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DPT 528 > Pediatric Cardiovascular and Pulmonary Health Conditions > Flashcards

Pediatric Cardiovascular and Pulmonary Health Conditions Flashcards

1
Q

most interventions in pediatic CP conditions are directed at…

A

impairments from developmental abnormalities such as prematurity, infection, immunological deficiencies, trauma, diseases associated with childhood, and surgery

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2
Q

t/f: interventions for pediatric patients is different due to body size & physiologic differences

A

true

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3
Q

when does alveolar develop take place in utero?

A

32-40/42 weeks up to 8 yo

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4
Q

t/f: surfactant is still increasing up to 8 yo

A

true

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5
Q

does cardiovascular or pulmonary development occur first in utero?

A

cardiovascular development

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6
Q

what happens in cardiovascular development at 3 wks gestation?

A

pair of endothelial strands (angioblast cords) appear (everything else develop from these)

formation of primordial heart chambers

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7
Q

what happens in cardiovascular development at 21 days gestation?

A

cords form heart tubes

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8
Q

what happens in cardiovascular development at 22-23 days gestation?

A

tubes fuse to form a single heart tube and heart begins to beat

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9
Q

when does blood begin circulating in gestation?

A

at day 27

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10
Q

what happens in cardiovascular development at 10 weeks gestation

A

cardiac development is primarily complete!

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11
Q

blood flow in the womb (fetal circulation) bypasses the lungs and reaches the LV via what?

A

the foramen ovale or ductus arteriosus

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12
Q

what does the fetus use to obtain O2 and eliminate CO2?

A

the placenta

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13
Q

what happens in cardiovascular development at 4 weeks gestation?

A

early appearance of the septum primum, interventricular septum, and dorsal endocardial cushion

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14
Q

what happens in cardiovascular development at 5 weeks gestation?

A

perforations in the dorsal part of the septum primum form

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15
Q

what happens in cardiovascular development at 6 weeks gestation?

A

the foramen secudum forms

the heart chambers are forming

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16
Q

what happens in cardiovascular development at 8 weeks gestation?

A

the hear this pertioned into 4 chambers

there are normal opening bw the chambers to divert blood away from the lungs while they’re developing that should close by birth

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17
Q

what is the foramen secundum?

A

where blood goes through from the umbilical cord

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18
Q

what are congenital heart defects?

A

abnormal development of the heart and/or major blood vessels

failure of the heart septum, valves, or chambers to fully close prior to birth

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19
Q

when are congenital heart defects diagnosed?

A

prenatally, at birth, or during childhood

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20
Q

what is the most common of all birth defects?

A

congenital heart defects

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21
Q

what are the 2 categories of CHDs?

A

acyanotic

cyanotic

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22
Q

what are acyanotic CHDs?

A

the amount of O2 delivered to the body remains unaffected by the defect

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23
Q

what are cyanotic CHDs?

A

the amount of O2 delivered to the body is affected by the defect

the defect is such that it causes oxygen-poor blood to enter systemic circulation, causing a decrease in arterial oxygen saturation

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24
Q

t/f: most cases of CHDs are multifactorial and are caused by genetic and environmental factors

A

true

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25
Q

what is the predominant factor that causes CHDs?

A

genetics

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26
Q

altered cerebral perfusion affects what?

A

brain development and fxn

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27
Q

what are the major impairments of CHDs?

A

motor development delays

decreased motor fxn

exercise intolerance

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28
Q

what are neurodevelopmental delays that may result from CHDs?

A

cognitive dysfxn

speech and language delays

attention deficits

decreased executive fxn

decreased visual/spatial skills

emotional/behavioral dysregulation

decreased nutritional intake

decreased QOL

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29
Q

cardiomyopathy may be present in CHDs due to what factors?

A

idiopathic ventricular abnormalities

coronary abnormalities

techycardia or arrhythmias

exposure to infection or toxins

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30
Q

what are the risk factors for CHDs?

A

Down syndrome

German measles (rubella)

viral illness during a mother’s early pregnancy

alcohol consumption/smoking during pregnancy

poorly controlled DM

meds taken during pregnancy

advanced maternal age

parent who had a CHD

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31
Q

what are the acyanotic CHDs due to increased pulmonary blood flow? (focus on starred ones)

A

atrial septal defect*

ventricular septal defect*

patent ductus arteriosus*

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32
Q

what are the acyanotic CHDs due to obstruction of blood flow from the ventricles? (focus on starred ones)

A

coarctation of the aorta*(narrowed aorta)

aortic stenosis

pulmonary stenosis

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33
Q

in increased pulmonary blood flow in CHDs, is the blood shunting from R–>L or L–>R?

A

L–>R

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34
Q

why does blood shunting L–>R in CHDs not affect oxygenation?

A

bc it is oxygenated blood pumped back to the lungs and is continued to be pumped to the body while still containing O2

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35
Q

with increased pulmonary blood flow, there is a ___ in pressure in the pulmonary capillaries, ___ in blood volume on the L side of the heart, and ___ in overall stroke volume

A

increased, decrease, decrease

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36
Q

in obstruction of blood flow in CHDs, what is obstructed?

A

blood flow out of the ventricles

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37
Q

is there L–>R shunting in obstructed blood flow CHDs?

A

no

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38
Q

obstruction of the L leads to what?

A

decreased stroke volume

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39
Q

obstruction of the R leads to what?

A

cyanosis and hypoxia

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40
Q

t/f: there is a decrease in cardiac output in obstructed blood flow CHDs

A

true

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41
Q

is obstruction of blood flow in acyanotic CHDs R or L obstruction?

A

L

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42
Q

what are the s/s of acyanotic CHDs?

A

tachycardia

hypoxia

tachypnea /breathlessness when eating/crying

SOB

heart murmur

crackles/wheezing on lung auscultation

cardiac arrhythmia on ECG

LE and/or abdominal edema

heavy sweating

poor eating/difficulty eating

poor weight gain

failure to thrive

restlessness/irritability

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43
Q

what is atrial septal defect (ASD)? (KNOW THIS)

A

CHD caused by patent foramen ovale (PFO)

opening bw the R and L atria

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44
Q

t/f: ASD can lead to an enlarged R atrium and ventricle

A

true

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45
Q

is surgery required for ASD?

A

yes

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46
Q

what is ventricular septal defect (VSD)? (KNOW THIS)

A

CHD where the wall bw the R and L ventricles fails to form during fetal development

oxygenated and deoxygenated blood gets pumped back to the lungs

smaller amount of blood is pumped into arterial circulation

increases work of the heart

47
Q

surgery for VSD is required if not closed by ____

A

5 months old

48
Q

where does the fetal circulation come from in utero?

A

the patent ductus arteriosus

49
Q

what is the patent ductus arteriosus CHD? (KNOW THIS)

A

CHD caused by prostaglandin E1 production that doesn’t decrease after birth once O2 levels increase, leaving the hole open

abnormal opening remains bw the aorta and pulmonary artery

too much blood enters the lungs

50
Q

what meds can be given to a baby with an open patent ductus arteriosus?

A

indomethacin to decrease prostaglandin E1 production

51
Q

what is atrioventricular septal disorder (AVSD)?

A

a combo of ASD and VSD

a large hole in the wall that separates the L and R atrai

can be partial or complete

52
Q

what is partial AVSD?

A

defect in the mitral valve bw the L atria and L ventricle causing it to leak

53
Q

what is complete AVSD?

A

one large valve bw atria and ventricles

54
Q

what are the clinical signs of AVSD?

A

pulmonary HTN

HF

tachycardia

arrhythmias

55
Q

what is coarctation of the aorta? (KNOW THIS)

A

narrowing/constriction of a portion of the aorta

usually occurs with another heart defects

obstructed blood flow out of the LV

increased pressure proximal to the obstruction (HTN in the upper body)

decreased pressure distal to the obstruction (normal to low BP in LEs)

may not be detected until adulthood depending on severity

56
Q

what is Eisenmenger syndrome?

A

syndrome that develops from a CHD that results in large shunts of blood through multiple defects (any combo of acyanotic defects)

L–>R shunt that turns into R—>L shunt

57
Q

chronic hypoxemia leads to what?

A

polycythemia (inc RBC volume)

58
Q

what are the clinical s/s of eisenmenger syndrome?

A

edema

worsening cyanosis

hemoptysis

headaches, dizziness, vision changes, stroke if polycythemia occurs

59
Q

what conditions should be avoided with eisenmenger syndrome?

A

pregnancy, dehydration, isometric exercise, iron deficiency anemia, and significant time spent at high altitudes

60
Q

t/f: surgery is required for Eisenmenger syndrome

A

false, bc the body is usually adapting to the defects already

61
Q

in cyanotic CHDs, if there R–>L shunting of blood or L–>R shunting of blood?

A

R–>L shunting of blood

62
Q

what causes the cyanosis in cyanotic CHDs?

A

decreased gas exchange

deoxygenated blood returning to the L side of the heart

deoxygenated blood pumped into systemic arterial circulation

63
Q

what are the clinical s/s of cyanotic CHDs?

A

decreased arterial O2 saturation

central cyanosis

polycythemia

digital clubbing

64
Q

what is central cyanosis?

A

body tissues and muscles not receiving oxygenated blood so the lips, skin, abdomen, tongue, or entire body appear blue when the baby is born

65
Q

what is polycythemia?

A

increased RBC formation

the body’s attempt to improve arterial saturation

66
Q

why does polycythemia increase risk for CVA?

A

bc it increases blood viscocity

67
Q

what are the 4 abnormalities of tatrology of Fallot? (KNOW THIS)

A

1) VSD
2) pulmonary valve stenosis
3) overriding aorta
4) R ventricular hypertrophy

68
Q

what is overriding aorta in tetrology of Fallot?

A

the aorta is misplaced and shifted to the R over the VSD

69
Q

t/f: the misplaced aorta in tetrology of Fallot receives blood from the R and L

A

true

70
Q

how does tetrology of Fallot lead to decreased oxygenation?

A

a combo of oxygenated and deoxygenated blood is pumped into systemic circulation leading to an insufficient amount of oxygenated blood in the body

71
Q

does RV hypertrophy lead to L or R HF?

A

R HF

72
Q

what are the clinical s/s of tetrology of Fallot?

A

squatting and loss of consciousness (tet spells)

73
Q

what is squatting?

A

when a child squats to catch their breath

74
Q

what is hypoplastic L heart syndrome?

A

hypoplastic LV

aortic and mitral valve stenosis or atresia (complete closure)

coarctation do the aorta

underdeveloped L side of the heart

small aorta and LV

75
Q

when does hypoplastic L heart syndrome need to be treated by?

A

within days/weeks after birth

76
Q

t/f: blood flowing through PFO and PDA increases chances of survival in hypoplastic L heart syndrome

A

true

77
Q

what meds may be given to someone with hypoplastic L heart syndrome? why?

A

prostaglandin E1 bc it keep the PFO and PDA open until surgery can be complete

78
Q

what is transposition of the great arteries?

A

the pulmonary artery and aorta are switched (aorta over the R ventricle and pulmonary artery over the L ventricle)

no communication bw systemic and pulmonary circulation leads to deoxygenated blood being pumped to the body w/o passing through the lungs and oxygenated blood going to the lungs

79
Q

t/f: surgery is required shortly after birth with a transposition of the great arteries

A

true

80
Q

what are the clinical signs of transposition of the great arteries?

A

cyanosis and cardiac arrythmias

81
Q

what is tricuspid atresia?

A

tricuspid valve (bw R atrium and ventricle) is either not petent or absent

solid tissue formation bw heart RA and RV causes restricted blood flow

small, underdeveloped RV

blood goes from the RA to LA through ASD or PFO

82
Q

what are the clinical signs of tricuspid atresia?

A

severe hypoxia

signs of R HF

severe central cyanosis

83
Q

what is truncus arteriosus?

A

one large vessel exiting the heart (normal during fetal development but should separate by birth)

normal separation of the aorta and main pulmonary artery doesn’t occur in fetal development

R and L ventricles empty into a single large vessel

mixed oxygenated and deoxygenated blood

84
Q

truncus arteriosus requires surgery within ___ of birth

A

1 month

85
Q

what are the respiratory conditions of infancy?

A

prematurity

persistent pulmonary HTN

infant respiratory distress syndrome

sudden infant death syndrome

meconium aspiration syndrome

bronchopulmonary dysplasia

primary cilia dyskinesia

CF

86
Q

when is a newborn considered premature?

A

born b4 37 weeks gestation

87
Q

what are the signs associated with prematurity?

A

periodic breathing patterns

apnea of >20 sec during sleep

cyanosis

hypoxemia

bradycardia

88
Q

persistent pulmonary HTN is associated with what 2 things?

A

1) prematurity
2) PDA

89
Q

what is persistent pulmonary HTN?

A

pulmonary HTN that persists after gestation where it is normal

hypertrophy of smooth muscle of arterioles

constriction of pulmonary arterioles

increased in pulmonary vascular resistance due to constriction

enlargement of RA and RV due to shunting of blood L–>R through the PDA

90
Q

what are the s/s associated with persistent pulmonary HTN?

A

cyanosis

tachypnea

respiratory acidosis

loud S2 heart sound/tricuspid murmur

low APGAR score

intercostal retractions

nasal flaring

grunting

91
Q

what are the long term affects of persistent pulmonary HTN?

A

developmental delays, learning disabilities, and hearing problems

92
Q

what is infant respiratory distress syndrome? (KNOW THIS)

A

decreased pulmonary surfactant

most often in infants born b4 28th weeks of gestation

buildup of hyaline membrane debris along the alveolar walls

decreased gas exchange due to decreased alveolar surface area

thickened and inflammed alveoli (can collapse)

decreased lung elasticity

93
Q

what are the s/s of infant respiratory distress syndrome?

A

increased RR >60

nasal flaring

intercostal and subcostal retraction w/breathing

grunting on expiration

peripheral edema

94
Q

what is the treatment for infant respiratory distress syndrome?

A

supplemental O2, CPAP, or mechanical ventilation

95
Q

what is sudden infant death syndrome?

A

sudden unexpected death of an infant (<1 yo) during sleep

otherwise healthy infant

may be linked to respiration and possible asphyxia during sleep

96
Q

what are the risks associated with stomach sleeping in infants?

A

overheating

rebreathing expired air increases CO2 and decreases O2

temporary changes to heart and lung fxn and control which could affect the amount of O2 getting to the brain during sleep

97
Q

what is meconium aspiration syndrome? (KNOW THIS)

A

fetal sphincter muscles relax and meconium is released into amniotic fluid during labor or delivery

infant may aspirate on amniotic fluid and meconium

obstruction of airway

surfactant inactivation

98
Q

what is the treatment for meconium aspiration syndrome?

A

mechanical ventilation

supplemental O2

ECMO in more severe cases

99
Q

what is bronchopulmonary dysplasia? (KNOW THIS)

A

the most common cause of respiratory issues in infancy

caused by prematurity, need for ventilation, bacterial infection of placenta, sepsis

scaring/fibrosis of lung tissue/alveoli

thickened pulmonary arterial walls

inflammed lung parenchyma

lung ventilation perfusion mismatch

100
Q

what are the characteristics of bronchopulmonary dysplasia?

A

persistance of respiratory symptoms after 1 month

abnormal radiograph findings (cysts on lungs with spongey appearance)

dependence on supplemental O2

101
Q

what are the s/s of bronchopulmonary dysplasia?

A

wheezing

waking w/coughing

breathlessness

GERD (reflux)

heart defects (PDA)

pulmonary HTN

102
Q

what is pulmonary cilia dyskinesia?

A

rare autosomal recessive genetic disorder affecting cilia in the lungs, nose, and ears

deformation and dysfxnal abnormalities of cilia

fibrosis of lung parenchyma

thickened bronchial and tracheal walls

impaired ciliary clearance and transport of mucus from the airways

103
Q

what is the treatment for primary cilia dyskinesia?

A

same as CF

104
Q

what is CF?

A

genetic autosomal recessive disease affecting exocrine glands fxn

105
Q

what is the treatment for CF?

A

airways clearance 2x/day

rib cage mobility

postural training

exercise

nebulizer

enzymes with all meals

frequent eating

106
Q

what are the pediatric health conditions w/secondary cardiopulmonary issues?

A

Down syndrome

DiGeorge syndrome

Marphan’s syndrome

William’s syndrome

arthrogryposis multiplex congenita

FAS

107
Q

what are the secondary cardiopulmonary issues associated with Down syndrome?

A

endocardial cushion defect, VSD, ASD, tetrology of Fallot

cardiac defects and sleep apnea

108
Q

what is DiGeorge syndrome?

A

deletion of csome 22

primary immunodeficiency disease

cardiac abnormalities, abnormal facial features, thymic hypoplasia, cleft palette, hypocalcemia

109
Q

what is Marphan’s syndrome?

A

autosomal dominant CT disease commonly associated with aortic dissection and aorta mitral valve dysfxn/insufficiency

long extremities, tall, thin, scoliosis, pectus excavatum, stooped shoulders, elastic skin, fragile vessels

110
Q

what is Williams syndrome?

A

deletion of csome 7

supravalvular aortic stenosis and supravalvular pulmonary stenosis caused by a change in elastin production

111
Q

what is arthrogryposis multiplex congenita?

A

non-progressive neuromuscular disease

multi jt contractures requiring surgery

112
Q

what is FAS?

A

chronic alc exposure in utero

fascial dysmorphology, post natal growth retardation, poor coordination, hyperactivity, learning disabilities, developmental delays

cardiac abnormalities

113
Q

what are other pediatric health conditions w/decreased activity level and altered posture?

A

CP, spina bifida, DMD, and SMA

DPT 528 (9 decks)

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