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Pathophysiology 2 > Pediatric Pathophysiology > Flashcards

Pediatric Pathophysiology Flashcards

1
Q

Who falls into “Pediatric”?

A

Newborn: up to 4 weeks of age (28 days)

Infant: 30 days to 1 year old

Child: 1 to 8 to 12 years

Teen: 13 to 18 years

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2
Q

Special Considerations of Pediatric Population

A
  • Age and ability to comprehend
    • Keep teaching/learning short
    • Use fun games approach if applicable
    • Enlist family assistance
  • Parents present or absent
    • Decision maker for the child, depending on age
    • Parents to be contacted when treatment discussions are reviewed with the child
  • Emotional State
    • Frightened, confused, angry, sad.
    • Comfort them
    • Have toys and friendly objects present
  • Physical limitations
    • Certain diagnostic tests can be dependant on age (PFTs)
  • Presentation
    • Inability to properly express themselves
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3
Q

Pediatric Special Consideration

Presentation

A

Prenatal and birth Hx

Developmental Hx

Social Hx of family

Immunization Record

Parent as historian

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4
Q

What makes a pediatric patient different?

A

They are NOT little adults!

Most therapies, interventions, and drug regimens are not geared, tested, or approved for their population

Pharmacology

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5
Q

Pediatric signs of increased WOB

A

Tachypnea

Apnea

Nasal Flaring

Grunting

Head Bobbing

Seesaw Respirations

Intercostal Retractions

Tracheal Tug

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6
Q

Preventable Pediatric Disorders

A

Abuse

MVA’s

Near Drowning

Fires

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7
Q

Acute epiglottitis Vs Laryngotracheobronchitis(croup)

CXR

A

Croup- Subglottic narrowing, lower in the airway

Epiglottis-Swollen epiglottis (thumb sign), higher in the airway

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8
Q

Acute epiglottitis Vs Laryngotracheobronchitis(croup)

Symptons

A

Croup- Stridor, barking cough, fever variable, hoarse voice, no position preferred, retractions, irritable, does not appear acutely ill

Epiglottis-stridor, minimal cough, high feer, muffled voice, prefers sitting upright with chin forward, rertactions, drooling, anxiety, appear acuetly ill

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9
Q

Acute epiglottitis Vs Laryngotracheobronchitis(croup)

History

A

Croup- Gradual onset (2-3 days), previous cold

Epiglottis-Acute onset (few hours), compliant of sore throat

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10
Q

Acute epiglottitis Vs Laryngotracheobronchitis(croup)

Cause

A

Croup- Viral (parainfluenza, RSV)

Epiglottis-Bacterial (harmophilius influenze type B)

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11
Q

Acute epiglottitis Vs Laryngotracheobronchitis(croup)

Age

A

Croup- 3 mon to 3 yr

Epiglottis-2-6 yr

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12
Q

Bronchiectasis

A
  • Irreversible dilation and distortion of the bronchial tree
  • Develops as a result of airway obstruction, chronic infection and extensive inflammation
    • Dilation due to destruction of bronchial cartilageelastic fibres, blood vessels and smooth muscle
    • Foreign body aspiration, measles, pertussis, pneumonia, CF
    • Congenital condition in a small number of patients
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13
Q

Bronchiectasis

Pathophysiology

A

Irregularly shaped and dilated bronchi

leads to insufficient airway secretion clearance

Inadequate ciliary activity

The poor bronchial toilet increases the risk of infection

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14
Q

Bronchiectasis

Clinical Manifestations

A

Chronic, productive cough

Copious amounts of thick, purulent sputum

Foul smelling breath

Multiple URIs

SOBOE

Hemoptysis on occasion

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15
Q

Bronchiectasis

Management

A

Supplemental oxygen

Typically diagnosed by clinical manifestations and bronchoscopy or CT scan

Chest physiotherapy and postural drainage

Abx based on sputum culture

Surgical resection of the broncheictaticsection of the lung may be considered

Depends on severity and if the disease if localized

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16
Q

Bronchiolitis

A
  • Inflammatory disease of the bronchioles
  • Most common lower respiratory infection in pediatrics
  • Viral infection of small airways
  • Most common cause: RSV (Respiratory Syncytial Virus)
17
Q

Bronchiolitis Pathophysiology

A
  • Airway wall inflammation and edema, ++ increased mucous production
  • Small airwayobstruction
  • Primarily effects pediatrics <2
  • Infants prone to Respiratory Failure from Acute Bronchiolitis:
    • Immunodeficientinfants, comorbidities of CHD, CF, childhood asthma
18
Q

Bronchiolitis Causes

A

RSV (Respiratory Syncytial Virus)

  • Approx. 90% children infected in first 2 years of life, mostly presents as cold like symptoms
  • RSV diagnosed by Nasopharyngeal swab or aspirate
  • Predictable outbreaks from January to April
19
Q

Bronchiolitis Clinical Manifestation

A

Productive cough

Resp. distress: wheezing, tachypnea, accessory muscle use, nasal flaring, hypoxemia, ++ secretions

O/A coarse crackles

Hyperinflation on CXR

High PaCO2 (in severe cases)

Usually Clinical Diagnosis (by symptom presentation)

75% of infants after acute bronchiolitis have recurrent episodes of coughing and wheezing (often diagnosed as infant asthma)

20
Q

Bronchiolitis Treatment

A
  • Supportive in the majority of cases:
    • Bronchodilaters
    • Racemic epinephrine for severe bronchoconstriction
    • RSV-specificimmunoglobintherapy
  • Severe Cases:
    • CPAP
    • HFNC
    • May require intubation
21
Q

Bronchiolitis CXR

A

Reveal flattening of the diaphragm and widening of the anteroposterior diameter, which is indicative of severe air trapping.

Perihilar markings accentuated.

22
Q

Cystic Fibrosis (CF)

A

Recessive exocrine gland disorder characterized by excessive viscid secretion

23
Q

Cystic Fibrosis (CF)

Pathophysiology

A
  • Most common fatal geneticdisease affecting Canadian children and young adults
  • Caused by mutations in the gene that encodes multifunctional protein: CF transmembrane conductaneregulator (CFTR)
    • Function of this protein is to serve as an apical (side toward the lumen) chloride channel in:
      • Airway cells-causing improper regulation of sodium-chloride ions leading to thick, tenacious secretions
      • Intestinal cells
      • Exocrine glands
  • Variability of disease symptoms caused by over 1900 types of CFTR mutations
24
Q

Cystic Fibrosis (CF)

Clinical Manifestation

A
  • Dry cough progressing to frequent wet coughing spells with large quantities of secretions
  • Anorexia, weight loss
  • Wheezing
  • SOBOE
  • Chronic colonization of P. Aerguinosa
25
Q

Cystic Fibrosis (CF)

Cycle of Infection

A
  • CFTR dysfunction leads to a decrease in airway surface liquid which impairs mucous clearance, which leads to airway inflammation/infection. This results in chronic productive cough and Hyperinflation/Bronchiectasis.
  • Endstage CF:
    • pulmonary HTN
    • CorPulmonale
  • Most common pathogens associated with CF:
    • Staph Aureous,
    • Haemophilus influenza,
    • Pseudomonas
    • Aeruginosa
26
Q

Cystic Fibrosis (CF)

Non-Respiratory Manifestations

A
  • Pancreatic Insufficiency
    • Malabsorption of fats and proteins
    • Failure to thrive in infants
  • Meconium ileus (infants)
    • Meconium but on a much larger scale to the point where their ability to expel the meconium has been blocked
  • Reduced fertility
  • Increased risk of Diabetes
27
Q

Cystic Fibrosis (CF)

Diagnosis

A
  • Sweat Chloride Test (> 60 mmol/L)
    • Sodium Chloride concentration in sweat are abnormally high in CF
      • A small amount of a colorless odorless sweat producing chemical is applied to the patient’s arm. An electrode is attached to the chemically prepared area, and a mild electric current is applied to stimulate sweat production.
  • Infant Screening
  • Failure to gain weight
  • Bronchiectasis
  • Recurrent Pancreatitis
28
Q

Sweat Chloride Test

Infants Six Months or Younger

A

≤29 mmol/L: Normal (CF very unlikely)

30 to 59 mmol/L: Intermediate (Possible CF)

≥60 mmol/L: Abnormal (CF Diagnosis)

29
Q

Sweat Chloride Test

Infants Older than Six Months, Children and Adults

A

≤39 mmol/L: Normal (CF very unlikely)

40 to 59 mmol/L: Intermediate (Possible CF)

≥60 mmol/L: Abnormal (CF Diagnosis)

30
Q

Monitoring at a CF Clinic

A

Symptom assessment

Physical examinations

Regular sputum cultures

Spirometry

Nutritional Status

31
Q

Types of Treatment for CF

A

Bronchopulmonary Hygiene

Medications

Lung Transplant

32
Q

CF Treatment

Bronchopulmonary Hygiene

A
  • Percussion
  • Postural Drainage
  • BIPAP (during physical therapy)

Autogenic Drainage

33
Q

CF Treatment

Medications

A

Bronchodilators

Inhaled Recombinant Deoxyribonuclease(DNase)(Pulmozyme)–daily in >6 yrs

Nebulized 7% hypertonic saline (BID in patients >6 yrs) help draw out secretions

N-acetyl-cysteine (Mucomyst) – Help pplcough up secretion s

Ibubrofen

Azithromycin (patients > 6 yrs)

Tobramycin (treat P. Aeruginosa)

34
Q

Where do RT fit in with CF Treatment

A
  • End stagemanagement –BIPAP
  • Post-op Lung Transplant management
  • Home Oxygen Therapy
  • Spirometry-CF clinics

GOOD NEWS!

Due to improvements in therapy, median age of survival has increased from 31 years to 41 years in past two decades

Pathophysiology 2 (9 decks)

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