
  3. Tricuspid atresia
  4. Hypoplastic Left Heart Syndrome
27
Q

What are the 4 congenital heart abnormalities in the tetralogy of Fallot?

A
  1. Stenosis of the pulmonary artery or pulmonary valve narrowing
  2. Right ventricular hypertrophy
  3. Enlarged aorta
  4. Large VSD - Hole in the septum between right and left ventricles
28
Q

Acute cyanosis, which may be caused by feeding or crying, or may come on without warning

  • Symptoms: anxiety, air hunger, respiratory distress, increasing cyanosis and an altered level of consciousness.
  • Indicate an urgent need for repair of the heart defect.
A

Tet Spells

29
Q

What are PT interventions for tetralogy of Fallot?

A
  1. Pre-op and Post-op care - Education on positioning
  2. Positioning post surgically - Adult = dependent side-O2 perfusion; Child = up side- O2 perfusion
  3. Positioning to encourage age-appropriate activities with lowered metabolic costs
  4. Monitored exercise programs
  5. Aerobic conditioning
  6. Pulmonary Care
  7. Post-surgically (after discharge from hospital), children may require physical therapy to assist with achieving age-appropriate gross motor skills
30
Q

Should you use a maximal or sub maximal test when performing an exercise test with pts who have CHD?

A

submaximal

Record:

  • distance ambulated
  • RPE
  • Dyspnea
  • Vital signs before, during and after
31
Q

how is m performance impacted by pulmonary disorders?

A

Studies indicate those with chronic pulmonary disease have maximal strength measures that are 80% of healthy peers

32
Q

What are airway clearance techniques used in chronic pulmonary disease?

A
  1. Active Cycle of Breathing
  2. PEP and oscillatory PEP
  3. High Frequency Chest Wall Oscillation
  4. Intrapulmonary Percussive Ventilation (vest)
33
Q

Asthma is increased amongst those of _______ ethnicity. Does it affect boys or girls more often?

A

Black and multiracial (non-hispanic); boys 2:1

- medical mngt = albuterol or anticholinergic (SNS) inhalers + corticosteroids (decr inflammation)

34
Q

What is the clinical presentation of CF?

A
  1. Productive cough
  2. Abnormally frequent and large stools
  3. Failure to thrive
  4. Recurrent pneumonia
  5. Rectal prolapse – related to abnormally large stools
  6. Nasal polyposis
  7. Clubbing of the digits
35
Q

What does PT examination of CF include?

A
  1. Assessment of effective cough
  2. Auscultate for secretions
  3. Strength
  4. Aerobic Fitness – these are all Sub-max exercise tests: 6MWT, Step Test, Modified Shuttle Walk
  5. Posture - Pec, pec minor, poor diaphragm b rewathing, abdominals
  6. Chest Wall mobility

Health & Wellness (11 decks)

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