Pediatric Cardiopulmonary PT Flashcards
When does the respiratory system develop?
Begins at the 4th week of gestation
Pseudoglandular period (weeks 6-16):
-lungs have developed except gas exchange
-diaphragm begins to form at end
Canalicular period (weeks 16-26):
-pulmonary capillaries develop
-bronchioles give rise to alveolar ducts
-lung tissue is vascularized and fetus is able to be born at end of this period
Cardiac Development
-the heart beats by day 22-23
-circulates blood to the rest of the embryo by day 27
-development is primarily complete by 10th week
Prenatal blood circulation (complex)
- well oxygenated blood travels from the placenta via the umbilical vein and enters the fetal system through the umbilicus
- 1/2 enters the liver and 1/2 bypasses the liver and drains into the IVC via the ductus venosus
- once in the IVC, blood joins with less oxygenated blood that is returning from the abdomen, pelvis, and lower limbs
- blood reaches the R atrium and the majority of it goes through the foramen ovale into the L atrium
- this blood is then pumped through the aorta to the heart, head, and upper limbs
What is the ductus venosus?
It connects the umbilical vein to the IVC to bring in oxygenated blood from the mother
-it is controlled by a sphincter
What is the foramen ovale?
Connection between the right and left atrium
-allows the blood to bypass the pulmonary system
What is the ductus arteriosus?
Connects the pulmonary artery to the aorta to shunt blood away from the lungs
**When some of the blood doesn’t enter the foramen ovale and goes into the R ventricle, it travels through the pulmonary artery, but since the lungs aren’t functioning, that ductus arterioisus sends the blood through to the aorta
Different prenatal circulation pathways
Majority:
1. Umbilical vein
2. ductus venosus
3. IVC
4. R atrium
5. foramen ovale
6. L atrium
7. L ventricle
8. Aorta
9. Body
Some:
1. Umbilical vein
2. ductus venosus
3. IVC
4. R atrium
5. R ventricle
6. Pulmonary artery
7. Ductus arteriosis
8. Aorta
9. Body
When do fetal shunts close?
over the first few hours or days after birth
1. Foramen Ovale –> fossa ovale (soon after birth)
2. Ductus arteriosis –> ligamentum arteriosis (within 24 hrs)
3. Ductus venosus –> ligamentum venosum
4. Umbilical vein –> ligamentum teres
T/F knowing a pt’s gestational age at birth will help a PT understand potential problems in development of the cardiopulmonary system
True
What are cardiac defects classified as?
- Cyanotic: arterial oxygen saturation is decreased
- Acyanotic: normal oxygen saturation
Examples of Acyanotic lesions
Atrial Septal Defects (ASDs)
Ventricular Septal Defects (VSDs)
Atrioventricular septal defects (AVSDs)
Patent ductus arteriosus
Coarctation of the aorta
Pulmonary stenosis
Aortic stenosis
S/S of Acyanotic lesions
sweating
increased respiratory rate
heart failure
low partial pressure of oxygen
low stroke volume
increased work of heart
Atrial septal defects
When foramen ovale doesn’t fully close at birth
-results in heart murmurs and enlarged pulmonary artery to develop
-treatment: surgery at 2-3 yrs of age
Patent Ductus Arteriosus
if the ductus arteriosus doesn’t fully close
-too much blood may enter lungs
-tachycardia, increased respiratory distress, poor weight gain
-associated with prematurity or DS
Ventricular Septal Defect
When there are one or more small openings in the wall of the ventricular septum
-treatment: may include surgery, small holes may spontaneously close
Atrioventricular Septal Defects
Failure of the formation of either the tricuspid or mitral valves
-results in pulmonary HTN, lung congestion, HF
-15-40% in those with DS
-treatment: surgery required in first few months of life
Coarctation of the Aorta
Obstruction of left ventricular outflow due to narrowing of the aorta
-causes HTN in the upper body and low pressure in the LEs (pressure above constriction increases and pressure below constriction decreases)
-treatment: surgery
Cyanotic lesions
Involve right to left shunting of blood where blood bypasses the lung and results in decreased arterial oxygen saturation
Examples of Cyanotic lesions
Tetralogy of fallot
Hypoplastic Left Heart syndrome
Transposition of the Great Arteries
Tricuspid Atresia
Pulmonary Atresia
Truncus Arteriosis
Tetralogy of Fallot
- Pulmonary stenosis
- R ventricular hypertrophy
- Ventricular septal defect
- Aorta overrides septal defect
Results in low oxygen levels in the body- surgery required
Hypoplastic Left Heart Syndrome
Underdeveloped left ventricle, aortic and mitral valve stenosis or complete closure and often coarctation of the aorta
-CHF can develop
-treatment: surgery or heart transplant
Transposition of the Great Arteries
Aorta and pulmonary arteries are reversed!
-pulmonary artery leaving the L ventricle
-aorta leaving the R ventricle
-no communication between the 2 systems
**not compatible with life- need surgery!
Tricuspid Atresia
Tricuspid valve is either not open or absent
-results in anoxia, R sided HF, cyanosis, dyspnea
-surgery needed
Pulmonary Atresia
Pulmonary valve fails to develop and there is an obstruction of blood from the R side of the heart to the lungs
Truncus Arteriosis
There is no separation of the aorta or pulmonary artery and both the R and L ventricles empty into a single vessel
-1 vessel arises from the ventricles and carries both oxygenation and deoxygenated blood
-surgery required
What is considered prematurity?
<37 weeks gestational
-premature infants typically have periodic breathing where they take 5-10 second pauses in breathing
What is it called when with breathing that ceases for 20 seconds or longer and it is associated with bradycardia and hypoxemia?
Apnea of prematurity
T/F prematurity is associated with persistent pulmonary HTN
True- characterized by increased pulmonary vascular resistance
What is Respiratory Distress syndrome?
A hyaline membrane disease that is caused by a deficient amount of pulmonary surfactant where underdeveloped alveoli and pulmonary capillary beds further compromise gas exchange
What is the most common respiratory disorder in premature infants?
Respiratory distress syndrome
Meconium Aspiration Syndrome
Occurs when a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery
-Leads to respiratory distress syndrome as a consequence of airway obstruction or chemical irritation
-treatment: mechanical ventilation or oxygen required
Bronchopulmonary Dysplasia
Scarring of the lung tissue, thickening of pulmonary arterial walls, and a mismatch between lung ventilation and perfusion
-severe respiratory failure may cause this condition
-a predictor of poor developmental outcomes in infants with low birthweights
Cystic Fibrosis
Genetic, autosomal recessive disease that affects the exocrine glands
Primary Ciliary Dyskinesia
A rare disease where mucociliary clearance is impaired b/c of defective motility of cilia
-mucus transport is slowed
Respiratory conditions of Infancy
Primary Ciliary Dyskinesia
Cystic Fibrosis
Bronchopulmonary Dysplasia
Meconium Aspiration Syndrome
Pediatric conditions with secondary cardiopulmonary issues
Down Syndrome
Fetal Alcohol Syndrome
Spina Bifida
Duchene Muscular Dystrophy
Pediatric PT Interventions
- Rib cage mobility: in supine, prone, sidelying
- Strength: inspiratory muscle training
- Breathing patterns: train diaphragm and intercostals, increase thoracic mobility
- Airway clearance
- High frequency chest wall oscillation: vest to mobilize secretions
- Positive expiratory pressure: provides resistance to exhalation
- Blow toys: encourage deep breathing
- Assisted cough
T/F Trendelnburg positioning is completely safe for all children
False- the lower esophageal sphincter is not strong enough to prevent reflux until age 2 so this position should not be used in children under 2
Indications for when to stop exercise with a child
-chest pain or discomfort
-RPE > 17
-Dyspnea of 4
-dizziness
-visual changes
-pale of ashen appearance
-new onset of joint pain
-HR > 80% of max
-O2 less than 90%
